The Small Changes That Add Up to Better Health

By Maria Fleet

When we visit the doctor, we’re often getting tested to see if our health markers have changed for the worse – but in Dr. Deborah Horn’s world it’s just the opposite. She focuses on where her patients are succeeding.

Dr. Horn is the Medical Director for the University of Texas Center of Obesity Medicine and Metabolic Performance. As a specialist in treating obesity and excess weight, she starts off by asking her patients to identify the ‘single most important outcome’ they hope to achieve in coming to her practice. Surprisingly, it’s not usually a certain number of pounds lost. More often it’s something like better mobility or the ability to participate more in their lives.

For a patient she calls “Mrs. P”, it was being able to go visit her son, who lived in another town and, more dauntingly, in a home that was up three flights of stairs. At the time, Mrs. P. was living with  severe obesity and walked with a cane.

“I really find that ‘single most important outcome’ question helps me guide the individual coming to me… in what path we take together,” Dr. Horn says.

Along that path, she pays attention to a range of health measurements so patients can see progress, and experience some wins to help boost them along what is often a long road to better health. She takes readings of hemoglobin, A1C, blood pressure and cholesterol, but also measures more subjective things like functionality and pain. “I’m looking at where are all the places that we can win, so that along the journey that takes time, we can remember those places, identify them, measure them again, and show that success,” she says.

For Mrs. P., working with Dr. Horn to lower her weight also meant reducing her diabetes medications and gradually getting off blood pressure medications altogether. Along the way, she went from using a cane to walking without one.

In guiding Mrs. P and other patients like her to success, Dr. Horn is tackling head-on what has become a serious and growing epidemic in the U.S. as well as the world – obesity. The prevalence of obesity (defined as a body mass index of over 30) in the United States has increased from 30% to 42% since the year 2000, a troubling statistic given the other conditions that are associated with obesity.

“We now understand that there are 236 diseases or adverse health outcomes associated with obesity. And we can add one more to the list in the last two years, which is COVID,” she says.

These are daunting numbers – but there are some effective treatments for people struggling with excess weight. It’s just that many people don’t know about them.

That’s where specialists like Dr. Horn come in, who can offer a range of clinically proven treatments from lifestyle modifications, anti-obesity medications and/or surgery in a combination that’s right for the patient. And she provides careful monitoring that can furnish a window into their progress.

In the process of managing their weight, Dr. Horn is also helping her patients alleviate or prevent many other diseases. For example, she says, obesity puts stress on biological systems related to heart disease, which is the leading cause of death in the US.

“There are several ways that obesity contributes to cardiovascular disease, but at a mechanistic level, things like insulin resistance and inflammation are two of the most fundamental,” she explains. These are conditions that are known to increase the risk of heart attack or stroke.

On the positive side, even relatively small amounts of weight loss can result in measurable improvements in overall health. That’s why Dr. Horn and her patients pay attention to those health markers. And for heart health, the payoff can be big. Data from a study called the Look Ahead trial showed that people who lose about 10% of their total body weight could lower their risk of a cardiovascular event by about 20%.

But Dr. Horn never loses sight of the key benchmark – the ‘single most important outcome’ her patients talk about at the beginning of treatment. And Mrs. P is one of her success stories. After a year of therapy with Dr. Horn, tracking glucose levels, blood pressure, cholesterol and a host of other measurements, not only did Mrs. P get rid of her cane, but she traveled to see her son. She climbed all three flights of stairs – no problem – and got to meet his new fiancé.

Outcomes like that have Dr. Horn’s patients thanking her for changing their lives. But she gives the credit to her patients themselves, responding, “I didn’t change your life, I gave you the tools, and you changed your life.”