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Melanie Cole (Host): Welcome to Back to Health, your source for the latest in health, wellness, and medical care, keeping you informed so you can make informed healthcare choices for yourself and your whole family. Back to Health features conversations about trending health topics and medical breakthroughs from our team of world renowned physicians at Weill Cornell Medicine. I'm Melanie Cole and I invite you to listen as we discuss the ICHANGE program at Weill Cornell Medicine that focuses on nutrition and gastrointestinal diseases that are related to, or maybe made worse by obesity.

Joining me in this panel is Dr. Sonal Kumar. She's the Director of the Innovative Center for Health and Nutrition in Gastroenterology and an Assistant Professor of Medicine at Weill Cornell Medicine. And Dr. Carolyn Newberry, she's an Assistant Professor of Medicine at Weill Cornell Medicine and an Attending Physician at New York Presbyterian Weill Cornell Medical Center. Doctors, thank you so much for joining us today. And Dr. Newberry, I'd like to start with you. Since we have this obesity epidemic in this country, what are you seeing and how does weight, this excess weight that we're carrying cause digestive issues, such as heartburn and pain and bloating? What's the link there?

Carolyn Newberry, MD (Guest): As you alluded to there is definitely an obesity epidemic here in the U S. And with that, we have noticed rising rates of digestive problems that are associated with excess weight. So, some examples of those include, you mentioned heartburn and reflux disease, which there's actually a physiological mechanism where excess weight increases abdominal pressure, can actually make acid production worse and this can be complicated by poor dietary choices, which also leads to weight gain.

We also see this a lot in patients that describe bloating, distension, change in bowel habits. We think there's some correlation with the foods that we eat and our weight with changes in the microbiome, which can induce symptoms as well as changes in again, abdominal pressures and the way that the body processes food. Recognizing all of this, we wanted to create a program that was actually all encompassing and multidisciplinary that addressed both digestive health and nutrition and weight management.

Host: Dr. Kumar, as long as we're talking about these diseases, another one that comes to mind is fatty liver disease. Can you tell us how that's related to our discussion today?

Sonal Kumar, MD, MPH (Guest): Sure. Fatty liver disease. So, just like you can get fat anywhere else in the body, you can also get fat in the liver. Having fat in the liver that's not from alcohol, whether or not there's any damage from that fat is called non-alcoholic fatty liver disease, or NAFLD for short. And the problem with having fat in the liver is that over time it can lead to damage and it can lead to inflammation to the normal, healthy liver cells. They essentially get destroyed by that fat in the liver. And then that over time, can lead to scarring in the liver and scarring over time, over years and years can build up and ultimately lead to cirrhosis. Now most people think cirrhosis comes from alcohol use or hepatitis C or something like that, but really it can come from anything that causes damage to the liver, including fatty liver.

And this is not a small problem. Fatty liver disease is a problem that really affects 25 to 30% of the population, both in the United States and worldwide. And although it's such a common problem, unfortunately we don't have any medications for the treatment of fatty liver, but we do have good data that shows that losing weight and usually we tell patients about 10% weight loss can not only get rid of the fat, but also reverse any inflammation and damage. And that's how fatty liver disease really ties into GI disease and weight and its relation to obesity.

Host: Well then Dr. Kumar, what is the ICHANGE program? Tell us a little bit about how this came about and I hear it's the only program of its kind in New York City.

Dr. Kumar: So ICHANGE is something that we came up with and really had up and running about a year and a half ago. So, as we discussed earlier, there's a strong link between GI disease and weight. Whether it be reflux or change your bowel habits, fatty liver disease. There's links between the two. But there's also a link between GI diseases and other metabolic diseases. And when I say metabolic diseases, things like diabetes, high cholesterol, heart disease, they're all linked together. And we know that all of these problems really stem from potentially, partly at least weight, excess weight. And not only do they stem from that, they really respond to weight loss.

And all, oftentimes, like I mentioned, with fatty liver disease can be resolved with weight loss. The problem is that when patients have these multiple medical problems, diabetes, heart disease, fatty liver disease, reflux, they have to see multiple providers and there's often not a cohesive plan that sort of ties all of these providers and management plans together. And patients often receive fragmented care. And then with regards to weight loss, it's really hard. Oftentimes patients get the blanket recommendation that they should lose weight. But that doesn't work without really a personalized plan or something that really speaks to the patient, that's something that's sustainable.

It's really hard for patients to do that. So, we recognize these problems and these shortcomings in the medical care and we created the ICHANGE program. So, ICHANGE stands for Innovative Center for Health and Nutrition in Gastroenterology, and it was really created with a twofold purpose, just tying together the things that I mentioned earlier. One, is really to provide a more integrated approach to disease management that's related to excess weight and obesity. So, tying together the providers like gastroenterologists, endocrinologists who may manage diabetes and high cholesterol, cardiologists to manage heart disease, dieticians, to provide dietary plans.

And together we want to present the patient with a unified management plan, as opposed to having that fragmented care that they often get. And then the second goal, which sort of ties to the first is to really provide a personalized approach. By having all of these providers that are working together, really allows us to take the patient as a whole and give them a personalized approach to weight management.

And we're able to do that in iCHANGE. So, we have, this is a multidisciplinary program which means that we are all there onsite together at the same time. So, it's like a one-stop shop where patients can see all of the providers that they need to at the same time during the same visit.

Host: What an important program. You made so many good points and Dr. Newberry, for which patients is this program ideal for? Please tell us a little bit about how ICHANGE team of experts as Dr. Kumar was just saying, are uniquely positioned to help these patients. And what are some of the more important changes that they help patients with?

Dr. Newberry: I think that's a very important question because patients may be listening to this podcast and wondering if they are a good candidate for the program. So, since there is such a relationship between digestive health and excess weight, we are happy to see anybody who has a digestive complaint that would improve with diet and weight changes. And common examples of these include things like reflux, bloating, and abdominal pain, changes in bowel habits, as well as fatty liver disease. If a patient has one of these symptoms or diagnoses, then they can make an appointment in our clinic where we will address both those complications as well as come up with a personalized weight management plan Because we are working with a team of experts, we can do this in a multifaceted way. So we can use the multiple tools we have in our toolbox to help people manage their weight. Obviously, the main component of this program is diet and exercise as it is with any weight loss program, but we hopefully give patients personalized tools so that they can actually get success and achieve both sustainable and appropriate weight loss over time.

So, our dieticians meet with our patients on a regular basis. Actually generally through virtual visits at this point. So, it can be done based on a variety of different people's schedules. We also give exercise and activity counseling, set goals for those activities. And then the other unique thing about actually coming to a medically supervised medical weight management program is that we have some other tools that we can use if it's appropriate and a patient is interested in it.

So, these include medications that can regulate both hormone and blood sugar levels, as well as act as appetite suppressants as well as certain procedures that can be performed both endoscopically, which is actually a newer noninvasive approach to weight loss procedures, as well as the more classic surgical options.

So, when a patient comes in, we speak with them, we do a full medical assessment. We figure out what components of our weight loss tools they want to incorporate into their plan, which may actually change over time, depending on both the goals and how successful they are in achieving those goals. And we feel like we're really uniquely positioned to give them like a very good experience that's personalized to what they need to achieve success.

Host: Thank you for telling us all about this comprehensive approach. So, Dr. Kumar, you mentioned the multidisciplinary approach before. Tell us a little bit, expand just a little bit more on that. And you mentioned that it's a one-stop shop. What can a patient expect when they go there for their evaluation? When you say one stop shop, what does that really mean?

Dr. Kumar: So, I think it's really important for patients to really have a good understanding of it, what it means to come into our ICHANGE Program. So, this is an important question. What happens at that initial consultation, we give patients a very comprehensive assessment. So, we have body composition analysis. We do assessment for liver fat to look for fatty liver disease. And then as we've discussed, we have dieticians who meet with them virtually in the setting of COVID, to get their sort of baseline assessment there. This is all coordinated prior to the patient even stepping foot into the office.

And so we have a Patient Navigator who before the patient comes in, will look at the patient's chart talk to the patient and let them know what to expect and then coordinate everything. So, outside of the initial assessments like body composition analysis, liver fat assessment, outside of that, they also will have the appropriate visits scheduled. If they need to see an endocrinologist, we'll set up the endocrinologist on the same day. If they need to see me as a hepatologist, they'll see me in clinic on the same day, they stay in the same room and we rotate in and out. And then we, as providers get to speak as well so that we can provide that unified, comprehensive plan to patients when they come in.

Host: Dr. Newberry, how do patients like the program? How successful are they? Tell us what you seen.

Dr. Newberry: We are very happy to report that we have had a lot of patients satisfaction from the program. I think they appreciate as Dr. Kumar suggested the one-stop shop opportunity for them to see multiple providers in a single day. And additionally, we also provide Telehealth services so we can expand care and increased touch points in between in-person visits. When we analyze our data, our patients have had significant loss in total body fat. They have had significant loss in their overall weight and they have also reduced medication use for some of their digestive complaints, as well as reduced fat in their liver and scar tissue in their liver.

So, all the outcomes we're really trying to achieve in this program. And, if a patient is motivated and works with our program, we have had very good success with these patients.

Host: I imagine that you have. So, I'd like to give you each a chance to have a final thought. Dr. Kumar, why don't we start with you? What would you like listeners to take from this segment about the ICHANGE program at Weill Cornell Medicine, the team of incredible experts that are there to help patients with weight loss, nutrition, really, whatever it is that they need?

Dr. Kumar: I think the biggest thing for patients, or potential patients that are listening to this podcast is to understand that weight management does not have to be a daunting thing for them to undertake and a lot of medical problems are often tied to weight. And at the ICHANGE program, we recognize this and we really work hard with all providers across all disciplines to try and help patients achieve their weight loss goals.

Host: And Dr. Newbury, final word to you, what healthy habits and changes can and should people try to make in this new year? What do you tell your patients every single day about the importance of these lifestyle behaviors, changes, modifications, and this year can be their year to make those changes?

Dr. Newberry: Right. And I think that's a great closing point, 2021 is hopefully going to be a better year for everyone. And our program really emphasizes healthy weight loss through dietary habits, exercise habits, things that are actually both achievable and realistic for patients, you know we often have people come in and ask us about, what I would call fad diets, incredible calorie restrictions, or restricting entire like food groups, things like that. And that's really not our approach because those types of things are not sustainable. So, for people in the new year for like healthy lifestyle approaches, the biggest things we emphasize are eating less processed foods, so eating less sugar. Eating less things that come with a label and trying to increase intake of fruits, vegetables, whole grains, things that come from the ground, things that are more natural, sort of that perimeter of the grocery store shopping. And then activity is so incredibly important. And, even when we’re stuck in our homes or maybe our normal gym facilities aren't open, there's lots of ways to stay active. Whether that's climbing stairs in your home or your apartment building, or using a YouTube video or playing with your children in a more active way than you normally do. There's so many ways to get that 30 minutes of physical activity that we recommend to our patients.

And my closing remarks would be that I think everyone can benefit from those dietary and exercise approaches and patients in our ICHANGE Clinic, we continue to provide them those support services and realistic plans that they can not only achieve weight loss, but keep that weight loss off to improve their health.

Host: What great information. What an informative episode. Doctors, thank you so much for joining us today and telling us about this important program and Weill Cornell Medicine continues to see our patients in person, as well as through video visits. And you can be confident of the safety of your appointments at Weill Cornell Medicine.

That concludes today's episode of Back to Health. We'd like to thank our listeners and invite our audience to download, subscribe, rate, and review Back to Health on Apple podcasts, Spotify and Google Play Music. For more health tips, go to weillcornell.org and search podcasts. And parents don't forget to check out our Kids HealthCast I'm Melanie Cole.