BMIQ: A Scalable System for Delivering Professionally-Led Weight ManagementLouis J. Aronne, MD, FACPSanford I. Weill Professor of Metabolic ResearchWeill Medical College of Cornell University
J Clin Invest. 2012 Jan 3;122(1):153-62. doi: 10.1172/JCI59660. Epub 2011
Why don’t people just lose weight?High calorie intake overloads neurons conducting signals from fat cells and stomach to the brainOverloading neurons in hypothalamus causes injury and premature degradationStem cells which replace neurons can’t keep up in animals prone to obesity
– Number of neurons decreases– Inflammation develops
Fewer neurons plus inflammation, diminishes signalling and brain tries to re-establish equilibrium by increasing fat mass
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Lactate
Angiotensinogen
Leptin
Adipsin (Complement D)
TNF-a
FFA
PAI-1
Resistin
AdiponectinT2DM=type 2 diabetes mellitusFFA=free fatty acidPAI-1=plasminogen activator inhibitor-1TNF=tumor necrosis factor-alpha;IL-6=interleukin 6ASCVD=atherosclerotic cardiovascular diseaseC-C L2+chemokine (C-C motif) ligand2LPL=lipoprotein lipase
Insulin
IL-6
Estrogen
Hypertension
Hypertension
Thrombosis
Thrombosis
InflammationInflammation
Type 2 DMType 2 DM
Dyslipidemia
DyslipidemiaArthritisArthritisArthritisArthritis
ASCVDASCVDASCVDASCVD
Bray, G. J Clin Endocrinol Metab. 2004;89:2583-2589.Eckel RH, et al. Lancet. 2005;365:1415-1428.Slide: Aronne LJ after Dr. G. Bray. ©2007
CancerCancer
Fat Stores
C-C L2
LPL
As a result, treatment is not as simple as it looks
Professionally led behavioral obesity treatment is supported by the USPSTF and has been shown to be cost-effective
Shift in health care from fee for service to accountable care will favor prevention
Favors a shift towards obesity treatment in primary care: covered by Medicare
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Health care providers(HCP) don’t know how to treat obesity and have no resources
Treatment is grossly oversimplified. Result: Failure and demoralization of patient
and HCP
Need and demand exists fo a system which will deliver education to HCPs and resources and support to patients
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A structured, evidence-based weight loss program for live delivery by HCPs which is cloud-basedProgram materials for the provider to deliver and material and complete supporting interface for the patient.Can be delivered individually or in groups by MD, PA, NP, RDN, others.Structured enough for the novice, flexible enough for the pro.
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A structured, evidence-based weight loss program for live delivery which is cloud-based
Program materials for the provider to deliver and material and complete supporting interface for the patient.
Can be delivered by MD, PA, NP, RDN, others. Structured enough for the novice, flexible enough for the
pro. Education about obesity for the provider Detailed, expanded session materials support each office
visit
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Structured, effective program available to HCP on massively scalable platform
Includes online expert assessment to simulate our own care and evaluation
Used by Registered Dietitians at the community level to run groups
Treatment is available, flexible, professional
Result: Effective weight loss at reasonable price point
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Results: • Mean Weight loss - 15.9
lbs = - 6.5%• Labs from first 65 patients
.• Triglycerides - 30 mg/dl• HDL + 3.6 mg/dl• Hba1c – 0.3% ( non-
diabetic baseline)
Program: • 150 patients in an employee
wellness program,BMI 36, experienced RD
• 26 week program• Early version of BMIQ
materials • Initial visit, then live and
online classes delivered through the BMIQ system.
• Gym access and 2 sessions with trainer