The practice of Bariatrics is defined as a branch of medicine that deals with the control and treatment of obesity and allied diseases (Dictionary.com). As a Nurse Practitioner (NP) specializing in Bariatrics for the past 6 years I find it to be much more. Our team at Tri- State Bariatrics is able to assist our patients in returning to a “normal lifestyle.” One that is free from discrimination, morbidity, and mortality. Our patients require constant education, counseling, support, nurturing, empathy, consoling, and sympathy. They are riddled with co-morbid conditions such as Diabetes Mellitus, Hypertension (high blood pressure), Hyperlipidemia (high cholesterol), Sleep Apnea, and GERD (reflux). All of which cause devastating effects if not controlled. They are scrutinized and shamed for being obese. The general public and often health care providers feel that the patient is at total fault for their obesity.
The failure lies in not realizing that environment, genetics, and mental health issues play a major contributing role. As an educated Advanced Practice Nurse in Bariatrics I am able to sympathize with my patients. I have come to realize that obesity affects people for a variety of different reasons. Some patients are unable to control their addictions, some are unable to exercise secondary to physical limitations, and none are able to change their genetic make-up. Patients do not lack compliance, they lack understanding. Our patients rely on us to be a source of information and often just to be a sounding board. Surgery is the just the first step in the process of a life style change.
The interdisciplinary team including Surgeons, NPs, Nurses, Dietitian’s, Psychiatry, Support Staff, and Radiology available at Tri-State are invaluable resources available and are essential to your successful journey with weight loss. For those patients who are struggling prior to or even after weight loss surgery medication therapy may be an option. Weight loss medications are indicated for patients with a BMI greater than 30 or greater than 27 with significant medical complications, failure of diet and exercise regimens, and no contraindications. There are 2 new weight loss medications on the market that were approved for use in 2012 along with 6 other options for use in the appropriate patient.These options can be discussed with your Surgeon or NP.
Many of the older approved medications are for short term use and have adverse effects and drug or co-morbidity interactions. A commonly prescribed short term medication is Phentermine which can be used for up to 3 months in adjunct with diet and exercise as are all medication therapies. Orlistat is available by prescription as Xenical or over the counter as Alli. This medication may have some unpleasant bowel side effects. Both of these medications have shown to have modest weight loss effect. The newest medications to be approved are Lorcaserin (Belviq) and Phentermine/Topiramate ER (Qsymia).Both of these have been approved for long term use and have minimal side effects and less interactions with other medications and disease states. These medications may not be covered by insurance companies and can have an out of pocket cost of up to $200 per month. Belviq is twice a day while Qsymia is once per day. Qsymia is an extended release medication and cannot be used for patients who have had gastric bypass.