Scott Webb (Host): Obesity is an epidemic in America. And untreated obesity can lead to various health issues and even death. And joining me today to define obesity and explain the various options for folks, including surgery, is Dr. Nathan Allison. He's a bariatric and general surgeon with Health First.

 This is Putting Your Health First, the podcast from Health First. I'm Scott Webb. Dr. Allison, thanks so much for your time today. We're going to talk about one of the biggest problems, right? An epidemic really, is obesity. And we're going to talk through this today, what it is and signs and symptoms, and what you're doing to help folks, and all that good stuff. So, let's just start here, a foundational question for listeners. What is obesity? Can you define that for us?

Dr. Nathan Allison: You know, obesity is a complex multifactorial disease process that affects multiple systems simultaneously. So, really what it is it's excess fat storage throughout the human body that is causing it to both fibrose or scar and break down at the cellular level throughout the entire body. So, everywhere there's fat in the body, that fat produces different hormones and mediators in your body, some of which are what we call pro-inflammatory mediators. Things that make your body hurt, make your body age quicker, make your body scar more. And so if you have just a little bit of fat in your body, the amount of those mediating factors in your body or those hormones is really low. And so, the body's ability to heal itself and kind of not scar and fibrose is minimal. But when you have a lot of that, you have breakdown at the cellular level throughout your whole body. When you have a significant excess of fat storage in your body, it breaks down much faster and has much more impact on all of the surrounding areas within your human body. And so, that's really what obesity is. And it affects the cardiovascular system. It affects the pulmonary or lung system. It affects your joints. It affects your liver. It affects your pancreas. It affects really everything. The only areas in your body that don't have fat are the brain and the central nervous system, like your spinal cord. Every other part of your body has some component of fat in it. So, that's the area of concern that we want to talk about.

Host: Yeah. And are there signs and symptoms per se of obesity? You talked about all these other things that obesity can exacerbate or cause, you know, high blood pressure, diabetes, all those, you know, the sort of greatest hits, if you will. Are there signs and symptoms though?

Dr. Nathan Allison: The easiest sign is you look at the scale, right? And so, weight is a good marker, but really it's your BMI, your metabolic index, your basal metabolic index, how big are you in relation to your height. And so, that BMI is what is super important for us. And it's not a perfect science, right? Arnold Schwarzenegger in his prime was considered obese, but obviously he wasn't. But when you look at your weight over your height, that really is a good judge and that's your first sign, is your weight is going up, your height's not going up, right? So, you know that your weight is going to be a problem. But the symptoms of obesity are actually also multifactorial. For example, you might eat less than everyone else in your family, but you're still gaining weight. So, that's a problem that people recognize early. You're more sluggish and you're more lethargic because you're carrying extra amounts of weight. Your knees, your hips, your back, those things hurt because you're carrying more weight. You go to the doctor and they say, "Hey, your blood pressure is going up" or they do some blood work and they say, "Hey, your sugars are a little elevated." Those are all of the manifestations of obesity. But really, the first thing that you'll notice is, "Huh, my pants don't feel like they should," or "The weight is going up and I'm not trying to gain weight."

Host: Yeah. We check the scale, of course. That's something most of us can do at home. As you say, BMI obviously is a big factor. Are there different types of obesity or different classifications?

Dr. Nathan Allison: Yeah, there are. We look at the BMI as this scale that we use. And so, BMI from 18 to 25 is considered the ideal weight. Now, that doesn't necessarily mean that you are going to be your most fit at that, but that is just a rough estimate of a person's, what we consider their ideal range. And then when you go 25 to 30, it's considered overweight. Over a BMI of 30 to 35 is considered obese. And then, a BMI over 35 is considered morbidly obese. Now, there's actually some controversy over the word morbid or morbidly obese. When you go above a BMI of 35, you have a lot of potential to have significant risks that can affect the quality and the quantity of your life. And then, over a BMI of 40, so from 40 to 45, you start getting into these class 1, class 2 levels and stages of obesity. And then certainly over a BMI of 50, then you're in a very high stage, a very high class that comes with a tremendous amount of risk. So, those stages help us determine what we're going to offer a patient that is interested in losing weight.

Host: Yeah. And I'm wondering about the causes of obesity. Is it genetics, family history, you know, lifestyle choices? Are some people just sort of born obese, if you will, and others, it just kind of sneaks up on them? Maybe you can try to make some sense of this for me and listeners, of course.

Dr. Nathan Allison: What I would tell you is it's multifactorial, but you might be one of many obese people in your family, or you might be the only one. So, we know that genetics plays a significant component. There are these things we call bariatric set points, or you can look at them as a weight set point. Your body wants to be at a certain weight and it's going to work really hard to keep you at that weight. And that can be because of your metabolism, which we'll talk about in a second. It can be because of the age at which you live and how much physical activity you do.

But a big component, especially in women, is their hormonal cascade, their sex hormones, estrogen, progesterone, testosterone throughout their body in terms of how they function and how they age, how that's going to play into their metabolism. Now, metabolism is one of those things that is a huge factor in obesity and in overall quality of life and health. So then, your metabolism is how many calories you need in a day to just survive, just to be. You're not gaining weight. You're not losing weight. You're just staying where you are.

And so, you can imagine genetically if you're predisposed to have a metabolism of 1,200 calories a day and the person next to you has a metabolism of 2,200 calories a day, the person at 2200 calories is going to have a much higher opportunity to not gain weight when they eat something that's higher in calories. And so, that's unfair, right? It's just, but it's the way it is. So, you combine a very high-calorie diet, some of which is, you know, our fault society-wise, combined with now access to it that we've never had before with metabolisms that are changing for the worse because we're not moving as much as maybe we should, it leads to this problem of obesity. There is a component to this that is environmental, there is a component that is what we eat, but it's also this component of the types of foods that we're eating that is really driving this.

Host: Yeah. Multifactorial, as you said.

Dr. Nathan Allison: Multifactorial.

Host: Yeah. So, what are the risks of untreated obesity? And, you know, as our BMI goes up, are the risks sort of multiplied in a way?

Dr. Nathan Allison: So, I'm going to give you a question that will kind of resonate with you when you think about this. And that is, how many morbidly obese people do you know that are in their 80s? There are very few.

Host: I don't know any. Yeah.

Dr. Nathan Allison: There are none. There are none. And the reason for that is they all pass away before they make it to 80. Now, the national average age for women is 78 years old. And I can tell you that I don't know very many women over the age of 78 that carry a BMI over 40, because they don't make it that far. So, the first obvious thing is the risk factors of uncontrolled obesity is death, early death. And so, you can see that when you look at BMI over time, once you get above the inflection point of a BMI of 35, the chances of you dying from anything, pneumonia, flu, COVID was a big deal, right? That kind of opened everyone's eyes to, "Oh man, I really got to watch what I'm doing because, you know, Bob down the street passed away and he was just as big as I was." Those things are huge. And so, the most obvious thing is the idea that you're not going to live as long of a productive life. So, the quantity of life goes down dramatically as your BMI goes up.

The other thing that's important is the quality of your life, okay? So, you know, you might make it to 65 or 70, but the last five or 10 years of your life weren't all that good. You had heart issues. You may or may not have had cardiovascular problems that resulted in stents or heart attack or congestive heart failure, which really limits your ability to go and do the things that you want to do. My dad recently retired. And he says to me, "The golden years aren't so golden anymore." You know, it's because you can't do the things that you want to do. Your hips, your knees, your back, those things all become a problem. And now, you're getting a total joint at age 60 or 65 because of your weight or because of accommodation of your weight and your lifestyle. Those things make your quality of life also decrease.

Parents that are obese, there's a 67% chance that they're going to pass that obesity, not in terms of genetically, but just in terms of their children having obesity when they are an adult as well. So, that's a huge number. So, we really try to focus on the parents, because that's going to last into the children. And then if you look at the grandparents, the grandparents can't play with the grandkids like they used to, because they're dealing with it now. So, you know, it's cascade of events that happens once you get into the obesity level.

Host: Yeah. And you mentioned metabolism earlier. Some people can eat more than others and it doesn't affect them. They don't gain weight. Is that basically why some folks, some obese individuals struggle to lose weight or why some of us, you know, like I have family members who eat next to nothing, but they weigh probably too much, their BMI is probably too high. Is that it? Is it just metabolism?

Dr. Nathan Allison: It's not just metabolism. I have patients right now that their metabolism, we've calculated their metabolism. We have machinery, we have the technology to be able to tell you what your metabolism is. So if I have a person that says to me, "Hey, you know, I can't do this thing." I say, "Well, let's look at your metabolism." So, we look at the metabolism. And if your metabolism is 1,200, 1,300 calories, yeah, you have been dealt a bad deck of cards. But I am the dealer, and I'm going to reshuffle the deck.

Host: You're the dealer.

Dr. Nathan Allison: Right. So, I'm going to give you a tool that can help you with weight loss, whether it's a medicine, whether it's an exercise program, or whether it's a surgery that we offer. We can reshuffle the deck to help you because to be honest, you know, if you try to eat 1200 calories a day, I would challenge any of your listeners to say, "I'm going to eat 1200 calories a day and not want to kill someone, not be hangry."

Host: Sounds like just breakfast to me.

Dr. Nathan Allison: Yeah, I mean for some people that's literally like breakfast and then, "What's what am I having for lunch and dinner?" So, you know, that's a really difficult thing, but you also have to work the body, right? You can't just rely 100% on nutrition. So, what I tell people is a three to one rule, right? So if you are going to do this thing, I use the analogy of working out for your heart. For every minute that you're going to do cardio, I want you to do three minutes of weight training, muscle building, this and that, because for every pound that you're going to lose from your working out, you're going to lose three pounds from your diet. So, you really have to exercise and you really have to eat well. Because to eat 1200 calories a day isn't really a long-term thing, unless you've had weight loss surgery. So, you have to get your metabolism up and that means you got to start moving and burning calories and things like Fitbits. And your Apple iPhone, watches, and all these different things, those things are really good at kind of telling you how active you are. I don't know about you, but I go to the gym and I'll run on the treadmill for 22 miles. And it says I burned like 150 calories. That's like one scoop of pudding, you know, you're like, well, that didn't seem fair.

Host: I doesn't seem worth it, you know?

Dr. Nathan Allison: I think we think that we're really working really hard, but we're really not. And so, we've got to keep ourselves honest and accountable for what we're doing. So, we can kind of keep an eye on our metabolic rate.

Host: I want to get to the options for treating obesity, be they surgical, non-surgical. My mom had a weight loss surgery, the bariatric surgery a few years ago. And we still tease her because, you know, she can only eat a very small amount of food, but I want to have you go through that for folks, surgical and non-surgical.

Dr. Nathan Allison: So we'll, start with non-surgical. You know, the good old-fashioned diet and exercise, right? So, watching what you eat and exercising, that's tried and true. And no matter which direction you go, that is always going to be a staple of weight loss, right? So, that doesn't go away. A lot of folks think that, "Oh, well, if I have weight loss surgery, I don't have to do that diet and exercise stuff." That's actually completely false. You can't do anything without diet and exercise. So, we try to instill, you know, proper eating habits and the density. Again, it goes back to the density of food, like how many calories food have in them. There's a lot of weight loss clinics, you know, kind of throughout the United States. And they're going to offer you anything from appetite suppression to perhaps some of the more trendier medications that are out now. And those medications are designed to kind of help you do one of several things, right? You can either not feel hungry or get full quickly or slow the process upon which you eat and digest food. All of those things ultimately will end in you losing weight.

Now, some of these medicines are not very effective at all and they have lots of risk factors and side effects. And so, you know that you have to look at, is the juice worth the squeeze? But some of the newer medicines coming out, the GLP medications, these medications work by slowing the speed at which your food digests and then your stomach empties. And so, it gives you this sense of fullness. You don't feel as hungry. And some of my patients have actually said, "That drive that I need to eat and I'm always thinking about food is gone," right? So, that's a pretty powerful thing and there are medicines that are coming out that haven't hit the market yet that are going to continue this revolution in weight loss medication.

So, the most tried and true program out there in America based on evidence-based medicine is actually Weight Watchers. And Weight Watchers is the best program we have in America. And it doesn't include medication. It's just, you know, their point system and how they eat and some of the foods in which they sell you. And you can expect to have long-term 5% weight loss. That is an evidence-based medicine. You can look it up. But when you talk to people and you go to the introductory class, you're going to lose 20 pounds and maybe 30 pounds, but then they don't keep it up, right? So, you have to look at the long-term thing, so 5%. Some of the newer medications are in the 7-10% range. We don't have long-term data, because they haven't been out that long. But you're seeing 20-25% weight loss, sometimes almost 30% weight loss, which is tremendous for just having a medication as opposed to a surgery.

And then, you look at surgical arms, right? So if a person decides, you know, If" I'm 30 pounds overweight, I don't need surgery," right? That's an overkill. "If I'm 40, 50 pounds overweight, I'm going to work hard, maybe a medication, try to drive my weight down." We're talking about the BMIs over 35 with comorbidities, hypertension, diabetes, or we're talking about a BMI over 40, because now we know statistically you need a really big gun. And then, when we talk about those things, we need more horsepower to drive the weight down. Then, you're looking at things like the sleeve gastrectomy, the gastric bypass, and then there's also a surgery out there called the duodenal switch, which can really drive weight tremendously. So in our hands, our sleeve gastrectomy will lose about 72% of the extra weight you're carrying. So if a person comes to me and they're 100 pounds overweight, we're going to lose 72 pounds. That's pretty darn good. That's much higher than the medications out there. And then, the same thing with the bypass. They're going to lose about 83 pounds with the bypass. And the recidivism or the amount of weight that you'll gain long term afterwards, meaning like, you know, you got to your lowest and then you gained a little bit back is very good with the bypass. Less than 5% of people will gain more than 10% of their weight in our hands. And so, you know, when we look at the way that our bypasses are working, we look at the way the sleeves are working, we're very happy with those results you have to balance the risk of the surgery, which is not zero, but very low, with the reward. And so, that's the conversation that we try to have with folks when we talk about the spectrum of what you can do for a weight loss patient.

Host: Sure. This has been really good stuff today, really educational. And I just want to finish up, I was reading about the NewFit Program, the weight loss program at Health First. And I just want to have you tell us about that, tell folks about that, and what do you think sets it apart from other programs.

Dr. Nathan Allison: Well, I created the program in 2011, and we've been here ever since. Very proud of our program. We have been a top decile performer in all facets of weight loss since its inception. We have been a center of excellence, which is dictated by the American Society of Metabolic and Bariatric Surgery ever since we first applied. And we have held center of distinction for all of the major insurance carriers in our area from the beginning. And the reason that's important and the reason I highlight that is because they look at everything. They look at how quick you did your surgery, how effective the surgery was. How many medications did the patient come off of after their surgery? Did the patient suffer any complications at the time of surgery? How much did I have to pay for the surgery? You know, the insurance company, how much did they have to pay? Because if they have a complication, they have to pay for that, right? So, they look at all those things. And that keeps us in a very select group of programs in the nation.

But what I'm most proud of is the thousands and thousands of patients that will tell a friend each and every day that, "You need to go see these guys at NewFit, because they changed my life." And really, that is what pays it forward for us because, you know, if I change your life today, that's great. But if I change your life today and your friend's life tomorrow and their friend's lives the next day, that's really what it's all about, is trying to encourage people to take that next step in their weight loss journey and help them. And that's been the most rewarding thing for us, is just making a change, making an impact in this community.

Host: Yeah. That's a perfect way to end, I really appreciate your time today. As I said, this was really educational. I'm sure listeners, I can sort of see them in my mind, nodding their heads too. Thank you so much. You stay well.

Dr. Nathan Allison: All right. Take care. Thank you.

Host: Enjoy more living, less limits. Learn more about weight loss options at Health First and take a short quiz to learn if weight loss surgery can be the right choice for you at hf.org/newfit. And if you enjoyed this episode, please be sure to tell a friend, share on social media, and check out our entire podcast library. We look forward to you joining us again.