Empowering Patient Wellness Through Obesity Medicine

Wei Zhang MD ,PhD, and Vinni Makin, MD

The number of physicians obtaining board certification in obesity medicine has increased tenfold in the last decade, reflecting the growing demand for care from patients and healthcare systems. Obesity is a complex, adiposity-based chronic disease stemming from both genetic predispositions and environmental influences. Each patient has unique medical, socioeconomic, psychological and environmental circumstances. The complexity of the disease is best met by coordinated care from a team of experienced specialists.

Cleveland Clinic’s comprehensive obesity medicine program employs a collaborative strategy to address challenges and optimize patient outcomes. Our multispecialty clinic is dedicated to enhancing metabolic and mechanical health through comprehensive weight management.

A case example

A 42-year-old female recently seen at our practice exemplifies our approach. She initially presented with prediabetes, fatty liver disease, hypothyroidism, polycystic ovary syndrome (PCOS) and concerns about her weight – 258 pounds (BMI 40 kg/m²) at the start of her journey. She underwent a thorough evaluation by an obesity medicine provider and engaged with a registered dietitian and an exercise physiologist.

The patient was started on anti-obesity medications and took part in our obesity shared medical appointments (SMA). The program comprises monthly online meetings with a nutritionist and an obesity provider over six months.

After completing the SMA program, the patient returned for follow-up visits at the weight loss clinic every one to three months. Over the course of two and half years, our providers helped her obtain anti-obesity medications as medically indicated. Challenges included medication intolerance, pharmacy shortages and insurance coverage issues.

The patient also demonstrated remarkable dedication by modifying her dietary habits and increasing exercise tolerance. Our endocrine psychologist provided behavioral support on her weight loss journey.

Through collaborative efforts, the patient achieved significant progress, reaching 190 pounds (BMI of 31 kg/m²), which represented a total weight loss of 68 pounds (26%). Notably, her glucose levels resolved to normal, and an abdominal ultrasound confirmed regression of her fatty liver disease.

Obesity medication approach

In our obesity clinic, patients often express concerns about potential dependency on anti-obesity medications, yet similar concerns rarely arise for medications for treating other chronic conditions such as hypertension, dyslipidemia or diabetes.

Medications often are added when patients struggle to achieve optimal disease control by lifestyle change alone. While we aspire to achieve medication-free outcomes for all patients upon achieving ideal weight, we should acknowledge that discontinuing medication can lead to disease exacerbation, which in obesity is weight regain.

Health, strength, vitality

Patients also often ask how much weight they can lose in one month. We address this question by emphasizing quality over quantity of weight loss. We advocate for a balanced diet and strength training to foster not thinness but good health, strength and vitality.

The multifaceted benefits from weight management include reducing reliance on medications for related chronic conditions, mitigating future cardiovascular risks, and potentially reversing obesity-associated conditions such as diabetes, PCOS and fatty liver disease. With the right support in place, patients can succeed in achieving weight management and experience transformative wellness.

For appointment or referral information call 216.444.6568.