Transcript for 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


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

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