Efficacy depends on patient selection

 

Drugs have different effects in different patients. Selecting the right patient for a particular drug may increase the efficacy. Patient compliance is a key determinant of efficacy in anti-obesity pharmacotherapy. This is why experts often emphasize the importance of the consultation phase. Doctors are trying to establish their own criteria for accurate patient selection and successful consultation to reduce treatment discontinuation. Dr. Min-su Park chooses the right medication based on the patient’s obesity statistics. This is to limit the use of medication to patients with lower risk of dependency.

“Obese patients have weak determination and have difficulty adjusting their habits. Based on my experience, patients with weak will power had the BMI of 25kg/m² or higher or, poor response to non-medical therapies. Patients with a low risk of dependency had the BMI of 23kg/m² or higher, poor response to non-medical therapy and risk factors for hypertension, type 2 diabetes, and hyperlipidemia. I only recommend medication to patients who are deemed strong-willed and less likely to develop dependency based on these criteria. However, careful patient selection does not always mean good efficacy in all patients. If a patients only loses less than 2kg after 4 weeks of medication, I deem him/her a non-responder. I do not use medication in such patients.”

 

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Dr. Jung-ah Koh tries to increase patient participation in the therapeutic process by giving them behavioral assignments.

“Medication alone does not magically reduces weight but only aids in the patient’s conscious efforts to lose weight. I emphasize this point to my patients. I ask my patients to keep a food journal to track their food intake pattern. This reveals the patient’s tendencies and preferences which serves as a valuable reference when prescribing medication. Rather than calculating the total caloric intake, I focus on the frequency of their preferred food groups such as carbohydrates or fat, etc. to assign them a task of lowering their frequency of intake. For example, I recommend that they eat cucumber, carrots, cherry tomatoes, banana, sweet potato, egg white, and complex carbohydrates instead of simple carb snacks when they feel hungry from eating a smaller meal.”

Dr. Jang-bong Yoon provides advice at different stages and tries to help strengthen the patient’s determination.

“In the early consultation, I focus on correctly identifying the current status of patient, demystifying the popular beliefs about dieting and building the foundation for the cognitive behavioral therapy. During the course of therapy, I focus on what behavioral aspects need to be corrected and provide endless moral support to the patient. In the final consultation, I prepare the patient on the successful completion of therapy and educate on the ways to prevent yo-yo effect.”

Dr. Ki-nam Kim thinks the patient’s personal stories are important. He focuses on the source of motivation for weight loss.

“I believe the therapeutic effect is reduced without a clear objective. Therefore, I spend a sufficient amount of time listening to the patient’s reason for dieting, weight loss goal and desired treatment options. It is also important to take detailed history of past diet regimens the patient tried. I ask my patients whether they have been to another obesity clinic, which drugs they were treated with as well as dieting experiences at non-medical institutions. This information is important for setting an effective treatment plan.”

 

-To be continued-