The Primary Care Physician as a Member of the Bariatric Team

Typically, prior to surgery, the psychologist on the bariatric team is involved in assessing the patient's self-esteem and social support. The primary care physician can adequately handle this role either alone or in partnership with the psychologist. As a member of the bariatric team, the primary care physician is in a position to help some patients avoid surgery when success is not likely to occur. For patients who do have surgery, the primary care physician can provide postoperative medical and psychological care for months to years after the patient is discharged from the care of the surgeon.

The primary care physician trained in treating obesity as a chronic disease offers the morbidly obese patient who is not a good surgical candidate or does not have financial coverage for the surgery an alternative program for weight loss. The program presented in this book presents an initial modest goal of 10% weight loss over 6 months, with the possibility that more than 10% weight loss can be achieved over time. In fact, surgical patients should participate in a primary care program either before or after surgery as a way to maximize their weight loss efforts and to have a program in place that helps to control their obesity long-term.

Patients need to understand that surgery changes the stomach but does not change the mind. Eating behaviors, attitude towards food, perceptions as to how much food should be eaten at one setting must change. Bariatric surgery does not provide the patient with an automatic long-term weight reduction guarantee. Even after dramatic weight loss, weight regain through engaging in old eating behaviors can occur if emotional, mental, and social issues are not addressed before and after surgery. At present, psychologists, dieticians, and the surgeon address the patient's mental, emotional, and medical needs. As a member of the bariatric team, the primary care physician can continue this care indefinitely because of the long-term relationship with the patient. For instance, patients who have had bariatric surgery, especially those with restrictive-malabsorptive procedures, have special medical needs for the rest of their lives. Patients must be vigilant in preventing iron deficiencies, B12 deficiencies, and osteoporosis that can occur as a result of bypassing portions of the stomach and small intestine. If patients do not attend to these health needs, then avoidable illnesses may develop. Emotionally, after the surgery, relationship problems may develop that can possibly be traced back to the patient's many changes as a result of the surgery. It is important for the primary care physician to discuss this possibility with the patient; this concern can be addressed as a brief intervention during other scheduled appointments over the years following surgery.

For one reason or another, the majority of patients who medically qualify for bariatric surgery will never have the operation. Though the absolute number of patients having the operation is over 100,000 per year, this represents a small proportion of the total number of patients who meet the medical criteria for the surgery. The majority of patients either do not have coverage for the procedure, do not mentally or emotionally qualify as likely to be successful long-term, or simply do not want to address their obesity this way. In this situation, their best alternative is to have a knowledgeable primary care physician who can encourage and guide the patient to lose whatever amount of weight they are willing to try to lose.

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