Computer generated transcript

Warning!
The following transcript was generated automatically from the content and has not been checked or corrected manually.

Hello, everyone, and thank you so much for joining us today for the Global Obesity Academy International Program. My name is Doctor Sue Peterson. I'm an endocrinologist and obesity medicine specialist in Calgary, Canada, and I'm delighted to take you through this presentation that I've developed for you today. These are my disclosures. OK. Let's move into our 2nd case and our 2nd objective which focuses around bias-aware patient-considered communication around obesity. So here we'll talk about Mina. So she's here to talk about polycystic ovary syndrome. She's having infrequent periods about every 3 to 4 months, and they've become progressively less frequent and she's getting concerned. So she's 32, she's a stay at home mom, and she has a new diagnosis of pre-diabetes based on her lab work. She has polycystic ovary syndrome, obesity, and depression. Her only medication is for depression. She's taking citalopram 20 mg daily. And uh we see that her uh BP is a little bit elevated, and maybe she's nervous today. Maybe she's got undiagnosed hypertension. We'll need to look into that. And she declined to be weighed, and she also declined to have her weight measured. And actually, when you look back in her history, every time she's in your office, she declines to have her weight measured or to have her waist measured. And remember, uh, when we talk about asking permission, you also want to train your staff to ask permission to weigh patients. Patients because some patients actually don't want to have those measures taken, and Mina's one of those patients. And that sets off a bit of a flag for us and maybe some things that we should talk about with Mina. So, how would you bring up the topic of weight with Mina? Would you say, A, your periods are becoming less frequent? Has your weight been increasing? B, your weight must have gone up for pre-diabetes to show up. C, I'd like to support you in your concern of improving your polycystic ovary syndrome. Polycystic ovary syndrome is a health condition that's often associated with elevated weight. Is it OK if we talk about weight today in the context of this concern? Or, have you been trying anything to lose weight? So I'll give you a moment to digest those and pick the best response. OK. Wonderful. Well, the best answer here is C, and that's because we're asking permission to talk about weight, and that's gonna be really important with Mina, and she's given us a red flag that she doesn't like to be weighed, she doesn't like to have her waist measured, so we definitely need to ask permission. And that's the first. A in the five A's of obesity management in our Canadian guidelines. Um, something else we could say is, I noticed that your blood sugars are currently in the pre-diabetes range on your last lab test. This is very common and can be associated with weight gain or elevated weight, which is also very common. Would it be OK if we talked about weight today in light of that finding? So that's asking permission and also normalizing the conversation, helping her to feel that she's normal. It's normal to have weight struggles. It's, it's quite common to have pre-diabetes as well. So, asking permission, normalizing can be really a beautiful combination to really help Mina to feel comfortable. So, with your non-judgmental, empathetic request to ask about obesity, she opens up to us. It's wonderful. So, she tells us some very distressing stuff. She tells us that she was bullied as a teenager about her weight. She's been shamed. by doctors in the past and told to just go home and eat less and move more. She says she feels lazy, and she wishes that she had energy to exercise more. She describes her prior dieting failures, super disappointed in herself about these failures, avoids social situations because she feels ashamed about her appearance, and her weight has been on this yo yo trajectory for years. So now as we continue this conversation with Mina, we need to be sure to always keep her at the center of the conversation and really embrace these human aspects that she's opened up and shared with us. We have such a wonderful opportunity here to help Mina. We need to be empathetic and without bias, free of judgment, shame, and guilt. And there's a lot of ways that we can get this across. So, for example, simply remembering to use patient first language. And the number one easiest thing to remember is never, ever. Use the word obese. Why? That's an adjective. It's a descriptor of a person. We would never say Mark is cancer, we would say Mark has cancer. We would never define Mark as having as his cancer. Obesity is no different. Mina has obesity. Never say Mina is obese. Lose that word from your dictionary altogether. And here you can see some other ways we can shape our discussion. And the overwhelming theme here is that we want to put the focus on health gains, not weight loss, and that is a key message for today. So we really want to avoid the yo yo weight cycle that Mina has described, where she's had some success with lifestyle alone, but natural human biology does not allow her to maintain that weight loss long term. We know also that fluctuations in body weight or weight cycling, also called yo yo dieting, has been associated with poor health outcomes, adverse cardio metabolic. markers, increased risk of type 2 diabetes, and an increased risk of mortality and CV events. So what we need to have is to address weight management early in the natural history of obesity and help our patient with sustained weight loss. This has much greater likelihood of being obtained with long-term pharmacotherapy in addition to ongoing lifestyle change. So now that we've met Mina here who already has had a weight cycling history, we really wanna help her move forward into the future with a successful and a sustainable treatment plan. So, weight bias and stigma are really important considerations in Mina's journey. She's described herself as lazy. She's described herself as a failure. This is actually a patient describing internalized weight bias. This can have mental health consequences. This, uh, results in less success with weight management interventions than patients who don't have internalized weight bias. We want to help Mina understand that the yo yo weight that she has experienced is driven by natural biology. And it may also be contributing to her low self-esteem. So we wanna make sure she understands that our bodies vigorously defend weight. It's normal to have struggles with weight loss and help her to understand this is not her fault. Her low self-esteem is very much impacting her quality of life as well, and addressing that will be important in her journey, along with the health benefits of treatment to hopefully improve her quality of life. That's what we're here to do. And regarding what she describes as previous failures, remember, patients don't fail treatments. Treatments fail patients, and that's actually an important counseling point to help break that internalized weight bias that's really weighing Mina down and likely impeding her successes. So, how might Mina's past experiences impact her engagement and collaboration with you as the healthcare professional? This is really hard to understand and, and important to understand and think through. She might be dubious about any treatment that you recommend, and you're wondering, well, why is she not trusting me cause I haven't done anything wrong? Well, this is based on her previous experiences. So, understanding her previous experiences will help her, will help us to understand where she's at and how we We can engage with her. So, she's coming into this feeling hopeless. She feels like nothing will work. Um, she has a hesitancy to engage in treatments, possibly. She's got this track record of what she describes as failures. So we need to work through all of this and have these discussions with her. And it's really important that we have to earn Mina's trust. These past experiences can make it really difficult to be emotionally vulnerable to healthcare professionals around the very sensitive topic of weight. So what can you do to build a trusting relationship and help Mina feel empowered and confident? Well, always remember, asking permission to talk about weight is the number one thing and that's really important here. Mina would not have opened up to us if we hadn't asked permission. We want to partner with Mina in setting goals and treatment strategies. We wanna ask Mina what's important to her. It might be, well, I'd like to walk my dog twice as far as I do. Well, that can be a treatment goal. Incorporate that. That helps us, helps us to understand where she's at, and it helps her to understand that we're listening. And on that note, we want to invite her to tell her story. We want to listen to her and then summarize to ensure we understand and that she knows we understand what she's saying. And really importantly, make sure that your clinic is a welcoming environment to people of all body shapes and sizes. So, having um a variety of BP cuff sizes, uh, that doorways are large enough, chairs without armrests, exam tables that are big enough, um, appropriate scales in a confidential environment, asking permission for the patient to be weighed, appropriate reading in the waiting room. These are just a few of many examples that we can make sure that our environment is welcoming for all patients. So key messages for today, remember to use the 5 A's of obesity framework for assessment and management of obesity in your Canadian clinical practice. When you're offering pharmacotherapy, choose medication that aligns with health improvements and your patient's goals in partnership with your patient. We always need to ask permission to talk about obesity if our patient hasn't come forth with that on their own, and we always want to talk