Innovative Center Addresses GI Complications of Obesity
As treatment for obesity continues to challenge patients and physicians alike, the introduction of the Innovative Center for Health and Nutrition in Gastroenterology (ICHANGE) at NewYork-Presbyterian/Weill Cornell Medical Center is providing an option that offers a coordinated and systematic approach to management of disease and weight. This includes addressing the medical, nutritional, motivational, and compliance factors that are key to successful weight loss and concomitant improvement in associated GI disorders.
The new clinic brings together Sonal Kumar, MD, MPH, Director of Clinical Hepatology; Carolyn Newberry, MD, gastroenterologist and a physician nutrition specialist; Reem Z. Sharaiha, MD, MSc, Director of Interventional Endoscopy and Director of Bariatric and Metabolic Endoscopy in the Division of Gastroenterology and Hepatology; Michele Yeung, MD, endocrinologist; dietitians Danielle Staub, MS, RD, CDN, and Jessica Gold, RDN; Andrea Herr, ANP-CP, Chief of Luminal and Advanced GI and Clinical Coordinator of Bariatric and Metabolic Endoscopy; and patient navigator Marie Yanielle So, RN, Digestive Service Line Access Nurse. Together, they have combined their expertise to create a full-service, co-managed program through which care is meticulously organized, patients appointments grouped on a single day, and follow-up closely monitored in order to maintain patient motivation and facilitate compliance — major obstacles to patients on weight loss programs.
“There are over 200 million Americans who are either overweight or obese, so offering a comprehensive, multidisciplinary program such as ICHANGE to help individuals trying to lose weight is very important.” — Dr. Reem Z. Sharaiha
Located within the NewYork-Presbyterian David H. Koch Center, the clinic meets every Tuesday and offers screening, assessment, and medical and interventional therapies, all supported by complimentary nutrition counseling and guidance. “During the clinic, depending on their individual circumstances,” says Dr. Kumar, “a patient may see me for management of liver disease, Dr. Sharaiha if an evaluation is needed for an endoscopic procedure, Dr. Newberry who addresses general GI complications of obesity, such as gall stones and reflux disease, and Dr. Yeung for endocrine and metabolic considerations. All of this is coordinated through Yanie So, our patient navigator.”
“The key factor that resonates with patients is that they don’t want just one option,” says Dr. Sharaiha. “They want to be able to access the ‘toolbox’ of medication, nutrition, and endobariatric procedures. So, the advantage of ICHANGE is that it gives patients the choices they need.”
“Depending on who the patient is, what they’re looking for, and what their medical comorbidities are, we determine how many of us they need to see,” adds Dr. Newberry. “Sometimes, it’s all of us. We understand that people have busy schedules. The most effective weight loss programs are when you have accountability and when you have frequent touchpoints with your provider. To enable this to occur, we offer options that include telehealth visits and phone visits with our dietitian. This allows us to have more frequent follow-up with our patients while making it easier for them to work these appointments into their schedules.”
“This is not a concierge practice; the clinic takes all insurance,” continues Dr. Newberry. “The dietitian support is covered by our division, which is another benefit we were able to accommodate. There are several resources available for patients that wouldn’t necessarily have been accessible to them without high out-of-pocket expenses.”
Criteria for Patient Referral
- BMI >30 or >27 with comorbidities
- Motivated to participate in a structured weight/disease management program
- GI symptoms or disease that would benefit from weight management and nutrition counseling including:
- Non-alcoholic fatty liver disease/non-alcoholic steatohepatitis
- Functional disorders — IBS, functional heartburn, functional abdominal pain
- Biliary disease
- Interest in endoscopic options for weight management
Addressing the Clinical Consequences of Obesity
Fatty Liver Disease
Dr. Kumar, whose practice has a major focus on non-alcoholic fatty liver disease (NAFLD), notes that obesity is a chronic disease and ICHANGE is a way to centralize and structure treatment options for her patients. “In the seven years I have been with Weill Cornell, I’ve noticed that the number of patients with complications of obesity is going up and the age range of my patient population is going down, which is concerning,” says Dr. Kumar. “There’s no effective medications yet available that we can use to treat non-alcoholic fatty liver disease, although there are over 50 drugs in phase 1, 2, and 3 clinical trials, including many under study at Weill Cornell. Management still revolves around weight loss with a behavioral and lifestyle modification approach. Losing weight is really the only proven method of improving fatty liver disease and we help patients do that with dietary planning, medications, procedures, or a combination. Each patient’s plan is created just for them.”
“Losing weight is really the only proven method of improving fatty liver disease and we help patients do that with dietary planning, medications, procedures, or a combination. Each patient’s plan is created just for them.” — Dr. Sonal Kumar
As an option for patients, Dr. Kumar has created a program in partnership with the YMCA for patients with fatty liver disease, modeled on a diabetes prevention program for adults at high risk of developing type 2 diabetes. The weekly program, which consists of 25 classes, is led by a trained lifestyle coach who helps participants learn about healthier eating, physical activity, and other behavior changes. The goal is for participants to eat healthier, increase physical activity to 150/minutes per week, and lose a modest amount of weight (7 percent). The program is ongoing but so far has resulted in an average of five percent reduction in body weight for participants.
“We know that a 5 to 10 percent reduction in body weight decreases inflammation, fat, and fibrosis in the liver. Our goal is to help patients achieve that weight reduction by tackling it from all angles. Some patients may take this YMCA class, some may work individually with a dietitian, and others may take medications or get a procedure. And our comprehensive, multidisciplinary approach allows management of not only weight, but all the other comorbidities that come with obesity such as diabetes and heart disease.”
Dr. Newberry is a general gastroenterologist with a particular interest in nutrition and weight management, which she notes is also a valuable tool in treating many GI diseases. “As gastroenterologists, we understand how food is processed and digested and are equipped to address GI physiology as it relates to weight,” says Dr. Newberry. “Several diseases that we see in our general GI clinic, including heartburn, fatty liver disease, and functional symptoms such as chronic diarrhea, abdominal pain, and bloating, can often be tied to being overweight, obese, or what we eat. ICHANGE provides a model of care for patients presenting with general GI complaints for which weight loss with dietary counseling can help minimize symptoms and improve health overall.”
“The Innovative Center for Health and Nutrition in Gastroenterology provides a model of care for patients presenting with general GI complaints for which weight loss with dietary counseling can help minimize symptoms and improve health overall.” — Dr. Carolyn Newberry
Offering Expertise in Endobariatric Procedures
In addition to traditional weight loss treatments, the clinic offers endobariatic procedures as an option to patients for whom diet, exercise, and medications alone will not enable them to meet their weight loss goals. “Even though there are 90 million patients who are surgical candidates, only 2 percent undergo surgery each year,” says Dr. Sharaiha, who is widely recognized for her expertise and pioneering research as an interventional endoscopist with a focus on endobariatric endoscopic procedures. “Patients either fear surgery or want a less invasive option. That’s why we offer medication, dietary advice, and endobariatric procedures.”
In 2019 at the Digestive Disease Week meeting, Dr. Sharaiha presented five-year data on a study she and her Weill Cornell colleagues conducted on endoscopic sleeve gastroplasty. “There was a great deal of interest generated by this research not only because of successful outcomes, but we are also the only center that has followed our patients longitudinally,” says Dr. Sharaiha. “We demonstrated that at five years the procedure appears to be very effective at achieving sustained weight loss of greater than 15 percent with improvement in comorbidities.” According to Dr. Sharaiha, the ideal candidate for endoscopic sleeve gastroplasty is someone who has a body mass index of 30 to 40 who has failed conservative obesity measures, or someone who has a body mass index greater than 40 who does not want to undergo surgery.
“There are over 200 million Americans who are either overweight or obese, so offering a comprehensive, multidisciplinary program such as the Innovative Center for Health and Nutrition in Gastroenterology to help individuals trying to lose weight is very important,” notes Dr. Sharaiha. “The program is not just about patients losing kilograms or pounds, but also about improving their morbidity and mortality. This is the time when we need to treat the problem of obesity aggressively. We can definitely do this at Weill Cornell.”