MEET THE DIPLOMATE

milay luis lam, md

 

Milay Luis Lam, MD, FTOS, grew up in Lima, Peru where she did her medical school training at Universidad Peruana Cayetano Heredia. In 2009 she came to the US as a post doc research fellow to work at Elise and Celso Gomez Sanchez lab at University of Mississippi Medical Center, where she worked with mineralocorticoids and hypertension research. She moved in 2012 to Brooklyn, NY were she did her internal medicine and endocrinology training (Woodhull Med Center and SUNY Downstate). Upon graduation she stayed at SUNY as faculty and then moved to Pittsburgh for a faculty position at the division of endocrinology where she worked for the Obesity Medicine Group. She transitioned her career for a leadership opportunity, and is now the division Chief at Meritus Medical Center, where she leads a group focusing treatment in obesity and diabetes, and working with the community in Hagerstown, Maryland. 

Why did you pursue obesity medicine certification? I think it’s important to show the world the importance of the job we do. It’s not only that we “like treating obesity,” but that we are capable of doing it, and what better way of showing this than [achieving] obesity medicine certification.

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 “aha” moment was when I realized what obesity can do in the “right population” meaning, for the Asian/South Asian population, and the higher amount of visceral fat they have with lower BMI.  When I learned that Asian/South Asians were at higher risk with lower BMI, it made so much sense. My grandparents went from China to Peru in the 1930-1940s, so my parents were born in Peru, three of my grandparents were Chinese, and one of them was Chinese/ Peruvian. My mom got diabetes during her second pregnancy and my dad gained weight when my sibling and I were small. He ate a lot more and was focused on providing for us, then stopped exercising. That led to weight gain and eventually developing diabetes. I did not understand before why that happened, but when I learned, I focused my career on preventing diabetes and working on obesity. Both of my parents are no longer with me.

How do you currently incorporate your obesity medicine training into your practice?  I trained in internal medicine and then endocrinology. Perhaps 60-70 percent of my practice is managing obesity, in the context of endocrine disease, like PCOS and hypothyroidism, and non-endocrine disease, like obesity in the setting of pre and post bariatric care.

Why do you believe obesity medicine certification is valuable?  Obesity medicine is a “new field” and we need to learn so much more. Part of the certification is learning more about the disease we see on a daily basis, other providers trying to treat obesity with very little knowledge, not understanding that obesity is a medical problem like Hypertension or Diabetes, and trying to manage only with lifestyle modification , which we know, most of our patients need a multimodal approach, lifestyle, medication and many need surgery.

It’s important that more and more physician learn about obesity, and be more comfortable treating it, specially knowing that we have a lot of new therapies coming in the next few years.

What has been your greatest success story?  When I was working at SUNY Downstate in 2018, I had a patient with hypogonadism induced by obesity. He was  a very young person, 22 years old, with severe obesity and a BMI of 55. He had come referred by his PCP to see if I would prescribe testosterone. Being this young, we decided to work very hard on his weight, We started with a dietary plan, and at that time we added liraglutide. He then got a Roux en Y for obesity, and a few months later his testosterone came back up. I was very happy that we could help him be healthier in all aspects.

What is the biggest challenge you face in your practice? I still think we face challenges with insurance not understanding that obesity is a chronic medical problem. Once we get into a “normal BMI target,” they stop coverage for medications that are approved for long-term management. We need to work to educate more the insurance companies because unfortunately we depend so much on them.

What do you wish other physicians knew about treating obesity? That it is a very complex disease. We are learning more and more each day, but given the complexity of its nature, we have not learned how to treat it successfully yet, but we will not stop trying.

Is there anything else you would like to share about your experience with obesity medicine? I am amazed about how much advancement in the field we have seen in the past five years, and how we have changed the mind of many that did not believe obesity was treatable. When the second-generation obesity medications came out between 2012 and 2014, I saw hope, but even during that time, many providers were not open to prescribing medication. Now, 12 years have passed, and a new generation of meds have come out, and I see a change in people, more are more open to prescribe, although we are not were we should be. But there is so much hope for the people that suffer from obesity, I am very hopeful for the future.


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