Speaker 1:

Welcome to AACE Podcasts. Thanks for tuning in as we elevate clinical endocrinology by taking deep dives into trends and topics that can help us improve our patient care and global health. Find the latest episodes on AACE.com/podcasts. And now let's meet the endocrine experts who will be talking with us today.

Elizabeth Bauer, MD, FACP:

Hi, and welcome to another AACE podcast. I'm Dr. Lisa Bauers. I'm an endocrinologist and obesity specialist at the Naval Medical Center in San Diego and the current vice chair of AACE's Obesity and Nutrition Disease State Network. I'll be the moderator today for the podcast, and today we are going to be discussing the AACE journey for patients with obesity. It's a collaborative effort by Dr. Rosenfeld, Dr. Anish Patel, and myself. And then Dr. Izuora joined our patient journey team of advisors and has been developing new patient content. And so joining me today is going to be Dr. Cheryl Rosenfeld and Dr. Kenneth Izuora. And like I said, both of them have been extremely instrumental in the development of this journey. So thank you both for joining us. Dr. Rosenfeld, can you please introduce yourself and tell us about your area of expertise?

Cheryl Rosenfeld, DO, FACE, FACP, FSVM, ECNU:

Sure. I'm an endocrinologist in private practice in Parsippany, New Jersey. I'm an AACE board member, an adjunct clinical associate professor of medicine at the Touro College of Osteopathic Medicine in Middletown, New York. And an endocrinology subspecialty education coordinator for the New York Medical College Internal Medicine Residency program at St. Mary's General Hospital and St. Clair's Health in New Jersey.

Elizabeth Bauer, MD, FACP:

Great, thank you. And Dr. Izuora.

Kenneth Izuora, MD, MBA, FACE:

Thank you, Lisa. I'm Kenneth Izuora, an endocrinologist and professor of medicine at the Kerkorian School of Medicine at UNLV in Las Vegas. I'm currently the chief of the Division of Endocrinology and the program director for our Endocrinology Fellowship Training Program. I practice general endocrinology and I co-authored the current AACE Diabetes Guideline and Diabetes Algorithm. I look forward to our discussion today on the obesity patient journey.

Elizabeth Bauer, MD, FACP:

Yes, definitely. And thank you both for being here. But before we begin, I'd like to thank our sponsors Lilly and Boehringer Ingelheim for supporting this podcast. Also, if you're not driving and have access to the web, I suggest you open up the obesity journey so you can see what we will be talking about. The URL is AACE.com/obesity journey. Or you could just Google AACE obesity journey and it should be the first link that comes up as well.

Okay. Well, Cheryl, you've been part of these patient journeys now pretty much since the beginning. What is the background on these journeys? How did it come through? How did it start? What was the vision? If you could tell us a little bit about that.

Cheryl Rosenfeld, DO, FACE, FACP, FSVM, ECNU:

So I've been involved in patient education with AACE since before the journeys were started and patient education has really evolved over time. We have to keep pace with changing guidelines. The journeys were created to provide patient-friendly information combined with impactful documents that could be accessed by the patients no matter where they were in their journey, where they wanted to start their learning process.

For instance, somebody who's already been advised by their physician that they have stage two obesity can either start from the beginning of our patient journey on obesity or they can begin at the staging tab to find out exactly what their doctor was talking about.

Elizabeth Bauer, MD, FACP:

And how many patient journeys are there now? Because you've been involved with almost all of them, right?

Cheryl Rosenfeld, DO, FACE, FACP, FSVM, ECNU:

Currently, there are three. We have the first one, which was the thyroid patient journey. The second one was our obesity patient journey. And the third one was the patient journey for diabetes technology.

Elizabeth Bauer, MD, FACP:

Awesome, wonderful. And then Ken, why obesity?

Kenneth Izuora, MD, MBA, FACE:

Well, thank you. So obesity is the most common chronic disease in the United States. It affects about 40% of the population. That's about more than two out of every five people. And the prevalence of obesity is increasing, as we all know. And if you look worldwide, about one in eight people are living with obesity. And obesity has more than doubled since 1990. And at the same time, adolescent obesity has quadrupled.

So we also know that obesity is a leading risk factor for many other common medical conditions such as type 2 diabetes, heart disease, and osteoarthritis. The good news is that we have good quality evidence showing that weight reduction of about five to 10% can really decrease the risk of these chronic diseases associated with obesity. However, the problem or the challenge that we face is that getting the right information to our patients with obesity is challenging. Many patients struggle with the vast array of information available online, many of which are not accurate or helpful. So we at AACE wanted to make a reliable resource that someone living with obesity could turn to, to learn more about the condition.

Elizabeth Bauer, MD, FACP:

Definitely, I think each of us experienced that misinformation and problem where patients don't have good access to information for their disease process. So Cheryl, for the patient obesity journey, if you could walk us through the development of this journey, starting with the meta map and why the specific topics were chosen.

Cheryl Rosenfeld, DO, FACE, FACP, FSVM, ECNU:

Thank you, Lisa. So first of all, I have to say that these are resources that are really just for the patients. They're meant for physicians or other healthcare providers to give their patients access. So the resource has to align with the diagnosis and treatment of obesity, and as we call it, the adiposity-based chronic disease. And it'll walk them through what their journey could look like from the time that they bring up their obesity with their provider to treatment and surveillance.

So the journeys are based on the clinical guidelines. So this journey is based upon the AACE 2023 Obesity Stigma and Bias Consensus statement, the AACE 2016 Clinical Practice Guideline and Algorithm for Medical Care of Patients with Obesity. And then we've had some additional assistance. So we start their creation process from a meta map. So the meta map is sort of how we would have a patient follow their journey. So we start out with contemplation for this. How to talk to your doctor. What kind of questions to ask. We go into the initial assessments, so the medical tests that may be done, diagnosis of obesity, staging obesity, and then the treatments that go with each stage of obesity.

We then move into the patient's goals as well as care and continuity. So what to do if the goal isn't being attained, what if the goal is attained? What to do then? And then we build upon each part. So we have assistance from a variety of writers who help with the copy for the papers. And finally, everything is vetted by those of us who are working on this journey with AACE. First of all, the information has to be accurate. As Ken mentioned, there's a whole lot of information that's available that's not accurate. It's not correct. So we have to make sure that it is based upon these guidelines, it is presented in plain language. So easy to understand for patients. It's also focused on obesity, the disease, that has increased risk of complications. It describes the ABCD, adiposity-based chronic disease staging system that can help identify these complications and guide treatment.

And then finally, we feel that shared decision-making is extremely important in the treatment plan. It ensures the patient is actively involved in their care and participates in the treatment decisions and outcomes. So one of the things that I mentioned is that we did have some help. So all of the content was reviewed by the Obesity Action Coalition, and this is the leading patient advocacy organization for obesity to ensure that it was presented in a very patient friendly manner.

Elizabeth Bauer, MD, FACP:

And I do remember that with some of the edits that were recommended, they made so much sense. But we'd been working on it and we didn't think about it. So little edits that you would change a word and it just sounds so much more patient friendly. You mentioned adiposity-based chronic disease. Ken, can you explain what that term means?

Kenneth Izuora, MD, MBA, FACE:

Yes, thank you, Lisa. That's really an important clarification to highlight. So the term adiposity-based chronic disease, or ABCD like we call it in the short, was introduced by AACE in 2017 as a new diagnostic term for obesity. The idea is to recognize obesity as a chronic disease with several associated medical conditions. This includes the commonly associated conditions like type 2 diabetes, hypertension, hyperlipidemia, and cardiovascular disease. And also those that we may not always think about when we're thinking about obesity. Things like osteoarthritis, obstructive sleep apnea, gastroesophageal reflux disease, urinary incontinence, hypogonadism, and even psychological disorders related to obesity.

So by recognizing these complications, patients are more aware of them and also their healthcare providers are reminded to assess for their presence and severity during evaluation for obesity. This will provide additional guidance when considering treatment options. Another important impact of using the term ABCD instead of just obesity is that it takes away the stigma that our patients face when they're described as being obese or having obesity because of this recognition of obesity as a chronic health condition.

Elizabeth Bauer, MD, FACP:

And that does really make a difference in clinical care when you're using these terms, throwing out these terms. And for patients it means something different than the providers who are seeing it as a disease. But adiposity-based chronic disease, you're saying this is a chronic condition and it's because of the adiposity. So it's not just the weight, it's the adiposity that's causing it. So Cheryl, have your patients been using it? Have you had any feedback? What have we heard?

Cheryl Rosenfeld, DO, FACE, FACP, FSVM, ECNU:

Oh, I've had a lot of feedback. So first of all, patients are saying it's very helpful and it's presented in a non-threatening matter, which I think is really important. Patients are becoming more aware of the clinical diagnosis of obesity and how it's staged and how it's managed. So I think those are very important things for the patients to be aware of. I want them to feel comfortable approaching their physician with their questions.

Elizabeth Bauer, MD, FACP:

Great. Ken, have you had any feedback from patients?

Kenneth Izuora, MD, MBA, FACE:

Well, it's helpful for patients to be able to actually see it in a way that is easily understandable. And the feedback I've received is that it's easy to follow. And it's easy for them when they go home, they can review it and ask questions that maybe we didn't think about during the clinical encounter.

Elizabeth Bauer, MD, FACP:

Okay, good. And so we know that the obesity research landscape is constantly changing and new discoveries are being made, especially to this diagnosis and the pathogenesis and new anti-obesity medications with Zepbound just being FDA approved this year. So how is AACE going to ensure that the content is up to date. And Ken, I think you've been actively involved in this part.

Kenneth Izuora, MD, MBA, FACE:

Yeah, so the patient journey content is we revisit it yearly to incorporate major updates. However, we recognize, like you rightly pointed out, Lisa, the dynamic nature of health information, especially for obesity. So we also update the patient journeys in real time as new relevant and accurate information is available or treatments are developed. So because it's published online, we're able to make these updates as they come out.

Elizabeth Bauer, MD, FACP:

Great. So that will be wonderful for providers.

Cheryl Rosenfeld, DO, FACE, FACP, FSVM, ECNU:

And speaking of providers, I just want to let folks know the best thing to do in the office is keep the patient journey website open in the background on your computer. We're all using computers, we're all on our electronic medical record. Keep the patient journey open and then have the patients pick up the QR code with their smartphone at the time of the visit. And that really helps. They can save it for later. They can have a look at it on their own because like Ken said, they have questions after they leave the office.

So you want them to be able to have a resource. And also many patients are embarrassed to ask questions when they're in the office. So they have that resource at home and they can have their question answered or they might be empowered to ask a question that they might've been reluctant to ask in the past. So I think those are some helpful hints for physicians and for healthcare providers to use when they're using these journeys.

Elizabeth Bauer, MD, FACP:

Definitely. And I think, again, knowing that it's going to be updated, it is also going to be super helpful. I don't know how many of you guys with me, when I look at a patient handout, I scroll to the bottom and see the last time it was updated before I decide I want to actually give it to a patient. So Cheryl and Ken, I want to thank you both for joining today. We really hope everyone that you use this resource as it is one that is really helpful both for patients and providers. As both patients and providers we're working together to co-manage the complex chronic disease that is obesity.

I myself find it an incredible resource to be able to show patients as Cheryl was describing when I'm first describing what obesity is. And then at the end of the visit, I actually ask them when they're at home to look at the website. And the next time they come in, you can actually see how their questions have changed. They become more engaged in their care and they just understand it. But you can really see the change in the ones that have read it and not. It makes them more engaged and then it's a whole health multidisciplinary team action that website also points out.

So to learn more about the AACE journey for patients with obesity, please visit AACE.com/obesity journey. And thank you so much for tuning into this podcast.

Speaker 1:

Thanks for listening to another great AACE podcast. Join us for another episode at AACE.com/podcasts and help us in our mission to elevate clinical endocrinology together. We are AACE.