Dr. Devika Umashanker is an Obesity Medicine specialist practising in the US. In this interview with the M3 Blog, she speaks about fat-shaming, personalisation of treatment, the use of MDTs in the management of obesity issues, and taxing sugary products. Read the full interview below.
What inspired you to specialise in obesity medicine?
After completion of residency I worked as a hospitalist for a couple of years during which I noticed that the underlying cause of many of my admissions was obesity. During medical school or residency, there was not a significant amount of time allocated to teaching obesity medicine or nutrition. After studying the subject on my own and going to various conferences on obesity medicine, I was fascinated and intrigued with the sub specialty, which then led me to pursue a fellowship in obesity medicine at Weill Cornell Medical College.
If you look at data shared by The World Obesity Federation, it is clear there are differences between the percentage of obese adults in each country around the world. What could influence the level of obesity from country to country?
In my opinion, possible factors influencing the level of obesity from country to country are access to food, access to care and being able to treat obese patients effectively.
Further data shows the differences between the percentage of obese men and women in every country. Biologically, are there main differences between male and female metabolisms?
Women tend to have greater adipose tissue compared to men. Increased adipose tissue leads to increased insulin resistance, increased inflammatory markers, and decreased adiponectin levels, which all play a role in the pathogenesis of obesity and affect metabolism.
Would you say that the treatment for obesity must be personalised? In what way?
The treatment of obesity must be personalised because each patient is different. For example, each patient with obesity has a different set of comorbidities and a different combination of medications treating their comorbidities, which then leads to a different treatment plan.
Data shows that on current trends 2.7 billion adults worldwide will suffer from overweight and obesity by 2025. In your opinion, what would be the main points to work on in order to treat and prevent obesity?
The main points to treat and prevent obesity are early intervention, nutrition and exercise counselling, availability of anti-obesity medications, and universal insurance coverage for bariatric surgery, when appropriate.
What is your opinion on taxing sugary drinks, a measure that has recently been approved in the UK? Do you believe the impact will be significant? Are there other similar measures that you think would have a bigger impact?
In my opinion, obesity is similar to cancer. Obesity decreases quality of life, increases mortality, and individuals die from the complications associated with obesity. If cigarettes are taxed to prevent consumers from purchasing the product to reduce lung associated disease such as lung cancer and COPD, we should strongly think about the impact that taxing sugary drinks will have on our consumers in regards to obesity. In my opinion, I think the impact will be significant as it will make the consumer think twice before purchasing a sugary drink. Would taxing sugary drinks eliminate obesity? The answer is no. However, it may be a good starting point to consider.
How can physicians treating obesity benefit from working with different healthcare professionals, such as psychologists and psychiatrists, nutritionists, physical education professionals etc?
Working with a multi-disciplinary team including psychologists, exercise physiologists, bariatric surgeons and nutritionists is the most effective way to treat individuals with obesity.
What do you think about so-called ‘fat-shaming’ by healthcare professionals towards patients dealing with obesity? How can this be tackled?
I think ‘medical fat-shaming’ is prevalent in the medical community, but this can be tackled through education on the pathophysiology of obesity. Obesity is not volitional but rather a disease. Neuro hormonal dysregulation and hormonal imbalances play a significant role in obesity and as a medical community we need to come together and understand this universal concept.
Is there anything you would like to add?
Obesity medicine has come a long way but we still have a long way to go.