October 26, 2023 • 28 mins
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Ready to debunk the myths, lies, and half-truths about obesity and healthy living? Listening to this episode will challenge the 'health at any size' idea that obesity and health can coexist. I dive into a dissection of the 'obesity paradox' and 'fat but fit' - a term that has been doing rounds on social media and even within medical circles. The episode looks at the World Health Organisation's definition of health and discusses a study that proves that metabolically healthy obese people are at a higher risk of coronary heart disease than their normal weight, metabolically healthy counterparts.
I don't stop at challenging the 'obesity paradox'; we also take a hard look at the controversies around obesity and health, explaining why being 'metabolically healthy' doesn't necessarily mean you're healthy if you're obese. I bring to light the risks of obesity, including complications during pregnancy and other health issues, often ignored in popular discussions, including the impact of obesity on fertility.
This episode also talks about the dangers of taking everything you see online at face value and dispel some of the myths about caloric intake and the role the laws of thermodynamics has in weight gain and loss.
Thank you for listening! For more information please visit adoctorsview.uk
email: adoctorsview@gmail.com
instagram: @adoctorsview
twitter: @DrPolyvios
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Transcript
Episode Transcript
Available transcripts are automatically generated. Complete accuracy is not guaranteed.
Dr Paul Polyvios (00:00):
And listening to these people talking about
how, even though they'remorbidly obese, they're healthy
and their diet is healthy andthat they're fitter than they
ever were when they were slimmer, and that, if you disagree with
their preaching, you're not ascientist, doctor or someone
with a common sense or asensible opinion based on truth
and logic.
You are fatphobic and bigotedBecause remember everyone it's
(00:24):
far easier for everyone else tobe the problem and results of
blaming a lack of acceptance andto be a victim than it is to
admitting that you have aproblem and dealing with that
problem.
Dealing about it in a way thatwill impact not just you but the
others around you and impactthem in a positive light.
Welcome to Doctor's View withme, dr Bolivios.
(00:51):
Join me as I discuss everydaytopics in health and medicine
and provide the insights intoeveryday hospital life.
Sit back and enjoy the show.
Hello everyone.
Welcome to Doctor's View.
I'm Dr Polyvios.
Today's episode is a morecomplicated one than I initially
thought when drafting it out.
(01:11):
I want to revisit obesity andthe idea of obesity and health,
and we're going to talk a bitabout metabolic health and some
of the lies that we're hearingon social media and, sadly,
other people within the medicalprofession who are propagating
the idea of obesity and healthand saying that the two go hand
(01:32):
in hand and are not mutuallyexclusive, which, if you've been
a long time listener of theshow, you will know that it's
against what I believe andagainst what the evidence
actually shows.
And we're going to talk aboutsome of the evidence that favors
the obese and healthy argumentand some of the theories as to
why there is a so-called obesityparadox in a number of
(01:53):
different studies.
So to clarify, firstly, my mainreasons to why I don't believe
that you can be obese andhealthy is quite simply,
regardless of anything else thathappens to your health as a
consequence of obesity.
The World Health Organizationdefines health as a state of
complete physical, mental andsocial well-being and not merely
(02:14):
the absence of disease orinfirmity.
So if you're in a state whereyou are addicted to food to the
extent that you have allowedyour body to reach morbid
obesity, you cannot be in astate of physical, mental and
social well-being.
In the same reason, you cannotbe a smoker and be in a state of
physical, mental and socialwell-being because you're
(02:35):
suffering from an addiction.
Now you may not be displayingany physical symptoms or
problems and indeed blood testsmay be completely normal.
However, it doesn't tell youthe whole story.
So we know there's been anumber of studies that
demonstrate time and time againthat obesity is associated with
several cardiometaboticabnormalities.
(02:55):
It's a major risk factor fornot only cardiovascular disease
but also mortality, and itcounts for one in five deaths
worldwide.
And a major study was conductedwith three and a half million
people and it demonstrated thatafter following these people up
from nearly five and a halfyears later, they found that
even the metabolically healthyobese people had a higher risk
(03:19):
of coronary heart disease thannormal weight metabolically
healthy people.
So this has been proven.
There's been a lot of discussionand a lot of airtime given to
this so-called obesity paradox,and the obesity paradox is where
studies have shown that beingmorbidly obese or overweight has
(03:41):
no impact on, in some cases,actually had a better outcome in
certain diseases than if youare a patient of a normal body
mass index.
This has actually been debunkedseveral times with several
studies, and some of the reasonswhy we get these results is
because of the way the studieswere conducted and the inherent
(04:01):
bias within the study processand the methodology itself.
For example, there is anobesity paradox which talks
about the incidence ofdeveloping problems with type 2
diabetes in metabolicallyhealthy, obese people versus
metabolically unhealthy, normalweight people.
The study shows that you'remore likely to develop type 2
diabetes if you're metabolicallyunhealthy and of a normal
(04:23):
weight versus a metabolicallyhealthy, overweight individual,
suggesting that metabolic healthis what matters the most, and
not obesity.
What the studies fail to takeinto account is actually other
external factors, such assmoking and other lifestyle
factors, which play a huge partin the health of an individual.
(04:45):
And it's also been shown thatBMI is not necessarily the best
indicator of outcomes in a lotof these studies, for example,
you can be a personal trainer ora muscular athlete and
potentially have a BMI whichmakes you in the morbid obese
category, purely because muscleweighs more than fat, even if
(05:06):
your actual body percentage fatis very low.
And there's also been a numberof studies to show that the
waist to height ratio is abetter indicator of outcomes in
patients with heart failure.
So we must acknowledge thatwhen studies are talking about
high BMI and the obesity paradox, what they perhaps should be
focusing on is more body fatpercentage and the distribution
(05:30):
of fat, because that has beenshown to be a much better
predictor of outcome.
The paradox continues with heartfailure and cardiovascular
problems, and I think this iswhere the health at any size
movement got most traction.
Studies have shown thatpatients who are morbidly obese
with heart failure or heartdisease have better outcomes
(05:51):
than heart disease patients of anormal weight, and that may
well be the case.
However, there's somethingthat's often led out in this
discussion, and that's if theheart disease patients who were
overweight or obese in the studywere of a normal weight to
begin with, the chances of themdeveloping the heart disease and
(06:13):
subsequent health problemswould be far less to begin with,
so they wouldn't actually be inthat situation in the first
place.
The patients who are of anormal weight with heart disease
may actually have a number ofhealth issues to begin with
which could be a consequence ofother lifestyle factors, as we
said before, smoking or drug useor, sadly, genetic and family
history, and outcomes may wellbe worse when compared to other
(06:37):
patients who have no other riskfactors for development Heart
disease other than their obesity.
Now, this doesn't detract fromthe fact that if it wasn't for
their obesity, these patientswouldn't be in the study to
begin with, and that's becausethey wouldn't have the heart
disease.
So we also can't forget thefact that, whilst metabolically
(06:57):
healthy, obese people have alower risk of developing certain
cardiac diseases thanmetabolically unhealthy people,
the risk is still higher than ametabolically normal weight
person metabolically healthy,normal weight person.
But unfortunately, studies likethis have been taken out of
(07:20):
context and spun to make it seemthat obese people are healthier
than slim people, and that'snot the case at all actually far
from it, and it doesn't takemuch to see this.
So that's why I don't believein the obesity paradox.
It does not consider a lot ofother factors.
(07:41):
The I'm healthy and fat is justa contradiction in terms when
you think about the problemsthat arise because of obesity,
which starts from a young ageand actually only just get worse
when time goes on.
We talk a lot about beingmetabolically healthy and I've
(08:02):
done a podcast on this in thepast, speaking to Dr Philip
Avadia, a cardiothoracic surgeonin America about this, and he
went to great lengths to talkabout metabolic health with me
and its importance, and it was avery interesting discussion and
I learned a lot from it.
But sadly, the term metabolichealth now seems to have been
(08:26):
misrepresented with thismetabolically healthy obesity.
It is debated whether any formof obesity can ever be
considered healthy or whetherthe metabolically healthy obese
phenotype is merely a stage intransition to developing a
metabolically unhealthy obesephenotype over time.
(08:46):
In the same way, for example,how a lifelong 60 a day smoker
doesn't have any problems as aconsequence of smoking.
Yet Give it another 10 yearsand the chances of that still
being the case are very slimindeed.
And yes, we all know the oddperson who has lived to 100 and
they had the unhealthiestlifestyle imaginable.
(09:07):
They are anomalies.
They are not the normaldistribution, they are the
outliers and that's why they'recalled outliers.
They are not in the normal.
Very good for them.
But to take these one or twooutliers and apply that as a
generalized rule for everyone isnot only unscientific but it's
(09:28):
actually quite foolish.
Part of the contention withmetabolically healthy obesity
may actually also relate to howit's defined, and to date
there's no university accept isstandard for defining
metabolically healthy obesity.
So far, more than 30 differentdefinitions have been used to
create these phenotypes instudies.
(09:50):
Broadly speaking, metabolicallyhealthy obesity has been
defined frequently by theabsence of metabolic disorder,
the absence of cardiovasculardisease, including type 2
diabetes, absence ofdyslipidemia, hypertension and
atherosclerotic cardiovasculardisease in a person with obesity
.
However, most studies defineMetabolically healthy obesity is
(10:16):
having either none of thesethings, one of these things or
even two of these metabolicsyndrome components.
So therefore, you've got a lotof people being reported as
being metabolically healthyobese, but they're not
metabolically healthy.
They simply have fewermetabolic abnormalities than
those with who are being definedas metabolically unhealthy.
(10:38):
So this is, since that's a somuch conflation of the term
metabolically healthy obesity toessentially say that if you
only have one or two metabolicproblems, you're metabolically
healthy and that just meansyou're healthy whether you're
obese or not, and that's justplain rubbish.
(10:58):
And, even more tragically, thisis being used to feed the fat
acceptance movement and thehealthier any size movement,
when in fact what we should bedoing is encouraging people to
obtain a normal body fatpercentage.
Let's take another account oranother example, where you may
be inclined to say someone isobese and healthy.
(11:18):
I wonder what happens when youput that body under undue stress
.
I wonder if they would still behealthy.
So let's take pregnancy, forexample, something which is a
massive strain on the body andgenuinely a heroic and dangerous
process for any woman toundergo, and up until not that
long ago lots of women weredying in childbirth.
(11:40):
So let's take pregnancy andcouple that with obesity.
So what are the risks of beingobese and pregnant?
Well, let's talk about it.
You've got thrombosis.
This is a blood clot that cango in the legs.
That can form in the legs andthen go into your lungs and
cause pulmonary embolism, whichis a life threatening problem.
Gestational diabetes this isdiabetes during pregnancy.
(12:02):
If your BMI is above 30, you'rethree times more likely to
develop gestational diabetes.
If your BMI is over 25, therisk of developing high blood
pressure and preeclampsia is twoto four times more likely
compared to someone with anormal weight.
Mental health problems Problemsagain, this has been shown to
impact greater if you'reoverweight.
(12:23):
And then you've got the actualproblems that occur with the
baby itself.
The normal risk of miscarryingin an early pregnancy, say at
the age of 35, is about 20percent.
If you've got BMI of 30 orabove, that risk increases to 25
.
If you're overweight beforepregnancy or in early pregnancy,
(12:46):
this affects the way the babydevelops in the womb.
Overall, about one in athousand babies in the UK are
born with neural tube defects.
And if your BMI is over 30,your risk is nearly doubled and
if you're overweight, you'remore likely to have
complications during the birth,and the risk is doubled from
seven to a hundred in two tofourteen to a hundred.
Also, the overall risk ofhaving a stillbirth
(13:11):
unfortunately doubles to one ina hundred instead of, say, one
in two hundred.
You may also need additionalscans and overall it's just more
difficult to move around andstay active because of body
habitus.
The actual pregnancy aside, wehaven't even spoken about the
impact of obesity and fertility.
Excess body fat impacts theproduction of gonadotropine
release in hormone and this iseven more likely to be a risk In
(13:34):
hormone, and this is essentialto regulating ovulation in women
and the production of sperm inmen.
Specifically, gonadotropinereleasing hormone releases
Lutinizing hormone and folliclestimulating hormone, and both of
these are critical to thedevelopment of eggs and sperm.
I also just want to take thismoment to discuss the number of
(13:56):
lies that we hear online andjust listening to some people
talking on YouTube and how thereare a number of videos of
people who are morbidly obesetalking about the amount of
exercise they're doing each dayswimming, running, cycling and
if that is true and they'redoing an hour straight nearest
exercise every day for the lastfive years and they're still the
(14:17):
size that they are, then theamount of food that these people
must be eating is, quitefrankly, scary.
Either that or they're lyingabout the amount of exercise
that they're doing.
I believe it's actually amixture of both, and probably no
exercise and eating a hugeamount of food.
And listening to these peopletalking about how, even though
(14:38):
they're morbidly obese, they arehealthy and their diet is
healthy and that they're fitterthan they ever were when they
were slimmer, and that if youdisagree with their preaching,
you're not a scientist, doctoror someone with a common sense
or a sensible opinion based ontruth and logic.
You are fat phobic and bigotedbecause remember everyone, it's
(15:00):
far easier for everyone else tobe the problem and results of
blaming, a lack of acceptanceand to be a victim.
Then it is to admitting thatyou have a problem and dealing
with that problem, dealing aboutit in a way that will impact
not just you but the othersaround you and impact them in a
positive light.
Just seek help, takeresponsibility for your own
(15:22):
actions, rather than makingyourself insufferable to listen
to, gaslighting entire audiencesof vulnerable people who need
to hear the truth about theirhealth instead of actually what
they Believe they want to hear,all while just fueling their own
narcissism and sanctimoniousnarcissism is that.
And as a doctor advocating ahealthy diet and size, I meant
(15:46):
to believe that I'm the enemy.
If your body is in a state ofobesity, where you're constantly
in a state of inflammation,suffer with sleep apnea or even
just discomfort as a consequenceof your sides, and you're
struggling to walk because youhave joint pain or difficulty
doing simple tasks because ofyour body habits, I don't care
(16:06):
what the definition of metabolichealth is or whether you
consider yourself to bemetabolic healthy.
This is not a picture of health, and perhaps those advocating
that it is including somehealthcare professionals of my
time take a very long hard lookat the reality of the damage
that their message is doing.
The path of least resistance isalways the easier one, and
(16:30):
walking to the fridge is alwaysgoing to be easier than walking
to the gym.
But stop saying that the gymand the people that encourage
going to the gym are the enemy.
They are not.
They are trying to help, andthe fat acceptance movement and
those advocating health at anysize are just part of the
problem.
Another main contributor isactually a lack of education.
(16:51):
So, for example, one thingpeople don't really know much
about is calories.
Nor can many people actuallydefine what a calorie is If you
stop someone on the street Iactually saw a video of this
many years ago someone with amicrophone and a camera was
stopping everyone on the streetand asking what a calorie was,
and only one person was able todefine it.
(17:14):
And they happen to be adietitian as well.
So that's kind of unfair.
The definition actually haschanged, admittedly, as time has
gone on, but a calorie is aunit of energy.
It's the equivalent to the heatenergy needed to raise the
temperature of one gram of waterby one degree centigrade.
So I don't know if you rememberthis at school, but we would
(17:37):
set fire to a peanut back whenyou were allowed to have nuts in
school and we'd heat a beakerof water, one liter of water,
with a thermometer in it andyour time.
How long it would take for thatbeaker of water to raise, the
temperature, for the water toraise by one degree Celsius,
with the lit peanut underneathheating it up, and from the time
(17:59):
it took to go up by one degreecentigrade, you could then work
out the number of calories inthat peanut and you had the
weight of the peanut before youset fire to it and there was an
equation, you could work outexactly how much energy was in
that peanut.
So that's what calories in foodare.
It's a measure of energy inthat food.
So when you see calories on apacket, simply telling you how
(18:20):
much bang for your buck are yougetting really in terms of, in
terms of calorific intake?
Some things have very, veryhigh amounts of calories, some
things have very low amounts ofcalories, and it all depends on
the type of food content that itthat it contains.
A concept which people havedifficulty in discussing and
explaining, and a concept which,unfortunately, the fat
acceptance movement refuses tobelieve, is that the first law
(18:44):
of thermodynamic states youcannot create energy from
nothing.
It's merely changing form.
So you can't create or destroyenergy, and so what that's
trying to say is if you don'ttake energy in the form of food,
you cannot gain fat.
It's not possible.
If you burn 2000 calories a dayand you eat 3000 calories a day
(19:08):
, you will gain weight.
It's as simple as this.
With regards to the weight gain, if you burn 2000 calories a
day and you eat 1800 calories aday, you will lose weight.
It's simple laws ofthermodynamics.
It's simple physics.
There are some rare conditionsthat will increase your ability
to gain weight.
(19:28):
For example, if you have a poorfunctioning thyroid, where your
basal metabolic rate will bereduced, or circutern conditions
, where you retain a lot ofwater, your weight will increase
, but not necessarily the amountof fat.
But this is not the normal.
This is, again, outliers.
Most overweight people don'thave any of these problems.
(19:49):
And for those that areconstantly adamant that this is
the cause of obesity for mostpeople, well, that throws the
argument of healthy obesity outthe window, because you can't
have a condition which causesyou to be obese and then be
obese and healthy.
Paradoxical and also a lie.
And if you've ever tried tocalorie count, it's really
(20:14):
apparent just how quickly, howlittle food is needed to make up
2000 calories.
And I think where we as asociety are going wrong.
Not only is food far moreaddictive nowadays than it ever
has been, with the amount ofsalt and sugar and just general
yumminess of food, especiallyprocessed food, but we don't
(20:37):
realize just how many caloriesand useless calories are in such
small quantities of food.
A simple, small donut, forexample, is often over 400
calories and that might notsound like much, but that's a
huge chunk of your dailyallowance and it will take about
(20:58):
10,000 steps to burn off.
Now, 10,000 steps not manypeople do 10,000 steps a day.
I know a lot of people try anduse that as a barometer of
fitness, but very few actuallyachieve it, and it's it's very
easy to see how, even with justa few biscuits, with your tea
(21:20):
and coffee, you've already eatena tenth of your daily calorific
intake, or in some cases evenmore.
And that's not consideringbreakfast, lunch, dinner or any
other drinks, because, remember,drinks have calories too, not
just alcoholic drinks but otherdrinks.
So, aside from not movingenough, as a nation we're just
eating far too much.
(21:43):
I've spoken about basalmetabolic rates and by this I
mean essentially the energy youneed to just stay alive.
So if you're in satin a chairall day just breathing, that's
how much you'll burn off in a,in one day, and this will depend
on your size, your weight, yourage and whether you're male or
female.
Of course.
As you start moving, this goesup.
(22:03):
So that's where we get thisrough 2000 to 2500 calorie a day
mark that most people need,depending on how active you are,
because most people with basalmetabolic rate might be around
1400 to 1600 calories plus theamount of exercise you do so
very little mobility you'regoing to burn around 1800, 2000
calories a day.
(22:23):
The bigger you are, the higheryour basal metabolic rate is,
and that's why if a morbid leobese person starts to diet,
initially they lose weight very,very quickly because you've got
a very high basal metabolicrate and then as soon as you
start having a calorie deficitdiet, you lose rate very fast
(22:45):
and then as you lose the weight,your basal metabolic rate will
go down and then it becomesharder to lose that extra weight
.
As time goes on, so things doplateau.
I see a lot of reels and postsfrom so called health gurus
showing people what they eat ona daily basis, often advocating
(23:06):
an 1800 calorie diet, andthey're often very slim and
attractive and all the mealsthat they eat look yummy and
healthy, with lots of nuts andporridge and avocado, with three
set meals and snacks, and allof this food is actually very
calorie dense and they portraythis image that you can eat all
of this whilst talking about howfew calories each of their
(23:30):
meals is, and I think this isall bull.
I don't believe that thecalories that they are consuming
in the day is what theyactually say.
I believe that the meals andsnacks that they show when made
at home have far more caloriesthan they are actually
suggesting.
I have a theory that they areprobably eating half of the
(23:52):
amount of food that theyactually showing online to
maintain that shape or size, orthey are eating this amount of
food, but the thing that they'renot showing you is the huge
amount of working out andexercising that they are doing
on a daily basis to keep them ata healthy weight.
One thing is for sure it'scertainly easier to grow a
(24:16):
following and sell diet plans asan attractive and slim health
guru, I use that term looselywhen people like what that diet
plan shows and what its apparentresults are.
And don't get me wrong, it'sabsolutely fine to consume 3000
calories a day if you are doinga strenuous gym workout three
(24:37):
times a week and have a highmuscle mass and I'm maintaining
a high basal metabolic rate as aconsequence Absolutely you need
your 3000 calories, if not more, a day.
But very few people who areactually eating 3000 calories
and above a day are doing anyexercise whatsoever.
Animals store most of theirexcess energy as fat.
(24:57):
So, to put that intoperspective, there are nine
calories in one gram of fat.
So if you're overeating by 500calories a day, that's a one
small dessert or a couple ofbeers.
Even over a period of a week,you're overeating by three and a
half thousand calories.
That's nearly 400 grams a weekin fat being stored extra on
(25:21):
your body.
So in a month, that's a gain of1.6 kilos.
Now you can see, however, aperiod of just four months.
You've gained a stone, and howoften have you heard someone say
it's only small or it's healthy?
It might well be small orhealthy, and you justify eating
(25:42):
that small or healthy thing toyourself, but if you're eating
more calories than you need, youwill gain weight.
If I eat 3000 calories in fruitand vegetables a day, believe
me, I will gain weight.
Energy is energy.
Youtubers and influencersanother term I use very loosely
(26:02):
are very good at telling peopleexactly what they want to hear.
It generates popularity andincome.
Unfortunately, though, they arenot able to change the laws of
thermodynamics, regardless ofhow nice their avocado toast
with pine nuts looks.
And, for the record, I'm inabsolutely no way saying that
being skinny means healthyeither.
(26:25):
Being underweight is equally asdangerous, as being overweight
and just because you are of anormal weight does not make you
immune to problems or healthissues.
You almost certainly can beunhealthy and of a normal weight
, but the one thing I will notstand for is this idea that you
can eat whatever you want to thepoint of obesity without any
consequence, in being told thatthis is a form of healthy living
(26:48):
.
If a child was encouraged bytheir parents to smoke
cigarettes, they would be takenaway by social services, and yet
when we encourage children toeat absolute junk and allow them
to become overweight at a veryyoung age, we seem to be
applauding this nowadays, eventhough the health consequences
can be just as destructive.
So whilst I aim to be healthy, Icertainly have a long way to go
(27:12):
in having the best diet and thehealthiest lifestyle, despite
being a normal weight.
So over the last few weeks,I've made active steps to try
and change this, starting with afar more vigorous exercise
regime and with the help of apersonal trainer as well, and
I'll be producing a few moreepisodes on this in the future
to talk about the benefits ofexercise, but also the benefits
(27:34):
of having someone to help youand advise you on how to improve
your exercise and fitnesslevels, and also the benefits
that exercise and improvingstrength has, not only in
physical aspects, but alsomentally as well.
So I really look forward tosharing that with you very soon,
and with that I will leave you.
As always, please look afteryourself.
(27:56):
I'm Dr Polyvios.
Goodbye.
And listening to these people talking about
how, even though they'remorbidly obese, they're healthy
and their diet is healthy andthat they're fitter than they
ever were when they were slimmer, and that, if you disagree with
their preaching, you're not ascientist, doctor or someone
with a common sense or asensible opinion based on truth
and logic.
You are fatphobic and bigotedBecause remember everyone it's
(00:24):
far easier for everyone else tobe the problem and results of
blaming a lack of acceptance andto be a victim than it is to
admitting that you have aproblem and dealing with that
problem.
Dealing about it in a way thatwill impact not just you but the
others around you and impactthem in a positive light.
Welcome to Doctor's View withme, dr Bolivios.
(00:51):
Join me as I discuss everydaytopics in health and medicine
and provide the insights intoeveryday hospital life.
Sit back and enjoy the show.
Hello everyone.
Welcome to Doctor's View.
I'm Dr Polyvios.
Today's episode is a morecomplicated one than I initially
thought when drafting it out.
(01:11):
I want to revisit obesity andthe idea of obesity and health,
and we're going to talk a bitabout metabolic health and some
of the lies that we're hearingon social media and, sadly,
other people within the medicalprofession who are propagating
the idea of obesity and healthand saying that the two go hand
(01:32):
in hand and are not mutuallyexclusive, which, if you've been
a long time listener of theshow, you will know that it's
against what I believe andagainst what the evidence
actually shows.
And we're going to talk aboutsome of the evidence that favors
the obese and healthy argumentand some of the theories as to
why there is a so-called obesityparadox in a number of
(01:53):
different studies.
So to clarify, firstly, my mainreasons to why I don't believe
that you can be obese andhealthy is quite simply,
regardless of anything else thathappens to your health as a
consequence of obesity.
The World Health Organizationdefines health as a state of
complete physical, mental andsocial well-being and not merely
(02:14):
the absence of disease orinfirmity.
So if you're in a state whereyou are addicted to food to the
extent that you have allowedyour body to reach morbid
obesity, you cannot be in astate of physical, mental and
social well-being.
In the same reason, you cannotbe a smoker and be in a state of
physical, mental and socialwell-being because you're
(02:35):
suffering from an addiction.
Now you may not be displayingany physical symptoms or
problems and indeed blood testsmay be completely normal.
However, it doesn't tell youthe whole story.
So we know there's been anumber of studies that
demonstrate time and time againthat obesity is associated with
several cardiometaboticabnormalities.
(02:55):
It's a major risk factor fornot only cardiovascular disease
but also mortality, and itcounts for one in five deaths
worldwide.
And a major study was conductedwith three and a half million
people and it demonstrated thatafter following these people up
from nearly five and a halfyears later, they found that
even the metabolically healthyobese people had a higher risk
(03:19):
of coronary heart disease thannormal weight metabolically
healthy people.
So this has been proven.
There's been a lot of discussionand a lot of airtime given to
this so-called obesity paradox,and the obesity paradox is where
studies have shown that beingmorbidly obese or overweight has
(03:41):
no impact on, in some cases,actually had a better outcome in
certain diseases than if youare a patient of a normal body
mass index.
This has actually been debunkedseveral times with several
studies, and some of the reasonswhy we get these results is
because of the way the studieswere conducted and the inherent
(04:01):
bias within the study processand the methodology itself.
For example, there is anobesity paradox which talks
about the incidence ofdeveloping problems with type 2
diabetes in metabolicallyhealthy, obese people versus
metabolically unhealthy, normalweight people.
The study shows that you'remore likely to develop type 2
diabetes if you're metabolicallyunhealthy and of a normal
(04:23):
weight versus a metabolicallyhealthy, overweight individual,
suggesting that metabolic healthis what matters the most, and
not obesity.
What the studies fail to takeinto account is actually other
external factors, such assmoking and other lifestyle
factors, which play a huge partin the health of an individual.
(04:45):
And it's also been shown thatBMI is not necessarily the best
indicator of outcomes in a lotof these studies, for example,
you can be a personal trainer ora muscular athlete and
potentially have a BMI whichmakes you in the morbid obese
category, purely because muscleweighs more than fat, even if
(05:06):
your actual body percentage fatis very low.
And there's also been a numberof studies to show that the
waist to height ratio is abetter indicator of outcomes in
patients with heart failure.
So we must acknowledge thatwhen studies are talking about
high BMI and the obesity paradox, what they perhaps should be
focusing on is more body fatpercentage and the distribution
(05:30):
of fat, because that has beenshown to be a much better
predictor of outcome.
The paradox continues with heartfailure and cardiovascular
problems, and I think this iswhere the health at any size
movement got most traction.
Studies have shown thatpatients who are morbidly obese
with heart failure or heartdisease have better outcomes
(05:51):
than heart disease patients of anormal weight, and that may
well be the case.
However, there's somethingthat's often led out in this
discussion, and that's if theheart disease patients who were
overweight or obese in the studywere of a normal weight to
begin with, the chances of themdeveloping the heart disease and
(06:13):
subsequent health problemswould be far less to begin with,
so they wouldn't actually be inthat situation in the first
place.
The patients who are of anormal weight with heart disease
may actually have a number ofhealth issues to begin with
which could be a consequence ofother lifestyle factors, as we
said before, smoking or drug useor, sadly, genetic and family
history, and outcomes may wellbe worse when compared to other
(06:37):
patients who have no other riskfactors for development Heart
disease other than their obesity.
Now, this doesn't detract fromthe fact that if it wasn't for
their obesity, these patientswouldn't be in the study to
begin with, and that's becausethey wouldn't have the heart
disease.
So we also can't forget thefact that, whilst metabolically
(06:57):
healthy, obese people have alower risk of developing certain
cardiac diseases thanmetabolically unhealthy people,
the risk is still higher than ametabolically normal weight
person metabolically healthy,normal weight person.
But unfortunately, studies likethis have been taken out of
(07:20):
context and spun to make it seemthat obese people are healthier
than slim people, and that'snot the case at all actually far
from it, and it doesn't takemuch to see this.
So that's why I don't believein the obesity paradox.
It does not consider a lot ofother factors.
(07:41):
The I'm healthy and fat is justa contradiction in terms when
you think about the problemsthat arise because of obesity,
which starts from a young ageand actually only just get worse
when time goes on.
We talk a lot about beingmetabolically healthy and I've
(08:02):
done a podcast on this in thepast, speaking to Dr Philip
Avadia, a cardiothoracic surgeonin America about this, and he
went to great lengths to talkabout metabolic health with me
and its importance, and it was avery interesting discussion and
I learned a lot from it.
But sadly, the term metabolichealth now seems to have been
(08:26):
misrepresented with thismetabolically healthy obesity.
It is debated whether any formof obesity can ever be
considered healthy or whetherthe metabolically healthy obese
phenotype is merely a stage intransition to developing a
metabolically unhealthy obesephenotype over time.
(08:46):
In the same way, for example,how a lifelong 60 a day smoker
doesn't have any problems as aconsequence of smoking.
Yet Give it another 10 yearsand the chances of that still
being the case are very slimindeed.
And yes, we all know the oddperson who has lived to 100 and
they had the unhealthiestlifestyle imaginable.
(09:07):
They are anomalies.
They are not the normaldistribution, they are the
outliers and that's why they'recalled outliers.
They are not in the normal.
Very good for them.
But to take these one or twooutliers and apply that as a
generalized rule for everyone isnot only unscientific but it's
(09:28):
actually quite foolish.
Part of the contention withmetabolically healthy obesity
may actually also relate to howit's defined, and to date
there's no university accept isstandard for defining
metabolically healthy obesity.
So far, more than 30 differentdefinitions have been used to
create these phenotypes instudies.
(09:50):
Broadly speaking, metabolicallyhealthy obesity has been
defined frequently by theabsence of metabolic disorder,
the absence of cardiovasculardisease, including type 2
diabetes, absence ofdyslipidemia, hypertension and
atherosclerotic cardiovasculardisease in a person with obesity
.
However, most studies defineMetabolically healthy obesity is
(10:16):
having either none of thesethings, one of these things or
even two of these metabolicsyndrome components.
So therefore, you've got a lotof people being reported as
being metabolically healthyobese, but they're not
metabolically healthy.
They simply have fewermetabolic abnormalities than
those with who are being definedas metabolically unhealthy.
(10:38):
So this is, since that's a somuch conflation of the term
metabolically healthy obesity toessentially say that if you
only have one or two metabolicproblems, you're metabolically
healthy and that just meansyou're healthy whether you're
obese or not, and that's justplain rubbish.
(10:58):
And, even more tragically, thisis being used to feed the fat
acceptance movement and thehealthier any size movement,
when in fact what we should bedoing is encouraging people to
obtain a normal body fatpercentage.
Let's take another account oranother example, where you may
be inclined to say someone isobese and healthy.
(11:18):
I wonder what happens when youput that body under undue stress
.
I wonder if they would still behealthy.
So let's take pregnancy, forexample, something which is a
massive strain on the body andgenuinely a heroic and dangerous
process for any woman toundergo, and up until not that
long ago lots of women weredying in childbirth.
(11:40):
So let's take pregnancy andcouple that with obesity.
So what are the risks of beingobese and pregnant?
Well, let's talk about it.
You've got thrombosis.
This is a blood clot that cango in the legs.
That can form in the legs andthen go into your lungs and
cause pulmonary embolism, whichis a life threatening problem.
Gestational diabetes this isdiabetes during pregnancy.
(12:02):
If your BMI is above 30, you'rethree times more likely to
develop gestational diabetes.
If your BMI is over 25, therisk of developing high blood
pressure and preeclampsia is twoto four times more likely
compared to someone with anormal weight.
Mental health problems Problemsagain, this has been shown to
impact greater if you'reoverweight.
(12:23):
And then you've got the actualproblems that occur with the
baby itself.
The normal risk of miscarryingin an early pregnancy, say at
the age of 35, is about 20percent.
If you've got BMI of 30 orabove, that risk increases to 25
.
If you're overweight beforepregnancy or in early pregnancy,
(12:46):
this affects the way the babydevelops in the womb.
Overall, about one in athousand babies in the UK are
born with neural tube defects.
And if your BMI is over 30,your risk is nearly doubled and
if you're overweight, you'remore likely to have
complications during the birth,and the risk is doubled from
seven to a hundred in two tofourteen to a hundred.
Also, the overall risk ofhaving a stillbirth
(13:11):
unfortunately doubles to one ina hundred instead of, say, one
in two hundred.
You may also need additionalscans and overall it's just more
difficult to move around andstay active because of body
habitus.
The actual pregnancy aside, wehaven't even spoken about the
impact of obesity and fertility.
Excess body fat impacts theproduction of gonadotropine
release in hormone and this iseven more likely to be a risk In
(13:34):
hormone, and this is essentialto regulating ovulation in women
and the production of sperm inmen.
Specifically, gonadotropinereleasing hormone releases
Lutinizing hormone and folliclestimulating hormone, and both of
these are critical to thedevelopment of eggs and sperm.
I also just want to take thismoment to discuss the number of
(13:56):
lies that we hear online andjust listening to some people
talking on YouTube and how thereare a number of videos of
people who are morbidly obesetalking about the amount of
exercise they're doing each dayswimming, running, cycling and
if that is true and they'redoing an hour straight nearest
exercise every day for the lastfive years and they're still the
(14:17):
size that they are, then theamount of food that these people
must be eating is, quitefrankly, scary.
Either that or they're lyingabout the amount of exercise
that they're doing.
I believe it's actually amixture of both, and probably no
exercise and eating a hugeamount of food.
And listening to these peopletalking about how, even though
(14:38):
they're morbidly obese, they arehealthy and their diet is
healthy and that they're fitterthan they ever were when they
were slimmer, and that if youdisagree with their preaching,
you're not a scientist, doctoror someone with a common sense
or a sensible opinion based ontruth and logic.
You are fat phobic and bigotedbecause remember everyone, it's
(15:00):
far easier for everyone else tobe the problem and results of
blaming, a lack of acceptanceand to be a victim.
Then it is to admitting thatyou have a problem and dealing
with that problem, dealing aboutit in a way that will impact
not just you but the othersaround you and impact them in a
positive light.
Just seek help, takeresponsibility for your own
(15:22):
actions, rather than makingyourself insufferable to listen
to, gaslighting entire audiencesof vulnerable people who need
to hear the truth about theirhealth instead of actually what
they Believe they want to hear,all while just fueling their own
narcissism and sanctimoniousnarcissism is that.
And as a doctor advocating ahealthy diet and size, I meant
(15:46):
to believe that I'm the enemy.
If your body is in a state ofobesity, where you're constantly
in a state of inflammation,suffer with sleep apnea or even
just discomfort as a consequenceof your sides, and you're
struggling to walk because youhave joint pain or difficulty
doing simple tasks because ofyour body habits, I don't care
(16:06):
what the definition of metabolichealth is or whether you
consider yourself to bemetabolic healthy.
This is not a picture of health, and perhaps those advocating
that it is including somehealthcare professionals of my
time take a very long hard lookat the reality of the damage
that their message is doing.
The path of least resistance isalways the easier one, and
(16:30):
walking to the fridge is alwaysgoing to be easier than walking
to the gym.
But stop saying that the gymand the people that encourage
going to the gym are the enemy.
They are not.
They are trying to help, andthe fat acceptance movement and
those advocating health at anysize are just part of the
problem.
Another main contributor isactually a lack of education.
(16:51):
So, for example, one thingpeople don't really know much
about is calories.
Nor can many people actuallydefine what a calorie is If you
stop someone on the street Iactually saw a video of this
many years ago someone with amicrophone and a camera was
stopping everyone on the streetand asking what a calorie was,
and only one person was able todefine it.
(17:14):
And they happen to be adietitian as well.
So that's kind of unfair.
The definition actually haschanged, admittedly, as time has
gone on, but a calorie is aunit of energy.
It's the equivalent to the heatenergy needed to raise the
temperature of one gram of waterby one degree centigrade.
So I don't know if you rememberthis at school, but we would
(17:37):
set fire to a peanut back whenyou were allowed to have nuts in
school and we'd heat a beakerof water, one liter of water,
with a thermometer in it andyour time.
How long it would take for thatbeaker of water to raise, the
temperature, for the water toraise by one degree Celsius,
with the lit peanut underneathheating it up, and from the time
(17:59):
it took to go up by one degreecentigrade, you could then work
out the number of calories inthat peanut and you had the
weight of the peanut before youset fire to it and there was an
equation, you could work outexactly how much energy was in
that peanut.
So that's what calories in foodare.
It's a measure of energy inthat food.
So when you see calories on apacket, simply telling you how
(18:20):
much bang for your buck are yougetting really in terms of, in
terms of calorific intake?
Some things have very, veryhigh amounts of calories, some
things have very low amounts ofcalories, and it all depends on
the type of food content that itthat it contains.
A concept which people havedifficulty in discussing and
explaining, and a concept which,unfortunately, the fat
acceptance movement refuses tobelieve, is that the first law
(18:44):
of thermodynamic states youcannot create energy from
nothing.
It's merely changing form.
So you can't create or destroyenergy, and so what that's
trying to say is if you don'ttake energy in the form of food,
you cannot gain fat.
It's not possible.
If you burn 2000 calories a dayand you eat 3000 calories a day
(19:08):
, you will gain weight.
It's as simple as this.
With regards to the weight gain, if you burn 2000 calories a
day and you eat 1800 calories aday, you will lose weight.
It's simple laws ofthermodynamics.
It's simple physics.
There are some rare conditionsthat will increase your ability
to gain weight.
(19:28):
For example, if you have a poorfunctioning thyroid, where your
basal metabolic rate will bereduced, or circutern conditions
, where you retain a lot ofwater, your weight will increase
, but not necessarily the amountof fat.
But this is not the normal.
This is, again, outliers.
Most overweight people don'thave any of these problems.
(19:49):
And for those that areconstantly adamant that this is
the cause of obesity for mostpeople, well, that throws the
argument of healthy obesity outthe window, because you can't
have a condition which causesyou to be obese and then be
obese and healthy.
Paradoxical and also a lie.
And if you've ever tried tocalorie count, it's really
(20:14):
apparent just how quickly, howlittle food is needed to make up
2000 calories.
And I think where we as asociety are going wrong.
Not only is food far moreaddictive nowadays than it ever
has been, with the amount ofsalt and sugar and just general
yumminess of food, especiallyprocessed food, but we don't
(20:37):
realize just how many caloriesand useless calories are in such
small quantities of food.
A simple, small donut, forexample, is often over 400
calories and that might notsound like much, but that's a
huge chunk of your dailyallowance and it will take about
(20:58):
10,000 steps to burn off.
Now, 10,000 steps not manypeople do 10,000 steps a day.
I know a lot of people try anduse that as a barometer of
fitness, but very few actuallyachieve it, and it's it's very
easy to see how, even with justa few biscuits, with your tea
(21:20):
and coffee, you've already eatena tenth of your daily calorific
intake, or in some cases evenmore.
And that's not consideringbreakfast, lunch, dinner or any
other drinks, because, remember,drinks have calories too, not
just alcoholic drinks but otherdrinks.
So, aside from not movingenough, as a nation we're just
eating far too much.
(21:43):
I've spoken about basalmetabolic rates and by this I
mean essentially the energy youneed to just stay alive.
So if you're in satin a chairall day just breathing, that's
how much you'll burn off in a,in one day, and this will depend
on your size, your weight, yourage and whether you're male or
female.
Of course.
As you start moving, this goesup.
(22:03):
So that's where we get thisrough 2000 to 2500 calorie a day
mark that most people need,depending on how active you are,
because most people with basalmetabolic rate might be around
1400 to 1600 calories plus theamount of exercise you do so
very little mobility you'regoing to burn around 1800, 2000
calories a day.
(22:23):
The bigger you are, the higheryour basal metabolic rate is,
and that's why if a morbid leobese person starts to diet,
initially they lose weight very,very quickly because you've got
a very high basal metabolicrate and then as soon as you
start having a calorie deficitdiet, you lose rate very fast
(22:45):
and then as you lose the weight,your basal metabolic rate will
go down and then it becomesharder to lose that extra weight
.
As time goes on, so things doplateau.
I see a lot of reels and postsfrom so called health gurus
showing people what they eat ona daily basis, often advocating
(23:06):
an 1800 calorie diet, andthey're often very slim and
attractive and all the mealsthat they eat look yummy and
healthy, with lots of nuts andporridge and avocado, with three
set meals and snacks, and allof this food is actually very
calorie dense and they portraythis image that you can eat all
of this whilst talking about howfew calories each of their
(23:30):
meals is, and I think this isall bull.
I don't believe that thecalories that they are consuming
in the day is what theyactually say.
I believe that the meals andsnacks that they show when made
at home have far more caloriesthan they are actually
suggesting.
I have a theory that they areprobably eating half of the
(23:52):
amount of food that theyactually showing online to
maintain that shape or size, orthey are eating this amount of
food, but the thing that they'renot showing you is the huge
amount of working out andexercising that they are doing
on a daily basis to keep them ata healthy weight.
One thing is for sure it'scertainly easier to grow a
(24:16):
following and sell diet plans asan attractive and slim health
guru, I use that term looselywhen people like what that diet
plan shows and what its apparentresults are.
And don't get me wrong, it'sabsolutely fine to consume 3000
calories a day if you are doinga strenuous gym workout three
(24:37):
times a week and have a highmuscle mass and I'm maintaining
a high basal metabolic rate as aconsequence Absolutely you need
your 3000 calories, if not more, a day.
But very few people who areactually eating 3000 calories
and above a day are doing anyexercise whatsoever.
Animals store most of theirexcess energy as fat.
(24:57):
So, to put that intoperspective, there are nine
calories in one gram of fat.
So if you're overeating by 500calories a day, that's a one
small dessert or a couple ofbeers.
Even over a period of a week,you're overeating by three and a
half thousand calories.
That's nearly 400 grams a weekin fat being stored extra on
(25:21):
your body.
So in a month, that's a gain of1.6 kilos.
Now you can see, however, aperiod of just four months.
You've gained a stone, and howoften have you heard someone say
it's only small or it's healthy?
It might well be small orhealthy, and you justify eating
(25:42):
that small or healthy thing toyourself, but if you're eating
more calories than you need, youwill gain weight.
If I eat 3000 calories in fruitand vegetables a day, believe
me, I will gain weight.
Energy is energy.
Youtubers and influencersanother term I use very loosely
(26:02):
are very good at telling peopleexactly what they want to hear.
It generates popularity andincome.
Unfortunately, though, they arenot able to change the laws of
thermodynamics, regardless ofhow nice their avocado toast
with pine nuts looks.
And, for the record, I'm inabsolutely no way saying that
being skinny means healthyeither.
(26:25):
Being underweight is equally asdangerous, as being overweight
and just because you are of anormal weight does not make you
immune to problems or healthissues.
You almost certainly can beunhealthy and of a normal weight
, but the one thing I will notstand for is this idea that you
can eat whatever you want to thepoint of obesity without any
consequence, in being told thatthis is a form of healthy living
(26:48):
.
If a child was encouraged bytheir parents to smoke
cigarettes, they would be takenaway by social services, and yet
when we encourage children toeat absolute junk and allow them
to become overweight at a veryyoung age, we seem to be
applauding this nowadays, eventhough the health consequences
can be just as destructive.
So whilst I aim to be healthy, Icertainly have a long way to go
(27:12):
in having the best diet and thehealthiest lifestyle, despite
being a normal weight.
So over the last few weeks,I've made active steps to try
and change this, starting with afar more vigorous exercise
regime and with the help of apersonal trainer as well, and
I'll be producing a few moreepisodes on this in the future
to talk about the benefits ofexercise, but also the benefits
(27:34):
of having someone to help youand advise you on how to improve
your exercise and fitnesslevels, and also the benefits
that exercise and improvingstrength has, not only in
physical aspects, but alsomentally as well.
So I really look forward tosharing that with you very soon,
and with that I will leave you.
As always, please look afteryourself.
(27:56):
I'm Dr Polyvios.
Goodbye.
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