David Arterburn is one of those lucky people who knew as a kid what he wanted to be when he grew up. Fortunately for him, for his patients, and for the medical-scientific community, Dr. Arterburn is very successful on the path he chose.
After learning the basics of biology, chemistry, and human physiology in middle school, a young Dr. Arterburn was hooked and knew he wanted to become a physician. Once in medical school, he was fairly sure he wanted to become a surgeon, since he always enjoyed working with his hands. But he wound up choosing a different path when he realized how much he enjoyed talking with patients and helping them address ongoing health issues.
During his training at the University of Texas in San Antonio, Dr. Arterburn’s path started to become focused on helping patients deal with weight-related chronic disease, such as diabetes, heart disease, hypertension, and arthritis. Typically, for patients who want or need to lose weight, physicians encourage increasing physical activity and eating healthier foods. However, a conversation with one of his patients made Dr. Arterburn realize that San Antonio’s physical environment was very much working against people making healthy choices about losing weight.
I remember having a particular conversation where we were talking about behavioral modification for weight and for these types of health problems and he’s just like, “It is too hot here.” So, I was trying to get him to do physical activities. He’s like, “Why would I do that? It’s just so hot in Texas, you know?”
Dr. Arterburn knew it wasn’t only the hot physical environment, but the impact of the local food culture — which included highly caloric and hugely popular Tex-Mex fare — that was contributing to his patients’ struggles. Dr. Arterburn began using shared decision-making to discuss bariatric surgery with patients who could not lose weight by making changes in diet and exercise, and whose weight was severely impacting their health and well-being.
For many years, Dr. Arterburn and his colleagues studied the safety and weight-loss outcomes of bariatric surgery. They were particularly focused on long-term safety because of the severe side effects — including damage to heart valves and severe hypertension — that had impacted many people who had used the weight-loss drug fen-phen in the 1990s. Over time, Dr. Arterburn’s research found that bariatric surgery was both safe and effective for most patients.
Two years ago, Dr. Arterburn was presenting his bariatric surgery research findings at a medical conference. After he’d finished his presentation, he met Dr. Andres Acosta, a physician-scientist at the Mayo Clinic who wanted to discuss his findings. This led to them working together. Dr. Acosta had already developed a model based on genotyping and phenotyping to better understand how GLP-1 drugs (such as Ozempic and Wegovy) impacted patients’ weight loss and their experience of side effects. The research by Dr. Arterburn and Dr. Acosta will be very helpful to patients and doctors, especially when discussing individuals’ best approaches to weight loss.
I hadn’t been doing any genetic research at all (on the impact of GLP-1 drugs on weight loss). But when I saw his preliminary data, what he was showing is that he could predict two-fold differences in response to these treatments, for people who were categorized as likely to have the genes that predict response versus those who don’t have those genes that predict response…So that seemed really striking to me. I told him I’ve never seen anything like this in bariatrics or behavioral medicine. I thought this is one of the most promising things I’ve seen in a long time.
Even though Dr. Arterburn had not yet worked with the KP Research Bank, he was aware of it from colleagues and soon found out that Dr. Acosta’s model could be tested on Research Bank data. Dr. Arterburn was assured that the project could proceed successfully, as there are approximately 22,000 Research Bank participants who have taken of one of the 6 FDA-approved medications for weight loss.
As a result, the model that was developed at the Mayo Clinic is now being tested with a much larger and diverse KP Research Bank sample. This will help determine if the model works for people from different ancestries. If it does, then it will be key in helping people decide if they want to use these drugs to lose weight.
Essentially, what we’re going to be looking at among these 22,000 people, is, what is their weight change over time? For people with diabetes, what happens to their blood sugar over time? Can it sort patients effectively into people who are responders and non-responders in a similar way that they did at the Mayo Clinic? And if that is true, if we can really sort people in there with this genetic information, what it tells you is that there’s a genetic basis for these differences in response to treatment that we haven’t understood before.
And if that is the case, I really do think this is some of the most important information that we’re going to have about obesity treatment. Because with this information in hand, our shared decision-making conversation becomes different. It’s more personalized, it’s more informed, and patients don’t have to subject themselves to unwanted side effects of medications that aren’t going to be effective to them.
Initial results should be available later this year and findings will be included in future Research Bank newsletters. Dr. Arterburn is very grateful for the opportunity to do this research with Kaiser Permanente’s unique resource.
[The Research Bank] creates a resource that really, to my knowledge, would not be available anywhere. It’s not in the NIH databases in this way (with patients’ electronic health record information). So, it’s very unique and it allows us to pursue multiple types of questions simultaneously around both benefits and risks or side effects. So, this is great.
