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A conversation with pediatric obesity researcher Denise Wilfley, PhD
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Childhood obesity researcher and advocate Denise Wilfley, PhD, has spent 3 decades studying the etiology, prevention and treatment of obesity and eating disorders in children and adults, and has collaborated with policymakers and health care providers to improve access to effective treatment. For her work in addressing this still underserved area, Wilfley received The Obesity Society’s Oded Bar-Or Award in November.
Wilfley is the Scott Rudolph University professor of psychiatry, medicine, pediatrics, and psychological and brain sciences at the Washington University School of Medicine in St. Louis. She serves as the director of the Center for Healthy Weight and Wellness at the Washington University School of Medicine and helped lead the push for binge eating to be recognized as an eating disorder.
Endocrine Today spoke with Wilfley about the genesis of her work in pediatric obesity, how she is working to address the condition and translate clinical evidence into real-world practice and what is being done about barriers to treatment such as insurance coverage.
What was the defining moment that led you to your field?
Wilfley: My work with binge-eating disorder has led me to the field of pediatric obesity research and to where I am now. It was during a patient visit, 31 years ago when I was a clinical psychology student, that I was first introduced to a patient with severe obesity dealing with persistent binge eating. Following this visit, I became aware that binge eating was not formally recognized as a disorder and there was a lack of resources to diagnose and treat individuals dealing with binge eating. This patient had described feelings of distress, guilt and loss of control after a binge-eating episode, and I had no guidance on how to help her.
I embarked on a path to establish the clinical significance of recurrent binge eating, and I am proud to say that after 26 years of diligent and tireless work, 5 years ago, binge-eating disorder was formally recognized as an eating disorder.
Further, through multiple randomized controlled trials, I established two psychological treatments for binge-eating disorder. One of the most striking findings was that a high percentage of individuals with binge-eating disorder report being overweight or obese as youths. I became invested in the prevention and treatment of childhood obesity as a means of preventing binge-eating disorder.
I dedicated the first portion of my career to giving a voice and providing access to treatment to individuals with binge-eating disorder. I am now applying the same vigor and passion to advocating for children and adolescents with obesity.
What area of research in obesity research most interests you right now and why?
Wilfley: My early pediatric obesity research focused on creating an effective treatment for childhood obesity, family-based treatment. Childhood obesity is a significant public health concern, and these children need quality care. I worked to develop treatment, evaluate it and refine it to make it maximally robust. But here’s the dilemma: We have the intervention, we have the research to back it up, but it’s not readily available for children.
Children are not getting the care they need, and this is not OK. We need to take this effective, evidence-based interventions and work diligently to ensure children have access to it.
My current research addresses this by investigating the most effective way to translate this evidence-based childhood obesity treatment into real-world practice. Disseminating treatment successfully truly takes a village. In that pursuit, I’ve formed broad partnerships across the social, political, economic and private sectors to create systemic change, and I’ve enjoyed collaborating across disciplines with phenomenal leaders in the field who are also passionate about increasing access to care for childhood obesity.
What is the best career advice you’ve received?
Wilfley: The best career advice I received was to thank people along my journey. A thank-you note only takes a few minutes, but it makes a huge difference.
My career has been influenced by the invaluable stewardship and modeling of several brilliant mentors, providing me with the skills and tools to become an independent investigator. Without their guidance, I would not be where I am today, and I make sure they know how grateful I am for their support. I am also incredibly thankful for all of the collaborators, research staff members and students who have helped me carry out my vision. Obesity is a complex disease and it takes a big team to make a collective impact.
What do you think will have the greatest influence on your field in the next 10 years?
Wilfley: One huge step for obesity research will be getting payers to reimburse for high-quality treatment for childhood obesity. As more insurance plans begin to cover childhood obesity treatment, more children will be able to receive care. In 2010, the United States Preventive Services Task Force released recommendations for childhood obesity treatment, recommending that clinicians screen for obesity in children and adolescents aged 6 years and older and offer or refer them to comprehensive, intensive behavioral interventions to promote improvements in weight status. Because this is a “grade B” recommendation, insurance companies are required to cover this treatment. However, payers have been slow to come on board.
In 2015, I held a conference with multi-sector stakeholders to discuss how we can increase access to care for childhood obesity. One major barrier was lack of insurance coverage. Thankfully, the tide is changing to provide coverage for weight management, and more and more states have begun to reimburse. In my home state of Missouri, I have been working on this reimbursement issue, collaborating with health care providers and policymakers to get childhood obesity treatment covered. After lots of hard work, I am excited to announce that the proposed rule for reimbursement was posted for public comment in September 2018, and now the policy experts are reviewing the comments to the rule. It’s anticipated that the codes will be active and eligible providers will be able to start to bill the system for reimbursement in 2019. This is a huge step for increasing access to care in a way that’s economically sustainable.
What’s up next for you?
Wilfley: I plan to continue to work to increase access to quality care for childhood obesity. Currently, we are conducting two large-scale trials to offer evidence-based obesity treatment in primary care. Translating treatment into the primary care setting is a golden opportunity to reach children and intervene early. We will also bring together insurance companies, health care providers and policy experts so that our research findings may be used to take the next critical steps toward improving access to and reimbursement for effective primary care-based treatment for all children with obesity. Collaboration with a wide range of stakeholders will facilitate the rapid uptake of effective interventions for childhood obesity into clinical practice. – by Phil Neuffer
Disclosure: Wilfley reports she has consulted for Shire Pharmaceuticals, Sunovion Pharmaceuticals and Weight Watchers.