Structuring Care Around Obesity

Innovations in Diabetes & Endocrinololgy | Fall 2022

Obesity control is preventive medicine. That is the philosophy underpinning the work of Revital Gorodeski Baskin, MD, Director of the Obesity Program within the University Hospitals Diabetes & Obesity Center.

Revital Gorodeski Baskin, MD

“There is no quick fix to weight loss — it’s a journey,” she says. “However, if we tackle obesity and its downstream metabolic consequences with appropriate medical management, we can address a cascade of chronic conditions,” including:

• Coronary artery disease
• Stroke and cerebrovascular disease
• Liver disease
• Kidney disease
• Orthopedic pathophysiology
• Infertility challenges
• Polycystic ovary syndrome in women
• Low testosterone in men

Dr. Gorodeski Baskin was recruited to University Hospitals in November 2021 after more than a decade at The Cleveland Clinic. A graduate of Tufts University School of Medicine, she completed a fellowship in Endocrinology at The Ohio State University.

As she works to establish the UH Obesity Program, Dr. Gorodeski Baskin points out that successful weight management programs have been in place within various departments throughout University Hospitals Cleveland Medical Center.

“Addressing obesity is a systemwide initiative, and we recognize that different patients thrive with different approaches,” she says. Moving forward, she envisions adding a health navigator who can onboard patients and ensure they are routed to the most appropriate program for their unique weight-loss needs.

A novel aspect of Dr. Gorodeski Baskin’s program is a shared appointment model. She meets monthly with adult patients who have a body mass index (BMI) of 25 or higher. “Meeting in small groups contributes to accountability and camaraderie,” she says. “Patients express their appetite triggers, struggles and successes.” She also accepts referrals for patients who need to lose a prescribed amount of weight to be medically eligible for procedures, including organ transplant, joint replacement, or infertility treatment. These BMI restrictions are often in place because of insurance eligibility requirements or complication risks, so Dr. Gorodeski Baskin has been working with UH surgeons and endocrinologists to ensure patients are positioned to achieve the best outcomes.

The UH Obesity Program focuses on two recommended diets. “The Mediterranean diet is a lifelong way of eating,” Dr. Gorodeski Baskin explains. Well-researched in academic literature, the diet is rich in lean proteins, vegetables and healthy fats. She also oversees a ketogenic diet for patients who need to jumpstart weight loss.  “There are many ketogenic diets that are shown to be unhealthy long term, but we have adopted a safe and effective low-carb plan that limits red meat, dairy and fats,” she says. As these patients begin to see progress, some choose to stay on modified ketosis program and others eventually transition to the Mediterranean eating plan.

FDA-Approved Medications

New FDA-approved weight management medications are demonstrating significant impact for appropriately selected patients. “These pharmacological interventions work both peripherally to suppress appetite and centrally in the hypothalamus and other locations within the brain,” says Dr. Gorodeski Baskin. “However, patients must first be committed to the dietary program.” Intervention always starts with behavioral modification and the psychology of weight management.

Although studies show remarkable efficacy of new classes of anti-obesity drugs, high cost is a barrier for many patients. Most insurance companies do not classify them as preventive therapies. Without coverage, once-weekly injectable GLP-1 agonists can cost $800 to $1200 per month. Oral medications average $150 to $200 per month. Dr. Gorodeski and her colleagues are advocating for these medications to be covered as accepted formularies.

Year One Success

Currently, Dr. Gorodeski Baskin is seeking IRB approval to build a research database of body composition and metabolic markers for patients enrolled in her program. She also submitted a manuscript discussing the impact of diet and exercise on the remission of metabolic syndrome and recently presented four grand rounds to colleagues at University Hospitals.

“Obesity is becoming understood as a global pandemic,” she says. “If we can catch people early and help them develop healthy habits around eating and exercise, we can prevent so many problems later on.” However, she points out that success is not only measured in pounds. Improved insulin resistance, lowered hemoglobin A1C, reduced cardiometabolic markers, diminished stress and better sleep hygiene are signs of progress that Dr. Gorodeski Baskin celebrates with patients. “It is often the non-scale victories that improve quality of life,” she says.

For more information, contact Dr. Gorodeski Baskin at Revital.GorodeskiBaskin@UHhospitals.org.

Contributing Expert:
Revital Gorodeski Baskin, MD
Director of Obesity
University Hospitals Diabetes & Obesity Center
Assistant Professor
Case Western Reserve University School of Medicine