Bigger is Definitely Not Always Better

Overwhelmed by the outpouring information on obesity treatment? We have all the resources for you!

Credit: Giphy

In Today’s Edition: 58% of Americans are projected to be obese by 2035. The good news? APPs have the opportunity to halt this trend, but it gets overwhelming with constant treatment guideline updates, novel therapies, and FDA approvals. As usual, we have plentiful resources and helpful information to keep you informed with the latest trends and resources to excel at obesity care.

  • PA co-founds PAs in Obesity Medicine & guides for obesity treatment

  • The AAP establishes guidelines for pediatric obesity

  • Will new weight loss regimens render bariatric surgery obsolete?

  • For better or worse, weight loss apps join the semaglutide craze

  • As overweight patients seek care for back pain, a new trial warns against the use of opioids

  • Free CME is resources to complete the new DEA requirement

  • Our inspiration of the week is Karli Burridge, PA-C, FOMA, educator, leader, advocate, obesity specialist and founder of Gaining Health!

  • Clinical conundrums: Altered mental status (AMS) case debrief

Bigger is Not Always Better: Let’s Focus on Hot Topics in Weight Loss

PA co-founds PAs in Obesity Medicine & Guidance for Obesity Treatment

Looking for guidance in the massive output of updates in caring for patients with obesity? We have you covered this week. Karli Burridge is a nationally recognized expert in obesity medicine and actively educating other providers on how to incorporate obesity management into their everyday practices. Her podcast, The Gaining Health Podcast, has been helpful for this author to understand the complexity of the neuroendocrine factors behind obesity and improve individualized patient care. Featured in The Clinical Advisor, Gaining Health also provides comprehensive treatment programs so we don’t have to recreate the wheel! Win-Win! She is definitely our “Inspiration” of the week!

We have not forgotten about the kiddos!

According to the World Obesity Federation’s 2023 report, childhood obesity is expected to increase 100% by 2035 and 20% of our pediatric population is currently diagnosed with obesity. The American Academy of Pediatrics (AAP) has released, for the first time, guidelines on childhood and adolescent obesity. Prevention is always preferable to cure!

⚙️ The More You Know

Will new weight loss regimens render bariatric surgery obsolete?

While we won’t know long term effects of popular novel weight loss medications such as Glucagon-Like Peptide-1 Receptor Agonists (GLP-1RAs) like semaglutide, the benefits have shown promising results for both cardiovascular health and weight loss. Obesity poses a significant health challenge, and while lifestyle modifications are essential, additional anti-obesity medications (AOMs) can enhance weight loss. This case study highlights a 23-year-old male with severe obesity who failed significant weight loss despite lifestyle changes and a medication combination of phentermine, topiramate, and metformin. The addition of semaglutide resulted in an impressive 32.5% reduction in total body weight, comparable to metabolic/bariatric surgery outcomes, without the danger of surgery. Impressive!

For better or worse, weight loss apps join the semaglutide craze

We are undecided whether it is unsafe, or increasing patient access to care for weight loss, but it is happening. Recently Noom, an app designed to aid weight loss with food tracking and cognitive behavioral therapy (CBT), has announced a telemed platform to offer medication prescriptions. They aren’t alone, other for-profit companies like Weight Watchers (WW) have also recently joined the bandwagon. Let’s not forget, as providers, lifestyle modification is still first line, but we must also take into consideration benefits vs risks of side effects like gastroparesis, pancreatitis, and black box warnings for hereditary cancers. We are all for advances in healthcare, but commercialization raises a bit of a red flag for safety. Patients still need PCP visits and monitoring of lipids and all the other conditions associated with obesity.

Trial shows that opioids for acute neck and back pain are not recommended

It’s well-known that patients who are overweight frequently have pain. A meta-analysis establishes that overweight and obesity have the strongest association with seeking care for low back pain and chronic low back pain. We hope you already know this, but a recent randomized controlled trial has found that opioids are not effective in relieving acute low back or neck pain in the short term and can lead to worse outcomes in the long term.

Speaking of Opioids…

Remember that effective June 27, 2023, all practitioners will be required to attest that they have met new training requirements in order to obtain or renew a DEA license. All providers must attest they have fulfilled the 8-hour training requirement. Here are a few links to help fulfill the requirements. P.S. We have no monetary gain from use of these free resources. 🫶🏽

💡Inspiration for Aspirations

Meet Karli Burridge, MMS, PA-C, FOMA, our Inspirational APP of the Week.

She is a leader, patient advocate, entrepreneur, educator, and champion in obesity medicine.

Karli Burridge, PA-C, MMS, FOMA

Karli Burridge, MMS, PA-C, FOMA graduated from Midwestern University and is a board-certified physician associate (PA) and a fellow of the Obesity Medicine Association (OMA) and has been in practice for 14 years. She is the president of PAs in Obesity Medicine and serves on the board of the Illinois Obesity Society. She is the founder and owner of Gaining Health, a company that provides resources for clinicians and organizations who want to start or optimize obesity treatment programs. She is also the host of the Gaining Heath podcast and works at the Ascension Medical Weight Management program in Westmont, Illinois.

Her background is based in psychology and a master’s in physiology which formed her strong belief in providing holistic care. By becoming a PA, it gave her the opportunity to do just that; provide care for the whole person — mind and body. She’s not new on the bandwagon folks!

What interested her in obesity medicine?

Did you know that obesity medicine was previously left out of traditional medical training? Obesity was not even recognized as a disease by the American Medical Association (AMA) until 2013. Which is why we inquired about her current endeavors, founding the organizations, PAs in Obesity Medicine, and Gaining Health.

While working in bariatric surgery, she learned about the complexities of obesity and the numerous hormones and neuroendocrine systems that can make it exceedingly difficult for people with obesity to lose weight and maintain weight reduction. It’s not just a stigma of self-control. She was able to truly help her patients by combining her passion for healthy lifestyle changes with evidence-based tools like bariatric surgery and/or pharmacotherapy, as well as a thorough assessment of other factors that may be contributing to the development of obesity. She states, “I individualize treatment for my patients and make a significant difference in their health and well-being.”

Q: Tell us about Gaining Health

A: Today, 42% of the US adult population and 20% of the pediatric population have obesity; this number is projected to reach 58% of adults by 2035, according to the World Obesity Federation’s 2023 report. We need more clinicians who are trained in evidence-based, compassionate obesity care. However, training and education are just the beginning. Taking that education and then developing a comprehensive obesity treatment program can take a lot of time and effort, and many busy clinicians just don’t have the time and bandwidth to develop a program from scratch.

I started Gaining Health so that clinicians wouldn’t have to recreate the wheel every time someone wanted to start an obesity treatment program. With Gaining Health, we provide a roadmap and resources that clinicians use to develop their programs. They can get their programs up and running faster, more efficiently, and at a much lower cost. It has been very fulfilling to see so many clinicians start their obesity management programs. As a bonus, the clinicians are also finding a renewed love for their profession because they are getting to do what they have always wanted to do: help their patients get healthier and feel better.

Q: Is there anything else you would like to tell our readers?

I encourage clinicians to become educated in obesity medicine! PAs are perfectly positioned to be the leaders in this field and we need PAs in all kinds of specialties to be able to help patients with obesity. Obesity causes or contributes to the development of over 236 other medical conditions. When we treat obesity, everything else gets better, too! You can learn about obesity through the AAPA Obesity Toolkit and you can join PAs in Obesity Medicine. The OMA is another great place to receive education on obesity. Lastly, if you want to start an obesity treatment program, check out www.Gaininghealth.com, and listen to our weekly podcast, The Gaining Health Podcast (https://podcasts.apple.com/podcast/id1649411537).

I encourage clinicians to become educated in obesity medicine! Obesity causes or contributes to the development of over 236 other medical conditions. When we treat obesity, everything else gets better, too!

Karli Burridge, PA-C, FOMA

📈Future APPs

Passionate about obesity medicine?

APPs (PAs/NPs) can earn a certificate! Yes! Just another reason to inspire you to become an APP.

🧪Clinical Conundrums: Because We Love a Challenge!

Credit: Giphy

Case Review: Altered Mental Status (AMS) Debrief

Last week's case involved a patient presenting with altered mental status (AMS). Poll answer: Thiamine!

Let's dig a little deeper into ruling out other causes of AMS.

Given that he met criteria for SIRS using a SOFA score, but it's ok to empirically treat with antibiotics... and given an ETOH history, absolutely give thiamine and folate.

BUT would you have considered sending a TSH?

This patient ended up having a diagnosis of myxedema coma and was dismissed from the ER three prior times because of his history of ETOH abuse. Staff listened to the history but did not HEAR the family explaining that he no longer drank and had very little appetite the preceding weeks. He had no heart history (not on medications) but had bradycardia, facial and lower extremity non-pitting edema and only mildly elevated LFTs/ammonia. Werneke's is a great differential and can be irreversible, so empiric thiamine was given. He was hospitalized for three days until he had a rapid response for hypotension/bradycardia and unresponsiveness.

The NP ordered a TSH level resulting in >78. She gave IV thyroxine (no need to await a level), and he woke up the next day. How cool is that! Pro-Tip: Never forget the big picture, wider differential, even if it is rare.

The Internet Book of Critical Care is an awesome resource and pictures below are from their overview of emergency conditions. They have evidenced based cases and are a valuable resource. You. Are. Welcome!

Credit: The EmCrit Project, The Internet Bood of Critical Care

🔎ICYMI

  • Study shows the positive impact and contribution of PAs

  • New Tennessee law allows international medical graduates to bypass US Residency

  • Missouri tackles provider shortages with a new medical license category: The Assistant Physician (AP)…that’s not confusing at all

  • Protect your Asthmatics!

  • More on malaria and how to protect your family

  • Bug spray tips to repel ticks

  • Clinical conundrums: Test your knowledge on altered mental status (AMS) with this case based exercise

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