Angela Ford Jones, DNP, CHC
Independent Practice in Weight Management
1. What was the catalyst that started your career as an independent practitioner in weight management services?
I have always had a passion for healthy eating, healthy lifestyle, and weight management. During my 15 years in Family Practice, I noticed a growing interest from patients concerning their weight and many questions on how they might lose weight. I realized years ago that the advice to “eat less, move more” simply did not work for everyone.
In 2013, I realized, as a health care provider, we are leaving the job of weight-loss and obesity management to commercial programs and nonprofessionals. I was shocked at the amount of misinformation that was conveyed out there…
That is when I actively sought out a professional certification for Health Coaches and found the National Society of Health Coaches (NSHC). I participated in NSHC CoachClinic in October of 2014. What I learned and the certification I received gave me the confidence and skills to effectively help my patients in Family Practice with their weight issues.
2. What were the 3 most important steps you believe were key in developing your initiative there at the Baptist Clinic?
The first important step in developing my Weight Management Clinic initiative with Baptist was having my existing Health Coach certification from a reputable source like NSHC. This established my credibility with my health care organization.
The second most important step in that initiative was earning my Doctorate in Nursing Practice. The distinguished title along with the research I was able to conduct for my doctoral studies propelled me into the role of weight management expert. This, along with my Health Coach certification from NSHC furthered my credibility.
Thirdly, providing administration with the financial platform, evidence-based guidelines, and health outcome statistics was a defining factor.
3. How were you able to grow the number of private clientele as you have?
I started the NEA Baptist Weight Management Program in August 2016 with three patients on our first day. I now see 25-40 weight management patients a day.
There are several reasons why my practice grew so quickly. The first being the passage of the Affordable Care Act (ACA) that lead to Centers for Medicare and Medicaid (CMS) reimbursement for Intensive Behavioral Therapy (IBT) for obesity management in 2011. This opened the door for weight management treatment to patients who otherwise would not have been able to afford such services.
Patient success and outcomes was perhaps the biggest factor in our growth. When others saw their weight loss, they wanted to know what they were doing. Word of mouth has been my greatest marketing tool.
Inter-collaborative referrals have not only contributed to the growth of my practice but also provided stability. I receive referrals from Orthopedic surgeons, Cardiology, Rheumatology, Pulmonology, OB/GYN, Internal Medicine, and other Family Practice providers.
Providing weight-loss treatment has improved patient outcomes for total knee replacement and hip surgery. My service has given patients with chronic heart disease an option for weight-loss when they were not candidates for bariatric surgery. Obstetrics and Gynecologists have better mother/infant outcomes when weight is controlled through-out the pregnancy and weight gain and/or obesity is a barrier to conception. The bariatric surgeon in my health care organization has been a supporter as well. I provide insurance required medically managed weight-loss prior to surgery and I continue to offer IBT after through clinic visits and speaking at the weight-loss surgery support group monthly.
4. What level of importance did a business plan play in starting your independent practice, if at all?
Having a business plan was perhaps the key factor in convincing administrators of the need for a weight management clinic. I believe, as nurses, we are taught altruism but never taught how to manage the business side of health care.
5. Are there certain personality traits that are better suited for independent practice in weight management? And if yes, what are they?
I do feel one must have an understanding that obesity is a chronic disease and must be treated as such. In approaching weight management from this perspective, we must also understand that each patient comes to us from a different place. Being able to incorporate the Transtheoretical Model of Change, you meet each patient where they are in that change process.
Not only do you need the patience to guide a contemplative patient to the action stage of weight-loss, you must also assess the multi-faceted contributors to each person’s weight problem. Obesity is a combination of genetic, environmental, biological, hormonal, and behavioral components. As a Certified Health Coach, I utilize motivational interviewing skills to help each individual patient understand their relationship with food and the behaviors that drive their eating patterns. Underlying pathophysiology that contributes to weight gain, such as socioeconomic, educational, and environmental elements, must also be assessed and reassessed throughout the course of treatment.
6. Describe any “red flags” that others should be cautious of when considering or beginning independent practice?
When starting an independent practice, know your state’s practice laws and guidelines. hAlso, insurance reimbursement for obesity management is still in the early stages and it is easy to get bogged down with the details of coding. Learning major payer reimbursement guidelines, codes, and documentation needed in the beginning can save time and money in the long-run. Lastly, time-management must be foreseen before it is an issue. A growing practice can become hard to manage if you do not have a solid plan for growth.
7. What marketing initiatives have yielded the best results for you?
My most successful marketing initiatives have been great patient outcomes. My patient’s success stories are a greater marketing tool than any paid form of advertisement, however, a social media presence is essential nowadays. Involvement in community awareness, initiatives, and programs concerning healthy eating, weight-loss, and behavioral changes has been beneficial as well.
8. What seems to be the greatest #1 and #2 challenges for your clients related to weight loss and maintenance?
The greatest two challenges for patients regarding weight-loss and weight management are Knowledge and Change. We live in a fast-paced society that offers quick solutions to many problems. Weight-loss being the most profitable. Food industry makes eating poorly fast and cheap. Most patients come to me with no real concept of macronutrients, why we need them, and in what proportion we need them. They have simply bounced from one fad diet to the next without success or with weight gain after they return to old behaviors. Most of my patients are very shocked to learn weight-loss is a very simple concept and knowledge is power.
Change is perhaps the biggest obstacle. No diet plan offers guaranteed results unless you change your behavior to food. You must make a mental change to obtain a physical gain.
The support I have received from our bariatric surgery department has been overwhelming. In addition to providing monitored weight-loss and IBT prior to bariatric surgery, I teach educational classes on nutrition and behavior modification monthly for those post-op.
Orthopedic surgery referrals constitute almost 50% of my practice. Because of the service I offer, knee replacement surgery outcomes are improved. I have many patient success stories, but perhaps my most rewarding was a 55 year old gentleman referred to me by our Cardiology department. He had congestive heart failure and on his first visit he weighed 508 lb with a BMI of 72.9 on continuous O2 and a walker. After eleven months in my program, he had lost over 100 lb, was no longer wearing O2 during the day, and was coming to his visits with a just a cane. He is still an active participant and is about to reach 150 pounds lost.
10. Other thoughts:
As a DNP, I was able to incorporate the evidence-based guidelines for obesity management and fill a gap in practice within my health care organization and in my community. I am confident the future of health care is fertile for nurse leadership. As nurses, we must begin to seize opportunity to bring new approaches to patient care and not wait for the invitation to join.