Banerjee, Elaine, MD, MPH

Sandhu, Shabaaz

Schroeder, Robin S., MD

English

Lehigh Valley Health Network: LVHN Scholarly Works

Lehigh Valley Health NetworkLVHN Scholarly WorksUSF-LVHN SELECTIntensive Behavioral Therapy for the Treatment ofObesity in the ElderlyShabaaz SandhuUSF MCOM- LVHNElaine Banerjee MD, MPHLehigh Valley Health Network, Elaine_S.Banerjee@lvhn.orgRobin S. Schroeder MDLehigh Valley Health Network, robin.schroeder@lvhn.orgFollow this and additional works at: http://scholarlyworks.lvhn.org/select-programPart of the Medical Education CommonsThis Poster is brought to you for free and open access by LVHN Scholarly Works. It has been accepted for inclusion in LVHN Scholarly Works by anauthorized administrator. For more information, please contact LibraryServices@lvhn.org.Published In/Presented AtSandhu, S., Banerjee, E., & Schroeder, R. (2016, July 29). Intensive Behavioral Therapy for the Treatment of Obesity in the Elderly. Posterpresented at: The Prologue II Presentation Day, University of South Florida, Tampa, FL.©	  File	  copyright	  Colin	  Purrington.	  You	  may	  use	  for	  making	  your	  poster,	  of	  course,	  but	  please	  do	  not	  plagiarize,	  adapt,	  or	  put	  on	  your	  own	  site.	  Also,	  do	  not	  upload	  this	  file,	  even	  if	  modified,	  to	  third-­‐party	  file-­‐sharing	  sites	  such	  as	  doctoc.com.	  If	  you	  have	  insaCable	  need	  to	  post	  a	  template	  onto	  your	  own	  site,	  search	  the	  internet	  for	  a	  different	  template	  to	  steal.	  File	  downloaded	  from	  hEp://colinpurrington.com/Cps/academic/posterdesign.	  	  Introduc+on:	  	  As	  the	  prevalence	  of	  obesity	  in	  the	  United	  States	  conCnues	  to	  rise,	  so	  too	  does	  the	  number	  of	  older	  Americans	  who	  are	  considered	  obese.	  The	  medical	  complicaCons	  of	  obesity	  for	  the	  elderly	  can	  be	  profound,	  and	  may	  severely	  impair	  physical	  funcCon	  and	  quality	  of	  life	  [4].	  	  PreventaCve	  care	  has	  already	  found	  a	  strong	  hold	  in	  the	  primary	  care	  seOng.	  However,	  such	  strategies	  have	  historically	  been	  underuClized	  in	  the	  context	  of	  long-­‐term	  weight	  loss	  [2].	  	  	  To	  address	  this,	  the	  Affordable	  Care	  Act	  expanded	  Medicare	  to	  cover	  programs	  such	  as	  Intensive	  Behavioral	  Therapy	  (IBT)	  specifically	  in	  the	  context	  of	  obesity.	  IBT	  uClizes	  moCvaConal	  interviewing	  to	  facilitate	  self-­‐directed	  weight	  loss,	  and	  is	  being	  incorporated	  into	  weight	  management	  centers	  across	  the	  country	  [1].	  	  Plan: 	  	  	  Two	  primary	  care	  pracCces	  within	  the	  Lehigh	  Valley	  Health	  Network	  have	  served	  as	  pilot	  sites	  for	  IBT.	  LVHN	  maintains	  robust	  medical	  and	  surgical	  weight	  loss	  services,	  but	  IBT	  is	  a	  relaCvely	  new	  addiCon	  to	  the	  program.	  Data	  regarding	  its	  performance	  is	  sCll	  scarce.	  	  The	  goal	  of	  this	  study	  was	  to	  determine	  the	  feasibility	  of	  an	  IBT	  program	  in	  a	  primary	  care	  seOng	  by	  measuring	  weight	  loss	  within	  the	  target	  populaCon.	  This	  can	  be	  defined	  as	  Medicare	  beneficiaries	  classified	  as	  clinically	  obese	  (BMI	  >30	  kg/m2).	  PaCent	  saCsfacCon	  with	  the	  program	  was	  also	  invesCgated.	  Acknowledgments	  I	  would	  like	  to	  acknowledge	  the	  following	  for	  their	  support	  in	  this	  project:	  Elaine	  Banerjee,	  MD	  Robin	  Schroeder,	  MD	  LVHN	  Weight	  Management	  Center	  LVPG	  Family	  Medicine	  	  Do:	  	  To	  assess	  the	  medical	  effects	  of	  IBT,	  15	  paCents	  who	  had	  been	  in	  the	  program	  for	  at	  least	  two	  months	  and	  completed	  at	  least	  six	  IBT	  sessions	  were	  selected	  for	  a	  retrospecCve	  chart	  analysis.	  The	  parCcipants’	  weight,	  BMI,	  and	  blood	  pressure	  would	  be	  recorded	  from	  each	  visit.	  A	  database	  was	  built	  in	  order	  to	  determine	  the	  rate	  of	  weight	  change	  and	  any	  long-­‐term	  alteraCons	  in	  blood	  pressure.	  MedicaCons,	  labs,	  and	  medical	  diagnoses	  were	  also	  recorded,	  but	  there	  was	  as	  yet	  insufficient	  data	  to	  draw	  conclusions	  from	  these	  measures.	  	  	   In	   order	   to	   examine	   saCsfacCon,	   these	   same	   paCents	   were	   presented	   with	   a	   14	   quesCon	   survey	   in	   which	   they	   could	   provide	   anonymous	  feedback.	  The	  surveys	  were	  scored	  on	  a	  5-­‐point	  Likert	  scale,	  and	  were	  kept	  separate	  from	  the	  clinicians	  who	  had	  been	  seeing	  the	  paCents.	  PaCents	  received	   their	   surveys	  at	   least	   two	  months	  ager	  beginning	   the	  program.	  The	   results	  were	  entered	   into	  a	   separate	  database	   for	  analysis	  and	  any	  individual	  comments	  were	  noted.	  	  Act	  /	  Conclusions:	  Shabaaz	  Sandhu,	  Elaine	  Banerjee,	  MD,	  and	  Robin	  Schroeder,	  MD	  	  Literature	  cited:	  [1]	  Bartholomay,	  L.	  (2013).	  Medicare’s	  Intensive	  Behavioral	  Therapy	  for	  Obesity.	  [Powerpoint	  slides].	  Retrieved	  from	  hEp://www.health.state.mn.us/healthreform/homes/collaboraCve/lcdocs/webinars/medicareibtwebinar.pdf	  [2]	  Healthcare	  Obesity	  RecommendaCons:	  Complete	  List.	  (2012).	  Retrieved	  from	  hEps://www.hsph.harvard.edu/obesity-­‐prevenCon-­‐source/obesity-­‐prevenCon/healthcare/healthcare-­‐obesity-­‐prevenCon-­‐recommendaCons-­‐	  	  	  complete-­‐list/	  	  	  	  	  	  	  	  	  [3]	  Jacob	  JJ,	  Isaac	  R.	  Behavioral	  therapy	  for	  management	  of	  obesity.	  	  	  	  	  	  Indian	  J	  Endocrinol	  Metab.	  2012;16(1):28-­‐32.	  	  	  	  	  [4]	  Villareal	  DT,	  Apovian	  CM,	  Kushner	  RF,	  Klein	  S.	  Obesity	  in	  older	  adults:	  	  	  	  	  technical	  review	  and	  posiCon	  statement	  of	  the	  American	  Society	  for	  	  NutriCon	  and	  NAASO,	  The	  Obesity	  Society.	  Obes	  Res.	  2005;13(11):	  1849-­‐63.	  Further	  informa+on	  	  Study	  /	  Results:	  Figure	  1:	  Targe+ng	  obesity	  by	  behavioral	  therapy	  [3]	  33.5 34.0 34.5 35.0 35.5 36.0 1 2 3 4 5 6 7 8 Average BMI (kg/m2  ) Number of IBT Visits Average BMI Across IBT Visits Figure	  3:	  Change	  in	  average	  BMI	  over	  +me	  90.0 91.0 92.0 93.0 94.0 95.0 96.0 97.0 1 2 3 4 5 6 7 8 Average weight (kg) Number of IBT Visits Average Weight Across IBT Visits Figure	  2:	  Change	  in	  average	  weight	  over	  +me	  Number'of'Active'Participants'' 15'Average'#'Visits' 9.5'Average'#'Months' 3.75'Average'Weight'Lost' 2.30'kg''Average'Decrease'in'BMI' 0.83'kg/m2'Average'Decrease'in'SBP' 11.2'mmHg'Average'Decrease'in'DBP' 1.7'mmHg''Table	  1:	  Summary	  of	  medical	  outcomes	  Item% Average%Score%(105)%Appointments%were%available%at%convenient%times.% 4.875%The%physician/nurse%practitioner%(NP)/%physician%assistant%(PA)%helped%me%understand%what%foods%to%eat%to%help%reduce%my%weight.%4.875%The%physician/NP/PA%helped%me%understand%portion%sizes.% 4.875%The%physician/NP/PA%helped%me%set%goals%to%change%what%I%eat.% 4.875%The%physician/NP/PA%helped%me%set%goals%to%increase%my%physical%activity.% 5%The%physician/NP/PA%helped%me%set%goals%to%change%the%way%I%eat%(slower,%mindfully,%in%response%to%emotions,%etc.).%5%The%nurse%answered%my%questions.% 4.75%The%nurse%helped%me%identify%barriers%to%achieving%my%goals.% 4.875%Meeting%with%the%nurse%provided%motivation.% 4.75%I%feel%my%overall%health%improved%through%this%program.% 4.375%I%have%achieved%my%weight%loss%goals.% 2.25%I%have%made%progress%toward%my%weight%loss%goals.% 4%I%would%recommend%this%program%to%others.% 4.75%Overall,%I%have%been%satisfied%with%this%program.% 4.375%%Table	  2:	  Summary	  of	  survey	  data	  	   	   	   	   	   Table	   1	   summarizes	   the	  medical	   outcomes	   of	   IBT	  within	   the	   paCent	  sample,	  and	  Figures	  2	  and	  3	  visualize	  these	  data.	  Weight	  and	  BMI	  showed	  an	  overall	  decreasing	  trend	  over	  eight	  IBT	  sessions,	  and	  blood	  pressure	  fell	  by	  an	  average	  of	  11.2/1.7	  mmHg.	   It	   should	  be	  noted	   that,	  among	   the	  five	  paCents	  with	  post-­‐IBT	  lab	  work,	  A1C	  showed	  an	  average	  drop	  of	  0.5%.	  	   	   	   	   	  Table	  2	  summarizes	  the	  survey	  data.	  The	  data	  show	  that	  paCents	  were	  generally	  happy	  with	  the	  program	  itself,	  but	  were	  not	  as	  saCsfied	  with	  their	  total	  (as	  of	  the	  survey)	  overall	  weight	  loss.	  	  PaCents	  who	  parCcipated	   in	   the	   IBT	  program	  generally	   were	   successful	   in	   losing	   some	   weight	  over	  Cme.	  The	  Centers	   for	  Medicare	  and	  Medicaid	  Services	  (CMS)	  recommends	  a	  minimum	  weight	  loss	  of	  3	  kg	  over	  6	  months	  for	  IBT	  paCents.	  In	  this	  study,	  parCcipants	  lost	  an	  average	  of	  2.3	  kg	  in	  an	  average	  of	   3.75	   months.	   Further,	   there	   was	   a	   drop	   in	  average	  blood	  pressure.	  In	  the	  absence	  of	  a	  control	  group,	   these	   changes	   cannot	   be	   aEributed	  specifically	  to	  IBT.	  However,	  the	  survey	  results	  also	  appear	   to	   lend	   some	   support.	   Although	   most	  paCents	   had	   not	   yet	   achieved	   their	   weight	   loss	  goals,	  there	  was	  a	  consensus	  that	  they	  were	  making	  progress	   in	   a	   posiCve	   direcCon.	  Nearly	   all	   paCents	  agreed	  that	  they	  had	  been	  well	  educated	  within	  the	  program	   about	   the	   different	   aspects	   of	   diet	   and	  exercise,	  and	  how	  these	  affect	  weight	  loss.	  	   Though	   IBT	   has	   shown	   some	   iniCal	   promise,	  there	   is	   no	   data	   regarding	   long-­‐term	   weight	  maintenance	   within	   the	   Medicare	   populaCon.	  Furthe ,	   Medicare	   will	   only	   p ovide	   coverage	   to	  those	  paCents	  with	  a	  BMI	  of	  30,	  or	   “obese”.	  Once	  paCents	   fall	   into	   the	   “overweight”	   category	   (BMI	  25-­‐29.9),	   they	   are	   no	   longer	   covered	   for	   IBT.	  CompensaCon	   for	   IBT	   is	   also	   generally	   lower	   than	  o her	   types	   of	   ffice	   visits.	   A	   financial	   f asibility	  evaluaCon	  has	  been	  planned	  in	  order	  to	  invesCgate.	  	  The	  issue	  of	  elderly	  obesity	  is	  likely	  to	  worsen	  with	   Cme,	   and	   Medicare-­‐covered	   IBT	   is	   a	   step	   to	  address	   this.	   Further	   research	   should	   be	   done	   to	  determine	   its	   long-­‐term	   efficacy	   in	   terms	   weight	  maintenance.	  The	  medical	  effects	  of	  IBT,	  in	  terms	  of	  blood	   glucose,	   cholesterol,	   and	   A1C,	   will	   be	  examined	  in	  a	  follow-­‐up	  study.	  For	  more	  informaCon,	  please	  contact	  the	  author	  at	  shabaaz@health.usf.edu	  

Intensive Behavioral Therapy for the Treatment of Obesity in the Elderly

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Intensive Behavioral Therapy for the Treatment of Obesity in the Elderly

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