Understanding Obesity with Dr. Liliana Gomez-Medley
Liliana Gomez-Medley is a doctor working in family practice who has spent a portion of her life studying and certifying in obesity.
More than one-third of adults in the US have been diagnosed with obesity. Society has led us to believe that being overweight and having obesity is something that comes from choice more than anything else. As more and more people suffer from this chronic disease, it seems like we have gotten it all wrong when it comes to how we view obesity, its causes, and what we can do to help. We talk to Doctor Liliana Gomez-Medley as she tells us about her experience treating patients with obesity in her family practice and offers her empathetic take on a disease that is far more than what it seems.
Listen here:
Jessica Reales: Why don’t we start by you telling us a little bit about yourself, what your profession is, and why you took interest in studying obesity?
Liliana Gomez-Medley: Hi, yes, my name is Liliana Gomez-Medley, I am a trained and certified physician in family medicine and certified in obesity medicine. The reason why I chose to do this is because I understand that obesity is a chronic disease that is the root of many of the chronic diseases that we manage every day. And that’s why I love to treat patients as a whole person and being a chronic disease, of course, and helping them to lose weight will help other chronic diseases as well.
What do you consider to be the drivers of obesity?
Yes, as I said, obesity is a chronic disease is multifactorial, there are many causes: endocrine, genetics, environmental. And, you know, the definition is very long because of the same reason. And as I said, there is not only one factor there are many and that’s why we are learning every single day, new things about this disease that is devastating. Many people in the United States including children have the disease and and that’s why it’s very important to be able to address it as well.
What does a treatment and diagnosis for children look like compared to adults in regards to obesity?
It’s kind of the same, I think it’s very important to address it as a family because you know, family is very important in this in this kind treatment and management and especially with kids is important to start early. Because many patients get to be teenagers with obesity, and if you don’t help them it’s sometimes very difficult to get to a healthy weight.
But with a good group of doctors and multidisciplinary you know different teams like nutritionists, physical therapists, sometimes behavioral health, you can you can help them but yes is very honestly is similar.
I think the approach is different because you include the family. However, in the adult, we also recommend somebody that they trust to help them in their, in their commitment to to lose weight.
Leaving physicality aside, how do experts measure if a patient is obese?
Well, we have different ways but the one that we have that is the most used is using the body mass index, where we with the weight of the patient and the height, we can calculate the number and then we can determine if the patient has obesity or not.
There are other ways with measurements like the waist circumference, the neck circumference also, there are special tools like for example, the DEXA scan, more specialized but yes, the one that we use the most and the one that we have is the BMI.
As we know BMI, sometimes of body mass index can be tricky because there are people that are very muscle built and that doesn’t mean that their fat but yes definitely body mass index is the one that we use and also, measurements and sometimes labs that can tell us if the patient has different metabolic problems. There are different ways that we can we can see and diagnose obesity as a disease.
When diagnosing a patient with obesity, in your experience are they usually receptive to treatment or are they hesitant? Can tell us a little bit about that?
Yes, most of our patients that are in primary care we see, we manage chronic diseases as for example, diabetes, hypertension, high cholesterol, fatty liver and many of these patients have the obesity disease.
The first step is always, as a doctor, you see that the patient is overweight, or with obesity, you ask permission to discuss their weight, if they’re open to that, and then you kind of start asking them, how willing are they to lose weight.
Most of them or very rarely, many of them have tried different, diets and they have done many things to lose weight. And that’s why you have to be very careful, because many of them, of course, they are aware that their weight is not healthy, so you just have to be very careful and respectful. And if they want then of course, you can start the conversation with them.
What is something that you do in treating patients that suffer from obesity that isn’t considered something that is “by the book?”
Yeah, one of the things is, when I get those patients, most of the time, they have been referred to me, but when they are my own patients that I see in my own practice, what I always ask them, when they asked me to help is what is their main motivation.
And I think that’s the most important thing, because that’s what is gonna drive them to success. Always the main motivation for many it’s that they want to be able to move easier, to play with their kids, to play with their grandkids. For others it may be to take less medications, for others it may be to have more energy, for others it may be to look better.
We start with that, and then we develop a plan. We ask questions about their past medical history, we develop a obesity history, you know, like from how long have they been having this problem, what is maybe the possible cause, if there is family history of obesity, and many cases there are in.
We go with all these questions, and little by little we start developing a plan and we check in what step they are because there are many people that are contemplating, but there are not really. There are others that are totally ready, and they already start doing something about it. So yes, we kind of explore all those things first.
How can you tell if somebody is ready to deal with their diagnosis of obesity?
First, there is a questionnaire for readiness. That’s one of the ways, the other way is that, I always ask the patients from 1 to 10 “how ready do you feel to lose weight?” If they say 2, you know, that they are not ready because you know, they’re probably, so negative and not ready.
If they say 10, I think they’re very unrealistic because you know, 10 is like “oh yes,” and many are like that, you know, “oh, yes, I’m ready!” when they started seeing and facing the reality that it’s not that easy, it’s hard.
When there are like a five six, you know, that they are more realistic and and they can really start doing the lifestyle changes that we want them to start working on.
How do you think anyone listening can implement change for obesity and become more understanding of it?
The most important is to understand that this is a disease, it’s chronic and many times it’s not even the patient’s fault. Sometimes they are propense to the disease. The environment, genetics. I think the first thing is to remove the bias and understand that this is a very difficult disease and that these patients need lots of support and love and respect too, and to understand that is not easy.
It’s very hard for them. Most of our patients that suffer from obesity, they have depression, they feel a lot of frustration, many of them are discriminated and it’s sad. Many of them are also very happy but you know, the most important is to be respectful and supportive and understand that yes, this is another chronic disease that we need to take seriously and, and try to help each other.
More than one-third of adults in the US have obesity and it seems that now more than ever, it is incredibly important to look at obesity for what it is: a chronic disease to be treated rather than only an active choice that is made.
