MEET THE DIPLOMATE

courtney younglove, md

 

Courtney Younglove, MD, FOMA, FACOG, DABOM began her career in Obstetrics and Gynecology in 2001. She obtained her board certification in Obesity Medicine in 2015 and initially tried to integrate her knowledge into her existing practice.  Her passion for the field continued to grow and it became more and more difficult to try and juggle two separate fields of medicine.  She eventually decided to pursue a career in Obesity Medicine full-time. She founded Heartland Weight Loss in 2018 and the practice has grown significantly since that time. She is very involved in the Obesity Medicine Association and is often found on a stage, presenting to clinicians or advocating for access to comprehensive obesity treatment within the employer/benefits space.  In addition to maintaining her private practice, she is currently working on an employer-provided obesity point solution to expand access to treatment.  When Dr. Younglove isn’t working, she can usually be found at an ice rink watching one of her three teenage boys play hockey or using some sort of power tool on her 6-acre urban farm.

Why did you pursue obesity medicine certification?  It was a perfect storm.  I had personally struggled with weight since puberty and tried every diet imaginable, without long-term success.  I heard the same story from my gynecology patients day after day.  It was the most common complaint I heard and I felt like a failure that I had nothing to offer them.  At the same time, obesity rates were climbing in our younger population.  The entire landscape of obstetrics was rapidly changing – with dramatic increases in pregnancy complications related to excess weight.   I developed a reputation as someone who treated women with obesity in a non-judgmental way, which shifted my obstetrical practice to caring for a high proportion of women with obesity.  This meant I was managing a lot of patients with gestational diabetes and hypertensive disorders of pregnancy, which meant a high rate of labor induction, c-sections, and postpartum complications.  Many of the things I was managing for my gynecology patients were also related to their weight and I eventually got tired of managing the complications and not having any tools to address the root cause – the excess weight.  I kept seeing brochures advertising CME credits in the field of Obesity Medicine (then called bariatric medicine) and figured it couldn’t hurt to try and learn more.  I spent a day at an “obesity essentials” course put on by the Obesity Medicine Association and was completely hooked.  The concept that obesity was more than a problem of willpower had never occurred to me and I dove into the science – and have never looked back!

Many doctors have told us about the “aha” moment that stimulated their interest in obesity medicine. Do you have an obesity medicine “aha” moment that sticks out in your memory?  I don’t have one specific moment but I remember looking at my schedule one day and writing down the reason for the visits.  Aside from the well-woman exams (during which almost every woman complained about weight gain), pretty much every visit was for an obesity-related complication (PCOS, endometrial hyperplasia, urinary incontinence, gestational diabetes, gestational hypertension, etc.) and it occurred to me that I was working too far downstream – I was essentially managing complications instead of preventing them.  I figured out how to graph vital signs in my EHR and began graphing all of my patients’ weight over time and it was shocking how many had been steadily gaining weight year after year.

How do you currently incorporate your obesity medicine training into your practice? My practice is completely focused on Obesity Medicine at this time.  After getting board-certified, I did a deep dive into what an intensive lifestyle intervention needed to look like, including a prescriptive nutritional intervention.  With very little insurance coverage for dietitians in the area, I figured that, in addition to providing medical management, it was also my role to address the other treatment pillars.  The longer I stay in this field and the more I learn, the more I realize how important the other pillars are, and I am constantly adapting the practice to reflect what I learn.

Why do you believe obesity medicine certification is valuable? Aside from a few lectures about vitamin deficiencies, I didn’t learn anything about nutrition in medical school.  Nor did I learn about metabolism, sleep, movement, the impact of chronic stress, motivational interviewing, or how to help people as they attempt to do really hard things like deploy an intensive lifestyle intervention.  Before doing the work to obtain certification, I considered anti-obesity medications risky and would never have prescribed them to my patients.  After becoming certified, I not only feel comfortable with the medications, but I also feel like I understand so much more about how we develop disease and how we can work on halting (and sometimes reversing) chronic disease.  Even if a physician doesn’t want to practice Obesity Medicine, exposure to the information and developing the mindset of thinking and addressing the disease of obesity with the same matter-of-factness that we discuss heart disease or depression will help patients so much.

What is your greatest success story so far? I hate measuring success in terms of pounds lost.  We’ve had lots of patients in our clinic lose 30% of their body weight or more, but what really makes me light up is when patients tell me that they think about food differently or no longer feel like they are hostage to weight cycling.  When we can help people figure out what drove the weight gain in the first place and interrupt that cycle, that’s when we have done something that will last them a lifetime.

What is the biggest challenge you face in your practice? Insurance coverage.  Commercial insurance carriers have placed (and continue to place) so many obstacles in the way of providing obesity treatment.  Obesity is a disease and should be treated under the umbrella of health insurance – just like we treat other diseases.  Before opening my practice, I did a deep dive into coding and health insurance and figured out how to treat my patients using health insurance (treating the comorbidities alongside the disease of obesity).  It has never been super profitable (private practice clinics that rely on office visits only never are), but that wasn’t why I opened the clinic and it wasn’t what guided my decisions.  I hired a nurse to do preventive medicine visits, deploying the intensive lifestyle intervention and prescriptive nutritional interventions that I had pulled together from the literature.  For a time, insurance plans reimbursed for these visits (not well, but enough to justify her salary).  When the pandemic began, we transitioned these visits to telehealth and outsourced them to a third-party health coaching company.  After a year, our biggest carrier suddenly (and without warning) stopped reimbursing for these visits via telehealth and we had to spend months trying to fix the books and take care of the patients that had to abruptly discontinue care.  We hired another nurse to perform these visits in person and a year later, that same carrier stopped reimbursing for those visits in person as well.   In early 2023, they began denying medical office visits, citing what they refer to as an “obesity exclusion” that is buried in their base plan.  Despite appealing the visits and demonstrating to them that, in addition to managing the disease of obesity, we are also diagnosing and managing obesity-related comorbidities, they have continued to deny reimbursement if we mention obesity treatment, discuss body composition, or prescribe any anti-obesity medication.  This large payor has gone back up to 12 months and retracted previously paid claims, shifting the financial burden to the patients.  We have since decided to drop this carrier and move everyone unlucky enough to have this carrier to self-pay.  Helping our patients navigate through that, while also creating a whole new business model (one that goes against my core belief that the disease of obesity should be treated by health insurance) and trying to balance that with a partially-insurance model has been the biggest challenge I have faced as a business owner.

What do you wish other physicians knew about treating obesity? I wish they could all see it as the complex, multifactorial disease that it is.  So many still think about it as an issue of willpower, which allows them to avoid addressing it with patients.   I can’t imagine ignoring a patient sitting in front of me with a broken bone because I wasn’t comfortable treating it – it would be unthinkable!  I love this “treat or refer” campaign that has recently been proposed – I hope it helps clinicians be more proactive in addressing excess weight with their patients.

Is there anything else you would like to share about your experience with obesity medicine? Being a part of a community of clinicians dedicated to treating obesity has been so inspiring.  Most people who go into this field are deeply passionate about wanting to help people – to make a difference.  Many, such as myself, walk away from successful careers to treat and advocate for people affected by excess weight.  The conferences are amazing, the collaboration is amazing, and the field is growing and changing like wildfire, which is exciting.


ABOM does not endorse or maintain control over any physician or affiliated entities featured in this section.  ABOM makes no representations, warranties, or guarantees, either express or implied, regarding the quality of care, performance, knowledge, services, inactions, actions or treatments (collectively “services”) provided by any such physician or affiliated entity and shall not be liable for any damage, loss, or other injury resulting from such services.  Individuals are encouraged to consult other sources to verify or obtain additional information about any such physician or affiliated entities.

 

X