Transcription:

Scott Webb: We know that obesity is a disease, one that may require surgery and dramatic lifestyle changes to overcome. I'm joined today by Dr. Joanna Oppenheim. She's the director of the LAMP Program, Lifestyle and Metabolic Program at Salinas Valley Health, and she's gonna tell us how she and the program work to help folks overcome obesity and other health issues. This is Ask the Experts, the podcast from Salinas Valley Health. I'm Scott Webb. Doctor thanks so much for your time today. It's gonna be an educational thing for me. I'm gonna learn more about the LAMP program and listeners will as well. So as we get rolling here, tell us about the Lifestyle and Metabolic Program and why it was created.

Dr. Joanna Oppenheim: So in about 2018, I was getting sort of frustrated about where everything was going and I was feeling like I just didn't have enough time to talk to my patients about diet, exercise, sleep, and how they could improve lifestyle issues that they were experiencing in their own life to reduce the risk or treat chronic issues. Fortunately, the hospital was very receptive when I asked them if I could start a wellness class. And I designed this program, which turned out to be three 90 minute session to address scientifically backed nutrition advice, exercise, sleep, stress management habits, and we even did a cooking demonstration. And this started in 2019. It was fun for me because I got to.

Scott Webb: I'm sure.

Dr. Joanna Oppenheim: Yeah, I got to interact with patients outside of the clinical setting and really start having discussions about what their life was like, what questions they had, and sort of more real life things. And during the course of 2019, it was great, but one thing that really came up was a lot of patients would say to me, Hey, this is a great class. I've implemented some of these changes, but now what? And most of them were asking for help for weight loss. I would say almost everybody. And then I realized, well, I don't know enough about it. I said, I know the basics. And it's interesting because I finished my training in 2001, and at that time, obesity wasn't even considered a disease.

And so my training in obesity was minimal. And so in a way, I used the 2020 pandemic year to learn more about it. And I thought, you know what? Patients are asking for this. I don't know enough about it. And it really piqued my interest. And so I spent 2020 learning a lot more about obesity medicine and then in early 2021 actually got board certified in obesity medicine and I started running sort of this half day clinic out of my office to help people specifically with obesity as you can imagine, it's not a very simple problem to fix, and I think that's one of the issues that I had, and I was recognizing in myself that my training.

I was really taught kind of just tell your patients to exercise more and eat less and it's really their problem and they should be able to fix it on their own. And don't waste resources on that. What's become. Painfully clear to me is that obesity drives so many of the diseases that we're supposed to be treating in the office and without addressing obesity, it really is just trying to put sort of a plug a hole in a dam without fixing where the problem's coming from.

Scott Webb: While we're talking about obesity, let's talk more about that because you're so right, it's only within the last decade or two maybe, where folks and medical professionals and everybody involved seems to recognize now that obesity is in fact a disease. So maybe we can just talk more about that. Like what is obesity? How does it affect the body as you're saying it is, for all intents and purposes, for many, it is sort of the root cause of so many of their other issues. Right?

Dr. Joanna Oppenheim: Absolutely. So the World Health Organization, their definition on their website is as follows. Overweight and obesity are defined as abnormal or excessive fat accumulation that presents a risk to health. The way I look at obesity, I see it more of a chronic relapsing disease, secondary to multiple causes resulting in abnormal functioning of the mind and body. And these causes can be genetically related, abnormal hormonal signaling behaviors. And these are learned behaviors, whether consciously or subconsciously, even from when you were a kid, that can affect how you live your life, which can promote obesity as an adult.

Quality and types of food that are available, physical activity, you know, your job, are you working swing shift that will impact whether or not you are obese or not. Sleep, all these things play a role and so when people, , gain weight, a whole host of things can happen, unfortunately, and I kind of put them into two buckets. One is sort of the actual physical manifestation of just carrying extra weight, and the other one is metabolic.

Scott Webb: How does this process work? Do patients need a referral from their primary to join the program, or can they just walk in and say, I'm here?

Dr. Joanna Oppenheim: Right now we're doing it with referrals from their primary care provider or a subspecialist that they see within the Salinas Valley system. Just because we need to track them. And unfortunately, we're a small clinic. We're starting up. There's not a lot of resources. The need is greater than the supply at this time. We will grow, but we really want to make sure that patients are ready for the program. So one of the things we do is when you get referred by your physician. We will send out a 13 page questionnaire that we have all patients fill out before we will even schedule an appointment. And once we get that back, we schedule your intake appointment.

When patients come in, part of their intake appointment is checking their blood pressure, their waist circumference, their neck circumference. We get labs if they haven't already been done. We take a detailed history and physical. And we start really drilling down into where the problems are. When I started this process, it was very interesting. Actually, my goal was to sort of set out this pathway that everybody could use that would be the same. And what I really began to understand when I worked with patients specifically for obesity was how individual every patient is.

And every patient has different needs, and you really have to work with patients where they're at and try and figure out where you're gonna get your biggest bang for the buck and start the process going. And expectation setting is really important. Yeah.

Scott Webb: I'm sure, and for folks who plateau and they need bariatric surgery, what's that process like? What are the benefits and maybe is there anybody who isn't a good candidate for weight loss surgery?

Dr. Joanna Oppenheim: Sure. So when you come into our program, our team consists of a health coach, a registered dietician. We have access to psychologists and also a weight loss surgeon. So bariatric surgery or weight loss surgery is indicated currently for patients with a body mass index greater than 40, or a body mass index greater than 35 with a comorbid condition. And comorbid conditions can be anything ranging from obstruct, sleep apnea, diabetes, high blood pressure, fatty liver osteoarthritis, and some other ones as well.

We evaluate our patients very carefully for bariatric surgery. Weight loss surgery, when you look at the data, is one of the best things you can do for long-term weight loss, but success requires a lot of behavioral changes. I will say this, when I initially was training and heard about weight loss surgery. I wasn't really a big fan. I didn't really know the data, and I probably think we didn't have it 20 years ago. And surgical techniques have gotten so much better that it really is a viable tool that we should be offering our patients who qualify. But patients also have to buy into it.

And I tell patients, look, do everything you can, because I want to be really careful here when I say this. I can have patients that are following a meal plan, exercising, sleeping, doing everything right, and they still can't lose weight or they've lost a significant amount of weight and they can't lose anymore. So it's really important for patients to understand that you can be doing everything right and still suffer with obesity.

Scott Webb: Yeah, I think you're so right and love hearing about the program, everything you're trying to do to customize and really individualize the. And everything that you're offering patients. So thank you so much and you stay well.

Dr. Joanna Oppenheim: You're so welcome. Thank you.

Scott Webb: And for more information on the lifestyle and metabolic program, call 831-759-3057. And if you found this podcast to be helpful, please be sure to tell a friend, neighbor, or family member and subscribe, rate, and review this podcast and check out the entire podcast library For additional topics of interest. This is Ask the Experts from Salinas Valley Health. I'm Scott Webb. Stay well, and we'll talk again next time.