Practicing Obesity Medicine as a Solo Practitioner

The number of people living with obesity has grown exponentially in the past few decades.¹ As a solo practitioner, there is a clear medical need for the effective treatment of obesity. Currently, the majority of treatment within obesity medicine is through multidisciplinary teams. However, the ability of a multidisciplinary team might be limited and may not be able to match the growing number of treatment needs due to the great increase in the number of people living with obesity. There is a clear need for healthcare practitioners all around the world to have the capacity to treat obesity if we are to put a dent into the significant number people living with obesity and its associated comorbidities.

Developing an effective treatment protocol for a primary care doctor without a multidisciplinary team is possible for the treatment of obesity. If we look at other chronic conditions such as high blood pressure and Type 2 diabetes, they were previously managed with multidisciplinary teams as they were quite challenging to manage effectively. Due to the lack of effective treatments the emphasis was on behaviour change through will power and intense instruction, which, unfortunately were still ineffective for the majority of individuals. With the introduction of effective pharmacotherapy for both hypertension and Type 2 diabetes, the ability to manage these conditions improved and this allowed solo practitioners to treat these conditions.

Similarly, we are now seeing the potential for solo practitioners to manage obesity as a result of the introduction of treatment guidelines and effective therapies. The Canadian obesity guidelines  for adults living with obesity were written with the solo practitioner in mind, giving physicians clear direction with treatment algorithms to support patients living with obesity.² Lifestyle interventions, incorporating dietary, exercise, and behavioral therapies should be implemented as part of any treatment plan. Pharmacotherapy, combined with lifestyle management, will likely be the main pillar that will allow us to have effective sustained weight management. Cognitive behavioral therapy (CBT) for weight management is best accessed and most effective if a patient is already on pharmacotherapy that decreases hunger and cravings, allowing for more effective psychological counselling. Bariatric surgery also benefits from pharmacotherapy, as many patients regain weight after bariatric surgery and need pharmacotherapy options to get their weight back under control.

In today's world, there are many tools that a primary care doctor has at their disposal to help with weight management. This includes:

1. Online resources to track dietary and caloric intake. These often come with healthy dietary suggestions, and are accessible for most people around the world.
2. Cognitive behavioral therapy is moving towards more virtual means, supplemented with online resources. There are now apps that incorporate CBT for weight management and online CBT courses such as the Macklin Method that are accessible to most patients.
3. A solo practitioner can use the resources of their local pharmacists to advise on the appropriate administration and titration of weight management pharmacotherapy, and to cancel out side-effect profiles.

All of these resources, helping with lifestyle management along with effective pharmacotherapy and appropriate training, will now allow a solo practitioner to treat obesity in an effective and successful manner. This, in turn, will enable greater intervention on a broader scale, allowing us to treat more people living with obesity than ever before.