Transcription:
Medical Weight Management Program at UAMS

Evo Terra (Host): Today, we're learning about the medical weight management program at UAMS. Joining us today is Dr. Dinesh Edem, endocrinologist and Director of the Medical Weight Management Clinic. This is UAMS Health Talk, the podcast from the University of Arkansas for Medical Sciences. I'm Evo Terra. Dr. Edem, welcome to the show.

Dr. Dinesh Edem: Thanks so much, Evo. Thanks for having me.

Evo Terra (Host): I'd like to start this by asking you to clarify, if you will, the difference between weight management and weight loss. They sound the same, but I know they're different.

Dr. Dinesh Edem: Yeah. That's a great question, Evo. And often, many people can get confused. When someone talks about weight loss, it seems like you only have to work hard until you lose weight, then you can give up after that. And you've known many people regain that weight once they're off a so-called diet. But the term weight management is much more broad and comprehensive as it involves like the initial weight loss, then weight maintenance or further weight loss, and then managing weight regain. So it involves the understanding of how to lose weight and keep it off for a long time.

Evo Terra (Host): And that's ultimately the goal because you're right, I've been on many of diets and I can shed the pounds quickly and they seem to come back just as quickly, which is always a challenge. Now I know, sir, that you're an endocrinologist. And so perhaps you can help us understand the relationship between our endocrine system and our weight.

Dr. Dinesh Edem: Yes. As endocrinologists, we are supposed to learn nutrition, metabolism and signs of how hormones work and that's part of our job. We also learn about energy balance, resting energy expenditure, and how many daily calories are needed to maintain, lose, or gain weight. So for example, if your body needs like 2000 calories to maintain your weight, and if you eat 1500 calories on an average, then you are in a calorie deficit and then you lose weight. The more the calorie deficit, more the weight loss. Not only that, we as endocrinologists also deal with secondary or hormonal causes of weight gain, like low thyroid, high cortisol or steroid levels, high growth hormone or low testosterone levels. But, you know, these are rare causes of weight gain, and many people think that these are more common than they actually are.

According to Mayo Clinic Precision Medicine Lab, they found out that there are four body types which lead to weight gain. So number one is hungry stomach where you don't feel full, you have to eat more. And next is a hungry brain where you have cravings, even though your stomach is full, so you end up eating more. Next are the emotional eaters who tend to eat in response to any kind of stress as they're coping mechanisms. And next, finally, there are slow metabolizers where you need to be on an even stricter calorie deficit than other people to lose weight. So there are these four body types. One person can have more than one body type. So there are different treatments available for different body types, and we should pair those treatments according to the body types.

Evo Terra (Host): Excellent insight. I mean, listening to you list off those things, I'm pretty sure I'm a hungry brain. I never really am hungry. But if somebody says, "Would you like some popcorn?" Sure, I'll take some popcorn, and I probably shouldn't do that.

Dr. Dinesh Edem: Right. So, you know, off the record, ideally we should eat when we are hungry and stop when we are full. But these days, because of availability of foods, because of our tongue liking certain foods, we tend to overeat even when we are not hungry. Plus when we are stressed out, we are not thinking too much. We just want to eat something. And we eventually eat a lot of foods that we like, so that's what happens. The nature is set against us. The biology is against us.

Evo Terra (Host): Pesky biology. Well, on this topic, would you say that it's more important for us to pay attention to what we eat or is it more important to spend time thinking about how much we eat?

Dr. Dinesh Edem: You see how much to eat and what to eat is a question that I get frequently. But let me tell you, there is no single diet that is better than the others. Multiple randomized control studies have shown there's no diet better than the other. The only diet plan that works is something which is low in calorie and the one which we can do for a prolonged period of time, so kind of sustainable eating. There are many fad diets and commercial diets in the market, which work in the highly motivated patients for few weeks to months. And then, they go off it and they usually gain the weight back. So I don't recommend these fad diets, like the keto diet, Mediterranean diet, South Beach diet. Number one, they're costly. They're hard to do just by themselves. So it's ideal to actually follow a diet given by a physician who knows what they're doing and do it for a prolonged period of time. So most of my patients, they eat a low carbohydrate diet as they have diabetes and low carb reduces their sugars. But ideally, you should eat a diet, which is high end protein, high fiber, they're filling foods, which are low in simple processed carbs and fat, which should be kind of a balanced diet, which has been missing from many restaurants these days.

Evo Terra (Host): Yes. It certainly can be. And you're right about that, I understand that the diet will get the weight off, but it's more about maintaining and continuing to eat that way so you can keep it off. You brought up endocrine issues, diabetes. So maybe you could tell us for a moment what makes weight management difficult for patients who have diabetes? And maybe you could answer that for both for the type 1 and type 2 of diabetes.

Dr. Dinesh Edem: You know, 12% of Americans have diabetes. That's a staggering amount of patients. Of all diabetes cases, type 2 patients are like 95% of all cases and type 1 are 5% of the cases. But both the patients in both these groups struggle with weight issues. In type 1, the weight increases if you eat more carbs and fats and take more insulin injections or use a pump, and then it makes you slowly grow and put on weight. So insulin makes you put on weight if you tend to eat more. So for these patients, we advise patients to reduce their carbs, calorie and insulin use and they lose weight. But for type 1, there are no weight loss medications indicated specifically for type 1, but they're indicated for type 2. But exercise is a great way to lose weight for any kind of diabetic as it keeps you in a calorie deficit, right? But in type 2 diabetes, in addition to exercise and diet changes, there are some medications which have been approved. But to answer your question with the same medications, like the Ozempic or Victoza, patients without diabetes lose more weight than with diabetes, which makes it harder to lose weight because diabetics are resistant to these medications sort of. But I have a lot of diabetics who lost a lot of weight and they're now diabetes-free and they're in remission as long as they're on a good diet.

Evo Terra (Host): And there's the good news. There's hope for everyone out there possibly. Great. So that was diabetes. Let's talk about thyroid issues. What are the challenges for patients with thyroid issues and how difficult is it for them to keep the weight off?

Dr. Dinesh Edem: Yes. So low thyroid hormones do slow down your metabolism and it makes it harder to be in a calorie deficit in such cases, as you have to eat even less to lose some weight. When you are frankly hypothyroid, you do gain weight, because the body's like shutting down, slowing down and you're packing on all these calories. But we want their thyroid levels or we call TSH, thyroid-stimulating hormone levels to be in the normal range. But thyroid disease as a cause of weight gain is usually overestimated in the general population. And when we check the thyroid labs, it's fine, but the patients still think it's the thyroid. But I think we have to be open-minded and explore other possible causes of weight gain

Evo Terra (Host): Such as?

Dr. Dinesh Edem: Increased calorie intake, overeating, excessive stress leading to overeating, underestimating the calories that someone is eating and reduction in the exercise, not walking, not being active as much. All these, they pack on the weight.

Evo Terra (Host): Yeah. Makes sense. It all goes back to math, doesn't it? Put in less calories and your body's burning you'll lose some weight there.

Dr. Dinesh Edem: Exactly. It's hard. It's not easy.

Evo Terra (Host): No. No, it's not easy at all. Can you tell me a little bit about the weight management program you're running at UAMS? Let's talk about the patient specifically. Who is a good candidate to be working with your weight management clinic.

Dr. Dinesh Edem: Yeah, thanks for asking. Our medical weight management clinic is located in Financial Centre Parkway. It's in West Little Rock. It includes myself, Dinesh Edem, and I'm specially trained and certified in obesity management. We also have an awesome APRN. Her name is Rebecca Amick and she's getting additional certification and training in obesity medicine. We also have a dedicated weight management dietician. Her name is Ashtyn Knowles who helps us and the patients be accountable with their diet and eating plan. So we see patients who have BMI more than 30 and who are ready and motivated to lose weight by changing their eating habits, increasing their physical and starting any weight loss medicines as needed based on the insurance coverage. And like the last resort, we can refer them to bariatric surgery and we collaborate with Baptist Bariatric Surgeons, and we refer patients there.

So the good candidate is anyone who has BMI more than 30 and any weight-related illnesses like hypertension, diabetes, high cholesterol, reflux disease, osteoarthritis, sleep apnea, heart attack, stroke, fatty liver, gallstones, PCOS and any weight-related issues. So if someone wants to come and see us, all they have to do is ask their doctor if they have any weight-related diseases. If they do, they can refer to our medical weight management clinic, where we can evaluate and suggest any treatment. So basically weight management is not about the diet or the exercise. It's actually about the mindset, the motivation, the willingness to lose weight, like knowing actually having the knowledge why you need to lose the weight, what happens if you don't lose the weight and how can I lose it and how can I keep it off. It's that, right? Knowing what diet. I can give you the best diet, but, you know, if somebody doesn't realize it, they won't be able to follow it. But I think this is pretty decent. With this information when they come in, I'm going to tell them all these behavioral tidbits.

Evo Terra (Host): Excellent. Well, Dr. Edem, thank you for all of the great information today.

Dr. Dinesh Edem: Sure. No, pleasure is mine. Thank you for having me, Evo.

Evo Terra (Host): And once again, that was Dr. Dinesh Edem, endocrinologist and Director of the Medical Weight Management Clinic at the University of Arkansas for Medical Science. To make an appointment, call 501-614-2340. Thanks for checking out this episode of UAMS Health Talk. For more information on this topic and to access the resources mentioned, please visit uamhealth.com.

If you found this podcast to be helpful, please share it on your social channels and be sure to check out our entire podcast library for topics of interest to you. My name is Evo Terra. Thanks so much for listening, and we'll talk next time.