Weight Management Informed Consent

Weight Management Informed Consent

Effective: October 16, 2024

Last Update: October 16, 2024

Services Provided:

Nurx Weight Management services offered by KMG Medical Group MO, P.C., KMG Medical Group KS, P.A., KMG Medical Group NJ, P.C. KMG Medical Group TX, P.A., and Michael Karagas, M.D., P.C. d/b/a KMG Medical Group (collectively “KMG Medical Group”), and KMG Medical Group’s engaged providers (our “Providers” or your “Provider”) may include a patient consultation, diagnosis, education, treatment recommendation, prescription(s), and/or a referral to in-person care, as determined clinically appropriate (the “Services”). Thirty Madison, Inc. d/b/a Nurx does not provide the Services; it performs administrative, payment, and other supportive activities for KMG Medical Group and the Providers. If the Services are rendered, patients are expected to adhere to the prescribed treatment plan that can include a combination of lifestyle changes, dietary changes, physical activity changes, and ongoing guidance and support to build healthy lifestyle habits that may promote weight loss (collectively “Weight Management Journey”).

Expected Benefits:

  • Patients who lose a medically significant amount of weight (about 10% of initial weight) can experience lower (1) cholesterol, which reduces the risks of heart and vascular disease, (2) blood pressure, which reduces the risks of hypertension, and (3) blood sugar, which reduces the risks of diabetes. If you currently take medications for one or more of these conditions, dosages may need to be adjusted during your Weight Management Journey, which you should discuss with your primary care provider.
  • Lifestyle updates, including diet and increasing physical activity, may favorably impact the above conditions and further your long term weight loss goals. Weight loss and increased physical activity may also provide important psychological and social benefits.

Service Limitations:

  • There is a possibility with any medical care that the combination of (1) any significant disease and (2) the added care regime, like the Weight Management Journey, may lead to side effects that have not yet been diagnosed or observed, up to and including death. Such outcomes may necessitate additional medical or surgical treatment.
  • Weight Management Journey success depends on the patient’s efforts; however, even with best efforts, there are no guarantees or assurances that any Weight Management Journey will be successful, and even if a Weight Management Journey is successful it is a lifelong undertaking and requires permanent commitment. A successful Weight Management Journey may take months or even years.
  • OUR PROVIDERS DO NOT ADDRESS MEDICAL EMERGENCIES. IF YOU BELIEVE YOU ARE EXPERIENCING A MEDICAL EMERGENCY, YOU SHOULD DIAL 9-1-1 AND/OR GO TO THE NEAREST EMERGENCY ROOM. IF YOU ARE CONTEMPLATING SUICIDE, DIAL 9-1-1 OR CALL/TEXT THE NATIONAL SUICIDE PREVENTION LINE AT 988. PLEASE DO NOT ATTEMPT TO CONTACT NURX., KMG MEDICAL GROUP, OR YOUR PROVIDER. AFTER RECEIVING EMERGENCY HEALTHCARE TREATMENT, YOU SHOULD VISIT YOUR LOCAL PRIMARY CARE PROVIDER.

Possible Risks:

  • Risks Associated With Being Overweight or Obese. Overweight and obesity pose certain risks, such as the likelihood of (1) high blood pressure, (2) diabetes, (3) heart attack and heart disease, (4) arthritis in my joints, hips, knees, and/ or feet, and (5) certain cancers. These risks intensify significantly with any weight gain.
  • Risks of Proposed Treatment. The use of appetite suppressants poses various risks, including by not limited to, pulmonary hypertension, nervousness, sleeplessness, headaches, dry mouth, gallbladder problems such as gallstones, dry mouth, pancreatitis, weakness, fatigue, binge eating disorders, tiredness, psychological problems, medical allergies, high blood pressure, rapid heartbeat, heart irregularities, and reduced potassium levels. These and other possible risks could occasionally be serious or even fatal.
  • Pregnancy. If a Weight Management Journey patient becomes pregnant, they must immediately stop any and all weight loss medications, supplements, etc. and let their Provider and primary care provider know as soon as possible. A restricted diet during pregnancy can damage a developing fetus, so precautions must be taken to avoid becoming pregnant during a Weight Management Journey.
  • Risk of Weight Regain. Obesity is a chronic condition. Many people with overweight and obesity that lose weight have a tendency to regain all or some of the weight over time. Important factors to sustain Weight Management Journey progress include regular physical activity, a continued restricted calorie diet, long-term medications, and a strategic plan for how to manage potential weight regain before it occurs. Medical studies of calorie deficit/portioned-controlled diets (including modified fasting) have shown varying results for patients who maintain weight loss. Some studies have shown that fewer than 5% of weight loss patients were able to maintain a reduced body weight after 5 years. Another study showed that after 3 years, weight loss patients, on average, maintained about one half of their initial weight loss. If a Weight Management Journey patient had fluctuations in their weight in the past, it may be more difficult to maintain weight lost during and after this Weight Management Journey. A published medical study indicated people whose body weight fluctuates greatly or often have a higher risk of heart disease and death compared with persons of relatively stable body weight, and such weight fluctuations may play a role in the development of other chronic diseases.
  • Sudden Death. Patients with severe obesity or severe obesity with serious hypertension, coronary artery disease, or diabetes mellitus have a higher chance of death when compared to people with healthy weights without any such medical problems.

Patient Acknowledgments:

I further acknowledge and understand the following:

  1. I understand that there are various ways to decrease my body weight and to maintain any weight loss, including a revised diet and physical exercise, which if followed diligently could be successful without medication, such as an appetite suppressant. I understand that my Weight Management Journey may consist of a balanced diet, a regular exercise program, instruction in behavioral modification techniques, involve the use of appetite suppressant medications, if clinically appropriate and that medical recommendations may change based on updated guidelines, evidence based practices, etc.

  2. My Provider will explain my diagnosis and the risks and benefits of various treatment options. I understand that my Provider will review my medical history and clinical information and create a treatment plan if, in my Provider’s professional assessment, they determine that a Weight Management Journey is appropriate for me.

  3. In order to manage my weight in the best possible manner, I understand that I may need to provide medical records from my primary care provider and other providers. I will make sure my Provider has a complete, accurate, and current medical history and let my Provider know about ANY concerns, symptoms, questions, etc. that come up even if I don’t consider them important. In particular, it is important that I tell my Provider if I have a past history of, type 1 or type 2 diabetes, glaucoma, thyroid cancer, pancreatitis, kidney disease, diabetic retinopathy, depression, or suicidal thoughts or behavior. I further affirm that I am not currently pregnant and will immediately let my Provider know if I become pregnant. I will let my Provider know about all the medications I am taking, including prescription drugs, as well as over-the-counter drugs, vitamins, and dietary or herbal supplements. If I am taking any antidepressant medications, any mood or other behavioral changes, I understand that these medications and my Weight Mangament Journey treatment may cause suicidal ideation and or homicidal ideation, and I understand significance of these risks associated with the medications and opt to proceed with using the prescribed medication.

  4. I understand that withholding information or providing inaccurate information about my health and medical history in order to obtain treatment may be detrimental to my health and in some cases may even lead to death. Neither KMG Medical Group or my Provider is responsible for wrong, incorrect, inaccurate information provided to them. I understand that it is my responsibility to follow my Provider’s instructions carefully and to report any medical problems immediately, regardless of whether I think that they may be related to my Weight Management Journey. Throughout my Weight management journey, I may need additional medical evaluation as deemed necessary by my Provider, for my safe treatment. I understand that if I do not adhere to the Weight Management Journey guidelines as recommended, KMG Medical Group may stop rendering care.

  5. I understand that a copy of my Provider’s educational and professional experience is available upon request.

  6. I understand that much of the success of my Weight Management Journey will depend on my efforts and that there are no guarantees or assurances made to me that my Weight Management Journey will be successful. I also understand that obesity may be a chronic, life-long condition that requires drastic changes in eating habits and permanent changes in behavior to be treated successfully.

  7. I understand that the medications that may be prescribed to me may or may not have been approved by the U.S. Food & Drug Administration as safe and effective for my condition or prescribed use. A determination will be made by a licensed clinician who may prescribe these products for such conditions because in their clinical judgment, use of the product is medically appropriate. Important drug safety information will be provided for any medication I am prescribed. I understand that my Provider will be available to ask any questions and receive any information necessary to adequately inform me concerning the benefits and risks associated with any prescribed medication, including but not limited to the use of the appetite suppressants, the benefits and risks associated with alternative therapies, etc. KMG Medical Group and my Provider are not responsible for any manufacturing/ ingredient changes, and other individualistic pharmacologic parameters for each medication and its manufacturer.

  8. I understand that there is no guarantee that I will be issued a prescription and that the decision of whether a prescription is appropriate will be made in the professional judgment of my Provider. If appetite suppressants are prescribed, I understand that they may be used for longer time periods than what is recommended in the medication package insert. I understand that the use of appetite suppressants for more than twelve (12) weeks involves some risk and hazards. Common risks include nervousness, sleeplessness, headaches, dry mouth, weakness, tiredness, psychological problems, medication allergies, high blood pressure, rapid heartbeat and heart irregularities. Less common, but more serious, risks are primary pulmonary hypertension and valvular heart disease. These and other possible risks could, on occasion, be serious or fatal. I understand my starting and/or continuing to receive an appetite suppressant will depend on my progress in weight reduction and weight maintenance, and side effects and associated symptoms. I understand that appetite suppressants may come in a vial with syringes and agree never to share needles or syringes because of the risk that would pose of infection.

  9. I understand the purpose of Weight Management Journey treatment is to assist me in my desire to get to a lower healthier weight in a safe manner. I understand that my Provider reserves the right to deny care for potential medication misuse or for any other reason if, in the professional judgment of my Provider, the provision of the Services and continuation of my Weight Management Journey are not medically or ethically appropriate. If my Provider feels medication may not be safe for me, they will discuss other options with me for my safety.

__I acknowledge that I have carefully read, understand, and agree to the terms of this Weight Management Informed Consent and consent to receive the Services. __