Medical Partnerships

The Problem:

  • Obesity rates and chronic risk factors continue to rise
  • There are no local healthcare infrastructures in place to exclusively focus on & treat obesity
  • One-dimensional approaches to weight don’t work and yield high failure rates
  • Treatment requires understanding and addressing underlying factors
  • High risk patients can be identified, but the hand off to an actionable treatment is sometimes nonexistent

The Synovia Solution:

  • Innovative, community-based multidisciplinary model
  • A new category in healthcare: a sensitive, comprehensive approach to weight loss
  • Hybrid use of technology to help assess, manage, and improve quality care
  • Partnering and coordinating care with the medical community

How We Partner with the Medical Community

Partner with Synovia

Since our beginning we knew that our model must work in partnership with the medical community.

Primary Care Physicians

When PCPs identify overweight and obese individuals, CoreLife provides a trusted resource that previously did not exist.

Surgeons

For any surgeon that determines weight reduction and management is necessary before a surgery (to reduce complication risk and improve outcomes) or after a surgery (to avoid re-admittance and enhance outcomes)

Specialists

For any specialist (ENT, Endocrinologist, etc) that determines BMI optimization would help improve, impede or prevent a diagnosis.

Synovia is:

  • Comprehensive
  • Tailored
  • Professional and Compassionate
  • Partnered with experts in the medical community

Synovia has the expertise and resources to treat obesity and our programs can help clients to be more successful because we work in support of the referring physicians to coordinate care and maximize patient outcomes. This provides physicians with more time to manage and care for their patients.

Patient Care and Obesity

Obesity can result from a combination of causes and contributing factors.  Examples include age, genetics, lifestyle, activity, diet, medical problems, medications, socioeconomic issues, pregnancy, lack of sleep, and more. It also directly affects the care you give your patient.

Risks for people who carry too much weight:

It is established that if a patient is overweight they are more likely to develop health problems, including:

  • Type 2 diabetes
  • High blood pressure
  • Metabolic syndrome
  • Heart disease
  • Stroke
  • Cancer

How can Synovia assist you in your practice?

When PCPs identify overweight and obese individuals, Synovia provides a trusted resource that previously did not exist. In addition, Synovia identifies patients without a PCP or an undiagnosed condition that is then referred back to the PCP for further care and assessment.  In this capacity,Synoiva acts as an additional touch-point for high risk patients and can help direct them back into the healthcare system for the care they need, decreasing the likelihood of a more serious diagnosis. Synovia has the focus, time, expertise and tools to treat obesity and its lifestyle and environmental factors; our care delivery system has shown to be more successful because we work in support of  the partnering physicians to coordinate care and maximize patient outcomes.

Bariatric Pre-surgical Program

CoreLife works in support of you, the surgeon, to maximize surgical outcomes and enhance total health by providing medical oversight, nutritional education, tailored exercise, and behavior counseling.

Meets all insurance and surgical program requirements

Our professionals adhere to the specific protocol of your Bariatric Center to satisfy established pre-surgical requirements, offering the best opportunity for long-term success. By accepting insurance, we are able to perform these services more cost-effectively for your patients, making us more accessible than other weight-treatment options.

Program Planning Considerations for Prediabetic/Diabetic Patients

Within Synovia we have developed a special prediabetic/diabetic clinical pathway.  While many core pieces of our care delivery remain similar to our general weight loss patients, there are some specific differences tailored to the needs of the diabetic or prediabetic patient.

One of the main similarities is that many of our daily intake recommendations remain unchanged. This occurs because our ideal macro-nutrient ratio for most of our patients already lines up with the ratios most commonly cited in diabetes studies and recommended by diabetes educators.
For those that don’t have specific allergies, dietary restrictions (e.g.,veganism), or issues such as kidney disease we guide our patients towards an ideal macro-nutrient ratio comprised of protein, fat, and carbohydrates. However, all of our plans and programs are individualized, so we start by evaluating the patient’s current intake pattern, also factoring in their readiness to change. We then adjust their initial goal accordingly to ensure that it’s achievable and not too drastic of a change from the dietary standard to which they are accustomed. The goal is adjusted over time as new habits are formed to ultimately get as close as possible to the ideal ratio.
One difference in pathway for our diabetic patients is an increased fiber intake goal. For non-diabetics under 50, we recommend 35g/day for men and 25g/day for women. With our diabetic patients we recommend an increase (if tolerated) to 40g/day and 30g/day, respectively.
We also encourage all of our patients to consider tracking and logging their intake, whether it is through an app on their smartphones, a fitness tracker, or a simple diary on paper.  Patients who can make logging a habit tend to hold themselves accountable more reliably; this is especially important for our diabetic patients. While our non-diabetic patients understand that individual meals or snacks can be a little off as long as they still achieve their goals for the overall day, our diabetic patients need to be more careful to control their blood sugar levels. We set goals for the maximum number of carbohydrates consumed per meal and per snack. The exact grams for each will depend on the individual’s overall calorie goal and recommended number of snacks for their schedule and lifestyle. It is important to note that many of our patients are beginning organized exercise programs for the first time in their lives. Whether they are exercising with our trainers in our studio or on their own we recommend a pre-workout protocol to avoid hypoglycemic complications.

Example Protocol

When significantly reducing overall intake, insulin-dependent diabetics also need to adjust their medication dosages. We strongly encourage these patients to regularly test their blood sugar levels so they can adjust their insulin accordingly.

Process Diagram

Orthopaedic risks in people who carry too much weight

In orthopaedics, evidence is mounting that a high BMI can cause or exacerbate musculoskeletal conditions, such as osteoarthritis, and diminish treatment outcomes. For example, being overweight increases the risk of wound infection, pulmonary complications, deep vein thrombosis, pulmonary embolism, myocardial infarction  and other complications following orthopaedic surgery.

Drawing of runners

How can Synovia help?

The forecast for surgical outcomes can be greatly improved, especially with regards to postoperative joint function, by having patients lose weight and reduce BMI before undergoing joint replacement surgery. Weight loss may potentially decrease the pain to the point where surgery will no longer be needed. Weight loss may also be able to delay the procedure for a number of years. Artificial joints need to be replaced every 15 years, on average, so delaying the surgery is a positive thing.

Care at Synovia

The team-care approach at Synovia is used to treat overweight and obese patients with hip and knee arthritis.  With our well-rounded approach, we can help the patient lose weight, improve their health, and optimize nutrition before joint replacement to maximize its benefits.

Drawing of a family

Polycystic Ovarian Syndrome (PCOS)

PCOS is an endocrine disorder that occurs in 9-18% of reproductive aged women and has a strong familial genetic link. Of this population, 95% of these women are obese. PCOS is a chronic condition characterized by elevated levels of androgen hormones (ie, mainly testosterone) from the ovaries and is closely associated with insulin resistance. The overproduction of these androgens in women is associated with hirsutism (excessive hair growth on the face and body), acne skin problems, alopecia (male pattern baldness), and irregular or absent menses. Insulin resistance (IR) occurs in approximately 50%-70% of women with PCOS. Insulin resistance causes weight gain in the abdominal area leading to increase in visceral stores. Studies have shown that high visceral fat stores are linked to an increased risk in developing cardiovascular disease (CVD) and diabetes. According to one estimate, up to 50% of women with PCOS develop Type 2 Diabetes by the age of 40. Hyperinsulinemia is associated with weight gain which leads to insulin resistance which results in further weight gain. This vicious cycle of weight gain is why so many patients with PCOS struggle with not only weight loss but maintaining a healthy weight as well. In addition to metabolic complications, there is also a close relationship with binge eating/over restricting behaviors due to changes in glucose levels leading to insulin changes. These eating behaviors also contribute to depression and anxiety issues due to unstable weight control. In summary, all women with PCOS would benefit from CoreLife services because the medical staff and registered dietitians can monitor their diet and lifestyle to help improve health outcomes.

Diet and Lifestyle Recommendations for Living with PCOS:

Hyperinsulinemia is the greatest predictor of hormone imbalances related to PCOS and the first line of intervention is diet and lifestyle changes. Hyperinsulinemia causes the body to store fat in the abdominal area increasing the waist circumference. In addition, the higher insulin levels also leads to higher testosterone levels which consequently interferes with ovulation and menstrual cycles. IR can lead to cause hypoglycemic events which leads to an increase in carbohydrate cravings. An increase in waist circumference is also a risk factor for developing CVD. Dyslipidemia is the most common metabolic abnormalities that impacts HDL levels, total cholesterol and triglycerides. Due to the nature of these risk factors, women with PCOS are also at higher risk for developing Cardiovascular Disease (CVD). Post menopausal women with PCOS are also at higher risk for CVD due to the hormonal changes having a worsening effect on lipids as they age. At CoreLife, all patients with PCOS have access to a Registered Dietitian to help develop a diet and exercise plan that could reduce their risk of furthering metabolic processes. In creating a diet plan, it is important to consider preventing hypoglycemic and hyperglycemic events, so the recommended pattern is to ensure that complex carbs are paired with lean proteins at main entree times. In addition, every CoreLife location has a gym with personal trainers to aid with new lifestyle changes.

We recommend all of our patients at CoreLife track their daily intake. In studies, daily food journaling has shown that those who track consistently lose 25% more weight than non trackers. Tracking is easy and adds a level of accountability to help the patient stay on track while adapting to a healthier diet and lifestyle.  Many of our patients have never participated in regular fitness routines and therefore are just getting started with lifestyle changes. A weight loss change of 5-10% has a positive impact on some metabolic parameters and therefore the need to increase physical activity is an important component to overall health outcomes. All patients are encouraged to participate in regular activity by utilizing CoreLife gym and trainers to help achieve their goals. At the CoreLife locations, gyms are available for clients to use and can  work with a certified personal trainer to develop individualized fitness plans.

Pain Management

Joseph E Stapleton, MD RD LDN

With obese patients, weight loss should be an important element of pain rehabilitation. Chronic pain can have many sources: arthritis, a lingering bone or joint injury, fibromyalgia, chronic fatigue syndrome, etc. However, one common thread throughout chronic pain patients is inadequate nutrient intake. Coupled with a higher rate of chronic pain amongst obese individuals, it becomes clear that nutrition plays a large role in both combating and limiting chronic pain. This is where CoreLife can help. While our primary concern is weight loss, that in and of itself can have overarching effects. When BMI is lowered, stress on joints is lifted, reducing pain, or alleviating it altogether.

Inflammation and Chronic Pain

Inflammation is an important factor in chronic pain. In many cases (such as osteoarthritis) it is a major player in causing pain; in other scenarios it acts as a multiplier to it. Thus, it is important to consume foods that are known to be anti-inflammatory while limiting intake of foods suspected to cause inflammation.  Nutritionally, foods that are inflammatory tend to be foods that CoreLife already encourages patients to limit, with anti-inflammatory foods lining up well with our general recommendations.

How CoreLife Works with Chronic Pain

Regular exercise can reduce inflammation and chronic pain. Many individuals with chronic pain avoid exercising in the area where their pain originates or avoid exercise altogether, when safe, guided exercise can actually alleviate pain. If a specific joint gives an individual trouble, then strengthening the muscles around that joint takes strain off it, reducing the pain. The best way to do that is by working with a therapeutically minded personal trainer within the activity guidelines provided by your primary care physician or specialist for your chronic pain. The act of losing weight itself will also help to ease the strain on chronically hurting joints and bones, simply by lowering the load that they must bear daily.   Similarly, the reduction in blood pressure expected as hypertensive obese patients lose weight can have a large effect on chronic inflammation and patients that suffer from migraines.

Supplementation can be helpful in reducing inflammation related pain, as research works to confirm many hypothesized mechanisms of action.  B vitamins play a role, so we would recommend that chronic pain patients utilize our CoreVite injections. Glucosamine has been shown to have an effect with joint and bone related pain, but do not recommend to those with shellfish allergies or to diabetics taking insulin, as it can limit their medication’s effects. Fish oil is another supplement that can be beneficial to patients, along with standard protein supplementation for those that cannot meet their elevated protein goals from whole foods alone.

Lastly, if part of a patient’s chronic pain management plan from their doctor includes opioid medications, then we need to address their some of their most common side effects. Sedation/lethargy can hinder patients getting physical activity into their day, along with potentially masking important pain signals during bouts of exercise. Its is recommended that patients schedule workouts with a trainer and that they schedule them so they take their dose of pain medication after their workout rather than before. Constipation is very common, so proper fiber and water intake must be reinforced. Nausea can lead to improper intake, especially limited protein intake, so effective strategies unique to the patient need to be developed to ensure proper intake.

Weight Loss & Management   –    HRA/Biometric Screening  –   On-Site Fitness/Health Centers
CoreLife provides specific employee benefit programs that may be offered independently or within an existing wellness program. All employee programs are available at your workplace or at a CoreLife office.

On average, over 70% of your employees are overweight or obese and less than 10% of those high-risk employees engage in “traditional” employer sponsored programs. At CoreLife we provide weight management, fitness and health programs that are designed to target high-risk employees and maximize employee engagement. As weight management specialists, we are uniquely qualified to manage employee health programs.

  • Engages high risk employees
  • Can be offered independently or within existing wellness program
  • Ability to customize benefit that matches CoreLife services with the goals of the company