Gregg Masters 00:08
This episode of PopHealth Week is brought to you by Health Innovation Media. We create thought leadership content that supports your value proposition for omnichannel distribution and engagement. Connect with us at www.popupstudio.productions. I’m Gregg Masters Managing Director of Health Innovation media and the producer co-host of PopHealth Week. Joining me in the virtual studio is my partner, co-founder, and principal co-host Fred Goldstein, president of Accountable Health, LLC on today’s show, our guests are Weill Cornell medicine faculty, Dr. Lewis Aronne, and Dr. Katherine Saunders, co-founders of Intellihealth, a company fighting the global obesity epidemic. They also host the podcast weight matters. Louis J. Aronne, MD, a fellow in the American College of Physicians is the director of the comprehensive Weight Control Center at Weill Cornell Medicine and the past chairman of the American Board of obesity medicine. Catherine H. Saunders, MD diplomat of the American Board of obesity medicine is Assistant Professor of Clinical Medicine at Weill Cornell and assistant attending physician at New York Presbyterian Hospital. And with that introduction, Fred, over to you.
Fred Goldstein 01:28
Thanks so much, Greg and doctors, Aronne and Saunders, welcome to PopHealth Week.
Louis Aronne 01:32
Thank you, Fred. Really appreciate it.
Katherine Saunders 01:34
Thank you for having us. Fred. We’re excited to be here.
Fred Goldstein 01:37
Oh, really it’s our pleasure. It’s a it’s a great topic, obviously population health, and maybe why don’t we start just a little bit of quick background, maybe start with Dr. Aronne and then Dr. Saunders, your background and sort of what you’re doing now.
Louis Aronne 01:48
So, Fred, I’m the Sanford Weill professor of metabolic research here at Weill Cornell Medical College in New York City. I run the comprehensive Weight Control Center, which is a multidisciplinary treatment center for people with obesity. I’ve been doing this since 1986. When I first came to Weill Cornell, got interested in obesity. And my entire career has increasingly been devoted to figuring out why it’s hard for people to lose weight, and how to treat it with certain dietary interventions, medications, procedures, and some of the other more advanced strategies that we now have.
Fred Goldstein 02:33
fantastic and you Dr. Saunders.
Katherine Saunders 02:35
Yes. So I also have been at Weill Cornell for a while for medical school residency, I was fortunate to learn about Dr. Aronne early in my medical career. So right around the time that I was developing a patient panel in internal medicine and primary care, I found out about all of the work Dr. Aronne was doing and was increasingly getting frustrated that most of my patients were struggling with weight-related health complications. And I had, you know, minimal education, from my medical training on how to how to even understand weight, how to even talk about weight. So I was fortunate to to do a fellowship, we actually started a fellowship program. I was the first fellow in obesity medicine at Weill Cornell, and then joined the faculty practice where I still see patients and something that we talked about Fred, which we can get into, later on, is one of our big areas of expertise is you know, besides seeing patients with obesity, helping them lose weight to you know, improve or resolve their weight-related medical problems. But one of the big things we see is often one weight regain after bariatric surgery, and two weight gain from prescription and over-the-counter medication. So we see people who have had weight gain for many, many, many different reasons. And the approach that Dr. Aronne develop that we all practice is really a comprehensive, compassionate approach to this very heterogeneous disease of obesity.
Fred Goldstein 04:09
Yeah, thanks, Catherine. I know Dr. Aronne. And Dr. Saunders, when I think about this, I think about all these approaches that we see out there that are on television, you know, or being whether it’s a weight loss program from XYZ or another ABC company or some approach. But it’s really not been looked at, I guess, other than sort of what you’re doing. Maybe others have been developed from a medical perspective, I assume there have been some big advances made or at least some advances in that area that allow for the approach you’re using to work.
Louis Aronne 04:37
Yes. So one of the key things is that we’ve now begun to understand the weight regulating mechanisms of the body. And what what that has shown us is that weight is regulated by a complex series of neuronal-based systems and hormonally based systems, and there are 8, 10 hormones that are telling your brain how much of the, and how much fat is stored, and other inputs as well. And what it looks like happens over time, is that by eating fattening food, your body develops resistance to some of these hormones, so that your brain can’t tell how much fat is stored, or how much you’ve eaten. And the default is set for for survival purposes, the default is set at a higher weight, and eating more food. And as a result, over time, your weight gets ratcheted higher and higher and higher. And so basically, one of the key findings that has guided the kind of treatment that we offer is the recognition that the environment meaning eating too much high calorie, high fat, high sugar, food, leads to something physical in your brain, that makes it really hard to lose weight. That that is really one of the keys. So it’s, there’s something physical going on. That is why people can’t lose weight. It’s not that they don’t want to, it’s that something is pushing back, that makes it very hard for them to comply with even the best dietary recommendations.
Fred Goldstein 06:28
As I was telling Gregg earlier, one of my cousins worked with pillow rats back in the days ahead of Endocrinology, and was looking into this whole obesity issue, you know, these genetically modified rats that were obese? So what you’re saying I guess and Dr. Saunders you can comment on this, that then leads to being able to discover various interventions for those hormone irregulation, etc. And so we’re looking more at some medical approaches along with the behavioral and biologic and the other approaches.
Katherine Saunders 06:55
Yes, exactly. So you know, the cornerstone of always do is still absolutely, you know, lifestyle intervention. So dietary strategies, physical activity, and behavioral techniques. But for the majority of people who need to lose a clinically significant amount of weight, that’s just not going to cut it, unfortunately. And so now that we have a better understanding of, you know, the pathophysiology, and exactly, you know, which hormones are involved, you know, what areas of the brain they, they signal to, we can now actually have much more targeted treatment. And so we have, you know, not a huge but we have a sizable enough armamentarium of medications that are really targeted to help in a variety of different ways. And so our expertise is really figuring out, you know, which medication is most appropriate for which patient and, you know, just like any other health condition where, you know, if you have high blood pressure, and one medication is not working, sometimes two or three are required, you know, with combinations of medications. So that’s really been what Dr. Aronne has developed over the course of his career and, and the way we practice figuring out the right medication, the right combinations of medications, and, you know, doing that in a very, very, very customized way.
Fred Goldstein 08:15
So I think of the average person out there, and how many physicians are there who are practicing in specials specializing in obesity, like the two of you are doing.
Louis Aronne 08:27
There aren’t that many. Over the past 10 years, there has been a dramatic increase. We started a Board the American Board of Obesity Medicine, in 2011. And as a result, physicians are now able to take an exam and become certified. That doesn’t mean they’re experts, but it means they have a minimum level of competence that’s been demonstrated by passing the exam. And if you look at the number of people who are getting interested in this and taking the exam, it’s increased dramatically. In fact, last year, over 1,000 physicians pass the exam. The total number right now is around 5,000. But when you think about the prevalence of obesity in the population, it’s so high that 5,000 physicians is not nearly enough, this is really a population health problem and a primary care problem. Those are the kinds of solutions that that we need to begin to make a dent in this.
Fred Goldstein 09:38
Absolutely. That’s what I was getting at was even with 5,000 physicians, given this the huge issue we face in the United States and beginning to be you know, obviously around the world, that kind of expertise, and then how do you disseminate that information out to the rest of the primary care physicians? And are you seeing more of that happening? And then I guess we can use that to begin to lead into using telehealth and the rest of it. But are you beginning to See primary care physicians looking at at either upgrading their training or they have access to individuals like you to help with the obesity management problem?
Katherine Saunders 10:07
It’s yes and no, I think in some academic institutions where they have, you know, a weight center, we see more of that at our institutions, we have primary care physicians asking us all the time because they we share patients with them, and they see that they do well, and they they want to use the medications we’re using, but they’re not trained. So there’s much more interest in using some of the newer, highly, highly effective medications. So different areas of the country, I would say, have started to adopt this more than others. But that’s exactly kind of the crux of the problem. This this massive, massive supply-demand mismatch. So if you think about the fact that 20, or sorry, 74% of the country has overweight or obesity, and what doctor Aronne said there are fewer than 6000, obesity medicine certified physicians in the country. Clearly, you know, technology has to be part of the solution, because there just aren’t enough healthcare providers to do what we need to do. So that’s that’s what we’re doing with with our company Intellihealth. Our mission is to scale and democratize access to the kind of medicine that that we practice.
Fred Goldstein 11:19
And before we get in that one other question, there’s this I’ve heard ongoing discussions, BMI, good measure, not good measure. In some cases, it’s not appropriate and others it is where are we with that?
Louis Aronne 11:30
That’s a great question. BMI, is a reasonable measure of overweight and obesity. And it’s been correlated with an increase in risk. And if you modify BMI with waist circumference, it’s quite reasonable. Now, are there better measures? Yes, but they’re too cumbersome and expensive. All you need is a weight and height, and you can calculate BMI. And, again, you can measure someone’s waist circumference, if it’s too large, then you can see if someone who has a normal weight is at risk, because of the location of their fat, but as time goes on, noninvasive methods are being developed, which will be able to estimate body composition. So, the same way, what you take your phone and you point it at the wall, and it measures how big the wall is, I mean, that to me is like mind-boggling, things like that are going to, you’re going to point it at somebody, or you’ll point your phone at yourself. And it’s going to estimate how much fat you have on your arms, your legs, how much you have in your abdomen. And that may be a better measure of risk. But it’s going to take a long time to do that kind of work and figure out whether these measures are the same better or worse than BMI.
Fred Goldstein 13:05
So we should just continue to keep using it because it is a relatively good measure of what’s going on, as you said, we get that increased risk associated with increased BMI that we can correlate,
Louis Aronne 13:15
right. But if you have, for example, there’s somebody who is modestly overweight, but they have type two diabetes and high triglycerides and heart disease, that person is at an exaggerated risk compared to their weight. And similarly, there are people who are significantly overweight who are at lower risk. And we still don’t completely understand all of that. Inflammation is a modifier. There are many different modifiers. But BMI is an important factor.
Katherine Saunders 13:49
I would also add one of the biggest misperceptions, a question that we get from our patients all the time when we’re talking about health goals, patients often feel that they need to get to a BMI of 25. And that’s the goal no matter where they start. And so that’s something that we talk about quite frequently, you know, if someone comes in with a BMI of 28, and, you know, getting to 25, maybe that is a reasonable goal. But if someone starts at a BMI of 40, you know, our goal certainly is not in most cases, a BMI of 25. So, in terms of, you know, success and ultimate goal, we talk more about, you know, percentage of total body weight loss, because data shows that, you know, 5% 10% You know, there’s a dose-response has been shown to be correlated with reduction in health risks and, you know, improvement or resolution of weight-related health complications.
Gregg Masters 14:44
And if you’re just tuning in, you’re listening to PopHealth week our guests are well Cornell medicine faculty, Dr. Lewis Aronne, and Dr. Katherine Saunders, co-founders of in Intellihealth, whose tagline notes we are fighting the global obesity epidemic one patient and one personalized treatment plan at a time, they also host the podcast, weight matters.
Fred Goldstein 15:07
And one of the big issues with with this whole area, you know, previously was that this yo, yo, you know, we saw people lose weight, they get it back. And so a lot of people just said, one is not possible or give up, give up. It’s just not going to work. What what’s different now is that the new medications, all the stuff, you’ve learned, Dr. Aronne, that we now can apply to this area that make it something that we can begin to see long-term success for some patients.
Louis Aronne 15:31
Fred, that’s exactly right. So what we’ve learned over the years, is that by using medical therapies, in conjunction with behavioral treatment, we’re able to get people to lose more weight, and maintain that weight loss. So if we look at a typical behavioral weight loss program, about a third of the people in the program will lose 5% or more of their body weight, which reduces the risk of diabetes, by the way by about 50%. So that’s really worth it. What we’ve seen in our program, is that if we take people who haven’t done well in a behavioral program, and we use our dietary intervention are Intellihealth Evolve platform, and medical therapies that are currently available, we can get over 60% of them to lose 5% or more of their body weight. And many of these people in the kinds of projects we’ve done have failed standard programs, it’s not like they never tried, they tried it, it didn’t work, we all of a sudden, get them to lose weight by using these kinds of strategies. So I think it emphasizes that there’s a physiology behind the difficulty losing weight. And again, that’s something that many people don’t want to believe, until we show it to them. And until they actually lose the weight. And they’re like, Oh, my God, I can’t I can’t believe this, the people are demoralized, because they have failed so many times, and they’re stigmatized. They’re treated badly. And we don’t do that in our programs. But you know, we’re on the patient side against the disease. We don’t judge people, for how things have gone in the past. And we emphasize, I mean, this is our mantra that it’s not your fault. It’s nobody’s fault, that they have weight problem either have bad genetics, which is a very small number of people, or they have been exposed to a food environment that has caused their setpoint to get higher. And when we use the kind of strategies that we have available, you know, we are very successful. And if you look at programs, I mean, we have nine physicians, but there are programs that are built like ours, that are covered by insurance, by by the way, there. You know, in Canada, they have programs that have 20 or 30 physicians, because everything is covered by Health Canada, you know, that’s where we’re headed, with our programs, if this is moving into the mainstream of healthcare, that’s what I see happening in the next couple of years.
Fred Goldstein 18:26
Absolutely. And I think you said something very important, which is one word that really makes people hopefully begin to think of this differently. You said it’s a disease. It’s a disease. And and I think that then changed it. And now you begin to look for these things. So Tell, tell me about Intellihealth, what is it? What does it do?
Katherine Saunders 18:43
Sure, so Intellihealth is our company where our mission really is to use technology to scale and democratize access to what we’re doing, which just hasn’t been possible without technology because of this supply-demand mismatch. And so we have a software platform called Evolve, that has a patient-facing side and a provider facing side. On the patient-facing side, it has a lot of educational materials, information, different things work for different people, so courses, articles, meal plans, recipes, whatever appeals to different patients. And most importantly, for us on the provider side, there’s a health assessment so that health assessment feeds into algorithms that we have developed that generate recommendations that the patient has access to, and then the provider has access to a provider version of those recommendations. And so on the provider side, the provider, you know, depending on their expertise or lack of expertise, and you know, their comfort with obesity medicine has access to plenty of education that explains you know, what obesity is why is the disease, how to evaluate obesity, how to treat obesity, a lot of the themes that we’ve been talking about how to talk to patients with obesity, we have training guides for medical assistants training guides for dietitians. What happens with drug-induced weight gain bariatric surgical weight regain. And then very importantly, in terms of the recommendations that are generated, we have a whole clinical decision support tool, and most importantly, a medication decision support tool. Because the feedback that we’ve heard is that even when providers, you know, are board-certified in obesity medicine, it really takes a lot of time and experience to get comfortable using the medications. So to have a patient, fill out the assessment, and then see for each patient, consider these medications, use these medications with caution, don’t use these medications, is the best support that we can provide, in addition to everything else that we have. One other feature a couple other features, I’ll mention and stop me whenever I’m talking too much. remote patient monitoring has been a big thing, especially with the pandemic, and it’s now covered by insurance. So we have the ability to collect data, including weights from a scale, blood pressure, heart rate, glucose, we’re talking about collaborating with other industries to collect different kinds of data. And that can actually be used to really track patients in an extremely effective way between visits, and provide us with all the data that we need. So you know, if you think about the fact that our time with patients is so limited, we maybe have a 20-minute appointment, right now, without the use of this technology, we all spend about half of our time collecting data from the patient. And so if we go into each of those appointments, with all of this data, it really makes such better use of our time with the patient to go over that data and really use that time for education, which as we’ve discussed in this field is extremely important to, you know, just help the patient understand, you know, why this has been so hard, why it’s not their fault, and, you know, reinforce a lot of the important themes that we talked about, and then come up with a treatment plan together. So it basically facilitates, you know, the the type of practice that we do. And it’s, you know, a whole obesity medicine practice, kind of in a box, really every aspect of, you know, everything we do, we’ve we’ve thought through very, very carefully. And we’ve tried to figure out, you know, a way of streamlining it and expanding it with best practices.
Fred Goldstein 22:24
So this may be a dumb question. I’m not sure. But you talked about the medicine, selection, etc. Have you? Are there now evidence-based guidelines for treatment approaches for individuals with obesity, are we still working on developing that because it’s so new.
Louis Aronne 22:39
There are evidence-based guidelines from the Endocrine Society, which came out several years ago. But whenever you develop these kinds of guidelines, they can never be specific enough. Nor are they handy enough. In fact, the idea to develop Intellihealth and evolve specifically is something that came to me when I edited the first National Institutes of Health Guide to obesity treatment for physicians and this came out back in the early 2000s. And what I had was a, you know, book about this thick with diets and all the tools you need. In fact, it had many of the things that we have in Intellihealth right now, but it was in a booklet form. But it was not usable. You know, if you went through it, and you memorize that, maybe you’d be able to do something. But it’s not at your fingertips when you’re seeing a patient and trying to get from not knowing anything to the point where you feel confident prescribing a medicine for a patient when you’ve had no training in this area before. It just does does not work.
Fred Goldstein 23:59
And and I assume that given the research going on in this area, there will be new meds that are being tested or are coming out. So I guess it might be a fair chunk of work to try to keep this app updated.
Katherine Saunders 24:11
Yes. And we we, we actually prepare for the FDA approval of new meds in advance. So the day you know, the next new medication comes out in a couple of months, we’ll already have content we’ll have it integrated into our algorithms. So yes, it definitely is a fair amount of work. But this is kind of crucial to what we’re doing.
Fred Goldstein 24:35
Absolutely keep the quality up on that and keep it relevant for what’s happening today. And from a patient perspective, is this something they go to their physician and get or can they do they go to the internet and download it from the app store? Or how does that work?
Louis Aronne 24:50
It is an app. And it is you know, we’ve now built an app for the patient side. The provider side is a web-based application. And so there are we are delivering this care ourselves. And we now have a company which will be available to deliver care for those who want it. But we are now going to providers of various types to enable them to utilize the Intellihealth platform. So, for example, at our healthcare system here, here in New York, New York Presbyterian, we’ve implemented the program by integrating it into our electronic medical record system. So it’s widely available now, just by doing that it’s widely available to our providers, if they want to deliver care, you know, those are the kinds of implementations of this that are really going to make a difference, because now all of a sudden, everybody has the ability to deliver this kind of care.
Fred Goldstein 25:57
And have you set that up to be integrated with multiple these I’m here at the HIMSS conference with multiple different EMR vendors.
Katherine Saunders 26:04
Yes, it’s it’s it’s not an easy thing to do. And one Epic is not another Epic, but we are, are underway with other electronic health records as well.
Fred Goldstein 26:18
Excellent. So, you know, I’m thinking of all these, you know, say, for example, the Medical Center in Mississippi, where they have a huge issue with obesity, this is something that they could then implement within their medical record system to begin to provide this expertise and this platform that allows for a broader based approach to care for those with obesity.
Katherine Saunders 26:38
Exactly.
Fred Goldstein 26:39
And how are you taking that to market? Is it the two of you? Are you got a team out there? Or how does that work, and
Louis Aronne 26:46
we actually have a company. We have a real company, with real CEO and a CEO and whole staff, programmers and salespeople who are handling this, we have a number of pilot projects that are underway, you know, we’re getting really good results, we’re very enthusiastic about it. You know, when when we implement this as part of our own system, we got hundreds of referrals. So it actually, in a sense, exacerbated the program, the problem that we’re facing where we’re getting too many patients here, we want other people to see the patients on their own. And people were so excited when when they saw that patients could be treated for their obesity, they just kept sending them to us. So more education is going to be necessary to get them on board and doing this on their own. But I feel like we have a really important step forward.
Fred Goldstein 27:49
Yeah. Well, I really want to thank both of you for joining us. It’s fantastic to actually see the work you’re doing in this area and what you’ve created. And I think, you know, hopefully, this will continue to expand out. So thank you, Dr. Aronne and Dr. Saunders, for joining us.
Louis Aronne 28:02
Thanks so much Fred
Katherine Saunders 28:04
thank you so much, Fred, for having us.
Fred Goldstein 28:07
And Back to you, Gregg.
Gregg Masters 28:08
And thank you, Fred. That is the last word on today’s broadcast. I want to thank Weill Cornell medicine faculty, Dr. Louis Aronne and Dr. Katherine Saunders, co-founders of Intellihealth and hosts of the podcast weight matters for their time and insights today do follow their work on Twitter via at @LJAronne. That’s LJ A R O N N E and on the web via www.WeillCornell.org/ comprehensive/weight/control/center or @intellihealth via www.intellihealth.co. And finally, if you’re enjoying our work here at PopHealth Week, please like the show on the podcast platform of your choice. Share with your colleagues and do consider subscribing to keep up with new episodes as they’re posted for PopHealth week my co-host Fred Goldstein. This is Gregg Masters saying Bye now