Sanjay Kalra  ( Department of Endocrinology, Bharti Hospital, Karnal, India. )
Saurabh Arora  ( Department of Endocrinology, Dayanand Medical College and Hospital, Ludhiana, India. )
Nitin Kapoor  ( Department of Endocrinology, Diabetes and Metabolism, Christian Medical College, Vellore (TN) -632004, India, and Non Communicable Disease Unit, Melbourne School of Population and Global Health, Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, Melbourne, Victoria, Australia. )

Obesity has reached pandemic proportions across the world. Though novel therapies continue to emerge to promote weight loss, long term maintenance of the lost weight is one of the major challenges in obesity management. A multidisciplinary team approach is often useful in recommending the best patient centric method of losing weight, but this requires constant motivation, guidance, support and need for troubleshooting at times of need. To address this, we propose a new avatar in the obesity management of obesity called the “Baro-Buddy” which is a portmanteau, derived from ‘baros’(weight) and buddy (friend). This brief manuscript describes the eligibility, role and utility of a barobuddy in day-to-day management of obesity.

 

Keywords: Barobuddy, obesity, overweight, peer support, person-centered care.

 

DOI: https://doi.org/10.47391/JPMA.22-004

 

The Challenge

 

Obesity has reached pandemic proportions globally and in the south Asian region.¹ Though many individuals are able to achieve short term weight loss, long term weight maintenance is often a major challenge for people living with obesity. Obesity management guidelines list various means of treatment: behavioural therapy, lifestyle modification, pharmacotherapy and surgery.² In practice, however, it is difficult for persons living with obesity to adopt new behaviours, and to adhere to them long term.³ The obesity care team meets the person living with obesity for a short period of time, and at infrequent intervals. Behavioural change, on the other hand, is a lifelong process which needs sustained motivation.⁴ Psychologists and behavioural therapists  do help, but this is a human resource which  is not available or accessible to all.

 

The Concept

 

To overcome this, we suggest the use of “Baro Buddies”. The word barobuddies is a portmanteau, derived from ‘baros’(weight) and buddy (friend). A barobuddy can be a health care professional, a paramedical personnel, a lay person with interest in obesity management, or a close family member/friend. At times it may be also another person living with obesity who has been successful in weight management and is able to motivate others to maintain weight.

The  responsibilities of a barobuddy are the same as those of a buddy: to support acceptance of healthy diet, physical activity patterns and behaviours. Depending upon his/her ability, and the needs of the person being treated, the barobuddy may provide encouragement, psychological, support and information or active treatment tips. He/she may help in troubleshooting, whenever required. Examples of such help include learning how to decline an invitation to an ‘unhealthy’ event, handling a minor side effect of medication, and sourcing nutritious foods or exercise options in the locality.

The barobuddy acts as a facilitator for communication between the person living with obesity, and other stakeholders in health. These stakeholders include the family, friends, colleagues at school/work, and health care professionals.

The barobuddy may work to empower caregivers, such as family, to understand what food to cook and how to serve it. The concept of culinary happiness can be introduced in obesity care by barobuddies. The barobuddy can serve communication gaps between the person living with obesity management more efficient.

The barobuddy may himself/herself be a person living with obesity who has successfully managed weight in the past. The impact of counselling by such a person may be much more impactful than some health care professionals. Leading by example through a structured peer support group has been shown to be very effective in managing other chronic diseases.^5-7

Though barobuddies may already exist in current day practice in anecdotal cases like a gym instructor or a dietitian, but formalizing their nomenclature as a barobuddy will promote the widespread use of this avatar and strengthen the fight against the obesity pandemic.

 

The Corps

 

We suggest a few pragmatic steps to create a corps of barobuddies, and involve them in obesity care.

1. Train existing health care staff in the basics of obesity management, including communication and support skills. Encourage them to act as barobuddies to people living with diabetes.

2. Equip qualified  professionals, such as dieticians and physiotherapists, with certification in obesity care,  and utilize their skills as barobuddies.

3. Train people who have successfully overcome obesity in themselves or their family members, and create a team of lay barobuddies.

4. Create a peer support group of persons living with obesity, on the lines of Alcoholics Anonymous, and term it Barobuddies.

5. Offer barobuddy support through digital therapeutics programmes. Such support can be integrated into interventions for persons living with obesity, diabetes or PCOS.

 

The Crux

 

As we grapple with the obesity pandemic, out-of-the-box solutions will be needed for its management. Barobuddies provide a much-needed strength to our fight against obesity. Barobuddies can also be facilitated by a clinician running an obesity management center, by having a group counselling session once a month for a small group of patients with a similar barophenotype attending the clinic.⁸ People who have lost significant weight can share their experiences and others can clarify their queries and discuss viable options for facilitating weight loss options in their locality. The key roles of a Barobuddy is summarized in Figure.

 

 

 

Summary

 

We propose a new avatar in the management of Obesity called the “Barobuddy” as an important person in facilitating the management of obesity. The barobuddy apart from facilitating the action plan laid out by the treating team akin to diabetes and respiratory educators, also forms an important link between the patient and the treating team. This will help patients to clarify their basic queries from educators.

 

References

 

1.       Verma M, Das M, Sharma P, Kapoor N, Kalra S. Epidemiology of overweight and obesity in Indian adults - A secondary data analysis of the National Family Health Surveys. Diabetes & Metabolic Syndrome: Clinical Research & Reviews. 2021. 2021;15:102166. doi: 10.1016/j.dsx.2021.06.003.

2.       Kapoor N, Sahay R, Kalra S, Bajaj S, Dasgupta A, Shrestha D, et al. Consensus on Medical Nutrition Therapy for Diabesity (CoMeND) in Adults: A South Asian Perspective. 2021;14:1703-28.

3.       Kalra S, Kapoor N, Kota S, Das S. Person-centred Obesity Care - Techniques, Thresholds, Tools and Targets. Eur Endocrinol. 2020;16:11-3.

4.       Kalra S, Kapoor N, Bhattacharya S, Aydin H, Coetzee A. Barocrinology: The Endocrinology of Obesity from Bench to Bedside. Med.Sci.2020;8:51.

5.       Lotfaliany M, Sathish T, Shaw J, Thomas E, Tapp RJ, Kapoor N, et al. Effects of a lifestyle intervention on cardiovascular risk among high-risk individuals for diabetes in a low- and middle-income setting: Secondary analysis of the Kerala Diabetes Prevention Program. Prev. Med.2020;139:106068.

6.       Kapoor N, Lotfaliany M, Sathish T, Thankappan KR, Tapp RJ, Thomas N, et al. Effect of a Peer-led Lifestyle Intervention on Individuals With Normal Weight Obesity: Insights From the Kerala Diabetes Prevention Program. Clin Therap. 2020;42:1618-24.

7.       Aschbrenner KA, Naslund JA, Gorin AA, Mueser KT, Scherer EA, Viron M, et al. Peer support and mobile health technology targeting obesity-related cardiovascular risk in young adults with serious mental illness: Protocol for a randomized controlled trial. Contemp. Clin. Trials. 2018;74:97-106.

8.       Kapoor N, Kalra S, Kota S, Das S, Jiwanmall S, Sahay R. The SECURE model: A comprehensive approach for obesity management. J Pak Med Assoc. 2020;70:1468-9s.