Liver Disease Specialist: Obesity Has Reached Crisis Proportions

A recent report found that 42% of U.S. adults are obese.

Obesity should be addressed through a multi-modal management approach involving a range of healthcare providers including primary care physicians, obesity specialists, nutritionists, and counselors, a liver disease specialist says.

Obesity rates have increased steadily over the past decade and now 42% of U.S. adults are severely overweight, according to a recent report from NORC at the University of Chicago.

Obesity is a serious problem in the United States, says Tejas Joshi, MD, director of liver diseases at Marshall Health. "It is a growing issue. Ten years ago, one-third of Americans were normal weight, one-third were over-weight, and one-third of them were obese. A recent study showed 42% of the U.S. adult population is suffering from obesity. As we look to 2030, we expect 50% of U.S. adults will be obese."

Obesity is related to several medical conditions, he says. "The severity of the obesity problem is directly linked to the health conditions associated with obesity. There are consequences, and some of the consequences are going to be in different formats—mechanical, metabolic, and neurological. One mechanical consequence is sleep apnea, which causes difficulty in sleeping. Another mechanical consequence is added weight on joints leading to arthritis. Metabolic consequences include conditions such as diabetes, high cholesterol, and fatty liver disease. A neurological consequence is depression."

Obesity has also been linked to a dozen kinds of cancer, including gastrointestinal, urinary, and pancreatic cancers, Joshi says.

Many healthcare providers should be involved in helping obese patients achieve weight loss, he says. "Optimally, we should approach obesity through multi-modal management via various providers—primary care, obesity specialists, nutritionists, counselors, as well as education from specialists that the patient may be seeing secondary to obesity-related consequences. So, if you are seeing a heart specialist because you have cardiovascular disease on top of obesity, the multi-modal management approach includes the heart specialist talking about a cardiac-health diet and weight loss. If you are seeing a hepatologist because you are suffering from fatty liver disease not related to alcohol, then the hepatologist should be involved in educating, counseling, and putting referrals in."

Through multi-modal management, we can achieve meaningful weight loss and address the obesity epidemic, Joshi says. "Your primary care provider could be the one to prescribe medicines, provide you with information, and put referrals in. A nutritionist could talk about various diets. When it comes to counselors, we must recognize that obesity plays a role in depression—depression can worsen obesity in some cases and obesity can drive depression."

Relatively new medications are a step forward in efforts to address obesity, he says. "GLP-1 agonists are one of the newest classes of medication that has achieved Food and Drug Administration approval for the treatment of obesity. There are more of these GLP-1 agonists as a class—even more are entering Phase 3 clinical trials. These drugs are a good addition to the treatments that healthcare providers have to battle the obesity epidemic."

Ozempic, which is FDA-approved for treatment of diabetes, is a GLP-1 agonist that should not be prescribed to treat obesity, Joshi says. "In the case of Ozempic, we have to prescribe medications based on their FDA-approved indications. If you have a patient who is diabetic who also has obesity, then if you started them on Ozempic one of the effects is weight loss. But providers should be prescribing medicines based on their FDA-approval."

Lifestyle changes are essential to address obesity, he says. "In lifestyle, we have to recognize appropriate times to eat and when not to eat. For example, you probably should not eat a couple of hours prior to sleeping. We need to recognize healthy foods—those that are not complex carbohydrates. We need to recognize that given the illness you are currently suffering from, there may be a specific diet scientifically shown to benefit that condition. Exercise is important. It is recommended that we get about 150 minutes per week of moderate-intensity exercise such as brisk walking 30 minutes a day."

In Joshi's practice, FibroScan, an ultrasound-based diagnostic tool that measures liver scarring, has helped influence patients' behaviors, he says. "I plan to publish a study that shows FibroScan motivated my patients to lose weight. We had patients who we diagnosed with FibroScan. We gave them educational material. We had them return in 90 days. And just learning that their liver was affected by their lifestyle choices and their weight was a motivating factor. On return, we had these patients re-examined, and they had lost weight. Their sugar numbers had gone down. FibroScan helped motivate them."

Related: New Guidelines Promote Expansion of Bariatric Surgery to Treat Obesity