Adam Nally, DO, says his own weight issues as well as those of his father—who weighed 400 pounds and died at age 58—are never far from his thoughts when he works with his patients who suffer from obesity.
“I felt like I was going down the same path. Even though I exercised and significantly restricted calories and fat, I was failing to lose weight,” says Dr. Nally, the owner of Nally Family Practice in Surprise, Arizona.
Knowing the complexities of managing obesity and the diseases it can cause, Dr. Nally felt he didn’t have the training to fully meet his patients’ needs and sought additional training.
Interested in learning more about the biological underpinnings of this disease—which affects more than one-third of U.S. adults—more physicians are seeking board certification in obesity medicine. In 2015, a record number of 419 first-time candidates passed the American Board of Obesity Medicine (ABOM) certification exam, an 23% increase from 2014. Obesity medicine is an emerging subspecialty; the board certification exam was first administered in 2012.
“For so long, people were blamed for being obese and having weight problems. Now, institutions are beginning to recognize the need for applying clinical knowledge to patient care for obesity,” says Louis J. Aronne, MD, the ABOM’s chairman.
Because they did not receive obesity training while in medical school, Dr. Nally and Adarsh Gupta, DO, the director of the Center for Medical Weight Loss and Metabolic Control in Stratford, New Jersey, took courses on obesity before obtaining board certification in obesity medicine. The courses covered the causes of obesity, behavior modification, exercise and diet counseling, and other disorders caused by obesity.
“Treating obesity is not just about diet and exercise. It’s a multifaceted process. You have to manage both the metabolic and functional components of the disease,” Dr. Gupta explains.
For example, if a patient is on blood pressure medication and loses weight, the medication dosage needs to be adjusted so it’s proportional to the patient’s new weight.
“If I don’t do that proactively, the patient’s blood pressure could get too low,” Dr. Gupta says.
Working with patients
Psychological components also play a role in treating obesity.
“It’s not that patients don’t have willpower. It’s that food stimulates powerful hormonal signals that often can only be modified by behavioral therapy,” says Dr. Nally.
When developing a personalized treatment plan with his patients, Dr. Gupta asks them, “How can we control the foods you eat now? That’s the goal.”
Instead of giving up traditional foods at a family gathering, Dr. Gupta recommends cutting down the portion. If patients enjoy eating pasta, he’ll recommend swapping al fredo sauce with marinara sauce.
“These small changes can help control calories,” Dr. Gupta adds.