Ep. 13: The Obesity Pandemic and What You Can Do about It!

welcome to the deliberate way the podcast that explores the deliberate way that innovators approach their craft for

those who don’t know Dr bellerin Omar is the director of GI metabolic bariatric

and robotic surgery at Holy Name Medical Center in the great state of New Jersey here and amongst the many accolades and

accreditations maybe one of the most notable about Omar is that he’s completed more than 1,00 robotic

surgeries many in bariatric over the years he’s working in this space and uh

you know aside from being a gifted surgeon who’s helped countless patients he’s also one of the leading Minds

around this notion of healthy and sustainable weight loss because you know losing the weight is only part of the

issue but keeping it off that’s the big problem that everybody struggles with so

it’s uh great to talk about this and I’m gonna jump right in Omar because over

the past few weeks since New Year’s has passed I notice seeing that Forbes as

this uh this survey that they put out and they claimed that two of the five leading New Year’s resolutions were of

course losing weight and improving Fitness and they’re always you know

right on the top of the list so as an expert in this space I have to ask you

why is weight loss always at the top of people’s personal goals what what why is it always there again and again and

again what do you think well first off then thanks for the uh

introduction um listen weight loss it’s uh it’s always at the top of our daily

you know problems like so you know so to speak if you think about it uh obesity

or being we overweight it’s a it’s a pandemic and uh in and you know United

States is not far from that um statistically we are 40% overweight or

BMI over 30 and which is considered obesity type one and you know if you if

you count out of every 10 people that means that four or five of them are going to be either overweight or obese

so you know it’s uh it has different different implications so you know it’s in the top of the mind of people every

year you know I got to ask you I mean you were not born in the United States and is this every bit of an issue in in

other countries I know it’s a naive question but when you think about it from all of my clinical standpoint like

viscer I feel like yeah there’s overweight people all over the place but is America like are we like is that like

our chief export is overweight people or is it other is it sort of a pandemic in

that it’s in every country right now and just as big of an issue yeah no you know this is and this is according to CDC uh

and also the World Health Organization you can see that uh you know Canada is

also a big a big problem um and also Asia okay it’s mostly

you know North Asia uh you see also in South America it’s a big problem obesity

from all the way from Mexico all the way down to Brazil Paraguay Chile Argentina

uh it’s uh you know it’s it’s both it’s genetic predisposition but also it is

environmental uh but I have to say that the top three countries according to the World Health oranization is United

States Canada and Australia well MH so we’re in good company it’s uh and you

know I want to just kind of wind back for a moment I mentioned that you know you you came from another country from

Venezuela um take me back for a moment about how do you get involved in bariatric surgery coming from Venezuela

specifically I mean I know as a young kid you wanted to be a surgeon and you know it kind of turned you on to it but

Bariatrics a really specialized area in my mind um and also the idea of weight

loss um what turned you on to that why why bariatric why weight loss yeah so

you know I think once you become a surgeon you or as physician um you know

first of you you really have that commitment of helping people and you know trying to make life different I

think uh bariatric surgery what what fascinates about this is that you can

really make a dent in patient’s uh lifestyle and life changes you know you really are part of

their transformation process you can actually see how these patients you know

you kind of unleash the person that’s been inside uh you know somebody who has been

uh having obesity issues for the longest and you can see you know stories like

you know doctor I don’t have any more diabetes now I you know I ran my first uh you know half marathon my first

marathon it’s uh is is rewarding the other thing is that you have uh it’s

like a long standing commitment with the patient in you so it’s not just the surgery it’s just uh you know you keep

following up these patients you know regularly um inclusive once a year so you canot see their uh their uh you know

their modifications and I think that is what grasps the best out of bariatric

surgery is the the the capabilities to witness

that well let let me uh I’m going to be a little provocative for a moment um you

know there are people not myself included but I’ll voice those people um that believe bariatric surgery it’s just

a shortcut for people who are to put it bluntly who are lazy they don’t want to

do the hard work of diet and exercise that takes time that takes habit change

what do you say when people you know make that allegation what what’s your reaction to that so you know bariatric

surgery is not is not a shortcut and N any of the Obesity related uh

measurements uh for weight loss so to speak you know the way I see it is that

you can see this as a as a pyramid okay uh everything that you do is a tool for

weight loss of course you have the diet and exercise program which is the base

and then on top of that you can add you know the medications endoscopy procedures and of course Sur you can

tell that the surgery is is a little bit more of an aggressive uh but it’s the only it’s

only proven method for long-term weight loss um but if you think about it only

it’s out of every people in America who’s eligible for bariatric surgery only one or two% goes for bariatric

surgery and let me let me uh just let me interrupt you for a second when you say

about eligible who would be eligible like what what does that mean exactly correct so in order to to standardize

the what is what what is best for who uh we have a measure which is called the

BMI or the body mass index which is a relationship between the weight in kilograms and the relationship divided

by the square of your height in meters and that gives you a number and normal

is 20 roughly 20 to 25 but if you’re 25 to 30 that’s that’s uh overweight and

number 30d is considered obesity and then you have obesity type one type two type three depending on how much you

have but if you have BMI of 40 or more then it’s considered uh morbid obesity

so to be eligible for surgery you have to have comorbidities obesity related

comorbidity which is hypertension diabetes or sleep which is the most three Commons and a BMI of 35 or 40 in

between 35 or 40 I say and if you’re 40 or more whether you have it or not uh

you’re eligible for surgy so those are the two kind of elements and this is NIH

criteria uh and they developed this in 1992 and it’s been since 1992 the same

premise although we’re evolving into having people from you know obesity type

1 30 to 35 who have you know severe commities to start getting the surgery

because you think about it somebody who’s BMI is 30 32 but very difficult

manage uh diabetes then you don’t have to wait for this patient to become more obese in

order for them to be eligible for surgery so now nowadays we are uh you

know the society is pushing more for these type of uh patients who are not you know obese enough so to speak to go

into surgery let me uh let me just ask you like putting it into context how many people how many people fit that

that criteria of you know over 30 BMI or or even that morbidly obese like are we

talking about like a couple million people like how this is CDC and this is

uh 2021 uh it’s 40% of Americans 40% 40% of

americ 4% or or over 30 BMI or correct 30 BMI consider obese wow and then if

you see you know there is also uh a differentiation if you see non-hispanic

blacks is 49% wow that’s almost 50% if you get Hispanics and this is America

and CDC right so 44.8% and non-h Hispanic whites is

42% so it’s you know if you go into different uh uh categories or ethnic

groups then you can see a more of a difference yeah I I let let me let me

pivot for a moment because I’m going to ask you more about bariatric in a moment but you know when I think about you know

putting on you know the news like the past like few weeks or so I’ve been very kind of sensitized that every time I put

on kind of like network TV not that anybody watches that anymore but you know if you did I feel like every other

commercial is for OIC and I never even heard really of what OIC was and I I work and and do a lot of work in the the

life sciences Pharmaceutical face I didn’t know much about it and then I dug in a little deeper I found there’s over

270 million views uh of the hashtag for OIC it’s pervasive like every commercial

every day it’s like become almost like a part of like the media landscape right

now and if I feel like it was a sudden onset I know it wasn’t that sudden um is

this a golden age of weight L loss medicines like is this like the start of

something will we see see many more oics out there and and why does it feel like all of a sudden like it just came on to

the Horizon out of nowhere um so that’s multiple questions but you know you attack it the way you want to like what

do you think about the the rise of OIC yeah so specifically with OIC and it’s

very interesting that you know is not the first uh drug that has been

developed for obesity or weight loss think about it specifically with OIC is

one of of the so-called glp1 so glucagon peptid like one Agonist this is an

hormone that’s been produced in our gut and the first uh you know research about

this was when patients after bariatric surgery we saw these type of H hormones

uh very very elevated and and and this is a god hormone that is being produced

at the end of our uh so to speak our our small bow gold all the way to the it’s

called the Helen and it’s being gets stimulated by food so if you create any sort of

bariatric surgery that goes and diver the food quickly to that area then you’re going to have a rise in

gpy the actual hormon and the gp1 does a lot of stuff in the uh in the uh in the

human in the metabolic aspect of it okay first one is you know it goes to your

brain and and starts uh uh uh modifies the the the satiety right you get more

satiety early satiety less hungry um also in the liver the heart is it’s it’s

being it seems to be a protective for cardiovascular risk also the the gp1

stimulates insulin production okay so it was very at the beginning and OIC is for

is fd8 approved for diabetes it can be off label use for

obesity at higher dose and it’s not it wasn’t approved for for weight loss

originally no no that’s the correct yeah and then the same uh

the same company developed uh uh wovi wovi wovi is the newly one it’s uh the

FDA approved it in 2022 um and it’s you know this this glp1

and you also have S Senda monjaro okay U different companies with the same

principles at gp1 Agonist different names uh they’re delivered by injections

and lately these ones are once a week it also cause some uh delay in the gastric

empting and this is kind of the keyless tendon of this because some patients have you know chronic nausea feeling

dizzy you know fatigue and it’s all related to the empty the EMP slow EMP

emptiness of the stomach these are the things about OIC um I don’t know if that anwers some

of the questions well I I guess you know like maybe more to the point is like so there’s been an explosion of different

products but all of the sudden it seems that it’s there’s been like a marketing Blitz uh of late um was it just the time

because of the approvals of these products or do you see anything else maybe it’s also New Years and people are

are more or more susceptible to it do you see kind of any of these patterns in your practice of of a lot more inquiries

and more people asking for it looking for even people who are maybe borderline not overweight but are more for vanity

purposes what do you what do you say so let’s put it this clear these are uh

approv for weight loss if you have a 27 BMI now we talk about BMI so this is

what medications for weight loss approv or should be indicated 27 of BMI so

you’re overweight but you have any sort of comorbidity hypertension diabetes you

know high cholesterol Etc sleep apnea or if you have 30 of BMI or more with

depending whether you have comorbidities or not so you see that indication is a little bit more flexible than

surgery um the I think the Boom is

because you know if you think about the first ones the first ones are

fenamin Topamax the zenal the cmia so xenical I would say is just one

thing but the the fenamin to Pyramid cmia uh Bic Etc they all wear uh like

brain they will is they will kind of go into your hunger uh nucleo in the in

your brain basically increase your appetite or or make you less hungry Etc

they’ll have a lot of side effects okay side effects uh you know uh

hypertension patients with insomnia with anxiety panic attacks

Etc and you know it’s very difficult for the patients to continue with that

medication so it’s usually three to six months and you see how they but when the

gp1 came they they really worked they you know the studies the longest studies

are for 5 years 68 months okay usually with with O zic and and wi GOI and you

see how there is a substantial reduction of weight loss and let me put this in also in uh in

perspective um in order for you to know how effective a drug or anything else

you you you you kind of need to know how much of the weight loss or percentage of weight loss this thing is going to you

know achieve in around a year or so or followup so if you if you take bariatric

surgery that is 30 to almost 40% of your of your total weight that you’re going

to lose on average over the course of a year you know somebody with 300 pounds that’s CL that’s close to 90 to 100

pounds when you go to medications uh non OIC related right

this was classically 5 to 10% now if you go to OIC Zenda we go all these jelty

ones there you know 30% of that people are GNA reach at least 15 to 20% of

weight loss so total weight loss does that mean that potentially that this will be an alternative for bariatric

surgery yeah it’s definitely an alternative I I don’t think it will it

will we definitely as bariatric surgeons we’re seeing uh less people coming in for

Bariatrics but you know historically it has happened in the past you know if you

think about we can talk about the the uh the gastric balloons right gastric

balloons were were also FD approved in 2015 and three balloons came out to the market everybody was getting the

balloons nobody was going for bariatric surgery the Cav is that FDA only

approved those for six months you have to remove the balloons and then when you get the balloons out the patient regain

the weight right right is that a circle and also the balloons were very

expensive not covered by insurance you also have the endoscopic procedures

endoscopic gastroplasty which is similar to The Sleep gastrectomy also out of pocket is not

covered not the best results so you know you see that also now with the OIC we

goby and all that I I wantan to I want to come back to something you mentioned about the older medicines so I I recall

back in the late 90s early 2000s you mentioned the drug xenical which was a product made by the Swiss manufacturer

Ro who I actually worked for for a period of time and I remember you know

the the kind of the Scuttle but the news on the street was this product was going to be a revolution um it had a massive

Financial forecast they expected for you know droves of people and it didn’t work

as well uh as they had hoped it it would and one of the reasons that was pointed

to is almost more of a punchline for a lot of like late night um you know standup comedians and and you know for

just you know side jokes and the early memes out there was that when somebody used a product that they would

experience oily discharge or oily stool which you know there was stories of

people you know getting off their office chairs or out of their cars and they had a very unpleasant experience they’

soiled themselves and but this side effect wasn’t seen in the clinical trials and when I asked one researcher

what happened why is it that in the real world we’re seeing all these side effects but in the trial you didn’t and

he said there was a very simple reason when we did the studies people were eating very clean very restrictive diets

exercising but in the the real world people were going to Burger King and McDonald’s they weren’t exercising they

weren’t eating clean and so that kind of brings me to this thought about this next wave of products um what’s done in

the clinic doesn’t always perfectly imitate what happens in the real world are there causes of concern or any

canaries in the coal mine from your standpoint when you think about the next leading products out there in the the

weight loss space definitely done because it’s exactly what you’re saying um you know

we need a longer followup studies right with cicle

was exactly what you said um the the senle was just a absorption of fat it

will not absorb fat but nobody told the people that they need to eat less fat because the more fat that you eat then

the more fat is going to go through the GI and you’re going to have you know continents and you know large amount of

of greasy you know bowel movements and everything that comes with it right um

the same the same is with fentam and all those right so we you know when they

came out it was it was great still still some people use Vin for weight loss and

works for some people um and I think this is what’s going to happen to the new GLT ones you

know I think I think the the gastroparesis is is is a big one we

don’t know how long uh you know this if it’s reversible if it’s something that

is just as you use the medication certainly some people have been dropping

OIC and wobi and all this because of that no imagine you you know having a

lot of acid reflux and feeling full and nauseated all the time fatig you know uh

vomiting Etc depends on how you how you tolerate this I would think that you

know there’s going to be more research and and also the the uh the population

is going to start to kind of get to realization and also the prescription or

the prescrib as well because you know the FDA reported in October 23 that is a

back order for OIC and we really if you think about

OIC um OIC um and uh in monjaro those

are the ones that are approved for diabetes so there diabetic people that

are waiting for those medications to be back in the shelves right but because

there’s not enough you know there’s a this balance in offer and demand because of the reason we have been describing

then these people are getting affected by that so is this kind of there was a I guess a bit of a dynamic you know going

back again to the 1990s when Viagra was first launched it was approved for

erectile dysfunction but it became in some cases like a party drug for some people and I know people weren’t

necessarily writing prescriptions for that but nevertheless things get you know used off label for all alternative

purposes um is it is there the the the risk or or is it out there that you’ll

have like you know Highwood actors and actresses to maintain their kind of fit appearance um who have to sometimes go

up and wait go down and wait is it something that people do you expect would use for for other reasons vanity

or otherwise so definitely you know social media and also the the Hollywood

celebrities uh they are the ones who have been in you know and this is just

me witnessing it uh how the hype about this drugs started uh because you can

tell that uh they all freely speaking about it and and you know social media before and after and all that it’s uh

it’s interesting that you never know exactly what are the reality Behind these things right because like I’m

telling you 30% of people who do 20% of weight loss it’s not that much either

right so you can see these dramatic changes and it’s not what everybody’s going to experience it’s important to

send that message out you know everybody reacts differently and statistically is

30% so it’s one it’s like one in three people who’s going to have at least you know 20% Which is

not superior but it’s you know it’s more than 5 to 10% major of people it’s going to do five to 10% of weight loss like if

you’re you know if you’re 200 uh 200 pounds you’re only going to lose 10

10 to 20 pounds so to play the contrarian for a moment though if you’re somebody who is you know you know

overweight let’s not even say morbidly obese you’re overweight you’re you’re probably feeling a high degree of

urgency of you know to lose weight so you’re you’re probably willing to roll the dice um I I do do you see there the

the motivation is there and it’s hard to probably um to comat that and maybe it’s

a good thing overall I I don’t know your your your thoughts about um even people

have marginal gains that’s better to have those marginal gains because there are other secondary effects of of being

overweight depression loneliness isolation other there’s other physical comorbidities that go along with it so

even a small gain um might that be kind of the juice might be worth the squeeze so to speak 100% I think um as long as

the base you know understand that any of these things are not going to work by

themselves this has to be like I said the pyramid diet exercise and lifestyle

modification is the is kind of the big base of or the foundation all of this uh

unfortunately uh you know and this is already studied in in in in this uh in

these papers that once you stop the medication there’s a chance that you’re going to regain the weight

the same happen with the balloons and normals it h it can happen but it

happens less with bariatric surgery so you know everything has risks right but

I think like you said everything has a gain as long as the patient embarks into

a very solid plan you know not just like something just going to start doing and see what happens well I’m I’m glad you

I’m glad you say that because I I’m going to GA you talk to hundreds of patients um postsurgery pre-surgery who

are going to be facing a new reality and they’ve likely gone or will go from being clinically obese to having a more

normal body weight and it’s a pretty big transformation um what are two to three

deliberate practices that you recommend or encourage your patients to follow to

prevent relapse and return back to their former weight what would you and I know there’s the there’s the off the-shelf

things you hear every time you’ll see in USA Today or People magazine but as a real Insider who sees and talks a lot of

people what are some of the Habit changing practices that you would recommend for them to do yeah so again I

always and this is what I told tell my patients anything we do it has to be with a solid base and I think this the

base of this pyramid of you know healthy diet for example you have to limit try

to limit your calorie intake okay so it’s a you know the FDA approve the FDA

recommends 2,000 calories a day um and basically you know it’s not that

difficult you have to cut the carbs right and and the the big carbs are the

pasta the bread the rice and the potatoes basically you cut those guys half or try not to or at least at least

one meal or not all three meals then you’re doing it the other thing that I

re recommend is the lifestyle modification again the FDA approves at least 150 minutes of exercise a week

which is 30 minutes roughly every day and you know combining some uh uh

strengthening muscle strengthening exercises because if you increase your muscle mass you’re also GNA decrease the

chances of glucose intolerance Etc and then number three is the followup okay

you you know whoever’s you decide to start this way you try to follow up you

know try to to get uh uh you know checkins you can do it with your

physician you can do it at your gym you can do it at your own house but kind of circle back to see what are the gains

the goals and what the expectations are I I have to ask you one one followup

about these more deliberate practices these all sound reasonable and sound and and very familiar um habits are hard to

build and they’re even harder to change I’m sure you must come across people

like they they have their you know their morning coffee with you know a ton of

creamer or even just the other day I shared an article just about you know

how it’s still conventional wisdom for a lot of people you should drink a tall glass of orange juice which most um most

docs are saying nope that’s not a good idea that’s like eating four pieces of fruit and really loading up on sugar

which is not great for your body how do you get people who have been so entrenched in their habits to be willing

to or and to even try to to shift those habits because even though they’ve gone through you know the surgery they s to

contend with the every day um you know like when you open the refrigerator or you’re working from home that’s the

hardest part like what do you how do you guide them on that yeah that’s exactly how you know understanding that the

patients are not alone right so if you’re going through a process of either medication or any surgical weight loss

you know there’s there should be a team behind it’s usually um it’s very difficult to change

drastically any of these things so you have to usually work with a nutritionist and and also be the commit the committed

person and also have a support system I think the support system is a big one

you know you see patients that come to my office and and they tell me doctor I’m the only one who’s trying to do this

in my house you know I’m trying to eat less and then I sit and then you know

the the the table is full with all these things that I cannot eat so of course you know next time just bring your

parents bring you know bring everybody here and I’m going to talk to everybody so that is and to the point then that I

have been operating on on entire families and I you know wow this is

entire families entire families they this is very you know uh uh positive for

me it’s a positive reinforcement you know it’s uh wow it’s great it’s gratifying that I have operated the mom

the dad the daughter and the son and everybody changes their way of living

and practicing the daily lives and that’s that is the key you know that is

the key because everything else is a tool but if it doesn’t change from within it won’t

change I I uh I love that that input that advice and I think that really goes

that level deeper that people need which is you know have it change takes time

and it does require commitment and it may even be adjusting your environment around you if if everybody is you know

eating an enormous you know meal every day and they’re you know they’re they’re

eating unhealthy things and ordering fast food it’s so easy to relapse so can you change your environment can you get

your support system to help guide you I love that as a practice easier said than done but maybe that’s the next the next

one that we do which is about how do you really create a support system that’s supportive um Omar I’ve got one more

thing for us to do yeah and this is an opportunity to test your knowledge with

a game that I like to call myth or reality so here’s how it’s going to work

I’m gonna have you as my contestant and the game is weight loss myth or reality

so you’re an expert should be easy but what I’m going to do is present you a statement and I’m going to ask you to

tell me if you think it’s a myth or reality I don’t have the answer but I’m going to press you a little bit to see

what it is whether it is truly a myth or you think it’s a reality so you ready to play along let’s do it all right so our

first myth of reality question body mass index or BMI is the best measure for

determining if a person is overweight or obese myth that is reality it is because

that is that is what you know the FDA the World Health

Organization all the determining factors to classify whether somebody has

overweight obesity or not is the BMI is it and I’ll ask one quick followup are

there other surrogate measures things that maybe aren’t so obvious that could be as good if not better of a predictor

from your experience yes I mean the uh the

um the glucose okay the uh the early fasting glucose for example tolerance uh

curve tolerance of glucose or glucose after two hours um you know the girth

measurement okay um The Weight by

itself um those are those are kind of the cholesterol levels the your

hemoglobin A1c um you know in order to have you an idea

how is your metabolic situation but I think you know the one that is really

easy that you can check on your own and tight trate at least you know once a

month or once a week is the BMI BMI all right you heard it here it’s a reality

all right next one obesity has more to do with your genetics than it does with

your personal health choices myth a real ity so if you put it this way it’s a

myth because uh they’re not mutally exclusive items tell me more so yeah so

there’s a component of genetics right uh definitely it’s uh it’s there um you can

see family of you know obese patients and a family that patients that are non

obese so that kind of can run in their family the other thing is the Environmental your personal health

choices you can decide not to use that route

um um you know I have have patients that come doctor I do not eat you know

anything more than you know no I restrict my carbs I do not do any more snacking I use Orly protein and I still

can lose weight so you can understand and you ask a little bit in the family history that is a genetic component and

the other is the one that’s snacking all the time and that family does that you know it’s I would say

that it’s it’s both you know it’s uh both are determinants of how you know

how your weight is going to be to all your your life you can there’s one that you can

modify for sure um and that doesn’t mean that you won’t respond well to these

measurements that we’re talking about well I I wonder Omar if the you know

people who are more inclined let’s say to seek out fast food or fattier foods

that they have a genetic predisposition for and it’s not a a conscious choice

you could say you could consciously reject it but subconsciously or it’s in their it’s in their genes that they

crave it whereas there other people they could could could give or take you know

take it or leave it I I don’t need to have it so they don’t crave it at all and others it’s it’s almost existential

it’s part of who they are yeah it’s part of you know how your insulin metabolism

is your glucose metabolism how your centers like you’re saying you know the satiety centers and the hunger

centers um those are where the Cravings are form etc those are things that are

within you different difficult to curve sometimes but you

know I’m gonna throw out a new myth of reality for you ready yeah all right

obesity is about willpower not biology kind of plays off our last one

your thought is that a myth or a reality I would say it’s a myth because it’s a combination of both yeah talk a little

bit more about you have to have you know biology again is how your you know how your body reacts to different uh uh you

know scenarious for example you and I we can get a a a sugar monitor device and

we are fasting the both of us and you and I we’re going to take the same the

same amount of sugar you know let’s say a a brownie right you’ll see you’re

going to react different than I react and and everybody’s individual so

there’s some sort of biology there that means that you know you’re probably your cells are you know your glucose you

probably have more muscle mass than I have and your your your glucose is going to go into your muscle mass

immediately whereas me I don’t have much and you know it’s just going to linger a

little bit more time and that means that is going to go into lipogenesis and get

it into uh you know into fat forming cells so so that’s sort of the biology

behind you know the genetic biology component and of course willpower it’s

uh it’s exactly what you’re saying you know I cannot get that brownie so the brownie is there but for example

you know you’re a fit guy then you’re not going to get the brownie oh the brownie Boom the brown you know what I

mean like is that also right the The Willpower it’s like no we’re not going

to provoke ourselves because we are in this mindset and eventually it becomes a it

becomes a habit to your point yeah I that’s that’s really interesting and

there’s something you brought up I I’ll just ask you maybe just to speak for a moment about this the Quantified self I

I recall that you you actually ran an experiment on yourself so you don’t just

talk about it but you actually do it of measuring your blood glucose and I main

that you you are tracking your blood glucose and seeing how it varied over the course of a day a week um so you

could make better choices of yourself but tell me a little bit more about that and you know what what prompted you that

that part I’m telling you about research and that you know and diet and dietitians and

nutritionists that is the part that is just so individual this is the glucose

uh the the continuous glucose monitor uh CGM and there many Brands and they’re

they’re very you know approachable and and really not that expensive to get so

what this is going to do is basically see how you react to certain car carbohydrates for example I can

eat white rice if I eat white rice I Spike really really you know high in

white rice it seems so benign right white rice go brown rice and it’s

different did you know that before or you you this is a complete Revelation from Revelation because what they say

you know they say oh try not to eat rice but for example I eat potatoes I don’t have the same Spike as

if if I eat uh white rice right or pasta for example right so there are different

uh food choices so to speak that you can try as individual and I think you know

holding that CGM you don’t have to have it all the time you you know you can make an investment for like a couple of weeks or whatever and just test what are

the you know grapes for example I can eat D I can eat grapes but orange juice

is horrible it’s a u you know how the uh how the nutritionist say oh you have to

avoid this this this they gave you a list and then you know if you want to do a diet you’re like okay so now I cannot

eat anything but using this you cannot tailor I’m down to Grass buckwheat and

and goat cheese and that’s it correct which which then we can we can start talking about the diets right all these

Atkins paleo it’s exactly that well I you you raise a couple of good things

I’ve got a few more myth realities for you um something my mom swears by even

today and I can’t get her to reconsider it um eating breakfast is necessary to

lose weight you got to eat a good breakfast Omar um is that a myth or a

reality I will say reality really oh my mom was right then so and and I think

I’m going to put in this perspective do you want to load your cars early

you want to eat as much as you want in terms of that because you have you are less sensitive you’re more sensitive to

your insulin in the morning anyone and you know to your point is if

you now let’s say you don’t eat breakfast and you pile everything to eat

very late right some people eat at you know I have friends with at 8 9 10 p.m.

that the worst time that you can eat mhm again you are your insulin uh you’re

more resistant to insulin at night because you have the other uh hormones

the cortisol the adrenaline they are all starting to spike at night and those are

the ones who are going to keep your glucose out remember the more your glucose is out it’s not being utilized

the more the glucose is going to go into form fat now I I got to ask you then intermittent fasting you don’t eat late

at night but you don’t eat early in the morning either corre is that violating

that that myth or that that reality that is so I would say that because breakfast you know doesn’t have to be in the

morning really breakfast is when you break fast so right so so that is a good

that is a very good point I I see breakfast in the morning and not breaking a fast you can break fast at

11: a.m and that’s your breakfast but you’re do an intermittent fasting and that that’s the other

great you know con is we haven’t you know intermittent F not that we just

Discover it if you think about it go all the way back when we were Hunter gathers right we we did not we did not have a

breakfast lunch and dinner right so we ate what we killed we ate what we got

right so it’s going back to that period of time where you are able to fast so

your body can fast as much as you can and you know have the the amount of

calories that you that you get you know in a small amount of of time of your in

your day so a matter of fact you know if you can do a two intermittent fasting a week or three or maybe just 120 hour

fasting it’s just just think about it every time you eat your glucose raises

you have all these hormones trying to bring it down and all the metabolic is working right um You have to wait a

little bit until everything settles and then you eat the second time now you

have you pack all your meals in five to six hours and then you don’t eat anything after let’s say 600 p.m. what’s

going to happen is that overnight your system is going to be low inflammation no you know there’s not going to be much

metabolic situation happening at the glucose not going to be you know being

stored or creating you know uh lipogenic stuff you’re you’re

going to be more into the you know constructing building muscle stuff like that so I I have to ask you a build on

this yeah intermittent fasting is it the next big fed is it g to go away in a

year people are not even going to remember it they’re like oh I remember that thing is that here to stay or is

that listen I don’t know how to I I really don’t know the answer because that will be like you know why

do we think about the other you know the Paleo the uh the Atkins right they when

they came out oh my God but intermittent fasting is you are eating a balanced

diet you’re basically limiting how much you’re getting or what you’re getting at

certain time of throughout your uh your 24 hours so there’s no

more signs like you know cut your carbs do a keto now do more fat no you do a

balanced diet and I think the the problem is always you know how to sustain that if

you’re not into that right because some people like to snack at night uh you

know I can tell you I do intermittent fasting intermittently I don’t you do intermittent intermittent

fasting correct I don’t do it every day I say you know maybe if I’m gonna have a big dinner on Friday they you know I’m

just trying I’m going to try to the you know skip dinner or eat at 5:00 p.m.

the days you know ahead heading to that and then that day it’s going to be a l meal late meal Etc so you’re just

playing with your own physiology and you’re not doing anything wrong with it

because that’s the problem with the other diets that you’re basically the fat diet the so-call diets fat diet

which are you you basically substract one of the component which is usually

the carbs and you know you you limit the

people or the patient with that for like a month or two months and it’s it’s very difficult to substain not to eat you

know carbohydrates right so then all of a sudden you stop you’re GNA regain

because now you’re going to start eating that stuff that you is good for you you know and and then you go into the keto

keto diet which is even a little bit worse you know if you think about it keto diet is is mainly fat and and keto

was developed for kids with epilepsia epilepsia because of the you know you

wanted to um nurture your um your uh

brain cells with the Ketone bodies which is exactly what happens when you don’t

eat much carbohydrates you start your your source

of energy is not glucose but ketones and the ketones are derived from the from

the fat and the protein you know takedown basically so intermittent

fasting probably here to stay but hard to know for sure that you got to figure

a way to fit it into your own personal habits diet and lifestyle correct I’m gonna ask you

first of all you’ve been you’ve been a great guest but I can’t let you go until I ask you this last question um when you

think about um you know not to somebody who’s a prospective patient for bariatric or for for zic or any other

the kind of follow on weight loss um you know metabolic products out there um

what advice would you give people who are who are struggling with with weight gain or or the the inverse weight loss

and they just feel like they’re stuck and they they’re not sure what to do next what would you advise them to do

what what would be your kind of your deliberate guidance to them as an expert in this field yeah I will tell those uh who have

recognized that they have a weight loss you know a weight problem that you know these people are not alone you know

understand that you’re not alone there’s a lot of practitioners behind the Physicians the dietitians uh you know even in at your

gym you know people that have gone through many different uh academic

environments and you know and goals and they understand this you know we know now that obesity is a disease it’s not a

stigma you know it’s h it’s it’s not your fault okay and and we are all here

to help that that people we’re here to help you you know if it’s from starting

to tweak your diet a little bit to all the way to perform surgery we’re here

for you the idea is to understand that you know if you’re feeling this you know if you have realized then come out and

look for help because there is help and and we’re here waiting for you awesome

Omar you are a scholar a gentleman and an expert too it’s been a real pleasure

having you really enjoyed talking about this and we’ll see what happens over the coming months and years in the space of

weight gain weight loss look forward to talking to you about it again