CCE Cardiometabolic disorders: Medical College of Wisconsin

September 18, 2009

Obesity has been a focus of study and treatment at the Medical College of Wisconsin since the obesity and metabolic research program was founded in 1966.

One year later, patient follow-up showed improvement in 9 out of 11 outcome measures, including a 4.4 percent weight loss, 2.9 percent decrease in low-density lipoprotein, and a 12.2 percent decrease in triglycerides.

The average patient entering the program has a body mass index greater than 40 kg/m2 with additional cardiometabolic disorders. Many are taking antihyperglycemic, antihypertensive, and lipid-lowering agents. About 80 percent of patients are referred because they have diabetes or are at risk of developing it, says clinic director Irene O'Shaughnessy, MD. "Their primary care physician has identified that their obesity is significantly affecting their health." Women with polycystic ovarian disease and difficulty conceiving are also referred to the clinic.

Treatment begins with a detailed history of the patient's eating and exercise habits, stressors, home life, and whether the family supports the patient's desire to lose weight. Baseline measurements of key cardiometabolic indicators are taken, followed by referral to the exercise physiologist, dietitian, and, when necessary, psychologist, to help with issues inhibiting weight loss.

Patients return monthly, meeting with a different team member for each visit. "We're not just medical advisers-we're also cheerleaders," O'Shaughnessy says. "Many times, all the patient sees is numbers on a scale, and they may not pay attention to the fact that their blood pressure or blood sugars are better."

O'Shaughnessy avoids prescribing weight-loss medications initially. "There is a danger in offering medications on the first visit because then it looks like the other things aren't important. If they've initiated lifestyle and diet changes and weight loss is still slow to occur, and if I feel they're going to be compliant with the regimen, then I'll consider medication."

Ann Maguire, MD, MPH, associate professor in the division of general internal medicine at the Medical College, has referred patients to the clinic for six years. "I think the major advantage is the multidisciplinary nature and the enhanced level of support that patients can get with the opportunity to interact with physicians, nurse practitioners, pharmacists, dietitians, and psychologists," she says.