Obesity Care Approaches With Integrative Medicine

Discover the benefits of integrative medicine for obesity care in treating weight issues through holistic, personalized methods.

Abstract

Welcome to our educational post on navigating the multifaceted challenges of obesity and chronic disease management. From my perspective as Dr. Alex Jimenez, and informed by my extensive training as a Doctor of Chiropractic, Advanced Practice Registered Nurse, and certified functional medicine practitioner, this article serves as a deep dive into the real-world complexities our patients face. We will journey through a series of detailed case studies that highlight distinct yet common hurdles: from the profound impact of low socioeconomic status, food insecurity, and cultural dietary habits to the logistical hurdles of geographic challenges and the physiological toll of chronic stress and structural barriers.

Throughout this guide, I will share evidence-based strategies, drawing from the latest research in nutrition, exercise physiology, behavioral health, and pharmacology. We will explore practical solutions for making healthier choices in unconventional settings, the nuances of culturally sensitive dietary modification, and creative, safe, at-home exercise options. A significant portion of this post is dedicated to understanding and managing the profound impact of chronic stress and emotional eating on weight management. We will also examine the role of modern anti-obesity medications (AOMs), including GLP-1 receptor agonists, and discuss how to select the appropriate pharmacotherapy while considering patient-specific factors like insurance coverage and accessibility.

Crucially, this post will illuminate the power of an integrative care model. I will explain how our practice, Injury Medical Clinic PA, led by our esteemed Medical Director, Dr. Maria Guadalupe Cardenas, MD, combines medical oversight with chiropractic care, functional medicine, and comprehensive rehabilitation. This collaborative approach allows us to provide holistic, patient-centered care that addresses not just the symptoms but the root causes of chronic illness, ensuring our patients receive the multifaceted support they need to achieve lasting health and well-being.

Our Integrative and Multidisciplinary Team: A Collaborative Approach to Health

At the heart of modern, effective healthcare is collaboration. I am Dr. Alex Jimenez, and my practice is built upon this very principle. My credentials—DC, APRN, FNP-BC, CFMP, IFMCP, ATN, CCST—reflect a career dedicated to understanding the human body from multiple perspectives, from its intricate biomechanics to its complex biochemistry. However, true comprehensive care extends beyond a single practitioner’s expertise. The human body is an intricate system, and addressing complex conditions like obesity, chronic pain, or injuries from a single vantage point is often insufficient.

This is why I am honored and proud to work alongside Dr. Maria Guadalupe Cardenas, MD. Dr. Cardenas is a highly respected physician, board-certified in Internal Medicine, with an impressive tenure of over 40 years. Her extensive experience and deep medical knowledge are invaluable. As the Medical Director and Collaborative Physician (NPI #1164426749, Texas MD License #J2933) at our practice, Injury Medical Clinic PA (also known as Mission Plaza Injury Medical Clinic) here in El Paso, Texas, she provides the essential medical oversight that anchors our integrative model. This partnership between a Doctor of Chiropractic (DC) like myself, who also holds advanced practice nursing and functional medicine credentials, and an experienced Medical Doctor (MD) is a powerful synergy. This structure is common and highly effective in forward-thinking integrative and injury care clinics, ensuring patients receive the full spectrum of care under one roof.

Our clinic operates as a multidisciplinary team. This structure allows for a seamless fusion of different specialties. Here’s how our team at Injury Medical Clinic PA works together to provide holistic and personalized care:

• Medical Oversight (Dr. Cardenas, MD): Dr. Cardenas provides crucial medical direction, overseeing diagnostic processes, prescribing necessary medications when appropriate, and ensuring all treatments align with the highest standards of medical safety and efficacy. Her role is vital in managing the complex comorbidities often associated with obesity and personal injury, such as hypertension, diabetes, and metabolic syndrome. She reviews complex cases and ensures our treatment plans are medically sound.
• Integrative Chiropractic Care (Dr. Jimenez, DC): As a chiropractor, my focus is on the body’s structure and its relationship to overall function. I utilize spinal adjustments, soft tissue therapies, and other manual techniques to restore proper biomechanics, alleviate pain, improve nervous system function, and enhance the body’s innate ability to heal. In the context of obesity, this is critical for addressing musculoskeletal pain that can be a barrier to physical activity and for improving overall physiological communication.
• Functional Medicine: With my certifications in Functional and Integrative Medicine (CFMP, IFMCP), we dig deeper to uncover the root causes of disease. Instead of just treating symptoms, we investigate the intricate web of genetics, lifestyle, and environmental factors that influence a patient’s health. This involves comprehensive lab testing, nutritional analysis, and personalized plans to address gut health, hormonal imbalances, detoxification pathways, and more. This dual focus allows me to create highly personalized wellness plans.
• Personal Injury and Rehabilitation: We specialize in treating patients who have suffered injuries, often from automobile accidents or workplace incidents. Our rehabilitative services focus on restoring function, reducing pain, and preventing long-term disability through targeted exercises, physical therapies, and chiropractic adjustments.
• Advanced Practice Nursing (APRN, FNP-BC): My qualifications as a Family Nurse Practitioner allow me to bridge different disciplines, providing comprehensive patient assessments, developing treatment plans, and offering patient education from a nursing perspective that emphasizes holistic well-being.
• Integrated Services: We blend these core disciplines with a suite of other services, including nutritional coaching and behavioral health support. When a patient comes to us, they are not just seeing a chiropractor or a medical doctor; they are entering a coordinated system of care designed to address their health from every possible angle.

This collaborative model allows us to create a cohesive and powerful treatment strategy. A patient with obesity and back pain, for instance, can receive a medical evaluation from Dr. Cardenas, chiropractic adjustments and rehabilitative exercises from me, and a functional medicine workup to address the metabolic drivers of their weight gain and inflammation. This comprehensive approach ensures that we are not just managing a single symptom but are treating the whole person, paving the way for sustainable health and lasting results. The following case studies are perfect illustrations of how we apply this integrated philosophy to navigate the complexities of chronic disease.

Case Study 1: Navigating Low Socioeconomic Status and Food Insecurity

Let’s begin by exploring a case that embodies some of the most profound challenges we see in clinical practice: the intersection of poverty, food insecurity, and chronic disease. I want to introduce you to a patient we’ll call Sarah T. Her story powerfully illustrates how systemic issues directly impact individual health.

Presenting Sarah T.: A Profile of Resilience and Struggle

Sarah is a 30-year-old single mother of two young children, ages five and eight. She works part-time as a cashier at a local coffee shop. Her financial situation is precarious; she is classified as low-income, relying on government assistance programs like the Supplemental Nutrition Assistance Program (SNAP), commonly known as food stamps. To make ends meet, she frequently depends on a local food pantry and, at times, leftovers from her job to feed herself and her children.

From a clinical standpoint, Sarah’s health markers are flashing warning signs:

• Body Mass Index (BMI): 37.5 kg/m², placing her in the category of Class II Obesity.
• Waist Circumference: 42 inches, an indicator of high visceral adiposity (the dangerous fat stored around internal organs) and increased cardiometabolic risk.
• Metabolic Health: Her lab work reveals a classic picture of metabolic syndrome.

• • Hemoglobin A1c:0%, indicating prediabetes. This means her body is struggling to manage blood sugar effectively.
  • Triglycerides: 165 mg/dL (elevated).
  • HDL Cholesterol (the “good” cholesterol): 38 mg/dL (low).
  • LDL Cholesterol (the “bad” cholesterol): 111 mg/dL (borderline high).

• Blood Pressure: 136/76 mmHg, which is considered elevated.
• Mental Health: Sarah also lives with anxiety and depression, conditions deeply intertwined with her constant financial worries, her health concerns, and the immense stress of raising two children on her own.

Currently, she is not taking any medications. This presents both a challenge and an opportunity for us to intervene with foundational, lifestyle-based strategies.

Understanding the Weight History: A Story of Trauma and Transition

To effectively help any patient, we must first listen to their story. Taking a thorough obesity and weight history is not just about plotting numbers on a chart; it’s about understanding the life events that have shaped a person’s health journey.

Sarah’s struggles with her weight began after the birth of her children, a common experience for many women due to hormonal shifts, changes in sleep patterns, and increased stress. However, her weight gain became more significant over the past five years, during which she gained approximately 60 pounds. This period coincided with a traumatic life event: her divorce from an abusive husband.

This detail is critically important. A history of trauma can profoundly alter a person’s physiology and psychology. Chronic stress from abuse can lead to dysregulation of the hypothalamic-pituitary-adrenal (HPA) axis, the body’s central stress response system. As highlighted by Kyrou et al. (2018), this can result in elevated cortisol levels, which promote the storage of visceral fat, increase appetite for high-calorie “comfort ” foods, and disrupt sleep—all of which drive weight gain. Recognizing this history of trauma means our approach must be exceptionally patient-centered, empowering, and sensitive to avoid any chance of re-traumatization. As Williams, Lawrence, and Davis (2019) emphasize, such experiences are not just psychological burdens but are deeply embedded in an individual’s physiological health.

A Deeper Look at Sarah’s Diet and Physical Activity

Nutrition History:

When we discussed her dietary habits, Sarah explained that they are highly variable and dictated by circumstance. There’s no regular pattern, which is a hallmark of food insecurity. Her diet primarily consists of:

• Foods obtained from the food pantry.
• Items she can purchase at SNAP-eligible stores.
• Leftovers from the coffee shop where she works.

Unfortunately, these sources often provide foods that are high in refined carbohydrates, calorie-dense, and low in essential nutrients like protein and fiber. Items like pastries, sugary drinks, pasta, and processed snacks are cheap, readily available, and shelf-stable, making them staples in a food-insecure household. Fresh produce and lean protein are often expensive and inaccessible luxuries.

Physical Activity History:

It’s equally important to understand a patient’s relationship with physical activity, both past and present. We must ask not only what they are doing now but also what they have enjoyed in the past.

Currently, Sarah is not engaged in any regular physical activity. However, she shared that before having children, she was quite active. She enjoyed walking, group exercise classes, and, in particular, dance classes at a gym. This is a crucial piece of information. It tells us shedoesn’tt dislike exercise; she faces significant barriers to it. The primary barrier is financial—a gym membership is not in her budget. Her roles as a single parent and a part-time employee also create significant time constraints. Knowing what she enjoys gives us a positive foundation to build upon.

The Overlapping Web of Challenges

Sarah’s situation is a perfect storm of interconnected barriers:

• Financial Constraints: Her limited budget and reliance on assistance programs severely restrict her access to nutrient-dense foods like fresh produce and lean protein.
• Food Insecurity: This creates a constant state of uncertainty, impacting not just what she eats, but when and how much. This unpredictability can lead to a cycle of undereating followed by overeating when food is available, which disrupts metabolic regulation.
• Time and Access Barriers: Juggling parenting, work, and household responsibilities leaves her with little time or energy for structured physical activity.
• Lack of Insurance Coverage: Her health insurance does not cover obesity pharmacotherapy, limiting our options for medical intervention.
• Psychological Burden: The immense weight of her financial stress, her history of trauma, anxiety, and depression all contribute to a state of chronic stress that physiologically promotes weight gain and makes it harder to adopt and sustain healthy behaviors. Dutton and Bodell’s (2021) research underscores how this chronic stress is a key factor in both the development and maintenance of obesity.

It’s vital to recognize that we cannot and should not attempt to solve all of these problems in a single visit. This is why establishing a therapeutic alliance and scheduling regular follow-up appointments is paramount. Our approach must be incremental, focusing on one or two manageable goals at a time, building momentum and self-efficacy with each small success.

Our Integrative Treatment Goals for Sarah

Our comprehensive plan for Sarah must be multifaceted, compassionate, and realistic. We want to empower her to take control of her health by providing her with tools and resources that fit her life.

1. Identify and Leverage Community Resources: We need to help her navigate her local environment to find affordable, healthier food choices. This involves understanding what her local food pantry offers and how to maximize her SNAP benefits.
2. Develop Realistic Exercise Recommendations: We will co-create a physical activity plan that is enjoyable, accessible, and fits into her demanding schedule. We’ll start slow and build gradually.
3. Address the Psychological Impact: We must acknowledge and address the profound impact of food insecurity, chronic stress, and her history of trauma on her health. This means fostering a safe and empowering clinical environment and connecting her with mental health resources.
4. Explore Affordable Pharmacologic Options: Even without coverage for newer obesity medications, we can explore older, more affordable, off-label options that may provide her with a much-needed metabolic boost.

A Walk Through Sarah’s Typical Day: Identifying Opportunities for Change

To truly understand Sarah’s challenges and identify actionable opportunities, I asked her to walk me through a typical day. This narrative provides invaluable context that a simple food log or questionnaire often misses.

• 6:00 AM: The day begins. Sarah wakes up and gets herself and her two children ready for the day.
• Breakfast: The kids’ breakfast is typically cereal with milk or juice—quick, easy, and kid-approved. Sarah often skips breakfast herself or grabs something on the go.
• Morning Routine: She drops her children off at school. A small relief is that they have free school lunches, which eases some of her financial and logistical burden.
• At Work: She arrives at the coffee shop. Her “breakfast” is often a coffee, but it’s important to ask what’s in the coffee. For Sarah, it includes sugar-sweetened vanilla syrup. Throughout her shift, she often grazes on leftover scones, muffins, or other pastries from the previous day. This is not a structured meal but rather a continuous intake of high-sugar, high-fat foods. This grazing pattern can lead to sustained high levels of insulin, promoting fat storage.
• 12:00 PM (Lunchtime): Sarah’s eating schedule is erratic. She doesn’t take a formal lunch break. She continues to drink coffee and snack on leftovers as time allows.
• 3:30 PM (After School): She picks up her kids. The School: An after-school snack, typically processed, high-carbohydrate items like Goldfish crackers or pretzels. She often joins them, eating some of their snacks.
• Dinner: Dinner is a daily puzzle, determined by what was available at the food pantry or what she could afford with her SNAP benefits. She also prioritizes foods her children will eat to avoid waste, a common concern for families with limited resources. This often leads to meals like pasta, macaroni and cheese, frozen pizza, or chicken nuggets—foods that are palatable and cheap but nutritionally poor.
• Evening (Post-Bedtime): After a long day of chores, bathing the kids, and getting them to bed, Sarah finally gets some “me time” around 9:30 PM. For many people, especially those under immense stress, this is a vulnerable time. She decompresses by watching TV and snacking on cookies, pretzels, or chips. This isn’t about hunger; it’s about using food as a coping mechanism to manage stress and seek comfort. This behavior is deeply rooted in the brain’s reward system.
• Bedtime: She goes to bed late, often scrolling on her phone until around midnight. The blue light from the phone can suppress melatonin production, disrupting her circadian rhythm and impairing sleep quality. She sometimes snacks in bed as well.

This daily narrative is a goldmine of clinical information. It highlights specific patterns—the morning sugary coffee, the daytime grazing on pastries, the evening stress-eating—that we can gently and collaboratively begin to address.

Nutritional Strategy: Working Within a World of Constraints

Our nutritional guidance for Sarah cannot be a generic “eat more salads and grilled chicken” prescription. It must be grounded in her reality.

1. Empowerment Through Knowledge:

The first step is education. We need to empower her to become a savvy consumer within her limited environment.

• Food Label Literacy: We can teach her how to read nutrition labels at the food pantry or grocery store. The goal is to focus on a few key metrics: finding foods higher in protein and fiber, and lower in sugar and simple starches.
• Leveraging Technology: Since Sarah has a smartphone, we can introduce her to free nutrition-tracking apps. These apps are not just for counting calories; they can be powerful educational tools. She can scan a barcode at the food pantry and instantly see the nutritional breakdown of an item, helping her identify better choices in real-time.
• Identifying “Power Foods”: We can help her create a list of affordable, nutrient-dense foods to look for. These might include:

• • Canned proteins: Tuna, salmon, or chicken (packed in water).
  • Legumes: Canned or dried beans, lentils, and chickpeas are excellent sources of protein and fiber.
  • Nut Butters and Seeds: These provide healthy fats and protein.
  • Frozen Produce: Frozen fruits and vegetables are just as nutritious as fresh, last longer, and are often more affordable.
  • Eggs and Dairy: If available and affordable, these are excellent protein sources.

2. Clinical Immersion and Community Engagement:

As healthcare providers, our advice becomes infinitely more practical when we understand the resources available to our patients. I strongly encourage all clinicians to volunteer at a local food pantry. Doing so provides firsthand insight into the types of food that are actually available. My own experience revealed an abundance of fresh produce but a scarcity of fresh protein. Knowing this allows me to give Sarah more specific and useful advice, such as pairing the available vegetables with canned beans or tuna to create a more balanced meal.

3. Utilizing Educational Resources:

We can also direct Sarah to resources designed specifically for her situation. The USDA SNAP-Ed program offers a wealth of educational materials, recipes, and tips for eating healthy on a budget. Their website, as cited in our references, is a valuable tool we can share.

4. Setting Realistic, Incremental Goals:

Once Sarah has a foundational understanding of nutrition, we can work together to set achievable goals. This is where motivational interviewing becomes essential. Instead of dictating a plan, I would ask, “Based on what we’ve talked about, what’s one small change you feel confident you could make this week?” Perhaps the goal is to limit total carbohydrates to under 100 grams per day or to ensure she gets a specific amount of protein at one meal. These small wins build the confidence needed for long-term change, a principle central to lifestyle modification approaches described by Wadden, Tronieri, and Butryn (2020).

Medication Management: Finding Affordable and Effective Options

Sarah’s lack of insurance coverage for branded obesity medications like Wegovy® or Zepbound™ is a common and frustrating barrier. However, it does not mean we are without options. We must think creatively and utilize older, more affordable medications, often in an off-label capacity. This is where Dr. Cardenas’s medical oversight is crucial, ensuring any prescription is safe and appropriate for the patient.

• Metformin: Sarah has prediabetes. Metformin is a first-line medication for type 2 diabetes and is frequently used off-label for prediabetes and weight management. It works by improving insulin sensitivity and reducing the liver’s production of glucose. It is incredibly affordable (often available for just a few dollars a month) and can lead to modest but meaningful weight loss.
• Generic Sympathomimetics: Medications like phentermine, phendimetrazine, and diethylpropion are sympathomimetic amines that work by suppressing appetite. While they are FDA-approved only for short-term use (up to 12 weeks), their long-term, off-label use is common in obesity medicine, provided state laws permit it, and the patient is carefully monitored. These medications are also very inexpensive.
• Topiramate (Off-Label): Topiramate is an anti-epileptic medication that is also used for migraine prevention. A known side effect is weight loss, often due to appetite suppression and changes in taste perception. It can be used off-label as a monotherapy or in combination with phentermine the formulation of the brand-name drug Qsymia®).
• Bupropion + Naltrexone (Off-Label): The combination of bupropion (an antidepressant) and naltrexone (an opioid antagonist) is available as the brand-name drug Contrave®. However, prescribing these two medications as separate generics can be significantly more affordable. This combination can be particularly beneficial for Sarah. Bupropion can help address her underlying depression and anxiety. At the same time, the combination works on the brain’s reward pathways to reduce cravings and emotional eating—the very behavior she exhibits in the evenings.

By exploring these generic, off-label options, we can provide Sarah with a pharmacological tool to complement her lifestyle changes, making her efforts more effective and sustainable.

Re-Imagining Physical Activity: The FITT-VP Principle in Action

For physical activity to become a lasting habit, it must be enjoyable, accessible, and integrated into a person’s life. We will use the FITT-VP principle, as outlined in the Canadian obesity clinical practice guidelines (Wharton et al., 2020), as a framework to co-create a plan with Sarah.

• F (Frequency): How often? We might start with a goal of 3 days a week.
• I (Intensity): How hard? We’ll begin with low-to-moderate intensity.
• T (Time): How long? Perhaps just 10-15 minutes per session initially. The key is to start with a duration that feels completely manageable.
• T (Type): What kind of activity? This is where we draw on her past enjoyment of walking and dancing.
• E (Enjoyment): This is the secret ingredient! If she doesn’t enjoy it, she won’t stick with it.
• V (Volume): The total amount of activity per week. Our initial goal will be modest, with a long-term aim of reaching the recommended 150 minutes of moderate-intensity activity plus two days of strength training.
• P (Progression): We will plan for gradual increases in frequency, time, or intensity as she gets stronger and more confident.

Here are some concrete, no-cost or low-cost ideas we could explore with Sarah:

• At-Home Workouts: She can find countless free dance workout videos on platforms like YouTube. She can do these in her living room, perhaps even involving her kids for a fun family activity.
• Community Resources: Local libraries often lend out exercise DVDs. Community centers or parks may offer free or very low-cost fitness classes.
• Walking: A simple walk around her neighborhood is a great starting point. She could listen to music or a podcast to make it more enjoyable.
• Bodyweight Strength Training: We can teach her simple exercises like squats, lunges, push-ups (on her knees to start), and planks that she can do at home with no equipment.
• Utilizing Technology: Her smartphone has a built-in accelerometer that can function as a pedometer. We can set a small, achievable daily step goal and gradually increase it.

The Chiropractic and Holistic Perspective: Addressing the Foundations

Beyond nutrition, medication, and exercise, a truly holistic plan must address the body’s foundational systems. This is where integrative chiropractic care and a focus on sleep and mental health become indispensable.

1. Chiropractic Care for Pain and Function:

For many individuals with obesity, musculoskeletal pain is a major barrier to physical activity. The excess weight places significant strain on the joints of the spine, hips, knees, and ankles. As a chiropractor, my role would be to:

• Assess and Correct Biomechanical Imbalances: Through a thorough examination, I can identify areas of spinal misalignment (subluxations) and joint dysfunction that contribute to pain and limit mobility.
• Perform Chiropractic Adjustments: Gentle, specific adjustments can restore proper joint motion, alleviate nerve pressure, and reduce pain. This can make movement more comfortable, making it easier for Sarah to engage in the walking or dancing she enjoys.
• Improve Nervous System Function: The spine houses the nervous system, which controls and coordinates every function in the body. By improving spinal health, we can enhance the communication between the brain and the body, potentially improving the function of the very systems—like the endocrine and digestive systems—that are involved in metabolism.

For Sarah, relieving the physical stress on her body can directly improve her ability to become more active and can also help reduce her overall physiological stress load.

2. Sleep Hygiene: The Unsung Hero of Weight Management:

Sarah’s habit of scrolling on her phone until midnight is a significant, yet often overlooked, driver of her health issues. Poor sleep or insufficient sleep has profound metabolic consequences, as detailed by Yaribeygi et al. (2017):

• It increases ghrelin (the “hunger hormone”).
• It decreases leptin (the “satiety hormone”).
• It impairs insulin sensitivity.
• It increases cortisol
• It diminishes willpower and executive function, making it harder to resist cravings and stick to a healthy plan.

Our intervention here would be gentle and educational. We would talk about the importance of sleep and collaborate on creating a relaxing bedtime routine.

• The “Digital Sunset”: Suggesting she put her phone away an hour before her desired bedtime.
• Creating a Sleep Sanctuary: Making her bedroom a cool, dark, and quiet environment reserved for sleep.
• Wind-Down Activities: Replacing phone scrolling with activities like reading a book, listening to calming music, or gentle stretching.

Even a small improvement in sleep quality can have a disproportionately large positive effect on her metabolism and energy levels.

3. Mental and Emotional Support:

Sarah’s journey is laden with trauma and chronic stress. Addressing her mental health is not an optional add-on; it is a core component of her treatment plan. We must be a source of support and a bridge to professional help.

• Empathetic Listening: Creating a safe space where she feels heard and validated.
• Connecting to Resources: Actively helping her find low-cost or free mental health services in her community. This could include community mental health centers, support groups (both online and in-person), or counseling services offered through churches or non-profits.
• Trauma-Informed Care: Every interaction must be guided by the principles of trauma-informed care, emphasizing safety, trustworthiness, choice, collaboration, and empowerment. We must put her in the driver’s seat of her own care, allowing her to set the pace and make choices that feel right for her.

By weaving together these diverse threads—nutritional guidance tailored to her budget, affordable medical options, realistic physical activity, foundational chiropractic care, and robust mental and emotional support—we can create a truly comprehensive and compassionate plan for Sarah. Her case is a stark reminder that obesity is rarely a simple matter of “eat less, move more.” It is a complex condition deeply embedded in a person’s life story, environment, and physiology. Our role is to act as skilled and empathetic guides on their journey toward better health.

Functional Medicine’s Influence Beyond Joints- Video

Case Study 2: The Crossroads of Culture, Diet, and Chronic Disease

In our multicultural society, understanding the deep-seated connection between cultural dietary habits and chronic health conditions is paramount for effective patient care. This case study explores this intricate relationship and highlights our collaborative, integrative treatment strategy.

Introducing Our Patient: Rajesh

Let me introduce you to Rajesh (a representative patient profile). He is a 52-year-old Indian American gentleman who works as an IT specialist. He lives with his wife, who lovingly prepares their family’s traditional Indian meals, and they have one teenage son. Rajesh came to our clinic with several health concerns that are, unfortunately, all too common.

Rajesh’s Health Profile: A Snapshot of Metabolic Syndrome

When we look at Rajesh’s clinical presentation, we see a constellation of findings that point toward metabolic syndrome, a cluster of conditions that occur together, significantly increasing the risk for heart disease, stroke, and type 2 diabetes.

• Class One Obesity: His Body Mass Index (BMI) is 31, which places him in the category of class one obesity. BMI is a useful screening tool, but it doesn’t tell the whole story.
• Central Adiposity: More concerning is his waist circumference of 43 inches. This measurement is a critical indicator of visceral fat—the metabolically active fat that surrounds the internal organs. High levels of visceral fat are a major driver of inflammation and insulin resistance.
• Gastroesophageal Reflux Disease (GERD): He takes omeprazole, a proton-pump inhibitor, to manage his acid reflux. While providing symptomatic relief, long-term use of such medications can have its own set of consequences, including potential nutrient malabsorption. From a functional medicine perspective, GERD is often linked to dietary triggers and intra-abdominal pressure from excess weight.
• Type 2 Diabetes: Rajesh has a formal diagnosis of type 2 diabetes and is currently on metformin 1000 mg. His most recent Hemoglobin A1c (HbA1c) was 6.8%. The HbA1c test gives us a three-month average of his blood sugar levels. A level of 6.5% or higher is diagnostic for diabetes, so at 6.8%, his diabetes is not yet under optimal control.
• Hyperlipidemia: He also has elevated blood lipids (cholesterol and triglycerides), for which he is prescribed atorvastatin, a common statin medication. Here are his specific numbers:

• • Total Cholesterol: 220 mg/dL (Desirable: <200)
  • LDL (“Bad”) Cholesterol: 140 mg/dL (Optimal: <100)
  • HDL (“Good”) Cholesterol: 35 mg/dL (Protective: >60)
  • Triglycerides: 250 mg/dL (Normal: <150)

This lipid profile is characteristic of insulin resistance: high triglycerides, low HDL, and often, an increase in small, dense LDL particles, which are particularly atherogenic (plaque-forming).

Uncovering the Roots: The Weight History

As with any patient struggling with weight, the first step is to take a detailed weight history. This narrative provides crucial context beyond the numbers. Rajesh reported that he was of a normal weight throughout his childhood and adolescence. His weight gain has been insidious—a gradual creep of two to three pounds per year over the last ten years.

This pattern is very common. There was no single “triggering event” like a major injury, a stressful life change, or a new medication. Instead, it was a slow, almost unnoticeable accumulation resulting from a subtle but persistent energy imbalance. This slow progression often allows the associated health problems, like rising blood sugar and blood pressure, to develop silently over many years. His job as an IT specialist is also fairly sedentary, which is a significant contributing factor to a lowered total daily energy expenditure.

The Central Role of Diet and Culture

When we delved into his dietary habits, the core of the issue became clear. Rajesh’s diet is primarily vegetarian, which can be incredibly healthy. However, the composition of his diet is what matters most. His meals are rich in traditional Indian staples that he and his family love:

• Rice: A frequent base for meals.
• Naan: A delicious but refined-flour flatbread.
• Lentils: An excellent source of protein and fiber, but often part of a larger carbohydrate-heavy meal.
• Ghee-based dishes: Ghee (clarified butter) is a traditional fat, but its use can contribute significantly to overall calorie intake.

A significant challenge emerged during our conversation: his wife, the primary cook in the household, is understandably resistant to changing her traditional cooking methods. These recipes have been passed down through generations and are an expression of love, culture, and identity. This is a critical point. In our clinic, we always ask, “Who does the grocery shopping? Who prepares the meals?” The answer identifies a key person who must be part of the health journey. As Dalle Grave, Calugi, and Marchesini (2020) point out, attempting to impose dietary changes without involving family is a recipe for failure and can create tension.

Physical Activity: Sporadic and Unstructured

In terms of physical activity, Rajesh’s efforts are sporadic. He enjoys playing pickleball with friends and family, which is fantastic. It’s social, fun, and a great form of exercise. However, it’s not a structured part of his routine. He has access to a gym at the same facility where he plays pickleball, but he doesn’t utilize it regularly. This combination of a sedentary job and inconsistent physical activity creates a significant gap between the calories he consumes and the calories he expends.

A Day in the Life of Rajesh: Mapping the Metabolic Journey

To truly understand the physiological impact of his lifestyle, we walked through his typical day, from morning to night. This detailed mapping allows us to pinpoint the exact moments where interventions can be most effective.

• 7:00 AM: The High-Carbohydrate Breakfast: Rajesh wakes up and starts his day with a traditional breakfast, often including Idli (steamed rice cakes) or Dosa (a crepe of rice and lentils), plus coffee with milk and sugar.

Physiological Impact: This meal is predominantly composed of rapidly digesting carbohydrates, leading to a sharp spike in his blood glucose. His insulin-resistant cells struggle to take up this glucose, leaving it in the bloodstream. The liver converts the excess into triglycerides and stores it as visceral fat, worsening the cycle of insulin resistance. The meal lacks sufficient protein and fiber, which are essential for satiety and slowing glucose absorption.

• Mid-Morning to Afternoon: The Lunch Skip and Vending Machine Trap: Rajesh often gets so busy at work that he skips lunch entirely. By mid-afternoon, intense hunger and rebound hypoglycemia set in, leading him to the office vending machine for chips or cookies.

Physiological Impact: Skipping lunch creates a long gap without fuel, which can slow metabolism and lead to intense cravings. The vending machine snacks are a perfect storm of refined carbohydrates and unhealthy fats, perpetuating a rollercoaster of blood sugar and insulin levels.

• Evening: The Traditional Family Dinner: Dinner is the main meal, and it is hearty and carbohydrate-dense, including rice, dhal (lentil stew), vegetable curries with potatoes, and roti or naan.

Physiological Impact: The sheer volume of carbohydrates overwhelms his metabolic capacity. The large bolus of carbs late in the evening leads to another significant glucose and insulin surge. Because he is less active, his liver converts the excess carbohydrates into fat for storage via de novo lipogenesis, worsening his obesity and hyperlipidemia.

• Post-Dinner: The Dessert Ritual: The meal concludes with a sweet dessert.

Physiological Impact: This final addition of concentrated sugar is the final blow to his metabolic control, providing an unnecessary spike in blood glucose just before bed and contributing to his elevated HbA1c.

The Power of Asking the Right Questions

In functional and integrative medicine, the quality of our questions determines the quality of our solutions. When discussing nutrition with any patient, especially one like Rajesh, it is essential to ask with genuine curiosity and respect:

“Do you have any religious, cultural, or personal beliefs that guide or restrict your dietary choices?”

This question is a powerful door-opener. It signals to the patient that you see them as a whole person, not just a diagnosis. It allows us to proactively address potential conflicts and co-create a plan that fits within their life, rather than asking them to build a whole new life around our plan.

Our Integrative Treatment Plan for Rajesh

Our goals for Rajesh are clear: improve his glycemic control, promote weight loss, and reduce his cardiovascular risk. Our approach must be collaborative, culturally sensitive, and multi-pronged.

Goal 1: A Culturally Sensitive Nutritional Strategy

The cornerstone of our plan is not to eliminate his traditional foods but to re-engineer the plate and the recipes.

• Portion Control and Plate Re-engineering: We use the “plate method” as a visual guide, aiming to shift the proportions:

• • 50% Non-Starchy Vegetables: Spinach, okra, cauliflower, etc., prepared in traditional styles.
  • 25% Lean Protein: Dhal, paneer, tofu, chicken, or fish.
  • 25% Starchy Carbohydrates: Reducing the portion of rice, roti, or potatoes.

• Incorporating Low-Carb Alternatives: We negotiate substitutions, such as cauliflower rice for white rice or using whole wheat flour (atta) for roti.
• Engaging the Family: This is non-negotiable. I would strongly encourage Rajesh to invite his wife to his next appointment. We can praise her cooking, acknowledge her traditions, and then gently explain the physiological reasons for adjustments. Often, family members become powerful allies. We can also provide resources like the Obesity Medicine Association’s Cultural Healthy Eating Guides.
• Meal-by-Meal Modifications:

• • Breakfast: We need to boost protein. Suggestions include scrambled tofu or paneer, Greek yogurt, or chilla (savory lentil-flour pancakes). We’d also plan to gradually reduce sugar in his coffee.
  • Lunch: To break the skipping habit, he needs a simple, protein-rich option. The easiest fix is a high-quality protein shake. Alternatively, a “grab-and-go” kit of nuts, vegetables, and fruit works well.
  • Dinner: This is where plate re-engineering is key. We focus on boosting protein in the curries, shifting proportions on the plate, and making smart swaps like quinoa for white rice.
  • Dessert: We encourage swapping sweet desserts for fresh fruit or plain yogurt.

Goal 2: Strategic Use of Medications

In our practice, Dr. Cardenas and I collaborate closely on medication management. A crucial detail is that Rajesh’s plan does cover incretin-based injectable therapies for his diagnosis of type 2 diabetes.

• The Power of Incretin-Based Therapies (GLP-1 Receptor Agonists): These medications (e.g., semaglutide) are game-changers. They enhance insulin secretion when blood sugar is high, suppress glucagon, slow gastric emptying (increasing satiety), and act on the brain to reduce hunger. For Rajesh, starting a GLP-1 agonist, managed by Dr. Cardenas, could be transformative, addressing both his diabetes and his weight. The appetite suppression would make dietary changes much easier to adhere to.
• Alternative Oral Medications: If GLP-1s are not an option, we have other effective oral AOMs, such as Phentermine/Topiramate or Naltrexone/Bupropion, which target appetite and cravings.

Goal 3: A Structured and Enjoyable Physical Activity Plan

We build upon what Rajesh already enjoys, using the FITT-VP principle to make it consistent.

• Schedule the Fun: We’d suggest he join a pickleball league to turn a sporadic activity into a consistent commitment.
• Utilize the Gym Access: We’d encourage him to go to the gym on three other days of the week for just 30 minutes, combining cardiorespiratory exercise with resistance training.
• The Importance of Resistance Training: Building muscle is crucial for insulin resistance. Muscle tissue is a primary site for glucose disposal. The more muscle mass a person has, the more “parking spots” they have for glucose to go after a meal.
• Combating Sedentarism at Work: We’d advise him to set a timer to get up from his desk every 30-60 minutes for “exercise snacks”—stretching, walking, or a few bodyweight squats.

Goal 4: The Role of Integrative Chiropractic Care

While addressing his metabolic health, we must not neglect his neuromusculoskeletal system. A sedentary job and excess weight place significant stress on the body.

• Spinal and Postural Assessment: I would conduct a thorough chiropractic examination to assess his spinal alignment and posture. Years of sitting at a desk can lead to postural distortions like Forward Head Posture and Upper Crossed Syndrome.
• Chiropractic Adjustments: Gentle, specific adjustments can restore proper motion to restricted joints, relieving pain and stiffness. This improves nervous system function by ensuring nerve signals are transmitted efficiently between the brain and body, including the organs and muscles involved in metabolism.
• Corrective Exercises: I would prescribe specific exercises to address his postural imbalances, such as stretches for tight chest muscles and strengthening for weak upper back muscles.

By integrating chiropractic care, we ensure his physical structure can support his new, more active lifestyle. This synergy between the medical management led by Dr. Cardenas and the musculoskeletal support I provide is the essence of our integrative model.

Case Study 3: Overcoming Geographic and Nutritional Barriers

One of the most significant challenges we face is helping patients who live in environments that are not conducive to a healthy lifestyle, often referred to as food deserts. This case study speaks directly to this issue.

Meet Maria: A Profile of Resilience

Let’s meet our patient, Maria L. She is a 45-year-old Hispanic woman who works in a warehouse.

• Living Situation: Maria lives alone in an area officially designated as a food desert, where access to affordable, nutritious food is severely limited, a challenge reviewed by Singh and Krausz (2020).
• Health Metrics: Her BMI is 40, which places her in the category of Class III obesity.
• Primary Health Concern: Her main diagnosed health issue is hypertension, well-controlled with medication. She also complains of persistent low energy.

A comprehensive baseline evaluation is non-negotiable for patients with limited healthcare access. It’s our responsibility to practice comprehensive care and screen for undiagnosed conditions like hypothyroidism or nutrient deficiencies that could contribute to her symptoms.

The Daily Struggle: Understanding Maria’s Reality

Her environment shapes Maria’s daily reality:

• Food Sources: She primarily relies on local convenience stores and gas stations, where food is overwhelmingly processed, high in sugar, unhealthy fats, and sodium.
• Physical Activity: Her activity is confined to her demanding warehouse job. Her neighborhood feels unsafe, preventing outdoor exercise.
• Transportation: Limited transportation makes trips to a larger grocery store a significant logistical challenge.

To help Maria, we must set realistic goals: identify alternative food sources, develop safe indoor exercise routines, and explore virtual resources for health coaching and support.

A Day in Maria’s Life: The Foundation for Our Plan

I always start by asking patients to walk me through their day to build rapport and create a personalized plan. Maria’s day is long and demanding: a 5:00 AM start, a one-hour commute each way, a twelve-hour warehouse shift, and dinner from a drive-thru. Our plan must be woven into this grueling schedule.

Nutritional Strategy 1: Healthy Eating from the Gas Station

Giving Maria an unrealistic plan is demoralizing. So, we meet her where she is, creating a “gas station healthy eating plan.”

• Stick to the Perimeter: Healthier options are usually in the refrigerated sections.
• Avoid the Obvious: Consciously skip the aisles with chips, donuts, and candy.
• Become a Label Detective: We teach her to look at portion sizes, then calories, and finally macronutrients (minimal sugar, low sodium, higher protein).
• Portion Control is Key: Look for single-serving packages.

Nutritional Strategy 2: A Sample Meal Plan from Unconventional Sources

This is not an ideal diet, but it is a realistic and vast improvement:

• Breakfast: Hard-boiled eggs, a banana, and water or unsweetened coffee.
• Lunch: A grilled chicken sandwich (no creamy sauces) with a side of fruit.
• Dinner: A tuna salad kit with crackers and a side of veggie sticks.
• Smart Snacks: Low-sugar protein bars, dried fruit in moderation, or a small amount of dark chocolate.

Nutritional Strategy 3: Exploring Alternative Food Sources

As Maria gains confidence, we explore longer-term options:

• Local or Mobile Farmers’ Markets: We research any that operate near her home or workplace.
• Grocery Pickup Services: She could place an online order at a grocery store near her workplace and schedule a pickup after her shift, saving significant time.
• Meal Planning and Prepping: We would work with her on simple strategies for cooking for one, like batch-cooking chicken or quinoa to use throughout the week.

Physical Activity: Bringing the Gym Home

With her unsafe neighborhood, we must focus on in-home exercise.

• Leverage Technology: I tell my patients: YouTube is your free personal trainer! We help Maria find free workout videos she enjoys, like Zumba or bodyweight strength training.
• Start Small: I echo my colleague’s advice: start with just 10 minutes a day. The goal is to build the habit. Consistency is far more important than intensity at the beginning.

The Role of Chiropractic Care in Maria’s Journey

Maria’s warehouse job involves repetitive motions that lead to musculoskeletal strain. Integrative chiropractic care plays a crucial supportive role.

• Comprehensive Structural Evaluation: I would perform a thorough assessment to identify any misalignments or areas of restricted movement.
• Chiropractic Adjustments: Gentle adjustments can restore joint motion, alleviate nerve pressure, and reduce pain, making it easier and safer for her to engage in her at-home exercises.
• Corrective Exercises: I would prescribe exercises to strengthen weak muscles and stretch tight ones, correcting imbalances caused by her job and improving her functional capacity.

Building a Support System: The Power of Connection

Maria’s life is isolating. Building a support system is a necessity.

• Telehealth Check-ins: Regular virtual follow-ups provide accountability and encouragement, bridging the geographic gap.
• Virtual Support Groups: Connecting her with an online community can combat feelings of isolation. As I’ve noted in my clinical observations from Health Coach Clinic, she may feel on her own, but with our team and a virtual community, she is not.

Considering Anti-Obesity Medication (AOMs) for Maria

I am a strong proponent of AOMs. My approach would be to start with intensive lifestyle coaching. However, if her hunger and cravings are a significant barrier, we would absolutely consider them. Assuming her insurance does not cover AOMs, our options change:

• Incretin-Based Therapies (GLP-1s): These would likely be excluded due to high out-of-pocket cost.
• Affordable Options: We could consider phentermine for long-term, off-label use, or prescribing the individual components of Qsymia (phentermine/topiramate) or Contrave (naltrexone/bupropion) off-label to reduce cost. Dr. Cardenas’s medical oversight is critical here to ensure safety and appropriateness.

Case Study 4: Managing Chronic Stress and Structural Barriers

Our next case study introduces the intersection of chronic stress, emotional eating, and systemic barriers that impede access to care.

Meet Jamal: A Pillar of the Community

Jamal R. is a 38-year-old African American teacher, married with three children, and deeply involved in his community.

• Health Metrics: His BMI is 34 (Class I obesity).
• Primary Health Concerns: He struggles with emotional eating, especially when stressed, and has diagnosed hypertension.
• The Access Paradox: His state insurance plan covers AOMs, but there are no local obesity medicine specialists. This creates a paradox: coverage with no practical access.
• Workplace Barriers: He finds it difficult to take time off from his teaching job for appointments, an issue he observes disproportionately affecting Black and Hispanic teachers, suggesting potential structural racism or implicit bias.

Jamal’s weight struggles began about five years ago as his responsibilities and stress levels increased. He is “maxed out.” His family eats “kid-friendly” meals high in refined carbs. He is active as a volunteer basketball coach but has no formal exercise routine.

Defining the Challenges and Goals for Jamal

Jamal’s case is complex, involving psychological, behavioral, and systemic factors.

Primary Challenges:

1. Chronic Stress and Emotional Eating: Work-related stress triggers unhealthy eating.
2. Medication Access Barrier: Lack of local providers and difficulty taking time off work.
3. Time Scarcity: Family and community duties leave little time for self-care.

Our Goals for Jamal:

1. Behavioral Strategies: Implement sustainable strategies for managing stress-related eating.
2. Explore Medication Options: Bridge the access gap and have a thorough risk-benefit discussion.
3. Sustainable Stress Management: Integrate stress-reduction practices into his routine.
4. Acknowledge Systemic Issues: Address the structural challenges with empathetic and trauma-informed care.

A Day in Jamal’s Life: Pinpointing the Stress Points

Jamal’s day is packed with responsibility. Breakfast is cereal or pancakes with the kids. Lunch is from the school cafeteria. The 3:00 PM stress spike sends him to the vending machine. After school, he coaches basketball. Dinner is a high-carb, kid-friendly meal.

Nutritional Strategy: A Family-Centered Approach

For Jamal, the plan must be a family affair.

• Reinventing Breakfast: Incorporate more protein with ideas like “egg muffins” made ahead of time.
• Navigating the Cafeteria: We coach him on building a better salad, focusing on lean protein and a vinaigrette-based dressing, and avoiding high-calorie toppings.
• Transforming Dinner: We introduce healthy swaps like zucchini noodles (“zoodles”) for pasta or baking chicken instead of frying. Getting the kids involved in cooking and having a “try-it” rule can help.

Behavioral Strategy: Tackling Stress-Related Eating

Jamal’s afternoon snack is a direct response to stress. We need to replace this coping mechanism.

• Identify the Trigger: The 3:00 PM stress spike.
• Develop Alternative Coping Mechanisms: Instead of the vending machine, he could try a 5-minute mindful breathing exercise, a short walk, or have a “healthy-coping” kit at his desk with almonds or a protein bar.

The Role of Chiropractic and Functional Medicine for Jamal

Jamal’s chronic stress has profound physiological consequences.

• HPA Axis Dysregulation: Chronic stress leads to HPA (Hypothalamic-Pituitary-Adrenal) axis dysregulation, impacting cortisol rhythms and leading to fatigue, cravings, and abdominal fat storage.
• Nervous System Imbalance: Stress keeps the body in a “fight-or-flight” state.

My approach for Jamal would include:

1. Functional Lab Testing: An adrenal stress profile (e.g., a 4-point salivary cortisol test) can map his cortisol curve and help us target interventions.
2. Chiropractic Adjustments: Adjustments are effective at modulating the nervous system, helping shift the body from a sympathetic-dominant state to a more balanced “rest-and-digest” (parasympathetic) state. This directly counteracts the physiological effects of stress.
3. Targeted Nutritional and Supplement Support: Based on labs, we might recommend adaptogenic herbs like Ashwagandha or Rhodiola to support HPA axis function, along with B vitamins, magnesium, and vitamin C.
4. Pain and Mobility: As a coach, he’s active. I would assess him for any underlying musculoskeletal issues to keep him pain-free and mobile.

Solving the Medication Access Puzzle: The Role of Telehealth

Jamal has insurance coverage but no local provider. This is a perfect scenario for telehealth, as discussed by Lerman and Gellad (2022).

• Connecting via Telehealth: Our clinic could serve as his provider through virtual visits, eliminating the need for him to take time off work and travel. Even if state regulations require periodic in-person visits, telehealth can handle the frequent follow-ups needed for medication management and coaching.

Choosing the Right Anti-Obesity Medication for Jamal

Since his insurance covers AOMs and his key issue is emotional eating, we have several options:

• Contrave (Naltrexone/Bupropion): This is often a first-line choice for patients with craving-driven eating. Naltrexone reduces the “reward” feeling from food, and bupropion can help with cravings.
• GLP-1 Receptor Agonists: Many of my patients who are emotional eaters report a “quieting” of the “food noise” in their brains with these medications, making it easier to manage triggers.

The decision would be made in a shared discussion, using the medication as a tool to facilitate comprehensive care.

Physical Activity, Self-Care, and Community Leadership

Jamal is constantly helping others. My approach, as I’ve detailed through my professional experience on LinkedIn and Health Coach Clinic, is to help him reclaim time for himself and leverage his strengths.

• The 30-Minute Morning Reset: I often find that for busy people like Jamal, waking 30 minutes earlier three days a week is transformative. It’s not just about exercise; it’s about reclaiming identity. This time block lowers perceived stress, primes circadian rhythms, and creates a keystone habit. A morning bout of moderate movement increases skeletal muscle glucose uptake, boosts BDNF for mood, and starts a virtuous cycle of better choices.
• Movement Snacks (NEAT): Non-exercise activity thermogenesis (NEAT) is a powerful lever. We can sprinkle 2–5 minute movement breaks across his day—standing while teaching, taking stairs, or doing air squats. Interrupting sitting reduces postprandial glucose and triglyceride excursions.
• Sleep Hygiene as Treatment: Fixing sleep is often the highest-yield intervention. We focus on regularity, light exposure, temperature, and a wind-down routine.
• Coaching the Coach: He can leverage his role by warming up with his team, modeling recovery breathing, and sharing goals. This transforms service into self-care and reframes movement as leadership.

By empowering him, we not only help him but also create a ripple effect that benefits his entire community. This aligns with his intrinsic drive to serve and can be a powerful source of positive reinforcement.

This holistic, multi-layered approach—addressing the biological, psychological, structural, and systemic—is the essence of modern, effective, and truly compassionate healthcare.

References

• Blüher, M. (2019). Obesity: Global epidemiology and pathogenesis. Nature Reviews Endocrinology, 15(5), 288–298.
• Dalle Grave, R., Calugi, S., & Marchesini, G. (2020). The influence of family and couple dynamics on the treatment of obesity. Eating and Weight Disorders – Studies on Anorexia, Bulimia and Obesity, 25(6), 1475–1483.
• Dutton, G. R., & Bodell, L. P. (2021). The role of stress in obesity development and maintenance. Current Obesity Reports, 10(3), 269–278.
• Kyrou, I., Randeva, H. S., Tsigos, C., Kaltsas, G., & Weickert, M. O. (2018). Clinical problems caused by obesity. In K. R. Feingold, B. Anawalt, M. R. Blackman, A. Boyce, G. Chrousos, E. Corpas, W. W. de Herder, K. Dhatariya, K. Dungan, J. Hofland, S. Kalra, J. Kaltsas, N. Kapoor, C. Koch, P. Kopp, M. Korbonits, C. S. Kovacs, W. Kuohung, B. Laferrère, M. Levy, E. A. McGee, R. McLachlan, M. New, J. Purnell, R. Sahay, A. S. Shah, F. Singer, M. A. Sperling, C. A. Stratakis, D. L. Trence, & D. P. Wilson (Eds.), Endotext. MDText.com, Inc.
• Lerman, S. F., & Gellad, W. F. (2022). Telehealth for the treatment of obesity: A narrative review. Journal of General Internal Medicine, 37(Suppl 2), 643–650.
• Singh, G., & Krausz, A. A. (2020). Food deserts: A state of the science review. Urban Science, 4(4), 53.
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• Wadden, T. A., Tronieri, J. S., & Butryn, M. L. (2020). Lifestyle modification approaches for the treatment of obesity in adults. American Psychologist, 75(2), 235–251.
• Wharton, S., Lau, D. C. W., Vallis, M., Sharma, A. M., Biertho, L., Campbell-Scherer, D., Adamo, K., Alberga, A., Bell, R., Boulé, N., Boyling, E., Brown, J., Calam, B., Clarke, C., Crowshoe, L., Divalentino, D., Forhan, M., Freedhoff, Y., Gagner, M., … Wicklum, S. (2020). Obesity in adults: A 2020 clinical practice guideline. Canadian Medical Association Journal, 192(31), E875–E891.
• Williams, D. R., Lawrence, J. A., & Davis, B. A. (2019). Racism and health: Evidence and needed research. Annual Review of Public Health, 40, 105–125.
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