Bridging the Gap Between Mental Health and Obesity Care

To Orlando Malate, DNP, MBA, APRN, PMHNP-BC, his patients are more than just a diagnosis.

Whether he's caring for patients in a psychiatric setting or educating future healthcare professionals, Malate works hard to truly understand a patient before developing a treatment plan.

Today, he wears two professional hats.

Clinically, he practices as a psychiatric and mental health nurse practitioner at the Kohn Brain Clinic, where he is the only provider who specializes in obesity medicine. While most of the clinic focuses on neurology and psychiatry, colleagues refer patients to him for obesity management.

Outside the clinic, he works in academia at West Coast University, helping to educate the next generation of healthcare professionals.

"I enjoy both," he said. "It's good that I'm practicing so I can translate what I know in practice into the academic environment."

Together, these roles have shaped a treatment approach that focuses on comprehensive, patient-centered care.

A Journey Close to Home

For Malate, both psychiatry and obesity medicine are very personal to him. His wife lives with psychiatric conditions and related weight gain. His daughter also lives with mental health challenges. Watching his family navigate those challenges motivated him to continue his education.

"You experience it with your family," he said. "You feel like they need support, and that you need to advocate for them. So, you keep pushing."

Even with a healthcare background, Malate believes there is always room to learn more.

"I don't want to know everything," he said. "I want to continue learning and to specialize in areas that benefit my patients so I can look at them more holistically."

This eagerness is what ultimately led him to obesity medicine.

Bridging Two Specialties

Working in psychiatry gave Malate a unique perspective on obesity care. He realized that many psychiatric medications could contribute to weight gain, yet discussions about the side effects don't always happen. He wanted to change that.

Instead of referring patients to a specialist to treat the weight gain, he pursued obesity medicine so he could treat it and the psychiatric conditions himself.

"If a patient can see one provider who can help with all of this, why not?"

That approach benefits both patients and colleagues.

Malate’s patients no longer need multiple appointments with different specialists. Providers in his practice also come to him for guidance on initiating obesity treatment with their own patients.

For Malate, it creates an easier experience for everyone involved.

Building Success One Step at a Time

Although medications have transformed obesity treatment, Malate believes lasting success requires much more than a prescription. He forms every treatment plan around the four pillars of obesity medicine, which he learned through the Obesity Medicine Association.

"Medication is not the be-all and end-all," he said. "Learning those four pillars is essential."

He worries that current marketing and public conversations, focusing almost exclusively on medications, fail to acknowledge nutrition, physical activity, and behavioral health.

"This is just a quarter of obesity management," he explained. "There are three others that you won't see in a commercial. It’s all about medications, so that's what many primary care providers know."

Malate often begins treatment with behavioral change.

Many of his patients have limited access to psychotherapy, so he incorporates cognitive behavioral therapy techniques into obesity treatment and helps patients build realistic habits one step at a time.

"We have four pillars of success, but that doesn’t mean that they all need to be done right away. It takes time. Habit formation takes time."

Every Step Counts

One lesson Malate emphasizes with every patient is that progress doesn't have to be dramatic to be meaningful.

"Behavior can only change if we can see it and we can measure it," he said.

Rather than overwhelming patients with major lifestyle changes, he encourages them to start with small victories. He emphasizes that movement does not always have to equate to exercise.

"If you go to the bathroom, that's movement," he tells patients. "If you're walking from one block to another, you're moving. If you're taking your kids to school, you're moving."

Those everyday moments become building blocks for larger changes down the road. Malate helps patients find practical ways to incorporate healthier habits into their existing routines.

Teachers might walk while lecturing. Busy parents might find movement throughout the day. He believes that care does not always have to be task-oriented.

"This is just part of their life," he said. "They have other things to do."

Navigating the System

Like many obesity medicine specialists, one of the biggest challenges Malate faces is helping patients access obesity medications.

Practicing in both Wisconsin and Illinois, he regularly navigates complicated prior authorization requirements. He handles obesity medication authorizations himself because he knows persistence can make a difference.

He often submits multiple prior authorizations for the same patient and still receives denials. He recalls one patient who had a medication denied four separate times before they decided to just pay out of pocket.

Malate works hard to make sure his patients get the care they need. These requests and denials reinforce why he continues to advocate for his patients and the field of obesity medicine.

Learning to Better Serve Patients

Whether he's treating patients or teaching students, Malate describes himself as a lifelong learner.

His desire to always learn more has guided every stage of his career and continues to shape how he practices obesity medicine.

He frequently uses educational resources from the Obesity Medicine Association to introduce patients to the four pillars and provide evidence-based information they can revisit at home.

Many patients are surprised to learn obesity treatment extends far beyond medication.

Looking Ahead

Although he values both of his roles, Malate says his favorite part is obesity consultation and treatment.

Helping patients understand the connection between mental health, behavior, metabolism, and chronic disease allows him to provide holistic and individualized care.

His advice to other clinicians is simple: "Walk with your patients," he said. "It's a journey. Meet them where they're at."

As the OMA celebrates Member Appreciation Month, Malate's story highlights the importance of treating the whole person rather than a single condition. By combining his expertise in psychiatry, obesity medicine, and education, he is helping patients build healthier lives with compassionate, human-centered care.