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Weight Loss Medications & Other Non-Surgical Options · Bryan Health Podcasts

• 0:03
  Melanie Cole, MS (Host): Welcome to Bryan Health Podcast.
• 0:05
  I'm Melanie Cole.
• 0:06
  And today, we're talking about non-surgical weight loss options.
• 0:10
  Joining me is Tara Troyer.
• 0:12
  She's a nurse practitioner and a bariatric nurse navigator at Bryan Medical Center.
• 0:17
  Tara, thank you so much for being with us today.
• 0:20
  Let's start by talking a little bit about obesity.
• 0:23
  I mean, it's becoming an epidemic.
• 0:26
  And what do you see every day?
• 0:29
  Tara Troyer: We see that definitely it is an epidemic.
• 0:31
  . But it is starting a lot younger as well too, and pediatric
• 0:34
  obesity is a big concern as well.
• 0:36
  And with all of that, our chronic medical conditions are
• 0:40
  getting worse and more complex
• 0:42
  . Melanie Cole, MS: Well, I certainly agree with you.
• 0:44
  It puts you at risk for so many other conditions.
• 0:47
  Why don't you start by telling us a little bit about some of the non-surgical
• 0:51
  weight loss options that are out there?
• 0:53
  Because now, I mean, we hear about the GLP-1s, we hear about medical weight loss.
• 0:58
  Of course, there's all these millions of diets out there
• 1:01
  and groups and support groups.
• 1:03
  Tell us about some of these options.
• 1:05
  Tara Troyer: We really look at a whole comprehensive care model that looks
• 1:11
  at every single aspect, including medical nutrition therapy, starting
• 1:15
  with behavior modifications, physical activity, and absolutely medical and
• 1:19
  surgical interventions could be an option.
• 1:22
  Melanie Cole, MS: Okay.
• 1:23
  So , who makes good candidates for these kinds of methods when somebody
• 1:28
  comes to you and they're not really looking for bariatric surgery?
• 1:32
  Tara Troyer: Sure, absolutely.
• 1:33
  Pretty much anybody would be a good candidate when they're concerned about
• 1:38
  their weight, if it's affecting their quality of life, especially when it
• 1:41
  comes to medical nutrition therapy or even just looking at healthy eating
• 1:45
  lifestyle, behavior modifications that could attribute maybe later on to
• 1:50
  an obesity issue, physical activity.
• 1:53
  Now, the medication interventions do come a little later on.
• 1:57
  . We look more at BMIs of thirty or more, which takes into
• 2:01
  consideration height and weight.
• 2:03
  But then if also BMI is a little bit lower, if they have some of those
• 2:07
  conditions , such as type 2 diabetes, high blood pressure, heart disease,
• 2:12
  sleep apnea, there's a lot of things that could be affected by obesity that
• 2:18
  lead to these chronic medical conditions.
• 2:21
  Obesity is chronic, it's a complex disease process, and
• 2:24
  it should be treated that way.
• 2:26
  It's a long-term care for a chronic disease problem.
• 2:29
  And it's not just for quick-fix, short-term changes it needs
• 2:32
  to be a long-term approach.
• 2:34
  Melanie Cole, MS: It certainly does.
• 2:36
  . So when we think of the lifestyle changes what are we looking at?
• 2:40
  Tara Troyer: Well, one of them is nutrition therapy.
• 2:42
  So really, we look at what does a healthy plate look like?
• 2:45
  What do healthy food choices look like?
• 2:48
  What do good portions look like?
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  I mean, our portions these days are out of control.
• 2:54
  And so, we like to really focus on what whole foods are good.
• 2:58
  We don't need supplements.
• 2:59
  We don't need special drinks and all of that stuff.
• 3:02
  Looking at the whole foods that you can purchase at the grocery store, looking
• 3:06
  at the foods that fit into certain lifestyles, cultures, eating habits.
• 3:11
  I mean, night shift, day shift, there's so many different situations.
• 3:15
  So, it's a very specific personal-focused approach.
• 3:19
  And it's, again, set to be long-term changes.
• 3:23
  And then, we look at behavior modifications, incorporating, you know,
• 3:26
  what's the psychological impact having on their weight loss or weight gain.
• 3:32
  , We now have a counselor in our office physical activity, structured exercise.
• 3:37
  It doesn't have to be an expensive equipment, in an
• 3:39
  expensive gym, or a gym at all.
• 3:42
  You can park further away, take the stairs,.
• 3:45
  It could be as much as just walking to go get the mail and walking back if
• 3:49
  normally we're just sitting on the couch.
• 3:51
  So, many different ways that we can increase activity in our day-to-day.
• 3:55
  Then, we talked about the medical interventions with
• 3:58
  weight loss medications.
• 3:59
  It is another opportunity, another intervention.
• 4:02
  And you mentioned perfectly these are all just tools.
• 4:06
  Melanie Cole, MS: Yeah, so they are.
• 4:07
  Now, when those lifestyle changes are not enough, there are medications
• 4:12
  that we keep hearing about in the media and all over now.
• 4:15
  They can be a really good option when prescribed by your
• 4:20
  practitioner, by your clinician.
• 4:22
  So, speak a little bit about these medications.
• 4:25
  Tara Troyer: Yes.
• 4:26
  And I am first going to speak a little bit about reviewing what current
• 4:29
  medications that the patients are on.
• 4:31
  There are so many medications out there that we're not aware of that can be a
• 4:37
  cause of either weight gain or a barrier to weight loss, maybe increased appetite.
• 4:42
  So, it's really good to review those with a specialist in this area like
• 4:46
  myself or your PCP, mental health provider, whatever it might be, but to
• 4:50
  review what medications currently might be attributing to some of the issues.
• 4:55
  But right now, with different kinds of medications that we have, there
• 4:58
  are some requirements for those.
• 5:00
  You have to have BMIs that are equal or greater to 30 or 27 if you have some of
• 5:06
  the comorbidities that we talked about, such as type 2 diabetes, hypertension.
• 5:11
  And then, some of the medications, like those GLP-1s that we hear
• 5:15
  so much about, there are a lot of requirements with those in order to
• 5:19
  be eligible for coverage, which is a whole 'nother podcast in and of itself.
• 5:23
  types of medications that we have right now, there are specific ones for
• 5:27
  appetite suppression, and these class of meds are usually like a stimulant,
• 5:31
  something to help you feel fuller faster.
• 5:34
  And then, we have meds that address some of the metabolic dysfunctions that
• 5:38
  we have, such as insulin resistance.
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  And the biggest class I would say that we use a lot is the
• 5:44
  behavior modification medications.
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  These address the constant thoughts of food, that nagging need to want to snack
• 5:51
  and eat even when you're not hungry; the inability to stop eating once you've
• 5:55
  started eating; cravings for sweet treats, carbohydrates such as breads and pastas.
• 6:00
  So, there's a certain class of meds for those too.
• 6:03
  Then, there are the meds that are multifactorial that can take care of
• 6:06
  a lot of those things in one, which specifically would be like those GLP-1
• 6:11
  medications that are all over the news.
• 6:14
  Melanie Cole, MS: Well then, Tara, tell us some of the reasons why a medication
• 6:18
  wouldn't be suitable for someone.
• 6:20
  Does it interact with the medications that they've been on?
• 6:23
  And as you said, there are certain criterias, especially for those GLP-1s.
• 6:28
  So, why might some medications not be suitable for people?
• 6:33
  Tara Troyer: Each medication that we have and each class of medication, they
• 6:36
  all come with their own possible side effects, interactions, contraindications.
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  And that is why it's really important to discuss these medications with someone
• 6:45
  that specializes in the area or that's very familiar with their medical history,
• 6:50
  such as their primary care provider.
• 6:52
  If you are taking medications for a certain kind of mental health
• 6:57
  disorder that they may have, the medications we use for behavior
• 7:01
  modifications might collide with those.
• 7:04
  If you have certain conditions, maybe like gallstones or kidney
• 7:08
  stones, there's medications that can cause that to get worse.
• 7:12
  If you have anxiety, some of the stimulants for appetite suppression
• 7:15
  can definitely make that worse.
• 7:16
  So, it's really going step by step through the current medications they're
• 7:20
  taking and some of their medical history in order to find a very specific
• 7:25
  plan that would work for them and be safe when it comes to medications.
• 7:30
  Melanie Cole, MS: Tara, have you seen these medications work?
• 7:33
  Tell us a little bit about what you've seen, and if they are working
• 7:38
  and someone loses the weight and gets to their goal weight, do they
• 7:42
  have to stay on those medications?
• 7:44
  Tara Troyer: I have seen medications work phenomenally when it comes to utilizing
• 7:49
  nutrition therapy, physical activity, and using this as just an adjunct
• 7:53
  to that to help with those cravings, with the constant thoughts of food.
• 7:58
  But also, with some of the mental health medications that we take
• 8:02
  specifically, they can cause an insulin resistance and increase in appetite.
• 8:06
  And sometimes we can't change those meds all the time.
• 8:09
  So, we need to work with it.
• 8:10
  We all need to work together for it.
• 8:12
  And I have seen people find a better quality of life, decrease their
• 8:18
  pains, decrease their amount of meds because they have a comprehensive
• 8:22
  look at how their weight is affecting them and what they can do.
• 8:26
  As far as lifelong, it really depends on the reason behind the medication.
• 8:32
  If they were taking a medication to help modify a behavior and they're able to come
• 8:36
  off of that medication and be monitored and be able to establish those long-term
• 8:41
  habits, then maybe it can be a short-term med with a long-term behavior change.
• 8:46
  My experience shows, though, majority of the time they do become lifelong as part
• 8:51
  of their long-term weight management plan.
• 8:53
  This is very similar to the medications that are taken for management of
• 8:57
  any other chronic disease state.
• 9:00
  So if you're taking a medicine to help with food noise that is maybe part of
• 9:05
  a other medication or part of another condition, going off the medicine that has
• 9:10
  curbed that, those other aspects are still there, and they're not going to go away.
• 9:16
  And so, the appropriateness is really important, I should say, to be able
• 9:20
  to work with a provider that can spend the time and be able to prescribe
• 9:25
  these meds and monitor it on a long-term basis as the progress goes.
• 9:29
  Sometimes we change meds as the patients progress.
• 9:32
  Maybe they don't need the same things all the time.
• 9:35
  It's just an ongoing condition.
• 9:37
  It's ongoing monitoring.
• 9:39
  Melanie Cole, MS: Yeah.
• 9:39
  You put that really well
• 9:41
  Tell us a little bit about Bryan's approach to
• 9:43
  nonsurgical weight loss options.
• 9:45
  Share for patients what the process includes, the consultation,
• 9:50
  the plan, repeat visits.
• 9:52
  Because for some patients, Tara, that's the scariest part is that first visit.
• 9:58
  Tara Troyer: Oh, absolutely.
• 10:00
  This is such a sensitive, very personal thing that people have been battling
• 10:07
  usually lifelong or there's been a situation, and it's just life-changing.
• 10:11
  In our program, the initial consultation can get started whether you go
• 10:15
  through your primary care provider, a different specialist, or if you
• 10:19
  want to just call into the office.
• 10:21
  And we will just ask the questions, are you interested in non-surgery?
• 10:26
  Are you interested in surgery?
• 10:27
  And then, if you want to just meet with somebody to get an idea of
• 10:31
  maybe what are all the options, I want to know all of them, we'll get
• 10:34
  you set up with the dietician in our office, myself or one of the surgeons.
• 10:38
  Do a full assessment.
• 10:39
  What has your history been like with food?
• 10:42
  What has your history been like with your weight, with your medical conditions?
• 10:46
  And then, discuss at that initial consultation what
• 10:49
  some of your options would be.
• 10:51
  And then, we do tailor the plan from there.
• 10:54
  Then, we'll decide with the patient being they are the ones steering this boat.
• 10:58
  They get to decide what is right for them.
• 11:01
  And we will then help them in their journey to get to the goals that
• 11:05
  they are wanting, that they have set for themselves, whether it is
• 11:09
  get off some of the medications, whether it's able to run a marathon.
• 11:13
  Whatever their personal goals are, that's what our goal is for them.
• 11:17
  And whatever it takes as the process goes, we will change it up.
• 11:21
  We will work with them as things change to be able to reach the end goal for them.
• 11:28
  We do repeat visits either every couple weeks, once a month, whatever's
• 11:32
  appropriate for their needs as well.
• 11:35
  And we always are here.
• 11:37
  There is never an end date to this process.
• 11:39
  We will be here if the weight comes off and stays off for checks
• 11:44
  to keep that in check and to keep you where you want to be.
• 11:47
  If things don't quite go as you want in life for you and you need to come
• 11:51
  back and we need to reassess things, we are here and we are non-judgmental.
• 11:56
  All of the people in our office are very open and very sensitive, when
• 12:00
  it comes to this whole process.
• 12:03
  Melanie Cole, MS: Well, that was so well said, Tara.
• 12:05
  Thank you so much for joining us today and really explaining what that
• 12:09
  process is like and explaining all of the options out there to help people
• 12:14
  that are struggling with their weight.
• 12:17
  So, thank you so much for coming on and sharing your expertise
• 12:20
  and telling us all about that.
• 12:22
  I'd also like to thank our Bryan Foundation partner, Davis Design
• 12:26
  And for more information, please visit bryanhealth.org/bariatrics.
• 12:31
  That concludes this episode of Bryan Health Podcast.
• 12:34
  Please always remember to subscribe, rate, and review Bryan Health Podcast on Apple
• 12:40
  Podcasts, Spotify, iHeart, and Pandora.
• 12:42
  Until next time, I'm Melanie Cole.