William Yancy, MD, is the focus of this week’s faculty spotlight. Dr. Yancy talks about being a second-generation Duke employee, teaching clinical research seminars, his research investigating the effects of diet preference on weight loss, water-skiing and other subjects.
How long have you been at Duke? How long have you been at the Division?
I actually grew up in Durham with both of my parents working for Duke. I was then an undergraduate at Duke and returned to Duke in 1999 after residency to join the GIM fellowship. I have been in DGIM since then.
What does a typical day for you at the Division look like?
All days are different for me, keeping life interesting. I see primary care outpatients at the VA as a staff physician for Ambulatory Care one half day; I see weight management patients in the Duke Lifestyle Medicine clinic one half day; and I teach residents in the VA PRIME clinic one half day. My research projects are typically pretty hands on so I frequently attend group weight management sessions during parts of other days. The rest of the time is spent managing research projects or monitoring safety issues in their participants, writing, mentoring, or teaching in the Duke CRTP.
You sometimes teach seminars at the Clinical Research Training Program. Can you tell me more about that? Are you teaching a seminar this fall? If so, what is the subject area?
I have taught the Clinical Research Seminar with some great partners over the years—Gene Oddone, Maren Olsen, and Skip Woolson, along with a bunch of terrific guest faculty members. The course is a capstone course and is unique in that the students actually do much of the teaching. We have topics in clinical research, for example handling missing data, choosing control groups, and stopping clinical trials early, and provide reading on these topics along with a clinical trial that is a good illustration of the topic. Students sign up for topics and present them to the class with the faculty emphasizing and expanding on important points. The class is offered in the spring.
Among others, you’re currently working on a study investigating the effects of diet preference on weight loss success. Can you tell me more about that project?
This project examines the commonly held notion in diet research that since there are many diverse diets that lead to weight loss, we should offer our patients a choice among them to improve their adherence, and thus weight loss. This is a major advance from the one-diet-fits-all approach that we used to have, but the notion had not been tested adequately. So, we used a doubly randomized preference trial to compare patients who were offered a choice between a low-carbohydrate or a low-fat diet versus patients who were randomly assigned to one of the diets. The results were not what we expected and are being submitted for publication.
Another article reporting the choices that were made by the Choice arm participants, and predictors of choice, was recently accepted by the journal, Appetite. Megan McVay is a junior faculty member and clinical psychologist in our group who was lead author of that article. Other DGIM collaborators include Corrine Voils, Cynthia Coffman and Gene Oddone. And Matt Maciejewski is helping brainstorm some ancillary analyses that are possible because of the unique study design.
You’re also working on a study that aims to improve the assessment of adherence to blood pressure medicine in veterans. What are some of the problems with the way we measure adherence those medicines today? What problems does non-adherence cause?
This study was a co-PI effort with Corrine Voils, and really was her insightful idea. She observed that many self-reported medication adherence questionnaires mixed up two important but distinct constructs: the extent of non-adherence and the reasons for non-adherence. And, few questionnaires assessed an adequate spectrum of reasons for non-adherence. The project developed a new questionnaire that is more likely to help clinicians to address non-adherence. Medication non-adherence is very common but currently not assessed well in the clinical setting; it leads to many adverse outcomes as well as unnecessary medication dose escalations.
What’s one passion or hobby do you have outside of the Division?
My biggest passions are fitness and athletics, which I enjoy with my family and friends whenever I can. I particularly enjoy basketball and waterskiing but am anticipating the need to transition to activities that are less hazardous to my aging joints.