July 14, 2025 • 10 mins
Over the past 100 years, the poorest Americans have shifted from being underweight to becoming the group most likely to be overweight. Dr. Michael Koren joins Kevin Geddings to explore some of the social determinants of health underlying this trend. They touch on the complex biological, economic, and environmental factors contributing to higher obesity rates among economically disadvantaged Americans.
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Episode Transcript
Available transcripts are automatically generated. Complete accuracy is not guaranteed.
Announcer (00:01):
Welcome to the MedEvidence Monday Minute Radio
Show hosted by Kevin Gettings ofWSOS St Augustine Radio and
powered by Encore Research Group.
Each Monday morning, dr MichaelKoren calls in to bring you the
latest medical updates withinsightful discussions.
Medevidence is where we helpyou navigate the real truth
behind medical research, withboth a clinical and research
(00:21):
perspective.
So sit back, relax and getready to learn about the truth
behind the data in medicine andhealthcare.
This is MedEvidence.
Dr. Michael Koren (00:31):
And so the poorest people in the United
States tend to be the mostoverweight.
And that's a complete change indemographics than the way
things were 100 years ago so 100years ago demographics than the
way things were 100 years agoso 100 years ago, food was about
30% of the budget of UShouseholds.
Now it's only about 10% of thebudget, and people who are
(00:52):
overweight tended to be the mostaffluent people because they
had access to rich foods.
Now that whole script has beenswitched and people who are now
at the lower end of the economicspectrum are the ones that are
most likely to be overweight,and it brings up now at the
lower end of the economicspectrum are the ones that are
most likely to be overweight,and it brings up really, really
interesting issues about one,why this is the case and two,
(01:13):
how do we deal with it, andpeople that have studied this
carefully think it'smultifactorial.
There's a lot of reasons whypeople at or below the poverty
line are much more likely to beoverweight.
One of them, that's been arguedis access to good food.
Quite frankly, I'm a little bitskeptical about that, but that's
one of the concepts, and I'lltalk a little bit more about
(01:33):
that in a second, but the otherconcepts, I think, are probably
more accurate.
People at or below the povertyline are stressed, and a lot of
people eat to reduce theirstress.
Eating brings us pleasure, andif you're struggling with your
finances, you're maybe morelikely to indulge in food.
Another important part isimpulse control, and this gets
(01:54):
into some of the biologicalarguments.
So people who struggle withimpulse control may also
struggle with some financialissues that are related to being
in a less good financialsituation, and we're learning
more and more that impulsecontrol issues are actually
biologic, including impulsecontrol issues that are involved
(02:15):
in whether or not we choose fat, choose fatty foods or we stop
eating once we're initiallysatiated or full.
So these are really interestingthings that science is starting
to help us understand betterand we actually have treatments
for these things nowadays.
So that's another part of it.
And then the concept of fooddeserts is another concept.
(02:37):
Do people live in places wherethey may not be able to get the
same food as other people, orthey're afraid to go out and
exercise?
People that maybe live ininner-city places where there's
a lot of crime may not have thesame access to go out and take
walks or bike riding or doingthings that help them control
their weight.
So there are a lot of factorshere that go into the
(02:59):
observation, which was a truth,that people who are at or below
the poverty line are much morelikely to be overweight.
Kevin Geddings (03:08):
Very interesting .
Yeah, we of course hear aboutthe obesity issue, diet issues,
constantly.
There are options out there, Iguess, and as people are trying
to consider those, they shouldreach out to ENCORE Research
Group right, because there maybe a way for them to deal with
their obesity issues and also bea part of a clinical trial.
Dr. Michael Koren (03:27):
Yeah, and that's absolutely true.
So there's a couple advantagesabout doing something through
research.
One is that there's no cost foranything that we do.
We're funded by outside grants,either from industry or from
the government typically,although nowadays private equity
and other people are alsocontributing to the funding for
clinical research.
So it never costs a patientanything to be part of a
(03:50):
research study.
In fact, in a lot of ourstudies we actually pay patients
, so we reimburse patients fortheir travel and their time.
So that can certainly behelpful for people who are down
on their financial luck, sothat's important.
But the other thing is thatthere's support staff involved
in these studies.
So if you get involved in anobesity trial, they'll typically
(04:11):
be a nutritionist that willhelp you make better food
choices.
And, of course, we're lookingtypically at medicines that can
help people over time.
So, for example, we have amedicine that we're working with
right now that can actuallysuppress your appetite for a
month with one injection.
So these are the type of thingsthat we're studying and it's a
nice opportunity for people whoare maybe having trouble making
(04:34):
ends meet, get some help withtheir obesity problem and
perhaps some help on theeconomic side as well.
Kevin Geddings (04:40):
Yeah, because we hear over and over again the
folks who just think they shouldgo out and take a GLP-1 and
Ozempic, Wegovy, Zepbound andone of those.
You know, depending oninsurance coverages, you know
they probably won't be able toafford the drug, correct?
Dr. Michael Koren (04:53):
Yeah, it is certainly a problem and, by the
way, that's a problem for peoplewho are actually relatively
well off.
These drugs are very expensive.
If your insurance companycovers it, that's terrific, but
not everybody has that luxury,so certainly that is something
for many middle-income peopleand upper middle-income people.
Quite frankly, these are notinexpensive drugs.
Kevin Geddings (05:13):
Well, if you would like to participate or you
know someone in your family,your circle of friends, who
could benefit from a clinicaltrial dealing with obesity and
weight issues, we wouldencourage you to go to the
website, encoredocscom.
Of course, they're locallybased right here in Northeast
Florida, with offices here in St.
Johns County and St.
Augustine, right next to UFFlagler Hospital.
Encoredocs.
com that phone number,904-730-0166.
(05:40):
And I'll give you that numberhere in just a moment.
Again, speaking of weight lossand Ozempic and GLP drugs and
all that, there's so muchinformation out there, a lot of
really bad information onFacebook and places like that.
There's a better place to goand get your health-related
information correct, Dr.
Koren.
Dr. Michael Koren (05:57):
Yeah.
So MedEvidence is our platformfor discussing the truth behind
the data, and our discussionabout the obesity paradox is a
perfect example of the type ofthings that we talk about.
So let's just do a thoughtexperiment between you and me,
Kevin.
So we talked about the factthat there's a clear
relationship between being poor,being out or below the poverty
(06:18):
line and being overweight, soI'm going to give you two
choices in terms of solving theproblem of obesity.
We can either give everybody inthat situation $30,000 a year,
or we can get them a medicinethat will curb their appetite
and impulse control.
Which of those two is going tomore likely solve the obesity
(06:39):
problem?
Kevin Geddings (06:41):
I would guess.
No, I would guess curbing yourappetite, because you just told
me that the grocery bill is lessa percentage today than it was
20 years ago, right?
Dr. Michael Koren (06:54):
Right.
Well, I would agree with that.
Again, that experiment has kindof been done.
There have been experimentsthat have been done looking at
guaranteed income.
And unfortunately, guaranteedincome don't seem to improve
health consequences.
So this is the whole differencebetween a correlation and
fixing the problem.
So we know there's acorrelation between being
(07:15):
economically disadvantaged andbeing overweight, but just
giving people money doesn't fixit.
What fixes?
That is dealing with theunderlying issues of stress
control and probably the biologythat leads to people eating
more than they should.
So that's the interesting thingthat we do and the interesting
thing is we talk about in thatevidence and again, this is not
(07:36):
judgmental at all we're justtrying to help people and solve
problems and, quite frankly,getting $30,000 a year may solve
other problems for a lot ofpeople, but it's not going to
make them skinnier.
So this is the kind of thingswe like to talk about in
MedEvidence and hopefully peoplewill look at this as an
objective resource where wereally dig into issues and help
people navigate them and ofcourse, we also introduce really
(07:58):
the nice opportunities inclinical trials to help people.
So again as we just discussed,getting involved in a clinical
trial on obesity may or may notget your medicine, but it'll
certainly help you with impulsecontrol, with knowing more about
nutrition and making gooddecisions.
That will help both you andyour family.
Kevin Geddings (08:15):
Now, this can be life-changing stuff and, of
course, if you maintain a weightissue or you have too much
excess weight over time, we doknow for pretty much a fact,
right, Dr.
Koren?
That it will cause increasedhealth risk, right.
Dr. Michael Koren (08:29):
Totally.
We certainly know that obesityis associated with multiple,
multiple health risks it'sassociated with cholesterol,
it's associated with high bloodpressure.
It's associated with fattyliver disease.
Kevin Geddings (08:42):
Correct Wow, we're losing it, Dr.
Koren.
Correct Wow,
Dr. Michael Koren (08:46):
Getting down to a healthy weight is probably
one of the most important things, if not the most important
thing, that you can do to makeyour life better and healthier.
Kevin Geddings (08:56):
Well, learn more about the clinical trials you
can participate in.
If you would like to finally dosomething about your obese
weight status, go to EncoreDocs.
com, EncoreDocs.
com.
Not only could you getprofessional guidance, hands-on
approach to your weight loss,potentially be a part of leading
edge medical research, but youmay even get paid for it.
(09:17):
It won't cost you anything andyou'll make some money Go to
EncoreDocs.
com.
That's EncoreDocs.
com.
Call 904-730-0166, here locally904-730-0166.
Dr.
Koren, any closing thoughtsbefore we let you go this
morning?
Dr. Michael Koren (09:37):
No, thank you for your interest in this issue
and again, we're here to helpour community and I think
helping people control theirweight is a great opportunity
for us to reach out to thecommunity and hopefully make a
difference.
ThereYou go, Dr.
Michael Koren, once againEncoreDocs.
com, that's EncoreDocs.
com.
Announcer (09:55):
Thanks for joining the MedEvidence podcast.
To learn more, head over toMedEvidencecom or subscribe to
our podcast on your favoritepodcast platform.
Welcome to the MedEvidence Monday Minute Radio
Show hosted by Kevin Gettings ofWSOS St Augustine Radio and
powered by Encore Research Group.
Each Monday morning, dr MichaelKoren calls in to bring you the
latest medical updates withinsightful discussions.
Medevidence is where we helpyou navigate the real truth
behind medical research, withboth a clinical and research
(00:21):
perspective.
So sit back, relax and getready to learn about the truth
behind the data in medicine andhealthcare.
This is MedEvidence.
Dr. Michael Koren (00:31):
And so the poorest people in the United
States tend to be the mostoverweight.
And that's a complete change indemographics than the way
things were 100 years ago so 100years ago demographics than the
way things were 100 years agoso 100 years ago, food was about
30% of the budget of UShouseholds.
Now it's only about 10% of thebudget, and people who are
(00:52):
overweight tended to be the mostaffluent people because they
had access to rich foods.
Now that whole script has beenswitched and people who are now
at the lower end of the economicspectrum are the ones that are
most likely to be overweight,and it brings up now at the
lower end of the economicspectrum are the ones that are
most likely to be overweight,and it brings up really, really
interesting issues about one,why this is the case and two,
(01:13):
how do we deal with it, andpeople that have studied this
carefully think it'smultifactorial.
There's a lot of reasons whypeople at or below the poverty
line are much more likely to beoverweight.
One of them, that's been arguedis access to good food.
Quite frankly, I'm a little bitskeptical about that, but that's
one of the concepts, and I'lltalk a little bit more about
(01:33):
that in a second, but the otherconcepts, I think, are probably
more accurate.
People at or below the povertyline are stressed, and a lot of
people eat to reduce theirstress.
Eating brings us pleasure, andif you're struggling with your
finances, you're maybe morelikely to indulge in food.
Another important part isimpulse control, and this gets
(01:54):
into some of the biologicalarguments.
So people who struggle withimpulse control may also
struggle with some financialissues that are related to being
in a less good financialsituation, and we're learning
more and more that impulsecontrol issues are actually
biologic, including impulsecontrol issues that are involved
(02:15):
in whether or not we choose fat, choose fatty foods or we stop
eating once we're initiallysatiated or full.
So these are really interestingthings that science is starting
to help us understand betterand we actually have treatments
for these things nowadays.
So that's another part of it.
And then the concept of fooddeserts is another concept.
(02:37):
Do people live in places wherethey may not be able to get the
same food as other people, orthey're afraid to go out and
exercise?
People that maybe live ininner-city places where there's
a lot of crime may not have thesame access to go out and take
walks or bike riding or doingthings that help them control
their weight.
So there are a lot of factorshere that go into the
(02:59):
observation, which was a truth,that people who are at or below
the poverty line are much morelikely to be overweight.
Kevin Geddings (03:08):
Very interesting .
Yeah, we of course hear aboutthe obesity issue, diet issues,
constantly.
There are options out there, Iguess, and as people are trying
to consider those, they shouldreach out to ENCORE Research
Group right, because there maybe a way for them to deal with
their obesity issues and also bea part of a clinical trial.
Dr. Michael Koren (03:27):
Yeah, and that's absolutely true.
So there's a couple advantagesabout doing something through
research.
One is that there's no cost foranything that we do.
We're funded by outside grants,either from industry or from
the government typically,although nowadays private equity
and other people are alsocontributing to the funding for
clinical research.
So it never costs a patientanything to be part of a
(03:50):
research study.
In fact, in a lot of ourstudies we actually pay patients
, so we reimburse patients fortheir travel and their time.
So that can certainly behelpful for people who are down
on their financial luck, sothat's important.
But the other thing is thatthere's support staff involved
in these studies.
So if you get involved in anobesity trial, they'll typically
(04:11):
be a nutritionist that willhelp you make better food
choices.
And, of course, we're lookingtypically at medicines that can
help people over time.
So, for example, we have amedicine that we're working with
right now that can actuallysuppress your appetite for a
month with one injection.
So these are the type of thingsthat we're studying and it's a
nice opportunity for people whoare maybe having trouble making
(04:34):
ends meet, get some help withtheir obesity problem and
perhaps some help on theeconomic side as well.
Kevin Geddings (04:40):
Yeah, because we hear over and over again the
folks who just think they shouldgo out and take a GLP-1 and
Ozempic, Wegovy, Zepbound andone of those.
You know, depending oninsurance coverages, you know
they probably won't be able toafford the drug, correct?
Dr. Michael Koren (04:53):
Yeah, it is certainly a problem and, by the
way, that's a problem for peoplewho are actually relatively
well off.
These drugs are very expensive.
If your insurance companycovers it, that's terrific, but
not everybody has that luxury,so certainly that is something
for many middle-income peopleand upper middle-income people.
Quite frankly, these are notinexpensive drugs.
Kevin Geddings (05:13):
Well, if you would like to participate or you
know someone in your family,your circle of friends, who
could benefit from a clinicaltrial dealing with obesity and
weight issues, we wouldencourage you to go to the
website, encoredocscom.
Of course, they're locallybased right here in Northeast
Florida, with offices here in St.
Johns County and St.
Augustine, right next to UFFlagler Hospital.
Encoredocs.
com that phone number,904-730-0166.
(05:40):
And I'll give you that numberhere in just a moment.
Again, speaking of weight lossand Ozempic and GLP drugs and
all that, there's so muchinformation out there, a lot of
really bad information onFacebook and places like that.
There's a better place to goand get your health-related
information correct, Dr.
Koren.
Dr. Michael Koren (05:57):
Yeah.
So MedEvidence is our platformfor discussing the truth behind
the data, and our discussionabout the obesity paradox is a
perfect example of the type ofthings that we talk about.
So let's just do a thoughtexperiment between you and me,
Kevin.
So we talked about the factthat there's a clear
relationship between being poor,being out or below the poverty
(06:18):
line and being overweight, soI'm going to give you two
choices in terms of solving theproblem of obesity.
We can either give everybody inthat situation $30,000 a year,
or we can get them a medicinethat will curb their appetite
and impulse control.
Which of those two is going tomore likely solve the obesity
(06:39):
problem?
Kevin Geddings (06:41):
I would guess.
No, I would guess curbing yourappetite, because you just told
me that the grocery bill is lessa percentage today than it was
20 years ago, right?
Dr. Michael Koren (06:54):
Right.
Well, I would agree with that.
Again, that experiment has kindof been done.
There have been experimentsthat have been done looking at
guaranteed income.
And unfortunately, guaranteedincome don't seem to improve
health consequences.
So this is the whole differencebetween a correlation and
fixing the problem.
So we know there's acorrelation between being
(07:15):
economically disadvantaged andbeing overweight, but just
giving people money doesn't fixit.
What fixes?
That is dealing with theunderlying issues of stress
control and probably the biologythat leads to people eating
more than they should.
So that's the interesting thingthat we do and the interesting
thing is we talk about in thatevidence and again, this is not
(07:36):
judgmental at all we're justtrying to help people and solve
problems and, quite frankly,getting $30,000 a year may solve
other problems for a lot ofpeople, but it's not going to
make them skinnier.
So this is the kind of thingswe like to talk about in
MedEvidence and hopefully peoplewill look at this as an
objective resource where wereally dig into issues and help
people navigate them and ofcourse, we also introduce really
(07:58):
the nice opportunities inclinical trials to help people.
So again as we just discussed,getting involved in a clinical
trial on obesity may or may notget your medicine, but it'll
certainly help you with impulsecontrol, with knowing more about
nutrition and making gooddecisions.
That will help both you andyour family.
Kevin Geddings (08:15):
Now, this can be life-changing stuff and, of
course, if you maintain a weightissue or you have too much
excess weight over time, we doknow for pretty much a fact,
right, Dr.
Koren?
That it will cause increasedhealth risk, right.
Dr. Michael Koren (08:29):
Totally.
We certainly know that obesityis associated with multiple,
multiple health risks it'sassociated with cholesterol,
it's associated with high bloodpressure.
It's associated with fattyliver disease.
Kevin Geddings (08:42):
Correct Wow, we're losing it, Dr.
Koren.
Correct Wow,
Dr. Michael Koren (08:46):
Getting down to a healthy weight is probably
one of the most important things, if not the most important
thing, that you can do to makeyour life better and healthier.
Kevin Geddings (08:56):
Well, learn more about the clinical trials you
can participate in.
If you would like to finally dosomething about your obese
weight status, go to EncoreDocs.
com, EncoreDocs.
com.
Not only could you getprofessional guidance, hands-on
approach to your weight loss,potentially be a part of leading
edge medical research, but youmay even get paid for it.
(09:17):
It won't cost you anything andyou'll make some money Go to
EncoreDocs.
com.
That's EncoreDocs.
com.
Call 904-730-0166, here locally904-730-0166.
Dr.
Koren, any closing thoughtsbefore we let you go this
morning?
Dr. Michael Koren (09:37):
No, thank you for your interest in this issue
and again, we're here to helpour community and I think
helping people control theirweight is a great opportunity
for us to reach out to thecommunity and hopefully make a
difference.
ThereYou go, Dr.
Michael Koren, once againEncoreDocs.
com, that's EncoreDocs.
com.
Announcer (09:55):
Thanks for joining the MedEvidence podcast.
To learn more, head over toMedEvidencecom or subscribe to
our podcast on your favoritepodcast platform.
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