Obesity physician Alexander Nathanson on common misconceptions

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This week’s Making Rounds spotlights Alexander Nathanson, an obesity medicine physician at NYC Health + Hospitals/South Brooklyn Health.

Nathanson shared some common misconceptions people have about his work treating patients with obesity, and his outlook on how perceptions around obesity are changing.

This interview has been lightly edited for length and clarity.

How would you describe your job to someone who doesn’t work in healthcare?

I work with individuals who struggle with increased body weight. My job involves identifying what’s causing their increased weight, and often this is not as straightforward as it may seem. I work with my patients to find safe ways to reduce their weight. Often this can be done by adjusting their lifestyle, such as with nutrition education and psychosocial support. In cases where patients are not reaching their goals with this approach, we will consider adding in certain anti-obesity medications, and we may consider surgical options.

What’s the biggest misconception people might have about your job?

Some people may think all of our patients have severe obesity, like what they see on certain reality shows (i.e., My 600-Lb. Life). While we do take care of such patients, one does not need to be at that stage to benefit from our service. The condition of obesity is incredibly common throughout our society and many people don’t realize that they may fall into this category. While we take great care to not shame people about their weight or body image, the data is very clear that reducing weight can potentially add many healthy years of life.

What healthcare trend are you most optimistic about and why?

I’m happy the system is starting to be more empathetic to patients suffering from obesity.

It’s becoming clearer that obesity is not simply a matter of poor lifestyle; it’s a disease. Researchers are identifying many pathways used by the body to regulate body weight and food intake—think of how the brain keeps your body temperature within a certain range. We are now fairly confident that there is a similar mechanism that regulates one’s body weight. This helps explain why it is so difficult to keep weight off long term. If you lose some of your body weight, your brain will take measures to try to regain it. The only way to win the battle against obesity is to understand that this is a chronic disease and it will require long-term vigilance, if not treatment.

What healthcare trend are you least optimistic about and why?

We now have medications that have shown to be highly effective at promoting weight loss, and they have the potential to reduce the number of bariatric surgeries performed. Unfortunately, these drugs are generally very expensive and insurance coverage has been sparse. To further complicate matters, they’ve been popularized by various celebrities and social media influencers who may or may not truly need them, and may portray them as being a quick fix. Meanwhile, there are countless patients who would benefit but are unable to access them. While awareness is increasing and insurance coverage is gradually improving, it may still be a while before enough patients who need these drugs can actually get their hands on them. This will raise new questions about equity and can potentially create a new class division between those who can and cannot access highly effective anti-obesity medication.