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Ken Fujioka Part 5, Treating Diabetes With Weight Loss

In part 5 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 his philosophy for treating patients and what he wants healthcare providers to take away from his presentation.

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: We talked about treating the patient as an individual. That’s been around just recently from the ADA. If you go back 50 years, we had only one oral drug.  In 1995, we had two oral drugs.  And now, look at what we have.  Everything we have is a combination, even a triple combination.  That’s not even including the hyperlipidemia. You’re including the weight management in there. The first patient I worked with, I downloaded their monitor, and I out together a beautiful report, made some suggestions, 26 pages with column charts and pie charts. Their readings on Mondays and Thursdays and the weekend. And I remember the physician came in and I said look what I did for Mrs. Rose.  He looks at me and says: “are you out of your mind?  If you want to give me a report, give me a half of page, summarize it.  I don’t have time to look at this stuff.”  The reason I bring this up is, patient has hypertension, hyperlipidemia, high blood sugars, and are overweight.  You can’t throw it all at once to them.  What is your philosophy of how to treat that patient?

Dr. Fujioka: You are getting into what is called polypharmacy. Just giving drugs for this and that.  It’s real clear, you get somebody to lose weight, you take care of all that; blood pressure comes down.  We also know that if you look at dyslipidemia, the best thing for high triglycerides and low HDL is weight loss, not a statin.  We also know that quality of life improves, sleep apnea improves.  Hence why we have taken a very different approach at Scripps Clinic, of treating their diabetes but treating their weight at the same time.  We treat both – we can actually get rid of medications.

Steve: The sign of a good presenter is that people take away what you say and they put it into practice.  What would you like to tell from your experience, what would you like to get out to PCPs as some of the things they should consider and think about doing where you’ve had success?

Dr. Fujioka: If you look at PCPs they are in the best position to deal with both diabetes and obesity.  Particularly, early on in diabetes, when weight loss is so critical, you can even put them in remission.  One is, just recognize weight.  Bring it up, just ask the patient if they would deal with it; 80% are willing to talk about it.  It’s not that you have opened up a can of worms: if you are comfortable treating them – go ahead, if not – send them to somebody who is.  As we move into this new era of accountable care, we will see more and more weight loss centers within large accountable care groups that deal with [obesity].  You have to look at obesity as a complex, chronic disease.  You can’t look at it as a very simple thing.  You are going to see centers popping up more and more, and they will be a natural gateway.

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