Amanda Wilde (Host): In America, we are very weight conscious. We know maintaining an appropriate weight improves our health and quality of life on so many levels, yet managing weight is something else entirely. So next, we'll sort through weight management solutions with a panel of experts. This is Maimo MedTalk. I'm your host, Amanda Wilde. Joining me today are Dr. Nina Paddu, an Obesity Medicine Specialist, Dr. Alexander Abdurakhmanov is a Bariatric Surgeon, and Nina Dahan is a Dietitian at the Maimo Weight Management Center. Welcome to all of you, and thank you for being here. 

Nina Dahan, MS; RDN; CDN: Hello.

Nina Paddu, MD: Thank you.

Alexander Abdurakhmanov, MD: Thanks for having us.

Host: Dr. Paddu, could you start us off by explaining the role of a primary care doctor in the management of obesity? Because I think that's the first person we think of when we think of going to the doctor. So we have a problem with weight, we see our primary care physician and what is their role? 

Nina Paddu, MD: Sure, as a primary care doctor, I think we have a great opportunity to help our patients because we tend to know them very well and have a good understanding of their health concerns and their health goals. However, I would like to add that it is important to ask permission first when asking our patients if it's okay to discuss their weight. 

As you mentioned, this is a sensitive and complicated area, so we want to make sure we're addressing it as appropriately as possible. I would first want to examine their overall health and also ask them, in my visits, what are their health goals? What does having good health mean to them?

And then I would want to see, does carrying excess weight potentially affect their health? Considering if they have for example, Type 2 diabetes, high blood pressure, high cholesterol or osteoarthritis; all of those conditions can be affected by carrying extra weight. And so by addressing weight, we can improve all of those conditions. 

It's been shown in research that losing as little as 5 to 10 percent of body weight loss can oftentimes improve these symptoms when the severity of overweight or obesity is not as high. So an example of that could be someone who is noticing extra abdominal waist circumference. On top of that, they have a BMI of say 29 and they have Type 2 diabetes. 

Losing weight in that situation can really improve their overall metabolic health, potentially improve or reverse diabetes. 

Host: Let's talk about how we do address obesity. Dr. Paddu, just staying with you, what role do prescription medications play in weight management because it's really popular right now, isn't it? 

Nina Paddu, MD: Yes, it has become very popular and I would say first we want to examine what patients have tried initially because the foundation of successful weight loss and weight loss maintenance is having a healthy lifestyle. This means attending to what they're eating, their physical activity, their sleep hygiene, and also stress management.

All of these components, to me, qualify as a foundation for a healthy weight loss plan. And then if they notice that they have tried several times to lose weight, but cravings, high appetite, less sense of fullness, return when they're losing weight and they regain the weight and there's weight cycling, in addition to potentially metabolic diseases such as diabetes, fatty liver, high cholesterol; then I would say that is a good candidate for a weight loss medication.

However, we always have to look at any contraindications to medication, examine their medical history to make sure it's safe. And then I also always screen my patients for eating disorders. That sometimes goes overlooked and we want to make sure we're having a healthy relationship with food and that we are not potentially ignoring signs for anorexia, bulimia,

or, binge eating disorder, and so that's what I would first do.

Host: Looking holistically at each individual, Dr. Alex, as a Bariatric Surgeon, what are the key factors you consider when recommending surgery as a weight management solution? 

Alexander Abdurakhmanov, MD: Yeah, so surgery is very safe and very effective. And a lot of times, diet and exercise, which is kind of that first tier of treatment, is not enough. A lot of times, the medications as well are not enough. And when patients have a lot of weight, the best way to lose that weight and keep it off is surgery.

And these operations are very safe, very effective, and they have really good results. And this is the best way that patients keep the weight off and lead a healthy life afterwards. And so those are the things we look for in deciding who would benefit from surgery.  

Host: Do you find that changes after bariatric surgery are sustainable for patients long term? 

Alexander Abdurakhmanov, MD: Absolutely. Our patients are so happy after their surgeries. They lose the weight, they keep it off. They're motivated, by continuing their lifestyle changes. Because before surgery, they diet and exercise, and they'll maybe lose a pound or two and it's very hard for them to keep it going.

After surgery, they maintain that same lifestyle. They really see the, the weight come off. And so they're finally able to break that cycle, and keep that weight off. And you see a complete transformation. And so all of our patients always say, I wish I did it sooner. They can't thank us enough and they're very thrilled with the results.  

Host: Well Nina, now as the dietitian here in the group, how do you support patients through their weight management journey at the Maimo Weight Management Center?  

Nina Dahan, MS; RDN; CDN: I see patients from each aspect. Patients who are taking the medications. I help patients before and after surgery to work on their lifestyle changes. Looking at medication and surgery as a tool; lifestyle changes are very, very important in making those changes. People are learning how to live with a new anatomy, with a stomach that's smaller, with absorption that changes with bypass surgery.

When patients are taking medications, there are certain nutrients that we need to focus on. So I'm there to support those patients, whether they choose a medical weight loss or the bariatric surgery. When patients choose not to go either route, we do know that diets don't work, and it's a huge industry, but dieting doesn't work. 

And we've seen over the years how in general, the population has become more overweight. By working on understanding a person's triggers for eating, whether it's developing a healthy relationship with food, whether it's learning how to eat mindfully, choosing better food options for them, understanding that you can be social, you could be at a holiday party, you could be on vacation and still manage.

Eating and enjoying the food and still stay on track with your weight loss goals, that's where I step in to support the patients and it's personalized nutrition. I assess each and every patient very specifically to understand where they're coming from, their history, the diets that they've tried, in order to try to pinpoint for each individual patient what would be the best goals and the best strategies for them so that they're not wasting their time and they see the results in their weight loss, which then translates into better self esteem, perhaps, certainly better health outcomes. 

Host: Dr. Paddu, how can listeners determine when they need to seek professional help for weight management, of the kinds we've just discussed, versus managing it independently? 

Nina Paddu, MD: I think that patients have to just examine what they have been trying and see if it has been successful. I think if someone has been trying their best to eat a healthy meal plan, getting in activity, trying their best with their sleep hygiene and stress management.

If they're doing what they can with that, but they're still not seeing results; I would love to see them to assess if not only medication is appropriate, but I also will rule out other conditions that could be causing their weight gain, such as rare endocrine issues. I can screen for that, and assessing for insulin resistance, which can be a common cause of weight gain over time.

And also, checking for potentially, in some cases, I can do genetic obesity testing. This is not that common, but in certain cases I can assess for that as well. So there's many things we can do, but if patients are having any trouble, and I would be happy to speak with them, I often recommend medications, if there are several weight related comorbidities and patients can benefit from losing at least 10 percent body weight loss. We can achieve that with medicine, but if there is a significant amount of weight loss, as Dr. Alex suggested, then oftentimes bariatric surgery is a more sustainable solution. Generally, this is recommended, for more severe obesity, as this has shown very good long term data for more robust weight loss. 

Alexander Abdurakhmanov, MD: And this is Dr. Alex. I just wanted to jump in, to give an additional answer. Patients can do a quick BMI calculator, to assess whether they can benefit from weight loss. And the BMI is just body mass index. It's a quick measure of height and weight, and so you can plug it in, in a lot of BMI calculators.

And if you get a number over 30, I think you can definitely benefit from seeing Dr. Paddu or Nina Dahan. And if you get a BMI over 35, then I would love to see you in my office and talk to you about surgical options. Again, we provide every single option that's out there, whether it's lifestyle modification, medications, support, and surgery, and we'll choose the plan that's right for you.  

Host: So really, together, you have all the tools for success. It can be intimidating, but also a relief to get this process started and to see your doctor and start talking about these things. Nina, what advice would you give listeners who are just starting their weight management journey? And is it the same advice you'd give someone who is not just starting their weight management journey but needs assistance? 

Nina Dahan, MS; RDN; CDN: It is quite different in terms of the guidance they're going to get. Somebody who's struggled to lose weight for several years, tried every diet under the sun, after doing an assessment, they're more likely to want to try something a little bit more with medical weight loss and or surgery. When someone has just gained weight, perhaps lifestyle changes, night shift workers, start to gain weight, or just vacationing and holidays, when people just feel a little bit uncomfortable with a few extra pounds; that's really a great way to nip it in the bud before it becomes an issue that needs medication or bariatric surgery.

Certainly, as soon as you start to realize that you are uncomfortable in your skin and you want to develop better eating habits for your weight loss, you want to develop a better relationship with the food, then that's the point to make an appointment with a dietician, and then we take it from there, and then because we work so nicely as a team, we know when to pull in other members of the team as needed. 

Alexander Abdurakhmanov, MD: This is Dr. Alex. I'm just going to jump on that answer. I think that's really well said, Nina. We all try to lose weight. We all feel our belt get a little tight. And so I think exactly what you said, once we start feeling a little heavier, a little winded going up the stairs, I think that's a great time to kind of focus on our health and talk to a nutritionist, and see Nina and see us at our Weight Management Center. 

Host: Well thank you, all three of you, for the work you do in the field of weight management and for keeping on the cutting edge of that to help the rest of us. 

Nina Paddu, MD: Thank you.

Alexander Abdurakhmanov, MD: Thanks so much.

Nina Dahan, MS; RDN; CDN: Thank you for giving us a chance, yes. 

Host: That was Dr. Nina Paddu, an Obesity Medicine Specialist, Dr. Alexander Abdurakhmanov is a Bariatric Surgeon and Nina Dahan, Dietitian at the Maimo Weight Management Center. 

Thank you so much for joining me today on Maimo MedTalk. I'm Amanda Wilde. To make an appointment with the Maimonides Weight Management Center, call 718- 283-6962. For general information, visit maimo.org. If you found this Maimo MedTalk podcast helpful, please share it on your social media channels. To listen to additional episodes of Maimo MedTalk, please visit maimo.org.