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additional technologies such as bioelectrical impedance, air/water displacement plethysmography, or dual-energy x-ray absorptiometry scan may be used (Garvey et. al., 2016). After a patient has received a diagnosis of obesity, clinical guidelines suggest that therapies be prescribed based on the patient’s BMI and presence of comorbidities. Patients with aBMI of 25-29.9 are considered overweight. These patients should participate in lifestyle therapy and behavioral interventions to lower BMI and return to a healthy weight (BMI >30). Common treatment includes nutrition counseling, education and training in physical activity suggestions, and education in behavior modifications such as stress reduction, problem-solving strategies, goal setting, and self-monitoring. Pharmaceutical interventions are suggested for patients with a BMI >30, or >27 in the presence of comorbidities including, but not limited to, metabolic syndrome, type 2 diabetes, cardiovascular disease, asthma, liver disease, and obstructive sleep apnea. Patients with a BMI greater than 40 should be considered for bariatric surgery. When a patient has one or more severe obesity-related complications, bariatric surgery may be considered with a BMI >35. Education and lifestyle therapy should be used in conjunction with both pharmaceutical intervention and bariatric surgery (Garvey et. al., 2016). A2c: Standard of practice of disease management.
OBESITY9Practice standards in Johnson County and the rest of Kansas are in line with national guidelines set out by the American Association of Clinical Endocrinologists and the American College of Endocrinology (Garvey et. al., 2016). There are not official practice guidelines for theJohnson County, Kansas area, but an internet search for medical weight loss produced 34 results for in the county. These standalone facilities are in addition to the many primary care practices and hospital based facilities that treat patients for obesity. Because Kansas does not mandate insurance coverage of weight loss and obesity treatment, standard practice varies by area based on population and socioeconomic make-up. Without state-specific recommendations, national guidelines should be followed when diagnosing, treating, and educating patients on obesity (Garvey et. al., 2016; Johnson County Kansas Health and Environment, 2016; NIDDK, 2018). No specific records detailing standard practice or pharmaceutical obesity treatment by area is available, but data from community health reports in several different Kansas Counties shows a trend of higher medication utilization and positive patient outcomes in Johnson County. (Johnson County Kansas Health and Environment, 2016). A3: Managed Disease ProcessObesity management is multifactorial and requires the patient to commit to lifestyle changes, continued education on the disease process and advancements in treatment, and sometimes medically supervised treatments such as prescription medication or bariatric surgery.