May 6, 2024
Excess Weight Gain and Obesity and Immune Related Diseases in 2 cases
I want to share a few recent case experiences that shed light on the patient provider experience in the context of a collaborative clinic model based on prevention and the patient first mentality.
In the struggle against the US based disease onslaught that is excess weight gain, longevity with the patient remains the greatest winner for a quality outcome. What do I mean when I say this?
Let me tell you a story. I care for a wonderful young man who is about to turn 17 years old. I have known him since birth and his struggle with weight has been profound for most of these 17 years. Year after year we have honest and loving conversations about nutrition, movement, stress reduction and all of the Integrative levers of health. He listens, his mother loves him and we make plans. Most years, the outcomes were less than optimal. However, never was his weight a punitive conversation despite his mother's and my fear and struggle. It was a loving and educational relationship full stop. Now, don't get me wrong, I can get frustrated with the lack of change and the headwinds against these poor kids. (Think big Ag/school food/food deserts. Think limited safe play spaces. Think bullying in schools. etc..)
At the end of the day, the greatest lever that a provider can wield is love coupled to education. I say this because over my 25 years of work at SPA, I see these repeated follow ups where I hear the magic words, I am listening now! I heard you! Thank you so much for never giving up on me! Thank you for caring when others did not! This just happened minutes before I wrote this quick section.
The answer to obesity is NOT GLP1 agonists as the AAP, the AMA, Big Pharma and other medical organizations would have you believe. The answer is not society/media normalizing excess weight in a bid to avoid shaming someone despite the risks of the disease. The answer is not to avoid the time it takes to teach in clinic on your busy day. To not tackle these issues head on is to doom the person to medical metabolic damage from the earliest ages leading to early and earlier disease onset as we are seeing. I did not go into this field to accept that reality. The kids need us to be their voice in the darkness. The state and federal narrative is absolutely failing our children. I do not say this lightly. We spend more money on the back end of a problem then focusing on prevention and healing the system before it gets broken to the point of needing a gastric bypass surgery, needing a 15000$ per year drug for the rest of your life beginning in childhood, etc.. This seems so obvious to me.
In clinic, the answer is to never use negative words towards the person and their behavior. Use negative words towards the dysfunctional behavior of corporations/government , food stuff, chemicals, etc... Tell the child that it is not their fault so much as the they are a polar bear in the desert. They are mismatched between the world they find theirselves in and the metabolic reality of their bodies. The answer is to be energetically open hearted to their healing and the stress that may be at the root of the problem. The answer is to care enough to ask questions and pose solutions. The answer is to be honest about the trajectory of health if one maintains a modern lifestyle that prizes taste, comfort and passivity over action, education and choosing the right choice. The answer is to use more positive words than negative. This is true in life in general.
For those interested in more information on GLP1 from the pediatric perspective, visit this you tube page: link
What about the other case?
This story involves a young teenager with a complex eye inflammatory disorder and a very complex skin viral plantar wart issue that was to date not effectively dealt with.The eye specialist aptly recognized an inflammatory disorder referring the patient to an immune specialist. They had also seen a qualified dermatologist. Where the story becomes interesting is this - after seeing multiple specialists looking at a narrow scope of problem from their viewpoint, the patient remained on medicine to control symptoms without a clear diagnosis or plan for resolution after two years. The answer appeared to be there the whole time hidden in the tea leaves of labs and symptoms. My partner and I discussed this case together after she saw her for the rash, leading to new viewpoints and a final answer confirmed by further testing. It was a tricky case to be sure, but not one that should have remained hidden for so long. This is not about our success in solving the case as much as it is a discussion of collaboration. Multiple minds are always more capable than a single entity view.
What this and many cases call for is a step back and a global look from 30,000 feet moving in until close enough to see the unifying details. It requires multiple viewpoints and persistence. In short it required collaboration. This has become increasingly less likely to happen in the siloed world of subspecialty medicine and fast paced visits prizing time over quality. Clinics like the immune dysregulation clinic at the Children's Hospital of Philadelphia are bucking this trend by having multiple specialists discuss cases together to see the missing links and make the connections. This is how I was trained at the University of Virginia. Discussion among different thinkers often met with the best results. Keeping that ethos alive is of paramount importance to me for the children. This is the collaborative medical model that is needed moving forward. This also happens to be the ideal incubator for young MDs, PAs and NPs to learn in. This may also be the place that general artificial intelligence meets medicine. Imagine a time when we can talk through a case with GAI and get a road map for a possible solution.
I remain supremely optimistic that medicine will see the breakpoints of siloed fast paced not patient centered medicine and push for more collaborative care. The current medical model being thrust upon us is wrong footed. It is a study in money first and patient second.
There is a hope for sure that the patient will fall back into the center of the care experience despite the fact that we are heading the other way all over the place in the medical ecosystem.
Find a medical advocate in the meantime - keep them on retainer!
Dr. M
