Mastering Obesity Medicine: Care Strategies and Expert Insights 

Obesity is a growing health concern, affecting 4 out of 10 Americans according to the CDC - Centers for Disease Control and Prevention. For Direct Care clinicians, understanding and managing obesity is crucial.

In this post, we delve into the importance of Obesity Medicine, offering insights and practical strategies, and feature an interview with Dr. Matthea Rentea, an Obesity Medicine Physician.

What is Obesity Medicine?

Obesity Medicine is a medical specialty focused on the comprehensive care and treatment of patients with obesity. It involves a multidisciplinary approach that includes medical, nutritional, behavioral, and sometimes surgical interventions to help individuals achieve and maintain a healthy weight.

The goal of Obesity Medicine is not only to reduce excess body weight but also to improve overall health and prevent related complications such as diabetes, heart disease, and certain cancers.

The Role of Obesity Medicine Association

The Obesity Medicine Association (OMA) is a leading authority in this field, boasting around 5,000 members. These members comprise 55% clinicians, 25% nurse practitioners and medical assistants, and 20% students and residents. 

Nearly half of OMA's clinician members work in private practice, with specialties ranging from Internal Medicine to Endocrinology and Pediatrics.

Interview with Dr. Matthea Rentea, an Obesity Medicine Physician

Dr. Matthea Rentea is a board-certified specialist in Internal Medicine and Obesity Medicine, and the founder of Rentea Metabolic Clinic, currently serving patients in Illinois and Indiana.

With over a decade of experience, Dr. Rentea is passionate about helping patients achieve optimal metabolic health and weight management. Dr. Rentea aims to challenge the stigma associated with obesity and offers compassionate, personalized care to support long-term health outcomes.

Dr. Rentea is also passionate about helping other medical professionals enhance their obesity care and offer consulting services. Today, she will speak to us about integrating weight loss medicine in your practice.

Could you tell us about your background and how you became interested in Obesity Medicine?

I started in internal medicine, and I went into primary care during residency. I initially thought I wanted to do endocrinology, focusing on diabetes. However, I realized that a lot of diabetes management could be done in primary care. 

But as I was working for years and years in primary care, I realized we were never actually getting down to what the problems were. Meaning we were never really getting down to what was happening nutritionally, with movement, or with insulin resistance. 

And so I came to learn that Obesity Medicine was a field where there were all these different pillars where you would do all of it at the same time. I saw that patients were getting such amazing results doing things differently. So I started to get additional board certifications and really began to incorporate these different tools. I realized that I just really enjoyed it. 

Also, for myself, I'm an Obesity Medicine patient, and it was the first thing, honestly, once I started to use those medications and do things in that way, that had ever really helped me in a concrete way long term. So I started my own practice a few years ago, and it's been really fun to help patients in this way.

What are some common barriers patients face in their weight loss journey, and how do you help them navigate these challenges?

That's a great question. There are so many barriers when it comes to working on weight management long term. Some of them are going to be purely metabolic, meaning these are things like overcoming insulin resistance, high blood sugar, elevated cholesterol, and high blood pressure. These metabolic concerns are things we have to take care of, and sometimes they can be handled with medication. 

So sometimes, the first barrier can be that we know medically a certain medication might be necessary, but they don't have access to these medications. It often involves having the skill set to realize if, let's say, a name-brand GLP-1 is not covered, are there other oral generics? It's really knowing that there's more than just one medicine out there. 

The second obstacle is that often a lot of things need to change for your health to move in a different direction, and overwhelm takes over. I find the most skilled physicians have a very easy roadmap to take their patients on. For example, some hurdles that I help patients with include how we can simplify getting enough protein and fiber, and how we can slowly make these changes without an overnight overhaul. The challenge for both the patient and the physician is creating a roadmap so that this gets done in a way that's not overwhelming. We want patients to achieve the things we're recommending. When they do, they feel really empowered and want to keep going.

Then, the third obstacle is the ability to stay with these changes long-term. This requires a lot of continuity of care and encouragement from the physician, always highlighting the wins. How is this patient actually achieving amazing things? Because they're only looking at the pounds lost, when really there are so many other amazing things that have happened. The goal is to show patients the other amazing things that are happening: you're walking more, you're starting to lift weights, your labs look better. They need to look at all of that and not just the weight that's been lost.

How do you approach the initial consultation with a patient seeking weight loss assistance?

I actually start first with the meet and greet to make sure that they are aligned with what my clinic offers. In that meet and greet, I really want to see if this is someone who wants to do all this work. Do they really want to take on working on nutrition, movement, looking at stress in their life, and what their sleep looks like? 

I really ask them if they are willing to work on these different things because some people come into this area wanting just medication, which can be incredibly helpful, but they're not actually wanting to do all the other things that my clinic offers. I talk to them to see what they have struggled with, what they have tried before, what they are wanting to do at this moment, and if it aligns with my vision. 

And then what I try to do on the first visit is I really take all of their history and see where the first areas are that we can make the biggest impact. So everyone isn't doing the first things right away, right? I'm looking at what everything looks like and what the little areas are where we can make progress, without trying to overwhelm them with too many things because it's already a lot to do right when they get in the clinic.

What role do nutrition and exercise play in your weight loss program? Can you discuss the importance of a multidisciplinary approach in obesity care?

One of the differences between Obesity Medicine and other fields is that we view getting to health through multiple what we call Obesity Medicine pillars. So if you look at this, we tend to think about nutrition, exercise, behavioral health - meaning stress management, how you respond to stress, anxiety, depression, things like that - and then there's medication and surgery. So there are these different pillars. 

"Think about a traditional kitchen table. There's going to be four legs on this. And maybe if you're not so strong at one of them, the table can still stay up. So if you have three instead of four, but as soon as you lose two, that table is going to fall over, right? And so the same thing happens with our health; we actually need to work on all of these things, or one of them doesn't work as great as the others." 

I always want to come back to these newer medications, but they've been around a long time, these GLP-1. They are really only as effective as you also being able to do nutritional changes, exercise changes, as well as behavioral changes. I'll give you an example. Let's say, I'm going to get on medication and only do the nutrition part. If you're not doing exercise, you're going to lose a lot of muscle. So again, your health is not going to be the best. Let's say you’re saying I'm going to do all the exercise, but I don't care about nutrition. You're still going to lose muscle because you're not going to get the protein right. 

So if you're going to worry about all of the pillars, you're going to keep that table up nice and steady. We're going to balance all the things we're doing. You're going to get better results. You're going to lose more weight, and you're actually going to keep it off because your basal metabolic rate is going to be where we want it to be.

What specific strategies or tools do you use to monitor and support patient progress?

One of the tools that I love the most is going to be a body composition scale. The reason I say this is that the body composition scale does not just tell you how much your weight has gone down, but it also lets you know how your skeletal muscle mass is changing and your fat mass, meaning the pounds of fat that you have on your body. 

The reason that this matters is that we, for a really long time, have just glorified the scale going down without caring what is actually going down. You could have lost 5 lbs. Well, just so that people know, it's really hard to gain muscle. So if you're not looking at body composition change over time, you don't actually know what's happening. You think, OK, this person could have lost 20 lbs, but actually half of it could have been muscle, right? That's always the big concern if you're not doing things in the right way.

One of the main tools I use is the InBody. It's affordable, usually like 20-30 dollars, where you can find a gym or some location near you where you can hop on this, get a printout, and then your doctor can help you go over it. I, with my patients, at a minimum, say at least quarterly, meaning at least four times a year, we get this done just to be able to follow if what we're doing with exercise and nutrition is working. Otherwise, we're going to change our approach.

If that's not accessible to someone from a price standpoint, then I will use just a tape measure to measure, for example, the abdominal circumference or to see if they're losing inches. That could be a tool, but I don't like to just rely on a scale number. I like to use body composition. Other than that, I'm really about also monitoring labs, so maybe six months in, or depending on how long it is, the type of interventions that you're doing, seeing if our cholesterol levels are down or if blood sugar is coming down. It's really about giving people hope, seeing that all this hard work that they're putting in actually means something metabolically.

How do you stay updated with the latest research and advancements in Obesity Medicine?

Things are changing all the time, so there are obviously a lot of physicians that I follow in the online space because I find that things often flow rapidly in Obesity Medicine. An article will come out, a study will be published, and next thing you know, everyone's talking about it. So there's just staying up to date with peers, but a big way that I do this is by going to a lot of medical conferences. I probably go to about five or six conferences a year. 

You will probably hear what I really want to describe as the art of medicine. But how are people actually practicing? A study is one thing, the actual practice of medicine is another, and so I find that not only do you get to hear the lectures at these conferences, but you get to talk to physicians as well. 

One that I think is really invaluable is the OMA Annual Conference.

Could you tell us more about your consultancy program to help other practices incorporate a weight loss program into their services?

One of the things that I found - the reason that I have my practice but also started to work with some physicians who are starting their practices - is that they didn't know, first, some logistical things about how to get this off the ground, and second, they didn't know how to support patients in the program. 

I started to help people with how they can streamline bringing patients into the clinic in an easy way so that it's not painful. If you get the right information when they come in, it will be really streamlined. 

How do you build out systems within the clinic so that you can follow them long term, so they feel supported, and so they have all the information that they need? The way that my consulting works with people is really just an hour where we sit together and talk through different things, then we'll say, OK, let's do XYZ and meet again in a month. I really help people in a very customized way to work through what they are trying to start.

One of the challenges within Obesity Medicine is that a lot of people are starting what are called micro practices, meaning it's just them, right? They don't necessarily have a big clinic, things like that. So you really have to figure out how you can make it work in a way that is easy, where you do need to make a profit. Otherwise, you're not going to be sticking around. 

You also really want to make sure that the quality is super high, so that those who come to work with you are getting amazing results and really value you as a physician.

I just found that a lot of people kept asking, how did you do it? Because from the beginning, my clinic was profitable, the structure worked, and the retention was there. So I just found that with this consulting service, I offered it as an opportunity for people to pick my brain and for us to think about how they are going to make it happen within their state, and that was very valuable for physicians.

Do you have any messages for those starting in Obesity Medicine?

I want to say you can do it. If you are new and you are starting a practice, you can make this clinic however you want to make it. You can structure it how you want to. It might never look the same as someone else in your area that you follow online. When I first started my practice, everyone said it wouldn't work. No one understood what the value was.

But I knew, having gone through the struggle myself in life, that if I found a doctor like me, I would sign up for it. I knew the struggle my patients went through and what they would have needed. So you need to think about the actual problem you are solving, and you need to be very passionate about it.

But you can a million percent do this. You do not need to spend high on overhead. You can get it started in the most scrappy of ways, then prove the concept, and keep building with time. You can do this simply; all that is needed is that you literally just get started. 

Don't let anything hold you back. You can do it!