Joining forces, Medical Academic and iNova Pharmaceuticals hosted Dr Jocelyn Hellig, a specialist physician and endocrinologist, for an enlightening discussion on managing patient expectations in obesity therapy.  

How does one manage patient expectations during a weight loss journey? How many of these expectations are even realistic? Medical Academic and iNova Pharmaceuticals proudly hosted specialist physician and endocrinologist Dr Jocelyn Hellig on 13 March for a presentation on patient expectations in obesity therapy.  

In obesity therapy, what patients want is often not congruent with what we can offer them,” Dr Hellig pointed out. “Often patients will expect to be thin at the end of therapy, but the concept of thinness is itself rather outdated.” Patients will often fixate on achieving a number on a scale, and this number often relates to specific life events during which patients felt at ease and which they would like to return to.  

“This is often a throwback to their weight at marriage, or just before the birth of their first child,” Dr Hellig said. From a clinical perspective, the weight they seek is therefore often an arbitrary number, and not necessarily the one most suited to them from a cardiometabolic perspective. Dr Hellig indicated that many patients also wish to lose to attain a sensation of 'feeling normal’. 

“This is quite reasonable and really relates to improving quality of life in tangible ways – tying one’s own shoelaces, fitting into an aero plane seat, not shopping at a plus-size clothing store or playing with your kids.” But what does the current landscape of clinical practice offer these patients?  

WHAT THE THERAPIES OFFER 

Current medications can, in the medium term, induce weight loss of between 6% and 16% of total body weight, Dr Hellig said. This pales in comparison to the efficacy of bariatric surgery (gastric bypass in particular), which can typically cause an average weight loss between 25% and 35%. While both pharmaceutical and bariatric interventions result in radical weight loss, they typically don’t conform to patient expectations about being 'thin' at the end of a treatment regime.  

“Sadly, the drugs we currently have are expensive and are generally unavailable to the general public, due to the extent of global demand,” Dr Hellig said. She pointed out that, while BMI and metabolic were correlated, it is impossible to get a clear picture of a person’s metabolic risk strictly by focusing on their BMI. A far more sensitive marker of metabolic health is waist circumference. 

“The International Diabetes Federation defines obesity as a waist circumference of more than 80cm in women and more than 90cm in men,” Dr Hellig pointed out. In male patients of South Asian descent, the wait circumference cutoff is slightly lower.  

WEIGHT BIAS AND STIGMA 

Dr Hellig was quick to point out that a doctor’s perception of obese patients can adversely affect their ability to treat them. “Two of the most common societal perceptions around obesity are weight bias and stigma,” she said. Weight bias refers to the idea that obese people lack willpower or won’t be cooperative with lifestyle management approaches, while stigma is when one acts on weight-biased beliefs.  

“Both weight bias and stigma are prevalent in the healthcare industry,” Dr Hellig said. These judgmental beliefs are not helpful for developing a true understanding of obesity, which at its core is a disease resulting from a deficit between energy intake and energy expenditure.  

What factors contribute to energy intake? Does being thinner help you live longer? How many minutes of exercise per week is required to keep the kilos off? To find out, watch a recording of this webinar here: https://vimeo.com/922838800/5d3184d96a accredited for 1 CPD point.