and good evening.

Thank you so much for watching HealthLine on PBS Fort Wayne.

>> I'm your host Mark Evans tonight a very important topic and we're going to learn some new things about weight management and are a physician on duty tonight, if you will, on the panel is Dr. Ryan Singleman.

>> He's been here with us a few times before.

In fact, it was only about maybe four or five months I think it was.

But we wanted you to come back because we wanted to really focus in on a couple of the entities of weight loss weight management.

>> So thank you so much for being here.

It's my pleasure.

Appreciate the invitation.

And we're going to open the phone lines for you and the phone line or the numbers on the screen already it's two six zero actually locally or 866- if you're a long distance (969) 27 two zero and we will be taking your calls for the next half hour.

>> No commercial interruptions because it is public television.

So we're going to get right to it and make sure you call in whether it's for yourself or a loved one or a friend.

Let us know what your questions are and we're going to go ahead and roll this out.

>> Like to know what the current status is of obesity in the United States?

>> Well, that's it's a bit of a challenge right now when you look at the whole landscape of excess body weight across the country.

>> We used to think that the predictions showed by twenty twenty five around 50 percent of the people in our country would have a BMI of 30 or more and 30 being the traditional definition of the disease of obesity that's been revised.

We used to think that now by 20 30 it's going to be 60 percent.

Oh my.

So it's going up substantially.

>> Well you would think with all you hear in the constant preaching that it would go the other way to the more positive end.

>> There's a lot of different pressures that push on people to have unhealthy habits or in accord an ounce of calories coming in or just different pressures on their social life that you get the vast amount of unhealthy foods that are out there that are full of calories but not very nutritious and they're much cheaper than say trying to buy fresh fruits or fresh vegetables or as people may want to go organic.

You've got tons of calories, liquid calories in whether it's pop or juice or milk or soda.

>> You have easy availability of fast food and so many people can't cook on their own anymore or they don't have time to.

>> They've got two jobs.

They've got kids in school.

They're running from school into home and then back out to another sporting event.

They don't have time to cook anymore.

>> So there's so many small pressures being put on it, let alone the fact that we are already stressed.

We're dealing with covid.

We're dealing with potentially having to work, as I said, two or three jobs.

It's a lot of little factors that go to make it really hard to maintain a healthy body weight.

>> Right.

Well and to maintain your healthy body weight and to lose weight before you start maintaining the healthy body weight.

>> That's all individualistic thing.

Yes.

You know and we talked to off the show but I'll go ahead and announce it.

>> I've lost 30 pounds since April and you look fantastic.

>> Well, thank you.

And I've got about ten more to go to make my doctor happy but it's actually if you have that desire to lose weight and you have the right direction, sure.

>> I think you could be much more successful in fact.

>> I know so so you were you were talking about the various facets.

It's not necessarily calories fewer calories and more activity anymore.

>> Well, that's kind of the cultural model and we brought some graphics going to talk about this this year.

But the culture model of weight loss is typically is this idea of I want to eat less and move more and I think we've got that first I want to pull it up onto our screen for our viewers there.

>> So this is a great example.

So the current culture model is whatever I'm eating all of my calories in my activity.

If those things are not in balance it's going to in fact impact my body weight.

>> But so the city of eat less move more equals lose weight that doesn't always work out and the reason it doesn't always work out is that losing excess body weight the disease of obesity is really complicated that simple formula calories plus activity.

I want to expand that a little bit.

We got this next slide to show this is something called the Foresight Obesity System map and it's kind of complicated.

It looks like a bunch of spaghetti on a screen.

>> There is a lot that goes into detailing the disease of obesity and we can take this massive amount of spaghetti and boil it down to a few key components which would be on this next slide we can talk about.

So the key components that we look at when you boil it all down can hit these major points is your genetics, your physiology.

It's your psychology.

Yes, nutrition and there's social factors and even medication that you may or may not be taking all those different influences are going on that drive the disease of obesity.

>> Wow.

And psychology really stuck out at me because I'm very familiar with the other ones.

>> But how does psychology come into play?

That's a great question.

>> So when you take an individual who maybe they have had upbringing that is not being great.

There's this whole concept called the ACS which you behold the topic on itself.

So these adverse childhood events, things that maybe they've had personal trauma, psychological trauma, physical sexual, emotional, all these different things that are play and that changes how you may interpret your relationship with food people who deal with depression, people who do with anxiety you often reach for food because that gives you some dopamine hits in your brain.

>> There can be different kinds of eating disorders where like binge eating disorders where you are trying to protect yourself so it's with food.

So there's a lot of psychological factors that go into that need to be understood because people can be struggling to lose body weight and do do a great job but then have a bad day at work or have a stressful event happened.

I had a patient actually come in today who had recently lost a loved one and said you know what, I just didn't want to do it anymore.

I just ate whatever was in front of me and they were really struggling.

>> So it's about having to come alongside people and partner with them to help them be successful.

What's challenging is if you looked at all those different types of things that influenced the disease of obesity, we've actually learned that is about there's about fifty seven different types of the disease of obesity.

>> Fifty seven different types.

Fifty seven different types.

Well, name a few of those well a lot of them in a breaking down to specific diseases or specific influences whether it's just like environmental factors, genetic factors, whether it's just the types of food that you're eating.

>> What makes it challenging though is because there's so many different types there is no one size fits all when it comes to losing body weight and that's really challenging because if you go on any Internet form or watch any commercial on TV, it's we've got it.

We've got the one thing that works you've got the one neat trick or my favorite thing which my wife yelled at me the other day because I was in the checkout aisle at Kroger and I was reading one of those magazines that said hey you can lose 60 pounds in three months and I can reach for it.

You know, put that down.

>> You're not going to get upset today but we push these ideas that it's so, so simple.

What the reality is is fifty seven different types of obesity and it makes it really hard just to find that one easy thing to lose weight.

>> All right.

We talked about medications Rosano there's a big fan of CBS Fort Wayne and of course HealthLine is online for Rosano.

>> Thank you for calling.

What is your question for Dr. Singleman?

I'd like to know which bloodpressure medications are most likely to cause.

Weight gain is like ACE inhibitors, beta blockers, theoretics, channel blockers and if any of them do, what can you do about it now?

>> Great, great questions.

Thank you.

So a lot of medicines that we take can influence your body to gain weight to retain weight or actually even make you hungrier or just defeat your ability to lose body weight.

From a general standpoint there's a lot of reasons why you may be on certain types of blood pressure medicines.

But as a general rule, if you are on a beta blocker and again there may be good reasons for you to be on one because of beta blockers job can slow down your heart rate that can also adversely affect your ability to lose weight because by slowing down your heart rate you're in essence dampening your metabolism.

>> You're dampening the number of calories you're going to burn a day and that could make it a little harder for you to lose weight.

Now that doesn't mean though that you shouldn't be on it for a lot of different reasons if you've had a heart attack, if you have atrial fibrillation, if you've had certain kinds of heart failure, you need to be on a beta blocker.

That doesn't mean you can't ask your doctor about it because if you're on one just for strict blood pressure, there might be other types of medicines you could be on that wouldn't hurt your ability to lose weight so much.

>> Yeah, well that makes sense and of course you should I guess ask your doctor especially if you're going to be losing weight or have plans to how this may affect your weight loss.

>> Absolutely.

Because there's so many small factors in it that can really contribute to your weight loss and the may need to have healthy approaches to it when people are losing a lot of excess body weight and let's say they're taking insulin and if they were someone like yourself who's lost 30 pounds, your needs are going to drastically change.

>> So if you kept taking the same amount of insulin and you had lost that much body weight, you can actually drop your sugars to dangerous levels.

>> So there's many reasons if you think about trying to change body weight.

Absolutely talk to your physician about that.

>> We had talked about the cultural model of weight loss which is eat less move more calories and activity.

But if you take the big spaghetti map we can actually boil that down to some kind of root essence and then reapply that to our culture model which I'll show you this slide here if you take a look at this next one and when you look at this as it's being pulled up here there you go.

Fantastic.

So if you look at this, we kind of expanded a little bit more.

It's not just your calories and your activity but also your metabolism and your hunger hormones and your fulness hormones that are all kind of trying to balance itself out to equal your current body weight.

>> So when you look at this with the individual controls is just that first small portion the individual can control how many calories they're eating.

They control what their activity looks like.

But if you want to change your metabolism, if you need help conquering your hunger hormones, if you don't feel full and you need those Foldes hormones to be working for you, that's really Riggen probably need to talk to a physician to help you to get control over that aspect of your health .

>> Yeah.

And you know, I keep hearing the word calories and I guess it could be a culprit but you have to have calories.

>> What is calorie?

>> Oh, that is a great question and I think that if most people are honest they don't really know.

Yeah, People say well it's whatever tastes good or it's what's in sugar or it's what's in donuts but at a very baseline level a calorie is nothing more than a unit of energy.

>> Let's talk about your car for a second.

Do you know how many miles per gallon you get?

Yeah, let me tell Shura about 27 28.

>> OK, that's not bad if you get five a gallon right now that be pretty terrible and you'd be looking for a new car probably with the price of gas and if you had a car that was getting 70 or 80 miles a gallon you'd be like this is phenomenal.

So we look at the energy balance of a vehicle based on miles per gallon when we take a look at your body, if I said how many miles per gallon do you get?

>> No idea right now because we don't regulate the energy in your body like a car.

You know it's based on calories not on gasoline.

>> So let's break this down.

If you were laying in bed all day not moving your body still needs energy.

Your heart's still beating.

You're still thinking, you're still breathing, you're still making urine and other things.

>> So that takes energy.

Your body has to get that energy from somewhere and it's either going to get it from the food and drink that you consume or from the stored energy on your body.

>> True.

And sometimes that can even be muscle.

Yes, absolutely.

Muscle or protein definitely contains calories.

So when you get down to the very basic essence a calorie is nothing more than a unit of energy and that comes into our body by what we eat or drink and it's either in the form of sugar or carbohydrates same thing.

>> It's in the form of proteins or it's in the form of fat.

>> And if we get too much energy, what happens?

Well, so I'll put you this way if you had two different vehicles one had ten gallon tank it's a normal 10 gallon tank and this one had let's say ten gallons.

It was a special tank is an expandable tank.

You take as much fuel as you wanted it and you took both those vehicles and you drove them till they were empty and the first when you put ten gallons.

So when you put 20 gallons in it and you drove them both for ten gallons, this one's empty this one thousand gallons and it put another ten gallons in it and you do that again another 10 gallons do that again and you kept putting more and more gallons at the end of the month.

This car still has 10 gallons in this car and 100 gallons in which car is going to weigh more.

Right.

It's the one with the hundred gallons, right?

Exactly.

That's exactly the human body.

Our body is extremely adaptable and if you're consistently putting more fuel in the body than the body needs, it doesn't waste it.

>> It just like that expandable fuel tank, it's getting bigger and bigger and expanding that out.

So that's what happens when we get too many calories.

Our body stores it to wait for that day when it's going to burn off that extra body.

>> Well, that makes sense.

It really does.

If you're just joining us, you're on PBS Fort Wayne for Health Line.

We have Dr. Ryan Singleman as our special guest and he is a weight loss physician and family medicine practitioner and we're going to get some calls coming in right now.

I see them coming in but we'll wait until they're ready after they're asking their question there.

But I want to go ahead and talk more about these calories when it comes to calories.

>> It's not just the foods we eat.

>> It's also what we drink.

Absolutely.

And it's amazing how many calories a lot of the things we drink have.

>> You're exactly right.

I think it's a little frustrating for me as I share before we were on air that oftentimes I'll be sitting at dinner and I'll go well do I want to have an adult beverage or do I want to have a dessert because they may have exactly the same number of calories I need to choose because I have to try to eat within my budget for myself.

>> Sure.

And that's not a fun choice to have to make but I guess that's what makes us adults.

Well, there was a day I would say I both very absolutely but I've learned better since then.

>> Let's see we have the call coming in from Francis who prefers to be off the air which is just fine.

She's asking what would you recommend to a former cancer patient who needs to gain weight?

>> That's excellent.

So there's a lot of reasons why we lose weight with cancer.

It can be because the actual cancer itself it can be because of the therapy that is driven to help defeat the cancer.

And so when it comes down to trying to gain a healthy body weight, the first question is is it a hunger issue?

Do you not feel hungry appropriately?

The second thing is what are the calories that you are getting in and how do we help you to find appropriate calorie balance?

Usually what we want to do is try to get you to have more healthy fat and protein intake so that you're not getting just a bunch of extra sugars and which can then cause problems with your increased risk of diabetes or insulin resistance.

So it's usually fine in the healthier balance between fats and proteins to lower carbohydrate but getting what would be appropriate for your age and your height which is something that your physician or registered dietitian could help you with.

>> Very good.

And getting back to the calories you know, diet drinks, diet sodas good or bad, I hear that a lot and you could sit and have hours of discussion about the health benefits or drawbacks of different kinds of fake sugars and a lot of them out there and there are people who are more sensitive to one kind of fake sugar versus another.

>> But generally speaking your body doesn't know how to recognize those artificial sugars and they come in.

>> It can't metabolism.

It cannot turn them into fat.

>> So it basically just goes right through you.

In fact, there is quite a few fake sugars that if eat a lot of them they will definitely send you to the restroom but not to urinate.

>> Oh OK. Because your body does do then just kind of flushes right through especially if you're not used to them.

>> Absolutely.

But in general having a fake sugar I would rather see you have a diet sugar than one that's full of calories if you take the average just pick on a can of coke or bottle of coke oftentimes those have two hundred and forty calories versus zero if you drink the diet now if you are someone who drinks five or six of those a day and you go to a diet only version of it, you're going to lose a lot of body weight because you're not getting all those calories coming in any more.

>> So initially I was these people are trying to change your lifestyle.

Diet is definitely better than regular but ultimately we should be working on the total number of sodas sugar sweetened beverages are drinking in general.

>> Well, and I totally agree with you there and you know, if you look at the ingredient label on a diet beverage, there are things I can't even pronounce even trying to rehearse or practice them and that's kind of scary putting that kind of those chemicals into your body.

>> It can be we know that they are at least safe by the FDA standards but I don't think anyone really knows what does drinking four or five servings of that a day for 70, 80 years what's that really do?

>> And there's a big question about where a lot of these funky cancers and things come from.

>> Don't think it's necessary from our food but it makes you question that sometimes it does .

>> So the perfect beverage to have would be well water water it really is.

And how much water should we drink a day?

>> I love that question.

The old answer of a glass is a day.

>> Well there is not a lot of data behind that.

If you look at people who say we need drink a gallon of water a day, well there isn't a lot of great data about that either.

The idea behind drinking enough water to stay hydrated is an important one and not to be vulgar but you should drink enough water a day so that when you urinate your urine is colorless.

>> It should always be clear but you should drink enough water at least once a day.

Your urine is completely colorless, not yellow at all.

Then you know I'm saturated, I'm good.

I've hit my my minimum requirement of water a day so the more yellow it is the more dehydrated you are or the less hydrated you are to be truly dehydrated.

>> That's a whole other area but yes, you're just not as hydrated as maybe you should be and it can also depend on what you've eaten to make your urine more and more concentrated so that'll do it.

You might find that if you're someone who takes a handful of vitamins that after you take that it looks like mellow yellow.

>> OK, you know what I mean?

It's quite vibrant so.

All right.

Well here comes a tricky question for you how many calories can a person consume without gaining weight?

>> That's a phenomenal, phenomenal question.

>> So I'll put it to you this way our bodies are tremendous .

>> Be good at regulating its weight.

It doesn't like to waste energy.

It doesn't like to lose weight at all.

In fact, our bodies are primed to fight weight loss.

We have about four hundred calories sorry 400 hormones in our body that regulate our weight and now those 400 hormones we have found ten that help you lose weight.

>> It's not a fair fight when it comes to trying to maintain a normal weight whatever that weight is.

>> Whether you want to maintain your weight now or my weight or someone's weight, you need to eat within about the same fifty calories plus or minus every day to be able to maintain that weight.

So when you ask me how many calories can you get away with eating in a day, the sad thing is it depends on your height, your age, your sex and your activity level to know what would be considered a healthy amount of calories to consume versus an unhealthy amount.

>> So if you were to go to a physician who knows about weight loss, they would take all those things in account and give you some at least a starting point.

>> We'll see how this goes for you.

Absolutely.

OK, we have another call coming in a gentleman by the name of Mark as well is calling recently started a low carb diet and now has a very low energy level.

>> Well, his energy rise after the diet progresses that's a great question and usually the answer is absolutely yes because the what's going on is your body is going from a carbohydrate burning form to a more fat or ketogenic burning form and it's not uncommon at all to see that energy level dip and then come back up.

>> But there are people again we talk about fifty seven different types of obesity.

There are some people and some physiologies that although on paper you do better eating a low carb diet, you might need to increase the carb level enough just so that you can get by because you don't want to be showing up for work dragging or not be able to be there for your family at night.

>> There's that balance to figure out what is a perfect lifestyle for you in general.

>> Yes, your energy level should peak back up as you're going a low carb diet but if you find it's not, try experimenting with the number of carbs you're eating and if you're still struggling, another good thing to talk to your physician about.

>> Very good and I'm glad you mentioned that about watching the level because you know I've been a diet yo yo all my life weight loss yo yo and this time I'm going to keep it off and keep it off.

>> All right.

But it you know the question is OK, where where does it stop?

>> When do I need to bring on more calories?

I've had a situation before where I didn't see a doctor for four months and he had me on this weight loss program after I saw him four months later he looked at me and did a double take this as well.

I think you're losing too much now so we had to readjust and he wanted me to pack on a little bit more weight and so we had to readjust my calorie intake for the day and we're talking twenty years and we didn't know nearly as much back then as we do now.

>> I was first of all that's a great situation to be in.

>> I wish I saw that more often.

Usually it's about trying to help people get down to a healthier place for their body weight.

>> But generally speaking when you are wanting to get to a healthy place you've got to take a look at the BMI chart with a major grain of salt because that was really intended for people who are aged 18 to twenty four who are really in the army and if you're not eighteen twenty four , those BMI chart goals may be way too narrow for you and you might need to relax a little bit because as we get older, as our activities change, as our body fat changes because of just normal aging that goal of maybe a BMI of twenty two to twenty four may not be appropriate for you anymore.

>> So again that's something you should work with with your doctor.

Incidentally would you believe that about across our population the average calorie intake is eight hundred calories more day than they actually need?

>> Well it's probably yeah I can imagine especially with fast foods and the availability of the junk foods.

>> Yeah I brought a fun thought experiment for us today.

You ever eat at Subway?

I do.

>> That's fantastic.

Let's let's pull up the subway.

We're advocating subway.

We can't we cannot advocate a certain brand but for demonstration purposes we'll use this I use this one because I think a lot of our patients will go to Subway and they feel like they're eating healthy food.

So I pulled up an average you'll hear this is right off of their own calorie website and said OK, here's a foot long oven roasted turkey with American cheese and mayo and then there's a bag of chips and a twenty ounce coke now twenty ounces.

>> Right.

Let's just say if you're going to guess how many calories would you expect to be in that footlong oven roasted?

>> Well, seven hundred that's not bad.

>> And then a bag of chips yeah depends on the size but that kind of a bag probably about close to two hundred OK and then around the twenty what would you expect.

>> Twenty ounces we're talking close to 300.

Fantastic.

We show the next slide we've got those answers there to show it so the average amount of calories in a foot long sub is about eight hundred calories they're wow.

Two hundred and ten and that bag of sun chips and about two in the twenty ounce coke which means a total of about one thousand two hundred and ten calories in a single meal.

>> Now off to the side there I have a small demonstration of the average calories needed for a male versus the average calories needed for a female a day in this country.

Now these are averages we can actually pull up that slide that shows those full averages and a bit more detail.

So the average height of American male is five foot nine and if we don't take anything else we ignore their age and we ignore their athleticism.

>> We ignore their activity.

We just said how much if you are completely sedentary, how many calories should you need on average a day and that average is only about seventeen hundred and sixty or about sixteen hundred or sorry about eighteen hundred if we're counting.

Wow.

>> If we're female the average height of a woman in our country is only about five four which would mean that the average calorie needs are about thirteen hundred and six or about fourteen hundred calories a day and if you flip back to the slide looking at the average amount of calories in a single meal from subway even a foot long we'll look at twelve hundred calories right there.

>> So if you're a woman an average in this country that gives you two hundred calories left estimated for the entire day.

>> Oh my.

And you wonder why we struggle with this a little because if you are eating outside those calorie goals that's just one meal.

We didn't talk about breakfast.

We don't talk about dinner, didn't talk about the the mocha frappe or whatever you got from your favorite coffee do it right.

>> Right.

>> All those things start to add up.

Yeah, they sure do.

Well we can talk about this for another half hour maybe an hour.

>> We got to have you back again but time is up.

That certainly flew by yesterday.

Yes.

Dr. Ryan Cinnamon, we appreciate you being here and some very good advice and some good information.

>> Thank you.

Thank you very much.

And until next time thank you for watching.

>> Good night and good