Scott Webb (Host): This is One-on-One with Regional One Health, your inside look at how we're building healthier tomorrows for our patients and our community. Join us as we get to know some of the individuals who help provide life-saving, life-changing care for our community.

I'm Scott Webb. And today, Medical Director of Ambulatory Services with Regional One, Dr. Cyrilyn Walters, joins me to discuss healthy weight loss benefits and strategies. Doctor, it's nice to have you here. I have to confess, I go to the store, I do the shopping, and my head starts spinning. I don't know what to buy, what's healthy, what's right, what's wrong, all of that. There's so many fad diets out there and social media, and there's just a lot going on. So, it's great to have you here, great to have your expertise. We're going to talk today about healthy weight loss and what does that mean, right?

So before we get to all that, maybe just tell folks, me, and listeners why it's just important to maintain a healthy weight. Like, what are the benefits to us by maintaining a healthy weight?

Dr. Cyrilyn Walters: Well, having a healthy weight is actually very important. You know, from studies, we've found that many chronic health problems, high blood pressure, heart attacks, strokes, diabetes, kidney disease, that more than 50% of them are attributed to lifestyle changes. And so, that includes having a healthy weight. That includes your diet, being active, cutting down on substances like tobacco, alcohol, those types of things. So, we know that just from a healthy weight, that reduces your chances of being healthier and actually living longer without chronic diseases, up to 10 years more of life without a health problem if you have a healthy weight.

Host: Yeah. And as you say, a lot of this is within our control, right? Behavior, lifestyle, those kinds of things. And I'm sure one of the things that comes up a lot, Doctor, is maybe from you, from expert advice, is like folks, you know, wanting them to be realistic, right? And so, when we think about making some changes to diet, exercise, like how can we be realistic you know, with ourselves, with our goals, all of that?

Dr. Cyrilyn Walters: And, you know, one of the things that sometimes we don't do so well with patients is we just say, "Hey, you need to lose weight and exercise more." And we don't actually tell you what that means,

Host: Yeah, what does that mean, right? Yeah.

Dr. Cyrilyn Walters: How to do it, or what makes it sustainable. So, the big thing about lifestyle changes, and you mentioned before fad diets, it's not a diet. This is not the new next thing to lose 20 pounds. It has to be achievable. And so if you've gained 50 pounds in three, five years, you're not going to lose it in three, five months. And so, being realistic in terms of the amount of weight loss.

And sometimes when we think about it for our patients, we think about it in terms of percentage, because we know a 5% weight loss can reduce the medications you're on for high blood pressure and those types of things. So, being realistic iabout how much weight loss and how long it does take to happen, and making changes that are small but you can sustain them. Because that's where that persistent or that consistent weight loss or healthy weight happens, rather than going on the fad cabbage diet. And you lose, yes, 10, 15 pounds in a month, but you're not going to eat cabbage for the rest of your life. And so, you regain that weight, and then it becomes not sustainable, and it's hard for you to kind of have that motivation to continue when you do all of this stuff and then you just see the weight come off for a short period of time, and it goes back right where you began.

Host: Yeah. Yeah. And let me just state for the record, that if I have to go on a diet that involves eating a lot of cabbage, I am probably not going on that diet, Doctor. I can't speak for everybody. There might folks who love cabbage. I'm like more like once a year maybe, you know?

All right. So, let's talk then, Doctor. There's so much out there, news, social media, AI, wherever folks get their information. There's so much out there about weight loss medications, right? It's just everywhere I turn, people are talking about it, and there's signs and billboards and commercials. What role, Doctor, do weight loss medications play in our goal, hopefully, of sustaining a healthy weight, healthy weight loss, all of that?

Dr. Cyrilyn Walters: Yes. Just like many chronic diseases, the earlier you identify them or the earlier you try to address them, you may or may not need medication assistance. When it comes to obesity, and we look at obesity as a chronic illness just like diabetes, just like heart disease, just like high blood pressure, we consider it a chronic medical disease.

And what we found out about research in obesity is that there's a large component that just isn't about eating well and exercising well. There is some hormonal changes that your body goes through, and that's where weight loss medications really come in, is when you have done the dietary changes and, you know, not just your thought on what the dietary change is, but obviously working with a dietician or your provider to ensure that the dietary changes you are making, because there's a lot of hidden calories in food that we're not aware of.

When you do all the activity and you still are unable to lose that weight, there may be those hormonal or genetic components that are in play. And when that happens, that's where medications help. And a lot of the medicines, obviously, the one that most people know about are the GLP-1s, because they're the latest, greatest.

What we've found is that, one, they do help with a lot of the hormonal controls of how we gain weight, how we hold onto our calories, what turns into fat, what doesn't. They help with that as well, but the other part of obesity is that there's a low-level chronic inflammation that goes on that also increases your body's ability to hold on to weight, and those GLP-1s also help with that.

So, medications kind of come into play when you've done all that you can from the modifiable lifestyle changes, obviously with a provider that makes sure that you're doing that correctly. And when that doesn't work, then that's when medications and, even another level, you know, bariatric surgery is still a very good option for persons who have tried or can't tolerate the medicines and just are not achieving the weight loss that they need to be healthy.

Host: Right. Yeah. So, lots of things on the table here, obviously. I'm sure you would recommend, Doctor, to most folks, especially if they are obese and they've been trying for years to tackle this on their own, that they work with or speak with a healthcare professional such as yourself, right? So whether it's because they want to start using weight loss medications or just trying to lose weight in general, maybe just discuss the benefits of working with an expert.

Dr. Cyrilyn Walters: Correct. Correct. There is a comprehensive approach to obesity and, like you said, you know, it's not just the behavioral changes or those components. It's not just the lifestyle changes or the medications or the surgery. It's a comprehensive approach where you have all the professionals help you with that.

And we found that people who have more sustained weight loss are the ones that work with healthcare professionals in the fields that they need rather than doing it on their own. So if determining whether weight loss medications are appropriate, monitoring their side effects, even if, you know, one of the things with the GLP-1s that a lot of people talk about is you lose all this weight, but you stop them and you regain the weight.

How do you combat that working with someone so that doesn't happen to you? Because once you regain that weight, it actually becomes a little harder to lose it every single time. So, you don't want to have those yo-yos back and forth. You want to have someone that, is aware and can monitor what's happening. You don't have too much of a drastic weight loss too quickly. You don't have, you know, a plateau and that we get to the point where you can maintain it and not have it up and down.

So, having that healthcare professional, that dietician that can kind of go through foods with you, that exercise physiologist that can tell you which types of exercise are really the most helpful in terms of keeping a healthy weight. Those are the persons. Even a behavioral, because we have a lot of social aspects to eating. It's something that we do with our families, and so it's tied to certain things. And so, sometimes having that behavioral coach that can help you through when there is a relationship with food that tends to be social, that is hard to kind of pull away from. So, having those professionals, I think, is very important for not just losing weight and being on medications, but sustaining a weight loss overall.

Host: Really good stuff today. Great having you on. I want to give you a chance here at the end just to tell us a little bit about yourself, like why you were drawn to this field, what's your approach to patient care, all that good stuff.

Dr. Cyrilyn Walters: So, I would say my interest, I've always had an interest in just kind of preventative care. I grew up in the Caribbean. And in the Caribbean, you definitely have a culture of not taking medications for a lot of things. And I think, you know, obviously, there is a role for medications for a lot of things.

But I've always had the approach that, you know, preventing things early stops you from being on 10 medications and having all these problems later on. But it was really COVID that got me more interested in obesity, and that was because we saw that persons who had obesity were almost a 50%, depending on your BMI, 50% more chance of dying, going on a ventilator, or being on dialysis if you had COVID, and knowing that obesity is something that we can address. So, I got much more interested in it. And as a result, I'm now a diplomat of the American Board of Obesity Medicine. So, I went through that extra training to just kind of get into that approach.

So, my approach, again, for most of my patients are how do we prevent things before they start to happen? And if we have the opportunity to prevent this without going on a medication, how do we become aggressive with that? But also understanding there's a role for medication. I am not anti-medication. I am not, "This is the first thing." Everything has their roles. It depends on how quickly we address the problem or do we wait until it becomes a, you know, such a chronic issue that there's no other options other than medications.

Host: Right. Yeah, I hear what you're saying. It's like medications do have a role, may play a role in some people's lives, but maybe not everybody. And for folks, it's just behavior, lifestyle changes, diet, exercise. In others, medications or surgery or whatever it might be. There's just a lot of tools in the toolbox, right?

Dr. Cyrilyn Walters: Yes. And it just depends on that patient, what their goals are, what they want to achieve, and I help them get there.

Host: That's great. Well, it's great to have you on, great to benefit from your expertise. Thank you so much.

Dr. Cyrilyn Walters: All right. Thank you

Host: And for more information, go to regionalonehealth.org/primary-care. and thanks for making One-on-One with Regional One Health, part of your journey to better health. Join us next time as we introduce you to another member of the Regional One Health Family. I'm Scott Webb. Stay well.