Dr. Carl Lavie – Transcript


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Will not at any domestic handling brain hemispheres at entertaining and mentally invented telling psychodynamic and I believe I tell you things differently is an excellent frontotemporal occipital I at the things that is the authentic take you to Mr. placed in an human experiences in session my guess night is Dr. Colavito his book is obesity paradox Dr. Levine welcome to so Dr. we if you could just briefly get into your background education help us understand who you are on the specialists and cardiovascular diseases that good medical school at LSU in New Orleans are medicine residency at all. Only right now I trained and cardiovascular diseases at the Mayo Clinic in Rochester Minnesota look forward trying to about 25 years ago I am the author of over 800 medical publications and read textbooks including the obesity paradox will go to all old books for medical specialist and I’m a frequent left lecturer particularly in areas related to the prevention of cardiovascular diseases, so it’s less degraded and would you would you call this book controversial think it is controversial in some ways I think that the research that my colleagues and I have done during the past 15 years has been

in a way of evolutionary and I think the results have been somewhat confusing and supplies think to me as a Dr. and in some ways it turned conventional wisdom on its head but basically our research during the last 15 years has pointed out that that is not always Big Apple and in fact having a low level of fitness is much more important than body weight with regard to long-term prognosis okay so let’s chill wind of it what what are some of the modern and traditional definitions of obesity will quickly we define obesity by body mass index which is which is simply calculations based on height and weight and is given until Maccabeus wedding using the body mass index The ideal weight is considered a BMI between 18.5 and 25 overweight is 25 to 30 and obese is considered a BMI greater than or equal to 30 m² and mild class I obesity is 30 to 35 moderate obesity a class to obesity is BMIs about 3540 and then soon be obesity which is sometimes called morbid obesity I think that’s a meantime so I think we should will use terms of the obesity is BMIs 40 KG per meter squared or hire so what what in your opinion causes obesity I mean there are there genetic factors as well I like predispositions as well as just eating poorly like an exercise good this certainly all multiple causes of obesity including genetic causes and and even some very rare genetic disorders but I think that in our society by Paul the leading cause of beasties despite some people saying it’s due to the fast food diets are due to sugar sugar intake of sugary beverages my colleagues and I have published research that is demonstrated that the fundamental cause of the weight gain is occurred during last five decades is very more declines that have occurred in physical activity and not only does dad lead to weight gain but the lack of physical activity is also having a very negative effect on cardiovascular fitness which is perha

ps one of the strongest cardiovascular risk factors and predictors of long-term prognosis and weekly aspects the obesity paradox so how important is it to be physically active I think it’s it’s it’s very important because physical activity is the strongest determinant of fitness that certainly there are some non-physical activity factors that determine fitness some people are just born with higher levels of fitness and others but but probably 70 to 80% of fitness is determined by physical activity and so fitness is probably the strongest about cardiovascular risk factors in fact my colleagues and I published a number of studies that show that the individual even if they have some disorders like lipid disorders diabetes hypertension they often do better than the unfit individual who doesn’t have these disorders so fitness is a is a is a very important predictor of prognosis and outside in your book you pose a very I think I guess is this the paradox part of it and in my mind when I hear the word obesity like a trigger and I just I try turn off you know and I just I don’t respond to it but in your book you saying that being slightly obese is protected to the body helps the body and can prevent against heart disease well that’s not exactly how I would put it in the book but but the highlight the state right now that my book in no way tries to promote obesity will not saying that obesity is a good thing without saying that normal weight people should be trying to gain weight but but those large number of people in our society right now the percentages close 75% who are even considered overweight or obese in the obese percentages about 36% it’s not doomsday those people who have been trying to lose weight and it fail what was weight multiple times beginning good back and a right now sitting 20 3040 pounds over what they would like the way they can still have a very good prognosis especially if they fit like the

mentioned one very important study by Catherine legal and colleagues was published in January 2013 John my Journal American Medical Association one of the world’s most prestigious journals in this study got a lot of publicity and a lot of of negative publicity but what it was was a meta-analysis of 97 studies of over 2.9 million individuals and how I suggest Pollock is analyzed over to his 70,000 deaths and in this study day showed that the best of Bible was in the EMI group between 25 and 30 this is considered overweight BMI they had a 6% lower mortality than did those in the BMI that was normal between 18.5 and 25 and then the obese as a group at higher mortality what it was all because of the more severe obese because the class I obese which is BMI 3035 and as the group that many people follow their actually have a 5% lower mortality then did the normal BMI it was not quite statistically significant was almost exactly significant so all of the increase in mortality was due to the obese would BMIs about 35 and it particularly those about 40 so that all awake wrote the mildly obese group did not have a higher mortality so it’s really hard to say at this point in time that you will live longer if you BMIs in the normal range out that the study just assess mortality it didn’t assess some other things that you are certainly people to gain weight of the have worse lipids worse cholesterol high blood pressure is more diabetes so they may require more medications they know the high weight might be bad on the joints so they may not have the the best

mobility as they get older they might have happened highest quality of life reasons could be can open and just the Bible but I’ll data in the data revolvers is I think repeatedly showing that people can have quite good survival even if they carry a few extra pounds that out data particularly shows that if you hit if you have a high level cardiorespiratory fitness it doesn’t matter nearly as much what you went now world I think everyone would be there fit and metabolically healthy but if you don’t lose some of that as you age it would be much better to remain fit and being late and vice versa if one maintains good way to lose the fitness they fall into a group that has a very poor prognosis right so is led to this gross misrepresentation of what the human body should look like an error people who are suffering from anorexia bulimia and their body image is poor and how how we correct that what was led to that there are many reasons why one wants to do be alone weight and it’s not all elk relate certainly a lot of the reason has to do with appearance and the way our society has glamorized the independent sometimes glamorized being really unhealthily there you have it if you think of the a lot of the models they have extremely low body mass indices and a lot of times they have low muscle mass in the physically way and even though a lot of people say you know would think that they might look very good in it in that they consumer and then in the evening down they may not necessarily be healthy at all at but I so I think that a lot of it has been a perc

eption about society that that dinner not only is healthier which is certainly not correct but that it is an appearance that they want to have again for the event where close to the debate ensued look in think that that’s a perception that’s you know that goes beyond what my book is about my book is about really that help aspects of of weight and in the fact that one can be very healthy at higher than the ideal body weights and the vice versa if you look at someone who’s been a lot of people necessarily think that they healthy but it has many been people who were not physically active have a low amount of muscle and a knife it there actually Warsaw in the heavier person and especially worse off than the heavier person who’s got a good level of fitness only I’m really glad you said that your book is not an excuse for being an obese but let’s the drive… Point home how do you draw the line between people that may think exactly that your book may be an excuse and pick up your book them if they think oh well you know it’s okay for me to be obese have you respond to that will certainly in every interview are due and it several times in the book clearly say that but not cannot some somebody can get the flat the flash of the book and he and and maybe even I didn’t say it may be debate here is that it’s okay to be obese automated a actually the evidence good to be obese and and clearly that’s not what I’m saying I think the world everyone would remain in and metabolically healthy that’s not even close to what’s happening in our society and so what would I try to really called upon is that fitness is more important than weight with regard to long-term prognosis and if you you can have a good prognosis almost regardless of you awake now up that’s up the point at extremely high ways extremely high BMIs one probably override the the possibility of fitness can totally protect you but it’s also not very com

mon the have many people would BMIs in the upper 30s and the parties to be fit you can have a lot of people though it have BMIs between 25 and 30 and even in the low 30s actually better than people with much lower BMIs and what I mean by fitter is that we can measure fitness by treadmill test or or you know it many many people will comment you know it in the road race you’ll see some heavy people running some pretty good times and passing up in a people in the race that again may get heavier person would even be running fast then be there they would banner but the point is that even at higher weights a person can have quite good levels of fitness particularly adept physically active, so what is what is something that someone who’s listening to the show right now can do what is one thing that you would say or suggest that they can do to improve their health the the the biggest the the the biggest thing would be it did not physically active increased physical activity the goal should be all individuals to be doing about 150 minutes per week or more of moderate physical activity or 75 minutes per week or more of vigorous physical activity and that’s something that’s very obtainable for many people because moderate physical activity is basically a fast walk and so almost everyone can do 3040 minutes on many days per week over fast walk and so that’s something that number one that most people can do it for some reason one can walk because of their knees and get back another type of aerobic exercise like an elliptical machine a bicycle in a supine bicycle or swimming or even water exercises all would be ways to obtain that moderate level of physical activity hundred 50 minutes per more the week that would be the number one thing the second thing is is that muscle is also very important in one thing that all these people have highway people have journeyman a game way to

think that but generally you don’t gain all that you do gain muscle so for example if someone gains 20 pounds is not all 20 pounds of fat it if someone gains 20 pounds they working out: a lot of it will be muscle but he thing working out a making 357 pounds of muscle and so typically have yet people have more muscle been buried then people and vice versa when you lose weight you don’t just lose that you also lose muscle know if you you lose weight what you doing a lot of exercise you may maintain you leave Massey muscle mass and mostly them was that mass but most people when they go one of biggest diet and lose a lot of weight you cannot exercise the neck to maintain weight loss usually anyway but the weight they loses almost all combination of of that weight as well as muscle weight and and so that you know if you doing physical activity including resistance training doing some light weights to a three times a week particularly for older people is is a very important thing is a way to preserve muscle mass that’s typically is declining as we age you have very interesting so Dr. Dr. Louis there there is a chapter in your book called the purpose and power of that and if we disclose on this think it be interesting if you can begin to that well first of all that is the reserve and so you know if you if someone knew they would catch a bad disease cancer or develop their heart feel your had HIV infection of some types of bad muscle wasting connective tissue diseases like advance rheumatoid arthritis and other diseases like systemic lupus 30 mythos a

ll are bad kidney disease like chronic kidney failure it would be good to have more fat as a reserve the right the illness and so was some severe diseases you know that the heavier person is actually better all in the very person who has very little reserves it comes to fighting some of these chronic diseases but there are some other potential things that that could be doing that at that is that is beneficial protective and we have shown that in all patients with heart failure and quantity heart disease that having higher levels of body fat have actually correlated with better survival and so so again I’m trying to promote anyone for purposely trying to to to think that or to gain weight almost anyone would benefit from increasing muscle mass particularly for the thin person who’s who’s got very low muscle mass but almost everyone would benefit from muscle

mass but certainly patients who are then go on the way people would BMIs officially underway is BMIs under 18.5 but a lot of people think in our current society people have BMIs even between 18.5 and 2122 range it pretty low weight and put many of those people not only having more muscle mass probably haven’t a little bit that would be beneficial for their long-term prognosis and survival actually I certainly appreciate your time certain think you for being here where can people find more about your work by your book well you have a website of the book called obesity paradox.com and one could also a Google be obesity tax of these about LA the i.e. in love the obesity paradox and see a lot of material but again the website obesity paradox.com would have a lot of information excellent you so much for being here sure this is the human experience we are getting it out here you guys next week

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