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Obesity Podcast

  • SARA LOMAX-REESE:     Good afternoon. You are listening to the Tuesday edition of the Midday Café Healthquest Live on 900 AM WURD. We are on air, online and in the community. I am Sara Lomax Reese and I will be here with you for the next hour and I am really excited about today's show because we are going to explore the all-pervasive, complex, confusing issue of obesity. We are going to consider and answer the question, I hope, why are we so fat? That's the subject of today's Healthquest Live and to explore that issue we have our Einstein docs in the house, Dr. Donnee Patterson, who is a family medicine physician and Dr. Ramsey Dallal from Einstein's Bariatric Department. Welcome.

     DONEE PATTERSON, MD: Welcome. Thank you. 

    RAMSEY DALLAL, MD: Thank you very much.

    LOMAX-REESE: Thank you both for being here. So let's start at the top. Obesity and overweight continue to grow in America and really around the world and almost 70 percent of the population is considered overweight or obese and about 120 million are morbidly obese, and Dr. Dallal you can explain what morbidly obese is in just a minute, not to mention the growing epidemic of childhood obesity. Despite years and years of studies and public health campaigns, the first lady is on top of this issue, we just keep getting heavier and heavier. So let me start with you Dr. Donnee, as a family physician, why, in your experience, are so many people, and we know that in the African American community there is even a disproportionately higher rate, why are so many of us overweight or obese?

    PATTERSON: As you were saying, Sara, it is such a complicated issue. It is part genetics. It is part habit. Certain schools they have lunch every day at 12 so whether you are hungry or not, you eat at 12. Part of it is environmental queues. You see people eating around you, you smell, you get hungry. Part of it is societal issues, you know, mom says eat all your food. It's so complicated. Metabolic changes, ages, age of people, medicines, different people are on medicines that make them gain weight. It is such multifactorial that it's hard to fully get a grasp on it. One thing that we do want to say, different then some of the other topics that we talked about, high blood pressure and high cholesterol, we sort of have a sense of what's going on there and how to treat it and how to manage it, but obesity, because it is so different for many different people, the training is somewhat poor for medical students and residents and it is something that we don't have a perfect answer for and we want to explore that today, but we don't want to leave you without hope, but we want to explore that today.

    LOMAX-REESE: I want to turn to you Dr. Dallal. You are a bariatric surgeon. Now explain what that is.

    DALLAL: Well, I take care of patients with problems with obesity, generally through surgical methods, so we do the commonly talked about surgeries like the gastric bypass or the band procedures or the newer operations like the sleeve operation to treat people who are having severe medical problems related to their weight or who are significantly obese. 

    LOMAX-REESE: We will talk about other ways of managing obesity and success rates and things like that with surgical intervention in a minute, but there was a really powerful documentary that aired on May 14, I believe, on HBO called "The Weight of the Nation". I don’t know if you are familiar with that. I have to say that it kind of frustrated me because you know the consistent message around obesity is you know calories in, calories out, eat fewer calories, exercise more and you will lose weight and it seems like such a simplistic kind of recipe for weight loss and it sounds so simplistic, but it is so complicated and hard for people to have success and I wanted to see, Dr. Dallal, in your experience, what are, outside of surgical intervention, what are some things that people can do to address their weight issue or their weight problem?

    DALLAL: That's a very complicated question. Firstly, as a person who manages people with obesity every day through surgical methods, my preference would be that I didn’t have to do that at all. My preference would certainly be whether that there would be consistent non-surgical therapies and you know the problem is, you are right, the simplistic answer is if you eat less and take less calories you will lose weight. The issue is the brain is not wired to do that in a simple fashion or in a comfortable fashion. It's very uncomfortable to restrict calories. There's no magic diet plan. Most diet plans end up just being a lower-calorie diet, whether it is the Atkin's diet, South Beach diet, a Weight Watchers plan or Nutrisystem. There's really no significant differences between any of the diets and the results and at the end of the day it is what some diets make people more comfortable restricting their intake.

    LOMAX-REESE: Go ahead.

    DALLAL: So the most important aspect of any method to treat obesity is, one, restricting your calories, but how can you do that and maintain that war against your head that wants you to eat a little bit more then you need every day. Those are the tough questions. Some of the science has shown that things like support groups, find people around you who are interested in the same goals as you. It is very hard, for instance, I don’t know if people in your audience are smokers and they want to stop smoking, but their spouse doesn’t. That's extremely difficult. It's the same thing with trying to lose weight. If nobody in your house is trying to lose weight, and you have food in your house that tastes really good, that's high in calories, and you can munch throughout the day, it's going to be very difficult. One of the issues I think helps is find a group of people and have people on your side for this battle against your weight and obesity.

    LOMAX-REESE: We are talking today about overweight and obesity and the epidemic that exists in this country and is growing around the country. One of the things, there is a really fascinating article in Newsweek Magazine that the cover story says, "When I grow up I am going to weigh 300 pounds. Help," and it is a little baby on the front with some french fries, but the hypothesis of this article is the whole all calories are created equal is a fallacy, is not accurate, and that the fact that in the 30's, during the depression, that was the first time that they saw a childhood obesity epidemic and it wasn’t because people were eating too much, it was the kinds of foods that they were eating and so this article points to the fact that the level of sugar and processed carbohydrates like white rice, white flour, white sugar, all of those things is the fact that we have a higher concentration of those kinds of foods that are available all over the place for a very low cost, is one of the reasons why this obesity epidemic continues to build, even if you are maybe eating less. If you are eating the wrong things, you know you are still going to get fat. So I don’t know, Dr. Donnee, you want to respond?

    PATTERSON: Sure. If you think about it, back in the 1800's, the average amount of sugar intake was about four pounds a year, which is not even one of those little bags that we buy at the grocery store and then in the early 1900's it went up some and it goes up every year, but it was up nine or ten pounds a year, but this year, in 2011 and 2012, the average American eats about 80 pounds of sugar, so it is about 16 of those five pound bags a year and that's just sugar. That doesn’t talk about the other things that we eat that are high in calories and a lot of people drink their calories during the day. A normal average adult in America, their average calorie intake should be somewhere between 1,000 and 1,400. Now everybody is different sizes, 1,000 and 1,400 calories a day, but if you think about it, one Big Mac, that's about 950 calories. That's not including the fries and the supersize drink and the pie on the side or the milkshake or whatever. In one meal, or just a half of one meal, is all the calories that you need in the whole day. We are supersizing things. We are adding on things. We are not eating the fruits and vegetables that we once did in mass quantities and so those calories do add up. 

    LOMAX-REESE: Dr. Dallal, recently Mayor Bloomberg is kind of in the spotlight because he has said that he's going to actually ban sodas that are larger then 16 ounces, and that the rationale behind that is because of just what Dr. Donnee said, that there are all these kind of empty calories and it is contributing to the obesity epidemic. Can we legislate our way out of this issue? 

    DALLAL: I think as Americans many of us stand up and try to fight forcefully for our freedoms and liberties. I think sometimes it goes a little too far. There are many things that we legislate that were initially resisted, such as resistance for cigarettes and tobacco and advertising for tobacco and taxes for tobacco. Alcohol is closely regulated. Seatbelt laws - people were up in roar that Oh, my Gosh, you are going to make me wear a seatbelt. You are taking away my rights and liberties, but the problem is these things don’t just affect an individual, these affect society as a whole. It costs money to take care of people who are doing unsafe behaviors, whether it is through everybody's healthcare insurance payments that they make or otherwise. Similarly, with obesity, it is one of the most expensive single items in our healthcare. 

    PATTERSON: Absolutely.

    DALLAL: So the issue is sugar is, in some ways, addicting. The reason why sugar is bad is because it tastes so good and you get a negative feedback when you stop taking in sugar and sugar is very cheap and very plentiful and we are fooled into thinking we really need it, but we don't.

    LOMAX-REESE: So my question is we've gone through a focus on salt as being bad. We've gone through a focus on red meat being bad. There have been a lot of food groups that have been called into question, but sugar seems to have escaped the spotlight. I just want to show, tell a few of these interesting statistics that are in this article. The Coast Guard now assumes the average boat passenger weighs 185 pounds, which is up from 160, in place since 1960. More then a quarter of all Americans ages 17 to 24 are unqualified for military service because of their weight. The University of Alabama at Birmingham Hospital has replaced wall-mounted toilets with floor models that can hold at least 250 pounds. About five billion more is spent every year in the jet fuel needed to fly heavier Americans compared with 1960 weights. If we look at how that is affecting all kinds of the obesity epidemic is affecting all kinds of things, it could potentially affect national security. It could potentially affect our economic liability when we look at the healthcare system. The question is how do we mount some type of effective public health campaign that really gets to the heart of this and how do we affect public health policies that make healthy food more affordable and widely accessible.

    PATTERSON: One small thing about legislating obesity is our school lunches and people don’t quite think about it that way, but if you think about it a lot of our children, they are getting their morning meal, their lunch and maybe snacks in school. So that's one way that we can legislate obesity because childhood obesity is a massive epidemic. Starting in the schools and making sure their - and they have to be tasty because you know children are not going to eat things that don’t taste good so we have to start there because that baby on the front of the Newsweek does grow up to be obese if we don't take care of them when they are younger. 

    LOMAX-REESE: Absolutely. Absolutely. We are talking today with Dr. Donnee Patterson and Dr. Ramsey Dallal, who is a Director of the Einstein Bariatric Department, and we are talking about obesity and overweight. Dr. Dallal, can you give us the difference between obesity and overweight? A lot of times they are used interchangeably. 

    DALLAL: Yes, there are specific definitions and the definitions are really unfortunate because they're hard for people to really get a grasp on. Generally, we use a measurement called body mass index, BMI, and what it is is a way to control for somebody's height when you are talking about a specific weight. Shaquille O'Neal, I think he is 7'2" and 325 pounds. You know if somebody is 5'2" and 325 pounds, that's a little bit of a different problem. So that's what BMI tries to compensate for. A normal body mass index is supposed to be between 18½ and 25. When you look at 18½, that's like these really, really tiny Hollywood models. That's really skinny. Overweight is a body mass index between 25 and 30. You may be surprised. It doesn’t take that much to hit that body mass index. A lot of people are overweight. 

    LOMAX-REESE: Who came up with these guidelines by the way?

    DALLAL: You say that because it makes you feel that you have to achieve an unhealthy or a very difficult weight, who is assuming what's attractive perhaps maybe. Well, these numbers are based on life insurance policies. When insurers want to figure out who is going to live the longest and how much am I going to pay in premiums, they've looked at millions of, now there is a biased group here because they generally look at people who afford life insurance, which are generally middle-aged, good income white men. 

    LOMAX-REESE: Okay, that's where I was going because I am feeling like there is a racial and cultural bias going on in terms of the body mass index. 

    DALLAL: For instance, when you look at the development of diabetes and hypertension and sleep apnea and these medical problems related to weight, they affect different ethnicities at different weight levels. For instance, Asian Americans, in general, nothing specific, in general, tend to develop these medical problems at a lower weight then Caucasians or African Americans. So some people have suggested having different BMI categorization depending on ethnicity as well, but these body mass index aren't meant to be so rigid and bold. It only matters if you are a BMI or 25 or 27, am I really overweight or not? We are talking about body mass indexes as of 33, 43, 53, 63, it doesn’t matter what ethnicity you are, that's a problem. 

    LOMAX-REESE: Absolutely.

    PATTERSON: So, Sara, we don’t take the BMI as the hard and fast rule because,  like Dr. Dallal was saying, there are some ranges there, we understand that, but definitely there are people who are clearly 50 pounds, 100 pounds overweight, and it increases their risk of diabetes, sleep apnea, congestive heart failure, high blood pressure. I want to emphasize that even just a modest amount of weight loss, like eight pounds, eleven pounds weight loss can significantly change some of these medical conditions for some people.

    LOMAX-REESE: We are going to take a quick break. We are talking with Dr. Donnee Patterson and Dr. Ramsey Dallal and we are talking about this issue, this wide-ranging, complicated issue of obesity today and when we come back I want to talk a little bit more about the complications associated with obesity and this growing epidemic of childhood obesity and I would love to take some callers. If you are struggling with your weight or you have a wonderful success story, in terms of losing weight, give us a call, 215-634-8065. Toll free - 866-361-0900. Don’t go away. We will be right back. And we are back. You are listening to Healthquest Live on 900 AM-WURD and we are talking about obesity. There's so much all the time in the media, in the news about obesity. There is this HBO documentary called "The Weight of the Nation" that is still playing on cable. There's First Lady Michelle Obama, who has made this like her signature kind of cause. There is a new piece that came out that Walt Disney Chairman and CEO says that he is planning to announce that in 2015 his company will advertise only healthy, or at least healthier foods, on its kids-focused television programming. Mayor Bloomberg saying a ban on sodas over 16 ounces, so everybody is trying to grapple with this issue. Before we went to break, Dr. Donnee, you were talking about some of the real life-threatening illnesses associated with obesity and that's why, really, this is such a major issue. Talk a little bit further about the connection between being overweight or obese and diabetes, hypertension, heart disease, all of these things. 

    PATTERSON: Sure. It is very important. The more obese a person is they increase their risk for many medical conditions, high blood pressure, diabetes, heart failure, heart disease, and we know that there is a definite direct correlation with many of these medical conditions and it is harder to treat diabetes. We also know that even with just modest weight loss, their diabetes is not cured, but it can definitely improve and blood pressure can improve. So we take this very, very seriously and we also have to remember that obesity doesn’t just affect medical conditions that we can test with lab work. It also affects social situations. There is an increased risk of depression. There's increased bullying in school. It really does affect many, many aspects of life and as we know, a lot of obese people, they are discriminated against and Dr. Dallal was explaining, and I am sure that he can explain more, how a lot of obese patients they tend to get different kinds of jobs or they don’t get promotions the same way or they get discriminated in the airport. There is a recent program showing how a woman was obese and she had to pay for two seats on an airplane. There's a lot of bias. There's a lot of discrimination. So it is not just direct health effects. It's psychosocial things that are involved as well. 

    LOMAX-REESE: Dr. Dallal, so you are the Director of the Bariatric Department at Einstein. Now bariatric surgery, that's a relatively new kind of speciality or is it just something that is getting more attention and there are more people who are going, getting, being qualified for that kind of surgery?

    DALLAL: I think you are correct in both terms. The first weight loss procedures were done in the 1950's, but their popularity had only increased really since the late 1990's and early 2000's with the minimally invasive approaches that we do these procedures with and with the increase in interest by patients there has also been an improvement in training and organization and safety of these procedures so there are more surgeons preforming the operations. There are more specialized training programs for surgeons so that they can focus on this and provide the services as high-quality and as safely as they can, but as well there has been increased demand from patients as well. 

    LOMAX-REESE: I think of Al Roker and I think of Star Jones. I think both of them had some type of bariatric surgery and both of them seem like they're keeping their weight off, but what actually happens - and then we are going to go to the phone, so hold on Jim and Jim. What actually are you doing that allows people, who have been struggling with their weight?

    DALLAL: I think this is one of the most fascinating things, is how these operations work. Most of these operations work by making a person feel like they are not hungry very much. They don’t crave foods as much. They don’t feel deprived of foods, even though they are only eating a fraction of what they had eaten beforehand. It really works as if it is a brain operation more then a stomach operation and that's because we are changing the hormones and the nervous signals from the stomach and intestines to the brain, and it is a really fascinating development, because you see patients who have had a problem struggling with their weight forever, since they were six years old, and they come to me a couple months after surgery going, wow, I went to a restaurant and I couldn’t believe how much those people were eating. I was just - it was terrible. I couldn't watch them and then I realized that used to be me. So the operation, unlike what some people may think, that their stomach is just smaller and they get full quickly, it really works on behavior. It works making people feel the lack of hunger, the unpleasant feeling when you restrict calories.

    PATTERSON: Isn't that amazing?

    LOMAX-REESE: It is. They say that your gut or your intestines is kind of like your second brain so…

    DALLAL: Well, there are more synapses and nervous signals in the intestine then there are in the spinal cord. 

    LOMAX-REESE: Wow.

    DALLAL: It's a very complex organ and it does a lot of things, not just on a nervous system scale, but on the hormonal scale, it produces a lot of hormones that help regulate insulin, help regulate all other parts of the body. It is really a fascinating organ. 

    LOMAX-REESE: So do you anticipate that this is going to become more and more common? Who is a good candidate? If I wanted to lose ten pounds would I get bariatric surgery and I just can't lose it for like the last 15 years? Who is this appropriate for? 

    DALLAL: In general, there are strict guidelines, both established by the National Institutes of Health, the federal government, as well as insurers, as well as the surgical societies that I am a part of and you know the rough numbers are somebody who is 100 pounds over their ideal body weight would be a candidate for surgery. For instance, a 5'2" female, if they were about 220 pounds may be a candidate for surgery.

    LOMAX-REESE: And is this covered by insurance or is this something that you have to pay out of pocket?

    DALLAL: Most insurers cover this, but any individual policy may have exclusions. Just as there are a lot of financial strains throughout the economy in these last few years, some employers are buying policies that may have exclusions to these sorts of surgeries.

    LOMAX-REESE: And how much does it cost to get bariatric surgery?

    DALLAL: For 99 percent of my patients just whatever co-pays that their insurance requires. To pay out of pocket is quite expensive and may run between $15 and $20,000. It is usually something that we would rather have insurance cover, as it is a disease, and you wouldn't deny insurance coverage for somebody with hip arthritis that needed a hip replacement or who had heart pains and needed a coronary artery bypass or angioplasty. 

    LOMAX-REESE: We are talking with Dr. Ramsey Dallal and he is the Director of Einstein's Bariatric Department and we also have in studio, Dr. Donnee Patterson, who is a Family Medicine physician with Einstein Internal Medicine. We are going to go to the phones. If you have a question or a comment, call us at 215-634-8065, toll-free 866-361-0900. We've got Jim from Germantown. Thanks for waiting. 

    JIM: Good afternoon.

    LOMAX-REESE: Good afternoon.

    JIM: You know I respect the doctors there, but I am just a bit saddened that American medicine constantly overlooks natural supplements that have been proven to help people lose weight, to help people get the motivation to do the exercises, and I see hope that some hospitals are moving towards looking at these natural methods, such as Ubiqiunal, that gives people over 50 the energy to want to get up and the motivation to want to get up and exercise, such as sugar substitutes that are more natural, like agave and Stevia. There is even a web site, and I don’t usually just phrase a web site _______ 'cause any fool can put a web site up, but there is a very distinguished doctor, who is on PBS, channel 12, every week, and a web site that Bill Cosby is on the board of called the AmenClinics.com. They give very simple assessment forms there that people can complete to find out what are the natural supplements that their body may be lacking that are causing them to be obese and I just hope that more hospitals will follow Jefferson's example with their clinic that they have down there and I know you have had people on there from Jefferson previously. 

    LOMAX-REESE: Well, thanks for your call, Jim, and I think that there are lots of ways to so-called skin this cat, and for sure there are naturopathic and more kind of natural ways of doing it as well. I don’t know if either of you have anything you want to add.

    PATTERSON: Sure. I totally understand what you are saying, Jim. As a physician, I have been a physician for 14 years, and it is something that as physicians we really struggle with. We see our patients coming back and they've gained three pounds and they've gained eight pounds and then in three years they've gained 12 pounds and despite trying to have them do natural supplements, to encourage them to exercise, to encourage them to eat more fruits and vegetables, there are just some people that cannot lose weight and we go through hormonal testings. I think that Dr. Dallal and I would agree that we really have tried. I've been to conferences in Boston and Texas and California about obesity, and year after year they are talking about the same things because this is a multifactorial thing. There are just some people that don’t lose weight the same way and yes we do encourage diet and exercise over and over, but there are some genetic studies that they study adopted children and these adopted children, they are in an environment where they eat lots of fruits and vegetables and they are encouraged to exercise, but when they compare them to their biological parents, their weights are more similar to their biological parents then they are to their adopted parents in this natural environment. So there's just some people that it doesn’t happen that way and I have had patients go to other hospitals here in the city and be part of their weight loss programs, and they may have lost weight, but within a year or two they gain the weight back, and so possibly Dr. Dallal can talk more about the set points for people, but it is a very difficult thing and that's what we wanted to talk to you about today.

    LOMAX-REESE: Yeah, I think that there's always that you can lose weight, but keeping it off is the real challenge, the real difficulty. I wanted to, Dr. Dallal, we were off the air for just a minute, we were talking about exercise and some of the myths surrounding exercise because most doctors, most healthcare professionals, they say diet and exercise, diet and exercise, diet and exercise, that is the prescription for weight loss, but again turning to this article in Newsweek, they really question that exercise really is not as big of a component in the weight loss equation, and in fact, I am quoting this article, it says, "It takes a significant amount of exercise to burn even a modest amount of calories. Run three miles and you will burn up roughly the amount of calories in a single candy bar." So exercising can make you hungrier and so you eat more. It can make you feel, like you said, a sense of reward, that, oh, I just ran three miles I can eat whatever I want. So talk about your experience with exercise in this equation for weight loss.

    DALLAL: Well, firstly when you look at what correlates the most with obesity epidemic in this country it isn't a decreasing amount of exercise that has occurred over the last 20 years or 50 years, it is the increased amount of sugary foods that have been available. So there is no data to say that our problem is lack of exercise. Our problem is too much calories. With regard to how does exercise play into what physicians would recommend to patients, it is important to exercise. Although exercise, especially moderate exercise, is healthy in that in decreases your blood pressure and improves your insulin resistance, which helps your diabetes. It improves a lot of things, but in and of itself isn't a great weight loss mechanism, unless you're really working out a significant amount every day for a substantial period of time. Because moderate exercise, exercising 20, 30 minutes a day may burn, as you said, 300 calories. That's not even a bagel and people will think that they've burned a lot more, even these machines when you look at the treadmill it says, well, I burned 800 calories. If you step off the treadmill and turn the treadmill on it will still say 800 calories. It over-exaggerates. People over-exaggerate how much they think they're burning. They think that they're eating a whole lot less then they really are. So exercise is important and exercise has been shown to improve the maintenance of weight loss once weight loss does occur, but the primary way to lose weight is going to end up being caloric restriction. 

    LOMAX-REESE: We are going to go to the phones. We've got Jim from West Philly. Thanks for holding, Jim. Welcome to the show.

    JIM: How are you doing?

    LOMAX-REESE: Good. Is this Jim Kade?

    JIM: Yes, it is.

    LOMAX-REESE: Hey, Jim.

    JIM: How are you doing?

    LOMAX-REESE: Good.

    JIM: I just wanted to relate. I always dealt with weights for years. I smell food I gain weight. I don’t have to eat it. In the last, I'd say, three years, I have been able to lose between 40 and 50 pounds and keep it off and the way I was able to initiate the weight loss, because excess weight is excess calories, that means you have taken in more calories then your body needed to exist and the body has stored those calories so to reduce the excess calories on your body you have to restrict your intake to the point that you are taking in less calories then your body needs in a day to remove the excess weight. Now what I've found is that to do it proportionately by eating basically the same things, but smaller portions. Instead of eating a full plate of food you eat two thirds of that and you gradually diminish that and to make up for that hunger feeling you drink water until you can't drink anymore to fill your stomach up to capacitize it so that you can't eat anymore. Over a period of time with discipline your stomach actually shrinks to the point that you don’t get hungry with the amount of food you eat and if you proportionately do that and get it to a point where you are at the weight that you want and you are exercising, I've been able to stabilize in that way. I've stopped eating meat. I don't eat meat. I have not drunk a soda in four years and I have found out that I didn’t know before that all of these artificial sweeteners can be very damaging to your body, especially your joints, and cause you a lot of pain that you don’t even realize where it is coming from.

    LOMAX-REESE: Well, Jim, thank you very much for sharing your success story and Dr. Donnee I see you having some reactions to some of the things that Jim is suggesting. It's clearly working for him.

    PATTERSON: No, no, I applaud him. I think everything he said is right on. I'm just concerned sometimes just to tell people to drink as much as they can until they can't, until they pop, but other then that, I absolutely think everything he said was spot on. You have to watch your calories. You do still have to be active. His cholesterol is probably awesome, because I am a family doctor, I think about everything. So his cholesterol is probably awesome that he decreased the red meat and I applaud you. Thanks for calling.

    DALLAL: I found it interesting, his statement that his stomach shrinks. People have this idea that the size and the amount of distention that your stomach has is what differs and I can eat more then somebody else because my stomach is bigger. Pretty thorough studies have shown there is no difference in the size of anybody's stomach. Everybody's stomach is the exact same size, whether you are 500 pounds, 800 pounds, or 120 pounds. It's just the feelings that the brain gets when it tell you you are done, it has nothing to do with actual size of your stomach. 

    LOMAX-REESE: Interesting. We are going to go back to the phones. We have got C1 from Germantown. Hello?

    C1: Hello.

    LOMAX-REESE: Are you on a speaker phone?

    C1: No, not anymore.

    LOMAX-REESE: Okay. Do you have a question?

    C1: I have a statement. 

    LOMAX-REESE: Okay.

    C1: I've been listening. I've been a vegetarian since probably about 1994, 95, and this might hurt the doctors' feelings, but as a vegetarian, I found out over the years, I don’t listen to Western doctors too much. If you look at it, they cosign all the bad things, they cosign it. If you have a headache they cosign the Advil, the aspirin, after that they cosign the Sudafed. They don’t have any…

    LOMAX-REESE: Well, I think that's a little bit…I think that's a little bit…

    C1: No, no, because if you listen to them, natural things goes against their profession.

    PATTERSON: But you are making a generalization and I appreciate what you are saying. 

    C1: I am not making a generalization.

    PATTERSON: Yeah, because all doctors don’t do that. 

    C1: It goes against their profession because they have to promote these things.

    PATTERSON: Says who? 

    C1: All of the ________. All of this nonsense. 

    PATTERSON: No, no. We don’t have to promote things. I don’t have two nickels in any drug company and I will tell people that and I never will. I don’t push medicine and I will tell my patients for sure, I don’t want you on the medicine. If you can use herbs and decrease the salt in your diet and your blood pressure can come down and you don’t have to be on medicine, I will be the first to do a backflip for you in the office. I will be the first to applaud you. So it is kind of a generalization, but also think about the person that has such high cholesterol and they're a vegetarian already and they're exercising two, three, four miles a day and their cholesterol, their arteries are being clogged. We have to have a solution for them and it is not always the same for everybody. 

    LOMAX-REESE: Dr. Dallal, did you want to say anything?

    DALLAL: Well, you know, I must say, I am one of those people who provide care, which I believe has been shown to be beneficial, and I don’t recommend care that really hasn’t been. Many of the drugs that we do use have been shown to be safe and effective for the vast majority of people. I can't recommend things that haven’t been the same. So I think that the couple previous callers have put a little bit too much hope in the listeners' ears with regards to "natural supplements" that may magically improve their ability to eat or burn calories in some magical way. Ya know, I am a Western doctor, but that is not really been shown to be accurate, those beliefs, and I respect people's beliefs and I can't tell you whether those medications you are taking are harmful or not, but you know, just be careful about recommending drugs, which these are drugs, they're just not regulated. We don’t know whether they're effective or safe. 

    LOMAX-REESE: We are talking about obesity and overweight today and we've got some docs from Einstein who are sharing their information. That was Dr. Ramsey Dallal, who is the Director of Einstein's Bariatric Department and we have Dr. Donnee Patterson, who is a family medicine physician. I think that when it comes to overweight and obesity, this hyperfocus on what you are eating is a really important component and I think that if we can take that kind of focus and really educate ourselves, in terms of what works, when you eat is an important part of weight gain. Like if you are eating late at night, chances are you are going to gain more weight. You eat and then you go straight to sleep. That's not ever a good idea. There are so many different elements to this equation. Let's go back to the phones. We have got Coker from Germantown. Welcome to the program. Hello?

    SIS D: Are you speaking to me?

    LOMAX-REESE: I am. 

    SIS D: Oh, no, this is Sister D.

    LOMAX-REESE: Sister D?

    SIS D: Yes. That's why initially when you said Coker, I was waiting to hear him come on, but I'd like to send peace and blessings to everyone and I thank you for coming on to share this information with the community; however, I must say with all due respect, that a major part of the problem that people are facing obesity in this country is the lifestyle that this country promotes and the fact that we don’t learn in first and second grade, in the health class, how the body works, how the body functions, and the importance of fresh food, fruits and vegetables, to our system that make the system and enable the system to work well. There is a problem with constipation. No one ever speaks about that. People take in three and four meals a day and some don’t eliminate one time a day. If you have three or four solid meals a day you need to have at least that many eliminations a day because the body isn't holding onto weight as we always refer to it, the body is holding onto waste. The food should go in and the body should take out the nutrients and vitamins and minerals out of it and then whatever is left over, the body should throw it off. People don’t do that here in this country the way that it should be done and that's where the focus needs to be, educating the people. No we don’t need the drugs and the herbs come from the Earth. They have the vitamins, minerals and nutrients in it that the body has in it, the body is made to absorb these things. The body is not made to absorb drugs, even though there are many drugs that have been helpful.

    LOMAX-REESE: Sister D?

    SIS D: Yes?

    LOMAX-REESE: Thank you so much for bringing up those very important points. We have a couple of other people who want to get on so I want to make sure that we have an opportunity for other people to weigh in on this important topic. I think that Sister D brings up a very important point in terms of elimination. The other thing is all of this stuff, whether it's how people sleep, how they eliminate, all of these things seem like they are a part of the health of the physical body, the mind, all of those things and when you are not able to have, you know, a functioning system on all of these different levels it seems like you are going to be out of balance, whether it is on your weight or these other things.

    PATTERSON: One thing that I do want to say is I have patients that may come to me and they say, oh, I hate going to the doctor, but I want to emphasize that doctors are not the enemy and we really do put a lot of training into trying to be able to help people. Never once here, have we ever said, people should be on x, y, z medicine. We have never said, we haven't mentioned any medicines here today and we also want to emphasize that surgery is not for anyone. You specifically asked that question. Surgery is not for everyone. It is an individual choice. So we are not pushing any medicine and we are not saying that surgery is for everyone. We are talking about an epidemic called obesity and if it was easy then everyone would be thin, or more people would be thin, should I say. So we are trying to say it has many, many factors and that we need to think about this as a society, bring awareness to it, understand that it really does affect your health and that the rewards of weight loss are so exceedingly worth it, that we want to encourage people to find their way to make it to being not obese.

    LOMAX-REESE: Dr. Dallal?

    DALLAL: You know, I've had the opportunity to take care of patients of all sorts. I have operated on billionaires and millionaires and CEOs of companies. I have operated on people who don’t have much at all, operated on people of all ethnicities, of all backgrounds and many of these people have been successful in many, many, many aspects of their life. Many are quite intelligent, very well read and they can't control their weight. They can't control it. They can't control their diet. They can't do it. It is not for a lack of willpower for some of these patients. They really can't do it. They've had willpower to do amazing things in their life and this one thing escapes them. Their behavior just cannot be altered every day and every minute and every week and every year and they can't stay on top of that caloric restriction. We can talk about whether a good amount of sleep is helpful for weight loss. It is, or when you eat during the day, it may make some difference, but the overriding issue is, these are relatively minor, the overriding issue is we are just inundated by cheap, really good tasting food everywhere we go and these foods have been designed to taste good and our own tastes are designed to crave sweets and so it all works together. There's cheap food that tastes good that's all around us. Everybody else is doing it. I want to do it too and we can't control that pleasure feeling that we get from eating these high-calorie foods.   

    LOMAX-REESE: So what's the answer? I am sure you are not going to get a buy-in from the major food manufacturers to stop eating sweet, tasty, good foods and stop making them available all over the place. Is it just a matter of self-control and self-restraint or what are the answers? 

    DALLAL: Well, I think on two levels, as we talked about initially is there should be a national health policy with regards to the availability of food, how we design foods. This isn't a random event. We subsidize as a government, corn that makes high fructose corn syrup, that makes it very cheap so it is plentiful and everywhere. The high fructose corn syrup isn't necessarily evil compared to regular sugar. The problem is it is evil because it is really cheap and so you can put it in everything and make it taste really good. There are health policies that have already developed to promote the production of cheap sugar. Maybe we shouldn't be promoting the production of cheap sugar. Maybe we should be promoting the production of other foods so that they are more cheap and they are more nutritious and we go towards that, but you are right. There also is an individual component and it goes toward education, know what are the facts about obesity, what are the facts about nutrition, what is a calorie, what is a fat, what's a carbohydrate, what's a protein, what's really bad and what's really not bad, and the reality is there is nothing bad and good about food, it is moderation and understanding what you can tolerate and what you shouldn’t be eating. It is a multi-pronged approach.

    LOMAX-REESE: So for those people who have had surgery and they no longer want to eat as much, what is a healthy amount of food to be eating on a daily basis? I know, Dr. Donnee, you referenced that before, but what do you say Dr. Dallal?

    DALLAL: Well, that's what is fascinating. So if you take one of my patients who may have been 100 pounds overweight and say they went from 250 to 150 pounds and their sister was always 150 pounds, and you see them both now at 150 pounds and you try and you measure how many calories it takes each of those to maintain the 150 pounds. Unfortunately, my patient, who had to lose weight, has to eat less in order to keep her weight at 150. Your metabolism does slow a little bit. So when you ask what's a healthy amount to eat, it does matter where you are starting out. If you are at a healthy weight and you wanted to maintain your weight, one way to know if you have maintained your weight is to count your calories and see what you are eating every day. That's the amount of calories that'll maintain what you have. It varies person to person. We have general guidelines, maybe 2000 calories a day for a male, maybe a bit less for a female, but it depends on your activity level, your height, your age. It depends on a lot of things. That's not a clear-cut answer, but if you are losing weight and want to maintain it, you really do have to cut your calories and maintain them so. 

    LOMAX-REESE: So a really clear to do might be count your calories on any given day, just as a baseline, and then if you are trying to lose weight, recognize that you need to eat less then what you are at that current point.

    DALLAL: Some behaviors that have been shown to help people to succeed in weight loss are, one, count your calories. Understand what you are eating. You will be surprised by how many calories you are eating, especially when you start counting sugary beverages. Two, weigh yourself every day. There are normal fluctuations. Weigh yourself at the same time in the morning and firstly don’t get too excited about the fluctuations because then you see it enough and then you can track that. There's some great phone apps. Everyone has got these smart phones that you can track your calories, you can track your weights. Get an understanding of where you are and that's the first step in understanding what you will need to do.

    LOMAX-REESE: That's a great suggestion and I am going to do that. Dr. Donnee?

    PATTERSON: Let me help you just a little bit. All of this might be a little overwhelming and confusing. There is a little bit of help at weightcalculator.com. There are some that you pay for, don’t pay for it, because the other ones are free. You go to weightcalculator.com, you put in your height and your weight and it will tell you the amount of calories that you should eat that day to maintain your weight and then, like you said Sara, if you do less then that to lose weight, because some people have no idea where to start, what number to start with to actually lose weight.

    DALLAL: Yeah, those are good starting points, but if you don’t measure you won't know. 

    PATTERSON: Right.

    LOMAX-REESE: Absolutely. Excellent, excellent. Well, thank you both. You stayed an extra half an hour and I really appreciate it. Clearly, there is a lot of interest, there is a lot of sharing that people want to partake in so I want to thank you both so much for coming in and talking with us. Dr. Ramsey Dallal, who is the Chief of Einstein's Bariatric Department and Dr. Donnee Patterson, a family medicine physician with Einstein Internal Medicine, we are going to have you back a couple more times this month. We are looking forward to continuing to share great information around health and wellness. Thank you both.

    PATTERSON: Thank you.

    DALLAL: Thanks for having us.

    LOMAX-REESE: We are out of time. Next up is Keeping It Real with Al Sharpton. Remember to make health your number one priority. Celebrate the healer within and always always practice peace. Namaste.