In part 2 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 practitioner coverage available to the patients of his practice.
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: I noticed that when I looked up the scripts at the clinic, it was mentioned that you see approximately a thousand patients a month. So, I was trying to figure out how many practitioners do they need to see a thousand patients in one month. What kind of staff do they have to take care of the patients, and take care of the patients properly? It’s not a five-minute job when you’re dealing with obesity.
Dr. Fujioka: We actually have bigger time slots, if you can imagine that. Some of the doctors take up to 20 minutes for follow-up and an hour for a consult. That’s a lot of time in this day and age. We have two surgeons, we have 3 MDs, we have 2 NPs, and we have a PA. That’s a big staff. But, in addition, we have multiple registered dietitians that are also educators, we have behaviorialists and psychologists. Again, we will look at what is the cause. Sure some people eat for emotional reasons, that’s a smaller percentage. But it’s there and when you identify it, they see a psychologist. Other folks, its just behavior, they just need to change the behavior when they come home. Instead of getting home and going straight to the refrigerator, maybe they can go home, put the gym shoes on, and go for a 20-minute walk. They may also see a behaviorialistst. Some folks, they come in with a BMI of 45 and they have over 100 lbs to lose, we can throw all the meds and we can throw everything we want, and they fail that – so we need to think of surgery. Again, we look at all the different options.
Steve: What kind of a success rate do you see?
Dr. Fujioka: It’s really dramatically jumped. For surgery, you are talking about 80-85% chance of doing remarkably well. In the old days, with just diet and exercise, it’s about 20%, 1 out of 5 will do great, but 80% will struggle. Now with the meds, we are looking at 65 – 75% of patients who do diet, exercise, on a med, and are doing very well.
Steve: Is there a particular exercise that you like to recommend?
Dr. Fujioka: There is, actually. It’s funny you ask that. It has been studies and you look at different things like swimming, treadmill, stationary bike. First thing is, you want to pick some kind of exercise that has the lowest rate of injuries. It’s hard to imagine this, but if you tell someone to go for a walk and they are overweight, you got a 40% chance they might get injured. It’s very frustrating. We like stationary bike. With that said, we still like walking. Those two are neck in neck. We are looking at the patient and see how they do. Beautiful study by a guy named Tim Church, if you want the maximum weight loss in the diabetic, the best way is actually cardio and resistance training. Doing both – if you do just one or the other, you get weight loss, but not near as much as if you do both.