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Interviewer: There's a pretty good chance that either you or one of your family members is affected by diabetes, obesity and other metabolism issues. We're going to talk about a brand new clinic that can help you. Coming up next on The Scope.

Announcer: Medical news and research from University of Utah physicians and specialists you can use for happier and healthier life. You're listening to The Scope.

Interviewer: Dr. Tim Graham is the Medical Director of the Diabetes, Obesity and Metabolism Programs for University of Utah ÐÇ¿Õ´«Ã½ Care. Let's talk about the brand new clinic for diabetes, obesity and metabolism. It's such a big deal that it's become kind of a thing of its own now.

Dr. Graham: Yeah. We basically have what we call a service line that covers multiple clinics throughout University of Utah ÐÇ¿Õ´«Ã½care and we've got a couple of very exciting areas that we've brought new services to the people of Salt Lake and Utah. First off, we've got the Utah Diabetes and Endocrinology Clinic itself, which is now providing team-based diabetes care.

I often joke it really takes a village to take care of a patient with diabetes because individuals with diabetes have problems with eyes, they have problems with feet, they need special nutrition considerations. We like to have them work with exercise physiologists to improve their activity and to do it in a sustainable way where they don't develop sport-related injuries. They often have physical therapy needs, etcetera. And sometimes behavioral health needs. So we like to bring all those services in a team-based fashion to our patients who come into the diabetes center here at University of Utah.

Interviewer: And that's a kind of new way of thinking for diabetes. Am I correct on that?

Dr. Graham: It is. In the past, it used to be a very much a sub special physician-driven care plan where you would go see a doctor that would make some recommendations, send you back to your primary care provider. What we do is when a patient comes in and sees us, we provide all these services and we provide it in a nice, unified way so that you don't feel you've been juggled between providers. And then we send the patient back eventually to their primary care provider with a much more comprehensive care plan that sort of details all these things and doesn't just pay attention to the insulin dosing or other types of diabetes medication dosing.

Interviewer: What else does the clinic do and how is it helping people?

Dr. Graham: So we've also established a really exciting program in conjunction with bariatric surgery. We now have a pretty tremendous way to reverse diabetes using bariatric surgery. So probably better than any medication we can give people, if we can have them undergo gastric bypass surgery or gastric sleeve surgery, it largely reverses diabetes for a lifetime and longer-term studies are just coming now to bear that shows, this is a very sustainable effect and people do extremely well even a decade out past surgery.

And every decade you don't live diabetes is a decade that will save your body from a lot of damage. So we have partnered with bariatric surgery program to develop a unified approach to obesity. So anyone who has a BMI of 35 or more, and BMI is defined as kilograms per meter square, I use that term because I think more people will know what that is. And if you don't know, just Google BMI and you'll find any number of BMI calculators where you pop in your weight and your height and it will tell you what your BMI is.

But if you've got a BMI of 35 or more and you've got any obesity-related condition, that can be diabetes or it can be high cholesterol or it can be high blood pressure, if you have any of these conditions, then you're candidate for bariatric surgery. So we've recognized this is a really important sort of additional therapy we bring patients. And so we've got a medical bariatric program that's now partnered with the surgical bariatric program to provide what we call a comprehensive weight management program. And this also is not just for people who have very high BMI or who have diabetes. It's for people who just want to lose weight and would like get some medically-supervised nutritional attention and exercise physiology attention to help them.

Interviewer: From what you are telling me, this team-based approach, it seems like somebody might be listening and they're thinking, "I should be a little bit healthy, I should be able to eat better why can I not do this on my own?" But it's really a lot more difficult than that in today's world. And that's why you are bringing all these people, all these experts together?

Dr. Graham: Yeah, that's really one of the myths, I think, that our society sets up. It's like somehow, there is something wrong with you if you can't lose weight. That everyone should be able to have the willpower to do it. And we look at things like "The Biggest Loser." And while I love that sort of program for bringing to attention the problem with obesity, these people have all day of training. They have people preparing their meals for them. Who has the time, the money and the willpower to basically do that on a day-to-day basis?

The idea that it's just something we can easily do on our own without having help is really wrong-headed. And furthermore, I think it's even than the attitude of physicians for many years that the patient should just be able to do it on their own. And yet every time I have ever sent a patient out with just generalistic advice like, "Go lose weight and be healthier," they don't seem to come back having lost weight and eating more healthily. So I think that we really have to come up with personalized strategies to help patients, to support them, to even hold them to their goals. And people do better when they are working in a group like that generally.

Interviewer: Yeah. And I would imagine too that over the past many years we've learned a lot more about these things. And really you need to have those experts to have a better understanding of it?

Dr. Graham: Absolutely. The other side of this is that we now know that obesity is at least 50% genetic in origin. And so the idea that it's just because you're lazy and you don't exercise is completely incorrect. And anything that's genetic in origin has a biological basis so we now understand and very cutting edge research done here, both in Utah and elsewhere, that the brain is wired differently when you become obese and it's very hard to undo that wiring. So the fact that people, when they do lose weight, tend to have what we call recidivism where they gain weight back or very quickly.

Interviewer: We've all heard of that, right?

Dr. Graham: Yeah. That yoyo weight thing is absolutely hardwired in the brain. It's biological. It's not because of lack of will.

Interviewer: So a clinic like this really could help somebody that . . . it's not a magic pill, there is probably some work and some time involved, but it sounds like it would offer hope to somebody that has not had hope before or has failed in the past?

Dr. Graham: That's right. And I would say that also includes people who have very significant obesity. We use the term, and I don't like it because it sounds so negative, but morbid obesity, which is a BMI of 40 or more. People who get up that high have a very hard time losing weight and they need additional support, especially physical therapy. Think about many people are starting to get joint problems when you start getting heavier with a BMI of 40-45 range.

And so we need to bring a lot more things to bear to help these people, many of them will be bariatric surgery candidates, some of them won't. But just because they're not doesn't mean that they don't need special health care. And so we really are trying to bring medical bariatrics up to get up to speed with the great advances that have been happening in surgical bariatric. And to give a home for everyone with all these problems so that they don't have to just see the primary care provider who might tell them every time, "You know you need to lose weight. You know you need to . . . "

Interviewer: Every year you hear that, right? And then a year passes and then you come back and you're in the same boat.

Dr. Graham: It takes actually more than that to achieve the results.

Interviewer: Where can I find more information about the Diabetes, Obesity, and Metabolism Program?

Dr. Graham: Well, so we've got on the University of Utah website, we have information about . . . if you go to the Utah Diabetes Center, we've got a web page that will actually branch out all these different programs we've been developing.

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