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The Obesity Epidemic and Treatment Options Available
Dr. Michael G. Knight, Patient Safety Officer at The George Washington University Medical Faculty Associates, discusses obesity and its harmful affects.
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Learn more about Michael G. Knight, MD
Michael G. Knight, MD
Michael G. Knight, MD, MSHP is an Assistant Professor of Medicine and the Patient Safety Officer at The George Washington University Medical Faculty Associates and is affiliated with The George Washington University Hospital. Dr. Knight completed undergraduate studies at Oakwood University, and obtained his medical degree with special qualifications in biomedical research from the Cleveland Clinic Lerner College of Medicine of Case Western Reserve University. During medical school, he participated in the yearlong Clinical Research Training Program at the National Institutes of Health, where his research focused on metabolic disease and obesity in women of African descent.Learn more about Michael G. Knight, MD
Transcription:
Melanie Cole (Host): The obesity epidemic is spreading all over the world because of changes in the way that we eat, and live and work and play. Welcome to The GW HealthCast. I’m Melanie Cole and today we’re talking about obesity. My guest is Dr. Michael G. Knight. He’s an Assistant Professor of Medicine and the Patient Safety Officer at the George Washington University Medical Faculty Associates and The GW Hospital and is affiliated with The George Washington University Hospital. Dr. Knight, thank you so much for joining us. What an important topic we are discussing today. tell us about the current state of obesity, the prevalence, the global impact that this is having all over the world.
Michael G. Knight, MD, MSHP, FACP (Guest): Thank you so much for having me to talk about this important topic. We know that obesity, the rates are continuing to grow, and it’s really become an epidemic specifically in the western world but also across the globe. In the United States, our most recent rates have shown that over almost 40% of our population, so that’s about 93.3 million US adults are dealing with obesity.
We know that it’s linked to many of the chronic diseases that affect our communities such as high blood pressure, diabetes, cardiovascular disease or heart disease and really affects certain groups more than others. When we think about some of our minority populations such as African Americans or Hispanic Americans; we can see that those rates are even higher.
And when we think about the global context; we know that as we see more westernization especially in the diets and the amount of physical activity across the globe; we are seeing increasing rates of obesity and unfortunately, it’s related to diseases in many parts of the world.
Host: Well it certainly is and as someone who has also seen so much of this in my profession; tell us the working definition of obesity and how providers are defining it really Dr. Knight. What is BMI?
Dr. Knight: Sure. So, obesity when we say overweight, when we say normal weight; that’s what we think about and then there’s actually the medical definitions and those definitions are based on something called the body mass index and that is what we will say is BMI. So, the BMI is calculated based on your height and your weight. And so based on that we have various categories such as normal weight, when that number goes up to about 24.9, 25 and above to about 29.9 is overweight and then anything above 30, 30 and above on the BMI scale is classified as obesity.
When we get those classifications is because we know that in those specific ranges; we see increased risk of a lot of the associated diseases. Now one caveat is that BMI is just really that entry door to the conversation and the assessment of excess weight. It is not the one and only way to do it and the reason is because there are many people who the BMI is not accurately reflecting the amount of excess weight they are carrying.
So, for example, someone who is a body builder, someone who has a lot of muscle mass. If they are not very tall or even if they are; that muscle mass is going to come in as just pounds and the BMI does not differentiate between muscle mass and fat mass. And so someone may look very fit and have a high BMI and they are not actually obese in that context because it’s not fat mass, it is actual muscle mass.
So, again, we use BMI as an entry way to screen people for obesity and then the next level is really having the conversation and assessing the patient to see if it’s muscle mass, is it fat mass, are we dealing with associated conditions, what is their functionality and that gives us a bigger picture and a better picture of how excess weight may be affecting them and their risk for cardiometabolic disease.
Host: Thank you for clarifying that Dr. Knight as I’m one of those people that fit into that category. Now you and I are going to try and discuss what we think are some of the causes which are larger than we mere mortals can actually comprehend. But do you have some theories about whether it’s – I mean especially for the children and the childhood obesity epidemic that we are seeing today, school, recess, gym, the built environment, urban deserts, sidewalks, I mean it’s huge. Where do you see the biggest need to look at to determine and work on some of those causes?
Dr. Knight: Yeah, I think the biggest thing like you’ve outlined is prevention wo we don’t get there but then also how do we address it. One of the things that’s important to understand that obesity is a chronic disease so it’s not just something that you see on the scale. It’s actually a disease process and what that means is that there are individuals who have genetic risk factors so, it may run in the family. It also may predispose certain individuals even within a family to have excess weight.
And so, when we think about the types of foods we are having; some people are very sensitive to carbohydrates, especially high processed carbohydrates and when they take them in; while their friend, colleague or even sibling may not put on excess weight, they are having that response with the same meals. When we think about physical activity. You talked a little bit about childhood obesity. We know that decreased physical activity rates especially seen in our population in the recent decades, we do see an increase in weight gain, but also understanding that it’s not just what we eat and just what we do as physical activity.
It is much more than calories in and calories out. And that is what many people who deal with excess weight understand. As we start to put on excess weight our body changes. Our physiology changes. And it’s very difficult to lose it once it’s on, because everyone has what we call a set point. It’s kind of like a thermostat when it comes to your weight. And when you body gets to a certain place; it’s going to defend it. and it’s going to be very difficult to lose weight from that location.
And that’s why physicians like myself who are specialized and board-certified in obesity medicine are able to work with such patients to assess the best way forward to address the underlying issue that’s affecting their ability to lose weight.
Host: Then let’s do that. Let’s address the best way forward because for a little while there was some diet pills and they were gone. People are looking Dr. Knight for that magic pill. There really isn’t one. Speak about some of the most common ways that you suggest people lose weight.
Dr. Knight: Yes and I think that’s something that is so important. There is no magic pill. And though many of us wish there was; it is a long process. Because it’s not just losing weight, it’s also keeping it off. So, some of the things that we do here at our weight management clinic at the Medical Faculty Associates; we address nutrition. So, what kind of food you are eating and also macronutrients. Macronutrients are things like your proteins, your carbohydrates, you fats. What percentages are the best? What components are the best for you to allow you to lose weight?
As was stated, many of the most recent dietary approaches include lower carbohydrate approaches, because so many patients are dealing with inability to process carbohydrates effectively with conditions such as prediabetes, insulin resistance and diabetes. We also talk about physical activity. We know that for many times there is a certain level of activity and moderate activity not just to lose weight but to maintain weightloss.
Some patients will be aided or helped with medications. And it’s not for everyone. Everyone may not be interested. But for many folks out here who have been struggling to try various dietary approaches, we consider is a medication helpful for you in appetite suppression or in addressing some of the underlying issues such as insulin resistance and prediabetes.
And finally, some patients have to be referred for bariatric surgery because that’s their desire and also that might be most effective to address some serious health concerns. So, it’s a comprehensive approach and we are a comprehensive program that allows patients to figure out what is the best way to address their weight issue and not just to get to a certain number on the scale; but really to live their best life and feel comfortable and feel healthy and go on and work on their journey for better health.
Host: Great description. You are an excellent educator Dr. Knight. So, motivation is a big factor. Whether the person is motivated to come in to see you, to even consider bariatric if they fit the parameters of bariatric surgery; but even to start an exercise program or to stop with the junk food. Where do you see motivation as a tool and how can people – sometimes it takes a near death experience for someone to get motivated to really get that weight off. What do you want people to know about taking that first step?
Dr. Knight: Yes and motivation is so important in moving forward because as I said, it is a journey. It is a marathon, it’s not a sprint. And so having motivation that pushes you through that journey even though when it gets difficult is important. But I think one of the key pieces here is having attainable and realistic goals. In medical weight management; we’re not looking for someone to lose 50 pounds in a month. We want to see consistent and gradual weightloss and that’s what we work with patients to do.
Setting achievable goals. So, if you are a patient who never exercises, hasn’t been to the gym in three years; my expectation is not going to be that you are going to be in the gym for 45 minutes four times a week on day number two. That, for many patients, is discouraging and it really takes a hit to their motivation.
So, it’s setting attainable and achievable goals and then we increase as time goes on. We are in for the long run. And many of our patients will continue to see us month after month as they get more comfortable living a lifestyle that’s in line with their health goals.
Host: That’s certainly so true. As we wrap up and as we kind of said in the beginning, we can’t solve this in a ten minute podcast about obesity, but we can certainly offer listeners some beginning steps to take and some motivation as it were to get that going, to start that process and as you say; it’s a marathon, it’s not a sprint. So, wrap it up for us. What would you like listeners to take away from this and how they can begin and when they should contact an expert such as yourself.
Dr. Knight: What I want listeners to take away from this is that obesity is a serious and rising issue, not only in our country but around the globe. But we are so fortunate to have physicians such as myself who have really dedicated their time and expertise to help patients achieve their weightloss goals.
And so number one is understanding your body. Understanding how you react to the foods you eat. Understanding the level of activity it’s going to take to really get your body moving in the right direction. The first step is talking to your primary care physician. Have a conversation about your weight and what realistic goals are for you.
Start on a plan and then if you need to be referred to a specialist like myself; ask them for that referral. We are happy to see patients and work with them to really generate an individualized approach for comprehensive weightloss. And that is what we do. That’s what’s most effective and we are committed to helping each patient reach their own personal health goals.
Host: Absolutely great information. So, important for society as a whole and the state of public health Dr. Knight. Thank you for coming on with us today and sharing your expertise about this problem that is affecting so many millions of people around the world. TYou're listening to the GW Healthcast. Please visit GWDocs.com to get connected with Dr. Knight or another provider, or call 1-888-4GW-DOCS to schedule an in-person or virtual appointment.
Melanie Cole (Host): The obesity epidemic is spreading all over the world because of changes in the way that we eat, and live and work and play. Welcome to The GW HealthCast. I’m Melanie Cole and today we’re talking about obesity. My guest is Dr. Michael G. Knight. He’s an Assistant Professor of Medicine and the Patient Safety Officer at the George Washington University Medical Faculty Associates and The GW Hospital and is affiliated with The George Washington University Hospital. Dr. Knight, thank you so much for joining us. What an important topic we are discussing today. tell us about the current state of obesity, the prevalence, the global impact that this is having all over the world.
Michael G. Knight, MD, MSHP, FACP (Guest): Thank you so much for having me to talk about this important topic. We know that obesity, the rates are continuing to grow, and it’s really become an epidemic specifically in the western world but also across the globe. In the United States, our most recent rates have shown that over almost 40% of our population, so that’s about 93.3 million US adults are dealing with obesity.
We know that it’s linked to many of the chronic diseases that affect our communities such as high blood pressure, diabetes, cardiovascular disease or heart disease and really affects certain groups more than others. When we think about some of our minority populations such as African Americans or Hispanic Americans; we can see that those rates are even higher.
And when we think about the global context; we know that as we see more westernization especially in the diets and the amount of physical activity across the globe; we are seeing increasing rates of obesity and unfortunately, it’s related to diseases in many parts of the world.
Host: Well it certainly is and as someone who has also seen so much of this in my profession; tell us the working definition of obesity and how providers are defining it really Dr. Knight. What is BMI?
Dr. Knight: Sure. So, obesity when we say overweight, when we say normal weight; that’s what we think about and then there’s actually the medical definitions and those definitions are based on something called the body mass index and that is what we will say is BMI. So, the BMI is calculated based on your height and your weight. And so based on that we have various categories such as normal weight, when that number goes up to about 24.9, 25 and above to about 29.9 is overweight and then anything above 30, 30 and above on the BMI scale is classified as obesity.
When we get those classifications is because we know that in those specific ranges; we see increased risk of a lot of the associated diseases. Now one caveat is that BMI is just really that entry door to the conversation and the assessment of excess weight. It is not the one and only way to do it and the reason is because there are many people who the BMI is not accurately reflecting the amount of excess weight they are carrying.
So, for example, someone who is a body builder, someone who has a lot of muscle mass. If they are not very tall or even if they are; that muscle mass is going to come in as just pounds and the BMI does not differentiate between muscle mass and fat mass. And so someone may look very fit and have a high BMI and they are not actually obese in that context because it’s not fat mass, it is actual muscle mass.
So, again, we use BMI as an entry way to screen people for obesity and then the next level is really having the conversation and assessing the patient to see if it’s muscle mass, is it fat mass, are we dealing with associated conditions, what is their functionality and that gives us a bigger picture and a better picture of how excess weight may be affecting them and their risk for cardiometabolic disease.
Host: Thank you for clarifying that Dr. Knight as I’m one of those people that fit into that category. Now you and I are going to try and discuss what we think are some of the causes which are larger than we mere mortals can actually comprehend. But do you have some theories about whether it’s – I mean especially for the children and the childhood obesity epidemic that we are seeing today, school, recess, gym, the built environment, urban deserts, sidewalks, I mean it’s huge. Where do you see the biggest need to look at to determine and work on some of those causes?
Dr. Knight: Yeah, I think the biggest thing like you’ve outlined is prevention wo we don’t get there but then also how do we address it. One of the things that’s important to understand that obesity is a chronic disease so it’s not just something that you see on the scale. It’s actually a disease process and what that means is that there are individuals who have genetic risk factors so, it may run in the family. It also may predispose certain individuals even within a family to have excess weight.
And so, when we think about the types of foods we are having; some people are very sensitive to carbohydrates, especially high processed carbohydrates and when they take them in; while their friend, colleague or even sibling may not put on excess weight, they are having that response with the same meals. When we think about physical activity. You talked a little bit about childhood obesity. We know that decreased physical activity rates especially seen in our population in the recent decades, we do see an increase in weight gain, but also understanding that it’s not just what we eat and just what we do as physical activity.
It is much more than calories in and calories out. And that is what many people who deal with excess weight understand. As we start to put on excess weight our body changes. Our physiology changes. And it’s very difficult to lose it once it’s on, because everyone has what we call a set point. It’s kind of like a thermostat when it comes to your weight. And when you body gets to a certain place; it’s going to defend it. and it’s going to be very difficult to lose weight from that location.
And that’s why physicians like myself who are specialized and board-certified in obesity medicine are able to work with such patients to assess the best way forward to address the underlying issue that’s affecting their ability to lose weight.
Host: Then let’s do that. Let’s address the best way forward because for a little while there was some diet pills and they were gone. People are looking Dr. Knight for that magic pill. There really isn’t one. Speak about some of the most common ways that you suggest people lose weight.
Dr. Knight: Yes and I think that’s something that is so important. There is no magic pill. And though many of us wish there was; it is a long process. Because it’s not just losing weight, it’s also keeping it off. So, some of the things that we do here at our weight management clinic at the Medical Faculty Associates; we address nutrition. So, what kind of food you are eating and also macronutrients. Macronutrients are things like your proteins, your carbohydrates, you fats. What percentages are the best? What components are the best for you to allow you to lose weight?
As was stated, many of the most recent dietary approaches include lower carbohydrate approaches, because so many patients are dealing with inability to process carbohydrates effectively with conditions such as prediabetes, insulin resistance and diabetes. We also talk about physical activity. We know that for many times there is a certain level of activity and moderate activity not just to lose weight but to maintain weightloss.
Some patients will be aided or helped with medications. And it’s not for everyone. Everyone may not be interested. But for many folks out here who have been struggling to try various dietary approaches, we consider is a medication helpful for you in appetite suppression or in addressing some of the underlying issues such as insulin resistance and prediabetes.
And finally, some patients have to be referred for bariatric surgery because that’s their desire and also that might be most effective to address some serious health concerns. So, it’s a comprehensive approach and we are a comprehensive program that allows patients to figure out what is the best way to address their weight issue and not just to get to a certain number on the scale; but really to live their best life and feel comfortable and feel healthy and go on and work on their journey for better health.
Host: Great description. You are an excellent educator Dr. Knight. So, motivation is a big factor. Whether the person is motivated to come in to see you, to even consider bariatric if they fit the parameters of bariatric surgery; but even to start an exercise program or to stop with the junk food. Where do you see motivation as a tool and how can people – sometimes it takes a near death experience for someone to get motivated to really get that weight off. What do you want people to know about taking that first step?
Dr. Knight: Yes and motivation is so important in moving forward because as I said, it is a journey. It is a marathon, it’s not a sprint. And so having motivation that pushes you through that journey even though when it gets difficult is important. But I think one of the key pieces here is having attainable and realistic goals. In medical weight management; we’re not looking for someone to lose 50 pounds in a month. We want to see consistent and gradual weightloss and that’s what we work with patients to do.
Setting achievable goals. So, if you are a patient who never exercises, hasn’t been to the gym in three years; my expectation is not going to be that you are going to be in the gym for 45 minutes four times a week on day number two. That, for many patients, is discouraging and it really takes a hit to their motivation.
So, it’s setting attainable and achievable goals and then we increase as time goes on. We are in for the long run. And many of our patients will continue to see us month after month as they get more comfortable living a lifestyle that’s in line with their health goals.
Host: That’s certainly so true. As we wrap up and as we kind of said in the beginning, we can’t solve this in a ten minute podcast about obesity, but we can certainly offer listeners some beginning steps to take and some motivation as it were to get that going, to start that process and as you say; it’s a marathon, it’s not a sprint. So, wrap it up for us. What would you like listeners to take away from this and how they can begin and when they should contact an expert such as yourself.
Dr. Knight: What I want listeners to take away from this is that obesity is a serious and rising issue, not only in our country but around the globe. But we are so fortunate to have physicians such as myself who have really dedicated their time and expertise to help patients achieve their weightloss goals.
And so number one is understanding your body. Understanding how you react to the foods you eat. Understanding the level of activity it’s going to take to really get your body moving in the right direction. The first step is talking to your primary care physician. Have a conversation about your weight and what realistic goals are for you.
Start on a plan and then if you need to be referred to a specialist like myself; ask them for that referral. We are happy to see patients and work with them to really generate an individualized approach for comprehensive weightloss. And that is what we do. That’s what’s most effective and we are committed to helping each patient reach their own personal health goals.
Host: Absolutely great information. So, important for society as a whole and the state of public health Dr. Knight. Thank you for coming on with us today and sharing your expertise about this problem that is affecting so many millions of people around the world. TYou're listening to the GW Healthcast. Please visit GWDocs.com to get connected with Dr. Knight or another provider, or call 1-888-4GW-DOCS to schedule an in-person or virtual appointment.