Obesity: A Physician’s Perspective

REKHA KUMAR, MD, is an assistant professor of medicine at the Weill Cornell Medical College and an attending endocrinologist specializing in the diagnosis and treatment of various endocrinology disorders, including obesity and weight management. Dr. Kumar currently serves as the medical director of the American Board of Obesity Medicine (ABOM) and is certified as an ABOM diplomate. She is also board-certified in internal medicine, endocrinology, diabetes and metabolism.

The author of several papers and textbook chapters on obesity management, Dr. Kumar enjoys educating physicians on various aspects of obesity medicine ranging from etiologies of obesity to new pharmacologic therapies. She has lectured throughout the United States and has addressed policymakers on Capitol Hill on the importance of treating obesity as a disease.

BSTQ: How did you choose this area of medicine?

Dr. Kumar: While training as an internal medicine doctor and endocrinologist, I observed obesity was a contributing factor to most diseases. As a result, we were often treating complications of obesity without addressing the actual underlying condition of excess weight gain.

BSTQ: What are the most common misconceptions about obesity?

Dr. Kumar: Most common misconceptions are that obesity is a just a behavioral problem or that people with obesity are lazy. There is a behavioral component of the disease, but our biology does influence our behavior. For example, if we have dysregulated weight-regulating hormones or are taking medicines that affect appetite and/or metabolism, we will be inclined to eat more.

BSTQ: How common is obesity in the U.S.?

Dr. Kumar: Unfortunately, obesity is extremely common in the United States. Currently, approximately 40 percent of our population is obese. It is so extremely common that it has become normalized in certain populations.

BSTQ: What is the distinction between obesity and morbid obesity?

Dr. Kumar: Obesity begins at a body mass index (BMI) of 30, while severe or morbid obesity is a BMI of 40 or greater.

BSTQ: What treatment options have you found to be most effective for obesity?

Dr. Kumar: The most effective approach typically includes a combination of support for behavioral change, a caloriereduced nonprocessed low-glycemic diet, increased exercise and, occasionally, the use of medicines or surgery to help reduce body weight.

BSTQ: How do obesity treatment options differ for adults versus children?

Dr. Kumar: Many interventions in childhood are focused on diet and exercise along with family interventions, whereas in adults, there is more use of medicines and surgery.

BSTQ: What are your thoughts about treating the mental/emotional issues related to overeating and obesity?

Dr. Kumar: It’s actually a very important component. Obesity is associated with depression, and depression is associated with obesity. When dealing with a condition like obesity, it’s always vital to treat the whole person, and it can be beneficial to address any potential mood disorders while also focusing on behavior modification.

BSTQ: When is medication recommended for weight loss?

Dr. Kumar: Lifestyle interventions, including a calorie-deficit diet and physical activity, remain the cornerstone of treatment for people who are obese. However, lifestyle modifications are not always effective in providing lasting weight loss. The National Heart, Lung and Blood Institute of the National Institutes of Health recommends individuals diagnosed with obesity who fail to respond to lifestyle interventions, have a BMI of greater than 30 and present with a weight-induced comorbidity may benefit from having weight-loss medication added to their treatment plan. The goal of pharmacotherapy is not only to reduce weight, but more importantly, to improve the comorbid conditions associated with obesity such as hyperglycemia, hyperlipidemia and atherosclerotic heart disease.

BSTQ: When is weight-loss surgery recommended?

Dr. Kumar: Surgery is recommended for a BMI of 35 or greater if there is a weight-related complication such as prediabetes or hypertension, and it is commonly recommended when a person has a BMI of 40 or greater.

BSTQ: Are there any new studies in obesity medicine that you find promising?

Dr. Kumar: There are a number of new medicines in clinical trials that look promising. There are also more digital health companies focused on addressing the obesity epidemic through apps and telehealth that will make doctor visits for obesity care more accessible.