Despite obesity’s recognition as a chronic disease by the American Medical Association in 2013, bariatrician Kimberly Gudzune says the field of obesity medicine still has its skeptics.
“Based on past experiences, many physicians perceive medical weight loss as only dispensing medications like phentermine to help patients lose weight,” Gudzune says, referring to the stimulant first approved by the FDA for appetite suppression in 1959. “That’s not our goal at the Johns Hopkins Digestive Weight Loss Center.”
Instead, Gudzune and her colleague, Zoobia Chaudhry, approach treatment with a comprehensive strategy that includes intensive diet, exercise and behavioral counseling in addition to medication management. “Obesity is a complex disease, so we use more than one tool in the toolbox.”
Though it resides in the Division of Gastroenterology and Hepatology, the center is a collaboration between many specialties at Johns Hopkins. Treatment plans may integrate nutritionists, exercise physiologists, mental and behavioral health professionals, gastroenterologists and surgeons.
Gudzune has been through extensive continuing medical education to earn board certification in obesity medicine. “Obesity medicine is an emerging subspecialty. Most physicians don’t receive in-depth training on nutrition, exercise, counseling and medication management during residency or fellowship,” says Gudzune. “That’s one of the things that really distinguishes our clinic at Johns Hopkins.”
When she evaluates patients during their early visits to the clinic, she spends considerable time looking for clues that could contribute to obesity. “Eating disorders are under-recognized in this population,” says Gudzune. “Most people are familiar with bulimia and anorexia. But things like binge-eating disorder and night-eating syndrome may be contributing to a patient’s weight struggles.”
Gudzune also works with patients who have had bariatric surgery, assisting primary care physicians with nutritional management and other postsurgical issues.
In addition to her clinical practice, Gudzune’s research has drawn national attention.
In early 2015, she published results of an extensive study of commercial weight loss programs. Her findings: Despite grand claims, only a few have shown that their clients lose more weight than people not using the programs. Very few of the most popular commercial programs have been rigorously evaluated with randomized controlled trials.
Gudzune’s research has also examined how weight stigma may influence the relationships between clinicians and their patients with obesity. She published a study that concluded that overweight and obese people who feel their physicians judge them about their weight are less likely to successfully lose weight. “Given my research findings in this area, it is critically important to me that we deliver high-quality, compassionate care to our patients at the Digestive Weight Loss Center.”
Gudzune says there’s no minimum or maximum weight to be treated at the Digestive Weight Loss Center.
“I see patients who are only slightly overweight but want to take action now to prevent any complications associated with progressing to obesity,” she says. “The only real requirement is that they’re motivated.