Duane Sunwold knows what it’s like to struggle with kidney disease while gaining weight.
He nearly lost kidney function 22 years ago.
Recently, the Spokane Community College culinary teacher helped brainstorm ways doctors can talk to patients about obesity and kidney issues, on a discussion panel of medical specialists and patients within a study.
The study found a tie between kidney function loss and chronic obesity. Long-term obesity also is linked to many conditions, including diabetes and heart disease. As part of discussions, Sunwold and his doctor shared about his earlier kidney condition, and how after a few years on a plant-based diet, his disease went into remission.
“It was interesting because this group of obesity doctors and kidney doctors had never talked together before,” Sunwold said.
The research was coordinated by the National Kidney Foundation and the Obesity Society, which published findings in late October.
“Part of the discussion with our group was, how do you bring this up, how do you talk to patients if obesity could be contributing to kidney disease? When should an obesity doctor either start talking to a patient about kidney function or recommending a patient to a kidney doctor?”
Sunwold joined the 2021 session and helped summarize the subgroup’s ideas, separately published in the American Journal of Kidney Diseases in December. He was on the panel with his Spokane kidney specialist, Dr. Katherine Tuttle.
A social stigma toward obesity is a barrier – also sometimes in doctors’ offices – but that topic and nutrition need to be part of regular doctor-patient dialogues, Sunwold said.
“One thing we learned is that obesity as a risk factor for chronic kidney disease is rarely addressed by nephrologists,” he said.
“The kidney doctors had to learn to talk about obesity with patients and its weight management, lifestyle. When I was super sick, I gained all this weight because of medications. That’s another factor that needs to be discussed.”
The group offered strategies. One is to use motivational interviewing that encourages patients to bring up if they struggle with weight, he said. If they share first, “They’re much more receptive to talk about it than somebody saying, ‘Let’s talk about your weight.’ ”
Another strategy is to tell people about positive patient stories to encourage lifestyle changes, he said.
“My doctor brought up my story and the fact we need to have some positive stories to tell patients and to show them that changing lifestyle can have a huge impact on someone’s quality of life,” he said. “I was literally so close to a dialysis chair, and then I changed my diet.
“For me, the biggest impact was going to a more plant-enriched diet. For some reason, plant protein is more gentle on our kidneys than animal protein, and that is for everybody.”
In 2001, Sunwold was diagnosed with minimal change disease, a disorder that alters the cell size of the kidneys, where filtration takes place, and causes the organ to spill protein out of the bloodstream and into urine. He felt extreme fatigue and craved protein. He wasn’t obese yet, but gained 75 pounds while on prednisone.
“So I was trying to maintain weight while I was on a drug that increased my appetite horrendously.”
As a kidney patient, he had to limit proteins and salt. Tuttle had told him to try more plant-based meals, but Sunwold said he didn’t apply it until a dietician working at SCC asked him to try vegetarian cooking for 90 days. He felt better within two weeks. He continued, and by 2005, had reached remission.
He said the panel members traded ideas about patient discussions, while the obesity doctors sought input on when to talk about kidney risks and refer patients to kidney specialists. The members learned more about obesity as a predisposition to kidney disease.
“Obviously, it’s an ongoing discussion of what biomarkers do they use.”
The National Kidney Foundation has proposed for annual wellness exams to do a kidney test called glomerular filtration rate, or GFR, although that wasn’t discussed within the kidney-obesity group.
“I was on another panel where they brought in general practitioners to discuss how soon can we add this to a patient’s overall health,” Sunwold said. GFR has five stages.
“Stage 1, you’re healthy and at 5, you’re a dialysis-transplant patient and you’re at 15% or less of your kidney function,” he said. “A lot of people don’t show symptoms. I never showed symptoms until I was, like, Stage 4.5. Our bodies are able to compensate for a long period of time.”
Body Mass Index (BMI) is used as a screening tool for obesity, along with a doctor’s assessment. The calculation factors if weight is higher than what is considered healthy for height – for adults at 30 BMI or higher.
The U.S. obesity battle has many complexities, from genetic predisposition and exercise levels to fresh food access. More than two out of five adults have obesity in the U.S., according to data from the National Health and Nutrition Examination Survey.
Obesity trends got widespread news coverage last week, when the American Academy of Pediatrics issued new guidelines for earlier interventions in treating more than 14 million U.S. children and adolescents with obesity.
For adult patients, Sunwold said the panel discussed the amount of processed foods in the American diet, and other modern trends.
“It’s readjusted our body to a higher body fat, which then our bodies are designed to use for an emergency energy source. Our bodies naturally don’t want to give up fat and are going to fight to maintain that energy storage. And the longer you have it, the more it doesn’t want to give it up.”
He said the panel also talked about how obesity rates are disproportionately higher in some racial and ethnic groups, along with socioeconomic impacts of obesity.
“We talked about food insecurities and food deserts, where people don’t have access to fresh fruits and vegetables,” he said. “One of the doctors said she deals with patients who only have convenience stores they grocery shop in.”
People don’t always think about how diet affects health, Sunwold said. He also is a North Idaho College culinary instructor. At SCC, he teaches in hospitality management and cooking, including “Nutrition for Chefs.”
His students have become chefs or opened restaurants. Sunwold said they’re more receptive to customers’ dietary requests after learning about nutrition. Restaurant customers shouldn’t hesitate to ask for adjustments.
“There’s that whole connection that, no, we’re actually keeping people healthy if we do their requests.”