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guidelines for the screening and management of obesity and for overweight patients that are enrolled in the VHA or DoD system. This guideline begins with a complex algorithm for practitioners to help facilitate clinical decision-making in regards to overweight and obese patients. This thorough guide offers recommendations for the screening and assessment of normal weight, overweight, and obese patients. The guideline incorporates behavior and lifestylechanges along with dietary and physical approaches to weight loss, pharmacotherapy, and surgical intervention (Department of Veterans Affairs & Department of Defense, 2014).
PATHOPHARMACOLOGICAL FOUNDATIONS8An assessment is the first step to determine if a patient is obese. This will require the patient to have their height and weight measured, this is usually done each visit, but is recommended to be completed at least annually. These measurements are used to calculate the patients BMI, which is used to diagnose obesity. A BMI of 25-29.9 kg/m2 is considered overweight, 30-34.9 kg/m2 is considered obese (obese I), 35-39.9 kg/m2 is considered severely obese (obese II), greater than 40 kg/m2 is very severely obese (obese III) (Department of VeteransAffairs & Department of Defense, 2014). In addition to BMI, comorbidities should be reviewed at each visit to determine if a patient is at risk for obesity and obesity-associated conditions (OACs). Education is a vital piece to weight loss and healthy living; and though not every patient on the VA/DoD algorithm will meet the criteria for obesity, all patients will still benefit from patient education. A patient noted to be of normal weight will receive education about healthy diet and exercise to help them maintain their healthy weight. An overweight patient without OACs will also receive this education to help them achieve a healthy weight. An overweight patient with OACs, or an obese patient will be recommended to participate in a “comprehensive lifestyle intervention” which combines diet, physical activity and behavioral modifications. At a minimum, this “comprehensive lifestyle intervention” will have 12 sessions over 12 months, the purpose of which would be setting goals for their weight loss, discussing and modifying diet and exercise, addressing any barriers, learning how to maintain their new lifestyle, and self-monitoring (Department of Veterans Affairs & Department of Defense, 2014) with the purpose oflong-term success. If the patient is not able to meet their intermediate weight-loss goal, it is further recommended to consider pharmacotherapy and/or bariatric surgery as adjunct therapies (Department of Veterans Affairs & Department of Defense, 2014).C)Standard Practice of Obesity Management
PATHOPHARMACOLOGICAL FOUNDATIONS9Standard practice for managing obesity in my community of Suffolk County, NY is consistent with the guidelines established by both the VA/DoD and the New York State Department of Health recommendations. Locally, we have several food pantries and soup