role of private bariatric medical centres are we ready? dr. sean wharton, md, frcpc internal...
TRANSCRIPT
![Page 1: Role of Private Bariatric Medical Centres ARE WE READY? Dr. Sean Wharton, MD, FRCPC Internal Medicine Wharton Medical Clinic Adjunct Professor – York University](https://reader036.vdocuments.net/reader036/viewer/2022062417/551a0a6f550346a4248b4815/html5/thumbnails/1.jpg)
Role of Private Bariatric Medical Centres
ARE WE READY?Dr. Sean Wharton, MD, FRCPC
Internal MedicineWharton Medical Clinic
Adjunct Professor – York UniversityLead Author – Obesity Section - CDA Guidelines
CABPS, June 2012
![Page 2: Role of Private Bariatric Medical Centres ARE WE READY? Dr. Sean Wharton, MD, FRCPC Internal Medicine Wharton Medical Clinic Adjunct Professor – York University](https://reader036.vdocuments.net/reader036/viewer/2022062417/551a0a6f550346a4248b4815/html5/thumbnails/2.jpg)
Disclosures Grants/support
CIHR Heart and Stroke Foundation MITACS – Research
Honoraria/Advisory Board Novo-Nordisk Merck Bristol Myers Squibb Abbott Pharmaceuticals Eli-Lilly AstraZeneca
![Page 3: Role of Private Bariatric Medical Centres ARE WE READY? Dr. Sean Wharton, MD, FRCPC Internal Medicine Wharton Medical Clinic Adjunct Professor – York University](https://reader036.vdocuments.net/reader036/viewer/2022062417/551a0a6f550346a4248b4815/html5/thumbnails/3.jpg)
Objectives
Discuss the current environment of community based bariatric medicine
Example of a publically funded community based weight management clinic.
![Page 4: Role of Private Bariatric Medical Centres ARE WE READY? Dr. Sean Wharton, MD, FRCPC Internal Medicine Wharton Medical Clinic Adjunct Professor – York University](https://reader036.vdocuments.net/reader036/viewer/2022062417/551a0a6f550346a4248b4815/html5/thumbnails/4.jpg)
Current Environmentof Medical Bariatric
Centres Tertiary
HGH Ottawa Civic Edmonton Capital Region – Weight Wise
Community Practices Commercial
Weight Watchers Bernstein’s Herbal Magic
Evidence Based Practices BMI (Bariatric Medical Institute) Wharton Medical Clinic Family Medicine Practices
Yoni Freedhoff, MD
![Page 5: Role of Private Bariatric Medical Centres ARE WE READY? Dr. Sean Wharton, MD, FRCPC Internal Medicine Wharton Medical Clinic Adjunct Professor – York University](https://reader036.vdocuments.net/reader036/viewer/2022062417/551a0a6f550346a4248b4815/html5/thumbnails/5.jpg)
Questions?Community Based Bariatric
Programs Standardization
Funding
Meal Replacements Programs, Partial
Family Doctors or Specialists
Team Dietitians, nutritionists (bariatric educators),
exercise specialists, behavioural therapist, pharmacist, social work etc.
![Page 6: Role of Private Bariatric Medical Centres ARE WE READY? Dr. Sean Wharton, MD, FRCPC Internal Medicine Wharton Medical Clinic Adjunct Professor – York University](https://reader036.vdocuments.net/reader036/viewer/2022062417/551a0a6f550346a4248b4815/html5/thumbnails/6.jpg)
AnswersCommunity Bariatric
Medicine Efficient System – demand is great
Multi-disciplinary
Cost-effective
Family/childhood obesity a priority
![Page 7: Role of Private Bariatric Medical Centres ARE WE READY? Dr. Sean Wharton, MD, FRCPC Internal Medicine Wharton Medical Clinic Adjunct Professor – York University](https://reader036.vdocuments.net/reader036/viewer/2022062417/551a0a6f550346a4248b4815/html5/thumbnails/7.jpg)
![Page 8: Role of Private Bariatric Medical Centres ARE WE READY? Dr. Sean Wharton, MD, FRCPC Internal Medicine Wharton Medical Clinic Adjunct Professor – York University](https://reader036.vdocuments.net/reader036/viewer/2022062417/551a0a6f550346a4248b4815/html5/thumbnails/8.jpg)
115 Programs Analyzed
31 Surgical Programs2 Surgical Assessment Centres
82 Non-surgical Programs32 Community-based (group session, gym)41 Primary Health Care (MD, nurse, dietitian)7 Hospital-based
![Page 9: Role of Private Bariatric Medical Centres ARE WE READY? Dr. Sean Wharton, MD, FRCPC Internal Medicine Wharton Medical Clinic Adjunct Professor – York University](https://reader036.vdocuments.net/reader036/viewer/2022062417/551a0a6f550346a4248b4815/html5/thumbnails/9.jpg)
115 Programs
![Page 10: Role of Private Bariatric Medical Centres ARE WE READY? Dr. Sean Wharton, MD, FRCPC Internal Medicine Wharton Medical Clinic Adjunct Professor – York University](https://reader036.vdocuments.net/reader036/viewer/2022062417/551a0a6f550346a4248b4815/html5/thumbnails/10.jpg)
ASPQ Criteria for Bariatric Programs
Rate of weight loss Multi-disciplinary Dietary intervention (without long
term use of VLCD) Physical activity Effectiveness Safety Approach to advertising Cost Effectiveness
![Page 11: Role of Private Bariatric Medical Centres ARE WE READY? Dr. Sean Wharton, MD, FRCPC Internal Medicine Wharton Medical Clinic Adjunct Professor – York University](https://reader036.vdocuments.net/reader036/viewer/2022062417/551a0a6f550346a4248b4815/html5/thumbnails/11.jpg)
![Page 12: Role of Private Bariatric Medical Centres ARE WE READY? Dr. Sean Wharton, MD, FRCPC Internal Medicine Wharton Medical Clinic Adjunct Professor – York University](https://reader036.vdocuments.net/reader036/viewer/2022062417/551a0a6f550346a4248b4815/html5/thumbnails/12.jpg)
Pharmacotherapy 3/31 – surgical programs 12/82 – non-surgical program (11 PC, 1
hosp)
BMI Criteria 32/82 nonsurgical programs did not use
BMI as entry criteria
![Page 13: Role of Private Bariatric Medical Centres ARE WE READY? Dr. Sean Wharton, MD, FRCPC Internal Medicine Wharton Medical Clinic Adjunct Professor – York University](https://reader036.vdocuments.net/reader036/viewer/2022062417/551a0a6f550346a4248b4815/html5/thumbnails/13.jpg)
![Page 14: Role of Private Bariatric Medical Centres ARE WE READY? Dr. Sean Wharton, MD, FRCPC Internal Medicine Wharton Medical Clinic Adjunct Professor – York University](https://reader036.vdocuments.net/reader036/viewer/2022062417/551a0a6f550346a4248b4815/html5/thumbnails/14.jpg)
Primary care based programs show the greatest compliance. Encouraging – most accessible
Access to hospital-based non-surgical programs is extremely limited.
Bariatric surgery facilites are lacking in psychological supports, and physical activity compared to non-surgical programs.
![Page 15: Role of Private Bariatric Medical Centres ARE WE READY? Dr. Sean Wharton, MD, FRCPC Internal Medicine Wharton Medical Clinic Adjunct Professor – York University](https://reader036.vdocuments.net/reader036/viewer/2022062417/551a0a6f550346a4248b4815/html5/thumbnails/15.jpg)
Long-term weight-loss maintenance: a meta-analysis of US studies
13 Studies (VLCD and HBD) 1081 pts - F/U – 4.5 years Initial weight loss 30.8 lbs (14%)
Weight-loss maintenance 6.6 lbs (3%) 40.2% of patients maintained - 5% loss at 5
years NNT of 2.5
25% of patients maintained - 10% loss at 5 years
NNT of 5
Anderson et al. Am J Clin Nutr, 2001
![Page 16: Role of Private Bariatric Medical Centres ARE WE READY? Dr. Sean Wharton, MD, FRCPC Internal Medicine Wharton Medical Clinic Adjunct Professor – York University](https://reader036.vdocuments.net/reader036/viewer/2022062417/551a0a6f550346a4248b4815/html5/thumbnails/16.jpg)
Wadden et al. NEJM; Nov 14, 2011
![Page 17: Role of Private Bariatric Medical Centres ARE WE READY? Dr. Sean Wharton, MD, FRCPC Internal Medicine Wharton Medical Clinic Adjunct Professor – York University](https://reader036.vdocuments.net/reader036/viewer/2022062417/551a0a6f550346a4248b4815/html5/thumbnails/17.jpg)
![Page 18: Role of Private Bariatric Medical Centres ARE WE READY? Dr. Sean Wharton, MD, FRCPC Internal Medicine Wharton Medical Clinic Adjunct Professor – York University](https://reader036.vdocuments.net/reader036/viewer/2022062417/551a0a6f550346a4248b4815/html5/thumbnails/18.jpg)
Important aspects of a weight management clinic
Cost medical supervision frequent visits no pressure/non judgmental emotional support nutritional support convenient location with parking
![Page 19: Role of Private Bariatric Medical Centres ARE WE READY? Dr. Sean Wharton, MD, FRCPC Internal Medicine Wharton Medical Clinic Adjunct Professor – York University](https://reader036.vdocuments.net/reader036/viewer/2022062417/551a0a6f550346a4248b4815/html5/thumbnails/19.jpg)
How frequently would you like to come to a
professional centre for a weigh in?
34%
50%
2%
8%
4%
2%
every week
every 2 weeks
every 3 weeks
1/month
Whenever I want
no answer
![Page 20: Role of Private Bariatric Medical Centres ARE WE READY? Dr. Sean Wharton, MD, FRCPC Internal Medicine Wharton Medical Clinic Adjunct Professor – York University](https://reader036.vdocuments.net/reader036/viewer/2022062417/551a0a6f550346a4248b4815/html5/thumbnails/20.jpg)
Wharton Medical ClinicWeight Management Centre Launch – May 2008 A large community based bariatric
clinic – government funded – no charge to patients 9 Internists – 3 Nephrologist, 1
cardiologist, 2 ICU, 1 rheumatologist, 1 haematologist, 1 GIM
1 Dietitian/15 Nutritionist (Bariatric Educators)
Behavioural Therapy Team/Physiotherapy Team
Research Staff
![Page 21: Role of Private Bariatric Medical Centres ARE WE READY? Dr. Sean Wharton, MD, FRCPC Internal Medicine Wharton Medical Clinic Adjunct Professor – York University](https://reader036.vdocuments.net/reader036/viewer/2022062417/551a0a6f550346a4248b4815/html5/thumbnails/21.jpg)
Bariatric Educators
Education/Qualifications BSc Nutrition (Guelph, UWO, Ryerson) Post WMC - 2 MDs, 2 Masters, 4
dietitian internship Supervision/Quality Control
Dietitian/MDs 1/2 – 1/3 - salary of a dietitian Significant dietary concerns –
referred to the dietitian
![Page 22: Role of Private Bariatric Medical Centres ARE WE READY? Dr. Sean Wharton, MD, FRCPC Internal Medicine Wharton Medical Clinic Adjunct Professor – York University](https://reader036.vdocuments.net/reader036/viewer/2022062417/551a0a6f550346a4248b4815/html5/thumbnails/22.jpg)
WMC Clinic
Adults BMI 27-30 with 1 comorbidity, or
BMI>30 ? Change this to BMI 27 – 40 with 1
comorbidity, BMI > 40 (no comorbidities needed)
Treatment of cardio-metabolic conditions
Pharmacotherapy Surgical Referral/Medical and
Psychological Support/Pre and Post Op Management
![Page 23: Role of Private Bariatric Medical Centres ARE WE READY? Dr. Sean Wharton, MD, FRCPC Internal Medicine Wharton Medical Clinic Adjunct Professor – York University](https://reader036.vdocuments.net/reader036/viewer/2022062417/551a0a6f550346a4248b4815/html5/thumbnails/23.jpg)
Wharton Medical Clinic May 2012 19,069 pts (76% women)
3,734 pts current 75 - 100 new pts/week No waiting list 15-20 min GROUP education session at every
visit MD sees patient at every visit Visits q 1 – 3 weeks Metabolic and CV Risk assessment Evening Educational Classes Aggressive Diabetes Management
![Page 24: Role of Private Bariatric Medical Centres ARE WE READY? Dr. Sean Wharton, MD, FRCPC Internal Medicine Wharton Medical Clinic Adjunct Professor – York University](https://reader036.vdocuments.net/reader036/viewer/2022062417/551a0a6f550346a4248b4815/html5/thumbnails/24.jpg)
WMC Program Flowsheet
Visit #1BE/MD Visit
PMHX/Meds/Exam/Weight Hx/Consent to
research and Goals
Visit #2BE/MD Visit
Initiate Meal Plan
500 calorie/day deficit
Pedometer – walking
Resistance bands/Aqua
Organized eating
Visit q 3- 4 weeksBE/MD Visit
SUPPORT GROUPS
Manage medicallyDiabetic
managementCV management
Referrals
Baseline ECGBloodwork
RMRGXT
Wt, Ht, BMR, WC/HC
Blood pressure
WEEKLY WEIGH-INS ENCOURAGED – not billed to OHIP
1. FD - ASK
2. ASSESS
3. AGREE
4. ADVISE
5. ASSIST
![Page 25: Role of Private Bariatric Medical Centres ARE WE READY? Dr. Sean Wharton, MD, FRCPC Internal Medicine Wharton Medical Clinic Adjunct Professor – York University](https://reader036.vdocuments.net/reader036/viewer/2022062417/551a0a6f550346a4248b4815/html5/thumbnails/25.jpg)
BE #1Notes
![Page 26: Role of Private Bariatric Medical Centres ARE WE READY? Dr. Sean Wharton, MD, FRCPC Internal Medicine Wharton Medical Clinic Adjunct Professor – York University](https://reader036.vdocuments.net/reader036/viewer/2022062417/551a0a6f550346a4248b4815/html5/thumbnails/26.jpg)
BE #1Notes
![Page 27: Role of Private Bariatric Medical Centres ARE WE READY? Dr. Sean Wharton, MD, FRCPC Internal Medicine Wharton Medical Clinic Adjunct Professor – York University](https://reader036.vdocuments.net/reader036/viewer/2022062417/551a0a6f550346a4248b4815/html5/thumbnails/27.jpg)
BE #1Notes
Weight, Ht, BP, WC/HC
![Page 28: Role of Private Bariatric Medical Centres ARE WE READY? Dr. Sean Wharton, MD, FRCPC Internal Medicine Wharton Medical Clinic Adjunct Professor – York University](https://reader036.vdocuments.net/reader036/viewer/2022062417/551a0a6f550346a4248b4815/html5/thumbnails/28.jpg)
BE #1Notes
BE #2Presentations
![Page 29: Role of Private Bariatric Medical Centres ARE WE READY? Dr. Sean Wharton, MD, FRCPC Internal Medicine Wharton Medical Clinic Adjunct Professor – York University](https://reader036.vdocuments.net/reader036/viewer/2022062417/551a0a6f550346a4248b4815/html5/thumbnails/29.jpg)
BE #1Notes
BE #2Presentations
BE #3Individual visit
BE #4Individual visit
BE #5Individual visit
![Page 30: Role of Private Bariatric Medical Centres ARE WE READY? Dr. Sean Wharton, MD, FRCPC Internal Medicine Wharton Medical Clinic Adjunct Professor – York University](https://reader036.vdocuments.net/reader036/viewer/2022062417/551a0a6f550346a4248b4815/html5/thumbnails/30.jpg)
BE #1Notes
BE #2Presentations
BE #3Individual visit
BE #4Individual visit
BE #5Individual visit
![Page 31: Role of Private Bariatric Medical Centres ARE WE READY? Dr. Sean Wharton, MD, FRCPC Internal Medicine Wharton Medical Clinic Adjunct Professor – York University](https://reader036.vdocuments.net/reader036/viewer/2022062417/551a0a6f550346a4248b4815/html5/thumbnails/31.jpg)
BE #1Notes
BE #2Presentations
BE #3Individual visit
BE #4Individual visit
BE #5Individual visit
![Page 32: Role of Private Bariatric Medical Centres ARE WE READY? Dr. Sean Wharton, MD, FRCPC Internal Medicine Wharton Medical Clinic Adjunct Professor – York University](https://reader036.vdocuments.net/reader036/viewer/2022062417/551a0a6f550346a4248b4815/html5/thumbnails/32.jpg)
WMC - LecturesEducational Seminars
Topics How to complete a food journal Macro and micronutrients/label reading meal plans/eating out diabetic meal planning Emotional eating stress and weight, body image, support group Activity – pedometers, resistance bands
![Page 33: Role of Private Bariatric Medical Centres ARE WE READY? Dr. Sean Wharton, MD, FRCPC Internal Medicine Wharton Medical Clinic Adjunct Professor – York University](https://reader036.vdocuments.net/reader036/viewer/2022062417/551a0a6f550346a4248b4815/html5/thumbnails/33.jpg)
![Page 34: Role of Private Bariatric Medical Centres ARE WE READY? Dr. Sean Wharton, MD, FRCPC Internal Medicine Wharton Medical Clinic Adjunct Professor – York University](https://reader036.vdocuments.net/reader036/viewer/2022062417/551a0a6f550346a4248b4815/html5/thumbnails/34.jpg)
![Page 35: Role of Private Bariatric Medical Centres ARE WE READY? Dr. Sean Wharton, MD, FRCPC Internal Medicine Wharton Medical Clinic Adjunct Professor – York University](https://reader036.vdocuments.net/reader036/viewer/2022062417/551a0a6f550346a4248b4815/html5/thumbnails/35.jpg)
RMR Machine
![Page 36: Role of Private Bariatric Medical Centres ARE WE READY? Dr. Sean Wharton, MD, FRCPC Internal Medicine Wharton Medical Clinic Adjunct Professor – York University](https://reader036.vdocuments.net/reader036/viewer/2022062417/551a0a6f550346a4248b4815/html5/thumbnails/36.jpg)
![Page 37: Role of Private Bariatric Medical Centres ARE WE READY? Dr. Sean Wharton, MD, FRCPC Internal Medicine Wharton Medical Clinic Adjunct Professor – York University](https://reader036.vdocuments.net/reader036/viewer/2022062417/551a0a6f550346a4248b4815/html5/thumbnails/37.jpg)
Comparison of Group vs. Individual Treatment for Weight Loss: 6 months
0
2
4
6
8
10
12
14
16
Group Treatment
Preferred Non-Preferred
Individual Treatment
Preferred Non-Preferred
Wei
ght L
oss
(in
kg)
p < .02
Renjilian, Perri et al. J Consult Clin Psychol 2001; 69:717-721.
![Page 38: Role of Private Bariatric Medical Centres ARE WE READY? Dr. Sean Wharton, MD, FRCPC Internal Medicine Wharton Medical Clinic Adjunct Professor – York University](https://reader036.vdocuments.net/reader036/viewer/2022062417/551a0a6f550346a4248b4815/html5/thumbnails/38.jpg)
Barry at 404 lbs, BMI 60 Past Medical
History Diabetes Type 2 OSA – CPAP Hypertension High Cholesterol Urinary incontinence Hernia - ventral Obesity Class III Developmental Delay Intertrigo
Medications Metformin, Glyburide Ramipril, Lipitor
![Page 39: Role of Private Bariatric Medical Centres ARE WE READY? Dr. Sean Wharton, MD, FRCPC Internal Medicine Wharton Medical Clinic Adjunct Professor – York University](https://reader036.vdocuments.net/reader036/viewer/2022062417/551a0a6f550346a4248b4815/html5/thumbnails/39.jpg)
Barry’s Weight Loss Graph
![Page 40: Role of Private Bariatric Medical Centres ARE WE READY? Dr. Sean Wharton, MD, FRCPC Internal Medicine Wharton Medical Clinic Adjunct Professor – York University](https://reader036.vdocuments.net/reader036/viewer/2022062417/551a0a6f550346a4248b4815/html5/thumbnails/40.jpg)
Barry at 231lbs, BMI 33176lbs lost, 43% WL
Current Medical Hx OSA
CPAP turned down Diabetes type 2
Diet controlled Obesity Class I
Current Medications No medications
Off – metformin, ramipril, glyburide. Lipitor
![Page 41: Role of Private Bariatric Medical Centres ARE WE READY? Dr. Sean Wharton, MD, FRCPC Internal Medicine Wharton Medical Clinic Adjunct Professor – York University](https://reader036.vdocuments.net/reader036/viewer/2022062417/551a0a6f550346a4248b4815/html5/thumbnails/41.jpg)
Feasibility of a interdisciplinary
program for weight management in Canada
Sean Wharton MD; Sarah VanderLelie B.A.Sc; Saaqshi
Sharma M.Sc; Arya Sharma MD; Jennifer L. Kuk PhD
Canadian Family Physician, Feb 2012;852:32-8
![Page 42: Role of Private Bariatric Medical Centres ARE WE READY? Dr. Sean Wharton, MD, FRCPC Internal Medicine Wharton Medical Clinic Adjunct Professor – York University](https://reader036.vdocuments.net/reader036/viewer/2022062417/551a0a6f550346a4248b4815/html5/thumbnails/42.jpg)
Descriptive sample 1085 pts (3 months), 289 pts (6
months) 77% female
Age – 49.3 + 12.5 years
BMI – 40.5 + 8.1 kg/m2
![Page 43: Role of Private Bariatric Medical Centres ARE WE READY? Dr. Sean Wharton, MD, FRCPC Internal Medicine Wharton Medical Clinic Adjunct Professor – York University](https://reader036.vdocuments.net/reader036/viewer/2022062417/551a0a6f550346a4248b4815/html5/thumbnails/43.jpg)
69%
27% 21%
84%
33%45%
27%20%
0
500
1000
1500
2000
2500
Nu
mb
er
of
Pati
en
ts
Disease
Canadian Family Physician, Feb 2012;852:32-8
![Page 44: Role of Private Bariatric Medical Centres ARE WE READY? Dr. Sean Wharton, MD, FRCPC Internal Medicine Wharton Medical Clinic Adjunct Professor – York University](https://reader036.vdocuments.net/reader036/viewer/2022062417/551a0a6f550346a4248b4815/html5/thumbnails/44.jpg)
4743
38
3228
2117
1513986
0
10
20
30
40
50
1 2 3 4 5 6
Treatment Time (months)
Pre
vale
nce (
%)
5%
10%
Wharton et al. Can FamPhys, 2012;852:32-8
![Page 45: Role of Private Bariatric Medical Centres ARE WE READY? Dr. Sean Wharton, MD, FRCPC Internal Medicine Wharton Medical Clinic Adjunct Professor – York University](https://reader036.vdocuments.net/reader036/viewer/2022062417/551a0a6f550346a4248b4815/html5/thumbnails/45.jpg)
Prevalence of WMC Patients attaining
5% and 10% Weight Loss (18 months)
1,562 patients
![Page 46: Role of Private Bariatric Medical Centres ARE WE READY? Dr. Sean Wharton, MD, FRCPC Internal Medicine Wharton Medical Clinic Adjunct Professor – York University](https://reader036.vdocuments.net/reader036/viewer/2022062417/551a0a6f550346a4248b4815/html5/thumbnails/46.jpg)
Discontinuation (no visit in 3 months)
28.9% (N=452) lost 4.3 kg ± 6.1 3.7 % ± 5.0 of BW
31% - 5% weight loss 11% - 10% weight loss 8.4 ± 3.0 visits over 7.5 ± 1.4
months
![Page 47: Role of Private Bariatric Medical Centres ARE WE READY? Dr. Sean Wharton, MD, FRCPC Internal Medicine Wharton Medical Clinic Adjunct Professor – York University](https://reader036.vdocuments.net/reader036/viewer/2022062417/551a0a6f550346a4248b4815/html5/thumbnails/47.jpg)
Results- Prevalence of MNOB and MAOB
0%
10%
20%
30%
40%
50%
60%
70%
0 1 2 3 4 5 0 1 2 3 4 5
Baseline Follow-up
Prev
alen
ce (%
)
Clinical cutoffs Sub-clinical cutoffs
Number of metabolic risk factors
![Page 48: Role of Private Bariatric Medical Centres ARE WE READY? Dr. Sean Wharton, MD, FRCPC Internal Medicine Wharton Medical Clinic Adjunct Professor – York University](https://reader036.vdocuments.net/reader036/viewer/2022062417/551a0a6f550346a4248b4815/html5/thumbnails/48.jpg)
-7
-6
-5
-4
-3
-2
-1
0P
erc
en
t W
eig
ht
Lo
ss
(%
)
Sex
Ref
Female Male
Data adjusted for independent variables: sex, age group, BMI class, education, ethnicity and smoking status and treatment duration)
Unadjusted data
![Page 49: Role of Private Bariatric Medical Centres ARE WE READY? Dr. Sean Wharton, MD, FRCPC Internal Medicine Wharton Medical Clinic Adjunct Professor – York University](https://reader036.vdocuments.net/reader036/viewer/2022062417/551a0a6f550346a4248b4815/html5/thumbnails/49.jpg)
-7
-6
-5
-4
-3
-2
-1
0
Age Group
* Ref
Pe
rce
nt
We
igh
t L
os
s (
%)
**
*
Unadjusted Ptrend = 0.004
Adjusted Ptrend = 0.007
18-49 49-64 >64
![Page 50: Role of Private Bariatric Medical Centres ARE WE READY? Dr. Sean Wharton, MD, FRCPC Internal Medicine Wharton Medical Clinic Adjunct Professor – York University](https://reader036.vdocuments.net/reader036/viewer/2022062417/551a0a6f550346a4248b4815/html5/thumbnails/50.jpg)
-7
-6
-5
-4
-3
-2
-1
0W
eig
ht
Lo
st
(kg
)
BMI Category
Ref
* Unadjusted Ptrend <0.0001
Adjusted Ptrend <0.0001
OW OBCI OBCII OBCIII
![Page 51: Role of Private Bariatric Medical Centres ARE WE READY? Dr. Sean Wharton, MD, FRCPC Internal Medicine Wharton Medical Clinic Adjunct Professor – York University](https://reader036.vdocuments.net/reader036/viewer/2022062417/551a0a6f550346a4248b4815/html5/thumbnails/51.jpg)
-7
-6
-5
-4
-3
-2
-1
0
BMI Category
RefPe
rce
nt
We
igh
t L
os
s (
%)
Unadjusted Ptrend = 0.60
Adjusted Ptrend = 0.84
OBCIII
OBCIIOBCIOW
![Page 52: Role of Private Bariatric Medical Centres ARE WE READY? Dr. Sean Wharton, MD, FRCPC Internal Medicine Wharton Medical Clinic Adjunct Professor – York University](https://reader036.vdocuments.net/reader036/viewer/2022062417/551a0a6f550346a4248b4815/html5/thumbnails/52.jpg)
-7
-6
-5
-4
-3
-2
-1
0
Education
Less than HS HS or GED College University
RefPe
rce
nt
We
igh
t L
os
s (
%)
Unadjusted Ptrend = 0.46
Adjusted Ptrend = 0.33
![Page 53: Role of Private Bariatric Medical Centres ARE WE READY? Dr. Sean Wharton, MD, FRCPC Internal Medicine Wharton Medical Clinic Adjunct Professor – York University](https://reader036.vdocuments.net/reader036/viewer/2022062417/551a0a6f550346a4248b4815/html5/thumbnails/53.jpg)
Series1
-7
-6
-5
-4
-3
-2
-1
0W
eig
ht
Lo
st
(kg
)
Ref
*
* *
White Asian OtherAFHeritage
Ethnicity
![Page 54: Role of Private Bariatric Medical Centres ARE WE READY? Dr. Sean Wharton, MD, FRCPC Internal Medicine Wharton Medical Clinic Adjunct Professor – York University](https://reader036.vdocuments.net/reader036/viewer/2022062417/551a0a6f550346a4248b4815/html5/thumbnails/54.jpg)
Next steps for Wharton Medical Clinic
Research Current Studies
Comparison metabolically normal obese vs metabolically abnormal obese (submitted)
Economic analysis of effectiveness data Analysis of attrition rates OSA in patients unwilling to use CPAP -
randomized to GLP1 analogue vs placebo
PGX fibre in diabetics (placebo controlled)
Application of model to family medicine clinics
![Page 55: Role of Private Bariatric Medical Centres ARE WE READY? Dr. Sean Wharton, MD, FRCPC Internal Medicine Wharton Medical Clinic Adjunct Professor – York University](https://reader036.vdocuments.net/reader036/viewer/2022062417/551a0a6f550346a4248b4815/html5/thumbnails/55.jpg)
Recent publication for the Wharton Medical
Clinic
![Page 56: Role of Private Bariatric Medical Centres ARE WE READY? Dr. Sean Wharton, MD, FRCPC Internal Medicine Wharton Medical Clinic Adjunct Professor – York University](https://reader036.vdocuments.net/reader036/viewer/2022062417/551a0a6f550346a4248b4815/html5/thumbnails/56.jpg)
Research in non-surgical bariatric medicine
We are obligated to complete research in this area – we are still in our infancy.
![Page 57: Role of Private Bariatric Medical Centres ARE WE READY? Dr. Sean Wharton, MD, FRCPC Internal Medicine Wharton Medical Clinic Adjunct Professor – York University](https://reader036.vdocuments.net/reader036/viewer/2022062417/551a0a6f550346a4248b4815/html5/thumbnails/57.jpg)
Conclusion and Questions
Statement: Community based bariatric medicine is necessary Question: How are we going to pay for
it? Statement: Results from WMC are
promising Question: How can it get better, more
efficient and even more cost effective Are we Ready for community based
practice? Do we have a choice?
![Page 58: Role of Private Bariatric Medical Centres ARE WE READY? Dr. Sean Wharton, MD, FRCPC Internal Medicine Wharton Medical Clinic Adjunct Professor – York University](https://reader036.vdocuments.net/reader036/viewer/2022062417/551a0a6f550346a4248b4815/html5/thumbnails/58.jpg)
Thank You!
Sarah Vanderlelie, BSc
Jennifer Kuk, PhD Arya Sharma, MD Saaqshi Sharma,
MSc Rebecca Liu, MSc Marcia Villafranca Blair Leonard, MD
WMC Team