Kaiser Permanente internist on what inspires him to study obesity.
We spoke with David E. Arterburn, MD, MPH, senior investigator, Kaiser Permanente Washington Health Research Institute; internal medicine physician, Washington Permanente Medical Group; and affiliate professor, University of Washington Department of Medicine.
I’m motivated by the suffering that is caused by chronic health problems. I want to be able to give people high-quality information, clear guidance and access to treatment that can help put them on a path toward wellness.
Most of my research is focused on obesity, which is arguably the world’s biggest health problem, especially in the United States. It’s so common and affects every organ in the body. And people living with obesity suffer emotionally from social stigma at work and in relationships. I hope that my work on obesity can help people to reduce their weight and their suffering — and help them better understand obesity’s causes and their treatment options. I am optimistic about the future of obesity treatment. I believe that in my lifetime we’ll figure out how to provide effective, scalable and affordable lifestyle interventions for obesity. And medications and surgery will have an even greater role to play for select patients with obesity who stand to benefit the most from them.
When I lived in San Antonio, it had the third highest rate of obesity in the country. I cared for patients in a community health clinic who had all sorts of weight-related health conditions like diabetes and cancer. We treated those conditions, but I was motivated by a clear sense that my patients — and my colleagues — were at a loss about how to effectively and safely address the underlying cause of these problems: obesity.
Of course, we suggested exercise and diet, but we lacked the resources to provide real support for behavior change. The weight-loss drugs available then were unsafe or ineffective, and few people were even thinking about surgery for obesity.
Clinical leaders at Kaiser Permanente are eager to innovate to improve patients’ quality of care. I work directly with them on implementation and evaluation, including working on shared decision-making and unwarranted variation. That’s when some providers or clinics are providing more — or less — of a test or treatment than others are, and that variation isn’t explained by the characteristics or preferences of informed patients. Shared decision-making is one solution to this.
Kaiser Permanente has also been a leader in the National Patient-Centered Clinical Research Network (or PCORnet ®), which is taking research collaboration to a whole new level. Our PCORnet ® Bariatric Study is groundbreaking in the number of health systems participating — 41! We recently reported that adult and teenage patients had the most long-term weight loss with gastric bypass procedure, followed by sleeve gastrectomy and finally banding. We’re now looking at how these bariatric procedures impact diabetes outcomes and long-term safety. One highlight for me has been working with patient partners who’ve informed which questions we ask and how we do the science.
Shared decision-making is important for people with severe obesity as they consider their options, including intensive lifestyle changes, drug treatment and various types of bariatric surgery. Bariatric surgery includes different operations to change the digestive system and help people with severe obesity to lose weight. People need to know all of their options, not just the ones that their provider likes best. And in shared decision-making, health care providers make sure of two things: that they elicit and understand what their patient’s individual preferences are; and that their patients are well-informed about the benefits and risks of all the available options.
I love to spend time with my sons, who are both teenagers, navigating high school and making decisions about college. I try to encourage their development and model a healthy lifestyle for them. I’ve developed a good practice of meditating and exercising almost every day. We also run, bike, hike, ski and do yoga regularly, often with our friends.
The question about how I spend my time outside work relates back to the whole underlying motivation for my work in obesity. None of us is immune from suffering and struggles around our behavior. Maintaining our wellness requires sustained, concerted effort to counterbalance the innumerable societal pressures we face to eat, drink and work too much. We must create our own culture and structure our own environment in a way that supports our physical and mental well-being, so that we have the greatest chance to be happy, healthy and live with ease.