Obesity is a top health concern across
the country, and particularly in
Calvert County. CalvertHealth Weight
Management is working with the
community to provide a comprehensive
and customized approach to weight
management.
Obesity was one of the top health concerns
identified by Calvert County residents in
the 2023-2025 Calvert County Community
Health Needs Assessment. Over 41% of survey
respondents identified obesity as a top concern
and Calvert County ranks in the bottom 50%
of Maryland counties for adult obesity rates.
Obesity is a risk factor for many other serious
illnesses.
CalvertHealth’s team of doctors, nurse
practitioners and dietitians work with patients
to determine the best course of treatment
customized for each person’s individual health
needs. For some, this may mean weight loss
surgery. For others, medication is the way. For
both avenues, lifestyle changes are needed to
ensure success.
“The patient that is well suited is the
patient that is willing to make change in their
lives,” said Dr. Gregory Dalencourt, director of
CalvertHealth’s robotic surgery program.
A Customized Approach
There is no one-size-fits-all to weight
management, so CalvertHealth provides
surgical and non-surgical weight management
treatment options. Dr. Dalencourt says
that usually by the end of a patient’s first
appointment, the person will have a pretty good
idea of which route they want to take after the
providers understand the patient’s symptoms,
history and lifestyle.
The approach at CalvertHealth is to guide
the patient through the entire process with a team of doctors, nurse practitioners
and dietitians as the patient navigates
medication or surgery and the lifestyle
changes that come with that.
“We don’t need to refer them out. We
refer them in,” Dr. Dalencourt said.
Common concerns and hesitations that
patients express often involve affordability,
side effects and fear of dependence.
“I educate patients about potential
risks and benefits, emphasize the
importance of following a healthy diet
and exercise regimen instead of focusing
on the medication as a quick fix, and
also provide clear information about
costs and insurance coverage options,”
said nurse practitioner Tobi Agbelusi,
APRN, FNP-BC.
Medicated Weight Management
The experience of medicated weight
management is different for every
individual. Some patients use weight
loss medication for a short period of
time, while others use it long term. The
lifestyle changes required for successful
medicated weight loss include dietary
changes, hydration, sleep, and exercise.
Managing these lifestyle changes is also
different for everyone.
“This is why we have a team which
includes a nurse practitioner and
dietician to guide patients in meeting
their goals,” said nurse practitioner
Jessica Erisman, DNP, CRNP, FNP-C.
A common hesitation to medicated
weight management is medication side
effects, which Erisman said varies
depending on the drug and the person.
Each patient is educated on potential
side effects before being prescribed a
medication and the providers ask about
side effects at each visit.
“Often times we can recommend
tips and tricks to make side effects
manageable. Other times we may have to
change to a different medication until we find what works for the individual
patient,” Erisman said.
Another way of managing side
effects is to start patients with a lower
dose and gradually increase the dose
as tolerated, Agbelusi said. She also
encourages patients to eat small
frequent meals, avoid high-fat foods,
sugary foods, stay hydrated, avoid
triggers, and manage stress levels in
order to mitigate the side effects. To
learn more about medicated weight
management see sidebar “Ask the
Provider” on prior page.
Bariatric Surgery Options
The CalvertHealth Weight Management
Team has two robotic surgeons on staff
who specialize in minimally invasive
bariatric surgery, also known as
metabolic or weight loss surgery.
“Trying diet and exercise before
seeing the weight management team
is not a prerequisite to bariatric
surgery,” said Dr. Dalencourt. During the
treatment, the team will partner with
the patient for the necessary lifestyle
changes before and after surgery.
“You have to make changes in
how you approach your daily life. You
have to learn to eat right. The surgery
will not change your life; you need to
change your life so the surgery will help you meet your goals for your life,”
Dr. Dalencourt said.
Each patient has a plan to follow
with diet and exercise. This diet plan
starts at the first appointment even
before bariatric surgery. A typical
post-surgical diet starts with fluids and
advances slowly to more solid food over
one to two months. Most importantly,
the diet involves eating more healthy
balanced meals with lean protein,
fruits and vegetables, and healthy
carbohydrates.
“Taking the big step of surgery
helps patients take more healthy living
steps more easily,” Dr. Dalencourt said.
The surgery maximizes the efforts each
patient makes.
“The most common myth is the
minute you have weight loss surgery you
can’t enjoy life. Actually, we want people
to enjoy life. We just want you to eat well
and have life to enjoy,” he said.
The types of surgeries offered fall
under two types: sleeve and gastric
bypass. Most of the time, patients are
able to be back at work within two
weeks of surgery. Robotic surgery
reduces pain so there is less need for a
long time off work and less time needed
on pain medication. Both surgery types
are considered metabolic surgery. A
common misconception of these types
of surgeries is that it makes the patient
eat less. The surgeries do change the
anatomy to make the stomach smaller,
but this is a “training wheel” so people
can re-learn their hunger needs and
hunger cues. Reducing the stomach size
resets the satiation cues.
The surgeries work to change
a person’s anatomy to change the
hormonal response of the body. Weight
loss medication does the same thing to
the body hormonally that weight loss
surgery does. For example, gastric
bypass surgery reroutes the direction
of food which increases the amount of
GLP1 hormone in the body which leads
to increased metabolism and decreased
hunger. Sleeve surgery removes 70% of
the stomach, which removes 70% of the
hunger hormone.
The lifestyle changes involved with
metabolic surgeries come with huge
benefits. Dr. Dalencourt said a patient
with stage 3 kidney disease had surgery
and saw better kidney function in less
than six months and as a result, didn’t
need to consider dialysis. Patients who
enter the hospital on the day of surgery
on insulin for type 2 diabetes can expect
to leave the hospital without having type
2 diabetes due to the drastic changes in
hormonal response that the surgeries
can accomplish.
“The misconception is your life
ends when you have weight loss
surgery. You actually improve your
life,” Dr. Dalencourt said.
Weight and Overall Health
Weight management isn’t only about looking and feeling
a certain way in your body – it’s a crucial aspect to manage
overall health. When you take steps to manage your weight and become
healthier, you also reduce your risk for severe and often fatal conditions.
Obesity is associated with a higher risk of 13 types of cancers, which
make up 40% of all cancer cases in the country. These include breast
cancer, colon and rectal cancer, ovarian cancer, and pancreatic cancer.
According to the Centers for Disease Control and Prevention (CDC), risk
of cancer increases with the more excess weight a person gains and the
longer a person is overweight.
- Higher risk of high blood pressure and high cholesterol, which are risk factors for heart disease.
- Higher risk of Type 2 diabetes
- Risk of breathing problems including asthma and sleep apnea
- Risk of joint problems
- Risk of gallstones and gallbladder disease
The good news is with weight management, the risk is significantly
reduced for many conditions and in some cases, can reduce or eliminate
the need for treatment of other conditions.
Healthy Brain and Body
For millions of Americans, the prospect of losing weight is a
sensitive topic due to themselves or a loved one suffering from
an eating disorder.
Eating disorders are serious health conditions that must be well-managed.
Weight loss surgery and medication is not recommended for those who have
an eating disorder. The underlying disorder must be addressed before medical
weight management can be considered.
At CalvertHealth, a referral will be made to a mental health clinician if a
patient seeks help from CalvertHealth Weight Management.
If you or a loved one needs help, go to
https://www.nationaleatingdisorders.org/get-help/ for treatment and hotline information.
Ask the Provider: Weight Loss Medication - Jessica Erisman, DNP, CRNP, FNP-C
Q: Who is a good fit for surgery vs medication?
A: There is no one-size-fits-all set of prerequisites that would make someone a
good candidate for weight loss medication, other than a BMI in the overweight
or obese category (BMI over 25). There are some medical conditions that may
make one medication a better option than another, so it is important to know the
patient's medical history in making that decision. The decision between surgery
and medication is often patient preference.
Q: What are the most common hesitations you see about
going on weight loss medications and how do you
address them?
A: The most common hesitations about going on weight loss medication I see
are concerns about side effects, concerns about needing to stay on medication
long term, and cost of medication. These, as well as any other concerns, should
be discussed with the provider before a medication is prescribed so the patient
knows what to expect.
Q: What options are there for patients to be able to afford
weight loss medication?
A: Insurance coverage for weight loss medication is a benefit that employers have
to opt in to. I always recommend patients call their insurance company to ask about
coverage for weight loss medication or to contact their HR benefits administrator
ahead of time. There are some weight loss medications that are more affordable
out of pocket if insurance coverage is not an option and I use these often along with
GoodRx and manufacturer coupons to help mitigate cost concerns.
Q: How do patients partner with the dietitians on staff?
A: Our dietitians are an invaluable resource for our patients. We encourage every
patient to meet with the registered dietititan to come up with a plan for how and
what they should be eating, which is very individualized depending on age, gender,
height, starting weight and any chronic conditions. The dietitian will inform them
of their calorie and macronutrient needs and also help them with meal planning,
among any other dietary needs the patient may have.
Q: What is the one thing you wish everyone knew about
weight loss through medication and/or the approach to
weight loss treatment at CalvertHealth?
A: Weight loss is possible for everyone despite age, mobility level, chronic
conditions or any other perceived barriers. The clinicians at CalvertHealth Weight
Management have trained in this specialty to help patients overcome a variety of
barriers and lose weight successfully. We view our relationship with patients as a
partnership – we want you to feel like you have the support you need to
be successful.