Dr. Louis Aronne
Dr. Louis Aronne often scoffs when he hears someone dismiss obesity as a disease.
“We say it’s a disease and critics respond, ‘Well, people just eat too much,’” said Dr. Aronne, a world-renowned obesity expert at Weill Cornell. “But there is no question that obesity is in fact a disease, and we have to be more sophisticated in our management of it.”
That’s exactly what the Comprehensive Weight Control Center at Weill Cornell seeks to do. As director of the center, Dr. Aronne and his team are investigating the metabolic underpinnings of obesity and applying their insights to advance treatments and therapies that might change the course of the disease before patients develop diabetes, high blood pressure, heart disease and other associated conditions.
“We’re trying to treat the complications of obesity by treating the obesity itself,” said Dr. Aronne, the Sanford I. Weill Professor of Metabolic Research at Weill Cornell. “There is no better way to prevent diabetes.”
We sat down with Dr. Aronne to learn more about the center, obesity medicine and the innovative ways in which he’s treating the condition.
Q.: What is obesity medicine?
Dr. Aronne: Obesity medicine is a new specialty that recognizes that the condition is a disease, and that treating obesity is the best way to prevent diabetes. We’ve discovered that obesity causes damage to the circuits in the brain that control weight. As a result, the signal going from your fat cells, stomach and intestines to your brain is diminished, and so your brain tells your body to gain more weight. What we’ve also learned is that there are at least eight hormones that stop you from losing weight. It’s not that it’s someone’s fault, it’s not that they don’t want to lose weight, but there’s something physical going on.
Q.: Tell me a little about the Comprehensive Weight Control Center.
Dr. Aronne: We are one of the premier centers in the country treating obesity. We see this as a hub that develops new ideas and new treatments that clinicians can use to treat the most complex cases. We’ve done more than 60 trials of new medical and behavioral treatments, including one I developed and am the CEO of, called BMIQ.
Q.: How does BMIQ work?
Dr. Aronne: BMIQ is a comprehensive medical weight-loss program that allows doctors, nurse practitioners and dietitians from any healthcare setting to manage their patients. The program offers numerous tools, including diet plans and other educational information for the healthcare professionals. For patients, we include food trackers, a curriculum of 20 sessions to learn how to manage their weight and other support mechanisms. And for the patient it’s free; the institution pays for it. We’re not out there competing with Weight Watchers; what we’re trying to do is give healthcare providers the tools to treat their patients’ weight problems.
Q.: Is weight loss only about diet and exercise?
Dr. Aronne: In the past, all we’ve done is said, “Eat less and exercise more.” That’s never going to work. If it were that simple, I wouldn’t have a job. Whether it’s new medical or surgical therapies, to obesity medicine more widely accepted we need to educate physicians and we need to allow them to have the resources that centers like ours utilize.
Q.: You mentioned weight-loss drugs. Do they work?
Dr. Aronne: Medicines didn’t really make sense 10, 15, 20 years ago, but they do now. We know that hypothalamic POMC neurons, which play a fundamental role in the control of energy balance, are damaged in obesity. Medications appear to amplify or mimic signals through the hypothalamus, reducing appetite and increasing energy expenditure. In the future, we think that people will take these medicines to treat obesity – and to prevent hypertension, diabetes and high cholesterol from developing. We’re also working on new, minimally invasive devices and minimally invasive surgical procedures with gastroenterologists, in addition to new medicines.
Q.: Can you describe those techniques?
Dr. Aronne: For one, we insert a tube into the stomach. Normally, when someone can’t eat, we can put a tube into their stomach and put food in, but doctors at Sloan Kettering and Washington University in St. Louis came up with the idea of taking food out. The food is digested enough so people can feel full and they don’t overeat. We also investigated a tube that’s like an inner liner for 2 feet of the intestine. When food doesn’t touch the upper intestine, blood sugar comes down and weight is lost.
Q.: What do you see as the interplay between cancer, diabetes and metabolic disease?
Dr. Aronne: There is very little question that mechanisms found in obesity and diabetes stimulate the growth of tumor cells. By managing those problems, it looks like you can reduce the risk of getting cancer and the risk of recurrence of the cancer. Interestingly, oncologists are most interested in what we’re doing. It looks like being obese will reduce your chances of survival, and the treatments for cancer in many cases cause women to gain weight. Would we get better outcomes if we could stop the weight gain that results from these treatments? That’s why we developed BMIQ, to deliver quality weight management in just such a medical setting.
Q.: What makes diabetes and obesity prime targets for precision medicine?
Dr. Aronne: The same treatment doesn’t work in everybody. One diet may seem to work better for one person; another diet works better for another. Physical activity definitely helps. Trying to change behavior definitely helps. Medication can help some people. Surgery can help some people. Virtually anybody who has a weight problem can lose weight. But there’s no single cure for everyone.
Q.: Would you describe obesity as one of our greatest health challenges?
Dr. Aronne: It is absolutely the biggest one. It drives heart disease, diabetes, cancers. Right now, we’re waiting until those develop and then treating them. But if we can get at obesity and manage it before these things develop, it’s going to cost the healthcare system a lot less money. I think in the future we’re going to look at people who are extremely obese and we’re going to say, “What were we thinking waiting until somebody got like this? Why did we do that?” Especially with children, I think that we may start getting more aggressive earlier in their lives.