MEET THE DIPLOMATE
karl nadolsky, do
Dr. Karl Nadolsky is a clinical endocrinologist at Spectrum Health in Grand Rapids, MI, and clinical assistant professor of medicine at Michigan State University. He developed and served as director of the Diabetes, Obesity & Metabolic Institute and was faculty for the endocrinology fellowship program at Walter Reed National Military Medical Center, Bethesda until separating from the US Navy in 2017 after 9 years of service. Dr. Nadolsky graduated from Michigan State University in 2003 with a degree in kinesiology, earning academic all-American, four-time academic all-Big Ten scholar athlete and four-time NCAA qualifier honors for the varsity wrestling team. He stayed at MSU for one year serving as the strength and nutrition coach for the wrestling team. He graduated from Nova Southeastern College of Osteopathic Medicine in 2008 and completed a residency in internal medicine in Portsmouth, VA, graduating in 2011.
Following residency, he practiced for two years as a general internist and implemented a comprehensive obesity program at Naval Medical Center, Portsmouth. He is a co-author of the AACE 2016 Clinical Practice Guidelines for Comprehensive Medical Care of Patients with Obesity.
Why did you pursue obesity medicine certification?
My background in athletics and interest in the physiology of body composition and performance really set the basis for what I felt I could bring to society. I have a passion for lifestyle as medicine along with an interest in understanding pathophysiology and obesity is the underlying disease process that drives so much of the chronic disease we treat as a medical community. I specifically have interest in preventing and treating cardiometabolic disease including type 2 diabetes and atherosclerotic cardiovascular disease resulting from obesity. Having a recognized subspecialty in obesity medicine allows patients and colleagues to navigate and utilize those with an interest and expertise to best help the patients who need it most.
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?
My younger brother (also diplomate of ABOM) and I were discussing our future medical careers with our aunt (a cardiologist) describing our passion for helping others optimize nutrition and exercise to improve insulin resistance and she stated, “well that sounds like you should pursue endocrinology.” That sounded about right but when I was in residency, we were introduced to the Obesity Medicine Association (formerly ASBP) and The Obesity Society. It seemed obvious to me that if I could specialize in obesity, then that was the obvious path to choose. I had two mentors in residency who supported this goal and helped me pursue that.
How do you currently incorporate your obesity medicine training into your practice?
I practice obesity medicine within the field of endocrinology as it is obviously the critical component to the cardiometabolic disease of a large proportion of our patients. I just recently separated from the Navy and left Walter Reed National Military Medical Center where it was my top priority to put together a comprehensive obesity treatment program. It took nearly all of two years of fellowship and two years as faculty but we established a nice collaboration with bariatric surgery focusing on obesity and behavioral education for patients led by a clinical psychologist flanked by nutritionists and exercise physiology. I left it in good hands and I expect it to flourish. I just joined a new system in Grand Rapids, MI and we have the same goal. Obesity is such a critical condition to treat as the underlying cause or contributor to so many diseases, especially in endocrinology, that it must be addressed first-line. When I see patients one-on-one, I feel it is beneficial and appreciated to discuss their complications of obesity in the context of the pathophysiology of obesity as patients then get very engaged with the holistic treatment plan of dietary adjustments, physical activity, sleep, stress management, and then medications and/or surgery.
Why do you believe obesity medicine certification is valuable?
Certification is valuable for anyone who wants to be on the front lines of treating the obesity epidemic because it obviously prepares clinicians to practice at a level of standard of care and instills confidence in patients seeking that specialized help.
What is the biggest challenge you face in your practice?
Like most, I suspect, it boils down to systems-based practice and coverage for behavioral therapy, multidisciplinary components, and pharmacology. As a professional group, we need to continue working with colleagues and stakeholders to strive toward establishing standards of care and appropriate reimbursement to optimize outcomes for patients.
What has been your greatest achievement so far?
Clinically I am very proud of the program we established at Walter Reed National Military Medical Center but in the grand scheme of advancing obesity medicine, I am very proud of the contributions made to the American Association of Clinical Endocrinologists Obesity committee. I was a co-author of the 2016 clinical practice guidelines and have continued to help with the obesity resource center.
What do you wish other physicians knew about treating obesity?
Obesity is not a choice and all physicians need to embrace the complexity of the disease along with the external and internal factors which make it a very difficult disease to deal with on an individual basis (population basis also). It is important to avoid casting blame on patients and instead empower them with the knowledge of the disease and tools to combat it.
Is there anything else you would like to share about your experience with obesity medicine?
Obesity medicine is the ultimate “holistic” specialty as it is the disease process which adversely influences all systems. This requires concerted efforts by all stakeholders to continue to advance the support for care for patients in a comprehensive and multidisciplinary manner. Obesity medicine has continued to advance at a rapid pace since I certified in 2012 with more available pharmacology, understanding of pathophysiology, and progress with weight bias and acceptance as a disease process. I think the future is bright.
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