Hey everyone welcome to another week during the pandemic. This week we have Dr. Rocio who is a board-certified endocrinologist that specializes in diabetes and obesity. Listen to us talk about these diseases that effect our Western culture way more than anybody else (partially due to the access to all these fast-food chains). We breakdown how to live a healthier life, how this impacts you during COVID-19 and much more! We hope you enjoy it.
If you haven't listened to the episode yet, CLICK HERE. Then come back for these show notes:
Dr. Rocio is originally from Mexico and studied medicine back in her native country. She absolutely fell in love with New York and decided to come back to the city for her residency as well as, fellowship training. She always knew she wanted to be in medicine and did whatever she had to do to get there!
Why Endocrinology?
When she was in medical school she realized she wanted to do endocrinology. She liked the pathways, the access, and the feedback mechanism of all the hormones. She also had an interest in obesity and diabetes which guided her to become board certified not just in endocrinology but in obesity as well.
Why Obesity?
60-70% of her clientele comes in for obesity related issues. A lot of specialties don't deal with obesity in particular but it is a very important component in peoples general health.
A big problem is that we used to believe it was a lifestyle issue but we now know that is not the case. Genetic contribution, intake of processed foods, inability to portion control, and the mixing of cultures demonstrates the multifactorial nature of obesity.
"Our diet in the US is way more processed than in other countries".
If you look at other cultures for example, Italians. We obviously love the Italian lifestyle and we notice that they eat whatever they want but no one is gaining weight. Why is that? Again this leads back to the multiple contributing factors.
Let's talk Genetics
Multiple genes can lead to obesity
Some are severe genetic causes that manifest in early childhood others are very mild developing in adults
Cultural aspects plus your genetic predisposition plus environmental factors can worsen everything
What is BMI?
So we use BMI as a general standard to determine where you fall on the obesity scale
For physicians it begs the question, What can your weight predict to us about which diseases you are more likely to develop?
The ranges categorize you as follows:
Normal weight (BMI<24) - Note: underweight is also a BMI cut-off
Overweight (BMI 25-29)
Obesity Type I (BMI 30-35)
Type II (BMI 35-40)
Type III (BMI >40)
Treatment
- If you are overweight and without any co-morbid conditions (These include: HTN, Diabetes, Pre-diabetes, Joint problems, PCOS, etc.) what they try to do is determine the problem. After which, they work with you to help with various lifestyle modifications or at least bring to surface what the patient may be doing wrong.
"LIFE STYLE CHANGES ALONE WILL NOT BE THE ONLY THING THAT RESOLVES THE PROBLEM"
- With co-morbidities it becomes harder to treat without medication or pharmacologic intervention
Diet
The MOST important thing is to embrace CLEAN EATING:
Avoid processed foods
Avoid foods with a long shelf life
Avoid fast food
Avoid canned food
The less ingredients, the better
Homemade is better (you know what you're eating)
Grass fed milk and meats
Pasteurized eggs
Fresh food and vegetables
The only time, "BASIC is BETTER".
They try to teach all the clients about label reading and proper grocery shopping. The logic is that by giving this information it allows for you to follow this information and change your habits.
What diet should one follow?
If you will follow a type of diet obviously for lowering cardiovascular disease risk:
the Mediterranean diet is best
But, you know what our favorite quote is right?
"MODERATION IS KEY"
Dr. Rocio explains that it is, "hard to recommend other diets because they are very restrictive and strict even though some of them show a lot of promise". These include: Keto, Atkins, Paleo diets, among others. The issue is that in the long term you usually break your diet and end up binging.
The key is to be able to maintain these good eating behaviors for the long term.
Pharmacologic Treatment Options
It should be now obvious that obesity is a CHRONIC disease
With that said, there are medications that can help people lose weight and maintain the weight loss (aka can be used for years)
Medications are usually offered to individuals with:
BMI >27 with a comorbidity
BMI >30 without co-morbidities
Weight loss related meds are the most underused meds in the US even though there are many safe options with tolerable side effects
Surgery
Now that weight loss medication options exist Dr. Rocio says she has been referring less patients to surgery. The medications are FDA approved for chronic use and have demonstrated 60-80 pound weight loss. Many times these medications also help with controlling blood pressure as well.
However, there are some people who benefit tremendously from surgery and of course all of these procedures comes with their own risk as well as, side effects. The most common surgery is the gastric sleeve. The issue with this surgery is it has been associated with weight regain. This is likely due to the way the procedure is performed.
Dr. Rocio notes that the best results come from the gastric bypass. This surgical option is associated with little regain and the most weight loss. Previously, this latter procedure developed a bad reputation due to the post surgical complications. Since then, we have learned that many of these complications could've been prevented and require some closer follow up which has been shown to be an effective strategy
COVID and Obesity/Diabetes
Obesity and Diabetes is are some of the major risk factors for developing severe complications from COVID
Please note: it does not make you more likely to contract disease but if you do get the disease you are more likely to have a more complicated/severe course then those who do not have these risk factors
Patients with COVID who are less than 60 years old with a BMI of 30 or higher have an increased risk for hospitalization and admission to the ICU
The thought process behind this is that increased inflammation is related to illness severity. Those with obesity and diabetes are known to undergo a chronic inflammatory response. COVID itself causes severe lung inflammation. So adding all of this together is sort of like producing a "cytokine explosion or inflammation bomb" leading to worse outcomes in these patients.
Body Image VS. Unhealthy Weight
It's not about your body image it's about your health.
For example, remember the whole debate about Lizzo? Lizzo we love you and love how you promote a positive body image but, that shouldn't deter anyone from being healthy.
Body image perception and unhealthy weight are two VERY different things. These should not be something people cannot speak out against. Unfortunately, we are living in a world where you can't say anything or have an opinion without the backlash. We hope this point can come across in a positive light.
Myths
1. Adrenal fatigue
This is not a true disease as you either have normal working adrenals or adrenal deficiency which is a different disease where you're not making enough steroids
2. Obesity is your own fault
There are other causes for obesity that the pt is not solely responsible for (as previously discussed)
3. Thyroid hormone makes you lose weight
Thyroid hormone will not make you lose weight even if you take high doses of it
Be aware that there are major complications by taking unnecessary thyroid hormones such as, atrial fibrillation when your heart beats irregularly and can lead to a stroke
Secret Tips
Exercise and Weight loss
- 80% of weight loss is diet NOT exercise (A tip and a Myth... we live for a 2-in-1)
Exercising is great for:
Joints
Cardiovascular protection
Self-esteem/mood
But, not good for weight
- Always read the labels
Stay informed about nutrition
(The one who is most informed does the best)
- Core exercises and balance are more important than just spinning
(Also easier to maintain)
Note: pilates promotes a lot of core strengthening
Start now!! It is easier to start these practices during quarantine
We all heard of running potentially being bad for your knees and also let's not forget that during this pandemic you may be an asymptomatic carrier potentially transmitting the virus. So maybe forego the running entirely for now.
- Use this link HORMONE.ORG as the public version of the endocrine society providing you information on any endocrine related disease in a way anybody can understand
Where to find Dr. Rocio?
Office Location: 1107 Park Avenue NY, NY
(between 89th and 90th street)
located in the Upper East Side in NYC
Instagram: @newyorkendocrinology
Website: nyendocrinology
Facebook: NewYorkEndocrinology
Stay tuned for some increases in weight gain rates after this pandemic is over. We know boredom and anxiety is getting to everyone so the munchies kick in but make sure to have a well balanced diet. The day to start is today since yesterday is gone and tomorrow hasn't started yet. Don't forget to go for a stroll once this pandemic is over!
That's all for this week, don't forget to leave us feedback, rate, review, subscribe and send in your questions so we can continue to improve as well as, provide you high quality content.
Disclaimer: The Content on our podcast/website is not intended to be a substitute for professional medical advice, diagnosis, or treatment. Always seek the advice of your physician or other qualified health provider with any questions you may have regarding a medical condition. Never disregard professional medical advice or delay in seeking it because of something you have read on this website.