Full Transcript Introduction to Obesity and Womenu2019s Health 0:00 Obesity may lead to loss of ease in our daily functioning, just getting around, walking, going up a flight of stairs, carrying our groceries, 0:09 and also sitting in a theater seat or an airplane or just finding a comfortable spot where you're not feeling conspicuous. 0:18 And that's a very valid concern as well. 0:21 And then to move on to the issues that we're specifically going to talk about today, of course, obesity per se is associated with an increased risk of 0:34 dozens of diseases. 0:36 And that includes diabetes, certainly high blood pressure, coronary artery disease, stroke, and other kinds of cardiovascular disease. 0:47 Have you made it past menopause, or are you going through it now? 0:50 I'm Dr. 0:51 Pat McShane, and on the Women's HealthSpan Voices podcast, I'll guide you through the health challenges of the menoppausal years and beyond, 1:00 guiding the way to thriving in this powerful era of your womanhood. 1:05 Hello and welcome. 1:06 I'm Dr. 1:07 Pat McShane and this is Women's Health Span Voices. 1:20 And today we're going to be talking about obesity. 1:23 And you may say, why on earth would you want to talk about that? 1:27 Because I read about it all the time. 1:29 The best diets, the best foods to eat, foods, to avoid, time of day to, etc., etc. 1:37 Well, in fact, there has been some new information out recently and some accumulating information about some of the newer approaches to obesity. 1:48 So I thought it would be worth revisiting this topic briefly today. 1:53 As you know, probably, obviously the old advice about exercise more and eat less has proven to be inaccessible or unworkable for many,
New Weight-Loss Treatments and Lifestyle Approaches 2:07 many people. 2:08 There are some folks who can pull it off and actually lose weight and get into a normal weight range. 2:14 But that's certainly the minority. 2:17 Fortunately, we have several new options now, including the injectable weight loss medications, as well as oral versions of these that are just now getting 2:31 into the marketplace. 2:32 We'll see how those ultimately do, but they seem to be good. 2:36 There's no reason to think that they're not. 2:39 And most people can lose somewhere between 10 and 20% of their weight on these medications. 2:46 Surgery has kind of fallen into backseat with the advent of the injectable medications, Just to briefly talk about diet and exercise, 2:57 time-restricted eating seems to be an important first approach for many, many people. 3:04 If they can keep their eating to an eight or a 10-hour window, and particularly the last four hours before sleep, that may result in some pretty sizable 3:17 weight loss for a lot of people. 3:19 Keto diet is a great way to get started for many people as well, but it's not very sustainable. 3:26 So those are kind of the current things to be thinking about regarding the medications. 3:33 Older people seem to at higher risk. 3:37 and especially women with regard to muscle loss, especially if you're not eating enough protein and not doing any weight-bearing or resistance kinds of exercises. 3:50 Another issue is bone loss. 3:53 And I think the data here isn't as compelling. 3:56 We don't really know so much about bone-loss with the GLP-1 medications. 4:03 Dehydration, which is an issue for older people in general. 4:07 If you're not eating as much, you are not as compelled to eat because you on these medications. 4:13 Nutrient deficiencies, certain vitamins, etc. 4:17 And then just forgetting to eating if you have any memory issues besides the obesity situation. 4:25 So I think we don't really have a very good handle on these particular risks. 4:32 These are more theoretical risks because the GLP-1 medications are fairly new, but it's certainly something to be thinking about if you're considering 4:42 or if your on this medicines. 4:45 I am not an obesity expert, and I would refer you back to my colleague, Dr. 4:51 Carolyn Francovilla, on our podcast of several months ago. 4:57 She goes through in much more detail some of the approaches and some perils and pitfalls, as we say in the biz here, of these different approaches. 5:09 So please take a look at that. 5:12 The other thing that has happened recently is a major commission of scientists and clinicians to talk more about the role of obesity in our overall health
Risks of GLP-1 Medications in Older Adults 5:24 and lifespan. 5:25 And that was published in the Fall and in The Lancet, which is the major medical journal stemming from the UK. 5:35 It's quite lengthy and detailed. 5:36 If you're interested, please take a look. 5:39 And I will read out to you the definition that they have come up with for obesity. 5:46 We define clinical obesity as a chronic systemic illness characterized by alterations in the functions of tissues, organs, 5:57 the entire individual, or a combination thereof due to excess adiposity. 6:06 So adeposity is too much fat in your body. 6:10 And this is a pretty broad definition and it certainly calls into our thinking the other organs and the mechanism by which obesity impacts people. 6:23 I'm going to spend the rest of our little time here together talking in more detail about what are the clinical implications of obesity. 6:34 But just to back up for a sec, why do we care about obesity? 6:38 Well, For many of us, it's purely aesthetic, and we wish to look different than we do. 6:45 And that's certainly a valid issue. 6:48 For those of who are older and female, to have a third burden of toxicity, if you will, of being obese to add on to our issues because of female and being 7:01 older can be kind of a major burden. 7:03 And that would impact our job prospects perhaps, our romance prospects, or relationships with people. 7:13 And probably even in the medical system, being obese can lead to kinds of prejudice against a good, active treatment. 7:23 So none of us wants to be the victim of a prejudice or being overlooked. 7:30 And then obesity may lead to loss of ease in our daily functioning, just getting around, walking, going up a flight of stairs,
Lancet Definition of Clinical Obesity 7:38 carrying our groceries, and also sitting in a theater seat or an airplane or just finding a comfortable spot where you're not feeling conspicuous. 7:49 And that's a very valid concern as well. 7:52 And then to move on to the issues that we're specifically going to talk about today, of course, obesity per se is associated with an increased risk of 8:05 dozens of diseases. 8:07 And that includes diabetes, certainly high blood pressure, coronary artery disease, stroke, and other kinds of cardiovascular disease. 8:17 The list goes on and on, several kinds cancers and depression, anxiety on an on. 8:24 And reversal of the situation that is weight loss may be useful in many of these cases, certainly in the case of diabetes and high blood pressure. 8:36 One can reverse the situations with weight lost, but as we've talked about it, it's pretty difficult. 8:43 So what is the definition of obesity? 8:47 How do we figure that out clinically? 8:50 Well, the BMI or body mass index has been the standard for many, many years and it certainly has made its way into the literature. 9:00 It's easily measurable. 9:02 You just weigh someone and check their height and there's a table that you can easily figure out whether, according to your BMI, 9:12 you fall into the underweight, normal range, overweight, or obesity range. 9:18 And there's a couple of upper level obesity ranges as well, severe obesity. 9:25 It's pretty easy to do in a doctor's office and it's easy from a public health perspective to just crunch the numbers to figure out whether a given level 9:38 of obesity or overweight are associated with a particular illness or a clinical situation. 9:45 So I have been describing basically the situations, the clinical diagnoses for which obesity is a risk factor, but certainly many people with obesity do 9:58 not have any of these conditions. 10:00 And that is partly why this commission was drawn together to figure out what is a mechanism that obesity can cause these diseases and what working definition
Why Obesity Matters: Function, Stigma, and Disease Risk 10:15 should we be using. 10:16 So I'm going to read to you the definition of clinical obesity that they came up with. 10:22 The diagnosis of clinical obesity requires one or both of the following main criteria, evidence of reduced organ or tissue function due to obesity, 10:36 that is, signs, symptoms, or diagnostic tests showing abnormalities in the function of one more tissue or organ system, or substantial age-adjusted limitations 10:49 of daily activities reflecting the specific effect of obesity on mobility, other basic activities of the daily living, that is bathing, 11:01 dressing, toileting, continence, and eating, or both. 11:06 Now, one problem, of course, with this definition is that there are other conditions that may cause organ dysfunction that have nothing to do with someone's obesity, 11:19 and that's a very valid concern. 11:21 But certainly most of the people with obesity do not have these conditions that might otherwise give them a risk for certain issues, 11:32 such as issues with their blood glucose, risk of diabetes, blood pressure, et cetera. 11:39 So that's a valid consideration and often an issue that you may have had earlier in your life, Such as hepatitis may show up in altered liver function, 11:50 but not be related to your current level of obesity. 11:54 So to dig a little deeper into this situation, what are the mechanisms by which obesity might be causing issues with other organs? 12:04 And inflammation is certainly a big one. 12:06 The fat molecules do create a pro-inflammatory state in your body, and this in turn can impact multiple organ systems throughout your buddy. 12:19 So that's probably mechanism number one, Hormonal imbalances. 12:25 Alterations of satiety and appetite regulation. 12:30 Again, poor nutrition on the basis of poor appetite and an appetite for the wrong foods. 12:37 Insulin resistance is another big one. 12:41 And again, the fat cells per se generate many, many chemicals that impact the rest of our body in ways that we are just starting to figure out. 12:52 So we've been talking about BMI, body mass index, but that in itself may have some inefficiencies and really be totally off base. 13:05 And we're all familiar with the idea that the prime football players would all be classified as obese by the B.M.I.
BMI Limits and the Case for Waist Measurement 13:14 definition or obese or overweight at least. 13:18 But in fact, their excess weight is due to muscle. 13:25 And the converse of that is also true. 13:27 Many of us who fall into a normal weight category for our height would, in effect, be considered excessly obese or have too much fatty tissue by virtue 13:42 of the fact that we have minimal muscle for the amount of weight that And that is often a case of someone with an enlarged abdomen and a high level of 13:59 obesity in their belly, the apple shape as compared to the pear shape that many of us have, especially in our younger female condition. 14:08 So that is something for which a number of people have advocated measuring our waste. 14:17 And I in fact did a YouTube video on that a while back, and it's now on Dr. 14:25 Talks and the other platforms. 14:27 that we should be measuring our waist circumference because that is in fact an independent risk factor for a number of conditions and an indication that 14:40 may in effect be overweight or obese even though the scale may be telling us that are not. 14:46 So those are the two ends of the inaccuracy of body mass index. 14:52 We've been talking about the obesity situation putting us at risk of organ damage ranging from our glucose to our kidneys and heart and so on. 15:08 But what if everything looks fine when we go in for our annual checkup. 15:14 What's the story then? 15:15 But we're overweight, let's say, or even obese. 15:18 what should we be thinking about? 15:21 And the question is, we don't really know the answer to that question. 15:27 And let's back up for a second, talk about the normal trajectory of weight in women and how some of us may actually have lost weight, 15:37 in our older years, but maybe we're still kind of chubby for how much we weigh. 15:43 We're not very muscular. 15:46 So the average woman in the developed world reaches her maximum weight around her 50s, so her sixth decade of life. 15:56 And then our weights tend to drop slightly after that. 16:01 But in fact, much of the weight that we lose is our muscle. 16:06 And that's very unfortunate, of course, because that in itself can lead to frailty and increased risk of falls.
Preclinical Obesity and Closing Thoughts 16:14 It's associated with less good balance and less recovery from certain illnesses and so on. 16:22 So, muscle maintenance is critical as we get older. 16:27 So if you've said, well, I did hit my peak in my 50s, but now my weight's down a little bit, it might be worth finding out whether your waist circumference 16:40 is below 33 inches and even having a measurement of your percent body fat, which is the ultimate measurement that we really care about and the percent 16:52 of muscle that you have. 16:54 So back to the question of Preclinical obesity, in other words, where you have determined that there's excess adiposity in your body, 17:06 but nothing has shown up on the measurements that are done in the clinic or in to indicate that you're having any organ damage from your either overweight 17:18 or obesity. 17:20 And again, we don't really know what the percentage risk is of just maintaining that condition over the next number of decades. 17:29 I'm sure we can all cite people who are in some cases massively obese or certainly overweight who live to a ripe old age and have no issues at all. 17:41 So that's the case. 17:43 And I think if humanly possible, it's smart to peel off risk factors if we can by lifestyle, but that can be very, very difficult. 17:54 These are all things to be thinking about if you're sitting in your doctor's office and they tell you, well, you've gained some weight, 18:02 maybe you should be considering some of these therapies. 18:05 So I hope that I've given you a bunch of things to think about with a little bit of insight into how to thing about them. 18:15 And if this is the kind of information that you value, please like and subscribe and tell your friends. 18:21 I'm here to help you have the best information you can about current medical advances to give you the healthiest lifespan that can have. 18:31 Thanks and I'll see you again soon. 18:34 Thanks for listening to the Women's Health Span Voices podcast. 18:38 If today's episode spoke to you, follow the show and share it with a friend ready to take charge of her health. 18:45 And please leave a review. 18:46 It helps more women find us.
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