“The treatment of obesity is particularly challenging,” Dr. Ritchlin adds. “The most important strategy is to cut down on caloric intake, a goal that is difficult to achieve and maintain. Additional approaches include medications and bariatric surgery.”
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Dr. Ritchlin says he works with nutritionists in URMC’s Endocrinology Division to work with patients on weight loss and to emphasize to obese patients that they “play an active role in the treatment of their disease by losing weight.”
Both Drs. Matteson and Ritchlin agree that a multi-disciplinary approach to obesity is key for rheumatologists.
“I don’t think there can be too many cooks in the kitchen,” Dr. Matteson says. “Attention to obesity and its health and social consequences is the responsibility of the entire society, and certainly of all caregivers, including primary care providers (PCPs) and rheumatologists.”
With so many proverbial cooks in the kitchen, it can be difficult for rheumatologists to know who should take the lead with a patient. Dr. Matteson says that should be handled on a case-by-case basis.
“I think it depends on the relationship the patient has with their physician,” he says. “In some cases, it is the rheumatologist who is quarterbacking the coordination of healthcare for their patients, and in others, the PCP takes the primary role. In either case, the engagement of all specialties with the patient is crucial.”
The rheumatologist also has to handle the topic of obesity delicately. The personal responsibility of an obese patient’s response to their condition must be emphasized, but delivered professionally. Discussions should focus on weight control and rheumatic disease activity control, highlighting the importance of physical activity for both conditions and keeping weight control “in the forefront of the patient’s health goals,” Dr. Matteson says.
“It is important to monitor weight change at serial visits, acknowledge any weight loss and help patients work through the various treatment options without being paternalistic or denigrating,” Dr. Ritchlin adds. “Working with a team as described above is the best approach so the patient does not feel isolated or frustrated.”
Preaching at patients would only frustrate them and, potentially, reduce the positive impact of education, follow-up and encouragement, Dr. Matteson says.
“We can’t just tell our patients what to do. We need to show them what the benefits of optimal body weight and physical activity are, and provide the resources for them to link to healthy living programs and activities.”
Richard Quinn is a freelance writer in New Jersey.