Ethan Lazarus, Speaking:
I’m Ethan Lazarus. I’m a family doctor board certified in Family Medicine and Obesity Medicine. I’ve been practicing full-time obesity medicine since 2004. As a family doctor I spent 5 years watching my patients get sicker and sicker. I was putting my patients on insulin, cholesterol drugs, anti-hypertensives, and watching them get heavier, and as they got heavier I needed to pile on more treatments. As an obesity medicine doctor I get to take patients off of all those medications.
Weight is not just a function of how much we eat and how much we exercise. In fact, the main two drivers of a person’s weight are genetics and environment. When I explain this to an individual, they shake their head – they say, “It’s how much I eat.” Even doctors shake their head at me saying “That’s not true!” but it is. Because if you think about it, each individual that I see – I might see 1,000 other people that are the same gender, same age, and half are heavier than this person and half are lighter than this person. And you might see that this person maybe they would thrive in a different environment. Maybe if they become a Yoga instructor instead of a computer programmer their weight wouldn’t be such an issue for them.
So there needs to be a genetic predisposition and then the environment brings out the weight problem. So when we just focus on the food we’re missing the two main drivers – we’re not addressing the genetics and we’re not addressing the environment. So we really need to look at why the person got into trouble and not just treat the weight with a diet.
A lot of the patients that come in to see us have diabetes, high blood pressure, low thyroid, high cholesterol and a lot of patients have been placed on multiple medications by their other treating physicians many of which may be contributing to the weight and if we don’t deal with those other medications then the likelihood is the person will regain the weight as soon as they’ve lost it from the diet.
The second issue is that individuals of weight often have other medical problems. It’s my experience that as patients get heavier they receive a lower quality of medical care and things get missed. So if I have a patient that’s heavy and it was missed that they have a low thyroid, and we don’t treat the thyroid, then they are going to get into trouble keeping the weight off. Or if they don’t address the mood, or don’t address the insomnia, the depression, the anxiety, the nighttime eating – then we’re not going to have successful weight loss.
And then when we look at the environment most people don’t have an ability to just go out and change the environment. We can’t just change our relationships change our work environment change our food environment. So really if we’re going to address the environment we have to make structured behavioral changes where we go one tiny little step at a time. And when we string all those tiny steps together, now we can start to reshape the environment.
When people do commercialized diets or do-it-yourself type diets they are not going to be able to reshape their environments this way or by reading a book. Most people need a whole lot more help than that so we like to really get to know our patients and work with them so we know what’s causing the problem and we can educate our patients in terms of making these specific changes.