Apr 9, 2021

Interviewer: You've tried diet and exercise, and you're still not losing weight. What's next?

Dr. Jennwood Chen is from the Comprehensive Weight Management Program at University of Utah Health. And Dr. Chen, how often do you see patients that struggle to get to a healthy weight?

Dr. Chen: It's not uncommon when patients come to see me that they have a history of failed weight loss attempts, even though they are fairly religious with diet and exercise. That's likely because obesity is a multifactorial disease. There are many things that cause obesity and continue to or make it hard for people to lose and keep the weight off.

Interviewer: What are some of those other factors that keeps that weight on us?

Dr. Chen: Genetics plays a big role, medical comorbidities, obesity-related medical comorbidities, long-standing diabetes also makes losing and keeping the weight off difficult as well, how long you've been obese, we know this is a temporal relationship between how long you've carried this excess weight and/or diabetes, and how easily it is to take that and keep it off as well. Chronic stress, we know that shift workers, disrupting your sleep and therefore disrupting your glucose regulation will contribute to weight gain and diabetes. So there are many factors, and many factors that we're still learning about.

Interviewer: I think that could be kind of rough for somebody who's just heard over and over again, "It's diet and nutrition, diet and nutrition." And if you're not losing weight, it could be really frustrating, and you could start feeling like, "Well, what's wrong with me? There must be something wrong with me."

Dr. Chen: That's correct.

Interviewer: But what I'm hearing is there are other considerations, other than just what we hear all the time, diet and nutrition. You covered some of those. So when a patient has some other considerations like that, what are some of the tools that you have to help them then, beyond diet and nutrition?

Dr. Chen: I'm a bariatric surgeon, and certainly there are surgical options, but I work at a comprehensive weight management, and there are a plethora of new pharmaceutical modalities. We have a wonderful medical bariatrician there that prescribes and manages these medications as well.

Interviewer: And then, you had mentioned bariatric surgery as a way to do this as well. But I've heard of it in terms of metabolic surgery and not bariatric surgery. To kind of reframe that in people's minds, help me understand what that means.

Dr. Chen: I'm so glad you mentioned that. I think we've done ourselves a disservice by framing it as weight loss surgery. The weight loss comes for sure, but it's not the primary goal. It's really to restore your metabolic health and put you on a healthier trajectory. It's not a cosmetic surgery.

Interviewer: And then what is the hope, as far as you're concerned, if somebody comes in and they do get bariatric surgery, they start losing that fat, how does that then make them healthier?

Dr. Chen: So with the fat loss, we also see resolution or at least remission of a lot of the metabolic diseases, being diabetes, hypertension, obstructive sleep apnea, hyperlipidemia, PCOS, I mean, so many. It's quite amazing actually. I remember a time where I learned that diabetes was a chronic disease with no cure, and now we are curing it.

Interviewer: Well, Dr. Chen, it's reassuring to know that, you know, sometimes diet and nutrition just isn't enough when you're trying to lose weight. And the benefits of losing weight, just are so many that it's really worth trying some of these other pathways, if at all possible. Tell me a little bit about the University of Utah Health Weight Management Program and how you approach weight loss, you know, in addition to diet and nutrition.

Dr. Chen: So the University of Utah Comprehensive Weight Management Program is what I like to think of as a multi-disciplinary, holistic approach to treat obesity. And we tailor our approach to the needs of the patient. So whether it's, "I need to lose a few pounds, and I think I could do it through diet and exercise, that I just need some help implementing and sticking with healthy lifestyle choices," to, "I've tried this, I need some medical help via pharmaceuticals," to, "I've really thought about this, and I want to investigate surgical interventions." I mean, we cover it all, and we are open minded to all of it.

Interviewer: It's easy to forget, again, coming back to this theme, that diet and nutrition, that's kind of what we get hammered into our head over and over, that that's the only thing you have to focus on. Well, that's great. But if you don't quite understand nutrition, which, you know, is totally normal, you've got a nutritionist that can help you. If you need help with exercise, you've got exercise people that are part of the program. Cardiology, sleep, dieticians. I mean, just like all these things we talked about, you have somebody that can help somebody, regardless of what their situation is.

Dr. Chen: Yeah, it's in the name. That's why we call it comprehensive, you know? But you're absolutely right. Our traditional advice, "Eat less, exercise more," it just doesn't work for everyone. And that's really because obesity is a complex, multifactorial disease. And that's why, you know, we're proud of our comprehensive weight management. The bottom line is we're here to help in any way that we can, in a very team-oriented, tailored approach.

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