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Dr. Adrienne Youdim Knows Why Hunger Is So Much Bigger Than Food · Get Real with Jim Weiss

• 0:00
  Speaker 1: Hey, Jim, how are.
• 0:01
  Speaker 2: You say, I'm excited to talk about our next guest
• 0:06
  Speaker 2: with you.
• 0:08
  Speaker 1: Game?
• 0:09
  Speaker 2: Yeah, the doane of diet so you work with so
• 0:13
  Speaker 2: much more. Yeah, I mean I've done lots of different
• 0:16
  Speaker 2: things with doctor Udine, but she came into my life
• 0:21
  Speaker 2: as I was exploring different ways to take the weight
• 0:25
  Speaker 2: off in a healthy way. And really, you know, what's
• 0:28
  Speaker 2: I think unique about her is long before kind of
• 0:32
  Speaker 2: weight loss medicine was a thing, Adrian was working at
• 0:37
  Speaker 2: it at Cedar SINAI. I think the thing that she
• 0:41
  Speaker 2: does is pretty holistic weight management, and it's not just
• 0:46
  Speaker 2: about finding a drug that works for you, but also
• 0:50
  Speaker 2: ensuring that that's all balanced out with the diet, the exercise,
• 0:55
  Speaker 2: the mental focus, the meditation in particul She's very keen
• 1:01
  Speaker 2: on that, and I find her to be a very
• 1:04
  Speaker 2: data driven, science based practitioner. So I know a lot
• 1:09
  Speaker 2: of people are getting their zet bound and ozembic through
• 1:14
  Speaker 2: hymns and hers and different ways. I just have found
• 1:18
  Speaker 2: her to be a really good coach and counselor. You know,
• 1:22
  Speaker 2: as I think about my weight loss, which you know
• 1:26
  Speaker 2: has gone on, It's been a long journey for me.
• 1:29
  Speaker 2: But I would say this is I'm in the best
• 1:31
  Speaker 2: sort of shape and health with her support and help
• 1:34
  Speaker 2: than I've ever been.
• 1:35
  Speaker 3: That's amazing. Yeah, she was saying that she came on
• 1:38
  Speaker 3: the scenemen it was just her and Jenny Craig. It
• 1:40
  Speaker 3: was like, you know, that's it.
• 1:42
  Speaker 2: Yeah, that's a big takeaway because I think at that time,
• 1:46
  Speaker 2: you know, your hospital staff, your you know, medical staff
• 1:50
  Speaker 2: didn't really look at you know, maybe you did a
• 1:54
  Speaker 2: bariatric surgery or something, but nobody did any kind of
• 1:57
  Speaker 2: follow up. You know, there really wasn't a full dedicated practice.
• 2:03
  Speaker 3: When I was researching her for our episode, I was
• 2:05
  Speaker 3: really struck by the fact that she thinks so much
• 2:08
  Speaker 3: of weight, of our relationship to weight has to do
• 2:11
  Speaker 3: with our story, our mental health, and our trauma, and
• 2:14
  Speaker 3: working through that in a way helped shed the weight.
• 2:17
  Speaker 3: I was curious if that's something she also brings into
• 2:20
  Speaker 3: her practice with you.
• 2:21
  Speaker 2: She did, and does you know, Look, it's how much
• 2:25
  Speaker 2: food you put in at the end of the day.
• 2:27
  Speaker 2: I mean, you can exercise a lot and do all
• 2:29
  Speaker 2: the rest, but it's a calories in calories out world
• 2:33
  Speaker 2: and she knows that. But with the proliferation of the
• 2:36
  Speaker 2: GLP ones. You know, she wasn't throwing me right on
• 2:39
  Speaker 2: that right away anyway, but it was good to have.
• 2:44
  Speaker 2: You know, we've tried different things over the years. It
• 2:47
  Speaker 2: was interesting to get her take on that holistic approach,
• 2:51
  Speaker 2: from supplements to even the mental understanding that there were
• 2:58
  Speaker 2: probably things in my life that caused me to go there.
• 3:03
  Speaker 2: I don't think it was any one trauma per se.
• 3:05
  Speaker 2: I always say, you know, I got married, had two
• 3:10
  Speaker 2: kids quickly, and started a business, and moved to the
• 3:13
  Speaker 2: suburb and bought a house for the first time, all
• 3:16
  Speaker 2: at the same time. But she's helped a lot of people,
• 3:20
  Speaker 2: and I think, you know, this concept of hungry for more.
• 3:23
  Speaker 2: You know, we know that overweight is based on a
• 3:28
  Speaker 2: lot of things. And it's not just because you like
• 3:31
  Speaker 2: food and you like to eat, you know, all of
• 3:33
  Speaker 2: us do. But what makes it an obsession?
• 3:37
  Speaker 3: Even without GLP ones, how do we kind of address
• 3:39
  Speaker 3: or hear the food noise for long enough to stop
• 3:42
  Speaker 3: ourselves from going to the pantry?
• 3:44
  Speaker 2: Yeah, returning the tables Adrian Eugene today. Yeah, she's not
• 3:51
  Speaker 2: going to ask you questions. I'm going to ask you questions.
• 3:53
  Speaker 2: So I'm so excited to have you on the show,
• 3:55
  Speaker 2: all the work we do together and all to help you.
• 4:00
  Speaker 2: Imparted to me on weight loss journey over the last
• 4:03
  Speaker 2: couple of years, particularly as I navigated my wife's cancer
• 4:06
  Speaker 2: and while she lost weight, I gained weight. You know,
• 4:09
  Speaker 2: in the caregiving process. I was talking to people about
• 4:12
  Speaker 2: how that happens as a caregiver, kind of throw yourself
• 4:16
  Speaker 2: out the window a little bit, because no one's caregiving
• 4:18
  Speaker 2: the caregiver. But enough about that, and I just thought
• 4:21
  Speaker 2: i'd start out because I think this is going to
• 4:24
  Speaker 2: be a real interesting part. Is what's your origin story
• 4:28
  Speaker 2: and how did you build your practice? How did you
• 4:31
  Speaker 2: get here?
• 4:32
  Speaker 4: So many ways to answer that, I'll give you, like
• 4:35
  Speaker 4: the skinny on me personally, I am first generation immigrant
• 4:40
  Speaker 4: of Iranian Jews. My parents left Iran before the revolution,
• 4:46
  Speaker 4: Unlike much of my family who fled religious persecution after
• 4:50
  Speaker 4: the revolution. My father basically left Iran when he was
• 4:54
  Speaker 4: eleven for education and then went back to marry my mom.
• 5:00
  Speaker 4: You know, it's very much a part of my person
• 5:03
  Speaker 4: the side of me that is my father, very driven, very.
• 5:07
  Speaker 1: Much respectful of education.
• 5:11
  Speaker 4: And then the mom's side of me, which is really
• 5:14
  Speaker 4: grounded in Persian Jewish values, caregiving, care taking, nourishing service.
• 5:22
  Speaker 4: And I really think the work that I do as
• 5:24
  Speaker 4: an ob City Medicine specialists really embodies.
• 5:28
  Speaker 1: All of that.
• 5:29
  Speaker 4: It wraps up the knowledge base. This is an area,
• 5:34
  Speaker 4: as you know, of medicine that is rapidly evolving and
• 5:39
  Speaker 4: is grounded very much in science, and it's something that
• 5:44
  Speaker 4: is very tender, and so we have to be as physicians.
• 5:48
  Speaker 4: I think mindful of how much gets wrapped up in
• 5:53
  Speaker 4: people's body weight, their image of themselves, their self perception,
• 5:58
  Speaker 4: how that impacts their relationships, how they act.
• 6:02
  Speaker 1: Out there in the world.
• 6:04
  Speaker 4: So to then kind of fast forward to how I
• 6:07
  Speaker 4: got into ob City Medicine. I was slated for a
• 6:10
  Speaker 4: very different professional journey. I actually decided in the middle
• 6:15
  Speaker 4: of residency. I was married for four years already and
• 6:18
  Speaker 4: I decided to have a child, and that threw me
• 6:22
  Speaker 4: off the plan. Trajectory of being a GI fellow at
• 6:27
  Speaker 4: County Hospital at usc Q three, being on call every
• 6:31
  Speaker 4: third night was not palatable. So my chairman gave me
• 6:36
  Speaker 4: a year to explore other areas of medicine, and I
• 6:39
  Speaker 4: stumbled upon ob City medicine. Believe it or not, at
• 6:42
  Speaker 4: that time, I had gotten zero education in nutrition, obesity medicine,
• 6:49
  Speaker 4: the physiology and the science behind it, and I found
• 6:53
  Speaker 4: it fascinating. At Cedar Sinai, where I was a resident,
• 6:57
  Speaker 4: we had a bariatric surgery program. It was very wrong,
• 7:00
  Speaker 4: and then we had this little side show. It was
• 7:03
  Speaker 4: like a meal replacement program that operated on weekends.
• 7:08
  Speaker 1: It was staffed by fellows.
• 7:10
  Speaker 4: It was really like not a not a robust medical
• 7:14
  Speaker 4: weight loss program, to say it gingerly, and so I
• 7:19
  Speaker 4: took this concept to my chairman as a resident, that
• 7:22
  Speaker 4: perhaps we should have a more comprehensive program. Long story short.
• 7:28
  Speaker 4: He told me to write a business plan, which with
• 7:30
  Speaker 4: the help of Google I did, and then I was
• 7:33
  Speaker 4: named as the co director of the Center for Weight
• 7:35
  Speaker 4: Loss at Cedar Sinai the year I came out of training,
• 7:38
  Speaker 4: and it's been my passion ever since.
• 7:41
  Speaker 2: What was the hot thing then when you came out.
• 7:43
  Speaker 2: I mean, we didn't have glps, right.
• 7:45
  Speaker 4: There was nothing hot. It was me and Jenny Craig
• 7:50
  Speaker 4: and so trying to teach my colleagues that this was
• 7:54
  Speaker 4: actually a medical field with science, and that there was
• 7:58
  Speaker 4: a reason beyond van and cosmetics that we should engage
• 8:03
  Speaker 4: in this. I did grand rounds CMEs education. I mean
• 8:09
  Speaker 4: I was constantly educating my colleagues because I really had
• 8:14
  Speaker 4: to prove and substantiate in a way that this was
• 8:19
  Speaker 4: worth our attention as physicians.
• 8:23
  Speaker 2: Right, it's really I mean, you know, at that time
• 8:26
  Speaker 2: and even up until say five years ago, these things
• 8:29
  Speaker 2: were not the norm or the option. Any stories stand
• 8:33
  Speaker 2: out because I mean there's these shows like My six
• 8:36
  Speaker 2: hundred Pound Life and My thousand Pound Sister. Were you
• 8:40
  Speaker 2: treating people like that or really just the more rank
• 8:43
  Speaker 2: and file? Because I was going to ask, you're in LA,
• 8:46
  Speaker 2: so you're probably treating some noteworthy famous people. Are they
• 8:50
  Speaker 2: just like us? Are they just like us regular people?
• 8:53
  Speaker 4: I've always been very conservative and very I want to
• 8:59
  Speaker 4: say by the book. It's not so much being by
• 9:02
  Speaker 4: the book. It's a matter of always recognizing that this
• 9:07
  Speaker 4: is an important problem and also really respecting the patient.
• 9:14
  Speaker 4: And so over the years, yes, I practiced in Beverly Hills,
• 9:17
  Speaker 4: and over the years, I've been approached by reality TV,
• 9:21
  Speaker 4: I've been approached by supplement companies. The offers that I
• 9:25
  Speaker 4: have deferred. My husband, who's a plastic surgeon, was like.
• 9:30
  Speaker 1: I'll do it.
• 9:32
  Speaker 4: But I was always a hard no on anything that
• 9:36
  Speaker 4: I thought would minimize the integrity of my patients. And
• 9:42
  Speaker 4: so back then, I was doing one on one counseling.
• 9:45
  Speaker 4: I was offering the medications that were available. Those are still,
• 9:49
  Speaker 4: you know, viable options for some. Of course, they're not
• 9:51
  Speaker 4: nearly as effective as what we have now. But I
• 9:54
  Speaker 4: was doing much of what I am doing now, which
• 9:57
  Speaker 4: was really mindful and tiv individualized care. Then not only
• 10:03
  Speaker 4: addressed the physical aspect of obesity, but I was also
• 10:09
  Speaker 4: slowly cultivating this kind of I don't know, I don't
• 10:13
  Speaker 4: love the word holistic, but okay, holistic side mind, body side,
• 10:18
  Speaker 4: and identifying what I came to call this emotional and
• 10:24
  Speaker 4: spiritual hunger. Because while I was helping suppress hunger with
• 10:28
  Speaker 4: whatever drug I had then or with diet plans, et cetera,
• 10:33
  Speaker 4: I also recognized that there was always this underlying hunger.
• 10:38
  Speaker 4: The patient came in and they were in a deadbeat
• 10:41
  Speaker 4: job or in a deadbeat relationship, and I'm telling you, Jim,
• 10:45
  Speaker 4: it sounded like it was like this nagging, nagging buzz
• 10:49
  Speaker 4: you know, that was so palpable to me in the
• 10:54
  Speaker 4: room that it got to the point that I felt
• 10:57
  Speaker 4: like I cannot close my eyes. It like, this is
• 11:01
  Speaker 4: part of the treatment plan, This is part of the
• 11:04
  Speaker 4: healing to acknowledge that we need science based medical treatment.
• 11:10
  Speaker 1: Here's the prescription. But also we.
• 11:13
  Speaker 4: Need to address this underlying emotional, spiritual hunger that is universal,
• 11:20
  Speaker 4: by the way, overweight or not, this is the human condition. Well,
• 11:24
  Speaker 4: do you.
• 11:25
  Speaker 2: See a difference between men and women or have you
• 11:28
  Speaker 2: seen a difference between how men's hunger shows up or
• 11:32
  Speaker 2: a woman's or when you say universe is all the
• 11:35
  Speaker 2: same or what are the conditions?
• 11:38
  Speaker 4: Yeah, it's interesting because there's so many more similarities. Even
• 11:42
  Speaker 4: in my own mind, I guess I had this bias that,
• 11:46
  Speaker 4: you know, women were more sensitive or maybe open minded
• 11:52
  Speaker 4: or more forthcoming. I actually recognize that it really was
• 11:58
  Speaker 4: the onus was on me to create a comfortable space
• 12:04
  Speaker 4: where these things could be discussed. And when they are discussed,
• 12:09
  Speaker 4: people actually want to be vulnerable, people actually want to
• 12:15
  Speaker 4: be acknowledged. And the hungers they are the same, hunger
• 12:21
  Speaker 4: for belonging, for validation, for purpose and meaning. And then
• 12:28
  Speaker 4: some of the ones that are just they're not maybe
• 12:30
  Speaker 4: as deep, hunger for sleep. That's one of the chapters
• 12:32
  Speaker 4: in my book, Hungry for More, because we know sleep
• 12:35
  Speaker 4: deprivation will create like misalignment in those very same hunger
• 12:40
  Speaker 4: hormones that we're manipulating with these drugs.
• 12:43
  Speaker 1: So on one hand.
• 12:45
  Speaker 4: You know, you could be giving a GLP one drug,
• 12:48
  Speaker 4: but then on the other hand, you're not sleeping, and
• 12:51
  Speaker 4: Grellin levels go up, and people actually who take validated
• 12:57
  Speaker 4: surveys show that they're hunger for highly palatable foods go up.
• 13:02
  Speaker 1: So you know, in my mind, when you finally take.
• 13:06
  Speaker 4: Away that noise, that physiological hunger noise, you open people
• 13:13
  Speaker 4: up to addressing that emotional or spiritual hunger. They're no
• 13:18
  Speaker 4: longer fighting and grappling with the physiology of it. And
• 13:23
  Speaker 4: now you can ask yourself, yes, like distracting with it exactly.
• 13:29
  Speaker 4: So now you can ask yourself, like, when I get
• 13:32
  Speaker 4: up at five pm and head over to the pantry,
• 13:36
  Speaker 4: when I'm clearly not hungry, what is it that I'm
• 13:39
  Speaker 4: hungry for? Like, maybe I need respite, Maybe I need
• 13:42
  Speaker 4: to go outside and get fresh air, Maybe I need
• 13:45
  Speaker 4: to spend some quality time with a friend or a partner,
• 13:50
  Speaker 4: Maybe I need connection, Like what is that hunger that
• 13:54
  Speaker 4: is now being to use your words masked by food
• 13:59
  Speaker 4: or anything else for that matter, overworking, drinking, smoking, gambling, right,
• 14:05
  Speaker 4: all the other scrolling on your phone, all the other
• 14:09
  Speaker 4: ways in which we distract ourselves from that genuine hunger.
• 14:15
  Speaker 2: So you're on the drug, what do you have to do? Like,
• 14:17
  Speaker 2: you know, beyond exercise, You've talked to me about muscle
• 14:21
  Speaker 2: and bond. What do people need to know?
• 14:23
  Speaker 4: So there's a lot of facets to this, And here's
• 14:25
  Speaker 4: a huge frustration for me. I don't believe that you
• 14:30
  Speaker 4: need to be an obesity medicine specialist in.
• 14:33
  Speaker 1: Order to prescribe this drug.
• 14:35
  Speaker 4: Okay, but just like I don't even prescribe acutane, right,
• 14:39
  Speaker 4: I don't have to be a dermatologist to prescribe acutane.
• 14:42
  Speaker 4: But I don't prescribe something that I cannot offer the
• 14:47
  Speaker 4: kind of support in counseling that is in the patient's
• 14:52
  Speaker 4: best interest. And we're in a situation in which anyone
• 14:56
  Speaker 4: can prescribe, they will do so with out the counseling.
• 15:01
  Speaker 4: They'll escalate doses without being mindful of the response. And
• 15:06
  Speaker 4: quite frankly, I think a lot of the side effects
• 15:09
  Speaker 4: that we're hearing about out there, because I anecdotally don't
• 15:14
  Speaker 4: have that level of dropout or side effect burden, and
• 15:21
  Speaker 4: I can only explain that by saying, well, I know
• 15:26
  Speaker 4: how to counsel my patients, and I don't just keep
• 15:29
  Speaker 4: yanking up the dosage every month just because No, that's.
• 15:33
  Speaker 2: How we did it. You know, your emphasis on muscle
• 15:37
  Speaker 2: building and making sure we're tracking the bone density and
• 15:41
  Speaker 2: all those important things that you don't want to use
• 15:44
  Speaker 2: something like this that does so much good and then
• 15:46
  Speaker 2: end up doing harm.
• 15:48
  Speaker 4: I think the body composition point is an important one,
• 15:53
  Speaker 4: and it's one that people have talked about a lot,
• 15:55
  Speaker 4: right muscle wasting and loss of lean body mass, But
• 15:58
  Speaker 4: I want to emphasize some of the points for this
• 16:02
  Speaker 4: one in particular because number one, it's not the drug.
• 16:07
  Speaker 4: So any time you have effective weight loss, be it
• 16:11
  Speaker 4: diet or drug or bariatric surgery, you have the potential
• 16:16
  Speaker 4: to lose fat or muscle. And even under the most
• 16:20
  Speaker 4: pristine conditions, someone who's eating a ton of protein and
• 16:24
  Speaker 4: exercising engaging in strength training, that individual.
• 16:27
  Speaker 1: Will still lose muscle.
• 16:29
  Speaker 4: It's about mitigating that though. So yes, adequate protein on
• 16:34
  Speaker 4: the order of like eighty one hundred grams, which is
• 16:37
  Speaker 4: hard to do when you're on these drugs, right, because
• 16:40
  Speaker 4: there's not that much appetite. I share with my patients
• 16:45
  Speaker 4: to think about their stomach as like valuable real estate.
• 16:48
  Speaker 4: And if you're going to fill it with stuff that
• 16:51
  Speaker 4: doesn't matter, that's not nutritive, you're taking away space from
• 16:57
  Speaker 4: something that is. And that's also a totally different way
• 17:02
  Speaker 4: of thinking about things. It's like if I tell you, Jim,
• 17:06
  Speaker 4: don't eat a cookie. I mean, have you ever told
• 17:08
  Speaker 4: a child don't.
• 17:10
  Speaker 1: Eat a cookie? Or like, don't put your finger in
• 17:12
  Speaker 1: the socket.
• 17:13
  Speaker 4: It becomes their life's mission right to put their.
• 17:17
  Speaker 2: Finger in the socket.
• 17:19
  Speaker 4: But if we flip that to, hey, this isn't about
• 17:23
  Speaker 4: what you can't do, but what can you do to
• 17:27
  Speaker 4: support your health and well being, your body composition. You
• 17:30
  Speaker 4: can do more of this more nutritive food that actually
• 17:36
  Speaker 4: nourishes you more activity and exercise. It also is a nutrient.
• 17:42
  Speaker 4: It nourishes your mind and your body to move it.
• 17:45
  Speaker 1: To exercise it.
• 17:47
  Speaker 4: But one of the things that people don't understand is
• 17:49
  Speaker 4: that losing muscle is not just about like losing muscle.
• 17:54
  Speaker 4: What happens when people in their thirties, forties, and fifties
• 18:00
  Speaker 4: are using these drugs and now we're heading into their
• 18:02
  Speaker 4: sixties and seventies and have lost muscle and therefore have
• 18:07
  Speaker 4: increased percent body fat. So if you're losing weight and
• 18:12
  Speaker 4: you lose more muscle than fat, even though you're lighter
• 18:16
  Speaker 4: on the scale, your percent body fat has actually gone up.
• 18:21
  Speaker 4: And body composition is very important in terms of disease.
• 18:27
  Speaker 4: It's also important in terms of frailty, mobility, and when
• 18:30
  Speaker 4: you think about hip fractures, for example, there is a
• 18:34
  Speaker 4: very high likelihood that an older person who falls and
• 18:39
  Speaker 4: breaks their hip will die in that first year after
• 18:44
  Speaker 4: the fracture.
• 18:45
  Speaker 1: It's not as.
• 18:46
  Speaker 4: Sexy as talking about cardiovascular disease or cognitive decline, right,
• 18:50
  Speaker 4: and yet the reality is that falls and fractures are
• 18:55
  Speaker 4: a big cause of morbidity and mortality in older people.
• 19:00
  Speaker 4: And so I think we need to be really careful
• 19:02
  Speaker 4: about how we use these drugs as they are long
• 19:05
  Speaker 4: term drugs and as people age, without being mindful of
• 19:09
  Speaker 4: all the consequences.
• 19:10
  Speaker 2: I assume the science is going to fix some of
• 19:13
  Speaker 2: that new combinations and new formulations, but not entirely.
• 19:19
  Speaker 4: Yeah, I mean, yes, so there are you know, these
• 19:22
  Speaker 4: drugs that are in development. There's such a gamut of
• 19:26
  Speaker 4: what is happening in the pipeline, but specifically when it
• 19:30
  Speaker 4: comes to muscle mass, there are combination drugs coming out
• 19:33
  Speaker 4: that are going to work on muscle fibers, helping build
• 19:38
  Speaker 4: up muscle fibers in conjunction with suppressing appetite through a
• 19:42
  Speaker 4: g one Yes, and everything comes at a cost, Jim right.
• 19:48
  Speaker 1: Like, there is no silver bullet.
• 19:51
  Speaker 4: I suspect that those drugs will address one problem and
• 19:55
  Speaker 4: then we'll find something else because nothing is without cost,
• 20:04
  Speaker 4: you know, even not doing anything. So there's a lot
• 20:07
  Speaker 4: of patients who are like, no, I'm not I'm gonna
• 20:09
  Speaker 4: do nothing, I'm gonna wait. In Action comes with a cost,
• 20:14
  Speaker 4: and so it's our job to do the best we
• 20:18
  Speaker 4: can with what we have. And a lot of that
• 20:21
  Speaker 4: is tapping into an individual's personal agency, taking ownership and
• 20:27
  Speaker 4: responsibility for their part of using these drugs responsibly.
• 20:32
  Speaker 2: Is there a buyer markers that indicate it might be
• 20:36
  Speaker 2: okay to stay a little fat? Because you know what's
• 20:39
  Speaker 2: happened and we've seen this. There was that Dove campaign
• 20:43
  Speaker 2: several years ago about beauty at any size, and you know,
• 20:47
  Speaker 2: there was a lot of that discussion and now I
• 20:50
  Speaker 2: feel like, you know, we're in an era of back
• 20:53
  Speaker 2: to thin is in right or thinner is inner? You know?
• 20:58
  Speaker 2: The question really is is is it ever okay to
• 21:01
  Speaker 2: be fat?
• 21:03
  Speaker 4: There's so much there's so much in what you said. Yes,
• 21:07
  Speaker 4: beauty at every size, compassion at every size.
• 21:12
  Speaker 1: Health at every size.
• 21:13
  Speaker 4: I push back on is it possible to be overweight
• 21:17
  Speaker 4: and healthy? And yes? There's the caveat to this is
• 21:21
  Speaker 4: there's this fit and fat and I don't In my office,
• 21:26
  Speaker 4: I always say, don't say the F word. I don't
• 21:28
  Speaker 4: like the word fat, but but this is what they
• 21:30
  Speaker 4: call it. Fit.
• 21:32
  Speaker 2: Yeah, well, so thank you, because I you know, I'm
• 21:33
  Speaker 2: just saying it for a fact more than anything else.
• 21:36
  Speaker 2: But what do you call it? Then?
• 21:38
  Speaker 1: You know, excess weight?
• 21:40
  Speaker 2: Okay?
• 21:41
  Speaker 4: Overweight you know, or overweight? I don't even I don't
• 21:45
  Speaker 4: even love the term obesity. There's this pull on LinkedIn
• 21:50
  Speaker 4: this week about you know, whether clinicians should or are
• 21:53
  Speaker 4: using obesity. And I used to be like this die
• 21:56
  Speaker 4: hard academic. Yes, call it what it is, but like
• 22:00
  Speaker 4: it doesn't feel good, Like the public doesn't perceive the
• 22:04
  Speaker 4: word in the same way that the physician is using it.
• 22:07
  Speaker 4: If I use the word obesity, it's not a judgment.
• 22:10
  Speaker 4: It really just is what it is.
• 22:12
  Speaker 1: But if I use that.
• 22:13
  Speaker 4: Word and it makes my patient feel bad, then I'm
• 22:16
  Speaker 4: not going to use that word. But there are ways
• 22:19
  Speaker 4: of being healthy even if you have excess weight, and
• 22:22
  Speaker 4: so I'm all about health, but I don't like the
• 22:26
  Speaker 4: aspect of the body positivity movement that shames people for
• 22:33
  Speaker 4: wanting to lose weight and for also putting out this
• 22:38
  Speaker 4: fallacy that you are necessarily fit at every size you
• 22:42
  Speaker 4: can be. So I don't want to discount that altogether,
• 22:45
  Speaker 4: but it's kind of like this. In Europe, people smoke
• 22:49
  Speaker 4: and live to one hundred and ten years or whatever
• 22:52
  Speaker 4: it is.
• 22:52
  Speaker 1: The case may be.
• 22:53
  Speaker 4: Right that you can smoke and have a long life,
• 22:57
  Speaker 4: but the likelihood of you have a long, disease free,
• 23:03
  Speaker 4: morbidity free life is less if you smoke, and the
• 23:07
  Speaker 4: same is true for obesity. I think what the body
• 23:13
  Speaker 4: positivity movement was trying to get at is that our
• 23:17
  Speaker 4: culture until now and even now really shames the individual
• 23:23
  Speaker 4: and promotes this body image of underweight as the ideal
• 23:30
  Speaker 4: of beauty. And yeah, I push back against that a lot.
• 23:35
  Speaker 4: I actually think there's a lot of beauty in the
• 23:39
  Speaker 4: curves and the natural body that is right. Sure that
• 23:45
  Speaker 4: body changes over time, you know, like as a child
• 23:49
  Speaker 4: that looks a certain way than puberty, than pregnancy, than menopause,
• 23:54
  Speaker 4: like there are seasons in one's body. So I'm happy.
• 23:59
  Speaker 1: For that messaging.
• 24:01
  Speaker 4: I also think that what they were trying to say
• 24:04
  Speaker 4: again is compassion in every size, and that's where we've
• 24:09
  Speaker 4: missed the mark, because we don't have compassion for ourselves,
• 24:14
  Speaker 4: and therefore we don't have compassion for each other.
• 24:19
  Speaker 1: And that's really where the tragedy.
• 24:21
  Speaker 4: Of this because, as you mentioned earlier, over fifty percent
• 24:26
  Speaker 4: of our near fifty percent of Americans are considered to
• 24:30
  Speaker 4: have excess weight at the level of b and I
• 24:33
  Speaker 4: of over thirty. And yes BMI is not perfect, but
• 24:36
  Speaker 4: I'm not going to get into that right now. But
• 24:38
  Speaker 4: let's just you know, for the purposes of this conversation,
• 24:42
  Speaker 4: seventy plus percent are considered to have excess weight in
• 24:47
  Speaker 4: some form, and so the majority of us are struggling
• 24:52
  Speaker 4: with this problem, and yet I think we still fail
• 24:56
  Speaker 4: to meet it with the care and compassion that it deserves.
• 25:01
  Speaker 4: And more does need to be said about that. But
• 25:04
  Speaker 4: that doesn't mean that we shame people who are trying
• 25:07
  Speaker 4: to lose weight.
• 25:07
  Speaker 2: But isn't it genetics? I mean, is that a big
• 25:10
  Speaker 2: part of it versus lifestyle? I mean, you can't fight
• 25:13
  Speaker 2: your genetics, can you.
• 25:15
  Speaker 4: There are so many factors that are at play.
• 25:18
  Speaker 1: And even when we.
• 25:19
  Speaker 4: Talk about genetics, there's genetics like the gene that got
• 25:24
  Speaker 4: handed down from mom and dad and so yes, if
• 25:28
  Speaker 4: parents are overweight, then their children are more likely to
• 25:33
  Speaker 4: be overweight as well. There's also epigenetics, which is the
• 25:39
  Speaker 4: way environmental factors affect our genes and our progeny. So
• 25:46
  Speaker 4: what we passed down and we know. For example, there's
• 25:51
  Speaker 4: great data that came out of the Dutch Famine nineteen forties.
• 25:57
  Speaker 4: The Dutch collected really detailed data on not only people
• 26:04
  Speaker 4: who experienced the famine, but their children, children who were
• 26:08
  Speaker 4: born before, during after, and for example, people who were
• 26:14
  Speaker 4: in utero during the famine and were therefore exposed to
• 26:20
  Speaker 4: malnutrition in their moms were more likely to go on
• 26:24
  Speaker 4: to have certain diseases, including cardiovascular disease and obesity. It's
• 26:31
  Speaker 4: almost like the environment impacted the genes, and the genes
• 26:36
  Speaker 4: knew were programmed in a way that they had to
• 26:39
  Speaker 4: hold on to whatever they could get. Another great example
• 26:44
  Speaker 4: is trauma several years ago, before I left Cedar Sinai
• 26:50
  Speaker 4: as medical director, I did a grand rounds on adverse
• 26:53
  Speaker 4: childhood events or ACE adverse childhood events studies. There are thousands,
• 26:59
  Speaker 4: if not millions of publications on PubMed on adverse childhood events.
• 27:05
  Speaker 4: And essentially this came out of Kaiser, California. This physician
• 27:11
  Speaker 4: started collecting data noticed that people who had trauma and
• 27:16
  Speaker 4: childhood were more likely to be obese and have difficulty
• 27:21
  Speaker 4: losing weight and regaining the weight. And we think that's
• 27:24
  Speaker 4: because of psychological trauma, right like, oh, you were abused
• 27:29
  Speaker 4: and therefore you're sad and you eat more.
• 27:32
  Speaker 1: Wrong.
• 27:33
  Speaker 4: They actually have shown that there are changes in their DNA,
• 27:37
  Speaker 4: so genes that are methylated in non or untraumatized or
• 27:43
  Speaker 4: children who did not experience an adverse event are methylated
• 27:47
  Speaker 4: in those who did, and vice versa. So their actual
• 27:51
  Speaker 4: genetic makeup, the likelihood for certain genes to turn on
• 27:54
  Speaker 4: and off have changed because of the trauma that they
• 27:58
  Speaker 4: experienced in childhood.
• 28:01
  Speaker 1: And it doesn't have to necessarily be abuse.
• 28:04
  Speaker 2: They could have fallen off a bike or thought a
• 28:07
  Speaker 2: window or yeah, or you know, physical abuse, any traumatic event.
• 28:13
  Speaker 4: Even verbal abuse which you know I mean, I think
• 28:17
  Speaker 4: especially for those of us who were born to immigrants
• 28:21
  Speaker 4: or like old school, like basically all of us in
• 28:24
  Speaker 4: this age group, it was not abusive back then to
• 28:29
  Speaker 4: yell at your kids constantly or to use profanities.
• 28:33
  Speaker 1: Right now we know better, but those.
• 28:36
  Speaker 4: Experiences can have profound impact, and they can create epigenetic changes,
• 28:43
  Speaker 4: and the ACE studies have shown that those people are
• 28:45
  Speaker 4: more likely to suffer from obesity as well as a
• 28:49
  Speaker 4: whole host of other conditions like autoimmune disease, cardiovascular disease.
• 28:54
  Speaker 4: And again this is written in their DNA, so even
• 28:57
  Speaker 4: the genetic link is loaded much less all the other
• 29:02
  Speaker 4: factors that can impact. What about obesogens, what about microplastics?
• 29:09
  Speaker 4: What about the chemicals like BPA. Microplastics actually hasn't been
• 29:14
  Speaker 4: proven it will be, but like BPA that has been
• 29:20
  Speaker 4: well substantiated and documented that it is an obesogen or
• 29:26
  Speaker 4: something that impacts the endocrine axis. So it actually has
• 29:31
  Speaker 4: a negative impact on our normal function, our normal endocrine system,
• 29:36
  Speaker 4: and that makes people more likely to be overweight.
• 29:39
  Speaker 2: So, you know, we were talking about the old little
• 29:42
  Speaker 2: graphic that they had in the government with before food
• 29:46
  Speaker 2: you know whatever it is, it four food groups, maybe
• 29:48
  Speaker 2: there was a fifth, but anyway, at the point.
• 29:50
  Speaker 1: Cup of milk on the side, right, If you do all.
• 29:53
  Speaker 2: Those things, but then you know we have lactose intolerance
• 29:57
  Speaker 2: and we have gluten free and so some of that
• 30:01
  Speaker 2: falls out the window. Is the fallback protein? I wanted
• 30:05
  Speaker 2: to talk about that in your fuel program and can
• 30:08
  Speaker 2: I just take more powders and bars and get to
• 30:12
  Speaker 2: my goals? But they're kind of processed foods, so then
• 30:15
  Speaker 2: you hear bad stuff about that. Is it better to
• 30:19
  Speaker 2: just get the protein at all costs? Or are they
• 30:22
  Speaker 2: all created equal on equal? Let's talk a little bit
• 30:25
  Speaker 2: about protein and what's the healthy intake. Won't protein first
• 30:32
  Speaker 2: help everything? Because after my bariatric surgery, that's what my
• 30:35
  Speaker 2: docs said, get protein in first number one?
• 30:38
  Speaker 4: Yeah, So first of all, you know there's an RDA
• 30:41
  Speaker 4: or recommended dietary allotment for protein for adults. I think
• 30:46
  Speaker 4: it's around forty for women, around fifty for men.
• 30:50
  Speaker 1: I think that is too low.
• 30:53
  Speaker 4: It's definitely too low for someone who's losing weight. It's
• 30:56
  Speaker 4: also too low for someone who's aging. Actually, as we
• 30:59
  Speaker 4: get older, are protein requirements increase?
• 31:03
  Speaker 2: Really important to know.
• 31:04
  Speaker 4: That, and studies show that when people lose weight, if
• 31:07
  Speaker 4: they're not getting I round it to eighty to one hundred.
• 31:11
  Speaker 4: It's you know, for some people, depending on their starting weight,
• 31:14
  Speaker 4: could be a little.
• 31:14
  Speaker 1: Bit more, but you know, I think it's a good goal.
• 31:17
  Speaker 4: Eighty t one hundred, maybe eighty to one twenty for
• 31:19
  Speaker 4: some of the taller, bigger folks is necessary in.
• 31:23
  Speaker 2: Order to do more and steaks or what.
• 31:27
  Speaker 4: I always recommend food first, but I'm also not a puritan.
• 31:31
  Speaker 4: Perfection is not necessary in order to be effective, So yes,
• 31:35
  Speaker 4: try and get it from food. Animal proteins like meat,
• 31:39
  Speaker 4: as you suggested, Eggs is a good source. Vegetable proteins.
• 31:44
  Speaker 4: You know, you can get almost twenty grams of protein
• 31:47
  Speaker 4: from a cup of garbonzo beans, so beans, legumes also
• 31:52
  Speaker 4: a good source of protein. And then if you can't
• 31:57
  Speaker 4: get it through food, or if there's certain days where
• 32:00
  Speaker 4: you fall short, I am for supplementing with high quality
• 32:06
  Speaker 4: protein powders, protein bars on occasion. I don't think we
• 32:11
  Speaker 4: should be replacing all of our food with packaged foods,
• 32:16
  Speaker 4: you know, and that goes for protein or anything for
• 32:18
  Speaker 4: that matter. The issue of like processed and ultra processed
• 32:21
  Speaker 4: foods is a whole other issue of seventy percent. Some
• 32:26
  Speaker 4: studies show that eighty percent of our diet comes from
• 32:29
  Speaker 4: processed and ultra processed foods. And here's an interesting fun fact.
• 32:34
  Speaker 4: So they've done studies where they've checked hunger hormones following
• 32:40
  Speaker 4: like the whole food versus the process version. So for example,
• 32:46
  Speaker 4: chicken that you would roast at home versus a pretend
• 32:51
  Speaker 4: chicken patty that you may get from the frozen aisle
• 32:54
  Speaker 4: or from fast food, And then they check hunger hormones
• 32:58
  Speaker 4: after people ingest these, and people who consume the process
• 33:03
  Speaker 4: kind don't get the same response in their gut horns.
• 33:07
  Speaker 4: That makes a lot of sense. But if people knew
• 33:12
  Speaker 4: that that pretend food is actually not even suppressing hunger
• 33:17
  Speaker 4: on a physiologic level, like the hunger hormone is not
• 33:21
  Speaker 4: being suppressed, it gives you even more incentive to eat
• 33:26
  Speaker 4: food that's real.
• 33:28
  Speaker 2: Right, Well, that's for sure. So you have the podcast
• 33:32
  Speaker 2: health Bite, which is awesome, and I got to be
• 33:35
  Speaker 2: a guest of the book Hungry for More in the
• 33:37
  Speaker 2: newsletter What's next? What else? This is my last official question.
• 33:42
  Speaker 2: Then I have a couple of fun ones to end on.
• 33:45
  Speaker 4: I've really personally been impacted by world affairs over the
• 33:49
  Speaker 4: last couple of years and ongoing.
• 33:53
  Speaker 2: Yeah more today, Yeah yeah, And I have.
• 33:56
  Speaker 4: Been impacted by the way in which we have responded
• 34:01
  Speaker 4: in the United States and around the world. We are reactive,
• 34:06
  Speaker 4: we have lost our critical thinking abilities. We are stressed
• 34:12
  Speaker 4: and charged. And so this work that for me started
• 34:16
  Speaker 4: in my medical practice, I'm really taking out into organizations,
• 34:23
  Speaker 4: into nonprofits because I feel like when people learn to
• 34:29
  Speaker 4: nourish themselves properly and they manage that innate, reactive stress response,
• 34:38
  Speaker 4: then they will treat their partners and their children and
• 34:41
  Speaker 4: their colleagues better. And their colleagues and partners and children
• 34:47
  Speaker 4: will then go on and treat their interactions better, will
• 34:51
  Speaker 4: do better in our workplaces, will be more effective, more impactful.
• 34:56
  Speaker 4: Bottom line, the ripple effect of doing the this work
• 35:01
  Speaker 4: is so profound, and I think it is the answer
• 35:05
  Speaker 4: to the reactivity that we are seeing in the world
• 35:08
  Speaker 4: around us. And that is my battle cry, and that
• 35:11
  Speaker 4: is what I'm working towards.
• 35:13
  Speaker 2: Awesome. I love battle cries. So I always ask a
• 35:17
  Speaker 2: couple questions at the end that reveal a few things
• 35:20
  Speaker 2: about you as a person. What's your dream.
• 35:23
  Speaker 1: Vacation Huh, there's two? Can I give you two?
• 35:29
  Speaker 4: Yeah? I love to hop on a plane two hours
• 35:32
  Speaker 4: from here and be on a lawn chair by a
• 35:36
  Speaker 4: pool in Mexico.
• 35:37
  Speaker 2: Okay, easy.
• 35:38
  Speaker 4: I also love to be hop on a plane two
• 35:42
  Speaker 4: hours from here and sit under a redwood tree quietly
• 35:45
  Speaker 4: without anyone talking to me.
• 35:47
  Speaker 2: Nice. That's easy to do too, and I like doing that.
• 35:50
  Speaker 2: I like taking walks in the redwoods. So you are
• 35:53
  Speaker 2: going to be sequestered on a desert island. What album
• 35:56
  Speaker 2: are you bringing?
• 35:59
  Speaker 4: Oh?
• 35:59
  Speaker 1: Lord lord, that is a good question.
• 36:02
  Speaker 4: I don't know why this pops into my head, but
• 36:05
  Speaker 4: say what comes first?
• 36:06
  Speaker 1: Right?
• 36:07
  Speaker 2: Yeah, totally.
• 36:08
  Speaker 1: I'm taking Madonna and Cyndi Lauper.
• 36:11
  Speaker 2: You know, you and I. Well, you know, Madonna's makes
• 36:15
  Speaker 2: so much sense to me, right because you were talking
• 36:18
  Speaker 2: about movement, and she's got the wide range of songs
• 36:21
  Speaker 2: from the beginning to her more enlightened periods. So yeah,
• 36:26
  Speaker 2: that makes a lot of sense.
• 36:28
  Speaker 4: I may take my hot pink cut off gloves too.
• 36:34
  Speaker 2: You had those, huh?
• 36:35
  Speaker 1: One hundred percent? I actually still have them.
• 36:38
  Speaker 2: That's pretty awesome. Well, listen, thanks for being here. You
• 36:42
  Speaker 2: know you've helped me in enormous ways over the last
• 36:45
  Speaker 2: few now going on several years, long before gop ones,
• 36:49
  Speaker 2: and just want to say I support you in your
• 36:53
  Speaker 2: battle cry and I'm here to help make that reality
• 36:57
  Speaker 2: for as many people as we can. So thanks for joining,
• 37:00
  Speaker 2: learning and sharing, and let's see where this all goes
• 37:03
  Speaker 2: in the world.
• 37:04
  Speaker 4: I appreciate that since your sentiment, and this was a
• 37:07
  Speaker 4: lot of fun, so thank you, it really was.
• 37:12
  Speaker 2: Hey, everyone, thanks for joining me on the Get Real podcast.
• 37:15
  Speaker 2: You know, I hope you feel a little healthier hanging
• 37:17
  Speaker 2: out with me. You know it's going to be a
• 37:19
  Speaker 2: lot of fun. Passing this along to others. Please subscribe below,
• 37:24
  Speaker 2: Please share. I'm excited not just to talk about healthcare,
• 37:28
  Speaker 2: but a lot of other fun topics. It's about making
• 37:32
  Speaker 2: healthy talk about healthcare. It is not a lecture. This
• 37:36
  Speaker 2: is supposed to be fun. And look forward to spending
• 37:38
  Speaker 2: more time with you in the future.