Host: Welcome to Back to Health, your source for the latest in health, wellness,
and medical care, keeping you informed so you can make informed healthcare choices
for yourself and your whole family.
Back to Health features conversations about trending health topics and
medical breakthroughs from our team of world renowned physicians
at Weill Cornell Medicine.
I'm Melanie Cole, and we have a panel for you today with Dr.
Gwendolyn Jack.
She's an assistant attending physician at New York Presbyterian Hospital,
Weill Cornell Medical Center, and an assistant professor of clinical
medicine at Weill Cornell Medical College, Cornell University.
And Rachel Stahl Salzman, she's a registered dietitian and a lecturer
in medicine at Weill Cornell Medical College, Cornell University.
And they're here to highlight advancements in obesity care and
diabetes management for us today.
Thank you both so much for being with us, and Dr.
Jack, I'd like to start with you.
I'd like you to talk about the prevalence and the current state of obesity today.
It's really an epidemic, and how has that prevalence that we're
seeing and the rise in obesity contributed to the rise in diabetes?
Connect those dots for us.
Guest 2: So, thank you for the question.
What we can see from the data is that over the past several
decades, the rates of obesity as well as diabetes have increased.
So, for example, it is estimated that the obesity prevalence is approximately
42 percent, and this is an increase from about a decade ago when it was 30 percent.
Similarly, the rates of diabetes have also increased quite significantly
over the past few decades, and it's estimated that approximately 38 million
adults in the United States have type 2 diabetes, and really stark Because
approximately 1 in every 10 people
has diabetes in the United States.
And glaring to that is that 1 in 5 people are not aware that they have diabetes.
And then when we also think about the precursor to type 2 diabetes,
pre diabetes, it's estimated that 90 million people, million adults in
the United States have pre diabetes.
And more than 8 in 10 people with pre diabetes are not aware that they have it.
So more than 80 percent of people with pre diabetes are not aware.
And so it's really important to understand that there are so many
different factors that play a role.
There can be a role of genetics.
There can also be a role of the environment that we live in and
having access to healthy food options, having access to physical activity
and Also, understanding the stressors that play a role in increasing
the risk for diabetes and obesity.
Host: Those are some startling statistics, and yes, we're seeing this rise, and it's
just, it is really very interesting to connect those dots, and I thank you, Dr.
Jack, for doing that.
Rachel, we're in the spectrum now of diabetes diagnosis.
Is obesity a factor?
As we're looking at this increase in diabetes, there are also other
risk factors for diabetes as well, so where in the spectrum is obesity
considered a major risk factor?
Thank you.
Guest 1: Obesity is a major risk factor for the development of type 2 diabetes.
And this risk factor has, been a really crucial component for helping
to address both the prevention and management of type 2 diabetes.
And our leading organizations that we look to for guidance, the American Diabetes
Association, the American Association of Clinical Endocrinology, all highlight in
their treatment guidelines and algorithms that the treatment of obesity and weight
management needs to be front and center.
So that really goes to emphasize the importance of that.
But like you said, Melanie, and as Dr.
Jack alluded to, there are other risk factors that we need to consider when we
work with the people that we care for.
Genetics, family history of type 2 diabetes.
It's a long list of why people would, wouldn't take with
COVID things to the side.
There's a lot of other factors that factor into the overall size
Host: That's true.
All those things.
That's so interesting.
So, Dr.
Jack, the most significant challenges that clinicians face in managing
patients with both obesity and diabetes, and as someone who's worked
in that field as well, I, these challenges are so Not unsurmountable,
but they are certainly a challenge.
Speak about that and how that impacts patient outcomes.
Guest 2: Yeah, so I think, just underlying the point that obesity is actually linked
to, estimated to more than even 50 percent of new cases of type 2 diabetes, right?
So, underscoring the importance of addressing both at the same time.
Part of the challenge is that there are a lot of systematic issues or systemic
issues that need to be addressed in terms of access to healthy food options that
are also cost effective or affordable.
Also, access to medications that have been shown to be beneficial
for not only lowering the glucose or blood sugar, but also helping
with weight management as well.
And then having access to Healthy green spaces allow for increased
walkability having access to, again, optimizing or increase physical activity.
So really being able to have adequate resources and making sure that
those resources are distributed in an equal manner to everyone.
Guest 1: And I would add here, just taking it a little bit more in a specific
example is when people that have obesity or diabetes present to us, they often
might have other comorbidities that we know having obesity and type 2
diabetes can increase their risk for.
Things like cardiovascular disease, kidney disease, diabetes.
So from a dietician standpoint, it can become very challenging for the
person to know what to eat, to manage all of these conditions, and to put it
together into one individualized plan does take a lot of effort and work,
and many people don't know where to go.
So it's so important, that we focus on a multidisciplinary team in our approach
to helping these people with access to dieticians, diabetes care and education
specialists, nurse practitioner, and endocrinologists to bring that whole
care team together to support them.
Host: Well, it certainly is true that a multidisciplinary approach
is crucial for patients and people living with diabetes and obesity,
and it's such a complex topic.
This is such a bigger topic as Dr.
Jack, as you alluded to, with rural and urban deserts, with food insecurity, with
gym and recess and walkability in parks.
I mean, we could go on just about that part of it because that is so complex
and really compounds on the situation.
But Dr.
Jack, I'd like you to Pay a little bit of extra attention here in this podcast and
speak about the prevalence and management in different demographic groups.
How these disparities can be addressed because I think we're seeing such
a rise in diverse populations and underserved communities.
Speak just a little bit about that and any outreach that you want.
to let people know about.
Guest 2: Yeah, so I think it's important to increase awareness,
first and foremost, and then, of course, increase access to resources.
It's also important, as we think about a team based approach, is also
thinking about a tailored approach.
So, meaning that we are tailoring our approach to the person in front of us.
So, we're thinking about not just applying general.
Rules for everyone, but if, for example, when we're working with someone
and we advise for them to walk in their neighborhood, assessing whether
or not that's actually a barrier.
Are there concerns about violence in the neighborhood or walkable
space in the neighborhood?
So it's really about getting to know the person and tailoring
what our counseling and our advice is for that particular person.
So I think it requires an individualized approach.
in addition to
a team based approach.
So I think that's one of the ways that we can tackle it on
a more interpersonal basis.
Similarly, when we talk about food insecurity, it's about really making sure
that we're having increased access to affordable and nutritious food options.
when people have to think about whether or not they're going to be able to pay
rent or pay their bills and thinking about healthy food options, we really
want to be able to remove that out of the equation and allow for people to have
access to these nutritious items as well.
Guest 1: And I would add, I completely agree with Dr.
Jack's points, and it's been a big challenge to help overcome
some of these disparities.
One thing that has been really exciting to follow in this space,
and Melanie, you might be familiar with hearing about this, is the Food
as Medicine programs, especially around medically tailored meals.
So I'm really hopeful that strategies like this to provide You know, meals delivered
to individuals, especially in areas where they wouldn't have access to it, or
maybe they have disabilities that limit them to go to the grocery store to get
these important healthy ingredients could really help improve these disparities.
We've also done a lot of programming.
Dr.
Jack and I, we call us the Dynamic Diabetes Duo.
We've gone around in reaching to community centers across the boroughs.
You know, We're based in, Manhattan and really making efforts to touch different
communities and tailor our content.
To meet their specific needs.
And since COVID, we've done a lot of virtual, we've connected to senior
centers across different boroughs who might not have access to meet
with specialists in this space.
So we've really found that to be a great community based intervention to
help with some of these disparities and ultimately help educate people on what
they can do to support their health.
Guest 2: And I will just add to that by interacting with the community
members, we also learn as well.
I think it's a bi directional process because they teach us so much in terms
of how they're able to navigate some of these challenges and these barriers.
So, for example, you know, if lack of access to healthy food options in the
form of fresh fruits and vegetables.
Well, I have some people who buy frozen fruits and vegetables to be able to
get the nutrients even though they don't have the access readily available
for the fresh fruits and vegetables.
So I think it's important that we also listen to the community at large as well.
Host: What important points both of you just made.
Now, Rachel, talk about some of the exciting advancements in treatments.
as we're talking about awareness and outreach and food is medicine and even
exercise is medicine, tell us a little bit about some of the things that you're
doing with patients to help get them to understand the conditions and the
way they go together and those comorbid conditions, as you mentioned, high blood
pressure and all the rest that go with it.
Guest 1: This is such an exciting time in obesity and diabetes care
that I think, you know, it's like a whole conversation in itself.
We're constantly, seeing new FDA approvals, new products, new options
out for patients, increased access.
So it's been a really exciting time for us.
I would kind of highlight a couple key areas that definitely
excite me in this space, in the treatment of obesity and diabetes.
The first would be on the medication side, as I'm sure many of the listeners
here are hearing a lot about the GLP 1 receptor agonists and the dual receptor
agonists as helping to support both treatment of obesity and diabetes.
And I would say this is just the beginning of where we have yet
to go with these medications.
There are, clinical studies underway of Triple, they call
them the triple agonists.
So really interested to see where the space goes to help support the people.
But I would also say at the core of it is always lifestyle foundation as
a key factor in helping with these advancements and use of digital health
tools to help empower people, keep them engaged with their nutrition,
keep them engaged with their exercise.
We're seeing a lot with wearables and with all this data, then as the clinician.
We could now see it.
A lot of these apps and tools integrate into a healthcare provider side, so we
can actually see the data all together.
Their glucose data, their, food diary, their steps that they're
tracking to put together a whole plan.
And I would say the last piece, in the space too, that we're seeing is
the growth of artificial intelligence.
I think we could all, understand and acknowledge that in all
arenas of the world today.
And so I'm really excited about the role of that.
for Obesity and Diabetes Care.
Host: I'd love to give you each a final thought here, and Dr.
Jack, I'd like you to speak about patient education, empowerment, how
they all play a role together, and any exciting technology that you would
like to bring into this episode or discuss future thoughts about this
epidemic that we're seeing and this combination of Obesity and diabetes.
I'd like you to give us your best advice and wrap up.
Guest 2: Yeah, so just adding on to what Rachel mentioned, I think what we have
currently on the market as well as what is in the horizon in terms of medications,
I just want to highlight that.
Obesity is a medical condition and really it's important for us
to really de stigmatize obesity.
So when we talk about medications, there are several medications that have, for
example, an indication for diabetes, but they have a similar base medication.
So, for example, Terzapatide is a medication that many
may know of as Munjaro.
That is FDA approved for diabetes, but Now we have actually the
indication for obesity or weight management that's called ZEP bound.
And so there it's really important that we understand that the same way that
we would treat diabetes as a medical condition It's really important that we
also treat Obesity as a medical condition and to really destigmatize Obesity and
to really understand that we don't define people by their medical conditions.
So really staying away from using terms like obese patient and really
sticking to person with obesity and really humanizing the person.
So I think that, so just changing the way that we talk about obesity and
diabetes is integral whenever we're having discussions and conversations with people.
And In terms of treatment also using diabetes technology, highlighting
continuous glucose monitors, it's, always fascinating when someone is
able to see their data and see really the impact of certain foods, and
also the impact of physical activity.
And having that data in and of itself can be so empowering for people especially
as they're making these lifestyle changes or taking medications, or
after they have weight loss surgery.
It's so important to see this data available and seeing that there's such
a huge impact that nutrition makes, physical activity, and medications.
And so I think I'm so optimistic about the technological advances that we have and
also the medication advances that we have and really highlighting the importance,
again, of the team based model.
So, seeing the primary care doctors, seeing your endocrinologist, seeing
the dietician, nutritionist, these are all important, especially when
there's significant weight loss.
We want to make sure that there isn't significant protein
or muscle mass loss as well.
So, in summary, I would say Having the team based approach, integrating
technology to be able to see the data and see the impact of these interventions,
and then also individualizing our approach to the person in front of us, and really
utilizing lifestyle changes as well as potentially medications and other
options as well to holistically optimize diabetes care and weight management.
Host: You said that so beautifully, Dr.
Jack, and really it's true.
Individualizing that patient care for the patient in front of you.
Rachel, I'd like to give you the last word.
I'd like you to speak about your team and your approach to that patient centered
care because it is a sensitive thing and it is difficult for some people to hear
from you both, your experts, and so I'd like you to speak just from the patient's
perspective and from your team and how you work with compassion to help people
that are living with diabetes and obesity.
Guest 1: Absolutely.
This has been such a really great discussion, and I would, echo Dr.
Jack our work as a multidisciplinary team, practicing really person
centered care which really uses inclusive and non judgmental language.
And really just leading with empathy.
I think one of the biggest things that we have seen so much is, we always want
to share the latest and educate others, but we need to listen, understand
their biggest pain points in managing their obesity or their diabetes.
What bothers them at that particular time at that visit and understanding
that that can change over time as well.
So I think the importance of getting everyone on board to support
them in all the different avenues for their medications, for their
behavior change, for their lifestyle.
And using both motivational interviewing, shared decision making
to help empower them to really be educated and understanding of
how to manage their conditions.
Because as the reality is, a lot of that management is when
they're not in the office, right?
The amount of times they actually meet with us per year, you know,
if we're lucky, right, is, so much less than we would want.
So how we can really help support them between visits to
be empowered for their health.
Host: Thank you both so much for joining us today.
And that was an excellent discussion.
And you're both very good educators.
Thank you so much for sharing your expertise.
And Weill Cornell Medicine continues to see our patients in person
as well as through video visits.
And you can be confident of the safety of your appointments
at Weill Cornell Medicine.
That concludes today's episode of Back to Health.
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I'm Melanie Cole.
Thanks so much for joining us today.
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