Tuesday, February 27, 2018

Q&A with Dr. Sean Wharton: Obesity through the Eyes of an Expert

As a leading expert in the field of obesity and a Canadian Obesity Network (CON) member, Dr. Sean Wharton MD, FRCPC, PharmD has significantly contributed to the field of obesity in terms of research, treatment, education and patient advocacy over the course of his amazing career.

I had the pleasure of interviewing Dr. Wharton to learn about his career focusing on obesity and his thoughts on the various aspects surrounding this chronic disease. He also discusses what we can do as healthcare professionals to better help our patients living with obesity.

The excerpts below are a summary of my interview with him. I hope this interview provides some food for thought on how we currently manage obesity and what changes can be done to improve management for our patients.

Why did you choose to focus on obesity when there are so many other conditions to manage?
As a general internist, I chose to practice obesity medicine as it had a niche for internists that was unfilled by other subspecialties and there was very little focus on it. I felt that a lot of different chronic diseases being managed including diabetes and hypertension were frequently a result of a person's weight, so if you can manage obesity you can manage a lot of the other health conditions that are associated with it. It’s [obesity] a very interesting, new and exciting field to actually tackle.

What is the most frustrating aspect when dealing with patients or other healthcare professionals?
The most frustrating [aspect] in both patients and healthcare providers is a lack of understanding of the biology of weight change as well as the belief that it is [obesity] primarily a lifestyle issue and not a biological medical condition. I encounter this misunderstanding often and I think clinicians and patients want to believe that obesity is a lifestyle issue and they dismiss the fact that it’s a medical condition despite presented with evidence because it doesn't fit with their thought process.

Most of my patients have little understanding of the biological processes and feel that willpower and/or lifestyle changes are all that is needed to be able to keep weight off over the long term.

Are these biases that you mentioned affecting healthcare professionals’ ability to help patients?
Absolutely, these biases affect the clinicians ability to help patients to lose weight because they lack the true understanding of the biology of obesity. It [these biases] ends up impacting their relationship with patients, their ability to be sensitive to a patient's challenges and ability to offer other aspects of healthcare to their patients in a timely fashion.

Comments like “If you just lose some weight then we can do your pap-smear better because how can I do it if you don't lose weight” results in patients feeling embarrassed and unwilling to return. People who struggle with obesity do not visit their doctor as often [as those without] because of the embarrassment and stigma leading to significant decrease level of care which increases their risk of developing further problems. When they [healthcare professionals] tell patients “You can lose weight with just diet and exercise”, the patient becomes discouraged because they know that they can't and they feel that they’re disappointing their physicians, so they don't come back and see them.

How does commercial diets that guarantee weight loss impact practicing evidence based obesity management?
The short term willpower capacity [that these diets promote] is what ends up confusing people because they really believe that short term weight loss equals the ability to continue [losing weight] in the long term if they just keep on fighting. The analogy I like to paint is playing the slot machines in Vegas; you play it over and over again – winning once in a while, which tends to keep you going and thinking that maybe you’ll win big but in the end everybody loses money at the slot machine eventually. Of course there’s a small percentage of people that have won big and they’re held up as examples of what everyone else can achieve. It’s unfortunate because people want to believe in success and they want to believe in the dream but it’s misleading.    

What is the biggest achievement and setback that has occurred in obesity management?
I think the biggest achievement is the introduction of GLP-1 analogues [for obesity treatment] because for the first time the neurological and biological aspects [of obesity] were highlighted by a medication backed by a big pharmaceutical company. This facilitated the education of obesity to a large number of people whereas prior to that, the medications on the market didn't really highlight how much obesity is a biological and neurological process.

The biggest setback I think has been the commercialization of weight loss shows which continue to perpetuate that this [obesity] can be managed through lifestyle modification alone. People only see the initial weight loss success but not the regaining of weight after due to the biology [of obesity].

In your opinion, what are some of the most useful resources for obesity management for both healthcare professionals and patients?
In terms of physician and researcher resources, I found that the Canadian Obesity Network (CON) has been very good. For patient resources I have not found very many that are actually helpful but there are multiple websites that do not provide useful information about the biological aspect of obesity and do nothing to help a patient.

The few [patient resources] that are helpful include Dr. Yoni Freedhoff’s blog and Dr. Sue Pederson’s blog as well as Dr. Freedhoff’s book “The Diet Fix” which is pretty good but it’s a little wordy and not as patient friendly.

When should a general practitioner refer their patients to an obesity specialist?
I think any time a patient expresses that they are feeling lost, having difficulty managing weight and expressing the need to see somebody with greater knowledge. It shouldn’t be based on the patient’s health or weight. Although a patient might not fit the BMI criteria for referral to a weight management clinic, the degree of stress that is associated with weight gain and the need for greater understanding of their bodies is an important consideration. Of course if they have other health conditions associated with elevated weight (e.g. fatty liver, osteoarthritis, diabetes, hypertension and dyslipidemia) they should definitely find their way to an obesity specialist.

What is it the single best thing, as healthcare professionals we can do to reduce the stigma patients experience?
I think the best thing we can do is explain the biology [of obesity] to patients. I believe that not only the physician community but the patient community needs to be aware of it too. This goes a long way in accepting obesity as a medical condition and therefore provides the ability to actually treat it. By explaining to patients the biological process that dictates the weight gained once weight has been lost, it helps them understand their struggle and reduce the self-blame which can significantly affect their goals. With the appropriate goals, patients have a greater ability to be happy and self-efficacious.

Post Reflection
After speaking with Dr. Wharton, I could feel the immense passion he has for the field of obesity and it is exciting to see how the future of obesity management and treatment will change as more research is being conducted in different areas from pharmacotherapy, surgery to psychology.

For more information on topics discussed in the interview, here are some links: