Search for tag: "weight loss"

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Scot: We had a whole episode about Scot's fatness, and this is an update to the fatness because I decided to take a different route to losing the weight than I had in the past.

So we had Thunder Jalili on, and in order to lose the 15 pounds, I normally would put myself in a calorie deficit. I would figure out what my base metabolic rate is. And this gets a little complicated, but your base metabolic rate is basically the amount of calories your body would burn just to survive. And you eat less than that, and you do some exercising, and that puts you in a deficit, which then would encourage your body theoretically to burn fat.

Thunder told me not to do that, which was totally different. So this is a little update on what's going on.

You're listening to "Who Cares About Men's Health," providing inspiration, information, and a different interpretation on men and men's health. We've got a good crew here today. It's the core crew, as I like to call it. The MD to my BS, Dr. Troy Madsen.

Troy: Hey, Scot. I'm part of the core, and I'm proud of it.

Scot: All right. My name is Scot Singpiel, and we've got producer Mitch over here. He brings the microphones and so much more.

Mitch: So much more. Hoo-gah.

Scot: Mitch just got promoted.

Mitch: I know.

Scot: Mitch got a promotion.

Mitch: Love it. Yeah. Core, I'm in the core.

Troy: You're in the core.

Scot: Thunder encouraged me to just stop eating the stuff that got me there, which was Reese's peanut butter cups and probably drinking too much beer, to go back to time-restricted eating, which is this concept that you stop eating for a prolonged period of time. It could be 10, 12 hours, whatever. So you might stop eating at 6:00 at night, not eat until 6:00 the next morning. And get some activity. And remember that I had a fun time and it took me a while to get to where I was, and it might take me a little while to get back.

So I've got a little update. I'm down five pounds. Yeah, I've gotten rid of 5 of the 15.

Troy: That's pretty good.

Scot: Yeah. I mean, I don't know. We'll see if this continues. The win for me was I went on a weeklong vacation and I just didn't eat sweets.

Troy: Wow.

Scot: But you can't necessarily control what you eat as well when you're on vacation. And when I came back, I was at the same spot. So that makes me happy.

Troy: Oh, so that was the win. Okay. I was going to say, "You lost weight on vacation?" But you're just saying you were able to maintain.

Scot: I was able to maintain. I didn't think about it too much and I didn't probably have as much activity as I would.

Mitch: Did you road trip?

Scot: Yeah.

Mitch: Do you not get fun snacks every time you fill up the gas?

Scot: Normally, yes. This trip, no.

Mitch: Okay. Not this time? No?

Scot: No.

Mitch: All right.

Troy: It doesn't sound like a fun road trip.

Scot: No. The snacks . . .

Mitch: That's what I was about to say. That's a part of it.

Scot: Yeah. Well, we did have snacks. I mean, it was Triscuits and cheese, and it was trail mix, but not with chocolate in it. So it was a lot of nuts and some dried fruit. So kind of healthier stuff, I guess.

Mitch: Sure.

Scot: Yeah, Mitch does not look enthusiastic.

Mitch: No. I'm about to go on a road trip myself and highlight, day one, going and filling the tires, topping off at the gas station, and getting a big old sack . . .

Scot: That's right.

Mitch: . . . of every bit of junk food.

Scot: I mean, I guess . . .

Mitch: Maybe I won't do it this time.

Scot: No. I think every once in a while, you might be able to do that, right? I mean, if you're in a position. It just kind of worked out for me that way.

Mitch: Okay. That's good.

Scot: So anyway, down five pounds. I've been doing some reading and I'm a little scared, because I'm afraid that five pounds is just kind of those five easy pounds, right? Like, just maybe some water weight, some salt weight. I don't know.

So I started doing some reading because I was interested in this base metabolic rate and the different exercise levels. So you've got your base metabolic, which is your body. If you just sat around, did nothing, this is how many calories your body needs to function.

And then you've got some of these other levels, right? You've got sedentary. Sedentary, that's how you pronounce it. What is sedentary, do you think? And that bumps you up a couple. You get to eat a couple hundred more calories if you're sedentary. What do you think that is?

Troy: I mean, you're a couch potato. Those are couch potato calories. Those are like just lifting your arm to use the remote and turn on the TV and reach for your soda. Those are your sedentary.

Scot: This is, I think, where some people might run into problems. That's not the case.

Troy: Sedentary?

Scot: Sedentary, according to a couple places I looked, includes activities of daily living. So doing the kinds of things like going out and raking, vacuuming, and even they included walking the dog.

Troy: No. I think of sedentary as . . . Someone who's sedentary in my opinion, in medical terms, in my practice, if I describe someone as sedentary, they're not walking a dog. They're able to take care of themselves, so they're getting up, walking to the kitchen, and walking to the restroom, but they're not doing a whole lot beyond that. I don't see them as out raking leaves and walking dogs. I don't know.

Scot: Yeah. I think that's where this problem is. I think the problem could be as an individual that you're trying to figure out what your activity level is so you can go, "This is how much I should be eating." Well, I'm not sedentary because I go out and I do stuff. I clean the house. I rake leaves. I mow the lawn. In the definitions I've seen, all those things are included in sedentary. The difference is that you do not do 30 minutes of intentional exercise a day.

Troy: So that's the next step up? So to not be sedentary, you have to do 30 minutes of intentional exercise a day?

Scot: Yep, and that's called low active. And low active is daily . . .

Troy: No. Low active is 30 minutes?

Scot: Yeah. Low active is exercise equal to walking 30 minutes at four miles an hour, which burns anywhere from 135 to 165 calories for the average-weight person.

Troy: Four miles an hour is a pretty brisk walk.

Scot: That is an incredibly brisk walk. I have long legs and I can walk fast. I'm probably doing 3.7, 3.8 max. So that seemed a little weird.

Troy: That's fast. I don't know who made the scale up.

Mitch: Let me tell you. It is the FDA and the NCBI. [Crosstalk 00:06:08] this group is the front for public health. It was published back in 2018 when they decided that this is what sedentary meant.

Scot: So this is all going someplace that hopefully will be helpful to listeners and also is going to inform my thinking, and I wanted to throw this out to you guys.

So then the difference between low active to active is it's kind of the same. Your daily activities of living, except for you're doing an hour and 45 minutes of intentional exercise. So that's walking at four miles an hour.

Troy: A day?

Scot: Yeah, a day.

Mitch: A day.

Scot: And then very active is daily exercise walking four hours and 15 minutes at four miles an hour, or you could jog for two hours a day. And that burns anywhere from 1,100 to 1,400 calories.

Troy: This is an interesting scale.

Scot: It is. I mean, think about the individuals we've had on the show in the past who have struggled with losing weight, right? We're saying, "Well, if you get out and get those 30 minutes of activity, that should be pretty good." But I'm starting to kind of wonder if those 30 minutes is good for your cardiovascular health, it's good for your health in general, but if you're trying to lose some weight, you're going to have to go beyond that.

Troy: See, the problem with this scale, though, is there are just so many studies that show if you can just do 30 minutes of activity three times a week, there are very clear health benefits from it, where this scale is implying that those people are just low active, and even they're less than low active.

Scot: I'm going to say there's a differentiation. There's a fine differentiation here.

Troy: Thirty minutes?

Scot: Thirty minutes a day has health benefits for cardiovascular and those other things, but if you're trying to lose body mass, fat, you need to do more.

Troy: But do you think that's sustainable? We're talking 30 minutes of brisk walking at four miles an hour every day. For the average person, it's . . . I feel like you have to have a routine that's sustainable for you. And on the activity side, it sounds like they're recommending high activity, where I'm sure you could balance that with just some decreased caloric intake or adjustment in whatever your dietary intake is, and you're going to accomplish the same thing,

I don't know. I guess I'm trying to figure out where they're going with this, just because that activity level they're putting for active and very active is really active. And maybe I'm kind of taking it a little bit personally here, because I feel like I'm pretty active. I'm pretty active, but I'm not meeting their definition of very active.

I mean, maybe over the course of a week, if you added it all up, I would meet that definition. But over the course of a week, I get about 11 hours, 10 to 11 hours of . . . I don't want to call it jogging because I don't want to be called a jogger.

Scot: I mean, you're running.

Troy: It's running, but still it's . . . Yeah, that's really active what they're getting at there. Two hours a day of what they're describing as jogging.

Mitch: Well, again, this is just how you do your calculations. So when you look up base metabolic rates and things like that and try to get your diet clued in . . .

Scot: Yeah, and you're trying to figure out how many calories you need to sustain. But it could also be used for, "How many calories can I eat, and then what do I have to do to put myself in a bit of a calorie deficit so I can lose that weight?"

Troy: So maybe that's the flip side, just saying, "If you really want to eat this many calories, you're going to have to exercise a ton." Maybe that's what they're trying to say.

Scot: Yeah, I think so.

There was a "Time" magazine article, and I need to send this to you because they quote a lot of research. This is the next part of my thinking, because this was the next thing that I read.

So they cited many studies that exercising at a moderate level for 30 minutes, which is good for health, results according to these studies in little weight loss. So it's good for maintaining, but for losing it's not.

And then they cited some other studies. A combination of diet and exercise generated no greater weight loss than diet alone after six months. At 12 months, the diet and exercise combo showed an advantage, but it was slight, about four pounds on average.

So, in this, the conclusion that they came to based on the research . . . And there was another study. It said exercise results in weight loss when 400 to 500 calories are burned per session at least five times a week.

Troy: So I see what you're getting at here, Scot. What you're saying is if you want to lose weight, don't focus on exercise. Focus on diet. There are clear health benefits from exercise, but it's not going to accomplish the weight loss you need.

Scot: Yeah. Exercise is not going to accomplish the weight loss you need, diet and exercise. But then beyond that, you have to put in a certain amount of exercise, which they're saying is something that can burn 400 to 500 calories per session, 5 times a week, which they equated to 90 minutes of brisk walking or 30 minutes of running 8-minute miles.

Troy: Yeah.

Mitch: Geez.

Scot: I mean, 400 to 500 calories, that's a lot, right? Ninety minutes of brisk walking? Or if you get on a cardio machine and you're not pushing yourself super hard, 90 minutes, that's a lot.

Troy: It is a lot. And how many calories are in just a large soda?

Scot: Right?

Mitch: Too many.

Scot: Too many.

Troy: Yeah, you get a large soda for your road trip and right there you're at 400 calories.

Mitch: This is something that I'm really excited . . . We have a guest coming on in a couple weeks who is part of the weight management program here at The U. And she was talking a lot about in our little pre-interview . . . She was like, "Yeah, losing weight is a lot more than just diet and exercise," and I'm excited to kind of talk to her about all this.

Scot: Yeah. So, for some people, diet and exercise might work, but there are some people that it does not work. And she's going to hopefully tell us some of the things that could happen or some of the things that could be going on that could be preventing somebody from losing.

But I just feel like there's a huge disconnect in the information that I've received. And again, you know what? There are a lot of studies out there. Who knows? But if in order to get some weight loss I have to be doing 400 to 500 calories burned per session, that's a lot more than what I'm currently doing. So maybe that's where my frustration is that in the past I haven't lost weight, or where other people have frustration. So I feel like that needs to get figured out.

Troy: Yeah. I mean, again, it just seems like . . . Like you said, Mitch, maybe we'll have someone on here who talks about all the other factors besides diet and exercise. But my takeaway from this is that you can't just sweat off the calories. You've got to focus on the caloric intake if you really want to lose weight.

Scot: Yeah. You've got to focus on both.

Troy: Yeah. I mean, you've got to do both, but it's going to come down a lot to caloric intake. You can't just say, "I'm going to burn it off by going out and walking the dog," or something. It's a lot of exercise to burn off 400 to 500 calories.

Scot: Yeah. Like you said, what's an average soda have? And if you are doing 30 minutes, according to the scale, which is low active, that burns 135 to 165 calories. So a soda is probably what, 220? I'm guessing.

Mitch: It's 180 per 12 ounces.

Troy: A 12-ounce can.

Mitch: If you get a Big Gulp . . .

Scot: Yeah. So you can either walk for 30 minutes at four miles an hour to burn that or just not drink that, right? So that really kind of shows the importance of watching some of that stuff.

Anyway, here's what I'm thinking. And again, it comes back to sustainability on a couple of levels. One, time. I don't have 90 minutes a day. Two, I'm not in that great of shape anymore.

Troy: Oh, no.

Scot: And I don't know if I could sustain five sessions of 400 to 500 calorie burning and not be completely drained. So I don't know. Part of me wants to try to start to burn some more calories so I can get . . .

Here's the deal on the road trip. This time, instead of the punishment pants, I just sat and played with my fat to remind myself how miserable it is.

Troy: So you were just . . . Is this as you're driving? You're just holding your fat rolls and kind of bouncing them and jiggling them?

Scot: Yeah, exactly.

Troy: What are you doing?

Scot: You drive with one hand and you kind of bounce it and you kind of grab it.

Mitch: For the listeners, he's cupping underneath his lower abdomen and kind of making a flipping, squishing motion. I'm so glad I'm back in studio.

Troy: Yeah, that's wonderful.

Scot: I want not to have to do that anymore.

Troy: So was this what you did just to keep yourself from going in every gas station and getting a large soda and a big thing of candy or something?

Scot: Top of mind, man. Top of mind.

So I don't know what to do with this information other than to say it was kind of eye-opening to me the amount of activity that it kind of takes to burn fat. There are two things. There's the amount of activity that takes to be healthy and reduce the risk of disease. But if you're trying to get rid of body fat, that number has got to go up quite a bit. And then once you get rid of it, maybe your daily exercise goes down again because maintaining is easy. I don't know. But anyway . . .

Troy: I totally get it now. At first, I just thought, "Wow, where is this going?" But I get the point of it, that you have to exercise a lot to burn calories. I mean, that's the simple reality. You've got your basal metabolic rate and that burns quite a few calories, just the thing that keeps you alive. But then beyond that, it's not like you can tell yourself, "Hey, I just went and did a brisk walk with the dog for 30 minutes, and I'm going to reward myself now for that exercise by having a soda or taking in some extra calories." Yeah, you did not burn that many calories.

Scot: Yeah. Even if you don't take in those extra calories, you're probably not going to be losing much fat from just walking the dog.

Troy: Yeah. It takes a lot to burn. Yeah, it really does.

Scot: So that's my update. Those are the things I'm kind of struggling with and I'm trying to figure out. So I'll keep you up to date. Mitch, you have an update too.

Troy: Well, I was going to say, though, Scot, you made progress. I thought that was the best point. I mean, Thunder made a lot of great points, but the one that I think really made sense is it takes you a long time to put that weight on. Think how long it took. It's not going to come off in a month. It's a process. So you're a month out from that discussion with Thunder and you've already lost a third of the weight. That's great.

Scot: Yeah. We'll see if that keeps going down.

Mitch brought up that he felt like he had a different situation, that he has struggled his whole life to try to lose those extra pounds. What's your update?

Mitch: So I was weighing around 230 a little over a month ago, and I am just under 210 pounds as of this morning. So in a month I've lost over 20 pounds.

Troy: Wow. That's crazy. You've lost almost 10% of your body weight in a month.

Scot: Yeah. You want to ask him what he's done, Troy? Do you have any guesses what the difference is? For you, Mitch, this is crazy.

Troy: Let me guess. Did you just stop eating or what?

Mitch: No. I'm eating red meat and sunlight.

Troy: Eating red meat and sunlight. You just go outside and open your mouth.

Scot: Yeah. Any other guesses as to why? Like Mitch said, this is just kind of unheard of that it would be this easy.

Troy: Wow, I'm trying to think what you could have done. I'm guessing you went back to time-restricted eating. I'm sure that was part of it.

Mitch: I was doing that before. I'm still doing it.

Troy: Oh, you were doing it before. That's right. You were doing it before, and you had already really focused on cutting down on sodas and sweets and all that kind of stuff.

Scot: Yeah. He was doing all the right things, remember, and then he was just getting frustrated because it wasn't happening.

Troy: Yeah. I know you were talking more about the carbs. Have you focused more on carbs?

Mitch: I'm eating the same I've always eaten.

Troy: Did you get a different scale? I'm kidding. "This scale makes me look great."

Scot: The best way to lose weight is get that little dial underneath the scale and calibrate it differently.

Troy: Just change the dial. Wow. I really want to figure out how you've done this. Are you exercising more? I know you were trying to . . . You were already doing some exercising.

Scot: I mean, I'm doing it maybe once more a week, once more than I used to, but no, not really.

Troy: Okay. This is huge. You've lost almost 10% of your body weight in a month, and you were struggling before and you were doing everything right. So I don't know the answer. What have you done?

Mitch: So I got my hormones figured out.

Troy: That's right.

Mitch: So I've been working with Dr. John Smith, and he identified that I had really low testosterone. And now that the hormones are . . . I've been three, four weeks on this medication that we'll probably talk about in a future episode that just helps up my testosterone a little bit, and suddenly, I have tons more energy, and I'm losing weight like crazy, and I haven't changed anything.

I've been working out the same I've always been and struggled. I'm eating the same 1,800 to 2,000 calories every day that I've been doing forever and watching the macros and blah, blah, blah, sleeping all the time, etc. But all it took was getting my hormones in check and suddenly I'm starting to get to a healthy weight.

Troy: Wow. That's impressive. Are you putting on muscle mass too?

Mitch: We'll find out when I get in the BOD POD. I don't know if I trust my scale, but maybe. Hopefully. I don't know.

Scot: He just pulled out the guns.

Mitch: Scot, how are my guns?

Troy: He's flexing.

Scot: Does your scale give you a body fat percentage?

Mitch: It does.

Scot: And has that been dropping too?

Mitch: Yes.

Scot: My scale did not match up at all with the BOD POD, so it'll be interesting to see how accurate yours is.

Mitch: That's what I'm curious about too, yeah.

Troy: But it seems like on the scale it was all about relative change. Like, the number itself isn't as meaningful. How much has your body fat percent changed on your scale?

Scot: He's looking that up.

Mitch: It says 4%.

Troy: So you're a 4% body fat change. Like we've talked about before, the actual number maybe isn't super accurate on those home scales, but the relative change is . . . Again, that's significant.

Scot: It is significant. So it was all hormones. How does that make you feel?

Mitch: Well, it's a little strange because I do not want to be the guy that is like, "Testosterone solves everything. It's the magic bullet. You'll lose weight. You'll get your libido back," all the stuff you see on those irritating ads on the internet.

But if you legitimately have a hormonal imbalance, you should go talk to your doctor and you should probably get it fixed, right? It's not the magic bullet for people who are just a little low or something like that. But for me, I was well below the acceptable range when I did my follow-up test with John Smith, and it's night and day for me.

Troy: What was your level?

Mitch: I was in the lower 200s when I got it tested.

Scot: Because the low range is like 180, right?

Mitch: Three hundred.

Troy: He said if you're less than 300, you're low and you were . . . what did you say again? Low 200s?

Mitch: Yeah, 226 I think was the average between the two tests.

Troy: Yeah. So it wasn't like you were going in there and just being like, "Oh, I'm 330 and I need to get on testosterone." You were definitely below the level that he said he really kind of uses as a cutoff. And you'll get your levels rechecked here, it sounds like, in the next couple of weeks.

Mitch: Yeah. And we'll have him back on, and we'll kind of talk about what's going on. Yeah, there was something about, "No, this isn't 'optimizing T levels.'" I had a hormonal deficiency, and it was impacting metabolism, energy levels, etc. And it took some meds to get back to where I needed to be.

Scot: Wow. I think that's awesome.

Troy: It is.

Mitch: I think it's awesome too.

Scot: I keep looking for the thing that's wrong with me, Troy. I keep hoping . . .

Troy: What's yours, Scot?

Scot: I keep looking. Is it testosterone? No. I keep looking for that test that's going to just shine a light on why I have struggled in the past to put on muscle or to lose . . . Even when I was at my lower weight, I still had a good percentage of body fat because I just don't have a lot of lean mass. So I'm still looking for my thing.

Troy: The magic bullet.

Scot: Yeah. It's a magic bullet, right? What's the difference between a magic bullet and what Mitch experienced?

Troy: There's not. That is a magic bullet. That's a dramatic change. You want to talk about a magic bullet? Yeah. I mean, 4% body fat reduction, almost 10% weight loss in a month, that's impressive. And I've known very few people who could ever say they had that sort of experience while really not making any other changes. It sounds like you said you're exercising maybe one more day a week, but . . .

Mitch: Yeah. It's not huge changes. It's tracking a little closer on my calories. I'm working out a little bit more. It's not anything huge. It really is this medical thing that needed to get fixed before anything else could work.

Scot: And I think it's worth, if you are curious about testosterone, going back to our episode on testosterone. I think the thing to really keep in mind for everybody is it is not a magic bullet.

I can't remember what Dr. Smith said that range was. Like much beyond 600? You're not getting much return on that. So if you're around 500 or 600, you're probably fine, right? That's probably not what the problem is. Does that sound familiar to you, Troy?

Troy: I can't remember the exact numbers. I wish I did. Yeah, again, we should probably look at that just to give the exact numbers, but I do remember him saying the 300 number and if you're under that, you definitely need to be on some sort of hormonal therapy.

That episode, I was kind of skeptical throughout it, like, "Really? Do we really need testosterone? Does it really make that big of a difference?" But, Mitch, your experience, and clearly you met the criteria he talked about, and it's made a difference, no doubt.

Mitch: So I was having a conversation with one family member who had been experiencing some hormonal issues themselves. And it was really interesting because from the female perspective, hormones are a huge part of everything from energy levels to how your skin looks, to how much energy you have, how well you sleep, etc. And I think a lot of times as guys we just assume it's a yes or no, like an "Am I low on oil?" kind of approach to your car. Am I low on testosterone? Better put some more in me if it's going to work.

But talking with the doctor and stuff like that, testosterone has everything to do with estradiol levels, with all these other pieces and parts floating in your soup of juices all through your body. And it has a holistic impact on everything.

Troy: Yeah. That's cool.

Scot: Troy, do you have an update for us? Now, you don't have a weight problem. Actually, you'll be gaining about 8 to 10 pounds here in a few months in the form of a new life, a new Madsen.

Troy: I know. I've got a baby carrier that I'm going to be carrying on my . . . I looked at it. So, for the first several months, I carry the baby on my front side and then I can transfer the baby to my backside. I guess my back, not my backside. It's going to be another 8 to 10 pounds I'll be carrying around.

Scot: Are you going to go running with the newborn?

Troy: Oh, you know it. This is so funny. So Laura shared the news with me as I got home from work from a late shift. That next morning, I was reading all about running strollers, reviews, what's the best thing, all that stuff.

Scot: Good for you.

Troy: I know. This is embarrassing. I spent more money on a running stroller than I would ever care to admit. But I asked around. I talked to people. Yeah, I will be taking her running, and this is what some good runners I know recommended and said, "If you really are serious about going on long runs with a child, get this." So yeah, I'll be taking her running.

Scot: That's good. We learned that exercise is super important even for the dads when the child first comes along to counteract any potential . . . I mean, it's a massive lifestyle change, and you're trying to mitigate that as much as possible. Anything else going on? Any other new updates?

Troy: No, things are good. And it's a good point you made too, Scot, because I think it can be a massive lifestyle change. But I was talking to my brother about it. He was just visiting here a week or two ago, and he has three kids and he said that's what people always said to him too. It's a massive lifestyle change, but he said, "Hey, we're just going to do the same things we've always done. We're going to bring our kids." And his kids now are early teens down to about 9 years old. And the kids are crazy active. They love running.

My little 9-year-old niece, we just did a run. She ran a half marathon with me, just went out and busted out a half marathon trail run with me. They're just super active. And so I'm hoping that's how this can be. I'm hoping running can be something that we share as a family and that we're all out doing things together.

So I don't want it to be a massive lifestyle change, because I kind of have had that thought as I'm continuing to run. Not necessarily, "Why am I doing this?" but kind of the back of my mind thinking, "Wow, I'm not going to be able to do this as much in about two months." But then I tell myself, "Well, it doesn't have to change. We can keep doing this, we can stay active, we can keep running and doing all these things." So that's what I'm hoping for, and that's our plan.

Scot: Have to come up with some creative solutions and just have to be dedicated to it, I guess.

Troy: Yeah, I think so. Yeah, you come up with some creative solutions. You have to spend some money on some gear. Like I said, it's a whole lot more money than I ever expected to spend on a stroller, but it should be a stroller that lasts us for many, many years and hopefully running marathons together and doing lots of long runs with her. That's the hope, so we'll see how it all works out. I'll report back in about three months, Scot, and tell you where things are.

Scot: All right. Well, I guess that's that. This is going to be kind of an ongoing thing. We're really excited about some of the upcoming episodes talking about body weight control, losing some body weight, some fat if you have to.

Mitch: And having some people on to talk about testosterone again, and a little bit more about how all that connects and . . .

Scot: Yeah. And I'm just going to keep on keeping on and we'll see if I can catch up to Mitch. He's a Troy Madsen distance ahead of me in the marathon.

Mitch: Oh, no.

Troy: Mitch is smoking you, Scot.

Scot: He really is.

Troy: He's far beyond where I would be right now if this were a marathon. That's impressive.

Scot: I'm going to keep investigating just the amount of activity that you need and keep reading on that. I'll send you some of that information, Troy. You can see what your take is.

Troy: But give yourself credit though, Scot. You didn't lose 10% of your body weight, but you're down 33% of your weight gain. That's great.

Scot: No, I'm cool with it.

Troy: Yeah, you're making progress.

Scot: I just want to get to a point where I'm not playing with it anymore.

Mitch: You've got to quit doing that. I will leave the studio if you keep doing that.

Troy: Well, you can't play with it on a road trip, because you're sitting down. You're kind of hunched down. It's naturally just going to kind of bunch up there. So it's like, "Oh, feel all this fat here." I'm sure it's not as bad as you're saying it is.

Scot: All right. Well, gentlemen, as always, great conversation. Thanks for listening. And if you have any questions, you can reach out to us. It's super easy to do. You can just email us at hello@thescoperadio.com if you have any questions or stories you want to share. Thanks for listening, and thanks for caring about men's health.

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Interviewer: In spring of 2022, there were some headlines going around almost every news outlet saying that the FDA had finally approved a new weight loss drug, one that would promised 10% to 25% weight loss with little more than just a weekly injection. The drug is called tirzepatide, or a brand name Mounjaro.

Now, it seems a little too good to be true. So, today, we're going to be looking at what exactly is the drug and what can it actually do for weight management.

Joining us today is Juliana Simonetti. She is the medical co-director of the Comprehensive Weight Management Program at U of U Health. So she knows a thing or two about weight management.

Dr. Simonetti, thank you so much for joining us.

Dr. Simonetti: Yes. Thank you so much for having me here today. I'm very excited to be talking about this new drug.

Interviewer: So why don't we start there? What is tirzepatide and what does it do to the body?

Dr. Simonetti: I'll start by just telling a short story. I was at an endocrine meeting in California two weeks ago when this drug got approved by the FDA for the treatment of diabetes. And we were doing a lecture, and all of a sudden, everyone started clapping and announced that this drug had been approved by the FDA for the treatment of the diabetes. So that's the kind of excitement we're getting with this drug.

It is a new class of medication for the treatment . . . Currently, it's only approved for the treatment of diabetes. However, we have seen really significant amounts of weight loss with the medication, and they are doing clinical trials at this point, and they have the results of the clinical trial for the treatment of obesity with this drug as well.

Tirzepatide is unique in the sense that is a dual incretin medication. It attaches to two different receptors. So we have a class of medication that has been in the market now for about 15 years called GLP-1 receptor agonist. And some of the drugs I think are well known at this point, both for diabetes and for weight loss. All those drugs were initially developed for the treatment of diabetes, and then they found that they led to significant amounts of weight loss.

So some of the drugs currently on the market that are GLP-1 receptor agonists are Victoza, Ozempic, Trulicity, and those drugs really have revolutionized the treatment of diabetes in the sense that they bind to receptors in our body that stimulates our own pancreas to produce insulin. And at the same time, they cross the receptors in our brain and tell us that we're full.

Therefore, when you start eating, you feel fuller sooner. It leads to induced satiety, so therefore people eat less, and it promotes the release of our own insulin so you have better glucose control, better sugar control for the treatment of diabetes. And we have this induced satiety that leads to people eating less, feeling fuller, and therefore losing significant amounts of weight.

Interviewer: So tirzepatide has been approved by the FDA to help manage and treat types of diabetes. But there's a lot of evidence in their, I guess, Phase 3 trials that are showing real potential to help with weight loss. What are they finding?

Dr. Simonetti: That's right. So their clinical trials for diabetes show . . . for those participants that had diabetes, it led to a significant amount of weight loss. And so they also then did clinical trials for this medication for those without diabetes for the treatment of obesity.

And what they found is that they highest dose of the medication, which is 15 milligrams, can reduce body weight on average by 28.4 pounds, which is nearly about 14% of the total body weight. So, for someone that weighs about 200 pounds, they will lose on average of about 28 pounds on this medication, which is really, really significant.

Interviewer: Wow. That sounds like a lot of weight loss for people without diabetes, but what does it do for people who do have type 2 diabetes? What kind of results have they been seeing with them?

Dr. Simonetti: Yeah, the results, it's really interesting because the results for those with type 2 diabetes, on the highest dose, show that those participants lost almost 21% of their total amount of weight, which is really, really impressive. This is more than anything else, any other medication we currently have in the market.

Interviewer: So if I get this correct, there are other . . . I've seen other drugs out there that fill your stomach up, the Plenity or whatever it's called, or they claim to impact your metabolic system, etc., but this drug actually impacts your pancreas in a way to help with glucose levels and help suppress hunger.

Dr. Simonetti: Yes. So the class of medication I was talking about is the GLP-1 receptor agonists that already exist that have been in the market now for about 15 years. The newer ones, one of them being semaglutide, or the other name is Ozempic, has been the latest.

They also got approved for the treatment of obesity and leads to very significant amounts of weight loss and improvement in the sugars in our blood because it stimulates the pancreas to release insulin and tells our brain . . . So it works on the appetite centers of the brain.

The difference between some of these drugs and what you're talking about, Plenity . . . So Plenity is considered a device because it's three capsules that kind of inflate in your stomach and therefore makes you feel fuller, so you have the physical sensation of fullness. However, the GLP-1 receptor agonists work in your brain and in the appetite centers of the brain. It works in the brain to tell you that you're full, so you don't have those cravings and then sensation that you wanted to keep on eating. It really leads to the feeling of feeling fuller.

With tirzepatide, why this is so exciting and different is that this not only works with the GLP-1 receptors, but also works in another receptor called GIP, which is a glucose-dependent insulinotropic peptide. It's a mouthful, but it's really another hormone in our body that is usually . . .

Both of those hormones are released in response to us eating food. So when I eat carbs or sugar, it goes in my stomach and then reaches my stomach and my intestines, my gut. My body says, "Whoa, we got nutrients here." We release the GLP-1 and this other one called GIP hormones that then say, "We got food, we got carbs, we got sugar. Let's tell our pancreas to release insulin," because we just got some food in our body. We got some sugar in our body. And then it crosses the brain and tells the appetite centers in my brain that, "I just got nutrients. We should stop eating." It should make me feel a little fuller.

The issue with our natural hormones in our body is that they get taken down, they get broken down very quickly. They only last a few seconds. And these new drugs bind now to those two different kinds of hormones and lead to this really much heightened sensation of fullness and to a much more significant response lasting much longer than what our own body would produce.

Therefore, that's why they're so effective. And therefore, that's why they are also given once a week, which is really kind of neat for a lot of those medications. So you don't have to take a medication every day. It's a small injection once a week.

Interviewer: Wow. So I guess when I first came into this interview, I'm used to doing stories about how some new drug that came out is not actually going to help you with weight loss when you really look at the research. But with your professional opinion, as a doctor who works with patients suffering from obesity or helping them live healthier with their weight management, why is this drug so exciting like you keep saying?

Dr. Simonetti: It is so exciting because the amount of weight loss we are seeing with the clinical trials from this drug is much more significant than what we had seen previously.

So as a measure for FDA approval for a drug for weight loss is usually about 5%. And with the latest drug, which is semaglutide with the other name of Wegovy, we saw a significant more amount of weight loss, around 14%, 15% with the higher doses. And with tirzepatide, we are seeing weight loss of around 20% with the higher dose of the medication, which 20% is a lot of weight, right? So it's a really significant amount of weight loss that we are seeing with these new classes of medication.

And as we know, weight loss is extremely difficult, right? This idea that if we just diet and exercise, we should just be able to lose weight. And it's not true. Eighty-five percent of those that diet and exercise actually, unfortunately, end up gaining the weight back and this weight loss is not sustainable.

And there are a lot of reasons for that, right? There is genetics. So 60% to 70% of the way we are, we know that it's related to genetics or the way we accumulate fat.

There's also our environment, and then there is this regulation in a lot of the hormones. There are these regulation appetite hormones. There is this regulation with insulin. The more weight that we gain, the more insulin-resistant we become. Therefore, there is this combination of insulin resistance.

So 90% of those that have diabetes also have excess weight. And some of the older medications that we had for diabetes, like the glipizide, glimepiride, and even insulin would lead to more weight gain, which then meant more insulin resistance and then making the condition just worse.

And with these new drugs, we see significant improvement in weight. Therefore, you also see significant improvement in decreasing in insulin resistance and also improvement in the glucose control and the sugar control in the blood because it works in conjunction. You have the stimulation of the pancreas and decrease in appetite.

Reading through the clinical trials again, and I just had done a quick review before we sat down for this interview, really it's quite impressive. One of their trials, they compare this drug for participants that have diabetes that were taking insulin and they gave them the tirzepatide. And those that took the tirzepatide lost weight versus those that were taking insulin actually by itself gained weight. So this is, again, quite significant in the amount of weight loss as well as in the amount of glucose control that we get with this medication.

Interviewer: So for all of the people who are thinking, "Oh, hey, this is the drug that's going to make me lose all my weight, finally," it's not ready for them, right? Is that what I'm understanding correctly?

Dr. Simonetti: That's right. So this medication is not yet approved for weight loss. I believe it will be, hopefully, within the next year or two. They are just finishing the Phase 3 clinical trials for weight loss.

Currently, this medication is approved for those with diabetes, and I think it'll be a wonderful tool for those that have diabetes and excess weight, overweight or obesity. This would be just a wonderful medication because it leads to a significant amount of weight loss and improvement of their diabetes.

This is great, and I think this is going to really improve the care that we can provide. However, we need to remember that obesity is such a complex disease, right? There's a multitude of issues that go with it. So this is addressing maybe some of our physiology, but we still need to do lifestyle modifications with modifications in our diet, increasing physical activity.

Behavioral health is a really important piece. Oftentimes, we eat in response to feeling sad, depressed, because when we eat in particular foods that are sweet or high caloric foods, it releases dopamine and serotonin in our brain. So it actually makes us physically feel better at the moment. And therefore, we go back and eat more because then I need another hit and then I feel better. And it becomes that very vicious cycle that once you start eating certain things . . . know for me, it's a piece of chocolate, right? I'm having a bad day at work, I eat a little piece of chocolate and my life is better at that moment. However, that doesn't help me because then my sugars crash and it makes me want to crave it more.

So really trying to address as many things as possible, and that's why in our program, we have this multidisciplinary team approach. We have the registered dieticians. We have an exercise physiologist. We have two Ph.D. psychologists. We also have other options such as surgery. So we work with the bariatric surgeons.

So again, it's wonderful to have one more tool, a very effective tool in our toolbox, but this is a tool. We are able to use it, and the more tools that we have, I think the better offer we're going to be, but we have to address all these other pieces as well.

Interviewer: So, obesity, it is not as simple to treat as just getting a new injection, even with some of these great new drugs. So I guess we'll just keep a look on the headlines, see if this is approved for obesity treatment in the next couple years, and maybe we'll have you back on and we can talk about how you guys can utilize it in your toolbox to battle obesity.

Thank you so much for joining us, Dr. Simonetti. I really appreciate you taking some time to talk to us about this new drug.

Scot: All right. We're back with Thunder Jalili. He's our resident nutrition expert. And we're going to throw out another one of these things you might see on the internet, or some of this common sense, or, you know, something that you've believed for a long time. And we're going to find out if it's truth or if Thunder is going to debunk it on "Truth or Thunder-Debunked." Thunder, are you ready for your challenge today?

Thunder: I hope so.

Scot:: All right. Does eating at night really cause weight gains? Because there's this kind of, I think, this wisdom that you eat late at night and that's what's going to cause weight gains if you're eating like right before bed or something like that. So is that truth, or are you going to Thunder-debunk it today?

Thunder: No, I actually think there's truth to that.

Scot: What?

Thunder: Yeah.

Troy: Good, I was going to say don't tell me this is not true, because my whole takeaway from all our discussions is that this is true.

Scot: All right. Well, go ahead and explain.

Thunder: We talked in earlier podcasts about kind of the length of time that you eat, in terms of like what time do you eat in the morning when you wake up and then kind of when in the day you stop eating. And as we eat, our insulin levels go up, and that's kind of the hormone to store nutrients like fat.

So people that do that late-night snacking, you know, they've got to have something at, you know, 10:00, 11:00, 12:00 at night, maybe even later, they're kind of extending that whole time that they're putting calories into their system, and their insulin levels are high. So that's a recipe for, you know, storing fat.

So one of the ways that we would, like, advise somebody if they want to try to lose weight, you know, what are some easy steps I can think about, well, one of the easy steps is try not to eat after dinner, you know. Then you kind of have a longer time period where your body can go into that natural fasting state overnight and that helps us control our weight.

Troy: See, I'm so glad you said that, Thunder, because I have now, after all of these discussions we've had about this, I now watch the clock. I don't eat after 8:00, and sometimes it is a rush to get calories in before 8:00 p.m. I admit it's a little weird, but sometimes I am just like, okay, gotta eat, gotta eat, gotta eat. Okay, it's 8:00, I'm done.

Scot: So if you do work later, though, let's say you don't start eating until 6:00 p.m. and you shut it down at midnight. You're eating at night. Is that going to cause weight gains? Is there something about the night, or is it really just about that time of eating and not eating?

Thunder: It's not . . . there's nothing special about night. It's about the time period.

Troy: So maybe it was Thunder-debunked then. So it's nothing about the night in general. It's more just that period between when you last ate and when you eat again.

Thunder: Yeah. Oh, that's true. I guess in that sense it could be debunked. I guess I was assuming most people, you know, do have kind of a more regular schedule of having, you know, three meals, more or less, a day and then throwing snacks in there. So the night snacking, when I hear that, I assume that the person is, you know, kind of doing that normal, three-meals-a-day thing. But, yeah, to your point, if that's not you, if your first meal doesn't come until 4:00 in the afternoon, then, by all means, eat at 10:00.

Interviewer: Today, you're going to learn about four research-supported steps to begin your weight loss journey.

Dr. Jennwood Chen is a member of the University of Utah Health Weight Management Program, and he helps patients that want to lose excess weight, not only for appearance but more importantly for better health. So let's talk about those four steps. What are those four steps to help somebody create some new eating habits to help them lose weight?

Dr. Chen: Yeah, yeah, absolutely. So, you know, changing what you eat or starting any new habit is notoriously difficult, right? I mean, we all are familiar with the New Year's resolutions that are broken and abandoned by, you know, January 5th. And so really in looking at how people actually implement, start and retain healthy habits, I think science has really identified four steps, and those four steps are inspiration, intention, action, and repetition.

So really, so, for instance, if someone is wanting to make a healthy change in their diet, really you need an inspiration. So many of my patients, when I talk to them, "Why do you want to lose this? Why do you want to lose this weight?" And they'll tell me that, you know, "I have young children and I know that my excess weight is affecting my health and I want to be around for them and I want to be able to play with them and be active with them." And that's inspiration, and that inspiration is it's what you draw on in those times where you know it's going to get hard just to stay with it.

However, we know research tells us that that inspiration is fleeting. So you may be inspired today to make a change, and tomorrow you can't rely on that inspiration because you just can't feel inspired all the time. And so that's where the next step intention. Once you're inspired, you need to set an intention. Okay, tomorrow, I'm going to cut this out of my diet.

Interviewer: And when you talk about intention and you have a patient, what are some of the first suggestions you have? I've heard like eliminate sugary drinks. If that's something you do, maybe start to eliminate those. That's like a really low-hanging fruit, high-impact sort of a thing. Are there some other things?

Dr. Chen: Well, that is absolutely. If someone tells me that they, you know, drink a couple of cans of soda a day, I immediately jump on that one. And, you know, people will get pretty addicted to soda. I have patients that tell me, you know, they drink up to a liter of pop a day. And so that intention to make a change needs to be a realistic. For some people, you know, cutting a whole liter of soda out of their daily routine is not that realistic. So cutting it down to a half liter a day for a while and then weaning yourself off it is a more realistic thing.

Interviewer: All right. What is the next step? We've had inspiration and intention.

Dr. Chen: Action. So really, you know, once you've set an intention, the action, and by action I mean immediate action. If you have inspiration, your intention is to start cutting out the soda, don't start next week. Start with the next time you are going to have a soda, that next time and just take action right then. It could be a small thing. Yeah, I'm not going to drink the whole liter. I'm just going to, you know, cut out half a liter, but, you know, take action now.

Interviewer: All right. When the inspiration is there and you're ready to go . . .

Dr. Chen: That's right.

Interviewer: You got to cash in on those deals, right.

Dr. Chen: That's absolutely right.

Interviewer: So inspiration, intention, action, and now rinse and repeat with repetition.

Dr. Chen: Rinse and repeat. Absolutely, yeah. And so we know, on average, it takes about three weeks to really develop a "habit," you know, and it just doesn't happen unless you could repeat these steps.

Interviewer: After three or four weeks of somebody doing this, you know, they come back to your office. What do you find that are some of the other things they can do to succeed on these four steps or some of the things that maybe, you know, cause people not to succeed?

Dr. Chen: I really think that, through all of this, you have to have self-compassion. And that really means that when you slip and it's inevitable, we all do. We all miss going to the gym. Even though I say, hey, I'm going to go, you know, five days a week at 7: 30, there's just, you know, life happens and you just miss a day. You can't beat yourself up about it. You can't torpedo the whole idea just because you slipped up once.

And on the flip side, at the end of the week, when you have, you know, cut out a liter of soda a day for five days, you got to pat yourself on the back, and you should tell your family, you should tell your friends, and you should be proud of yourself really. And that's how we stay on the path.

updated: December 30, 2022
originally published: March 26, 2021

Interviewer: Tapeworms. How do you know if you have one and where did it come from, anyway? We'll examine that next on The Scope.

Announcer: Health tips, medical news, research and more for a happier, healthier life. From University of Utah Health Sciences, this is The Scope.

Interviewer: Kristen Case is from ARUP Laboratories, which is one of the country's top labs that specializes in identifying parasites so doctors know how to treat them. My first question for you, Kristen, is - and I'm sure it's the same thing that's on everybody's mind when they hear the word "tapeworm" - how much weight can I lose if I have one, and will it be in time for swimsuit season?

Kristen: Yes.

Interviewer: I mean, I joke, but look. I did an internet search. Look at this.

Kristen: Yes, you can lose weight if you have a tapeworm. That's one of the symptoms of having a tapeworm.

Interviewer: Yeah. This ad I found on the internet is an actual ad, "Sanitized tapeworms, jar-packed to lose fat."

Kristen: Yes.

Interviewer: That was a weight loss method at one point.

Kristen: Yes, it is, and it actually still is, but not in the United States. In other countries you still can infect yourself with a tapeworm to lose weight.

Interviewer: Ugh. So, okay, I'm imagining that's probably not a good idea, and let's get to that in a second. But first of all, if you get a tapeworm that you didn't want, how do you even get that? I don't even know how that happens. Is it from the ground?

Kristen: You get tapeworms from undercooked meat.

Interviewer: Okay.

Kristen: Undercooked beef, pork, and even fish.

Interviewer: That's where they live.

Kristen: Yes.

Interviewer: All right. So you consume that, then it ends up in your intestines or your stomach? Where does it live?

Kristen: It does. Yes, the end of the life cycle for that parasite is in the human intestine, and from there it just grows and grows. For example, the fish tapeworm, it can grow up to 30 feet.

Interviewer: Oh!

Kristen: It can live in you for up to a decade undetected.

Interviewer: And then if it does that for a decade undetected, then it just finally goes through its life cycle?

Kristen: Yeah.

Interviewer: Then do you pass it?

Kristen: Yes, you would pass it.

Interviewer: So that's when you go . . .

Kristen: That's when you would know.

Interviewer: "Oh, man."

Kristen: When you start passing segments of the tapeworm, that's when you know that you have a parasite, typically.

Interviewer: Oh, okay. Got you.

Kristen: There are some other symptoms like abdominal pain, weight loss. You can get anemic because that parasite is taking the nutrients from your intestines, so you can become anemic and have some vitamin deficiencies. But what that really presents like is you're tired, you're lethargic. That can mean a lot of different things to a doctor and so as they're trying to figure out maybe what you have, the parasite continues to grow undetected.

Interviewer: So then what do doctors start doing, because what you described as symptoms, you described tired. Who isn't? Who doesn't feel tired or run down? How do they even start to unravel that that's what it is?

Kristen: Usually, it's when the human passes a segment of that parasite or of that tapeworm. That's when they have the "ah-ha" moment, or if you're a really big sushi enthusiast, and you're eating a ton of raw fish and you tell your doctor that, he might start doing some testing for a tapeworm.

Interviewer: Okay. So then the doctor would take some sort of a stool sample, send it to you at ARUP Laboratories, and then how do you determine if somebody has a tapeworm? Is there some sort of a test or do you just put it under a microscope and start looking for them?

Kristen: Yes. We do some processing to that stool specimen, concentrate it so we can see as many parasites as possible if they're there, and then we look at it under a microscope. A very highly-trained person sits at a microscope and looks for what we call "eggs" or "ova" that are passed by these tapeworms in the stool.

Interviewer: So if I have a tapeworm, those will be there?

Kristen: Yes.

Interviewer: You might not see evidence of the tapeworm other than that, though?

Kristen: Yes.

Interviewer: Okay. So then you see that and you let the doctor know, "Well, your patient has a tapeworm." What does the doctor do at that point? Is there a treatment?

Kristen: Yes. Depending on which parasite you have, or which tapeworm you have, the doctor will prescribe some medication that kills that parasite and then the tapeworm passes.

Interviewer: All right. So other than the symptoms you kind of described, maybe some anemia, are they really dangerous?

Kristen: They can be and again it depends on which tapeworm. There's a tapeworm called "Taenia solium". You get it from eating undercooked pork, and it actually can go to your intestines or it can travel to other parts of your body and even end up in your brain. If it does end up in your brain that could have devastating results.

Interviewer: Sure, that would make sense. Here in the United States, how much of a danger is it that you're really going to get one, though? Are we pretty good here?

Kristen: Yes. Our food is really safe in the United States. We have food inspectors and things like that. But it is possible. We do receive tapeworms at ARUP that the person has no travel history outside of the United States, so that means that they would've contracted it somehow in the United States.

Interviewer: So it can happen, but it's not something to be super-freaked about?

Kristen: No. It can happen, but it's not very common in the United States.

Interviewer: A lot of times you see the eggs, and that's how you know that somebody . . . Have you actually been sent a tapeworm?

Kristen: Yes. We get a couple tapeworms that you can see with the naked eye. We get at least a couple a month. To the naked eye, the different tapeworms have some different characteristics, and so we can identify which type of tapeworm they have from that segment. Again, tapeworms are not super-common in the United States, so don't be scared. If you like your beef rare, I say eat it.

Interviewer: Okay.

Kristen: If you do travel to other countries where the food isn't inspected as well as it is here in the United States, be careful.

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Announcer: Health tips, medical news, research and more for happier, healthier life. From University of Utah Health Sciences, this is The Scope.

Interviewer: Sometimes it just doesn't seem right. You exercise. You're leading a healthy, active life. Maybe in another life, you have a little too much fat, but you fixed that, right? You're trying to lose it, yet some of those stubborn areas just won't go away. Well, I want to talk about two non-invasive fat reduction techniques. One is called the CoolSculpting; the other is Kybella. Dr. David Smart is a dermatologist with the University of Utah Health Care.

First of all, I always get little bit skeptical when I hear about non-invasive fat removal. I mean, I kind of hear the ads on the radio. I'm told there's no such thing as a quick fix. So your job . . .

Dr. Smart: Yet, here I am with quick fixes.

Interviewer: So your job is to convince me.

Dr. Smart: Got you. Let's take CoolSculpting. That's a great example. Cool Sculpting is a machine that was invented and developed by dermatologists. It's all based on this principle: fat cells are more sensitive to cold than skin cells, and muscle cells, and all the cells around it.

Interviewer: So they freeze easier?

Dr. Smart: They freeze easier and then they die from being frozen more easily. This has been well known in dermatology for some time. With frostbite, even sometimes, equestrians, it's called equestrians. It's equestrian fat loss. When they're riding horses in the very cold, those inner thighs that are really cold on that saddle, they'll actually start to lose fat on the inner thighs.

Interviewer: Because their fat's freezing?

Dr. Smart: Because their fat's freezing. Also, little children with popsicles, those popsicles sometimes will cause . . . if the popsicles been in the mouth too long, it will cause a fat loss in certain areas. So it's just this cold is killing off the fat. CoolSculpting has been around now for a long enough time, several years.

There have been hundreds of thousands of cases of CoolSculpting done and the results are very reliable. It's not a brand new fad, although there are a lot of machines in the same sector of non-invasive fat loss that I personally do not believe in and have used and thought, "Hey, this doesn't do anything." CoolSculpting is not one of those. CoolSculpting does show results.

Interviewer: So as a doctor, I would think that you would be more to encourage somebody to exercise to get rid of that fat. You know? That last five pounds or those little stubborn areas, "Just keep going and you'll get there."

Dr. Smart: It's important to remember or at least recognize that you can't spot treat fat when you're working out. No matter what exercise video says, you can't do more sit ups, necessarily. "If I really do crunches just very hard, I'm going to get rid of that fat right around the belly button or I'll do these side bends and that would get rid of my love handles." That's just not how the body works. You don't spot treat fat when you exercise.

The ideal candidate for one of these procedures, whether it's Kybella, CoolSculpting, is a person that is in relatively good shape, you haven't just started your weight loss journey, you're not necessarily more than 30 pounds outside of your weight goal, but you have a few stubborn pockets of fat that just don't seem to go away.

Interviewer: Because each one of us has our own little . . .

Dr. Smart: We've all got.

Interviewer: No matter how lean you are, like for example mine is right here on the backside, right?

Dr. Smart: Exactly. So are mine.

Interviewer: I could have a six-pack and I'd still have this roll a little bit.

Dr. Smart: On the back. This little love handle, it just wouldn't do away.

Interviewer: Is that what the CoolSculpting would treat?

Dr. Smart: Precisely, that is what is why it's developed to treat. It was rigorously studied by the scientists that made it in Harvard. It was not created by some company looking to make a quick dollar.

Interviewer: So there's actual evidence-based support?

Dr. Smart: Significant evidence to support this. It is a really great treatment for those areas. For men, right around the love handles, that's a very common area for men to have little pockets of stubborn fat. Women, outer and inner thighs and around the belly button. All these places are potential areas of opportunity to get rid of.

Interviewer: So can I use multiple treatments to treat multiple areas?

Dr. Smart: You sure can. Now CoolSculpting, that treatment was not designed to be a treatment course in the sense that very reliably with one treatment of the area that's treated, about 20% of the fat will leave. But depending on how much fat you have, you might need to do more than one.

Interviewer: So CoolSculpting works different areas of the body. Kybella works primarily for fat under the chin?

Dr. Smart: True. Now that's because it's FDA approved for that area. Kybella is actually a very, sort of groundbreaking, very exciting product. It's less than a year old now, as far as the FDA is concerned. It was FDA approved less than a year ago for the treatment of the submental fat pocket, which is just the double-chin area. That doesn't mean that fat in other areas doesn't respond to it, it just means that the studies were done to get FDA approval were done just there.

Interviewer: Is it the same technique? Is it freezing the fat or is it different than CoolSculpting?

Dr. Smart: It's different. So Kybella is a liquid. It's a chemical that's naturally found in the body. It's produced by the liver and helps to absorb fats in your diet, but if you inject it directly into the fat, it dissolves fat cells. So it's been done for many years in different countries, but it's not just been regulated. Finally, a company here developed a formulation and went through the very rigorous testing to get it safety and efficacy approved by the FDA.

You inject it in a series of injections, so similar to Botox, in very small needles under the chin and it dissolves fat. Most people need to do that injection anywhere from two to four times and it really sharpens the jaw and gets rid of the fat under the chin.

Interviewer: Side effects for either one of these two treatments?

Dr. Smart: With CoolSculpting, there's no cutting, there's no downtime, there's no nothing. As you can imagine, it's destroying some of the fat there. You do get some bruising and a little bit of tenderness that would come from feeling like, "I got a good bruise in this area." Those are the most common side effects. They happen pretty regularly.

Interviewer: What about Kybella?

Dr. Smart: Kybella, those are injections. You do have to be okay with some very small needle pokes. And then I would say that the most common side effect with Kybella is swelling. Most of the time, it's pretty mild. But about one in 10 get a good amount of swelling under the chin, to the size of almost like a golf ball or an Easter egg. So you definitely don't want to do Kybella right before you have some sort of event or some pictures to be taken. You'll most likely be okay, but pretty normally, like I say, about 10%, one out of 10 people, I feel like, get pretty appreciable swelling under the chin.

Interviewer: If somebody is interested in the Kybella treatment, that's physician only.

Dr. Smart: That is available only to physicians and specifically only to physicians that have been trained in Kybella. Allergan, the company that owns Kybella, was very particular about this when they released the medicine. A lot of things in cosmetic medicine get taken up by people that don't know how to use them and it gives the product a bad name because they're using it incorrectly, getting side effects and that's bad for the product, it's bad for the company. So the company was very sure to only release it to physicians that they have specifically trained to do this that have the pathology knowledge to handle any potential side effect that may come up and that aren't going to use it irresponsibly.

Interviewer: So with the case of CoolSculpting and Kybella, what else would a listener need to know to make an informed decision about using one of these procedures? What do they need to know?

Dr. Smart: The amount of people that could benefit from these procedures is enormous. We all have these areas of fat that really tend to bother us. What they should know is that it really does work. It is not a substitute for weight loss and that's probably what I would say to someone who's interested in CoolSculpting.

Whenever anyone comes in and they're interested in body shaping, whether that's liposuction, CoolSculpting, Kybella, we have a discussion about what your outcomes are and where you're starting from, as long as your expectations are realistic. It is not going to change your weight. If you're looking to lose weight, these aren't the treatments for you. If you're looking to simply sculpt some areas of the body, you're the perfect candidate.

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Dr. Miller: Weight loss surgery, is that right for you? We're going to talk about that next on Scope Radio.

Announcer: Access to our experts with in-depth information about the biggest health issues facing you today. The Specialists with Dr. Tom Miller is on The Scope.

Dr. Miller: Hi, I'm here today with Dr. Eric Volckmann. He's a bariatric surgeon and a professor of surgery here at the University of Utah. Eric, we talked a little bit on our last talk about body mass index and the scales of weight gain associated with overweight or obese. Can you talk a little bit about when one might want to consider bariatric surgery and under what circumstances?

Dr. Volckmann: Well, most insurers, including Medicare or Medicaid, start approving bariatric surgery at the body mass index of 35 kilograms per meter squared with a weight-related medical problem, such as diabetes, high blood pressure, high cholesterol, osteoarthritis, obstructive sleep apnea, things like that.

Dr. Miller: Could you give an example of what that would look like for a person that was maybe 5'10"?

Dr. Volckmann: Someone 5'10", I wouldn't be able to tell you the exact weight, but what I can tell you is most of us have become so immune to the fact that obesity and overweight are all around us that you wouldn't think that with the body mass index of 35 would qualify for surgery. They don't look like someone we typically consider morbidly obese.

And then, if you have a body mass index of 40 or higher, you do not need a weight-related medical problem to qualify for surgery. Those criteria came for my 1991 NIH consensus conference statement on gastrointestinal surgery for obesity. And at that time, what they thought was that once you reach those body mass indexes at 35 with a medical problem or 40 and higher, that the risk of being at that weight outweighed the risks of surgery, which is nowadays, almost 25 years later, much safer and easier to perform. And they also thought that your chance of achieving long-lasting weight loss without surgery was relatively low.

Dr. Miller: Is that still true, that your chance of weight loss without surgery is relatively low? For instance, what percentage of patients who would undergo a weight loss plan would be effective five years out, would actually lose the right amount of weight just by paying attention to exercise and diet?

Dr. Volckmann: Very low. What we see with our patients who come in the clinic, most of them have tried to lose weight on at least five to 10 separate occasions. And it's not the fact that patients can't lose weight. They do, sometimes 20, 30, 40, 50 pounds, but then they end up regaining the weight and then some. So you'll see this oscillating, fluctuating weight where it goes up and down with an overall upward trajectory. And what we're trying to do is stop that and allow patients to lose weight and keep it off. Bariatric surgery is really the most durable, best, long-lasting form of weight loss that we have in the current day and age.

Dr. Miller: One of the things that I might ask is in the long run after bariatric surgery, what sorts of outcomes do people expect? I mean, do they keep the weight off at five years? What are we looking at there?

Dr. Volckmann: Yeah, I compare it to having a bad meal in a restaurant. Everyone notices the person who has had weight loss surgery and regained the weight, much like the person who had a bad meal at a restaurant is very vocal about it. But people who do well with weight loss surgery often keep it to themselves. The majority of patients lose the majority of the weight and keep it off.

So what is the majority of the weight? We talk about excess body weight loss and that's the percentage of weight that you lose above your ideal body weight. So everything above your ideal body weight is your excess body weight. So gastric bypass patients, on average, lose about 60 to 80% of their excess body weight. So for someone who 100 pounds overweight that means they'll lose 60 to 80 pounds. Two hundred pounds overweight, 120 to 160 pounds. With sleeve gastrectomy, the average excess body weight loss is about 50 to 70% excess body weight loss. So a little bit less than what we see with gastric bypass.

Gastric bypass has been around since 1967. So we know a lot about weight loss surgery. The sleeve gastrectomy has not been around for as long, although it seems to be close to gastric bypass, but we don't have as know it is very good with gastric bypass and it seems to be somewhat similar with vertical sleeve gastrectomy.

Dr. Miller: Well, if you look at gastric bypass five years out, would you say that the majority of people who have had that surgery are able to keep that 40 to 60% weight off?

Dr. Volckmann: In my practice here, and we're about four to five years in, it seems like about 90% of our patients have kept the weight off.

Dr. Miller: That's great. That's really great.

Dr. Volckmann: It is a forced lifestyle change and that's what I tell patients, that the operation will help them eat less and stay full between meals. The people who are more successful, though, are the ones who eat properly and exercise. It requires really a lifestyle modification. Any of the operations can be overcome by emotional eating, eating for reasons other than hunger, stress, anxiety, depression, boredom, inactivity. So when I see patients who have regained the weight, they often have started consuming sugary beverages or . . .

Dr. Miller: Small meals frequently

Dr. Volckmann: Yeah. They'll start just eating throughout the day, often making poor food choices.

Dr. Miller: Well, this leads me to the discussion that when people come to see you, you have a whole program designed for them, prior to them ever having surgery that's focused around their eating habits, improving their healthy eating. Can you talk a little bit about that?

Dr. Volckmann: Here at the University of Utah, we're really committed to not only having great short-term outcomes, but we want patients to do well in the long-term. And that means staying healthy and keeping the weight off. Part of staying healthy means taking vitamins and minerals regularly after surgery. All of these surgeries require that you take them a multivitamin once or twice a day and calcium with vitamin D three times a day. So although patients generally improve their health and get off medications, they still need to take vitamin and mineral supplement and they need to be followed for life. So this is a commitment. It's certainly not an easy way out. Talk to any patient. They'll tell you it's not easy, but they're glad they did it and they'll do it again.

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Interviewer: There's a pretty good chance that either you or one of your family members is affected by diabetes, obesity and other metabolism issues. We're going to talk about a brand new clinic that can help you. Coming up next on The Scope.

Announcer: Medical news and research from University of Utah physicians and specialists you can use for happier and healthier life. You're listening to The Scope.

Interviewer: Dr. Tim Graham is the Medical Director of the Diabetes, Obesity and Metabolism Programs for University of Utah Health Care. Let's talk about the brand new clinic for diabetes, obesity and metabolism. It's such a big deal that it's become kind of a thing of its own now.

Dr. Graham: Yeah. We basically have what we call a service line that covers multiple clinics throughout University of Utah Healthcare and we've got a couple of very exciting areas that we've brought new services to the people of Salt Lake and Utah. First off, we've got the Utah Diabetes and Endocrinology Clinic itself, which is now providing team-based diabetes care.

I often joke it really takes a village to take care of a patient with diabetes because individuals with diabetes have problems with eyes, they have problems with feet, they need special nutrition considerations. We like to have them work with exercise physiologists to improve their activity and to do it in a sustainable way where they don't develop sport-related injuries. They often have physical therapy needs, etcetera. And sometimes behavioral health needs. So we like to bring all those services in a team-based fashion to our patients who come into the diabetes center here at University of Utah.

Interviewer: And that's a kind of new way of thinking for diabetes. Am I correct on that?

Dr. Graham: It is. In the past, it used to be a very much a sub special physician-driven care plan where you would go see a doctor that would make some recommendations, send you back to your primary care provider. What we do is when a patient comes in and sees us, we provide all these services and we provide it in a nice, unified way so that you don't feel you've been juggled between providers. And then we send the patient back eventually to their primary care provider with a much more comprehensive care plan that sort of details all these things and doesn't just pay attention to the insulin dosing or other types of diabetes medication dosing.

Interviewer: What else does the clinic do and how is it helping people?

Dr. Graham: So we've also established a really exciting program in conjunction with bariatric surgery. We now have a pretty tremendous way to reverse diabetes using bariatric surgery. So probably better than any medication we can give people, if we can have them undergo gastric bypass surgery or gastric sleeve surgery, it largely reverses diabetes for a lifetime and longer-term studies are just coming now to bear that shows, this is a very sustainable effect and people do extremely well even a decade out past surgery.

And every decade you don't live diabetes is a decade that will save your body from a lot of damage. So we have partnered with bariatric surgery program to develop a unified approach to obesity. So anyone who has a BMI of 35 or more, and BMI is defined as kilograms per meter square, I use that term because I think more people will know what that is. And if you don't know, just Google BMI and you'll find any number of BMI calculators where you pop in your weight and your height and it will tell you what your BMI is.

But if you've got a BMI of 35 or more and you've got any obesity-related condition, that can be diabetes or it can be high cholesterol or it can be high blood pressure, if you have any of these conditions, then you're candidate for bariatric surgery. So we've recognized this is a really important sort of additional therapy we bring patients. And so we've got a medical bariatric program that's now partnered with the surgical bariatric program to provide what we call a comprehensive weight management program. And this also is not just for people who have very high BMI or who have diabetes. It's for people who just want to lose weight and would like get some medically-supervised nutritional attention and exercise physiology attention to help them.

Interviewer: From what you are telling me, this team-based approach, it seems like somebody might be listening and they're thinking, "I should be a little bit healthy, I should be able to eat better why can I not do this on my own?" But it's really a lot more difficult than that in today's world. And that's why you are bringing all these people, all these experts together?

Dr. Graham: Yeah, that's really one of the myths, I think, that our society sets up. It's like somehow, there is something wrong with you if you can't lose weight. That everyone should be able to have the willpower to do it. And we look at things like "The Biggest Loser." And while I love that sort of program for bringing to attention the problem with obesity, these people have all day of training. They have people preparing their meals for them. Who has the time, the money and the willpower to basically do that on a day-to-day basis?

The idea that it's just something we can easily do on our own without having help is really wrong-headed. And furthermore, I think it's even than the attitude of physicians for many years that the patient should just be able to do it on their own. And yet every time I have ever sent a patient out with just generalistic advice like, "Go lose weight and be healthier," they don't seem to come back having lost weight and eating more healthily. So I think that we really have to come up with personalized strategies to help patients, to support them, to even hold them to their goals. And people do better when they are working in a group like that generally.

Interviewer: Yeah. And I would imagine too that over the past many years we've learned a lot more about these things. And really you need to have those experts to have a better understanding of it?

Dr. Graham: Absolutely. The other side of this is that we now know that obesity is at least 50% genetic in origin. And so the idea that it's just because you're lazy and you don't exercise is completely incorrect. And anything that's genetic in origin has a biological basis so we now understand and very cutting edge research done here, both in Utah and elsewhere, that the brain is wired differently when you become obese and it's very hard to undo that wiring. So the fact that people, when they do lose weight, tend to have what we call recidivism where they gain weight back or very quickly.

Interviewer: We've all heard of that, right?

Dr. Graham: Yeah. That yoyo weight thing is absolutely hardwired in the brain. It's biological. It's not because of lack of will.

Interviewer: So a clinic like this really could help somebody that . . . it's not a magic pill, there is probably some work and some time involved, but it sounds like it would offer hope to somebody that has not had hope before or has failed in the past?

Dr. Graham: That's right. And I would say that also includes people who have very significant obesity. We use the term, and I don't like it because it sounds so negative, but morbid obesity, which is a BMI of 40 or more. People who get up that high have a very hard time losing weight and they need additional support, especially physical therapy. Think about many people are starting to get joint problems when you start getting heavier with a BMI of 40-45 range.

And so we need to bring a lot more things to bear to help these people, many of them will be bariatric surgery candidates, some of them won't. But just because they're not doesn't mean that they don't need special health care. And so we really are trying to bring medical bariatrics up to get up to speed with the great advances that have been happening in surgical bariatric. And to give a home for everyone with all these problems so that they don't have to just see the primary care provider who might tell them every time, "You know you need to lose weight. You know you need to . . . "

Interviewer: Every year you hear that, right? And then a year passes and then you come back and you're in the same boat.

Dr. Graham: It takes actually more than that to achieve the results.

Interviewer: Where can I find more information about the Diabetes, Obesity, and Metabolism Program?

Dr. Graham: Well, so we've got on the University of Utah website, we have information about . . . if you go to the Utah Diabetes Center, we've got a web page that will actually branch out all these different programs we've been developing.

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