Public health experts agree that obesity has reached an epidemic in this country and around the world. More than a third of U.S. adults are obese. Obesity can cause many health problems and put you at a higher risk for diseases such as high blood pressure, diabetes, heart disease, stroke, sleep apnea and more.
Lisa Ferreira, MD discusses the obesity epidemic and the various treatment options available at BayCare, so you can live a more active, healthier lifestyle.
Learn more about BayCare's primary care services.
This podcast is for informational purposes only, and is not intended to be a substitute for professional medical advice, diagnosis, or treatment. This podcast does not create a physician-patient relationship. You should always consult your physician or other healthcare professional with any questions you may have regarding a medical condition. If you think you may have a medical emergency, call your physician or 911 immediately.
Selected Podcast
How Your Weight Affects Your Health
Featured Speaker:
Learn more about Lisa M. Ferreira, MD
Lisa M. Ferreira, MD
Dr. Lisa Ferreira was born and raised in Baltimore. She completed her undergraduate education at University of Delaware and Medical school at Jefferson Medical College in Philadelphia. Her residency was at Bayfront Medical Center, where she had the opportunity to serve as chief resident. She has been employed by BayCare since 2004 as a Family Practice physician. In 2016, she received her board certification in Obesity Medicine.Learn more about Lisa M. Ferreira, MD
Transcription:
How Your Weight Affects Your Health
Melanie Cole (Host): More than twelve and a half million Americans are severely overweight according to the US Department of Health and Human Services. Being seriously overweight can lead to life threatening medical conditions, however, there are many options both surgical and nonsurgical to help you live a healthier life. My guest is Dr. Lisa Ferreira. She’s a family medicine obesity medicine physician at BayCare Medical Group. Dr. Ferreira, give us the definition of obesity and what is BMI? What is it even all about?
Lisa M. Ferreira, MD (Guest): Well thank you for having me. Obesity is defined as a chronic relapsing multifactorial disease which breaking that down chronic. So, it is something that people deal with on and off for probably their entire lives. Relapsing, it can come and go. Multifactorial, there are lots of reasons that this can happen, and we now realize it is a disease. We never used to think of it that way. But in the medical community, we are realizing this is actually a disease people are dealing with. The disease also means that they have an increased body fat which can result in medical consequences. The BMI is the definition that physicians use in the office when patients come in to assess do they have obesity or not. And so, a BMI is a body mass index which is a formula that calculates a number based on your weight and your height and the definition strictly of obesity is going to be a BMI over 30.
Melanie: Are there certain risk factors? Is there a genetic component to obesity?
Dr. Ferreira: Absolutely. We do know there are a variety of causes of obesity and we used to think that this was just move more, and eat less, calories in and calories out and we realize now that’s not the case. That there are so many other factors in play. Genetics is certainly one of them and sometimes people are just predisposed to have a certain body type or a certain metabolism. So, genetics certainly could be involved. There are also genetic syndromes. Some people actually have genetic disorders which also make it more likely for them to suffer with obesity.
Melanie: Are all calories the same? And you mentioned calories in, calories out; now it used to be certainly what we thought of as the way to kind of count calories and all of that. But not all calories are created equal, are they?
Dr. Ferreira: Absolutely not. And we do know from a nutrition standpoint; that the more highly processed, more sugar sweetened foods and calories tend to be much worse for the body.
Melanie: So, how is a person to know? You know we all have seen all the diets out there Dr. Ferreira, we have seen the fad diets; it can be quite confusing to learn to read labels. What is a person who is trying to lose weight supposed to do first? Do you want them to start reading labels and looking at the quality of the calories that they are taking in? What do you like them to concentrate on?
Dr. Ferreira: Well I think we all can agree that again, the empty calories are not beneficial for the body. So, limiting simple sugars, limiting desserts, things that we think of as junk foods, highly processed, highly chemicalized foods, also looking at the beverages we are drinking, especially with kids these days. They are drinking a lot of sugar sweetened beverages such as Gatorades and fruit juices and sodas and we know that’s a good place to start to get rid of some of these empty calories.
Melanie: Where fats are concerned, and we have heard about the protein diets and we will get into some of that but where fats are concerned, back in the 70s and 80s, everything was a low-fat diet, low fat, but now avocados are huge, and fish and we hear all of these things about omega threes and how good certain fats are for you. Is that the same if you are someone who is really trying to lose weight?
Dr. Ferreira: Definitely. There are so many different eating styles and it’s really hard to know which style is right for any one person. That’s where meeting with a physician or a registered dietitian can help decide what specific eating style is best for each person. But we do realize now that our emphasis on low-fat over so many years has really not translated into health benefits. And so, you are right, there are what we think of as healthier fats now avocado, right, olive oil. There are certainly fats that we think are healthy. So, just following a strict low-fat diet really doesn’t seem like it’s gotten most people where they need to be from a health perspective.
Melanie: Where does physical activity fit into the picture because for someone who is obese; sometimes it’s a bit of a limiting factor maybe they have some comorbidities, knee problems, hip problems, heart problems and so exercise can be a little limiting. What do you tell them about getting some physical activity and getting going, getting started?
Dr. Ferreira: Sure. That can be difficult for people who do have physical limitations and that’s where meeting with and exercise physiologist if they have access to one or a trainer or someone could help them develop an individualized program which would work well for their limitations. We do know that obesity puts people at risk for arthritis and joint pain, so it can be very difficult to just go out and start exercising. But there are certainly exercises people can do like swimming. Swimming is a very low-impact exercise that is great for the joints and even just walking in the pool, something low-impact like that can really make a difference. People also sometimes try things like yoga or just some basic gentle strengthening exercises. You want to make sure that anything you do, you start gradually and make sure that you are not getting more pain when you are doing it, but there are really great low-impact and safe ways to exercise.
Melanie: Dr. Ferreira, I’m asking you the million-dollar question. What about medications? Are there any to help with obesity? Is there a magic pill we have all been waiting for?
Dr. Ferreira: Well we don’t like to say magic pill. We don’t believe there is a magic pill people can take and they don’t have to worry about their eating style and they don’t have to exercise and there’s just this magic. We don’t believe that at all. There are medications that are approved to help people with obesity. There are anti-obesity medications and they may be right for some people, absolutely. They are just another tool in our toolbox to help people lose weight. So, they certainly can be indicated. Those are things that you would discuss with your physician and figure out if you do meet the criteria for it. We like to usually make sure that the nutrition part and the exercise part are in place before we initially jump to medications. But again, that is an individualized decision between the patient and their doctor.
Melanie: And as you mentioned, the toolbox; which is such an important for physicians to have all of these different options to help obese people; what about behavioral therapy? Are there certain behaviors that you would like to discuss that you can say well these are behaviors that we have found help contribute to the causes of obesity?
Dr. Ferreira: Absolutely. Behavioral therapy is another equally important part of treatment for obesity. We talk about nutrition, we talked about physical activity, medication and behavioral therapy is certainly a component. Some people are suffering from increased stress or sleep deprivation or using food as a reward or using food as a way to help deal with anxiety. So, if you can work through those issues and habits with a behavioral therapist who specializes in obesity treatment, then that is ideal.
Melanie: Certainly, is and people have heard the term medically supervised weight loss programs. What does that mean?
Dr. Ferreira: So, to me that means meeting with your physician who has been trained, hopefully, in obesity medicine and those physicians are becoming more common. The idea behind that is getting a comprehensive approach to tackling obesity. And so, again, developing an individualized nutrition plan, developing physical activity that a person can do based on limitations. But looking over the entire picture of a person’s health. Looking at their medications they currently take. Some medications that we as physicians prescribe are for say stress or depression, diabetes, seizures, but these medications can sometimes have side effects of causing weight gain. So, if we look at those medications sometimes, we can make some adjustments and actually use medications that may help with weight loss or at least be weight neutral. So, I think doing this comprehensive approach is really what we mean by that term.
Melanie: And then there is bariatric surgery. There are many different types. People have seen celebrities that have lost over 100 pounds. Just give us a little bit of a definition of bariatric surgery and are there certain parameters for the severely obese to consider bariatrics?
Dr. Ferreira: Yes, so bariatric surgery again, is another tool in our toolbox that we use when we have tried these other types of treatment options and we are just not getting anywhere. There are BMI criteria for having bariatric surgery. But we want to make sure the other parts are in place. Certainly, bariatric surgery can be indicated for certain patients and there are procedures and every day, there are new procedures coming out. Our most common procedure right now is the vertical sleeve gastrectomy or the gastric sleeve people talk about. And there are lap bands, there are more invasive surgeries like gastric bypass. So, meeting with a bariatric surgeon could decide whether these surgeries would be indicated, but they can certainly be helpful as well.
Melanie: Wrap it up for us, because it’s really great information about this epidemic that we are seeing in this country and your best advice as an obesity physician; what do you want people to know about this epidemic and the treatment options available at BayCare Health?
Dr. Ferreira: So, the important thing to remember is that this really is a chronic disease. This should be thought of similarly to cancer, diabetes, thee other medical problems that we are treating in our offices, but obesity has had such a stigma to it, that sometimes people are embarrassed, or they have had bad experiences in the past and have experienced weight bias where even in a physician’s office they may feel uncomfortable. So, I think the thing I want to make sure people understand is that this is a chronic disease and should be thought of that way which needs medical treatment and so consulting with your physician to help with weight loss is certainly a wonderful idea. We have to remember that the prevalence of obesity in our country now is approaching 40% of our US adults. I can’t think of any other medical problem I treat in my office on a daily basis that is that common. But obesity is – and becoming even more common. So, we can’t not address it. We have to address it and we need to address it for the health of our patients. There are so many benefits of handling and helping patients work with their obesity. So, I really would just emphasize to consult your physician and bring it up. Bring it up with your physician and let them know that you are interested in addressing this as well. Search out an obesity medicine specialist because we are definitely comfortable treating obesity and the most enjoyable part of my day is seeing patients who I’m helping lose weight because they are getting results and they are feeling great. And that’s what it’s all about.
Melanie: That is absolutely perfect. Thank you so much Dr. Ferreira for sharing your expertise today. Because this is really a topic that is top of mind for so many people and so many people as you say are suffering from this disease of obesity. Thank you again for joining us. You’re listening to BayCare Health Chat. For more information please visit www.baycare.org that’s www.baycare.org. This is Melanie Cole. Thanks so much for tuning in.
How Your Weight Affects Your Health
Melanie Cole (Host): More than twelve and a half million Americans are severely overweight according to the US Department of Health and Human Services. Being seriously overweight can lead to life threatening medical conditions, however, there are many options both surgical and nonsurgical to help you live a healthier life. My guest is Dr. Lisa Ferreira. She’s a family medicine obesity medicine physician at BayCare Medical Group. Dr. Ferreira, give us the definition of obesity and what is BMI? What is it even all about?
Lisa M. Ferreira, MD (Guest): Well thank you for having me. Obesity is defined as a chronic relapsing multifactorial disease which breaking that down chronic. So, it is something that people deal with on and off for probably their entire lives. Relapsing, it can come and go. Multifactorial, there are lots of reasons that this can happen, and we now realize it is a disease. We never used to think of it that way. But in the medical community, we are realizing this is actually a disease people are dealing with. The disease also means that they have an increased body fat which can result in medical consequences. The BMI is the definition that physicians use in the office when patients come in to assess do they have obesity or not. And so, a BMI is a body mass index which is a formula that calculates a number based on your weight and your height and the definition strictly of obesity is going to be a BMI over 30.
Melanie: Are there certain risk factors? Is there a genetic component to obesity?
Dr. Ferreira: Absolutely. We do know there are a variety of causes of obesity and we used to think that this was just move more, and eat less, calories in and calories out and we realize now that’s not the case. That there are so many other factors in play. Genetics is certainly one of them and sometimes people are just predisposed to have a certain body type or a certain metabolism. So, genetics certainly could be involved. There are also genetic syndromes. Some people actually have genetic disorders which also make it more likely for them to suffer with obesity.
Melanie: Are all calories the same? And you mentioned calories in, calories out; now it used to be certainly what we thought of as the way to kind of count calories and all of that. But not all calories are created equal, are they?
Dr. Ferreira: Absolutely not. And we do know from a nutrition standpoint; that the more highly processed, more sugar sweetened foods and calories tend to be much worse for the body.
Melanie: So, how is a person to know? You know we all have seen all the diets out there Dr. Ferreira, we have seen the fad diets; it can be quite confusing to learn to read labels. What is a person who is trying to lose weight supposed to do first? Do you want them to start reading labels and looking at the quality of the calories that they are taking in? What do you like them to concentrate on?
Dr. Ferreira: Well I think we all can agree that again, the empty calories are not beneficial for the body. So, limiting simple sugars, limiting desserts, things that we think of as junk foods, highly processed, highly chemicalized foods, also looking at the beverages we are drinking, especially with kids these days. They are drinking a lot of sugar sweetened beverages such as Gatorades and fruit juices and sodas and we know that’s a good place to start to get rid of some of these empty calories.
Melanie: Where fats are concerned, and we have heard about the protein diets and we will get into some of that but where fats are concerned, back in the 70s and 80s, everything was a low-fat diet, low fat, but now avocados are huge, and fish and we hear all of these things about omega threes and how good certain fats are for you. Is that the same if you are someone who is really trying to lose weight?
Dr. Ferreira: Definitely. There are so many different eating styles and it’s really hard to know which style is right for any one person. That’s where meeting with a physician or a registered dietitian can help decide what specific eating style is best for each person. But we do realize now that our emphasis on low-fat over so many years has really not translated into health benefits. And so, you are right, there are what we think of as healthier fats now avocado, right, olive oil. There are certainly fats that we think are healthy. So, just following a strict low-fat diet really doesn’t seem like it’s gotten most people where they need to be from a health perspective.
Melanie: Where does physical activity fit into the picture because for someone who is obese; sometimes it’s a bit of a limiting factor maybe they have some comorbidities, knee problems, hip problems, heart problems and so exercise can be a little limiting. What do you tell them about getting some physical activity and getting going, getting started?
Dr. Ferreira: Sure. That can be difficult for people who do have physical limitations and that’s where meeting with and exercise physiologist if they have access to one or a trainer or someone could help them develop an individualized program which would work well for their limitations. We do know that obesity puts people at risk for arthritis and joint pain, so it can be very difficult to just go out and start exercising. But there are certainly exercises people can do like swimming. Swimming is a very low-impact exercise that is great for the joints and even just walking in the pool, something low-impact like that can really make a difference. People also sometimes try things like yoga or just some basic gentle strengthening exercises. You want to make sure that anything you do, you start gradually and make sure that you are not getting more pain when you are doing it, but there are really great low-impact and safe ways to exercise.
Melanie: Dr. Ferreira, I’m asking you the million-dollar question. What about medications? Are there any to help with obesity? Is there a magic pill we have all been waiting for?
Dr. Ferreira: Well we don’t like to say magic pill. We don’t believe there is a magic pill people can take and they don’t have to worry about their eating style and they don’t have to exercise and there’s just this magic. We don’t believe that at all. There are medications that are approved to help people with obesity. There are anti-obesity medications and they may be right for some people, absolutely. They are just another tool in our toolbox to help people lose weight. So, they certainly can be indicated. Those are things that you would discuss with your physician and figure out if you do meet the criteria for it. We like to usually make sure that the nutrition part and the exercise part are in place before we initially jump to medications. But again, that is an individualized decision between the patient and their doctor.
Melanie: And as you mentioned, the toolbox; which is such an important for physicians to have all of these different options to help obese people; what about behavioral therapy? Are there certain behaviors that you would like to discuss that you can say well these are behaviors that we have found help contribute to the causes of obesity?
Dr. Ferreira: Absolutely. Behavioral therapy is another equally important part of treatment for obesity. We talk about nutrition, we talked about physical activity, medication and behavioral therapy is certainly a component. Some people are suffering from increased stress or sleep deprivation or using food as a reward or using food as a way to help deal with anxiety. So, if you can work through those issues and habits with a behavioral therapist who specializes in obesity treatment, then that is ideal.
Melanie: Certainly, is and people have heard the term medically supervised weight loss programs. What does that mean?
Dr. Ferreira: So, to me that means meeting with your physician who has been trained, hopefully, in obesity medicine and those physicians are becoming more common. The idea behind that is getting a comprehensive approach to tackling obesity. And so, again, developing an individualized nutrition plan, developing physical activity that a person can do based on limitations. But looking over the entire picture of a person’s health. Looking at their medications they currently take. Some medications that we as physicians prescribe are for say stress or depression, diabetes, seizures, but these medications can sometimes have side effects of causing weight gain. So, if we look at those medications sometimes, we can make some adjustments and actually use medications that may help with weight loss or at least be weight neutral. So, I think doing this comprehensive approach is really what we mean by that term.
Melanie: And then there is bariatric surgery. There are many different types. People have seen celebrities that have lost over 100 pounds. Just give us a little bit of a definition of bariatric surgery and are there certain parameters for the severely obese to consider bariatrics?
Dr. Ferreira: Yes, so bariatric surgery again, is another tool in our toolbox that we use when we have tried these other types of treatment options and we are just not getting anywhere. There are BMI criteria for having bariatric surgery. But we want to make sure the other parts are in place. Certainly, bariatric surgery can be indicated for certain patients and there are procedures and every day, there are new procedures coming out. Our most common procedure right now is the vertical sleeve gastrectomy or the gastric sleeve people talk about. And there are lap bands, there are more invasive surgeries like gastric bypass. So, meeting with a bariatric surgeon could decide whether these surgeries would be indicated, but they can certainly be helpful as well.
Melanie: Wrap it up for us, because it’s really great information about this epidemic that we are seeing in this country and your best advice as an obesity physician; what do you want people to know about this epidemic and the treatment options available at BayCare Health?
Dr. Ferreira: So, the important thing to remember is that this really is a chronic disease. This should be thought of similarly to cancer, diabetes, thee other medical problems that we are treating in our offices, but obesity has had such a stigma to it, that sometimes people are embarrassed, or they have had bad experiences in the past and have experienced weight bias where even in a physician’s office they may feel uncomfortable. So, I think the thing I want to make sure people understand is that this is a chronic disease and should be thought of that way which needs medical treatment and so consulting with your physician to help with weight loss is certainly a wonderful idea. We have to remember that the prevalence of obesity in our country now is approaching 40% of our US adults. I can’t think of any other medical problem I treat in my office on a daily basis that is that common. But obesity is – and becoming even more common. So, we can’t not address it. We have to address it and we need to address it for the health of our patients. There are so many benefits of handling and helping patients work with their obesity. So, I really would just emphasize to consult your physician and bring it up. Bring it up with your physician and let them know that you are interested in addressing this as well. Search out an obesity medicine specialist because we are definitely comfortable treating obesity and the most enjoyable part of my day is seeing patients who I’m helping lose weight because they are getting results and they are feeling great. And that’s what it’s all about.
Melanie: That is absolutely perfect. Thank you so much Dr. Ferreira for sharing your expertise today. Because this is really a topic that is top of mind for so many people and so many people as you say are suffering from this disease of obesity. Thank you again for joining us. You’re listening to BayCare Health Chat. For more information please visit www.baycare.org that’s www.baycare.org. This is Melanie Cole. Thanks so much for tuning in.