- It's a disease that affects more than one in three US adults and about one in five kids and adolescents.

Tonight we're talking about the obesity epidemic and how we can all make lifestyle changes.

(upbeat music) (upbeat music continues) (upbeat music continues) Good evening and thanks for joining us for WTVP's "Docs on Call".

I'm Mark Welp.

Fighting obesity isn't just about looking and feeling better, it's also about saving lives.

It's estimated that obesity contributes to hundreds of thousands of deaths every year in America alone.

Dr.

David Tennant works for Carle Health.

He's a family medicine doctor and also leads the Obesity Medicine Clinic at Proctor Hospital in Peoria.

Doctor, thanks for coming on.

- It's good to be here.

- Appreciate it.

Well, first of all, let's define obesity for people.

What's the difference between being overweight, being obese, being morbidly obese?

- Yeah, all good questions.

So it's usually defined based on the body mass index.

And it's nice because it's easy to do.

You can do it essentially for free.

It's just your weight versus your height.

The basic idea is if someone's 200 pounds, well, are they five feet or are they six feet, right?

This is a different thing in terms of how much fat you're likely accumulating on your body.

But it's broadly defined, below 25 is normal, 25 to 30 would be overweight, and then 30 plus body mass index is obese.

And when you get to be above 40, then that's class three or morbid or severe obesity.

And it's not like totally perfect.

You know, some people have more muscle bulk than others, and you kind of know it when you see it.

I looked it up once.

The average BMI of the starting linebacker core for the Chicago Bears, and I think they were on average obese.

These people are obvious.

They're just incredibly muscular.

But for most people, most of the time, it's a pretty good, inexpensive estimate of where we are.

- Okay.

So, doctors still using that formula for the most part to- - Oh, yeah.

- To diagnose people.

Okay, good to know.

So talk a little bit about what you do at Proctor Hospital with the clinic and how you help people that are having issues with losing weight.

- Yeah.

So, to your point, it's a very common problem.

70% of US adults are either overweight or obese, 40% are obese, and 9 or 10% are severely obese.

And this problem has been going up significantly over the years.

If you go back in time like 100 or 120 years ago, nobody really knows what the percent of the population was that was obese, but it was probably around 1 or 2%, or maybe even lower.

I mean, it was really just a fraction of a fraction.

It's done nothing but go up over that time.

Now, those numbers I just said, I want to say it's a 2023 CDC number.

I don't know when the CDC is gonna next come out with some new numbers.

It wouldn't surprise me if it starts to tick down for the first time in who knows how long, but I don't know that for sure, and it still remains a big problem.

So, what do we do?

We approach obesity a couple ways.

So first of all, we treat it like a chronic disease, something akin to like diabetes or blood pressure or cholesterol, where, of course, lifestyle stuff plays a role, right?

That's obvious.

Nobody's disputing that.

But there's also hormonal factors which are not a personal responsibility thing, and where medications or maybe even surgical options could be useful for them.

And overweight, obesity, weight generally, poor metabolic health, we approach it very broadly one of three ways, and you should certainly think about all three.

Nutrition, which applies to everyone, and then plus or minus medication or surgery, and or surgery.

- Gotcha.

So, let's go back to what you were talking about, about how the obesity, how it has become an epidemic.

- Yeah.

- Why do you think that is?

- It's an interesting question.

I don't know if anyone knows it for sure.

It's a multifactorial problem.

What I could tell you is right now, the average American consumes 55% of their calories from an ultra processed food source.

And stipulated the term ultra processed, it's not, like, precisely defined.

You might get slightly different definitions, but you know it when you see it.

The basic definition is if you didn't make it or your wife didn't make it, it's fast food, right?

So if it's coming from literally a drive through or something frozen or in a bag, something that you could not create in your own kitchen, it's an ultra processed fast food.

And these tend to be obesogenic for a variety of factors.

Now, is it the sugar, is it the refined grains?

Is it something else, like, all the salt or the pesticides?

You know, who knows?

Like, the microplastics?

I don't know.

There's all sorts of possibilities.

But very broadly, it does seem to be the combination of large percent, the majority of our calories coming from an ultra processed source, reduced exercise, 'cause we're doing less physically demanding work, that plays a role, less than nutrition, and yeah, just the environment.

And we just, there's no question about it, the weight's been going up over the years.

- But you mentioned that you wouldn't be surprised if it goes down a little bit when this next set of info comes out.

Why is that?

- I have two theories.

The first is kind of the obvious, the use of GLP-1 medications.

This has been true for, you could maybe say 10, but certainly over the last five years, GLP-1s to address weight as a chronic disease is in widespread use, and it's all over the news, and I'm sure everyone has at least some passing thoughts on it.

The other thing, and I don't wanna give short shrift to it, I think the knowledge has changed.

You know, knowledge is kind of everything.

I heard it once before, that we have all the same resources as cavemen.

Actually, we have less, 'cause we've used some of the resources in the ground, right?

But what we have that they don't have is the knowledge of how to use them.

I was born in 1985.

I remember shopping with my mother in the '90s.

It was fat-free everything.

You know, I Can't Believe It's Not Butter, like, et cetera.

You can still go to the candy aisle today, and you could find something listed as a, quote, fat-free food.

And it's true as far as it goes, there's no literal fat in this thing in a package, but that's not really, they're not answering the question that you're asking.

The question that you're asking is, I, as the consumer, am I gonna get fat?

And the answer is yes.

So it's not really like a quite fat-free food.

And I think this is changing, where we're kind of understanding all of these... You know, the classic boogeyman is the food pyramid, which was, I mean, it was taught to every school child, at least when I was in school, and just these huge quantities of, like, refined grains, and that's just, what's the word?

Bad advice, you know?

So, and that seems to be going away, reducing the added sugars, reducing the refined grains.

People do seem to come in, at least coming in see me, to know that.

Like, how to execute that, I'm not saying it's a simple problem, but at least conceptually we're understanding it.

So I think it's a combination of medical advances and just improved knowledge across the board.

- And to your point, it seems like, you know, these days, everyone knows smoking is bad for you.

Most people have always known that, but now it seems like everyone knows it, and people, I think, they're not confused necessarily by what I should eat or how much I should eat.

So the question I've always had, and I've dealt with this my whole life, trying to lose weight, and it's been a roller coaster, how much of it is psychological?

Because it seems like, you know, you mentioned there's hormonal things that you can't control, but it seems like when you drill down, a lot of it's a matter of just self-control.

- That's in there.

You know, I don't... Well, first of all, I'm glad you mentioned the smoking.

I don't know if people know this, but if you go back in time to like the '50s or '60s, it was something like 40 or 45% of American adults smoked.

Now it's below 15.

I think it's pretty close to 10.

- Doctors used to be in commercials saying, "You should smoke these kind of cigarettes."

- Is that right?

- Yeah, yeah.

- It's wild.

So anyway, so big public health things can change.

You know, how much of it is psychological in terms of diet?

That's gonna be tough to define.

What I will tell you is if you avoid... Very broadly, that kind of works for essentially everybody, don't drink your sugars.

There's something, I don't know if you do it now, but there's something about drinking your sugars.

- Oh, I love soda.

- Oh, yeah.

- I mean, it's crazy.

- Yeah, yeah, don't do that.

(both laughing) There's something about drinking sugars.

You know, I've seen people who over long periods of time have done all kinds of interesting things with their diet, beneficial things.

And then for whatever reason, they won't stop insert sugary drink here.

Like, "The soda is the only thing that works for my heartburn.

I just really enjoy the juice."

You know, I don't know.

But for whatever reason, they don't stop drinking their sugars, they don't lose weight.

They might get healthier in other ways.

So that's a pretty good starting place across the board.

- Now, what about for people, since you brought up soda, what about people who say, "Okay, I'm gonna switch to diet."

Is that any better?

- Any, maybe, kind of.

- A little bit?

- Maybe.

And, you know, everything... I mean, look, it's a free country.

People can do as they want.

It's not illegal or immoral to be overweight.

There's nothing wrong with it necessarily.

But if you are actively trying to lose weight and get healthier, to my knowledge, the number of people who lost weight and got healthier by switching from regular soda to diet soda is, I believe, roughly zero.

And there's something about it, and I don't know what it is, whether it's just, it's still a sweet taste, so we still hormonally get these insulin surges and it still contributes to leptin resistance, or it just kind of makes us hungrier, or maybe to agree, 'cause it doesn't taste good.

You know, we're kind of lying to ourselves in the sense that, "Oh, it's diet, it must be healthy for us."

I don't think so.

It's pretty metallic.

It tastes more or less like the can that it comes in, you know?

And there's something about losing weight where you just have to be ruthlessly honest with yourself, where you just, and if you're gonna do it through diet, and I'm not saying I always live up to these standards that I'm setting out here, but you know, a cardiologist addicted to cigarettes should still tell people not to smoke, it's bad for you.

- [Mark] Sure.

- You can't know or understand everything that's in, say, like, a diet drink.

And if you don't really know what you're consuming, you're asking for trouble.

- Okay, noted.

You know, you mentioned it's not illegal.

People shouldn't be ashamed to be overweight.

And we don't want people to feel like that, but being overweight obviously does have an impact on your health.

- Oh, no question.

And to your point, like, shame is bad, but sometimes we take that too far and we say you have no responsibility for it.

Like, shame is bad, responsibility is good, is maybe the right framework to think of it.

And yeah, obesity and poor metabolic health, it's a risk factor for just about everything that plagues us today, right?

Arthritis, diabetes, cholesterol, blood pressure, probably the worst of the bunch, and the least diagnosed, obstructive sleep apnea.

People just aren't sleeping at night, so they're tired all day and just their quality of life is no good.

Yeah, it's a risk factor for essentially everything, and it's good to target it.

- So, it's kind of a chicken and egg thing.

You know, if you're obese, then what you just mentioned, you know, those numbers can go up, but if you're not obese and you do have some underlying health issues, what kind of underlying health issues can contribute to you being obese?

- It's an interesting way of putting it, yeah.

To your point, so there is a condition called metabolically healthy obese.

What that means is the number on the scale is high.

Stipulated.

That said, when you actually look at the labs or the blood pressure, they don't really have the problems that I just mentioned, right?

The blood pressure, the cholesterol, the diabetes.

So, these people do tend to develop these problems over time because the fat itself is hormonally active, and so, fine.

If you flash forward five or 10 years, they're at a higher risk for developing these things, but it's not definitional.

There are some people out there who are metabolically healthy obese, and the opposite is also true.

It's called normal weight obesity.

And what that is, according to the body mass index, their numbers look, if not normal, maybe slightly in the overweight range.

And then you pull up these labs, and it turns out they have all the things, right?

The blood pressure, the diabetes, the cholesterol, or at least some of these things.

And then you approach it the same way that we've always approached blood pressure and diabetes, you know, those anti-blood sugar medications and blood pressure medications and cholesterol.

And still, the diet advice, okay, fine, the number on the scale is not that high, the diet advice is still good, you know?

Try to avoid added sugars, try to avoid white flour, try to avoid ultra processed fast food generally, and you know it when you see it, and cook more at home, you'll get better.

- So, you know, that's what we hear, the big things, eat healthier, don't eat as much, exercise.

Seems simple, but yet we have an obesity epidemic.

So when people come to you and say, "Doctor, I need to make a change in my life," where do you start?

- Yeah, so, to your point, it's something like 80% of people who just try to go diet and exercise end up failing.

Now, failing could be a step on the way to success, right?

Just 'cause you failed once doesn't mean you don't try again.

Because diet and exercise is never going away when it comes to obesity and health management, ever.

There's no medication or surgery that changes that.

I very much doubt that there will ever be a medication or surgery that changes that.

But here's where, and I'm not a surgeon, I do medical, but here's where a medication like, say, a GLP-1, might be useful.

Let's say someone comes in and they're seriously overweight, BMI 35, 40, all the things that we talked about, the blood pressure, the diabetes, the sleep apnea, you name it, and they say, "Okay, I wanna get serious about my weight and my health right now.

Stipulated, I've spent too many years, you know, focused on fast food and not exercising, but let's not belabor that, let's focus on the future right now."

Cool, happy to help.

They're gonna start from a place where their own hormones and, to a degree, basic physics, is working against them.

What I mean by that is when somebody is obese and in poor health, they tend to be leptin resistant and insulin resistant, meaning they are literally hormonally predisposed to eat more food, to not feel full, and then pack it on as extra fat, which is not fair, but it's where we are.

And the basic physics problem of it is, you know, if somebody's 300, 350, 400 pounds, I mean, I as a doctor or someone else can say go exercise, and it's good advice as far as it goes, but we're talking about a large amount of mass that has to be moved.

You know, people come in and they tell me, and I believe them, it hurts just to roll out of bed.

Like, go exercise, like, it's true, but it's lacking a certain realism.

So, what something like a GLP-1 medication might do is it, to use a cliche, slows down the food noise.

What it literally does is it slows down gastric emptying, meaning it slows down the movement of food from your stomach lower down to your intestines.

So food sits in your stomach, your stomach physically stretches, nerve on the outside tells your brain to stop eating.

So we do less quantity.

When we do less quantity, we tend to do a better job with quality just because we're doing less of it.

And that alone, if you were to go online and look up an average, you're gonna get a number like 10, 15% total body weight loss, maybe a little bit more than that, and from there, since they're doing less of it, people are able to get some of their diet under control.

Once the number on the scale starts to go down and it's just physically less mass that they have to move, and this might take, you know, six, 12 months depending on where we're starting from, but then they are able to start exercising.

- So you mentioned GLP-1 drugs, which over the last five years- - Huge.

- Have just exploded.

Some numbers I looked up.

Right now, about one in eight US adults say they're taking a GLP-1.

- [David] Wow.

- Since January, more than 600,000 prescriptions have been written for Wegovy, one of the big brands.

You know, we're talking Wegovy, Ozempic, Zepbound.

All right, so, with these drugs, I mean, everyone's always looking for a magic bullet, magic pill.

And this seems like it's not going away, it's just getting more popular.

So, are you seeing results from people who are taking this?

- Oh, sure.

Yeah, and it's a tool, and it works for all the reasons that we just talked about.

You know, they just kind of do less quantities, so they tend to do a better job with quality.

You know, we can talk about some of the common side effects, medical side effects, and they're real, and they should always be discussed and considered and looked out for and all those things, but I'll tell you, for most people, most of the time, when they have an issue with these GLP-1s, it's not medical, it's financial.

They're just awfully expensive, and there's no reason to think that's gonna improve anytime soon, frankly.

- A lot of insurance plans just won't cover it.

- Yeah, yeah, that's true.

I mean, they're expensive.

I mean, you get it, you know, everyone hates their insurance company, but I mean, it's a business, and their margins are narrower than you might think.

And I don't work for them or take money from them, but it's just true.

It's a tough business.

And, you know, it's not a discount card.

I mean, it's a business.

So, anyway.

- Well, with paying all that money for a shot like this, does that in a way help people, you think?

Because now they're really invested in making this work.

- I don't know about that.

No, 'cause I mean, they could use the money for, like, healthier food and all kinds of stuff.

It's an interesting theory.

It'd be tough to, yeah.

- Well, what do you think about, you know, before there were GLP-1s, you know, there was gastric surgery, lap bands, things like that.

If someone says, "I want a GLP-1," would you say, "Okay, well, let's look at your history of trying to lose weight," or would you say, "Yeah, let's just give it a shot and see what happens"?

- Well, it all kind of depends.

You know, just to answer the original thing, one of the ways I'd like... This is never gonna happen, so I don't mind just saying it on TV, but I think one of the ways we could handle the cost of it, just make it over the counter.

I mean, really, all medications carry side effects, including over the counter medications.

Old fashioned, like, free market economics, I wonder if these things just got cheaper and more accessible and better for the consumer and all sorts of stuff.

But anyway, do I just blindly start a GLP-1?

No, every patient is a little bit different, right?

So, there are some black box warnings where you just can't go on it.

For example, it's not approved should you get pregnant, right?

So, young women of childbearing age, that's something to consider, especially if they're actively trying to have children in the near future.

Another one is something called medullary thyroid cancer, which is a rare form of thyroid cancer.

It's rare, but I ask everybody, whoever comes in, "Hey, do you have any personal or family history of that?"

And then I go over the side effects.

So, medically, so, if you think about it, the medication works by slowing the movement of food down, right?

So people tend to get side effects going the other way.

So, nausea, heartburn, constipation, counterintuitively, diarrhea.

This is all pretty minor stuff, really.

I mean, we've all kind of experienced this.

It's not that scary.

If you're patient, it probably goes away.

If it doesn't go away, you can stop the medicine, it goes away.

It just doesn't require a ton, really, to manage.

But it absolutely should be discussed every time.

- When you quit smoking, eventually, your heart gets better.

Your blood pressure gets better.

Your lungs can heal themselves.

When you lose weight, are you gonna be able to get rid of all those issues you had, the high blood pressure and everything else eventually?

- I'm reluctant to just blanket promise it'll go away, but there's no question about it'll get better.

You know, it's a common thing in my clinic where someone comes in with, you know, the diabetes, the blood pressure, the cholesterol.

They go on the weight medication.

So at first, we're adding a medicine.

But six, 12, 24 months from now, their total pill load, the number of medicines that they're taking, has gone down significantly because all of the above, the blood pressure medications got reduced or stopped.

The other diabetes medications got reduced or stopped.

So yeah, in total, you wouldn't call it... You'd call it controlled as opposed to gone.

- Sure.

Can you give us, just for folks watching who wanna lose weight, maybe they're not obese, but they've got a few pounds they'd like to get rid of, generally speaking, you know, where would you start with people?

- So, the best thing you could do is make foods at home from scratch.

And you know it's from scratch when you do it, right?

Just raw ingredients that you cooked.

But if you're gonna eat processed foods, you want to turn everything around.

Trust nothing on the front.

These are marketing terms, you can't trust it.

You gotta turn it around.

You're looking for added sugars and white flour and other refined grains, like corn and soy products, all these sorts of things.

These things tend to promote weight gain.

So added sugars and refined grains, if you're able to reduce or even eliminate that, specifically, the sugary drinks, for a lot of people, that alone is enough to help them lose some pounds.

- Okay.

You mentioned looking at labels earlier and how everything used to be no fat or low fat.

And that you still see those labels, and it's confusing, I think, for people, because, you know, let's say you look at a bottle of salad dressing, it says, "Low fat."

You look at another bottle, it says, "Low calories."

Another one says, "Low carbs."

How do you know which bottle to buy?

- Yeah, yeah, it's a good question.

I could tell you which one I would buy.

None.

(both laughing) I mean, I think you're better off just making a salad dressing.

It's easier than people think.

If I had to choose from those three, the low fat, the low or no fat, the low calorie, or the low carb, I guess I would probably pick the low carb.

But again, these are front labels, right?

You really do wanna turn it around and look at the back and see how much sugar they're putting in there.

- And if you look at those labels and towards the bottom, when you see all the words that you can't pronounce, and you don't know what they are- - It's a problem.

- Is that a red flag?

- Yeah, I would say so.

Yeah, that's bad news.

You know, I can't speak for every single one of these ingredients, but just broadly speaking, as these types of ingredients, these indecipherable ultra processed ones that you could not create in your own kitchen, have gone up in our diet, the obesity epidemic has gone with it.

That's a correlation, not a causation, but I mean, it sure seems related.

- Sure.

What are your thoughts on diets?

Because that, you know, before GLP-1s and things like that, that was, "Oh, try the keto diet.

Oh, try this diet, that diet."

I mean, are there any diets that you think are better than others?

- I don't have, like, a specific horse in that race.

Broadly speaking, if you're dieting, I always... You know, make your own foods.

I know I keep saying it, but it's true.

It's just really good advice, and it tastes better, and it's actually surprisingly cheaper, and so just do it.

Now, I think different people might respond differently just for whatever reason.

Maybe it's just as simple as their palate.

They just don't like eating meat.

Or they really like eating meat, you know?

I don't know.

And they can go plant-based, or if not keto, something keto adjacent to where you're going low carb.

These are all potentially right answers.

You know, whatever works for you.

- How beneficial do you think it would be for someone who's trying to lose weight to consult with, like, a dietician or nutritionist?

- It could help, you know?

I think if someone's really honest with themselves, where they keep a strict food diary for a week, don't do it longer than a week, you'll be a basket case.

Anybody would be.

But for one week, everything that goes in your mouth, you write it down, and you're looking for ultra processed stuff, you're looking for added sugars, you're looking for refined grains.

And it's not gonna go to zero, it's really challenging, I do understand that, but you're able to... You know, I eliminate that and I could have more whole foods here.

If you start with that, that might be enough for a lot of people, but not for everyone, right?

And so for people who on their own wanna stay out of the medical mill, let's say, and they wanna work on their own, and they're still not having the success they were looking for, by all means, go see a formal nutritionist, see someone, either me or someone like me, you know, a doctor.

So, yeah.

But most people can try on their own at first.

- Sure.

With your experience in working with people who are obese or trying to lose weight, what do you find is a good motivation for those people?

I mean, with people, I guess it could be anything from saving money to being healthy to whatever, but is there any one thing that you think really helps people?

- You know, that's an interesting question.

I want to answer it with a no, not like one thing.

But a lot of people come in and they're almost, I don't know, but they're almost over-motivated.

Like, they spend so much of their mental energy thinking about it for so many years, they're just essentially exhausted before they even get started.

And a lot of times, it's all about, you know, it's not illegal and it's not immoral to be overweight.

You don't have to do anything.

If you're happy with your life and your body the way that it is, you know, cool.

I have no... Great.

And just that, I find that relieving of a little bit of that burden is helpful.

- Anything else before we go that you wanna tell us that we haven't talked about in terms of helping folks lose weight or myths, misconceptions, anything you wanna break out there?

- Yeah, people think eating healthy foods is expensive.

It's not true.

You know, they've done studies on this.

The people look at the grocery prices, and it's true, they go up over time.

But I think what people are doing is they're thinking in terms of nominal, not real terms.

They're not adjusting for inflation.

You know, let's say over the last two years, your wage has gone up by 8%, but grocery prices have gone up by 4%.

These are real numbers, by the way, of like the average.

Have groceries gotten more expensive or cheaper?

I think most people would say expensive 'cause the number went up, but if you actually compare it to how much you're earning, it's cheaper, and it's just been true over, if you go back in time, the amount of discretionary income that Americans spend on their groceries has almost cut in half over the last 60, 70 years.

Nevermind the fact that we all have cooktops and ovens and dishwashers and easy recipes online.

You know, learning from a cookbook is really challenging, but learning from YouTube is very easy, 'cause it's infinitely patient and the recipe is spelled out for you.

So, what I would say is cooking and using whole foods is cheaper and easier than ever, so by all means, take advantage.

- Dr.

Tennant, we appreciate all the information.

Dr.

David Tennant with Carle Health, he is the lead at the Obesity Medicine Clinic at Proctor Hospital.

Thanks for all the advice.

We appreciate it.

- Happy to be here.

- All right.

And thank you for watching.

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