Latest / CareTalk: Healthcare. Unfiltered. / Transforming Obesity Treatment & Perception w/ Dr. Katherine Saunders

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Transforming Obesity Treatment & Perception w/ Dr. Katherine Saunders · CareTalk: Healthcare. Unfiltered.

• 0:00
  Ozempic and Wegovi are all the rage as everyone tries to lose weight.
• 0:03
  But even though obesity is everywhere, there are very few doctors who specialize in treating it.
• 0:09
  Today's guest, Dr.
• 0:10
  Catherine Saunders, is one of them.
• 0:12
  As founder of IntelliHealth, she's focused on scaling obesity treatment by enabling providers with technology.
• 0:18
  So, can this technology -enabled approach keep up with all the demand?
• 0:25
  you Welcome to Care Talk, America's home for incisive debate about healthcare business and policy.
• 0:34
  I'm David Williams, president of Health Business Group.
• 0:37
  And I'm John Driscoll, a senior advisor at Walgreens.
• 0:40
  Join the ever -growing Care Talk community on LinkedIn, where you can dig deep into the healthcare business and policy topics, access Care Talk content, and interact with the hosts.
• 0:50
  And please leave us a rating on Apple or Spotify while you're at it.
• 0:55
  Catherine, welcome.
• 0:56
  Before we jump into the weighty public, topics of obesity and the GLP -1s and what I think is sort of a revolutionary period of taking on this really difficult wave of illness.
• 1:10
  Maybe you could talk a little bit about your own journey about how you became one of the few ward -certified weight management obesity specialists in the country and what drew you to start IntelliHealth.
• 1:24
  Sure.
• 1:25
  Thank you so much for having me, John and David.
• 1:27
  I'm thrilled to be here.
• 1:29
  So yes, as you said, I'm a physician.
• 1:31
  I did all of my medical training at Weill Cornell Medicine in New York City.
• 1:36
  When I was in medical school, my mentor, Dr.
• 1:39
  Lou Arone, who is really one of the pioneers of this field of obesity medicine, he's been at it since the 80s.
• 1:47
  People thought he was crazy for the first 35 years, and now he's like, I told you so, I told you so.
• 1:52
  He gave a talk when I was in medical school about obesity being a disease and how he...
• 1:57
  was devoting his career to developing effective treatment protocols.
• 2:01
  And I just thought it was the most interesting thing I'd ever heard and knew right away that that's what I wanted to do as my career.
• 2:09
  So I started working with him in medical school, in residency.
• 2:15
  A group of physicians actually ended up starting a training program, a fellowship program at Cornell.
• 2:20
  So I was the first fellow at Weill Cornell in clinical obesity management.
• 2:26
  And one of the first, I just looked it up, I think one of the first 30 or so in the country, there were some early programs that had been at it for a little while.
• 2:37
  And so I did a fellowship program with him for a year and then I joined his faculty practice at Weill Cornell.
• 2:44
  And it didn't take very long at all once I joined the faculty to have a very long waiting list and to really just feel like we were maxed out and we wanted to do more.
• 2:54
  So my husband who is way more entrepreneurial than I am, although now I've kind of caught up.
• 3:03
  I've become entrepreneurial.
• 3:06
  He, you know, from the time I became interested was like, oh my gosh, you guys have this deep, deep, deep expertise.
• 3:12
  Nobody knows how to do this.
• 3:13
  There's so many people who need your help.
• 3:15
  Let's do something.
• 3:17
  And for many years I said, no, no, no, I'm building a clinical practice.
• 3:21
  I'm, you know, we're building a family.
• 3:23
  And so it took about five years for him to convince me to team up with Dr.
• 3:28
  Arone, who had been working on a software platform for several years.
• 3:33
  And so we took what he had started to build and just exploded it.
• 3:40
  And so this was in 2019 when my husband finally gave me an ultimatum that, you know, our field was about to blow up and it was really the time that we had to do this.
• 3:51
  And describe what you do within health, Intel Health, because again, I think there's a real focus on either, you know, diet programs or drug programs.
• 4:02
  You've got a really innovative approach, and particularly with what you're doing with the state of Connecticut.
• 4:07
  Then we can delve into the weighty topics, because Dave and I are both trying to lose weight.
• 4:12
  Happy to help.
• 4:14
  We can talk anytime you'd like.
• 4:16
  So with the program at IntelliHealth, we basically take everything that we had been doing very well for many years at the Weill Cornell Comprehensive Weight Control Center.
• 4:27
  And we initially started as a software program because we figured, given the magnitude of the obesity epidemic and the massive supply demand mismatch between the many people who need help and the very few providers who are very well trained in this area, we developed software to train providers to do what we do and to give them tons of support with every single patient in a personalized way at each decision point.
• 4:54
  So, you know, training courses, clinical decision support, medication decision support.
• 5:00
  We have a behavioral program that was actually studied at Brigham and Women's in a PCORI -funded trial that was published in JAMA.
• 5:07
  So we have the full service, you know, behavioral program.
• 5:11
  IBT, and then it's also a tool to help providers to understand how to prescribe medications.
• 5:20
  We started as a software platform, but in the first two years, we had so many requests to provide full service care ourselves.
• 5:27
  And it also was the beginning of the pandemic.
• 5:29
  So we ended up responding to the demand and starting our own clinical services.
• 5:36
  So we have an affiliated.
• 5:38
  telemedicine practice called FLITE, F -L-Y -T -E, and we do everything ourselves.
• 5:44
  So it's really kind of tech enabled with our own clinical team to deliver medical obesity treatment.
• 5:52
  What is it that makes obesity a disease and how does somebody know if they have it?
• 5:57
  That is a great question that a lot of people think they know, but it's very, it's much more complex than most people realize.
• 6:06
  So obesity is not just a disease, but it's a heterogeneous, complex, multifactorial, difficult to treat chronic disease.
• 6:17
  What happens when people gain weight and develop obesity is that there is actually inflammation around the area of the brain called the hypothalamus, the energy regulatory area.
• 6:29
  So when people have obesity, they are not getting feedback signals from their fat cells and their gut about how much fat they're storing, how much they've eaten.
• 6:38
  And we'll often talk about, you know, feeling more hungry, feeling like they just don't feel full the way they used to.
• 6:43
  And so weight gain really leads to weight gain.
• 6:47
  And then obesity is associated with over 200 weight -related health complications.
• 6:53
  The reason that it's so hard to lose weight is that, you know, our bodies have been evolved over time to be very good at not starving.
• 7:01
  And so think about trying to lose five pounds.
• 7:04
  at a certain point with any intervention, you start to get more hungry, you think about food more, metabolic rate slows down, your body just does everything possible to hold on to every calorie.
• 7:15
  So by the time we see people in our practice, they've lost and gained weight a million times to the point where nothing is working.
• 7:24
  And this is the story we hear that the same strategies used to work don't work now.
• 7:29
  And this is when...
• 7:31
  people are very good candidates for medical intervention to really use, you know, do a very thorough evaluation to figure out what's going on and then figure out how to optimize medically.
• 7:43
  So the variety of medical interventions has sort of changed over time.
• 7:46
  You remember, you know, various fads and different things that have come and gone.
• 7:50
  Certainly there's, you know, big news now on, on new drugs.
• 7:53
  How do you think about medical interventions and how has that changed?
• 7:57
  Yeah, so there's really this idea right now, there are several ideas that have been conflated.
• 8:02
  One, obesity treatment goes way beyond just weight loss.
• 8:06
  Two, obesity treatment isn't just one medication or one class of medications.
• 8:12
  It really is a whole specialty.
• 8:15
  And in order to treat obesity very well, we need to do a very thorough evaluation of each patient to understand all the factors that are leading to weight gain.
• 8:26
  all the barriers preventing weight loss, address all of those, optimize dietary strategy, optimize physical activity, optimize behavior.
• 8:36
  And then for appropriately selected patients, we figure out the most appropriate medication for each person.
• 8:46
  And maybe describe, I mean, we've talked a little bit about on this show, the GLP-1s, kind of what they are, how important they are.
• 8:56
  and why everybody on the upper East side apparently wants to be prescribed.
• 9:02
  Yes.
• 9:02
  So until a few years ago, the anti-obesity medications that we had were associated with about five to 10 percent total body weight loss, which is significant, but not as much as the numbers we're seeing now.
• 9:18
  And it's a dose response.
• 9:19
  So, you know, when someone needs to lose weight and they have obesity and weight related health complications.
• 9:25
  you know, they get clinical benefit at 5%, but more can be better.
• 9:29
  And so WeGoV was really groundbreaking.
• 9:33
  So WeGoV was FDA approved in 2021, and it was the second GLP -1 receptor agonist FDA approved for weight.
• 9:42
  The first one was Sexcinda in 2014.
• 9:46
  The class of GLP -1 receptor agonists are very effective for both diabetes treatment, and also for weight.
• 9:56
  And so Wigovie is associated with 15 % total body weight loss.
• 10:01
  So huge jump from the five to 10 previously to 15.
• 10:06
  And this class of GLP -1s has just been absolutely groundbreaking in that it's very effective.
• 10:13
  The most recently approved FDA medication is Zep -bound.
• 10:18
  which was approved only a few months ago.
• 10:21
  And that's a combination of GLP -1 plus another one of the gut hormones that work together to be more effective and more tolerable.
• 10:30
  And, you know, I don't mean to pick on David here, but he spends so much time on TikTok, but he thinks that if he just takes these drugs, that that's going to take care of his excess pizza and birthday cake intake.
• 10:44
  I is it...
• 10:46
  Are the GLP ones alone, are these drugs alone the solution for folks who are obese or who are diabetes?
• 10:55
  So again, it's not about one medication.
• 10:58
  It's really a whole comprehensive treatment plan.
• 11:02
  So sure, you can take a medication like this that reduces your appetite and makes you think about food less and reduces your portion size.
• 11:11
  But if you're eating only pizza and birthday cake, which you can get away with, sure.
• 11:17
  That's not what's best for your health.
• 11:21
  You know, we have to extend this podcast a little bit so we can have all the disclaimers that say, you know, events referred to are purely fictional and anybody, you know, that seems to be talking about it.
• 11:30
  There's a lot of David Williams out there.
• 11:32
  We'll just put it that way.
• 11:33
  So it's not even my birthday, John, but I am, maybe you got me ready to eat a cake now.
• 11:38
  I want to hear about barriers to treatment.
• 11:41
  because I think there's obesity is well recognized issues.
• 11:44
  A lot of people say everyone's taking it on the upper East side.
• 11:46
  Well, guess what?
• 11:47
  Not everyone lives there.
• 11:48
  That's also associated with a certain income level, access to care and so on.
• 11:53
  How do the things that we hear about in terms of health equity barriers to care access fit in when we're talking about obesity?
• 11:59
  Yeah, huge.
• 12:00
  We talk about this all the time.
• 12:02
  So several, there are many barriers.
• 12:04
  One is just the shortage of healthcare providers who are trained to do this.
• 12:08
  So we're seeing these these medications be prescribed all over the place by all sorts of different prescribers.
• 12:17
  But again, it really takes a whole evaluation and a lot of education and support to do this well.
• 12:23
  So we need more healthcare providers to be trained to do this well.
• 12:27
  That's one.
• 12:28
  Two, we need to improve access in terms of insurance coverage.
• 12:34
  It's very hit or miss still these days.
• 12:36
  We're also waiting for Medicare to, you know, to start covering anti -obesity medications in a larger way.
• 12:44
  Price, as you mentioned, these medications right now are extremely expensive.
• 12:50
  Then shortages, shortages have been a huge problem.
• 12:55
  And I would say the last barrier is something that's really important, which is weight bias, stigma, and discrimination, which really is a huge barrier to people getting the care that they need.
• 13:07
  And so maybe double -click.
• 13:09
  on, well, on the, the, that, that issue of bias, because I do think that there's a, there's a funny balance right now between those who are worried about fat shaming and those who are promoting, you know, sort of a more aggressive lifestyle, lifestyle interventions.
• 13:28
  I mean, how do you, how do you think about that problem and how do you manage it in your practice when you're and how you deal with folks who are really suffering?
• 13:36
  Yeah.
• 13:36
  So we know that obesity, is a chronic disease.
• 13:39
  We know that for most people with obesity, diet and exercise will not be sufficient.
• 13:45
  There's a lot of blame, there's a lot of shame, there's a lot of internalized bias in this area.
• 13:52
  So when we first see a patient, there's a lot of, oh, I'm just not trying hard enough, I just don't have the willpower.
• 14:00
  And so we do a lot of education to explain, this isn't a matter of willpower.
• 14:05
  this is what your body is doing that's making it so easy for you to gain weight, so hard for you to lose weight.
• 14:11
  But it's this internalized bias that many people have that prevents them from getting the treatment that they need.
• 14:17
  There's also a lot of bias, unfortunately, among the healthcare community.
• 14:22
  And so that prevents people from getting care they need in terms of providers feeling that way.
• 14:29
  I wonder on the provider side, whether there's some reasons why, you think about, okay, There's very few people that treat obesity as a specialty.
• 14:38
  There's also very few people that treat geriatrics as a specialty.
• 14:42
  If you go to the hospital, most people seem to be geriatric and you just go around the street, most people seem to have obesity.
• 14:47
  So why is there such a disconnect between supply and demand?
• 14:52
  Do you have any perspective on that?
• 14:53
  I mean, I guess you're part of the solution, but it seems crazy.
• 14:57
  Yeah.
• 14:58
  So I think there are different specialties where providers can make more or less money.
• 15:03
  And I think geriatrics and obesity specialties where it's more counseling and fewer procedures are traditionally ones that not as many people want to go into.
• 15:13
  That's maybe the case for geriatrics.
• 15:15
  For obesity, it's just such a new specialty that it's just getting started, but it is absolutely exploding.
• 15:24
  There were, you know, there are now 8 ,200 physicians who are board certified and that number is just absolutely skyrocketing.
• 15:33
  So things are changing.
• 15:33
  That's I didn't even realize that.
• 15:35
  So who are the GLP -1 drugs best for?
• 15:40
  And you could just break down everything from the lauried well to the really suffering Medicaid eligible.
• 15:46
  But maybe if you could sort of start with, because that's what people read about it.
• 15:51
  They don't even know who these drugs are for.
• 15:54
  Yeah, so these drugs are not for people with normal weight who are trying to lose five pounds.
• 15:59
  They have not been studied in that population.
• 16:01
  These drugs have been studied among patients who have obesity.
• 16:07
  So body mass index of 30 or above or body mass index of 27 or above with at least one weight related health complication.
• 16:16
  And so that's the FDA approved criteria.
• 16:20
  But they're really approved not just for weight loss, they're approved for the treatment of obesity.
• 16:28
  So weight loss is part of that, but it goes way beyond that in terms of, you know, resolving or improving weight related health complications, reducing the risk of developing other weight related health complications.
• 16:42
  So it's not just a vanity thing where, you know, people want to just lose weight.
• 16:47
  This is really a medical.
• 16:49
  situation where we use an anti -obesity medication to treat the disease of obesity.
• 16:56
  I've been really amazed at the early data related to the cardio effects.
• 17:04
  I mean, these appear to have, is it an anti -inflammatory effect?
• 17:10
  But what are the cardio -related benefits of the GLB ones based on the data we've got?
• 17:19
  Yeah, so it's still being studied.
• 17:21
  The select trial, which was the cardiovascular outcome trial with Wegovi was really groundbreaking.
• 17:29
  Which was massive too.
• 17:30
  It was a very large, which is a rare thing for a clinical trial.
• 17:34
  Yep, yep.
• 17:35
  Massive.
• 17:35
  So expensive.
• 17:36
  So many patients.
• 17:37
  So many years.
• 17:38
  It takes a long time for people to develop cardiovascular disease or have cardiovascular events.
• 17:44
  And so yes, humongous, rigorous.
• 17:47
  trial.
• 17:48
  But that showed that among people with obesity and without diabetes, because we've proven this with diabetes, without diabetes, an established cardiovascular disease that we go V is associated with a 20 % risk reduction in cardiovascular events.
• 18:06
  Which is massive.
• 18:07
  I mean, obviously the most likely thing to kill you, two things to kill you, and that's our...
• 18:14
  or cardiac events in cancer to have a 20%?
• 18:17
  I mean, so is this gonna, do you think the GLP ones or some form of them will reach the point of like statins where people wanna basically put it in the water supply?
• 18:27
  Yes, exactly.
• 18:28
  And so for the select trial data, we're still examining it.
• 18:31
  It definitely appears to go way beyond just the weight loss.
• 18:35
  I think inflammation, as you said, is a big part of it.
• 18:38
  We're going to see other indications beyond cardiovascular disease for, um, liver disease, um, for, uh, kidney disease.
• 18:47
  There's actually a study that Eli Lilly is doing.
• 18:50
  I think they're a year and a half into a five year study looking at multiple weight related complications.
• 18:55
  So that is a really, you know, groundbreaking study.
• 18:59
  So, um, and sleep apnea, sorry, sleep apnea is probably the next indication to come.
• 19:03
  Wow.
• 19:05
  So what is the expectation in terms of how long someone will need to take one of these medications?
• 19:09
  You talk about it as being a disease and being complicated, a lot of different pathways.
• 19:13
  Can you get to the point where you do sort of a reset and it's not part of the long-term plan?
• 19:18
  Do you come in maybe every few years, you go and do a refresher?
• 19:21
  I mean, what are people looking forward to here?
• 19:24
  Yeah, that's a great question that we get multiple times a day.
• 19:28
  So because obesity is a chronic disease, we use medical intervention.
• 19:34
  as a long -term strategy.
• 19:36
  So let's say, David, you came to see me with high blood pressure and we prescribed an antihypertensive medication and you came back a few months later, your blood pressure looked great.
• 19:46
  We wouldn't say, great, we solved the problem.
• 19:48
  Go off your antihypertensive.
• 19:50
  We would say, oh, wow, this is working and you're tolerating it.
• 19:53
  So, you know, weigh the risks and the benefits being on a medication that you're tolerating that's doing what it's supposed to be doing and controlling a major health risk.
• 20:02
  We would continue the option.
• 20:04
  So that's the way we think about this right now.
• 20:07
  That being said, I can't promise that patients are on the same medication now that they'll be on in five, 10, 20 years.
• 20:16
  There's so many medications in development.
• 20:18
  For example, more oral medications, medications that have a much longer half-life that can be dosed every month.
• 20:27
  So we may be able to make it as easy for patients as possible.
• 20:32
  We may also discover a cure for obesity in our lifetime.
• 20:37
  That would be absolutely amazing.
• 20:39
  But while we're getting there, I think, David, this was your statistic.
• 20:42
  Is it possibly true that 75 % of Americans are overweight and only 2 % are getting treatment?
• 20:50
  Yeah.
• 20:50
  So almost 80 % of the population either has obesity or overweight.
• 20:56
  Um, and the numbers are, you know, somewhere between 2 % and 5 % who are actually being treated according to medical guidelines.
• 21:05
  So devastating public health perspective.
• 21:09
  Yeah, it is.
• 21:11
  And that's why we started our company to, to really, you know, scale and democratize access to medical obesity treatment.
• 21:19
  So, Catherine, you talked about, you know, insurance coverage, talk about some of the challenges of access and so on.
• 21:25
  We haven't talked yet about employers.
• 21:27
  We sometimes have a role, you know, to certainly have an interest in the health of their employees and the dependents and their productivity.
• 21:35
  Are employers stepping up here?
• 21:37
  Yes and no.
• 21:38
  We do a lot of, I do a lot of talks to, to employer groups and we speak with many, many, many employers about, you know, how do you do this?
• 21:49
  Because right now with the high prices, you know, employers are looking at GLP ones been going up and up and up every year, just like the state of Connecticut.
• 21:58
  And it's not just, you know, say yes to covering all GLP ones without guardrails and then overspending or sitting back doing nothing and kind of watching and waiting.
• 22:10
  There's a huge middle ground.
• 22:12
  And that's what I really try to, you know, get, get across to employers that it doesn't have to be nothing or.
• 22:20
  overspending.
• 22:21
  And so what we offer and our program with the state of Connecticut employees is a great model for how this can be done in a very effective but also cost effective way.
• 22:33
  Because if you talk about giving a GLP -1 to every single person who's eligible with not enough education support, no guardrails, that's very expensive.
• 22:43
  And several companies and states have had your recent coverage.
• 22:47
  What we do is exactly what I talked about.
• 22:49
  Very comprehensive evaluation to identify is a patient on multiple weight gaining medications that need to be addressed.
• 22:57
  Do they have undiagnosed sleep apnea?
• 22:59
  There's so many different factors that we pull out of a comprehensive evaluation that lead to better treatment and sustained weight management.
• 23:11
  And so we also use all the other medications that we have in our armamentarium, not just GLP -1s.
• 23:18
  And so our data, we just looked at our six month data with the state of Connecticut, looks great.
• 23:23
  Our patients are doing beautifully, they're happy, and we're spending much less than we could be spending.
• 23:29
  Sounds good.
• 23:30
  John, last question to you.
• 23:32
  I guess, Catherine, you know, these are these are we're talking about targeted interventions and single platform.
• 23:39
  Is there a is there a magic bullet here for the obesity epidemic?
• 23:44
  Or is it going to require sort of a multiple approaches over over over over time?
• 23:50
  Because we got to reverse this diabetes and obesity epidemic in America.
• 23:55
  What is what's what's your path to a national solution?
• 23:59
  Yeah, that is a great question.
• 24:02
  I think it's really just getting as many providers as we can up to speed as quickly as we can.
• 24:08
  This is something right now that, you know, is.
• 24:10
  done in the specialty area, but needs to be done by more primary care doctors.
• 24:16
  They have to be part of this or other kinds of providers too, to really at least get the conversation started, do an initial evaluation, start treating with medication, and then really importantly, setting their patients up for success.
• 24:32
  So providing the education and support.
• 24:34
  So we need to figure out how to incorporate that more broadly.
• 24:39
  because it just can't just continue to be a specialty area that it is right now.
• 24:45
  Well, that's it for yet another episode of Care Talk.
• 24:47
  We've been speaking today with Dr.
• 24:49
  Catherine Saunders, founder of IntelliHealth about obesity.
• 24:52
  I'm David Williams, president of Health Business Group.
• 24:56
  And I'm John Driscoll, a senior advisor at Walgreens Health.
• 24:59
  If you'd like what you heard or you didn't, we'd love you to subscribe on your favorite service.
• 25:04
  And thank you so much, Catherine, for joining today.
• 25:07
  Thank you for having me.
• 25:08
  It's been a pleasure.