Nov 10, 2015

Interview Transcript

Dr. Miller: Overweight, obese, what do those terms mean? We're going to talk about that next on Scope Radio.

Female: Access to our experts with in-depth information about the biggest health issues facing you today, The Specialists with Dr. Tom Miller is on The Scope.

Dr. Miller: Hi, I'm here today with Dr. Eric Volckmann. He's a bariatric surgeon and a professor of surgery here at the University of Utah. Eric, welcome to the show today.

Dr. Volckmann: Thank you. Thank you for having me.

Dr. Miller: One of the things I think we need to have an understanding of is the terms overweight and obese. Those are medical terms, as I understand. I'd like you to define those for the folks that are listening. That'd be great.

Dr. Volckmann: Medically speaking, we talk about overweight and obese in terms of body mass index or BMI. That's a ratio of your height to your weight. If you go on any Internet search engine and type in "BMI calculator," you'll be able to find out what your body mass index is.

Dr. Miller: You could do that on your iPhone. You could do it on your laptop. You can be able to calculate that pretty quickly.

Dr. Volckmann: Absolutely. It'll ask you for your height, weight and sex. Plug those things in and it'll give you your body mass index.

Dr. Miller: When we look at body mass index, we break that down into categories. Normal would be a number from something like 18.5 to 25. Above that, you would be considered to be overweight or obese. Can you talk a little bit more about those categories?

Dr. Volckmann: Right. Overweight spans from a body mass index of 25 to 30. Then, we have class 1 obesity, which runs from 30 to 35, followed by class 2 obesity, which is body mass index 35 to 40. That's the weight at which we start considering weight loss surgery if you have a weight-related medical problem such as diabetes, high blood pressure, high cholesterol. Body mass index 40 or higher is considered morbid obesity. Above that, 50 has other terminology associated with it.

Body mass index is not a perfect tool. You can have an NFL linebacker with a body mass index of 35 and 2% body fat. It doesn't always indicate obesity, but for most people it does. Around a body mass index of 35, people are about 100 pounds overweight.

Dr. Miller: It's pretty close to what's going on medically with these patients, you would say. It's a pretty good way to look at health.

Dr. Volckmann: It's fast, easy and quick. It's the best, most useful calculator we have to determine whether or not someone is overweight or obese.

Dr. Miller: Number one, anybody can get on and figure out their body mass index. That would begin to guide them into terms of whether they're overweight or obese or class one or class two.

Dr. Volckmann: Absolutely.

Dr. Miller: The next thing I think we could talk about is why do we do this, why do we look at people's body mass index. I think it's because, as we talked about previously, certain levels of health are associated with having a normal body mass index. As you climb that body mass index scale, the risk of bad things happening gets higher. Is that right?

Dr. Volckmann: That's correct. As your body mass increases, your risk of dying increases. If you compare the mortality of someone with obesity, even class one obesity, to someone who's normal weight, the risk of dying is 50 to 100 percent increased.

Dr. Miller: Some of the medical conditions associated with weight would be metabolic syndrome, adult onset diabetes, high blood pressure, osteoarthritis, sleep apnea and other things.

Dr. Volckmann: Absolutely. Risk of heart attack, stroke, and if you look at someone who's had, for instance, weight loss surgery and you compare them to an individual same weight who hasn't, the risk of dying goes down by about 40%.

Dr. Miller: For those that are listening, number one is to go online, calculate your body mass index, determine where you are in the body mass index scale, and that will help guide your future discussions with your health care provider.

Dr. Volckmann: Yeah. Being a surgeon who treats obesity, one thing I've learned over the years is smoking is terrible for your health, but obesity is not far behind. It adds health risks in a number of categories including cancer, ovarian cancer, breast cancer, colon cancer, bladder cancer. You name it, the risk of cancer tends to be increased with obesity.

Dr. Miller: Obesity, to go on with that a little bit, it's not anyone's fault per se. It's the culture that we live in now, right? If we lived in a society where we had less access to high-calorie food, it may not be as big a problem. I think we're dealing with this in first world countries. Would you agree with that?

Dr. Volckmann: Yeah. I think we eat a lot of processed foods that tend to be high in calories. We tend to live somewhat sedentary lives. Portion sizes are increasing all the time. Obesity is a problem that's definitely on the rise in the United States. There are over 75 million people who suffer from obesity. That ends up being about one in three individuals. Right here in Utah, the obesity rate is just over 24%, so almost one in four individuals qualify as being medically obese.

Dr. Miller: Wow, that's impressive. Those are impressive statistics. One of the other things I wanted to ask you about is do you find that patients are disturbed by the term "obese" and does that turn a lot of people off, or do you find that people are more accepting of that these days?

Dr. Volckmann: I don't really find that that term turns people off in my clinic. Part of it is because people come to one of our bariatric surgery information sessions and we talk about obesity from a medical standpoint, what is obesity as it pertains to . . .

Dr. Miller: It is a medical term.

Dr. Volckmann: We talk about it as it pertains to body mass index. I think a lot of it depends on the delivery. If it's coming from a place where you're wanting to genuinely help someone improve their health, I think patients recognize that. I haven't found in my practice the discussion of obesity in patients' weight is problematic, although that's a question I get from providers very often.

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