Darrell Rebouche (Host): Hello, and welcome to Health on Point, presented by Willis Knighton Health. We're tackling a topic in this episode that affects millions of people, often silently, sometimes without warning. It's metabolic disease. From obesity and insulin resistance to fatty liver disease, diabetes, hormonal imbalances, these conditions are more connected than many people realize, and they're reshaping healthcare across the country. Our guest today is an internal medicine specialist who is medical director of the Willis Knighton Metabolic Disease and Obesity Clinic, Dr. Maurie Patterson. Thank you for being with us.

Maurie Patterson, MD: It's a pleasure.

Host: So can you explain what metabolic disease is?

Maurie Patterson, MD: Metabolism is basically how we take in food and convert it into energy, how our bodies convert to energy. And a metabolic disease is when there's a problem in those pathways. And you mentioned fatty liver disease, and that's probably a good one to give as an example. Most of us, when we eat carbs, carbs are meant to be quick energy. So, you eat carbs, you get a quick burst of energy. And that gives you the ability to go out and go for a run.

The problem is, most of us, when we eat that muffin, we don't go out and we don't go for the run. So, anything that you don't use at that particular moment actually gets stored later for energy. And you have to think about your liver as a Ziploc bag. So if you eat a muffin, you don't need all of that energy right now, the rest of it goes into the Ziploc. And if you never take that run, or if you only take the run every three to four days, but you eat the muffin every day, then what happens is the Ziploc bag, you just keep shoving more and more muffins in the Ziploc bag until it's bloated and cracked, and part of the Ziploc bag may not be functioning. And, so you have what is an over storage disease, and that leads to basically the inability to store properly and other metabolic issues. After, there's liver disease, which can even go on to cirrhosis.

Host: So now, you've got a dedicated metabolic disease and obesity clinic. And I'm curious, what were the steps? What led you to establish this clinic?

Maurie Patterson, MD: Obesity right now is a huge area of research. And there's so many treatments coming out, and it's really becoming more and more clear that obesity is not a symptom, it's not a cosmetic issue, but it's a chronic disease. And in order to treat a chronic disease, you really need to attack all of the issues that lead to that disease, both physical, mental, environmental, and also medical therapy. It's really so that we could give a more holistic approach to the treatment with the hope that, you know, you get better treatment outcomes.

Host: Obesity is a word that captures people's attention. And I guess there are different ways to define it. But clinically, it's pretty clear how to define it. How do you define obesity?

Maurie Patterson, MD: It's not as clear as you would think. I mean, right now, we're using BMI as our main way to define obesity, but it's very different depending on your muscle mass. And for that reason, in the obesity clinic, we actually use body composition as the main way we diagnose obesity. Because, well, in training, they always give the example, if you compare, I don't know if you remember Tim Tebow, the football player, but if you compare Tim Tebow and Donald Trump, both of them have the same BMI. And obviously, they don't look the same.

And so, the more muscle mass you have, the higher your BMI. And it doesn't necessarily mean that you're obese. The goal is to improve your body composition. Because you don't want to just focus on losing weight, because then you end up without the other benefits of weight loss, the health benefits.

Host: I don't think anybody would think of Tim Tebow as, I hate to use this word, but here it is, fat, right? So when people think of obesity, the average person thinks of someone who's simply overweight and, a lot of people are harshly judgmental of that. They think it's about willpower and about just being disciplined and losing that weight, but that's not always the case.

Maurie Patterson, MD: Historically, we've looked at obesity more as a symptom of other issues, whether someone's compensating for depression, anxiety, and they're emotional eating and it leads to obesity, or whether it's someone's inactive and it leads to obesity. But the problem with obesity is that there are actually genetic components that contribute to obesity. Your ability to store and process food is inherited to a large degree. And it's also affected by the nutrition you receive in utero. Poverty puts you at increased risk for obesity, food inequality. A lot of people don't have access to good nutrition. So, there's a lot of different factors that contribute to the development of obesity.

The disease itself, I mean, fat is an endocrine organ. It produces 50 different hormones that regulate metabolism, reproductive health, and also appetite. So, once you have that endocrine organ, it's trying to maintain itself. So, even if you lose weight, all of those hormones go through the roof to try to get you to regain it back and to maintain that body type, because your body sees itself as starving when you lose weight.

So, someone that is overweight, it may be that they are working night shifts. It may be that they're working two to three jobs and they don't have time to do activity. It may be that they're genetically predisposed and just every calorie that they put in, they store it instead of using it. And I mean, there's just a lot of factors. So, it's not a simple thing of willpower. I mean, if you look at other chronic diseases like hypertension, you would never say to someone with hypertension—the first-line treatment of hypertension, diabetes, the first-line treatment is diet and exercise. And you would never tell someone with hypertension or diabetes that they don't deserve treatment until they show you that they have the willpower to perform diet and exercise. When we see other chronic diseases, we treat those diseases. And, you know, we should treat obesity the same way.

Host: It's so much more complicated than the average person likely realizes. And therefore, that leads me to believe that your program, your Metabolic Disease and Obesity Clinic, must have a lot of components involved. Can you let us know what all is involved for the average patient and how your clinic is structured?

Maurie Patterson, MD: When people come in, we do a full history and physical. And when we go through the history, we go into what their everyday life is like as far as their activity, their diet, how many times a week they eat out, how many times a week they eat fast food. We try to get a, an idea of where they're getting their calories and how they're actually expending them.

And then, in part of that is also their mental state and how much stress they're under. How is that affecting their eating habits? Should that be treated as well? We have four components of our program in general, and it's activity, diet, stress reduction, and then medical therapy.

A lot of people in the treatment of obesity, you know, it's like the treatment of hypertension or diabetes. You just want to treat it with a medication. But you're not going to get all the benefits from treatment if that's how you treat obesity, because it's the other factors that actually change the body composition, increase your mobility, and lead to longevity in the long run. And that's what you're really going for, is to feel better and to live longer.

Host: No matter what doctor you go to, if you get your routine screenings as you should to maintain your health, or even if you're having an issue and you need to go see a specialist, but if it's your primary care physician, your cardiologist gastroenterologist, whoever it may be, your weight, your BMI, all of these are always a topic of conversation, whether it's good or whether it could be better. And so, I think we can strongly infer from that, that managing your weight and managing your metabolism can have great beneficial effects on your overall health. Is that correct?

Maurie Patterson, MD: That's absolutely correct. Obesity itself is associated with and leads to over 200 other diseases, 13 of them being cancer. Because like I said, basically, obesity produces hormones, it produces growth factors. With that, we're seeing earlier colon cancer because, you know, the obesity rates in the US are rising. We're seeing more endometrial cancer. We have breast cancer. Obesity is a huge risk for breast cancer, cardiovascular disease, stroke, diabetes. People that are obese spend about $1,600 more a year on medications, just because of their other diseases alone. So to not treat that as a factor, as a main cornerstone of chronic disease, you're really missing out on improving your overall health.

Host: This is Health on Point, presented by Willis Knighton Health. I'm your host, Darrell Rebouche. Our guest is Dr. Maurie Patterson, who's the medical director of the Metabolic Disease and Obesity Clinic at Willis Knighton Health. Dr. Patterson, I don't know if a lot of people would correlate obesity with cancer, but you just did. I mean, that is something that probably needs to be emphasized, don't you think?

Maurie Patterson, MD: A lot of people that have had estrogen-sensitive cancers, I mean, they have come out with studies where if you lower your BMI by 5, if you go from like a BMI of 35 to 30, then it decreases your chance of cancer recurrence by a lot. And so, I mean, it's definitely, it's never too late. It's never too late to address your weight. And, you know, you can prevent future adverse diseases and also improve your health outcomes for the diseases that you already have.

Host: I know that you are very proud of this, and it's been a passion project for you. It's something that you've put a lot of thought, a lot of study, a lot of planning, and a whole lot of expertise into. So, how is this metabolic disease and obesity clinic different from what it offers that other facilities in our region might not?

Maurie Patterson, MD: Coming at it from a different viewpoint. Like I said, I mean, we're looking at obesity as a chronic relapsing disease. It's not something you go in, you take a pill, you treat, and then you're done. Because those hormones are always there. Your genetic predisposition is always there. It's something that needs to be followed, and it's something that may need to be retreated. You may need to be on a maintenance therapy.

We're just coming at it from a different viewpoint, and it's not something that you treat with a pill and you're done. I mean, you need to look at diet and activity, or you're basically just losing weight. You're not increasing your muscle mass. You're not improving your mobility. If you treat obesity and you improve your muscle mass, you're less likely to end up in a nursing home. You're more likely to live independently for the rest of your life. And also, it's more likely to improve your cognitive status and help maintain it. And so, you definitely want those benefits. You don't want to just lose weight.

Host: Well, those are strong incentives.

Maurie Patterson, MD: No doubt.

Darrell Rebouche (Host): You are board-certified

Host: in obesity medicine. What does that really mean, and how does that work to the patient's advantage to have someone like you who is board-certified available?

Maurie Patterson, MD: it basically means that we have a special interest in obesity as a chronic disease. It changes the focus in how we treat it. So, it's not just a weight loss clinic, it's more looking at each patient is treated individually. And you're looking at what are their other comorbid diagnoses that are associated with their obesity that may be preventing them from losing weight. It's a more global approach.

And I think once you get into advanced obesity, BMI greater than 35 or 40, you know, people, I think, they could benefit from the additional resources that we have as far as diet, as far as referrals to increase their activity. We use a lot of physical therapy. And we use a lot of water therap. because some of these people, especially in the advanced stages of obesity, they're pretty immobile and you can't just flip a switch and start walking every day.I mean, you know, it's a one foot in front of the other treatment, which is why our program is a year-long. We see people every month for a year. And every time you come in, you see a provider and we address diet, activity, medical therapy, and stress reduction. Because, you know, people backslide. Life happens. And eating is a coping mechanism. So, it's something that, you know, it takes a while to develop good habits and to address the underlying physical issues as well.

Host: I'm an expert in eating as a coping mechanism. I can assure you of that. Aren't we all? You know, you talked about carbs. And I know nutrition counseling and all of that. But there's so much of this bundle, intake of protein, preservation of muscle. I think you touched on that, that people lose weight, but they need to not just lose the weight. They need to be careful that they're losing weight in the right ways, in the right places. All of these things roll together in the year-long or more treatment plan.

Maurie Patterson, MD: That's why we use the body composition, because everyone as they lose weight loses a certain amount of muscle mass. But as we age, our muscle quality is not the same. Muscles become stranded with fat as we age. And so, the muscle quality is not as good as when you were 20. So, you don't have as much leeway to play around with. And so, you definitely don't want to lose that muscle mass because then you just end up as a thin, frail adult, and that doesn't get you anywhere.

And so, we want to lose it in the right way, and you want to maintain that muscle mass. And every two months we do an InBody composition exam to see basically where you are and to see how much fat you're losing, how much of your weight is muscle mass, and we adjust your diet accordingly.

And so, with that, you know, I mean, we push the protein intake. Because you want to preserve as much muscle mass as you can because then when you get done losing weight, you're burning more calories at rest, which is what you want. Otherwise, it puts you at increased risk to regain it.

Host: Is there protein in those muffins you talked about at the beginning?

Maurie Patterson, MD: We can definitely get you some protein muffins.

Host: Okay.

Maurie Patterson, MD: We can get you resources here in Shreveport that make fantastic protein muffins.

Host: Good to know. I'm going to take you up on that. Yeah, I think a lot of people get down to basics for some things. You know, you talk about losing weight and doing it the right way, but also this could get expensive. I mean, how do you help people navigate affording your services?

Maurie Patterson, MD: Our appointments are all charged through your insurance, so insurance covers all of our appointments. So, it really comes down to medical therapy and what does your insurance pay for. I mean, everyone, you know, everything online is about the GLP-1s, and they are great medications. But, you know, there are 20 different medications that can assist with weight loss, and we use a combination of all of them. You know, some of them obviously are much cheaper than others.

The GLP-1s, this field is evolving and the cost is also evolving. And they're about to come out with a plan for patients with Medicare Part D where they're going to be able to get GLP-1s for $50 a month, which is going to be huge for Medicare patients. But, you know, there's a lot of people that aren't on Medicare that are still struggling to have access to this. And I think a lot of this is because insurance companies have kind of been allowed to see this as more of a cosmetic issue or a symptom of another disease instead of a chronic disease. And I definitely don't think that they understand that this is really the cornerstone of other chronic diseases.

And if you want to make headway with diabetes, hypertension, cardiovascular disease, you're going to have to treat obesity too. I think the prices will continue to come down. There's a lot of different options now. And, you know, this is basically what we do. So if there's any chance we can get your insurance to pay for it, we're definitely willing to do it, do the prior authorizations and write the appeal letters and all of the above.

Host: Nothing succeeds like success. And if you get going on a program and you see progress, that feels great, and it encourages you to keep going. But sometimes people hit plateaus. And I know also sometimes people maybe don't respond so well to the GLP-1 medication, the injections or whatever else is developing now. So, how do you help people navigate these frustrating moments where you might have to reconfigure what's going on?

Maurie Patterson, MD: That's why we cover stress management, diet, activity, and medical therapy. It's not as simple as just giving someone a pill. And especially during different, you know, times, If people are under stress, they tend to go back to what's worked for them in the past, they go back to emotional eating.

And so, it's a process, and people have to learn other ways to manage stress. And we treat comorbidities of obesity. So if somebody comes in and they're struggling with emotional eating, we adjust their psychiatric meds. If someone comes in and they're having problems with activity or they've had a knee replacement or they've had some problem that's affected their mobility, we put them in water therapy. I mean, it's a constant process to try tto keep moving you forward. And I think that's also what's different about this program, is that we're using other subspecialists as resources.

Host: Dr. Maurie Patterson is the medical director for the Metabolic Disease and Obesity Clinic at Willis Knighton Health. Sometimes things don't go your way. Sometimes you don't have all the success you want in a program like this. So, what's the most common reason for that, do you think?

Maurie Patterson, MD: There are people—going back to your other question—that are resistant to the GLP-1s, and there are also people that are not candidates for the GLP-1s. There's limited effectiveness to some of these other medications. And some people have schedules, you know. I mean, some people are, you know, a mother of three that's working two jobs and going to school at night. And it doesn't mean you don't work on your health, but it may not be the best time to be losing a lot of weight. But that doesn't mean that you can't do everything you can to keep from gaining any more weight until you get in a place where you can focus on it.

And there are newer medications that are coming out. There's triple therapy that's coming out, and we've got a lot of hopes with that one that it's going to help with some of these people that have been resistant to the combined GLP/GIP1s. There's so much research going on and there's so many drugs coming down the pike. There's going to be other options, other treatment options also.

Host: A lot of people struggle with weight over the course of decades. Maybe it's a lifelong struggle trying to maintain that weight. Maybe their weight fluctuates. You know, sometimes they lose weight, they don't lose it in the right way, they gain it back. Before someone reaches out to you at the Metabolic Disease and Obesity Clinic at Willis Knighton Health and seeks help, what questions should they ask? What kind of general research should they do, before they reach out for help this time they really, really want to succeed.

Maurie Patterson, MD: Everyone should start with their primary care physician. Because a lot of primary care physicians in town are very passionate about this as well, even though they're not obesity board-certified. I mean, they can certainly start the conversation, and they can start treatment. And, you know, if they decide that you need additional resources, then they can certainly refer you, or you can refer yourself.

it kind of depends on where you are in your life and how aggressive you want to be as,as far as the patient. Obesity is a chronic disease. It is a chronic relapsing disease. Once you have it, it never goes away. So, it may rear up throughout your life. And, you know, that's why you're going to your primary care physician, that's why you come to us, is to basically address the issues as they come up, just like you would with your diabetes or your hypertension.

Host: Dr. Maurie Patterson, thank you for your time today. And as always, thank you for your expertise. Thank you for being so fun to talk to. On my bingo card for this episode, muffins and Tim Tebow were not there.

Maurie Patterson, MD: There you go.

Host: So i'm grateful for you.

Maurie Patterson, MD: But that help you visualize, doesn't it?

Host: I'm never going to forget Tim Tebow. Right. All right. thank you. it's been great. And we appreciate everyone joining us for Health on Point. For Dr. Maurie Patterson. I'm Darrell Rebouche. Thank you for joining us.