Posted on Mar 30, 2022
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Dr. Tim: Hey, everyone. Welcome back to The in with Dr. Tim broadcasting today from the institute. Bute we are super psyched today to have Dr. Cate Varney. Dr. Cate Varney is a board-certified physician of both family medicine and obesity medicine. She’s certified by the American Board of Obesity Medicine and one of the 5,000 positions with this designation both in the US and Canada.
She treats obesity in a primary care setting and bariatric surgical clinic as well where she maximizes weight loss medically and treats weight regain following bariatric surgery which is really key because if we tighten someone’s little belly, and then they gain all the weight back, it’s quite impactful to them and the medical community for the long term. She performs research in obesity medicine and is currently the principle investigator in a study founded by the American Cancer Society. She is also involved in research about the physiological effects of the ketogenic diet and impact of exercise on lean tissue preservation and weight loss.
As an assistant professor at the University of Virginia Medical School – awesome school. Would have loved to have gone there – she designs and implements obesity medicine curriculum for the family and medicine residency. She is a national spokesperson for Obesity Society, the world’s largest scientific society dedicated to obesity. It sounds like she doesn’t have a lot of time outside work. But outside of work, she stays active with her three young boys and her husband and enjoys playing golf, tennis, and skiing. So, thank you, Dr. Varney for joining us today and giving us your time to talk about this critical, critical issue.
As my listeners know – and if you don’t know, we try to bring cutting edge topics to improve your health and performance. And this is probably one of the foremost ones. So, thank you again for being here today and sharing with us your expertise on this issue.
Dr. Varney: You’re welcome. My bio makes me sound a lot more important than I feel that I am. You know me back from the day when I didn’t have all those wonderful credentials behind my name.
Dr. Tim: Yeah. Dr. Varney and I, just so everyone knows, we go way back. We used to practice together here in Ogden, Utah. And Dr. Varney actually was our first medical director for the Positional Release Therapy Institute. Let’s dive into this. In the past, most people want healthcare professionals really believed, “Hey, you’re heavy. Prevent obesity. Just diet and then exercise. And you’re okay.” Right?
Dr. Varney: So easy. Yeah.
Dr. Tim: But here today, I’m hoping we knock down some of these misconceptions and really miss about diet, exercise, obesity. I’ll share with you just a quick little snippet so that people understand. I was obese. And I’ve been obese in periods of my life since childhood. So, at the age of 6, my mother and father divorced. It threw our family in immense poverty. Struggling times. And so, we went on – we didn’t have the best food. Lifestyle changed. Exercise changed. Availability of resources changed. I became obese as a young child. And then between the grades of 8th and 9th grade, I decided I was gonna lose weight. I was a child. I got tired of being teased.
So, that summer, I lost about 150 pounds with no guidance. And so, since that time, I’ve fluctuated. I was, I think in my early 30s, under a lot of stress. And I had shot up to 240 pounds. And I was in class. And my students were taking my blood pressure. And they said, “Dr. Speicher, I think there’s something wrong with the blood pressure cuff.” And I was like, “No. You’re just stressing me out, and I’m eating too much food, and I’m drinking too much beer,” and all these things. So, I went to the doctor. And I said, “Hey, I have high blood pressure. Can you give me some medication?” because my brother was on medication. It worked for him.
And he’s like, “Look. I’m not a big fan of putting you on blood pressure medication.” He said, “Why don’t you just lose weight?” And I was like, “Oh, okay.” So, I exercised like crazy. But the problem was I was exercising so much crazy. I was just eating more because I was exercising more. And I hadn’t really changed the way I ate. And so, I didn’t lose weight. And it took a really radical change for me in my behavior to get back down to a manageable blood pressure. My blood pressure at that particular time was about 170 over 110.
Dr. Varney: Whoa.
Dr. Tim: Yeah. So, when I lost 60 pounds, my blood pressure dropped to 110 over 50. Now I’m not saying I still don’t have issues and I don’t struggle with that. But I was able to bounce back. So, diet, exercise. Did it work for me? It’s debatable because I still have some high blood pressure. And I still struggle with some of my eating behaviors. So, why is it just not diet and exercise, Dr. Varney?
Dr. Varney: Gosh. You hit on so many things that I like to try to relay to my patients. I hear these things that you said that I tell my patients. You rarely ever hear somebody say, “Well, I had obesity once in my life. But I exercised and diet, and I lost it. And I’ve never had an issue again.” You always hear the same thing. “I’ve struggled with this my whole life.” So, there’s genetics. There’s genetics. There’s epigenetics. There’s psychological. And there’s environmental. That divorce was probably really traumatizing to you as a child whether you’re aware of it or not.
Being forced into poverty, we know that people that don’t have access to food and resources like the gym and – poverty increases your risk of obesity exponentially. So, it’s not just diet and exercise. It was these combination of things. Can you lose weight with diet and exercise? Absolutely. But it’s one of those situations where you’ve already got the genetics. You’ve got the psychological. The environment is set up. And then you add one more thing like access to not having fresh fruits and vegetables or non-caloried and stuff, and it piles on and on. And it just makes it increasingly more difficult.
I tell people that in – so, the second thing you said – you were like, “As soon as I exercised more, I get hungrier. I get hungrier.” And that’s a beautiful mechanism that is ingrained in our body. Our body is perfect. This is why we have survived for thousands of years as a human species is that there’s all these protective mechanisms. If you increase energy, your body thinks that you’re being chased around like a lion, so you need more energy. You need more fuel. So, it increases all these hormonal signals that says, “Eat, eat, eat.” So, we’re perfectly designed. But we’re not perfectly designed to be in this environment where food is plentiful, it’s calorie dense.
We have all these people that have obesity. But we say they’re malnourished because they’re not eating nutritious food. We have all these really super calorie-dense foods that shelf-stable that are working against us. So, all of these factors together just set people up for having higher rates of obesity.
Dr. Tim: And one of the things that I’ve been thinking these last two years particularly – prior to going into COVID land, back when it hit us and primarily March 2020, I had decided to really get in shape for my 50th birthday. And so, I was doing really well. And then COVID happened. And they shut down all the gyms. We’re at home. My wife’s baking all the time. It was twice a day. We’re having stress. And I completely went off track. And I think that the majority of the population also went off track. And also, with school shutting down, sports shutting down, athletic events shutting down, we are now aware that actually, we made the obesity problem worse.
And it appears it’s going to trickle forward in the future at least by current reports. So, I at that time really became aware as we started to move into the COVID pandemic that being overweight was a big deal, that I didn’t wanna be susceptible to having COVID because I think we now know that obesity is just second to age as far as your biggest risk factor of getting COVID. And you can speak to some of these stats too. But it appears now that we know that countries with a high BMI average – and maybe you can talk about that for people who don’t understand what BMI is – is that it puts us at extreme risk of not only contracting COVID, not doing well with COVID, and then dying from COVID, itself.
I think the latest estimate is upward near 80 percent of those who contract COVID are obese or overweight. And I think it’s almost – it’s at 90 percent or close to – somewhere in the 90 percent to 100 percent range that those who die of COVID, there’s a high correlation that they’re obese or they’re overweight. And I am very pro-vaccine in a sense of those who need it. But I’m almost thinking our best protection maybe against some of these viruses and illnesses in general is not being overweight or heavy.
Dr. Varney: Yeah. It’s really interesting. Last night, one of my friends sent me a link to a presidential press conference back in January where one of the reporters had asked the press secretary, “Why is Biden not pushing – we know that people that have obesity are not doing well. Why is Biden not pushing healthy lifestyles in addition to the vaccine?” You can tell she started squirming. She felt super uncomfortable. Nobody wants to talk about this.
Dr. Tim: What? Obesity? Or obesity in relation to COVID?
Dr. Varney: I think obesity in general because I think – she goes, “Well, we really rely on our public health officials to tell us what we need to echo to the public.” And I was just thinking, “We’ve been screaming this for years.” And the time to do something about obesity – we should have been doing something back in 1990 when we saw this huge spike from 1970 to 1990.
The obesity rates just skyrocketed. We should have done something back then. But we’re so reactive to this. And now unfortunately, we’ve gotten to this position where we’re behind the eight ball. But I think there’s this thought of – and let me say before I go on is that the vaccine is something that is immediate. Within two weeks, it can give us immediate protection. And weight loss takes time. But we need to act now. So, actually today, happy World Obesity Day. Today is World Obesity Day.
Dr. Tim: Oh, is it today? Is today the day?
Dr. Varney: Yeah.
Dr. Tim: Wow. How serendipitous –
Dr. Varney: One of the things that I put on my Twitter account was the time to act is now. In fact, the time to act was, again, years ago. There’s, in healthcare or in the literature, this, what I believe is the myth of metabolically healthy obesity where these are patients that have obesity, but they have yet to develop high triglycerides or dyslipidemia or glucose intolerance or diabetes or high blood pressure.
But just as what you had mentioned – so, that high blood pressure for you was probably creeping over the years. And what we see is that it’s not just obesity is just a light switch, that it just all of the sudden then were metabolically unhealthy. It’s a creep. And I think one of the biggest things that I see is not recognizing diagnosing and treating insulin resistance which can proceed – so, glucose intolerance prediabetes, diabetes by 10-15 years. But insulin resistance in itself makes losing weight super, super, super hard.
Dr. Tim: And I would love to get into that because here at the institute, I hate to say it, but probably half or more of our patients are overweight or obese. And we see them often have problems with medical issues, conditions, knee pain, back pain, things of that nature.
I even have some employees who – obviously, all of us could stand to lose a little weight, including myself. So, I often have patients say to me, Dr. Varney – they’re like, “Well, I know I might be a little heavy. But my doctor says all my blood tests are fine. So, I don’t really feel I need to lose weight because I’m active. I eat well.” But at the same time, I’m looking at their circumference of their waste which I think is a predictor of obesity.
Dr. Varney: The worst type of fat.
Dr. Tim: And so, they have a gut, a big gut. The rest of them maybe not so bad. But they’re not like I think what most people think of obese individuals. We think of morbidly obese. Like you can’t get out of bed or you can’t get through a door, you can’t sit in a seat. I think that’s changing from understanding now that you don’t want that. But just because you’re carrying extra weight, it’s just as impactful.
And what you said, we might not see these other, larger things develop like type 2 diabetes until later. But we’ve got these signals. We’ve got these body composition changes that are giving us signals that we’re going down that path. So, maybe you can clarify that for us for those who are listening and watching. When is it a problem? Because there’s different definitions of being overweight and obese.
Dr. Varney: It’s always a problem because if you look at the studies, the increased risk of cardiovascular disease, of chronic kidney disease, of diabetes is so much higher. Even cancer rates are so much higher in these patients that go from the overweight category, which is a BMI of 25 to 29. So, the overweight. And then when you go into obesity, then it really starts to skyrocket with your risk. When I work with bariatric patients, I tell them – if they’re starting before bariatric surgery, and they have a BMI of 50, the chances that they will attain a normal BMI, a BMI of 25 or less, it probably is not gonna happen. But I tongue in cheek joke with them this is not about looking good in a bikini.
This is about your metabolic health. And obesity can rob you of, on average, eight years of your life. Think about eight years. For us with kids, eight years of their life, how much you would miss. And so, when I tell them – I go, “When we go from a 50 to 40, if we can get you in a BMI of 30, that is huge. We have added so much time to your life.” And so, there’s two things we think about with obesity. We think of sick, adiposity disease. And then we think of what we call fat mass disease. So, fat mass disease is that just the presence of this excess weight is causing problems. So, we see that with sleep apnea.
So, the excess redundant tissue up here, it closes off the airway, and they get sleep apnea which is devastating. It increases your risk of coronary artery disease, your chances of heart failure.
Dr. Tim: Another thing too is just having the mass on your lungs and chest, your belly, your diaphragm – this high tier too is also impactful to your breathing with the sleep apnea piece.
Dr. Varney: Yeah. There’s actually a diagnosis code of obesity hypoventilation syndrome. So, you just can’t breathe. And that was one of the things with COVID that we saw very early on. How did we have to position these patients so they could breathe? Face down. So, when they were on their backs, it was so hard for them to breathe. So, when they put them in the prone position, facing down, it allowed them to ventilate the posterior aspects of our lungs that don’t get as much. So, they were getting more surface area to breathe.
Dr. Tim: I hadn’t made that connection. When I saw on TV when this whole thing was going down, and physicians, ICUs were facing patients face down, I was thinking, “Oh, well that’s just because of the COVID.” I didn’t make the connection because – I don’t know if I should say this. I don’t know. How do we say this? They were fat? They were –
Dr. Varney: They had obesity. They had obesity. It is a disease.
Dr. Tim: Yeah. And you had mentioned this. We don’t wanna talk about obesity. And with COVID, it was shied away from. And I picked up on different people saying, “Well, if we talk about obesity, we are ‘fat shaming’ people.”
And so, how do we navigate that? Because as we’ve talked, this is a big issue. It’s killing people. It’s [inaudible] [00:19:51] a disease. You can’t breathe. And you can’t sleep at night. You’re getting sleep apnea. And there’s all kinds of issues with that, with not getting oxygen to your brain and so forth. How do we get around that? How do we get around talking about this very sensitive issue and not having people feel like we are calling them out?
Dr. Varney: Right. I think with obesity is that it would be one thing – it’s one thing for us to talk about it as healthcare providers and physicians, to say, “You have obesity. This is what it’s doing. And oh, by the way, just eat less and exercise more,” which is really crappy advice.
So, I think it would be easier to tell people, “We really care about your health. And part of your health and part of your treatment plan is I’m gonna put you on this medication for your blood pressure. Also, let’s think about dietary changes. Let’s think about movement changes.” So, they don’t do a very good job, Tim, of educating us in medical school. On average, we get about 10 hours in four years of medical school lectures, 10 hours on obesity.
Dr. Tim: And I heard a crazy thing too. I think this is – I can’t remember his name. He’s a physician who is really a huge advocate for trying to get more nutritional training classes into medical schools. I think he wrote How Not to Die. You might be familiar with him. I can’t remember his name. I apologize. But he had said that medical schools really don’t have a nutrition-based curriculum whatsoever at all, that most physicians know very little about nutrition as medicine.
Dr. Varney: Yeah. I had to go back for this training. So, my primary board certification’s in family medicine. But I sat across from my primary care physician when I was struggling with the disease of obesity. And I said, “I need help.” And I love them as a person. But they said, “Okay. Cate, you’re a doctor. You know what to do. You just need to eat less and exercise more.” I’ve never tried that. I tell my patients all the time – I’m like, “I’ve been on a diet since I was in 4th grade.” Of course. It’s really defeating and impactful for somebody with obesity to, No. 1, say, “You have obesity. And we need to address this.”
And then say, “Here is some really bad advice that you’ve been told and you’ve actually done thousands of times in your lifetime. And you’re probably not doing it right. And you fail because you’re not doing it right.” So, to me, I feel like – and as somebody in remission from obesity, you feel hopeless. And you feel like, “Well, why should I keep on trying to do this over and over, and I just fail?” So, for you, as a rock climber, if you for five, 10 years, you are traininGo back