April 30, 2023 • 29 mins
04/30/23
The Healthy Matters Podcast
S02_E11 - Managing the Topic of Weight Management
Currently it's estimated that between 42-45% of Americans are living with overweight or obesity, and that number is expected to rise to around 50% by the year 2030! That'd be half of the U.S. population, and that makes this a very important conversation to be having now.
There are a lot of risks and health hazards associated with overweight and obesity - heart attacks, chronic kidney disease, high blood pressure, diabetes... the list is long and scary. But is all of this inevitable? What factors play the biggest roles? And what can be done to maintain a healthy weight?
On Episode 11, we'll have an in-depth conversation with Dr. Iesha Galloway-Gilliam, Medical Director of the Comprehensive Weight Management Center at Hennepin Healthcare. We'll discuss the common contributors to this condition, the role of Body Mass Index (BMI) and other calculations and available treatments and important strategies for weight management on this episode of the podcast. Join us!
Ever wondered what your BMI is? Try this calculator from the CDC!
Got a question for the doc? Or an idea for a show? Contact us!
Email - healthymatters@hcmed.org
Call - 612-873-TALK (8255)
Twitter - @drdavidhilden
Find out more at www.healthymatters.org
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Transcript
Episode Transcript
Available transcripts are automatically generated. Complete accuracy is not guaranteed.
Speaker 1 (00:04):
Welcome to the Healthy Matters podcast with Dr.
David Hilden, primary carephysician and acute care
hospitalist at HennepinHealthcare in downtown
Minneapolis, where we cover thelatest in health, healthcare and
what matters to you.
And now here's our host, Dr.
David Hilden.
Speaker 2 (00:20):
Hey everybody, it's Dr.
David Hilden, your host of theHealthy Matters podcast.
Welcome to episode 11.
Today we are gonna talk aboutweight management, what it means
to be overweight, what isobesity.
We're gonna talk aboutstrategies for maintaining a
healthy weight, and we're gonnaget some tips from an expert in
the field today.
Joining me is my colleague atHennepin Healthcare, Dr.
(00:43):
Aisha Galloway Gilliam.
She is the director of theComprehensive Weight Management
Center here at HennepinHealthcare in downtown
Minneapolis, and has a careerand a practice focused on the
management of your weight.
Dr.
Galloway Gilliam, welcome to theepisode.
Speaker 3 (00:59):
Thank you very much.
Happy to be here.
Speaker 2 (01:01):
It is great to have you here in a topic that is
affects so many people in ourworld, but we're gonna delve
into it a little bit more deeplyto see what, what resources are
available to people.
Could you start us off by sortof giving us a lay of the land
on the issue of weightmanagement and obesity?
What is the current state in theUnited States of people who are
(01:21):
living with obesity or beingoverweight?
Speaker 3 (01:24):
So, currently about 42% in approaching 45, between
42 and 45% of the United Statespopulation is living with
obesity by 2030.
That's predicted to be more like50% of the population in the
United States will be livingwith obesity, half the
population, half of thepopulation.
Speaker 2 (01:45):
Do we know why that is?
Why is it going up?
Speaker 3 (01:48):
There are hypothesis around that there is not a
solidified consensus.
My own personal belief afterreviewing some of the
epidemiological data and otherscience, is that it really has
to do with the way that ourenvironment has changed, in
(02:10):
particular our food environment,uh, really rapidly and very
radically over the past 50 to 60years.
So more access to food on a moreconsistent basis, and then also
the types of food that we haveaccess to and are eating in
(02:33):
addition to beverages that aresugar, latent and heavily
sweetened.
So
Speaker 2 (02:40):
Dr.
Galloway, Gillian, what isobesity?
Is there a definition of that?
Speaker 3 (02:45):
The definition of obesity is based on a metric
called body mass index.
And the body mass index is acalculation, it's a calculation
that really compares height toweight.
And the definition is a bodymass index of 30 or greater, uh,
(03:07):
is considered to be consistentwith obesity.
Under that definition, there aresubcategories, uh, that divide
obesity into class one, classtwo and class three obesity.
And then of course, the categoryof overweight, which is, uh,
considered to be a BMI between25 to 29.9, and a normal BMI is
(03:34):
18.5 to 24.9.
Speaker 2 (03:39):
So how is BMI measured?
Speaker 3 (03:41):
BMI is an equation.
It's an equation that, uh,compares our height to our
weight.
So you can literally Google it.
I mean, the CDC has a link whereyou are able to input your own
specific data.
The other way to do it is tolook for BMI charts.
(04:01):
Again, very much something thatyou can look on the internet and
then you can find your wait, youcan find your height, and then
you kind of trace it down, uh,to find your bmi.
So
Speaker 2 (04:13):
We can put a link to one of those BMI calculators in
our show notes.
I've heard the BMI criticizedas, as the only measure in that,
what if I've just big bones Ihave been making, or what if I
play for the Minnesota Vikings?
Aren't I, uh, they're all obese?
Is it an imperfect measure?
Speaker 3 (04:29):
It's not a perfect metric for body compartments
because that, that really iswhat's most important about
weight, is where and whatcompartments are affected,
because weight is just a number.
It doesn't tell us how much ofyour weight consists of muscle
(04:49):
mass, how much of your weightconsists of water, and how much
of your weight is made up ofadipose tissue or fat tissue.
So it's, it is an imperfectmeasure.
That said, we know that when weare dealing with a certain
severity of obesity, and that'swhat we would call class two
(05:10):
obesity is, is when you have aBMI of 35 or above, uh, there's
a pretty solid association withnegative health outcomes and
consequences.
So a adjunct tool is wastecircumference, and that's
another way to try to assess aperson's risk for conditions
(05:32):
like high blood pressure and,uh, cardiovascular disease in
the long term.
Speaker 2 (05:39):
When you bring up waist circumference, that
reminds me that people at, at agiven weight can have a
different body shape.
You know, we talk about the pearshape, where you're carrying
most of your extra weight inyour hips.
Mm-hmm.
ver, which isversus the apple shape where
you're carrying a lot of yourweight in your belly.
Mm-hmm.
, you know, the,the old beer gut that people
talk about.
Mm-hmm.
, does thedistribution of your weight make
(06:02):
a difference?
Speaker 3 (06:03):
Absolutely, yes.
Thank you.
Yeah.
So the, the apple shape is thedistribution that is most
closely linked to negativehealth consequences or that
increased risk for cardiacdisease.
The pear shape, however, is the,the weight that we carry around
(06:24):
our hips and thighs and ourbuttocks really hasn't been
linked to negative healthconsequences.
In fact, there's some datathat's just perhaps that's
protective.
So it really is the, that weight, uh, around our center, and
that's the weight that tends topack around our organs and
(06:44):
ultimately increase our chancesfor medical conditions in the
long run.
So,
Speaker 2 (06:49):
Aisha, let's talk about the health effects of
obesity and overweight.
In other words, why shouldpeople care?
Speaker 3 (06:56):
The health implications are vast.
There are definitiveassociations with increased risk
for multiple medical conditions.
So this includes heart attack,it includes congestive heart
failure, it includes chronickidney disease, it includes
diabetes, it includes high bloodpressure, um, even conditions
(07:20):
such as infertility, gallstones,gout, skin infections from, uh,
chronic swelling and theextremity is arthritis.
The list is pretty extensivethere.
Speaker 2 (07:37):
Like your whole body can be affected.
It sounds like
Speaker 3 (07:39):
That's exactly right.
Even speaking of that sort of,uh, smoldering levels of
inflammation can actually beincreased in our entire bodies.
Is
Speaker 2 (07:51):
It preventable?
So that's a short question, butit's a larger conversation.
It, so for people who areexperiencing obesity or being
overweight in their life, arethere ways that, that we can
reduce our risk for thatprogression?
Or is it a genetic thing thatyou're, that is inevitable?
Speaker 3 (08:09):
Uh, it's a good question.
It's a complicated answer.
Mm-hmm.
, uh, that you'reright, we won't be able to
completely unpack.
But here's what I'll say aboutit.
Uh, there's a lot ofheterogeneity in obesity,
meaning that no two people havethe exact same causality for
(08:32):
their weight and oftentimes as agenetic predisposition.
But there also is a verysignificant environmental
component.
Uh, not only that, but when westart to think about genetics,
and this is where, uh, thingsstart to get fairly fascinating,
um, there's an epigeneticcomponent.
(08:52):
And so when we talk aboutepigenetics, what that means is
it's not just about the geneswe're born with, but which genes
are expressed.
So our environments can changethe genes that are expressed,
which then may increase our riskfor conditions, including
(09:14):
obesity that we may not haveotherwise experienced if those
same genes weren't expressed.
Speaker 2 (09:20):
Oh.
So that's fascinating.
So you're saying that you mighthave a gene that never really
amounts to much unless you're inan environment
Speaker 3 (09:28):
That turns on the expression for it?
Oh,
Speaker 2 (09:31):
That is, that is fascinating.
Speaker 3 (09:33):
So there's an epigenetic component.
There have been some questionsaround whether even viral
infections in the past maychange the way that our, uh,
genes are expressed in thatepigenetic way and increase the
risk for developing, uh, obesitylater in life, changes that are
passed in utero from the, theperson carrying the child to the
(09:58):
, uh, child later on.
And then, of course, like Isaid, you know, our general
environment around food andoftentimes we're conditioned at
a very young age, uh, around thetypes of foods that we're going
to be attracted to later on.
Our affinity for sweet thingsoften starts in childhood, even
(10:21):
when we're looking at baby foodsin the way that, uh, those have
historically been very sweet andthe convenience factor.
So we're always on the runpicking up, uh, those food items
that are, uh, more highlyrefined and the difference that
that has on our biochemistrywhen we're consuming those more
(10:42):
highly refined or ultraprocessed foods compared to the
foods that are more intact orotherwise, uh, known as whole
foods.
There also is a fair amount ofconversation around the way that
our environment has changedaround physical activity.
So are we more sedentary nowthan we were decades ago?
(11:03):
And the answer is probably, butthe extent of our increase in
sedentary behavior doesn'texplain the obesity epidemic in
this country.
So, so it's, it's multimodal,multifactorial a lot of, of, of
reasons for the obesityepidemic.
(11:24):
So then when the question is canwe prevent it?
Well, there's a lot there to, tounpack and perhaps for some
people, but probably not foreverybody because of some of the
pre-condition geneticpredispositions that may have
been passed along in our currentfood environment.
That makes it harder cuz a lotof this starts to develop, uh,
(11:48):
at a younger age.
And then by the time it's comingforward, I, in a clinical
setting, it then is more of achallenge to, um, manage and
then the health conditions andimplications of it that may
already be in full force.
Speaker 2 (12:02):
I do wanna point out that we are talking about
obesity and overweight, andthere are also medical
conditions that lead to beingunderweight.
We're gonna talk about that in afuture episode.
So listeners, if you are alsointerested in some of the other
issues around, uh, beingunderweight, stay tuned.
We will cover that in a futureepisode.
Today I am talking with Dr.
(12:24):
Aisha Galloway Gilliam.
She is the medical director ofthe, uh, comprehensive weight
management center here atHennepin Healthcare in downtown
Minneapolis.
We've covered a lot of groundalready, but when we come back,
we're gonna talk about whattreatments are available to
people who are, uh, looking tomanage their weight.
We will do that right after ashort break.
Stay with us.
We'll be right back.
Speaker 1 (12:46):
You are listening to the Healthy Matters podcast with
Dr.
David Hilden.
Got a question or comment forthe doc, email us at Healthy
Matters hc m e d.org or give usa call at six one two eight
seven three talk.
That's 6 1 2 8 7 3 8 2 5 5.
And now let's get back to morehealthy conversation.
Speaker 2 (13:09):
Let's talk about the way people who are living with
obesity experience our societyor how they, how they're
treated.
In other words, some of thebiases and the mental health
issues around it.
You'll often hear someone saysomething like, well, it's your
fault.
You're just eating too much.
You're slothful and lazy.
And there's even abundantevidence that people who are
(13:31):
living with obesity areoverweight, are, are less apt to
get jobs and they're less apt tobe treated as accomplished and
smart and, and none of that'strue.
Mm.
And it's not a character flaw.
Yeah.
How do you respond to that?
Yes.
Or, or, or is that, or am am Imaking that up obviously?
Speaker 3 (13:47):
No, this is a great point and it is a conversation
that I have on a daily basiswith my patients because it's
very sad to know that people arebeing stigmatized for anything.
Um, and weight is a part ofthat, and it very much is again,
been conditioned and have thesocietal views on weight in
(14:12):
people who are living withoverweight or obesity, having a
lack of willpower, this being acosmetic issue and not a chronic
medical condition, which is whatit is.
And so there is a lot ofjudgments and a lot of
assumptions that patients whoare living with overweight or
obesity have to navigate on adaily basis when the fact of the
(14:35):
matter is someone who's livingwith obesity may be leading a
more healthy lifestyle than me.
They may be eating a wonderfuldiet, they may be very active in
exercising, they may be gettinggreat sleep, they may be be
managing their stress well andstill may be living with obesity
because of the complexity ofweight regulation and the
(14:57):
complexity of, uh, thepredisposing factors that
contribute to our weight.
So it is an unjust assumption tojust, uh, accuse someone who is
living with obesity of beinglazy and not caring about
themselves.
It's not true.
Speaker 2 (15:16):
That's an important message and well said.
Uh, what are some effective waysfor people to manage their
weight?
Speaker 3 (15:23):
That's a, a great question.
So I think the first part ofthat is to have a robust support
system, and that's wherecomprehensive weight management
programs come into place.
Now, if that's not realistic foryou and your day-to-day life, I
(15:43):
think that really being educatedon the physiology or the biology
of weight management is a goodplace to start because you need
to have some understanding ofthe biology of it so that you
don't burn out in the process.
Mm-hmm.
Uh, a lot of people come inreally very frustrated because
(16:04):
they have been taught that thisis a simple thing to manage.
If you would only eat less andexercise more, you would lose
all of the extra weight you'reliving with.
And that's not the reality ofthe situation.
So I think first it's gettinginformed on what obesity or
(16:26):
overweight is and then what itisn't.
And there's a reason we call itweight management and not weight
loss.
Speaker 2 (16:32):
Before you even move on from that, then Yes.
Is it, I take it it's not justdiet or it's not just exercise.
Speaker 3 (16:38):
Correct.
Th there's a, there's afoundation that it really is
important to set whenever we'retalking about a weight
management strategy and thereare four cornerstones or four
walls to the foundation, whatare they?
And those are lifestyletherapies.
And so it is definitelynutrition, it's how we're
eating, it's definitely physicalactivity or how we're
exercising, but it's also howsleeping meaning are we getting
(17:02):
enough and is it quality sleep?
And if there are otherconditions like sleep apnea
where you stop breathing inyour, in in your sleep at night,
are we identifying that andtreating it if it's present?
And then also, uh, and this is areally important one uh, as
well, how are we managing ourstress, our chronic, uh, stress?
Speaker 2 (17:23):
So let me just say the four years you said are,
they are diet, they are physicalexercise, but it's also sleep
and stress.
That's
Speaker 3 (17:30):
Correct.
Yeah.
The way that I think aboutweight management strategy is
we're building a house.
And so when we're building ahouse, the very first thing you
wanna do is have a solidfoundation, otherwise your house
crumbles.
Now we have to be realisticabout what to expect from those
modalities.
We could be doing all of thoseperfectly straight A's, and it
(17:53):
still may not and probably won'tbased on the data, completely
normalize your weight.
But what it does do is it stillallows you to invest in the bank
of health long term.
So we're still optimizing ourchances of living a long healthy
life by paying attention tothose, uh, those four areas.
Speaker 2 (18:17):
So that's the foundation.
I love that by the way.
I love that you started out witha support system and becoming
informed and then thesefoundational things, diet,
exercise, sleep, and stress.
What is the role of medication?
Yeah.
Because that's what people justsay.
It's almost the first thingpeople say.
Yeah.
So I like it that you led withthose other things first.
Yeah.
Yeah.
But then what is the role ofmedication?
Speaker 3 (18:37):
Yeah.
Very important role formedication as well because
again, where this is a chroniccondition and so we really have
to train ourselves to manage itand see it that way.
So just like we have medicationoptions for blood pressure and
other conditions, there aremedication options for weight
management.
(18:58):
And so when I think about, well,what's the role for medication?
I think about it as anotherfloor of our house.
So weight strategy, we'rebuilding a house, we got the
foundation, maybe we wantanother floor.
And this is all very muchindividualized.
There's a conversation thathappens around expectation
management and what people wantto use for managing their
(19:21):
weight.
And so medications are acompletely valid tool to use.
And thankfully now we've gotmedications that are more
effective than
Speaker 2 (19:29):
Do they work?
Speaker 3 (19:31):
Yes, they did.
The newer medications absolutelywork now it because
Speaker 2 (19:34):
The early ones didn't.
Holy cow.
We gave medications.
They gave you fatty diarrhea,explosive diarrhea.
You took them for two weeks andthat was that.
Speaker 3 (19:42):
Yeah.
They, and and I think it'simportant to define or clarify
what we mean by work too,because cuz of weight bias, the
expectation is if it doesn'tcause me to reach a completely
normal weight, it's not working.
So when we talk about working inthe weight management realm, the
bar for that is 5% total bodyweight loss.
(20:05):
So the oral medications, most ofthem are effective for around
that.
Um, they had to be to even enterthe market to
Speaker 2 (20:17):
5%.
Speaker 3 (20:18):
5%.
But it also depends on theperson and how they're gonna
respond to a a particularmedication.
But 5% is sort of the bar.
And the reason is that we knowthat with as little as five to
10% total body weight loss, youcan achieve really significant
health benefits.
But the newer class ofmedications, the injectable
class of medications are evenmore effective than the oral
(20:42):
medications.
So now we're talking about, youknow, up to 15% total body
weight loss on average with someof the, uh, injectable
medications that are currentlyapproved.
Speaker 2 (20:53):
And nothing has achieved that in my career until
lately.
That's correct.
I've never been able to tell apatient, take this medication,
you can lose 15% of your bodyweight.
Yeah.
And they can do that.
Are you seeing that in yourpractice people losing 15% of
their body weight?
Speaker 3 (21:05):
Yes.
So it's pretty phenomenal.
Speaker 2 (21:07):
What is the role of bariatric surgery?
Now the word is bariatric B asin boy, B A R i A T R I C O,
otherwise known as people talkabout gastric bypass surgery.
Like do we still do that?
Mm-hmm.
Speaker 3 (21:21):
We do.
And it is still a very, uh,important tool to have, uh, at
our disposal medications when weuse them for weight management
are permanent meaning
Speaker 2 (21:33):
You have to take them or the weight comes back, you
Speaker 3 (21:35):
Have to take them or yeah, if you stop the weight
comes back.
A bariatric surgery is still themost effective tool for
significant and sustained weightloss on average.
Right.
So there are some people who aregonna defy averages on either
side.
Speaker 2 (21:50):
What can people expect with weight loss with
surgery?
Yeah,
Speaker 3 (21:53):
So it depends on the surgery.
The amount of total body weightloss with, with surgery on
average is somewhere between and25 to 35%, again, broken up by
the type of surgery you have.
And this is specifically talkingabout, um, what's known as the
sleeve gastrectomy and gastricbypass.
(22:13):
I'm not including the band andthose numbers cuz we're, we're
Speaker 2 (22:17):
The gastric bandi isn't really doing that.
Speaker 3 (22:19):
Yeah, we're, and we're moving away from that.
So those are the, that's thekind of average amounts of
weight loss that can be seenwith with surgery.
The other thing with surgery isthat we know that there's
mortality risk reduction.
The medication component iswhere, where folks think about,
oh, I don't wanna take thismedication forever.
That's not involved withsurgery.
(22:41):
There are supplements thatpeople will have to take
vitamins, but, um, but nothaving to inject, take that at
the medication, um, for theirweight.
There may be other meds toconsider.
And then one of the other bigthings with surgery is for folks
who have diabetes, dependingupon how long they've had it, if
you were diagnosed with diabetesin a short period of time before
(23:03):
you had surgery, somewherebetween one to four years, you
can see diabetes going toremission, uh, after bariatric
surgery.
And that
Speaker 2 (23:15):
Is just a wonderful outcome.
So we have all these layers ofthe house.
I wanna, I wanna circle back tosome dietary issues.
In what you eat, is it all aboutcalories or does it matter what
foods you eat?
Speaker 3 (23:27):
It definitely matters what you eat.
This is a question that is wrwith opinions.
I am convinced in my my personaland medical opinion that what
you eat matters more than thecalorie content it contains.
(23:49):
Say we're, we're gonna compare aavocado, kind of a medium size
avocado, and we're gonna comparethat to an average sort of candy
bar.
Calorie content is actuallyfairly similar.
That said, when we think aboutwhat's in the candy bar versus
what's in the avocado and whatthose calories are made of, we
(24:09):
know that this avocado is highin calorie mostly cuz it's got
great healthy fats in it, monounsaturated fatty acids, uh,
which are healthy fats for thebody.
Whereas the candy bar a lot ofsugar.
So when our bodies process thosefood items, they're gonna elicit
a different biochemicalresponse.
(24:31):
We also know that calorierestricted diets don't work long
term.
You may see some weight lossover the short term, but then
our bodies actually compensatefor that calorie restriction and
start to work against us.
And so we end up hungriercrankier and still not where we
(24:52):
wanna be with our weight goal.
Speaker 2 (24:54):
I'm gonna follow up with that.
The, the diets.
People hear about that.
Some people call the fad diets.
There's keto, there's Atkins,there's self beach, there's
Mediterranean, all all those.
Uh, are you saying they don'twork?
Speaker 3 (25:05):
So it really depends on the dietary approach.
So, so something like keto orotherwise known as, you know,
uh, kind of a low carbohydrateor carbohydrate restricted diet
versus something like, uh, uh,what would be considered an
ornish diet, which is mostlyplant-based, you know,
vegetarian diet, vegan diet.
Those approaches are more inline with what I would call
(25:29):
macronutrient distributionadjustments.
And when I'm talking aboutmacronutrients, I'm talking
about carbohydrate, protein andfats.
So manipulating macronutrientsfor health benefits and they can
work if you can continue themforever.
So that's where it gets tough isthat whatever you're choosing,
(25:53):
it has to be sustainable.
Also, again, because we'retalking about genetic
predispositions, what works forone person may not work for the
next person.
Someone might respondbeautifully to keto and the next
person not at all.
So there's this built in trialand error that's involved.
(26:15):
But again, the more importantpart of that is can you sustain
that for the rest of your life?
Most
Speaker 2 (26:20):
Of these you probably can't.
Speaker 3 (26:21):
That's correct, yeah.
It's sometimes it ends up beingvery restrictive and people
can't have joy in their foodand, and it is not always
sustainable for those who it is.
And they've had a great responseto keto or vegetarian, vegan,
whatever, uh, type of diet, andthey feel it's sustainable for
them.
And they're also, again, workingwith their physician and
(26:43):
consultation and make sure therearen't deficiencies that are
developing or other healthconditions that we would be
concerned about them, uh,engaging with one of those diets
on then great.
You know, but, but that's apretty small percentage of the
population.
Before
Speaker 2 (26:59):
I let you go, what, what tips would you give our
listeners?
Speaker 3 (27:03):
Yeah, so I think when you are embarking on a weight
management journey, rememberself-compassion.
We haven't talked about thatbefore.
Be gentle to yourself along theway, otherwise this is a, a mute
point.
We're causing more harm, uh,because this is complicated.
Two is remember thosefoundational areas that we
(27:23):
talked about.
Focus on how we're eating, howwe're moving, how we're managing
our stress, and how we'resleeping.
This is a lot to unpack there aswell.
Uh, which leads me to my nextsuggestion would, would be if
you are finding yourselfstruggling to reach out to a
(27:44):
trained professional that canhelp you navigate this really
complicated area.
And we, we wanna be here tosupport you and to, to validate
what you've experienced and topartner with you on where to go
next in your journey with weightmanagement.
Speaker 2 (28:03):
Those are great tips for all of us.
Thank you Dr.
Aisha Galloway Gilia, thank youfor sharing your expertise, your
wisdom, and your time with ustoday.
Speaker 3 (28:11):
Thank you for having me.
Speaker 2 (28:12):
We've been talking about weight management with Dr.
Aisha Galloway Gilia here fromHennepin Healthcare.
Lots of great information today.
I hope you have picked upsomething that is applicable to
your life.
I know I have.
Please join us for our nextepisode and in the meantime, be
healthy and be well.
Speaker 1 (28:29):
Thanks for listening to the Healthy Matters podcast
with Dr.
David Hilden.
To find out more about theHealthy Matters podcast or
browse the archive, visithealthy matters.org.
If you enjoy the show, pleaseleave us a review and share the
show with others.
The Healthy Matters Podcast ismade possible by Hennepin
Healthcare in Minneapolis,Minnesota, and engineered and
produced by John Lucas AtHighball Executive producers are
(28:53):
Jonathan Camino and ChristineHill.
Please remember, we can onlygive general medical advice
during this program, and everycase is unique.
We urge you to consult with yourphysician if you have a more
serious or pressing healthconcern.
Until next time, be healthy andbe well.
Welcome to the Healthy Matters podcast with Dr.
David Hilden, primary carephysician and acute care
hospitalist at HennepinHealthcare in downtown
Minneapolis, where we cover thelatest in health, healthcare and
what matters to you.
And now here's our host, Dr.
David Hilden.
Speaker 2 (00:20):
Hey everybody, it's Dr.
David Hilden, your host of theHealthy Matters podcast.
Welcome to episode 11.
Today we are gonna talk aboutweight management, what it means
to be overweight, what isobesity.
We're gonna talk aboutstrategies for maintaining a
healthy weight, and we're gonnaget some tips from an expert in
the field today.
Joining me is my colleague atHennepin Healthcare, Dr.
(00:43):
Aisha Galloway Gilliam.
She is the director of theComprehensive Weight Management
Center here at HennepinHealthcare in downtown
Minneapolis, and has a careerand a practice focused on the
management of your weight.
Dr.
Galloway Gilliam, welcome to theepisode.
Speaker 3 (00:59):
Thank you very much.
Happy to be here.
Speaker 2 (01:01):
It is great to have you here in a topic that is
affects so many people in ourworld, but we're gonna delve
into it a little bit more deeplyto see what, what resources are
available to people.
Could you start us off by sortof giving us a lay of the land
on the issue of weightmanagement and obesity?
What is the current state in theUnited States of people who are
(01:21):
living with obesity or beingoverweight?
Speaker 3 (01:24):
So, currently about 42% in approaching 45, between
42 and 45% of the United Statespopulation is living with
obesity by 2030.
That's predicted to be more like50% of the population in the
United States will be livingwith obesity, half the
population, half of thepopulation.
Speaker 2 (01:45):
Do we know why that is?
Why is it going up?
Speaker 3 (01:48):
There are hypothesis around that there is not a
solidified consensus.
My own personal belief afterreviewing some of the
epidemiological data and otherscience, is that it really has
to do with the way that ourenvironment has changed, in
(02:10):
particular our food environment,uh, really rapidly and very
radically over the past 50 to 60years.
So more access to food on a moreconsistent basis, and then also
the types of food that we haveaccess to and are eating in
(02:33):
addition to beverages that aresugar, latent and heavily
sweetened.
So
Speaker 2 (02:40):
Dr.
Galloway, Gillian, what isobesity?
Is there a definition of that?
Speaker 3 (02:45):
The definition of obesity is based on a metric
called body mass index.
And the body mass index is acalculation, it's a calculation
that really compares height toweight.
And the definition is a bodymass index of 30 or greater, uh,
(03:07):
is considered to be consistentwith obesity.
Under that definition, there aresubcategories, uh, that divide
obesity into class one, classtwo and class three obesity.
And then of course, the categoryof overweight, which is, uh,
considered to be a BMI between25 to 29.9, and a normal BMI is
(03:34):
18.5 to 24.9.
Speaker 2 (03:39):
So how is BMI measured?
Speaker 3 (03:41):
BMI is an equation.
It's an equation that, uh,compares our height to our
weight.
So you can literally Google it.
I mean, the CDC has a link whereyou are able to input your own
specific data.
The other way to do it is tolook for BMI charts.
(04:01):
Again, very much something thatyou can look on the internet and
then you can find your wait, youcan find your height, and then
you kind of trace it down, uh,to find your bmi.
So
Speaker 2 (04:13):
We can put a link to one of those BMI calculators in
our show notes.
I've heard the BMI criticizedas, as the only measure in that,
what if I've just big bones Ihave been making, or what if I
play for the Minnesota Vikings?
Aren't I, uh, they're all obese?
Is it an imperfect measure?
Speaker 3 (04:29):
It's not a perfect metric for body compartments
because that, that really iswhat's most important about
weight, is where and whatcompartments are affected,
because weight is just a number.
It doesn't tell us how much ofyour weight consists of muscle
(04:49):
mass, how much of your weightconsists of water, and how much
of your weight is made up ofadipose tissue or fat tissue.
So it's, it is an imperfectmeasure.
That said, we know that when weare dealing with a certain
severity of obesity, and that'swhat we would call class two
(05:10):
obesity is, is when you have aBMI of 35 or above, uh, there's
a pretty solid association withnegative health outcomes and
consequences.
So a adjunct tool is wastecircumference, and that's
another way to try to assess aperson's risk for conditions
(05:32):
like high blood pressure and,uh, cardiovascular disease in
the long term.
Speaker 2 (05:39):
When you bring up waist circumference, that
reminds me that people at, at agiven weight can have a
different body shape.
You know, we talk about the pearshape, where you're carrying
most of your extra weight inyour hips.
Mm-hmm.
you're carrying a lot of yourweight in your belly.
Mm-hmm.
talk about.
Mm-hmm.
(06:02):
a difference?
Speaker 3 (06:03):
Absolutely, yes.
Thank you.
Yeah.
So the, the apple shape is thedistribution that is most
closely linked to negativehealth consequences or that
increased risk for cardiacdisease.
The pear shape, however, is the,the weight that we carry around
(06:24):
our hips and thighs and ourbuttocks really hasn't been
linked to negative healthconsequences.
In fact, there's some datathat's just perhaps that's
protective.
So it really is the, that weight, uh, around our center, and
that's the weight that tends topack around our organs and
(06:44):
ultimately increase our chancesfor medical conditions in the
long run.
So,
Speaker 2 (06:49):
Aisha, let's talk about the health effects of
obesity and overweight.
In other words, why shouldpeople care?
Speaker 3 (06:56):
The health implications are vast.
There are definitiveassociations with increased risk
for multiple medical conditions.
So this includes heart attack,it includes congestive heart
failure, it includes chronickidney disease, it includes
diabetes, it includes high bloodpressure, um, even conditions
(07:20):
such as infertility, gallstones,gout, skin infections from, uh,
chronic swelling and theextremity is arthritis.
The list is pretty extensivethere.
Speaker 2 (07:37):
Like your whole body can be affected.
It sounds like
Speaker 3 (07:39):
That's exactly right.
Even speaking of that sort of,uh, smoldering levels of
inflammation can actually beincreased in our entire bodies.
Is
Speaker 2 (07:51):
It preventable?
So that's a short question, butit's a larger conversation.
It, so for people who areexperiencing obesity or being
overweight in their life, arethere ways that, that we can
reduce our risk for thatprogression?
Or is it a genetic thing thatyou're, that is inevitable?
Speaker 3 (08:09):
Uh, it's a good question.
It's a complicated answer.
Mm-hmm.
completely unpack.
But here's what I'll say aboutit.
Uh, there's a lot ofheterogeneity in obesity,
meaning that no two people havethe exact same causality for
(08:32):
their weight and oftentimes as agenetic predisposition.
But there also is a verysignificant environmental
component.
Uh, not only that, but when westart to think about genetics,
and this is where, uh, thingsstart to get fairly fascinating,
um, there's an epigeneticcomponent.
(08:52):
And so when we talk aboutepigenetics, what that means is
it's not just about the geneswe're born with, but which genes
are expressed.
So our environments can changethe genes that are expressed,
which then may increase our riskfor conditions, including
(09:14):
obesity that we may not haveotherwise experienced if those
same genes weren't expressed.
Speaker 2 (09:20):
Oh.
So that's fascinating.
So you're saying that you mighthave a gene that never really
amounts to much unless you're inan environment
Speaker 3 (09:28):
That turns on the expression for it?
Oh,
Speaker 2 (09:31):
That is, that is fascinating.
Speaker 3 (09:33):
So there's an epigenetic component.
There have been some questionsaround whether even viral
infections in the past maychange the way that our, uh,
genes are expressed in thatepigenetic way and increase the
risk for developing, uh, obesitylater in life, changes that are
passed in utero from the, theperson carrying the child to the
(09:58):
, uh, child later on.
And then, of course, like Isaid, you know, our general
environment around food andoftentimes we're conditioned at
a very young age, uh, around thetypes of foods that we're going
to be attracted to later on.
Our affinity for sweet thingsoften starts in childhood, even
(10:21):
when we're looking at baby foodsin the way that, uh, those have
historically been very sweet andthe convenience factor.
So we're always on the runpicking up, uh, those food items
that are, uh, more highlyrefined and the difference that
that has on our biochemistrywhen we're consuming those more
(10:42):
highly refined or ultraprocessed foods compared to the
foods that are more intact orotherwise, uh, known as whole
foods.
There also is a fair amount ofconversation around the way that
our environment has changedaround physical activity.
So are we more sedentary nowthan we were decades ago?
(11:03):
And the answer is probably, butthe extent of our increase in
sedentary behavior doesn'texplain the obesity epidemic in
this country.
So, so it's, it's multimodal,multifactorial a lot of, of, of
reasons for the obesityepidemic.
(11:24):
So then when the question is canwe prevent it?
Well, there's a lot there to, tounpack and perhaps for some
people, but probably not foreverybody because of some of the
pre-condition geneticpredispositions that may have
been passed along in our currentfood environment.
That makes it harder cuz a lotof this starts to develop, uh,
(11:48):
at a younger age.
And then by the time it's comingforward, I, in a clinical
setting, it then is more of achallenge to, um, manage and
then the health conditions andimplications of it that may
already be in full force.
Speaker 2 (12:02):
I do wanna point out that we are talking about
obesity and overweight, andthere are also medical
conditions that lead to beingunderweight.
We're gonna talk about that in afuture episode.
So listeners, if you are alsointerested in some of the other
issues around, uh, beingunderweight, stay tuned.
We will cover that in a futureepisode.
Today I am talking with Dr.
(12:24):
Aisha Galloway Gilliam.
She is the medical director ofthe, uh, comprehensive weight
management center here atHennepin Healthcare in downtown
Minneapolis.
We've covered a lot of groundalready, but when we come back,
we're gonna talk about whattreatments are available to
people who are, uh, looking tomanage their weight.
We will do that right after ashort break.
Stay with us.
We'll be right back.
Speaker 1 (12:46):
You are listening to the Healthy Matters podcast with
Dr.
David Hilden.
Got a question or comment forthe doc, email us at Healthy
Matters hc m e d.org or give usa call at six one two eight
seven three talk.
That's 6 1 2 8 7 3 8 2 5 5.
And now let's get back to morehealthy conversation.
Speaker 2 (13:09):
Let's talk about the way people who are living with
obesity experience our societyor how they, how they're
treated.
In other words, some of thebiases and the mental health
issues around it.
You'll often hear someone saysomething like, well, it's your
fault.
You're just eating too much.
You're slothful and lazy.
And there's even abundantevidence that people who are
(13:31):
living with obesity areoverweight, are, are less apt to
get jobs and they're less apt tobe treated as accomplished and
smart and, and none of that'strue.
Mm.
And it's not a character flaw.
Yeah.
How do you respond to that?
Yes.
Or, or, or is that, or am am Imaking that up obviously?
Speaker 3 (13:47):
No, this is a great point and it is a conversation
that I have on a daily basiswith my patients because it's
very sad to know that people arebeing stigmatized for anything.
Um, and weight is a part ofthat, and it very much is again,
been conditioned and have thesocietal views on weight in
(14:12):
people who are living withoverweight or obesity, having a
lack of willpower, this being acosmetic issue and not a chronic
medical condition, which is whatit is.
And so there is a lot ofjudgments and a lot of
assumptions that patients whoare living with overweight or
obesity have to navigate on adaily basis when the fact of the
(14:35):
matter is someone who's livingwith obesity may be leading a
more healthy lifestyle than me.
They may be eating a wonderfuldiet, they may be very active in
exercising, they may be gettinggreat sleep, they may be be
managing their stress well andstill may be living with obesity
because of the complexity ofweight regulation and the
(14:57):
complexity of, uh, thepredisposing factors that
contribute to our weight.
So it is an unjust assumption tojust, uh, accuse someone who is
living with obesity of beinglazy and not caring about
themselves.
It's not true.
Speaker 2 (15:16):
That's an important message and well said.
Uh, what are some effective waysfor people to manage their
weight?
Speaker 3 (15:23):
That's a, a great question.
So I think the first part ofthat is to have a robust support
system, and that's wherecomprehensive weight management
programs come into place.
Now, if that's not realistic foryou and your day-to-day life, I
(15:43):
think that really being educatedon the physiology or the biology
of weight management is a goodplace to start because you need
to have some understanding ofthe biology of it so that you
don't burn out in the process.
Mm-hmm.
Uh, a lot of people come inreally very frustrated because
(16:04):
they have been taught that thisis a simple thing to manage.
If you would only eat less andexercise more, you would lose
all of the extra weight you'reliving with.
And that's not the reality ofthe situation.
So I think first it's gettinginformed on what obesity or
(16:26):
overweight is and then what itisn't.
And there's a reason we call itweight management and not weight
loss.
Speaker 2 (16:32):
Before you even move on from that, then Yes.
Is it, I take it it's not justdiet or it's not just exercise.
Speaker 3 (16:38):
Correct.
Th there's a, there's afoundation that it really is
important to set whenever we'retalking about a weight
management strategy and thereare four cornerstones or four
walls to the foundation, whatare they?
And those are lifestyletherapies.
And so it is definitelynutrition, it's how we're
eating, it's definitely physicalactivity or how we're
exercising, but it's also howsleeping meaning are we getting
(17:02):
enough and is it quality sleep?
And if there are otherconditions like sleep apnea
where you stop breathing inyour, in in your sleep at night,
are we identifying that andtreating it if it's present?
And then also, uh, and this is areally important one uh, as
well, how are we managing ourstress, our chronic, uh, stress?
Speaker 2 (17:23):
So let me just say the four years you said are,
they are diet, they are physicalexercise, but it's also sleep
and stress.
That's
Speaker 3 (17:30):
Correct.
Yeah.
The way that I think aboutweight management strategy is
we're building a house.
And so when we're building ahouse, the very first thing you
wanna do is have a solidfoundation, otherwise your house
crumbles.
Now we have to be realisticabout what to expect from those
modalities.
We could be doing all of thoseperfectly straight A's, and it
(17:53):
still may not and probably won'tbased on the data, completely
normalize your weight.
But what it does do is it stillallows you to invest in the bank
of health long term.
So we're still optimizing ourchances of living a long healthy
life by paying attention tothose, uh, those four areas.
Speaker 2 (18:17):
So that's the foundation.
I love that by the way.
I love that you started out witha support system and becoming
informed and then thesefoundational things, diet,
exercise, sleep, and stress.
What is the role of medication?
Yeah.
Because that's what people justsay.
It's almost the first thingpeople say.
Yeah.
So I like it that you led withthose other things first.
Yeah.
Yeah.
But then what is the role ofmedication?
Speaker 3 (18:37):
Yeah.
Very important role formedication as well because
again, where this is a chroniccondition and so we really have
to train ourselves to manage itand see it that way.
So just like we have medicationoptions for blood pressure and
other conditions, there aremedication options for weight
management.
(18:58):
And so when I think about, well,what's the role for medication?
I think about it as anotherfloor of our house.
So weight strategy, we'rebuilding a house, we got the
foundation, maybe we wantanother floor.
And this is all very muchindividualized.
There's a conversation thathappens around expectation
management and what people wantto use for managing their
(19:21):
weight.
And so medications are acompletely valid tool to use.
And thankfully now we've gotmedications that are more
effective than
Speaker 2 (19:29):
Do they work?
Speaker 3 (19:31):
Yes, they did.
The newer medications absolutelywork now it because
Speaker 2 (19:34):
The early ones didn't.
Holy cow.
We gave medications.
They gave you fatty diarrhea,explosive diarrhea.
You took them for two weeks andthat was that
Speaker 3 (19:42):
Yeah.
They, and and I think it'simportant to define or clarify
what we mean by work too,because cuz of weight bias, the
expectation is if it doesn'tcause me to reach a completely
normal weight, it's not working.
So when we talk about working inthe weight management realm, the
bar for that is 5% total bodyweight loss.
(20:05):
So the oral medications, most ofthem are effective for around
that.
Um, they had to be to even enterthe market to
Speaker 2 (20:17):
5%.
Speaker 3 (20:18):
5%.
But it also depends on theperson and how they're gonna
respond to a a particularmedication.
But 5% is sort of the bar.
And the reason is that we knowthat with as little as five to
10% total body weight loss, youcan achieve really significant
health benefits.
But the newer class ofmedications, the injectable
class of medications are evenmore effective than the oral
(20:42):
medications.
So now we're talking about, youknow, up to 15% total body
weight loss on average with someof the, uh, injectable
medications that are currentlyapproved.
Speaker 2 (20:53):
And nothing has achieved that in my career until
lately.
That's correct.
I've never been able to tell apatient, take this medication,
you can lose 15% of your bodyweight.
Yeah.
And they can do that.
Are you seeing that in yourpractice people losing 15% of
their body weight?
Speaker 3 (21:05):
Yes.
So it's pretty phenomenal.
Speaker 2 (21:07):
What is the role of bariatric surgery?
Now the word is bariatric B asin boy, B A R i A T R I C O,
otherwise known as people talkabout gastric bypass surgery.
Like do we still do that?
Mm-hmm.
Speaker 3 (21:21):
And it is still a very, uh,important tool to have, uh, at
our disposal medications when weuse them for weight management
are permanent meaning
Speaker 2 (21:33):
You have to take them or the weight comes back, you
Speaker 3 (21:35):
Have to take them or yeah, if you stop the weight
comes back.
A bariatric surgery is still themost effective tool for
significant and sustained weightloss on average.
Right.
So there are some people who aregonna defy averages on either
side.
Speaker 2 (21:50):
What can people expect with weight loss with
surgery?
Yeah,
Speaker 3 (21:53):
So it depends on the surgery.
The amount of total body weightloss with, with surgery on
average is somewhere between and25 to 35%, again, broken up by
the type of surgery you have.
And this is specifically talkingabout, um, what's known as the
sleeve gastrectomy and gastricbypass.
(22:13):
I'm not including the band andthose numbers cuz we're, we're
Speaker 2 (22:17):
The gastric bandi isn't really doing that.
Speaker 3 (22:19):
Yeah, we're, and we're moving away from that.
So those are the, that's thekind of average amounts of
weight loss that can be seenwith with surgery.
The other thing with surgery isthat we know that there's
mortality risk reduction.
The medication component iswhere, where folks think about,
oh, I don't wanna take thismedication forever.
That's not involved withsurgery.
(22:41):
There are supplements thatpeople will have to take
vitamins, but, um, but nothaving to inject, take that at
the medication, um, for theirweight.
There may be other meds toconsider.
And then one of the other bigthings with surgery is for folks
who have diabetes, dependingupon how long they've had it, if
you were diagnosed with diabetesin a short period of time before
(23:03):
you had surgery, somewherebetween one to four years, you
can see diabetes going toremission, uh, after bariatric
surgery.
And that
Speaker 2 (23:15):
Is just a wonderful outcome.
So we have all these layers ofthe house.
I wanna, I wanna circle back tosome dietary issues.
In what you eat, is it all aboutcalories or does it matter what
foods you eat?
Speaker 3 (23:27):
It definitely matters what you eat.
This is a question that is wrwith opinions.
I am convinced in my my personaland medical opinion that what
you eat matters more than thecalorie content it contains.
(23:49):
Say we're, we're gonna compare aavocado, kind of a medium size
avocado, and we're gonna comparethat to an average sort of candy
bar.
Calorie content is actuallyfairly similar.
That said, when we think aboutwhat's in the candy bar versus
what's in the avocado and whatthose calories are made of, we
(24:09):
know that this avocado is highin calorie mostly cuz it's got
great healthy fats in it, monounsaturated fatty acids, uh,
which are healthy fats for thebody.
Whereas the candy bar a lot ofsugar.
So when our bodies process thosefood items, they're gonna elicit
a different biochemicalresponse.
(24:31):
We also know that calorierestricted diets don't work long
term.
You may see some weight lossover the short term, but then
our bodies actually compensatefor that calorie restriction and
start to work against us.
And so we end up hungriercrankier and still not where we
(24:52):
wanna be with our weight goal.
Speaker 2 (24:54):
I'm gonna follow up with that.
The, the diets.
People hear about that.
Some people call the fad diets.
There's keto, there's Atkins,there's self beach, there's
Mediterranean, all all those.
Uh, are you saying they don'twork?
Speaker 3 (25:05):
So it really depends on the dietary approach.
So, so something like keto orotherwise known as, you know,
uh, kind of a low carbohydrateor carbohydrate restricted diet
versus something like, uh, uh,what would be considered an
ornish diet, which is mostlyplant-based, you know,
vegetarian diet, vegan diet.
Those approaches are more inline with what I would call
(25:29):
macronutrient distributionadjustments.
And when I'm talking aboutmacronutrients, I'm talking
about carbohydrate, protein andfats.
So manipulating macronutrientsfor health benefits and they can
work if you can continue themforever.
So that's where it gets tough isthat whatever you're choosing,
(25:53):
it has to be sustainable.
Also, again, because we'retalking about genetic
predispositions, what works forone person may not work for the
next person.
Someone might respondbeautifully to keto and the next
person not at all.
So there's this built in trialand error that's involved.
(26:15):
But again, the more importantpart of that is can you sustain
that for the rest of your life?
Most
Speaker 2 (26:20):
Of these you probably can't.
Speaker 3 (26:21):
That's correct, yeah.
It's sometimes it ends up beingvery restrictive and people
can't have joy in their foodand, and it is not always
sustainable for those who it is.
And they've had a great responseto keto or vegetarian, vegan,
whatever, uh, type of diet, andthey feel it's sustainable for
them.
And they're also, again, workingwith their physician and
(26:43):
consultation and make sure therearen't deficiencies that are
developing or other healthconditions that we would be
concerned about them, uh,engaging with one of those diets
on then great.
You know, but, but that's apretty small percentage of the
population.
Before
Speaker 2 (26:59):
I let you go, what, what tips would you give our
listeners?
Speaker 3 (27:03):
Yeah, so I think when you are embarking on a weight
management journey, rememberself-compassion.
We haven't talked about thatbefore.
Be gentle to yourself along theway, otherwise this is a, a mute
point.
We're causing more harm, uh,because this is complicated.
Two is remember thosefoundational areas that we
(27:23):
talked about.
Focus on how we're eating, howwe're moving, how we're managing
our stress, and how we'resleeping.
This is a lot to unpack there aswell.
Uh, which leads me to my nextsuggestion would, would be if
you are finding yourselfstruggling to reach out to a
(27:44):
trained professional that canhelp you navigate this really
complicated area.
And we, we wanna be here tosupport you and to, to validate
what you've experienced and topartner with you on where to go
next in your journey with weightmanagement.
Speaker 2 (28:03):
Those are great tips for all of us.
Thank you Dr.
Aisha Galloway Gilia, thank youfor sharing your expertise, your
wisdom, and your time with ustoday.
Speaker 3 (28:11):
Thank you for having me.
Speaker 2 (28:12):
We've been talking about weight management with Dr.
Aisha Galloway Gilia here fromHennepin Healthcare.
Lots of great information today.
I hope you have picked upsomething that is applicable to
your life.
I know I have.
Please join us for our nextepisode and in the meantime, be
healthy and be well.
Speaker 1 (28:29):
Thanks for listening to the Healthy Matters podcast
with Dr.
David Hilden.
To find out more about theHealthy Matters podcast or
browse the archive, visithealthy matters.org.
If you enjoy the show, pleaseleave us a review and share the
show with others.
The Healthy Matters Podcast ismade possible by Hennepin
Healthcare in Minneapolis,Minnesota, and engineered and
produced by John Lucas AtHighball Executive producers are
(28:53):
Jonathan Camino and ChristineHill.
Please remember, we can onlygive general medical advice
during this program, and everycase is unique.
We urge you to consult with yourphysician if you have a more
serious or pressing healthconcern.
Until next time, be healthy andbe well.
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