While the popular press debates the merits of various fad diets, Jeanne Clark, MD is asking hard questions about the science behind achieving and maintaining long-term weight loss.
“We know that weight loss is important for people struggling with obesity, but we’re not great at achieving long-term results and we don’t know how to best match various treatments with individual patients,” she explains. Clark, who is a general internist at Johns Hopkins, sees patients every week who are struggling with obesity and obesity-related illnesses, such as diabetes and nonalcoholic fatty liver disease. Bariatric surgery is very effective, she notes, but it is reserved for only the very obese.
“Should BMI continue to be the main criterion for a patient to be eligible for bariatric surgery,” wonders Clark, “or should there be a more comprehensive assessment?”
Clark’s interest in questioning standard practice was sparked during her residency at Dartmouth-Hitchcock.
“At the time, the chairman of medicine was Hal Sox, a generalist, who served on the U.S. Preventive Services Task Force,” Clark recalls. Sox’s work—and that of Drs. Elliott Fisher and Gil Welch who were studying variations in health care—inspired a healthy skepticism in Clark that has helped make her a successful researcher.
She has been a key investigator for several multi-center, landmark trials examining weight loss strategies, including the Action for Health in Diabetes trial (Look AHEAD). “The Look AHEAD trial, which is the longest weight-loss study ever, showed us that sustained weight loss is achievable for a small number of people,” says Clark, who is the inaugural recipient of the Frederick Brancati, MD, MHS, Endowed Professorship in Medicine at Johns Hopkins. But no study has revealed a strategy that will lead to sustained, long-term weight loss for the majority of people with obesity.
In addition, patients struggling with obesity have relatively little information on which weight-loss strategy might work best for them, says Clark. Her current research is aimed at filling that information gap. She and her colleagues are comparing the effectiveness and mechanisms of diabetes improvement of three weight loss methods: lifestyle change, gastric banding surgery, and gastric bypass surgery. Her hope is to collect the data necessary for patients and physicians to make informed choices about weight loss approaches.
Although progress in weight-loss research “sometimes seems slow,” says Clark, “I am inspired by the possibilities of helping people lower their risk for obesity-related diseases.”