Pennington Biomedical Research Center in Baton Rouge, is bringing together biomedical professionals in obesity and nutrition research to answer critical questions and find solutions to the obesity epidemic now affecting nearly 1 in 8 people worldwide.

Recognized by the National Institute of Health as a center of excellence in nutrition and obesity research, Pennington Biomedical and the Pennington Biomedical Research Foundation are proud to partner with LPB on this important program.

Information at PBR dawg.

Support for this program is provided by the Foundation for Excellence in Louisiana Public Broadcasting, and from viewers like you.

Last year, Americans spent over $50 billion on weight loss drugs like Ozempic and Rigau VO00740007.

Look out!

Cause here I have.

You always had trouble losing weight and keeping it off.

Same.

You really doing this epic?

No, I'm doing Manjari, my gyro.

So I played it to 50.

I got up to two, three, 355.

What?

Yeah, and I started doing my gyro, and I got.

I went from 355 two to, 285.

Wow.

And I'm going to get to 270 technology for 2024.

It will have the most impact on our economy on the short and medium term is not I.

Anyone want to shout it out?

GLP one drugs I think this is the most impactful technology of likely than at last 10 or 20 years in the United States.

Novo Nordisk charges US $969 oh for 15 times more than they sell that product in Germany.

What we are dealing with today is not just an issue of economics.

It is not just an issue of corporate greed.

It is a profound moral issue.

Hello and welcome to Louisiana Spotlight.

I'm Karen Liebling, your host for tonight's show.

We've all seen these commercials and heard these tunes burned into our minds as the prevalence of obesity medications has skyrocketed.

These drugs, and more importantly, the root causes of obesity, are the focus of this spotlight.

Before we begin, I want to acknowledge that tonight's topic, obesity, is a sensitive and complex issue that affects many of us, our families and our communities.

Now, we know this can be a difficult subject to discuss, and we want to assure you that our goal tonight is to have a compassionate, stigma free and informative conversation.

We're here to understand, not to judge, and to explore solutions that can improve the health and well-being of all Louisianans.

With that in mind, let's look at the facts.

In 2024, Louisiana ranked fourth in the nation for adult obesity with 40% of adults classified as obese.

Just 20 years ago, the obesity rate was between 15 and 19%.

Obese is defined as having a body mass index of over 30.

But many physicians say it is much more complex than just a number.

And in Louisiana, our toll are also at risk.

Louisiana ranks 45th in the country with a 21.8% obesity rate for children ages 10 to 17.

The crisis not only affects individual health, but also strains our health care system and economy.

Well delve into the factors contributing to Louisiana's high obesity rates.

Exploring the interplay of genetics, environment, socioeconomic factors, and more.

We'll discuss potential solutions, including new medications like GLP one.

And address the critical issue of health equity and tackling this challenge.

But first, let's visit Unique Physique in Baton Rouge, a weight loss clinic that's making waves for its comprehensive approach to weight management.

I'm Michael McIntosh.

I'm the owner and CEO of Unique Physique Wear, a nontraditional weight loss clinic focusing on GLP one and GIP medications.

So unique physique started as a kind of a brainchild in November 2022.

I knew that these medications were going to be coming out on the market, and I knew that the purpose of the medications compounded was to get people healthier access and cheaper access to GLP one medications.

At that time, GLP GI was not available, just GLP one.

So I set out to open this clinic with the idea of providing the cheapest option for patients in Louisiana, mainly in Baton Rouge.

We did not anticipate being nationwide.

We grew very rapidly.

The big joke as we set out to see 20 patients a month.

We're averaging about 50 patients a day.

I mean, realistically, I need to lose weight myself.

I joke if there was a supplement that came on the market to help lose weight, I own it.

It was in my cabinet, and I probably wasted $20,000 just on weight loss supplements.

Over time.

I was doing all the right things.

I was eating healthy.

I was working out.

I was intermittent fasting, high protein diet.

I just couldn't get over the hump at that point.

I just said for me to open a practice that's using a certain medicine, I got to make sure it works.

And so injected with the compounded medicine and gave myself the first time the next week.

From that one week period till today, I lost almost 70 pounds.

And healthy weight.

Healthy weight loss.

Slow, steady.

Which is what we preach here.

If you haven't trained yourself how to eat and it is truly training yourself how to eat.

You can't just use the medicines.

If you train yourself how to eat and do it slow and steady, the weight will stay off.

We have patients ranging from 14 to 90, literally.

We have physician to our patients.

We have other clinicians to our patients.

We have athletes that are patients.

It just I mean, men, women, it runs the gamut.

You really realize the struggle that most of the country has that most people don't realize.

My name is Candace and I am a nurse for a primary care doctor.

I have been overweight and struggling my entire life.

Never as big as I am now or was.

However, it's been a struggle my entire life.

It's absolutely tough.

You either deal with it or you do something about it.

And I was at the point where I have two children, and I just wanted to be here for them in the future.

So I had to do something.

I've tried several different diets to which I've actually succeeded temporarily.

You know, you get off the diet and you try to go back to your some semblance of normal, and it all comes right back.

I mean, I was to the point to where bariatric surgery was not even an option because I was so overweight.

I just want to live and I want to be there for my children, you know, and my husband.

So it was, I guess, about a year and a half ago, the, you know, people had been on it.

I was watching them come and go.

And I mean, you know, we're seeing results on people.

And then finally one day I was just like, hey, well, let me try it.

And I did.

And oh, my, what a life changer.

I have lost 103 pounds in the last year and a half.

Well it was it wasn't immediate.

It was definitely not immediate.

However, I started noticing whereas before I would you know, put food on my plate and I would feel like I had to eat it because it was there.

And now when I get enough, my mind tells me, you got enough, and I'm able to turn it off easy and push it away and okay, you're full.

And I've noticed that cravings that I had before, I don't have anymore, you know, so it's completely different.

I lived my entire life always on a diet.

And so that's the beauty of these medicines.

You no longer have to be, as I used to tell patients, you don't have to be that person that goes, I can't eat that because I'm eat kilo today.

Or I used to call it on a program and I'm on the program.

Well, which program are you on?

Name it.

I was on all of them.

Right.

And now it's.

I can go out to eat, go where I want, eat what I want.

But am I eating the whole meal?

And I know I'm eating one piece of bread instead of the whole loaf of bread.

So I'm hoping for the future that as many people can get on as possible, whether it's us or anyone else, because it's just life changing.

It really is.

The approach we just saw at Unique Physique represents just one of the many strategies being employed to combat obesity in Louisiana.

To help us understand the bigger picture.

I'm joined now by Doctor Shauna Levy.

She is the associate professor of bariatric surgery and the medical director of Tulane's Weight Loss Center.

Welcome.

Thank you for joining us to talk about this very important subject.

Yeah.

Thank you so much for having me.

So let's start.

First of all, give us an overall sense of obesity in Louisiana.

Give us a picture.

Yeah.

So obesity, it's we're one of the worst states in the country when it comes to obesity.

I just looked up the latest statistics were ranked seventh in terms of worst obesity in the country.

And this is a long standing problem.

In our state, you are a, bariatric surgeon.

For those that are not familiar with the surgery.

Can you explain the concept of it?

Because there is a lot of confusion about what it is and what it is, and what it does and what it doesn't do?

Yeah.

So, you know, obesity is a complicated disease.

And I'm sure we're going to talk about that today.

And it works.

It occurs for many different reasons in our body.

You know, part of it has to do with the environment that we live in.

And, making this disease more progressed and a lot of it has to do with hormonal pathways that go in our body, that really drive our hunger to more than what we need to really fuel our body.

And so bariatric surgery works by restricting the amount of food that you can eat in your body, but also affecting those hunger pathways that really send a signal that tell us to eat, when we already have enough energy for our body.

So we're want to eat less, but also we end up absorbing less because of the changes that occur with our anatomy.

So it's a couple different mechanisms, but it really helps to address this disease in multiple different avenues.

Are we surgically making the stomach smaller?

Yes, yes.

It's a short answer.

There's three different main surgeries, that occur with bariatric surgery, a sleeve gastrectomy, a Reuben Y gastric bypass, and a duodenal switch.

And they're basically different treatments for different severity of disease.

And so they affect your anatomy or your body in different ways.

And so, you know, not everybody is benefits from the same treatment.

And as your disease progresses or becomes more severe, you have different other conditions associated with obesity would sort of affect or impact which surgery is best for you.

And so they affect our anatomy in different ways.

Whereas the sleeve gastrectomy, all you're doing is removing a big portion of your stomach, the gastric bypass and the duodenal switch.

Not only do they affect the amount of space available for food, but they also impact the absorption of nutrients by rearranging your small intestine.

All right.

Let's talk about how we got here.

How did Louisiana, evolve to rank so high with obesity?

What is going on?

Yeah.

So, you know, 70% of our state has either overweight or obesity.

So it's fair to say the large majority of our state is in some way affected by weight.

And I think this goes back, you know, many, many generations, because our state is has a lot of poverty.

It has a lot of, you know, lack of education.

We have a lot of scarcity of food insecure food insecurity.

This really has affected our obesity rates and also a lack of resources.

You know, our our state is very under-insured, especially when it comes to treating the disease of obesity.

And so for a long time, you know, people don't have access to bariatric surgery and now don't have access to GLP one medications.

And what happens when you don't treat any chronic disease?

It's going to progress.

And so as a state, you know we've really had a lot of, you know, prevention of disease but also treatment of disease, which has caused the overall disease to progress and worsen in our rates to continue to rise.

So I understand that bariatric surgery is cost prohibitive for a lot of people.

And not necessarily covered by insurance, and a lot of people don't have the insurance for that.

So these GLP one medications are making weight loss more accessible and more attainable.

What is what are your thoughts on that and its effectiveness in combating obesity?

Well, actually, GLP one medications are actually much more expensive than bariatric surgery.

And actually our access to barrier to surgery is better than the GLP one medications because in our state, Medicaid covers bariatric surgery and Medicare.

It's just a lot of commercial insurances don't cover bariatric surgery in this state.

And they actually came out with a recent study looking at the cost of GLP one medications and surgery.

And it takes about a year to a year and a half of paying for GLP one medications is the same cost as one bariatric surgery.

So when we think about cost, actually it's much more cost effective to do surgery than medications.

But when you asked about the effectiveness of GLP one medications, it's just the truly game changer.

You know, we keep using that phrase, but it really is in terms of offering another avenue.

You know, not everybody wants to do surgery.

Not everybody qualifies for surgery.

And so GLP one medications are another way to treat obesity without having to undergo surgery.

Now the compounded versions are more affordable for the general population.

Those versions do not require insurance payment.

You can pay out of pocket for those that can afford it.

Are there any concerns about the compounded versions available to the general public?

Yeah.

So you know, one thing that I just want to bring up when we think about cost is that the reason that medications are so expensive is not necessarily the month to month price, while those are expensive, is that GLP one medications are designed to be taken for life.

And so when we think about cost, we can't just think about, you know, okay, I'm going to be able to afford it for six months.

I'm going to scrape all my money together and pay for it.

You know, it really needs to be taken for life because the problem is when you stop taking these medications, the hormones that you're replacing are going to go right back to where they were.

And so your hunger's going to go up and you're going to have rebound weight gain.

So we need to consider that when we think about cost.

Yes compounding is more affordable.

And there are risks and benefits for everybody.

You know when somebody doesn't have access to FDA approved medications, I think compounding is is it is another option.

I mean, it's, you know, you'd rather treat your obesity than not have any treatment at all.

The concerns with compounding are who's prescribing it?

How is it being regulated?

You know, is the patient being fully assessed for any sort of problems or complications before giving it?

I think the thing that's not standardized about compounding medications is, you know, the pharmacies, right.

Each compounding pharmacy makes their own formulation.

And so there's no national oversight.

It's depending on the pharmacy run by the state.

And so if there's a problem you know, it can affect the people who are receiving from that compounding pharmacy who makes a good candidate for their bariatric surgery, who makes a good candidate for these medications.

Are they one in the same?

So there's different criteria for who qualifies for medication.

And who qualifies for surgery.

Medication.

Your body mass index can be as low as 27, as long as you have some sort of weight related, associate condition like diabetes, high blood pressure, fatty liver disease.

If your body mass index is between 27 and 30, you qualify for medication.

If your body mass index is 30 and above, you also qualify for medicine and you don't necessarily need another comorbid conditions.

Bariatric surgery really starts coming into play more around a body mass index of 35.

So it's a little bit of a difference.

But there is of course a lot of overlap.

And I think it depends on what the patient wants.

You know, some people are fine with taking medication for the rest of their life and some aren't.

You know, and they might consider surgery.

Some have higher BMI.

You know, you saw the lady, the woman in the package that said she was maybe on the bigger side for even qualifying for surgery.

That's somebody who might benefit from medication and then surgical intervention.

Now we know without question, bariatric surgery leads to more weight loss than medication.

So if somebody has more weight to lose than medication can offer, then they might consider surgery and permanent weight loss.

Because, as you pointed out, once you get off of these medications, the weight returns, right.

So I guess more permanent would probably be better language because obesity is a chronic, progressive relapsing disease.

And so I, I guess joke that the weight is never lost.

It knows exactly where to find you.

It's just how easy it is it to keep it off.

It's never really that easy.

But the thing about bariatric surgery is it gives you a tool to help you maintain your weight loss.

And it all depends on your severity of disease.

For somebody who has really severe disease, it's going to be harder to keep it off.

And that person might benefit from surgery and medication.

You know, it's not really a one size fits all when it comes to treatment of obesity.

And it really is such a fascinating conversation because a patient that we just saw lost 103 pounds over a year and a half taking the medication, and she said that it reduced cravings and, it said that the medication can in some ways speed up metabolism.

So can the same be said for bariatric surgery?

Does it reduce cravings?

Does it accelerate metabolism?

So, you know, the hormones that are given in these GLP one medications are actually mimicking the changes that occur with bariatric surgery.

So while, you know semaglutide works on one hormonal pathway and turns appetite works on two hormonal pathways, there is even more hormonal pathways that are part of our hunger cycle and pathway that bariatric surgery can impact.

So let's let's circle back to, the core point that we want to make in our show.

And that is that obesity is a disease.

Oh, it's a disease.

It's not a choice.

People are genetically predisposed to be obese.

And I want to hear your thoughts as a physician on this.

Yeah.

And so, you know, I'll just explain it to you the same way I explain it to our patients.

You know, it's.

You didn't do anything wrong.

There's no reason for shame.

All the society would have you believe something different.

Our brain has a weight, what we call weight set point.

And this is influenced by our genetics and how we were raised and our environment, our gender and multiple different factors.

And it when you have obesity, that weight set point is higher than what you would you know, know is healthy for your body.

But when you go on a diet and you lose weight, your brain is literally trying to pull you back to that weight set point, which makes it incredibly hard to keep weight off.

And it's so discouraging for patients who are doing all the right things, and they're doing the keto and the interior fast and all these things, just like you heard in the package.

They cannot keep the weight off, but they they are been told it's because they're lazy.

It has nothing to do with it.

It's all these hormones in the pathway that are driving them back to that weight set point.

Well, doctor LaVey, before we go, any message that you would like to share with our viewers, those that are struggling with their weight?

Yeah.

So, you know, one thing I hear a lot is that people want to weight to a certain point to try and treat the disease of obesity like I'm not big enough or I'm not XYZ, or I haven't tried enough diets.

Would you ever consider that with another disease, like if you had stage one breast cancer, you don't want to nip it in the bud and be proactive and get it on the treatment.

It should be no different with obesity.

This is a disease.

And the more proactive we are about treating the disease, the more successful we're going to be with our outcomes.

Well, thank you so much for joining us and for sharing your insight and your expertise.

Thank you so much.

Well, coming up, we will take a closer look at the obesity issues our state is facing as well as discuss the solutions.

But first, let's visit the Pennington Biomedical Research Center in Baton Rouge, where scientists are at the forefront of studying new treatments for weight management.

Take a look.

I'm Steve Fields.

I'm a physician, and I've been doing it for 40 plus years.

And I work in the area of obesity, primarily.

What causes obesity?

People have been trying to figure that out for a long time, but we have a pretty good idea in general now, and that is that, we all have a genetic factor that relates to obesity.

So if we think about the world as a whole or people who are genetically very thin, and there are people who are genetically very obese, most of us are somewhere in between.

And, if you had that predisposition for obesity, then the environment we live in, we call it the obese genic environment, particularly in Louisiana, it's very hard to escape it.

And we've long since walked away from the idea that lack of willpower is what causes obesity.

We now know it's this combination of your genes and where basically where you live and who you are.

In Louisiana, you know, it's a combination of this genetic predisposition and the environment we live in here.

East Carroll Parish has the fifth highest obesity rate in the United State of any any, parish.

In a way, it's a model for looking at why some areas have more obesity than others.

And we can see the more educated people are, the more wealth they have.

The better foods they can eat, the more active they are.

All of those factors combined to create your individual setting and why you may not become obese in this environment.

I have half a dozen studies, clinical trials right now, but Pennington has 75 current trials in progress, not a roll hall for new drugs, but many are.

And so we're, really having a boom, in a sense, of these drugs.

GLP one drugs, mimic a natural compound in the body that's, secreted after you eat a meal and makes you feel full.

Stop eating eventually, and also improves the control of sugar in your blood and white.

The scientists found that it could suppress appetite and slow the stomach from emptying, and make people feel fuller and feel like eating less.

These drugs, came into Pennington largely under the recognition that they were weight loss drugs and the trials done here, their phase two trials and later the phase three trials, those trials, almost all of the drugs that are now available or being developed have been tested here at Pennington.

As these drugs are moving into use in chronic diseases like congestive heart failure, they're also showing benefits to sleep apnea, reducing the risk of diabetes.

So it's not just a cosmetic effect.

This is actually improving people's health I think, you know, where do these drugs fit in.

And we have to start with saying we need to prevent obesity.

That's the first step.

But once people are obese, this is really a wonderful development for people who have struggled with weight their whole lives and have risk factors like diabetes, but we have to integrate them into a broader, treatment where people also get good lifestyle, management because it's very hard to stay on these drugs your whole life.

If you don't stay on them, you regain the weight.

And so we have to develop a whole, protocol around these drugs that includes lifestyle measures aimed at the long term.

We are fortunate to have with us tonight two experts who are at the forefront of obesity treatment and research in Louisiana, doctor Katherine Hudson is a GI doctor specializing in bariatric procedures.

She is the director of obesity medicine at University Medical Center in New Orleans, and serves on the board of the Louisiana Obesity Society.

And we also have Doctor Martinet cross Sellwood.

She is a professor at the Tulane School of Medicine and is the director of the Tulane Center of Health Outcomes, Implementation and Community Engagement Science.

Welcome both of you to this show.

So, Doctor Hudson, let's start with you.

Based on your experience, what are some of the unique challenges facing your patients?

Well, in my practice, I see a lot of patients, who have Medicaid.

And one of our biggest limitations is access to treatment of the disease of obesity.

So, Doctor Castlewood, your research focuses on health disparities.

How do factors like race and gender and socioeconomic status, how does that impact obesity?

Well, as we talked a little bit earlier, about 40% of adults in Louisiana are living with obesity, and there's 70% that are overweight and obese.

But 40%.

And while obesity affects everyone across age, sex, gender, race, socioeconomic status and geography, what we do know in Louisiana is that we have higher rates of obesity in those who live in rural areas, and those who are living in poverty or have low income.

Those who are identify as black and have other socioeconomic disadvantage.

And so knowing this and knowing that access to effective treatments is limited in those who also who not only have, you know, a disadvantage with respect to their disease, but also access to resources.

This contributes to the potential for health disparities in our great state.

So, Doctor Hudson, how has the concept of obesity as a medical condition evolved?

Well, you know, in 2013, the AMA officially came out and said that obesity is in fact a disease.

But we've we've known that for a long time.

The benefit of of saying yes, officially now it's a disease, is that we can start the uphill battle of legislating and and increasing access to the treatments that we need.

So we we're talking about on a policy level, and I think this is a good segue way to talk about that.

What does need to happen on a policy level?

Doctor Chris would I'd love to hear what you have to say.

Well, there are a number of different areas that we can with that we need to address.

And some of them have to do with the ability to access which are dealing with policy, but access to the treatments that are effective.

And that can happen to policies with respect to health insurance coverage.

It can also be important on whether or not we have, access to these healthy community resources.

So in looking at where we are, with the, evidence based guidelines and our ability to utilize these have have health care providers prescribe them, but also have the access to the resources of the patients can adhere to those guidelines is critically important.

As well as ensuring that we have sufficient coverage that gives not only availability of treatments, but real access to treatments, to patients who may not be able to achieve those in one of those treatments, as we've been discussing, are the medications that GLP one medications.

Doctor Hudson, what are your thoughts on that?

And are there concerns about their long term effects are still relatively new.

Yeah.

So the drugs are not as new as we might think.

We've actually been using GLP one medications for almost 20 years now.

They've been FDA approved, for the treatment of diabetes back in 2004 or 5.

And then for the treatment of obesity is as far back as 2009.

So we have some decent data on how those drugs affect patients long term.

I think those drugs, just as Doctor Shawna Levy mentioned before, they truly are game changers.

And what we're finding out is that those drugs mimic the gut hormones that we know are released when we eat fruits and vegetables.

When patients have bariatric surgery.

And we're finding out that those drugs not only help with the disease of obesity and diabetes, but they're also being considered for the treatment of other diseases, cardiovascular disease.

They're looking at brain health, liver or.

So I think we're going to see a lot from these drugs.

They're certainly not going away anytime soon.

So this question is to the both of you.

So both of you feel free to answer what can we do to better integrate obesity treatment and management into the primary care setting?

Yeah, I will say, you know, in my clinic, I specialize in treating patients with very high BMI, who are seeking bariatric surgery and in a medicaid population.

And we don't have coverage for anti-obesity medications.

And very often my, referral inbox is full with so many patients who are in desperate need of treatment.

But even if I expanded my clinic, we still couldn't couldn't satisfy all of those referrals.

What we really need is for, for there to be better coverage, for there to be less barriers to treatment.

So when I prescribe a medicine, if a patient does have coverage with their insurance, we have to jump through a lot of hoops, a lot of prior authorizations.

That creates a lot of burden in our clinic.

And so for primary care doctors to start adding obesity medicine to their practice, they need to add extra clinic staff who need to sit on the phone with the insurance company and fight for those, those medications or that coverage.

So we really need legislation that supports access to treatment, and then we need additional education so that all providers really primary care, but also our endocrinologists, our cardiologists, our orthopedist, really all doctors should be understanding these medicines and prescribing them.

So it seems counterintuitive for insurance companies not to enthusiastically support obesity treatment and management.

What is what is happening?

I think the problem right now is that the cost of these medicines is too high.

And when we compare the cost of these medicines in this country, versus any of the other countries where they're available, it's almost five times more.

And so that is an issue with the way that we regulate health care in this country.

So that also needs to be addressed.

Your thoughts?

Yes.

Well, I would like to add a little different perspective to the primary care, because we are currently leading the Louisiana Community Engagement Alliance that's focused on health disparities across Louisiana.

And we are implementing a large study to test evidence based interventions that are non-medical or surgical.

So diet and exercise, by doing a creative way of integrating not only a patient empowerment through self-monitoring of their weight, but also empowering the health systems to have available resources for the implementation of their guidelines.

Community health workers to help do the coaching around diet and exercise.

To give patients tools that they can use, and linking them to the community resources for healthy living.

And by.

We're anticipating that although each one of these things has been proven to be effective on a limited scale, that by integrating them across the across the the way with patients health systems and the community, we have a better chance of of supporting primary care practices and patients and achieving their ideal body weight.

Bye bye bye bye everyone working together because we've already heard the medicines alone won't do it.

They're not the long term sustainable.

Neither are the surgeries.

They are a great, important tool, but they need to be balanced with diet and exercise and, you know, change of a lifestyle that can help patients sustain them and their health care systems, help them sustain their ideal weight over time.

I think that's the overarching, concern is just lifestyle management.

We know obesity is a disease.

We know it needs to be managed throughout your life.

How do we provide the tools and the support system and the resources to empower individuals to do that?

And therein lies the solution and the problem all in one.

Yes.

Yeah, I think it it goes back to again coverage.

If patients come to my clinic and I'm going to treat them, even though I can sit there with them for one hour and counsel them, that's, that's a little bit out of the ordinary to be able to spend that much time with a patient.

They don't have coverage for a dietitian visit.

So I have to sort of be I have to do the behavioral health side of it.

I have to do the dietitian counseling myself because these patients don't have access to that.

So without the tools that we need, we're not going to be successful.

And you're absolutely right.

These these medicines, these procedures, these surgeries, they were all studied in conjunction with lifestyle modification.

So nobody expects patients to be successful without lifestyle modification.

And that is one of the most timely and costly aspects of the treatment.

So we're going to continue that conversation.

I want to thank you both for these insights.

So continuing our discussion shortly, but first let's take a look at an innovative program aimed at combating childhood obesity in our state.

Give me God.

Make your heart spin.

Make your heart sing.

These fourth graders are making their hearts sing as the teacher leads them in a movement activity from the Grow Healthy program.

It's a statewide initiative aimed at reducing childhood obesity and improving nutrition.

We do moving.

Bingo.

So now we're doing food bingo, but then also, we do my play.

The rate of Louisiana youth with obesity is nearly 22%, five percentage points higher than the national average.

Grow healthy aims to reduce that statistic through school and community outreach.

Scientists at the Pennington Biomedical Research Center developed Grow Healthy based on decades of research.

Over 1 in 5 of our children and adolescents are already considered having obesity, so their height and weight ratio is above what is considered to be healthy for their age.

And then also if you look at severe obesity.

So these are kids that are even at a higher level.

And these are kids that may start actually developing type two diabetes and asthma.

And some of the cardiovascular health problems that come with obesity, that's more like 7 or 8% of our children.

And that's higher often than the national average.

And we've we've seen increases over time, not only in overall obesity, but in the number of kids that are hitting that severe obesity status.

The Grow Healthy Toolkit for schools also teaches healthy eating habits, working in tandem with nutritious food choices served up in the school cafeteria.

We're not using the food pyramid anymore, so a lot of us grew up learning about that.

So the USDA moved to at my plate model instead of the pyramid.

So it's an actual plate, and it shows you the portions of different food groups you should be serving yourself.

So half of your plate should be fruits and vegetables, a quarter of your plate should be lean protein.

So that could be lean meat or beans, other protein sources.

And then a quarter of the plate should be a whole grain.

And then also you want to have some type of dairy serving, but that needs to be a lower fat dairy serving.

And so for kids skim milk this is a great option.

They're in its first year.

Grow healthy is partnering with fourth grade classrooms in Caddo and East Baton Rouge parishes.

The program plans to include students through eighth grade statewide.

I've learned that you have to move around and keep healthy, eat, healthy to stay strong.

And what have you learned about eating healthy?

Well, you, you have to make sure that you keep, eating a limit, like, unhealthy food and eat mostly healthy food every day and move around.

Well.

Come on, come on.

All right, we're back with Doctor Catherine Hudson and Doctor Emma Tonet Castlewood.

And we're joined by Natalie Gerow, president and CEO of Second Harvest Food Bank.

Thank you all for joining us.

So, Natalie, let's start with you.

Tell us first about the mission of Second Harvest Food Bank.

So Second Harvest is the, larger, first and oldest anti-hunger organization in the state of Louisiana.

We provide 40 million meals annually across 23 parishes of south Louisiana.

But we do it in a variety of ways and with many, many partners, more than 700 partners.

So we just saw a story grow healthy.

The efforts to combat childhood obesity and Louisiana.

Let's talk about some of those contributing factors.

And Natalie, let's start with you, because a lot of this comes back to access to healthy food.

Absolutely.

More than 30% of the communities that we serve in South Louisiana are called food deserts, which means that we have low food access and low income as well.

And I think that's a huge contributor.

Food deserts can be, in urban areas can be where you're at least a mile away from a grocery store selling good food, nutritious food.

And in rural areas that's 20 miles south to Doctor Chris Elwood, you talked about, lifestyle management, community efforts to combat obesity, food deserts.

Definitely a significant factor in that.

Yes, absolutely.

If, individuals and patients and children cannot get access to the fruits and vegetables that are associated with a better diet, leading to, better weight management, it's very difficult for them to achieve what they need to and to reduce obesity.

So, Doctor Hudson, I want to talk to you about the long term effects of childhood obesity.

Yes, we know that patients who, suffer with obesity in childhood are, you know, very likely to have problems with obesity as adults.

We try to to get patients in very early to treat the disease early, as you heard Doctor Levy say, because we know that this is a lifelong disease.

And that's that's one of our biggest issues when it comes to the barriers to, access to treatment.

Because if we only have 1 or 2 things, do we want to use our biggest gun on these patients who are so young?

What we really need is combination and sequential therapy.

We need lifestyle modifications throughout life.

We need medications, we need endoscopy, we need surgeries, and we need to use them in combination and in sequence so that these patients can live a full life.

Because, as we heard, this is a recalcitrant disease.

It continues to come back even when medications and, and interventions are successful.

We know that there is recidivism.

So we've been talking at the policy level.

What changes need to happen in order to reduce obesity and of course, reduce childhood obesity.

Now I want to hear from you your perspective on what needs to happen at the policy level, especially as it relates to access to healthy food.

You know, I'm so glad that we're making this connection between obesity and poverty and low nutrition.

For us, hunger and food insecurity is really about good nutrition.

And we have to be really careful with the policy prescriptions that we use, because sometimes things that we think are going to be really good in communities, and we believe in meeting people where they live in their communities.

And that's our role is more the preventative health care side that we all would like.

For families that have Snap, for instance, to make healthy food choices.

But if we decide at the state level that they can only use their snap cards for healthy food choices and the only store they have access to sells fried chicken and maybe bananas at three times the cost that you would buy them in the grocery store.

Now you've made it impossible for a family to make their food budget work.

So we just have to be very thoughtful, very careful, and we have to really participate in these public private partnerships, where we do things like mobile markets, and make food, making food available as part of that intervention, that helps change lifestyles.

But we have to do it where people live.

Doctor Hudson, we've been talking about these weight loss medications.

Do you have concerns with children using these weight loss medications and their long term effects?

I mean, we have data and an FDA approval for the, you know, portion of our pediatric patients.

I don't think that there's any difference or any concern.

You know, when we when we think about bariatric surgery in patients who are under 18, what we worry about is that the patient has gone through puberty, their growth plates have closed.

It's not going to stunt their growth to lose a large amount of weight.

But I think what's nice about the medications is you can ty treat those medicines and say, look, you're getting too much weight loss and we need to make sure you're getting enough protein as you're losing weight.

So you can kind of adjust that.

When you have a bariatric surgery, you cannot undo what you've done.

And so I think that this is a really nice option to have for the pediatric population.

While I have your attention, you work with Medicaid patients.

What are their unique challenges and obstacles to weight loss and obesity treatment?

I mean, specifically in Louisiana, we are we are so lucky that we have access to bariatric surgery.

However, I think the the the aspect of obesity that we miss or is not obvious to the public is that, when we look around, we see that obesity is ubiquitous.

What we don't see is that patients are really, are going even further.

So I see a lot of patients, like I said, BMI 60 to 100 or more who no longer can leave their house without an ambulance ride.

And so that patient population with very high BMI is continuing to grow.

And so we have bariatric surgery.

But but a lot of times patients need to lose weight to get down to a safer weight, to have that bariatric surgery.

And without access to medications, you know, we're really struggling to help those patients even get to a treatment that they have coverage for.

So this question is for the entire panel.

So feel free to volunteer your answer.

And that is we're talking about childhood obesity.

And there tends to be a legacy of obesity within a family.

When you see an overweight child, there's a high probability that the parents are overweight.

And that is not to put blame.

That is simply to say what is happening.

We know that obesity, is a disease.

We know that it can be genetic, genetically linked.

But what other dynamics are at play that this legacy of obesity continues?

Generation to generation?

Well, I can start, from the less professional aspect.

So the reason that poverty and obesity is sometimes linked is that families with limited means, by the cheapest food possible, and often that's the least healthy, most calorie dense.

And if you live in communities that are food deserts and you don't have access to a grocery store that sells fresh fruits and vegetables, and you've been used to eating from the local convenience store at the end of the street, or the fried chicken joint, and so have your parents, and so have your parents parents.

Now you've started to build a culture of really generational poverty, and that poverty really impacts your education and your thinking about how you're eating as well.

So the solutions can't be, suddenly will we'll give you a medicine.

It's got to be coupled with how do we teach folks to adopt these healthy lifestyles as as the doctors have been talking about, how do we show them recipes?

How do we, give them access to these foods, you know, on an ongoing basis, long term, to kind of change those generational, cultural things that have happened in our community with so much chronic poverty.

Doctor Castlewood.

Right.

And we mentioned earlier about the biological and the behavioral aspects that probably become family dynamics, but also in this social, environmental have in a way that they live in, it compounds and reinforces, whatever the activities are, they, you know, what they've been doing habitually as a, as a family.

One of the things that's very important to know is that the data are pretty clear now that children who have, you know, early access to obesity, getting early onset hypertension and diabetes have much greater risk for bad health outcomes as they get older than those who perhaps become obese later in life.

So this is so very important to to be able to address this at this early stage, because even at this early stage, it is it is bringing on increased risk to these children that they will experience for the rest of their lives.

We talk about various factors and also access some of that is also geographically dependent.

Well, when I'm talking about rural communities that don't have the access to food and health care, anyone want to share their thoughts on on that as a contributing factor?

It's huge.

I can tell you.

It's huge.

Huge.

There are many parishes that we serve amongst the 23 parishes that stretch from the Mississippi to the Texas borders, parishes that have no public transportation system because they can't afford it.

And where often the population in these rural areas are older, they don't have cars, so their ability to access nutritious food is even less.

And let me just mention as well that once you start down the road of these bad health outcomes, you're only making your the issue of affordability worse.

Because if you've got diabetes and hypertension and you're having to afford medicines, and that's even less money that you have for nutritious food to eat.

So we find challenges in rural areas.

Cameron Parish after Hurricane Laura, we addressed a whole lot of options because they didn't have access to milk or eggs, within an hour of their homes and still don't in many cases.

So we've seen that rural hunger, exacerbated by some of the things that we've been through as a state doctor.

Hutson, any other thoughts on health disparities?

I mean, I see it every day in my clinic because I'm at such a large academic institution.

It's a safety net hospital.

My patients come from all over the state and sometimes even out of the state.

But these patients are, you know, lucky that they're able to make that 3 or 4 hour drive to our facility.

And just asking them to come back for imaging or asking them to come back for a procedure or labs, you know, it's not so easy.

They're not just down the street and they can come back in and get something.

So, you know, we try to consolidate all of the needs within visits.

We try to accommodate, you know, there are certain insurance coverages or Medicaid that will provide some medical transport time.

And we try to help facilitate that in our patients.

But when we when we are treating a patient, we really have to think about comprehensive care and also how they're accessing things.

And so if we're not taking into consideration that that for me to ask a patient to come in to do a weight check or do some labs or something like that, that's a huge burden for that patient.

We talked earlier about the importance of community support and there being grassroots community initiatives.

We saw this story on Grow Healthy.

That's a step forward, empowering communities and families.

What else can we do at the grassroots level to empower people and combat obesity?

Natalie, we'll start with you.

You know what I. I love the fact that we're working more and more, with health care entities.

So I'll give you an example.

We have a program called Mobile Market, which is a rolling grocery store.

We buy all that food and then we sell it to people for about 30% less than they can afford it in grocery stores.

And by the way, we're spending that money with our local Louisiana farmers.

Well, at Lafayette General, on the day where they bring their Medicare patients in from the surrounding parishes, the rural parishes, they've asked us to bring in our mobile market.

So they're transporting these, these patients in, they go to see their doctor, and then they get the opportunity to shop at the mobile market before they get transported home again.

And so we're thrilled to be asked, and so many of our oncology clinics were doing on site pantries.

So just imagine and this is where the hospital is said, you know, we were surprised when we did a census and we found out that food insecurity was one of the biggest barriers to our folks actually getting better.

So can you put a pantry on site, a therapeutic food pantry?

So that a cancer patient can go home and not have to worry?

Just think about the stress that is relieved after you've been through such a a tough treatment that you go home with the, the appropriate food, to eat in the house.

So there are many, many ways that, we can work together.

And we're thrilled to be partners with health care.

Final thoughts on the state of wait in Louisiana.

Before we go, Doctor Hudson, we'll start with you.

You know, I, I think that while all of the interventions that we have access to have not seemed to slow things down or the trajectory of, obesity in our state, I think that we've identified what the issue is and it's really access we have we have amazing options now.

We just need access to them.

And we can't forget that one of our biggest barriers is truly it is stigma.

And so we can address that first within ourselves, to recognize where where we have bias that we, you know, implicit bias that we don't even know we have.

And then we can get involved with organizations such as the Obesity Action Coalition.

Locally, we have the Louisiana Obesity Society, where we can sort of empower ourselves through education and advocacy opportunities.

You know, politicians need to hear from us.

Our insurance companies need to hear from us.

They need to know that we are demanding treatment for this disease that is impacting almost everybody in the state.

So I think we really need to consider, you know, the trajectory of the disease where our issue is, which is access and how we personally can address that.

Doctor Chris Ellis.

So while I agree that obesity is just a major concern for our state, I'm feeling very optimistic that we now have a toolkit that has a spectrum of choices and interventions from, of course, lifestyle modification, medications and surgery to help individuals grapple with this condition.

I think that there's an increased focus on community engagement so that we can address many health disparities that exist.

And that, you know, that we have an opportunity to reduce the risk we have for long term health care consequences that reduce the health resilience in our state, which is what we saw during Covid 19.

We had high rates of mortality.

It was, you know, leading at some, at some points during the pandemic and mostly attributed to the low health resilience associated with hypertension, diabetes and high rates of obesity in our state.

So I'm optimistic.

We now have a, you know, a spectrum of a toolkit that we can implement and utilize.

It's now our ability to policy and through implementation to get this into the hands of the individuals who can benefit in that way.

So food insecurity in Louisiana is really about good nutrition and good health.

So the more that communities can work with their health care entities to provide this comprehensive and preventative health care measures, I think the healthier that our state can become if at the health care level, in patient intake, you ask the question, are you food insecure?

The intervention can be as simple as saying, here's the list of food pantries in your neighborhood and community so that we can make sure that you have access to this nutritious food.

So we look forward to being part of the solution for our families and and helping to improve the health and and thereby making helping everyone fulfill their own best potential.

All right.

Well, I want to thank all of you for coming on set to share your expertise and your insight on the state of waste in Louisiana.

It is a story.

We will continue to follow it, an issue that is important to all of us.

So thank you again.

I'm afraid we have run out of time for our discussion tonight.

Again, I want to thank our panel of experts for sharing their expertise and insights on this critical, critical issue facing our state.

So what do you, our viewers, think?

We encourage you to comment on tonight's show by visiting the LPB Dawgs Louisiana Spotlight and clicking on the Join the Conversation link.

We would love to hear your thoughts on addressing obesity and Louisiana.

Thank you for watching.

And remember, small steps can lead to big changes when it comes to health.

Goodbye.

For a copy of this program, call 1-800-973-7246 or go online to lpb.org.