PAs treat people with obesity every dayit affects every specialty

March 5, 2024

By Jennifer Walker

About nine years ago, when she was practicing in family medicine, Martine Altieri, PA-C, FMG, MHS, now a cardiology PA, was struck by how her collaborating physician addressed obesity with patients. He would tell them the long-held advice about treating this disease: They needed to exercise more; they needed to eat healthier food and less of it; they needed to fill half of their plate with greens. The patients really felt apprehensive about having this conversation because of the way he approached it and mostly blamed them for gaining weight, Altieri said. I always felt bad for them. I thought, Theres got to be another way.

During the pandemic, Altieri began to take courses on obesity medicine, completing the Fundamentals of Obesity Treatment course with the Obesity Medicine Association (OMA) and the Obesity Management in Primary Care Training and Certificate Program with AAPA in collaboration with The Obesity Society. In these programs, she learned how to approach an obesity diagnosis and craft comprehensive, evidence-based plans for patients based on the four pillars of clinical obesity treatment: nutrition therapy, physical activity, behavior modifications, and medical interventions.

Then in 2022, Altieri found a way to formally bring obesity medicine into her work. She was applying for a position with MyCardiologist, a group of private practices in Florida, when interviewers asked what new ideas she could bring to their practice. Altieri expressed a desire to start an obesity medicine clinic tailored to cardiology patients. She was hired and has since been making that dream a reality.

Today, Altieri, who is based in Boca Raton, Florida, is focusing on building up the clinic to address obesity, which was classified as a chronic disease by the American Medical Association in 2013. She is also a leader, advocate, and educator in several special-interest groups and AAPA caucuses, including PAs in Obesity Medicine, for which she is director at large. Altieriwho is also the public relations chair for PAs for Women Empowerment and a co-host for the Journal of the American Academy of PAs (JAAPA) podcastvalues this role because she sees the importance of all PAs learning how to approach obesity with their patients.

Every PA should be interested in obesity medicine, she said. It affects every specialty.

Addressing Obesity in a Cardiology Practice Altieri graduated from medical school in Haiti before moving to the United States in 2008 to be with her husband. To become a physician in the U.S., she would have had to go through the lengthy process of taking the three-step United States Medical Licensing Exam and completing at least a three-year residency program. Then she learned about the PA profession through her sister-in-law, and realized that she could practice more quickly if she became a PA.

After graduating from the PA program at Miami Dade College in 2010, Altieri practiced in family medicine, urgent care, and hospital medicine before transitioning to cardiology. At MyCardiologist, about 80% of her patients are age 70 or older. Altieri has a full schedule in this specialty: She does rounds at the hospital, cares for patients in an outpatient setting, and spends a half-day a week doing implants of loop recorders, a device that looks for causes of cardiac symptoms, such as irregular heartbeats and palpitations.

Yet, Altieri still has undertaken additional responsibilities to support her patients who have obesity and other chronic conditions that can increase the risk of cardiovascular diseases. She recently finished developing a template and resources for the obesity medicine clinic, including prioritizing the medication list and working with a dietician to create food plans that are specific for cardiac patients. When creating these resources, she thinks about her patients backgrounds. If you tell a Haitian patient they need to follow a Mediterranean diet, they dont know what that is, she said. We have to be specific. I give patients specific food lists so they know what they can buy and eat.

[For more information on obesity, check out AAPAs Obesity Toolkit]

When treating obesity, Altieri has also stuck to one approach that she learned in the beginning of her courses: She asks permission before starting the conversation. Not everyone is available or willing to talk about obesity, she said. You cant just offer obesity management. They have to be ready. Altieri likes to ask, May I talk to you about obesity? If her patients say no, she knows it is not the right time to address this topic.

Altieri also manages the Ambulatory Patient Monitoring Program to offer earlier interventions for patients who have high blood pressure, heart failure, and/or obesity. This initiative focuses on at-home monitoring of blood pressure, oxygen, pulse, and weight. Patients use a blood pressure device and a digital scale that transfer their readings to their charts via the cloud. Based on these metrics, which Altieri checks monthly, she will schedule virtual visits for patients if changes need to be made to their treatment plans for hypertension or heart failure. Altieri estimates there are more than 170 patients enrolled in the program.

We are looking for opportunities to add patients who have recurrent hospitalizations for heart failure or repeated ED visits with uncontrolled hypertension, and who we feel would benefit from more care at home, she said. Our goal is to prevent hospitalization and reduce ER visits. And patients like the idea of someone looking after them.

Educating Communities About Obesity and More Altieri is involved with several groups and activities that focus on various aspects of medicine. For PAs for Women Empowermentwhich focuses on advocating and promoting leadership roles for women in the PA profession and healthcare in generalAltieri manages the groups social media accounts. She educates the community about initiatives like The Pump Act, which states that mothers in the workplace have a right to break time and a secure spot to express milk for up to one year after their childs birth, and highlights women who hold or have held prominent positions within healthcare.

In 2023, Altieri also became a co-host for the JAAPA podcast. Previously, each episode of this show was focused on summarizing and reviewing JAAPA articles. But Altieri and her fellow co-host, PA Kim Ketchersid, introduced a new concept: They started to interview the authors who published the articles.

And since 2021, Altieriwho is currently working on a certification in cardiometabolic healthhas been a founding member of PAs in Obesity Medicine (PAOM). This group offers periodic information sessions that highlight obesity medicine education programs for PAs. PAOM also hosts webinars on obesity medicine topics throughout the year, such as a recent CME presentation on approaching and treating obesity from the endocrine perspective.

PAOM, whose membership has grown by 32% in three years, also plans to hold a meeting at AAPA 2024 in Houston, Texas, where several board members will present on obesity medicine. The groups goal is to reach as many PAs as possible with education and resources about the growing specialty.

PAs treat people with obesity every day, Altieri said. The more PAs know about obesity as a disease, the more we can help our patients.

Jennifer Walker is a freelance writer in Baltimore, MD. Contact Jennifer at[emailprotected].

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PA Martine Altieri Brings an Obesity Medicine Clinic to Her Cardiology Patients - AAPA