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Signs of Obesity

Obesity is like a credit card – “you play before you pay” – which we all know can easily become problematic, unmanageable, and a recipe (no pun intended) or blueprint for disaster. “Calorie abuse” (or more properly “body abuse”) is the most challenging addiction to treat…and yes, addiction is the proper term (see the 5 “C’s” of Addiction). To put it into context, unlike all drugs of abuse, which we can tell you to stop using, we cannot do the same with food. But in the same respect, some people can’t be “trusted” to control their own intake or volume of calories hence obesity sets in. And as we all know, weight is very easy to put on but very difficult to take off; therefore, just as with all medical conditions, prevention is the best medicine. So assuming you’ve already passed that milestone, we can help you regroup and get focused on weight loss and future “calorie control” through education and motivation to keep the pounds from returning.

A successful (meaning goal achievement and threshold maintenance) weight management program consists of commitment to long-term lifestyle strategies/behavioral modifications that encompass and promote a healthy eating pattern (determined by volume and consistency of calorie intake ➜ CALORIES IN) and physical activity (determined by volume and consistency and frequency of aerobic exercise ➜ CALORIES OUT); then vigilant and persistent surveillance needs to occur by putting into place ways to track weight and its composition (meaning proportion of lean and fat mass) over time.

Obesity contributes to a multitude of medical problems/complications that can lead to increased rates of morbidity (poor quality of life) and mortality (death) including:

The 5 “C’s” of Addiction

COMPULSIVE use

Loss of CONTROL

Continued use despite negative CONSEQUENCES

CRAVINGS

CHRONIC maladaptive behaviors

  • high blood pressure
  • high LDL (“bad cholesterol”)
  • low HDL (“good cholesterol”)
  • high TAG’s (“blood fat”)
  • diabetes mellitus
  • coronary artery disease (heart blood vessel blockage)
  • myocardial infarction (MI = heart attack)
  • cerebral vascular accident (CVA = stroke)
  • gallbladder disease and gallstones
  • fatty liver disease
  • metabolic syndrome/syndrome X (having 3+/5 of the following which places you at increased risk for coronary artery disease, diabetes mellitus, fatty liver disease, and several cancers; it is due to insulin resistance arising from abnormal fat tissue storage and function)
    • abdominal obesity (defined as a waist circumference of ≥ 40 inches in men and ≥ 35 inches in women)
    • high blood pressure or being treated for such
    • hyperglycemia (high blood sugar) or being treated for diabetes mellitus
    • hypertriglyceridemia (high blood fat) or being treated for such
    • low HDL (“good cholesterol” and defined as < 40 mg/dL in men and < 50 mg/dL in women) or being treated for such
  • polycystic ovarian disease/syndrome (PCOD/PCOS)
  • infertility
  • osteoarthritis (OA = joint ache / pain / inflammation / destruction)
  • gout
  • obstructive sleep apnea (OSA = breathing problems while sleeping) with secondary
    • snoring
    • narcolepsy/excessive daytime sleepiness
    • congestive heart failure (CHF)/cor pulmonale (heart disease due to a lung problem)
  • cancers
    • endometrial (lining of the uterus)
    • breast
    • colon
    • gallbladder
    • liver
    • kidney
  • low quality of life and/or dissatisfaction with life
  • mental health issues including
    • depression
    • anxiety
    • depression with anxiety
    • chronic guilt/shame
    • chronic despair (hopelessness)
    • chronic grief (helplessness)
    • suicidal ideation (thoughts)
    • suicide attempts/completion
  • physical activity limitations such as
    • bathing
    • grooming
    • having sex
    • cooking
    • shopping
    • driving
    • working
    • exercising

OBESITY TREATMENT OPTIONS…remember, it’s all about “volume control”

  • “muzzle for your mind”…willpower… can be hard to maintain with so much temptation
  • “muzzle for your belly”…anatomic limitation (such as gastric bypass, banding, sleeve, stapling, folding, removal, and ballooning or switch procedures)… much more to it than meets the eye, and mind!!
  • “muzzle for your mouth”…medicinal limitation with
    • phentermine (Adipex-P® )
    • phentermine + topiramate (Qsymia® )
    • bupropion + naltrexone (Contrave® )
    • orlistat (Xenical® , Alli® )
    • liraglutide daily injection (under skin) (Saxenda® )

OBESITY INTAKE FORM

  • Date Format: MM slash DD slash YYYY
    • *Due to Commonwealth of Kentucky statute, a KASPER (Kentucky All Schedule Prescription Electronic Reporting) log for the prior 12 months must be run in order to investigate whether any chronic narcotic/controlled/scheduled medications are being prescribed for the medical director to review as part of the verification process to judge whether a potential patient is an appropriate candidate for obesity treatment with phentermine.
    • **Please note that none of the provided information is kept or stored in any format; unless of course you are deemed to be an appropriate candidate for our program and present for an appointment, at which time it will be made part of your electronic medical record. If you fail to present for your initial appointment without notifying us, it will be destroyed immediately after your appointment time has passed as well as when/if you are deemed to not be an appropriate candidate for our program.

    • You will be contacted at the number provided after your information is reviewed by the medical director. Decisions will fall into one of the following three outcomes:
      1. If you are deemed to be an appropriate candidate for our program, you will be directed to view three items(see below)
      2. If further discussion or verifications are needed, our staff will contact you for more information and will be able to make a decision about your appropriateness for our program immediately
      3. If you are deemed to NOT BE an appropriate candidate for our program, the reasoning behind this decision will be offered and any issues or concerns can be addressed immediately.

    • Once you are found to be a viable candidate for our program, you will be given a time-limited passcode that will allow you access to view the following three items which will assist you in making a decision to proceed with making an initial appointment to start treatment or not. You will be asked to sign a hard copy of the third item which will be scanned and placed in your electronic medical record:
      1. Phentermine information sheet
      2. Cost summary sheet
      3. Medication-Assisted Treatment Agreement for Obesity

    • After you have reviewed these three items, you will need to call the office at (859) 556.7487 to inform us that you either wish to make an appointment (a Friday only appointment will be offered) or that you would rather not make an appointment (and your information will be destroyed immediately).

    • Three things to bring to your initial appointment:
      1. A Kentucky issued + unexpired + picture + identification card
      2. Payment as noted in the cost summary sheet
      3. A great attitude filled with motivation, excitement, and optimism !!!