Top 10 Obesity Myths with Dr. Angela Golden, Part 2

This week we continue our fascinating discussion with Dr. Angela Golden, a leader in the world of Obesity Medicine, on the Top 10 Obesity Myths. We covered Myths 1-5 last week. This is Part 2, where we talk about Myths 6-10.

Episode Highlights:

17:24 The urban myth is that one, that 3,500 calories is a pound of fat. Because if it was true over a course of a year, it would either equal a 52 pound weight gain or a 52 pound weight loss if I reduced my calories by 500 calories a day.

19:54 If you put two people next to each other one, who's never had obesity. And one who has, the person with obesity actually absorbs food differently than the person who doesn't. And it's because of the way that the gut is impacted by inflammation from obesity. So more calories are absorbed By the intestines of someone, with the disease of obesity.

31:46 We all have a responsibility to help those of us living with obesity to not have the stigma and the blame around it. And one of the easy ways we can do that is to get rid of the word "obese". Yes. O B E S E should just be removed from every dictionary and all the language. Because I'm not an obese woman. I am a woman living with obesity. Yes. I live with a chronic disease. I am NOT labeled by that disease.

--- Full Raw Transcription Below ---

Dr. Angela Zechmann (00:28):
All right, so welcome back everyone. This is part two of our two part series with Dr. Angela Golden. .

Angela Golden, DNP (00:41):
It's so good to be back with you.

Dr. Angela Zechmann (00:43):
Yes, it's wonderful. So last week for those of you who did not hear last week's, last week's part one, we're doing the top 10 obesity myths. And this happened because I heard Dr. Angela, …Dr. Angie, give a talk at the Obesity Medicine Conference in Atlanta. It's probably been three or four weeks now ago, I think. Yeah, it's been a little while. Yeah, it was a great talk. And so I found her later at a function and I said, would you please be on my podcast? Because so many people don't know this stuff, including a lot of obesity medicine specialists, frankly, and certainly a lot of your healthcare providers and most people who struggle with this disease.

Dr. Angela Zechmann (01:29):
And so she said, she'd be happy to be on the podcast. So last week we talked about the first five obesity myths. Now, if you weren't on last week, I just Want to tell you who Dr. Angie is. She has a doctorate in nursing, and she has an obesity medicine practice in Flagstaff, Arizona. But she's a, she's a premo-educator for those of us in obesity medicine, and for nurses all over the country and all over the world. She is the past president of the American Association of Nurse Practitioners, which is the group for nurse practitioners in the country. She gives talks all the time. She's a consultant in the development of patient education materials. She's done all kinds of research. She's authored a book. I mean, this woman knows her stuff and is very happy to teach it. And so I'm just absolutely thrilled to have her on the podcast with us. So thank you again, Dr. Angie,

Angela Golden, DNP (02:33):
I'm so glad to be with you.

Dr. Angela Zechmann (02:34):
Yeah, I wanted, I Want to just review the, the first five obesity myths that we talked about last week for people who hadn't heard of them. The first obesity myth was that obesity is a risk factor and not a disease. And so we talked a lot about how, yeah, it actually is a disease and it is associated with a lot of poor health outcomes. So we talked about that. Myth two is that it's all about willpower. And so we talked about some of the neurochemistry of this disease and how it is not willpower that is creating the problem. Myth three is that we use diet meds to treat it. And we talked about how these are not diet medications at all. These are medications that are helping to correct the neuro-chemical imbalances that create this disease.

Dr. Angela Zechmann (03:27):
Myth four is,, myth four is that you have to lose a lot of weight in order to have any benefit. And we disputed, we dispel that myth with, with data and research. And then myth five is that I can't change it because it's all in my genes and it's all hereditary. And we talked about how that's not true either. So those are the first five myths. And if you want more information on those ones, go back and listen to last week's podcast, but let's start now with myth six. So what's myth six, Dr. Angie.

Angela Golden, DNP (04:05):
So myth six is that surgery is cheating. And, you know, yeah, I think what's interesting is I don't know any other disease process that surgery is part of the possible treatment paradigm. Yes. That we would ever call it cheating. I mean, think about coronary artery disease, right? And then you have plaque in your coronary arteries. Nobody says, oh, you had bypass surgery. What a cheater you are. I mean, nobody would ever say that they would be like, oh my gosh, you had to have coronary artery bypass surgery. So, you know, you have clogged arteries. People expect you to, you know, have to have some kind of intervention mm-hmm , but we don't talk about bariatric surgery that way. So, yeah, I think what's important for us to talk about how that bariatric surgery works. You know, the two most common bariatric surgeries that are happening in the United States right now are the roux-en-Y gastric bypass and the sleeve gastrectomy mm-hmm . And I think what's fascinating is that, you know, for a long time people just said, oh, they just make the stomach smaller.

Dr. Angela Zechmann (05:12):
Yes.

Angela Golden, DNP (05:13):
Wait, , you know,

Dr. Angela Zechmann (05:14):
I've heard that so many times ,

Angela Golden, DNP (05:16):
You know, there's no question that they do do that, but really what they're doing is they're affecting the gut brain communication mm-hmm so they seem to be lowering that defense of the higher body fat mass. They're changing how the hormone and the brain talk to each other. Yes. So appetite is decreased and it happens almost immediately after surgery. mm-hmm So it can't be just about decreasing the size of the stomach. Right. So we know that this is happening right away. And so I think to me, that's been one of the most fascinating things to keep in mind about bariatric surgery, as one of the tools mm-hmm that can treat obesity. It's not the only tool anymore than medicines are the only tool.

Dr. Angela Zechmann (06:07):
Right.

Angela Golden, DNP (06:08):
But I think the audience should know it's one of the tools and it's certainly not a way to cheat  

Dr. Angela Zechmann (06:13):
Right. Yeah. I, I hear that all the time that, well, you know, that'd be taking the easy way out, but then there's all of these risks to surgery. And then people don't think about the risk to obesity out of control when they're considering the risk to surgery, which these days are quite minimal because they do so much of it laparoscopically too.

Angela Golden, DNP (06:32):
Right.

Dr. Angela Zechmann (06:32):
So,

Angela Golden, DNP (06:34):
Yeah. In fact, I think the risk right now is 0.03%, which is less than having your gallbladder removed.

Dr. Angela Zechmann (06:43):
So there you go. It's less risk than a gallbladder surgery, like, and it's a, I think bonafide treatment option.

Angela Golden, DNP (06:51):
It is. And I think the way we can look at that is to say how it impacts the disease. So when we look at bariatric surgery, couple of examples that I think are big impacts are; 83% of type two diabetes can actually be completely reversed, that's that's bariatric surgery, and 92% of high blood pressure.

Dr. Angela Zechmann (07:15):
92% of high blood pressure can be resolved with bariatric surgery. Yeah. Wow. Yeah.

Angela Golden, DNP (07:20):
And even 55% of migraines are resolved. So when you think about that, I mean, people don't often think that they're bariatric surgery again, when we treat obesity, as you well know, we're doing much more than number on a scale. That's not why we're treating it. We're trying to impact all the things that obesity causes, like we talked about with myth number one, which was mm-hmm , we're trying to prevent all the things that obesity causes. Mm-hmm

Dr. Angela Zechmann (07:48):
. Yeah, yeah. You know, and it's so interesting because we hear over and over again in our conferences about how people who have obesity and are eligible for medical treatment or bariatric surgery, they're just not being told this information, like no, like typical healthcare professionals don't understand the disease of obesity. And they certainly do not outline the potential possible treatments for people. And so it gets to be really, really frustrating for them. So we just Want to make sure that everybody listening to this podcast, and if you're listening to this podcast and you are like, wow, this is really interesting. I've got friends who need to know this by all means, share it with them because we want people understanding what's going on with this disease.

Angela Golden, DNP (08:41):
And I would, and I would say it's the majority of your audience because only 3% of people with obesity get the choice of having a medication. And only 1% of those qualified for surgery are ever referred for surgery. What other disease?

Dr. Angela Zechmann (08:59):
I know well, that's because it's a will powered problem. exactly right. Not, not, not at all. We talked about that last week, if you didn't hear it last week. All right. Yes. So that's, I'm so glad to hear you say that, that surgery is a really viable option and is not risky at all. So that's awesome. Okay. So what is myth? Number seven,

Angela Golden, DNP (09:28):
Just exercise, more to lose weight.

Dr. Angela Zechmann (09:31):
You are singing my tune .,

Angela Golden, DNP (09:34):
You know, and, and I always, I always feel bad for so many of my patients who come in and they'll say, I am I exercise every single day? Why am I not losing weight? Mm-Hmm and my heart breaks for them, because I know how hard they're trying mm-hmm to control their disease. And most of it's cause they don't understand the disease mm-hmm and here's what we know about exercise. If you are actively trying to lose weight, it can only provide a modest amount of weight loss. In fact, only about five pounds on average mm-hmm so, and then we're going to add a little bit of insult to injury here because when you do bouts of exercise, you often increase your sedentary activity. The rest of the day. Yes. And some of us, I know I've been guilty of this every once in a while. Mm-Hmm we think, oh, you know, I rode that bike for an hour at the gym mm-hmm so I can have a little piece of cake tonight. Mm-Hmm we think we can eat more. And so,

Dr. Angela Zechmann (10:43):
You know what, I call this, I call this the exercise halo effect yes. I dunno. I made that up. Yeah. It's like you have this like TETA. I did so well on my treadmill this morning or my bike or whatever it might be, I get to eat, you know? And so yeah,

Angela Golden, DNP (10:59):
The exercise also increases the hunger hormone gremlin. So sometimes after you exercise, you really are hungrier.

Dr. Angela Zechmann (11:08):
Mm-Hmm  

Angela Golden, DNP (11:09):
Yeah. It's not just that you think you can eat more, but you really are hungrier. So, but I Want to be really cautious here. I don't want anybody in the audience to think that you and I are telling them not to increase their physical activity. Right. Because activity is good and it's good for many, many diseases. We know it improves blood pressure. It improves glucose control for people with diabetes. Mm-Hmm it's great for the prevention of obesity and your podcast is Keep Your wWeight Off mm-hmm activity is 50% of maintenance for obesity. Yes. It's how you keep the weight off. Yes. So activity is very, very important. But for keeping your weight off, we're talking probably close to 300 minutes a week.

Dr. Angela Zechmann (11:58):
Mm-Hmm  

Angela Golden, DNP (11:58):
Yeah. That's a lot. And people will look at me and go, you have gotta be kidding. Mm-Hmm so I think the key is for everybody to realize that all movement is good. Mm-Hmm so just get up and move mm-hmm if you're sitting there right now, listening to this, get up and walk in place, walk around your house. Yeah. Listen, listen to the podcast while you're out. I mean, right now here where I live, it's 73 degrees.

Dr. Angela Zechmann (12:25):
Oh, lucky you,

Angela Golden, DNP (12:26):
We should probably be out walking while I'm taping this, except there'd be too much background noise.

Dr. Angela Zechmann (12:31):
Exactly.

Angela Golden, DNP (12:33):
But you know, I think that wherever you can get some extra movement in mm-hmm it all adds up. Mm-Hmm it doesn't have to be a concentrated amount of time. And I think that that's a really important take home message. Mm-Hmm it doesn't have to be exercise. It can just be activity

Dr. Angela Zechmann (12:52):
Mm-Hmm yeah. Yeah. Well, you know, what I discovered is that exercise really helps. It really helps me personally with my mental health. Absolutely. Because I just, I feel so empowered when I'm exercising regularly and that gives me the motivation that I need to chop my vegetables and cook my food and do all of those other things for me because I know I'm taking care of myself. And I see this really consistently with my patients too, when they're exercising, even if they know that, you know, it's not going to be the calorie burn that matters, they know they're taking care of themselves and they're feeling empowered and motivated. And that's just a really, you know, among all of the other things that exercise does for us.

Angela Golden, DNP (13:35):
yeah. And I think that's why it's important for people to think of it as activity mm-hmm and you know, if they're a desk worker, you know, there's somebody that's at their desk, most of the day set an alarm. So that every hour they get up and move for five minutes

Dr. Angela Zechmann (13:49):
Mm-Hmm  

Angela Golden, DNP (13:50):
Yeah. Every time they do that, they can recognize that empowerment of I did this for me.

Dr. Angela Zechmann (13:56):
Yeah. Yeah. Now I have a quick, I have a quick question for you, you know, all those smart phone apps that people have where they're calculating how many calories they should eat every day. And if they go out and they take a walk or whatever, and let's say they burn 300 calories, it adds an extra 300 calories to their daily intake. What do you think about those?

Angela Golden, DNP (14:17):
I, I hate them.  

Dr. Angela Zechmann (14:18):
Okay. I do too.

Angela Golden, DNP (14:22):
So I have a desk cycle, which means that when I'm sitting at my desk and I'm working on creating a talk or somewhere mm-hmm, , I'm usually riding my bike and I'm not really sure where the app thinks I live maybe on a different planet, because it will say that that I've used 800 calories. Well, there is no way on earth that I used 800 calories. It's I even put light cycling. Ah, and I can't eat 800 more calories that day. Give me a break. Right. So right. I tell patients to totally ignore the added calories because.

Dr. Angela Zechmann (14:58):
I do too.

Angela Golden, DNP (14:59):
it's incorrect. I don't know what, I don't know what calculator that the programs use and they all do it. It's not just one program that does it. They all do it. So I just tell 'em they just ignore that.

Dr. Angela Zechmann (15:11):
Yeah. Excellent. I do too. I, I just am like, you know what? Your body is not a simple math formula. It just doesn't work like that. Yes,

Angela Golden, DNP (15:20):
Yes. Which actually takes us to myth eight wonderfully.

Dr. Angela Zechmann (15:25):
Okay, great. What's myth eight?

Angela Golden, DNP (15:27):
Calories in and calories out. Fewer calories and exercise more. It's that simple.

Dr. Angela Zechmann (15:34):
Yes.

Angela Golden, DNP (15:34):
okay. It's not it's it's our bodies are not a math calculation, as you just said. Mm-Hmm in fact, if it was that easy, we wouldn't have the obesity problem that we have. Mm-Hmm You know, one of the premier obesity physicians in the United States is Dr. Robert Kushner mm-hmm and he likes to talk about obesity treatment is well beyond diet and exercise. Mm-hmm And I love using that because I think so many of the people in your audience and many of my patients come in and they think it is truly just, tell me what diet and how much exercise to get. Mm-hmm .

Angela Golden, DNP (16:15):
And that, that just isn't what it is. Let's face it. We don't tell anybody with diabetes, just eat less sugar mm-hmm or somebody with hypertension, all you have to do is eat less salt. Mm-Hmm both of those can be part of what we talk about, but it's not the only thing we talk about. So we need to use all the tools in our toolbox to help treat the disease of obesity. So we talk about making changes in lifestyle and absolutely that can include changes in eating. Mm-hmm It can include increasing activity and it can include working on sleep and stress and adding appropriate medications. Yes. But we don't do that with obesity as a general statement for healthcare providers, we don't put all of that together for obesity.

Dr. Angela Zechmann (17:12):
Yeah.

Angela Golden, DNP (17:13):
So I think one thing that we have to get rid of is this misconception that it's simple calorie math. Mm-hmm Because you know, the, the urban myth is that one, that 3,500 calories is a pound of fat.

Dr. Angela Zechmann (17:32):
I love the way you said that's an urban myth. I love that.

Angela Golden, DNP (17:35):
Yeah, it is. Because if it was true over a course of a year, it would either equal a 52 pound weight gain or a 52 pound weight loss if I reduced my calories by 500 calories a day.

Dr. Angela Zechmann (17:49):
Mm-Hmm

Angela Golden, DNP (17:50):
And we, that clearly doesn't happen. We've, you've had patients, I've had patients, your audience has done this, where they have reduced their calories by 500 calories a day. And they did not lose 52 pounds that year.  

Dr. Angela Zechmann (18:03):
Right.

Angela Golden, DNP (18:04):
The 50, the 3,500 calories came from Dr. Wishnofsky in 1958

Dr. Angela Zechmann (18:11):
Mm-Hmm  

Angela Golden, DNP (18:13):
He was a medical researcher. And all he did was try to find out how many kilo calories did a pound of fat store.

Dr. Angela Zechmann (18:22):
Mm-Hmm  

Angela Golden, DNP (18:23):
He wasn't trying to find out how much food you had to eat, how much food you had to burn, mm-hmm and we have things there's a, there's a, and I don't know if in your notes you can put in links or not, but there's something called the NIH body weight simulator. And it's a calculator that takes into account what we call metabolic adaptation.

Dr. Angela Zechmann (18:49):
Oh, okay.

Angela Golden, DNP (18:50):
And it will show you, it will show your audience, what can they really lose when they take into account eating and activity?

Dr. Angela Zechmann (18:59):
Mm-Hmm  

Angela Golden, DNP (19:00):
So it's a nice way. You can just Google NIH body weight simulator, and it it'll pop right up. Or I

Dr. Angela Zechmann (19:06):
Can, we'll put the, we can put the link in the show notes too. Perfect. We can do that.

Angela Golden, DNP (19:11):
But I think there's another thing that people are never aware of. That just really kind of adds to the confusion mm-hmm many of us have become very astute at reading labels.

Dr. Angela Zechmann (19:23):
Mm-Hmm  

Angela Golden, DNP (19:24):
But the FDA allows a 20% margin of error on a label  

Dr. Angela Zechmann (19:30):
20% margin of error. So,

Angela Golden, DNP (19:32):
So something that is 150 calories on the label could really be 130 or 180.

Dr. Angela Zechmann (19:40):
Oh my gosh. wow. Yeah, that's a lot. So I

Angela Golden, DNP (19:45):
Think, yeah. And, and I think that when we add to that, what we're learning about our gut, our intestines

Dr. Angela Zechmann (19:52):
Mm-Hmm ,

Angela Golden, DNP (19:53):
And that if you put two people next to each other one, who's never had obesity. And one who has, the person with obesity actually absorbs food differently than the person who doesn't. And it's because of the way that the gut is impacted by inflammation from obesity. So more calories are absorbed By the intestines of someone, with the disease of obesity.

Dr. Angela Zechmann (20:24):
That's Interesting.

Angela Golden, DNP (20:25):
So that you can see, I mean, I think it's really clear that a calorie isn't just a calorie.

Dr. Angela Zechmann (20:31):
It's very clear. Yes. Yes. And I have also attended lectures where they talk about some people have different gut bacteria. People with obesity have different gut bacteria than people, without obesity that can affect the way foods get predigested and absorbed. There's just, there's so many other factors. I wish, I wish it was as simple as calories in and calories out, but dang, it's just not.

Angela Golden, DNP (20:58):
You and me both. Although we might be out of a job, but that would be okay with me. I would actually be okay if it was that easy for everybody.

Dr. Angela Zechmann (21:07):
Yeah. Oh man. All right. So okay. So that's myth eight is that it's not as easy as calories in and calories out. What is myth? Number nine?

Angela Golden, DNP (21:22):
What's the use? It all comes back.

Dr. Angela Zechmann (21:25):
oh. This is so hard. And this is the Keep The Weight Off podcast. So let's talk about this. Yes .

New Speaker (21:31):
So as a woman who lives with the chronic disease of obesity, I've always laughed and said that every time I lost 15 pounds, it went out and found five friends and came back.

Dr. Angela Zechmann (21:43):
 

Angela Golden, DNP (21:46):
And you know, the reality is I always blamed myself. I said, it's cause I didn't have enough willpower. Mm-Hmm Well, I debunked the willpower myth. Mm-Hmm so now let's debunk this one.

Dr. Angela Zechmann (21:57):
Okay.

New Speaker (21:57):
When we, what we have learned about the disease of obesity is that there's something called metabolic adaptation. And once we have this disease, our hypothalamus, an area in the brain actually begins to defend mm-hmm the higher amount of fat mass mm-hmm as the normal in our body. Mm-Hmm yes. So` when we lose weight, it actually defends the higher mass and says, oh no, no, no, no, no, you need to eat more. Yes. And you need to not move as much. Yes. So the brain is actually telling us by increasing the amount of hunger hormone

Dr. Angela Zechmann (22:44):
Mm-Hmm

Angela Golden, DNP (22:44):
and not being able to hear the satiety hormone as well. Mm-Hmm , that's called metabolic adaptation. And so all these times, and I'm sure many in your audience have experienced this they've lost weight and then they've gained it back. Now. I don't Want to pretend that part of it isn't because I did start to eat again. And some of it is, I swear, it's called, I call it calorie creep where yes, it's really not very much, but you know, a hundred calories here, a hundred calories there, but it's because my hunger hormone is higher.

Dr. Angela Zechmann (23:25):
Yes.

Angela Golden, DNP (23:27):
So with that in mind, people need to realize that there is a biologic adaptation occurring that increases the hunger hormone. It's more than willpower.

Dr. Angela Zechmann (23:39):
Mm-Hmm, ,

Angela Golden, DNP (23:40):
It's a biologic occurrence that's causing that increase in hunger. And are there things we can do about it? Yes. There are. We can use macronutrients like protein to help offset that, but we can use medications to offset it. Mm-Hmm mm-hmm

Dr. Angela Zechmann (24:00):
yeah.

Angela Golden, DNP (24:00):
I also know that if I go back to tracking my food carefully, I can see the calorie creep come in

Dr. Angela Zechmann (24:08):
Mm-Hmm

Angela Golden, DNP (24:09):
or I can see that I'm not moving as much if I go back to tracking my activity.

Dr. Angela Zechmann (24:15):
Mm.

Angela Golden, DNP (24:15):
So I can use my behaviors to help work on it. Mm-Hmm but you know, I also make sure that I've kept my quarterly appointments with my obesity specialist.

Dr. Angela Zechmann (24:26):
Yes

Angela Golden, DNP (24:27):
so that I continue my treatment of my chronic disease.

Dr. Angela Zechmann (24:30):
Exactly, exactly. Yes. Yeah. You know, it is so interesting. You, you can't underestimate the fact that you live in a society where everybody glorifies, overeating too. Like we're always overeating as a society. Yeah. And we're we're eating a lot of products that contain a lot of sugar and flour that are going to reestablish sort of a new baseline in our brain for whether we're sensing satiety or not. And so that's why the protein is so important. Like if you replace the sugar and flour products with more protein, then you bring the leptin levels back down and you increase the satiety hormones more excuse me, you bring the insulin levels back down so that you can increase the satiety hormones. But there, you know, they did a study on biggest loser patients where they discovered that even after they had attained a steady state, their basal metabolic rate just kept going down too. Mm-Hmm

Angela Golden, DNP (25:29):
 

Dr. Angela Zechmann (25:30):
And that's part of that metabolic adaptation. Yes. Is it not?

Angela Golden, DNP (25:33):
It is. And that's why keeping your lean muscle mass through weight loss and keeping it as high as you can with maintenance is so important. Mm-Hmm so that's why for people in the audience that are seeing an obesity specialist, or you've been fortunate to find a primary care provider who understands obesity, they've talked to you about anaerobic or weightlifting

Dr. Angela Zechmann (25:57):
Mm-Hmm

Angela Golden, DNP (25:58):
it's to keep that lean muscle mass as high as you can, because the more muscle mass you have, the higher your resting metabolic rate can stay.

Dr. Angela Zechmann (26:09):
Yes. So,

Angela Golden, DNP (26:10):
Yeah. And that, that, you know, that Rin [unclear] study on the biggest loser that you mentioned, I think one of the keys there is that they studied those people six years later. Yes. Wasn't just six months, six years later. And their basal metabolism rate that furnace that burns all the time was lower. Even with the weight regained, they still had a lower metabolic rate. And that's because of the disease of obesity. It's not because they have too little willpower to keep their metabolic rate faster.  

Dr. Angela Zechmann (26:43):
Right. well, I also, in my opinion, it's also just because when you're doing something like Biggest Loser, you're so focused on really fast weight loss, starving the body, you know, I'm always preaching about how important it is to make sure that we do not put our body into a famine state, you know, that we are feeding it, yes, real food and enough foods that it doesn't go into that state. So yeah,

Angela Golden, DNP (27:13):
Absolutely. I'm not allowed to watch those shows when I'm at home because I'm screaming at the TV the whole time.

Dr. Angela Zechmann (27:20):
I would be too . All right. So that's myth number nine. What is myth number 10?

Angela Golden, DNP (27:28):
That there is healthy obesity.

Dr. Angela Zechmann (27:30):
Ah, okay.

Angela Golden, DNP (27:33):
So there is a, a movement that there's health at every size and… Mm-hmm

Dr. Angela Zechmann (27:37):
 

Angela Golden, DNP (27:38):
I, so I am a really, really big fan of saying I'm treating obesity to prevent its complications or mm-hmm to hopefully resolve the complications. I'm not treating obesity because I want a patient to be in a certain size of clothes mm-hmm or because I think there's a certain way that people should look.

Dr. Angela Zechmann (28:03):
Right.

Angela Golden, DNP (28:05):
But we know th`at excess adipose tissue or that fat tissue exposure to that over time,

Dr. Angela Zechmann (28:15):
Mm-Hmm,  

Angela Golden, DNP (28:16):
Greatly increases cardiovascular risk mm-hmm metabolic risk, like for diabetes mm-hmm as well as functional risk for things like your joints. Yeah. Not just from the size on them or the mass on them, but from the inflammation, yes, to the joints. Yeah. So there have been numerous studies, there's a, a study called the Mesa study that showed the quote, metabolically, healthy people with obesity, meaning when they first started, they had no symptoms or signs of any metabolic disregulation, their insulin levels were normal, their sugars were normal. Mm-Hmm Within 12 years had metabolic syndrome.

Dr. Angela Zechmann (29:07):
Mm.

Angela Golden, DNP (29:08):
So it's not fast, but it's that long term exposure to this increased adipose tissue. Yes. That causes the damage. This is why, and I'm sure for you, it's exactly the same. It's why I treat obesity. I'm sure it's why you have this podcast. It's why I agreed to be on this podcast because I am so passionate about people understanding that it's not about how someone looks. That's the reason I treat obesity. Mm-Hmm It's about the impact of the adipose tissue on their health.

Dr. Angela Zechmann (29:44):
Mm-Hmm Yes. I could not agree with you more so I could not agree more. It, so, I do, I do appreciate the, you know, because, because there's so much messed up in, in terms of body image, mm-hmm, in terms of the expectations for women in, in our culture. But I think, you know, it's, it's in the western culture that we're sort of expected to have really small thin bodies. And so I agree with the body positivity movement absolutely. That we need to accept bodies in all shapes and sizes and and if there's obesity, it needs to be treated . So it's not either, or here it's both.

Angela Golden, DNP (30:32):
Exactly. Exactly. And I think that, I think that's why the Help At Every Size movement has so much power behind it, because it really is about accepting ourselves.

Dr. Angela Zechmann (30:46):
Mm-Hmm  

Angela Golden, DNP (30:48):
And there's been so much blame and shame around excess fat tissue.

Dr. Angela Zechmann (30:55):
Mm-Hmm  

Angela Golden, DNP (30:57):
That it resonates for so many of us to be able to say, I am who I am mm-hmm but I am who I am works great unless it's impacting my cardiovascular, my metabolic health, my quality of life. Yeah. And then I need it treated. Yeah. I don't have to be a size six . I will probably, probably haven't wore a size six since I was six years old, you know, I'm probably never going to wear a size six again, but I want to be able to have quality of life and good health. And I want my patience and I want your audience to have that.

Dr. Angela Zechmann (31:32):
Mm-Hmm  

Angela Golden, DNP (31:34):
And you know, I, I have a plea that I, yeah, that I try to put in, anytime I talk about obesity, whether it's to healthcare professionals, it's to an audience like you have, and that's that we all have a responsibility to help those of us living with obesity to not have the stigma and the blame around it. And one of the easy ways we can do that is to get rid of the word obese. Yes. O B E S E should just be removed from every dictionary and all the language, because I'm not an obese woman. Right. I am a woman living with obesity. Yes. I live with a chronic disease. I am not labeled by that disease. Yes.

Angela Golden, DNP (32:17):
And to me that's a big, big difference saying I have a chronic disease is not the same as saying I am the disease. Exactly. So I would beg your audience to start thinking in terms of a person with a disease, as opposed to the person being the disease. Yes. And I think if, if they do nothing else, if they don't remember a single one of the myths that I hope we debunked if they would just do that, I would leave this knowing that something powerful came out of it. Yes. Because I just think that means so much to those of us living with obesity to not be labeled. Mm-hmm

Dr. Angela Zechmann (32:55):
Yes. I correct everybody who says, who says I'm obese? No, no, no, no, no, no. You're not obese. You have a disease.

Angela Golden, DNP (33:03):
exactly. Yeah. Yep. Yep. You have obesity. You, you are not the disease yes,

Dr. Angela Zechmann (33:10):
Exactly. Like we wouldn't say that you are a breast cancer, you have breast cancer and you're right. You know, you're not, you're not a hypertensive per se. You're somebody who has hyper blood pressure. Right, right. Like you have hypertension. So same thing is true with this disease. And the more we understand that this is a disease and the more we look around and we see how many people are struggling with this disease. And we start to think about what's going on in this country, the more we're going to be able to do something about it.

Angela Golden, DNP (33:39):
Exactly. Yeah, exactly.

Dr. Angela Zechmann (33:41):
Yeah. Yeah. Awesome. Okay. So let me review the last, the, the obesity myth that we talked about today. And if you didn't hear the first five, you'll have to just go back and listen to that podcast. So myth number six was that surgery is cheating. We debunked that big time. Myth number seven is that you need to exercise more to lose weight. And we talked about how crazy that is. Myth number eight is that if you just eat fewer calories and exercise more, that it's very simple and you're going to lose weight that way. And we completely debunked that one. Myth number nine is that what's the use, it all comes back. And the truth there is that there are some biochemical adaptations that are, are metabolic adaptations that our body makes, but it is entirely possible to lose the weight and keep it off and not gain it back.

Dr. Angela Zechmann (34:37):
And myth number ten is that there's something called healthy obesity. And we talked about how that is not true, that even if you do not have any of the correlates when you first get measured of insulin resistance, blood sugar issues, all of that within 12 years, there is an increase in risk because of the excess adiposity. So, and we talked about how important it is to make sure that we don't say that somebody is obese, that somebody has obesity, that it is a disease. So that is a good summary. Do you have anything else you Want to add? Dr. Angie,

Angela Golden, DNP (35:21):
I just Want to thank you so much, Dr. Angela for having me on your podcast and I truly enjoy your podcast and often recommend to all of my patients that they listen to it because I think it's great information and is so positive. It just gives such a great message of yes, you can do this and it's, it's doable. It's treatable.

Dr. Angela Zechmann (35:42):
It is, it's doable. It's treatable. It requires more than you think , which is why we're here to help. . Exactly. So, all right. Great. Well, thank you again. Thank you so much for being on this, and I know you have patience to go see and things you gotta get done. So I really appreciate your being on the podcast with us today. And everyone listening, thanks for listening. And we will see you all next week. Take care of everyone. Bye bye.

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Dr. Angela

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