Selected Podcast
Weight Loss and Medical Conditions in the Realm of our Weight Management Program at ChristianaCare
Dr. Lehnhard discusses weight loss and medical conditions in the realms of ChristianaCare's Weight Management Program.
Featuring:
Learn more about M. James Lenhard, MD, FACP, FACE
M. James Lenhard, MD, FACP, FACE
M. James Lenhard, M.D., FACE, FACP, is medical director of Christiana Care Health System's Diabetes & Metabolic Diseases Center, the Diabetes & Metabolic Research Center and Christiana Care's Weight Management Center.Learn more about M. James Lenhard, MD, FACP, FACE
Transcription:
Melanie Cole, MS (Host): Welcome. This is ChristianaCare’s weight management podcast series. I'm Melanie Cole and today we’re talking about weight loss and management conditions in the realm of our weight management program at ChristianaCare. Our speaker in this podcast series represents ChristianaCare’s weight management, a program that uses healthcare experts such as dieticians, exercise, and behavioral specialists to help people lose weight and keep it off. Joining me is Dr. James Lenhard. He’s the section chief in endocrinology and metabolism and the medical director of metabolic health services at ChristianaCare. Dr. Lenhard, pleasure to have you joining us again today. Tell us about the complicated world of obesity and why it’s sometimes so hard to treat.
M. James Lenhard, MD, FACP, FACE (Guest): Obesity is really complicated. There's a whole bunch of things that happen in the human body to control how much food we eat and intake and the energy we expend. There’s hundreds of different hormones and neurotransmitters that are involved in this. No one person is quite the same as the next one. A lot of people have individual needs and problems that are different from other people that come down the road.
Host: Well, that’s certainly true. A while back the AMA recognized obesity as a disease, Dr. Lenhard. So give us a working definition of this disease of obesity.
Dr. Lenhard: Obesity is a condition of weighing more than what is good for your health. It’s really an epidemic. It’s bigger than both the tobacco and opioid epidemics in terms of mortality and cost. So it’s a really large problem.
Host: What is defined as obesity? If a person is 10 pounds overweight, 20 pounds overweight? What is considered overweight and what’s considered obese? What’s the difference?
Dr. Lenhard: We have a scale that we use called the body mass index or BMI for sure. It’s not like the doctor or the nurse practitioner looks at someone and says, “Boy, you look like you're overweight.” We use a scale. It’s available online if you do a Google search for BMI. It’s basically measured in kilograms per meter squared. A normal healthy weight is thought to be between 18.5 and 25 kilograms per meter squared. 25 to 30 is considered overweight. Above 30 would be the medical definition of obesity.
Host: So as we’re talking about this as a disease, there are other conditions—comorbid conditions—that can arise from being obese and certain other conditions can be made worse by being obese. What other diseases does it contribute to or have an effect on?
Dr. Lenhard: I think most people have heard that being overweight increases your risk of heart problems, high blood pressure, and diabetes. Maybe some people haven’t heard that, but those are fairly well known I find. High cholesterol as well. A lot of people are not as aware of the link between obesity and other conditions. The one that I think is really concerning is that close to half of all the other cancers in the United States are linked to what we weigh. That is not something that is always widely known. It includes uterine, esophageal, kidney, pancreatic, colon, rectal cancer, post-menopausal breast cancer. All are directly linked to obesity. Of the other cancers that are not directly linked, people that are obese tend not to do as well as people that are leaner. In addition to cancer, obesity is connected to something else that is becoming really common and worrisome. That's called fatty liver. Fatty liver is the very first stage that someone goes through towards cirrhosis, liver failure. We usually think of liver failure in the setting of alcoholism. There's no question that’s a link, but there's now more people getting liver failure, needing liver transplants due to obesity than due to alcohol. It’s the fastest growing cause of liver failure in the country. I find a lot of people don’t realize that obesity is associated with depression. The two go hand in hand, especially since many obese people are discriminated against and that makes depression worse. Pregnant ladies or people trying to become pregnant may suffer from infertility and that’s connected to obesity as well. Sleep apnea is a very common disorder that is closely linked to obesity.
The other one that people don’t always put together, I think, is arthritis. If you think about it, if you put more weight on your joints they wear out quicker. When someone has joint pain, the way that it’s treated often is with pain medicines, anti-inflammatories. The side effects of those include renal damage, high blood pressure, and bleeding from the stomach. Those are all really common in large folks that have arthritis due to obesity.
Host: So it’s really a cascade of conditions and other issues that can result from obesity. It is interesting, Dr. Lenhard, some of those things many people might not have known. What about the epidemic that we’re seeing among our children? What are some of the health consequences as you look to the future of maybe a 10 or a 12 year old obese child that’s going to start seeing adult like conditions cropping up for them way earlier? Like arthritis that you mentioned or high blood pressure or diabetes. Speak about that for us if you would.
Dr. Lenhard: Sure. The biggest risk of being an obese adult is being an obese adolescent. The weight that you gain during adolescence often sticks with you. That’s not a universal and I don’t want to discourage anyone from trying but addressing it right when it starts in the adolescent years has a much better success rate than waiting until someone has had obesity for many decades. The rate of obesity is perhaps increasing the quickest in our children right now.
Host: It certainly is. Now let’s talk about a little bit more of a positive note because not everybody realizes that when you lose weight, some of these things you’ve mentioned are actually reversible. So tell us some of the health benefits of weight loss that can possibly be reversed or more managed as it were if that person was to lose a significant amount of weight.
Dr. Lenhard: Well perhaps the most notable benefit is that you live longer. It helps to prevent death. So there was a famous study done close to 20 years ago now that said if you lose and keep off 10% of your body weight in a year that your chances of dying from anything over the next year go down by at least 30%. That includes all causes. Car accidents, diseases, you name it. Maybe people who weigh less are able to jump out of the way of the car heading their way a little quicker, but you're less likely to die. So that’s the main thing I would stress is that a little bit of weight loss goes a long ways towards improving your health. But all of the different disease states that we mentioned are at least improvable or possibly reversible. So I've seen obstructive sleep apnea go away completely in people that lose a significant amount of weight. Fatty liver can reverse as long as it’s not all the way towards the end of that path, which is cirrhosis. Cancers don’t reverse without treatment, but you can prevent the new onset of cancer. If it’s caught early enough, diabetes may be reversible as well.
Host: So let’s talk about some of the things briefly that people can try. We’ve heard of unchecked hunger or mindlessly eating. Can you briefly speak to those just a little bit? What does that even mean to say that, unchecked hunger?
Dr. Lenhard: Some people feel extremely uncomfortable from hunger. Despite trying all of the tricks that our team offers to them—such as eating low calorie bulky food like popcorn or vegetables or drinking a lot of water—they still feel hungry. That is a basic instinct that has allowed humans to survive for all of these years. When you're hungry, you eat. We don’t understand why some people feel more hungry than others do. It’s hard to measure. I can't get a hunger level on someone, but if someone tells me they're hungry I believe them. We have medications that are FDA approved that help to check somebody’s hunger and make it easier for people to follow a diet and lose weight.
Host: Tell us about setting goals. If people are going to look into your program but before they do they want to start setting some goals, workable goals, because they're looking at these workable diet plans, they're looking at fad diets which don’t always tend to work. Tell us about setting goals and what you want people to think about when they're just starting to really take that action and make a change.
Dr. Lenhard: I think it’s very important that people set realistic goals. People tend to want to achieve more than what is physiological possible. Unfortunately, the average human can only lose and keep off about 10% of their body weight. Now someone always raises their hand and says, “My friend lost an extra amount.” Absolutely true. I'm just talking on average. So if someone comes in and says I want to lose 50% of my body weight before my daughter’s wedding next month. It’s not realistic and really can't be done. So setting a biologically realistic goal, I think, is vitally important. Being ready to deal with setbacks. If you gain some weight and regain some of it back again, that’s typical and normal and doesn’t mean that you're a failure.
In addition, people tend to get stuck into various diets like you mentioned. I think the research has now identified for us what the best diet of all is. The very best diet of all is the one that you stick to. It has to be realistic. Most people drop their diets within a month or so. So if I tell someone in order to lose weight you're going to eat only things that you hate and nothing that you love, you know it’s not realistic and they're not going to stick with it. I'm not telling you which particular diet someone should follow, but it has to be realistic to the individual.
Host: Completely agree. That’s really sound advice, Dr. Lenhard. Before we wrap up, tell us about the weight management program at ChristianaCare. What’s it like? What type of providers are involved? What are you doing?
Dr. Lenhard: So we’re talking mostly about our medical weight management program. We have a surgical weight management program as well that may be the topic of some different podcasts. In the medical weight management team, we have a variety of healthcare professionals. We have doctors and nurses—nurse practitioners I should say—that are mostly trained in endocrinology and metabolism such as myself. We would be the people that would be evaluating people for some of the morbidities that are associated with obesity that we talked about a few minutes ago. We would also be the people that might prescribe weight loss medications and monitor for potential side effects. We have health psychologists. Some people, as you mentioned, tend to eat in response to stress or boredom or depression or past history of physical or sexual abuse. Those patients often benefit from a psychologist with a special training in the area.
We have exercise physiologists. Some people who have damaged their joints, anytime they try and exercise they hurt themselves. We have specialists that can help stay active without damaging themselves. Last but definitely not least we have some very talented dieticians because food is always a key part of this, and most people need a little extra education in that area.
Host: Well they certainly do. Do you have any final thoughts you’d like to leave the listeners with if they're looking into a medically supervised weight loss program, such as the one that you’ve just described at ChristianaCare? What would you like them to think about as they enter into what is difficult but absolutely rewarding and can change their lives?
Dr. Lenhard: It’s never to late to try. You can always try to lose weight no matter how old you are or how many medical problems that you have. Be ready to accept some fallback and weight regain because it’s natural and human. It doesn’t mean that you're a failure if that happens. Do it for yourself because it will make your life longer, healthier, and happier.
Host: Great advice Dr. Lenhard. Thank you so much again for joining us. That concludes this episode of ChristianaCare’s weight management podcast series. For more information regarding weight loss programs or to schedule an appointment with the weight management team, please call 302-623-3475 or you can visit christianacare.org/weight for more information and to get connected with one of our providers. Please remember to subscribe, rate, and review this podcast and all of the other ChristianaCare weight management podcasts. Until next time, I'm Melanie Cole.
Melanie Cole, MS (Host): Welcome. This is ChristianaCare’s weight management podcast series. I'm Melanie Cole and today we’re talking about weight loss and management conditions in the realm of our weight management program at ChristianaCare. Our speaker in this podcast series represents ChristianaCare’s weight management, a program that uses healthcare experts such as dieticians, exercise, and behavioral specialists to help people lose weight and keep it off. Joining me is Dr. James Lenhard. He’s the section chief in endocrinology and metabolism and the medical director of metabolic health services at ChristianaCare. Dr. Lenhard, pleasure to have you joining us again today. Tell us about the complicated world of obesity and why it’s sometimes so hard to treat.
M. James Lenhard, MD, FACP, FACE (Guest): Obesity is really complicated. There's a whole bunch of things that happen in the human body to control how much food we eat and intake and the energy we expend. There’s hundreds of different hormones and neurotransmitters that are involved in this. No one person is quite the same as the next one. A lot of people have individual needs and problems that are different from other people that come down the road.
Host: Well, that’s certainly true. A while back the AMA recognized obesity as a disease, Dr. Lenhard. So give us a working definition of this disease of obesity.
Dr. Lenhard: Obesity is a condition of weighing more than what is good for your health. It’s really an epidemic. It’s bigger than both the tobacco and opioid epidemics in terms of mortality and cost. So it’s a really large problem.
Host: What is defined as obesity? If a person is 10 pounds overweight, 20 pounds overweight? What is considered overweight and what’s considered obese? What’s the difference?
Dr. Lenhard: We have a scale that we use called the body mass index or BMI for sure. It’s not like the doctor or the nurse practitioner looks at someone and says, “Boy, you look like you're overweight.” We use a scale. It’s available online if you do a Google search for BMI. It’s basically measured in kilograms per meter squared. A normal healthy weight is thought to be between 18.5 and 25 kilograms per meter squared. 25 to 30 is considered overweight. Above 30 would be the medical definition of obesity.
Host: So as we’re talking about this as a disease, there are other conditions—comorbid conditions—that can arise from being obese and certain other conditions can be made worse by being obese. What other diseases does it contribute to or have an effect on?
Dr. Lenhard: I think most people have heard that being overweight increases your risk of heart problems, high blood pressure, and diabetes. Maybe some people haven’t heard that, but those are fairly well known I find. High cholesterol as well. A lot of people are not as aware of the link between obesity and other conditions. The one that I think is really concerning is that close to half of all the other cancers in the United States are linked to what we weigh. That is not something that is always widely known. It includes uterine, esophageal, kidney, pancreatic, colon, rectal cancer, post-menopausal breast cancer. All are directly linked to obesity. Of the other cancers that are not directly linked, people that are obese tend not to do as well as people that are leaner. In addition to cancer, obesity is connected to something else that is becoming really common and worrisome. That's called fatty liver. Fatty liver is the very first stage that someone goes through towards cirrhosis, liver failure. We usually think of liver failure in the setting of alcoholism. There's no question that’s a link, but there's now more people getting liver failure, needing liver transplants due to obesity than due to alcohol. It’s the fastest growing cause of liver failure in the country. I find a lot of people don’t realize that obesity is associated with depression. The two go hand in hand, especially since many obese people are discriminated against and that makes depression worse. Pregnant ladies or people trying to become pregnant may suffer from infertility and that’s connected to obesity as well. Sleep apnea is a very common disorder that is closely linked to obesity.
The other one that people don’t always put together, I think, is arthritis. If you think about it, if you put more weight on your joints they wear out quicker. When someone has joint pain, the way that it’s treated often is with pain medicines, anti-inflammatories. The side effects of those include renal damage, high blood pressure, and bleeding from the stomach. Those are all really common in large folks that have arthritis due to obesity.
Host: So it’s really a cascade of conditions and other issues that can result from obesity. It is interesting, Dr. Lenhard, some of those things many people might not have known. What about the epidemic that we’re seeing among our children? What are some of the health consequences as you look to the future of maybe a 10 or a 12 year old obese child that’s going to start seeing adult like conditions cropping up for them way earlier? Like arthritis that you mentioned or high blood pressure or diabetes. Speak about that for us if you would.
Dr. Lenhard: Sure. The biggest risk of being an obese adult is being an obese adolescent. The weight that you gain during adolescence often sticks with you. That’s not a universal and I don’t want to discourage anyone from trying but addressing it right when it starts in the adolescent years has a much better success rate than waiting until someone has had obesity for many decades. The rate of obesity is perhaps increasing the quickest in our children right now.
Host: It certainly is. Now let’s talk about a little bit more of a positive note because not everybody realizes that when you lose weight, some of these things you’ve mentioned are actually reversible. So tell us some of the health benefits of weight loss that can possibly be reversed or more managed as it were if that person was to lose a significant amount of weight.
Dr. Lenhard: Well perhaps the most notable benefit is that you live longer. It helps to prevent death. So there was a famous study done close to 20 years ago now that said if you lose and keep off 10% of your body weight in a year that your chances of dying from anything over the next year go down by at least 30%. That includes all causes. Car accidents, diseases, you name it. Maybe people who weigh less are able to jump out of the way of the car heading their way a little quicker, but you're less likely to die. So that’s the main thing I would stress is that a little bit of weight loss goes a long ways towards improving your health. But all of the different disease states that we mentioned are at least improvable or possibly reversible. So I've seen obstructive sleep apnea go away completely in people that lose a significant amount of weight. Fatty liver can reverse as long as it’s not all the way towards the end of that path, which is cirrhosis. Cancers don’t reverse without treatment, but you can prevent the new onset of cancer. If it’s caught early enough, diabetes may be reversible as well.
Host: So let’s talk about some of the things briefly that people can try. We’ve heard of unchecked hunger or mindlessly eating. Can you briefly speak to those just a little bit? What does that even mean to say that, unchecked hunger?
Dr. Lenhard: Some people feel extremely uncomfortable from hunger. Despite trying all of the tricks that our team offers to them—such as eating low calorie bulky food like popcorn or vegetables or drinking a lot of water—they still feel hungry. That is a basic instinct that has allowed humans to survive for all of these years. When you're hungry, you eat. We don’t understand why some people feel more hungry than others do. It’s hard to measure. I can't get a hunger level on someone, but if someone tells me they're hungry I believe them. We have medications that are FDA approved that help to check somebody’s hunger and make it easier for people to follow a diet and lose weight.
Host: Tell us about setting goals. If people are going to look into your program but before they do they want to start setting some goals, workable goals, because they're looking at these workable diet plans, they're looking at fad diets which don’t always tend to work. Tell us about setting goals and what you want people to think about when they're just starting to really take that action and make a change.
Dr. Lenhard: I think it’s very important that people set realistic goals. People tend to want to achieve more than what is physiological possible. Unfortunately, the average human can only lose and keep off about 10% of their body weight. Now someone always raises their hand and says, “My friend lost an extra amount.” Absolutely true. I'm just talking on average. So if someone comes in and says I want to lose 50% of my body weight before my daughter’s wedding next month. It’s not realistic and really can't be done. So setting a biologically realistic goal, I think, is vitally important. Being ready to deal with setbacks. If you gain some weight and regain some of it back again, that’s typical and normal and doesn’t mean that you're a failure.
In addition, people tend to get stuck into various diets like you mentioned. I think the research has now identified for us what the best diet of all is. The very best diet of all is the one that you stick to. It has to be realistic. Most people drop their diets within a month or so. So if I tell someone in order to lose weight you're going to eat only things that you hate and nothing that you love, you know it’s not realistic and they're not going to stick with it. I'm not telling you which particular diet someone should follow, but it has to be realistic to the individual.
Host: Completely agree. That’s really sound advice, Dr. Lenhard. Before we wrap up, tell us about the weight management program at ChristianaCare. What’s it like? What type of providers are involved? What are you doing?
Dr. Lenhard: So we’re talking mostly about our medical weight management program. We have a surgical weight management program as well that may be the topic of some different podcasts. In the medical weight management team, we have a variety of healthcare professionals. We have doctors and nurses—nurse practitioners I should say—that are mostly trained in endocrinology and metabolism such as myself. We would be the people that would be evaluating people for some of the morbidities that are associated with obesity that we talked about a few minutes ago. We would also be the people that might prescribe weight loss medications and monitor for potential side effects. We have health psychologists. Some people, as you mentioned, tend to eat in response to stress or boredom or depression or past history of physical or sexual abuse. Those patients often benefit from a psychologist with a special training in the area.
We have exercise physiologists. Some people who have damaged their joints, anytime they try and exercise they hurt themselves. We have specialists that can help stay active without damaging themselves. Last but definitely not least we have some very talented dieticians because food is always a key part of this, and most people need a little extra education in that area.
Host: Well they certainly do. Do you have any final thoughts you’d like to leave the listeners with if they're looking into a medically supervised weight loss program, such as the one that you’ve just described at ChristianaCare? What would you like them to think about as they enter into what is difficult but absolutely rewarding and can change their lives?
Dr. Lenhard: It’s never to late to try. You can always try to lose weight no matter how old you are or how many medical problems that you have. Be ready to accept some fallback and weight regain because it’s natural and human. It doesn’t mean that you're a failure if that happens. Do it for yourself because it will make your life longer, healthier, and happier.
Host: Great advice Dr. Lenhard. Thank you so much again for joining us. That concludes this episode of ChristianaCare’s weight management podcast series. For more information regarding weight loss programs or to schedule an appointment with the weight management team, please call 302-623-3475 or you can visit christianacare.org/weight for more information and to get connected with one of our providers. Please remember to subscribe, rate, and review this podcast and all of the other ChristianaCare weight management podcasts. Until next time, I'm Melanie Cole.