You Might Be Obese and Not Even Know It | Dr. Vyvyanne Loh

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Jack Heald: Welcome. I'm Jack Heald, and joining me today is Dr. Vyvyanne Loh. Vyvyanne, thank you so much for being with us. What one specific health issue do you want to address today? 

Dr. Vyvyanne Loh: Normal weight obesity. 

Jack Heald: I'm sorry, that sounds contradictory. Normal weight obesity? 

Dr. Vyvyanne Loh: Yes. That means that even though you have a normal weight, And, or normal BMI, you still have obesity and that happens quite a lot.

So if we look at obesity as an abnormal amount of fat in your body, then if you have a high percentage of body fat in your body and you might be a normal weight, you would still have normal weight obesity. 

Jack Heald: Oh, okay. Okay. So you're not. Okay. Commonly understood as overweight, nevertheless, medically, you have obesity.

Dr. Vyvyanne Loh: Medically, metabolically, yes, you have obesity. So for a man, that would be greater than 25 percent body fat, for a woman, greater than 35 percent body fat. 

Jack Heald: So if you're over 25% body fat, you're obese, regardless of your weight. As a man, if you're over 35% as a woman, you're obese regardless of your weight.

Dr. Vyvyanne Loh: Right. You could be a hundred pounds and you could still have obesity. 

Jack Heald: Okay, very good. So why this particular issue? 

Dr. Vyvyanne Loh: Because it gets missed. Nobody thinks of obesity when they see someone who looks thin and that means that the person's health risks are ignored, never addressed. And we think that they're healthy just because we're basing it on how they look, right?

When they may have actually significant health risks based on their body composition. 

Jack Heald: Okay, my next question is always what's the biggest popular misconception about this issue, but you may have already addressed it. I'll just I'll ask the question. What's the biggest popular misconception, conception?

Dr. Vyvyanne Loh: That it, that if you look thin, you're healthy. Right. And that's not true at all, that if you look thin, then by definition, you don't have a weight problem. Yeah. You don't have a weight problem, but you may still have an obesity problem. 

Jack Heald: Okay. So my next question always is what's the truth and it sounds like the truth is you can't depend on the scale to tell you whether you have an obesity problem.

Dr. Vyvyanne Loh: That's right. You can't depend on the scale. You can't depend on those BMI charts. 

Jack Heald: Oh, charts. So the charts are different from what you're talking about? 

Dr. Vyvyanne Loh: So the BMI charts are weight over height squared in metric units. That's how you define your BMI. If you're a normal weight for your height, then likely your BMI is in the normal range, but you may still have obesity.

Jack Heald:: Okay. What are the early warning signs that our listeners could look for? 

Dr. Vyvyanne Loh: It's so insidious that most people don't know they have the problem and worse their healthcare providers don't know they have the problem, right? Sometimes I will have people tell me that, I just feel like I am softer in the middle than before.

Or maybe. Right. And even though their weight has stayed the same as they've aged, they've just noticed changes. They may have a little bit more of the jiggly fat around their waist or under their arms. But they're still staying the same weight. So I'm healthy, right? No, you're not. Not necessarily. 

Jack Heald: So the early warning indicators would be just getting softer without necessarily adding weight.

Dr. Vyvyanne Loh: Yeah, and it, again, really is hard to pick up because unless you do some kind of study like a DEXA scan to evaluate your body composition, you're not going to know. And when you go to your doctor's office, they're just going to have you step on a scale, right? And if that number is the same as the last time you were here, they're thinking that you're maintaining your weight.

But if you lose 5 pounds of muscle and gain 5 pounds of fat you're gonna have the same weight when you step on the scale. But now your body has drastically changed. 

Jack Heald: I've got one of those scales that uses, I think it's electrical resistance to allegedly measure body fat. What do you think about those?

Dr. Vyvyanne Loh: Those are notoriously inaccurate and they tend to give you a much lower number. And so people think that, that's why you 4% or 10% body fat. And that's actually quite abnormal because that would be a different medical condition called lipodystrophy, which means you'd be very sick.

When I hear people tell me that at the gym they had a body fat scale that told them they were 10 percent body fat, that's pretty inaccurate. 

Jack Heald: So this isn't inside the normal questions that I would ask. What are the accurate ways to get this measurement?

Dr. Vyvyanne Loh: The most accurate would be CT and MRI, it's not easy to get those kinds of tests. So the next best thing would be to get a DEXA body composition, which is like an X-ray. And it's the same machine that people use to get their bone density done. It's very quick and there's really almost no radiation to your body.

Very safe. You can do it various times, over the course of a year because there's really no radiation exposure and that will help you follow your body composition over time. 

Jack Heald: Okay. We'll make sure that there are links to that kind of thing in the show notes. That takes us to the meat of the matter. The predicted outcome if we are developing this particular issue and don't do anything about it? 

Dr. Vyvyanne Loh: I think one of the things that people don't realize is as your body composition changes, let's say you are losing muscle and gaining fat, which happens over time with age. That's a normal consequence of aging.

Then essentially you're going to have some issues with. For example, glucose disposal in your body. So your muscles are the biggest sink for glucose. And when you lose muscle mass, that glucose has nowhere to go. And you'll note that over time, you may have increasing blood glucose levels, right? Blood sugar levels.

And you might be tipped over to a diabetic condition, even though you're eating the same food. Doing the same things that you've done most of your life. And this is because over time, if you're not paying attention and you're losing muscle, but you're gaining fat, the weight stays the same, but your body composition has changed and your body now handles glucose very differently.

So people will say, I don't know why I'm suddenly pre-diabetic. I'm eating the same way. I exercise the same, but if you have lower muscle mass, you're then that might be contributing to the higher blood sugar level. 

Jack Heald: It sounds like you're describing the way we develop diabetes and just coming at it from a slightly different angle, a reduction in, and I want to make sure I understand.

A reduction in muscle mass means you have less ways for the body to dispose of it. Blood sugar, glucose in your system, therefore there's more of it bloating around in your blood, which puts a higher demand on your pancreas to produce insulin, which leads to insulin resistance, which leads to prediabetes, which if not treated into diabetes and heart disease and all that kind of stuff.

Dr. Vyvyanne Loh: Yeah. Cause best place for glucose to go would be to into muscle. Tissue, right? But you have a smaller volume of muscle tissue than there's less space for it to go into, let's say, so that's just one consequence. But as you lose muscle mass over time, you actually have a higher rate of dying from anything.

Jack Heald: Is that basically just two ways of saying the same thing? 

Dr. Vyvyanne Loh: You become more frail and so you're less, resistant to different diseases and injuries that you may have over time. So with frailty, your risk of complications and risk of death from anything is always higher. 

JJack Heald: Okay I had a question that's outside the norm just because I was curious and it's out of my head now. All right. Let's talk about the the specific action is find out now what your actual BMI is. 

Dr. Vyvyanne Loh: No, your body composition. 

Jack Heald: I'm sorry, not BMI, body composition. Yes. And the simplest way to do, that's a DEXA scan. 

Dr. Vyvyanne Loh: Yeah, it's the most accurate way that is easily accessible. 

Jack Heald: All right I think I had one done several years ago and as I recall it didn't take long and it wasn't terribly expensive but it was really frustrating because, 

Dr. Vyvyanne Loh: Cause you didn't like the number.

Jack Heald: It revealed the facts that I make, I don't know that I was obese, but I do remember that number must've been pretty close to 25 and I was usually higher than most people think. 

Jack Heald: Okay. There are a million different ways to talk about dealing with this. So we'll, what you should take, what you should do in that event or what you should do to keep from getting there. But we want to stay tightly focused. All right. So normal weight obesity. So what's one of the biggest compliments that you get in your practice? 

Dr. Vyvyanne Loh: Why do I always cry when I come see you, Dr. Loh? 

Jack Heald: You got to unpack that. 

Dr. Vyvyanne Loh: Oh I think of it as a compliment because Patients feel comfortable enough to be vulnerable and to just open their hearts out when they talk to me.

And so there's usually a lot of tears. We have tissues around. My medical assistant used to say, Why do you always make them cry? Why are they always crying when they leave your room? But I feel that it's because, patients feel that they can open up and they feel safe and they can be vulnerable. And to me, that's a compliment. 

Jack Heald: Oh, I absolutely agree. That's pretty rare. Why do you think that happens with you and not usually with other practitioners? 

Dr. Vyvyanne Loh: I don't really know. I just know that I'm interested in the person in front of me, right? The whole person in front of me and it's not just what they've come in to see me for.

I just want to know the person and what they've been going through because that is directly related to their health as well. So that might be it. 

Jack Heald: So what's one of the most common complaints you hear? 

Dr. Vyvyanne Loh: It's really hard to keep the weight off, Dr. Low. So losing weight isn't as tough as keeping the weight off over time.

Jack Heald: What do you say? 

Dr. Vyvyanne Loh: And I say I think your last question is. The eight words. Right. I say the, I say to them, being healthy means being at normal. That's five words. Wow. Right. Because if 90%, if we go by percent body fat, 90% of Americans have obesity. And we know that about 93% of Americans have metabolic dysfunction.

So if you're going to be in that 7-10%, you're in the elite category, which means you're abnormal. So if you're going to be healthy, metabolically healthy, then get used to being abnormal. Right? Which means you're not doing the things that everyone does. Oh everyone, does this or they can do this and that.

And I'm like I gotta choose. You want to be everyone or you want to be healthy and in the elite category. 

Jack Heald: For new listeners, Dr. Loh just answered the last question I always ask, which was, if you could deliver just one message about health and had only eight words to deliver, it in, what would those eight words be?

Dr. Vyvyanne Loh: So I did it in five. 

Jack Heald: Repeat it. Repeat it. Cause that may be five of the most potent words I've heard in a long time.

Dr. Vyvyanne Loh: Also, getting healthy means being abnormal. We add three more words, it would be deal with it.

Jack Heald: That's fantastic. Deal with it. All right. Thank you. Dr. Vyvyanne Loh. I appreciate it. You used a phrase I haven't heard before. Normal-weight obesity, apparently tremendously common. The best thing to do to begin with is figure out where you are. And then there's lots and lots of help for how to get that body composition restored.

Dr. Vyvyanne Loh: And when you do, then just get used to being abnormal. 

Jack Heald: Get used to being abnormal. What is just getting that body fat percentage for men under 25, for women under 35, is that a significant step forward? 

Dr. Vyvyanne Loh: Yeah, it is. And hopefully, at the same time, you're also building or at least preserving muscle mass, right?

People focus on losing weight all the time. You might not want to lose weight. What you want to do is change your body composition, lose fat, gain muscle. If you do lose 2 pounds of fat, but you gain 2 pounds of muscle, you're going to look and feel very different than before, but when you step on the scale, it's going to be the same number, right?

Jack Heald: It's not going to tell, it's not going to tell the real story. 

Dr. Vyvyanne Loh: That's right. 

Jack Heald:All right. Very good. Dr. Vyvyanne Loh, thanks for being with us. We look forward to seeing you again. 

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