A Multidisciplinary approach in weight management

March 05, 2021

Dr Kirubakaran Malapan on COVID-19 and Obesity


A Multidisciplinary approach in weight management

Obesity is a serious clinical and public health issue. According to studies conducted by the World Health Organization (WHO) the global burden of disease has grown to epidemic proportions, and over 4 million individuals died each year as a result of being overweight or obese (WHO, 2020). In Malaysia, based on the recent National Health & Morbidity Survey 2019, more than 50% or about 1 out of 2 Malaysians were either overweight or obese. This was found to be highest among females (54.7%), people of Indian ethnicity (63.9%) and people between the ages of 55 to 59 years old (60.9%).

 

      Obesity is a major risk factor linked to conditions such as heart disease, stroke, diabetes, high blood pressure, infertility, and as many as 11 types of cancers, including leukemia, breast and colon cancer. No less real are the social and emotional effects, including discrimination, low self-esteem, lower quality of life and depression. The WHO declared COVID-19, the infectious disease caused by the coronavirus SARS-CoV-2, a pandemic on March 12, 2020. Emerging data suggest that adults with obesity may be at risk for a more serious and complicated course of COVID-19, the severity of the disease being exacerbated by biological and social factors associated with obesity.

 

"Obesity-related conditions seem to worsen the effect of COVID-19; indeed, the Centers for Disease Control and Prevention (CDC) reported that people with heart disease and diabetes are at higher risk of COVID-19 complications.

 

 "WORLD OBESITY SCIENTIFIC STATEMENT AUGUST 2020”

      Numerous studies have shown that many obesity-related conditions improve with a 5-10 percent weight-loss. However, effective treatment strategies for overweight and obesity have been elusive. Over the years, it has become evident that drastic weight loss goals, undirected and narrow approaches to the treatment of obesity are rarely effective and that a broader and multidisciplinary strategy is most effective. As obesity is a chronic disease, healthcare providers must be prepared to treat patients for many years. Weight loss can be achieved through a variety of modalities, but the long-term maintenance of the weight lost is much more challenging.

 

      Multidisciplinary care aimed at small steps and practical approaches to lifestyle change can be an effective means of treatment for many patients who find it difficult to lose weight. A successful weight management clinic or centre will have several members, each uniquely contributing their expertise holistically giving patients better odds at successfully losing weight and maintaining the weight loss. Members of the team include — physicians, bariatric surgeons, dietitians, physiotherapists, psychologists and bariatric nurses—bringing a unique set of skills to bear on patient needs. Options such as lifestyle modification, with essential changes in diet and physical activity form the base of the weight management strategy over which other modalities such as medical nutrition therapy, pharmacological agents, counselling, cognitive behavioural therapy, hypnotherapy, endoscopic procedures and bariatric surgery can be offered.

 

      Physicians & bariatric surgeons, can address medical issues that might affect weight loss and help patients with evidence-based approaches in weight management. Bariatric surgeons will be able to offer endoscopic options, bariatric and metabolic surgery which has been established to be the most effective treatment for morbid obesity, producing sustained and durable weight loss with improvement or remission of comorbidities and longer life. Dietitians help patients gradually learn to eat less and incorporate healthier foods into their diets. Physiotherapists or fitness experts teach practical ways to integrate physical activity into day-to-day life. Psychologists help patients mentally prepare for the process of lifestyle change and address barriers to change. Finally, bariatric nurses are the integral members of the team who can help patients feel comfortable in a medical setting and assist in the coordinating of the various options in management of these patients.

        In conclusion, there is not a ‘one‐size‐fits‐all’ treatment approach in the management of obesity and future treatment strategies should focus on a personalized approach taking into consideration patients individual needs to successfully target weight loss and health behaviours. As obesity is a chronic disease, the integration of a chronic care approach is critical for the successful adaption of sustainable health behaviours ensuring good and lasting outcomes.

 

 

 

DR KIRUBAKARAN MALAPAN

Consultant General, Breast, Endocrine & Bariatric Surgeon,

Penang Weight Loss Clinic & Surgery,

Gleneagles Hospital Penang, Malaysia.

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