Featured Speaker Heart Failure Now
Dr. Ali Zentner, MD, FRCPC, Internal Medicine, Obesity : Developing Effective Treatment Plans for Patients With Obesity
Dr. Ali Zentner received her undergraduate medical degree from McMaster University and completed her Internal Medicine Residency with an extra year of Cardiology training at the University of Calgary. In addition to her Fellowship in Internal Medicine, Dr. Zentner is a Diplomat of the American Board of Obesity Medicine. Dr. Zenter the author of The Weight Loss Prescription: A Doctor’s Guide to Permanent Weight Reduction and Better Health for Life, and is a former medical consultant for Global National News Dr. Zentner is the Medical Coordinator of the Vancouver Island Bariatric Program in Victoria and also runs a busy prevention practice in Kerrisdale. She is a strong advocate for lifestyle intervention in the treatment of diabetes, hypertension and cardiovascular disease. On a personal note, Dr. Zentner advocates that setting an example is the ultimate form of inspiration for patients. She is an avid marathoner and triathlete. Whether it is climbing Mount Kilimanjaro or cycling across Canada, she believes that life’s adventures are the lessons of who we are and what we are capable o
In October of 2016 the Canadian Medical Associated formally acknowledged obesity as a chronic disease, joining the American Medical Association, European Society for Diabetes and the World Health Organization, as well as the CDC.
We need to appreciate that this is a complex, multi-faceted disease that involves genetics, physiology and environmental triggers, and that the treatment plan that this disease very much needs is a complicated one.
You’re not going to come up with it at one visit with a patient, and just like any appropriate responsible treatment plan it should have different facets involved. It should absolutely involve the patient in a realistic manner, and it should adjust and accommodate for the life cycle of this very much chronic disease. Weight loss is not the only goal here. It’s better health.
A patient should not have quote a goal weight. A patient should have a best weight. That’s a weight that they’re most comfortable achieving and maintaining long term, that’s going to improve their health and not kill them to stick to. That’s going to be realistic, and appropriate, and most importantly comfortable.
The goal of treatment isn’t to set X amount of pounds by Y date. I call that destination dieting and it doesn’t work. We don’t do that in any other area. We don’t say “we’ll set a goal of this amount of blood pressure reduction within this amount of weeks” so to speak.
The goal of treatment here is to set specific goals when it comes to, for example, food diarizing or food tracking, when it comes to restriction of liquid calories, for example, when it comes to some movement. The reality of treatment here is that it should be reflective. A patient should come back in a timely manner that’s appropriate for them, see how those goals are coming about, and then reset goals down the road.
As far as exercise goes, exercise is absolutely medicine, but it doesn’t aid in weight loss. When a patient talks about exercise as the important way to lose weight, really our goal would be to readjust their expectations there, and to inform them what really leads to weight loss is adjustment of micronutrients, perhaps medication when appropriate.
And where exercise plays a significant role is getting them to feel fitter, and stronger, and improves a whole host of other comorbidities that might be associated with other diseases.
It might improve their blood sugars, it’s going to help their arthritis, it’s going to improve their mood, it also helps with memory and depression. It’s ironic that exercise pretty much addresses every other disease except for obesity.
When you’re starting a patient on medication it’s important to remember that whatever we do for weight loss we have to do for weight maintenance. This is a chronic disease, it involves long term therapies. But there are two key points to remember.
A patient doesn’t need to make a decision forever in one instance. So the classic question is “do I have to take this drug for life?” And the answer is “you can decide that as your life progresses.” They don’t have to make that yes, no decision in that one instance.
The most important thing to remember is there are huge barriers here. Not just to change, but there are barriers in managing any chronic disease. There’s mental barriers, many of our patients have comorbidities of depression. Remember, a third of women who have obesity have been sexually abused. You’re dealing with a host of psychosocial issues as well.
There’s mechanical barriers, barriers to movement, sleep apnea, arthritis, et cetera. There’s medical barriers in terms of these patients often have other metabolic diseases that they’re on medications for, that may be even contributing to weight gain even further, or are just impeding their quality of life, and then finally there’s monetary barriers.
There’s financial issues that patients come to, and remember, that you may go in with the best of intentions, and you’re going to sit in front of a human being who brings with them a treasure chest of a variety of different factors that we then have to respect and accommodate.
And the most important thing to remember is we don’t have to fix everything. We just have to support and encourage, and be a place that facilitates that change.