Oprah and Obesity Doctors on the New Way to Lose Weight | The State of Weight | Oprah Daily

[Applause] hi everybody so great to be with you in New York welcome to all the oer daily insiders thank you for watching and so listen this is a conversation i' so excited to have because I know you all have been seeing the headlines and it's blowing up your social media feeds the new weight loss drugs everybody's talking about OIC wovi Manjaro will they change the game on the health battle hundreds of millions are fighting every day more than two billion adults two billion adults that's one quarter of the world's population are overweight or obese and

it's estimated that by 2035 that number is going to reach more than half the world today in most countries y'all obesity I didn't know this until preparing for the show obesity kills more people than malnutrition that was a W for me too so you all know I've been on this journey for most of my life my highest weight was 237 lbs I don't know if there is another public person whose weight struggle has been exploited as much as mine over the years so I am ready for this conversation with me our top experts and this

audience has some interesting questions and opinions and I know many of you watching have on your mind as well so questions like is being overweight a lack of will power or is obesity a medically treatable disease are these new drugs a miracle cure a silver bullet for weight loss can anybody take them are they safe that's what we all want to know so want to introduce our panel Dr Fatima Cody Stanford she goes by Dr Fatima is an associate professor of medicine and pediatrics at Harvard Medical School and an obesity medicine physician scientist at the

Massachusetts General Hospital weight Center Dr Rachel Goldman who goes by Dr Rachel is a licensed psychologist in private practice and clinical assistant professor in the department of Psychiatry at the NYU Grossman School of Medicine Dr Melanie Jay is a primary care doctor board certified in obesity medicine and the director of the NYU langone comprehensive program on Obesity she also works with veterans at the New York Harbor Veterans Affairs and SEMA sistani is the Chief Executive Officer of Weight Watchers I've been an investor and on the board of Weight Watchers since 2015 I invited Sima today

because I know many people want to know where Weight Watchers stands on this issue we're going to get to that so so happy to have you all here so happy to be here okay let's start with this 10 years ago the uh American Medical Association declared obesity a chronic disease now a lot of us miss that but many people can't wrap their brain around what that really means so Dr Fatima I read that you played a central role in that designation a decade ago can you define for us what it means that obesity is a

disease absolutely why do we call obesity a disease we call a disease because there is malfunction in how the body is operating and there's two primary Pathways of the brain that actually regulate weight one pathway is our anorogenic pathway when we hear anorogenic what do we hear we have less food intake and less food storage now we have a different pathway of the brain and when patients have overweight and obesity they're typically upregulating the orogenic pathway of the brain oogenic is the opposite of anorogenic that pathway supports storage of atopos atopos is a fancy word

for fat now I just threw out a lot of vocabulary there yeah but that tells us that there is dysfunction in how the body is regulating weight and it's going on in our brains and it's influenced by the world around us our genetics development environment behavior all play a role in our body's dysfunction or disregulation of our adapost that organ that is fat so what I'm hearing is that it's a brain thing yes and this is a question uh I remember many years ago on the oah show I don't know decades ago now when I

was first having this conversation trying to explain to the public why alcoholism was a disease and many people did not believe that alcoholism was a disease they just thought people over drink and that why don't you just put the bottle down so how is this somehow relatable to that because is every is every alcoh every person that over drinks is not an alcoholic every person that overeats is not necessarily uh uh have have obesity as as a disease can you explain that why for some they're just Overeaters and some is a disease because of the

brain thing right absolutely well it's about how much we take in and how much we store so we all have those friends my husband is here in the audience he's this friend of mine who can eat whatever he wants and he doesn't really store that and you're like how is that even possible uhhuh and then we have those people that look at pizza and they're like my gosh I just looked at it and I feel like I stored it yeah where are your husband um husband is in the back corner over there yeah husband has

a name thank youy Cory oh thank you Cory can eat apple pie at 11:00 at night and he's able to do this body defends a very lean set point he's able to eat what he wants and his body just defends that lean set point if I were to do the exact same behaviors I would store more excess atopos my body is more predisposed to storing more fat damn sure mine is is that the word I've been looking for adapost yes I'm a adapost Storer okay all right all right so that is a that is a

scientific fact that some people's bodies operate differently than others we can accept that right we can see that and for those of us who are at aost stores no matter how many times because you all have watched me diet and diet and diet and diet it it's a recurring thing because my body always seems to want to go back to a certain weight absolutely and that's that idea of weight set point okay there's so that is real that is completely real the brain knows where it wants to be and it's going to do whatever it

can to bring you back to that so that's why you always go back and it's nothing you did wrong it's just the brain is super powerful yeah it is yeah so Dr J you say one way to think about obesity is similar to cancer that it has different causes and it's different for every person absolutely thank you Oprah thank you for hosting such an amazing conversation about such an important topic good you know of course obesity is different than cancer in many ways and what we talk about a lot in terms of what influences whether

or not someone's develops obesity with not just their genes but we talk about social determinance of health so that's what kinds of foods are you exposed to in your environments what kind of opportunities do you have for exercise what kind of stress trauma are you under a lot of my patients you know develop obesity after they you know suffer from personal trauma as doctors we give patients medications that cause weight gain and for some people that leads to increase risk of obesity so there are a lot of analogies between Cancer and other chronic diseases and

obesity but there's not just one cause it's not just that people are eating too much and not exercising enough okay the most I've gotten so far you I'm tracking I think are we tracking is that there's something in some people's brains that works differently than other people's brains your husband's brain is different than yours and we've seen those people who can eat anything they want and seemingly not gain weight and then we're the utop POS holders here adapost adapost yes how do you spell it a d i p o s e okay so we we

the adapost holders know that if we looked at that Apple if I ate an apple pie at 11:00 at night I would be 2 lbs heavier in the morning there's just I I mean I can't eat eat after a certain time yes so when it comes to the National conversation around obesity what are we getting wrong I know you were consultant for that movie The Whale which I thought was so profound thank you thank you and thank you so much for being here and once again this conversation is such an important one and actually in

answering that question I want to add what we're getting right right like we're we're having this conversation and this is huge and the whale similarly you know it's it's a step in the right direction and what we need to continue doing is having these conversations about the fact that obesity is a disease because one of the things that we're getting wrong is this idea that it is calories in calories out and like Dr Fatima just said it's not that for everyone it's that for for some people but it's not for others and people that really

struggle with their weight with their health and with obesity it's not that it's not about moving more and you know eating less and that is what we have to change we have to change that conversation as we're doing here we have to educate more people and raise more awareness about this you know I know that we're going to get push back from a lot of people saying oh now it's a disease overa now you're saying it's a disease how do we make this conversation uh accessible to PE for people to understand that it really is

and that it's not now just a cup out yeah so I think it starts with Shifting the language that we use right so one of the things is you know using people first language for instance you know it's a person with obesity same as we would say with cancer right it's a person with cancer and this is going to start familiarizing people with a person with obesity exactly or a person struggles with obesity so really putting the person first you know we don't want to Define an individual by their medical condition right we don't want

to just label somebody because of their medical condition but the problem with that is it's difficult with obesity I'm I'm admitting it you know I'm an expert in this field but it's difficult because obesity is one of the diseases maybe the only one that we look at somebody and we might know we we don't know if they have obesity but obesity has to do with you know our health but by looking at somebody we see their physical appearance right so so this and not that everybody in larger body has obesity so that's complicated to also

wrap our heads around but it's it's difficult because of that right but it's hard I mean I even have to remind myself sometimes to use that language and to kind of shift that but I think that's a really good place to start is to change the way that we're thinking about this well how do you know when you have when it actually is a disease for you versus it's not your willpower because I'm going to get to you because one of the things that Weight Watchers has been saying all these years is that you know

you just take the blue point and the green points and the red point and that you know and and as we know as a member of the board the blue points and the green points and all those points if you are not meticulous with the points you end up putting the weight back on so now where is Weight Watchers in this conversation well I'll start by saying you know I joined a CEO last year but my um my history with Weight Watchers began in 2013 as a member I gained 60 pounds after having my first

child and even though I know how to live healthy habits my mom who's here is has her PhD in food science she's a registered dietitian so I know how to live healthy habits and I struggled and Weight Watchers helped me because I'm not an out of post carrier right and so what we introduced this we introduced this category almost 60 years ago but unknowingly we introduce the shame also for people who diet and exercise alone was not enough and Dr Maya Angelou said do the best you you can until you know better and when you

know better do better we know better now so we need to be the first to approach this with authenticity and say weight is a spectrum and Weight Watchers as the the doctor number one doctor recommended program it worked for some like me but not all and for those people we don't want them to internalize that as a moral failing obesity is not a moral failing it's a chronic relapsing condition so now Weight Watchers purchased a company that helps people figure out what works for them that's right that's right because it's a spectrum and so what

people need help with is understanding if they're one of those people living in a larger body who has been struggling with the genetic biological environment Al underpinnings of obesity and and so we're now able to do that we're able to provide a broader solution set and and and that's important to address the stigma because as you mentioned with alcoholism heart health is a great example right if you are suffering from high cholesterol or hypertension you still have to have lifestyle intervention right you should quit smoking you should eat better you should move more but for

some you need a Statin medication right you need an Ace inhibitor that doesn't mean you don't also do lifestyle intervention but it's an and and so we want to be clear about that and be the first to say where we got it wrong and where we can do better so that the people who need access to need need to go out and ask for help especially when they've been stigmatized even by doctors in cases blamed and shamed that they can they can look to Solutions and we want to be part of that solution and also

the question that's in the Forefront of my mind is how do you know if it is a disease for you or if you're just an overeater yeah so like SEMA was talking about you know that for some people they really struggle right and and I think the first place to begin is that if you are somebody that has tried on your own making those lifestyle changes and are really struggling to lose that additional weight to get in the healthy you know just to feel healthy then that could be a sign that it's time to seek

additional help right and what I mean by that is get you know go for a consult see your medical provider see a healthare professional and ask be curious you know I heard about this this you know I've tried this it's not working I'm still struggling you know what do you think um and I think that's the first step that you know but it's as SEMA said it's important that you make those changes too right to be healthy overall we want to think about health physical and emotional health you know we need to be moving our

bodies more we need to be consuming nutritious food anyways so I think you know if you're already doing that and you're struggling You Don't See you know that the number change although it's not all about the number we know but you don't see that and you don't feel good in your clothes or if you've tried and failed anded or that y yoing y I've yoyo my whole exactly then that can be a sign that maybe you are somebody that has obesity which is a metabolic disease there's other diseases involved as well and puts you at

higher risk of other conditions then I would say you know it's it's time to see a medical professional so you have obesity you're not obese absolutely exactly you have obesity so I know you all have a lot of question the audience has a lot of questions but before we get to that Dr uh can you uh give us an overview of these medications absolutely and and how they work so there are a lot of medications the ones that have been getting a lot of attention as of late are what we call gop1 receptor agonists go1

stands for glucagon like peptide 1 receptor Agonist okay so how do those meds work how exciting how exciting right let's talk about I had to introduce to you guys this this concept of how the brain regul weight for you to understand how those medications work the primary way in which they work is they upregulate that anorogenic pathway so a lot of people on these meds say I feel different something feels different I don't understand what it is it's because it hit that pathway in the brain that pathway in the brain and guess what I downregulated

the oogenic pathway of the brain so the primary reason why I think these medications are getting this level of attention is that they go right to the source of the problem in the brain they're hitting the brain they're hitting the brain okay so it makes you less hungry but it has nothing to do with your your stomach so so no that's not true so the gop1 receptor Agonist I can't go through all the pathways but the gp1 the the other you feel less full and that's coming from your brain it's coming from your brain but

the gp1s those injectables we've been hearing a lot about they also slow movement through the GI track so let let's just call them by name so the glp ones are o mjo those are some of the key mararo is a gp12 it's actually a dual Agonist so it has two components in it okay I just call it hungry brain and hungry gut and they're talking to each other and these medications help slow that conversation down with the brain and get you to a place if you're somebody who was living with obesity where you can actually

adhere to LIF style changes that come a little more naturally to others but I'm going to I'm going to push back a little bit because there are non-responders to these medications yeah there are people that go in the meds and they're like wait a minute I lost four pounds why did this person over here lose 50 lbs because that must not be the dysfunction in your body and it's okay right so when we see people as a failure even when they go on the medications because it didn't work it's not their fault we are not

they're not atap POS holders it just means that that's not the pathway that's dysfunctional in their body and we're still learning different path Pathways and how they interact and interplay with this complex multifactorial disease so the drugs may not work for everybody exactly and and that's where we can also continue to shift that conversation and use different language because it's not that you failed the drug it's the drug fa exactly absolutely and that's what we have to keep in mind with all of these treatments okay can you all tell us is it better to have

just the glp1 or is it better to have the glp1 combined with whatever the other thing is in monjaro which which is better I we haven't really done yet the head to head right it looks like from the studies that you get a little bit more weight loss with the monjaro because you have that combination and there'll be other combinations coming out by the way so if you're getting confused with all the alphabet soup that Dr Fatima is saying just wait but there's something called Triple G a triple g a Triple G that's coming out

it's called recalde or something ratri ratri yeah baby and so that just that's another G it's another G I'm waiting on the Triple G so that has the G that's the it has the gop1 right you guys got that yep and it's the G and it's got another thing and it has a glucagon receptor in it also so the Triple G gop1 Gip glucose insulin Tropic polypeptide and glucagon the 48 week studies show 24.2% total body weight loss that's exactly what I read8 weeks yes