Overweight or obese physicians were less likely to discuss weight loss with heavy patients: only 18% of these doctors discussed losing weight with their patients while 30% of normal weight physicians did.

More interestingly, 93% of doctors diagnosed obesity in their patients only if they believed their own weight was equal to or less than that of their patients; only 7% of doctors believed their weight exceeded that of their patients diagnosed obesity.

You certainly wouldn’t go to a dentist with horrible teeth or a hairdresser with horrible hair, and you should avoid advice from an overweight healthcare provider.

So this is where we are headed… while I applaud the attention we must all place on this urgent issue, as a species we have gone from food scarcity and malnutrition to food excess and the malnutrition of overconsumption, in less than 30 years out of a 2-3 million year history. Maybe it’s not an app we need. Maybe it’s an issue of food quality (vegetable oil, refined grains, acellular carbohydrates).

https://www.cnbc.com/2019/08/17/weight-watchers-new-childrens-app-kurbo-faces-backlash.html

According to a “NEW” study published in Obesity, “lifestyle interventions focused on altering dietary and physical activity habits using behavioral strategies can produce sustained weight loss among African Americans and Hispanics who have type 2 diabetes (T2D)” Which ivory tower have they been living in or is this new information to their sources of funding?

Maybe some of these researchers could come to visit outpatient clinics that have been successfully doing this for 20 plus years.
Pharmaceuticals have only a short-term role in a long-term lifestyle and behavioral issue.
Bariatric surgery is an induced dietary restriction and malabsorption syndrome, patients often overheat the restriction with liquid calories or develop such significant malabsorption that they develop secondary complications .
I treat obesity, exactly the same as I treat addiction.

The only intervention I have ever found to be successful in the long term was providing the patient with behavioral management tools in altering habits (using substitution and harm reduction), and then a re-education of what was truly “healthy” (and that didn’t include starting the day with a bowl of cereal and skim milk.

In a busy clinical practice, a brief direct interaction, providing just in time information that is “doable” is the only thing that I have found useful. The more esoteric the information or the more complicated the protocol, the worse the adherence.

Download our entire protocol for free on the profile page.

Weight Loss Experiences of African American, Hispanic, and Non‐Hispanic White Men and Women with Type 2 Diabetes: The Look AHEAD Trial. Obesity, 2019; 27 (8): 1275

My clinic started as an interventional pain clinic, but I quickly realized that chronic pain was more than an isolated pathology of excessive pain. I have amazing tools that can relieve a patient’s symptoms, but I can’t reverse the course of the disease unless I treat the underlying cause, the metainflammation. Pain simply doesn’t become chronic in metabolically healthy people.

Unfortunately, less than 12.2% of the US population is metabolically healthy and more than 60% are overweight or obese.

Chronic diseases driven by obesity accounts for >$480 B direct costs. The total cost of chronic diseases due to obesity is > $1.7 T (about 9.3% of the US GDP or 47% of the total cost of chronic disease spending nationwide). These are MASSIVE costs, and overtime WILL BANKRUPT the US economy.

I believe that failing to treat the patient’s underlying pathology, the cause of the patient’s symptoms, is a disservice to the patient and to society.
Patients rarely seek preventative treatment, they most often wait for their symptoms to manifest, and pain is the cardinal symptom that drives them to seek care. Pain after all is the body signaling mechanism of impending tissue damage. Patients are also highly motivated and receptive to lifestyle changes when confronted with a lifetime of painful suffering.

I still have an interventional pain clinic, but now the interventions include lifestyle and chronic disease interventions that provide patients with tools and techniques to reverse metainflammation. We have gone from treating the patient in isolation to treating the community around the patient, to maintain adherence to lifestyle changes.

The prevalence of vending machines that stock soda in schools, particularly elementary schools, is concerning for the overall health and well-being of the country. Sodas are made largely with high fructose corn syrup. Fructose activates the dopaminergic reward system more than glucose, and high fructose corn syrup is spiked with extra fructose, far beyond what the labels suggest. Additionally, reinforced behavior, accentuated by the casino-like feel of vending machines, increases consumption in vulnerable populations, such as young children.

The ability of children, not adults, to make these choices, combined with the hedonic reward of dopamine, only increases consumption. Fructose preferentially is stored as fat through first-pass hepatic effects, leading to insulin resistance and potentially diabetes.

Background:

The per capita consumption of high fructose corn syrup — the mainstay of soft drinks and other sweetened beverages — has increased from 38.2 pounds in 1980 to 868 pounds in 1998 (Chou et al., 2004). In 1942, the annual U.S. production of soft drinks was 90 8 oz. servings per person; in 2000, it was 600 servings (Jacobson, 2005). Sodas and other sweetened beverages are readily available in our nation’s schools. Vending machines are placed in almost all of the nation’s middle and high schools (Weicha, Finkelstein, Troped, Fragala, & Peterson, 2006) and are in approximately 40 percent of our elementary schools (Fernandes, 2008). Both school vending machines and fast food restaurant use have been associated with increased intake of sugar-sweetened beverages by youth (Weicha et al, 2006). When vending machines are placed in elementary schools, black children are more likely to purchase a soft drink from these machines (39 percent) compared to white children (23 percent) (Fernandes, 2008). Could it be that these machines are becoming vendors of death?

Our eating patterns can influence insulin production and weight gain, and it’s important to give our bodies time to burn energy from food. Most people eat from the time they wake up until the time they go to bed — typically three main meals, multiple snacks, and often soda in between. This pattern leads to chronic high insulin production, which fatigues the insulin receptors. In addition, insulin is a fat storage hormone, and elevated insulin levels lead to fat accumulation in the liver, creating metabolic inflammation.

Your metabolism exists in two states – the “fed” (insulin high) state and the “fasted” (insulin low) state. Either we are storing food energy (increasing storage), or we are burning stored energy (decreasing storage or fat lysis). If we start eating the minute we roll out of bed and do not stop until we go to sleep, we spend almost all our time in the fed state. Over time, we gain weight, because we have not allowed our body time to burn stored food energy.

People wonder what weight has to do with experiencing pain and its treatment. I am an interventional pain physician, and sometimes I get the question, “Why are you so worried about a patient’s metabolic function? Why worry about their weight? Just treat the pain.”

However, almost all of the patients in our clinics are overweight, and when we evaluate their biochemical markers, they have prediabetes and metabolic inflammation. Even the ones who aren’t overweight have elevated GGT and evidence of fatty liver and insulin resistance. Clinical studies in Europe have found that “increased risk of adverse cardiovascular outcomes associated with type 2 diabetes does not begin at the diagnostic cutoff for plasma glucose (or HbA1c) at which the condition is diagnosed. Rather, there appears to be a continuum of increased microvascular and macrovascular risk that extends to levels of glycemia well below these cutoffs.”

Therefore, treating metabolic inflammation is treating the pain. and treating metabolic inflammation early, before the patient requires insulin, is the key to treating and managing chronic pain. The omega-6 pro-inflammatory pathway is the common link.

Hopper I, Billah B, Skiba M, Krum H. Prevention of diabetes and reduction in major cardiovascular events in studies of subjects with prediabetes: a meta-analysis of randomized controlled clinical trials. Eur J Cardiovasc Prev Rehabil. 2011;18:813–823.

Low-fat food doesn’t always mean healthy, and looking at fat negatively can actually lead to insulin resistance and weight gain. Demonizing fat because it has more calories per gram ignores the information transmitted in food to your body and encourages consumption of ultra-processed foods.

If it says “low-fat” and you think it’s healthy, think again. You have fallen prey to Big Food and Ancel Keys.

Focusing simply on calories in and calories out produce an inherent bias against high-fat food, which may actually protect against obesity and related diseases. The simplistic calorie focus results in dietary guidelines that support replacing fat with starch and sugar, which promotes insulin resistance.

Malhotra A, DiNicolantonio JJ, Capewell S. It is time to stop counting calories, and time instead to promote dietary changes that substantially and rapidly reduce cardiovascular morbidity and mortality. Open Heart 2015;2(1) doi: 10.1136/opener-2015-000273 [published Online First: Epub Date|.

The standard advice of dietitians and physicians to those who want to lose weight is simple: eat less, move more. However, this advice doesn’t actually produce favorable odds for losing and maintaining a healthy weight.

Using the standard calorie reduction approach recommended by the dietitians produces a probability of attaining a normal weight at 1 in 167. Following this standard advice of eating less, move more generates a greater than 99% failure rate, and explains why most people don’t get sustainable weight loss.

These odds are not in your favor. They favor obesity, prediabetes, and diabetes. These odds favor expensive and chronic medication management.

It’s time to follow a new path to health.

Fildes A et al. Probability of an Obese Person Attaining Normal Body Weight: Cohort Study Using Electronic Health Records. Am J Public Health. 2015;105: e54–e59.

Our weight depends on a variety of factors, but one secret to a healthy weight is found in awareness of the role the hormone insulin plays in fat storage.

It is wrongly assumed that consuming excessive calories is the root cause of obesity. However, a calorie of food energy has different metabolic fates depending upon the hormonal stimulation. That same calorie may be used to generate body heat or stored as body fat. It can also act as a signaling molecule to trigger a secondary response. The gut microbiome then interacts with the consumed molecules first and creates its own signaling to the human host and affects metabolic pathways, increasing or decreasing nutrient availability.

Obesity is a disease of failed energy partitioning, not one of total energy intake, and one of the primary drivers of this partitioning is the hormone insulin. Insulin is specifically a fat storage growth hormone. The mere presence of insulin causes an immediate metabolic shift from using fat as a fuel source, to storing circulating glucose to glycogen for a total of about 500 grams. Once the initial glycogen stores are full, then glucose is converted to fat storage, a nearly unlimited storage capacity.

Insulin is specifically a fat storage growth hormone. The higher your insulin and the more often your insulin spikes determine your fat storage, not the number of calories you eat.