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Clinical Encounters: Obesity

Skills Training for Primary Care Providers

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Obesity Treatment: A Collection of Patient Cases

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Obesity Treatment: A Collection of Patient Cases

Up to 3.5 hrs CE

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This activity is designed to change: Competence, Performance, Patient Outcome. Up to 3.5 hr(s)

Upon completing the case(s), the health professional will:

  • Use multiple different types of interventions to treat obesity in their patients. 
  • Be able to assess and provide several interventions for treating obesity in their patients.
  • Recognize the importance of ongoing weight management interventions for their patients with obesity.

Patient Cases:

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Medical Problem Related to Obesity course image
Medical Problem Related to Obesity

0.5 Hrs

Case: Miranda Jones

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Assessing Patient Abdominal Obesity course image
Assessing Patient Abdominal Obesity

0.25 Hrs

Case: Aaron Limbaco

View Activity Outline

 
Interventions for Overweight Patient course image
Interventions for Overweight Patient

0.25 Hrs

Case: Carlos Watson

View Activity Outline

 
Motivational Interviewing for Obesity course image
Motivational Interviewing for Obesity

0.25 Hrs

Case: Betty Craft

View Activity Outline

 
Dietary Change for Abdominal Obesity course image
Dietary Change for Abdominal Obesity

0.25 Hrs

Case: Xavier Harris

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Physician Patient Using Food to Cope course image
Physician Patient Using Food to Cope

0.5 Hrs

Case: Dr. William Golden

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Pharmacotherapy for Patient with Chronic Obesity course image
Pharmacotherapy for Patient with Chronic Obesity

0.5 Hrs

Case: Rebecca Collins

View Activity Outline

 
Lifestyle Change Before Weight Loss Surgery course image
Lifestyle Change Before Weight Loss Surgery

0.5 Hrs

Case: Dave Abbott

View Activity Outline

 
Weight Loss Surgery Case with Follow up course image
Weight Loss Surgery Case with Follow up

0.5 Hrs

Case: Stacy Murdock

View Activity Outline

 

Professional Practice Gaps

Training Activity References

Audience and Accreditation

Audience: Healthcare providers, healthcare students

TypeEst. TimeReleasedExpires
AMA PRA Category 1 Credit(s)™Up to 3.5 hr(s)1/1/2112/31/2021

AMA PRA Category 1 Credits™

Accreditation Statement: 

Clinical Tools, Inc. is accredited by the Accreditation Council for Continuing Medical Education (ACCME) to provide continuing medical education for physicians.

AMA Credit Designation Statement: 

Clinical Tools, Inc. designates this enduring material for a maximum of 3.5 AMA PRA Category 1 Credit(s)™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.

A letter of completion for up to 3.5 hours is available for non-physicians.

A score of 70% on the post-test is required to complete the activity.

Participation Requirements

Funding: Initial development of this activity was supported by a grant from the National Institute of Diabetes and Digestive and Kidney Diseases (#2R44DK091144-01A1) and NIDDK (#4R44DK108608-02).

Authors

As an ACCME accredited provider of continuing medical education, Clinical Tools, Inc. requires everyone who is in a position to control the content of an educational activity to disclose all relevant financial relationships with any commercial interest to the provider. The ACCME defines ‘relevant’ financial relationships as financial relationships in any amount occurring within the past 12 months that create a conflict of interest. Any conflicts of interest are resolved prior to the delivery of the educational activity to the learner. CTI does not permit individuals with financial conflicts of interest to participate in any stage of activity development.

T Bradley Tanner, MD (President, Clinical Tools, Inc.)
Disclosure: Has no relevant financial relationship(s) with ineligible companies to disclose. Dr. Tanner is the owner of Clinical Tools.

Read Bio
T. Bradley Tanner, MD is president of Clinical Tools and responsible for the vision of the company. He has received funding via grants and contracts from NIDA, NIAAA, NIMH, NCI, AHRQ, CDC, the Dept of Defense, and NASA to develop medical and health education projects. Dr. Tanner served as principal investigator on 2 NIDA grants to develop the DATA-2000 qualifying buprenorphine training program and clinical practice tools on BupPractice.com. He also has a strong background in technology and oversees the development and delivery of all Clinical Tools websites. Dr. Tanner is also a board-certified psychiatrist with experience in inpatient, outpatient, and emergency health settings. He currently treats patients and educates medical students and residents via his role as a Clinical Associate Professor of Psychiatry at the University of North Carolina at Chapel Hill.

Karen Rossie, DDS, PhD (Research Scientist, Clinical Tools, Inc. )
Disclosure: Has no relevant financial relationship(s) with ineligible companies to disclose.

Read Bio
Karen Rossie, DDS, PhD, directs projects at Clinical Tools. She majored in biology at Cleveland State University and studied dentistry at Case Western Reserve University followed by completing a Masters in pathology at Ohio State University, and later, a PhD in Psychology from the Institute of Transpersonal Psychology. She taught and practiced oral pathology and oral medicine for 15 years at the Ohio State University and the University of Pittsburgh, doing research in autoimmune disease, bone marrow transplantation, oral cancer, salivary gland disease, candidiasis, and diabetes. She has used this diverse background to lead or contribute to CTI projects related to tobacco cessation, opioid abuse treatment, anxiety, dementia care, alcohol use disorder, screening and brief interventions for substance abuse, obesity, and pain and addiction.

Reviewers

Steve Applegate, MEd, MEd (President, Applegate Consulting, )
Disclosure: Has no relevant financial relationship(s) with ineligible companies to disclose.

Read Bio
Mr. Applegate has experience in substance use counseling, state initiatives impacting substance use, and professional training. His prior positions include director of higher education and instructional design at the North Carolina Governor’s Institute on Alcohol and Substance Abuse, project director of the North Carolina Initiative of the Mid-Atlantic Addiction Technology Transfer Center, and program director of the Addiction Sciences Center (an outpatient substance abuse treatment center at the University of Virginia Health Sciences Center). Mr. Applegate works as an on-site consultant and travels to the Clinical Tools (CTI) office on a monthly basis from his office in Richmond, VA. Mr. Applegate helped design the CTI Instructional Manual and works to continue to revise it as we expand our Instructional Design methodology. Mr. Applegate has extensive experience with online education and training, especially in the area of substance abuse. He often pushes the envelope of technology and brainstorms with Clinical Tools how we can utilize new technology in our products. He helped guide development of the curriculum plan and assessments in Phase I of the current project.

Most Recent Reviews

CTI Content Review: June 5, 2020
CTI Editorial Review: June 25, 2020

View Reviews


Reviews for this activity

Important topic

Important topic. Enjoyed this format.

— Family Medicine

Outstanding!!

Outstanding!! Easy to follow... Can reflect and transform to practical daily experiences...

— Diabetologist

I like the case presentation.

I like the case presentation.

— Bariatric Medicine Specialist

Excellent Training

Excellent training on Obesity! Even more outstanding that it is free!

— Psychiatrist

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Funding Information Development of this website was funded entirely by grant #2R44DK091144-01A1 and #5R44DK108608-04 from the National Institutes of Health (NIH)/National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK). The website contents are solely the responsibility of the authors and do not necessarily represent the official views of NIDA. Ongoing development and maintenance is funded by the training fee and Clinical Tools, Inc. No commercial support is received.
Clinical Tools is accredited by the Accreditation Council for Continuing Medical Education (ACCME) to provide continuing medical education for physicians.

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Training Activity References

Aaron Limbaco Activity References

  • Bays, HE, JC Seger, C Primack, and et al. 2017. “Obesity Algorithm, Presented by the Obesity Medicine Association.” Obesity Medicine Association. https://obesitymedicine.org/obesity-algorithm/ (July 18, 2017).
  • Belavy, DL, M Mohlig, AFH Pfeiffer, and et al. 2014. “Preferential Deposition of Visceral Adipose Tissue Occurs Due to Physical Inactivity.” International Journal of Obesity 38: 1478–80. http://www.nature.com/ijo/journal/v38/n11/abs/ijo201426a.html?WT.ec_id=IJO-201411 (February 11, 2015).
  • International Diabetes Federation. 2006. “The IDF Consensus Worldwide Definition of the Metabolic Syndrome.” IDF.org. https://www.idf.org/e-library/consensus-statements/60-idfconsensus-worldwide-definitionof-the-metabolic-syndrome (July 31, 2014).
  • Jensen, MD. 2007. “Should We Measure Waist Circumference vs BMI vs Waist-Hip Ratio.” Presented at the 54th Annual Advanced Postgraduate Course (2007), American Diabetes Association. https://professional.diabetes.org/search/site/Should%20we%20measure%20waist%20circumference%20vs%20BMI%20vs%20waist-hip%20ratio (July 31, 2014).
  • Jensen, MD, DH Ryan, CM Apovian, and et al. 2013. 2013 Report on the Management of Overweight and Obesity in Adults: Full Panel Report Supplement. The National Heart, Lung, and Blood Institute. http://jaccjacc.cardiosource.com/acc_documents/2013_FPR_S5_Obesity.pdf (March 10, 2015).
  • Keating, SE, EA Machan, HT O’Connor, and et al. 2014. “Continuous Exercise but Not High Intensity Interval Training Improves Fat Distribution in Overweight Adults.” Journal of Obesity. https://www.ncbi.nlm.nih.gov/pubmed/24669314 (July 22, 2015).
  • National Heart, Lung and Blood Institute. 2000. “The Practical Guide Identification, Evaluation, and Treatment of Overweight and Obesity in Adults.” https://www.nhlbi.nih.gov/files/docs/resources/heart/prctgd_c.pdf (July 25, 2013).
  • Nimptsch, Katharina, Stefan Konigorski, and Tobias Pischon. 2019. “Diagnosis of Obesity and Use of Obesity Biomarkers in Science and Clinical Medicine.” Metabolism: Clinical and Experimental 92: 61–70. https://www.ncbi.nlm.nih.gov/pubmed/30586573 (April 10, 2019).
  • Thomas, EL, G Frost, SD Taylor-Robinson, and et al. 2012. “Excess Body Fat in Obese and Normal-Weight Subjects.” Nutrition Research Reviews 25: 150–61. https://www.cambridge.org/core/journals/nutrition-research-reviews/article/excess-body-fat-in-obese-and-normalweight-subjects/820BA0E5D204E5DD5C6AFF1E795C5616 (September 10, 2015).
  • World Health Organization. 2006. “BMI Classification.” Global Database on Body Mass Index. http://apps.who.int/bmi/ (August 29, 2014).

Betty Craft Activity References

  • Barnes, R. D., & Ivezaj, V. (2015). A systematic review of motivational interviewing for weight loss among adults in primary care. Obesity Reviews : An Official Journal of the International Association for the Study of Obesity, 16(4), 304–318. https://doi.org/10.1111/obr.12264
  • DiLillo, V., & West, D. (2011). Motivational interviewing for weight loss. Psychiatric Clinics of North America, 34(4), 861–869. Retrieved from https://www.ncbi.nlm.nih.gov/pubmed/22098809
  • Miller, W., & Rollnick, S. (2011). An Overview of Motivational Interviewing. Retrieved from https://www.umass.edu/studentlife/sites/default/files/documents/pdf/Motivational_Interviewing_Definition_Principles_Approach.pdf
  • Miller, W., & Rollnick, S. (2012). Motivational Interviewing: Helping People Change (3rd ed.). Retrieved from http://www.guilford.com/books/Motivational-Interviewing/Miller-Rollnick/9781609182274
  • Rahm, A., Boggs, J., Martin, C., & et al. (2015). Facilitators and barriers to implementing SBIRT in primary care in integrated health care settings. Substance Abuse, 36(3), 281–288. Retrieved from https://www.ncbi.nlm.nih.gov/pubmed/25127073
  • Reims, K., & Ernst, D. (2016). Using Motivational Interviewing to Promote Healthy Weight. Family Practice Management, 23(5), 32–38. Retrieved from https://www.aafp.org/fpm/2016/0900/p32.html

Dave Abbott Activity References

  • Barr, S., & Wright, J. (2010). Postprandial energy expenditure in whole-food and processed-food meals: Implications for daily energy expenditure. Food & Nutrition Research, 54. https://doi.org/10.3402/fnr.v54i0.5144
  • Bays, H., Seger, J., Primack, C., & et al. (2017). Obesity Algorithm, presented by the Obesity Medicine Association [Informative]. Retrieved July 18, 2017, from Obesity Medicine Association website: https://obesitymedicine.org/obesity-algorithm/
  • Belavy, D., Mohlig, M., Pfeiffer, A., & et al. (2014). Preferential deposition of visceral adipose tissue occurs due to physical inactivity. International Journal of Obesity, 38, 1478–1480. Retrieved from http://www.nature.com/ijo/journal/v38/n11/abs/ijo201426a.html?WT.ec_id=IJO-201411
  • Department of Health and Human Services. (2018). Physical Activity Guidelines for Americans, 2nd edition [Informative]. Retrieved September 29, 2017, from Office of Disease Prevention and Health Promotion website: https://health.gov/paguidelines/guidelines/
  • Garvey, W. T., Mechanick, J. I., Brett, E. M., Garber, A. J., Hurley, D. L., Jastreboff, A. M., … Reviewers of the AACE/ACE Obesity Clinical Practice Guidelines. (2016). American Association of Clinical Endocrinologists and American College of Endocrinology Comprehensive Clinical Practice Guidelines for Medical Care of Patients with Obesity. Executive Summary. Complete Guidelines available at https://www.aace.com/publications/guidelines. Endocrine Practice: Official Journal of the American College of Endocrinology and the American Association of Clinical Endocrinologists, 22(7), 842–884. https://doi.org/10.4158/EP161356.ESGL
  • Jensen, M. D., Ryan, D. H., Apovian, C. M., Ard, J. D., Comuzzie, A. G., Donato, K. A., … Yanovski, S. Z. (2013). 2013 AHA/ACC/TOS Guideline for the Management of Overweight and Obesity in Adults A Report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines and The Obesity Society. Circulation, 01.cir.0000437739.71477.ee. https://doi.org/10.1161/01.cir.0000437739.71477.ee
  • Johnson, R., Appel, L., Brands, M., & et al. (2009). Dietary sugars intake and cardiovascular health – A scientific statement from the American Heart Association. Circulation, 120, 1011–1020. Retrieved from http://circ.ahajournals.org/content/circulationaha/120/11/1011.full.pdf
  • Kushner, R., & AMA. (2011). Talking about weight with your patients. Retrieved from http://www.texmed.org/WorkArea/DownloadAsset.aspx?id=26248
  • Polyzos, S. A., Kountouras, J., & Mantzoros, C. S. (2019). Obesity and nonalcoholic fatty liver disease: From pathophysiology to therapeutics. Metabolism, 92, 82–97. https://doi.org/10.1016/j.metabol.2018.11.014
  • Ross, R., Hudson, R., Stotz, P., & et al. (2015). Effects of exercise amount and intensity on abdominal obesity and glucose tolerance in obese adults: A randomized trial. Annals of Internal Medicine, 162(5), 325–334. Retrieved from https://www.ncbi.nlm.nih.gov/pubmed/25732273
  • Ryu, S., Chang, Y., Jung, H., & et al. (2015). Relationship of sitting time and physical activity with non-alcoholic fatty liver disease. Journal of Hepatology, 63(5), 1229–1237. Retrieved from http://www.journal-of-hepatology.eu/article/S0168-8278(15)00473-0/abstract
  • Stamos Kovacs, J. (2009). The Dos and Don’ts of Counting Calories [Informative]. Retrieved December 22, 2015, from WebMD website: https://www.webmd.com/diet/dos-donts-counting-calories
  • Tremblay, M., LeBlanc, A., Janssen, I., & et al. (2011). Systematic review of sedentary behaviour and health indicators in school-aged children and youth. International Journal of Behavioral Nutrition, 8, 98. Retrieved from https://ijbnpa.biomedcentral.com/articles/10.1186/1479-5868-8-98
  • Univ of Texas MD Anderson Cancer Center. (2016). Sugars in Western diets increase risk for breast cancer tumors and metastasis: Study in mice points to sugar’s impact on inflammatory pathways as culprit. ScienceDaily, 76, 24–29. Retrieved from https://www.sciencedaily.com/releases/2016/01/160104080034.htm
  • USDA. (2014). Dietary Reference Intakes [Informative]. Retrieved January 6, 2015, from USDA National Agricultural Library website: https://fnic.nal.usda.gov/dietary-guidance/dietary-reference-intakes
  • World Health Organization. (2015). Guideline: Sugars intake for adults and children. Retrieved from http://www.who.int/nutrition/publications/guidelines/sugars_intake/en/
  • Yannakoulia, M., Poulimeneas, D., Mamalaki, E., & Anastasiou, C. A. (2019). Dietary modifications for weight loss and weight loss maintenance. Metabolism: Clinical and Experimental, 92, 153–162. https://doi.org/10.1016/j.metabol.2019.01.001

Dr. William Golden Activity References

  • American Medical Association. (2013). AMA Adopts New Policies on the Second Day of Voting at Annual Meeting. AMA. Retrieved from http://news.cision.com/american-medical-association/r/ama-adopts-new-policies-on-second-day-of-voting-at-annual-meeting,c9430649
  • Chrousos, G. (2009). Stress and disorders of the stress system. Nature Reviews. Endocrinology, 5(7), 374–381. Retrieved from https://www.ncbi.nlm.nih.gov/pubmed/19488073
  • Jackson, E. R., Shanafelt, T. D., Hasan, O., Satele, D. V., & Dyrbye, L. N. (2016). Burnout and Alcohol Abuse/Dependence Among U.S. Medical Students. Academic Medicine: Journal of the Association of American Medical Colleges. https://doi.org/10.1097/ACM.0000000000001138
  • Jensen, M. D., Ryan, D. H., Apovian, C. M., Ard, J. D., Comuzzie, A. G., Donato, K. A., … Yanovski, S. Z. (2013). 2013 AHA/ACC/TOS Guideline for the Management of Overweight and Obesity in Adults A Report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines and The Obesity Society. Circulation, 01.cir.0000437739.71477.ee. https://doi.org/10.1161/01.cir.0000437739.71477.ee
  • Kassi, E., Pervanidou, P., Kaltsas, G., & et al. (2011). Metabolic syndrome: definitions and controversies. BMC Medicine, 9, 48. Retrieved from http://www.biomedcentral.com/1741-7015/9/48
  • Keeton, K., Fenner, D. E., Johnson, T. R. B., & Hayward, R. A. (2007). Predictors of physician career satisfaction, work-life balance, and burnout. Obstetrics and Gynecology, 109(4), 949–955. https://doi.org/10.1097/01.AOG.0000258299.45979.37
  • Koliaki, C., Liatis, S., & Kokkinos, A. (2019). Obesity and cardiovascular disease: revisiting an old relationship. Metabolism, 92, 98–107. https://doi.org/10.1016/j.metabol.2018.10.011
  • Kovesdy, C., Furth, S., Zoccali, C., & World Kidney Day Steering Committee. (2017, March 8). Obesity and Kidney Disease: Hidden Consequences of the Epidemic. – PubMed – NCBI. Retrieved May 6, 2019, from https://www.ncbi.nlm.nih.gov/pubmed/28540059
  • Luppino, F., de Wit, L., Bouvy, P., & et al. (2010). Overweight, Obesity, and Depression: A Systematic Review and Meta-analysis of Longitudinal Studies. 67(3), 220–229. Retrieved from https://jamanetwork.com/journals/jamapsychiatry/fullarticle/210608
  • Mai, X., Chen, Y., Camargo, C., & et al. (2012). Cross-sectional and prospective cohort study of serum 25-hydroxyvitamin D level and obesity in adults. American Journal of Epidemiology, 175(10), 1029–1036. Retrieved from https://www.ncbi.nlm.nih.gov/pubmed/22312120
  • Mathes, W., Brownley, K., Mo, X., & et al. (2009). The biology of binge eating. Appetite, 52(3), 545–553. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2694569/
  • Mota, M. C., De-Souza, D. A., Rossato, L. T., Silva, C. M., Araújo, M. B. J., Tufik, S., … Crispim, C. A. (2013). Dietary Patterns, Metabolic Markers and Subjective Sleep Measures in Resident Physicians. Chronobiology International, 30(8), 1032–1041. https://doi.org/10.3109/07420528.2013.796966
  • Oreskovich, M. R., Shanafelt, T., Dyrbye, L. N., Tan, L., Sotile, W., Satele, D., … Boone, S. (2015). The prevalence of substance use disorders in American physicians. The American Journal on Addictions, 24(1), 30–38. https://doi.org/10.1111/ajad.12173
  • Peckham, C. (2015). Physician Burnout and Exercise. Retrieved March 10, 2016, from Medscape Physician Lifestyle Report website: http://www.medscape.com/features/slideshow/lifestyle/2015/public/overview#11
  • Polyzos, S. A., Kountouras, J., & Mantzoros, C. S. (2019). Obesity and nonalcoholic fatty liver disease: From pathophysiology to therapeutics. Metabolism, 92, 82–97. https://doi.org/10.1016/j.metabol.2018.11.014
  • Sanyal, D., & Raychaudhuri. (2016, August). Hypothyroidism and obesity: An intriguing link. Retrieved May 6, 2019, from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4911848/
  • Shanafelt TD, Boone S, Tan L, & et al. (2012). Burnout and satisfaction with work-life balance among us physicians relative to the general us population. Archives of Internal Medicine, 172(18), 1377–1385. https://doi.org/10.1001/archinternmed.2012.3199
  • Spencer, S., & Tilbrook, A. (2011). The glucocorticoid contribution to obesity. Stress (Amsterdam, Netherlands), 14(3), 233–246. Retrieved from https://www.ncbi.nlm.nih.gov/pubmed/21294656
  • Sturm, R. (2007). Increases in morbid obesity in the USA: 2000–2005. Public Health. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2864630/
  • Tonkin, R., & Sacks, D. (1998). Obesity management in adolescence: Clinical recommendations. Paediatrics & Child Health, 3, 395–398. Retrieved from http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2851302/
  • Vela-Bueno, A., Moreno-Jiménez, B., Rodríguez-Muñoz, A., Olavarrieta-Bernardino, S., Fernández-Mendoza, J., De la Cruz-Troca, J. J., … Vgontzas, A. N. (2008). Insomnia and sleep quality among primary care physicians with low and high burnout levels. Journal of Psychosomatic Research, 64(4), 435–442. https://doi.org/10.1016/j.jpsychores.2007.10.014
  • Vicennati, V., Pasqui, F., Cavazza, C., & et al. (2009). Stress-related development of obesity and cortisol in women. Obesity (Silver Spring), 17(9), 1678–1683. Retrieved from https://www.ncbi.nlm.nih.gov/pubmed/19300426
  • World Health Organization. (2002). Obesity: Preventing and managing the global epidemic (Report of a WHO Consultation No. WHO Technical Report Series 894). Retrieved from World Health Organization website: http://www.who.int/nutrition/publications/obesity/WHO_TRS_894/en/

Carlos Watson Activity References

  • Academy of Nutrition and Dietetics. (2014). RDs=Nutrition Experts. Retrieved from http://www.eatrightpro.org/resources/about-us/what-is-an-rdn-and-dtr
  • Chou, R., Dana, T., Blazina, I., Daeges, M., Bougatsos, C., & Jeanne, T. L. (2016). Screening for Dyslipidemia in Younger Adults: A Systematic Review for the U.S. Preventive Services Task Force. Annals of Internal Medicine, 165(8), 560–564. https://doi.org/10.7326/M16-0946
  • Department of Health and Human Services. (2018). Physical Activity Guidelines for Americans, 2nd edition [Informative]. Retrieved September 29, 2017, from Office of Disease Prevention and Health Promotion website: https://health.gov/paguidelines/guidelines/
  • Hu, F., Li, T., Colditz, G., & et al. (2003). Television watching and other sedentary behaviors in relation to risk of obesity and type 2 diabetes mellitus in women. JAMA, 289(14), 1785–1791. Retrieved from http://www.ncbi.nlm.nih.gov/pubmed/12684356
  • Institute of Medicine (IOM), Committee on Nutrition Services for Medicare Beneficiaries, Food and Nutrition Board. (2000). The Role of Nutrition in Maintaining Health in the Nation’s Elderly: Evaluating Coverage of Nutrition Services for the Medicare Population. Retrieved from http://www.nap.edu/read/9741/chapter/15#271
  • Jensen, M. D., Ryan, D. H., Apovian, C. M., Ard, J. D., Comuzzie, A. G., Donato, K. A., … Yanovski, S. Z. (2013). 2013 AHA/ACC/TOS Guideline for the Management of Overweight and Obesity in Adults A Report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines and The Obesity Society. Circulation, 01.cir.0000437739.71477.ee. https://doi.org/10.1161/01.cir.0000437739.71477.ee
  • Jensen, M., Ryan, D., Apovian, C., & et al. (2013). 2013 Report on the Management of Overweight and Obesity in Adults: Full Panel Report Supplement. Retrieved from The National Heart, Lung, and Blood Institute website: http://jaccjacc.cardiosource.com/acc_documents/2013_FPR_S5_Obesity.pdf
  • Lambert, M. (2014). ACC/AHA Release Updated Guideline on the Treatment of Blood Cholesterol to Reduce ASCVD Risk. American Family Physician, 90(4), 260–264. Retrieved from https://www.aafp.org/afp/2014/0815/p260.html
  • National Heart, Lung and Blood Institute. (2013). Managing Overweight and Obesity in Adults. Retrieved from http://www.nhlbi.nih.gov/health-pro/guidelines/in-develop/obesity-evidence-review
  • USPSTF. (2008, June). Final Update Summary: Lipid Disorders in Adults (Cholesterol, Dyslipidemia): Screening – US Preventive Services Task Force. Retrieved April 3, 2019, from https://www.uspreventiveservicestaskforce.org/Page/Document/UpdateSummaryFinal/lipid-disorders-in-adults-cholesterol-dyslipidemia-screening
  • USPSTF. (2016, November). Final Update Summary: Statin Use for the Primary Prevention of Cardiovascular Disease in Adults: Preventive Medication – US Preventive Services Task Force. Retrieved April 3, 2019, from https://www.uspreventiveservicestaskforce.org/Page/Document/UpdateSummaryFinal/statin-use-in-adults-preventive-medication1
  • Williams, P., & Thompson, P. (2013). Walking Versus Running for Hypertension, Cholesterol, and Diabetes Mellitus Risk Reduction. ATVBAHA, 112. Retrieved from http://atvb.ahajournals.org/content/early/2013/04/04/ATVBAHA.112.300878.abstract

Miranda Jones Activity References

  • Bradley DW, Murphy G, Snetselaar LG, et al.. The incremental value of medical nutrition therapy in weight management. Manag Care. 2013. Available at: http://www.ncbi.nlm.nih.gov/pubmed/23373140 Accessed on: 2015-03-03.
  • Farley AC, Hajek P. Aveyard P, Interventions for preventing weight gain after smoking cessation. Cochrane Database Syst Rev. 2012. Available at: http://www.ncbi.nlm.nih.gov/pubmed/22258966 Accessed on: 2015-02-12.
  • Garvey WT, Mechanick JI, Brett EM, et al. American Association of Clinical Endocrinologists and American College of Endocrinology Comprehensive Clinical Practice Guidelines for Medical Care of Patients with Obesity. Endocrine Practice. 2016; Vol 22 (Suppl 3): Available at: https://www.aace.com/disease-state-resources/nutrition-and-obesity/clinical-practice-guidelines/comprehensive-clinical Accessed on: 2017-08-17.
  • Ilanne-Parikka P , Eriksson JG. Lindstrom J, Effect of lifestyle intervention on the occurrence of metabolic syndrome and its components in the Finnish Diabetes Prevention Study. Diabetes Care . 2008; 31: 805-7. Available at: http://www.ncbi.nlm.nih.gov/pubmed/18184907 Accessed on: 2015-02-02.
  • Jensen M, Ryan DH, Apovian CM, et al. 2013 AHA/ACC/TOS Guideline for the Management of Overweight and Obesity in Adults . Journal of the American College of Cardiology. 2014. Available at: http://circ.ahajournals.org/content/early/2013/11/11/01.cir.0000437739.71477.ee Accessed on: 2015-01-21.
  • Jensen MD, Ryan DH, et al. 2013 Report on the Management of Overweight and Obesity in Adults: Full Panel Report Supplement. . 2013. Available at: http://jaccjacc.cardiosource.com/acc_documents/2013_FPR_S5_Obesity.pdf Accessed on: 2015-03-10.
  • Kurt K, Spitzer RL,Williams JBW, Validity of a Brief Depression Severity Measure. JGIM: Journal of General Internal Medicine. 2001. 16, 606-613. Available at: http://onlinelibrary.wiley.com/doi/10.1046/j.1525-1497.2001.016009606.x/full
  • Mayo Clinic Staff. DASH diet: Healthy eating to lower your blood pressure. Mayo Clinic. 2013. Available at: http://www.mayoclinic.org/healthy-living/nutrition-and-healthy-eating/in-depth/dash-diet/art-20048456
  • Mechanick JI, Youdim A, Jones DB. et al., Clinical practice guidelines for the perioperative nutritional, metabolic, and nonsurgical support of the bariatric surgery patient–2013 update: cosponsored by American Association of Clinical Endocrinologists, The Obesity Society, and American Society for Metabolic & Bariatric Surgery. Obesity. 2013. Available at: http://www.ncbi.nlm.nih.gov/pubmed/23529939 Accessed on: 2014-10-13.
  • Muir M. Archer-Heese G, Essentials of a bariatric patient handling program. The Online Journal of Issues in Nursing. 2009; 14: . Available at: http://www.nursingworld.org/MainMenuCategories/ANAMarketplace/ANAPeriodicals/OJIN/TableofContents/Vol142009/No1Jan09/Bariatric-Patient-Handling-Program-.html Accessed on: 2015-05-11.
  • O’Hara P, Connett JE. Lee WW, Early and late weight gain following smoking cessation in the lung health study. American Journal of Epidemiology . 1998; 148: 821-830. Available at: http://aje.oxfordjournals.org/content/148/9/821.long Accessed on: 2015-02-11.
  • Rexrode K, Rundek T. Body mass index and stroke in UK women. Neurology. September 2016:10.1212/WNL.0000000000003186. doi:10.1212/wnl.0000000000003186.
  • Ross R, Hudson R, Stotz PJ, et al.. Effects of exercise amount and intensity on abdominal obesity and glucose tolerance in obese adults: A randomized trial. Annals of Internal Medicine. 2015; 162(5): 325-334.
  • Shlisky JD, Hartman TJ, Kris-Etherton PM, Rogers CJ, Sharkey NA. Nickols-Richardson SM, Partial Sleep Deprivation and Energy Balance in Adults: An Emerging Issue for Consideration by Dietetics Practitioners. J Acad Nutr Diet. 2012; 112(11): 1785-97. Available at: http://www.ncbi.nlm.nih.gov/pubmed/23102177 Accessed on: 2014-03-31.
  • Simon GE, Von Korff M, Saunders K. et al., Association between obesity and psychiatric disorders in the US adult population. JAMA Psychiatry. 2006; 63(7): 824-830. Available at: http://archpsyc.jamanetwork.com/article.aspx?articleid=209790 Accessed on: 2015-03-16.
  • Tremblay MS, LeBlanc AG, Janssen I, et al. Systematic review of sedentary behaviour and health indicators in school-aged children and youth. International Journal of Behavioral Nutrition.. 2011; 8: 98. Available at: http://www.ijbnpa.org/content/8/1/98 Accessed on: 2014-12-31.
  • Vincent HK, Vincent KR . Lamb KM, Obesity and mobility disability in the older adult. Obesity Reviews . 2010; 11: 568-579. Available at: http://www.ncbi.nlm.nih.gov/pubmed/20059707 Accessed on: 2015-05-11.
  • Wannamethee SG , Sharper AG . Walker M, Overweight and obesity and weight change in middle aged men: impact on cardiovascular disease and diabetes . J Epidemiol Community Health. 2005; 59: 134-9. Available at: http://www.ncbi.nlm.nih.gov/pubmed/15650145 Accessed on: 2015-02-02.
  • WHO. BMI classification. Global Database on Body Mass Index. 2006. Available at: http://apps.who.int/bmi/ Accessed on: 2014-08-29.

Rebecca Collins Activity References

  • Abuissa, H., Jones, P., & Marso, S. (2005). Angiotensin-converting enzyme inhibitors or angiotensin receptor blockers for prevention of type 2 diabetes: a meta-analysis of randomized clinical trials. 46(5), 821–826. Retrieved from http://content.onlinejacc.org/article.aspx?articleid=1136856
  • Jensen, M., Ryan, D., Apovian, C., & et al. (2013). 2013 Report on the Management of Overweight and Obesity in Adults: Full Panel Report Supplement. Retrieved from The National Heart, Lung, and Blood Institute website: http://jaccjacc.cardiosource.com/acc_documents/2013_FPR_S5_Obesity.pdf
  • Kroenke, K., Spitzer, R. L., Williams, J. B. W., & Löwe, B. (2009). An ultra-brief screening scale for anxiety and depression: the PHQ-4. Psychosomatics, 50(6), 613–621. https://doi.org/10.1176/appi.psy.50.6.613
  • Kumar, R., Sharma, R., & Bairwa, K. (2010). Modern development in ACE inhibitors. Der Pharmacia Lettre, 2, 388–419. Retrieved from http://scholarsresearchlibrary.com/DPL-vol2-iss3/DPL-2010-2-3-388-419.pdf
  • National Heart, Lung and Blood Institute. (2013). Managing Overweight and Obesity in Adults. Retrieved from http://www.nhlbi.nih.gov/health-pro/guidelines/in-develop/obesity-evidence-review
  • Rosendorff, C., Black, H., Cannon, C., & et al. (2007). AHA Scientific Statement: Treatment of Hypertension in the Prevention and Management of Ischemic Heart Disease. Circulation, 115, 2761–2788. Retrieved from http://circ.ahajournals.org/content/115/21/2761.full
  • Sharma, A., Pischon, T., & Hardt, S. (2001). Hypothesis: Beta-adrenergic receptor blockers and weight gain: A systematic analysis. Hypertension, 37, 250–254. Retrieved from http://www.ncbi.nlm.nih.gov/pubmed/11230280
  • White, W., Weber, M., & Sica, D. (2011). Effects of the angiotensin receptor blocker azilsartan medoxomil versus olmesartan and valsartan on ambulatory and clinic blood pressure in patients with stages 1 and 2 hypertension. Hypertension, 57, 413–420. Retrieved from http://hyper.ahajournals.org/content/57/3/413.long
  • Wiysonge, C., Bradley, H., & Volmink, J. (2012). Beta-blockers for hypertension. Cochrane Database Syst Rev, 15(8), CD002003. Retrieved from http://www.ncbi.nlm.nih.gov/pubmed/22895924

Stacy Murdock Activity References

  • Aills, L., Blankenship, J., & Buffington, C. (2008). ASMBS allied health nutritional guidelines for the surgical weight loss patient. 4, 73–108. Retrieved from http://asmbs.org/wp/uploads/2014/05/nutritional-guidelines.pdf
  • Alexandrou, A., Tsoka, E., Armeni, E., & et al. (2015). Determinants of secondary hyperparathyroidism in bariatric patients after Roux-en-Y gastric bypass or sleeve gastrectomy: A pilot study. International Journal of Endocrinology, 2015. Retrieved from http://www.hindawi.com/journals/ije/2015/984935/
  • American Diabetes Association. (2014). Prediabetes: Strategies for Effective Screening, Intervention, and Follow-Up. Retrieved April 1, 2019, from Prediabetes website: https://professional.diabetes.org/sites/professional.diabetes.org/files/media/prediabetes.pdf
  • Bays, H., Seger, J., Primack, C., & et al. (2017). Obesity Algorithm, presented by the Obesity Medicine Association [Informative]. Retrieved July 18, 2017, from Obesity Medicine Association website: https://obesitymedicine.org/obesity-algorithm/
  • BioSpace. (2019, April 16). Gelesis Granted FDA Clearance to Market PLENITYTM — a New Prescription Aid in Weight Management. Retrieved April 16, 2019, from BioSpace website: https://www.biospace.com/article/gelesis-granted-fda-clearance-to-market-plenity-a-new-prescription-aid-in-weight-management/
  • FDA. (2016). FDA approves AspireAssist obesity device. Retrieved from http://www.fda.gov/newsevents/newsroom/pressannouncements/ucm506625.htm
  • FDA. (2018). FDA approved obesity treatment devices. Retrieved from https://www.fda.gov/MedicalDevices/ProductsandMedicalProcedures/ObesityDevices/default.htm
  • Fiore, K. (2013). New Guidelines for Weight-Loss Surgery Upgrade Sleeve Procedure. Retrieved from http://www.medpagetoday.com/Endocrinology/Obesity/38112?utm_content=&utm_medium=email&utm_campaign=DailyHeadlines&utm_source=WC&xid=NL_DHE_2013-03-28&eun=g648601d0r&userid=648601&email=lsoler@webmd.net&mu_id=5780408
  • Jensen, M. D., Ryan, D. H., Apovian, C. M., Ard, J. D., Comuzzie, A. G., Donato, K. A., … Yanovski, S. Z. (2013). 2013 AHA/ACC/TOS Guideline for the Management of Overweight and Obesity in Adults A Report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines and The Obesity Society. Circulation, 01.cir.0000437739.71477.ee. https://doi.org/10.1161/01.cir.0000437739.71477.ee
  • Kushner, R., & AMA. (2011). Talking about weight with your patients. Retrieved from http://www.texmed.org/WorkArea/DownloadAsset.aspx?id=26248
  • Livingston, E. (2010). The incidence of bariatric surgery has plateaued in the U.S. American Journal of Surgery, 200(3), 378–385. Retrieved from https://www.ncbi.nlm.nih.gov/pubmed/20409518
  • Mechanick, J., Youdim, A., Jones, D., & et al. (2013). Clinical practice guidelines for the perioperative nutritional, metabolic, and nonsurgical support of the bariatric surgery patient–2013 update: cosponsored by American Association of Clinical Endocrinologists, The Obesity Society, and American Society for Metabolic & Bariatric Surgery. Obesity (Silver Spring), 21 Suppl 1, S1-27. Retrieved from https://www.ncbi.nlm.nih.gov/pubmed/23529939
  • MedlinePlus. (2016, October 15). Fesoterodine: MedlinePlus Drug Information. Retrieved April 1, 2019, from Fesoterodine website: https://medlineplus.gov/druginfo/meds/a609021.html
  • Nudel, J., & Sanchez, V. M. (2019). Surgical management of obesity. Metabolism: Clinical and Experimental, 92, 206–216. https://doi.org/10.1016/j.metabol.2018.12.002
  • Skibora, L. (2014). Skeletal effects of bariatric surgery: examining bone loss, potential mechanisms and clinical relevance. Diabetes, Obesity, and Metabolism, 16(12), 1204–1213. Retrieved from http://onlinelibrary.wiley.com/enhanced/doi/10.1111/dom.12363/
  • Tucker, M. (2013). New Bariatric Surgery Guidelines Reflect Rapidly Evolving Field. Medscape Medical News. Retrieved from https://www.medscape.com/viewarticle/781619
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Xavier Harris Activity References

  • Barnes, R. D., & Ivezaj, V. (2015). A systematic review of motivational interviewing for weight loss among adults in primary care. Obesity Reviews : An Official Journal of the International Association for the Study of Obesity, 16(4), 304–318. https://doi.org/10.1111/obr.12264
  • Logan, D., & Marlatt, G. (2010). Harm reduction therapy: a practice-friendly review of research. Journal of Clinical Psychology, 66(2), 201–214. Retrieved from http://onlinelibrary.wiley.com/doi/10.1002/jclp.20669/abstract
  • Miller, W., & Rollnick, S. (2012). Motivational Interviewing: Helping People Change (3rd ed.). Retrieved from http://www.guilford.com/books/Motivational-Interviewing/Miller-Rollnick/9781609182274
  • Rahm, A., Boggs, J., Martin, C., & et al. (2015). Facilitators and barriers to implementing SBIRT in primary care in integrated health care settings. Substance Abuse, 36(3), 281–288. Retrieved from https://www.ncbi.nlm.nih.gov/pubmed/25127073
  • Reims, K., & Ernst, D. (2016). Using Motivational Interviewing to Promote Healthy Weight. Family Practice Management, 23(5), 32–38. Retrieved from https://www.aafp.org/fpm/2016/0900/p32.html

 

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Professional Practice Gaps

Professional practice gaps exist when there is a disparity between educational needs and the ideal or desired level of knowledge, competence, and performance. Evidence-based guidelines for obesity management are not being followed by physicians and other providers at a level that matches the high incidence of obesity (Kraschnewski et al., 2013). The guidelines include a recommendation to use motivational interviewing techniques to encourage behavior modifications in overweight and obese patients (Fitch et al., 2013), as well as long term dietary change, increased physical activity, behavioral supports, and monitoring (Bays et al., 2016-2017; Garvey et al. 2016). Training physicians in these guidelines will help physicians help their patients lose weight and increase the amount of weight lost (Barnes & Ivezaj, 2015).

The low rate with which clinical guidelines for managing obesity are followed by medical providers appears to be in part due to lack of knowledge of obesity, nutrition, and physical activity (Smith et al., 2016). Moreover, physicians lack adequate training and competence in behavior change strategies related to health improvements including weight-loss (Dietz et al., 2015). Training in the evidence-based practice guidelines will help address this competence need. Additionally, because the rate of applying evidence-based guidelines to counsel patients having weight problems is low, it follows that many providers would benefit from experiential training in applying them. Experience with interactive case scenarios involving weight management helps address this performance need.

Practice Gap References

  • Barnes RD, Ivezaj V. A systematic review of motivational interviewing for weight loss among adults in primary care. Obes Rev. 2015; 16(4): 304-318. Available at: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4491487/ Accessed on: 2017-09-28.
  • Bays HE, Seger JC, Primack C, et al. Obesity Algorithm, presented by the Obesity Medicine Association. . 2016-2017. Available at: https://obesitymedicine.org/obesity-algorithm/ Accessed on: 2017-08-17.
  • Dietz WH, Baur LA , Hall K . Management of obesity: improvement of health-care training and systems for prevention and care . The Lancet . 2015. Available at: http://www.thelancet.com/journals/lancet/article/PIIS0140-6736%2814%2961748-7/abstract Accessed on: 2015-03-13.
  • Fitch A , Everling L , Fox C. Health care guideline: prevention and management of obesity for adults. Institute for Clinical Systems Improvement . 2013. Available at: https://www.healthpartners.com/ucm/groups/public/@hp/@public/documents/documents/cntrb_037112.pdf Accessed on: 2015-02-24.
  • Garvey WT, Mechanick JI, Brett EM, et al. American Association of Clinical Endocrinologists and American College of Endocrinology Comprehensive Clinical Practice Guidelines for Medical Care of Patients with Obesity. . Endocrine Practice. 2016-2017; Vol 22 (Suppl 3): . Available at: https://www.aace.com/disease-state-resources/nutrition-and-obesity/clinical-practice-guidelines/comprehensive-clinical Accessed on: 2017-08-17.
  • Kraschnewski JL, Sciamanna CN, Stuckey HL, et al. A silent response to the obesity epidemic: decline in US physician weight counseling. Med CAre. 2013; 51(2): 186-92. Available at: https://www.ncbi.nlm.nih.gov/pubmed/23047128 Accessed on: 2017-09-28.
  • Smith S, Seeholzer E, Gullet H, et al. Primary care residents’ knowledge, attitude, self-efficacy, and perceived professional norms regarding obesity, nutrition, and physical activity counseling. Journal of Graduate Medical Education. 2016; September: 388-394. Available at: http://www.jgme.org/doi/pdf/10.4300/JGME-D-14-00710.1?code=gmed-site Accessed on: 2017-09-28.
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