Super Size It With Guest, Dr. Allen Kinsler

Map-of-Obesity-ratesUltrarunner, Dr. Allen Kinsler joins us today to discuss his work with low income and homeless populations and the issues of obesity in the US. Seems like rich folks are gaining weight just as fast, maybe faster, but is it for different reasons? And, the new ET Fartlek feature is a fail. I don’t have the energy to play with the audio tracks, so we’ll work the fartleks into the next show… You’ll have to listen to know what that means.

Direct .mp3 file: Super Size It With Guest Dr. Allen Kinsler

Obese show appendix. Allen sent this to me after the show – Lots of complex issues (I think he’s looking to secure a spot on a future show again… hmmm):

Thank you very much for having me on. I think the saliva finally started coming back in my mouth about 30 minutes ago. Totally nervous. Hopefully I didn’t come across as a pompous asshole doctor. The problem is so complex and getting worse. It is a huge source of frustration. Not to mention that the numbers of people out there that are obese are going to overwhelm the medical system. Some would argue that has already happened.

Medicine/medical care, is very personal and can be a sensitive subject. Everyone has their own experiences and there is nothing more personal than one’s health. It was really hard because the way I practice medicine works for me and my patients. Certainly not everyone agrees with me which is why I am always reluctant to discuss this in public forums.

I am big into figuring out the cause and fixing that issue. I do a fair number of joint injections for pain. However I refuse to inject someone’s joint with steroids unless they agree to go to physical therapy. My explanation is that the pain is there for a reason and steroids are getting rid of the pain but not fixing anything. We need to fix the mechanical problem. I get some resistance but it is amazing when they go and sort out the issue and I never have to inject them again. The more economical plan for me is to just keep injecting them every 3-6 months that only really helps me ($). I refuse to work that way.

I got curve balled with the weight loss drug question: I still don’t know the answer as I haven’t looked up the drug. The quick snap shot of all the weight loss drugs thus far are is this: they yield about 10% weight loss (but only in about 50-60% of people, it’s not even a given that if you take the pill you will lose weight. the pills only work as long as you are on them. Drug approval time for treatment is usually less than 6 months, some of the amphetamine based ones are no more than 3 months. In 12 months time after stopping the drug people gain all the weight back. Cost is usually $300+ a month. In my view having someone lose 30 lbs over 6 months for$1800 (not to mention the costs to see me, get labs, etc etc) when they are going to gain it back seems to be pretty futile and a waste.

I do use medications, many are very helpful. However for my chronic disease stuff (diabetes, blood pressure, cholesterol) medications are always accompanied lifestyle counseling and tons of encouragement with the goal that one day we can hopefully stop the pills.

I did attach 2 articles that I tried to incorporate into the show that provide good discussion. They likely make way more sense than I did.

Really appreciate the work you guys put into the show.