He”™s devoted to his day job, which has him shuttling from his Greenwich home to medical offices in Purchase and on the Upper East Side. Yet it”™s his moonlighting gig in the city that might make Dr. Louis J. Aronne almost a household name in America ”“ for those who stay up late.
The founder of Westchester Medical Group”™s Comprehensive Weight Control Program in Purchase, Aronne in late July again donned his white clinician”™s smock for a taping of the “Late Show with David Letterman” at CBS Television studios in Manhattan. Letterman is his long-time friend and patient, whose well-publicized heart ailment several years ago was diagnosed by “Dr. Lou.” His white-coated appearances with the talk show host have been so numerous that the American Federation of Television and Radio Artists requires the M.D. ”“ who hosted the Food Network”™s former “Getting Healthy” show in the mid-”˜90s ”“ to pay AFTRA union dues.
The doctor was back to resume the “diet challenge” launched by Letterman in March. That was when Aronne”™s second weight-control book, “The Skinny: On Losing Weight Without Being Hungry,” was published by Broadway Books, a Random House Inc./Doubleday Publishing Group imprint. Letterman provided a dust-jacket blurb in which he credits the author with saving his life and weaning him from a steady diet of pork chops and candy.
“I”™m very excited about this book,” Aronne said a few days after the studio taping. It will be issued in paperback next year, he said.
Another Letterman accomplice, George Clarke, weighed in on a scale in front of the studio audience. A CBS building engineer, Clarke packed nearly 260 pounds on a short frame that put his body mass index in the obesity range when he picked up Aronne”™s book last spring and began heeding a dietitian”™s advice. By late July, he had lost 52 pounds, following the doctor”™s scientifically based meal plans, designed to sate one with non-fatty foods that restore the body”™s natural weight-regulating mechanisms and diminish its “fullness resistance.”
Weight control is about biology, not willpower: that”™s Aronne”™s perception-changing message. “If you don”™t first override the internal biology,” he writes, “typical approaches to weight loss ”“ such as portion control and calorie counting ”“ don”™t work.”
“It”™s about your body and your brain and your hormones,” he said. To lose and control weight, “You need to change your diet in a way that makes these signaling pathways (between stomach and brain) more competent. That”™s what these dieting principles are all about.”
”˜An exciting time”™
Aronne has found what works in 23 years of treatment and research as founding director of the Comprehensive Weight Control Program at New York Presbyterian Hospital/ Weill Cornell Medical Center in Manhattan. “It”™s taken 20 years to find a way of treating obesity properly,” he said at his York Avenue office, where the high-spanning Queensboro Bridge is a looming neighbor.
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Pure willpower is not the answer. “If it were that easy, I wouldn”™t be here doing this for the past 23 years,” he said
In 1984, as a medical fellow at the New York Presbyterian/Cornell center studying cost efficiencies in hospital care, “I got interested in obesity as a way of cutting health care costs,” he said. His research showed obesity was a big risk factor for hospitalized patients.
More than two decades later, as new findings on diet-induced obesity emerge from lab studies, “We”™re beginning to understand weight regulation in a way that”™s going to help us understand this problem and develop effective solutions,” Aronne said. “It”™s an exciting time in the field.”
The comprehensive weight control program focuses less on numbers of pounds shed and more on overall health changes that save patients”™ lives and lower health care costs. Aronne distinguished its individual, holistic medical approach from the glut of commercial weight-loss panaceas, much of which he dismissed as costly “nonsense.”
“There”™s a lot of stuff that”™s not effective and there”™s no evidence that it works,” he said. “I think we need to move into an era where it”™s something that”™s based more on science instead of sort of a hocus-pocus. Unfortunately, that”™s where we are.
“We”™re not trying to do the Dr. Atkins thing. We treat people with obesity the way that cardiologists treat people with heart problems, the way that nephrologists treat kidney patients. By focusing on that, we”™ve been able to get amazing results.”
”˜Tough population”™
In Westchester, the weight control program has operated for five years at the Westchester Medical Group”™s 3020 Westchester Ave. office in the town of Harrison. “They”™re a very forward-looking group,” he said of the approximately 150-physician multispecialty practice. Aronne spends one day a week in the office, which is staffed by two full-time physicians.
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“They have patients who lost a tremendous amount of weight,” said Aronne. The average weight loss for patients in the program is 40 to 50 pounds, according to a WMG spokeswoman.
“The stuff that we do, we get referral patients that nobody else can get to lose weight, including surgical patients,” Aronne said. “In most cases, we do get them to lose weight.”
“It”™s a pretty tough population to treat,” said Aronne”™s Westchester colleague, Dr. Nitya Sharma. As in any weight-loss program, attrition rates are high, she said. Still, “We”™ve had a lot of success stories.”
Normally, treatment has been an out-of-pocket expense for obese patients, as insurance companies do not accept morbid obesity as a primary covered disease. About a year ago, WMG began billing insurers for program patients who meet the criteria for obesity and also are treated for related covered diseases such as high blood pressure, heart disorders, diabetes and sleep apnea.
“We know there”™s a large population of people we”™re not getting to because they can”™t afford us if they have to pay out of pocket,” Sharma said. “If they are meeting the criteria for obesity, we cannot take them on for insurance if they have no other medical conditions. Unfortunately, I have patients who are 28, 29 and they haven”™t lived long enough” to develop the obesity-related diseases approved by insurance carriers.
Sharma said WMG physicians are considering starting a cooperative program with Westchester corporations and businesses to combat obesity.
Weighing in
The Centers for Disease Control and Prevention last month said a recently completed study showed the medical costs of treating obesity-related diseases may have soared as high as $147 billion in 2008, nearly doubling over a decade. The prevalence of obesity rose 37% between 1998 and 2006 and medical costs climbed to about 9.1% of all U.S. medical costs, researchers said. Obese people spent 42% more than people of normal weight on medical costs in 2006, a difference of $1,429. Prescription drugs accounted for much of the increase. Sharma and Aronne said some prescription and over-the-counter drugs themselves can cause weight gains.
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“For business, obesity is a tremendous drag on profits and it costs businesses a fortune” in insurance premiums, sick leave, disability payments and lower productivity, said Aronne. “Getting people to lose weight is very important for business. It should be part of the fabric for doing business.”
Employers should offer incentives to encourage employees to lose weight, he said. Instead, though, businesses often adopt the prevailing attitude that it”™s a matter of willpower. They “keep blaming people for the problem,” he said.
The author of “The Skinny” in the last year launched an online tool for businesses, patients and health care professionals, the Cardiometabolic Support Network, to reduce the fast-growing costs associated with obesity. The series of dietitian-led, 12-week online programs, which Aronne called “a very, very sophisticated approach that goes beyond the book,” allows large-scale participation at low cost.
Aronne is looking to partner with a business to develop the network.
