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Caitlin Whyte (Host): Welcome to the Healthy Headlines podcast series by Capital Health. I'm Caitlin Whyte. In this episode, we are joined by Dr. Kashif Anwar, Director of the Medical Weight Loss Program at Capital Health Metabolic and Weight Loss Center. With Board Certifications in Obesity Medicine and Family Medicine, Dr. Anwar helps patients break harmful eating patterns and establish lasting routines for long-term health. ​Doctor, we are so happy to have you on the show today. To start us off, can you tell us why do some people struggle with their weight?

Kashif Anwar, MD: I find that people struggle with their weight in a lot of different ways. There are multiple factors we are learning more and more that control our weight; from genetics to environment, and we've only grazed the surface of this.

The often discussed theory of calories in calories out doesn't tell the full picture. A lot of times, excess calories from what we may need will trigger a response in our bodies that are hard to undo. And for everyone, it is a different set point that that may occur. Also, different people have different urges and signals in their bodies that compel them to eat more than others or feel hunger more than others, I should say.

Host: That is fascinating. Well, what are some of the ways that people try to self-manage their weight, and why do these approaches sometimes not achieve the goals that people are looking for?

Kashif Anwar, MD: There are a lot of different ways people try to self-manage, from physicians onwards within society. It definitely is important core to adjust eating habits and to adjust activity levels as well. And so people do different things in regards to that, different variations. They may strictly have less calories when it comes to their food.

They might change some of the macronutrients in their food, meaning having less carbohydrates or carbs, having less fats, eating more protein. They may adjust the time of day that they may be eating more. Strategies such as intermittent fasting work on that in terms of eating later in the day or rather even earlier in the day, depending on how you may do it, but just doing it for a set amount of time during the day.

That's one way with diet; with exercise, there's differences between cardiac exercises and strength training. And cardiac exercises would entail things that we commonly do, such as walking, running, ellipticals, bikes, things of that nature. When it comes to strength training, yeah, we're talking about weightlifting, using exercise machines to help strengthen skeletal muscle, which makes a big difference in terms of the biochemical pathways in our body for eating.

And people try different ways to self-manage this. It may be doing it more independently, trying to set a schedule, counting calories, keeping track of what they're eating, having an exercise schedule. They may entail some extra help, whether it's with a nutritionist, whether it's with a personal trainer.

They may also look into more in-depth programs, such as what we do at Capital Health in our medical weight loss program. And beyond those two things, what I kind of implied as well is changes in behavior and that's where some of the support comes into play between the nutritionist, between personal trainer, psychotherapy as well.

And those are some ways that people self-manage in terms of diet and exercise that often used term, and also watching their mental health.

Host: Well, on that note, doctor, at what point should someone reach out to their doctor to explore some of the ways they can get help with their weight loss? And when does Capital Health Metabolic and Weight Loss Center get involved in that process?

Kashif Anwar, MD: So people should definitely be mindful of what they're feeling and what advice they may be getting from medical professionals and others. It's difficult because there are a lot of social biases against excess weight. This is one of the few conditions in medicine that is visible to people, and we put a lot of stigma on people who have excess weight.

And so sometimes it is hard for patients to speak about this, for people to speak about this with their providers because of many years of feeling stigmatized and, and, stereotyped against not just by the general public, but by the medical community. That being said, finding a physician that is going to listen to you is gonna be important, and physicians that are adept at it.

And to answer your question more directly, they should be looking at this when they have made multiple attempts on their own to reach a healthy weight. In terms of a healthy weight, a lot of times what we do is talk about A BMI of 25 or less being normal. That's oft used measurement throughout the medical community in our society.

BMI being body mass index. It's only supposed to be a rough measure, not a full measure of tracking because there are people who come in different shapes and sizes that may be at a healthy weight if it's more muscle than body fat, for example, but have a high BMI. That being said, if you have had a change in your weight, a sudden increase and are unable to bring it to what it used to be before, with changes in diet and exercise, changes in your sleep, changes in your behaviors, your family dynamics or psychosocial dynamics; then that would be definitely a time to approach your provider seeking more assistance. Where we come in, we tend to find the patients that have the most success, are patients who have had multiple attempts, have not necessarily taken extra steps or done anything more than those steps that I talked about tend to be prime and ready to use some of the different tools that we may have at our program.

Patients that have never even thought about their weight, we welcome them as well for sure, and give them a lot of food for thought. And in terms of the different options we may have, but generally speaking, we recommend if in the medical definition of treatment of obesity with say medications, a BMI greater than 30 or a BMI, greater than 27 with a comorbidity, which includes things like hypertension, diabetes, high cholesterol, obstructive sleep apnea, coronary artery disease, peripheral artery disease, are usually the main ones that we recommend patients see us for if they're thinking of medications.

Host: So, in what ways does the medical weight loss program at Capital Health help patients that provide better outcomes than self-managing? And how does the program monitor short-term and more importantly, long-term success?

Kashif Anwar, MD: At Capital Health Medical Weight Loss Program, we have a lot of tools at our disposal and a lot of support to help patients with their journey. First off, there's me, there's also other physicians there as well, Dr. Vishnu Oricanti, also Dr. Jooyeun Chung, who actually started this program and still at Capital Health is in the program as a bariatric surgeon and overall director of the program and heading those things, is also available to see patients. And there's also a nutritionist that we have that will meet with patients regularly to track their journey, to offer feedback and input and to adjust what may be going on in, in that regard.

We also have great staff that work on the backend, making sure that patients are getting the medications and the support that they may need, extend as an extension of us. And what I mean by that, in our program, we usually have patients in one of two aspects. We have them in a, either a medically supervised diet, which we've used for many years using meal replacements.

The diets are usually 1200 or 800 calories a day, and I know it's very low, but it usually is only going to be for a couple weeks to months, depending on the patient. Then there's an adjustment phase and a maintenance phase with that, and when we talk about the meal replacements, we have products that are bar shakes, putting soups that are high in protein, low in carbs, low in fat, and don't taste like cardboard, but we definitely in that program have patients coming in more frequently, seeing the nutritionist, usually weekly going over what they had the previous week, what they're going to have in the coming week, purchasing the products right at our office and going from there. Now that is cash pay. The appointments will be covered by insurances with me and hopefully with the nutritionist as well, but that depends on a patient's insurance.

The other group that we have is have patients or when the other physicians come see the nutritionist who is not necessarily going to see the patient as frequently, but definitely important to see them regularly, to go over more general nutritional counseling and then considering anti-obesity medications.

And they've become obviously, the preferred option for many people as it's become more popular, more effective than what we've ever had before. And in terms of the different medications then, there's a lot of barriers for patients to get those medications, whether it may be insurance, whether it may be supply, whether it may be other comorbidities, a patient may have that lead to what we call a contraindication and not being safe to take certain of the medications.

A lot of the medications that are in the news today are the safest and most effective things We've had things such as Wegovy, which is known as semaglutide, brand name, Wegovy for Obesity Treatment, or Zepbound, generic name tirzepitide, and Zepbound's a brand name when it comes to using for obesity treatment.

Those are also commonly referred to as Ozempic or Mounjaro respectively, but there's slight differences, mainly legalese and insurance coverage. We definitely have staff reaching out to patients to ensure that they are doing well on these medications as well. Um, we also use older medications, and by older I don't mean necessarily ancient, just that, some of these have been mean the last 10, 15 years, that are also effective and maybe not overall as effective as the medications I mentioned earlier, but in the right person definitely can hit a little bit better.

Host: Well, what is the process that most patients follow when they join the program doctor, and what are the most important things in your opinion that they need to know from the start?

Kashif Anwar, MD: The process usually is coming to see one of us first. We usually have a decent amount of paperwork, a packet that we have patients fill out. So we ask patients to come early. We then see the patients and taking a history, taking their weight loss journey, what they've done in the past, if anything, going over some things in that packet itself.

I then usually explain to the patients what the program entails, pretty much what I just said in terms of the different options we have there. Answer whichever questions, and then come up with next steps. And a lot of it depends on patient preference as well. If they are more interested in doing the meal replacements versus if they're interested in doing medications and the discussing what are the safest options with those? At the end of the day, we give them orders for blood work and EKG, more so for the meal replacement plan and having a baseline, but also necessary if we're going to do any kind of medications that may have stimulants and them. We set up a follow up with me and the set up of an appointment with the nutritionist as well.

If we decide on a medication and if it seems that it would be safe to take at that time, we go ahead and send in a prescription to the preferred pharmacy for the patient and our staff then will look into working on any kind of authorization for that medication. Then we usually have regular follow-ups with myself and the nutritionist going forward.

And that's usually what is going to be the process. The most important things that I would tell patients to know from the start, that you didn't gain it all overnight. You're not going to lose it all overnight. That if there are any issues when it comes to the medications or the different things that you are using, then you want to definitely reach out to us and stay in good contact with us.

A lot of this comes back to mindfulness and we are not going to be able to help a patient or deal with some of the things if they're not reaching out to us. And the other thing I would add is, especially for patients who may be doing the medications, is that medications, if they work well, that's great.

They, they've gotten better and better, but they aren't going to work as well if you aren't making changes in diet and exercise. So even patients that are on medications, it would be very important for those patients to see the nutritionist regularly and making whole changes. I find the people who have the most success losing the weight are the ones that are keeping all those aspects in mind.

Making behavioral changes to help with diet and exercise along with say, doing medications. If they're doing the meal replacements, same ideas in terms ofseeing the nutritionist regularly and how to adjust activity level and also that there are other things to adjust. Sleep being one of the big ones I would say, and psychosocial dynamics that they may have around to try to adjust those as well.

And I think those are probably the biggest things that patients need to understand from the start. It will take a while for you to lose the weight potentially, and just because some lose weight faster than others, isn't not necessarily a reason for discouragement. We're here to help.

Host: So how does your program work in tandem with the bariatric surgery program that's also offered at Capital Health Metabolic and Weight Loss Center?

Kashif Anwar, MD: I mentioned earlier, Dr. Jooyeun Chung, longtime director of everything at the center, she is our bariatric surgeon. And she also sees patients, for the medication, a medical weight loss program, I should say. And working in tandem, we have the same staff, we use the same nutritionist, we use the same support staff that are knowledgeable about the bariatric program.

And if a patient expresses interests or would like to learn more about those; we definitely set up the patient to learn more about those options as well. Usually, Dr. Chung holds a monthly webinar for patients who may be interested in bariatric surgery before she meets with them one-on-one in an appointment.

The other thing I would add is that we definitely look at patients that may benefit either before or after surgery with some medical weight loss options first. Whether it's to help reduce the weight to make surgery more successful, whether it's to give that a fair try if a patient hasn't tried those before, or in the case of people after bariatric surgery, and this might sound disheartening or discouraging;but there is weight regain that tends to occur with any kind of weight loss method, whether medications, whether diet, exercise, behavioral changes along with that, whether surgery. Some weight regain is okay in terms of some of the treatments that we use. How much weight loss a person may have, may get a little too low and there's going to be some level of bounce back, but. obviously the, some of the problems and why people get discouraged is if the bounce back is almost all the way back to what they used to weigh. And so when it comes to post-bariatric surgery patients, if there are those who are starting to regain more weight than expected, then definitely getting in with us as soon as possible in terms of looking at different options, is going to be ideal.

And we are in constant communication, like I said, using same staff, same offices, same everything.

Host: And finally, doctor, if someone is looking for more information or they want to schedule an appointment, who should they contact?

Kashif Anwar, MD: So to schedule an appointment with us, our phone number is 609-537-6777 And for more information, they can visit our website@capitalhealth.org/weightloss. That's capital with an a CAPITAL. And that's going to be some of your best resources in terms of finding out more from us and about us.

Host: Thank you, Dr. Anwar, for your insights and thank you for listening. If you're interested in scheduling an appointment with Capital Health's medical weight loss program, please call 609-537-6777, and for more information, visit us online at capitalhealth.org/weightloss.