KORRKORRMedical Technologies, Inc.www.KORR.COM

Treating Obesity with

Indirect Calorimetry

Evidenced-based Solution for

Primary Care Practice

KORR

Treating the Overweight and Obese

““When we win, I eat. When we lose, I eat. I also eat when we

get rained out””Tommy Lasorda / Manager LA Dodgers

Energy Intake is a major element in determining whether weight is gained, lost, or maintained….If your patient is like Tommy Lasorda, your major challenge is to help that individual manage their energy balance

Reference:Kazaks, A. Obesity: Food Intake. In: Bray GA, ed. Office Management of Obesity. Philadelphia, PA: Saunders; 2004: 91-106.

KORRRole of Provider

Provider

Patient Disease

MANAGER

Provider

Patient Disease

CONSULTANT

Typically the Primary Care Provider’s role is to Manage the disease. However, in treating obesity a more realistic role for the clinician is “consultant” or even “coach”. The patient must take the active role in managing their eating behavior.

Reference:Bessesen DH. Applying Stages of Change theory to Office-based Counseling. In: Bessesen DH. Evaluation and Management of Obesity. Philadelphia, PA: Hanley & Belfus, Inc; 2002: 33-39

KORR

Treating ObesityGuidelines for Primary Care from NIH / NHLBI

Primary Care Physician Guidelines:

Reference:

National Heart, Lung, and Blood Institute (NHLBI) – National Institutes of Health. Clinical Guidelines on the Identification, Evaluation, and Treatment of Overweight, Obesity in Adults – the evidence report. June 1998

Patient and Physician devise goals and treatment strategy for weight loss and risk factor control.

Assess reasons for failure to lose weight.

Set a diet that will create a 500-1000 kcal/day deficit, to yield a weight loss of 1-2 lbs per week

Maintenance Counseling: Dietary therapy, behavior therapy, physical activity.

KORRWhat is Needed?

When consulting the Overweight or Obese Patient:

Make the 5 minutes that is spent with the patient as efficient and

effective as possible. Remove the excuse “I have a slow metabolism”

Provide the patient the exact caloric prescription that will lead to 1-2 lbs/week weight loss

Consult the patient on the need to manage their energy balance.

Motivate the patient to be more active

KORR

Why use Indirect Calorimetryin Primary Practice?

• Set the patient on a diet that will create a 500-1000 kcal/day deficit that will lead to 1-2 lbs per week weight loss.

• Remove the excuse and the psychological barrier by showing the patient the problem is not a “SLOW METABOLISM”

• Teach the patient principles of Energy Balance using their own data.

• Assess reasons for failure to lose weight. Is it low energy expenditure or is it patient non-compliance?

KORRREEVUE by KORR

The ReeVue is the technological advancementthat makes assessment of resting energy expenditure (REE):

ACCURATE

PORTABLE

INEXPENSIVE

The REEVUE is a “Metabolic Cart” stripped down to just the components necessary to perform an accurate resting energy expenditure (REE) measurement. Simplicity of use and maintenance are key.

KORRThe Procedure

Step 1Step 1:: Medical assistant conducts procedure.Patient’s exhaled gases are

analyzed to measure the oxygen consumption and computation of Resting Energy Expenditure1 (metabolic rate)

Step 2Step 2:: Provider consults patients on results.Provider uses results to

recommend a daily caloric intake. Also, the provider consults the patient on various aspects of Energy Balance.

a. Procedure is very simple and can be performed by any medical assistant.

b. Procedure and the consult is typically scheduled as a separate visit.

Notes:

c. Procedure is CPT Coded and is reimbursed by Medicare.

1REE is calculated using the Weir equation with an assumed RQ=0.83. See “Weir, J.B., New Methods for Calculating Metabolic Rate with Special Reference to Protein Metabolism. J. Physiology, 1949 109: pages 1-9” 

KORRThe Report

The patient’s data is The patient’s data is presented in a graphical presented in a graphical format that is designed to format that is designed to educateeducate

KORR

Energy Balance = Energy In – Energy Out

Energy Out Energy In

A balance scale isused to teach the

concept of energy balance.

“To lose weight, energy intake must be less than energy expended”

The Report

Reference:Kazaks, A. Obesity: Food Intake. In: Bray GA, ed. Office Management of Obesity. Philadelphia, PA: Saunders; 2004: 91-106.

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KORRThe Report

Patient’s data is Patient’s data is presented in graphical presented in graphical format that creates a format that creates a “forum for education”“forum for education”

The patient’smeasuredmetabolic rate

Estimates of additional calories burned from lifestyle and exercise

Maintenance

Daily caloric requirement For patient to maintain their weight

Patient’s Energy Balance

Weight Loss

Daily caloric requirement for patient to lose weight

Energy Output Energy Intake

KORRProvider Consult

• Address Psychological Barriers

• Discuss a Weight loss Strategy

• Set a Caloric Prescription

• Discuss Behavioral Changes

• Send Patient home with Educational Materials

The following slides show how the test results and the report can assist the caregiver in providing an effective consult.

The power of the patient provider encounter should not be underestimated. If the patient is ready to make changes, the provider is in a key position to educate and motivate the patient. In the few minutes you have with the patient you may need to do the following:

KORR

Provider Consult

Address Psychological Barrier

Remove the excuse of a slow Remove the excuse of a slow metabolic rate.metabolic rate.

You might say…

“The test shows that you have a fast metabolic rate. You can lose weight! Now let’s discuss how to balance what you eat with what your body burns.”

The calculated predicative normal values are used for comparison.

KORR

Provider Consult

Discuss Weight loss Strategy

“To lose weight, you need to burn more calories than you eat. This is the most calories you can eat and still lose weight!”

You might say…

The report recommends a range of calories for effective weight loss

Weight loss Zone (kcal/day)

This is calculated from the measured resting energy expenditure.

Knowing the exact range for the individual may be the key to their success.

KORR

Provider Consult

Set a Caloric Prescription

“Each day you need to try and target this number of Calories. You should consider keeping a record of what you eat each day”

You might say…

Provider uses the results of the test to establish a caloric prescription.

Consult the Patient on the Amount of Daily Calories

KORR

Provider Consult

Discuss Behavioral Changes

You might say…

Caloric D

eficit

• Discuss the benefits of being more active.

• Explain that they do not want to increase the calories when they Exercise. Let this add to the caloric deficit.

“Adding exercise and increasing activity will help burn more calories and will help the weight come off faster.”

This is not a diet. This is a new way of life!

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Provider Consult

Maintenance Phase

“ You have learned how to eat to your metabolism during the weight loss. Now we just need to increase your daily calories a little bit for maintaining your weight. ”

You might say…

Energy Balance: Like balancing a checkbook, it is a life skill

Maintenance Zone (kcal/day)

The number of caloriesneeded to maintain weight is also determined by the REE measurement. The patient should be counseled to stay below the upper number of kcal / day