A San Francisco endocrinologist and obesity medicine specialist says the Wegovy phenomenon has led to an explosion of new referrals for obesity management.
“The hype and curiosity surrounding weight-loss drugs is driving demand for management care,” says Dr. Shilpa Jain, medical director of the Weight Management & Metabolic Center in San Francisco.
Dr. Shilpa Jain
Dr. Jain says the hype isn’t misplaced: There are effective medications out there. But, she says, it’s important to understand that lifestyle changes are critical for long-term weight loss.
At Sutter Pacific Medical Foundation, Dr. Jain leads a team of nurse practitioners, a physician assistant, registered dietician, certified diabetes specialist, medical assistants and a program coordinator. Together, they provide evidence-based, highly personalized care for people with obesity and metabolic complications such as diabetes, hypertension, hyperlipidemia and Polycystic Ovary Syndrome. The team also coordinates care with Sutter Health primary care, bariatric surgery, hepatology, cardiology and other specialists.
San Francisco resident Cathy Sable, who takes the weight-loss drug Mounjaro, said seeking weight management services through the Sutter center transformed her life.
Like many people during the pandemic, Sable packed on the pounds. Her 100-pound weight gain was due to a fractured pelvis, being sedentary and a love of good food. “I’m an eater. I love to eat,” she says.
Sable, who has struggled with weight most of her life, had gastric bypass in 2008. It crept back up in 2020, and she was referred to Dr. Jain in 2021.
“I’m not an eater of junk food…cookies, chips and things like that, but I eat late at night, like 9 p.m. or 10 p.m. My Eastern European culture is one where there’s a lot of food-centric traditions, so I’m around food a lot,” she said.
Sable credits the program’s registered dietician Hanna Rifkin for helping her to understand food, her relationship to food and her eating mindset.
Dr. Jain says most people who seek out her Sutter clinic want to lose approximately 30% of their body weight, often about 50-60 pounds. “Many people do achieve significant weight loss, but the degree of weight loss depends on how successful they are with improving their lifestyle in a sustainable and meaningful way. Medication can be an additional support.”
Obesity as a complex disease
Per current medical guidelines, obesity is defined as a body mass index of 30 kg/m2 or greater. Excess fat mass can lead to a variety of metabolic, mechanical and psychosocial health consequences.
Prevention and treatment of obesity can help reverse negative impacts on one’s health. The challenge is that many people don’t know where to start or they have failed on other weight loss and exercise programs.
“It can be very difficult to lose weight and keep it off on your own. Studies show it’s easier to lose weight with support,” says Dr. Jain.
Individuals like Sable have reached their weight loss and metabolic health goals with professional help and medication interventions like Wegovy, Ozempic and Mounjaro.
According to Sable, “For someone like me who has issues around food, [the drug] is like a miracle.”
She says the combined approach of clinical supervision, regular consults with the dietician and medication made everything click. She’s now lost the 100-pounds she gained. “I have all this energy again!”
At the Sutter center, patients begin with a consultation with Dr. Jain that includes a thorough medical history, physical exam and laboratory evaluation. Next, the team creates a personalized plan, which may include a weight-loss medication if medically appropriate. Patients then begin to meet with the team regularly to assess progress and re-evaluate health outcomes as their weight changes.
“I was very pleased with my experience. Right from the start, Dr. Jain got to know me, my story and what I had tried,” said Sable. “I felt no judgement. Everything was built from there.”
More approaches to tackling obesity
Across the Sutter Health network, clinical care teams approach weight loss and obesity management through nutrition counseling, weight loss classes and medically supervised programs. The integrated health system also offers the latest options in bariatric surgery and endoscopic procedures at many of its hospitals and outpatient surgery centers throughout Northern California.
Dr. Nisha S. Patel
Dr. Nisha Patel, a transplant hospitalist, obesity medicine specialist and lipidologist at Sutter’s California Pacific Medical Center, says her hospital-based clinic has also seen the demand skyrocket for patients seeking treatment for obesity and other cardiometabolic diseases.
Dr. Patel’s practice focuses on treating obesity in patients with end organ dysfunction like advanced heart failure, kidney disease and liver failure. Several of her patients are preparing for organ transplant and often have comorbid obesity, heart disease, diabetes, high blood pressure, high cholesterol, nonalcoholic fatty liver disease and sleep apnea.
Dr. Patel shares that transplant centers around the country are slowly starting to integrate obesity care into their programs like CPMC is doing. She attributes this shift to an increased recognition of obesity as both a chronic disease and also the considerable national media attention on new effective therapies like semaglutide.
The drugs Wegovy and Ozempic both contain semaglutide. The difference comes down to the design of the injector pen and dosage. While Wegovy is specifically FDA approved for weight loss, Ozempic is not. Rather, Ozempic – only FDA approved for the treatment of type 2 diabetes – has an often-celebrated side effect of weight loss. And that’s what fueling people’s appetite and curiosity for taking the drug.
Mounjaro, like Ozempic, is also only FDA approved for the treatment of diabetes, but it may soon be approved for obesity management given how much weight loss it has shown to produce.
Dr. Jain holds a Wegovy injection pen.
Regardless of these medications, carrying excess weight is hazardous to our health.
“There are many negative health complications that can result from considerable weight gain. We know these include impairments in a person’s quality of life, mental health and metabolic consequences,” says Dr. Patel. The good news is that even small increments of weight loss are meaningful in terms of boosting one’s overall health.
“Clinically we know that aiming for a 10% total body weight reduction can improve quality of life and reduce the risk of developing and complications from multiple chronic diseases,” she says.
Weight management care can provide and put into one place the support, guidance, strategies for patients need to experience long-lasting weight loss and all-around improved health.
Adds Dr. Jain, “We set long-term goals in clinic together and emphasize that although weight loss can be difficult, we can do this together. Our team is committed to helping people achieve their goals and lead healthier lives.”
