2022 Atlanta Board of Trustees Meeting

Item B (3) (f) This language is very castigatory, blaming the patient for the disease of obesity. It has no place in a medical board rule and should be removed. Past poor performance does not indicate the patient can ’ t do well moving forward. Under this rule, a patient gets one shot at treating their obesity, and if they don ’ t do well, is barred from ever being treated again. Item C (3) While we desire all patients to lose 5% or more body weight within the first 3 months, some of the patients with the most severe obesity do not. Oftentimes we can simply stop weight gain, or are lucky to achieve any weight loss. Even the PI for Qsymia states that it can be continued if at 3 months the patient has lost 3% or more, or that if the response is less than 3%, the medication dose can be increased from 7.5 mg phentermine to 15 mg phentermine. You could add language that in the event 5% weight loss is not achieved within 3 months, the provider document pros and cons of continuing medication to see if 5% can be achieved at 6 months, if there is a compelling reason why the benefits outweigh the risks of continuing treatment, or can change the treatment (phentermine to diethylpropion), augment treatment (add topiramate), raise dose (from 8 or 15 mg to 30 or 37.5 mg), etc. This language is overly prescriptive and will result in the more complex patient not being able to continue on treatment. Item C (4) (b) – this language is not consistent with how the disease of obesity acts. Obesity is a chronic progressive disease. Virtually everybody that successfully loses weight regains it over time. However, they will sustain a percentage weight loss vs. where they would have been untreated. For example, if you treat a patient who is 200 pounds and they lose 10% of their weight in the first 6 months and sustain that for 6 more, they will be 180 pounds at the end of the year. But most slowly gain weight – 1-2 pounds per year. Within 10 years, they will likely be back up to 200 pounds. Conversely, were they not treated, they would gain a similar amount of weight and now be 220 pounds. A requirement to sustain weight loss is not consistent even with the newest medications like Saxenda, where in their 3 year trial patients regained about 1/4 th of the weight that was lost. Even bariatric surgical patients regaine about 1/3 rd of the lost weight. Further, there is no “ goal weight. ” This is a myth that should be retired. I encourage you to strike item C (4) (b) as it will result in all treated patients having their treatment stopped. When treatment is stopped, weight regain is quite rapid posing further risks to the person ’ s health. Item C (5) – Why would you need to stop a weight loss program due to alcohol use? These do not appear related. Further “ Drugs ” is non-specific – I ’ d clarify – “ other stimulants, whether prescription or illicit. ”

Item C (5) (c) – see above. This language should be stricken.

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