Battling Obesity by Breaking Down Barriers

This case is one we've all seen before. Mary is a middle-aged woman with progressive weight gain following three pregnancies and a battle with depression. Her weight gain resulted in several other diagnoses, including type 2 diabetes, hypertension, and severe knee osteoarthritis.

Sarah Ro, MD

Now weighing 280 lb (127 kg), she is on increasing doses of insulin, antidepressants, sleep medications, a nonsteroidal anti-inflammatory drug, and a statin. She feels quite defeated and has lost hope for any possibility of improvement. Multiple doctors tell her that she needs to lose weight by moving more and eating less. She feels like shouting, "But how?" It is not as if she hasn't tried. She can't exercise because of her knee pain. Food has become her sole source of comfort. Although she has seen a dietitian for years, the scale hasn't budged and her hemoglobin A1c is out of control. With each insulin dose increase, her weight climbs, too. We've all witnessed this story.

Jennifer McCauley, MD

As primary care physicians at UNC Health in Hillsborough and Chapel Hill, North Carolina, it's apparent to us that the constant feedback loop of weight gain, increased medication, decreased mobility, more weight gain, and more medication isn't a winning strategy. Mary met criteria for