Partnership Is Key for Community Awareness of Obesity and Chronic Disease: A Q&A With Katie Queen, MD

Katie Queen, MD

Image Credit: Franciscan Missionaries of Our Lady Health System

Katie Queen, MD, is medical director at Our Lady of the Lake Children’s Health Weight and Nutrition Center in Baton Rouge, Louisiana; vice chief of staff for Our Lady of the Angels medical staff in Bogalusa, Louisiana; and board certified in obesity medicine. At a recent Institute for Value-Based Medicine^® (IVBM) population health event from The American Journal of Managed Care^® (AJMC^®), “Advancing Innovations in Wellness and Food Security to Address Obesity and Chronic Conditions In Louisiana,” Queen was a member of the panel discussing “Innovations in Obesity Medicine, Treatment of Chronic Disease, and Prevention Strategy.” The event was held in conjunction with Ochsner Health’s Healthy State initiative.

Louisiana has one of the highest obesity rates in the country, with close to 1 in 4 adults, or more, considered to have obesity. In this interview with AJMC, Queen addresses the complexity of obesity as a medical condition and its most common comorbidities, pivoting to virtual care during the COVID-19 pandemic while ensuring that patients who lived in a rural location continued to receive adequate care, and the importance of integrating awareness of obesity and chronic disease prevention into local food culture.

This interview has been edited for clarity and conciseness.

AJMC: What are some of the top comorbidities/chronic diseases resulting from obesity?

Queen: Obesity, as a complex medical condition, can lead to a variety of comorbidities and chronic diseases:

• Type 2 diabetes: Excess fat, especially around the abdomen, can lead to insulin resistance, which can result in elevated blood sugar levels, leading to diabetes.
• Cardiovascular disease: Obesity is closely linked to heart disease and related conditions such as high blood pressure, high cholesterol, and atherosclerosis. Excess fat can also lead to plaque buildup, increase heart attack and stroke risk.
• Hypertension: With obesity, the heart has to work harder to pump blood to a larger body, which can raise blood pressure.
• Sleep apnea: Fat deposits surrounding the upper airway can increase the collapsibility of the upper airway. Poor sleep quality, daytime fatigue, and other health issues frequently result.
• Nonalcoholic fatty liver disease: In individuals with obesity, excess fat accumulates in the liver. In some cases, the condition can progress to more severe liver diseases, including cirrhosis.
• Osteoarthritis: Obesity puts extra stress on the joints, particularly the knees and hips, which can lead to degeneration of joint cartilage and increase the risk of osteoarthritis.
• Certain cancers: Potential association have been seen between obesity and several cancers, including breast, colorectal, kidney, and pancreatic. Chronic inflammation and hormonal changes are thought to contribute, but the exact mechanisms are contribute not fully understood.
• Depression and anxiety: Obesity is known to contribute to depression and anxiety, which can lead to overeating and weight gain; the relationship is bidirectional.
• Gastroesophageal reflux disease: Obesity increases pressure on the abdomen, which may lead to stomach acid backing up into the esophagus.

AJMC: What are the mechanisms of action behind obesity leading to the above conditions?

Queen: There are several, and the relationship is complex, with genetics and the environment playing roles. Fat tissue produces inflammatory chemicals that can cause low-grade inflammation throughout the body, contributing to their development; obesity can disrupt the hormonal balance necessary to regulating metabolism and appetite; mechanical stress placed on joints from excess weight can lead to wear and tear on the musculoskeletal system; and body fat is deposited around organs, which can also cause stress.

AJMC: Are there conditions that are more common in pediatric vs adult patients?

Queen: Prediabetes/insulin resistance, high blood pressure, fatty liver disease, and depression/anxiety are more common in a pediatric patient population, and often are precursors to the actual diseases of adulthood. Essentially, treatment of pediatric obesity is prevention of adult disease.

AJMC: Access to health care services, especially in rural areas of Louisiana, has been a concern. During the pandemic, how you were able to pivot to virtual care to reach underserved populations, ensuring access to obesity medicine and chronic disease treatments?

Queen: Prior to the pandemic, we were not doing any telehealth, so I had to teach myself a crash course on how to do a telehealth visit, and I switched to mostly virtual during the pandemic. In my rural pediatric clinic in Bogalusa, Louisiana, we would sometimes pair a virtual visit with a “drive-by” car exam, where a patient who needed a physical exam would drive up to the clinic, wait outside, and I would come out to the car with my stethoscope and otoscope (all gowned and gloved up, of course!) and do the exam from the car. We still do telehealth often, and now my weight management clinic is half telehealth, which gives me and the patients flexibility.

AJMC: Can you discuss potential long-term implications of these digital health innovations?

Queen: Virtual is never as good as in person, in my opinion—that human connection is hard to replicate by video conferencing. But I will say that the option of telehealth is valuable for both myself and my patients. I am able to work from home every other week rather than driving over an hour each way to Baton Rouge, and my patients are able to miss less school. The parents often check them out of school for the appointment and then do the video visit in the parked car, and then bring them back to school. I have even had school nurses run the video visit so that the parent doesn’t have to miss work, and the parent can video conference in from their location. Even in rural areas, patients appreciate the option for us to meet them where they are, as transportation is often difficult.

AJMC: Louisiana is known for its unique cuisine and cultural traditions, which can sometimes contribute to unhealthy eating habits. Can you discuss the importance of integrating awareness of obesity and chronic disease prevention into local food culture?

Queen: There are several reasons why having these discussions is important. Communities are more likely to embrace and adopt lifestyle changes when they see how they align with their cultural practice and preferences, and by collaborating with community organizations, by actively engaging with health initiatives, people are more likely to take ownership of their health. They are also more likely to see these changes as a natural part of their lives.

Working with community organizations also can help address issues of food accessibility and affordability, which are important factors in making healthier choices, and when individuals see others in their community making healthier choices, they are more likely to be encouraged and motivated to do the same. Community-based holistic initiatives can also help to address the various aspects of health, including nutrition, physical activity, mental health, and social well-being—and are more likely to yield lasting results.

Prevention and cultural preservation are important factors here, too. Integrating awareness of obesity and chronic disease can not only help to reduce the burden on health care systems and improve public health outcomes, and raising awareness about the links between obesity, unhealthy eating habits, and chronic diseases is essential. When people understand the health risks associated with their choices, they are more likely to make informed decisions. In some cases, integrating health awareness into local food culture can help preserve and revitalize traditional, healthier food practices and recipes that may have been lost or replaced with less nutritious options.

Ultimately, the goal is to create an environment where making healthier choices is the norm, where access to nutritious food is equitable, and where the community as a whole is committed to improving health outcomes and preventing obesity and related chronic diseases.

AJMC: What were some of the innovations covered in your IVBM panel discussion, and how can they be tailored to address the specific health needs of the state's diverse communities?

Queen:I helped our health system, Franciscan Missionaries of Our Lady, to develop a multidisciplinary pediatric and adolescent weight management program at the Our Lady of the Lake Children’s Hospital of Baton Rouge. We have grown to a team of obesity medicine specialists, dietitians, and behavioral and health coaches, and we work with patients from anywhere in Louisiana. Also, we are training the Our Lady of the Lake Children’s Health pediatric residents during their community health rotation.

I am also working with Pennington’s Greaux Healthy Campaign to develop a toolkit for primary care providers to address childhood obesity in the primary care office, along with development of a partnership between Our Lady of the Lake Children’s Health and Pennington Biomedical Research Center to develop the first accredited adolescent bariatric program in Louisiana.

I helped No Kid Hungry/Share Our Strength to implement a food prescription program in our rural pediatric community of Bogalusa, Louisiana. We enrolled over 100 families at risk for food insecurity in a program where they received monthly debit cards to shop for fresh fruits and groceries at the local Walmart. Many of our families tried fruits or vegetables that they had never tried before, and I noticed that the body mass index trajectory of several children slowed after participation in the program.

AJMC: What collaborative efforts can health care providers, policymakers, and community leaders in Louisiana undertake to create a comprehensive and sustainable approach to combating obesity, managing chronic diseases, and implementing effective prevention strategies?

Queen: Partnership is key. If we all just stay in our lanes, it will take longer than if we cross paths and work together. I think the most important thing is to include the patient/community voice—from faith communities to our patients and families. We may be the experts in obesity, but they are the experts of what it is like to live with obesity. All of us deserve a seat at the table.