Ounces of prevention

It was meant as a joke, but it stung. Larry Chu , MD, had just stood up in front of the room at the closing dinner of the first Medicine X conference, a fast-paced, multi-day program on emerging technology in medicine for which he is the executive director. He remarked that he hadn’t eaten anything all day. A senior faculty member said, “Really, Larry? Because it looks like you could afford to skip a meal.”

“I was speechless,” says Chu, an associate professor of anesthesiology whose weight has fluctuated between 200 and 275 pounds over the past 12 years. “Now I can say, ‘Go look at my blog. Look at those days I ate 500 calories a day and didn’t lose any weight.’”

Chu’s blog, Precision: me, chronicles the first 90 days of his effort to lose weight and reverse prediabetes. On it, he tracks his weight, lab values, medications, food, exercise, and symptoms like hunger and headaches.

“Obesity and weight loss are a very strong case for precision health. We know that one single approach will not work for everyone,” he says. Chu and his weight-loss physician, Rami Bailony, MD, of Enara Health, knew Chu had gotten stuck at certain weights in the past, unable to lose any more.

His exercise regimen was solid; he’d been working out with a personal trainer for a decade. And he’d had periodic success with low-carb diets — they curbed his appetite — but he couldn’t cease them without regaining weight.

Bailony and Chu thought that Chu’s high insulin levels were contributing to his weight gain, and that a very-low-calorie diet would lower them while providing balanced macronutrients. If it didn’t work, they’d use what they’d learned to try something else.

Chu believes this type of physician-patient partnership will become increasingly common. “Precision: me is in many ways a demonstration project of how people can participate in precision health care,” he says. “Imagine what we could learn if people shared their data the way I’m sharing the data, and we could then pool that data. We’d have a much more detailed and powerful view of obesity.”

As fond as he is of data — and this is a man who has strapped a continuous glucose monitor to his leg and named it “Dexy” — Chu also emphasizes the value of storytelling: “Stories add context to the data.” Precision: me includes podcasts in which he and Bailony discuss misconceptions about obesity — fat people are lazy, make bad choices, just need to take better care of themselves — as well as the judgment and guilt Chu has felt over the years.

“I’m really glad we have the website and the blog to show people: This is my world,” he says during the “Frustration” podcast. “I ate 800 calories a day for 10 days and I didn’t lose any weight.”

Ultimately, Chu did shed 48 pounds over the 90-day experiment. By Day 60, his hemoglobin A1C — a three-month average of blood sugar — had almost normalized and his triglycerides, a type of fat in the blood associated with insulin resistance and heart disease, had plummeted. In one puzzling result, however, his low-density lipoprotein, or “bad cholesterol,” increased. Perhaps sharing the data online, Bailony says, “will allow someone to pipe in and say, ‘Hey, I know why.’”

Although the blog project is finished, the personalized approach is not. “As I come off the very-low-calorie diet, Dexy will be even more useful,” Chu says. Based on how much his glucose spikes within an hour of eating, he is developing a “personal glycemic index” of foods.

“We don’t know his long-term story,” Bailony says. “Hopefully, he’ll decide to share that.”