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Ken Fujioka Part 1, Weight Loss For Type 2 Diabetics

In part 1 of this Exclusive Interview, Dr. Ken Fujioka talks with Diabetes in Control Publisher Steve Freed during the ADA 2017 Scientific Sessions in San Diego, CA about the various weight loss conditions a patient may experience and the medications that can help.

Ken Fujioka, MD is director of the Nutrition and Metabolic Research Center and the Center for Weight management in La Jolla California at the Scripps Clinic.

Transcript of this video segment:

Steve: This is Steve Freed with Diabetes in Control and we are here in San Diego for the American Diabetes Association 77th Scientific sessions.  We have some great interviews with some of the top endocrinologists all across the globe.  We have a special guest with us, Dr. Ken Fujioka.  Maybe we can start off by you telling us a little about yourself and your practice.

Dr. Fujioka: I am in the department of endocrinology at the Scripps Clinic.  In the mornings, typically, I do research.  In the afternoons, I see patients.  Our clinic is a little bit different. Again, it is under department of endocrinology, but our emphasis is actually weight loss in type 2 diabetics.  Patients come to us wanting to lose weight, or they are referred to us to get their weight under control to help with their diabetes, and so our emphasis is very different, but I really like our outcomes.  We seem to be doing a good service.

Steve: You say your specialty is weight loss, but blood sugars are important, too.

Dr. Fujioka: Correct.

Steve: So, obviously you have to do both.

Dr. Fujioka: Correct.

Steve: Technology has changed dramatically over the years, all the new medications.  I am sure that you are familiar, when it comes to weight loss drugs, that’s fairly recent.  We used to have them years ago, but we found out they were too dangerous and  caused cardiovascular incidences.  Basically, we started with nothing after that time-frame after they discontinued them.

Dr. Fujioka: There was one that made it through. That was an oral statin.

Steve: But, now we have a number of drugs that you can use for weight loss.  So, just out of curiosity, is there a particular [weight loss] drug….I know you’re always supposed to look at the patient as an individual, different strokes for different people. But is there one of the weight loss drugs that you’ve seen the best success with?

Dr. Fujioka: No.  What you’re saying is very appropriate. Every patient is different.  It is very important to remember that the way humans regulate their weight is that once they get to the highest weight they have ever been at they are stuck at that weight. But, how they got to that weight, what drives their…maybe too many calories, maybe they can’t burn enough of calories?  There’s different ways of looking at it. There are four drugs and each has their own place.  One is good for satiety, one is good for cravings, one is particularly good for diabetes and weight, one is just all around great for binge eating.  They all vary, and they all have different mechanisms.

Steve: How do you determine the best route to go?

Dr. Fujioka: It is real important that as the healthcare giver you look at the patient and you figure out why is their weight high. It sounds simple, but it is not as easy as calories in and calories out. Cravings is a particular, you can almost say, diagnosis. If somebody thinks about a particular food, and they get a reward from that food. We have a medication for that.   Somebody has binge eating, that’s a very classic diagnosis, it’s now in your EMR – you can input binge eating and it will show up.  That is somebody who eats two times normal portion feeling out of control. That is very common so there is a drug very specific for that.  Some patients just eat simply, a little bit too much.  Now they are making some good choices, but their portion size is just too big – there is a medication for that. It really varies, and you really need to take a very good history on the patient.  Are they reward eating? Are they binge eating? Are they having trouble with portion sizing, or is it just everything and they are really struggling?

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