Dr. Sarah Stombaugh:
This is Dr. Sarah Stombaugh and you are listening to the Conquer Your Weight Podcast, episode number 53.

Announcer:
Welcome to the Conquer Your Weight podcast, where you will learn to understand your mind and body so you can achieve long-term weight loss. Here’s your host, obesity medicine physician and life coach, Dr. Sarah Stombaugh.

Dr. Sarah Stombaugh:
Hey everyone, welcome. I just got home from the OMA, the Obesity Medicine Association annual conference and learned a lot of great stuff, some great lectures, some topics that were new to me, some topics that were refreshers or had some good just additional information that I was able to pick up and bring home with me. And today I wanted to share that with you all. So today we are focusing on what I learned at the OMA 2023 fall conference and let’s dive into that. The very first lecture that stood out to me was a lecture about treating pre-obesity. And this is actually the first time I have heard the phrase pre-obesity. A lot of times we talk about overweight, meaning a BMI between 25 and 29.9, and that you cross into the obesity threshold once you hit a BMI of 30. So using the language of pre-obesity is really interesting because I think it helps us to take more seriously as a medical society, the condition that may be leading patients to struggle with not just their weight, but the medical conditions that can go alongside of those.

So we know that there is a relationship between obesity and things like diabetes, high blood pressure, high cholesterol, arthritis, acid reflux, many of these different medical conditions, however many of them start before we’re even struggling with significant excess weight to the point of obesity where we would typically your BMI might be 25, 26, 27. And by exploring pre-obese and treatment of pre-obesity, can we potentially reverse or even prevent some of these medical issues from occurring in the future? So what I like about this so much is that when you look at many patients you can see year to year, if you’re looking at their blood sugar levels, you’re looking at their hemoglobin A1C, that’s a lab that tracks the blood sugar over three months period of time. If you’re looking at their cholesterol, if you’re looking at their blood pressure numbers, you can see over time, typically there’s a slight increase that happens year to year before they ever get diagnosed as having diabetes, having hypertension, having any of these issues.

And a lot of times we’re seeing some of those increases as the patient is in the overweight category, sometimes even before that. And so the question is here, can we take steps in order to reduce the root cause, which for some people is their weight to reduce the root cause in order to reduce the risk of those things ever occurring. The interesting thing too is that we know that for someone who has dealt with obesity and some of these medical issues, there’s a huge reduction in their risk of any other medical issue just by losing weight. So let’s say we have a patient who has a BMI of 35. If they reduce their weight and bring it down to a BMI of let’s say 28, we’ve reduced their BMI by seven points. That risk reduction is humongous. What it’s not though is equivalent to someone who has always had a BMI of 28.

So having had that elevated weight, even bringing it back down to a BMI of 28 is going to be a higher risk than someone who had ABMI of 28 that entire time. The analogy that was given was similar to smoking, and you may have heard this type of data before, which is that for a smoker, someone who quit smoking after five years, we see that their risk is dropped significantly. I mean, we really slash their risk of lung cancer, other cancers, heart disease significantly, but it never completely goes back down to the level of someone who was never a smoker. And it turns out the same thing may be true for people who deal with obesity, that having that increased weight over time, even if they’re able to bring their weight down back to a normal level, that may not be the same as someone who had a normal body weight throughout.

And so this is especially important for our children, for young adults to prevent them from ever dealing with those issues in the first place. So if you have children in your life, this is an excellent time that as you are working on your own relationship with food, your own relationship with yourself and your body and exercise and how you learn to connect with your body, you can share that same information with your children so that they can learn to best connect with their body to improve their health before it ever becomes an issue. The other thing is policy. And so are there things that we can do even at a national federal level in order to improve school lunches, to reduce our access to sugar and sweetened beverages, things that we know can really drive up the risk for obesity. And it’s really important kids are eating at school.

Many kids eat at school every single day. And so if we can guarantee that kids are getting a really healthy lunch every day for some kids that’s even breakfast every day. And if we’re able to give them those good nourishing meals that is going to have such profound impacts for them. So I wanted to share that because I thought it was just a really interesting way of looking at prevention from a slightly different lens. I had went to another lecture about sleep and there were a few points that really stood out to me that I wanted to share with you. I think you all know that I love sleep. I think there is nothing more important than sleeping. Sleeping is the most important thing in my life. Truly, we joke that our children are good sleepers because it’s so important to us that we are good sleepers.

I am a very heavy sleeper. If my kids want me in the middle of the night, they better call out and really ask for it because I am very serious about my sleeping. And we know that sleep is one of the most important things we can do in order to support a healthy weight. And so if you are not sleeping, that is something that is worth figuring out. Don’t feel bad about it, don’t feel guilty about it. We know that there are so many people who are not sleeping well, but if you are not one of them, if you are someone who gets a bad night of sleep over and over again, please, please, please go talk to your doctor. There’s an entire field of medicine dedicated to sleep medicine. So you can ask to get a referral to a sleep medicine physician, and that’s especially for people who are snoring, people who are getting an appropriate number of hours of sleep, but waking up feeling exhausted.

Regardless, you may be dealing with snoring, with sleep apnea or with other medical conditions that are causing you to get a poor quality of sleep. And that was one of the interesting things I learned too. We’ve known for a long time that the ideal amount of sleep for humans is seven to eight, or at least adult humans is seven to eight hours per night. When we get less than that on a chronic basis, it can be a major issue. Interestingly, when we get more than that, the reason why it’s a problem is because getting more sleep is likely signifying that there’s some sort of quality issue with your sleep that’s requiring you to get a higher number of hours of sleep in order to get a decent quantity of good sleep. And so someone who’s sleeping nine or 10 hours a night who’s having a lot of issues with snoring, for example, that may actually be the equivalent of seven hours of sleep.

And so even though they perceive that they’re in bed for a decent number of hours, the number of hours that they’re actually getting good sleep is not as high. So that seven to eight hours is really that perfect window. If you’re getting a lot more than that and waking up tired, go talk to your doctor, ask to see a sleep medicine physician, and if you’re getting a lot less than that, let’s work on that and figure out a way to improve that sleep. That might mean in the evening you have a good routine by which you were winding down for bed, you’re not having caffeine late in the day, you’re minimizing alcohol, minimizing processed sugars, making sure that you are setting yourself up for the best sleep success possible. Because one of the things I was reminded of is how quickly we can induce insulin resistant in people who are sleep deprived.

So what that means, insulin resistance is the root cause of obesity of diabetes, pre-diabetes, many different medical conditions. And we know that when we’ve gotten poor sleep, especially when we get that continuously, it drives up our stress hormones and that plays a role in the way our body processes energy such that we become more insulin resistant. We are craving more highly processed, more highly dense energetic foods and it can be a major, major problem. So there were actually studies where they took college-aged boys, so healthy boys who were in their early twenties and for a week they had them sleep for just four hours a night. And after it wasn’t even a week, it was six days after six days of getting four hours of sleep per night, every single one of those six days, they induced pre-diabetes. So insulin resistance significant enough that it was at the level of pre-diabetes for these completely healthy college age boys.

And so imagine that exact same thing that you might be doing to your body, especially if you’re older, especially if you’re a woman. Women are more likely to be insulin resistant compared to men especially because of changes in our hormone levels as we go through peri and menopause. And that is significant. So if you are not sleeping, I would love to help you if you’re in Illinois or Virginia, but please, please, please talk to your doctor and make sure that that is something that you’re working on. We also learn, we know that dementia can be related to sleep and that sleep is the time in which our body, our brains are able to process some of these breakdown products in order to process things in order to reduce the risk of dementia. So we are at the point where 10, 20 years from now, we may be seeing the direct reflection of poor sleep in an increased prevalence of dementia.

So diet, exercise, all of that stuff is important and I’m going to be here and say it right now that from a weight loss standpoint as well as a general health standpoint, I don’t think there is anything more important than sleep that we can be doing. Alright I think I appropriately emphasize that, but please, please, please make sure you’re sleeping. The other thing that I know, but I don’t know that a lot of my patients necessarily know this or at a higher societal level that we know this is the prevalence of eating disorders. So eating disorders are very common in people who have overweight and obesity. The most common is binge eating disorder. And I see this very frequently in my practice. Interestingly, a lot of patients who come to see me recognize that they have times where they’re out of control of their eating or have what they describe as even binges, but they don’t necessarily translate that to the definition of binge eating disorder.

And it’s very common that no one has either asked them those things before or never diagnosed them with that before. So binge eating disorder is very, very common, especially if you’re having in the evening finding that you are turning to food as a source of comfort going back to the pantry over and over again, driving through the drive-through on the way home from work. If you are having any of those type of behaviors speak with someone who is an obesity medicine physician, even a psychiatrist or a primary care physician who specializes in eating disorders, there’s a good chance that you might be struggling with an eating disorder and not even realize that. And the reason that’s so important is that we actually have treatment for many of these things, and so there may be medications that can help support you in order to decrease those bingeing episodes.

The other thing that I wanted to share is the definition of atypical anorexia. So anorexia by definition is a restrictive eating disorder in which someone has a lower than normal BMI. So a body mass index of less than 18.5 associated with this food restriction. Interestingly though, regardless of your body weight, if you are restricting food to a significant amount, you can be dealing with symptoms of anorexia. And you can imagine how this could go undiagnosed or unrecognized because let’s say you have a body weight of 250 pounds and you simply stop eating, you start really restricting your food intake and your weight drops rapidly to 200 pounds. You are still likely falling in the obese category, maybe falling in the overweight category. So people aren’t always as aware of the fact that you were dealing with that restriction that you were actually dealing with anorexia.

And if you look at your blood work, you look at the effects that that could have on your body, that can be very, very significant. And so I’m here to say if you are struggling with your weight, stopping eating is not the answer. That can be a very dangerous thing and it may be unrecognized because a lot of times clinicians are not necessarily looking for people with anorexia who also have overweight or obesity. And so that’s just something worth pointing out. I see it. It’s more common than you would even think. And so I do see that in patients from time to time that they have had a history of that type of behavior. And it’s really important to be aware of that. So you can help your patients to get or help yourself if you’re someone who struggled with this to get the full support of an eating disorder specialist, an obesity medicine physician who is trauma informed therapist who has this type of background to make sure that you are really getting that comprehensive support to lose weight in a way that is healthy.

So one of the other things is thinking about new medications. So right now everyone’s talking about Wagovy, Saxenda, Ozempic, there’s been lots of conversations about those. We’ve had some conversation about the medication Mounjaro, which is tirzepatide. And the good news about that it is an FDA-approved medication for type two diabetes. But if you are listening to this episode live, it is not yet approved for the treatment of obesity that is coming down the pike really, really, really, really soon. We expect that to be available in December. And so that is not too far away. So I’m really excited for my patients to start getting access to that medication for their weight loss and especially as some of my patients have experienced, and we are seeing these shortages of medications. So having another medication that is available for the treatment of obesity is going to be an excellent tool in our toolbox.

We also know there are a lot of great medications coming down the pike. There are about five different medications that are in phase two clinical trials right now. And so over the next two to five years, I think we’re going to see a huge evolution in the treatment of obesity. And I’m really excited for that and I hope that you are too because one of the things as a society, we have a really big obesity bias such that we are often really skeptical about taking medications for obesity. And we may not want to take those medications when the same person would gladly take a medication for blood pressure or for their diabetes or for their asthma or for their depression or whatever other medical condition it is that they’re dealing with. And so there are some people who lose weight without medications, absolutely, but there’s nothing wrong with wanting to or needing to use a medication to support your weight loss journey.

And as we see more and more of these medications available, I hope that helps to de-stigmatize the use of medications for those who need or want to have that as part of their weight loss journey. One of the other things I wanted to share, and the last thing I wanted to share from the conference was about weight regain. And one of the things we know is that it is very common to gain weight after a major weight loss. And many of you unfortunately know this from experience when we implement certain things in order to lose weight, that even if that process goes well, it’s easy for the weight regain to happen. And that can happen for a lot of different reasons sometimes because we were really restricting ourselves during the weight loss process. And so as soon as we let up from that restriction, we are eating more food, maybe we are moving less and that can contribute to weight regain.

But honestly, one of the biggest things we see is this major dip in metabolism that happens. It is real. We know that this happens. We know that after a chronic caloric deprivation, so after someone who has lost weight, especially when they’ve lost weight through decreasing their amount of calories that chronically, they are required to eat about 300 to 400 calories per day, less on average than someone of the same body weight who didn’t previously have that history of obesity. And so this is significant, and for some people it’s three to 400 calories that may be more for some people that may be less for other people. And so when every day you are needing to make sure that you are either consuming less than 300 to 400 calories or you’re burning more calories, that can make it really challenging in the longterm in order to support that lower weight.

This might mean a few different things. One, we know that exercise can be a really important part of weight maintenance. Part of that is because exercise is helping to burn extra energy that may help to contribute to that decrease in amount of calories we burned. However, one of the sad things is we also know that as we lose weight in order to conserve energy, our muscles become more efficient. So what that means, you’ve probably had the experience of getting on a treadmill. You put in your height and your weight and like, okay, you burn 150 calories for every mile that you walk. That’s not actually true, right? If it’s just taking your height, your weight, and your age, there’s really a lot of other information that’s going to go into that. But we do know that let’s say it takes 150 calories per mile that you walk over time, as you lose weight and your muscles become more efficient, maybe it actually takes you less energy to move your body through space.

So it might take a hundred calories per mile that you walk. And so even though you perceive that you’re exercising more and more, your muscles are more efficient, they’re burning less energy every time you exercise. And so therefore you either need to exercise more or you need to exercise differently. And I want to emphasize the exercising differently because this is a piece that is so, so important. So we know that we have different types of muscles, and particularly our type two muscles, those are our slow twitch muscles, the muscles that are really important for weightlifting, for example, that by doing resistance exercises that can help to develop our type two muscles. And the reason that that is so important is that our type two muscles are quite inefficient, which might sound bad at first glance, but that’s actually a really good thing. It means it takes more energy in order to use those muscles compared to our fast twitch, our type one muscles.

So what that means is that resistance type exercises are going to burn more calories compared to a cardio type exercise. The other part of that is resistance exercises are going to be one of the most important things in order to preserve maintain our lean muscle mass. So in the weight loss journey, we often talk about weight loss, but we don’t really care about weight loss so much as we care about fat mass loss. And the reason that distinction is important to draw is that as you’re losing weight, there’s going to be some fat mass loss. There’s also going to be some muscle mass loss. And in some ways it’s okay. You can imagine that let’s say a body that weighs 300 pounds is going to take a certain amount of muscle to move that body through space to move that body through its daily activities.

So if a body weighs 200 pounds, it is simply going to require less muscle in order to move that body through space through time. As a body that weighs 300 pounds. So it may okay for there to be a slight decrease in our muscle mass, but what we don’t want to see is a major wasting away of our muscle mass. So as we are losing weight, it’s important that we’re doing those resistance exercises. It’s important that we’re emphasizing protein in the diet, and those two things are going to be the most important defense that we have in order to preserve our lean muscle mass.

Alright, so that is everything that I wanted to share with you all. If any of that was new to you and you’re like, oh wow, that’s really cool. She said something that I haven’t heard a doctor say before. I would love to work together to help you with your weight. So come on over to my website. It’s at www.sarahstombaughmd.com. I see patients in Illinois and Virginia. I now have an in-office location in downtown Charlottesville, Virginia, but I’m also still seeing patients from all across the state of Illinois and Virginia for telemedicine. So if you are looking for that support, I would love to work with you, pop on over to my website, fill out the form on the individual visits page. I look forward to seeing you soon. I’ll see you all next week. Take care.