Obesity and Weight Management
October 2023
Dr. Pressly spent over 17 years as a beloved Novant Health family medicine physician before becoming board certified as an obesity medicine specialist. In 2020, she transitioned to CoreLife Novant where she now helps patients achieve and maintain a healthy weight. As we are all aware, obesity rates in the US are at an all-time high with more than 42% of American adults being classified as obese (BMI> 30) as are nearly 20% of US children. Overweight numbers (BMI 25-29.9) in this country are absolutely staggering with 74% of adults and 32% of children considered to be overweight.
Dr. Pressly focused on the science behind the disease of obesity (there was so much to learn here-for healthcare providers as well as everyone else!), and she shared insights on new weight loss drugs (oral meds and injections) and who they benefit. Dr. Pressly was accompanied by Paige Macauley, RD, Director of Dietetics at CoreLife, who addressed the keys to nutrition and lifestyle habits that lead to a healthy weight at every age. This was an enlightening evening for all attendees!!
"Obesity & Weight Management" Themes:
Implicit weight bias is actually INCREASING with time whereas bias towards gender/race/sexuality are slowly decreasing - obese people make lower salaries, bias decreases the quality of their healthcare, obesity promotes avoidance of self-care, and has a profound psychological impact that actually makes gaining weight more likely. Bias/lower salaries are even more profound for women of color.
Obesity is a disease. Many people - in medicine and otherwise - do not understand the disease of obesity.
Obesity is a "chronic, progressive, relapsing, and treatable multi-factorial neurobehavioral disease, wherein an increase in body fat promotes adipose tissue dysfunction and abnormal fat mass physical forces, resulting in adverse metabolic, biomechanical, and psychosocial health consequences"
70% of obesity is related to genetics and there are 300 genes associated with obesity.
Obesity rates are steadily increasing (42% of adults and 20% of kids in America). We are on track for the vast majority of all black and brown women to be obese by the 2030s.
Sleeping less than 7 hours is associated with hormone changes that lead to weight gain
There are COUNTLESS hormones that are related to obesity- many obese people having varying levels of these hormones that alter their satiety, hunger, and some create a food addiction - again, this is hardwired into their genes/their hormones/their body cell receptors
Obesity drugs have been around for decades, lots of press now on Ozempic and Wegovy (both are different formulations of exact same drug, semaglutide) and Mounjara due to social media. Very expensive weekly injections, many issues in getting insurance companies to cover these drugs - issues include BMI must be high enough, comorbidities must be present in some cases, etc. Need to remember there are other oral drugs that are very successful, including Metformin, bupropion, phentermine + topiramate to name a few. These are being overlooked in the frenzy around Ozempic/Wegovy/Mounjaro. Lots of side effects with these - nausea, gastroparesis, constipation, reflux, etc but patients are having such success (15% and even more of total body weight loss) that many don't seem to care about bad side effects. But there is no end to being on these drugs - you have to take them or else most gain the weight back.
Likely bariatric surgical procedures (bypass/bands/sleeves) will be a thing of the past as these drugs will likely be as effective as surgery by the end of 2024.
Concerns -will these drugs essentially only be available for those with high resources due to extreme expenses such that to boil it down - the "haves" can be thin and the "have nots" cannot afford them?
Are some people (celebrities and others who can afford it?) on these drugs just to get thin and not using them for actual obesity?
"Set point theory" - our bodies have a preset weight baseline that can be set when you spend 6-9 months at a certain weight. If you try to go below that weight, it is a continued fight to stay below your "set point." For example, if you lived for 9-12 months or whatnot at a higher weight postpartum, a set-point at that weight can be hard to tackle as our body wants to get back to that higher number. How fun is that?
Many women gain about 1.5 lbs/year during their 30s/40s around menopause. It is very hard to resist this weight gain.
Protein is so very important, we need to be eating MUCH more of it. In general, we suck at eating enough protein (my words not Paige's -ha). Side note Peter Attia has written/posted/podcasted a lot on this topic. Since "Outlive" I never ever go to a restaurant without ordering protein - meat/fish on salad/etc, and I have let go of being a pescetarian since it is just so hard to eat enough protein with so little time to think about it/meal plan/etc.
Consider protein powder! Cressent puts it in her coffee in the morning :)
Resistance training/weight lifting should be a non-negotiable part of working out for all of us women. It increases our muscle mass and since muscle mass steadily declines (it peaks ~ 30 yo,) this helps maintain healthy bones/muscle and also keep up our metabolism.
Paige cited a study of a "Front-loaded" diet with high protein early in the day (think eggs, greek yogurt, peanut butter) and then light lunch and even smaller dinner - can lead to significantly more weight loss (11%) vs a diet with the EXACT same number of calories in reverse order (ie large dinner and light/no breakfast) (4% weight loss). Also regarding the order of foods in your day - low willpower at night/urges are created when you have not eaten much all day - and then likely we go for the straight refined sugar which gets in our bloodstream the fastest when we have been low on carbs during the day. Low calorie during the day leads to hunger/drive at night that's hard to resist.
"Whole foods" are always better than ones that are cooked/processed - chewing actually burns calories as does rest of digestion of whole foods (vs apple juice is basically mainlining sugar). So whole fruits are better than smoothies, although smoothies are better than pancakes!
Intermittent fasting works for many but can be associated with loss of muscle mass/can be hard to get an adequate amount of protein with these diets.
The only diets that work are the ones that are sustainable. A very low calorie diet may work short term but then will surely fail when you go off the unsustainable, restricted eating plan.