Teaching Doctors To Help The Obese
Tuesday, January 26, 2010
Obesity may be America's number one health problem. Yet doctors who specialize in weight management say most physicians know very little about treating obesity, especially now that treatments have become more sophisticated.
SAN DIEGO Obesity may be America's number one health problem. Yet doctors who specialize in weight management say most physicians know very little about treating obesity, especially now that treatments have become more sophisticated.
A study in the New England Journal of Medicine last year found that the average American has gained life expectancy because cigarette smoking is on the decline. The bad news is the gain has been more than offset by the problem of obesity. That's why Robert Kushner, a medical professor at Northwestern University, wants to help doctors learn more about treating America's new epidemic.
"Obesity affects more than nine organ systems and over forty medical problem," he said. "So how you uniquely identify and treat that is not known to most physicians. Furthermore most physicians shy away from even dealing with obesity. For them it's almost a Pandora's box. Once you open it you don't know where to go or where it's going to end."
Kushner is working to create a way to test physicians' knowledge of obesity and certify them as being specially qualified to treat the condition. Dr. Ken Fujioka, a doctor at Scripps Clinic in San Diego, is helping to write the exam. He said obesity has serious medical impacts that require medical solutions.
"Weight gain is not always the patient's fault in the sense that they have a personality problem or that they have a problem with food," said Fujioka. "They aren't getting the signal that they have enough fat around."
Fujioka gives one example of how becoming obese affects the creation of a hormone called leptin, which tells the brain to stop eating.
"Let's say you gain 50 pounds, and you lose 20 pounds," said Fujioka. "If you lose that weight then all of a sudden the body says 'I don't want to lose this weight.' So it lowers leptin inappropriately. Even if you have enough fat around, it lowers it. So the brain gets the signal, 'Oh, there's not enough fat around. I need to gain.' Even though you're still overweight."
One of Fujioka's patients is Joe Cook, whom I met at the Sushi House, an Encinitas restaurant whose menu helps Joe walk a narrow path toward weight loss. Cook is 64 years old and now weighs 312 pounds, down from 387 pounds at the height of his weight gain.
"It started after I left the service and I started gaining weight and started gaining weight," said Cook. "And it just kept going up. I quit doing exercises. And over the years I got a lot of weight on me and my medical insurance sent me to Dr. Fujioka."
Cook said his weight gain caused several medical problems.
"I've gotten diabetes. I've gotten heart problems. I've got kidney problems. Ah… you know, those three are enough so I decided not to get any more," said Cook.
Joe Cook takes a medication which mimics a hormone called GLP-1. Fujioka says the drug increases the production of insulin and it also stimulates a part of the brain that tells the body that it is full. Cook says he's experienced a dramatic decrease in his appetite since he started taking the medication. Fujioka says medicine faces an enormous challenge helping patients lose weight in an environment he describes as toxic. Dr. Kushner, of Northwestern, agrees.
"You know if you live in an environment where you don't have to do any physical activity and food is available everywhere and that's what everyone in the population is doing, you can have all the discipline and will power you want but eventually you're going to harmonize with your surroundings," said Kushner.
Joe Cook said, for him, losing weight was a matter of building determination.
"A person… they've got to make up their mind. They've got to have the wake-up call that I had when doctor Fujioka said to me, that day, 'You're kidneys are failing, and if you don't change what you're doing you're going to die.' That was the wake-up call this old Marine needed. I said I may die but I'm going to be put in a regular-sized casket," said Cook.
The sharp decrease in cigarette smoking has been a boon to American health. But it's hard to know if we'll see the same success in the fight against obesity. At the very least, Doctors Kushner and Fujioka hope patients will get more help from doctors as more of them specialize in weight loss medicine.