In this MD Newsline exclusive interview with endocrinologist/obesity medicine specialist Dr. Rocio Salas-Whalen, we discuss promising developments in obesity research and why all physicians should learn about obesity medications and use them in their practice, or refer their patients to an obesity medicine specialist. We also discuss obesity as a chronic multifactorial disease, and how to overcome insurance barriers when prescribing obesity medications.
MD Newsline:
Is there any research that excites you or that you think is important for physicians to know related to obesity treatment?
Dr. Rocio Salas-Whalen:
“Earlier this month, there was a new medication, Wegovy (semaglutide)), approved by the FDA for obesity. It’s a once-weekly injectable medication that has been used to treat diabetes. Now, it’s approved to treat obesity when used at a higher dose.
I want my colleagues who are not obesity medicine specialists or endocrinologists to know that patients should not have to go through so many steps and physicians to get to me. Right? We’re missing so many patients.
As doctors, we don’t feel comfortable prescribing a medication that we have no experience prescribing. But a patient with obesity can be seen by any specialty, even if the patient is being seen for their eye checkup or their sinus pressure. It doesn’t matter. Every subspecialty is treating patients with obesity. So we all should be able to talk to our patients about obesity and obesity treatment.
If you don’t feel comfortable prescribing obesity medications—because you’re not comfortable with the side effects or showing your patients how to use these medications—refer your patients to an obesity medicine specialist. Or learn about the obesity medications that we have available. The more of us that know how to treat obesity, the better.
Family medicine doctors, gynecologists, gastroenterologists, orthopedists—any physician should know that these medications are available for them to prescribe to their patients.”
MD Newsline:
What is your advice to other physicians on how to overcome insurance barriers when prescribing obesity medications?
Dr. Rocio Salas-Whalen:
“Many health insurances categorize obesity medications as lifestyle drugs. So, it’s going to take a multidisciplinary effort to reeducate healthcare providers and health insurance companies to get obesity medications properly categorized and properly covered.
Many physicians also tell me about their hesitancy to prescribe obesity medications because they’re so expensive and they’re not paid for by insurance. Why? Because we’re not prescribing them. If there’s no demand, insurance won’t cover them. It’s a vicious cycle.
So we have to start prescribing obesity medications more. We have to start going through the prior authorization process for these drugs. We have to go over all the hurdles that we face with insurance coverage for all kinds of medications so that the insurance companies say, ‘ok, there’s a demand for these drugs. Let’s make them more accessible.’ ”
MD Newsline:
Can you speak to the struggles the American healthcare system has had in recognizing obesity as a disease?
Dr. Rocio Salas-Whalen:
“It’s really interesting because recognizing obesity as a disease seems to be such a relatively new concept. But it’s really not that new. The World Health Organization diagnosed obesity as a disease in 1942. So since then, they have considered obesity a disease. The American Medical Association didn’t diagnose obesity as a disease until 2013.
So, for every American physician who completed their training before 2013, obesity was never discussed as a disease. It’s still a very new concept in the United States. Our generation of physicians is still learning that obesity is a disease and that we can treat it with medication. It’s really interesting how long it has taken us to recognize obesity as a disease and treat it like one.”
MD Newsline:
What is your take-home message for physicians about obesity?
Dr. Rocio Salas-Whalen:
“It’s to embrace the concept of obesity as a chronic multifactorial disease. We have to rename it. We have to remove the burden from the patient in trying to treat it themselves. We have to remove the bias and the stigma surrounding obesity.
There was a great article in the New England Journal of Medicine about obesity bias in healthcare. Most of the healthcare professionals in the interview were found to view patients with obesity as lazy, ignorant, and less successful in achieving their treatment goals. So, immediately when the patient comes in to see us, many of us are already putting the weight of our biases on their shoulders, like, ‘it’s not going to work. I’m just wasting my time. I’m not going to have this conversation.’
We have to address our biases and how we act on them. Because if we don’t, how is the general population going to make these changes without us? So, as physicians, we have to embrace medicine. We have to embrace change because medicine is changing all the time. So we learn more. And then we know better. We cannot just cling to what we already know.
It really blows my mind when patients come to me on metformin for weight loss because that’s the only drug that’s been offered to them. I feel like we’ve squeezed as much as we can out of metformin, and it’s not giving us any more benefit. And metformin is so poorly tolerated. I feel bad for my patients.
Another medication that physicians resort to prescribing for weight loss is thyroid hormone. I have so many patients that come to see me, and they’re hyperthyroid because the physician didn’t know what to do to help them lose weight, so they kept going up, and up, and up on the dose of thyroid hormone. I always tell my patients, ‘no, we have to stop that medication. Now, we actually have medications for weight loss.’ ”
Responses have been condensed and lightly edited.
