17: Weight Loss: Why It Can Be Important

Join us on Your Checkup as we kick off a comprehensive series on one of the most pervasive chronic conditions: obesity. In this first installment, we delve into what it truly means to classify obesity as a chronic disease, the various ways it is measured, and why understanding it is crucial for your health. This episode sets the stage for a deep dive into a topic that affects millions—don't miss the beginning of our journey towards better health!

Takeaways

Obesity is recognized as a chronic disease by the AMA for over 10 years.
The prevalence of obesity is increasing globally, especially in the U.S.
BMI and waist circumference are common methods to measure obesity.
BMI may not accurately reflect body fat in all individuals.
Waist circumference is important for assessing abdominal fat and related health risks.
Genetics play a significant role in obesity, accounting for about 50%.
Obesity is linked to numerous health complications, including diabetes and heart disease.
A weight loss of 5-7% can significantly reduce diabetes risk.
Obesity can lead to increased mortality rates and various diseases.
The conversation around obesity should be compassionate and informed.

Keywords

obesity, chronic disease, health risks, BMI, waist circumference, mortality, diabetes, cardiovascular disease, health education, patient care

Transcript

Ed Delesky, MD (00:00)
Welcome back to Your Checkup. We are the patient facing medical podcast where we bring conversations from the doctor's office to your ears. On this podcast, we try to bring medicine closer to its patients. I Ed Delesky a family medicine resident in the Philadelphia area. And we are so excited that you could be back here again with us today. So we were chatting about what we were going to discuss beforehand and get a little giddy when we're going to do this. And there's a little flair to it. And we're just sitting here with two mics, but

Nicole Aruffo, RN (00:14)
and I'm Nicole Aruffo, I'm a nurse.

Ed Delesky, MD (00:29)
We were talking about this smart aleck who were so happy that they took advantage of our our fan mail, but they came after me and they came after me with my claim that Subway doesn't advertise anymore. Of course, Subway advertises.

Nicole Aruffo, RN (00:48)
I see Subway commercials all the time. I'm Peacock.

Ed Delesky, MD (00:51)
Subway, of course, advertises

Peacock National Television and they use sports. They use athletes now. They don't use the other guy who we won't give credit to. Of course. And of course, I've seen an NBA game in the last five years.

Nicole Aruffo, RN (01:08)
Yeah, he has. It's actually been painful.

Ed Delesky, MD (01:12)
That's why we have two TVs. Something we haven't talked about, I edited out of a couple other episodes, is that for shared entertainment purposes, well, you explain what our situation is.

Nicole Aruffo, RN (01:22)
So we have two TVs in our living room, just stacked right on top of each other, quite big TVs. Some would say, some would say they're not big enough. And we watch all of our fun shows on the bottom. And then Eddie puts his stupid Mets games, his stupid Sixers games on the top one on mute. And it really is the key to a happy relationship.

Ed Delesky, MD (01:51)
I think it is. It's worked out great so far. Yes. Yeah. Those two things. That's not what our episode is about today. What are we going to talk about today, Nick?

Nicole Aruffo, RN (01:53)
That and a king bed.

You're welcome for that.

We're

talking about obesity today. One of multiple episodes we're going to do on the topic. Yeah. It's a hot topic.

Ed Delesky, MD (02:11)
What you can expect from today's episode is a conversation about what obesity is and why it's important. And the first words I want to say out of my mouth are that obesity is a chronic disease. I'll say it again. Obesity is a chronic disease. This is not news. This has been a thing since 2012 when the American Medical Association came out and said that obesity is a chronic disease.

Roll tape episode over. my God. I wish. No.

Nicole Aruffo, RN (02:46)
It's a hot topic.

Ed Delesky, MD (02:49)
It is a, yeah, it is a hot topic. This itself could be our hot take. So prevalence is a word used in medicine to describe how frequently a disease is around. Obesity as a chronic disease is rising in prevalence globally, everywhere, especially in the United States. So obesity is becoming increasingly prevalent here in the 21st century and

Obesity is defined as, by the World Health Organization, as excess or abdominal fat accumulation that presents a risk to health. Which I think is an incredibly important definition because of the key word, presents a risk to health. And before we even dive into the ins and outs of obesity, we're going to cover today, obesity as a medical.

condition and from the medical perspective. And this is distinctly different from weight as it relates to society, culture, pop culture, religion, social interactions. Today, we are only going to talk about it from a medical point of view. So obesity is a challenging thing to quantify. And there are two

mainly accepted ways that are most common and accurate to use to approach to see if someone has obesity. And those two ways are BMI, body mass index, and waist circumference.

Nicole Aruffo, RN (04:31)
And the ranges for what would be considered from normal to obesity for the BMI, just to be thorough, normal, your BMI would be 18.5 to 24.9. And you can look up a BMI chart online. I'm sure we all know this by now.

Ed Delesky, MD (04:49)
And they're based on your height and weight.

Nicole Aruffo, RN (04:52)
Overweight is 25 to 29.9 and then obesity is when we hit 30 or above and then under obesity there are three classes essentially in increments of five so class one is 30 to 34.9, class two is 35 to 39.9 and then class three is 40 or above.

And before we talk any further about that, know that BMI is also another hot topic, probably controversial. Probably controversial. And I mean, you know, every fitness influencer out there is saying that BMI is garbage. So why do put so much weight into BMI? What are your thoughts?

Ed Delesky, MD (05:42)
Because I think BMI works for about 95 % of people. It takes your height and your weight, and it correlates that relationship to how much fat you have. But there are a couple different situations where this falls through. When you have someone who is younger and very muscular, so a professional athlete, an Instagram influencer who's bodybuilding, or someone who's just

an average person who happens to be muscular, it overestimates the BMI and the impact of the specific fat that that person has in their body.

Nicole Aruffo, RN (06:21)
It doesn't measure the exact percentage of fat, think is why people... Correct. ...steer away from it.

Ed Delesky, MD (06:27)
Yeah. And it's something that's easy to measure and it can be done at every office visit, but it's a proxy for the actual thing, but the actual thing being the fat content that someone has in their body, which is not so easily measured. The other people that BMI kind of doesn't do justice to is that older people lose muscle mass with aging. And so it may underestimate their

fat percentage in their body as they age. And the other special classification for BMI is that those classes that you mentioned work well for almost everyone, but the cardiovascular risk, which is why these are stratified into class one, two, and three, is that as you go up, there are more risks that for Asian populations, overweight is defined as a different category. Overweight for an Asian population

is defined as a BMI greater than 23 to 24.9 and obesity as 25 or greater. And so those are the stipulations on BMI for what is generally a useful tool, but not perfect for sure.

Nicole Aruffo, RN (07:42)
So we talked about BMI as the first tool. about waste circumference? It's hard to say. Waste circumference.

Ed Delesky, MD (07:50)
It is. It took us three takes to get that waist circumference. So waist circumference is useful because it's a measurement of abdominal obesity and abdominal fat has a specific independent risk that isn't accounted for in BMI. so this otherwise stated visceral fat. And if you're listening to this, you know who you are.

But these are, these have other names that are called central adiposity, visceral, android, male type obesity. And what we know is that this specific type of fat distribution increases the risk for heart disease, diabetes, hypertension, dyslipidemia, which is high cholesterol, and metabolic dysfunction associated steatotic liver disease, which is a long name for problems with your liver because of obesity.

So that's why we do this waist circumference. So now that we know why visceral fat or abdominal fat is important to consider, what do we think about the actual numbers? What's a high number? What's something that we think about?

Nicole Aruffo, RN (09:04)
So elevated waist circumferences for men, it's 40 inches or 102 centimeters or above. And then for women, it's 35 inches or 88 centimeters or above. And that's when your risk increases for heart disease and really everything, right? And we measure our waist circumference with a flexible measuring tape starting at your belly button and then

going all the way around back to your belly button to get the measurement. If you don't have a measuring or like a flexible one, you could use like a string or a rope and then lay that out flat. We've done that.

Ed Delesky, MD (09:46)
and then you can put it up in the house.

Nicole Aruffo, RN (09:48)
You

can have it as decoration for motivation to decrease your waist circumference.

Ed Delesky, MD (09:54)
Exactly. And so with all of that, we've taken some time to explore definitions of obesity, classifications and how we can use them in the clinic. And that's exactly why these things are used. Because like you see someone, it's a part of the vital signs that are taken and you can get that information, you can get BMI. But I will say that with the way circumferences aren't so frequently used, but you certainly can request it to be done, or you can

track it at home. And maybe a couple people from this episode will be tying a flexible tape measure around their belly.

Nicole Aruffo, RN (10:30)
I've never gotten my like waist measured at the doctor. I'm from someone who like regularly goes because I'm a good patient and go to my doctor yearly unlike someone else in this room who doesn't do that.

Ed Delesky, MD (10:36)
It's a new.

So one other key piece I wanted to talk about is that

Nicole Aruffo, RN (10:53)
Wait, did they do that to you in school? What? They would like...

like weigh you, get your waist, and they would like do all that stuff. And then they would tell you that you were obese, even though you like were an athlete and worked out for three hours every day. And then mom got mad at the school. Did that ever happen to you? is that my own personal trauma?

Ed Delesky, MD (11:15)
And that might be your own personal trauma. No, I was just a thick boy growing up. Speaking of thick boys, it turns out that obesity as a disease is something that happens to people. another layer of this is that it's believed that genetics are to be 50 percent responsible for obesity.

Nicole Aruffo, RN (11:37)
Yeah, this is pretty cool. I don't think people know that.

Ed Delesky, MD (11:39)
Yeah, this is not so much something that people do to themselves. It just happens to them, which I think is a huge thing as we move towards this disease model of obesity and away from whatever it was before. So it's a complicated thing. It's not one gene that is turned on and all of a sudden, boom, your BMI is above 30. It's multiple genes and there's a complex interplay between your genes.

things around your genes called epigenetics and your environment and how different things in your body, different genes are turned on or turned off based on how your body interacts with your environment, which means your food. And so all of these things could predispose you that if you have a sedentary lifestyle or excess calorie intake, you may have some factors that may allow you and your body to maintain more fat and

give you obesity. That is to say that there are secondary causes. So when we say secondary, there are other things causing you to have obesity. And so those are usually looked at when you're getting an evaluation from your physician. There are medicines that can do this to you. There are medical conditions. And so you should go be seen if you're thinking about this or you've experienced a weight gain that was kind of abnormal and it should be considered. But the vast majority of them

are in the former part of this discussion. So in the first half of the episode, we were able to discuss those things, a description of obesity, how we measure it in the office. And in the second half, we're hoping to describe to you why it's so important to address as a chronic disease.

Nicole Aruffo, RN (13:26)
why don't we talk about how BMI affects mortality?

Ed Delesky, MD (13:31)
So.

Nicole Aruffo, RN (13:32)
Or why don't you say what mortality is for the people that don't know?

Ed Delesky, MD (13:36)
Mortality is a measurement in medicine of death by a certain entity, a clinical entity. So like a disease. How lethal is a disease is mortality. And so there are some figures here and I'll mind you that when people are reading things and giving evidence that it's with what's the best available evidence at the time. So we're in 2024 here.

We're reading from resources that are saying that if someone was 40 years old, someone with obesity, BMI greater than 30 had 4.2 years shorter of a lifespan than someone who wasn't or a woman had three and a half years shorter of a lifespan compared to a woman of a healthy weight. And that's what we're talking about here. There are several different reasons why that play out, but we are talking years of life taken away.

because of this condition. And there are several different reasons why that happens. But I will say from doing some reading and listening today, the risks really are at the BMI of 30. When you're at 25 to 29, you're in that overweight category, I think it still warrants an evaluation of everything around obesity that can go wrong, which we're going to talk about in just a moment. But the risks start.

at 30 and often serves as a goal for where you can get to. So associated with obesity, we talked about how there's increased risk of mortality. That's just one study, but there are lots of evidence and data to discuss that stated point. So morbidity is described as living with a disease or feeling unhealthy and obesity contributes to a lot of morbidity.

Specifically, there is a lot of metabolic risk and morbidity associated with obesity. With diabetes, there's insulin resistance that comes with the extra fat tissue, otherwise called adipose tissue. It's been described that more than 80 % of cases of type 2 diabetes are attributed to obesity. But the good news, which we're not going to talk about today specifically, is that a weight loss of 5 to 7 %

can decrease the risk of type two diabetes. The reason that we're not talking about this today is because we feel like you have to walk before you run. And it's really important to lay the foundation of what this chronic disease is. Anyway, back to it. So there are also several different cardiovascular complications that can occur because of obesity, including hypertension, which we've done whole episodes on, which can be a major player in your lifestyle management to address that separate condition.

And several heart disease, heart diseases, including coronary heart disease, heart failure, or atrial fibrillation. There's an increased risk of stroke and blood clots. And shockingly, there is actually an increased risk of cancer, which 40 % of cancers have been attributed to being people being overweight or obese, which is shocking and disturbing all at the same time. There are several different ones that happen outside of metabolic risk, including musculoskeletal, like people get arthritis more often.

And people often have reproductive side effects, which makes it tough for fertility, or perhaps they have chronic kidney disease. It really does end up touching every part of the physical body, but it also touches on the psychosocial function of someone as well, including stigma associated with obesity and everything that goes on with culture. People with obesity may have higher risks of depression and especially in people who are younger or female. And there's also risks in the respiratory system, including obstructive sleep apnea.

or other respiratory complications. But altogether, the list goes on and on, but there are a ton of complications and morbidity associated with this disease.

So on today's episode, we were able to really get at what the definitions of obesity are, how they're important and how they're measured in the clinic setting. And what's to come is understanding weight loss and how it is so much more complicated than calories in and calories out and different theories around weight loss, including this theory of a metabolic set point, which we'll explore in the future. And then even further in the future, we'll talk about

other things outside of lifestyle changes you can make, including medications. And so hopefully you come back next time. But in the meantime, we really appreciate that you were able to come back for this episode. So hopefully today you were able to learn something for yourself, a loved one.

Nicole Aruffo, RN (18:30)
or perhaps a neighbor who has obesity.

Ed Delesky, MD (18:33)
And as always, you can listen to all of our episodes on anywhere where you listen to podcasts. We have fan mail on our, in the episode descriptions, which people have been using to reach out for one reason or another.

Nicole Aruffo, RN (18:46)
Wait, we didn't talk about who we thought, going back to the beginning, who wrote that about, you've never watched an NBA game.

Ed Delesky, MD (18:54)
Honestly, he was a South Jersey person and I have no idea who it could possibly be.

Nicole Aruffo, RN (18:59)
Which one of your friends likes basketball?

Ed Delesky, MD (19:01)
They all like basketball. So that doesn't narrow it down at all. Please reveal yourself. If you didn't know your cell phone numbers are hidden. So I can't actually see who messages us. And so that's that.

Nicole Aruffo, RN (19:11)
of South Jersey.

mic.

Ed Delesky, MD (19:20)
Maybe Mike. I think he would have just said it though. Yeah.

Nicole Aruffo, RN (19:23)
That's my guess.

Ed Delesky, MD (19:27)
Maybe Murphy.

Nicole Aruffo, RN (19:28)
they live in South Jersey?

Ed Delesky, MD (19:31)
They're moving soon, but for the time being. So you too can get involved with us and send us some fan mail and we'll discuss it on the next episode. If you have any interesting ideas for episodes you'd like us to discover or talk about, then please send it in. We'd love to chat with you. And also don't be shy. If you want to reach out to us on Instagram or send us an email, we are so happy to do that too. Also, if you would feel so in...

to support the show. have a link there where you can make a nominal donation to us for either our time or updating equipment so we can finally get Nikki a boom arm. One thing or another. So that was all we have for you today. This episode is one of a multi-part series, so please come back next time and we'll discuss more about obesity and other related topics. But in the meantime, thank you so much for coming back.

Stay healthy, my friends. Until next time, I'm Ed Delesky. Thank you and goodbye.

Nicole Aruffo, RN (20:26)
I am Nicole Aruffo

Ed Delesky, MD (20:52)
We explicitly disclaim any liability relating to the information given or its use. This content doesn't endorse any treatments or medications for a specific patient. Always talk to your healthcare provider for a complete information tailored to you. In short, I'm not your doctor, I'm your nurse, and make sure you go get your own checkup with your own personal doctor.

Nicole Aruffo, RN (21:06)
I am not your nurse.