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Michael
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May 14 • 5 tweets • 2 min read
"If someone has myopia, you wouldn't tell them to try harder to see. You would not shame them for needing glasses." -Lee Kaplan

Yet, in obesity, we shame people for seeking evidence-based treatments and implore them "to eat less and move more" harder. #YWM2022Virtual
The legacy bias in bariatric surgery qualification #YWM2022Virtual
Weight stigma worsens the AEs of obesity. onlinelibrary.wiley.com/doi/full/10.10…
[Paraphrase]: "Obesity IS A DISEASE, not just a risk factor for other diseases. It is a disease because its existence is predicated on biological dysfunction." -Lee Kaplan #YWM2022Virtual
Speaking of my biases, I think Lee Kaplan gives some of the best lectures on obesity. He has a profound understanding of the disease of obesity and is an effective communicator.

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More from @MichaelAlbertMD

Michael
May 15
1/ NOT THE THREAD DIGITAL HEALTH WANTS TO READ, BUT THE THREAD IT NEEDS TO READ. Walk with me…🧵
2/ Many people know about the darling of digital health — Livongo. Arguably the highest profile digital health company ever due to an $18.5 billion dollar merger with Teladoc back in 2020. medcitynews.com/2020/10/telado…
3/ Livongo is/was known for its digital diabetes program. Unfortunately, the market never demanded that Livongo prove their program works. By the time Teladoc published an RCT, it turned out that the program was NO BETTER THAN USUAL CARE. ncbi.nlm.nih.gov/pmc/articles/P…
Read 13 tweets
Michael
May 14
Why is losing weight hard? Evolutionary adaptations to prevent starvation and death constrain weight loss. Conversely, hypothalamic inflammation can promote wt gain affecting the fxn of the homeostatic feedback system that constrains wt.
-Dr. Katherine Saunders #YWM2022Virtual
Weight Loss Goal? Not a number but a health improvement. With modern treatments, I would argue we should aim for 10% TBWL. #YWM2022Virtual
An example of a patient's AOM weight loss journey. Weight loss journeys should be realized over years as virtually no one gains all their weight in 3-6 months. Setting expectations early on is essential!! #YWM2022Virtual
Read 5 tweets
Michael
Mar 22
1/ STEP 4 Trial of Semaglutide for obesity treatment is a beautiful illustration of the physiology of body weight regulation. Let's explore it in this 🧵 Image
2/ First off, all study participants "received open-label once-weekly subcutaneous semaglutide, 0.25 mg, increased every 4 weeks to the maintenance dose of 2.4 mg once weekly by week 16, and continued to week 20."
3/ In addition, all participants received a lifestyle intervention from week 0 to week 68, which included:
👉counseling
👉Calorie-reduced diet
👉150 mins of PA / wk
👉tracking

In behavioral weight management, this is referred to as standard behavioral therapy (SBT). Image
Read 11 tweets
Michael
Mar 20
1/ Understanding Obesity Pathophysiology Through Outcomes:

IMO, the limitations of these surrogate measures (fMRI & PET), make outcome studies a more reliable insight for understanding obesity mechanisms.

A [thread] on outcomes for clinical interventions for obesity. 🧵
2/ Do Diets Matter? Yes and No. They matter because you have to eat, and you want to do so in a way that promotes health. But, are they reliable txs for obesity? No. Meta-analysis of long-term RCTs (avg wt loss 0-4 kg). Most intensive diet interventions result in 3-5% wt loss. Image
3/ But...but...what about low carb? Mind you, I am talking about population averages. There will always be a level of precision that will be difficult to capture in studies. Most intervention studies have outcomes representing a waterfall plot where results are variable. Image
Read 24 tweets
Michael
Mar 15
1/ Is Obesity A CHOICE?

The thread 🧵. For starters, please answer the following question ⬇️
2/ So Why We Are Gaining Weight? Unquestionably, we are eating more, and this increased consumption at a population level is the leading candidate.
3/ How much more? Around 20% more Calories are ingested per day. With a large % coming from ultra-processed food sources.
aicr.org/resources/blog…
Read 23 tweets
Michael
Nov 4, 2021
1/ It is no surprise that Semaglutide is the bell of the pharmacotherapy ball. Let's review some key takeaways from the STEP trials to understand why SEMA 2.4 mg is so exciting.
*credit to Dr. Wadden. #OW2021

STEP 3
2/ Intervention: Intensive Behavioral Therapy + Low Calorie Diet +/- SEMA 2.4 mg #OW2021
3/
Control arm: IBT + LCD lost ~6% BW.
vs.
Experimental arm: IBT/LCD/SEMA 2.4 lost 16% BW. #OW2021
Read 6 tweets

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