Episode 143: How to Choose Your Obesity Medicine Specialist

[00:00:00] Welcome back to the Back on Track Achieving Healthy Weight Loss,

[00:00:04] where I help you get on track and stay on track with your weight loss journey.

[00:00:09] I'm your host, Dr. Alicia Shelly. So let's get started.

[00:00:13] Music

[00:00:28] Hello and welcome to the Back on Track Achieving Healthy Weight Loss podcast.

[00:00:34] I'm your host, Dr. Alicia Shelly. Now this past week, Costco unveiled their new weight loss program

[00:00:42] and they're teaming up with Sesame, a telehealth company, to provide online weight loss programs

[00:00:48] for membership fee of $179 for members and $195 for non-members. And this will give their clients

[00:00:57] access to medical providers who can prescribe anti-obese medications like GOP1 and oral tablets.

[00:01:05] And they're not alone. There are other programs out there just like them such as the Weight

[00:01:10] Watchers Telehealth Clinic, PlushCare.com, Rowe and many more. But the question is how do you know

[00:01:19] if you can trust them? How do you know that these companies are the best place for you?

[00:01:25] And so today we're going to talk all about it and I have four things that you should be aware of

[00:01:30] prior to getting started with your weight loss journey and where to go to seek help.

[00:01:35] So before we get started, let's kind of talk a little bit about what options we have when it comes

[00:01:42] to getting weight loss care. Now you have your traditional in-person clinic where the doctor,

[00:01:49] you'll see the doctor, they'll either take your insurance or they may include a dietitian

[00:01:54] in their program and exercise physiologists or psychologists and support groups.

[00:01:58] This is a clinic that I run here in Douglasville. Whereas more in person, you see me,

[00:02:03] you see my colleague and we have other specialists that provide this program for you.

[00:02:09] And the pros about it is that you definitely get that hands-on approach. You have people

[00:02:14] that you can talk to, you can message, you know them, you know their face. And you're able to

[00:02:18] get that individualized care, one-on-one care with that provider. And then on top of that,

[00:02:24] it's kind of helping in multiple ways. It's actually looking at how you eat,

[00:02:27] looking at how you move and having that emotional support. And so there are many

[00:02:32] in-person clinics throughout America is just trying to find which one fits you. And not all of them

[00:02:38] will have the different specialists like the dietitian exercise physiologist, there'll be

[00:02:43] some words just the doctor. And that's okay because the doctor can give you the counseling

[00:02:48] that you need. But definitely be aware of places where it's maybe just a nurse that's there

[00:02:55] or you don't get that individualized care that you're looking for. Because sometimes,

[00:03:00] those places may not be as reputable as other places. Let me just put it like that.

[00:03:06] Now the second place where you can get care is their direct patient care or concierge clinic.

[00:03:12] This is where you see the doctor but it's completely cash pay. They take a monthly membership

[00:03:18] fee where each month you pay for access to the doctor. The one pro about it is that

[00:03:24] the doctor sees less patients. So you really get hands on, you're not like another number.

[00:03:29] And then also they're able to spend more time with explaining things to you,

[00:03:33] making sure you understand, making sure that whatever limiting beliefs or whatever obstacles

[00:03:38] that you are having currently, they're able to help you work through those areas to kind of

[00:03:43] get you to a good place. They could also have access to your nutritionist, also access to

[00:03:48] the exercise physiologist, or even a psychologist to kind of help with where you are in the

[00:03:53] process. So they have multiple avenues, different people that can help you with your weight loss

[00:04:00] journey. Because I will say this, weight loss is not just taking a pill or changing your

[00:04:05] diet and exercise. It's important but it's not the only thing. And so sometimes we need

[00:04:10] support. We need that accountability and having these specialists like the dietician,

[00:04:15] exercise physiologist can be helpful. And then you have your telehealth options where

[00:04:21] the individual docs, you have some docs that do their obesity practice just online.

[00:04:27] And you go and you see them and you talk to them about weight loss and everything like that.

[00:04:32] But in their practices they can have different programs. They may have a coaching program that's

[00:04:38] virtual and they may have a nutritionist that you can go to or support group. It's all

[00:04:42] depending on the individual doctor. So you do have variety. But then you have the big companies

[00:04:48] like your Costco, your Weight Watchers where they team up with another telehealth company that

[00:04:54] provides providers that can actually have a consultation with the patient and then prescribe

[00:05:00] medication. Now I've never worked for these Costco or these other places. I did work prior

[00:05:06] to the pandemic for a telehealth company for primary care. And so usually with that

[00:05:12] they kind of have a script that you go through with the patient and then they meet all the

[00:05:17] boxes, then you prescribe the medication. But I wouldn't say that it's one on one and

[00:05:24] then also some of these doctors may not necessarily be certified in obesity medicine.

[00:05:28] So you just never know who you're getting. But with that, the consultation, they prescribe

[00:05:34] the medication and then you can be able to specifically with Costco, you can be able

[00:05:38] to text if you have any questions or anything like that. And so the couple things you

[00:05:42] should know. So these are the three areas as far as traditional in-person clinic, direct

[00:05:47] patient care, concierge clinic, telehealth where you can kind of get your weight loss care.

[00:05:51] But there are a couple things you should know before you step foot or before you call or

[00:05:56] make your appointment. Now the first thing you want to know is that you need to know what

[00:06:00] you're looking for because if you're somebody that really wants people to explain things,

[00:06:05] you need people to kind of give you that hands on approach where you have any questions

[00:06:09] or answering it right on the spot, then you may want to stick to an additional in-person clinic.

[00:06:14] But if you're somebody who's super busy, you've done your research, you know exactly what

[00:06:19] medication you want, then maybe a telehealth may be better because it's quick, you get to have

[00:06:24] your appointment, you see that person, you get your medication and you move on. And if you're

[00:06:29] one that's really wanting like more time with the doctor, different resources like a dietician,

[00:06:35] then also you would consider the direct patient care and concierge clinic. But number one, you've

[00:06:39] got to really know what you want and what you want to get out of this. Now let me put a plug in

[00:06:45] for lifestyle interventions and the importance of it. So when they did any of these studies with

[00:06:50] medications, there was all in combination with calorie deficit diet and Actrosod. So it's

[00:06:57] important that these medications that we have that as our foundation. And so sometimes I

[00:07:03] have patients that come in my office and they say to me all the time, well I know what I need to do,

[00:07:08] I just don't do it. Well you may want to consider having an accountability partner

[00:07:13] or a dietician. They can help lead you through the process somebody who this is what they do.

[00:07:18] You know this is their expertise, this is what they went to school for. And so you can trust

[00:07:22] and believe that the information they're going to give you will be beneficial for you.

[00:07:27] And everyone's different in how they display it out but I definitely recommend seeking that

[00:07:32] consultation so that you kind of know what you can do to improve in your lifestyle habits.

[00:07:38] So and then the other thing, the other example I like to think about is think of LeBron James.

[00:07:44] He doesn't just shoot on his own and just entrusts his own self. He definitely has talent,

[00:07:49] don't get me wrong, but he has a coach. He has a shooter coach that kind of helps them

[00:07:52] kind of perfects his shooting. And so that's the same way with these specialists,

[00:07:56] the dietician exercise physiologists. They are perfecting how you eat,

[00:08:00] they're reflecting how you move and they're actually helping and giving you the support you need

[00:08:05] as you lose weight. Now, the number two thing you should make sure you know before you contact

[00:08:10] any of these offices is that you need to know what your insurance covers. So many times I have

[00:08:17] patients that come into my office wanting a medication but they don't know if it's

[00:08:21] excluded by their plan. And you may not know if it's excluded by your plan. But how do you

[00:08:26] know? You go online, if this happens with your insurance they usually have like a website where

[00:08:32] you can actually put in the medication and see if it's covered. So what I'm finding here,

[00:08:37] especially with the injectables is that with employers not all employers have opted in to

[00:08:44] cover weight loss medications. So what does that mean? You may have a commercial insurance,

[00:08:50] but because your employer has not checked that box then that means they won't cover it. So regardless

[00:08:57] of what we do, the prior authorizations, the appeal letters, they are still going to deny it

[00:09:03] because of the fact that they just don't cover it. And you can actually save time,

[00:09:09] you can save money by at least taking the five minutes to call your insurance.

[00:09:14] Now the one thing that I thought was interesting was the Costco is that although you pay a

[00:09:18] membership fee to see the doctor every month, what we'll find is if your insurance does not

[00:09:25] cover the medication then they say you can opt to pay self-pay and pay out of pocket.

[00:09:30] And so it's not like you have to have insurance in order to go through them.

[00:09:35] And so what that means is if you're not prepared to pay out of pocket you want to kind of know

[00:09:40] what is covered so that you know that you're not necessarily, you know, you're paying all this

[00:09:44] money for membership and you can't get the medication because your insurance does not cover

[00:09:49] it. So it's important that you kind of know this before you go in because then it actually makes

[00:09:53] the difference. You can have an intelligent conversation with the doctor saying, hey,

[00:09:57] this is what my insurance covers, what do you think would be the best option for me? Or my

[00:10:01] insurance does not cover anything, what would be the most cost-effective medication for me?

[00:10:06] So you can be able to ask the provider right then when you see them.

[00:10:10] And then the other thing that you should be aware of is that not all professionals are obesity

[00:10:16] medicine certified or shall I say a diplomat, the American board of obesity.

[00:10:21] Now to become a diplomat of the American board of obesity you have to actually go through

[00:10:26] several classes, study, take a test and pass. And then even for people who are a nurse

[00:10:32] practitioner they actually have a certification for nurse practitioners in obesity.

[00:10:36] And what that kind of tells you is that this is somebody who's done the extra step

[00:10:41] of going in and getting the extra knowledge of obesity. And not only just knowing,

[00:10:46] just prescribing medications but knowing the pathophysiology of why obesity occurs,

[00:10:52] they can be able to share with you strategies of if you're hit a stalemate, what should you do

[00:10:56] after that? Like these are people who have really committed to obesity and have been studying

[00:11:03] and actually know the different medications that kind of promote weight gain and what you

[00:11:07] should do about them. And so you really want to make sure that the person you're going to

[00:11:12] is that professional and you can actually go to the American board of obesity medicine

[00:11:16] where they have a list of their graduates and people who are certified. Also you can go to

[00:11:22] the obesity medicine association or OMA where they can tell you a list of people who are

[00:11:27] certified in their membership. So this may be helpful for you if you're trying to find somebody

[00:11:32] who's in your area or even somebody that does telehealth because there's people who do

[00:11:36] and they are certified. And you may be thinking, well why is it so important for them to be

[00:11:40] certified? Well because there's more to obesity than just taking a pit. And so you really want

[00:11:46] to have somebody who knows what's going on and know how they can help you when you hit a pit

[00:11:51] fall or you hit an obstacle in your way when it comes to losing weight. So it is important.

[00:11:58] And then the last thing you should do is be open to the process. So whatever program that

[00:12:03] you decide to start, be open to what they're telling you. Be open to anything new that they

[00:12:10] may share with you that you're not aware of. So many patients I see in my clinic where they just

[00:12:15] shut down. They're like, I don't want to hear anything you have to say, I just want to appeal

[00:12:18] and be gone. And the sad thing is they will get the prescription, you know, I'll write the

[00:12:22] prescription but they don't see the best results because they didn't take anything else in

[00:12:27] consideration. They weren't open to the process. So be open to the process. You may be surprised

[00:12:33] about the changes that entail. And in fact, I had a lady today, she saw one of my colleagues

[00:12:38] initially but she said when she came to her college she's like, oh this is not going to work.

[00:12:41] But then she opened herself to the process and she was able to lose 27 pounds. So make sure

[00:12:47] that you open yourself to the process. Well I thank you so much for your time. I want to

[00:12:52] wish you as best as luck as you enter into this wellness journey. Know that we are here to help

[00:12:57] as best as possible and know that there are lots of great doctors out there in your area who want

[00:13:02] to help you, who want to help you see better health, who want to see you in a better light,

[00:13:08] most importantly. And so thank you again for joining us on the back on track,

[00:13:12] Achieving Healthy Weight Loss Podcast. If you liked this episode, please feel free to

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[00:13:22] And I look forward to seeing you all next time.