Kim Regular, a CRPCN registered nurse and diabetes educator, and Dr. Bahn Al-Yousif, a doctor at Papillon Medical Clinic in Okotoks with a diploma in obesity medicine, started their weight management program in March 2020, just as COVID-19 was really starting to be felt. The pandemic in no way slowed this program’s necessity, as many patients resorted to food as a coping strategy during this diﬃcult time.
During the initial 90-minute intake Kim’s assessment focuses on helping the patient understand that obesity is a very complex chronic disease. She works hard to ensure patients do not feel judged, and understand that it is not their fault.
Weight is controlled by 37 hormones controlling the body’s homeostasis, with constant communicating via regulatory mechanisms in the brain, the gut, and the storage system. When there is a breakdown in one area, the weight gain starts. Kim helps patients understand the “why” and remove the guilt and shame so they can move forward.
Kim’s comprehensive coverage of topics that may impact weight management are eye-opening to many, for example, the effects of poor sleep quality. Sleep deprivation is associated with decreased leptin (an appetite-suppressing hormone) and increased ghrelin (an appetite-stimulating hormone) which may increase cravings for calorie-dense foods. Poor sleep quality may also lead to decreased fat loss during caloric restriction. So, Kim may suggest an obstructive sleep apnea assessment.
Patient mental health is another critical area assessed. These four screens guide Kim’s assessment and determine next steps.
- Depression: using the Patient Health Questionnaire (PHQ-9)
- Anxiety: using the Generalized Anxiety Disorder Scale (GAD-7)
- Binge Eating: The National Eating Disorder Information Center calls binge eating disorder a mental illness that can seriously aﬀect psychological and physical health. It is characterized by recurrent episodes of eating large quantities of food then experiencing shame, distress or guilt afterwards.
- Attention Deﬁcit Hyperactivity Disorder: If conversation and information gathering dictate, an ADHD assessment is made. Impulsive and disordered eating and unplanned meals are partially to blame for ADHD’s strong correlation with obesity. Plus, the dopamine-seeking brain relies heavily on the pleasure aspect of food.
These assessments are critical in Dr. Bahn’s determination of which medications to oﬀer a patient and if they are receptive to trying any.
Kim uses food models and a balanced portion plate to show a correct portion size. Other topics include label reading, glycemic index and how physical activity can help in the weight loss journey.
Kim talks about what wellness means to the patient and moves beyond their weight. She uncovers their goals, as well as the barriers to moving forward. For those with ﬁnancial barriers, Kim’s work goes above and beyond, accessing the food bank and other community programs or services to help the patient be successful.
In Kim's words....
I’m recording and reviewing the patient’s chronic disease history while completing an initial assessment — conditions such as dyslipidemia, hypertension, diabetes, obstructive sleep apnea. During our ongoing sessions, I assess the patient’s understanding of these conditions, educate, and provide further supports on programs and workshops that may help them better understand their chronic diseases.
I review their recent serology with them to help them understand their blood glucose levels, cholesterol, triglycerides, TSH, liver enzymes, GFR, and from there we focus on what we need to work on. Later on, we’ll re-test and show the progress they are making.
Obviously when I see a patient I take their height and weight measurements, but I really like to assess where they are at mentally, what their motivators are, what they wish to accomplish, and whether they anticipate any barriers in their weight loss journey. We set realistic SMART goals that are reassessed at each follow-up visit.
One of my recently retired weight management patients suddenly stopped goal-setting and lost his motivation. In assessing him further I was able to identify he was depressed, so I connected him with his family physician, who prescribed an antidepressant and encouraged him to follow up with a mental health counsellor.
Another patient shared that she knew what she needed to do from a nutrition standpoint but just couldn’t ﬁnd the motivation. So, we provided a free trial of a Freestyle Libre, enabling her to see the eﬀects of diet choices immediately. It’s what motivated her to correct bad habits and start her weight loss journey.
This is a very comprehensive program. It comes at peoples’ weight issues from many angles. It is so rewarding for the patients and for me to be able to help patients improve health outcomes and be empowered in what is one of the most challenging chronic diseases to treat.