Why Your Doctor is Telling You to Lose Weight

Has your doctor told you to lose weight? If you have been to an appointment recently then odds are the answer is yes. Although frustrating (especially when they don't refer you to a dietitian), there are some reasons they have been recommend to encourage this. In this episode we walk through why weight loss (fat loss) can be beneficial. 

If you have questions, or topics that you want to hear about, head over to our Instagrams https://www.instagram.com/bayleethedietitian/ or https://www.instagram.com/brianna.dietitian/ and send us a DM! You can also follow the podcast https://www.instagram.com/mocktailminutes/

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Unwell 

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Transcript

Baylee 0:27

Hello everyone Welcome back to this week's episode of Mocktail Minutes This is Bailey

Brianna 0:32

And this is Brianna.

Baylee 0:33

this week I am local wellness cafe they make their own juices So I got their wellness blend has orange carrot green apple lime and ginger It's actually really good Usually I don't like ginger ones,

Brianna 0:47

Oh yeah, ginger. I like overdosed on it when I was pregnant. I'm doing an unwell Was it you that had one of these? Okay. Yeah. I'm doing the watermelon one. Surprise. It's okay. It's not my favorite watermelon thing, but it's pretty good. I like these.

Baylee 1:07

I was debating on that one, I was like eh There's like a something an orange can the unwell one I did I'll do that next week

Brianna 1:18

Yeah, that sounds good. But these ones have a good amount of electrolytes, so I.

Baylee 1:22

all the unwell brands that I've tried have been good and they have I didn't know they had the like the unwell protein like the clear

Brianna 1:30

Oh, I didn't either.

Baylee 1:31

It's in a can

Brianna 1:32

I'll have to try that. Yeah, I just, this is the energy one. I don't know if the one you got was energy. Okay.

Baylee 1:38

energy one

Brianna 1:39

Yeah. I'm gonna look for the protein ones at

Baylee 1:42

Yeah I I found it at Target That's where I got

Brianna 1:44

Hmm. Well, I go there enough too, so,

Baylee 1:47

Yes. Well this week we about everyone's favorite topic, uh, but we thought it'd be really important to dive into because we are weight loss dieticians we're gonna talk about like your doctor keeps telling you to lose weight and you do have excess weight or no you need to lose weight You've probably heard this a million times and you're like I get it Like my doctor keeps telling me to lose weight so this will happen but we wanna give you a deeper understanding as to why are they telling you this Why do they just keep telling you to lose weight and everything Because I feel like that's where the story often ends for many people is go lose weight just go lose weight We don't A they don't they aren't given the explanation B they aren't given the tools or the resources

Brianna 2:39

and it feels a little like, just like an easy blanket thing, right? Like, oh, well, okay, go lose weight and then all these will be healthier. But for a lot of people that have like metabolic dysfunction, I feel like it's a little bit harder because you have excess weight or because you're having like other, you know, metabolic issues. So it feels just a little bit like defeating. You know,'cause most people go to the doctor'cause they're like, I'm having a hard time losing weight. I'm like, well just

Baylee 3:08

well your answered I know you came here because you need to lose weight but oh yeah you need to lose

Brianna 3:13

so yeah. Just lose weight. And he was like, okay, cool.

Baylee 3:16

but we wanna explain kind of talked about a little bit like bo body positivity like We are not saying you have to be part of skinny talk or whatever you wanna call it The fact of the matter is excess fat does lead to different diseases It leads to poor health outcomes Like that is a fact Now it doesn't mean you have to be at the ideal body weight that these equations calculate where it's like oh I'm I'm actually above my ideal body weight And I have a great metabolic health so we're not saying that you have to necessarily be there but factually having excess fat does contribute to it A few different things So up like your metabolic health and insulin resistance you have excess weight so you have fat cells that enlarge and they become a little dysfunctional so they store more triglycerides than their Designed to hold releasing free fatty acids in two circulation and fat begins depositing in your liver and muscle So this actually interferes with your insulin signaling pathways So when we think about this insulin should be binding to your cell receptor The cell should open so glucose can get in insulin resistance that signaling is blocked or it's resistant And so glucose stays in the bloodstream for longer and that's what causes us to have higher blood sugars then compensates by adding more insulin which is what adds to the insulin resistance because we're producing more than what we should eat over time that blood blood glucose rises your pancreatic beta cells fatigue a little bit We get pre-diabetes and that can develop into type two diabetes when you lose weight this is shrinking your fat cells It reduces free fatty acid so kind of like spill over and it decreases that liver and muscle fat So then you have insulin sensitivity have that lower fasting insulin and you have better glucose uptake insulin sensitivity can improve within weeks of just modest weight loss even before you have like large scale changes.

Brianna 5:33

and this is also why, like when we're thinking about. Insulin resistance. We'll look at triglycerides.'cause if you have high triglycerides floating around, we know, okay, this is what's happening. So sometimes if you're like, well, I don't know, my insulin resistance didn't really get that much better, but my triglycerides weren't really down. Okay, then you're still in the right direction like this. The other thing is visceral fat and organ function, so visceral fat. We've done an episode on this. This is like the unhealthy fat, the really highly inflammatory fat sits in the abdominal cavity, and it can be around like the liver, the pancreas, intestines, kidneys. So this is the one that's really highly metabolically active. That's different than subcutaneous fat or the fat that you can, like maybe pinch, whatever. This is one that's harmful. So. It drains directly into the portal vein, which goes straight into the liver. So this exposes the liver to free fatty acids, inflamm, inflammatory cytokines, endotoxins. And this is, we also did an episode on this, something that drives like fatty liver disease, increased triglyceride production. Your VLDL or like your. Little precursor to your like lousy cholesterol. It starts to be overproduced, and then you have elevated a OB particles in the blood and it's gonna interfere with pancreatic beta cell production. So again, insulin production and your insulin working well. So. When we lose weight, or especially if you have a lot of excess weight to lose, you start to reduce visceral fat. And visceral fat actually is gained and lost pretty easily in people that have a lot of it. So just that little bit of reduction in visceral fat is gonna improve hepatic insulin sensitivity. It's going to lower liver fat, percentage, reduce triglycerides, improve cholesterol. Like I said, it's usually lost earlier than subcutaneous fat, which is why your metabolic markers improve. This is another reason why it's like, okay, even if you feel like, oh, I only lost two pounds, or I only lost four pounds, okay, that could actually be really significant in terms of visceral fat lost, so don't discredit it. Follow your labs.

Baylee 7:53

together

Brianna 7:55

Yeah.

Baylee 7:55

our previous episodes too the next thing like chronic inflammation so that adipose tissue is immuno immuno effective

Brianna 8:07

Mm-hmm.

Baylee 8:08

as fat mass increases We have what's called macrophages that infiltrate your fat tissue Hypoxia occurs inside enlarged fat cells and cells will release those inflammatory cytokines So this is where like CRP that is a common one we look at, uh, interleukin six I would say is another one or IL six that is more common but there's like also TNF alpha or CP one those are other Key markers that can be EL elevated And this is what creates low grade chronic inflammation And so that inflammation is what contributes to atherosclerosis. Insulin resistance, um, neuro degeneration and even it kind of flourishes tumor growth environments So fat loss reduces that infiltration reduces that cytokine production and it reduces just oxidative stress on the body CRP alone can actually drop significantly with a 10 weight reduction this is again where sometimes we discredit like if you are pounds you're like okay I would like to see some difference pound difference can actually drop your CRP levels AKA showing that you have dropped your inflammation.

Brianna 9:27

Yeah, and that's a big one. The CRP is like a big one. That's when I always have people like ask their doctors to run because that's just a good little, like, is my body on fire? If it's on fire?

Baylee 9:37

anytime, not that I change a lot I would

Brianna 9:41

Mm-hmm.

Baylee 9:42

I think anytime we can put some numbers not just like oh Bailey said I'm probably have got some inflammation or Brianna said I probably have some inflammation I think it helps just to have those numbers pick Okay And then you can see the improvements as you make changes.

Brianna 9:57

and it's nice'cause I feel like that's motivating, you know? But the other thing is thinking about your cardiovascular system. So excess weight, specifically fat, affects the cardiovascular system mechanically and metabolically. So mechanics strain would simply be you need higher blood volume. Increased cardiac output demand and then left ventric ventricular height per, lemme start over. Left ventricular hypertrophy risk. The word hypertrophy is very hard for me to say. I hate it so much, but anyway, just thinking like your heart has to work harder. It's working harder. It's like a car, right? Like if you drive the car harder, it's gonna break down more easily. So it's like that chronic stress that's not good. It's not stress that you're like adapting to when you like go work out and you're like running, you know? And then the metabolic strain would be that obesity drives dyslipidemia. So again, high cholesterol, high triglycerides. A lot of that lousy LDL and then sometimes even lowers like the good cholesterol, which kind of just snowballs into being more at risk for damaging blood vessel lining, heart disease, that sort of thing. So weight loss can reduce systolic and diastolic blood pressure. So basically a better blood pressure. You have a lower resting heart rate, improved endothelial function, and then reduces arterial stiffness. So you wanna be looking for lower triglycerides, lower A OB, increased HDL. So when I think HDL, you want it high and then lowering L-D-L-L-D-L-L, low H high. That's all you gotta, for.

Baylee 11:39

larger particles So we have small and we have large ones Think about it like ball versus beach ball Would you rather get hit in the head with a golf ball or a beach ball Golf ball's gonna hurt a little bit more It's more dense so we want more beach balls when it comes to LDL particles too And then when we think about liver health so we had an episode on M-A-S-L-D and excess fat stored in the liver leads to that metabolic dysfunction associated stoic liver disease Aga M-A-S-L-D that develops with insulin resistance increasing fat mobilization liver takes those free fatty acids. Um, fat accumulates And this can progress in a way of like Cytosis Two steatohepatitis Two fibrosis two cirrhosis So when you lose weight we're reducing that intra hepatic fat so that liver fat improving your liver enzymes a LT and a ST we're improving liver And so insulin sensitivity too so a 5 weight loss can actually reduce liver fat. Um, which is pretty cool I mean that's a good amount

Brianna 12:51

Yeah. The other thing is hormone regulation. So fatty tissue is hormonally active. It's one reason why when women start going through menopause, they start storing a little bit more fat because they're making less hormones. So your body's trying to compensate. So some key hormonal disruptions would be like leptin resistance. So leptin is the hormone that signals fullness, like I'm full, I don't need anymore. It helps with appetite regulation. High body fat leads to chronically high leptin. So your brain stops responding to it. So hormones are just like little signalers. Anytime we start having a lot of it, our body goes, oh, like there's a lot of this floating around. We probably don't need to listen to it as much, and then it doesn't work. That's why you know, too high of insulin. For too long your body stops listening, so your brain stop. Yes, and that's a big one for like people who are like, I have a lot of food noise. This could be why. So you're having leptin resistance. You just don't feel full. You feel hungry all the time. You're always thinking about food. So obviously if you're more hungry, you're probably going to eat more. And that can be one reason why weight loss is a little bit difficult. And then you also have sex hormone disruption. So fat tissue contains aromatase, so it converts test testosterone to estrogen. Leads to low testosterone in men, estrogen dominance in women. And again, this could be a major contributor, why you're having weight loss resistance, and then cor cortisol. So visceral fat increases cortisol active activity locally, so it worsens fat storage, especially around like the midsection. That's always, I feel like the area that a lot of pe, like a lot of women are like, I just wanna get rid of it. A lot of that is cortisol driven. So. Weight loss effect would be improved. Leptin sensitivity, normalizing ghrelin signaling so that hunger fullness, increasing testosterone, improving ovulation and menstrual cycle, and then reducing PCOS severity or like symptoms.

Baylee 14:50

The next thing I would say is your musculoskeletal system So weight is going to affect biomechanics So this is a lot of times where when we think about joints like the load of your joints So for every pound of body weight knees experience four pounds about 4.4 pounds of pressure while walking even more when you're running your leg climbing stairs So having extra weight Is going to accelerate gly cartilage wear osteoarthritis meniscus damage and so we wanna reduce like that joint compression again that less inflammatory cytokines especially in that synovial fluid which is the fluid between your joints have improved and just like your gait like your walk reduction often occurs before that large weight loss due to that in inflammation reduction And are a lot of joint injuries that are literally related to weight Again that is just a fact That's not your doctor being mean but it's just like it's putting extra Weight on your body it can't support Think about like even if you held like five pounds above your head eventually your shoulders are gonna get tired especially if you're like going up and down like lateral raises even You could do that with two pounds your shoulders are gonna get

Brianna 16:15

Yeah.

Baylee 16:15

because

Brianna 16:16

Yeah, and a little caveat to this,'cause I had somebody ask me a couple months ago, well, like, well then doesn't like putting on muscle like do that to my body too. Your body, this is the difference between fat and muscle. Your body is never gonna put on more muscle than like your skeletal system can handle. It's just not, whereas fat, you can continue to put on fat and also fat is inflammatory. So it's a little bit different. Also, you know, your muscles are helping your skeletal system, whereas fat is not. So just, yeah.'cause I had someone be like, well isn't that just the same thing? Like, I don't wanna put on muscle'cause my knees are gonna hurt. It's different than fat. So caveat. But I mean, I write, I was like, oh, that is like, kind of a good question. The next would be sleep and respiratory. So obesity increases the risk of obstructive sleep apnea or OSA because fat deposits around your neck and it narrows your airway, your tongue fat increases, and so you can have. I know it's so crazy. You could have, which is I was thinking about like pregnancy. I felt like my tongue was always swollen, but whatever. That can lead to like airway collapse and then reduce lung volume when laying down. So this, you know, OSA of structured sleep apnea. It's not good because then you're taking in less oxygen. So oxygen desaturation, you have frequent awakenings, your sympathetic nervous system activation. It's gonna worsen blood pressure, worsen insulin resistance, worsen appetite hormones. So weight loss helps you reduce that airway obstruction. It improves oxygen saturation and reduces apnea or hyperopia index, basically, are you getting oxygen to your brain? So even modest. Weight loss reduction can help OSA severity. I will say if you have sleep apnea, wear your CPAP machine because that is gonna help all of this. If you're just constantly not getting good oxygen, you're not helping your insulin resistance, your appetite, like all of it's gonna snowball into a worse effect. So even just wearing your CPAP machine can help you with weight loss.

Baylee 18:23

like that 10 weight loss You will see the changes there

Brianna 18:28

Mm-hmm.

Baylee 18:29

The next thing is cancer risk So obesity contributes to cancer in a couple different ways actually due to extra insulin So is growth promoting. Um, inflammation causes DNA damage We have excess estrogen which drives like resin endometrial cancer. So as you lose the weight this is gonna lower insulin reduces your estrogen excess and lowers inflammatory signaling So that risk and recurrence rate often drops

Brianna 18:59

Yeah, and this is where it's also important to note to know like the weight loss that we're talking about is not just like we're talking mostly fat loss.

Baylee 19:10

Yes.

Brianna 19:11

Because you can, and this is, I think where the caveat is sometimes, like when doctors will say like, lose weight, your diabetes will get better. And then I'll have people who have lost weight and it hasn't gotten better. And that's because they lost all their muscle and they kind of like made it worse. So all of this weight we're talking about is reducing fat.'cause that's.

Baylee 19:31

your doctor you look They're just trying to make your labs look better and so we've just simplified it into call and get weight loss where really we're focusing on the fat loss

Brianna 19:40

Yeah, so caveat. And then the last one would be brain and cognitive health. So metabolic dysfunction affects the brain directly. We've talked about this as well with like type three diabetes. But insulin resistance in the brain, so it impairs glucose metabolism. Remember that your brain uses glucose. That's its main source of energy. It likes it. So if your brain is having a hard time using it. You're gonna have atrophy. Your brain cells are gonna be starved for like a lack of, that's a very simplified way. Like if you're a neurosurgeon listening to this, you're gonna be like, what the heck does she just say? But we probably don't have a neurosurgeon, so that's cool. Regardless, your brain can't use sugar. And this is linked to Alzheimer's, AKA, the type three diabetes like hypothesis. So. Inflammation cytokines can cross that blood brain barrier. It promotes even more. Neuro degradation reduces cerebral blood flow. So with weight loss, fat loss, you can have improved executive function, less brain fog, better memory, reduced neuroinflammation, and then improved brain drive. Neurotrophic factor bd, NF. So exercise related weight loss especially enhances neuroplasticity through a multitude of reasons. But exercise makes is, is good for your brain. Yeah.

Baylee 21:00

what we want you to realize is Weight or fat loss improves health not simply just because you weigh less on the scale but because it is changing fat cell biology your hormone signaling your inflammatory load your organ fat deposition depositing I guess you could say

Brianna 21:22

Yeah.

Baylee 21:23

Your vascular brain metabolism So it's like a full metabolic shift you focus on fat loss and especially when you focus on fat loss number one But number two muscle gain

Brianna 21:36

Muscle gain.

Baylee 21:37

where we're you're really gonna see these areas like like I said your doctor's not you look And that's why they're telling you to lose weight looking out for your metabolic health So I know it can be annoying when you're constantly being told this but there is a reason and I think it is important to PO point these things out

Brianna 21:57

Yeah, and I mean sometimes they're, they should be looking at your labs, sometimes they're not. Sometimes they're just looking at like the BMI chart and being like, oh, you should do that. But really it's your labs that. Can be improving. And this is where I would also say if you're someone who's, maybe you are your ideal body weight or you are a good BMI, but your labs are like outta whack, especially as you age. This is where it'd be interesting to get a dexa to see like just how much visceral fat, you know, that metabolically unhealthy fat do I have. Because maybe you're the quote unquote skinny fat where your body weight looks okay, but your labs are seeing a whole different story. I actually had someone in the hospital the other day like. Her mom has like dementia and is all this, and she's like very thin and she's like, my mom's never been fat. Like, how did she get like dementia and diabetes? And I was like, well, there's probably signals along the way of like some red flags labs going up and maybe you just never paid attention to it, or maybe you just never got'em, or you didn't know. But your metabolic health is very, very important. So, and this is also where I try to encourage people, like if a lot of these markers are outta whack. You may need to do some intensive interventions to kind of get them in line.

Baylee 23:07

point like you were saying like just because like these things occurred Doesn't mean you're overweight too Like we're not saying like you can only get cancer if you're obese type of thing We're also not saying you can cure cancer not being obese These are just kind of risk factors that come along with it and why there is an emphasis on weight loss or better yet the fall loss

Brianna 23:32

Yeah, so look at the bigger picture. What is your body telling you? Looking under the hood, what's going on? We wanna take all of these things into account. So if you're someone who has gone to the doctor and they've told you to lose weight, but you're struggling to lose weight, now would be time to.

Baylee 23:50

people.

Brianna 23:50

Yeah, now would be a time to get some intervention with some people that can help you shameless plug.

Baylee 23:58

All right, rest of your week and we will be back next week with a new topic. Bye.