Good afternoon. I'm Dr. Nester Del Cruz Munoz and today we're going to talk about why do we need to treat obesity. Um we and why we shouldn't just leave it alone. And the great news is that there is some hope out there. There's a good chance uh for good treatments for a healthier life. So 74. Did you know that 74% of US adults are overweight? That means three out of four of us are suffering with problems with our weight and are not in the ideal body weight range. 40% or four in 10 Americans are suffering from obesity. Uh which is an incredible number. This is over twice the number that it used to be about 35 to 40 years ago. Why do we care as physicians? Because 254 different health problems are caused by or worsened by obesity. Um and so obesity is causing a huge epidemic of a lot of different medical issues around the country and around the world now. And um obesity is involved in just about everything. So if we look at some of these medical issues, you look on the ones in red uh which are the most ser serious ones. Cardiovascular disease like high blood pressure, coronary artery disease and heart attacks and strokes very common upon amongst patients suffering from obesity. Type 2 diabetes also very common. In the normal uh weight population, it occurs about 8 to 10% of the time. in the patients uh suffering from obesity. It's about 25 to 30% uh have two type two diabetes and many many more are suffering from pre-diabetes and insulin resistance. Um there's obesity related cancers. About 13 different types of cancers are more common in obese patients and are and have worse outcomes in obese patients. Lung dysfunction. About 65 to 70% of patients that are diagnosed with obesity have uh obstructive sleep apnea and aren't sleeping well. And that's actually the most common cause of death while sleeping. Uh liver dysfunction. So um liver dysfunction is actually the from from obesity is overtaking hepatitis as the most common cause of liver transplants in the United States. Um so it is a really big deal. Heartburn and reflux is also there and chronic kidney disease that's the biggest increasing killer in the United States right now is chronic kidney disease and it's directly related to obesity. on this other side are a bunch of other uh medical issues associated with it and not to dismiss any of them. Um but uh you know this is just the biggest ones of the 254 that we know that are that are related. So what's really important? Is it the weight that's important or something else? And it really is something else. It's the amount of fat and the amount of fat around the belly that's the most important. And this is an inbody scale that we use in our office. Um, and it's a body composition analyzer. And we use it with our patients because I don't care to track your weight, but I want to find out what the percent body fat is. And the number that I tell my patients is the most important number is not how much you're weighing. It's not your BMI, but it's actually your percent body fat. And the the problem with obesity is that that percent body fat goes way up higher than it should. And that's what brings on the disease processes. So, it's a vicious cycle. It starts with a little bit of weight gain just from taking in extra calories over a little bit of time, a little bit of reduced physical activity and all of a sudden you get a little bit of accumulated fat especially around the midsection. When that happens then things start happening inside. Uh you get more health problems. So that triggers the coorbidities such as diabetes, sleep apnea, hypertension um you know and the things that can go come along with it. the back pain, the knee pains, the things that make it difficult to move more. And then that leads to reduced activity. Patients spend less time being active because it's not as comfortable it was before. And then what does that do? That actually circles back around for further weight gain, further issues, further uh health problems. And it's just a vicious cycle that people go around and around this circle getting worse and worse over time. So why is it so difficult to control our weight? And it's not because it's psychological and it's not about willpower, but it's about physiology, biology, and neurobiology. We know that our weight is controlled by our gut. And the gut sends hormonal signals as well as neurologic signals to the brain stimulating certain sections of the bl brain which which control our appetite. So there's a set point theory which states that the body is not like a like a balance or like a seesaw where calories in and calories out are what matter but rather the body has a set point or a weight that it tries to defend and that's based on our genetics and the environment's uh interactions with the genetics. And when that set point is too high if you start trying to lose weight your body doesn't think that you're doing something good. It thinks that you're in danger and so it works to try to present that pre or prevent that weight loss and make you get back to the weight where it thinks it's safe and that's where the hormones such as grein and leptin uh take effect. Grein is our hunger hormone. We know that that we get grein levels go up before meals and they go down as people eat. And what's been shown a long time ago is that patients that are suffering from obesity have a lot more ghrein in their bodies and the levels are much higher than patients that are thinner. Uh same thing, leptin is produced by the fat and it kind of lets the brain know how much fat we have. And in patients that are suffering from obesity, sometimes there's something called leptin resistance where the brain doesn't recognize the leptin level and it actually keeps asking for more leptin, meaning it keeps asking for the body to store more fat. So why do they fail? Why do diets fail? I mean, we know that really only 5%, maybe 10 if we're if we're generous, of people who try diets can keep the weight off long term. So why is that happening? Well, some of the reasons we've talked about their biologic factors such a hor such as hormonal changes. We know that when people diet their grein levels actually go up. So they feel hungrier than they did before. The the hunger the hormones that make you feel full go down like GLP1 and P Y. And those are things that normally make you feel full after a meal. And if they're suppressed by your body, you don't feel as satisfied when you eat a meal. And then there's metabolic adaptation. If the body thinks it's in danger, it slows the basil metabolic rate down to try to prevent uh um protect calories and hold on to calories because it doesn't know when you're going to get enough food. So, this fights it harder because it makes it worse to try to lose more weight if your basil metabolic rate is going down. Then there are behavioral challenges. People try all sorts of crazy things to lose weight. Very strict diets, very strict exercise plans and those are very difficult to maintain in the long term. because we don't have enough time, we don't have the energy and it's hard to maintain something that really throws you off balance so much uh for for a long period of time. And then the environmental influences, we have easy access to high caloric foods more than ever in human past. And when that happens, that stimulates those hormonal levels and changes even more than than uh it did before. So all of these things combined really really do increase the chances of regular diets just failing. Um, but it doesn't mean we should give up because what's the lifetime risk of disease if you're suffering from obesity? We know that patients have a 70 to 80% lifetime risk of cardiovascular disease. Okay, 70 to 80%. Almost all of them will develop cardiovascular disease. Heart attack risk is about 30 to 40%. Stroke risk about 20 to 30%. Diabetes risk about 60 to 70%. Obesity related cancers. This is a crazy one. About 20 to 30% of patients suffering from obesity will develop an obesity related cancer over their lifetime. Kidney disease and kidney uh issues um about 15 to 20%. Again, that's the highest rising uh uh cause of death right now in the United States. So, what happens if you can reduce your weight by 5% of your total body weight? Meaning, if you weigh 200 lb, what happens if you can lose 10 lbs? Well, your cardiovascular risk goes down 15 to 20%, heart attack risk goes down 10 to 20%, stroke risk goes down 10 to 15%, diabetes risk goes down. Similarly, obesity related cancer risk goes down 5 to 10% and the um kidney disease risk goes down 10 to 15% as well. So, it's a significant improvement even for just a small maintained weight loss. If we can get more weight loss, go up to 10% weight loss, then the numbers get much better. you see them starting to go into the 25 to 30% improvement and diabetes about 30 to 40% improvement. Um but so you're getting significant improvement with a 10% body weight loss. That is metabolically I mean um uh medically important weight loss. When we go above 25% total body weight loss, which is what we normally see with all of our beriatric surgeries, sometimes we see even as high as 42% total body weight loss. But above 25% then you start seeing really significant numbers. You have 40 50% decrease in the cardiovascular risk. Heart attack risk similar decrease. Stroke risk a 30 to 40% decrease. Uh diabetes risk is about a 50 to 60% decrease as well as a significant decrease in new diagnoses of diabetes over the lifetime. Obesity related cancer risk goes down about 30 to 40% and the kidney disease um uh percentages go down 30 to 40%. So, it's a big change for people after they have lost the weight and maintain the weight loss. So, a big positive for people to try to do that. The good news is not only are people uh living healthier, but they're living longer. The the mortality risk goes down significantly with with weight loss. So, a 5% weight loss brings down all cause mortality about 10 to 15%. A 10% weight loss brings it all down to 20 to 30%. And a 25 or more percent weight loss brings it down to 40 to 50% and there are some studies even as high as 89% decrease in mortality showing that losing weight is worth it. The chances of being alive and 10 or 15 or 20 years later are much higher for patients that have lost weight than patients that maintain their obesity and kind of ignored what was going on. So what do we do to try to treat obesity? Well, there's a whole spectrum of of treatments and we're going to talk about those in later videos, but we talk about lifestyle changes. We're going to talk about medications and endoscopic and surgical options. Um, so that's going to be in the next video. Follow and subscribe along so that you can see them when they come along. Um, if you have any questions or you want to get uh seen by by us in our clinic, um, this is our QR code and our office phone number to give us a call and we're happy to see you and help you at any time. All right. Real science, real surgery, real results.

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