April 16, 2021 by John Fernandez
Q&A on Weight Management: There’s No ‘One-Size-Fits-All’ Solution
For decades, public health experts have warned us about the negative consequences of the obesity epidemic. The numbers continue to rise, however, with no sign of slowing down. The U.S. Centers for Disease Control and Prevention reports that more than 70 percent of adults over age 20 are either overweight or obese. Despite the estimated 33-billion dollars spent on diet products annually, Americans are not winning the war against their expanding waistlines.
There’s no magic pill, or one-size-fits-all solution, says Manuel B. Torres, M.D., a family medicine physician with Baptist Health Primary Care, who specializes in weight management. “Part of the challenge is the fact that I think we tend to focus on the wrong organ,” Dr. Torres explains. “We’re trying to lose body fat, which is what we see in the mirror. But the true organ that is in control of this whole scenario is your brain. The brain needs to be satisfied with the consumption of food that’s coming in, and the brain needs to be satisfied with how much energy is there stored just in case.”
Jonathan Fialkow, M.D., deputy medical director and chief of cardiology at Miami Cardiac & Vascular Institute and host of the Baptist HealthTalk podcast, believes it’s unfair to judge those with weight issues, saying: “I think what’s important for people to understand is number one: if you’re overweight or struggling to lose weight, it’s not a personality factor. You’re not failing in anything. Your body wants to hold on to energy it has stored. There are drivers that are creating that status of craving and holding onto energy, although there are tools and ways to correct that.”
Dr. Torres brought his expertise on weight management strategies to a recent episode of the podcast, discussing the multifaceted reasons why people gain weight, why fad diets don’t work, and how Baptist Health physicians can tailor weight management plans to patients’ individual needs. Check out the Q&A below for details.
Dr. Fialkow: “When we say we want people to lose weight or maintain a healthy weight, what do we really mean by that?”
“ ‘How much should I weigh?’ is a question we get a lot. And I always say, it depends upon your body frame, and that’s a number that we can calculate. So, it’s not just about the gross number on the scale. We want to try to help patients begin to focus on trying to improve their body fat index or body mass index, BMI. And that number, as you know, as a cardiologist, correlates to cardiovascular risk.
“A BMI greater than 30 is considered obese, greater than 35 is a stage 2 obesity, and then greater than 40 is considered morbidly obese or category 3 or stage 3 obesity.”
Dr. Fialkow: “Arguably, people don’t eat more foods that they shouldn’t because they want to. There are drivers, cravings and things.”
Dr. Fialkow: “From your experience, why do people gain weight?”
“There are many different reasons. Part of the specialty of obesity medicine really is to answer that question, particularly because – newsflash — not everybody is the same, right?
“We have genetic causes as to why people gain weight. There are very significant obesity-related diseases that are diagnosed in pediatrics and adolescents.
“For adults, there are multiple things that are contributing to that slow and steady weight gain. There are macro environment issues, like how we tend to favor the lazy choice in regard to parking spaces and elevators and things like that. And there are the micro-environment influences on the patient. Are they surrounded by a family of heavy eaters? Are they surrounded by a family of people that are encouraging poor nutritional decision-making and those kinds of things? Assessing the macro environment and the micro-environment in a particular patient will often lead to decisions on treatment.”
Dr. Fialkow: “I find it fascinating how evolution plays an element. If you think about it, man evolved (in conditions of) a very uneven food supply. Most of man’s existence was just finding the next meal.”
Dr. Fialkow: “So, we’re really not evolutionarily geared towards being very active. Evolutionarily, if I could push a button and do something, that’s better than having to use energy. We’re also evolutionarily geared towards storing food, right? If we have extra food, we want to hold on to it.
“So, it’s not because you’re not exercising. How often does someone who gains weight come to me and say, ‘Well, I just have to exercise.’ No, no, no, it’s not. You’ll burn calories, but you’re still going to store energy eating the wrong foods.
“Let’s talk dieting in general. Everyone who’s considered themselves as overweight has tried to diet.”
Dr. Fialkow: “Why don’t diets work?”
“I think part of the reason why diets don’t work is because we try to approach weight loss with a sort of one-size-fits-all. The current fad of trying to avoid carbohydrates all together, sure, can have some changes on the scale, but may be difficult in regards to sustainability and longevity. It’s an unrealistic approach for most people.
“People’s personality and approach and motivation really matters because one of the biggest things that we have to do obviously is change, and change is sometimes hard to make permanent.
“So, if someone decides to go low calorie and low carbohydrate, it’s not low calorie and low carbohydrate Monday through Wednesday, and then Thursday, Friday. ‘Oh, well, it’s the weekend.’ And then, ‘I’ll start again on Monday.’ It’s trying to be consistent.
“I often talk about the three C’s: calories, carbohydrates, and the most important one being consistency. The consistency is really what matters.”
Dr. Fialkow: “Ultimately, lean people shouldn’t judge overweight people. It’s not a personality defect. It’s not a flaw. They’re hormonally… I mean, how many times have I treated 300-pounds twins? I mean to the pound. Tell me how it’s not genetic and certainly hormonal for twins to have almost the same exact weight.”
“This is all genetically predetermined. And I try to help patients understand. ‘Sir or ma’am, you’re a good weight gainer. Genetically, you’ve been sort of manufactured to be a good weight gainer.’
“And then, on top of that, you’re living in a macro environment where there’s plenty of food availability. So, if you match genetics for a good weight gainer with massive amount of surplus food availability, and then you also match that with other macro environmental situations where you’re not really spending a lot of energy to do routine things, then that’s going to lead to slow and steady weight gain.”
Dr. Fialkow: “We’re not going to get into different diets and pros and cons. Although I think, arguably, eating food in the most natural form and avoiding sugar would be a good starting point, as much as you can. What’s your approach? What tools do you use in your practice as an expert in obesity medicine?”
“The good news here is that at Baptist Health, we’re really expanding in regards to what is available to the patient. We have to implement multiple tools to really help develop a weight loss strategy. We look at common calorie intakes, macronutrient distribution. We evaluate the patient metabolically. Does this patient have a genetic disorder? Is this patient genetically predetermined to gain weight? And then implementing a pharmaceutical strategy.
“And sometimes pharmaceuticals can come in very handy, especially if the patient already has additional comorbidities. For example, a lot of diabetic medications are now really favoring weight loss. Maybe even medication adjustment. If the patient is on psychotropic medications that are really prone to weight gain, can we talk to the psychiatrist? Can we try to adjust those medications to promote weight loss?”
Dr. Fialkow: “So, it’s very much tailored to the individual.”
“There are very specific ways to approach obesity, where your individual treatment plan for your obesity needs to be evaluated by a physician who has the experience and the knowledge to try to guide you.
“We can talk about additional, more significant strategies that definitely have a greater effect on weight loss, like for example, bariatric surgery. I work very closely with our bariatric surgeons and we definitely implement a surgical approach when it’s indicated. It may not be the strategy that we implement today, but it’s definitely a tool in our toolbox.”