Video: How one doctor is looking at obesity in a novel way

AMA Wire
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For one physician, treating obesity is all about taking a new approach.

“Obesity is the only entity, illness, process, disease … where we accuse the patient of doing something wrong,” said Fatima Cody Stanford, MD, a clinical and research fellow in obesity medicine and nutrition at Massachusetts General Hospital/Harvard Medical School. “When a patient comes in with hypertension, we don’t say, ‘You fix it. You go fix your hypertension and then come back.’”

That approach isn’t working, Dr. Stanford said. If it were, we wouldn’t be spending more than 20 percent of U.S. health care dollars on obesity-related issues.

In an AMA “Innovations in Medicine” talk—a brief, informal presentation in the style of TED Talks—Dr. Stanford shares how her work at Massachusetts General Hospital’s weight center is changing the treatment approach for overweight patients. It’s more than just diet and exercise for many patients, she said. Her work includes investigating how patients’ environments, such as their sleep patterns, can affect their biology.

Dr. Stanford shares stories of two obesity-related deaths that hit close to home—one, the loss of her young cousin, and the other, an 11-year-old patient. Both died from obstructive sleep apnea.

“There’s something that we’re not doing,” she said. “People are going untreated for conditions that have an impact on their weight. I need to offer them solutions, or I am failing at my job.”

Get inspired and hear about new approaches, ideas and creativity in medicine by viewing this talk and others in the AMA’s Innovations in Medicine series.

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I would also consider other things like do the patients watch a lot of programming that has commercials for junk food? Who are their friends? Are those friends health-conscious and do they eat healthy or do they just not care? Other things also can help such as having a dog. I remember reading research of how walking a dog is likely to help keep you in shape because you go for more walks than you would if you did not have a dog. There are many factors to consider but, indeed yes, outside of a metabolic issue, I disagree with this doctor. It DOES come down to diet exercise and rest so your body can recover. That's the ultimate foundation of obesity. If you are eating unhealthy foods and not expending proportional energy, you will gain weight and also do harm to your organs (i.e. trans fat which leads to heart disease). The foundation and the crux of obesity lies in diet and exercise. The outside factors can have an influence such as lack of sleep, friends, media consumption but those are not as important as diet and exercise.
Excellent talk. I also agree with nandrolnededanoate's comments. Our more sedentary life style and emphasis on food, restaurants, microbreweries and other alcohol-assoiciated empty calories, and athletic viewing rather than doing all contribute to obesity. Six hours of television or computer sitting per day! I suspect sleep apnea is more often the result of obesity, rather than the cause; once you get to that point, treatment may be helpful. We need to do a a better job encouraging patients to understand their options, and yes, choices, to help bring this disease under better control.
In my office for the past 2 years I have used a combination of metrics to assess a person's fed state (often overfed), nutritional status via chemistry, lipid, glycohgb and nutrient/vitamin status (D level, B12, and antioxidant status via the biophotonic scanner) and body fat analysis. Arming patients with this information allows them to see their status and provides motivation to improve/optimize these metrics. This leads to an engaged, motivated patient that choses to improve diet and lifestyle. We remeasure metrics depending upon the situation. The metrics and results lead to a conversation about micronutrients/nutrition and away from a conversation of macromolecules (protein,carbs and protein). We then move to plate-building techniques with preferences and choices driven by the individual. The results have been significant and sustained. Being in private, busy practice I have not performed a formal study to date.
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Jun 22, 2018
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