Selected Podcast
Obesity as a Chronic Disease
Dr. Lenhard explains how obesity is a chronic disease and needs to be treated as such.
Featuring:
M. James Lenhard, MD
M. James Lenhard, MD is the Section Chief, Endocrinology and Metabolism; Medical Director, Metabolic Health Services. (Both are at ChristianaCare). Transcription:
Melanie Cole (Host): Welcome. This is ChristianaCare’s podcast series. I’m Melanie Cole. And today, we’re talking about obesity as a chronic disease. Our speaker represents ChristianaCare Weight Management; a program that uses healthcare experts such as dieticians, exercise and behavior specialists to help people lose weight and keep it off. Joining me is, Dr. James Lenhard. He’s the Section Chief of Endocrinology and Metabolism and the Medical Director of the Metabolic Health Services at ChristianaCare. Dr. Lenhard, I’m so glad to have you join us today. What a great topic, huge, so broad this topic. Tell us a little bit to begin with about the current state of obesity today. What are we seeing in the trends and what’s really the burden on society as a result of the obesity epidemic we’ve been seeing?
M. James Lenhard, MD, FACP, FACE (Guest): Thanks Melanie. As you pointed out, obesity really is a burden to society. In our program, we try not to define a person by their weight. People are more than just a number on a scale. But there’s no getting around that obesity is a risk to your health. The level of obesity in America unfortunately continues to rise and worldwide for that matter. All categories are still increasing. The good news is that some categories seem to be leveling off a little bit meaning they are not going up as fast as these two. So, still no where’s near the desired amount but just not getting worse as quickly.
Host: What’s defined as obesity? Tell us a little bit about BMI and while you’re doing that, back a few years ago, the AMA recognized obesity as a disease, itself, so, tell us a little bit about the definition of it and why it’s recognized as a disease.
Dr. Lenhard: Obesity is defined by numbers. It is not the clinician looking at someone and saying boy you look really heavy today. It’s based on a scale and it’s called the body mass index or BMI. And it’s essentially weight divided by height converted to metric, a little more complicated. But there is formulas and calculators online. It tells you what your weight should be for your given height. And we think that a normal body mass index is between 18.5 and 25, between 25 and 30 is what we clinically call overweight and a BMI over 30 is how we medically define obesity.
And the way that this scale was determined was to look at some of the disease outcomes from obesity. So, for example, it’s very well known that the heavier someone gets, the greater their risk for diabetes and high blood pressure and heart disease. I would suspect that most people know that. And the upturn in the risk of those diseases occurs around a BMI of 30 and that’s how we came up with that diagnosis.
Host: Since it’s a chronic condition and it generally is responsive to long term treatments, Dr. Lenhard, tell us the importance of a multidisciplinary team approach within the individualized approaches that are tailored to the individual. When we are talking about obesity, it takes many people to help someone and there’s also a certain level for the patient themselves, a real will to do something about this. tell us a little bit about the multidisciplinary approach and why that’s so important for obese patients.
Dr. Lenhard: Obesity is really complicated. We’ve identified over 100 different hormones and neurotransmitters that are involved in regulation of body weight and food intake. Right there, that tells you that there’s a whole bunch of different systems in the human body that are involved in this. There are a number of different medical problems that arise from obesity and some patients have differing needs.
So, for example, some people because of the complexity, struggle a great deal with disordered eating and someone like that would benefit from a health psychologist. Other people don’t have that particular issue but have more problems with mobility. They want to exercise but because of other medical problems; it’s challenging. And someone like that would benefit from an exercise physiologist. Some other people have very complicated medical histories. And need someone to keep a close watch on the other drugs they are taking and the other medical conditions as they lose weight. And one of our physicians or nurse practitioners fills that role very nicely.
Virtually everyone would benefit in some way from seeing the dietician at some point. So, we are all involved, and we tend to play to our strengths and address the areas that we’re best trained to deal with.
Host: You mentioned, Dr. Lenhard, how complicated of a disease this is and when I look at some of the causal relations, and we’re talking about school and recess and gym, the built environment, urban food deserts, even the paradox of obesity and hunger. There’s so much that goes into this. if you were to give a talk or tell people what you want them to know about looking at their own communities and really getting involved in their communities to look at that causal relation; what would you tell them?
Dr. Lenhard: Since about a third of Americans qualify for obesity and another third qualify for what we call overweight, that BMI category of 25 to 30 that we talked about; you can’t convince me that two thirds of Americans are suffering from a lack of willpower. That’s just not possible. So, that tells us that we live in an obesifying environment. Obesity is a mix of genes and the environment and depending on which study you believe; they are roughly equal, maybe the environment playing a slightly bigger role. So, it’s very much a product of the particular neighborhood and environment in which somebody lives with all of the different things that you just mentioned playing a role.
Host: Doctor, if you would, please tell us about the difference between and endocrinologist for adults and a pediatric endocrinologist and when you feel it’s important for parents to discuss this with their pediatricians and seek out a specialist if necessary.
Dr. Lenhard: The concepts are very similar, and it involves the multidisciplinary approach that we just mentioned, and it involves starting early before hopefully someone gets health problems and it also involves setbacks. So, setbacks where you regain some weight are virtually inevitable and it does not equal failure. It means you just had a setback and if you get back onto the path again; you can have success.
Host: So, do you measure obesity differently for children and adults or is it the same across the board?
Dr. Lenhard: No, it’s different in kids. Kids have something called an adiposity rebound where when kids are just born, they are on the chubby side to help conserve their heat and then they lose weight and then adolescence they regain it and that’s all part of normal human development. It doesn’t necessarily equal obesity. Adults don’t have that. They are fully developed, and the BMI is what we go by the most.
Host: Well it’s so important and when we’re looking more at causes and prevalence; behaviors that parents can look to and that they can ask their pediatricians about, whether it’s video games, or getting exercise after school, participating in team sports and then of course role modeling, trying to eat healthy. What do you tell people when you’re looking at all of these different aspects as we’re talking about this as a chronic disease? What do you want them to know about those kinds of things and those behaviors?
Dr. Lenhard: Well I would agree with you. Obesity very much is a family affair. As you mentioned, obese kids often become obese adults and they go on to have obese kids themselves. And some of that is genes. You can’t escape the strong genetic link of obesity, but some is also the environment. it is very distressing to learn that about a quarter of the teenagers in America have a condition known as prediabetes. That’s a precursor to developing diabetes even though they are teenagers. And some of them, are clearly obese and in need of assistance. Others have different issues. So, a family type approach, I think makes all the sense in the world for overall group success.
Host: Before we conclude, and as we said at the beginning, it’s a complicated topic. What would you tell parents of obese children when it’s time for them to really see a specialist, a pediatric endocrinologist, a metabolism specialist, someone that can really help them, because it’s such a sensitive thing as well Dr. Lenhard, it’s hard to tell your child they are overweight or obese and sometimes even the parents don’t want to hear it. So, what’s your best advice as we’re talking about obesity as a chronic disease. Give us your best advice as the expert that you are.
Dr. Lenhard: As I mentioned before, I think it’s important to note that obesity is not something that defines you. It is something that can affect your life. It’s not a cosmetic issue. It’s not how you look, although we want people to be happy about their appearance. It’s a risk to your health. And the more we do something about that, the fewer health problems there will be. There’s definitely a degree of sensitivity and patience and understanding that goes into talking to people about their weight or their children’s weight.
But if it’s defined in health, many people come around to realize that that’s really what we are focused on.
Host: Definitely. So, important and thank you so much Dr. Lenhard for joining us today and sharing your incredible expertise. This concludes this episode ChristianaCare weight management podcast series. For more information regarding weightloss programs or to get your body mass index score to schedule an appointment with Weight Management Team please call 302-623-3475 , visit us at christianacare.org/weight to get connected with one of our providers. Please remember to subscribe, rate and review this podcast and all the other ChristianaCare podcasts. If you found this podcast informative, please share on your social media and be sure to check out all the other interesting podcasts in our library. Until next time, I’m Melanie Cole.
Melanie Cole (Host): Welcome. This is ChristianaCare’s podcast series. I’m Melanie Cole. And today, we’re talking about obesity as a chronic disease. Our speaker represents ChristianaCare Weight Management; a program that uses healthcare experts such as dieticians, exercise and behavior specialists to help people lose weight and keep it off. Joining me is, Dr. James Lenhard. He’s the Section Chief of Endocrinology and Metabolism and the Medical Director of the Metabolic Health Services at ChristianaCare. Dr. Lenhard, I’m so glad to have you join us today. What a great topic, huge, so broad this topic. Tell us a little bit to begin with about the current state of obesity today. What are we seeing in the trends and what’s really the burden on society as a result of the obesity epidemic we’ve been seeing?
M. James Lenhard, MD, FACP, FACE (Guest): Thanks Melanie. As you pointed out, obesity really is a burden to society. In our program, we try not to define a person by their weight. People are more than just a number on a scale. But there’s no getting around that obesity is a risk to your health. The level of obesity in America unfortunately continues to rise and worldwide for that matter. All categories are still increasing. The good news is that some categories seem to be leveling off a little bit meaning they are not going up as fast as these two. So, still no where’s near the desired amount but just not getting worse as quickly.
Host: What’s defined as obesity? Tell us a little bit about BMI and while you’re doing that, back a few years ago, the AMA recognized obesity as a disease, itself, so, tell us a little bit about the definition of it and why it’s recognized as a disease.
Dr. Lenhard: Obesity is defined by numbers. It is not the clinician looking at someone and saying boy you look really heavy today. It’s based on a scale and it’s called the body mass index or BMI. And it’s essentially weight divided by height converted to metric, a little more complicated. But there is formulas and calculators online. It tells you what your weight should be for your given height. And we think that a normal body mass index is between 18.5 and 25, between 25 and 30 is what we clinically call overweight and a BMI over 30 is how we medically define obesity.
And the way that this scale was determined was to look at some of the disease outcomes from obesity. So, for example, it’s very well known that the heavier someone gets, the greater their risk for diabetes and high blood pressure and heart disease. I would suspect that most people know that. And the upturn in the risk of those diseases occurs around a BMI of 30 and that’s how we came up with that diagnosis.
Host: Since it’s a chronic condition and it generally is responsive to long term treatments, Dr. Lenhard, tell us the importance of a multidisciplinary team approach within the individualized approaches that are tailored to the individual. When we are talking about obesity, it takes many people to help someone and there’s also a certain level for the patient themselves, a real will to do something about this. tell us a little bit about the multidisciplinary approach and why that’s so important for obese patients.
Dr. Lenhard: Obesity is really complicated. We’ve identified over 100 different hormones and neurotransmitters that are involved in regulation of body weight and food intake. Right there, that tells you that there’s a whole bunch of different systems in the human body that are involved in this. There are a number of different medical problems that arise from obesity and some patients have differing needs.
So, for example, some people because of the complexity, struggle a great deal with disordered eating and someone like that would benefit from a health psychologist. Other people don’t have that particular issue but have more problems with mobility. They want to exercise but because of other medical problems; it’s challenging. And someone like that would benefit from an exercise physiologist. Some other people have very complicated medical histories. And need someone to keep a close watch on the other drugs they are taking and the other medical conditions as they lose weight. And one of our physicians or nurse practitioners fills that role very nicely.
Virtually everyone would benefit in some way from seeing the dietician at some point. So, we are all involved, and we tend to play to our strengths and address the areas that we’re best trained to deal with.
Host: You mentioned, Dr. Lenhard, how complicated of a disease this is and when I look at some of the causal relations, and we’re talking about school and recess and gym, the built environment, urban food deserts, even the paradox of obesity and hunger. There’s so much that goes into this. if you were to give a talk or tell people what you want them to know about looking at their own communities and really getting involved in their communities to look at that causal relation; what would you tell them?
Dr. Lenhard: Since about a third of Americans qualify for obesity and another third qualify for what we call overweight, that BMI category of 25 to 30 that we talked about; you can’t convince me that two thirds of Americans are suffering from a lack of willpower. That’s just not possible. So, that tells us that we live in an obesifying environment. Obesity is a mix of genes and the environment and depending on which study you believe; they are roughly equal, maybe the environment playing a slightly bigger role. So, it’s very much a product of the particular neighborhood and environment in which somebody lives with all of the different things that you just mentioned playing a role.
Host: Doctor, if you would, please tell us about the difference between and endocrinologist for adults and a pediatric endocrinologist and when you feel it’s important for parents to discuss this with their pediatricians and seek out a specialist if necessary.
Dr. Lenhard: The concepts are very similar, and it involves the multidisciplinary approach that we just mentioned, and it involves starting early before hopefully someone gets health problems and it also involves setbacks. So, setbacks where you regain some weight are virtually inevitable and it does not equal failure. It means you just had a setback and if you get back onto the path again; you can have success.
Host: So, do you measure obesity differently for children and adults or is it the same across the board?
Dr. Lenhard: No, it’s different in kids. Kids have something called an adiposity rebound where when kids are just born, they are on the chubby side to help conserve their heat and then they lose weight and then adolescence they regain it and that’s all part of normal human development. It doesn’t necessarily equal obesity. Adults don’t have that. They are fully developed, and the BMI is what we go by the most.
Host: Well it’s so important and when we’re looking more at causes and prevalence; behaviors that parents can look to and that they can ask their pediatricians about, whether it’s video games, or getting exercise after school, participating in team sports and then of course role modeling, trying to eat healthy. What do you tell people when you’re looking at all of these different aspects as we’re talking about this as a chronic disease? What do you want them to know about those kinds of things and those behaviors?
Dr. Lenhard: Well I would agree with you. Obesity very much is a family affair. As you mentioned, obese kids often become obese adults and they go on to have obese kids themselves. And some of that is genes. You can’t escape the strong genetic link of obesity, but some is also the environment. it is very distressing to learn that about a quarter of the teenagers in America have a condition known as prediabetes. That’s a precursor to developing diabetes even though they are teenagers. And some of them, are clearly obese and in need of assistance. Others have different issues. So, a family type approach, I think makes all the sense in the world for overall group success.
Host: Before we conclude, and as we said at the beginning, it’s a complicated topic. What would you tell parents of obese children when it’s time for them to really see a specialist, a pediatric endocrinologist, a metabolism specialist, someone that can really help them, because it’s such a sensitive thing as well Dr. Lenhard, it’s hard to tell your child they are overweight or obese and sometimes even the parents don’t want to hear it. So, what’s your best advice as we’re talking about obesity as a chronic disease. Give us your best advice as the expert that you are.
Dr. Lenhard: As I mentioned before, I think it’s important to note that obesity is not something that defines you. It is something that can affect your life. It’s not a cosmetic issue. It’s not how you look, although we want people to be happy about their appearance. It’s a risk to your health. And the more we do something about that, the fewer health problems there will be. There’s definitely a degree of sensitivity and patience and understanding that goes into talking to people about their weight or their children’s weight.
But if it’s defined in health, many people come around to realize that that’s really what we are focused on.
Host: Definitely. So, important and thank you so much Dr. Lenhard for joining us today and sharing your incredible expertise. This concludes this episode ChristianaCare weight management podcast series. For more information regarding weightloss programs or to get your body mass index score to schedule an appointment with Weight Management Team please call 302-623-3475 , visit us at christianacare.org/weight to get connected with one of our providers. Please remember to subscribe, rate and review this podcast and all the other ChristianaCare podcasts. If you found this podcast informative, please share on your social media and be sure to check out all the other interesting podcasts in our library. Until next time, I’m Melanie Cole.