Your initial appointment will consist of a full history & physical with all of the standard components, including:
- Chief Complaint
- History of Present Illness
- Past Medical, Family, and Social Histories (including medication reconciliation)
- Detailed Review of Systems
- Comprehensive Physical Exam
- Review of Any Available Laboratory Testing
- 12-Lead Electrocardiogram if Indicated
In the appointment, we will also assess the following:
- Current overall health status
- Obesity history and status including but not limited to:
- Development and progression of the disease
- Contributing factors
- Genetic and environmental influences
- Nutrition history
- Physical activity history
- Prior treatment attempts (both self treatment as well as medical)
- Reasons for prior successes and failures
- Contributing medications
- Assessment for eating disorders or other psychological contributors
- Assessment of obesity and metabolic syndrome related medical comorbidities
- Assessment of patient readiness for change
- Acquisition of additional health related data including, but not limited to, the following labs:
- Comprehensive metabolic panel to assess electrolytes, renal function, hepatic function,
- Complete blood count
- Urinalysis and urine microalbumin
- Lipids, potentially including advanced lipoprotein assessment
- Assessment of insulin and glucose metabolism using fasting insulin and glucose and
- Selective use of oral glucose tolerance testing
- Assessment of chronic inflammation using a high sensitivity CRP test
- Assessment of vitamin D status
- A TSH to screen for thyroid disorders
The initial treatment includes the following:
- Adjustment of current medications:
- Decrease or eliminate medications that cause weight gain
- Decrease antihypertensive mediations as required to prevent hypotension or
- Decrease insulin and oral hypoglycemic medications as required to prevent
- Selective initiation of weight loss medications
- Exercise prescription and/or referral appropriate to the individual patients readiness for change, physical abilities, and requirement for specialized instruction
- Selective referral for psychological/psychiatric assessment