My grandmother.  She was a pediatrician who graduated from medical school in 1914!  She also firmly believed in preventive medicine. She was a big advocate before it was even called preventive medicine; it was just called taking good care of yourself.

She always told her grandkids that we could achieve good health through exercise, nutrition, and hygiene more than doing anything else. She worried about antibiotic resistance and believed strongly that physicians should live up to the ‘do no harm’ principle. She really was ahead of her time.

Despite all the scientific proof we have regarding the benefits of health education, screening, and early intervention, preventive medicine is still as progressive a concept today as it was in my grandmother’s time.

I developed my clinical skills during medical school at London Hospital Medical College, a large referral hospital. I was taught that patient history was the most valuable piece of the medical puzzle. I found that getting patients to seriously talk in depth was key to diagnosing medical conditions.

I learned to combine this investigative approach with scientific analysis to get a more complete view of the patient. To me, the extra patience and time it takes to really listen to a patient’s history are the most powerful tools a doctor has in her bag.

In the late 1980’s, while I was a resident at a community hospital in Pennsylvania, a movement towards preventive medicine was underway within the family medicine community. Research was emerging about metabolic syndrome, syndrome X, insulin resistance, and other amazing insights showing a strong case that major cardiometabolic problems (such as diabetes, heart attacks, strokes, and obesity) were preventable.

The research showed that these conditions were largely due to underlying physiologic imbalances, influenced by both genetic and environmental factors involving hormones such as insulin. In this incredible environment, I began to dedicate my practice based on the concept that extensive patient evaluation, preventive screening, and early intervention are the most effective strategies for every patient’s health and wellness. As a doctor, the concept that I could help reverse patients’ genetic vulnerabilities to ensure a healthier, longer life was beyond exciting to me.

Much to my disappointment, the movement towards preventive medicine within the medical community as a whole largely receded by the mid 1990’s, giving way to managed care, insurance company demands, and shorter medical visits for patients.

Because preventive medicine involves physical activity, I became increasingly interested in sports medicine and earned a Certificate of Added Qualification in Sports Medicine in 1999.

I immersed myself in sports science because it resonated with my philosophy of preventive medicine and health in general. Sports science focuses on the body becoming the best it can be. Medical science emerges from health crisis management. I wanted to connect the sports science with the science of cardiometabolic health, prescriptive exercise as medicine, exercise physiology, nutrition, prevention and treatment of overtraining syndrome, injury prevention, and sports performance. Combining all of these things gives me additional insight to help patients to not only improve their physiology, but to avoid critical disease and feel and be their best.

My initial work with some of my patients who were athletes led me to develop an interest in metabolism, which lead to an interest in obesity.  I dove into the research with a never-ending curiosity. These two things are critical in preventive medicine because obesity can be a symptom of underlying cardiometabolic risks.

Like my grandmother, I thought that eating nutritious food, exercise, and other healthy habits was the key to reversing obesity and overweight conditions. But, after working with many patients, including high-level athletes struggling with overweight and low energy issues, and reading the research, I had to admit that the commonly-held belief that diet and exercise were the answer to ending obesity simply did not add up. This was an “aha” moment for my philosophy and my practice.

So, I turned to science for answers. I attended conference after conference, read textbook after textbook, journal after journal. At scientific conferences over a decade ago, speakers stated that although patients reported eating X calories and exercising X minutes, they were not losing weight. I was excited that others were noticing this! But to my dismay, they explained confidently that the reason for the discrepancy must be that patients were under-reporting their food intake and over-reporting their exercise. End of discussion.

I often spoke up and expressed concern that practitioners were using a convenient explanation rather than looking to science for answers.

Over the last 15-20 years, approximately 100,000 scientific studies have been published regarding hormones, cytokines, and neurotransmitters that regulate metabolism. These include discoveries about insulin receptors, GLP-1, leptin, adiponectin, NPY, PYY, ghrelin, and many more.

Genetic factors and potential environmental triggers such as phthalates, BPA, and other endocrine disruptors have been identified and evaluated.

This vast research about the physiology of obesity challenges us to recognize that excess weight is a symptom of underlying metabolic disturbance rather than a cause of cardiometabolic disease. That means that science reveals that the weight is the symptom, not the problem. That’s revolutionary to most people!

The commonly-held belief that we have an obesity epidemic in this country because Americans are not eating properly or exercising enough confounds me every day. It’s so frustrating to know that there has been scientific information readily available for the past 15-20 years about why most Americans are suffering from what I call diabesity–the combined epidemic of diabetes and obesity.

In spite of today’s crisis situation, prestigious hospitals and major medical centers are still using outdated normal glucose ranges and missing thousands of cases of pre-diabetes. Very few doctors even know how to test for insulin resistance, leptin resistance, and adiponectin malfunction or are aware that reversing this resistance and malfunction can re-align a patient’s metabolism. Patients are told to diet and exercise, yet the rates of diabetes and obesity are not declining. It just doesn’t add up that the weight won’t go down or, if it does temporarily, that it won’t stay down.

It’s amazing to me that most doctors still blame the patient’s bad habits and lack of control rather than thinking that something is deadly wrong with the advice being given to their patients.

In 2012, I founded the Diabesity Institute: a non-profit whose mission is to increase access to effective medical care for those suffering from diabesity by advancing the science of metabolism.

We hope to accomplish our goals in the following ways:

1. Reach out to the community to educate the general public about the science of diabesity, breaking the deprivation-diet cycle and addressing the stigma of obesity.
2. Develop a curriculum to educate medical professionals about the science and clinical practice of diabesity, and explain the link between metabolic dysfunction, type 2 diabetes, and obesity.
3. Build a body of scientific evidence for diabesity, based on targeted primary research, clinical data analysis, and existing academic literature.

To learn more about our work and how you can help end the diabesity epidemic, visit our website.