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IMA Weight Management

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IMA Weight Management PGY-2 Curriculum

Goals

  1. Improve counseling skills for PGY-2 residents
  2. Improve care for patients with overweight and obesity

Objectives

  1. Use patient-first preferred language consistently in all electronic and verbal interactions with patients with obesity to model empathy and respect. (Professionalism)
  2. Apply clinical guidelines when ordering appropriate laboratory tests during the metabolic evaluation of patients with obesity. (Patient Care and Procedural Skills)
  3. Use the 5A framework in order to suggest individualized, realistic, and specific recommendations for behavioral change for patients with obesity. (Interpersonal and Communication Skills)
  4. Reflect on the weight-first approach to manage weight-related comorbidities holistically. (Practice-Based Learning and Improvement)
  5. Compare risks and benefits of antiobesity medications in order to prescribe them safely and effectively for guideline-eligible patients. (Medical Knowledge)
  6. Collaborate with other disciplines for guideline-eligible patients e.g. community resources and surgical and medical specialties to effectively treat obesity. (Systems-Based Practice)

Activities

Session 1: slides (Sextile 1, 3, or 5)
Reflection Assignment: 2min written reflection for one of your primary care patients (Sextile 1, 3, or 5)
Session 2: 7-min Video Pre-Reading and slides (Sextile 2, 4, or 6)

Antiobesity Medications

FDA-approved antiobesity medications

BMI >= 30 or >= 27 + 1 comorbidity

  • Zepbound (tirzepatide)
  • Wegovy (semaglutide)
  • Saxenda (liraglutide)
  • Qsymia (phentermine/topiramate)
  • Contrave (naltrexone/bupropion)
  • Orlistat

Medicaid in the State of NY does NOT cover ANY FDA-approved antiobesity medication.

Medicare will cover Wegovy for patients who would meet inclusion criteria for the SELECT trial, i.e. BMI at least 27 with at least one ASCVD: 1) heart attack, 2) ischemic or hemorrhagic stroke, or 3) symptomatic PAD or amputation. You will need to associate the specific ASCVD as the prescribing diagnosis. Medicare will NOT cover a medication that is only FDA-approved for obesity, i.e. Zepbound, Saxenda, Qsymia, Contrave, and Orlistat will be categorically denied.

Caveats: Starting doses of Zepbound and Wegovy are widely on back order. Liraglutide has some recent data demonstrating increased pancreatitis, SBO, and gastroparesis.

The following GLP1RA will be denied for patients without T2DM: Ozempic, Trulicity, Bydureon, Mounjaro.

Low-cost antiobesity medications for patients without coverage

  • metformin
  • separately prescribed phentermine/topiramate
  • separately prescribed naltrexone/bupropion
  • phentermine

Reference: .ANTIOBESITYMEDICATIONS

At most ~$30 per month with GoodRx.

Questions

Reach out to Christine Schindler or Shyam Sundaresh

Employee Program for anyone prescribed an AOM

p Employee Health Pharmacists

Referral Criteria for IMA Weight Mgmt Clinic

  1. Obesity by any definition, or Overweight plus a comorbidity

  2. Must have had a recent primary care visit

  3. Patients will schedule at the front desk, NOT through an Epic referral

  4. Patients must be interested in visiting IMA Weight Management a total of 4 times