August 15, 2016
7 min read

ODs poised to help manage obesity proactively, comprehensively

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“Always have a kind, compassionate heart,” when discussing obesity and its associated comorbidities with a patient, Kimberly K. Reed, OD, FAAO, recommended. “There is such a long, deeply entrenched history of stigmatizing the condition that overweight patients rarely encounter health care professionals, or many people in their life, without ridicule.

“It would be nice if we could start the trend that we don’t value patients based on how thin they are,” she added.

Obesity is a disease like any other disease, Reed, a member of the State of Florida Governor’s Task Force on Diabetes, said in an interview with Primary Care Optometry News.

“Many treat obesity as a character weakness, a personality flaw,” she added. “I think the other aspect is that by increasing awareness and having the conversation with our patients, it helps de-stigmatize the issue,” she said.

Talking about obesity and not ignoring the condition or treating it in a taboo-like manner creates a positive interaction with patients and inspires people to be proactive about their health, Reed said.

Agustin L. Gonzalez, OD, FAAO, says discussing lifestyle and looking at obesity, high blood pressure and diabetes provides the opportunity to think of the body first instead of focusing only on the eye.

Image: Gonzalez AL

Preventive care

PCON Editorial Board member Scott A. Edmonds, OD, FAAO, wants more optometrists to preventively manage obesity in their practices.

Considering that optometrists are practicing in more of a medical model, and many call themselves optometric physicians, Edmonds told PCON that obesity management should be handled as a part of preserving one’s long-term health.

Typically, optometrists are taught to treat the eye, often thinking of it as a separate entity of the body, according to PCON Editorial Board member Agustin L. Gonzalez, OD, FAAO. However, in medical school, it is the opposite, where doctors look at the body and then the eye as an extension of the body.

“That eye-centric, single body system mentality must change for optometrists to establish a primary care role in the health care system,” he said.

Reed and Gonzalez believe in a holistic perspective, looking at the body as a comprehensive system. Optometrists are poised to affect the outcomes of those with diabetes, they said.

“By embracing this message of lifestyle and looking at obesity, high blood pressure and diabetes all as an entity, it provides the opportunity for optometrists to think of the body first,” Gonzalez said.

“Obesity treatment is not so much medicine and surgery,” Edmonds said, “but counseling, diet, lifestyle and nutrition. We are in a good position to talk to patients about these issues and how they will affect eye health in the long term.”

Scott A. Edmonds

To discuss obesity in the optometric practice, Edmonds suggests taking a patient’s vital signs during an appointment. That way, an optometrist has medical grounds on which to talk about the patient’s health risks without making the patient feel that the talk is unwarranted.

Time is of the essence, he said. It is much easier to deal with diabetes when a patient is 16 or 22, but once he or she is older, the condition is more difficult to treat. Treatment options are more limited the older a patient gets, he said.

People are getting diagnosed with type 2 diabetes at a younger age, Edmonds said. Optometrists need to understand family history and the possible genetic correlations with diabetes, heart disease and more risk factors, “as part of preserving the long-term health of your patients.”

Under-assessment/underestimation of one’s weight status is widespread in type 2 diabetes patients, according to research from Victor Mogre and colleagues in Obesity & Clinical Practice.

In this study, 50.5% of patients did not know which category of weight status they were, and 63.6% under-assessed their weight status.


Furthermore, 80% of the participants reported an inability to measure and calculate their body mass index, and another 75% said they lacked knowledge on healthy weight, according to the study.

A large knowledge gap seems to exist for many patients.

Edmonds also recommended investigating sudden changes in refractive error and using a blood glucose finger stick test, which is within the scope of optometric practice in many states.

Another condition to watch for is unusual aging, he said. Conditions such as blepharitis and dry eye in a younger patient can be evidence of undiagnosed type 2 diabetes. Also pay attention to any premature aging of the tear film and lids. More commonly, optometrists will only look for vascular changes to the retina.

PCP comanagement

In addition to learning about the many risk factors, Edmonds encourages optometrists to communicate better with other physicians, as opposed to only working with ophthalmologists.

Gonzalez, agreed, saying that ODs have a large opportunity to work with primary care physician (PCPs), more so than ophthalmologists. He added that while in one day he may see a few cataract patients, he will encounter 20 hypertensives and/or patients with diabetes.

There is financial opportunity here, as well, he explained. It is a message that he hopes professional associations and organizations will carry forward to their optometric members.

“Optometrists involved in this type of interaction with PCPs will bring great value in this era of online refraction that threatens our practices,” Gonzalez said. “Having this type of interaction is critical to create value to differentiate your services from the [mass market eyeglass retailers] of the world. Adopting a model that manages the patient can ultimately be the tool that protects your practice from external threats.”

A cellular problem

During the Ocular Nutrition Society’s symposium prior to the 2013 American Academy of Optometry annual meeting, Daniel Pompa, DC, explained how obesity is caused by the inability to burn fat, resulting from hormone resistance.

Daniel Pompa

“Most Americans are stuck in sugar-burning mode. You don’t have to be overweight to have this problem. They get cravings they cannot control because they have no hormonal ability to utilize fat for energy,” he said at the symposium.

Pompa takes a page out of the optometry world in using contrast sensitivity testing to identify potential neurotoxicity.

He is the author of The Cellular Healing Diet and features Cellular Healing TV podcasts from his website.

He believes optometrists are positioned in a way to address inflammation and potentially identify the toxins driving the inflammation, before other providers notice there is a problem.

Gaining weight is the result of an improperly functioning or confused cellular system, he told PCON. The hormonal system in a patient with obesity is out of sync. The body’s cellular responses can no longer “hear” a person’s hormones.

Many people take hormones daily, “but taking more isn’t the solution. The key is to better hear the hormones you currently have,” Pompa added.

Recent research from Umeå University in Sweden published in the Journal of Affective Disorders highlights the link between cortisol levels and metabolic diseases. The researchers show that patients with bipolar disorder or recurrent depression with low levels of cortisol to a larger extent than other patients suffer from: obesity (34% vs. 11% among other patients), dyslipidemia (42% vs. 18%) and metabolic syndrome (41% vs. 26%).

Pompa suggested that the solution is often misunderstood as needing to count calories, where the real solution is fighting the inflammation. He hears many patients complain about eating right and eating less than most people they know, but still dealing with being overweight.

The toxins and inflammation must be addressed for true, long-lasting results, he said. Some examples of toxins can be mold, heavy metals and glyphosate (an active ingredient in herbicides).


He spoke of Stephanie Seneff, senior research scientist at the MIT Computer Science and Artificial Intelligence Laboratory, whose recent work has concentrated on nutrition and health. She believes glyphosate is in part responsible for the impact on the steep rise in obesity. Her papers and works explain how sulfate deficiency throughout the body is behind most modern diseases and conditions and how toxic chemicals in the environment, such as herbicides, may cause this deficiency.

Pompa understands that the No. 1 way to assess toxins and inflammation is through the eyes, and optometrists are poised to identify these risk factors up front.

“It is possible that these symptoms indicate a deeper toxic issue,” he said. “The Visual Contrast Sensitivity test, which is available for free at, can be very helpful, as well as looking at signs of diabetes and cardiovascular disease, both driven by inflammation.”

Treat the whole patient

Kimberly K. Reed

Reed says optometrists must work holistically, in a comprehensive manner. Finding the root cause of obesity in every patient may be impossible, but optometrists who exhibit a compassionate mindset and comprehensive exam will be headed in the right direction.

Optometrists can discuss a comprehensive approach to obesity management, including an exercise plan, lifestyle changes, surgery or medicine, she said.

By 2035, about 700,000 new cancers are predicted to be caused by being overweight or obese, according to an editorial from The Lancet in January.

“Obesity is a form of serious malnutrition... if two-thirds of a population had serious undernutrition or anorexia nervosa, there would be a recognized national emergency. Obesity needs much more serious attention than countries and global health organizations are currently prepared to give,” the editors said.

Our experts say optometrists have a call to action. The best way to treat this epidemic is head on, while being compassionate and understanding. — by Abigail Sutton

Disclosures: Gonzalez is a consultant for Bausch + Lomb and Shire. Edmonds and Pompa reported no relevant financial disclosures. Reed is global medical lead for U.S. Medical Affairs at Shire.