COMMENTARY

Good Primary Care Is Obesity Medicine

Ingrid Kohlstadt, MD, MPH, FACN

Disclosures

November 26, 2007


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When the "check engine" symbol flashes on your automobile console, you don't assume the recent oil change will fix the problem. You or your mechanic must look under the hood.

Similarly, when the bathroom scale reads inappropriately high, simply maintaining good diet and exercise is unlikely to be sufficient. Primary care doctors should take a close look at the metabolic engine.

Diagnosing and treating 5 commonly overlooked metabolic troubles could be the best obesitymedicine for many patients in the current epidemic:

  1. Sleep apnea: Obesity has long been known to cause sleep apnea. Recent researchhas demonstrated that sleep apnea, even in healthful weight people, isobesigenic.[1] Positive airway pressure can break the vicious obesity-sleep apneacycle.[2]

  2. Chemosensory disorders: Diminished taste and smell acquired from medical and iatrogenic causes unfavorably alter food selection. Diagnosis and treatment canhelp patients return to healthful diets and weightreduction.[3,4]

  3. Polycystic ovary syndrome (PCOS): PCOS is associated with dietary obstacles, such as sweet cravings, bulimia nervosa, central adiposity, low cholecystokinin (a satiety peptide), and insulin resistance.[5,6] Emerging treatments can improve diet adherence, which can improve PCOS.

  4. Suboptimal vitamin B12: Obesity exacerbates gastroesophageal reflux. Medications which treat reflux can reduce vitamin B12.[7] Nutrient optimization can restore both metabolic energy and the patient's energy.

  5. Hypovitaminosis D: Low-fat diets, indoor exercise, and fat-malabsorbing obesity treatments converge to lower vitamin D. Obesity increases the pretest probability of low vitamin D.[8] Uncorrected low vitamin D levels worsen insulin resistance, thereby forestalling weight loss.[8,9]

You can help your patients succeed in diet and exercise by diagnosing these nutrient-related conditions. Encourage your patients to take as good care of their irreplaceablebody as they do their favorite car.

That's my opinion. I'm Dr. Ingrid Kohlstadt at Johns Hopkins University.


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