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8 Ways In Which Nephrology Prepared Me For Bariatric Medicine

230px-Patient_receiving_dialysis_03Last night I gave McMaster University’s Karl E. Stobbe lecture on obesity management in St. Catherines, Ontario.

A commonly asked question is how my training in internal medicine and nephrology brought me to obesity.

While that story is rather simple (many problems in nephrology are related to people’s excess weight), the far more interesting aspect of this is how, over the years, I have realised how perfectly my experience in nephrology, especially working with patients who have chronic kidney disease, prepared me for my current work in bariatric medicine.

Here are some of the more salient reasons:

1) Both obesity and chronic kidney disease are complex often life-long disorders that can affect every aspect of a patients health and well-being.

2) Both necessitate a long-term (lifelong) management approach that must address both the underlying drivers as well as the health consequences of the problem as well as prevent further progression (whenever possible).

3) Both are best delivered in the context of multi-disciplinary care involving nurses, dietitians, physiotherapists, occupational therapists, social workers, mental health workers and many other allied health professionals.

4) Nephrologists are often the only doctors that patients with kidney failure see regularly  – this means that they have to deal with all aspects of patient care – both minor and major, not unlike family doctors. Indeed, nephrologists are often functioning as the “family docs” of their patients on dialysis.

5) Patients with kidney disease present with a wide range of health problems – cardiovascular, metabolic, infectious, auto-immune, respiratory, gastrointestinal, musculoskeletal, nutritional, and virtually every other kind of disease, including mental health problems.

6) Nephrologist often have to be aware of and help manage the many psychosocial problems that their patients can present with.

7) Nutrition plays a very significant role in  managing patients with kidney disease, especially in patients on dialysis. Management of macro and micronutrients is something nephrologists have to deal with on a daily basis whether it is protein intake, minerals (e.g. sodium, potassium, calcium, iron, etc.) or vitamins (e.g. Vit D, or water-soluble vitamins like B complex or Vitamin C).

8) Obsessing about body composition, fluid balance, sarcopenia and nutrition are all standard issues that nephrologists are trained to worry about.

I would not have know just how valuable my training in nephrology would have been for my current practice – but looking back, I don’t think I could have been better prepared for the challenges of bariatric medicine.

Toronto, ON


  1. Dr. Sharma:

    Can you give us a link for your lecture?

    I have been thinking of substituting a nephrologist for cardiologist because my heart is fine, but my kidneys are not (eGFR, approximately 50%), pretty much as it has been for 15 years), and I get little general health advice from my cardio, or GP.

    I think you are unique in your broad interest in the patient. I think that’s because of your

    Most specialists, including the nephrologists I have seen over the years, seem interested solely in the sub-system of their specialty. As for nephros, mostly, they seem to be that eventually, I’ll be on dialysis, and that’s when they can be helpful.

    Normal — hah! — BMI of 23. Fat composition via impedance, about 20. Fasting Glucose, 80 -90.

    Of course I exercise, eat healthy, no sugar, avoidance of wheat and minimization of lectin intake, plenty of polyphenols via coffee, rooibos, yerba mate, green tea, peppermint tea, clove tea, etc.

    Of course plenty of green leafy vegetables and even some starchy veg.

    I’m trying to optimize my health within the constraints of my affliction. I’ve gotten nearly zero help from cardiologists and, sadly, nephrologists.

    Might I be better served by seeking out an endocrinologist?

    I’ve been following, as best I can, given my 50-years-ago chemical engineering education,
    the progress of delineating the microbiome. Does the future belong to gastroenterologists– at least those, who like you, are interested in the whole patient?

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  2. Just to clarify, you meant MICROnutrients where you said NITROnutrients. As far as I know, I have never heard of the latter, but want to make sure I am not missing out on something I should know!

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  3. Only a deep Internal Medicine background led to a comprehensive approach to obesity.
    that is why you are an outstanding doctor.

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