Can Diabetologists Take On Obesity Care?Wednesday, June 21, 2023
For the past 30 years or so, I have given countless talks to diabetologists urging them to pay more attention to obesity management – all to little avail.
Interestingly enough, now, that we have new effective medications for obesity, which come with loads of pharma funding for research, education and conferences and as we near the end of significant new pharmacological developments in diabetes care, we are witnessing a sudden surge in interest amongst diabetologists and their professional organisations in taking on obesity as part of their “portfolio”.
This is good!
Not only is there considerable overlap between patients with type 2 diabetes (T2DM) and those with obesity (indeed, it is hard to find a T2DM patient without obesity), effective treatment of obesity can lead to substantial improvements in glycemic control (and even complete remission of T2DM), and the incretin-based medications for obesity are also of use for managing T2DM.
Moreover, given the sheer number of diabetologists out there, together with the rather extensive and well-established infrastructures for diabetes care, expanding their mandate to also managing obesity appears a logical and long-overdue step.
However, there are some important caveats.
For one, the majority of people with obesity do not have diabetes and will probably never get it. For these individuals, going to a diabetes centre would seem strange, given that glycemic control is the least of their worries.
Anyone who has any experience with obesity medicine knows that people presenting at obesity and bariatric centres are rarely there because they are concerned about their HbA1c levels. Their problems are chronic pain, sleep apnea, infertility, polycystic ovary syndrome, fatty liver disease, urinary stress incontinence, osteoarthritis, GERD, migraines, and a host of other issues that have nothing to do with glycemic control.
Furthermore, a substantial proportion of patients presenting at bariatric centres have depression, anxiety, ADHD, BED, history of trauma, chronic grief, addictions, internalised weight bias, and plain old emotional eating, all of which need to be properly diagnosed and managed as part of obesity care.
Finally, no one can claim to have expertise in obesity medicine, who is also not comfortable with the pre- and post-surgical management of patients undergoing bariatric surgery (so far, despite strong evidence, diabetologists have rarely referred a patient for bariatric surgery never mind getting involved in their post-surgical care).
While there is no reason why diabetologists should not be able to learn about and attend to all of these issues, this is a rather big leap from simply managing diabetes and its complications.
But the key word here is “learn”. At this point, most diabetologists will simply not have the expertise of those of us who have been practising obesity medicine for a while, and have routinely dealt with all of the above issues, but, this is of course something they can (and probably should) learn.
Fortunately, we now do have an increasing number of obesity specialists and professional obesity organisations, who have all of the necessary expertise and can provide excellent education and even certification in obesity care. Diabetologists interested in expanding their practice to obesity care (even if just for their patients with T2DM) should be bee-lining to these resources.
It is now up to the diabetes community to reach out to the obesity community to short-circuit the learning curve, rather than attempting to reinvent the wheel.
This can only be in the interest of all our patients living with obesity.
Disclaimer: I have received honoraria as an independent medical, research and/or educational consultant from various companies including Aidhere, Allurion, Boehringer Ingelheim, Currax, Eli-Lilly, Johnson & Johnson, Medscape, MDBriefcase, Novo Nordisk, Oviva and Xenobiosciences.