The Dr. Hyman Show - Can You Be Healthy At Any Size?

Episode Date: March 31, 2023

This episode is brought to you by InsideTracker and Athletic Greens. We are amidst a metabolic health and obesity crisis that has taken the world by force, hijacking our biology, creating cellular dysfunction, and ultimately making us overweight, depressed, infertile, and chronically ill. The food industry tries to convince us that all calories are the same and then supports a narrative that blames the victim, insinuating that it’s the individual’s fault they are overweight.  In today’s episode of my series I’m calling Health Bites, I talk about how we’ve lost our way when it comes to diet and health care, why fat shaming is never the answer, why weight-loss drugs are not the solution to the obesity epidemic, and much more. This episode is brought to you by InsideTracker and Athletic Greens. InsideTracker is a personalized health and wellness platform like no other. Right now they’re offering my community 20% off at insidetracker.com/drhyman. AG1 contains 75 high-quality vitamins, minerals, whole-food sourced superfoods, probiotics, and adaptogens to support your entire body. Right now when you purchase AG1 from Athletic Greens, you will receive 10 FREE travel packs with your first purchase by visiting athleticgreens.com/hyman. Here are more details from our interview (audio version / Apple Subscriber version): Statistics on the metabolic health and obesity crisis (3:26 / 1:28)  How your environment influences your health (4:52 / 2:52)  The problematic idea that eating less and exercising more is the key to weight loss (6:15 / 4:22)  Why being overweight is not your fault (9:59 / 8:35)  Can you be healthy at any weight? (12:23 / 10:26)  How Big Food and Big Pharma make money off of our ill health (16:04 / 12:30)  The problem with treating obesity with pharmaceutical drugs (17:06 / 15:17)  Countering the obesity-as-genetic argument (19:52 / 17:20)  Mentioned in this episode FoodFixBook.com FoodFix.org

Coming up on this episode of The Doctor's Pharmacy. It's a systemic problem. We have a food environment that's producing food that's pretty much doing everything possible to increase the production and consumption of foods that are killing us and that are making us overweight. Hey everyone, it's Dr. Mark here.

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Welcome to The Doctor's Pharmacy. I'm Dr. Mark Hyman. That's pharmacy. Then I have a place for conversations that matter. And if you ever wondered about why we're so overweight as a country, what to do about it, whether it's a problem at all, whether we should be supporting the framework of healthy at any weight, or whether we should be aggressively treating obesity, I think you're going to find this podcast very interesting. It certainly is going to raise a lot of controversial issues. It crosses a very Or is that fat shaming? Is it bad to talk

about the importance of improving metabolic health and losing weight? Because it's racist, as some suggest, because it discriminates against brown and black people who are particularly more affected by obesity and weight issues. So we're going to dive into all that. I think it's going to be a bit interesting, controversial for you. Right now, we're in a serious crisis. 93% of Americans, more actually, 93.2% of Americans are metabolically unhealthy, meaning they have some form of pre-diabetes, insulin resistance, diabetes. 75% are overweight, 42% are obese. You know, 25% of teenage boys have prediabetes or type two diabetes, something that didn't exist when I was in medical school. 40% of kids are overweight. Is this okay? An average kid who's overweight as a kid loses 13 years off their life, earns less income, and is more

socially marginalized in many ways. This is a real problem, and we can't ignore it, whether we like to think we can or not. But we're in a serious crisis. It's affecting not just us, but the population around the world. Globally, there's over 2 billion people that are overweight. The metabolic crisis is hijacking our biology, creating cellular dysfunction, accelerating aging, and it basically makes us overweight, depressed, infertile, and chronically sick. So why is this happening? Was there this problem 50 years ago, 100 years ago? I mean, I was born a little while ago, 63. But when I was born in 1959, 5% of people were obese. Now it's

eight times that, 42%. How could that be genetic, As some scientists suggest that, oh, obesity is genetic. Oh, it runs in families. Well, not necessarily. In fact, Christakis' work out of Harvard showed that you're 171% more likely to be overweight if your friends are overweight than if someone in your family is overweight. Think about that. It's the social framework that we live in, the peer pressure, the environment that actually determines so much of what's going on in our biology. And what's really changed over the last 50 plus years, 60 years, is the food industry. Big food has basically taken over our food supply, has produced over 600,000 ultra-processed foods full of sugar and starch

and chemicals that damage our metabolism. And that we're literally sacrificing the next generation without really taking this problem on head on. So we're going to talk about all these things today. We're going to talk about the science of metabolism and weight loss. Why weight loss is not just about calories. It's about quality and quality of the ingredients and quality of the food and the type of macronutrients and the other compounds in food. So I think, you know, one of the things I want to sort of say at the outset is that, you know, if all calories were the same, then weight loss was simply a matter of eating less and exercising more, then if we all follow that advice, we'd lose weight, which we don't. And secondly, that

advice is actually very destructive because it implies that if you don't eat less and exercise more, there's something wrong with you. It blames the person who's overweight for being overweight, which is a phenomenal, awful, horrible framework for thinking about obesity. It has nothing to do with biology. It's not your fault if you're overweight. Now, yes, you make choices and you have personal choice and you can choose to exercise or you can choose to eat differently. And that's all for sure make the right choice. If your whole environment and society is set up to eat more and exercise less, well, that's going to be the default of what you're going to do. Now, you can always overcome that, but it's really hard for many people, especially those who are underserved, who live in food deserts, who have challenges accessing healthier food, to actually do the right thing. But even if we all wanted to do the right thing, and I think most of us do,

even if we try to do the right thing, there's a problem, which is that the calories that we're eating are very different than the calories we used to eat. They're extremely high in refined products, ultra-processed food. If you eat ultra-processed food, it will actually drive your appetite up.

And the average person who's given an unlimited food to eat, processed food or whole foods, eat 500 calories more a day of ultra-processed food. In a year, that will add up to 52 pounds of weight gain just from eating ultra-processed food because it increases your appetite because it's addictive and causes you to eat more because we're trying to get nutrients from food that's nutrient deficient. Just like kids eat dirt when they want to get iron, we eat more food because we're looking for the nutrients, but they're just not there. So the whole idea of energy balance is complicated. It has to do with your microbiome,

your genetics, your metabolism, the quality of the food, the impact on insulin, hormones. I mean, it's a very complex soup. So just to try to say simplistically, it's all about energy and calories in, calories out. It just doesn't't apply and if you look at the science carefully and this is not my opinion this is work of really top experts at harvard and other places the energy balance hypothesis is one that's been promoted by coca-cola if that tells you anything about what it's uh supporting and the because if true, right, it was all about calories, a hundred calories of Coke and a hundred calories of broccoli, no difference in terms of your biology. Well, that that's just an absurd notion. We know that's not true, but it's essentially what

the food industry wants us to believe. It's what our government tells us. It's what our professional associations that are often co-opted, like the American Heart Association, American Diabetes Association, the Academy of Nutrition Dietetics, are all basically saying, which is really a problem. So the quality of the food you eat matters more than the quantity, and it affects everything. So food is information. You've heard me talk about this. Food is instructions. It's code. And depending on the quality of the food, it will have profoundly different effects. If you have, for example, broccoli or sugar, they're both carbohydrates, but they have profoundly different effects on your metabolism and your microbiome, on your chemistry, on every aspect of your health. So we kind of have to move away from that. And we have to understand that it's not your fault if you're overweight, that it's because of our toxic food system. It's because of things that often we are being exposed to that we have no control over.

And that you're not going to lose weight by trying to restrict calories and exercise more. It's just really hard to do. You have to understand how to work with your body rather than against it. Now, there are a lot of reasons we struggle with weight loss, and some of them have to do with the food we're eating. But some of them are because of nutritional deficiencies that occur. For example, if you're nutritionally deficient, you're more likely to be overweight. If you have microbiome imbalances, that can cause weight gain. You see, for example, you can take the microbiome imbalances that can cause weight gain. You see, for example, you can take the microbiome out of a fat mouse and put in a skinny mouse, and that skinny mouse, without changing its diet,

will gain significant amounts of weight, right? How does that make sense if it's all about calories? Inflammation is something that drives weight gain because it causes insulin resistance so anything that causes inflammation toxins allergens microbes stress all drive waking environmental toxins we know these are called obesogens obesogens are compounds like bisphenol a and and heavy metals and pesticides which affect our metabolism and actually increase insulin resistance and waking gain. Hormone challenges that we have, for example, thyroid and stress hormones, sex hormones, all can affect our metabolism, our genetics, also in our social relationships. So there's a lot of things that are going on that affect our metabolism. Now,

I want to sort of touch on, and I've talked a lot about metabolism. I've written dozens of books on it. I've spoken a lot about this, but I want to dive deep into some of the controversies. First is just to say that and reinforce that the idea of fat shaming, the idea of blaming the victim, I think it's fundamentally wrong. And we should not do that because we understand that there are forces at work that are driving our obese nation to become more obese. And we have to deal with those. And that has to do with the structural built environment, our food environment, stresses, toxins, all the things that we don't always have control over. Now, there's a sort of a conversation out there that there's healthy at

any weight, the body positive movement. It's racist to say we should be losing weight, that it's not what we should be focused on, that actually the science supports that you can be healthy at any weight. And I think I just want to address this for a minute because it's just not true. And I can say this as a practicing doctor for 30 years who's tested thousands and thousands of patients overweight, look at their deepest metabolic health, their deepest biochemistry. And it's very rare to see someone who's overweight who's, quote, healthy in my perspective. But there was a paper that was published pretty recently, and it was published in the Journal of

Demography. It was called Sources and Severity of Bias in Estimates of BMI Mortality Association. And in English, it basically means that we found that, gee, if people at lower weights might have higher mortality, but maybe only about an increase of 2% to 5% risk if you're overweight for death, which doesn't seem like that much, right? But it's actually due to something called reverse causation. Reverse causation means that as you get older, for example, if you lose weight and your body mass index is low, there's a reason for it, right? Let's say you have cancer. Your risk of death goes up and you lose weight when you have cancer. So you might be very, very skinny and your mortality risk goes up and you lose weight when you have cancer. So you might be very, very skinny and your mortality risk goes up. It's not because of being skinny, it's because of the cancer. This is called reverse causation. It's a well-described phenomena in scientific research. So the scientists looked at large populations linked to mortality, over 17,000 cases over decades, looking at correlation of body weight.

And then they tried to figure out, you know, what was going on with these people? Why were they losing weight? Were they older? And so forth. So you could tell over time, this is a national survey, the Nutrition Examination Survey, the National Health and Nutrition Examination Survey called NHANES. They tracked people over decades. And so you can say, okay, well, this person was healthy weight, and then they lost weight, and then they died, right? So you can kind of see that this is really changing our idea of what it means to be overweight. In fact, their estimates were up to 90% increased risk of mortality from being overweight, not 2% or 5%. So this kind of changes the conversation from the healthy to any weight conversation. That's not to say we should be blaming the victim, as I said, but that we should be really thinking

about, you know, what's really driving this and what's causing it and how do we start to try to rethink this. So I think, you know, this sort of pro-obesity movement, this body positive movement, this healthy in any way movement, I think doesn't address the real issue, which is that we live in a toxic food culture. We have a food system that is causing more death than anything else on the planet. It's killed over 11 million deaths a year. This is from the Global Burden of Disease Study of 195 countries. It's far exceeded smoking. We know that, for example, COVID, your risk of dying from COVID was dramatically higher if you're overweight, right? Because it's not a healthy state.

You're in an inflamed state. You're in a disease state. And so we kind of have to look at the food system as a whole and big food and big pharma basically have set up the system to cause us to be overweight and then to fix it with drugs, which just is a terrible thing for us. It's good for them because they make more money. So the big food problem is something I've talked about quite a bit. And I wrote a book about it called Food Fix. I encourage you to read it if you're interested in this topic. But our food system has been subverted. Our health has been subverted.

And our policies drive accelerated production, agriculturally, manufacturing, distribution, and consumption of ultra-processed food, which is now 60% of our calories. And as I said, increases the risk of obesity, but also increases the risk to mortality. For every 10% of your calories of ultra-processed food, your risk of death goes up by 14%. So we can't ignore the fact that we are in a food system that's driving this, and it's the ultra-processed food that's driving this. And it's the ultra processed food that's doing this. Now, there's sort of an interesting kind of shift in our thinking about a weight loss, which has to do with a pharmacologic solution. And I just read a headline today that made me want to vomit. It's from The Economist. And it says, new drugs could spell an end to the world's

obesity epidemic. The long-term effects must be carefully studied, but the excitement's justified, says the headline. I think this is terrifying for me. And the reason this has taken off is the TikTok generation, it's the social media advocating for drugs for obesity by celebrities. And what I'm talking about is Ozempic and Mugobi and another drug that's out there that's even more effective than those drugs. And so everybody's like, quick fix, let's do this. And it's going to solve our obesity epidemic it's not it definitely can cause weight loss but it's not free of side effects it can cause problems with muscle loss which is really a disaster long term for health it can increase the risk of certain cancers like thyroid cancer kidney pancreatic problems. So it's not a free ride

and it's insanely expensive. Now the price may come down, but it's anywhere from $1,300 to $1,700 a month. And if the 75% of people in America who are overweight took it, that would be a $425 billion a month or $5.1 trillion a year to our healthcare system, which now is maxing out at $4.1 trillion a year, which is more than double any other nation. So this is just an absurd proposition. And yes, this is a drug that can be helpful for diabetics. Yes, it can be helpful in certain situations like any medication, but to promote it as a solution for obesity epidemic is insane. And by the way, the American Academy of Pediatrics just came out, and this just made me nuts, actually, came out and recommended that we should be taking obesity seriously in kids. Agreed.

That we should be treating it aggressively in kids. Agreed. That we should be treating it aggressively with medication and bariatric surgery. Agreed. That we should be treating it aggressively in kids. Agreed. That we should be treating it aggressively with medication and bariatric surgery. Hell no. Hell no. Do we put a kid on Ozempic or Rigobi at 10 years old for life at $1,700 a year, a month, I mean, with all these side effects, is that the problem? Is the problem a ozempic deficiency that's causing obesity? No, it's because of our food environment. And what's shocking is that even some of the people in the pediatric field are saying, well, it's genetic. Like you explain this to me,

how do obesity rates go from like, you know, a couple of percent to 20% in kids in a generation? How do we go from no kids having type 2 diabetes to 25% of kids who are teenagers having pre-diabetes or type 2 diabetes? Does that make any sense? How do we go from like maybe that one overweight kid in the class and now 40 of kids being overweight how does that explain anything it's not genetics our genetics don't change that fast our environment changes and so we cannot rely on drugs or surgery i mean putting kids on bariatric surgery protocols and thinking you're going to do a gastric bypass to solve this is just insane. Again, it's just not economic. It's $30,000 a treatment.

It comes with all kinds of risks and side effects, all kinds of nutritional deficiencies. me about a case of a young person who ended up getting a gastric bypass, having a severe nutritional deficiency, and ended up with something called Wernicke's encephalopathy, which causes permanent neurological damage because of a nutritional deficiency from getting his stomach stapled. And he was presenting at her class. I'm like, oh God. So we cannot fix this problem through surgery or medication. It's a systemic problem. It's not an individual problem. It's not your fault. It has to do with the fact that we have a food environment that's producing food, manufacturing food, that's marketing food, that's providing food for the poor through food stamps, that's pretty much doing

everything possible to increase the production and consumption of foods that are killing us and that are making us overweight. We need to change that. So a future has to look very different. We have to deal with this systemically. It's really why I wrote Food Fix. It's why I actually created the Food Fix campaign, which is a nonprofit, 501c3, to educate lawmakers and an advocacy group, 501c4, to help change policy. So we're working in Washington right now doing hearings. We've passed some legislation. We've created a number of different things to focus on chronic disease nutrition. We're having food as medicine initiatives. We're trying to pass a bill to study food as medicine. This is the solution. It's not a pharma or surgical problem. It's a social, environmental, political problem. is important. And I think we should not shy away from leaning into a real discussion about the

causes of obesity to face the fact that it's not an individual problem. We shouldn't be blaming the individual, but we shouldn't be ignoring it either. We shouldn't be saying it's okay. And I think this new data from the nutrition examination survey, the National Health and Nutrition Examination Survey, it should kind of raise our attention quite dramatically because a lot of the people saying that it was okay to be overweight as a body positive movement were using other data that was really flawed. And I think this new data makes it really clear when you kind of go into the kind of fine-tooth comb analysis of the data that there was other factors at play that showed that, you know, people who were lower weight when they're older, you know, had more mortality.

It wasn't because they were skinny. It was because they were sick. And I think we have to realize that this is a massive crisis now, and we have to deal with it, and we can't ignore it, and we certainly can't medicate or operate our way out of it. So hope has been helpful for you. I hope you maybe are inspired to try to address your own food environment and help change the policies that matter. You can do that by following a lot of the guidelines. You can go to foodfixbook.com and there's a food fix action guide. A lot of things you can do as individuals, how to advocate policy, how to work with your lawmakers. So I encourage you to check it out. And thanks for listening to the podcast.

If you love this podcast, be sure to share with your friends and family, leave a comment and how you've addressed the issues of this in your life. And subscribe to every of your podcasts. And we'll see you next week on The Doctor's Pharmacy. Hey, everybody, it's Dr. Hyman. Thanks for tuning into The Doctor's Pharmacy. I hope you're loving this podcast. It's one of my favorite things to do and introducing you all the experts that I know and I love and that I've learned so much from. And I want to tell you about something else I'm doing, which is called Mark's Picks. It's my weekly newsletter. And in it, I share my favorite

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to enhance my health and get healthier and better and live younger longer hi everyone i hope you enjoyed this week's episode just a reminder that this podcast is for educational purposes only this podcast is not a substitute for professional care by a doctor or other qualified medical professional. This podcast is provided on the understanding that it does not constitute medical or other professional advice or services. If you're looking for help in your journey, seek out a qualified medical practitioner. If you're looking for a functional medicine practitioner, you can visit ifm.org and search

their find a Practitioner database. It's important that you have someone in your corner who's trained, who's a licensed healthcare practitioner, and can help you make changes, especially when it comes to your health.