Racing to Catch Up: Obesity Medicine

More than 100 million American adults have obesity and nearly 1 in 10 adults have severe obesity, according to the latest research from the U.S. Centers for Disease Control and Prevention, despite a slight decline in the national obesity rate from 41.9% to about 40.3%.

Standing against that overwhelming tide are a very small but growing number of physicians who specialize in obesity medicine, including Manisha Chand, MD, DABOM, with Cleveland Clinic in Florida. As an American Board of Obesity Medicine (ABOM) diplomat, she is one of more than 8,200 physicians trained and certified in obesity care.

Dr. Chand leads the Obesity and Lifestyle Medicine Program within Cleveland Clinic’s Primary Care Institute in Florida. The regional pilot program was launched in January 2024 and has brought a new level of obesity care to over 1,200 patients across southeast Florida where Cleveland Clinic operates a five-hospital regional health system.

Why obesity medicine?

Dr. Chand’s interest in obesity medicine is rooted in the coronavirus pandemic.

The self-described “COVID graduate” says the final year of her family medicine residency brought the role of obesity in healthcare outcomes into stark focus. “Young or old, the patients I saw in the critical care unit during the pandemic often shared obesity as a common denominator,” she says.

Following her residency and ABOM certification, Dr. Chand maintained a hybrid practice in Washington state, where 70% of her practice focused on primary care and 30% on obesity medicine. Since joining Cleveland Clinic in 2023, 100% of her practice is dedicated to obesity medicine.

Dr. Chand is based in Weston, Florida, where she sees patients at the Krupa Center across from the main campus of Cleveland Clinic Weston Hospital. She also rotates once a week to the Family Health Center, St. Lucie West in St. Lucie County, which is part of Cleveland Clinic Martin Health.

Her focus includes obesity management, pre and post-operative bariatric medicine, health and wellness, nutrition counseling, and the management and reversal of chronic illnesses.

"It's very fulfilling to watch the health and quality of life of my patients improve, and I often see a ripple effect within their families,” says Dr. Chand. “I’ve seen spouses, children and even cousins benefit from the obesity care I provide my patients.”

In addition to the positive outcomes achieved in her practice, Dr. Chand points to a retrospective cohort study published earlier this year that demonstrated a primary care-based weight navigation program can improve treatment and outcomes for patients with obesity.

A multimodal approach

Dr. Chand's approach to obesity management is multifaceted, incorporating nutrition support, exercise and fitness programs, appetite control techniques, stress management, sleep management, and prescription medication management. She also collaborates with a nutritionist and a primary care pharmacist, who is certified in weight management by the American Society of Health-System Pharmacists. Both are an integral part of the team and provide added guidance and support for patients.

“We use first generation and newer GLP-1 drugs, when appropriate, but dietary and lifestyle modifications are a fundamental component of every patient’s treatment plan,” she says. “It takes a multimodal approach to sustain weight loss.”

Dr. Chand worries, however, that as more patients seek out popular anti-obesity medications (AOMs), they will not receive the holistic care that leads to longer-lasting results.

An inflection point

"Obesity medicine is a pretty new subspecialty that has grown rapidly,” says Dr. Chand. “There are more certified physicians and more obesity medicine fellowships than ever before, but it's nowhere near enough to meet the current demand for obesity care.”

The American Board of Obesity Medicine was established in 2011, followed the next year by the launch of the first obesity medicine fellowship program in the United States. One year later the American Medical Association officially recognized obesity as a disease. Fast forward a decade and there are 33 programs registered with the Obesity Medicine Fellowship Council, including Cleveland Clinic’s program in Ohio.

“It took exceptional work to get us to this point, but the work is not done,” says Dr. Chand. “Thanks to a generation of researchers, we know that obesity has many contributing factors, including genetic, physiological, environmental and social, and that it is linked to many other diseases. Unfortunately, there is still no definitive way to define and diagnose obesity.”

Earlier this year, however, at the International Congress on Obesity held in São Paulo, Brazil, The Lancet Commission on the Definition and Diagnosis of Clinical Obesity announced it is conducting a global study to establish a clear definition for obesity. The commission was established in 2023 to look at the etiology of the disease, distinct pathophysiology, and clinical manifestations in order to define the clinical signs and symptoms for obesity and treatment targets.

Lack of obesity education

Equally concerning is the prevailing view that obesity is a choice that can be reversed by voluntary decisions to eat less and exercise more, according to a joint international consensus statement for ending the stigma of obesity published in 2020.

“Too many healthcare professionals still view obesity as a risk factor rather than as a disease, and among those who recognize the value in treating obesity, most don’t feel equipped to help patients,” says Dr. Chand.

These sentiments are not surprising. A survey of 40 medical schools conducted in 2018 found that obesity is not being prioritized in their curricula. Only 10% said they believed their students were "very prepared" to manage patients with obesity, and one third of the schools indicated they had no obesity education program in place with no plans to develop one.

There is evidence, however, that some medical schools are working to address the lack of obesity education. In June a team at Case Western Reserve University School of Medicine reported on their efforts to introduce a comprehensive first-year curriculum on obesity. Notably, they found among participants a significant decrease in the belief that obesity is caused by poor personal choices.

As an obesity medicine specialist, Dr. Chand says part of her role also entails educating other physicians.

“I’m glad to be a resource for my primary care colleagues, and we often discuss obesity management issues, including the use of medications, during our biweekly team huddles,” she describes. “I’m also collaborating with a colleague in Nephrology at Weston Hospital to develop and hopefully standardize obesity care pathways in kidney disease.”

In addition, Dr. Chand enjoys teaching and when requested, offers opportunities for medical students, nurse practitioner students, and physician assistant students to shadow her during their primary care rotation.

Most of all, Dr. Chand says she is happy there is much more recognition of the role obesity plays in health outcomes and that important conversations are now taking place with patients, among her colleagues in primary care, and across an array of specialties.