Top 10 Obesity Myths with Dr. Angela Golden, Part 1
dr. angela golden myths podcast
At a recent Obesity Medicine Conference in Atlanta, I met Dr. Angela Golden, a leader in Obesity Medicine education, and someone who herself struggles with the disease. After her awesome presentation, "The Top 10 Obesity Myths," I accosted her at a function and asked her to be on my podcast, so she could educate all of YOU on these myths, some of which your own health care providers may believe. We cover the first 5 myths this week and the second 5 myths next week. Tune in for our enlightening discussion!
6:11 So the current research shows us that people who have untreated obesity can have eight years shorter life.
8:59 People who are overweight were at higher risk for sudden death. So obesity is a CHRONIC disease.
17:13 We all need to recognize this isn't about willpower. It's a chronic disease. For example, you wouldn't say that your blood pressure was elevated because you 'didn't have enough willpower'.
Hey everyone and welcome to today's podcast. I am super excited. I have a very special guest with me today and her name is Dr. Angela Golden, and she goes by Dr. Golden, Dr. Angie. and so we're both sort of like Dr. Angela , we're calling it Dr. Angela one and Dr. Angela two. And she's going to be with us for this episode and for next week's episode of the podcast to talk to us about the top 10 obesity myths. So welcome Dr. Angie,
Dr. Angela Golden (01:04):
Thank you so much for having me. I'm so excited.
I know I'm so excited too. I want to explain to our listeners how this came about. So you might remember that a few weeks ago, I was at an obesity medicine conference in Atlanta, and Dr. Angie gave an amazing talk on the top 10 obesity myths. And as I listened to her, I was thinking about all of you. And I was thinking, wow, this is what every person struggling with this disease needs to hear. And so I snagged her at a function later that day. I said, will you please come and be on my podcast and share your wisdom with my audience? And she said, absolutely, I'd be happy to, so thank you so much. I really appreciate it. Now. Here's what I want you to know about Dr. Angie. She's got a doctorate in nursing, but not only that, but she's the past president of the American association of nurse practitioners, which is like the association in America for people who are nurse practitioners. Right? Like, am I correct there? Like, this is, this is a big deal.
Yes, it is. The immediate past president…..
Yeah. It's the national organization. Yeah.
Yeah. She's also got her own practice in obesity medicine in Flagstaff, Arizona. And there she provides evidence based obesity treatment for her patients. She's a consultant in the development of patient education materials. She she's authored a book on obesity and a chapter on obesity management. She's written peer reviewed articles. She's done research. She's been interviewed by the media. She is doing national and international presentations on obesity and health policy and clinical care and leadership. I mean, she's just a, such an accomplished woman and she's a very amazing and engaging presenter. So I am super excited to have her with us. So we're going to talk about the first five obesity myths today, and then next week we're going to cover the myths number six through 10. So I'm super excited for this discussion and for all of our listeners to hear what you have to teach Dr. Angie.
I'm excited to do this. This is my favorite topic to get to talk about the things that aren't true, that everybody thinks are.
. Exactly. All right. So what is myth? Number one,
Myth. Number one is that obesity is not a disease. It's just a risk factor.
Ah, okay.
And the truth is obesity is a chronic, serious, relapsing and treatable disease. I love the way Dr. Primack, who is a past president of the obesity medicine association adds that and treatable to his definition.
The world health organization defines obesity as abnormal or excessive fat accumulation that presents a risk to health. I think that's important. Yes, because we, you know, we have to talk about this, not as just fat or adipose tissue, which is the medical word for fat mm-hmm because that's not the important part. It's not just that you have excess fat cells. It's what it does to your health. Yes. And as, as one of my disclosures, I should say, I'm a person, a woman living with obesity. I love that I'm in maintenance right now, but I've lived with this disease. And I can tell you as the World Obesity Federation says it is a chronic relapsing and progressive disease. Mm-Hmm . I have been working on treating this disease for many, many years, and it's hard to stay in a maintenance space with it because of its relapsing and progressive nature.
So relapsing mean, it means that it comes back and progressive means that it gets worse over time. So getting it under control and keeping it under control is a really important aspect of this disease. It's……
But as Dr. Primack says it's treatable. So that's what we want everybody to understand. Yeah.
You know, and a lot of my patients say, how's it a chronic disease. They understand diabetes is chronic. They understand hypertension or cholesterol or chronic diseases, but they don't really understand, first of all, what a chronic disease is, but how obesity is one and a chronic disease is something that causes the entire body or an organ or a system to kind of malfunction over time. And when you look at obesity, we can see that that happens because it can actually change what the heart looks like. Mm-Hmm Obesity can cause that to deposit in other organs, like the liver, the kidneys, the heart. Mm-hmm , It can even cause a shortening of life. So the current research shows us that people who have untreated obesity mm-hmm can have eight years shorter life.
So it'll take eight years off your
Life. Yeah. If it's untreated. I know.
Yeah. Wow. Okay.
So the second piece of chronic disease is that it has stages and in organ dysfunction. And for obesity, the American Association Of Clinical Endocrinologists have three stages to the disease. OK. Okay. The first stage is zero. And that's that you have excess adipose tissue but it has no complications.
Stage one is that you have a mild or moderate complication and that the disease can be treated with moderate weight loss, which we'll talk a little bit more about later. And a moderate complication would be like prediabetes or pre-hypertension or perhaps gastric reflux.
Stage two there's at least one severe complication and more aggressive treatment is needed. Mm-Hmm . So for stage two obesity, we're talking about having the disease of obesity that's causing diabetes, hypertension, high cholesterol. So you can see that we meet this, this second definition of chronic disease and the third that it causes other diseases. In fact, mm-hmm we have evidence now that obesity has 236 other diseases that it can cause including,
I know the one that scares me the most, I think is that it causes 14 obesity related cancers.
Mm mm-hmm
and then the fourth criteria for something to be a chronic disease is that it's manifested by signs and symptoms
And if we look at obesity, obesity can cause exercise intolerance, we can't exercise or have as much activity, resistance to insulin is mm-hmm part of obesity. And then what a lot of people don't understand is the chronic inflammation that occurs because of the fat cells, putting out chemicals that cause chronic inflammation. And then I mentioned already the fat deposits to other organs. Mm-hmm And then the hormonal part of this disease is the increase in hunger. So all of these, that disregulation of our, of our hormones all are part of the signs and symptoms. And that's why, but I think this part is the, one of the take home message. There's nothing new about this 2,500 years ago, Hippocrates, which I'm sure all of your listeners have heard of recognize that people who are overweight were at higher risk for sudden death.
Mm mm-hmm yeah. Yeah. So obesity is a chronic disease. Now what, you know, what just occurred to me that I find interesting about the the stages that you just talked about. They don't say specifically how much people weigh, you know, what their body mass, (Exactly} or their body fat percentages because you don't have to have a lot of obvious weight gain to be suffering from these complications.
You can have type two diabetes and not have a lot of excess weight.
Yes ma'am so, yes. I love that about the ACE explanation of obesity as a disease. Mm-Hmm Nowhere are they BMI or weight specific? They're really talking about the complications that the excess adiposity causes. Mm-hmm And I think that that's the take home piece of this. It's not the excess fat, it's what the excess fat causes.
And I think that, that, that's why your podcast is so critical because it's not just losing it. It's keeping it off, that that chronic piece of it is keeping it off. That makes the difference in the health outcomes.
Yes, yes. Yeah. 14 cancers. You're at risk for when you have this disease and it's out of control that's yes. Well, that's scary. So, all right. So that's myth, number one, that actually, this is a disease. It's not a risk factor the way so many of us have thought of it. It is a disease that creates all sorts of complications. So what's myth number two.
It's all about willpower
Willpower. Oh, my favorite topic
So the fact is that obesity is a neuroendocrine disorder
Neuroendocrine. Okay. Like that's a long word. What does that mean?
So, so let's start with what willpower means. Willpower says by dictionary that that's the control exerted to do something or restrain impulses. And as a woman who lives with obesity, I have been told many times in my life that I needed to control my impulse to eat. Mm-hmm . But if we really look at what obesity is, the neuroendocrine nature of it, that means that the brain has control overeating mm-hmm . And the endocrine part means that there are hormones, which are the chemical messengers inside our body mm-hmm and the peptides, which are amino acid chains Mm-Hmm that message the brain. mm-hmm . So that's the neuroendocrine, the brain and the chemical messengers talking back and forth to say whether or not I should eat more food or move more.
That's not willpower. I don't have willpower over the chemical messengers inside my body.
Yeah. So true. I I've heard one of, one of our colleagues say at a conference one time, trying to tell someone who is struggling with the disease of obesity to stop eating is a little bit like trying to tell a woman in her childbearing years to just stop ovulating. Like you don't have any control over when you're ovulating and when you're not ovulating.
Right, and, and that's hormonal.
And you don't have any control over your hunger levels when you have obesity and you don't have any, like, your brain is telling you not to move, right. Like that's a big piece of it as well. So…..
So the hypothalamus is one of those areas of the brain that controls what we call homeostatic control of eating. Mm-hmm . And that's what responds to those chemical messengers or those hormones to increase appetite and decrease energy expenditure or decrease appetite and increase energy expenditure. In other words, move more. Mm-Hmm . So if we think about that same part of the brain, the hypothalamus regulates our body temperature. Yes. So if you think about being in Southern Arizona, the Phoenix area, where it's going to be hitting a hundred here pretty soon and you're outside your body temperature, doesn't go up to a hundred because the hypothalamus does all of these things to keep your body temperature regulated, that's homeostatic control. And we actually have that overeating too through the hypothalamus mm-hmm . Now there is a difference. We also have what's called hedonistic control that help with food choices.
So that's different than our temperature for sure. Mm-Hmm But this is the, this is where that idea that willpower is the sole reason for increased food intake comes from. But it's only a part of the system.
So yes, there is a part that if you walk by someplace and you smell chocolate chip cookies baking, and it makes you think of your grandmother, you might reach out and have a chocolate chip cookie mm-hmm , but it's only a small part of it. Mm-Hmm We still have that homeostatic part. Mm-hmm . And so, as you mentioned, we also have the part on locomotion or energy expenditure. That's also hormonal. Mm-hmm . So here's what happens with the disease of obesity; it's got two parts to it. The first is something causes an increase in the amount of adipose tissue or fat cells. Mm-Hmm mm-hmm and then the brain has a dysregulation mm-hmm that says that new fat mass has to be defended. Mm-hmm
So as someone loses their weight, the brain defends it and it defends it by having chemicals that say eat more
So that is not willpower. No, there's one other thing that people don't understand about the adipose tissue and that's that it's one of the few cells in the body that can not only get larger, it's called hypertrophy mm-hmm but increase in number called hyperplasia. Yeah. So when we have obesity, ourselves can get bigger and they can increase in number
Mm-Hmm And then the brain is going to defend that.
Yes. And so that's, that's one of the reasons why it's so hard to control. You know, the interesting thing is that I find a lot of people who, you know, they'll come in and they'll just say, I know I need to exercise, but I'm just lazy. Mm. And I am just saying to them, you are not lazy. If you had any idea what your brain is telling you, your brain is telling you. No, no, no, no, no, no, no. Don't move. Don't move. No, we don't want to move because we're trying to defend the fat cells that are there.
So, and I also find, you know, because this is such a, a disease with so many complications, like a lot of times there's thyroid issues and there's blood sugar issues and there's insulin resistance and there's anemia and all kinds of other things. Some for some people I'm just like, I'm not even sure how you're getting out of bed every day. Do not even begin to think that you're lazy.
So, and I look at people that have accomplished so much in their lives. Mm-Hmm and I wonder how they can think that they have no willpower. I mean…..
You a doc, you know, somebody's got a doctoral degree and they look at me and say, I have no willpower. Exactly. I'm looking at them going really?
So I, I think that we all need to recognize this isn't about willpower. It's a chronic disease. And you wouldn't say that your blood pressure was elevated cause you didn't have enough willpower.
That's a chronic disease too. So hopefully we've busted that myth.
I hope so, too. So for those of you who are listening, this is not a willpower issue. This is brain chemistry. Okay. What is myth three?
They are diet meds,
Diet meds. Okay.
So diet meds really imply that the medications are only going to impact what we eat or that they're only for weight loss. Mm-Hmm In reality, the FDA approved anti-obisity medications are there to treat the pathology of the neuroendocrine disease. They're impacting satiety or the peptides or the hormones of the chronic disease of obesity. And I'm sure with your patients, you have to have the same discussion with them that mm-hmm these medications are for the chronic disease of obesity. They're not short term medications. They're really treating that underlying nature of the disease. Yeah.
Yes. And and that's, that's a huge piece of this because understanding that there that the, the brain is trying to defend fat cells. And then what these medications are doing is to correct that and that there are so many people out there who are prac, who are practicing medicine, who do not understand that obesity is a disease and that obesity is a chronic disease and that's not their fault is they just didn't, they just haven't learned this stuff yet, but they might be willing to put somebody on an obesity medication for a few months or for a little while, until the weight comes off. And then they're like, oh, we need to stop it now. And it's like, mm, you wouldn't do that with high blood pressure. You wouldn't say, let's just get your blood pressure down. And then we'll take you off your blood pressure medications because wow. It's fixed. Like no.
And so, so really, you know, finding somebody who understands that this is a chronic disease and understands that you need ongoing treatment is really, really important for those of us, for those of our listeners who are struggling with this disease or who know somebody who's struggling with this disease. Like most healthcare professionals are still going to tell people to just diet and exercise. And that's just mostly because they don't know better.
It is. And, and you know, my physician colleagues, NP's, PA's, mm-hmm, , it's not being taught in their programs. I mean, we, it's not, we can't blame them. Mm-Hmm because it's just not taught in their underlying programs yet. They have to get this information after they graduate. Mm-Hmm if they're going to know about it. So mm-hmm you have the chronic disease of obesity and you found someone who knows this disease, hang onto them. Yes.
Refer people to them. But I think the listener who is saying, wow, how do I find somebody like that. In the United States, The Obesity Action Coalition is a patient focused organization and they have a list of clinicians. Mm-Hmm The Obesity Medicine Association has a list of clinicians. Mm-Hmm if you're outside the United States, The World Obesity Federation has that. And so does the European Society For Obesity, it's E.A.S.O., I can't remember what the, A stands for and I apologize for that. But they also have a list of clinicians. So people can go on to their websites and look for someone who understands it. But there's nothing wrong with going to your clinician and saying, do you understand the chronic disease of obesity and how to treat it? And if they say yes, great. And if they say no, then ask them if they know somebody in the community that does. Mm-hmm Many times they've heard a lecture and they can do a referral.
Mm-Hmm yeah, yeah. You know, it's so interesting. I started in obesity medicine almost 15 years ago, and there were like 300 people that were board certified in obesity medicine at that time. wow. Now I don't know, what are there, four or 5,000 now. So mm-hmm, , there's, there's a, there's a much bigger network of people that your, that your physician could refer you to if they're not comfortable themselves treating obesity. But just to really understand, like, these are not diet medications, these are not medications that you're going to use for a few months and then be done with. This is a chronic disease and you need to, you need to envision ongoing treatment in the same way that you would if you had diabetes, if you had high blood pressure, if you had whatever chronic disease you might have. So, okay. What's myth four?
You need to lose a lot to have any benefit.
This is a good news one.
Yes. You
Really only need to lose about 5 to 10% of the body weight in order to impact the complications of adiposity. So you can reduce cardiovascular risk, like hypertension, mm-hmm you can prevent or delay type two diabetes. I love that word. You could prevent type two diabetes. You can improve osteoarthritis. For those of us with obesity, sometimes knee pain is what actually took us into the provider to start with. Yeah. And so improving that quality of life. Yeah. But reducing those obesity associated complications, but here's one of the things I really want to put out there. It's not just losing the 5 to 10%. Cause if you think about somebody who weighs 200 pounds, that might be 10 to 20 pound weight loss, but it's keeping it off.
It's keeping it off as your podcast is working so hard to help people with. It's keeping it off for that six months. That's the critical piece. Mm-Hmm Because that's what impacts that, those obesity associated disorders. Right. So that I think is, is the good news part. You lose it, you keep it off and you can have such tremendous impact on health and quality of life.
Amen. Amen. So okay. So you don't have to lose a lot to have an incredible benefit. But the, the goal is to keep it off. Okay. What is myth number five?
I can't change it. All. My family is heavy.
Oh, okay.
And as part of my disclosure, I always talk about the fact that my father had obesity. He weighed almost 400 pounds at five foot eight mm-hmm . and so it would be easy for me to say, well, I have obesity. There's nothing I can do about it. Yes. But in fact, there's a lot I can do about it. There is, this is a treatable disease, even with the genetics involved because genetics isn't the, cause it just creates the susceptibility. Yes. So what we know now is that there are some very rare situations where there's a single gene that causes obesity, but the majority of us with obesity, it's really because in, when you look at the entire genetic makeup of someone, there's probably about two hundred different areas in our genetic makeup that have a susceptibility and something has to turn that susceptibility on. So a lot of people will say, genetics is the padlock and the environment, or some physiology is the key that opens that padlock.
So, so we start with that heritable trait, the heterogeneity of the disease and then some etiology comes along. So one of the etiologies that can come along that most people aren't even aware of are some prescribed medications are called obesogenic, cause they can actually cause weight gain.
Mm. They can generate obesity.
Yes. I think….
We pull that trigger. Yeah,
Exactly. Yeah. I think what we think of more commonly and what I think is some of the most exciting research coming out is what's happening in the gut that microbiome.
Mm. Yeah.
Probably for maybe some of our ultra processed foods that changes the guts microbiome. Yes. Maybe that's what unlocks the susceptibility. But we also know that there are endocrine disrupting chemicals. Yes. And then of course the American diet, those low macronutrient high calorie foods, mm-hmm that may be also part of what unlocks this.
And there's so many more things. I mean, these are just a few of the examples. But when we look at it what we probably going to find in the future is a lot of different types of obesity because the cause is going to be so different from one person to the next. Mm-hmm . And so yes, I have a susceptibility to obesity, but something turned that on and as we treat the disease, finding what turned it on and treating from that space may be our best bet at what helps treat it the best. Mm-hmm . But right now we're still kind of in that guessing game of doing that. So we treat it from a broad evidence-based place to treat it in its chronicity.
Yeah. Yeah. Have you heard of the Pima Indian tribe?
Yes. They're from here in Arizona. Well, they're originally from in Mexico, but they right. Live in, in Southern Arizona.
My understanding is that when we, I mean, they're a, they're just a really Primo example of how you have to have an environmental trigger. So when they're in Mexico, they don't struggle with obesity or diabetes. But when they move to the United States, suddenly a huge percentage of them developed obesity. And remember it's a disease. So we don't say that they're obese. We say they developed obesity. So a huge percentage of them developed obesity and diabetes as well. So there was some sort of environmental trigger in the United States that caused, that basically unlocked was the key that unlocked it for them. So….
And there's, there's a lot of research. Their tribes been very kind to allow a lot of research for us to be able to look at their percentage of diabetes and obesity. And there's a lot of research into the endocrine disrupting chemicals. Mm-Hmm, in our food supply in our environment, but also a lot into the types of foods that are different and the difference in activity. So a very broad look at how all of that may be attributing to their 80% obesity rate and their 60% diabetes rate, even in children as young as 10 and 12.
Wow. Yeah.
So really so much learning occurring at the university of Arizona, thanks to the kindness of the tribe to allow us to learn from them. But I think again, the take home message comes back to, this is a disease. Mm-hmm , It has a genetic proponent to it mm-hmm , but we have a lot of other things that impact it. So we need all of the treatment tools that are available to help treat it initially and then continue the treatment so that we can have long term success in impacting health and quality of life.
Awesome. Yes. Awesome. Okay. So this has been great. So this is the first five of ten obesity myths. I'm just going to review them really quickly so that you all remember them. So myth one is that obesity is a risk factor and not a disease. And you're going to hear this from, you'll hear this in the news a lot that obesity is a risk factor. They even say obesity is a risk factor for COVID right? Mm-Hmm Obesity is a disease in and of itself that is associated with how many other conditions, 236?
Other conditions, including 14 obesity related cancers. So obesity is the underlying disease process. And what we want to do is we want to work at getting that disease under control because it is treatable. Myth number two is that this is a willpower issue. And the truth is this is not a willpower issue. This is a neuroendocrine disorder, which means that the brain is responding to errors in hormones and peptides. And that the increased hunger and decreased activity level has a biochemical reasoning, not a will power issue. Myth number three is that these are diet medications. And the truth is these are not diet medications. These are obesity, anti obesity medications, and they need to be used for the chronic treatment of this disease. Meaning we don't want to just use them and then take them away. We want to treat this like the, the chronic treatable disease that it is.
And both Angie and I encourage anybody who needs chronic treatment for this disease to ask their healthcare professional, if they are familiar with the treatment of the disease of obesity. And if they're not familiar ask if they know anybody who is and to if they, if the person that you are, that is your primary care person, doesn't know anybody who knows how to treat obesity, then go to the Obesity Action Coalition or the American Board Of Obesity Medicine or Obesity Medicine Association. What were the other ones you mentioned?
So if they're outta the United States, they can look at the Canadian Obesity Network, E.A.S.O. in Europe or the World Obesity Federation.
Awesome. So there are people who do have specialized training in treating obesity, and that's what you need. Myth number four is that you have to lose a lot of weight to have any benefit. And the truth is you don't have to lose a lot of weight. Five to ten percent is all you need to lose to really reduce your risk of, of all of the complications of obesity and live a much longer happier, healthier life. And myth number five is I can't change it. My entire family is heavy. The truth there is that yes, there is a genetic predisposition in other words, and there's over 200 genes that have been identified, but that it also takes an environmental trigger to cause those genes to come into action. And so there's a lot you can do in terms of reducing your exposure to environmental triggers. That will be very, very helpful. Did I miss anything?
I think that did it all For the first time.
That is awesome. Okay. So join us next week for the next five. And again, thank you so much, Dr. Golden for being here. I am super, super happy that you are here to share this with us and we will see you all next week. Take care, everyone bye bye.