Episode 30 – Dr. Carl Lavie

experiences in session my guest tonight is dr. Karl La Vie his book is the obesity paradox dr. Levey welcome to hxp thank you for having me so dr. Louie if you could just briefly get into your background your education help us understand who you are I’m a specialist in cardiovascular diseases I did medical school at LSU in New Orleans I did my medicine residency at a Schnur in New Orleans where I am right now and I trained in cardiovascular diseases at

the Mayo Clinic in Rochester Minnesota before returning to Aashna about 25 years ago I am the author of over 800 medical publications and three text books including the obesity paradox book the other two are all books for medical specialists and I’m a frequent lecturer particularly in areas related to the prevention of cardiovascular diseases mmm okay so let’s let’s dig right in I mean would you would you call this book controversial I think it is

controversial and 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 revolutionary and I think the results have been somewhat confusing they’ve been surprising to me as a doctor and in some ways have turned conventional wisdom on its head but basically our research during the last 15 years has pointed out that fat is not always the devil 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 let’s rewind a bit what are what are some of the modern and traditional definitions of obesity well typically we define obesity by body mass index which is which is simply calculations based going height and weight and it’s given in kilogram per meter squared and using the body mass index method the ideal weight is considered a BMI between 18 point 5 and 25 overweight is 25 to 30

and obese is considered a BMI greater than equal to 30 kg per meter squared and mild a class 1 obesity is 30 to 35 moderate obesity a class 2 obesity is BMI is about 35 to 40 and then severe obesity which is sometimes called morbid obesity I think that’s a mean term so I think we should really use the term severe obesity is BMI is 40 kg per meter squared or higher so what what in your opinion causes obesity I mean there are there genetic factors as well like

predispositions as well as just eating poorly lack of exercise there’s certainly are multiple causes of obesity including genetic causes and and even some very rare genetic disorders but I think that in our society by far the leading cause of obesity is despite some people saying it’s due to the fast food diets or due to sugar sugar intake and sugary beverages my colleagues and I have published research that has demonstrated that the fundamental cause

of the weight gain that has occurred during the last five decades is very marked declines that have occurred in physical activity and not only does that lead to weight gain but the lack of physical activity is also having a very negative effect on cardio respiratory fitness which is perhaps one of the strongest cardiovascular risk factors and predictors of long-term prognosis and really affects 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 the certainly there are some on physical activity factors that determine fitness some people are just born with higher levels of fitness than others but by far probably 70 to 80 percent of fitness is determined by physical activity and so Fitness is probably the strongest of our cardiovascular risk factors in fact my colleagues and I have published

a number of studies that show that a bit 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 very important predictor of prognosis in our society hmm but in your book you pose a very I mean I guess this is the paradox part of it and in my mind when I hear the word obese it’s like a trigger and I just I turn I turn off you know and I

just I don’t respond to it but in your book you say that being slightly obese is protective to the body helps the body and can prevent against heart disease well that’s not exactly how we put it in the book but but uh and I’d like to say right now that my book in no way tries to promote obesity we’re not saying that obesity is a good thing we’re not saying that normal weight people should be trying to gain weight but for those

large number of people in our society right now and the percentage is close to 75% who are either considered overweight or obese and the obese percentage is about 36% it’s not doomsday for those people who have been trying to lose weight and I fail or who have lost weight multiple times but gained it back and a right now sitting 20 30 40 pounds over what they would like to weigh they can still have a very good prognosis especially if they fit

and I’d like to mention one very important study it was a Catherine fleagle and colleagues it was published in January 2013 JAMA Journal American Medical Association one of the world’s most prestigious journals and this study got a lot of publicity and a lot of negative publicity but what it was was a meta-analysis of 97 studies of over 2.9 million individuals and it had a lot of statistical power because they analyzed over 270,000 deaths and in this study

they showed that the best survival was in the BMI group between 25 and 30 this is considered the overweight BMI they had a 6% lower mortality then did those in the BMI that was normal between 18 point 5 and 25 and Nicole and the obese as a group had higher mortality but it was all because of the more severe obese because the class 1 obese which is BMI 30 to 35 and that’s the group that many people fall in they actually had a 5

percent lower mortality then did the normal BMI it was not quite statistically significant but it was almost statistically significant so all of the increase in mortality was due to the obese would be a mize above 35 and particularly those above 40 so the overweight group and 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 your BMI is in the normal range now that this

study just assessed mortality it didn’t assess some other things that you know certainly people if they gain weight are gonna have worse lipids worse cholesterol high blood pressures more diabetes so they may require more medications they you 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 the highest quality of life so there are other reasons to be thin oven in just

survival but our data and the data of others is I think repeatedly showing that people can have quite good survival even if they’re carrying a few extra pounds and how data particularly shows that if you fit if you have a high level of cardio respiratory fitness it doesn’t matter nearly as much what you weigh now in a perfect world I think everyone would be thin fit and metabolically healthy but if you’re gonna lose some of that as you age it

would be much better to remain fit and gain weight than vice-versa if one maintains good weight but loses their fitness they fall into a group that has a very poor prognosis right right so I mean what do you think has led to this gross misrepresentation of what the human body should look like I mean there are people who are suffering from anorexia bulimia and their their body image is poor I mean how how do we correct that what what has led to that I

think there are many reasons why one wants to be a lower weight and it’s not all health-related certainly a lot of the reason has to do with appearance and the way our society has glamorized being thin and sometimes glamorize being really unhealthily thin you know that if you think of a lot of the models they have extremely low body mass indices and a lot of times they have low muscle mass and a physically weak and even though a

lot of people say you know would think that they might look very good in their in their bathing suit or in their in their evening gown they may not necessarily be healthy at all and but I saw I think that a lot of it has been a person option of our 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 their for their wearing clothes the the bathing suit look and and I think that

that’s a perception that’s you know that goes beyond what my book is about my book is about really the health aspects 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 thin a lot of people necessarily think that they’re healthy but the fact is many thin people who are not physically active have a low amount of muscle and they not did they’re actually worse off than the

heavier person and especially worse off than the heavier person who’s got a good level of fitness hmm well you know I’m really glad that you said that your book is not an excuse for you know being a beast but let’s let’s drive that that point home how do you draw the line between people that may think exactly that that your book may be an excuse maybe they pick up your book and they think oh well you know it’s okay for me to be obese how do you how do you

respond to that well certainly in every interview I do and in several times in the book I clearly say that but you know again I somebody can get the flesh that the flesh of the book and he and and maybe even though I didn’t say it maybe do it they hear is that it’s okay to be obese or maybe they actually hear that it’s good to be obese and and clearly that’s not what I’m saying I think in a perfect world everyone would remain then

fit and metabolically healthy that’s not even close to what’s happening in our society and so what I try to really pound upon is that Fitness is more important than weight with regard to long-term prognosis and if you fit you can have a good prognosis almost regardless of your weight now up that’s up to a point at extremely high weights extremely high BMI is one you probably override the the possibility that Fitness can totally protect you but it’s

also not very common to have many people would be amazed in the upper 30s and authorities to be fit you can have a lot of people though that have BMI between 25 and 30 and even in the low 30s who are actually fitter than people with much lower BMI and what I mean by fitter is that we can measure Fitness by treadmill tests or or you know it many many people will comment you know in a road race you’ll see some heavier people running some pretty good times and

passing up dinner people in the race and again it may be that heavier person would even be running fast and be even better if they would thinner but the point is that even at higher weights a person can have quite good levels of fitness particularly if they’re physically active ok 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 biggest the the the biggest thing would be if they’re not physically active to increase the physical activity the goal should be for all individuals to be doing about a hundred and fifty 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 30 40 minutes on many days per week of a fast walk and so that’s something that number one that most people can do and it for some reason one can’t walk we because of their knees and their hip and their back another type of aerobic exercise like an elliptical machine a bicycle and a supplying bicycle or swimming or even water exercises all would be ways to obtain that moderate level of physical activity 150 minutes per more per week that would be the

number one thing the second thing is is that muscle is also very important and one thing that obese people have or higher weight people have should even they gain weight they gain fat but generally you don’t gain all fat you do gain muscle so for example if someone gains 20 pounds it’s not all 20 pounds of fat if someone gains 20 pounds and they working out hard a lot of it will be muscle but even if they’re not working out they may gain 3 5 7 pounds

of muscle and so typically heavier people have more muscle than very thin people and vice versa when you lose weight you don’t just lose fat you also lose muscle now if you if you lose weight while you’re doing a lot of exercise you may maintain your lean mass and your muscle mass and mostly then lose fat mass but most people when they go on a vigorous diet and lose a lot of weight you know if they’re not exercising they’re not gonna maintain

the weight loss usually anyway but the weight they lose is almost all combination of that weight as well as muscle weight and and so to prevent that you know if you do in physical activity including resistance training doing some light weights 2 or 3 times a week particularly for older people is is a very important thing as a way to preserve muscle mass that’s typically is declining as we age hmm yeah very interesting so doctor dr. levy there

there’s a chapter in your book called the purpose and power of fat and if we could just close on this I think it’d be interesting if you could get into that well first of all that is a reserve and so you know if you if someone knew they were gonna catch a bad disease eye cancer or develop bad heart feel you all have HIV infection or some types of bad muscle wasting connective tissue diseases like advanced rheumatoid arthritis and other diseases

like systemic lupus erythematosus all are bad kidney disease like chronic kidney failure it would be good to have more fat as a reserve to fight the illness and so for some severe diseases you know that the heavier person is actually better off than the very thin person who has very little reserves when it comes to fighting some of these chronic diseases but there are some other potential things that fact could be doing that that is that is beneficial

and protective and we’ve shown that in our patients with heart failure and coronary heart disease that having higher levels of body fat have actually correlated with better survival and so so again I’m not trying to promote anyone for purposely trying to uh to gain fat or to 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 thin who are under way people would be em eyes officially under way it is BMI is under eighteen point five but a lot of people think in our current society people have BMI is even between eighteen point five and twenty-one twenty-two range they’re pretty low weight and for many of those people not only having more muscle mass but probably having a little bit fat would be beneficial for their long-term

prognosis and survival hmm okay well dr. levy I certainly appreciate your time sir thank you for being here where can people find more about work by your book well we have a website on the book called obesity paradox calm and one could also Google the V obesity paradox l’viyah spelled la VI e and la vie obesity paradox and can see a lot of material but again the website obesity paradox calm would have a lot of information excellent thank you so much

for being here sir this is the human experience we are gonna get out of here we will see you guys next week