Meeting News Coverage

3 weight loss methods diabetes educators must understand

ORLANDO — Three diabetes educators with expertise in weight loss discussed three tactics to help obese patients with diabetes lose weight at the American Association of Diabetes Educators Annual Meeting.

In a conversation panel with the meeting attendees, these leaders in weight loss explained how different patients have specific needs that could fit with one weight loss method better than others.

Group weight management programs

Amanda Kirpitch, MA, RD, CDE, CSSD, LDN, a nutrition and diabetes educator at Joslin Diabetes Center, discussed group weight counseling tactics that helped reduce weight in people with obesity and diabetes.

Kirpitch cited data from the Diabetes Prevention Program, in which patients with prediabetes who participated in a lifestyle intervention group had 58% lower risk for contracting diabetes than patients in a control group.

Amanda Kirpitch, MA, RD, CDE, CSSD, LDN

Amanda Kirpitch

Lifestyle intervention includes a mix of exercise, nutrition education, behavioral change, self-monitoring with constructive feedback and weigh-ins.

Positive evaluations of individuals who join the group are an important guarantor of group success. Group members must be willing to talk and listen, and exhibit stable mental health with an absence of aggressive behavior.  Patients should be willing and engaged in the program for the program to work.

“The team approach is an opportunity for staff and providers to discuss their own attitudes toward patients with weight problems. It’s important to deliver consistent messaging across providers in the care team, too. It makes a huge difference when you’re dealing with groups in general. You want to be telling each patient the same thing, too, because they talk” to each other, Kirpitch said.

Cognitive Behavioral Therapy is an important part of the group, too. “Where is the patient going, and what are we going to do to change that behavior?” Kirpitch asked.

“It’s not about willpower. It’s about skillpower. It’s not about willing your way through weight loss. It’s about having the skills to help you work through weight loss,” she said.

Flexibility is also an important part of the skills that group members learn, Kirpitch added. Group members need to be able to learn to adjust the plan in order to maintain the plan.

In the middle of the multi-week therapy program, Kirpitch challenges group members with a competitive fitness contest, with a small prize for the winner. Another motivating skill the group participants learn is accountability.

“Follow-up is the main key for accountability in the long-term,” she said. “Logging is important as well. The easier the log is to use, the more patients are likely to use it.”

Weight loss medication

Recent FDA approvals and developments in weight loss medications were reviewed by Josh Neumiller, PharmD, CDE, associate professor, pharmacotherapy, Washington State University, who said that drug therapy can be used in adjunct to lifestyle modifications to help patients lose weight.

Medications approved for weight loss in the United States can be categorized as short-term (phentermine, diethylpropion, benzphetamine), long-term (orlistat) and new long-term agents (lorcaserin, phentermine/topiramate), according to Neumiller. He also noted that it is important to consider the weight effects of antihyperglycemic agents being used.

Neumiller gave an overview of how some of these drugs function, and he said that it is important for diabetes educators to learn about the different mechanisms that make weight loss drugs effective. He also cited numerous drug interactions that may complicate the disease management plan for patients with cardiovascular, bone, hormone or other diabetes-related illness, and noted that educators who work with an endocrinologist or primary care provider should understand potential drug interactions.

When Neumiller asked educators to determine whether some patient cases would do well on certain drugs, the educators again identified that psychological patterns and poor eating habits are an area of focus that should be addressed before prescriptions are added or dropped in a patient’s medication regimen.

A separate concern surrounding weight loss from obesity drugs is the potential for hypoglycemia, especially with respect to drugs that reduce appetite and therefore food intake, Neumiller pointed out. “Thinking about hypoglycemic risk is important,” he said.

Bariatric surgery

Stacy Smith, MS, RD, LD, CDE, registered dietitian and certified diabetes educator, Cleveland Clinic Florida, addressed which patients coming to the nutrition and diabetes counseling center are good candidates for bariatric weight loss surgery.

“A lot of times, you see improvement in diabetes right after surgery. You don’t even need to see a patient lose a lot of weight. Of course, the weight loss is what helps maintain these gains,” she said.

Smith advised that many patients could benefit from psychological counseling before surgery to prevent bariatric relapse, or as an intervention that can make surgery unnecessary.  “Bariatric surgery is an effective treatment for type 2 diabetes, but it’s not for everyone, and it’s not a cure for type 2 diabetes.”

Smith reviewed several cases and asked the diabetes educators attending the meeting whether each patient was a good candidate for surgery. Many educators identified that psychological problems and binge habits are a red flag that need to be addressed before surgery can be recommended.

“A lot of bariatric patients have a fear of hunger, and counseling can help them learn how to handle their hunger, rather than avoid their hunger,” she said. “Binging is a big issue too, and needs to be addressed, and more importantly, why the patient is binging.”

Smith strongly recommended bariatric surgery for patients who were more severely overweight, and who did not possess some of the deeper psychological issues that complicate eating. She emphasized that teaching healthy eating habits and intuitive eating was most important for patients who both do and do not pursue surgery, rather than relying on short-term diets. — by Reagan Copeland

Disclosure: Neumiller reported financial relationships with AstraZeneca, Janssen, Johnson & Johnson, Merck, Novo Nordisk, and Sanofi. The other speakers stated no relevant financial disclosures.

ORLANDO — Three diabetes educators with expertise in weight loss discussed three tactics to help obese patients with diabetes lose weight at the American Association of Diabetes Educators Annual Meeting.

In a conversation panel with the meeting attendees, these leaders in weight loss explained how different patients have specific needs that could fit with one weight loss method better than others.

Group weight management programs

Amanda Kirpitch, MA, RD, CDE, CSSD, LDN, a nutrition and diabetes educator at Joslin Diabetes Center, discussed group weight counseling tactics that helped reduce weight in people with obesity and diabetes.

Kirpitch cited data from the Diabetes Prevention Program, in which patients with prediabetes who participated in a lifestyle intervention group had 58% lower risk for contracting diabetes than patients in a control group.

Amanda Kirpitch, MA, RD, CDE, CSSD, LDN

Amanda Kirpitch

Lifestyle intervention includes a mix of exercise, nutrition education, behavioral change, self-monitoring with constructive feedback and weigh-ins.

Positive evaluations of individuals who join the group are an important guarantor of group success. Group members must be willing to talk and listen, and exhibit stable mental health with an absence of aggressive behavior.  Patients should be willing and engaged in the program for the program to work.

“The team approach is an opportunity for staff and providers to discuss their own attitudes toward patients with weight problems. It’s important to deliver consistent messaging across providers in the care team, too. It makes a huge difference when you’re dealing with groups in general. You want to be telling each patient the same thing, too, because they talk” to each other, Kirpitch said.

Cognitive Behavioral Therapy is an important part of the group, too. “Where is the patient going, and what are we going to do to change that behavior?” Kirpitch asked.

“It’s not about willpower. It’s about skillpower. It’s not about willing your way through weight loss. It’s about having the skills to help you work through weight loss,” she said.

Flexibility is also an important part of the skills that group members learn, Kirpitch added. Group members need to be able to learn to adjust the plan in order to maintain the plan.

In the middle of the multi-week therapy program, Kirpitch challenges group members with a competitive fitness contest, with a small prize for the winner. Another motivating skill the group participants learn is accountability.

“Follow-up is the main key for accountability in the long-term,” she said. “Logging is important as well. The easier the log is to use, the more patients are likely to use it.”

PAGE BREAK

Weight loss medication

Recent FDA approvals and developments in weight loss medications were reviewed by Josh Neumiller, PharmD, CDE, associate professor, pharmacotherapy, Washington State University, who said that drug therapy can be used in adjunct to lifestyle modifications to help patients lose weight.

Medications approved for weight loss in the United States can be categorized as short-term (phentermine, diethylpropion, benzphetamine), long-term (orlistat) and new long-term agents (lorcaserin, phentermine/topiramate), according to Neumiller. He also noted that it is important to consider the weight effects of antihyperglycemic agents being used.

Neumiller gave an overview of how some of these drugs function, and he said that it is important for diabetes educators to learn about the different mechanisms that make weight loss drugs effective. He also cited numerous drug interactions that may complicate the disease management plan for patients with cardiovascular, bone, hormone or other diabetes-related illness, and noted that educators who work with an endocrinologist or primary care provider should understand potential drug interactions.

When Neumiller asked educators to determine whether some patient cases would do well on certain drugs, the educators again identified that psychological patterns and poor eating habits are an area of focus that should be addressed before prescriptions are added or dropped in a patient’s medication regimen.

A separate concern surrounding weight loss from obesity drugs is the potential for hypoglycemia, especially with respect to drugs that reduce appetite and therefore food intake, Neumiller pointed out. “Thinking about hypoglycemic risk is important,” he said.

PAGE BREAK

Bariatric surgery

Stacy Smith, MS, RD, LD, CDE, registered dietitian and certified diabetes educator, Cleveland Clinic Florida, addressed which patients coming to the nutrition and diabetes counseling center are good candidates for bariatric weight loss surgery.

“A lot of times, you see improvement in diabetes right after surgery. You don’t even need to see a patient lose a lot of weight. Of course, the weight loss is what helps maintain these gains,” she said.

Smith advised that many patients could benefit from psychological counseling before surgery to prevent bariatric relapse, or as an intervention that can make surgery unnecessary.  “Bariatric surgery is an effective treatment for type 2 diabetes, but it’s not for everyone, and it’s not a cure for type 2 diabetes.”

Smith reviewed several cases and asked the diabetes educators attending the meeting whether each patient was a good candidate for surgery. Many educators identified that psychological problems and binge habits are a red flag that need to be addressed before surgery can be recommended.

“A lot of bariatric patients have a fear of hunger, and counseling can help them learn how to handle their hunger, rather than avoid their hunger,” she said. “Binging is a big issue too, and needs to be addressed, and more importantly, why the patient is binging.”

Smith strongly recommended bariatric surgery for patients who were more severely overweight, and who did not possess some of the deeper psychological issues that complicate eating. She emphasized that teaching healthy eating habits and intuitive eating was most important for patients who both do and do not pursue surgery, rather than relying on short-term diets. — by Reagan Copeland

Disclosure: Neumiller reported financial relationships with AstraZeneca, Janssen, Johnson & Johnson, Merck, Novo Nordisk, and Sanofi. The other speakers stated no relevant financial disclosures.

    See more from American Association of Diabetes Educators Annual Meeting