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Obesity
Dr Joseph George discusses the clinical definition of Obesity and why we should know and care about the difference between being overweight and obese.
Featured Speaker:
Joseph George, MD
Dr. Joseph Anthony George is a graduate from the Strathmore College of Arts & Science's in Nairobi, Kenya. He received his medical degree from the University of Navarra Pamplona in Navarro, Spain. After completing his medical degree, Dr. George did an internal medicine residency at Cooper Medical Center in Camden, NJ and his Cardiology fellowship at Rutgers Medical School in Piscataway, N.J. Dr. George is Board Certified in Internal Medicine and Cardiology. He is also a member of the Orange County Medical Society and New York State Medical Society. Dr. George is an attending physician at Montefiore St. Luke Cornwall. Transcription:
Obesity
Alyne: What is the clinical definition of obesity and why should each of us know and care about whether we're just a little overweight or far heavier than we should be? Here to explain is cardiologist, Dr. Joseph Anthony George, an attending physician at Montefiore's St. Luke's Cornwall. I'm Alyne Ellis. Welcome to our Health Track podcast. Welcome, Dr. George.
Dr Joseph George: Thank you. Thank you for inviting me.
Alyne: Let's begin with the distinction between being overweight and being obese. What's the difference?
Dr Joseph George: It's defined primarily by the body mass index. So a body mass index or a BMI as it's called, 25 and 29 would be overweight and obesity would be a BMI of greater than 30.
Alyne: And how is that measured? How do you find that out?
Dr Joseph George: Okay. So the BMI is measured by some mathematical calculation. Basically, the body weight in kilograms divided by the square of the height in meters. There are apps available to quickly calculate that, and that gives you a BMI. Another way would be to measure the circumference of the waistline. Circumference of greater than 40 inches in a man would consider that individual having obesity. And a conference of 35 inches in a woman would also render her having obesity
Alyne: And when we measure ourselves, is it right above the hip line or a little higher if we're going to do it ourselves?
Dr Joseph George: Above the hip line.
Alyne: So, right where that hip bone ends is where you would put the tape measure, straight across and around where your belly button is, I guess.
Dr Joseph George: That's correct.
Alyne: So tell me, I've heard over and over the belly fat is really dangerous. And why is that?
Dr Joseph George: it leads to a greater increase in risk of developing diabetes, also developing coronary artery disease and subsequently heart attacks. You know, one of the things that we see even in the sports is that we have this culture where we have the lineman weighing 350, 400 pounds and they can sprint very short distances very rapidly, but you see this, you know, rubber fat in front of them on their bodies. And, unfortunately when they leave their sports, early in life when they retire, they're left in the red zone without a coach to encourage them how to get rid of it because their life expectancy is actually shortened carrying all that weight.
Alyne: That was one of the things I was thinking about is that as you follow or read studies about people who are obese, what is the percentage of it shortening your lifespan by a decade or a few years, or, what?
Dr Joseph George: So it generally depends on how much obesity one has. So a body mass index of greater than 40, the lifespan is reduced by eight to 12 years. And a BMI of 30 to 34 shortens it by about four years. That's a rough estimate. Yeah, so obesity does have an impact on one's life expectancy.
Alyne: And if I were to lose that fat, does that mean that my life might be lengthened?
Dr Joseph George: Yes.
Alyne: So I've also heard that people who have internal fat, which you can't see, but also around your middle, that that can be dangerous. Maybe you could tell us about that.
Dr Joseph George: Yeah, that's a difficult measurement to obtain short of doing a CAT scan of the abdomen, where one can uncover a lot of internal fats. And that also is considered to be a detrimental to one's health.
Alyne: And is it possible to be obese and healthy at all? I mean, you mentioned this lineman running and, at that point, I guess, because he's exercising he's in at least some good shape. What about that?
Dr Joseph George: Well, to be obese and to be healthy are actually contradictory. You know, recently I saw a photograph, it was titled young, healthy man dies due to COVID. And, looking at the picture, he had obvious obesity and obesity is considered a single risk factor of succumbing to COVID-19. The problem with obesity is that it leads to hypertension, diabetes and coronary artery disease, which carry their complications earlier in life.
Alyne: So as an internal medicine specialist and as well as a cardiologist, what markers do you also look for when you see someone coming in who is obese? Do you run special tests to find out how much damage has been done?
Dr Joseph George: One of the things I will do is to check to see if they have already developed diabetes or if they are pre-diabetics. We will also check their lipid levels to see whether their lipid levels are on the high side. And if they have high blood pressure, we measure their blood pressure to ensure that they don't have hypertension, but unfortunately, many, many people with obesity come in with elevated blood pressures.
Alyne: And obviously you put them on medication at that point, but that doesn't solve the larger problem, I assume.
Dr Joseph George: No, actually once I had them captive in my room, at least I have some time to go over with them, about the risks of having diabetes. Particularly when people come in at a young age with obesity, make them aware that should they develop diabetes early in life and obesity is a driver for one to develop diabetes, and if they live a long enough lifespan, they have allowed that much time to develop the complications from diabetes, which are not very good.
Alyne: So let's talk about what you do about it. And as you, as a doctor, what methods do you recommend? Have you watched a lot of people try to turn their life around and lose some weight?
Dr Joseph George: I think, first of all, it's making them aware of what the problem is and what the risk is of having obesity, which really is considered to be a chronic disease. It's reminding them that the main causes for obesity is lifestyle, which is primarily eating large portions and not exercising on a regular basis.
So one of my goals when they are in the office is to have them try to change their mindset, have an attitude, if you will, that stepping out of the office to make a commitment to themselves, that they're going to take charge of their health. And they're going to start with eating smaller portions at meal times and eliminating high carb diet of foods that are fried and then skipping out on snacks.
And the other thing that goes hand in hand with eating differently or eating healthy is committing oneself to a regular lifestyle of exercise. And I encourage them to start off at least 20 minutes a day, five days a week, and then gradually work up to 30 minutes. Remind them that, once they make that commitment to go on for that walk, when they sit down at the table later on, they've subconsciously reminded themselves that they're taking their health in their hands and changing paths for their good.
Alyne: And during that walk, should that be a brisk walk?
Dr Joseph George: Well, generally, I tell them to be comfortable with what they’re doing. I generally tell them to go off with a stroll and enjoy the walk and then gradually build up speed. And if they feel a little short of breath or winded or they have any symptoms, to back off. I tell them to generally walk a few hours after eating, not right after eating or before eating.
Alyne: Now what about medications? I know, for example, there's some kind of pill you could take that supposedly reduces the amount of fat in the food because you can't process it.
Dr Joseph George: Yeah. I have not looked too deeply into that because know that America always looked for a quick fix. I think the secret to losing weight essentially for all of us is to just change the way we eat, how much we eat and get into a healthy lifestyle of walking regularly.
Unfortunately, most of the pills that we've had, had not had a good outcome. We had side effects with valvular heart disease, developing as a result of some of the appetite suppressants. So, I'm not an expert in that field as far as medications.
Alyne: It sounds like you think that mindset is really the big difference, that the changing how you think about food and drinking and exercising is the big deal.
Dr Joseph George: Yeah, very much. I mean, I've seen and I've had people go through bariatric surgery and I've seen, unfortunately, you know, they lost 300 pounds where they started off with 350, 300 pounds and lost a hundred pounds and I've seen them go right back to it again because they didn't change their eating habits. And so they eat more frequently small amounts, and it's disappointing to see that they're back where they started after having gone through all of that.
Alyne: And do you recommend that someone get a life coach or some sort of person to help them with this journey to lose weight?
Dr Joseph George: I do. Quite often, it should be the spouses, the partners they live with. That makes a big difference because if one partner's engaged, it does help the other ones psychologically to do that. There are weight watcher programs that can at least get them to jump start and on the track to a healthy lifestyle.
Alyne: And I guess my final question would be that many of the markers you see that can be such a dangerous sign things are coming, that when someone loses weight, those really do clear up.
Dr Joseph George: That's true. We do see people's blood pressure come down to normal where we don't have to use any medication in those who became hypertensive when they had the obesity. And we do see that people's blood sugars declined to normal range when they are no longer obese if the obesity was triggered by excessive food consumption. I do see that.
Alyne: And I'm assuming that their chances of a heart attack go down as well.
Dr Joseph George: That's correct.
Alyne: Anything else you'd like to add, sir?
Dr Joseph George: I just want to encourage people to get started. I know there's an old saying that says, "Long distance begins with one or two steps." But I feel that there should be a sense of urgency that we really hit the ground running each individual as they walk, once they are aware of what the problem is and what the complications are, to make that change so that they can live longer and enjoy their lives or enjoy their retirement.
Alyne: Well, thank you so very much for your advice today. It sounds like with a change of heart that this is really possible. Thank you.
Dr Joseph George: It is. Thank you.
Alyne: Cardiologist, Dr. Joseph Anthony George is an attending physician at Montefiore St. Luke's Cornwall. I'm Alyne Ellis. Thank you for listening to this episode of our Health Track podcast. Head on over to our website at montefioreslc.org to get connected to one of our providers.
And if you found this podcast helpful, please share it on your social channels and be sure to check back in soon for the next podcast. Thank you for listening.
Obesity
Alyne: What is the clinical definition of obesity and why should each of us know and care about whether we're just a little overweight or far heavier than we should be? Here to explain is cardiologist, Dr. Joseph Anthony George, an attending physician at Montefiore's St. Luke's Cornwall. I'm Alyne Ellis. Welcome to our Health Track podcast. Welcome, Dr. George.
Dr Joseph George: Thank you. Thank you for inviting me.
Alyne: Let's begin with the distinction between being overweight and being obese. What's the difference?
Dr Joseph George: It's defined primarily by the body mass index. So a body mass index or a BMI as it's called, 25 and 29 would be overweight and obesity would be a BMI of greater than 30.
Alyne: And how is that measured? How do you find that out?
Dr Joseph George: Okay. So the BMI is measured by some mathematical calculation. Basically, the body weight in kilograms divided by the square of the height in meters. There are apps available to quickly calculate that, and that gives you a BMI. Another way would be to measure the circumference of the waistline. Circumference of greater than 40 inches in a man would consider that individual having obesity. And a conference of 35 inches in a woman would also render her having obesity
Alyne: And when we measure ourselves, is it right above the hip line or a little higher if we're going to do it ourselves?
Dr Joseph George: Above the hip line.
Alyne: So, right where that hip bone ends is where you would put the tape measure, straight across and around where your belly button is, I guess.
Dr Joseph George: That's correct.
Alyne: So tell me, I've heard over and over the belly fat is really dangerous. And why is that?
Dr Joseph George: it leads to a greater increase in risk of developing diabetes, also developing coronary artery disease and subsequently heart attacks. You know, one of the things that we see even in the sports is that we have this culture where we have the lineman weighing 350, 400 pounds and they can sprint very short distances very rapidly, but you see this, you know, rubber fat in front of them on their bodies. And, unfortunately when they leave their sports, early in life when they retire, they're left in the red zone without a coach to encourage them how to get rid of it because their life expectancy is actually shortened carrying all that weight.
Alyne: That was one of the things I was thinking about is that as you follow or read studies about people who are obese, what is the percentage of it shortening your lifespan by a decade or a few years, or, what?
Dr Joseph George: So it generally depends on how much obesity one has. So a body mass index of greater than 40, the lifespan is reduced by eight to 12 years. And a BMI of 30 to 34 shortens it by about four years. That's a rough estimate. Yeah, so obesity does have an impact on one's life expectancy.
Alyne: And if I were to lose that fat, does that mean that my life might be lengthened?
Dr Joseph George: Yes.
Alyne: So I've also heard that people who have internal fat, which you can't see, but also around your middle, that that can be dangerous. Maybe you could tell us about that.
Dr Joseph George: Yeah, that's a difficult measurement to obtain short of doing a CAT scan of the abdomen, where one can uncover a lot of internal fats. And that also is considered to be a detrimental to one's health.
Alyne: And is it possible to be obese and healthy at all? I mean, you mentioned this lineman running and, at that point, I guess, because he's exercising he's in at least some good shape. What about that?
Dr Joseph George: Well, to be obese and to be healthy are actually contradictory. You know, recently I saw a photograph, it was titled young, healthy man dies due to COVID. And, looking at the picture, he had obvious obesity and obesity is considered a single risk factor of succumbing to COVID-19. The problem with obesity is that it leads to hypertension, diabetes and coronary artery disease, which carry their complications earlier in life.
Alyne: So as an internal medicine specialist and as well as a cardiologist, what markers do you also look for when you see someone coming in who is obese? Do you run special tests to find out how much damage has been done?
Dr Joseph George: One of the things I will do is to check to see if they have already developed diabetes or if they are pre-diabetics. We will also check their lipid levels to see whether their lipid levels are on the high side. And if they have high blood pressure, we measure their blood pressure to ensure that they don't have hypertension, but unfortunately, many, many people with obesity come in with elevated blood pressures.
Alyne: And obviously you put them on medication at that point, but that doesn't solve the larger problem, I assume.
Dr Joseph George: No, actually once I had them captive in my room, at least I have some time to go over with them, about the risks of having diabetes. Particularly when people come in at a young age with obesity, make them aware that should they develop diabetes early in life and obesity is a driver for one to develop diabetes, and if they live a long enough lifespan, they have allowed that much time to develop the complications from diabetes, which are not very good.
Alyne: So let's talk about what you do about it. And as you, as a doctor, what methods do you recommend? Have you watched a lot of people try to turn their life around and lose some weight?
Dr Joseph George: I think, first of all, it's making them aware of what the problem is and what the risk is of having obesity, which really is considered to be a chronic disease. It's reminding them that the main causes for obesity is lifestyle, which is primarily eating large portions and not exercising on a regular basis.
So one of my goals when they are in the office is to have them try to change their mindset, have an attitude, if you will, that stepping out of the office to make a commitment to themselves, that they're going to take charge of their health. And they're going to start with eating smaller portions at meal times and eliminating high carb diet of foods that are fried and then skipping out on snacks.
And the other thing that goes hand in hand with eating differently or eating healthy is committing oneself to a regular lifestyle of exercise. And I encourage them to start off at least 20 minutes a day, five days a week, and then gradually work up to 30 minutes. Remind them that, once they make that commitment to go on for that walk, when they sit down at the table later on, they've subconsciously reminded themselves that they're taking their health in their hands and changing paths for their good.
Alyne: And during that walk, should that be a brisk walk?
Dr Joseph George: Well, generally, I tell them to be comfortable with what they’re doing. I generally tell them to go off with a stroll and enjoy the walk and then gradually build up speed. And if they feel a little short of breath or winded or they have any symptoms, to back off. I tell them to generally walk a few hours after eating, not right after eating or before eating.
Alyne: Now what about medications? I know, for example, there's some kind of pill you could take that supposedly reduces the amount of fat in the food because you can't process it.
Dr Joseph George: Yeah. I have not looked too deeply into that because know that America always looked for a quick fix. I think the secret to losing weight essentially for all of us is to just change the way we eat, how much we eat and get into a healthy lifestyle of walking regularly.
Unfortunately, most of the pills that we've had, had not had a good outcome. We had side effects with valvular heart disease, developing as a result of some of the appetite suppressants. So, I'm not an expert in that field as far as medications.
Alyne: It sounds like you think that mindset is really the big difference, that the changing how you think about food and drinking and exercising is the big deal.
Dr Joseph George: Yeah, very much. I mean, I've seen and I've had people go through bariatric surgery and I've seen, unfortunately, you know, they lost 300 pounds where they started off with 350, 300 pounds and lost a hundred pounds and I've seen them go right back to it again because they didn't change their eating habits. And so they eat more frequently small amounts, and it's disappointing to see that they're back where they started after having gone through all of that.
Alyne: And do you recommend that someone get a life coach or some sort of person to help them with this journey to lose weight?
Dr Joseph George: I do. Quite often, it should be the spouses, the partners they live with. That makes a big difference because if one partner's engaged, it does help the other ones psychologically to do that. There are weight watcher programs that can at least get them to jump start and on the track to a healthy lifestyle.
Alyne: And I guess my final question would be that many of the markers you see that can be such a dangerous sign things are coming, that when someone loses weight, those really do clear up.
Dr Joseph George: That's true. We do see people's blood pressure come down to normal where we don't have to use any medication in those who became hypertensive when they had the obesity. And we do see that people's blood sugars declined to normal range when they are no longer obese if the obesity was triggered by excessive food consumption. I do see that.
Alyne: And I'm assuming that their chances of a heart attack go down as well.
Dr Joseph George: That's correct.
Alyne: Anything else you'd like to add, sir?
Dr Joseph George: I just want to encourage people to get started. I know there's an old saying that says, "Long distance begins with one or two steps." But I feel that there should be a sense of urgency that we really hit the ground running each individual as they walk, once they are aware of what the problem is and what the complications are, to make that change so that they can live longer and enjoy their lives or enjoy their retirement.
Alyne: Well, thank you so very much for your advice today. It sounds like with a change of heart that this is really possible. Thank you.
Dr Joseph George: It is. Thank you.
Alyne: Cardiologist, Dr. Joseph Anthony George is an attending physician at Montefiore St. Luke's Cornwall. I'm Alyne Ellis. Thank you for listening to this episode of our Health Track podcast. Head on over to our website at montefioreslc.org to get connected to one of our providers.
And if you found this podcast helpful, please share it on your social channels and be sure to check back in soon for the next podcast. Thank you for listening.