and good evening.

Thank you so much for watching HealthLine here on PBS for a way.

>> And I'm your host Mark Evans and we have a very timely subject we'll be discussing tonight since the holidays are approaching very fast.

In fact we're kind of right in the start of them and we've got a little ways to go but we're going to be talking about extra body weight and weight management.

We have a very special guest, Dr. Ryan Singleman who is a weight management physician, if you will.

But family and obesity medicine is what you would call your specialties and it's nice to have you back on the show again.

>> Thank you.

It's been a pleasure to be here.

>> I don't honestly think we have you on quite often enough because obesity being such the another epidemic that we're dealing with and have for several decades but we'll get more into that in a while.

But I wanted to ask because you are in obesity medicine and I do interview a lot of doctors on this program and I think you're the first and only one I've ever stumbled across with that kind of title.

Is that something new and new Advent in the medical industry ,obesity medicine?

>> It really is.

It's been an interesting evolution.

We know that we've had a problem with excess body weight in the disease obesity in America for decades now but really since two thousand eight is when the Board of Obesity Medicine came together, we started focusing solely on this as a disease state that if we start to reverse it we can actually reverse over two hundred and sixty other diseases.

The thing that we've learned though in studying it and why it became its own board certificate is that it's a very complicated subject and far more complex than most Americans give it credit for and especially within our culture and our cultural approaches to extra body weight .

>> All right.

And we do of course invite phone calls from our viewing audience and the numbers on your screen to give us a call.

You don't have to necessarily go on the air if you just want to leave us with your question, that's fine.

But that's what this show is all about is to address your concerns and answer any questions that you have pertaining to the topic we're discussing.

The number is on your screen to give us a call and you could do that in the next 30 minutes so we don't step down for commercials because we are a public television and we thank you so much for watching and supporting PBS Fort Wayne.

>> So Dr. Fingerman, how bad is is the current status of obesity in the United States?

>> I don't see it getting better.

I don't necessarily see it taper off.

I could be wrong.

>> I tend to think it might be getting worse.

Well, it certainly hasn't been helped by covid in fact, when the unintended consequences of having the shutdowns and dealing with covid is that so many more people were home where they're working from home or kids were home from school and when people are stressed when they are emotional or when they're just sitting and working five feet from the pantry and they tend to eat more.

So we've actually seen the rates of obesity double in some of the states right now.

Last statistics I saw is that by the normal definition of obesity, the historical definition of obesity which is someone whose body mass index or BMI is 30 or greater that we're looking at here in Indiana about thirty five percent of the adult population and around 16 percent of the kids the pediatric population have the disease of obesity.

>> However, I did say the old or normal definition of obesity there's a new one that's been proposed by the American Academy of Obesity Medicine and also by the World Health Organization because depending on your race, ethnicity, cultural background, you may have the disease of obesity before you have BMI of 30 and that's because when you start to develop extra body weight it puts risk to your health that might start you to gain problems with diabetes or sleep apnea or high blood pressure.

>> And when that happens you start to set this whole cascade of effects going on that makes your health so much worse and depending on your ethnicity you might have that disease state that really is obesity at a BMI of twenty six or 27 which has led us to a new definition of obesity which is excess body weight that puts a risk to your health .

It eliminates a number because it really is more than a number.

>> Well how is that calculated or a special tool you can use to find out what somebody's BMI is and what you break that down a little bit.

Why why is it called BMI and why is it so important so.

>> Very good question.

Historically body mass index is a way of calculating your body weight and you can go on the Internet you probably have it on your phone.

These calculators all available you put in your height, you put in your weight and it spits it out the formula isn't so important anymore because all those calculators are out there with also interesting to note is that the way this formula was derived was back in about the nineteen forties the United States Army needed to figure out how it was going to feed its guys for World War.

>> They came up with some calculations of how many calories a day should an eighteen to twenty four year old six foot tall man active the army eat so that they could figure out how do we feed our troops?

Guess how many calories they came up with three thousand two thousand calories.

>> Now if you look at the back of any nutrition label, how many calories is say this guesstimate is based on it says these caloric values are based on an estimated need of two thousand calories a day.

You ask most Americans they estimate they need two thousand calories a day.

The only people historically who need two thousand calories a day are nineteen forties men six feet tall aged 18 to twenty four who are active in the Army.

So if you don't fit that category you eat less calories than two thousand a day.

>> So what are we looking at as far as men, women and children ?

It really depends a lot on your age, ethnicity, height but in general on average the average American needs about one thousand three hundred calories a day.

The average American gets two thousand one hundred calories a day.

That's an eight hundred calorie difference between what they get and what you need and then all stacks up over time.

Absolutely.

That's how we end up going after several months going and she's right.

>> I'm missing about here, you know, right now bolthole it's sneaky because roughly speaking one pound of body fat just one pound contains three thousand five hundred calories or three thousand five hundred units of energy, which means that if you over a period of one week eat about seven to eight hundred calories more a day you'll put on a pound.

>> That makes sense.

It does and that's why I think a lot of people especially struggle this time of the year because there are all these good foods everywhere year cakes, there's cookies, there's candies, there's the name your favorite coffee shop specialty brew coffee full of different flavorings.

All those things are full of calories and sugars and and it all starts to add up and if you look back in time which I've done a lot it seems like the last couple of decades especially we've really focused on American obesity and at the same time we're seeing all these fast food restaurants and and convenience foods galore and it doesn't seem like the food industry is helping much because it's all about money and so forth and that's a whole nother subject.

Absolutely a whole a whole nother day of discussion.

>> But I want to break here for just a second, Doctor, because we have Rhonda who is called and she is asking off the air she says is BMI still an accurate way to measure a person's weight?

>> And at the same time could you explain how you do a BMI on someone?

>> Well, BMI is literally just a mathematical formula if you take your your body mass that's looking at your height and your weight through a quick formula and that's all it is.

And so really the simplest way is just a BMI calculator.

You can go on Google, you can get it on your phone and that'll knock it out right there.

>> The question is it the best way to measure your weight?

In other words, I think she's asking is it the best way to measure somebody's health because the best way to measure your weight is simply to step on a scale.

But the best way to is your health isn't really the BMI even though that's what we've used and based so much on anybody who's BMI is 30 or greater generally isn't going to be very healthy.

Now you can have a BMI in the twenty six 27 twenty eight range and technically be healthy because you may have a lot of muscle more muscle you have the more mass you have the higher BMI is going to be so you could have a ton of extra muscle.

You're someone who works out all the time you've gotten really big and bulky but your body fat person is really low and you could therefore be pretty healthy at a high BMI when you start pushing BMI of 30 or more you're not necessarily going to have a low fat content.

>> You're going to have a lot higher fat content.

She asked a question there which is is it the most accurate way to measure your weight?

I think she means is the most accurate way to measure your health and there's actually a tool that's much, much better.

>> And believe it or not, it's a tape measure.

There is something called your visceral adipose tissue that means the fat tissue that's in your abdomen that's in and around your internal organs specifically measure on your liver, around your kidneys, around your pancreas.

That fat tissue we know presents a significant risk to your health .

It increases your risk of so many different diseases including like your diabetes and high blood pressure and the like.

And the best way to measure that is to take two finger breaths about two inches over your belly button and then wrap a cord around your waist and to get that waist measurement and depending on your height you've got there are algorithms out that show you about how much that should be.

>> So the bigger that is, the more fat tissue you have in your belly, the worse off your health is going to be.

I could have family physician help you with your BMI.

>> Absolutely.

OK, very good.

Well, we're going to take a break here just a second and talk to Rosano who is I know a very avid viewer of PBS Fort Wayne and HealthLine Rosano.

>> What is your question for Dr. Singleman please?

Yeah, I have heard that it was said the best way to lose weight is that you burn more calories than you take in.

>> Is that true with this or is there any other way you have to do that?

I'm so glad you asked that, Rossana, because we were collide into that subject here in just a moment.

>> But go ahead and preface it please.

Absolutely.

So in essence, yes, that's what you want to try to do.

>> The tricky part is it's not nearly as easy as any gym owner or gym member.

Gym goer wants to let you know that you'd want to do and let me preface it like this we have studied the human body and watch how it burns calories and what's frustrating is our body is really, really good at conserving energy.

Rossana, I don't know you and I don't know if you've ever had the opportunity to drive a stick shift car but I'm hoping you have and I'm sure many of our viewers have done this before.

>> I have.

So you could theoretically drive 70 miles an hour in third gear.

>> It would be all kinds of heck on your car engine and your gas mileage would just go nosedive and you pay a hefty price at the gas tank for that.

>> Right.

Or you could do 70 miles in fifth or sixth gear.

>> You're just barely keeping the gas.

Your engines is gliding along and it's doing great when you start an exercise program of any kind initially you are going 70 miles an hour and third gear.

Your body's working really hard.

You're burning tons of energy.

You're burning tons of calories and that first couple of times you go you are just tanked afterwards.

What about the fourth time the fifth and the sixth time?

You know there's a reason why the more often you do something the better you get at you sweat less you don't the calorie burn as well as you did.

You don't actually have your heart rate up as much as it was.

In fact we now have really great evidence shows the more often you train the more often you do exercise like that, the fewer calories you burn at the time.

So it's important to understand yes, you do need to try to burn more calories than you're taking in but just going to the gym isn't going to offset it enough.

>> It has to be a change in that lifestyle if all you try to do January 1st is go all right, this is it.

I'm going to go to the gym.

It's not enough.

We've got to get your calorie intake.

We've got to get your energy intake back to a healthy level.

And if you want to add exercise on top of it, it will be the cherry on top.

But I tell lots of my patients have come to see me look exercise alone isn't going to cut it.

I'm happy if you want to exercise but that is ten maybe fifteen percent of the issue here you're looking at ninety to ninety five percent maybe down to eighty five percent of this is lifestyle and working on getting the body's own mechanisms and hormones and physiology working for well as a matter of fact in some of the information you sent to me to help form the outline of our program tonight, what was it you said the American cultural approach to weight loss is frequently completely wrong and fails 80 percent of the time and we've always heard that if you eat less and you move more and if you're not losing weight it's your fault and you need to try harder right.

>> Those things aren't holding to be true these days they're not because those are based on old cultural ideals that don't actually have scientific basis.

>> So let's start with eat less and move more if you could keep your engine in third gear at all times and always keep the engine revving.

So yeah, you would work all the time.

But the problem is is that our human bodies are extremely efficient.

We go back to the dawn of time when we are more hunter gatherers when we didn't know when that next meal was going to come so we would eat as many calories as we could from whatever kill we had with our plants we harvested and then our body has learned how to conserve and hold on to that.

>> So it's very, very reluctant to let go of that.

We used to think that actually a fat cell was nothing more than a storage vehicle for energy.

You eat too much one day and you stored in your fat cell as energy don't eat enough the next day the energy is given up by the fat cell and then that fat cell shrinks and disappears.

>> Well, we now know that a fat cell first of all never disappears.

>> It only shrinks.

>> Second of all, we have learned that fat cells are some of the most hormonally active organs in our bodies and that there are about four hundred hormones that regulate our body weight.

>> Of those four hundred hormones we have found ten that help us lose weight.

The other three hundred and ninety hormones help you either maintain or gain body weight which puts us in interesting predicament because whatever might drive you to gain body weight for whatever reason I'll talk about that in a second once you start to establish fat cells now you have these your body's own hormones, your body's own physiology trying to either keep you at that level or make you go higher.

So it's a lot like this idea of taking a snowball and rolling it down a mountain to where it gets worse and worse and worse over time.

So what you have to do is you've got to stop that snowball, push it up the mountain and deal with the underlying cause that's driving you to the disease of obesity.

If you're going to take a guess how many types of obesity would you think there are?

>> Oh boy.

Thirty that's a great guess.

>> Many people will say I didn't know there was more than one type.

There's been a few shows.

>> I'm sure that's fair.

There's about fifty seven types of obesity that we've identified so far as many I guess and it looks at things that get genetic factors, social factors.

>> You've got hormonal factors, medications that can be prescribed.

You have the psychiatric and psychology factors.

Yes.

there's dietary factors but there's also then familial.

So all these things together can drive people towards the disease of obesity but then once you start to develop it then your body's own physiology starts taking over.

>> I see all right.

We'll talk more about that in just a moment.

But we're going to go to line three with Richard.

Richard, thank you so much for hanging in there.

>> Your question for Dr. Singleman, please those Richard still with us?

Yes.

OK, Richard, go and ask your question please.

Thank I'd like to know what he almost answered the question genetically exactly why is the person genetically incapable of gaining weight and does the physical aspect of why they don't gain I know it's genetic but is there something internal or physical at that stop?

>> That's a good question.

That's a really, really great question and and just to kind of re-explain it, I think it boils down the question of I have my friend let's say his name is Joe.

He can eat three pizzas a day, drinks nothing but pure sugar and he never gains weight and he's always skinny as a rail.

>> Well, that the people who can do that are in the absolute minority.

We're talking about maybe a fraction of the percentage of our population and we can hate those people because you make it look so easy and it's not if you look at the average population about twenty percent of the human population who achieves excess body weight level BMI of maybe 30 or more only about 20 percent of those can lose weight effectively on their own.

It's roughly about the same amount of people who can quit smoking cold turkey.

You're just cut from a different cloth.

>> We are still studying to figure out what it is that makes them tick.

I mean we know there are people out there whose bodies naturally can clear the HIV virus and we're trying to figure out why there are just some people who have amazing physiology, amazing genetics and we haven't yet been able to crack that code and maybe someday we're going to develop therapies that that work on that so that we can move forward.

>> But 80 percent of people are going to need some kind of help whether that is counseling, whether that's accountability, whether that's medication, whether that's dietary coaching or in many cases all the above to effectively lose body weight and maintain it off.

>> I did say earlier that you've got all these hormones at play.

They're trying to get you to maintain that body weight and maybe drag you higher.

We have learned is that if we can get you to a healthier body weight and maintain it for about four to six months, that seems to be about what it takes to reset those parameters lower so that once you stop those therapies that maybe you're on medication or maybe you're doing counseling or whatever it might be that as long as you maintain a healthy lifestyle you're not going to be driven back to that higher body weight.

>> Well, let me try to clear something up about let's see what was a twenty twenty five years ago I went on a ketogenic diet and it was very successful.

>> It had to be monitored by a physician because you don't want to get too high as far as burning your ketones and so forth.

>> It was very successful.

I lost 40 pounds and shrinks.

The only thing is after I went off that diet of course I was learning how to eat well nice balanced meals.

>> I kept that weight off for about two years and it gradually came back.

>> So apparently I didn't learn something or there was something wrong with my physiology or whatever the case might be.

>> But according to that physician at that time because my height I'm not that torn about five foot eight he looked at a chart and said I should weigh right at one hundred seventy pounds when I got down to one hundred seventy and I looked weird my head was bigger than proportion for my body.

>> My pelvic bone was really sticking out and I just didn't look healthy.

>> So he says no we're going to stop go ahead and have your ad go back and gain about ten pounds.

>> So apparently the chart wasn't the absolute mean for that.

>> So do we still have that or is it a little bit more accurate these days?

No, unfortunately the BMI chart is still the BMI chart and you have to take that with a grain of salt now when we're looking at health is one thing when we're looking at excess body weight it's it's another thing.

>> So I start getting very I see a lot of attention to it once you start getting under the BMI of thirty and we start having deeper and deeper conversations what our goals what is health ?

What are we looking to reverse ?

But once you get the BMI of 30 or greater that gives us a pretty good indication of what your overall health is and definitely we want to make sure that we choose a body weight that fits your health goals, that fits your lifestyle and that if we can helps to fit your ideal for your own person .

One thing you did mention was you lost his body weight on a ketogenic diet which we could spend a long time about what is a perfect diet and the different diet types that are out there.

But he lost the whole show.

Absolutely.

But you lost his body weight you in a ketogenic diet and then you said something very telling.

You went off the diet and then the body weight started gaining.

>> Why do you go off the diet?

I just got a steer away from the the good habits.

I mean I stuck with him for the longest time.

>> I think maybe maybe if I don't if you don't mind me getting personal going through a divorce might help that I don't know but yeah I just steered away but you know a lot of that I still remember sure.

>> Probably hop back on that.

That's one thing I really try to focus on with people I consult with and with my patients is it's not about being on a diet, it's about choosing a healthier lifestyle.

A diet is something that we mentally do for four or five, 10, 15 weeks.

But as soon as you stop doing that diet and you go back to your previous ways of living, is it a shock that the previous body weight comes back too?

>> So it really is a whole lifestyle approach that we to tackle.

>> You absolutely can do it.

OK, line four we have jam.

Hi there.

>> What's your question for Dr. Singleman?

I'm curious about intermittent fasting and if it's intermittent fasting is a good way to lose weight and if you can continue to do the intermittent fasting, can that help lose weight as a very timely question, intermittent fasting has been kind of in vogue these days, if you will.

A lot of fad diets come and go whether they are Mikita.

We talk about Adkins paleo there are a whole food diet is many phenomenal types of diets and intermittent fasting is really captured people because it actually is trying to hook into maybe the more primordial genetics that we have as humans looking at OK, you could only eat during these certain periods of time and fast otherwise that kind of fits more.

The Hunter-Gatherer approach we talked about.

>> So yes, the intermittent fasting can absolutely be very successful helping people lose body weight and there are some fantastic physiology that comes alongside of it that does show it can improve the only blood pressure can help reduce sugars and help you drop your awarenesses if people have diabetes.

But the tricky part about intermittent fasting is that if you are consuming too many calories in a twenty four hour period and now you are shrinking your eating period down to maybe four to six hours out of a twenty four hour period if you still consume the same too many calories then intermittent fasting is only going to be so successful you can absolutely lose a lot of body weight and maintain it long time intermittent fasting but you still want to consume appropriate amount of nutrition for your body type and activity.

>> OK, that makes a lot of sense.

Well we have less than two minutes and we do have another question.

We'll finish this question up here.

Line five Elliott prefers to be off the air.

What kind of hormones or diets are needed in order for people to gain healthy weight?

>> Well, it'd be nice to have a conversation to give a bit more background on that because healthy body weight if you're looking to stick a BMI is anywhere from a BMI of twenty to about a BMI of twenty four anything below twenty or anything above twenty four you start getting into the possibility of unhealthy body weight.

So I would encourage you to do is sit down with your physician with your provider and say OK based on my activity level based on my height what would be an appropriate calorie intake for me to be healthy and to have that conversation because there is no one solid answer you can apply to everyone if there's any one takeaway I can give people that the disease of obesity is extremely complicated and anyone who says is a one approach is going to solve everything doesn't have all the deck all the cards in their deck.

It is a lot more complicated than that and you have to have an individual approach every person looking just about thirty seconds to go.

>> Some takeaways to help people get through the holiday season and not have to worry about losing so much weight after the holidays.

>> OK, here you go.

Eat your calories.

Don't drink them so avoid your sugar sweetened beverages.

Try not to drink all your calories in a bunch of fruit juices, pop sweet teas, coffees, what have you.

If you're going to go to big potluck, take a tablespoon of each dish and try it instead of getting a massive serving then you can decide where you want to spend your calories small portions eat more of your veggies and preferably not your green bean casserole which is too late and with too many different calories and going to ban on a full stomach.

>> Does that still again goes back to full stomach?

>> It's fine.

But did you eat too many calories that day?

Oh, it's a calorie it's a calorie thing.

Dr. Ryan Zimmerman, thank you so much for being here.

>> We hope you have a healthy holiday and we hope to have you back real soon would be my pleasure.

>> Merry Christmas to you as well.

Thank you so much.

And we will see you next week.

Jennifer Blomquist will be here .

We'll be talking about palliative care and hospice.

Meantime, please take care of yourself.

>> Thanks for watching and all your calls tonight.

Good night and good