Can a PA specialize in nutrition and weight loss?

[Bailsofheyy]

Hi! I’m currently an undergrad studying Nutritional Sciences and I’m thinking about PA school after. I love how there are specialities and I’m wondering if there is one for weight loss and working with patients who need to work on weight management. Is this a type of specialty or fall under a specific one? Thanks for the advice! 

[thinkertdm]

Yes, its called primary care.  Its the most special.  Love your go-to attitude!  I knew a PA who was a nutritionist turned PA.  The problem is, you bill higher as a PA than as a nutritionist.  But there are special clinics with that specialized knowledge.  

the fact of the matter is, once you have that PA degree, you can do what you want to do.  Sometimes it may take some work to find.  But you will have the knowledge to excel in a field of never ending possibilities.  

This post made possible by the contributions of hope and opportunity.  And the letters U and CAN.  

[Joelseff]

In PC I did A LOT of weight loss/Obesity mgmt and dietary consultation. My CP was a FP who did non surgical bariatric med on the side. I picked up a few things. They do have Bariatric PAs out there who only do obesity med.

Sent from my SAMSUNG-SM-G891A using Tapatalk

[Cideous]

Yes, there was a weight loss clinic hiring a PA/NP a few years ago.  All they did was weight loss, non-surgical.  Boring, but a no brainer type of work.  They paid no benefits though.

[thinkertdm]

2 hours ago, Cideous said:

Yes, there was a weight loss clinic hiring a PA/NP a few years ago.  All they did was weight loss, non-surgical.  Boring, but a no brainer type of work.  They paid no benefits though.

For the right person, its a mental challenge, how to convince, cajole, make, persuade, wheedle, coax, talk into, maneuver,  beguile, blarney, flatter, seduce, lure, entice, tempt, inveigle someone into changing.  Well, I would avoid seducing.  And luring.  Maybe even enticing.  

Anyways, its a game of chess.  Like two submarine captains.  "The Hunt for Red October" in an exam room.

[cbrsmurf]

At Kaiser, there are APP's that work specifically in weight loss and nutrition/diet.  It's called "positive choice."

[BirdDogPA]

A classmate of mine practices weight loss medicine.  He does a lot with nutrition and hormone replacement. Seems like a very cushy job. 

[surgblumm]

With the increase in DM in the United States and the large number of patients who have yet to be diagnosed, the answer is yes. I would suggest getting a CDE which is available in a course that is easily attended and working in endocrinology, weight loss or attching your self to a bariatric surgery practice as the person who becomes the the "life changer."

[sas5814]

You can specialize in just about anything. The question is...can you earn a living while doing it? Probably. You just need to be in the right place.

[surgblumm]

Interesting that you asked this question. If you are an FP or IM PA and have worked with DM and perhaps have a CDE certification, there is no reason why you cannot involve yourself in this. I would guess that any PA in medicine could also do this if it is within the scope of their SP. I had a question about being a Type 2 DM patient with Grade lll CKD so I sent  and PAs and NPs.a email to my PCP and requested that he or his NP answer this. This is the diet I sent him as it is a summary for physicians concerning Optivia. I tried to send the link, however, it is on the bottom of the page.

Robert Blumm <surgblumm@gmail.com>

 

 

 

 

 

 

 

https://optaviamedia.com/pdf/health-professional/OPTAVIA_DOC_Overview-for-HP.pdf

 

[True Anomaly]

Having gone through a pretty significant physical transformation myself recently, I’d say it would be incredibly difficult to have a practice where you teach people proper nutrition and fitness that is profitable.  I also think you truly need a fundamental understanding of how nutrition works- not just prescribe some easy plan that may not be right for the patient

That being said- there is so much good information on YouTube featuring actual PhD’s in nutritional science or actual dietitians, coupled with evidence-based videos on muscle growth and development without resorting to supplements- all for free.  The right clinician could help a patient sift the good info from the bad featured on some videos

[SedRate]

1 hour ago, True Anomaly said:

it would be incredibly difficult to have a practice where you teach people proper nutrition and fitness that is profitable.  I also think you truly need a fundamental understanding of how nutrition works- not just prescribe some easy plan that may not be right for the patient

  The right clinician could help a patient sift the good info from the bad featured on some videos

Recently read a research paper as a part of a CME regarding obesity, Obesity Pathogenesis: An Endocrine Society Scientific Statement, and it discusses how obesity is a much more complicated issue than the basics we're all taught such as cals in cals out, exercise, types of food, etc. It's a dense, scholarly paper so not light reading by any means but extremely enlightening. I now have a new appreciation for what obese pts have gone thru in their weight loss journeys as they often fail given the complexity of the issue. 

To those above who say weight loss medicine may be a cush or easy job, sure, that may be so. But I'd argue obesity medicine is a much more complex field if you're also helping to manage other comorbidities as well which some obesity specialists might and should do. You may be seeing these pts weekly or biweekly initially. That's gotta keep your clinic pretty busy, I'd think, especially if you're also managing obese pts' diabetes, HTN, cholesterol, joint pains, thyroid, etc. 

The obesity CMEs I recently did thru AAPA talked about addressing obesity first and foremost as obesity essentially worsens or contributes to progression of a large number of acute and chronic diseases. Obesity is often something I think is overlooked as it's so common and commonly accepted now, even in healthcare professionals who are treating pts. According to Healthy People 2020, about 40% of the general population in the US is overweight or obese. 

Anyways, as someone in orthopedics, I see a fair number of these obese pts. I try to always discuss their weight and how it affects their broken limb that we fixed, especially when it's a leg, as well as their increased risk for infection and reoperation. I also discuss how carrying extra weight increases the amount of stress on their joints, predisposing them to arthritis. It amazes me when I get a look of shock from some of these pts when I discuss their weight. It's as if no one's really told them how significant of a problem it is, which I'm sure and hope healthcare professionals have. 

Edited January 11, 2022 by SedRate

[surgblumm]

I am hearing what you suggested True Anamoly and would it not be nice for AAPA to gather all of these sites and make an information sheet for PAs to give their patients and add a piece of how PAs help patients to both become healthy and experience wellness as a service ? Maybe one of the higher ups can send the academy a message. It would be a good PR matching that of NPs.

[rev ronin]

Simple question:

Is obesity (that is, weight more than average, BMI >30) a disease, a symptom of other conditions, or a human characteristic that is not necessarily pathological?

 

[True Anomaly]

On 1/11/2022 at 6:08 PM, rev ronin said:

Simple question:

Is obesity (that is, weight more than average, BMI >30) a disease, a symptom of other conditions, or a human characteristic that is not necessarily pathological?

 

I’ll bite

I would say it’s pathological, as it is so closely associated with true pathologic disease patterns.  However, it’s also a symptom of how our society functions that takes advantage of our wants and needs.  Calorie-dense food is available EVERYWHERE, and a lot of it is not very satiating- so we tend to overeat a lot because being hungry is not what your body wants.  And with so many opportunities to overeat without thinking about it- whether it’s parties or family gatherings or food in the office or festivals or concerts or sporting events- it’s so incredibly easy to start putting on weight without thinking about it too much until it becomes really noticeable.

[MediMike]

On 1/11/2022 at 4:08 PM, rev ronin said:

Simple question:

Is obesity (that is, weight more than average, BMI >30) a disease, a symptom of other conditions, or a human characteristic that is not necessarily pathological?

 

Yes.

[ventana]

On 1/11/2022 at 7:08 PM, rev ronin said:

Simple question:

Is obesity (that is, weight more than average, BMI >30) a disease, a symptom of other conditions, or a human characteristic that is not necessarily pathological?

 

it is a reflection of the food supply and society....

[EMEDPA]

5 hours ago, ventana said:

it is a reflection of the food supply and society....

and the development of the internet. Why walk a few blocks to your neighborhood hardware store to buy something when amazon will ship it to you for less cost with free shipping? (now, no walk to the hardware store, grocery store, local restaurant, etc. It all comes straight to your door, allowing you to watch football or play video games all day long....)

pretty much any new convenience promotes weight gain. When a paved road was put into a distant indian village in Mexico, the average BMI increased rapidly over the next decade because folks no longer walked 10 miles to the nearest town, they drove motorbikes. You know how our ancestors used to catch game? They ran them to exhaustion. It was called persistence hunting. This is now practiced in just a handful of places worldwide. (Thank you medical anthro undergrad coursework). 

https://en.wikipedia.org/wiki/Persistence_hunting

[ventana]

45 minutes ago, EMEDPA said:It was called persistence hunting. This is now practiced in just a handful of places worldwide. (Thank you medical anthro undergrad coursework). 

https://en.wikipedia.org/wiki/Persistence_hunting

And here I thought persistence hunting was me going  into the woods day after day and never getting anything

[ohiovolffemtp]

15 hours ago, ventana said:

And here I thought persistence hunting was me going  into the woods day after day and never getting anything

Come visit me.  I've gotten 3 deer over the years - all in car season.  That's what happens on the way home when you're a nocturnist.

[rev ronin]

4 hours ago, ohiovolffemtp said:

Come visit me.  I've gotten 3 deer over the years - all in car season.  That's what happens on the way home when you're a nocturnist.

My wife's superpower is spotting deer while in a moving car.  Doesn't matter if they're on the road or off, nor what seat she's in. She always. Spots. The. Deer.

Probably has something to do with her older sister and both parents each having totalled multiple vehicles hitting deer in Nebraska when she was growing up. What's funnier is she's not the sort you would expect to be hypervigilant; she's an easygoing person, not edge-of-the-seat. Being bitten by a radioactive spider would have been cooler, I suppose, but oh well.

[rev ronin]

On 1/15/2022 at 12:54 PM, ventana said:

it is a reflection of the food supply and society....

 

21 hours ago, EMEDPA said:

and the development of the internet. [...] pretty much any new convenience promotes weight gain.

I think these are both, to quote ZDoggMD's mantra, true but partial.

We have an abundance of high glycemic load foods, and all of us can afford more calories than we need in a day: with hundreds of homeless in my county, they die from substance abuse or suicide, not starvation. We're optimized to seek out such foods, which came in handy in more physically demanding times, and maintain the same desires even with vastly reduced needs, as EMEDPA pointed out.

But two things are missing: 1) Diet culture and the weight yo-yo, and 2) mental health issues.

Diet culture doesn't try to lose weight legitimately, like by lifestyle changes, but by seeking out quick fixes, which the body typically interprets as starvation and essentially metabolically sabotages our efforts to lose weight.  This is a gross oversimplification, but far less of one than "increase activity, decrease calories".

Mental health issues, in our social-media-approval-addled society, disproportionately affect girls.  What happens when you combine an unhealthy attitude about size, weight, and appearance with a comorbid mental illness? You get an eating disorder--pick the ED based on the comorbid mental illness! Anxiety? ARFID or anorexia nervosa. Depression? Binge eating. Borderline personality? Bulimia nervosa.  Again, an oversimplification, but this is what I see every day in my clinic.  Fewer than 5% of patients with an eating disorder seeking treatment in my partial hospitalization program do not have at least one other diagnosed mental illness. The 40+ BMI female who will freely acknowledge that she intentionally gained weight to reduce the possibility of ever being raped or molested again is probably 1.5-2x more common than a patient with ONLY an ED--which in those cases is almost always anorexia nervosa and almost always has a family history as well as a plausible environmental trigger such as gymnastics or dance.

If I had one ask--and this is going to be touched on in my doctoral capstone project--for every primary care clinician, it would be this:

Screen for a eating disorders before you give any patient diet or exercise advice, and if positive refer for treatment instead.