Advancing Metabolic Health Through Coordinated Care

This Clinician’s View is written by endocrinologist Damon Tanton, MD, Executive Medical Director of the AdventHealth Metabolic Health Institute.

While metabolic disease has become one of the most significant threats to long-term health in the United States, our country’s health care system treats its consequences more aggressively than its causes.

In Florida, the urgency is clear. Only 36% of adults are currently at a healthy weight, which means roughly two out of every three adults are overweight or obese. Overweight is defined as a body mass index (BMI) of 25-29.9, and obese as a BMI of 30 or greater. Additionally, more than 2 million Floridians are living with diagnosed diabetes. As startling as those numbers are, future predictions are even worse. Nearly 60% of adults in Florida are projected to fall into the obesity category by 2030. These are more than simple statistics -- they are evidence that our current approach to metabolic health is failing to keep pace with the scale of the problem.

Metabolic Health | Dr. Damon Tanton

Breaking Down Silos to Deliver Connected Care

For too long, care for obesity, diabetes and related metabolic conditions has been fragmented across specialties, often addressing symptoms or episodes rather than the underlying drivers of disease. If we want to reverse these trends, we must move toward a more coordinated and proactive model of care.

That conviction led us to invest in years of strategic planning and research that has resulted in the establishment of the AdventHealth Metabolic Health Institute in Central Florida. This first-of-its-kind clinical model integrates endocrinology, obesity medicine and bariatric surgery under unified, non-surgical leadership, deploying a scalable, evidence-based model through newly established Health Optimization Centers.

At its core, our new institute brings together multidisciplinary expertise and sustained, whole-person patient support. Endocrine clinicians, dieticians, behavioral therapists and exercise physiologists work together as a coordinated team to address the biological and behavioral factors that shape metabolic health. The goal is not simply short-term weight loss -- it is long-term metabolic health improvement that reduces risk for chronic disease and improves quality of life.

One of the Metabolic Health Institute’s initial goals is to prioritize optimizing patients who are metabolically unfit for necessary surgical procedures. However, we are also slowly scaling operations to serve a broader population through risk stratification based on body mass index (BMI) and comorbidity burden.

It’s About More than Weight – Addressing Insulin Resistance as a Driver of Chronic Disease

At the Metabolic Health Institute, our work goes beyond simply promoting healthy weight management. We are digging deeper to address one of the primary drivers of metabolic disease – insulin resistance.

Recent analyses suggest that insulin resistance with associated hyperinsulinemia now exceeds 50% prevalence in the general population of developed countries, constituting what researchers have termed a "silent pandemic." It is the precursor for many chronic diseases because insulin is both the most obesogenic and inflammatory hormone in the body.

When insulin is unable to produce its full biological effect on target tissues such as skeletal muscle, the liver, and adipose tissue, this drives a cascade of negative pathological processes. In addition to diabetes and prediabetes, these disruptions in insulin signaling pathways contribute to the development of cardiometabolic disorders -- including obesity, dyslipidemia, chronic low-grade inflammation, endothelial dysfunction, and hypertension – and increase the risk of atherosclerosis and cardiovascular disease. Excess circulating insulin also plays a role in the development of cancers through abnormal stimulation of cellular proliferation and inhibition of apoptosis.

Understanding insulin resistance as a root cause of disease has important implications for care delivery. When metabolic dysfunction goes unaddressed, its downstream effects ripple across specialties throughout any health care system. Nowhere is this more evident than in the surgical setting, where poorly controlled metabolic disease substantially increases perioperative risk and can prevent patients from undergoing procedures altogether.

Improving Patient Health and Outcomes Through Surgical Optimization

Across the AdventHealth system, thousands of patients are unable to undergo necessary orthopedic, neurosurgical, and cardiothoracic procedures because they are significantly overweight or metabolically unfit for surgery. In many cases, these procedures are time-sensitive and may be lifesaving. Recognizing this urgency, we have prioritized this patient population for the Metabolic Health Institute’s initial outreach and intervention efforts.

For these patients, the risk is not driven by excess weight alone but by the broader metabolic complications that accompany it. A 2023 systematic review and meta-analysis published in the International Journal of Surgery found that metabolic syndrome, including high blood pressure, diabetes and high cholesterol, affects 46% of surgical patients and is associated with significantly poorer postoperative outcomes, higher infection rates and increased mortality.

One early example of our work is a collaboration with the AdventHealth Heart, Lung and Vascular Institute where we are focusing on their sickest patients with congestive heart failure (CHF). Many of these individuals are awaiting transplant and require complex, high-risk procedures simply to keep them alive. However, their weight and cardiometabolic status is preventing them from safely undergoing these interventions. Our team is working proactively with these patients and their physicians to develop personalized surgical optimization strategies to help ensure they can receive the lifesaving care they need.

Driving Multidisciplinary, Value-Based Care Through Health Optimization Centers

In addition to caring for surgical patients, the AdventHealth Metabolic Health Institute is aiming to guide patients throughout the communities we serve on personalized, comprehensive weight management and metabolic health care journeys. These include medical management, behavioral health support, lifestyle-based interventions and when appropriate, advanced solutions like bariatric surgery. At the center of this new care model are Health Optimization Centers, which are dedicated medical practices staffed primarily with endocrine-trained advanced practice providers (APPs).

Our institute embraces a science-first philosophy when it comes to metabolic health -- correcting physiological dysfunction before addressing behavioral and lifestyle factors. That is why each patient begins with a comprehensive laboratory evaluation and an initial consultation with an endocrine clinician. Based on these findings, we develop a personalized care plan that integrates the most effective evidence-based therapies for weight loss and metabolic health. Patients are then supported by our multidisciplinary team of dieticians, behavioral therapists and exercise physiologists, ensuring a coordinated, individualized approach that addresses the full spectrum of metabolic health.

The first two Health Optimization Centers have opened in Orlando and Lake Mary, with several additional locations planned for later this year. One of the key advantages of this innovative care model is its flexibility. Much of the evaluation process can be conducted virtually, with patients coming on-site only for select assessments such as body composition scans.

We are also working toward implementing large-scale screening for liver fibrosis using the Steatosis-Associated Fibrosis Estimator (SAFE), a next-generation, non-invasive scoring system that was designed specifically for metabolic-associated steatotic liver disease (MASLD). SAFE uses seven readily available clinical variables -- age, BMI, diabetes status, AST, ALT, platelets, and globulin – to detect clinically significant fibrosis (stage F2 or higher), the threshold at which the risk of liver-related and all-cause mortality begins to rise.

Our innovative approach aligns with the health care industry’s broader transition toward value-based care. By investing earlier in the care pathway – through prevention, timely diagnosis and proactive screening – we aim to maximize clinical impact and improve long-term patient outcomes.

Fulfilling Our Commitment to Whole-Person Health

While developing and growing AdventHealth’s Metabolic Health Institute is not an easy task, it is foundational to our health’s system’s commitment to providing whole-person health. If we are to move beyond managing disease and begin truly advancing wellness and prevention, the path forward must start with metabolic health. We need to meet patients where they are – body, mind and spirit – and work alongside them to address the core drivers of chronic disease. By doing so, we can shift the focus of care from reacting to illness to cultivating lasting health.