MANAGING YOUR CV RISK: the Obesity Paradox pt 1: What is it? Who cares?

Learn how to predict & prevent heart attack & stroke:

Learn how to reduce & reverse arterial plaque:
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ABOUT THIS VIDEO: This video is about the OBESITY PARADOX. What is it? Who cares? Why is it important? The bottom line is it's important for managing your heart attack risk. In fact, which is more important - weight loss or exercise? That actually depends on your age, weight and RFM ( Relative Fat Mass).

ABOUT DR. BREWER
Dr. Brewer started as an Emergency Doctor. After seeing too many preventable heart attacks, he went to Johns Hopkins to learn Preventive Medicine. While there, he went on the run the post-graduate training program (residency) in Preventive Medicine. From there, he made a career of practicing and managing preventive medicine and primary care clinics. His later role in this area was Chief Medical Officer for Premise, which has close to 1,000 primary care/prevention clinics. He was also the Chief Medical Officer for MDLIVE, the second largest telemedicine company. More recently, he founded PrevMed, a heart attack, and stroke prevention clinic.

At PrevMed, we focus on heart attack, stroke, and cognitive decline. We serve patients who have already experienced an event as well as those who have not developed a diagnosis or event. Dr. Brewer provides services via telemedicine or in person if you're in the Lexington, KY area. We find a lot of undiagnosed Pre-Diabetes or Insulin Resistance. Treating unrecognized risk factors like Pre-Diabetes allows reduction of risk and prevention of disease.

[stevet]

Thanks for another informative video. I am 70 years old and lift weights as well as mike in the mountains. I am 6' 1" at 212 lbs., which gives me a BMI of 28 - overweight. However, I carry more muscle than the average 70 year old, just by comparing myself in tears of what I can lift to others my age, and I have little fat around my middle.The reason I work on maintaining muscle mass is because of my observation of our aging parents. They got to the point where they could not step up 1 stair. They blamed it on age, but they also did nothing to build muscle thinking that they were too old. Unfortunately, none of their doctors recommended serious muscle building exercise. I hope more older people begin to understand they can get stronger and not accept decrepitude. Thanks again.

[geopietro]

Great video, interesting topic. Thank you.

[frankenz]

That was a problem for me in the past. Under 190 pounds on a (at the time almost 6'3" frame) low immunity was hitting me all the time. Ended up with it setting off shingles at 21. Haven't been right since, and that was over 30 years ago, as it triggered gene of HLA-B27. I was heavier as a teen and lost weight and muscle in very bad ways in my late teens to my early 20's, so muscle loss would explain thanks for bringing that to my attention Dr. Brewer. Had not thought of that. Always afraid of getting under 200 even now because of the past. I struggle to keep muscle mass as I have trouble with inflammation keeping me off my feet....literally.

[wcbibb]

Having a good appetite might indicate being healthy. If you are thin and sickly, you might be unhealthy to begin with. You might weigh less but are by no means more healthy. You might not feel like exercising. A little fat on your frame along with extra muscle is a good thing.

[billbucktube]

Dr Brewer, a TED talk by Eran Segal reported that following 2, 000, 000 blood sugar tests correlated with 5, 000 meals, food diary, personal dna and gut biome dna that diet advice is more complex than expected.
One person's blood sugar spikes with rice but not ice cream and another perdon is the opposite
His team developed an algorithm that predicted meal plans that evens out blood sugar spikes.
Do you think that if we were to follow his paradigm and level out blood sugar spikes through diet it would amplify the relative benefits of niacin, rosuvastatin et al?
Thanks

[tenminutetokyo]

I would say not heavier, but stockier. Being too thin can cause diabetes too.

[sapelesteve]

Very interesting Doc! I remember reading somewhere, or perhaps in a lecture, that everyone has a genetic "Set Point" for how much they are supposed to weigh & that trying to change it by losing weight is not an easy thing for them to do. So I guess if someone appears to be obese & the doc reads them the riot act about losing weight, he may be doing them an injustice as their system will always want to return to that set point. I think it's people in that catagory that wind up doing the Yo-Yo routine of constantly losing & gaining weight for most of their lives. Obviously, this does not apply to the morbidly obese population. Any thoughts on this? Thanks

[kinpatu]

Do you believe that lipid control (specifically having very low LDL and total cholesterol) can affect the endocrine system? I’ve had a sharp drop off in testosterone (to abnormally low) levels coincident with rosuvastatin + ezetimibe. I’m having trouble building muscle and am concerned about sarcopenia, as well as other effects.

[billbucktube]

Dr Brewer, of the items to help decrease arterial plaque, what is the order of efficacy? Is rosuvastatin responsible for say 50% of the improvement and ramipril the next 25 %, niacin 15%, etc?
What is the relative benefit of them lined up?
I imagine some of them are synergistic with others so it may be a complicated question to answer.
Thanks

[BombastusParacelsus]

The "obesity paradox" sounds to me like some kind of analog of "plus models" you can find these days in mass media.