Florida International University
Title: Weight management in a patient on psychotropic medication
Dr. Oscar Hernandez finished post-doctoral training in Internal Medicine and Pediatrics at Michigan State University. He is board certified by the American Board of Internal Medicine, American Board of Pediatrics and has been in private practice for over 30 years in Miami, Florida, USA. He has passed the Certifying Examination of the American Board of Obesity Medicine and is the founder of Florida Bariatrics and Nutrition. He practices primary care and obesity medicine helping thousands of patients who suffer from cardiometabolic illness and his work has been featured on the documentary “600 Pound Mom” on Discovery Channel, “Race Against Time” on TLC, and “Fat City” on Discovery Life. He is the host of the weekly “Health Talks” program on 90.9 FM (USA). His background as a private practitioner in primary care provides an excellent example of how collaboration between primary care physicians and psychiatrists can be achieved in a community setting.
Each year millions of patients are started on psychotropic medications as part of comprehensive psychiatric management for many mental health issues (1). Often these medications are weight positive and worsen cardiometabolic problems in a population already at risk (2, 3). The author examines the collaboration between psychiatrist and internist resulting in significant weight loss in the case of a patient with obesity, cardiometabolic problems and mood disorder. The author and investigator is a general internist and primary care provider in private practice.
A randomly selected patient on psychotropic medication for mood disorder was seen by the investigator in a community based medical weight loss service. The patient gave informed consent for the author to communicate with their psychiatrist. The patient had related cardiometabolic illness including obesity, metabolic syndrome, elevated lipids, high pressure, diabetes and suspected sleep apnea.
The investigator proposed a change of psychotropic medication to the psychiatrist who in collaboration with the investigator internist made the change. Additional lifestyle changes, activity program and weight loss medications approved by the United States Federal Drug Administration (4) were integrated into the patient’s weight loss program. Significant weight loss was achieved and all cardiometabolic outcomes improved. This allowed for cessation of diabetes and high blood pressure medications while maintaining normal pressures and acceptable hemoglobin A1C levels (5).
The patient was followed over a 6-month period with no negative psychiatric effects of the medication change. The patient’s cardiometabolic outcome significantly improved