Considering that over 40% of U.S. adults have obesity and there are fewer than ten thousand obesity medicine specialists, PCPs are a critical part of the solution as we tackle this epidemic. While PCPs have extremely limited time to delve into the complexities of obesity and provide support between visits, it’s wonderful when they are knowledgeable about evidence-based obesity treatment so that they can at least initiate the conversation and refer their patients to an obesity specialist.

But the collaboration doesn’t stop there. Obesity is not only a chronic disease in its own right; it is also associated with more than 200 other conditions that can affect all body systems. According to data from IQVIA, people ages 40-64 with obesity have 2.4 comorbidities on average. That figure rises to 4.9 for individuals 65 and over (and 7% of people in the latter age group have 10 or more comorbidities). Effective treatment requires taking these comorbidities — and the medications often prescribed for them — into account and communicating with other members of the patient’s care team throughout treatment.

The following are just a few of the subspecialties that obesity touches.

• Cardiology: The impacts of obesity on cardiovascular health — raising the risk of high blood pressure, heart attack and stroke, among other conditions — are among the best known and most thoroughly studied. In fact, the anti-obesity medication, Wegovy, was recently approved specifically to reduce the risk of adverse cardiovascular events in individuals with obesity and established cardiovascular disease.

• Endocrinology: Adipose tissue is an active endocrine organ that produces more than a hundred different hormones, so it’s no surprise that endocrinologists are frequently involved in treating obesity-related conditions — Type 2 diabetes being the most familiar, but also polycystic ovarian syndrome and infertility, among many others.

• Orthopedics: Obesity is a risk factor for the development of soft tissue damage and osteoarthritis in load-bearing joints, particularly the knees, due to both inflammation and mechanical stress. Joint pain then inhibits physical activity, which worsens obesity, creating a vicious circle — while also increasing the risk of complications associated with orthopedic surgery.

• Oncology: Obesity is a risk factor for the development of many types of cancers, including breast, colon, rectal, pancreatic, kidney, esophagus, ovarian, skin, liver, thyroid, gallbladder, brain (meningioma) and endometrial cancer. Researchers believe that excess body fat leads to hormonal and metabolic changes that trigger inflammation and promote tumor growth.

• Gastroenterology: Obesity is associated with many digestive system diseases, including gastroesophageal reflux disease, esophagitis, gallstones, metabolic dysfunction-associated fatty liver disease and cirrhosis, and various related cancers.

• Pulmonology: Individuals with obesity face a higher risk of asthma, obstructive sleep apnea and other respiratory conditions (including, as we observed with COVID-19, potentially worse outcomes from viral infections).

• Psychiatry: Obesity and depression are closely linked, with a bidirectional association, and it’s worth noting that many antidepressants can promote weight gain, so prescribers should be prepared to consider weight-neutral or weight-loss-promoting alternatives for patients with obesity when possible. Other common mental health comorbidities include anxiety and eating disorders.

For many of these obesity-related health complications, losing weight can be the first line of treatment, and the relationship is often dose-dependent, meaning that these conditions worsen as obesity worsens and improve as obesity improves. This correlation may lead us to instinctively reach for GLP-1 medications as the most effective option, since we want to help our patients lose as much of their excess weight as possible and experience the greatest benefit. But especially considering significant cost, coverage and supply constriants, other anti-obesity medications can still bring measurable health benefits and might even be preferable for many individuals. Losing just 5% to 10% of body weight can lead to clinically significant improvements in markers such as blood glucose, cholesterol and blood pressure.

Improving patient health — not just reaching an arbitrary number on the scale — is the ultimate goal. Obesity touches everything, and treating obesity can have a positive, cascading effect on other conditions. If we can help a patient achieve Type 2 diabetes remission, reversal of sleep apnea or improved fertility, we’ll have made a real difference in their life.

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Location of the Pancreas

The pancreas is located behind the stomach in the upper left abdomen. It is surrounded by other organs including the small intestine, liver, and spleen. It is spongy, about six to ten inches long, and is shaped like a flat pear or a fish extended horizontally across the abdomen.

The wide part, called the head of the pancreas, is positioned toward the center of the abdomen. The head of the pancreas is located at the juncture where the stomach meets the first part of the small intestine. This is where the stomach empties partially digested food into the intestine, and the pancreas releases digestive enzymes into these contents.

The central section of the pancreas is called the neck or body. The thin end is called the tail and extends to the left side.

Several major blood vessels surround the pancreas, the superior mesenteric artery, the superior mesenteric vein, the portal vein and the celiac axis, supplying blood to the pancreas and other abdominal organs.

Almost all of the pancreas (95%) consists of exocrine tissue that produces pancreatic enzymes for digestion. The remaining tissue consists of endocrine cells called islets of Langerhans. These clusters of cells look like grapes and produce hormones that regulate blood sugar and regulate pancreatic secretions.

Functions of the Pancreas

A healthy pancreas produces the correct chemicals in the proper quantities, at the right times, to digest the foods we eat.

Exocrine Function:

The pancreas contains exocrine glands that produce enzymes important to digestion. These enzymes include trypsin and chymotrypsin to digest proteins; amylase for the digestion of carbohydrates; and lipase to break down fats. When food enters the stomach, these pancreatic juices are released into a system of ducts that culminate in the main pancreatic duct. The pancreatic duct joins the common bile duct to form the ampulla of Vater which is located at the first portion of the small intestine, called the duodenum. The common bile duct originates in the liver and the gallbladder and produces another important digestive juice called bile. The pancreatic juices and bile that are released into the duodenum, help the body to digest fats, carbohydrates, and proteins.

Endocrine Function:

The endocrine component of the pancreas consists of islet cells (islets of Langerhans) that create and release important hormones directly into the bloodstream. Two of the main pancreatic hormones are insulin, which acts to lower blood sugar, and glucagon, which acts to raise blood sugar. Maintaining proper blood sugar levels is crucial to the functioning of key organs including the brain, liver, and kidneys.

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