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If your patient is suffering from diabetes, hypertension, dyslipidemia or a combination of these conditions,
as well as being obese, he or she has a multitude of significant issues to manage.
Weight control is only one. However, the extent to which he or she can be
compliant with a diet plan is usually indicative of his or her approach to
managing the other issues surrounding his or her disease.
Broaching the Subject and Getting Patient Buy-In
Assessing Your Own Attitudes about Obesity
Overcoming Obstacles to Compliance
Broaching the Subject and Getting Patient Buy-In
It is vital that patients are informed of how important losing weight is to maintaining their good health.
Unfortunately, research shows us that most physicians (no doubt facing the realities of today's busy practices)
are not counseling their patients about losing weight or exercising -
despite the fact that nearly one-fourth of adults in the United States are obese.26
Broaching the subject of losing weight with a patient can be a sensitive issue -
especially if the patient doesn't consider himself or herself extremely overweight
or is comfortable with his or her appearance.
Contact your Roche representative to find out the tools that are available to help
you talk with your patients more effectively and efficiently.
Some patients may think that they have no control over their weight.
For example, they may believe they are victims of their own genetics, when, in fact,
there are other factors such as environment and behavior that also contribute to overweight and obesity.
Unrealistic ideas about how much weight he or she needs
to lose or what it takes to lose weight and keep it off
(including fasting and extreme exercise) may also inhibit a patient's motivation.
Educate patients that even a moderate amount of weight loss (5% to 10%)5,41,42,72 along with moderate activity, a modified diet and XENICAL can significantly
decrease health risks.
Remember that your local Roche representative has
numerous tools and teaching aids to assist you in diagnosing,
educating and treating patients.
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Assessing Your Own Attitudes about Obesity
Many health care providers have had
frustrating experiences in treating overweight or obese patients,
which can result in feelings of failure, blame, or even prejudice towards these patients.
Your patients' weight-loss success depends largely on the relationship you build with them,
and your positive, nonjudgmental attitude can really make the difference.41
It is important to remember that obesity is a chronic condition of excess body
fat caused largely by an imbalance between the intake of calories and the expenditure of energy.
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Physiologic, biochemical and genetic evidence suggests that obesity is a
complex disorder of appetite regulation and
energy metabolism rather than a simple lack of willpower on the part
of the obese individual.42,50,54
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Overcoming Obstacles to Compliance
Once you've decided to broach the subject with a patient, here's what the research shows about
success with weight-loss control,
particularly among those with comorbidities:
- Weight-reduction diets tend to be successful only in the short term.
Within 3 to 7 years, almost all patients have returned to their previous weight.
10,25 In 4 studies, 2 to 5 times as many patients on XENICAL plus diet maintained a
weight loss of 10% or more of their body weight from randomization versus those on placebo plus diet.
- Patients vary greatly in the degree to which they are compliant with diet regimens;
those who attribute their diabetes, hypertension or dyslipidemia to their own behavior
(e.g., eating too much) are more likely to comply.29,52
- Making sure the diet includes foods a person is used to eating, including
ethnic recipes,
as well as a variety of foods, is critical.34,67
For example, as much as 40% of a family's food budget is spent in restaurants and on carry-out meals.
Foods eaten away from home are generally higher in fat, saturated fat, cholesterol
and sodium and are lower in fiber and calcium than foods prepared and eaten at home.
- Make sure the regimen is appropriate for each patient's circumstances.
- A prepared meal plan can also help increase compliance.37
Some patients may want to consider joining weight-loss programs that offer prepared meals.
- Patients often misconstrue what's involved in a diet. They tend to have misconceptions
about what "fat" and "thin" mean and the ways of controlling their weight.
The dietary and caloric guidelines recommended in the XENICAL program are
based on those established by the American Heart Association for all Americans.
- Education promotes compliance, with more education leading to higher levels of compliance.9,62,66 Physicians and other health care personnel must be prepared to devote
the amount of time that is needed to the endeavor.
Research has also told us a great deal about the way education can help,
the materials that must be covered and the continued support that is needed to maintain compliance.
- Physicians must be sure to emphasize the risks that are involved in not changing,
as well as the benefits to changing.25
- Physicians and patients must be partners in setting goals and making risk-benefit tradeoffs.
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- The family can be a strong ally in promoting compliance.
25,43,68 Moreover, their participation in the counseling process can substantially
increase compliance.25
- In addition to the physician, other health care professionals, including registered dietitians,9
nurses,43 nutritionists, psychologists, psychiatrists and pharmacists,
can play a part in the education process.
- The physician's role in establishing the medical plan and conveying information cannot
be overemphasized, however. Despite this, patients' information needs are sometimes not met by physicians.11
- The physician must also encourage the patient to ask questions, make lists and discuss concerns.
Training a patient how to do this effectively can significantly increase compliance.11
- The elements of successful weight-loss and weight-management programs include:
- An individually planned diet that creates a deficit of 500 to 1000 calories per day41
- Total fats should be 30% or less of total calories
- An increase in physical activity, especially to
maintain weight loss. For those who are very obese, exercise should begin slowly
(for example, walking for 30 minutes 3 days per week). A total expenditure of 100 to 200 calories
per day should be the goal41
- Behavior therapy, including
behavioral skills training,
self-monitoring,
self-efficacy enhancement and external
cognitive aids
- The role of education and
counseling in compliance does not
stop after the first visit or so.
Routine follow-up can serve to
reinforce behavior.25
- Patients should be given written materials after discussion and counseling to reinforce the
messages as well as to act as a future reference.
- Patients should be advised about available patient support programs
that enhance compliance, such as XENICare®.
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XENICare: An Effective Patient-Counseling Tool
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