As part of our “Meet Yale Internal Medicine” series, today’s Q&A is with Artur Viana, MD, Assistant Professor of Medicine (Digestive Diseases).
Q: Tell me about your work at the Yale Medicine Metabolic Health & Weight Loss Program.
A: In the Metabolic Health & Weight Loss Program, we help patients with obesity lose weight using a variety of therapies, such as nutritional counseling, a meal replacement program, medications, and endoscopic therapies such as intragastric balloon.
In medicine, obesity is defined as a body mass index (BMI) over 30. BMI is a number calculated using a person’s weight and height and is used to categorize obesity in three classes, with each group benefiting differently from the various therapies we offer. Treatments are tailored for the patient and their weight loss goals. When it comes to medications, there are at least five drugs or combinations of drugs that we can use. We think about the patient, we see what other conditions they have, and we choose the drug that best fit that patient. I have patients who come in and say, ‘I want to take the best medication to lose the weight,’ and I tell them, ‘The best medication is the best one for you.’ We know that obesity is a multifactorial disease, so we use a combined approach. A patient might start with OPTIFAST, a meal replacement program, then use a medication to keep the weight off. Additionally, our patients also work with a nutritionist to develop healthier dietary habits.
The interventions that we do here are effective in the 10 – 12 percent range of total body weight loss, and this is known to improve many diseases such as diabetes and fatty liver disease. In fact, when I prescribe a medication to a patient for a specific purpose of weight loss, the initial goal is five percent of total body weight loss in three months. For example, if someone weighs 200 pounds, we are looking at 10 pounds weight loss in three months. We know that about 10 percent weight loss can do a lot to improve a patient’s health.
Obesity is mostly driven by nutrition which is intimately tied to the function of the gastrointestinal tract. In addition, the interventions for weight loss work via changing intestinal motility, by decreasing satiety and also by making endoscopic changes in the intestinal tract. Excess weight also causes a number of gastrointestinal diseases such as gastric reflux and fatty liver disease.
Q: You worked at some of the top medical centers in the U.S., what brought you to Yale School of Medicine (YSM)?
A: I came here for my fellowship. What brought me here initially is that I was looking for the best training. I felt Yale was the best fit for me so I stayed here after completing my fellowship, which obviously indicates that I really enjoyed my time here.
In the northeast, Yale obviously compares to similar schools in New York and Boston but I like the mentality and the commitment to education here. I feel at home here. I like the collegiality. Most of my colleagues used to be my mentors, so that's a really good feeling. I also felt that I had great opportunity at Yale. I was interested in this obesity work before I came here, and before I graduated the opportunity to work as part of this group came up so I stayed.
Q: Why did you chose to specialize in gastroenterology?
A: Back when I started residency, I originally was interested in hematology / medical oncology (hem/onc), but after doing rotations in hem/onc during my residency, I didn’t feel like that was what I was looking for. In gastroenterology, I can help a lot of people the same way. I can help prevent colon cancer, for example, when you do a screening colonoscopy. I always liked the ability to work with my hands and was very good at procedures, and gastroenterology offers that as well.
And especially now that obesity is such a prevalent disease with so many co-morbidities, the role of the gastroenterologist is central in helping to mitigate the impact of this epidemic. It is very rewarding.
Q: How do you spend your time?
I am primarily a clinician, but I would like to do research. I have some projects going on in the gastroenterology side that are related to obesity. We are thinking about some things, especially the intersection of obesity with other diseases such as gastrointestinal reflux and esophageal motility.
Q: What is your career goal?
A: My career goal is to be a clinician / educator. I enjoy working with the fellows and teaching the medical students as well. It is great because they are in a different level of their training, and it's nice to see when you teach them a basic idea and they understand it. I think that is really cool. When it come to the fellows, it is really rewarding to watch not only their knowledge grow, but their procedural skills improve to the point they are able to perform technically challenging procedures independently. I want to stay in academics and develop myself as a clinician / educator.