Intellihealth’s Dr. Louis Aronne and Dr. Katherine Saunders talk with Dr. Leon Igel about the dual epidemics of diabetes and obesity, and the importance of improving access to evidence-based obesity treatment.
Diabetes and obesity are closely connected, but only one of the diseases is consistently treated in accordance with medical guidelines.
Dr. Leon Igel hopes to change that by educating both the general public and clinicians about the causes and effective treatments of obesity. Igel is an endocrinologist who specializes in the care of patients with obesity. He’s also the medical director of Flyte Medical.
In this episode of Weight Matters, Dr. Louis Aronne and Dr. Katherine Sanders talk with Dr. Igel about the links between obesity and diabetes, the treatments that can help patients manage both diseases, and the role of telemedicine in increasing people’s access to care.
How Diabetes and Obesity Connect
When a person gains weight, they often become more resistant to insulin, which is responsible for controlling the body’s glucose levels.
“As weight continues to climb, the body tries to dump in more and more insulin to try to do a better job of controlling your sugar,” Igel explained.
This leads to more weight gain, because the body stores sugar in adipose (fat) tissue. The increased insulin levels are also connected to type 2 diabetes.
“Over 11% of the United States has diabetes, and a large percentage are actually undiagnosed,” Igel shared, explaining that pre-diabetes and diabetes rates also increase with age. “Everyone is in this sort of progression toward diabetes, and a lot of that ties in so closely to weight gain that occurs over time and throughout someone’s lifetime.”
Though most medical professionals understand the connection between diabetes and obesity, they don’t account for the fact that many diabetes medications cause additional weight gain. Igel, on the other hand, prefers a weight-centric approach to diabetes treatment that focuses on using medication that is either weight neutral or leads to weight loss.
Barriers to Access for Obesity Treatment
The increased weight gain that comes with certain diabetes medications is a symptom of a larger problem in healthcare: 80% of patients with type 2 diabetes receive medical care according to guidelines, but less than 2% of patients with obesity receive guideline-based care.
This is partly because insurance is more likely to cover medications for diabetes and high blood pressure than to cover medication for obesity, which is often the root cause of those other conditions.
Additionally, there is a major shortage of practitioners who are trained to treat obesity.
“If you look at the American Board of Obesity Medicine and how many providers are credentialed, we have under 6,000 ABOM certified diplomates,” Igel shared. “If you contrast fewer than 6,000 providers with the 74% of the U.S. population that has overweight or obesity, even if all those 6,000 providers were treating to their fullest capacity, we’re never going to meet that supply/demand mismatch.”
As a result, many patients seeking treatment for obesity may receive outdated and ineffective advice, such as encouragement to diet without any medication or other support.
“We can’t continue to treat diabetes and obesity the way we have in the past, either telling a patient that they need to be doing more to further reduce their food intake even though they’re very hungry, or to feel starving all the time,” Igel explained.
Instead, patients tend to see greater results if they take a medication that allows them to feel full while consuming fewer calories each day.
“If there was a way to improve that access to medication and also provider education, I think those two things would go a very, very long way,” Igel shared.
The Benefits of Telemedicine
Many providers have expanded their telehealth offerings in response to the pandemic, and Igel has noticed that this treatment method also gives key advantages to individuals who are seeking treatment for obesity.
Patients who previously had to travel long distances to see a specialist can now follow up with their doctor from the comfort of their home.
“It’s allowed us to have timely appointments that our patients don’t have to cancel because of other work responsibilities or childcare responsibilities. They can have their appointments during a break in their workday or during a break in childcare,” Igel explained.
In turn, the reduced number of no-shows allows Igel and his team to see a higher number of patients each day.
“I really think it’s made a tremendous difference in our patient access.”
Follow Weight Matters wherever you get your podcasts to never miss an episode. To learn more about Dr. Sanders and Dr. Aronne’s work to transform specialized treatments for chronic conditions through the best in medical science and advanced digital technologies, visit www.intellihealth.co/podcast
