Dr. Brandon Steinberg discusses High Blood Pressure and Obesity.
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High Blood Pressure and Obesity
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Learn more about Brandon Steinberg, MD
Brandon Steinberg, MD
Dr. Brandon Steinberg is board certified in family medicine. He completed his undergraduate degree in physiology from McGill University in Montreal, Quebec, Canada. Dr. Steinberg earned his Doctor of Medicine from St. George's University in Grenada, West Indies. He continued his medical education by completing a family medicine residency at the Mayo Clinic Hospital in Jacksonville, Florida. Dr. Steinberg's training and clinical expertise has prepared him to provide the best possible care to his patients. He is a dedicated family physician and a very hard worker. Dr. Steinberg's primary concern, when working with patients, is their total satisfaction with their care and experience.Learn more about Brandon Steinberg, MD
Transcription:
High Blood Pressure and Obesity
Introduction: This is BayCare HealthChat, another podcast from BayCare Health System. Here's Melanie Cole.
Melanie Cole: Welcome to BayCare HealthChat. I'm Melanie Cole, and today we're discussing high blood pressure and obesity. Joining me is Dr. Brandon Steinberg. He's a Family Medicine Physician at BayCare. Dr. Steinberg, it's pleasure to have you join us today. Tell us a little bit about obesity and blood pressure and the relationship between the two?
Dr. Steinberg: So, first off, let me just define obesity, define hypertension. I think it'll make things a little bit easier for the audience to understand, but when we talk about obesity, we're generally talking about weight and height in relation that combines to form what we call a body mass index. A body mass index of 25 to 29.9 is considered overweight and 30 and above is considered obesity. There's different classes ranging between mild, moderate, and severe, also known as morbid obesity, which would be class three. Projections from the National Health and Nutrition Examination Survey have actually demonstrated that over 700 million people worldwide were considered to be obese just in the year of 2015, not just overweight, but actually obese. And it has been reported that these numbers have more than doubled since the 1980s. The CDC reported in 2017 and 18 at the prevalence of obesity in the United States of America was approximately 42.4%. And that children age two through 19 were 18.5% obese, which represented about 13.7 million children in the United States. And these are some pretty serious numbers and obviously concerns that need to be addressed further.
In terms of blood pressure, when I talk about that I may interchange it with the word hypertension, but that means blood pressure. According to the American College of Cardiology and the American Heart Association, it's a blood pressure reading of the top number or the systolic number, as we know it of 130 to 139, and the bottom number or the diastolic number of 80 to 89. That's known as class one, hypertension or stage one hypertension. And that's generally at the point where we're keeping a close eye on our patients. We don't necessarily start medications. Where we generally start medications is a top number or systolic of 140 and a bottom number of 90. Lots of things come into effect the blood pressure and that would be age, weight, race, chronic diseases, such as kidney dysfunction, salt intake, alcohol consumption, physical activity, or lack thereof, as well as medications, illicit street drugs, sleep apnea, and other concerns. It's also reported that obesity tends to be linked to primary essential hypertension or blood pressure by a very strong correlation. That's 65 to 75% of individuals that have obesity tend to have primary blood pressure problems, which is pretty significant.
Host: Well it's certainly is and what a growing problem and an epidemic. And I imagine as we're seeing this with our children, even the obesity problem with our children, we're going to see more hypertension as they grow into teenagers and young adults, if they remain obese. Tell us a little bit about what you would do when you identify somebody who has a consistently high blood pressure and they are obese. It seems like this perfect storm, because now, as you said, they're at risk for sleep apnea and diabetes and heart disease and all these other things. What can you do for them? What's the first line of defense?
Dr. Steinberg: Well, obviously we have an individual that comes in and they're obese and they have hypertension. We need to address both issues and we need to address them both at the same time. So in terms of obesity and treatment, the first step is always going to be less, is more. And that's how we like to do it in practice in the sense that behavioral weight loss. So reduction in caloric intake, improvement in physical activity, improvement in certain types of exercises, will thus help reduce weight and hopefully show a pretty significant drop in blood pressure. But at the same time, you don't want to leave an individual that's hypertensive while you're treating their blood pressure, hypertensive for an extreme period of time. So if someone comes in and they're obese, yeah, you're going to start the behavioral modifications, the diet, the exercise, the activity, just the stuff that we're supposed to do, the eating the vegetables, the clean protein, stuff like that, and then the cardio activity. But you're also going to want to treat their blood pressure if it's elevated enough to warrant medication.
There are other things we could also use for weight loss. And I tend to err on the more cautious side when it comes to weight loss medications, but there are several that are FDA approved. One of them is called liraglutide and that's a GLP1 type of medication. It's actually used in diabetics to help reduce blood sugar levels. And it's been found to be effective in obese individuals. Also orlistat which has been used as well as multiple other medications that tend to reduce the urge to eat. Some people do use medications, such as phentermine, which I'm a little bit more hesitant to use at times because I find that it does speed up metabolism, but it also causes risk of palpitations, chest pain and other concerns along those lines. Then there's also surgery obviously, but the main goal is to modify the behavior because if the behavior isn't modified, you're never going to have a good result. You're never going to lose that weight. And you're never going to pull that blood pressure down.
Host: Thank you for saying that. And for the correlation, people often wonder which one do you tackle first, but you mentioned that you have to really tackle them together and look at them as this confluence of situations that contribute to each other. Let's talk about, you mentioned medicational intervention. What about medically supervised weight loss programs? And then you even briefly touched on surgery. Where does something like bariatrics fit into the picture of trying to get someone's hypertension under control by getting their obesity under control?
Dr. Steinberg: I think that's a good point. Obviously, weight loss surgery is specifically bariatric surgery like Roux-en-Y gastric bypass procedures or gastric banding procedures. They have intragastric balloon systems. They have a lot of different ways of addressing it from the surgical standpoint, but generally it's when a patient has demonstrated that they cannot achieve the optimal weight loss that is required to help improve their overall health. And that'll be determined based on an evaluation with a bariatric surgeon, but it's generally a person that remains overweight, has tried to behavioral modifications, has tried the weight loss with diet and exercise has tried possibly one or two medications. And they continue to have a high risk of comorbidities such as coronary artery disease, chronic kidney disease, and other problems that come with that uncontrolled hypertension, and that uncontrolled high blood pressure that's associated with the obesity. And that's when you'll start to walk down the road of bariatric surgery.
Host: If you had to tell someone what you'd like them to do first to get started, whether it's walking or looking at their salt intake, looking at their diet or beginning an exercise program, not everybody can do all of these things at once, Dr. Steinberg. So how do you triage it? How would you put a priority list for a patient and say, okay, I want you to start with this. And this is going to help you get on the road to better health in general.
Dr. Steinberg: I think the first thing to tackle, the hardest thing that I find with patients that are trying to attempt weight loss, is obviously improving diets. It's just tough. I'm able to get people outside. I'm able to get people walking ideally for five to six times a week for up to 30 minutes, but getting someone to change their diet has so many barriers and you get a lot of patients that have issues with – my job doesn't give me enough time to eat a healthy meal, or I'm always on the move and I need to eat fast food, or I don't have the money to eat something healthy. I think that if we're able to improve diet, and if we're able to make small changes, reducing salt intake, reducing fried foods and greasy foods and eating more vegetables and fruits, I think we do see a notable improvement, but it's just overcoming those barriers. Whether it's, I don't have enough time for this, or I don't have the money for this, or it's just not in the cards right now. And it's getting people to overcome that, I could then work on the exercise and the other components that need to be addressed.
Host: Well, I certainly appreciate you saying how difficult it can be to change diet. And as you say, people don't always know what to do with vegetables. They could walk around the produce department and not really know what to do with bok choy or kale or any of those things. And salads can be tough to make. They're a pain really. So I'd like you to give us your best advice as a family medicine physician, to really getting going on that diet, actually something that people can do. Cause there's a lot of things online. There's new tech apps and things that can help people and starting that exercise program. And when you feel it's important that they look to a specialist like you to help them along this journey,
Dr. Steinberg: They need to seek medical advice immediately if they are having high blood pressure, whether obesity is the cause or not. If they do have issues with high blood pressure, it could lead to many other problems. And at that point they absolutely have to seek some form of medical advice, whether it's family med or internal med or cardiology or whoever, but definitely need to look up somebody. But that being said, the best advice I could give somebody is that if you think it's not good for you, it's probably not good for you. So if you go to the grocery store and you try and meal prep, it can be cumbersome. It can be overwhelming. If they can make a salad for lunch and eat oatmeal for breakfast and try clean proteins like chicken or fish, salmon, tilapia, grouper, or stuff like that for dinner and they could put it with some vegetables, maybe a little bit of rice or a little bit of potato. I think they could have a pretty good meal, but it's definitely difficult to stay consistent. So what I tell my patients usually is I get that you want to eat unhealthy sometimes, or you want to cheat from time to time, but as long as you do that in moderation and you don't do that on a daily basis and you don't even do that three days a week, I think you'll show some serious improvement in the long run.
Host: I agree completely. And thank you so much, Dr. Steinberg, for joining us really great information and so important for the community at large to hear about this correlation between obesity and hypertension, and really the complications that these two together can cause. So thank you again, and to learn more about BayCare's primary care services, please visit our website at baycare.org for more information. That concludes this episode of BayCare HealthChat. Please remember to subscribe, rate, and review this podcast and all the other BayCare podcasts. Remember also to share this show with your friends and family on social media, because that way we're learning from the experts at BayCare together. And these are such important topics. And don't forget to check out all the other interesting topics in our library until next time I'm Melanie Cole.
High Blood Pressure and Obesity
Introduction: This is BayCare HealthChat, another podcast from BayCare Health System. Here's Melanie Cole.
Melanie Cole: Welcome to BayCare HealthChat. I'm Melanie Cole, and today we're discussing high blood pressure and obesity. Joining me is Dr. Brandon Steinberg. He's a Family Medicine Physician at BayCare. Dr. Steinberg, it's pleasure to have you join us today. Tell us a little bit about obesity and blood pressure and the relationship between the two?
Dr. Steinberg: So, first off, let me just define obesity, define hypertension. I think it'll make things a little bit easier for the audience to understand, but when we talk about obesity, we're generally talking about weight and height in relation that combines to form what we call a body mass index. A body mass index of 25 to 29.9 is considered overweight and 30 and above is considered obesity. There's different classes ranging between mild, moderate, and severe, also known as morbid obesity, which would be class three. Projections from the National Health and Nutrition Examination Survey have actually demonstrated that over 700 million people worldwide were considered to be obese just in the year of 2015, not just overweight, but actually obese. And it has been reported that these numbers have more than doubled since the 1980s. The CDC reported in 2017 and 18 at the prevalence of obesity in the United States of America was approximately 42.4%. And that children age two through 19 were 18.5% obese, which represented about 13.7 million children in the United States. And these are some pretty serious numbers and obviously concerns that need to be addressed further.
In terms of blood pressure, when I talk about that I may interchange it with the word hypertension, but that means blood pressure. According to the American College of Cardiology and the American Heart Association, it's a blood pressure reading of the top number or the systolic number, as we know it of 130 to 139, and the bottom number or the diastolic number of 80 to 89. That's known as class one, hypertension or stage one hypertension. And that's generally at the point where we're keeping a close eye on our patients. We don't necessarily start medications. Where we generally start medications is a top number or systolic of 140 and a bottom number of 90. Lots of things come into effect the blood pressure and that would be age, weight, race, chronic diseases, such as kidney dysfunction, salt intake, alcohol consumption, physical activity, or lack thereof, as well as medications, illicit street drugs, sleep apnea, and other concerns. It's also reported that obesity tends to be linked to primary essential hypertension or blood pressure by a very strong correlation. That's 65 to 75% of individuals that have obesity tend to have primary blood pressure problems, which is pretty significant.
Host: Well it's certainly is and what a growing problem and an epidemic. And I imagine as we're seeing this with our children, even the obesity problem with our children, we're going to see more hypertension as they grow into teenagers and young adults, if they remain obese. Tell us a little bit about what you would do when you identify somebody who has a consistently high blood pressure and they are obese. It seems like this perfect storm, because now, as you said, they're at risk for sleep apnea and diabetes and heart disease and all these other things. What can you do for them? What's the first line of defense?
Dr. Steinberg: Well, obviously we have an individual that comes in and they're obese and they have hypertension. We need to address both issues and we need to address them both at the same time. So in terms of obesity and treatment, the first step is always going to be less, is more. And that's how we like to do it in practice in the sense that behavioral weight loss. So reduction in caloric intake, improvement in physical activity, improvement in certain types of exercises, will thus help reduce weight and hopefully show a pretty significant drop in blood pressure. But at the same time, you don't want to leave an individual that's hypertensive while you're treating their blood pressure, hypertensive for an extreme period of time. So if someone comes in and they're obese, yeah, you're going to start the behavioral modifications, the diet, the exercise, the activity, just the stuff that we're supposed to do, the eating the vegetables, the clean protein, stuff like that, and then the cardio activity. But you're also going to want to treat their blood pressure if it's elevated enough to warrant medication.
There are other things we could also use for weight loss. And I tend to err on the more cautious side when it comes to weight loss medications, but there are several that are FDA approved. One of them is called liraglutide and that's a GLP1 type of medication. It's actually used in diabetics to help reduce blood sugar levels. And it's been found to be effective in obese individuals. Also orlistat which has been used as well as multiple other medications that tend to reduce the urge to eat. Some people do use medications, such as phentermine, which I'm a little bit more hesitant to use at times because I find that it does speed up metabolism, but it also causes risk of palpitations, chest pain and other concerns along those lines. Then there's also surgery obviously, but the main goal is to modify the behavior because if the behavior isn't modified, you're never going to have a good result. You're never going to lose that weight. And you're never going to pull that blood pressure down.
Host: Thank you for saying that. And for the correlation, people often wonder which one do you tackle first, but you mentioned that you have to really tackle them together and look at them as this confluence of situations that contribute to each other. Let's talk about, you mentioned medicational intervention. What about medically supervised weight loss programs? And then you even briefly touched on surgery. Where does something like bariatrics fit into the picture of trying to get someone's hypertension under control by getting their obesity under control?
Dr. Steinberg: I think that's a good point. Obviously, weight loss surgery is specifically bariatric surgery like Roux-en-Y gastric bypass procedures or gastric banding procedures. They have intragastric balloon systems. They have a lot of different ways of addressing it from the surgical standpoint, but generally it's when a patient has demonstrated that they cannot achieve the optimal weight loss that is required to help improve their overall health. And that'll be determined based on an evaluation with a bariatric surgeon, but it's generally a person that remains overweight, has tried to behavioral modifications, has tried the weight loss with diet and exercise has tried possibly one or two medications. And they continue to have a high risk of comorbidities such as coronary artery disease, chronic kidney disease, and other problems that come with that uncontrolled hypertension, and that uncontrolled high blood pressure that's associated with the obesity. And that's when you'll start to walk down the road of bariatric surgery.
Host: If you had to tell someone what you'd like them to do first to get started, whether it's walking or looking at their salt intake, looking at their diet or beginning an exercise program, not everybody can do all of these things at once, Dr. Steinberg. So how do you triage it? How would you put a priority list for a patient and say, okay, I want you to start with this. And this is going to help you get on the road to better health in general.
Dr. Steinberg: I think the first thing to tackle, the hardest thing that I find with patients that are trying to attempt weight loss, is obviously improving diets. It's just tough. I'm able to get people outside. I'm able to get people walking ideally for five to six times a week for up to 30 minutes, but getting someone to change their diet has so many barriers and you get a lot of patients that have issues with – my job doesn't give me enough time to eat a healthy meal, or I'm always on the move and I need to eat fast food, or I don't have the money to eat something healthy. I think that if we're able to improve diet, and if we're able to make small changes, reducing salt intake, reducing fried foods and greasy foods and eating more vegetables and fruits, I think we do see a notable improvement, but it's just overcoming those barriers. Whether it's, I don't have enough time for this, or I don't have the money for this, or it's just not in the cards right now. And it's getting people to overcome that, I could then work on the exercise and the other components that need to be addressed.
Host: Well, I certainly appreciate you saying how difficult it can be to change diet. And as you say, people don't always know what to do with vegetables. They could walk around the produce department and not really know what to do with bok choy or kale or any of those things. And salads can be tough to make. They're a pain really. So I'd like you to give us your best advice as a family medicine physician, to really getting going on that diet, actually something that people can do. Cause there's a lot of things online. There's new tech apps and things that can help people and starting that exercise program. And when you feel it's important that they look to a specialist like you to help them along this journey,
Dr. Steinberg: They need to seek medical advice immediately if they are having high blood pressure, whether obesity is the cause or not. If they do have issues with high blood pressure, it could lead to many other problems. And at that point they absolutely have to seek some form of medical advice, whether it's family med or internal med or cardiology or whoever, but definitely need to look up somebody. But that being said, the best advice I could give somebody is that if you think it's not good for you, it's probably not good for you. So if you go to the grocery store and you try and meal prep, it can be cumbersome. It can be overwhelming. If they can make a salad for lunch and eat oatmeal for breakfast and try clean proteins like chicken or fish, salmon, tilapia, grouper, or stuff like that for dinner and they could put it with some vegetables, maybe a little bit of rice or a little bit of potato. I think they could have a pretty good meal, but it's definitely difficult to stay consistent. So what I tell my patients usually is I get that you want to eat unhealthy sometimes, or you want to cheat from time to time, but as long as you do that in moderation and you don't do that on a daily basis and you don't even do that three days a week, I think you'll show some serious improvement in the long run.
Host: I agree completely. And thank you so much, Dr. Steinberg, for joining us really great information and so important for the community at large to hear about this correlation between obesity and hypertension, and really the complications that these two together can cause. So thank you again, and to learn more about BayCare's primary care services, please visit our website at baycare.org for more information. That concludes this episode of BayCare HealthChat. Please remember to subscribe, rate, and review this podcast and all the other BayCare podcasts. Remember also to share this show with your friends and family on social media, because that way we're learning from the experts at BayCare together. And these are such important topics. And don't forget to check out all the other interesting topics in our library until next time I'm Melanie Cole.