Nutrition; Prevention

The art and science of tackling obesity

Empowering patients with evidence-based strategies, anti-obesity medication, and mental health support can help them achieve their weight wellness goals.

It takes a village to treat a disease as complex and pervasive as obesity.

In the United States, more than 42% of adults are living with obesity, according to the Centers for Disease Control and Prevention (CDC), and that rate continues to rise. One of the root causes of heart disease, stroke, Type 2 diabetes, and certain types of cancer, obesity exacts a staggering toll on our communities – more than $147 billion in medical costs and an estimated 300,000 lives per year. Having obesity also significantly increases the chance of severe illness and hospitalization from COVID-19.

Offering generic advice such as “eat less, move more, don’t eat carbs,” simply is not enough to help patients or begin to stem the tide of this epidemic.

Since joining UT Southwestern’s Weight Wellness Program in 2016, I have learned the value of a team-based approach to obesity management. Our dedicated team of physicians, advanced practice providers, dietitians, mental health providers, and nurses all play an integral role in helping our patients manage their weight and mitigate the effects of obesity.

Every year, The Obesity Society’s annual conference, (ObesityWeek) welcomes a diverse group of researchers and clinicians from around the world to share research, new anti-obesity therapies, and advocate for better public health policies. The international conference also accentuates the fact that obesity management is as much an art as it is a science – one that continues to evolve.

Let’s look at three key areas that are helping us cultivate more tools and strategies to combat obesity.

Managing weight through medication and lifestyle changes

Most patients realize there is no “quick-fix” to help them lose weight, but there is an expanding group of medications that target different pathways to treat obesity.

GLP-1 receptor agonist medications make the stomach empty slower and signal the brain that you are full, reducing cravings. They can also help improve fatty liver.

Anti-obesity medications have been around a while, but they have evolved from amphetamine-derived drugs, such as phentermine, to an array of options that target various pathways related to weight regulation. For example, a relatively new class of medications called GLP-1-receptor agonists slow stomach emptying and signal to the brain that you’re full. Glucagon-like peptide-1 (GLP-1) receptor agonists also help improve blood sugar, blood pressure, and fatty liver disease – conditions often associated with obesity.

Semaglutide (Wegovy™), which was approved in June 2021 by the Food and Drug Administration for weight management, has been a game changer for people with obesity. In clinical trials, participants lost about 15% of their starting weight after receiving semaglutide. Patients in our Weight Wellness Program often exceed that 15% mark because of our unique, patient-centered approach.

Medications are not a panacea, but they can be a vital piece of an individualized treatment plan as patients establish sustainable behavior changes to support a healthier weight and lifestyle. This year’s ObesityWeek will highlight new pharmacologic therapies on the horizon, in addition to diverse approaches to caring for people with obesity. Stay tuned!

A deep dive on mental health and stress

Some patients in our Weight Wellness Program have shared that they are “totally blown away” by the depth of the initial interview and visit with our team. The doctor, dietitian, and care team delve into aspects of lifestyle, patients’ relationship with food, along with mental health and medical history.

We strive to develop relationships with our patients that are built on a foundation of mutual respect and trust.

Along with nutrition counseling and evaluation for potential treatments to facilitate weight loss, we discuss stressors in their life – how things are going at home, with their job, their finances, their kids, etc. Patients have commented that their encounters with our team are the first time healthcare providers have truly listened to them and viewed them as a whole person beyond their weight.

The real breakthroughs come when we connect with our patients and begin to understand their unique barriers. It allows us to customize an effective weight management strategy as well as understand our patients’ struggles. Oftentimes, this connection fosters the greatest impact on their health and lives.

We now have six advanced practice providers (APPs) in the Weight Wellness Clinic. The expansion of our APP group has improved clinic accessibility. The ability to follow up with patients every four to six weeks gives providers the opportunity to support patients as they navigate lifestyle and medications changes for long-term weight management.

Addressing bias and diversity in obesity care

There is an inherent bias in our culture that suggests people who struggle with obesity and being overweight are lazy or lack willpower, which is amazing considering nearly 70% of the U.S. population has a body weight above the healthy range. Even some medical professionals fall prey to this notion, suggesting that their patients simply aren’t “doing what they’re supposed to do” to lose weight.

Treating obesity as a complex, multifactorial disease is the first step toward more effective weight management.

Healthcare providers have an integral role in empowering patients and recognizing efforts to improve their health. I have had the pleasure of caring for patients at various points during their weight management journey. For example, I have worked alongside patients who have come into the Weight Wellness Clinic Program in the mid 200-pound range and a provider may think “you need to lose weight”, not realizing this patient started their weight journey when they were close to 600 pounds. Maintaining any degree of weight loss is a tremendous achievement.

At UT Southwestern, we make a concerted effort to provide care to underserved areas in North Texas. We also strive to educate providers in primary care and other subspeciality clinics as a way to expand the reach of our expertise in the care of patients with obesity. One of our APPs, Hilary Trevino, shared our clinic’s approach to obesity care through the APP lecture series. The Medical Director of the Weight Wellness Program, Dr. Jaime Almandoz, frequently speaks to professional organizations to help other clinicians integrate weight management into their practices.

UT Southwestern plans to expand the interdisciplinary obesity management program to Texas Health Dallas, where patients can see obesity medicine specialists, bariatric surgeons, and plastic surgeons in a single location.

As the only academic medical center in North Texas with a dedicated, multidisciplinary weight management team, UT Southwestern is committed to empowering patients with evidence-based strategies to treat obesity and achieve their wellness goals. Our team will help you create a plan that is aligned with your long-term health and so that you can achieve a successful outcome.

For more information about the Weight Wellness Program, call 214-645-2800.