Learning and Earning with Gateway Professional Education CME/CEU Webinar Series Obesity and Weight Management Nicole Kohler, CDE, Clinical Design Specialist, Gateway HealthSM Jennifer Pennock, MD, Center for Diabetes & Endocrine Health, West Penn Hospital Megan Proper, PharmD, Sr. Pharmacist, Gateway HealthSM Wednesday, October 2, 2019 1 | DATE| PRESENTED BY: DISCLOSURES Speakers for today’s webinar have no real or potential conflict of interest in relation to this presentation 2 | DATE | PRESENTED BY: To receive CME/CEU credit for today’s webinar • If you haven’t already, create an account at cme.ahn.org • Text code xxxxxx to xxx-xxx-xxxx • You will receive an email with a link to complete evaluation and claim CE credit • You MUST text by the end of the day today to receive credit! • For pharmacists only: instructions given in Chat box towards end • Questions? Email us at [email protected] Save the dates! Wednesdays 12-1pm: • November 6, 2019 – Cultural Competency • December 4, 2019 – Management of Hepatitis C in the Primary Care Practice Setting 3 | DATE | PRESENTED BY: Enroll today to receive monthly webinar invitations: https://www.surveymonkey.com/r/NZJYDF7 Questions? Email [email protected] This activity has been planned and implemented in accordance with the accreditation requirements and policies of the Accreditation Council for Continuing Medical Education (ACCME) through the joint providership of Allegheny General Hospital and Gateway Health Plan. Allegheny General Hospital is accredited by the ACCME to provide continuing medical education for physicians. Allegheny General Hospital designates this live webinar activity for a maximum of 1.0 AMA PRA Category 1 CreditTM. Physicians should claim only the credit commensurate with the extent of their participation in the activity. Allegheny General Hospital is approved by the American Psychological Association to sponsor continuing education for psychologists. Allegheny General Hospital maintains responsibility for this program and its content. Social Workers may claim credits for attending educational courses and programs delivered by pre-approved providers, such as the American Psychological Association. Allegheny General Hospital Department of Pharmacy Services is accredited by the Accreditation Council for Pharmacy Education as a provider of continuing pharmacy education. 4 | DATE | PRESENTED BY: SHOUT OUT! To arrange for a group viewing and lunch at your practice for a future webinar, please contact your Gateway Clinical Transformation Consultant (CTC). Suggestions for future topics/speakers? Email your CTC or [email protected] Self nominations welcome! 5 | DATE | PRESENTED BY: Obesity and Weight Management GATEWAY HEALTH’S MEMBERSHIP POPULATION Gateway has a ~46,000 members classified as overweight or obese • 66% female • 33% male • Average age: 33.7 Concurrent Disease Prevalence • SMI: 30.0% • Hypertension: 26.8% • Asthma: 12.5% • Diabetes: 12.2% • Cardiac: 3.9% • COPD: 2.2% Many facing Social Determinant of Health factors: living in a food desert, residing in a rural residence, experience socioeconomic inequity and transportation inequity Health Service Analytics Reporting: PA Medicaid March 2018 - February 2019 GATEWAY HEALTH’S MEMBERSHIP POPULATION Childhood (ages 2-20) Adult (21+) Enrollment: ~12,000 Enrollment: ~33,000 Females: 50% Females: 72.3% Males: 49.9% Males: 27.6% Average Age: 12.3 Average Age: 41.5 Concurrent Disease Prevalence Concurrent Disease Prevalence • SMI: 11.9% • SMI: 36.6% • Asthma: 10.6% • Hypertension: 26.0% • Hypertension: 1.7% • Diabetes: 16.1% • Diabetes: 1.4% • Asthma: 13.1% • Cardiac: <1% • Cardiac: 5.3% • COPD: 2.9% Health Service Analytics Reporting: PA Medicaid March 2018 - February 2019 OBESITY AND WEIGHT MANAGEMENT NEW! Healthy Weight Management under Gateway to Lifestyle Management (GTLM) program Childhood Weight Management Program Gateway to Weight Management Adult Weight Management Program WHAT WE OFFER Childhood Nutrition and Weight Management Services •For MA beneficiaries under 21 years of age Credentialing Registered Dietitians •Nutritionists enrolled in the MA Program Weight Management Texting Program •Enrollees receive 3-5 actionable and inspirational text messages each week Collaboration with Provider Practices •Developing programs/initiatives tailored to patient needs Staff Training and Education PROVIDER SUPPORT Focused on getting services completed and provider education • Toolkit • Provider Reference Guide and Toolkit Rate Change from 2016 to 2019 Current Measure (Percentage Points) Percentile ABA 20.2 50th WCC - BMI 17.18 50th IN DEVELOPMENT Community Initiatives Practice Well-Visit Days In-Home Assessments Obesity and Weight Management Learning 2017and TOWNEarning HALL with Gateway What I Want You to Get From this Talk 1) Understand weight-bias and how to decrease the impact on patients 2) Basic evaluation for patients with obesity 3) Treatment steps for patients with obesity Weight Bias in Healthcare • 24% nurses stated that they were repulsed by obese people • 31-42% nurses stated they would prefer not to care for those with obesity at all • Healthcare professionals specializing in the treatment of obesity have weight bias • Weight shaming leads to worse outcomes Obesity Action Coalition . Weight Bias in Healthcare. A Guide for Healthcare Providers, 2014 Schwartz, M et al. Weight Bias Among Professional Specializing in Obesity. Obesity Research Vol 11, No 9 Sept 2003. Decrease Impact of Weight Bias on Patients • Understanding and compassion for their disease • “People-First Language” – Patient with obesity (instead of obese patient) – Weight-friendly terms • Excess weight • Unhealthy weight • High BMI • Emphasize – Behaviors, not blame – Health, not weight Obesity is an epidemic 17 Why is the Rate of Obesity Rising? • Easy access to high calorie foods - • Less physical activity - many sit at desk all day • Ambient temperature • Maternal age • Viral – Adenovirus-36 shown in mice and chickens to cause obesity. – Studies show that people with obesity are more likely to have had this virus than people without obesity. • Endocrine disruptors SW Keith, et al, “Putative contributors to the secular increase in obesity: exploring the roads less traveled.” International Journal of Obesity (2006) 30, • Sleep patterns 1585–1594 Atkinson, Richard. “Obesity Due to a Virus; How This Changes the Game.” Spring 2012 Issue Your Weight Matters Magazine Obesity is a disease American Medical Association recognized obesity as a disease - 2013 “Recognizing obesity as a disease will help change the way the medical community tackles this complex issue that affects approximately one in three Americans,” Dr. Patrice Harris, AMA member of the board Obesity Algorithm®. ©2016-2017 Obesity Medicine Association. Reference/s: [13-15] Genetics Twin study Monozygotic Dizygotic Borjeson, Acta Pael Scand 1976 Usually not monogenetic Specific genetic causes: • Leptin deficiency • MC4R deficiency • Prader Willi Hormones Stomach – Ghrelin Small intestines – CCK, GLP-1 Large intestines – OXM, PYY Pancreas – Insulin, Amylin Fat - Leptin Bell et al, Genetics of Human Obesity, Nature Reviews Genetics 2005 Medications that contribute to weight gain . Diabetes medication: . Insulin . Pioglitazone . Sulfonylureas (glipizide, glimepiride and glyburide) . Antipsychotic drugs (Clozapine, Olanzapine, Zotepine) . Antidepressant drugs (amitriptyline, paroxetine and sertraline) . Drugs for epilepsy (valproate, carbamazepine and gabapentin) . Prednisone . Blood pressure medication (beta-blockers) . Implantable Progestins . Anti HIV (HAART) Microbiome . bacteria, viruses, and fungi occupy almost every surface of the human body . about one bacterium for every cell in the human body . exposed during birth . influenced by environmental factors . Studies in mice and humans – types of bacteria effect weight Mouse studies Germ free Conventionally donated Conventionally raised Born by C-section Germ free mouse Vaginal birth Sterile environment At 8 weeks old Non-sterile environment 10 cc of fecal contents of conventionally raised mouse spread onto mouse’s fur Sterile autoclaved food Non-sterile food Mouse study results Germ free mice harvest less energy from food. ©2004 by National Academy of Sciences Fredrik Bäckhed et al. PNAS 2004;101:44:15718-15723 Emotional and psychological . Past trauma . Women who experiences sexual trauma are twice as likely to be obese . Depression and anxiety, daily stresses . self-soothing . Eating disorders . Binge eating disorder . Most common eating disorder . binge eat on average at least once a week . Night eating syndrome – eating most of calories at night Evaluation History • Weight History – Ask permission to talk about weight – Weight gain – Childhood, puberty, pregnancy, menopause – Job activity change – Prior weight loss efforts & outcomes • Four key contributors to weight – Nutrition – Physical activity – Sleep – Mood • History of diseases that might affect anti-obesity med choice, seizure disorder, glaucoma, pancreatitis, heart valve disease PMH/PSH Potential causes of Metabolic Other complications of weight change complications weight • Thyroid disease • Prediabetes • Cholecystectomy • Sleep Apnea • Diabetes • Asthma • Depression • Gestational diabetes • Heart Failure • Eating disorder • ASCVD • Urinary stress • Cushing features • Metabolic syndrome incontinence • Meds • NAFLD/NASH • Osteoarthritis • Bariatric surgery • PCOS • Gout • Dyslipidemia • GERD • Hypogonadism