Diabetes, Obesity and the Diabetes Educator
Lisa Ranes, RD CDE -- Manager of Diabetes, Endocrinology and Metabolism Center – Billings Clinic, Billings MT
As diabetes educators, we are fully aware of the prevalence of both type 2 diabetes and obesity. We are also aware that obesity increases the risk of type 2 diabetes and have engaged in the delivery of the diabetes prevention program within our diabetes centers. What are we doing for our patients who have type 2 diabetes and obesity? It seems to me that DSME programs fully focus on controlling blood glucose over helping patients manage their weight.
Weight is a topic of discussion when delivering DSME but how are you approaching it? As a diabetes educator, do you have the belief that obesity is simply calories in and calories out or do you understand the complexity of the disease regarding the hormones that drive energy balance. If we don’t have the knowledge and understanding of obesity as a disease than our focus remains on glucose control in our visits. Discussing glucose levels can be easier and safer to discuss because of our knowledge, expertise, and it is not a sensitive topic like weight can be.
A study published in Diabetes Care suggests that prioritizing glucose control over weight management can be costly. The study found the lowest costs were associated with patients who kept their weight stable regardless of glucose control. Patients with weight gain and poor glucose control had the highest costs. When we focus only on glucose with the use of medications, weight gain is difficult to prevent unless using some of the newer agents such as SGLT-2 inhibitors or GLP-1s. In my experience, we don’t focus enough on lifestyle changes. Maybe because we set unrealistic expectations around weight. What if we focused on preventing weight gain and not so much on loss? Or is it, because of the lack of reimbursement for DSME and the limited hours health plans allow.
Our solution for this was implementing our medical weight management program, called Weight Smart. Weight Smart is a medical weight management program that is supervised by an Obesity Medicine doctor and utilizing Intensive Behavior Therapy (IBT) as the foundation. IBT can be delivered by Registered Dietitians and billed incident to the provider. IBT is what clinical evidence suggests. The most effective behavioral weight loss treatment is in-person, high intensity (>14 session in 6 months) comprehensive weight loss interventions provided in individual or group sessions.
We implemented Weight Smart in our Diabetes Center last fall and our first patients will be completing the program the end of March. We are seeing significant weight loss and high patient satisfaction and additional revenue to the center.
In addition to our medical weight management program, we also deliver a Metabolic Surgery Program within our center, with onsite Metabolic Surgeons.
What is your diabetes center doing for your patients with type 2 diabetes and obesity?