As a physician first and plastic surgeon second I know enough about metabolism, nutrition, exercise, and the fact that no operation, procedure, therapy, or drug has all benefits and no downside to know that this too- the Ozempic fad- will pass. Obesity is complex, but not in the way suggested by ideological zealots who include climate ch…
As a physician first and plastic surgeon second I know enough about metabolism, nutrition, exercise, and the fact that no operation, procedure, therapy, or drug has all benefits and no downside to know that this too- the Ozempic fad- will pass. Obesity is complex, but not in the way suggested by ideological zealots who include climate change and the patriarchy in its causes. The UK has it basically correct. Not everyone is destined genetically to be thin as determined by some arbitrary scale, such as the BMI chart. An NFL linebacker weighing 280 lb with less than 5% body fat will be obese on that chart. Obesity is much like porn, sometimes not easy to pin down, but you know it when you see it. You don't need a scale. I counsel overweight and obese patients every day and I always tell them the same thing. The equation for weight gain, overweight, and obesity remains the same as it always has: calories in must equal calories out or you will gain weight. We are not plants and cannot manufacture calories from sunlight. No one, shy of very uncommon hormonal disorders, will gain weight if they consume fewer calories than they expend. The challenge is to find the sweet spot where a person is comfortable, feels good, and has a good quality of life. Nothing has replaced a healthy, limited calorie, largely plant-based diet combined with a program of regular physical exercise in maintaining weight and, more importantly good health and well being. That equation is too simple, or too hard, for too many people. As to the obese body positivity ideologues who relentlessly push the message that they are happy in their bodies, I am not buying it. I believe they are trying very hard to convince themselves that what they see in the mirror, and feel, is not real. Is there such a thing as self-gaslighting? As with so many "revolutionary" things in medicine, we will find that there is a real downside to Ozempic and one day we will ask, "Whatever happened to that Ozempic thing?" Mark my words. R. Bosshardt, MD, FACS
I want to try it. Do you think it's safe? I want to lose about 20lbs. Yes. I eat well and go to the gym, but I want to lose it quickly for the summer. Thoughts?
I cannot recommend it for two reasons. 1. I do not know enough about it to speak confidently as to its safety and effectiveness 2. I know enough about the human body and have seen enough of these "magic bullets" come and go, e.g. fen phen, to know that none of them seem to deliver on their promise. Nothing has replace a mindful, consistent program of healthy diet and exercise, but that is either too boring, too difficult, or just doesn't make anyone rich.
I recently did a BMI analysis with my nutritionist to level set my starting point, as I wanted to address my glucose number trending up over the past few years. I’ve got 40,000 miles on the road bike over the years and still exercise (cycling and lifting) 5 to 6 times a week. My diet was good, but as I learned, too many simple sugars and carbs. The BMI was “normal” in every reading. For a 61 year old that’s pretty good. But I learned that just to be “normal” you have to work your ass off. Something most people will not do. I’ve since deconstructed my diet and replaced all the simple sugars and carbs will healthy fats, proteins, etc… to feed my body. Lost a few pounds, which I did not need. My glucose dropped like a stone. So now I am more educated about what I should put in my mouth, which allows me to make better choices.
When the call from my family Dr. came to alert me of the rising glucose, the message was: reduce your sugar. Not how, not who to go see, just figure it out by yourself.
Brian, at 51, I get it. I do spin class 4 days per week and generally turn down sweets to maintain my weight and health. I do try to focus more on protein at each meal, when I’m on target. It’s not always easy.
A blood sugar scare in my 40's led me to KETO. I hesitate to mention it because most people assume it means butter and bacon at every meal. It could, but for me it means I eat more chicken or steak and a lot more veggies, skipping the rice that is served with the meal. I lost 30 pounds, blood sugar returned to normal and even my cholesterol dropped.
Exercise has never been an issue - I run, walk, and cycle - but not quite to your level.
It is hard work - there is sugar in everything! Everything! This means prepping and cooking more whole foods and almost completely avoiding the standard American diet
I agree with you, Richard. Calories in must equal calories out. But Ozempic and its pharmaceutical cousins are here to stay, I'm afraid. Vanity will win out. As it always does.
This is the 21st Century's version of Viagra. The quick fix is in..
Lee, must ask, why would you throw Viagra in this comment? There’s nothing wrong with ED medicine for men who truly need it. A former partner had prostate cancer in his early 50s and needed ED medicine if we were going to be intimate. There’s nothing wrong with that. I get really tired of people slandering ED medicine as if it’s the problem.
Good point. Ozempic use for diabetes and health threatening obesity I agree is not for vanity or ego. It should be prescribed. I was referring to the casual use of a serious drug for reasons that are not health threatening. I used Viagra as an example (perhaps a bad one..). Its use is very often quite casual, as men who are not stricken with any illness take it as well. But it's use by men who are compromised by a health problem I heartily endorse.
Not vanity. Credibility. Anyone can comment and voice an opinion and that is their right. My opinion was based on 45 years as an MD. Perhaps it was redundant since I mentioned at the top of the comment I am a physician and plastic surgeon. I wanted to be clear what my expertise is. I also have 25 years of writing a medical column in the Orlando Sentinel and have a broad fund of knowledge from my research for that. I have a strong interest in wellness and health. Sorry if I offended or sounded like I was putting on airs. Rick
Well said. It is a simple equation, yet the difficulty lies in its execution. This is because the person who gains 500 pounds won’t be the same person who loses it. An internal shift in habits and values must occur. Medicine, with its emphasis on external interventions (drugs, injections, and surgery), is ill-equipped to encourage its patients to change their lifestyles. Wegovy is certainly effective, but I fear it may be so effective that we begin to outsource basic health to Big Pharma, and behaviors and choices will no longer matter.
Good observation. I think the outsourcing you describe has already occurred. A significant part of the problem is that medical doctors are not schooled in pharmacology. That is why the drug rep business is so good. Anyone required to take prescription meds routinely or often should deal with a good, independent pharmacist.
What a shame your very insightful and relevant expert comment is not "liked" to the top instead of the one with men-babies crying over perceived slight over "patriarchy".
Every day I pass a gym in my woke NYC neighborhood that proclaims "IN THIS GYM, WE BELIEVE ALL BODIES ARE BEAUTIFUL." (among other shibboleths of the left). Huh, isn't the purpose of a gym to change your body to a stronger and more healthy one? At least it gives me my daily laugh as I never tire of mocking their pretensions.
The gym is in the business of signing people up and getting them to pay their monthly dues. They sell hope, so making people feel comfortable enough to sign up is perfectly good marketing. It may be a “shibboleth of the left” in other circumstances, but in this one, it’s fine.
No, the gym isn't for the woke dolts. I don't think they are selling the "fat positivity" aspects; they are selling to people who are "fat positive" but hope otherwise.
Sorry, as the doc mentions above - a linebacker weighing 280 will fall into the obesity scale. Saying they believe all bodies are beautiful could actually just be a way to welcome people in that feel shame about their bodies. Shame is a self-feeding loop. A lot of people don't go into gyms because they feel out of place. Meanwhile, if obese people DID go to gyms, even to do low impact exercise, it would benefit them greatly. They SHOULD welcome all bodies - not all bodies react the same to exercise. I will never be 'thin' because I have a frame that lends itself to curves and muscles. and i'm cool with that - never a size 4 but i'm fit AF.
I totally agree. I see a really fat person out walking and my first thought is, "that is not a good look", but it is quickly followed by "that is inspiring that somebody is doing SOMETHING in spite of any potential embarrassment". I consider it paying my dues when I get overweight and have to look less than elegant while working out. I have ONLY myself to blame for any consequences once I know how to fix it.
Thanks doc, I don’t know how many diet programs there are out there telling people calories don’t matter. As though the laws of thermodynamics can be dismissed. But one of my nutrition professors had a great line, which I remember 40 yrs later---“It is easier to change your sex than your eating habits”. A bit facetious, but makes the point about cultural food habits being pretty set. Overzealous dietitians are not going to persuade people in the south to give up pulled pork and corn bread, so teach smaller portions. Gradually. And walk. Everywhere.
I'm reminded of Woody Allen's 1973 film "Sleeper", which, in one scene, made fun of the often transient nature of accepted "wisdom" regarding diet: two doctors are discussing Woody's character, who has recently been revived after spending 200 years in suspended animation after a surgery gone wrong:
Dr. Melik: This morning for breakfast he requested something called "wheat germ, organic honey and tiger's milk."
Dr. Aragon: [chuckling] Oh, yes. Those are the charmed substances that some years ago were thought to contain life-preserving properties.
Dr. Melik: You mean there was no deep fat? No steak or cream pies or... hot fudge?
Dr. Aragon: Those were thought to be unhealthy... precisely the opposite of what we now know to be true.
Yeah. It was a nice idea. I think it can’t be a mandate from on high, but somehow needs to arrive from the families themselves. That is unlikely because of the policies that keep people dependent on government assistance. There’s no win.
Yeah and telling them that they can't lose weight because of racism and/or climate change doesn't help.
The system will do anything to tell "you" that you have no power to change your circumstance. That you need "them" to change because blah blah blah.
Find someone who has fell for that victim BS and with love and compassion help them see the truth. That is how we can change our society and help each other.
And this is not me saying people SHOULD lose weight. But if people want to lose weight they should do it in a healthy way, not with drugs that cause life altering side effects.
Regardless of your size, you should love yourself. It makes life so much better. :)
As a physician first and plastic surgeon second I know enough about metabolism, nutrition, exercise, and the fact that no operation, procedure, therapy, or drug has all benefits and no downside to know that this too- the Ozempic fad- will pass. Obesity is complex, but not in the way suggested by ideological zealots who include climate change and the patriarchy in its causes. The UK has it basically correct. Not everyone is destined genetically to be thin as determined by some arbitrary scale, such as the BMI chart. An NFL linebacker weighing 280 lb with less than 5% body fat will be obese on that chart. Obesity is much like porn, sometimes not easy to pin down, but you know it when you see it. You don't need a scale. I counsel overweight and obese patients every day and I always tell them the same thing. The equation for weight gain, overweight, and obesity remains the same as it always has: calories in must equal calories out or you will gain weight. We are not plants and cannot manufacture calories from sunlight. No one, shy of very uncommon hormonal disorders, will gain weight if they consume fewer calories than they expend. The challenge is to find the sweet spot where a person is comfortable, feels good, and has a good quality of life. Nothing has replaced a healthy, limited calorie, largely plant-based diet combined with a program of regular physical exercise in maintaining weight and, more importantly good health and well being. That equation is too simple, or too hard, for too many people. As to the obese body positivity ideologues who relentlessly push the message that they are happy in their bodies, I am not buying it. I believe they are trying very hard to convince themselves that what they see in the mirror, and feel, is not real. Is there such a thing as self-gaslighting? As with so many "revolutionary" things in medicine, we will find that there is a real downside to Ozempic and one day we will ask, "Whatever happened to that Ozempic thing?" Mark my words. R. Bosshardt, MD, FACS
I want to try it. Do you think it's safe? I want to lose about 20lbs. Yes. I eat well and go to the gym, but I want to lose it quickly for the summer. Thoughts?
I cannot recommend it for two reasons. 1. I do not know enough about it to speak confidently as to its safety and effectiveness 2. I know enough about the human body and have seen enough of these "magic bullets" come and go, e.g. fen phen, to know that none of them seem to deliver on their promise. Nothing has replace a mindful, consistent program of healthy diet and exercise, but that is either too boring, too difficult, or just doesn't make anyone rich.
Wise words--thank you
I recently did a BMI analysis with my nutritionist to level set my starting point, as I wanted to address my glucose number trending up over the past few years. I’ve got 40,000 miles on the road bike over the years and still exercise (cycling and lifting) 5 to 6 times a week. My diet was good, but as I learned, too many simple sugars and carbs. The BMI was “normal” in every reading. For a 61 year old that’s pretty good. But I learned that just to be “normal” you have to work your ass off. Something most people will not do. I’ve since deconstructed my diet and replaced all the simple sugars and carbs will healthy fats, proteins, etc… to feed my body. Lost a few pounds, which I did not need. My glucose dropped like a stone. So now I am more educated about what I should put in my mouth, which allows me to make better choices.
When the call from my family Dr. came to alert me of the rising glucose, the message was: reduce your sugar. Not how, not who to go see, just figure it out by yourself.
Brian, at 51, I get it. I do spin class 4 days per week and generally turn down sweets to maintain my weight and health. I do try to focus more on protein at each meal, when I’m on target. It’s not always easy.
Yes, the point being - it is hard work.
Work that too many people don’t want to do.
A blood sugar scare in my 40's led me to KETO. I hesitate to mention it because most people assume it means butter and bacon at every meal. It could, but for me it means I eat more chicken or steak and a lot more veggies, skipping the rice that is served with the meal. I lost 30 pounds, blood sugar returned to normal and even my cholesterol dropped.
Exercise has never been an issue - I run, walk, and cycle - but not quite to your level.
It is hard work - there is sugar in everything! Everything! This means prepping and cooking more whole foods and almost completely avoiding the standard American diet
I agree with you, Richard. Calories in must equal calories out. But Ozempic and its pharmaceutical cousins are here to stay, I'm afraid. Vanity will win out. As it always does.
This is the 21st Century's version of Viagra. The quick fix is in..
Lee, must ask, why would you throw Viagra in this comment? There’s nothing wrong with ED medicine for men who truly need it. A former partner had prostate cancer in his early 50s and needed ED medicine if we were going to be intimate. There’s nothing wrong with that. I get really tired of people slandering ED medicine as if it’s the problem.
Good point. Ozempic use for diabetes and health threatening obesity I agree is not for vanity or ego. It should be prescribed. I was referring to the casual use of a serious drug for reasons that are not health threatening. I used Viagra as an example (perhaps a bad one..). Its use is very often quite casual, as men who are not stricken with any illness take it as well. But it's use by men who are compromised by a health problem I heartily endorse.
I should have been clearer, sorry.
You put MD after your name on substack? Vanity!
Not vanity. Credibility. Anyone can comment and voice an opinion and that is their right. My opinion was based on 45 years as an MD. Perhaps it was redundant since I mentioned at the top of the comment I am a physician and plastic surgeon. I wanted to be clear what my expertise is. I also have 25 years of writing a medical column in the Orlando Sentinel and have a broad fund of knowledge from my research for that. I have a strong interest in wellness and health. Sorry if I offended or sounded like I was putting on airs. Rick
Well said. It is a simple equation, yet the difficulty lies in its execution. This is because the person who gains 500 pounds won’t be the same person who loses it. An internal shift in habits and values must occur. Medicine, with its emphasis on external interventions (drugs, injections, and surgery), is ill-equipped to encourage its patients to change their lifestyles. Wegovy is certainly effective, but I fear it may be so effective that we begin to outsource basic health to Big Pharma, and behaviors and choices will no longer matter.
https://buildingdocs.substack.com/p/medical-alchemy-miracle-drug
Good observation. I think the outsourcing you describe has already occurred. A significant part of the problem is that medical doctors are not schooled in pharmacology. That is why the drug rep business is so good. Anyone required to take prescription meds routinely or often should deal with a good, independent pharmacist.
What a shame your very insightful and relevant expert comment is not "liked" to the top instead of the one with men-babies crying over perceived slight over "patriarchy".
Self-deception
Every day I pass a gym in my woke NYC neighborhood that proclaims "IN THIS GYM, WE BELIEVE ALL BODIES ARE BEAUTIFUL." (among other shibboleths of the left). Huh, isn't the purpose of a gym to change your body to a stronger and more healthy one? At least it gives me my daily laugh as I never tire of mocking their pretensions.
Brilliant business model - target people who are going to sign up and never show up. Revenues up, costs down!
Lol....gyms are "woke."
The gym is in the business of signing people up and getting them to pay their monthly dues. They sell hope, so making people feel comfortable enough to sign up is perfectly good marketing. It may be a “shibboleth of the left” in other circumstances, but in this one, it’s fine.
So it's just a magnet for other woke dolts?
Got it.
No, the gym isn't for the woke dolts. I don't think they are selling the "fat positivity" aspects; they are selling to people who are "fat positive" but hope otherwise.
Sorry, as the doc mentions above - a linebacker weighing 280 will fall into the obesity scale. Saying they believe all bodies are beautiful could actually just be a way to welcome people in that feel shame about their bodies. Shame is a self-feeding loop. A lot of people don't go into gyms because they feel out of place. Meanwhile, if obese people DID go to gyms, even to do low impact exercise, it would benefit them greatly. They SHOULD welcome all bodies - not all bodies react the same to exercise. I will never be 'thin' because I have a frame that lends itself to curves and muscles. and i'm cool with that - never a size 4 but i'm fit AF.
I totally agree. I see a really fat person out walking and my first thought is, "that is not a good look", but it is quickly followed by "that is inspiring that somebody is doing SOMETHING in spite of any potential embarrassment". I consider it paying my dues when I get overweight and have to look less than elegant while working out. I have ONLY myself to blame for any consequences once I know how to fix it.
Thanks doc, I don’t know how many diet programs there are out there telling people calories don’t matter. As though the laws of thermodynamics can be dismissed. But one of my nutrition professors had a great line, which I remember 40 yrs later---“It is easier to change your sex than your eating habits”. A bit facetious, but makes the point about cultural food habits being pretty set. Overzealous dietitians are not going to persuade people in the south to give up pulled pork and corn bread, so teach smaller portions. Gradually. And walk. Everywhere.
I'm reminded of Woody Allen's 1973 film "Sleeper", which, in one scene, made fun of the often transient nature of accepted "wisdom" regarding diet: two doctors are discussing Woody's character, who has recently been revived after spending 200 years in suspended animation after a surgery gone wrong:
Dr. Melik: This morning for breakfast he requested something called "wheat germ, organic honey and tiger's milk."
Dr. Aragon: [chuckling] Oh, yes. Those are the charmed substances that some years ago were thought to contain life-preserving properties.
Dr. Melik: You mean there was no deep fat? No steak or cream pies or... hot fudge?
Dr. Aragon: Those were thought to be unhealthy... precisely the opposite of what we now know to be true.
Dr. Melik: Incredible.
Lol. Remember when Michelle Obama tried to work on healthy school lunches in schools?
Yeah. It was a nice idea. I think it can’t be a mandate from on high, but somehow needs to arrive from the families themselves. That is unlikely because of the policies that keep people dependent on government assistance. There’s no win.
Yeah and telling them that they can't lose weight because of racism and/or climate change doesn't help.
The system will do anything to tell "you" that you have no power to change your circumstance. That you need "them" to change because blah blah blah.
Find someone who has fell for that victim BS and with love and compassion help them see the truth. That is how we can change our society and help each other.
And this is not me saying people SHOULD lose weight. But if people want to lose weight they should do it in a healthy way, not with drugs that cause life altering side effects.
Regardless of your size, you should love yourself. It makes life so much better. :)
"It is easier to change your sex than your eating habits”.
Given the "trans" epidemic, wonder what he or she would say today?
She would say it’s even easier now.