After the Pandemic: New Approaches to Obesity Management?

For MedPage Today‘s “After the Pandemic” series, we asked our editorial board members to discuss what significant and lasting effects the COVID-19 pandemic will have on medicine and the delivery of healthcare.

Here, we interview Yoni Freedhoff, MD, founder and medical director of the Bariatric Medical Institute in Ottawa, Canada.

Check out some of our other articles in the series here.

Can you share an anecdote about a patient you saw in your practice and how the pandemic influenced their situation? What was the outcome?

Freedhoff: Sharing very specific anecdotes isn’t HIPAA friendly, but what I can easily state is that for a very large percentage of my patients and their families, the pandemic has changed their dietary patterns, and for the most part, for the worse.

People’s access to food has increased dramatically as they’re always near their kitchens, and people might be choosing more indulgent foods for comfort more frequently to treat, albeit temporarily, some of the heightened stress in their lives, and many people’s exercise routines have been thrown out of whack due to lockdowns and their efforts at minimizing contact with others. For many that’s led them to gain weight and/or to see exacerbations of diet-responsive medical conditions.

On the flip side, though, I’ve also seen patients who had been hugely reliant on ultra-processed foods and/or restaurants who have in fact improved their weight and health by way of spending far more time cooking.

In what ways has the pandemic changed how you personally care for patients? How has your practice adapted to the pandemic?

Freedhoff: We transitioned to fully virtual even before the order was given for us to do so. Turns out, I’m a huge fan of virtual care both for myself and for the patients in that why should they spend their time driving to and from their appointments when we can simply click into a virtual call?

Of course to be fair, my practice is not one that requires much laying on of hands and so it’s especially amenable to virtual care. It has also allowed us to see people from all over the province (we’re in Canada) rather than just those within drivable distance to the clinic.

How have your patients adapted to seeking care during the pandemic? Do you expect these changes to continue in a post-pandemic world?

Freedhoff: As per the answer before, they’ve adapted well. Our on-site fitness classes have switched to Zoom fitness classes as well as one-on-one visits with our trainers virtually. For some that’s meant increased likelihoods of attendance, as shyness might have led them to not come in person, but by way of Zoom and leaving their video feeds turned off, they join in.

For others though, they miss the human-to-human personal interaction that group fitness classes provide.

I expect that post pandemic, both for the counselling appointments and fitness, there will remain a mix of virtual and in person.

As people became more sedentary during the pandemic lockdowns, do you expect obesity rates to continue to rise long after the pandemic ends?

Freedhoff: This question perpetuates a tough-to-shake myth, which is that exercise/activity is the primary driver of weight. It really isn’t. Though exercise can have a strong indirect impact on weight by way of its impact on mood, energy, sleep, pain, and health — and in turn their effects on behavior change — as a direct driver it simply doesn’t burn enough calories to make a big dent.

But as to the question of obesity rates rising — that I certainly see happening in that we definitely hadn’t seen them peak pre-pandemic, and given that there haven’t been any dramatic changes to our food environment or food culture, there’s no reason to think, pandemic or not, that rising rates would be leveling off.

How might clinical practice change across the board as a result of this rise in obesity prevalence?

Freedhoff: The biggest change we will be seeing in clinical practice with respect to obesity doesn’t have to do with the pandemic; it’s rather the ongoing approvals of medications that are truly safe and effective in the management of weight. The sooner medicine starts treating obesity like the chronic condition it is, which like other chronic conditions responds both to lifestyle levers of change and to medications, the better, and where treatment is free from judgment.

Think of it like hypertension. Yes, many lifestyle interventions can help, but MDs don’t hesitate to prescribe medications to those who are not able or interested in making those changes and do so free from blame. I look forward to a day when it’s no different for obesity.

As elective surgeries took a back burner during the pandemic, do you expect to see an upswing in bariatric surgery after the pandemic?

Freedhoff: I sure hope so, as it is right now far and away our most effective and durable treatment for obesity and it’s been proven unequivocally to increase quantity of life, improve quality of life, and frequently leads multiple other chronic medical comorbidities to go into remission. And for readers who don’t know me, I’m not a surgeon.

Last Updated May 20, 2021