Obesity Week

October 31-November 4, 2016; New Orleans, LA; Days #1-2 Highlights

Executive Highlights

Greetings from the Big Easy! Our team has been enjoying sunny New Orleans, where the annual Obesity Week meeting began Tuesday. Co-sponsored by The Obesity Society (TOS) and the American Society for Metabolic and Bariatric Surgery (ASMBS), this conference has already provided us with a wealth of new insight on a range of topics in obesity. Most notably – especially in light of the upcoming election – we heard an evaluation on the effect of the Berkeley sugar-sweetened beverage tax on prices, sales revenue, and consumption of taxed beverages. In addition, the ever-popular Innovative Emerging Pharmacotherapy and Devices Forum provided a fascinating overview on a diverse array of novel obesity therapies – from drugs to duodenal mucosal resurfacing to gut sensory modulation, an approach we are only first hearing about. We also heard from the great Dr. Donna Ryan on a new framework for thinking about obesity management – what she pithily terms the “10 Commandments of Obesity Management.” On the prevention front, we heard the full results from the SNAP study, a longitudinal assessment of weight gain prevention in young adults – a population we learned is especially susceptible to weight gain, and whose weight gain is especially associated with worsening of cardiovascular complications and even increased cancer risk.

Below we share our biggest takeaways from the first two days of what promises to be a fascinating conference. If you haven’t already, take a look at our conference preview for a sneak peek of the packed agenda to come.

Top Ten Highlights

1. Dr. Shu Wen Ng (University of North Carolina, Chapel Hill, NC) presented an evaluation of the Berkeley sugar-sweetened beverage (SSB) tax, finding that taxed beverages experienced an increase in cost and a sales decline.

2. Dr. Ken Fujioka (Scripps Clinic, La Jolla, CA) presented a new analysis of pooled data from the SCALE Obesity and Prediabetes/SCALE Diabetes trials of Novo Nordisk’s obesity drug Saxenda (liraglutide 3.0 mg) in order to identify an early response criterion for predicting weight loss. Analysis of the data indicated that ≥4% weight loss at 16 weeks is a strong predictor of clinically relevant weight loss at 56 weeks.

3. The Innovative Emerging Pharmacotherapy and Devices Forum, a perennial favorite at Obesity Week, provided a fascinating overview of novel obesity therapies currently under development, with targets ranging from the brain-based to the gut-based.

4. At a Novo Nordisk-sponsored corporate symposium – to thundering applause and laughter – powerhouse obesity expert Dr. Donna Ryan (Pennington Biomedical Research Institute, Baton Rouge, LA) issued her “Ten Commandments of Obesity Management.”

5. Dr. Rena Wing (Brown University, Providence, RI) presented two year results from the Study of Novel Approaches to Weight Gain Prevention (SNAP), demonstrating the effectiveness of a lifestyle modification program to prevent weight gain and improve glycemic control in young adults.

6. The esteemed Dr. Ronald Kahn (Joslin Diabetes Center, Boston, MA) delivered a keynote lecture emphasizing the complex interplay between genes, environment, and the gut microbiome in the development of obesity.

7. Speaking to an absolutely packed hall, Dr. Sadaf Farooqi kicked off Obesity Week 2016 by addressing how the prevalence of stigma against obesity in the general population is at odds with the breadth of evidence suggesting that many genetic variants predispose certain individuals to obesity.

8. Another packed symposium on reducing weight bias in healthcare featured valuable patient, clinical, and systemic perspectives on how to reduce the scourge of obesity stigma.

9. The power of adherence was a major theme during a pre-conference review course for the American Board of Obesity Medicine examination, with speakers almost unanimously emphasizing its significance in the context of diets, medication management, exercise, and supplementation following bariatric surgery.

10. A symposium titled “Clearing Up the Diabetes and Obesity Conundrum” provided clear guidelines for clinicians to follow when treating the growing number of patients with comorbid diabetes and obesity.

Top Ten Highlights

1. Dr. Shu Wen Ng (University of North Carolina, Chapel Hill, NC) presented an evaluation of the Berkeley sugar-sweetened beverage (SSB) tax, finding that taxed beverages experienced an increase in cost and a decrease in sales. The study analyzed UPC and transaction data from nine locations of two grocery chains inside and outside Berkeley in the first six months since the tax’s implementation in March 2015. Regardless of location, taxed beverages were priced higher than non-taxed beverages by an average of  a $0.70 per ounce. Sales of taxed SSB fell by 8.5% (p<0.001) in Berkeley and rose by 6.6% in non-Berkeley areas. Interestingly,  these non-Berkeley sales increases were more prevalent in stores closer to Berkeley relative to more distant ones, raising the possibility that people travelled outside Berkeley to seek cheaper soda in neighboring towns (although it is impossible to determine this based on the present analysis). Non-taxed beverage sales rose in Berkeley, leaving no change in overall Berkeley beverage sales post-tax relative to pre-tax. Overall, the results demonstrate an average pass-through (revenue growth due to increased costs) of approximately 70% on SSB; there was no significant change in pass-through for untaxed beverages.

  • Although these data suggest a promisingly reduction in the purchase and consumption of SSB in the Berkeley area, the study does have limitations. This study tracked only two out of the six major grocery chains in Berkeley, so the conclusions are not necessarily generalizable to all stores or store types. In addition, Dr. Ng noted that this study was unable to account for other cofounding factors that may have occurred in the pre-tax and post-tax periods, nor whether the changes in pre- and post-tax sales revenue were due to changes consumer or distributor behavior, such as people purchasing SSBs from other stores. A one-year evaluation is currently under review. Nonetheless, the study supports many thought leaders’ avocation of the soda tax. Indeed, during the recent National Academy of Medicine meeting on the 30 year rise in obesity and type 2 diabetes Drs. Steven Gortmaker and Kelly Brownell discussed the enormous healthcare costs that could be saved and tax revenue that could be collected if soda taxes were implemented more widely. Philadelphia and Berkeley have already passed soda taxes, and San Francisco, Oakland, Albany, CA, and Boulder as well as Chicago are in the midst of debates – we believe the momentum is on and that we’ll look back upon this time and see it as a period of tremendous success.
  • Following the theme of sugar-sweetened beverages, a poster presentation by Mr. Gregory Farenga (University of Connecticut, Storrs, CT) demonstrated that cessation of SSB intake led to significantly improved weight loss outcomes in individuals (n=214) enrolled in a three-month internet behavioral weight loss program. Individuals who drank SSBs at baseline but stopped once beginning the online weight loss program lost 6.3% body weight compared to only 4.1% in participants who did not change their SSB intake and 3.1% in participants who increased their SSB intake during the program (p<0.01).Participants’ baseline SSB intake had no association with baseline BMI and was not predictive of percent weight loss during treatment (p=0.21). However, over the course of the weight loss program, participants significantly reduced their SSB intake by approximately 7 ounces/week on average (p<0.03). Although this study is not a rigorous randomized trial, these results do support the idea that minimizing SSB consumption is an effective weight loss strategy (and, by extension, that discouraging SSB consumption via a soda tax may improve public health more generally.)  

2. Dr. Ken Fujioka (Scripps Clinic, La Jolla, CA) presented a new analysis of pooled data from the SCALE Obesity and Prediabetes/SCALE Diabetes trials of Novo Nordisk’s obesity drug Saxenda (liraglutide 3.0 mg) in order to identify an early response criterion for predicting weight loss. Analysis of the data indicated that ≥4% weight loss at 16 weeks is a strong predictor of clinically relevant weight loss at 56 weeks. The investigators defined clinically relevant weight loss as a body weight reduction of ≥5% weight loss and compared efficacy outcomes in early responders to early non-responders to the therapy. The strongest predictor was determined by assessing a composite of the positive predictive value of early responders and negative predictive value of early non-responders. The criterion of ≥4% weight loss at 16 weeks yielded an overall correctly predicted value of 80%, the highest among all other criteria (≥3%, ≥4%, ≥5% weight loss at 8, 12, 16 weeks). Early responders and early non-responders exhibited remarkable disparities in weight loss, with an average of 11% (11.2 kg [25 lbs]) reduction in the former group versus an average of 3% (3.2 kg [7 lbs]) reduction in the latter group after 56 weeks. We hope that these findings can guide clinical decision-making by helping providers discern earlier in the course of treatment whether Saxenda is effective for the patient. Given its injectable administration and the extremely high cost of Saxenda ($1,068/month) and its poor reimbursement and access, an earlier determination of its effectiveness could save patients money, time, and hassle. (Dr. Fujioka noted that only one out of every three Saxenda prescriptions he writes gets covered by insurance.) We hope results from studies like these can be disseminated through treatment guidelines to help healthcare providers learn to most effectively utilize this agent – our sense is that many healthcare providers are unsure of when and how to use obesity drugs in many cases and we believe that greater patient and provider education can help boost the obesity pharmacotherapy field.

3. The Innovative Emerging Pharmacotherapy and Devices Forum, a perennial favorite at Obesity Week, provided a fascinating overview of novel obesity therapies currently under development. We noticed a dichotomy between novel drug therapies targeting the brain versus non-pharmaceutical therapies targeting the gut. In an overarching comment on the state of obesity treatment, Novo Nordisk’s Dr. Kevin Grove (who we had the pleasure of interviewing during Obesity Week 2014) underscored that combination therapy offers the most potential for success. He joked that when it comes to obesity therapy he believes that “1+1=3.” That is, the synergy that arises from targeting multiple mechanisms with two or more drugs may provide benefits beyond what would be expected on a purely additive basis.

  • On the pharmacotherapy front, commentary focused on drugs impinging on the hypothalamic melanocortin pathway. Dr. Lee Kaplan (Massachusetts General Hospital and Harvard Medical School, Boston, MA) highlighted Rhythm Pharmaceuticals’ phase 2 melanocortin 4 receptor (MC4R) agonist setmelanotide. This phase 2 candidate was recently featured in the New England Journal of Medicine for producing sustained and steady weight loss (~4 lbs/week) and marked hunger reduction in two patients with genetic obesity due to rare defects in the pro-opiomelanocortin (POMC) gene. Dr. Kaplan explained that several other genetic obesity conditions are characterized pathophysiology downstream of the melanocortin 4 receptor that setmelanotide targets, suggesting that this drug may have even broader applicability. Dr. Kaplan further pointed out that we do not fully understand the spectrum of the presentation of genetic obesities or how many people have a form of obesity that is setmelanotide-responsive. Dr. Lora Heisler (University of Aberdeen, Scotland) described the promise of 5-HT2C receptor agonists, which reduce appetite via action on POMC-expressing neurons. Her research suggests that 5-HT2C receptor agonists, such as Eisai’s Belviq (lorcaserin), also have a direct effect on glucose homeostasis, independently of alterations in food intake or body weight; this raises the possibility that this drug class may be suitable for the treatment of not only obesity but also the comorbidity of type 2 diabetes.
  • We also heard discussion around novel therapies that impinge on the gut – attempting to mimic the effects of bariatric surgery in a less invasive (and less expensive) way. Noting the effectiveness of bariatric surgery, but expressing doubt over its scalability, Dr. David Maggs of Fractyl Laboratories (Lexington, MA) provided an overview of duodenal mucosal resurfacing (DMR), an endoscopic procedure designed to “rejuvenate” the mucosal surface of the duodenum by hydrothermal ablation, replicating the duodenal exclusion that occurs in roux-en-Y gastric bypass surgery. Fractyl recently completed the first in-human study of DMR, reporting A1c reductions of 2.5% three months post-procedure for patients who underwent DMR for the long duodenal segment (n=28) and 1.2% for patients who underwent DMR for the short duodenal segment (n=11). Finally, Dr. Mark Tager of Ambra Bioscience (San Diego, CA) discussed the company’s pipeline of novel gut sensory modulating dietary supplements. Composed of a proprietary combination of GRAS-designated (generally regarded as safe) dietary ingredients, these supplements deliver non-nutritive tastants directly to the L-cells in the lower GI-tract, mimicking the effect of food and triggering the release of hormones such as GLP-1, PYY, and oxyntomodulin. This “L-cell triumberate” of hormones, Dr. Tager explained, is a compelling hypothesized mechanism underlying the metabolic effects of bariatric surgery. Ambra plans to begin clinical trials in 2017 to assess the potential of its supplements to deliver long-term weight loss and metabolic improvement.

4. At a Novo Nordisk-sponsored corporate symposium – to thundering applause and laughter – powerhouse obesity expert Dr. Donna Ryan (Pennington Biomedical Research Institute, Baton Rouge, LA) issued her “Ten Commandments of Obesity Management.” At the core, her recommendations all center on the notion that good weight management is good chronic disease management; rather than focusing on body weight, BMI, and an ideal target weight, physicians should encourage their patients to frame weight loss in the context of overall body health. Dr. Ryan noted that she has detected an encouraging shift in obesity management guidelines away from BMI-centricity toward a more personalized approach where the patient’s unique health risks, not their body size, drives treatment intensity. Of course, the actual implementation of these improved treatment guidelines is an ongoing challenge: obesity care mostly rests largely with primary care physicians, who do not always receive sufficient education on the latest behavioral, pharmacological, and surgical weight management techniques; furthermore, reimbursement remains difficult for obesity therapy. Dr. Ryan’s Ten Commandments of Obesity Management provide a simple framework to make obesity care more tractable for health care providers. They are as follows:

  • (1) Thou shalt use BMI as part of the electronic health record, but thou shalt not use it as a diagnosis that directs treatment;
  • (2) Thou shalt consider the patients’ genetic/ethnic background as part of the BMI and waist circumference risk assessment;
  • (3) Thou shalt not treat on BMI alone. Thou shalt remember that waist circumference is a risk factor and use it and other health risks to direct treatment;
  • (4) Thou shalt not worship at the shrine of ideal weight, but rather extoll the virtue of good health and set a weight goal based on a health target;
  • (5) Nor shalt thou worship at the shrine of any one diet;
  • (6) It is your job to teach the skills training in behaviors to produce weight loss or to refer the patient to someone who can;
  • (7) Thou shalt not impugn thy patient’s willpower, but rather prescribe aids to help thy patient adhere to the diet and exercise plan;
  • (8) Thou shalt prescribe medications according to the label, and if the patients lose 5% or more, thou shalt continue those medications.
  • (9) Thou shalt refer patients for bariatric surgery, especially if they suffer metabolic complications of obesity;
  • (10) Thou shalt expect a relapse if treatments are stopped.

5. Dr. Rena Wing (Brown University, Providence, RI) presented two year results from the Study of Novel Approaches to Weight Gain Prevention (SNAP), demonstrating the effectiveness of a lifestyle modification program to prevent weight gain and improve glycemic control in young adults. Noting that weight gain in young adulthood (ages 18-35), versus weight gain in other life stages, occurs at the fastest rate, is associated with worsening in cardiovascular risk factors, and has the greatest negative effects on cancer risk and morality, Dr. Wing argued that preventing weight gain in young adulthood is a public health issue of paramount importance. In the SNAP study, young adults (n=599; BMI: 21-30 kg/m2) were randomized to receive one of two self-regulation interventions: the “large changes” intervention involved an initial recommendation of 5-10 lb weight loss to buffer against future weight gain by temporarily reducing caloric intake by at least 500 calories per day and exercising 250 minutes/week; the “small changes” intervention emphasized making small daily changes to prevent weight gain, reducing dietary intake by 100 calories/day and exercising enough to burn an additional 100 calories/day (approximately 2,000 extra steps). Both interventions emphasized weighing oneself daily to maintain awareness of target weight. The interventions involved 10 face-to-face meetings over the first four months of treatment, followed by biannual online refresher courses for the remainder of the trial. Weight change after two years was a loss of 0.78 and 1.5 kg in the small and large intervention groups, respectively, and a gain of 0.54 kg in the control group (p<0.001). Furthermore, the large change intervention produced significantly greater improvements in fasting insulin and HOMA-IR than the control group (-1.49 and -.28 uU/ml respectively for insulin, p=0.009  and -0.33 and -0.03, respectively for HOMA-IR p=0.005).  Thus, such lifestyle interventions not only prevent weight gain but also produce metabolic benefits. Dr. Wing noted that even though these changes are modest after two years, the effects could multiply over time. To evaluate this, an extended version of the study, SNAP-E, will follow participants through six years of follow up, additionally assessing how their cardiovascular risk factors are influenced by the weight gain prevention program. More on the SNAP study can be found in its original JAMA Internal Medicine publication.

6. The esteemed Dr. Ronald Kahn (Joslin Diabetes Center, Boston, MA) delivered a keynote lecture emphasizing the complex interplay between genes, environment, and the gut microbiome in the development of obesity. Dr. Kahn drew upon his own research, recounting how his lab has observed a differential response to a high-fat diet between two genetically distinct mouse lines – where B6 mice are obesity prone, 129 mice appear show obesity resistance. Responses to diet can also dependent on external environment. Dr. Khan explained how 129 mice ordered from different breeding facilities (signaling different diets and animal care techniques) display significantly different gut microbiome profiles which, despite their identical genetic background, leave one 129 strain with even greater obesity-resistance than the other. As further demonstration of the microbiome’s plasticity, Dr. Kahn’s team determined that after three generations of living in the same environment, mice of different genetic and environmental backgrounds (the B6 mouse line and the 129 mouse lines from different facilities, all of which had previously demonstrated very different phenotypes)  now exhibited a remarkably similar, though not identical, microbiome profile and weight gain response to a high-fat diet. Altogether, this body of work underscores the incredibly complex relationship between genes, the environment, and the microbiome to determine an organism’s metabolic phenotype. Microbiome research remains in its infancy, but the topic is certainly exploding with interest – the session moderator remarked that Obesity Week 2015 featured only a single microbiome talk, whereas the current meeting features entire symposia dedicated to the subject. While several unanswered questions remain, the microbiome’s influence on metabolism is becoming more clear. The exciting implication of this is that the microbiome could be the next target for advanced obesity therapies.

  • Dr. Kahn’s research has identified certain single bacterial genuses driving metabolic phenotypes. For instance, Clostridiales bacteria are correlated with body weight, Clostridium bacteria are correlated with liver weight and adipose inflammation, and Lactobacillus gasseri bacteria are correlated with blood glucose. This finding drove most of the Q&A session, during which Dr. Kahn commented that the next task for scientists is to identify the most important single bacterial species within these genuses driving the effects on weight, adiposity, and blood glucose. From there, it may be possible to design probiotics containing a combination of desired species of bacteria to improve specific metabolic outcomes. We’re so intrigued by this prospect for a novel obesity and diabetes therapy, though again, we must acknowledge that microbiome research remains early-stage with much room for growth in the years to come.

7. Speaking to an absolutely packed hall, Dr. Sadaf Farooqi kicked off Obesity Week 2016 by addressing how the prevalence of stigma against obesity in the general population is at odds with the breadth of evidence suggesting that many genetic variants predispose certain individuals to obesity. Dr. Farooqi asserted that a deeper understanding of genetic determinants would ameliorate the widespread stigma against obesity. Her presentation described the genetic determinants of energy homeostasis, with a particular focus on studies evaluating loss of function mutations in the leptin, MC4R, and KSR2 genes. On the other hand, she also explored a rather counterintuitive and intriguing alternative approach to studying obesity – investigating the physiology of thinness to inform drug discovery for obesity. Dr. Farooqi concluded by calling for an integrated, multidisciplinary approach to treating obesity, citing the extensive network of pathways that act to protect against starvation and thus increase propensity for accumulation of adipose tissue. The audience was very receptive to her lively talk, peppered with plenty of humor and anecdotes. We greatly appreciated Dr. Farooqi’s comprehensive overview of the cutting edge of obesity research and we can only hope that some of this early-stage discovery work can be translated into viable therapies. The obesity field has been increasingly challenging – with Novo Nordisk most recently acknowledging that the field is increasingly becoming a single-player market – and we hope that this does not discourage innovative biotech firms or established pharmaceutical companies from investing in this field.

8. A packed symposium on reducing weight bias in healthcare featured valuable patient, clinical, and systemic perspectives on how to reduce the scourge of obesity stigma. Obesity counselor Ms. Nanette Adams (Harahan, LA) shared the physical, emotional, and social hardships she endured being obese from a young age, and told the remarkable story of her years undergoing lap band, sleeve gastrectomy, and roux-en-y gastric bypass surgery (all three major bariatric surgery procedures!). As both a patient and a provider, Ms. Adams poignantly described her struggles with obesity care and how healthcare providers can work to better mitigate this. She urged that healthcare providers should use “people first” language and challenged the HCPs in the audience to evaluate their own subliminal biases toward patients with obesity. “Believe your patients when they say what they are doing. Don’t dehumanize them,” she advised, “understand that your words do impact them – they may leave and cry for hours because you used the wrong words.” Ms. Adams reflected that by decreasing her own bias, she was able to better intellectually understand health and weight, in addition to enhancing her empathy for people affected by obesity. She ended her presentation with the inspiring message that “as a patient, I am more than my weight.” Next, Dr. Trina Histon (Kaiser Permanente, Oakland, CA) shared some of Kaiser Permanente’s strategic initiatives to address weight bias. Dr. Histon pointed out that seemingly small adjustments – such as ensuring that the facility’s chairs, beds, gowns, and scales can accommodate patients with obesity – can make a huge impact on the patient experience, promoting an environment where all individuals feel safe and welcome when seeking care. However, she also noted that, despite these institutional improvements, “we’re not perfect – before you’re a doctor or a nurse you’re still a human being.” Indicating that there is still much to be done in clinical management to reduce weight bias, she also remarked, “we don’t have it all figured out, but we have made a lot of progress.” This was a great talk that we hope receives significant attention.

  • Dr. Kimberly Gudzune (Johns Hopkins University, Baltimore, MD) reviewed the evidence on interventions designed to mitigate weight bias in clinical practice. Dr. Gudzune pointed out that a patient’s obesity immediately shapes a clinician’s attitude, interpretation of symptoms, decision-making, and ultimately treatment, making individuals with obesity vulnerable to receiving less efficacious treatment recommendations. (This bias appears to arise even before physicians begin clinical practice; Dr. Gudzune shared saddening statistics that 74% of US medical students have anti-fat bias and 67% have explicit weight bias.) She urged for more designs and program tests to minimize effects of weight bias in healthcare settings. Interventions including virtual and in-person patient encounters and bariatric sensitivity training have been able to promote stigma reduction and induce empathy in medical students, though other interventions including a four-week curriculum on the controllable reasons of obesity actually increased weight bias among students. Dr. Gudzune noted that these interventions were brief in duration, and more studies are required to conclusively determine best practices. Nevertheless, this is a cogent reminder of the wide scope of weight bias and the need for careful bias reduction.

9. The power of adherence was a major theme during a pre-conference review course for the American Board of Obesity Medicine examination, with speakers almost unanimously emphasizing its significance in the context of diets, medication management, exercise, and supplementation following bariatric surgery. Dr. Maria Collazo-Clavell (Mayo Clinic, Rochester, MN) showed data supporting this observation, demonstrating that weight loss is more strongly correlated to diet adherence rather than diet type. She overviewed a classic study by Dansinger et al. in JAMA comparing absolute weight change over 12 months in patients assigned to Atkins, Zone, Weight Watchers, and Ornish diets; no significant differences were observed, and high variability was present in each diet group.  Although these data were published in 2005, the emphasis on adherence is as timely a topic as ever across all categories of obesity care – from nutrition to pharmacotherapy to physical activity. This is a message we heard recently from Dr. Donna Ryan at the Cleveland Clinic Obesity Summit: the best weight loss regimen is, quite simply, the one patients can best stick to.

  • Dr. Collazo-Clavell emphasized that the issue of adherence goes beyond individual willpower: she astutely pointed out that much of the decisions involving food over the past several decades have been made by people other than consumers. According to Dr. Collazo-Clavell, everyday decisions involving food – such as fast food portion sizes and serving sizes of bottled drinks – have all increased dramatically without the input of consumers. This change, she posited, has added to the difficulty of maintaining consistency in diets. In addition, current literature has not progressed in terms of offering an “optimal” supplement regimen. These and other factors act as major barriers to nutritional adherence.
  • The ABOM review session also reviewed previously-reported data supporting the use of diabetes medications co-opted for obesity treatment – most notably canagliflozin, liraglutide, and metformin. These trials demonstrate a trend towards multifaceted treatment of obesity that targets multiple pathways, in order to yield a synergistic effect in weight reduction.

10. A symposium titled “Clearing Up the Diabetes and Obesity Conundrum” provided clear guidelines for clinicians to follow when treating the growing number of patients with comorbid diabetes and obesity. Dr. Peter Vash (UCLA Medical Center, Los Angeles, CA) explained that the main objective in treating patients with diabetes should be individual glycemic goals within realistic limits. He advocated for the use of SGLT-2 inhibitors and GLP-1 agonists as a way to intensify therapy in obese patients with diabetes, due their weight loss side effects. He further warned clinicians to be aware of any additional medications the patient may be taking with adverse weight gain side effects (anti-depressants are particularly notorious), recommending that these be replaced with weight-neutral alternatives whenever possible. Acknowledging the challenge of treating diabetes and obesity, Dr. Vash noted that the use of medication is part science and part art, and the doctor-patient relationship is “the active ingredient” in the design of an effective obesity and diabetes treatment regimen.

  • ADA Professional Practice Committee member Ms. Charlotte Hayes provided an outline of the most up-to-date ADA Standards of Medical Care, highlighting the newest section added about obesity management for treatment of type 2 diabetes. This section explains that clinicians should design diet, physical activity, and behavioral therapy to achieve an initial 5% weight loss, after which comprehensive weight maintenance should be prescribed. Perhaps the boldest update to these guidelines is an explicit recommendation against the consumption of sugar-sweetened beverages as a means of controlling weight and minimizing cardiovascular risk. On the subject of healthy eating and weight control, Ms. Hayes disclosed that there was no “ideal” eating pattern (i.e., Mediterranean diet, vegetarian, low carb, etc.) that is demonstrated to benefit all individuals with diabetes. Although total energy intake is an important consideration, individuals with diabetes should focus on choosing nutrient-rich whole foods rather than adhering to a “rigid prescription” for diet. Indeed, Dr. Donna Ryan (Pennington Biomedical Institute, Baton Rouge, LA) did mention during the recent Cleveland Clinic Obesity Summit that the best diet is simply the one that people can best stick to.

-- by Abigail Dove, Sam Haque, Jennifer Zhao, Helen Gao, Payal Marathe, Sarah Odeh,  and Kelly Close