Podcast Summary
Obesity as a Chronic Metabolic Disease: The American Medical Association recognized obesity as a chronic disease in 2013, shifting the focus towards comprehensive understanding and effective treatment strategies.
Obesity is no longer just considered a lifestyle problem, but a chronic metabolic disease. Dr. Rosio Salas Whalen, an endocrinologist specializing in obesity, emphasized this point in our podcast discussion. She shared her personal journey into this field, driven by Mexico's high diabetes rate and the connection between diabetes and obesity. Dr. Salas Whalen's background in endocrinology, along with her board certification in obesity medicine, has equipped her well to tackle this complex issue. She noted that the definition of obesity has evolved significantly, with the American Medical Association recognizing it as a chronic disease only recently, in 2013. Prior to this, obesity was often viewed as a simple matter of eating less and exercising more. However, with the acceptance of obesity as a chronic metabolic disease, healthcare professionals can now approach it with a more comprehensive understanding and effective treatment strategies. Additionally, the COVID-19 pandemic has brought further attention to the importance of managing weight, as it increases the risk of developing chronic conditions like type 2 diabetes and hypertension.
Obesity and COVID-19: A Deadly Connection: Obesity is a chronic inflammatory condition linked to severe COVID-19 cases, higher ICU admissions, and mortality rates. Mental health treatments can worsen obesity, making it crucial to address this issue for overall health.
The COVID-19 pandemic highlighted the significant connection between obesity and increased severity of the disease. Studies have consistently shown that patients with higher BMIs had more severe cases, higher ICU admissions, and higher mortality rates. This inflammatory condition can lead to a weakened immune system, making it harder for individuals to fight off viruses like COVID-19. It's essential to recognize that obesity is a chronic inflammatory condition that can lead to numerous health issues, including mental health concerns. Furthermore, mental health professionals must be aware that many medications used in mental health treatment can contribute to weight gain, exacerbating the problem. The COVID-19 pandemic served as a stark reminder of the importance of addressing obesity as a critical health issue.
Understanding the Complexity of Obesity: Obesity is a multifaceted issue deeply rooted in personal experiences and emotional journeys, requiring a shift in how we view and approach treatment. Family history and mental health play significant roles.
Obesity is a complex issue deeply rooted in personal experiences and emotional journeys. Patients who struggle with weight have often spent decades trying various diets with little success, leading to significant emotional distress. It's essential for healthcare professionals to understand that obesity is not a matter of laziness or lack of willpower. Instead, it's a multifaceted issue that may require a shift in how we view and approach treatment. Furthermore, food is not just about nutrition; it's also about comfort and culture. Mental health plays a significant role in both obesity and eating disorders. As healthcare providers, it's crucial to ask about family history, including weight struggles and exercise habits, to better understand the potential genetic and environmental factors contributing to obesity. In most cases, there is a family history of obesity, and acknowledging this can help patients feel less alone and more understood in their journey towards better health.
Exploring obesity through genetic and environmental factors: Doctors consider family history, gender, menstrual history, lifestyle factors, sleep apnea, and metabolic health to understand obesity's complexities. Tools like impedance machines provide more accurate insights.
A comprehensive approach to understanding obesity involves a detailed exploration of both genetic and environmental factors. During consultations, doctors delve into family history, gender, menstrual history, lifestyle factors such as exercise, eating habits, and sleep patterns, and the use of medications. Sleep apnea, a common environmental factor, can contribute to obesity through a vicious cycle of sleep deprivation and increased cortisol levels. Doctors also utilize tools like impedance machines to gain more accurate insights into a patient's metabolic health beyond just BMI or weight. Metabolic health is defined as having a higher ratio of skeletal muscle mass to body fat mass and minimal visceral fat. By taking a holistic view of a patient's history and health, doctors can better understand and address the complexities of obesity.
Understanding Metabolic Health Beyond Physical Tests: Maintaining muscle during weight loss and incorporating strength training are crucial for optimal metabolic health. Exercise significantly impacts muscle mass, which in turn influences body fat percentage.
Assessing a patient's metabolic health involves more than just measuring their ability to perform physical tests or checking their hand grip strength. Metabolic health is determined by factors such as insulin resistance, blood pressure, and cholesterol levels. The ability to exercise and maintain muscle mass during weight loss is crucial, as muscle loss can lead to an increase in body fat percentage. Exercise, including strength training, plays a significant role in maintaining muscle and improving overall health. Studies have shown that combining weight loss with strength training can result in more fat loss than muscle loss. During the maintenance phase, gaining muscle can help rebuild any lost muscle, acting as an additional tool in maintaining weight loss. It's essential to understand the importance of muscle mass in overall health and metabolic health, as it can significantly impact body fat percentage without the need for medication.
Medications for weight loss in emotional eaters: GLP-1, GIP, and myelotidinesterase type medications decrease food reinforcement and increase satiety hormones, leading to weight loss in emotional eaters.
GLP-1, GIP, and myelotidinesterasep type medications are effective for weight loss in patients with emotional reinforcement issues with food. These medications work by decreasing the positive reinforcement response to food and increasing satiety hormones, leading to smaller meal sizes and fewer food cravings. The speaker personally has experienced a reduction in stomach emptying and cravings after trying these weekly injections. These medications, such as semaglutide and tirzepatide, have shown significant weight loss compared to daily versions or older medications like orlistat and Saxenda. The decision to prescribe these medications depends on the patient's history with food and emotional relationship with it.
GLP-1 drugs mimic appetite-regulating hormones and can effectively reach the brain: GLP-1 drugs, discovered after bariatric surgery, effectively target the brain and gut to regulate appetite and improve glucose control, unlike the mechanical restriction of bariatric surgery
GLP-1 drugs, which were discovered after the use of bariatric surgery, work differently in the body compared to the mechanical restriction provided by the surgery. While bariatric surgery physically shrinks the stomach and slows down the release of appetite-regulating hormones, GLP-1 drugs mimic these hormones and can reach the brain to suppress appetite. The short half-life of naturally produced hormones makes it challenging for them to cross the blood-brain barrier, leading to regain of weight in bariatric surgery patients. In contrast, GLP-1 drugs, which have been available since 2005, can effectively target the brain and gut to regulate appetite and improve glucose control. These medications have a proven safety profile and can be used for weight loss and diabetes management, regardless of diabetes status.
New diabetes medications promote weight loss: New diabetes drugs like liraglutide, semaglutide, and tirzepatide help manage blood sugar and promote weight loss by mimicking the natural hormone GLP-1, but they may not be covered by insurance and can be costly.
Certain medications used for diabetes management, such as insulin and some oral drugs like sulfonylureas and pioglitazone, can cause weight gain. However, some newer medications in the GLP-1 receptor agonist class, like liraglutide, semaglutide, and the latest addition, tirzepatide, have been found to not only help manage blood sugar levels but also promote significant weight loss. These drugs work by mimicking the natural hormone GLP-1, which regulates appetite and metabolism. They have been approved for weight loss in addition to their diabetes indications. While these drugs can be effective, they may not be covered by insurance and can be expensive. For example, tirzepatide, which is the latest addition, is currently available with a $25 monthly coupon for 12 months for patients with commercial insurance. Semaglutide's weight loss version, Wegovy, has experienced stock shortages. It's important to note that this information is for educational purposes only, and individuals should consult their healthcare provider for personalized medical advice.
Investing in obesity medications for root cause treatment: Shift focus to medications like GLP-1 receptor agonists, address root cause, increase demand, and reduce healthcare burden
The current healthcare system and insurance companies need to shift their perspective on obesity treatment by investing in medications like GLP-1 receptor agonists, such as Gavi and Ozempic, which address the root cause rather than just managing complications. The shortages and high costs of these medications can be addressed by increasing demand and prescription from healthcare providers. It's crucial for physicians to change their mentality towards obesity and remove the bias that it's solely a lifestyle problem. While there are potential side effects, such as nausea and vomiting due to slow emptying, there have been no reported cases of medullary thyroid carcinoma in humans since 2005 with the use of these medications, except for those with a first-degree relative history of this rare, aggressive type of thyroid cancer. Regular screening and biopsies before starting treatment are not necessary. Overall, investing in these medications now could lead to significant cost savings in the long run by preventing complications and reducing the burden on the healthcare system.
Awareness of potential side effects of GLP-1 receptor agonists for weight loss: While effective for weight loss, GLP-1 receptor agonists like semaglutide and tirzepatide can cause dehydration, increasing the risk of severe complications. Prioritize conscious hydration and ensure insurance coverage and medical supervision.
While GLP-1 receptor agonists like semaglutide and tirzepatide are effective for weight loss and have a low risk of human cases reported in the last 20 years, it's essential to be aware of potential side effects, particularly dehydration. Although rare, pancreatitis is a concern for patients with type 2 diabetes. Dehydration, which can lead to severe complications like kidney stones, acute renal failure, and even loss of consciousness, is a more significant issue than nausea or gastric side effects. Patients should prioritize conscious hydration as part of their treatment. Additionally, ensuring insurance coverage for weight loss medications and receiving proper medical supervision are crucial for optimizing results and minimizing risks. The drugs may be available without a prescription in some places, but they are still medications with potential side effects and should be used under medical guidance. I practice in California, Florida, Vermont, Georgia, and New York, and offer both in-person and telemedicine consultations. Stay tuned for Part 2 of our discussion on GLP-1 receptor agonists. If you have any questions, please email me through psychiatrypodcast.com.