You Wear it Well

It was one of those days in the office...

Crazy, unpredictable, variably inefficient … too many people to see in a fair amount of time. And we didn't even have one Drug Rep! Sounds like a day in Family Practice, right?

Anyway, the day has left me in a kooky mood, so I thought I'd relate a patient story I heard recently, with a brief commentary.

When I asked a patient yesterday if she introduced the idea of her referral for Weight Loss Surgery, or her PCP did, she said

“No, it was my idea. In fact I had to bring it up at my office visits 2 or 3 times in a row until she decided it was OK for me to go. Her response to my first request was for me to tell her my weight. I said I was 5'1” and 198# (BMI 37.4). Her response was that 'You wear it well', and didn't want to refer me. We did discuss lifestyle change, and I did my best, but ended up here for surgery when I kept gaining.”

All I could think of initially was the Debarge song from the '80s of the same name. I still am playing it my head, it's stuck there.

So, what's my commentary? Many issues, but to start just one. Maybe 2.

Firstly, from her response to her PCPs reaction about having surgery for her weight, she was initially frustrated, concerned, and embarrassed. She didn't know how to read her Doctor's reaction. Indifference, discomfort with the idea of surgery, or was she  unaware of the benefits of Bariatric Surgery? Of note, she did have OSA, HTN, Impaired Fasting Glucose, and mild dyslipidemia.

Next, when exactly does a Bariatric Surgery referral fit in to the plan for a patient with obesity and associated co-morbidities? I suspect this is a personal provider decision based on experience, comfort level,  and documented lack of success with prior attempts at lifestyle modification, which is always first line. I hope we will talk in future posts about this topic, as it gets down to the nuts and the bolts of every day practice, and I'd love to hear your take on it.

Suffice it to say that Weight Loss Surgery is NOT for everyone, and is NOT first line for obesity or associated disease states.

But in the case of this patient that went to her Doctor's office, is a good candidate for the surgery, is well prepared with why she wants to have it done, and asks her PCPs permission- I think she was looking for a better response. Even a 'physician supervised' lifestyle mod plan with dates attached for followup, and a timeline for surgery, if she agreed with her choice, would have been preferable.

By the way, she's 4 mos out now from Gastric Bypass, over 40# lost, euglycemic, normotensive (off meds), and with an improved lipid profile, off meds. She does in fact Wear it Well now...