Transcription:
Is My Medication or Health Condition Causing My Weight Gain?

Melanie Cole (Host): More than twelve and a half million Americans are severely overweight, according to the US Department of Health and Human Services. Obesity can cause so many health problems and put you at a higher risk for other diseases such as high blood pressure, diabetes, heart disease, and more. My guest today is Dr. Elizabeth Lowden. She's a bariatric endocrinologist and the Medical Director of Medical Weight Management at Northwestern Medicine's Metabolic Health and Surgical Weight Loss Center at Delnor Hospital.

Dr. Lowden, how do you determine what are the underlying factors that contribute to weight gain. If somebody is seeing their weight go up, how do you start the process of determining why that's happening?

Dr. Elizabeth Lowden, MD (Guest): Well thank you for having me. We usually spend a lot of time talking to the patients. So you can glean a lot from learning about their weight trajectory over time, whether they've been up and down or just a steady gain, whether the weight gain corresponded with a start of certain medications or the diagnosis of a disease, and really what's worked for them in the past.

Melanie: Are there certain medications and health conditions that can impact weight gain or cause weight gain that's unintended? Or the person's not just over-eating, but certain medications and things that they're doing or other comorbidities are causing them to gain weight?

Dr. Lowden: Yes absolutely, and I do love the way that you mentioned in addition to over-eating because most of these can worsen weight gain, but many of them do not cause the weight gain. So for example, some people do have genetic issues that are related to weight. This would be something like leptin deficiencies or true disorders that are based on their genes, and these are incredibly rare and very often diagnosed in early childhood.

What can be more common though are things like thyroid disease, insulin resistance, and more rarely an issue of elevated cortisol levels, a pathological elevation known as Cushing Syndrome. But of course there are a number of medications as well that can potentiate or worsen weight gain, and these can be very common; things like blood pressure medicines, or antihistamines even, anti-depressants. Really if you want to figure out why someone is gaining weight, you have to look at all the underlying causes, the medications they're on, as well as what they're doing with their food.

Melanie: And tell us about the new Northwestern Medicine Metabolic Health and Surgical Weight Loss Program, and the integration of different care providers, who's involved. Tell us a little bit about the program.

Dr. Lowden: Well we have a truly comprehensive program in the west region, which is essentially just west of the city. We employ a number of different specialties, all within one center, to provide that very integrated comprehensive care.

So we have the medical side which includes me, the bariatric endocrinologists, we have nurse practitioners, we have a number of bariatric surgeons that work with us including our Bariatric Director, Dr. Pittman, and then we also utilize nurse specialists, dieticians in our everyday clinic, and have access to a number of different programs that involve health psychologists, we have a state of the art fitness center on campus that we're affiliated with, and we also have a demonstration kitchen. So we really try to bring a lot of this knowledge to the community.

Melanie: What a great comprehensive program, Dr. Lowden, so tell us a little bit about the medical weight management aspect of the program and how, you know, you use it to combine treatment, education, behavior, medicational intervention, all of these things to help people lose weight.

Dr. Lowden: You know, weight loss is not easy. I think that anybody who has dieted will tell you that it can be a struggle, and so we give patients every tool that we have, and we use very individualized approaches. So we could do something as basic as just speaking with them about what they're doing, and utilizing our dieticians to provide them with a better diet, or just recommendations for what they can do in their everyday life to make healthier choices.

The step up from there is to utilize the different weight loss medications, and we do use all the FDA approved medications. These really are just, like I said, another tool. Something to make those lifestyle changes and that diet easier. We have meal replacement programs, which can really assist with kind of more medically supervised and rapid weight loss, all the way up to of course bariatric surgery.

And so any weight loss attempt needs to include those lifestyle changes. We work closely with people to determine what would be the best option for them.

Melanie: So you've mentioned bariatric surgery. Tell us a little bit about this type of treatment option as a tool to help people lose weight if they're severely obese. Where does that fit into this picture? When does that discussion begin?

Dr. Lowden: Well the discussion usually begins when they meet certain weight criteria, and so that would be a BMI - a body mass index - or a weight to height ratio that's above forty, which is categorized as morbidly obese, or above thirty-five but with certain weight related issues like diabetes or sleep apnea.

And at that point we say, "Are you able to be successful with dieting on your own?" For some, the answer is yes, but for many, that's not the way that's going to get them to where they need to be because they can't overcome certain obstacles that come with weight loss such as hormonal changes in regard to appetite and hunger.

So once we determine that that's something that might work for them from a medical perspective, we give them the options which can include things like the traditional Roux-en-Y gastric bypass, or a sleeve gastrectomy, and we talk through the pros and cons that include things like food restriction, hormonal changes like I said, but also potential for malabsorption in a beneficial way.

Melanie: So then tell us what people can expect as far as additional sessions maybe with a psychologist or trainers when those are incorporated as needed, and you can also incorporate into that the bariatric program, and how these types of providers are also involved in that process of bariatrics.

Dr. Lowden: So I do truly think that we have a very unique way of approaching weight loss here. When someone first comes into the program, they meet with our bariatric nurse, they meet with the provider which generally starts on the medical side either with me or our nurse practitioner for a full medical assessment to see if anything is contributing to their weight. But also, we have our dietician come in, and that's one of the more rare pieces that we don't see in a lot of other programs.

So in that first visit, you really have a pretty comprehensive plan when you leave. We are partnered with the gym on campus to provide additional opportunities that allow people who have medically complicated issues to more successfully exercise. We have the access of health psychologists and people that will say, "Maybe you need a little bit of extra focus on disordered eating, or life issues that are contributing to the way that you're eating," and then we'll refer on to them. And of course we always have the surgeons, too. So being one big team really allows us to sit down and talk about patients, follow up with each other, and then of course with the patient, and bring them in as often as they feel, as often as we feel they need to be successful.

Melanie: Dr. Lowden, many people see in the media and commercials nutritional products. Food is such a big part of weight loss or healthy living really in general. Tell us a little bit about the New Direction program and how that involves nutritional products, and then teaches people - you mentioned the demonstration kitchen - teaches people, which is some of the most difficult part of weight loss, to shop and cook for themselves.

Dr. Lowden: The New Direction program is really fantastic, and it's a great way for people to learn a little bit more about long-term healthy eating. When a patient starts, they choose one of two pathways. The very low calorie diet, which is all meal replacement in the forms of protein shakes and bars, or something we call the low calorie diet where they use some meal replacements and some real food. But all of this is coupled with weekly educational meetings and support groups where various speakers come in to talk about things that come up in life. What do you do when you're in the grocery store and you don't know exactly what you're supposed to buy? What kind of exercises can you do if you have limitations like osteoarthritis? What to do about stress eating or holiday eating?

After people lose the weight that they are looking to, or they've reached certain health related goals, then we transition them to a maintenance program, and this is really the important key because there are so many nutritional products out there that boast great weight loss, but when people are done, what do they do?

By keeping them in a maintenance program, we maintain their accountability, we provide resources to make sure that they have long-term success, and we have the ability to pull them back into the clinic or a more intensive program if it seems like they're struggling. And so we do have good success with that, and patients enjoy all aspects of the program.

Melanie: Wrap it up for us, Dr. Lowden, with your best advice and information for listeners, what you'd like them to take home from this episode regarding Northwestern Medicine Metabolic Health and Surgical Weight Loss Program, and losing weight, the importance of maintaining that healthy BMI. What would you like them to know?

Dr. Lowden: Weight loss is complicated, and maintaining your weight is complicated, and so we are lucky that we have group specialists all in one location that can help anyone determine the right way to lose weight for that person based on their medical issues, their history, and their preferences, and reaching out to a program like ours is a good way to ensure long-term success.

Melanie: What great information. Thank you so much for coming on with us today, for sharing your expertise, and explaining so many of these difficulties and struggles that people have that are trying to lose weight. Thank you again for joining us. You're listening to Northwestern Medicine PodTalk. For more information on the latest advances in medicine, please visit www.NM.org. That's www.NM.org. This is Melanie Cole, thanks so much for tuning in.