Caitlin Whyte (Host): Welcome to a new episode of In Their Words. Today, we have the privilege of diving into the world of Dr. Suppiah, a distinguished primary care and bariatric physician with UPMC Central Pennsylvania Bariatrics. We'll explore the advancements in bariatric medicine, the crucial link between diabetes and weight management, and the pivotal role of programs like community paramedicine and reducing recurring hospital visits.

But before we dive into our conversation with Dr. Suppiah, we want to extend our heartfelt thanks to our dedicated listeners. Your support and interest in our podcast means the world to us. And it's your enthusiasm that drives us to continue sharing these inspiring stories. So, sit back, relax, and get ready to embark on a journey with us.

Sumathi Suppiah, MD: My name is Sumathi Suppiah. I'm a family physician with the UPMC Central Pennsylvania Primary Care and bariatric physician with UPMC Central Pennsylvania Bariatrics. I'm board-certified in Family Medicine with American Board of Family Medicine and Obesity Medicine with American Board of Obesity Medicine.

So, I chose family medicine after my medical education because I enjoy taking care of people of all ages and backgrounds. A few years ago, I chose to pursue a career in obesity medicine because I realized that many chronic diseases stem from obesity. By treating obesity, we can decrease the likelihood of developing chronic health conditions and improve the conditions like diabetes, hypertension, heart disease, cancer, kidney disease, arthritis, diabetes and sleep apnea.

I am from Sri Lanka. It's a small island in Southeast Asia. I did my medical education in India. So, I came from a family-- my father was a businessman and no medical background at all. So I, myself, and my brother, we decided to go to med school, because we saw so many disease even when we were very young age. So when I was in medical school, I always wanted to work with a different population and different age groups.

So once I finished my medical education, we moved to the United States to pursue my career because, as you know, where I grew up in Sri Lanka, there were ethnic problems and we had to move out of the country for a short period of time, even for education. So when I was choosing my residency, to choose a career in medicine, as I said, I felt family medicine is always on my first option, because of the different cultures and different age group you work with. So, I decided to do family medicine and I was practicing family medicine here in York for the past 13 years.

Recently, a few years ago I decided to do a career in obesity medicine especially just before COVID and even during the COVID. At that time, I started realizing there are a lot of chronic health conditions, which is stemming from obesity and overweight. And that's how I did my fellowship in Obesity Medicine. And I have board certification in Obesity Medicine from American Board of Obesity Medicine. I did not go to Sri Lanka since COVID. Both my parents are no more now, but I have a few family there in Sri Lanka. I'm planning to go this year, probably end of this year.

Host: And the world of Dr. Suppiah, medicine isn't just a profession. It's a family legacy. It's safe to say that medicine runs deep in their family.

Sumathi Suppiah, MD: I have two boys. My older one is actually pursuing a career in Nursing. And my younger son is in college now, he just entered college, and my husband is a physician as well. It's not only me, it's my brother who is also a physician. He is a pulmonologist in United Kingdom. He lives in Scotland.

Host: Now, let's turn our attention to the innovative strides being made in the field of diabetes and weight management right here at UPMC Central PA. Dr. Suppiah, with her extensive experience is well-equipped to share with us what this renowned healthcare institution is doing to stay at the forefront of these critical areas.

Sumathi Suppiah, MD: I've been working with UPMC Central Pennsylvania, we joined UPMC Central Pennsylvania five, six years ago. Before that, I was a physician with the Memorial Hospital here in York, Pennsylvania. But I see UPMC Central Pennsylvania has more innovative ways of helping patients with many conditions, especially when it comes to obesity, treatment of obesity.

We have a very comprehensive program for patients who need treatment for their obesity. So, our program, especially the bariatric program, we offer both medical and surgical support to help our patients to achieve their weight loss goals. Our medical weight management service, it's available in six locations within the Central Pennsylvania. And with a team of nearly ten providers, they are dedicated to help patients achieve their weight loss goals. And they are all certified in Obesity Medicine.

We provide consultation either in person and virtual visits, and I feel that is one of the ways we can help patients who cannot come in for appointments. So, we are very flexible with appointments. And our program aims to help patients in adhering to the four pillars of obesity treatment.

So to to treat obesity, it's not only just like the medications. There are a lot of other principles we follow, for the patients to follow these principles. And we have more resources available through UPMC Central Pennsylvania. For example, we have trained dietitians who help with the nutrition goals of the patients. We have different options in helping patients' nutrition needs. One of them is the meal replacement programs. And if they need any supplements, we do even offer through our UPMC Superstore online stores.

And the physical activity exercise, we have partnered with Select Physical, and they have this wellness program. So, patients do six weeks of a program covered through the insurance. And after that, they can stay with them for six months to achieve their physical activity health goals.

And the psychologists, UPMC Central Pennsylvania, they have Pinnacle Health Psychological Associates who help us achieve patients' psychological goals. And then, medications. So, our providers are trained in obesity medicine, so we do treat patients with medication, medication help, and getting these medications approved through the insurance. So, this is a comprehensive program. We work with the surgeons. So when patients fail all these steps, we can help them get the surgery and to reach their health goals.

This is for bariatrics. And you asked about diabetes and they have so many programs for patients with diabetes to help them manage the disease. So, they have a trained endocrinologist and diabetic nurses, diabetic education program, again, nutrition counseling, nutrition help, and sometimes even we identify if the patient is qualified for any medical assistance to get the medications for a cheaper price. And we have care teams through the social workers. We identify what are the barriers for their treatment. So we have a multidisciplinary team we have. And if a provider needs help with treating a patient, if there is any barriers, always we have support system. So, I think it's a very more innovative way. We have this support system to help us and help the patients.

And the other thing is community paramedicine. So, the community paramedicine team, they work closely with us, both with the inpatient and outpatient. They offer various forms of assistance upon request from us, the providers. So as a part of their patient care process, they conduct home visits to identify any potential barriers. During this visit, they conduct a thorough interview to identify any financial obstacles that may be impacting their care and support them with the resources for financial aid. They also educate the patients about the disease process and the importance of medication compliance. And if a patient has, for example, transportation issue is the reason they are not able to come to the appointment, they arrange for that. And many other issues, like housing issues, if there is any mental health issues, they identify it, they communicate with the provider so that it's easy for us to proceed during the appointment with the patients.

Host: As we've learned from our last episode, reoccurring hospital visits can be an expensive and challenging adventure, not just for the patients, but for the entire healthcare system.

Sumathi Suppiah, MD: Yes, definitely, because as an example, let's say that if a patient is getting admitted to the hospital, during the discharge, our care team nurses, they communicate, they help the patient, they actually call us and schedule appointment to be seen by the primary care provider. And they help the patients schedule the appointment with a specialist if they needed to see. So, it's always somebody. It's not that the patients, they have to make this appointment, they have to do it on their own. There are always people in the background. They help the patients. And when I see the patients, and if they need something, I can again refer back to them, the care coordinators, and they would help. For example, I had a patient and patient has to take insulin and he does not have a refrigerator to refrigerate medication, and they found a solution for that. They found resources where they can refrigerate the medication. So, I think working with a team of people, it's the goal. We were able to reach the patient's health goal faster and it also reduces the hospital admission.

Host: Dr. Suppiah has a wealth of knowledge and experience in helping patients better themselves, and her insights are invaluable. When asked how patients can make meaningful improvements in their health and wellbeing, here's what she had to say.

Sumathi Suppiah, MD: Yes. So, I would say education. Education about the disease process is crucial. First of all, we have to make the patients understand their disease process, what it is, instead of just telling them, "Okay, you have diabetes." Just explain to them what is happening, what is happening in their body, how this disease is going to affect them, and what are the consequences, health consequences, having the problem, and health consequences having higher weight. So, education is very, very important.

So, this can be done by our diabetic educators. So when we have a patient diagnosed with diabetes, we refer them to diabetic education. So, they explain to the patient in and out of the disease process, complications, how to manage this disease and the diet. So, the education about the disease is the prime point here.

It is also important to understand the causes, and that's the providers. As a provider, we educate the patient. And then when they go to the diabetic educator, they get more education about that. And when you asked about how diabetes diet and environmental factors reflecting on these diseases, I would say when it comes to diabetes, we always think that it's genetic factor. You have the gene and you have the disease. But not necessarily. It is not only influenced by genetic factors, but also other factors including environmental factors.

And if you talk about environmental factors, let's say that somebody is working in an environment, their food access either at home or at work, if they're working in an environment where they cannot even refrigerate their food, so they have to pack something, and packing food is not going to be very healthy. It's going to be unhealthy. And if somebody is living in a neighborhood where they cannot even go for a walk, it's not safe for them to go out and walk, so they cannot get their physical activity, and if they have any orthopedic conditions, physical limitation, injury. So, these are the things we have to consider. It's not always like they chose to eat unhealthy, they chose not to exercise. It's so many factors behind it. So, it's always not only the genetic factors or environmental factors, so many other factors.

So if you have any unhealthy behavior, example, like, smoking, alcohol consumption, that also affects your disease process. So, it's very important to help them. The education about this unhealthy behavior is very, very important. So, utilizing the resources available, especially it is available through even social media, through UPMC, we offer multiple resources for patients to utilize to overcome any unhealthy behavior or even disease. For example, to learn about healthy diet, we have a nutrition, dietitian consultation. There are so many group sessions we provide, group education we provide. So, utilizing those programs is very important. For example, if they have smoking issues, we do have programs like smoking cessation programs. So, utilizing that can help them.

Behavioral health, stress, depression, anxiety this can affect somebody's health. This is one of the factor, people gain weight. Because when you have depression, it affects your eating behavior. When you're under a lot of stress, you tend to eat. So, that kind of, you know, affects your weight, you gain weight and you develop diabetes. So, treating that root cause is very important and there are a lot of resources available.

You reach out to your provider, medication treatment and behavioral health counseling. Those resources are very important to utilize. Again, like, physical inactivity, if it is due to any injury, reach out to your provider. Utilizing physical therapy is one of the other resources that you should utilize. And there are most of the employers, they provide the wellness program. It is mostly underutilized. So, I would recommend utilizing the tons of resources available.

What we do here in UPMC Central Pennsylvania, especially the bariatric group, when we evaluate patients for obesity or overweight, first, we evaluate patients, what is the reason they are gaining weight. So, we address those causes. If there is any barriers, we identify those barriers. And we help the patients to understand those barriers and come out of that. And then, we help them with changing their lifestyle and adding either medication or surgery to help them.

So if you take the diabetes, obesity is a huge contributing factor for diabetes. If I say that just losing five to 10% of body weight loss can prevent diabetes. And losing 10-15%, so for example, if you are, let's say, 200 pounds, just like losing 20 pounds off your total weight, you can actually improve your diabetes and be healthy and improve other health conditions like heart disease or hypertension.

So doing this, like, you know, you don't have to do it like within a week. So one healthy habit at a time. Let's say you have so many unhealthy habits, so when your provider is identifying, "Okay, smoking is not good," slowly, you cannot just quit smoking overnight. Slowly quit smoking, gradually do it. And the same thing when you have unhealthy eating habits, give up one unhealthy eating habit at a time. So, we had patients just giving up sugar-sweetened beverages for a month, they were able to lose like a five to six pounds. So, it's small changes in your day to day unhealthy habits can improve your weight, which can improve your diabetes and other health conditions.

Host: Dr. Suppiah's dedication to making a difference in the lives of her patients is truly remarkable. And it's an honor she deeply cherishes. Her commitment to their well-being, her passion for health care and her drive to improve the lives of those she serves shines brightly in her work.

Sumathi Suppiah, MD: Yes. We had many patients. Actually, once a month, all our providers, we have a meeting and we discuss very rewarding patient cases and, you know, very difficult to manage and their disease process. So, there are many, many patients we came across. So, for example, I had a patient who had weight. And as I said, the weight gain can happen many other reasons too, like if you have some hormonal imbalance in your body, no matter what you do, sometimes you will not be able to lose weight.

So, for example, there is a condition called polycystic ovarian syndrome. It's a hormonal imbalance in your body. I had a patient, she came, so I was talking to her, and I was talking to her history and everything, and she had a diagnosis of polycystic ovarian syndrome. And if your body goes through this hormonal changes, very difficult time to lose weight. So, when we talked, we talked about her dietary habit, exercise. So, she was doing everything, like what she's was supposed to do. There is no unhealthy habit I can find on her. And she's been exercising, eating healthy. She doesn't eat out, like restaurant food, which the caloric content is very high and you can gain weight very fast.

So, I told her, "You have a disease of obesity, it needed a combination of lifestyle change and medication. You are doing what you could do. I think it's my turn to help you." And she started crying and she said, "Okay. You're the first person who said it's a disease. Wherever I go, people judged me. And when I discuss with them what I eat and how I exercise, they look at me and they judged me. And they were thinking that I'm lying to them."

Then, I started treatment on her. So, she had done her first three pillars. She changed her behavior previously and she did her nutrition therapy. She is doing very healthy eating habits. And then, the third one, she is physically active and exercising. So, I treated her with medication. She is still ongoing with the treatment for her obesity and she had lost a total of 90 pounds. And then, she had obstructive sleep apnea, she improved that and she is off of her treatment for obstructive sleep apnea. And the other thing is when you treat obesity in those patients and when they are in childbearing age, they will be able to go back to their fertilization naturally.

The thing is, more and more, we have to understand obesity is a chronic disease. It is not because of lack of motivation. It is not because of somebody is lazy. It is not because of they are intentionally eating unhealthy, adopting unhealthy behavior. So because it has so much etiology, like even when a woman is pregnant and if they adopted an unhealthy lifestyle, it affects the baby. It's called epigenetics. It affects the DNA methylation of the baby and they can become more prone to gain weight later in the life. So, it is a disease process and there are so many hormonal changes that happens in your body when you have that initial weight gain for any reason. And once you have the damage to your body, it is hard for you to lose weight with any measures. It's an ongoing treatment, you have to treat chronically lifelong, so that you can be healthy and not develop any other weight-related conditions.

Host: The obesity epidemic is undeniably a significant public health challenge. And Dr. Suppiah is acutely aware of its impact. She doesn't shy away from this critical issue. Instead, she confronted head-on with determination and innovative approaches.

Sumathi Suppiah, MD: So, as a society, I think we are doing a great job in handling the obesity epidemics. I think this is due to increased awareness and availability of the treatment options. So if you take until a few years ago, I was practicing as a family physician and I did not have much knowledge about the disease of obesity until I did my certification in obesity medicine.

So, I learned in and out of there are a huge reasons for somebody to gain weight, you know, there are multiple reasons for somebody to gain weight. So, I think awareness. And now, more and more, most of the healthcare, like, first you take the healthcare physicians and other providers, they are more aware of the disease process itself. And we started realizing, "Okay. So, we are treating so many other health conditions, which you need so many medications. And when it comes to the medications, again, cost of the medications, very expensive. And for example, obesity causes, I said, diabetes, high blood pressure, cholesterol, kidney disease, heart disease. And if somebody has like three of these diseases. And if you need three medications to treat each health problem, you need nine medications. And cost of that nine medications is so high.

So, physicians started realizing that, and it's a huge burden on physicians too, because to get these medications approved and get the right resource for the patients to do it. So, they realized, "Okay. So, treating obesity can help." So, more and more awareness. And the physicians are talking to their patients about the disease of obesity. And the patients are also realizing and social media, I would say, that they're learning more about the disease process from the social media and they are reaching out, they are reaching out for help. And now, like, not only that, the health organization, American Medical Association, designated obesity as a chronic disease in 2013. And we needed to treat this condition because nearly 42.4% of Americans are affected by the disease. So, it's actually promoting all the health conditions, like I said, like diabetes, hypertension, high cholesterol, obstructive sleep apnea. As I said, it's not only the poor lifestyle or like genetic factors, hormonal imbalance in your body. Identifying and treating is very, very important.

So, most of the time the patients see the primary care physician a lot. They recommend it should be done in a primary care setting, but because of the time constraint and you treat a patient with multiple medical issues, like five or six medical issues, it is very hard for them to counsel a patient because it takes a lot for the patient, educate the patient. We spend almost an hour with a new patient getting more history about the disease and educating about the disease and how to move forward, how to take care of the disease of obesity.

So more and more now, physicians are reaching out help from a provider who is specialized in obesity. And the patients are also aware of the disease process and what it can do to your body.

Host: In the realm of healthcare, patients with limited resources often face significant challenges. That's why organizations like the UPMC Pinnacle Foundation play a crucial role in providing support and assistance. Dr. Suppiah is deeply grateful for the invaluable help. It provides her patients.

Sumathi Suppiah, MD: It means a lot to us because when we try to control any disease, like you take obesity or diabetes, we are prescribing medication, which start with a cheaper medication. We do not go for a very expensive medication. Because when you prescribe medication, there are a lot of things you look into: any contraindications and if the patient develops side effect, and then you're going to go to a different medication. So if that medication is very expensive, the patient's not going to take it, and they don't take it. And I cannot call them noncompliant, because they are noncompliant because of the cost of the medication because they don't have the enough fund to buy the medication. So if we have any resource, any financial resources helping these patients, it is wonderful. That can help these patients. Most of the patients are not taking medications because of the cost of the medications.

I was a physician with UPMC Memorial. Then, we were with another healthcare system Community CHS. It was a for-profit organization. Then, we became Pinnacle, and now UPMC. And I can see the difference. And from where I started my journey as a family physician here in York, there's so much changes. With the UPMC, I can tell I'm getting more help helping patients to achieve their health goals. And as a team, there is a huge team, and when you need help with helping the patients, you can always reach out to the team of people who can help you, who you can rely on.

 The main thing is there is so much stigma about this disease. Like, nobody think obesity is a disease. But if we realize that, and that's changing now, when you talk about even when I was a physician, family physician a few years ago, I was little reluctant to talk to a patient about their weight, because I used to think that, "Okay. I don't want to hurt their feelings," because that's what we were thinking. But knowing that it's causing so many issues and the way I started explaining to the patients, I feel very comfortable talking to them. And the patients are also very interested in knowing about their body. And they are realizing, "Okay, this is the problem and there is help available I should utilize." I think the culture is changing, culture about the thought about obesity is changing. I think moving forward, we will do a great job as a group, I guess. .

Host: As we draw near to the end of this insightful episode of In Their Words, we've journeyed into the world of Dr. Suppiah, a dedicated physician at the forefront of healthcare innovation. We want to thank you, our loyal listeners, for joining us on this enlightening voyage. Your support and engagement drive us to continue sharing these remarkable stories. Stay tuned for more empowering episodes of In Their Words. Until then, friends.

This podcast is brought to you by the UPMC Pinnacle Foundation and UPMC in Central PA. UPMC in Central PA has seven acute care hospitals, with 1,160 licensed beds, over 160 outpatient clinics and ancillary facilities, and more than 2,900 physicians and allied health professionals, and approximately 11,000 employees in Central PA. It is a healthcare hub serving Dauphin, Cumberland, Perry, York, Lancaster, Lebanon, Juniata, Franklin, Adams and parts of Snyder Counties.

The UPMC Pinnacle Foundation exists to provide resources to meet the needs of our most vulnerable patients, promote health and lifelong wellness in our communities and support our workforce so we can attract, train and retain the best and brightest talent at UPMC in Central PA.

To make a difference and join their philanthropic mission, visit upmcpinnaclefoundation.Org.