MEET THE DIPLOMATE

dan maselli, md

Dr. Maselli is a gastroenterologist in Atlanta, GA, practicing at True You Weight Loss, the first and highest volume dedicated program for metabolic and bariatric endoscopy (“endobariatrics”). His clinical care focuses on the treatment of patients affected by obesity and related conditions through endobariatric procedures—such as endoscopic sleeve gastroplasty, intragastric balloons, transoral outlet reduction, and endoscopic revision of the vertical sleeve gastrectomy—as well as anti-obesity medications. Dr. Maselli actively participates in prospective trials on novel endobariatric therapies and has published extensively in the field. He enjoys the opportunity to speak on and educate learners about the role of endobariatrics in the multidisciplinary obesity care continuum. 

Why did you pursue obesity medicine certification? I am a gastroenterologist who helps patients affected by obesity through endoscopic bariatric therapies (endobariatrics). As much as I enjoy endobariatrics, I recognize that obesity and obesity management is more than just a procedure. I wanted to ensure that I was treating patients in the context of their chronic condition, and formal obesity medicine education and certification struck me as a powerful way to do this.

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? When I was in my general gastroenterology fellowship, I was very interested in non-alcoholic steatohepatitis (NASH); however, I was frustrated at the lack of therapeutic options available for these patients, who were repeatedly told, “just lose weight.” Our research team then published a study on the use of endobariatric procedures in the treatment of NASH. This experience taught me at least two things: first, it highlighted how obesity directly or indirectly drove a lot of the pathology we observe in the digestive tract, and second, that patients with obesity may need (and, for that matter, deserve) effective treatment options for obesity beyond recommendations of behavioral modification.

How do you currently incorporate your obesity medicine training into your practice? My practice focuses entirely on the endoscopic and pharmacologic management of obesity, so the principles of obesity physiology, diagnosis, risk stratification, and management are bedrock elements of every day of my care for patients.

Why do you believe obesity medicine certification is valuable? The obesity medicine certification has helped me understand obesity as a chronic, progressive, relapsing, and multifactorial disorder. Framing obesity as a disease—and a chronic one—has helped me explain the benefits and rationale of both treatment and long-term follow up to my patients. Equally as important, this certification has provided training in recognizing, avoiding, and addressing obesity stigma, which has improved the way I approach each encounter and care for my patients.

What is your greatest success story so far? I’ve enjoyed performing the purse-string transoral outlet reduction (TORe) procedure for patients who experience a return of weight after their Roux-en-Y gastric bypass. The purse-string technique is pretty challenging, and the first time I was able to perform this on my own felt like a tremendous accomplishment.

What is the biggest challenge you face in your practice? I continue to see the multiple, pernicious ways that obesity stigma harms and hinders patients affected by obesity—and their openness to seeking treatment. Whether through anti-obesity medications or an endoscopic bariatric therapy, many of my patients have said they’ve been told these are the “easy way out of obesity.” It’s really quite a shame. Moreover, treatment for obesity has been frustratingly cast as an impulse of vanity, which also is rooted in stigma. So, we have patients who are seeking treatment to improve their health and well-being—within a chronic, progressive disease with over 200 related comorbid conditions—who are told your treatment is unjustified or unworthy or superficial or cheating. This outlook causes patients with obesity to avoid seeking medical care (worsening health outcomes) and may pose barriers to coverage for safe and effective treatments.

What do you wish other physicians knew about treating obesity? I would hope they would be amenable to the framing of obesity not as a manifestation of lack of willpower but as a chronic, progressive, multifactorial, and relapsing condition—one worthy of concern, treatment, and longitudinal care.

Is there anything else you would like to share about your experience with obesity medicine? It’s an exciting field that endeavors to frame one of the most prevalent and relevant health conditions of our time—there’s not a specialty within medicine that isn’t touched by this disease.


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