Written by Rosalind Fournier
Photography by Beau Gustafson
When the American Medical Association voted in June to officially classify obesity as a disease, it was a welcome development in the eyes of many research scientists and physicians. The AMA’s position has the potential to make an important difference in determining the willingness of insurance companies to cover obesity treatments, while maybe—just maybe—spurring a shift in the public’s attitude towards the problem.
The designation has its share of skeptics—but Dr. Timothy Garvey, professor of medicine and chair of the department of Nutrition Sciences at the University of Alabama at Birmingham, is not one of them.
“Obesity is like lung cancer, for instance,” says Garvey, who is known worldwide for his research in the pathogenesis of insulin resistance, type 2 diabetes and obesity. “You have somebody who smokes cigarettes, which is a behavioral act, and then they get lung cancer. Everybody recognizes lung cancer as a disease that needs to be treated it according to a medical model.
“Well, obesity is related in part to behavioral activities as well,” he continues, “and it’s every bit a disease as lung cancer is. Just like lung cancer, there are genetic determinates of the disease that interact with behaviors and environment to create the disease. And it’s not a benign disease—it confers morbidity and mortality and decreases quality of life primarily due to the complications that come with it.”
Garvey knows that plenty of us think otherwise. It’s too tempting, as he put it, to think of being overweight or obese as a “lifestyle choice.” It’s why we tsk-tsk at the woman who doesn’t fit in a standard airplane seat, the overweight teenager who dares to eat a candy bar in our presence, or even the patient who goes in for bariatric surgery as a last-resort because none of his other attempts at weight loss have worked. Who hasn’t heard the words reverberate in their head a million times: If they’d just eat less and exercise more… And then, I eat sensibly to stay slim, why can’t they?
Further adding fuel to the prejudices while simultaneously slowing the search for answers is the fact that for a great many people, things like portion control and regular exercise do work wonders in helping with weight loss and weight control. Even many who’ve see the pounds creep up over the years achieve remarkable results through fairly conventional interventions, including enrolling in respected weight loss programs, finding a “diet buddy” to exchange healthy recipes and exercise with, or even downloading popular iPhone diet apps like MyFitnessPal that track every calorie that goes into your body. In other words, some, if not all, of the conventional wisdom is true.
But it’s still not the whole story. There is an increasing amount of scientific research being done on other possible factors, including not just variations in metabolism, but also genetic composition, little-known viruses, and our environment. Meanwhile, when simply overeating is the primary cause of weight gain, Garvey says that can also involve “complex psychological behavioral traits, and even those can be determined by genes,” he says. “So there are few simple answers. But in my view we’re now in a rapidly changing environment in terms of how people conceptualize obesity and how it will be managed.”
The hope is that the more we understand about why people gain excess weight, the better able we’ll be to help those whose weight is undermining or potentially destroying their quality of life through complications, or co-morbidities, ranging from diabetes and heart disease to osteoarthritis, sleep apnea and stress incontinence.
“All of these are complications of obesity that make people suffer and make people die early,” Garvey says matter-of-factly. “Sounds like a disease to me.”
Daron Drew, an outgoing woman in her 20s, says that a few years ago she would have described herself as the “happy, fun, chubby girl” whose social–butterfly persona masked a lot of inner turmoil. “Inside, I had a lot of pain,” she says. “I would be thinking, ‘Am I pretty enough? Why am I not married?’ Just the same things that all girls think about. And when I got sad about a breakup or had a bad day of work, I would go get wings and French fries and a big sweet tea. Whenever I got into mental ruts in my life, I was turning to food.” She weighed 290 pounds and was moving in the wrong direction.
Tom Walton, a first-time grandfather in his early 60s, remembers weighing around 190 pounds in the early 1980s. From there, like so many people, he too started moving in the wrong direction in terms of his weight. “I gradually worked up to 250 in the mid ’90s, and it just kept creeping up,” Walton remembers. He attributes most of the weight gain to being careless with his diet and living a very sedentary lifestyle. “I wasn’t exercising, wasn’t doing anything—just working at a desk all day looking at a computer.”
By last fall, he was looking down at the scale to a number that scared him into taking action. He weighed 371 pounds. “So I had a wake-up call and said, ‘I’ve got to do something.’ I was borderline diabetic and didn’t want to go there, so I told myself, it’s time to get it together.”
Around the same time, he read an article about a man who had lost 300 pounds with help from UAB EatRight, a holistic, lifestyle-oriented weight control program at the University of Alabama at Birmingham. Walton looked into it, and by October, he was on board with the program.
For Drew, who works in human resources at UAB, it was a casual conversation with a potential hire that lit a fire in her. “She told me about this program—UAB EatRight—that she and her husband were doing, and she had lost 200 pounds,” she remembers. “I said, ‘What do I have to lose?’ I’m the kind of person who will try anything once. I started researching it, saw how people lost so much weight, and for me it was just ‘wow,’ and I ended up joining the program.”
A Flight Surgeon’s Inspiration
The impetus behind the creation of EatRight came from an unlikely source: an Air Force flight surgeon named Dr. Roland Weinsier who helped a sergeant’s wife lose weight using a plan that focused on volume rather than calories. He later joined the UAB faculty and put his theories to work in what eventually the EatRight program.
Today, UAB Eat Right has grown into one of the country’s most successful weight-loss programs. Director Taraneh Soleymani attributes that to the program’s comprehensive, patient-driven approach. “It’s not just a physician caring for them,” she says. “We have exercise trainers, dietitians…our team approach is very unique.”
Dietician Lindsay Lee agrees. “We don’t just give patients a diet, or just give the same diet to everybody. We really try to set goals together with the patient.”
Many patients who need to lose 50 pounds or more and may have moderate to high-risk medical problems related to their weight begin with EatRight Optifast, a program that kick starts weight loss with six to 12 weeks—depending on the patient’s needs and goals—of a full liquid-meal-replacement diet.
Both Drew and Walton started out with the Optifast diet. For Drew, although she’d already come to understand many of the triggers that caused her to overeat, being restricted to an all-liquid diet taught her a lot about the role food normally played in her life. “It’s almost like you have to change your total mindset. There were days last summer when I would just go home and go to sleep because I didn’t want to do anything,” she says, adding that it wasn’t because the diet left her feeling hungry or lethargic but because eating was so much a part of her normal activities—especially her social life—that for a while everything she used to enjoy seemed to lose its luster.
“When you go to church and go out to eat afterwards, or go to the mall and stop by the food court, or go to a cocktail party, what are you doing to do? You’re going to eat hors d’oeuvres and drink alcohol,” she says. “You don’t realize how many things you do in your life revolve around food.”
Re-learning to Eat
Another challenge came when it was time to start incorporating solid foods back into her diet. For six weeks, she followed a transitional plan of first eating one meal a day, with Optifast meal replacements for the rest, and working her way back to a fully “normal”—or, better put, “new normal”—diet. She began preparing grilled chicken, salmon, vegetables and other healthy alternatives to the fried foods and pizza she still craved. “I had to retrain my taste buds,” she said. “It works, but it’s a struggle. It’s not something that comes naturally to me. It’s a lifestyle change.” She says the support and behavioral counseling she continued to receive through EatRight taught her tricks like always thinking ahead about meals, whether it’s suggesting a healthy restaurant when she’s planning to eat lunch out with a friend or what she’s going to make for dinner that night. “I’m always forward thinking about my nutrition and what I’m putting in my body.”
Walton agrees that learning new eating habits as he was coming off the Optifast diet was hard at first, but spurred on by his wife, who lost 25 pounds herself with a shorter version of the EatRight program. He took it on as a challenge. “I grill a lot of vegetables out on the grill with a little vinegar, and I’ve learned to love asparagus, broccoli, squash, Brussels sprouts, okra and bell peppers,” he says. “I don’t eat steak and hamburgers and stuff like that anymore. I eat grilled chicken, and it’s delicious. I love yogurt, which I never had before this diet. Yogurt’s my ice cream now.”
Walton now weighs 220 pounds and has even inspired one of his employees to join the program. “He started back in February, and he’s already lost almost 90 pounds.” He says his goal is to get below 200 before his 62nd birthday in December.
For her part, Drew is now a size 12—a far cry from the size 22 she wore when she started—and hopes to get down to an 8 or 10. In the meantime, she says, her thinner self has taught her a lot about who her true friends are. While one might expect the response to someone losing weight to be overwhelmingly positive, Drew sometimes has mixed feelings about what she hears. “While I was on the diet, people would say, ‘You’re going to gain all that weight back.’ And even now, people make some of the meanest comments I’ve ever heard in my life. They don’t think they’re doing anything bad, but they’ll say, ‘I know people must like you more now.’ Really? Why wouldn’t they like me then?’ So I really prefer people just don’t talk about my weight when I see them. I don’t mind telling them that I did it through UAB EatRight or answering questions like that, but I don’t want the entire conversation to be about my weight loss.”
A Lifetime Commitment
Both Drew and Walton admit they’re not perfect and still occasionally give into the temptation to eat something they usually consider off-limits. But they both feel they have the tools and determination when that happens to get back on track. “Have I had a weekend where I’ve just bombed it? Yes,” Drew says. “But EatRight has changed my thought process and helped me to correct my bad behavior. So when I have days where I think, ‘Oh, I just want to eat what I want to eat,’ I know that I can’t live a healthy life thinking like that.”
For Walton, he has an additional motivator that keeps him on track if he ever finds himself starting to waver. “I have a beautiful seven-month-old granddaughter, and she was one of the inspirations that sparked me and motivated me to get my act together in the first place,” he says. “Thinking about her helps me stick with the choices that are good for me. I want to still be around 18 years from now to see her graduate from high school.”
* * *
David Allison, PhD, distinguished professor and associate dean for science at the University of Alabama at Birmingham School of Public Health, is on the cutting edge of research being done in the scientific arenas of obesity and weight loss. He has worked at some of the most prominent institutions in the field, including the New York Obesity Center at Columbia University and St. Luke’s Roosevelt Hospital, which at the time was the only federally funded obesity research center in the U.S. There are now several more, including UAB, where Allison directs both the Nutrition Obesity Research Center and the Office of Energetics.
Recently Allison took time to tell us about some of the latest revelations in obesity research—including a few he describes as “surprising, unexpected or even counterintuitive.” He also held forth on some of his biggest pet peeves, such was theories about obesity and weight loss that get lots of attention but have little scientific evidence to back them up.
Q: Far and away the most common advice overweight people hear is just to “eat less, exercise more.” It’s like a mantra. In what ways are we oversimplifying the problem?
A: I have come to believe that there may be factors influencing obesity levels in individuals or populations that don’t necessarily involve simply telling individuals to try to eat less or exercise more. That doesn’t mean that it’s inappropriately said that eating less or exercising more is important. What it means is there may be unconventional, unexpected or even counterintuitive factors that seem to influence obesity—some of which seem to influence obesity via forms of food intake and some that seem to influence obesity independent of food intake.
We all intuitively recognize that we’re not all the same, and what works for you might differ from what works for me. Yet actually demonstrating that is a little bit difficult. We have some very general things, like if you’re very severely obese, obesity surgery may be the best bet, whereas if you’re very mildly obese or simply overweight, surgery may not be appropriate. But that’s not really building on this idea of people having different causes of their weight problems and then getting to those causes. It’s still largely a point of conjecture.
Q: Is the medical community in general coming around to the idea that we might need to look beyond the conventional wisdom on weight loss?
A: Clearly I think the nation’s interest in obesity has increased tremendously in the last 20–30 years, just as obesity has increased tremendously. So what’s happened is that it went from being mostly a topic that a slightly obscure group of academics studied to being something where the public-health community cared about it.
However, as more people who aren’t hard-core scientists became involved, there’s actually been some degradation of the quality of thinking in the obesity field compared to 20 years ago. A lot of people are offering a lot of opinions about what we should do that are often uninformed by the science of obesity.
So we can respect the public-health advocates for the goodness of their intentions and in some cases the wisdom of what they’re providing or saying. But we can also say it’s time to ask some hard questions about what the evidence actually supports.
Q: Speaking of which, do you get frustrated when you go through the grocery checkout line and see that half the magazines have stories about yet another new miracle weight cure?
A: It is maddening the extraordinary degree of misinformation out there about many things, but especially obesity and body weight. It’s really quite sad. So we do try to work to dispel some of that misinformation. We had a paper in the New England Journal about six months ago about myths and presumptions of obesity that thankfully got a good deal of press, and I think did get people thinking more critically about obesity and what we really know and don’t know.
But if you look at the press releases that organizations put out, including sadly sometimes those scientific journals, and especially the university press offices, they’re often very misleading and exaggerated. You look at the kind of statements that the scientific authors themselves sometimes make in the media, and they’re often inappropriate or exaggerated when it comes to their own work. Then you look at what the mass media writes, and it often exaggerates it further or completely misconstrues it. The poor consumer is left totally confused and misled.
Q: So what are some of the science-based theories that you won’t find on the cover of a mainstream magazine?
A: In 1994, Dr. Jeff Friedman at The Rockerfeller University did studies of mice that led to the identification of the hormone leptin. And this hormone circulates through the body and bloodstream, and it seems to be involved in the regulation of body energy source, appetite, food intake and energy expenditure.
Now it turns out that the vast majority of humans in the world have normal leptin, so the ability to make leptin is not the cause of obesity for most people. There are, however, a very small number of people with mutations in the leptin gene that make it so they cannot make a form of leptin that works. Those people don’t get the signal in their body and brain of having enough fat. And they act as though they starving both behaviorally and physiologically; they have ravenous appetites and low energy expenditure and become hugely obese.
What’s interesting is that once you find such a person, the thing to do is obvious. Just like for a type 1 diabetic who can’t make insulin, the obvious thing to do is to give them insulin to make up for what they can’t produce ordinarily. So for these people, just give them leptin. That’s a life-changing treatment for them.
Now, you’re talking about only a dozen or so people on the entire planet. But this is a great example of how once you understand how people become obese, you know how to cure it. We need to find out how to do that more generally.
Q: What are some other questions about obesity that interest you right now? I know you’ve been looking at viruses that could contribute to obesity…
A: It’s been shown very convincingly that a virus called adenovirus–36 causes obesity in several animal species including mice, rats, chickens and marmosets. They’ve also shown it’s associated with obesity in humans. Whether it causes obesity in humans remains debatable, but when you’ve got an association with humans and four different animal special which have shown causation, it’s plausible that it causes obesity in humans as well. And so I think that’s a very high area of interest.
Q: What about epigenetics, or genetic modifications brought about by different environmental cues?
A: There are many ways in which the environment can affect body weight or obesity. One way is through genetic modification. So the environment can create what is called epigenetic effect, and that involves changing a sequence of the nuclear DNA, making a chemical alteration to the DNA. We know from animal studies that it can be done and can have effects. What we’re still learning is what effects it will have on humans.
Potentially this can in part account for regional and geographic differences in obesity rates. But we don’t fully understand these. Again, I think the public health advocates often look at things like geographic differences in obesity at a very superficial level and came up with ideas like “food deserts” (a theory that people living in poorer areas have less access to healthy foods than those in wealthier areas). And I don’t think the idea of food deserts was ever terribly well thought out from a scientific point of view. So far the data collected in the past few years has suggested that food deserts probably do not play an important role in obesity.
Q: It does seem as though all of us feel qualified to talk about what does or doesn’t cause obesity.
A: Let’s suppose, for example, you and I were talking about a different disease or condition than obesity. Let’s say we were talking about a disease in which some people didn’t grow bone properly and so their bones were extremely weak. Such diseases exist. Now, most of us are not experts in bone formation. So it would seem improbable that you and I might wind up at a cocktail party somewhere talking about this horrible disease of bone formation, and start speculating on what to do…but obesity somehow seems different. There are a lot of prejudices about obesity, and we just think we understand it.
And you even hear people say sometimes that we don’t need science to know what’s obvious…that we should stop doing this and start doing that. It reflects this kind of naivety about obesity, and I think the cause of that, both within and without the academic community, is often a sense that we don’t need to approach it like scientists. My message to the community has been to say, we should treat it just like any other question we treat as scientists, with an open mind.
* * *
Some 200,000 people in the U.S. elect to have bariatric, or weight-loss, surgery every year. It is almost always an option of last resort for patients who are considered morbidly obese and have tried and failed many times over to lose weight through other means. Whether it’s a celebrity like Sharon Osbourne, Anne Rice or former American Idol judge Randy Jackson, or closer to home, such as someone in your family or circle of friends, chances are that you know of someone who has had bariatric surgery. Nevertheless, no matter how many people elect to take this drastic step, negative perceptions of the procedure stubbornly persist.
“In some circles, there’s definitely a stigma to it,” says Dr. Richard Stahl, who leads the University of Alabama at Birmingham bariatric surgery program along with Dr. Jayleen Grams. He adds that even some of his own colleagues and primary care physicians tend to take a dim view of the procedure. “You sometimes hear people say, ‘Sure, those patients lost the weight, but they didn’t do it on their own.’ In reality, by the time the patients come to us, they have already tried and failed numerous weight-loss measures…it is not that they want to have surgery or that it was a first stop for them.” In fact, Stahl will not perform bariatric surgery—which is an umbrella term for different kinds of weight-loss surgeries, including gastric bypass, sleeve gastrectomy and adjustable gastric binding surgery—on a patient who has not tried to lose weight through alternate means.
“We still think the best way to lose weight if you’re able to do it is with diet and exercise, not with surgery,” Stahl continues. “The problem is, for people who are that big, seldom do diet and exercise have long-term success. And in those cases, they might be candidates for bariatric surgery.”
Stahl never actually set out to develop a specialty in bariatric surgery. But he did his residency training at Carraway Methodist Medical Center under the tutelage of Dr. Henry Laws, considered a pioneer in bariatric surgery, and received extensive training in the cutting-edge work Laws was doing.
After his residency, Stahl went into private practice as a general surgeon, and word grew quickly that he was well trained in weight-loss surgery. “As I began doing more and more on my own rather that just in training, I got pretty interested in it. The patients did so well, they were so grateful for the procedure, and it really changed their lives.”
Then in the early 2000s, he began doing the operations laparoscopically, a major advance in bariatric surgery. Stahl, already in heavy demand for weight–loss surgery, saw it basically take over his practice, and he’s never looked back.
The requirements to become a candidate for bariatric surgery can vary from one practice to the next—as can additional requirements insurance companies often impose in order to cover the procedure. In general, though, a body mass index (a weight to height ratio) of at least 40 is required. Stahl says he also looks for “significant obesity-related co-morbiditiey,” including Type 2 diabetes, heart disease, hypertension, arthritis, joint disease and obstructive sleep apnea that may qualify a patient for weight loss surgery at a body mass index of 35. Co-morbidities are no small factor. If losing weight were just about looking better, Dr. Stahl and other bariatric surgeons would probably not be in the business they’re in. But the co-morbidities of obesity not only dramatically reduce a patient’s quality of life, they are often fatal, which helps to explain the fact that being obese is a leading cause of preventable death in our country.
Weight-loss surgeries themselves, of course, do carry some risks. These include the possibility of developing gallstones and a risk of blood clots, pulmonary embolism or deep vein thrombosis. Gastric bypass patients can also develop a leak between the stomach and intestine requiring additional surgery to repair it. Risks depend somewhat on the patient’s overall health going into surgery and have been reduced over the years as techniques have improved.
Moreover, Stahl is quick to point out that even without risks, the surgery is not a panacea. Patients are extensively counseled on the changes in diet and exercise they must make post-surgery to make the weight-loss stick long term. Surprisingly, it’s been found they have a hidden weapon in that battle: “The operations actually physiologically change the person’s appetite, drive and desire to eat,” Stahl explains. “There is something about creating this new avenue for food to travel”—gastric bypass, for instance, involves dividing the stomach into unequal portions; the food that is swallowed goes into a portion only an ounce in size or smaller, before passing into the intestine farther downstream than it would have pre-bypass—“causing alterations in gastrointestinal hormones that we are only beginning to understand. There is something about the signaling between the GI tract and the brain that actually makes it easier for patients to follow a diet.”
Stahl concedes it is still possible for a patient to eventually undermine the surgery and regain all of the weight they lose, but this is rare. In fact, the long-term success rate is fairly remarkable: Stahl says the commonly accepted definition of successful weight-loss surgery is when a patient loses 50 percent or more of his or her excess weight (pounds above a person’s ideal body weight). For gastric–bypass surgery, the weight–loss surgery that has been around the longest, 70 to 80 percent of patients successfully meet that standard—and for those who don’t, most still derive significant benefits from whatever amount of weight loss they do achieve.
Stahl also points to other important measures of success that go beyond numbers on the scale. Improvement of a patient’s co-morbidities is another important measure, and most patients see significant improvement in—or outright disappearance of—some or all of these. Even with diabetes, for which no outright cure is available, Stahl points out that weight-loss surgery is “far and away the most successful treatment,” with somewhere between 60 to 80 percent of patients being able to come off of all of their diabetes medications.
“Those are all the great objective measures of success,” Stahl says, “but then there’s the subjective success. And that’s the patient who comes back to you a year, two or even five years after surgery and says, ‘You’ve given me my life back.’ But in fact, I in no way gave them their life back. They took their life back. They took control of the situation, had the operation and they feel wonderful about it.”
* * *
These days, Beth Parker’s husband likes to tease her and call her a cheap date. That’s because when they go out to dinner, she not only eats less than she used to, she eats less than the average American who may never have struggled with weight issues.
“I can order a kid’s meal and split it with him,” she laughs.
Now a svelte size 6–8, Parker has seen her life change in more ways than she can count since having had gastric–bypass surgery in 2007. Prior to that, “I pretty much struggled with weight all my life,” she says. At one point she weighed 295 pounds. “You would be amazed how cruel people are when you’re overweight. I wish everybody knew what it felt like, so they would understand what it feels like.”
Her breaking point, she says, wasn’t so much a particular weight she’d reached as a dangerous shift in her attitude about it. “I just didn’t care anymore,” Parker says. “That was the straw that broke the camel’s back. I was in my early 30s, and I knew something had to happen.”
She started learning about weight-loss surgery after she began working at the University of Alabama at Birmingham and went in for a consultation. She says she underwent extensive screening and was deemed an excellent candidate for the surgery, especially because she had not yet developed any of the serious complications that often come with being seriously overweight.
She had the surgery, and it represented a major turning point. With gastric bypass, the stomach is basically divided into two unequal parts. The smaller part, where people experience fullness, is only the size of one or two tablespoons. “You can basically eat a thimbleful of stuff, and that’s about it,” Parker explains. It still took a couple of months before others could begin to see the pounds coming off—and she says there were times the weight loss seemed to plateau—but over the long haul, she just kept losing and losing. Then one day she came out of the shower and noticed something that hadn’t happened in about as long as she could remember. “I could wrap a towel around myself fully,” Parker explains. “That was my ‘aha’ moment.”
Today, she says she’s as committed as ever to staying thin and is fully aware that while surgery might have kick–started the weight loss, the rest is still up to her. “A lot of people think surgery is the easy way out,” she says. “But I have to work out just as much as everybody else, and constantly watch what I eat. And I take it as a challenge: I’m going to show any skeptics that I am not going to fail.”
Parker attributes her success to a number of other things, including a strong support system comprised of family, friends and her physician. She carries a picture of herself at her heaviest on her cell phone as a constant reminder of what she doesn’t want to look or feel like ever again. Finally, a few years ago, she took a further step of having plastic surgery to remove the excess skin that lingers after a person has lost an extreme amount of weight. That surgery represented another major milestone in her commitment to staying thin. “I got my life back,” she says.
Parker adds while nobody who meets her now would ever know that she used to be overweight, she doesn’t mind sharing. “This is my journey, and I’m proud of it. That was who I was, and this is who I am now. It’s just been a life-changing experience.”
* * *
When you think of weight-loss medication, it’s hard to think past the ubiquitous infomercials, absurd-sounding promises and those ’50s era “diet pills” that were actually amphetamines.
The good news, according to Dr. Timothy Garvey, professor of medicine and chair of the department of Nutrition Sciences at the University of Alabama at Birmingham, is that we’ve come a long way since then.
Prior to 2012, he says, we had a handful of medications, and each came with distinct limitations. Phentromin, among the most commonly prescribed, is only approved for short-term treatment—less than three months—“which doesn’t jibe too well with the fact that obesity is a lifetime disease, so it was of limited utility,” he says. Another one, Orlistat, impairs fat absorption but can have unpleasant side effects like flatulence (and worse), particularly for people who continue to eat a high-fat diet while taking it. “Both of those medications were modestly effective, but that’s all we really had,” Garvey says.
But the summer of last year two new prescription medicines came on the market that seem to show greater promise. One is Qysmia, for which Garvey was involved in many of the clinical trials. “It’s actually a combination of two drugs, both of which have been around for a while, but combined, they get some synergy that results in greater weight loss than either one alone and with fewer side effects,” he explains. The other new drug he considers promising is Belviq, just approved in June.
“These medicines don’t absolve the patient from any responsibility they need to bring to the table to help treat their disease,” Garvey emphasizes. “But as medications are needed to improve patients’ health and fight this disease, I think we should be ever–ready to use those to the patients’ benefit. And there are more on the way that are being developed and tested, and the hope is that just as with diabetes, we will have multiple drugs we can use as we individualize therapy. So I think the future looks bright.”