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In this MD Newsline exclusive interview with endocrinologist/obesity medicine specialist Dr. Rocio Salas-Whalen, we discuss obesity awareness, obesity prevention, and the importance of talking about obesity with patients. We also discuss Dr. Rocio Salas-Whalen’s treatment strategy for patients with severe obesity.

MD Newsline:

How can communities and physicians raise obesity awareness and work to prevent obesity?

Dr. Rocio Salas-Whalen:

“I think we need a multidisciplinary approach that should start in school at a very early age. We teach how to use condoms. Why can’t we show children how to make healthier dietary choices? At any level of socioeconomic status, there’s always the opportunity to make a healthier choice from the food that is available. Right?

By educating children on nutrition at a young age, we can improve that part of the equation. And then, we need to educate physicians so that they can educate their patients. I think there’s a huge problem with the healthcare system and health insurance that we don’t have the time to have those discussions. It’s very sad, and that’s one of the reasons why I don’t take insurance because I want to have those conversations with my patients.

Treating diabetes requires a very similar approach, having conversations with patients about lifestyle, exercise, and nutrition. It’s easier just to talk about medications, but we always have to have conversations about lifestyle choices and medications.

I have patients who will tell me, ‘you’re the first doctor who’s discussed my weight with me.’ I know many of my colleagues want to have these conversations with their patients, but they don’t have the time. [In the insurance world], we only have 15 or 20 minutes to treat a patient.

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So I think we have to take a step back and take the time to have these conversations with our patients. Because in doing so, we might be able to prevent complications from obesity, and the need to prescribe more medications for these complications.”

 

MD Newsline:

What would you say to physicians who are uncomfortable talking about obesity with their patients?

Dr. Rocio Salas-Whalen:

“I think part of the problem of the obesity epidemic in the United States is that we’re very politically correct. But if you think about it, obesity may be our Achilles tendon. There was a recent article in The New York Times that said 3 out of 5 military applicants are refused because of their weight. Obesity is a huge problem with a wide-reaching impact, even impacting our national security. If we can’t talk about obesity, we will never fix the problem.

I try to be as sensitive as I can when talking to my patients about their weight, but I always try to remember, if I don’t have this conversation with my patients, and I’m a board-certified endocrinologist and obesity medicine specialist, who will have this conversation with them? Right? So we have to start talking about obesity with our patients.

We cannot normalize obesity. We cannot normalize being sick. I am very pro-health. I value loving one’s body and loving oneself. But we have to learn to separate these issues. And if, as doctors, we can’t address the issue of obesity, then who will? Right?”

 

MD Newsline:

What is your treatment strategy for patients with severe obesity?

Dr. Rocio Salas-Whalen:

“Obesity medicine has changed a lot. We used to offer diet and exercise or bariatric surgery, without many options in between. But now, with weight-loss pharmacotherapy, in the last two years since I opened my practice, I’ve only had to refer one patient for bariatric surgery who was unresponsive to obesity medication.

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I have patients who have lost 100 to 110 pounds with weight-loss drugs. And these drugs are approved for chronic use, which is important because obesity is a chronic disease. With weight loss medications, lifestyle changes, and education on nutrition and exercise, patients can do great at losing weight.”

 

Responses have been condensed and lightly edited.

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