Clinical Diabetes Digital Publication
Overweight and Obesity Management for Primary Care Clinicians
John Anderson, MD, Frist Clinic, Nashville, Tennessee
Robert Kushner, MD, Professor of Medicine & Medical Education, Northwestern University Feinberg School of Medicine, Chicago, Illinois
Eden Miller, DO, Diabetes and Obesity Care, Bend, Oregon
Joe Nadglowski, President/CEO, Obesity Action Coalition, Tampa, Florida
Christopher Still, DO, FACP, FTOS, Director, Geisinger Obesity Research Institute, Danville, Pennsylvania
Obesity imposes a substantial health burden and has increased in prevalence in recent years. Despite its health impacts, obesity remains undertreated in primary care settings because of a variety of barriers. Recommended approaches to the clinical management of obesity require an understanding of the physiology of the condition as well as patients’ perspectives and effective nonpharmacologic and pharmacologic treatment options. Notably, recent approvals of new pharmacologic agents for weight management offer clinicians additional options to implement as part of an individualized weight management strategy for patients.
In this series of short videos, the authors discuss the burden and impact of obesity as a disease, approaches to communication and patient motivation for obesity management, and available evidence-based treatments. They also discuss practical considerations for implementing these interventions in the primary care setting.
The videos can be viewed in their entirety below, and an executive summary of the panel’s recommendations is available on the Clinical Diabetes website at https://doi.org/10.2337/cd22-0082 or by clicking the thumbnail to the left.
This peer-reviewed publication was developed in adherence with Good Publication Practice (GPP3) guidelines. All authors meet the International Committee of Medical Journal Editors (ICMJE) criteria for authorship and have disclosed all potential conflicts of interest.
Learning Objectives
- Recognize obesity as a serious, chronic disease
- Communicate with the patient in a manner conducive to joint decision-making
- Perform a patient history and exam with appropriate testing
- Individualize patient care based on knowledge of a variety of approaches to treatment and the latest developments.
These discussions will facilitate better utilization of therapy that will improve patient health outcomes by focusing on the evidence supporting an array of treatments for overweight and obesity.
About the Authors
John Anderson, MD, received his Bachelor of Arts with high distinction, Phi Beta Kappa, at the University of Virginia and his internal medicine medical degree and residency at Vanderbilt University. Dr. Anderson practices internal medicine and diabetes at the Frist Clinic in Nashville, Tennessee. He is Past President of the 38-member multispecialty clinic and has served in leadership roles at Centennial Medical Center, a 670-bed HCA tertiary care referral hospital. He has served as Chair of the Department of Medicine for two separate terms and has been a member and Chair of the Board of Trustees of Centennial. He has received numerous honors, including recognition as a "Top Doctor," Nashville Business Journal 2010–2017, and Honorary Fellow of India College of Physicians and Doctor of Humane Letters, New York College of Podiatric Medicine.
Dr. Anderson is Past President, Medicine & Science, of the American Diabetes Association (ADA), and he has served two separate terms on the National Board of Directors as well as three years on the Executive Committee. Dr. Anderson has been an ADA volunteer for more than 25 years, both locally and nationally. He has participated on multiple committees and task forces, including Chair of the Advocacy Committee and Co-Chair of the ADA’s Health Reform Task Force, among others. In 2013, Dr. Anderson received the Banting Medal for Scientific Achievement, the highest scientific award of the ADA, for his service as President of Medicine & Science.
In addition to his primary care practice, Dr. Anderson continues to consult and lecture both nationally and internationally, with a focus on improving the care of people with diabetes in the primary care setting. He has authored numerous publications in The Journal of Family Practice, Diabetes Therapy, Diabetes Care, Clinical Diabetes, and Postgraduate Medicine.
Robert Kushner, MD, PhD, is Professor of Medicine and Medical Education at Northwestern University Feinberg School of Medicine and Director of the Center for Lifestyle Medicine in Chicago, Illinois.
After finishing a residency in Internal Medicine at Northwestern University, he went on to complete a postgraduate fellowship in Clinical Nutrition and earned a Master’s degree in Clinical Nutrition and Nutritional Biology from the University of Chicago, Illinois. Dr. Kushner is past President of The Obesity Society, the American Society for Parenteral and Enteral Nutrition, and the American Board of Physician Nutrition Specialists and a founder and first Chair of the American Board of Obesity Medicine. Dr. Kushner has authored over 250 original articles, reviews, books, and book chapters covering medical nutrition, medical nutrition education, and obesity and is an internationally recognized expert on the care of patients with overweight or obesity issues. He is author/editor of multiple books; current books include Nutrition and Bariatric Surgery (CRC Press, 2015), Lifestyle Medicine: A Manual for Clinical Practice (Springer, 2016), Creating a Lifestyle Medicine Center (Springer, 2020), Six Factors to Fit–Weight Loss that Works for You! (Eat Right Press, 2020), and Primary Care: Evaluation and Management of Obesity (Wolters Kluwer, 2022).
Eden Miller, DO, a board-certified family physician, received her medical degree from Kirksville College of Osteopathic Medicine in 1997. Returning to the Northwest, she completed her residency in family practice at East Moreland Hospital in Portland, Oregon. Recently completing her certification in obesity management, she is the founder of Diabetes Nation, a nonprofit organization, and is CEO and a practicing physician at Diabetes and Obesity Care in Bend, Oregon.
Dr. Miller has cultivated a special interest in diabetes since contracting type 1 diabetes while in medical school. Out of that personal experience, her practice has extended into a subspecialty in diabetes care. An impassioned speaker, Dr. Miller has given over 1,000 lectures in the field of diabetes, to health care professionals and patients alike, on subjects such as diabetes management, continuous glucose monitoring technology, insulin pump therapy, obesity, metabolism intervention, clinical research, and health care policy. Her adage for care is that she “only succeeds as a clinician if she turns patients into experts on their own disease.” Dr. Miller believes that a “physiologic patient-individualized approach to diabetes intervention is crucial to success.”
Joe Nadglowski is President & CEO of the Obesity Action Coalition (OAC), a nonprofit organization formed in 2005 dedicated to elevating and empowering individuals affected by obesity through education, advocacy, and support. A frequent speaker and author, Mr. Nadglowski is especially passionate about access to obesity treatments, tackling weight bias and sharing his own experiences with obesity. He has more than 25 years of experience working in patient advocacy, public policy, and education and is a graduate of the University of Florida.
Christopher D. Still, DO, FACP, FTOS, is Professor of Medicine at the Geisinger Commonwealth School of Medicine. He is also the Medical Director, Center for Nutrition and Weight Management, and Director, Geisinger Obesity Institute, Geisinger Health System, Danville, Pennsylvania. Dr. Still has been studying developments in nutrition, metabolic syndrome, and obesity for nearly 3 decades. His work has included research into genetic markers for obesity, nonalcoholic steatohepatitis, and diabetes; the metabolic differences among obese, formerly obese, and normal-weight men; surgical options for severely obese persons; and leptin-level determination among elderly obese women. He is principal investigator on a rural elderly nutrition and aging study of approximately 22,000 individuals.
Dr. Still is certified by the American Board of Internal Medicine, American Board of Obesity Medicine, American Board of Physician Nutrition Specialists, and American College of Nutrition. He is a member of several professional societies, including The Obesity Society, the American Society for Metabolic and Bariatric Surgery (ASMBS), and the American Society of Parenteral and Enteral Nutrition. He is a fellow of the American College of Physicians and the American College of Nutrition. He served on the board of directors for the Obesity Action Coalition and is Past President of the National Board of Physician Nutrition Specialists. He and his program have been featured on CNN, National Public Radio, ABC News, and The Discovery Health Channel. He was awarded the ASMBS Integrated Health Circle of Excellence Award.
Dr. Still has recently edited the book Nutrition and Bariatric Surgery and the ASMBS Textbook of Bariatric Surgery, Volume 1, and has authored multiple textbook chapters. He has published articles in several journals, including The New England Journal of Medicine, Obesity, Proceedings of the National Academy of Sciences, Lancet Endocrinology, Annals of Surgery, Gastroenterology, Journal of Clinical Gastroenterology, Surgery for Obesity and Related Disorders, and Human Molecular Genetics. He has lectured on topics such as vitamin and mineral metabolism; diet, nutrition, and exercise; obesity through the life cycle; and perioperative medical and nutritional management of the bariatric surgery patient.
Disclosures
The Illinois Academy of Family Physicians adheres to the conflict-of-interest policy of the ACCME and the AMA. All individuals in a position to control the content disclose any relationships they may have with commercial companies whose products or services may be mentioned so that participants may evaluate the objectivity of the presentations. In addition, any discussion of off-label, experimental, or investigational use of drugs or devices will be disclosed by the faculty. Only participants who have no conflict of interest or who agree to an identified mitigation process prior to their participation were involved in the CME activity.
John Anderson, MD—Consultant and/or speaker’s bureau: Abbott Diabetes, Alfa Sigma, AstraZeneca, Bayer, Eli Lilly, Gelesis, Insulet, Novartis, Novo Nordisk, and Sanofi.
Robert Kushner—Advisory board or consultant: Altimmune, Lilly, Novo Nordisk, Pfizer, and WW.
Eden Miller, DO—Consultant, advisory board and/or speaker’s bureau: Abbott Labs, AstraZeneca, Boehringer-Ingelheim, Eli Lilly, Merck, and Novo Nordisk. Research: Abbott Labs, Pendulum.
Joseph Nadglowski—No disclosures to report.
Christopher Still, DO—Research, consulting, or speaker’s bureau: Ethicon Endosurgery and Novo Nordisk.
Austin Ulrich, PharmD (editorial support)—no relevant financial relationship or interest with a proprietary entity producing, marketing, reselling or distributing health care goods or services.
All relevant financial relationships have been mitigated.
Sponsorship
This activity is sponsored by the Illinois Academy of Family Physicians, the Primary Care Metabolic Group, and the Primary Care Education Consortium.
Support
The production of this video series and associated materials was funded by an educational grant from Novo Nordisk, Inc., in Plainsboro, NJ.
Acknowledgment
The authors received writing/editorial support in the preparation of this digital manuscript and executive summary from Austin Ulrich, PharmD, RPh, of the Primary Care Education Consortium. The content for this article and the associated video series were produced according to the policies of the Accreditation Council for Continuing Medical Education (ACCME). Novo Nordisk had no input into the topic, forum discussion, or any content for this article and the accompanying videos.
