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