Beyond The Textbooks: The Iconic Scholar Podcast
Join us as we take you beyond the pages and delve into the minds of healthcare’s brightest minds, exploring their journeys and the wisdom they’ve gained beyond traditional textbooks. Each episode offers thought-provoking conversations with healthcare leaders to uncover the untold stories behind their achievements, lessons learned, and challenges that have shaped their careers. Whether you’re a seasoned professional or just starting out, tune in to discover the secrets to a successful career and the innovations driving the future of healthcare.
Beyond The Textbooks: The Iconic Scholar Podcast
E12: Shifting Perspectives on Obesity Medicine with Dr. Matthew Lindquist
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Can understanding obesity as a chronic disease transform patient care? Join us on the Iconic Scholar podcast as we welcome Dr. Matthew Lindquist, DO, DABOM, a leading expert in obesity medicine and co-founder of the MoKan Weight Loss and Metabolic Health Clinic. Tune in as we unravel the underlying societal factors contributing to the obesity epidemic in the United States, shedding light on how social media and cultural norms play a role. Dr. Lindquist offers invaluable insights from his extensive training and the impact of his mentors in shaping his career.
We tackle the pressing issue of bias and stigma in healthcare, particularly for overweight children, and how these experiences can deter individuals from seeking necessary medical care. The episode dives deep into the efforts to incorporate obesity education into medical school curriculums, highlighting the uphill battle due to the lack of mandated policies. Despite the small victories, such as securing an hour-long lecture on obesity, Dr. Lindquist emphasizes the necessity of continued advocacy to improve understanding and treatment of obesity as a chronic disease.
Our conversation shifts to the emerging landscape of weight loss medications and the importance of individualized treatment plans. We explore how nutrient-stimulated hormones like GLP-1 and GIP offer new hope but also underscore the significance of considering family history, lifestyle, and under-evaluated conditions.
Wrapping up, we debunk common misconceptions around fad diets and the portrayal of obesity in reality TV, while promising to provide tangible tips for sustainable weight loss in future episodes.
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Welcome to the Iconic Scholar podcast. I'm your host, andrea Kessler, co-founder of Scholarnetics360. Get ready to journey beyond textbooks and learn from healthcare's brightest minds. Each episode is packed with insights and wisdom from industry leaders uncovering the lessons and experiences that shape their careers. Join us to unlock the secrets to your successful career and discover the innovations shaping healthcare's future. Remember, while we're here to educate and inspire, we are not offering medical advice, just fun, educational and authentic conversations. Okay, let's begin.
Eder Garavito:What is up everyone? Edward Garavito here, co-host of the Iconic Scholar podcast. Andrew has given me the reins today, so I'll be flying solo, but don't worry, we've got some epic content lined up for you. Today I have a very, very, very special guest who's both close to me and to ScholarNetX360. I've known Dr Matthew Lindquist since, I believe, 2010, when we met as random roommates while he was pursuing his doctor of osteopathic degree and I was working on my doctor of physical therapy degree.
Eder Garavito:Now you know what? 13, 14 years later, whatever it's been Matt is a board member of the Midwest Obesity Society and he's a diplomat of the American Board of Obesity Medicine. I don't know what any of that is. I'll let him explain it to y'all when we know what all that stuff is. But the cool thing is, not only is he a part of Scarlet X360, he's also the founder and owner of MoCan Weight Loss and Metabolic Health Clinic in Kansas City.
Eder Garavito:Fun fact after graduation, both Matt and I because we're like best buds we left Arizona literally at the same time together, following each other. Except this guy made a permanent stop in Kansas and I kept going to North Carolina, and so, like the rest is history. But he has been an instrumental part in the development and the idea and the concept of SkarnXU60. But I'm going to let him share all the details. So welcome, matt. Thanks for hanging out with us today. Tell us a little bit about yourself, man. You got all these cool credentials that I don't think many of us know what they are and what they mean.
Matthew Lindquist:At our man. It's an absolute pleasure. You know we get to like. You know obviously we get to chat and talk shop like practically every day. But this I know I've been bugging you for a while to actually do this, man. I you know, sometimes I actually forget our drive away from Arizona and you guys like putzing out in New Mexico.
Eder Garavito:Yeah, we got the flat tire and you kept going. Yeah, I guess the story is that, yeah, we got a flat tire, you kept going, you just left us there to die.
Matthew Lindquist:My dad and I, I mean you had your pops, that is right.
Eder Garavito:And my dog, the most important thing.
Matthew Lindquist:Yeah, yeah, well, yeah, so after we moved out, you know, I came here to Kansas City to do my internal medicine and pediatrics training and so I got, you know, kind of a masochist dream, which was, you know, dual, you know dual, board certified dual training and internal medicine and peds and during that I kind of, you know, kind of kept this in, like built this like slow burn that I've had throughout my career of getting into obesity. And and then I, you know, I mean we've we've talked about this a ton. I just got super lucky training with one of the top like peds, obesity docs in the country, dr Brooke Sweeney, and actually are the founder of the weight management clinic here in the in the main children's hospital here. She's actually the first author of the most recent AAP, so the Pediatric Obesity Guidelines. So, man, I just had baller mentors when I came here and they showed me what being an obesity doc looks like and could be.
Matthew Lindquist:And so, yeah, like, right out of training I stayed on as faculty at our safety net hospital and created, so I founded that clinic at University Health here in KC, got to work, you know, one day a week at the children's hospital with, you know, with my mentors so have, since, you know, branched off, as you know, into my own practice. So it's been an insane ride and been, you know, huge part of things to, as you know, into my own practice. So it's been an insane ride and been a huge part, thanks to my amazing mentors that I stumbled on here.
Eder Garavito:Yeah, I mean, mentorship is huge. But also the cool thing is Matt was thinking about opening this clinic forever and then this Scalernet 360 idea came up and then we both just dove headfirst into both businesses. He just got done way before we did, but he's he's doing something cool down there I feel like we're business toddlers.
Matthew Lindquist:You know that like two or three year old phase where they're you know, yes, they might be like playing in parallel and like that is like us in our you know our, like business, you know career, where you know we've been like playing with each other parallel with Mocan and Scholar Netics, and just crawling.
Eder Garavito:I think we're at the crawling phase. Now Some of those reflexes are integrated, we're no longer like newborns. But yeah, it's been fun, we've learned a lot and it's been cool to bounce ideas back and forth as we built both of those things. But with all those credentials, man, I really wanted to pick your brain on the concept of obesity and it's just something that I think is so prevalent, not only in the United States, not only objectively, but visually, right as you kind of walk anywhere. We see a lot of overweightness in our country. But there are so many factors that go into this. Social media plays this game of like what is good, what is bad. Then there's TV. Then of course, we have all the Miss America stuff and sports. I mean, just the influence we have in this country is wild. But what I'm interested in and for those of you who can't see Matt right now you're not watching the video I mean Matt's like what?
Matthew Lindquist:You're like 5'10 and like 140 pounds or something crazy.
Eder Garavito:I'm massive, dude, I'm massive, yeah, yeah, he's tiny.
Matthew Lindquist:This guy's tiny but he got into obesity medicine. Yeah, I've always just been a sick figure. I had to bust my butt just to gain a couple pounds for sports back in the day and still struggle to do the same sports back in the day and still struggle to do the same. And, interestingly, I actually can explain the biology of obesity and weight regulation to my patients, even in the setting of my weight and how I can't gain weight. It's just like literally my genetics is kind of. I have very protective genetics, I think, from an obesity standpoint.
Eder Garavito:And so what does protective genetics mean? Because I'm curious how your care is received by those who are obese. Do they ever show up and like who's this skinny guy telling me that I got to lose weight? Life's easy for him, but you want to gain weight and they want to lose weight. So you both have your own issues. Just one has, I think, a lot more stigma behind it, right, but what does that mean?
Matthew Lindquist:You got to one question and I think that for a long time I would think more patients would kind of be like, hey, why is this skinny white boy? Especially when I was at the safety net hospitals. Unfortunately there's, you know, underserved, underinsured, like you know, minorities, and you know and here I am, this like totally nerded out. You know, skinny white boy, but I was beloved and I think mainly just because they weren't judged, you know, I talked to them within the context of just biology, because that's you know, and as a chronic disease, because that's you know, that is obesity. So if you're treating it or struggling with it, like you are, you're competing with biology and evolution. And I kind of joke to my patients like don't you know, don't compete with evolution, it's a, you know, it's a formidable opponent.
Eder Garavito:I agree, I don't think we're ever going to beat evolution, right? So I just want to make sure that I understand you correctly and the listeners understand you correctly too. Is that we're not going to beat evolution. That's just not happening. But how much of obesity is due to genetics versus lifestyle choices? Do we have a chance against evolution, or is it just one of those things where really things are changing and we don't have much control over?
Matthew Lindquist:What mean is?
Matthew Lindquist:You know, we, like you know, so, over over millennia, centuries, like we've the evolutionary pressures have set up these mechanisms in our body that, like help us maintain our weight, lower our you know, our metabolic rate and kind of spare our energy during times of fasting, right, because we, because, you know, many generations ago we were mainly like hunters-gatherers, right, and so we didn't have this like nonstop access to calorically dense food, and so, you know, we needed things that, like you know, I kind of joke, like if you, you know, if you put me and one of my patients, like if you put us in like Ireland in the 1700s, like I'm dead and they're probably thriving and maybe like normal weight and they have no evidence of malnutrition, right, because they just have a more energy efficient body.
Matthew Lindquist:So the disease really lies within that interplay, right, between your genetics and your environment. You know, right now, like, especially in america, and you know, and then the rest of the world, with our outsourced, you know, american diet, like, yeah, it's a problem across most of the world now too, but but man, I'm in america, like we're, we got, yeah, I mean, with the plethora of information now and I think there's some conversations in the government we're not even going to get into politics about starting to block social media for some children of certain ages because they have so much access to so many things.
Eder Garavito:right. But going back to that concept that you just talked about, that you would not survive in medieval times because, once again, you're like 140 pounds versus somebody who perhaps was larger. They have a more efficient, energy-efficient body, as you mentioned, and there's evidence that we know that centuries ago, those who were larger were richer, healthier, wealthier, etc. We not only have access to all this information, as you mentioned, and things, cetera. We not only have access to all this information, as you mentioned and things. But I think at this point, most of us know that the Barbie dolls and super skinny bodies that everybody loved for so long are unhealthy, and it's obvious that we know that the very large, morbidly obese bodies are unhealthy. So where's that happy medium? Because I think that's maybe where some of us struggle, like, okay, I shouldn't look like that super starved, jacked person, but I can't be morbidly obese, so like, where's the happy medium?
Matthew Lindquist:and that's what we don't do well in our culture, right, is that happy medium.
Matthew Lindquist:And you know, this is where man this like this, like perfect storm, with, you know, these new meds crashing into the American culture and fascination with thinness, right, and that message that particularly women have been hearing forever, which is like you're not thin enough, your skin's not tan enough or tight enough, whatever, it's like you're just not good enough. And then these meds come out, you know, semaglutide, terzapatide, and which are absolutely life-changing drugs for people with obesity, like 100%. But unfortunately, we as a, you know, as a medical society, we're like we weren't ready to grab the ball. You know, we just like haven't been teaching obesity to our med students or residents, fellows, et cetera. So we have, like, you know, the vast majority of docs out there like know nothing about obesity, you know.
Matthew Lindquist:Then there's like, again life-changing drug comes out and who fills the? You know who fills the void TikTok and med spas. And so this is where the danger lies is when someone who's doing your nails or your Botox or doing your hair is treating your chronic disease, but they have no idea what they're doing. The only outcome they're looking for is number go down, dude.
Eder Garavito:That's a recipe for disaster, disaster yeah, and when you talk about number, you're talking about weight. Go down, right, wait, yeah, yeah, it's like it's like the opposite of that.
Matthew Lindquist:Have you seen the meme for like crypto?
Matthew Lindquist:no, but I just I like just heard about this, but it's like you know, I I think it was initially for crypto and then now for just the stock market, basically, and it's just like some kind of that mindless cartoonish type thing and it's just like number go up. So I think that's like weight loss with a med spa. Now is the opposite of that. It's just like number go down, number go down, number go down, but like meanwhile, you know, meanwhile they're like wasting away, like all their muscles gone. They look gaunt and malnourished because they had no one that knows what they're doing guiding them right. But number go down.
Matthew Lindquist:Number go, but number go down.
Eder Garavito:The emphasis that we place is yeah, you know you're overweight or your BMI is, etc. We wouldn't even go into the treachery of the adequacy of BMI, but yeah, I think a lot of the focus is you need to lose weight. So I was a thicker child. When I was younger and I struggled with weight loss and my brothers were thin. I had a primary care physician. That doesn't matter if I named them or not, they're beyond retired, but it was their family doc and eventually I decided to not go to them anymore. And I was young and so my parents did ask me like did he do anything to you? Etc. And he never did anything to me. But I never felt comfortable in this care. I felt judged. Just like you said, I don't judge my patients, but here's like pre-teen and eventually teenage boy who you know has this, has a large appetite, but also plays soccer, plays hockey and plays football and his and his love is hockey, dreams hockey, sleeps ice hockey. And then, if only we played hockey together, eddie.
Matthew Lindquist:Right yeah, the only thing missing from our relationship, that would be.
Eder Garavito:Well, it's going to happen, don't you worry. But I'm playing hockey and I go get just my annual physical or something like that. And again, it's just like you go to the dentist and you're not flossing they're going to yell at you. I feel like I'm just going to go to the doctor get my physical and he's just going to bitch at me about how I'm still fat. And so I explained to him I play hockey, I play competitive hockey, this is what I do, and this guy literally hits a desk.
Eder Garavito:This is when I decided I was gone. He said to me well, you know, you have to go out there and you have to run like 20 miles a week or something crazy or something. I'm like, dude, go F yourself, like I'm not doing this. And so eventually I stopped going on because I felt so judged and I mean, I'm like you know, 13 years old, what have you? And I think that's what I love about you, that you just don don't judge. But going back to what you mentioned about medical students not getting enough education about obesity, what is your thought on them not getting enough education on obesity and therefore graduating and just being judgmental instead of understanding the condition?
Matthew Lindquist:We have so many studies that show exactly what you experienced across A all society but unfortunately, in the doc's office, whether it's primary care or any subspecialist and one, the data absolutely shows if you're judged, stigmatized, experienced bias, you're not going to come back. So less likely to come back, actually less likely to be successful in weight loss attempts we actually see increased cortisol, decreased self-regulation all the things that you would want and encourage someone to do to control obesity and their health go out the window once, or at least more likely to fly out the window once. You've you know that patient has experienced bias or stigma from you. So so then, okay, so how do we, you know, how do we get ahead of that bias?
Matthew Lindquist:So for me, you know when I so when I was at my you know kind of recent former institution associated with the med school, and at the time I was actually on like the counseling curriculum and I was trying to get obesity in our med school, so undergraduate medical education curriculum and I had some support, but that you know that's not like a mandate right now from the governing bodies like ACGME and to their defense, they have so many other things that they have to kind of check off right that if this is not this mandate from a policy standpoint and as know like it's a huge ask to change curriculum for you know, like a big, you know professional school, the only thing I could do was get like an hour lecture for for these med students in like their first clinical year. So so you know this one it's a six-year program, kind of like undergraduate slash graduate, you know md program, and so it was like the fourth year, so like they're almost licensed at that point they got a couple years left, so four out of six.
Matthew Lindquist:But you know, it's like that was like the earliest I could get in and like teach them about like just the genetics and physiology and biology of obesity For one hour, yeah, yeah.
Eder Garavito:Okay, that's wild.
Matthew Lindquist:And then that just got dropped as I left.
Eder Garavito:So now, nobody replaced you for that one glorious hour of talking about this One amazing hour to cover all of this.
Matthew Lindquist:Yeah, yeah.
Eder Garavito:I mean, I know we could talk about this forever. That is crazy.
Matthew Lindquist:So but you know there, you know there are a lot more great docs out there, academics, and you know, and I know they're doing work at their, you know their institutions and and this message is getting louder but but yeah, we're still like it's not even that we're catching up with our current or soon to graduate med students. It's like we're still getting behind, like we're not getting all of them out there and ready. And then you know, the vast majority of docs currently practicing again don't know, like we're never taught obesity. No, we're never taught obesity. So we've got a long ways to go in the medical field until we're really ready to understand this disease.
Eder Garavito:Sure, and I think that's a valid point. We got a long way until we understand this disease. But here's a caveat In PT school stereotypical standard PT school is three years. Standard medical school is four years. Yeah, not residency, fellowship, just the actual didactic portion. And I know, like you mentioned, some can change. But things that most PT programs lack are things like women's health, pelvic health, lymphedema and things like that.
Eder Garavito:And when students sit down and start taking their licensure exam, their practice exams, they always come back to us like we didn't learn about this, we didn't learn about that, and then we'll do something similar. Well, we'll bring a specialist in to talk for them for an hour. But here's my argument with that is like, look, we can't teach you everything unless you want to be in school with us for seven or eight years. I can't teach you all this stuff about women's health and canine therapy and aquatics and wound care, and I'm speaking specifically to PT school. So your one hour is at least one hour they're getting, but it's absolutely just asinine that they only give you one hour, right? So my question really is here In a perfect world, if Matt was to go to a medical school board, whatever that is, and say we need to change this so that students get more education on obesity because it is important. What changes would you make without extending medical school for more than it already is?
Matthew Lindquist:That's a really good question. I think I'm going to start the answer with how I start pretty much every lecture or every talk I give about obesity, which is you know, it's a chronic disease. So obesity is just it's a chronic disease and so you know. So let's fill that, you know, let's take obesity out of there and say, okay, what would we do if this was high blood? You know hypertension, you know heart disease, cancer, you know, would we like, what would we do if we just didn't talk? You know like. You know like students coming out or doctors graduating medical school, and they didn't know, like the basics of hypertension. You know like we'd have problems right and and so that's you know. So that's where we're starting.
Matthew Lindquist:So you know, I don't need you to know, like how to treat and evaluate, like advanced you know, severe genetic obesity. Need you to know, like how to treat and evaluate, like advanced you know, severe genetic obesity? You know that's not in the wheelhouse of every doc, just like you know, just like I didn't get taught, like you know, advanced advanced heart failure, you know, coming out of med school. So, but you know we should at least know the like pathophysiology. So, but you know we should at least know the like pathophysiology, so the you know what regulates hunger, the basics of like okay, when we lose weight or try to lose weight, ie you know right the class like eat less, exercise more. You know, of course, you know the cure-all.
Eder Garavito:I mean, I'm telling you that's worked for me in the past, but I've turned into, like you know, little skinny person without any muscle but you know that's yeah, but the number went down.
Matthew Lindquist:Number went down number go down, yeah, yeah, until you know and until it doesn't, and then it comes back up 100. Yeah, because our bodies fight to maintain they are man and consistent in fighting to maintain our set point Right. So like and we've all done this at some you know to some extent, which is you lose a few pounds and it may be like two or three for some people, it may be five or 10 for others, and then so they go, like you know, five or 10 below that that number, and then they come back up and they go five or 10 above you know, and you just like, waffle up and down Rollercoastering diet or something right.
Matthew Lindquist:You know you stay around that weight right. And this is coming back to like the most basic, like human biological concept, which is homeostasis.
Eder Garavito:But see, that's the thing. When you say to something like basic, I think to you and I it is basic, right, but to many it's not. And so how?
Matthew Lindquist:do we explain that?
Eder Garavito:Because, even as I know what homeostasis is well, yeah, I know. But even though I know what homeostasis is, how do I change my set point?
Matthew Lindquist:Oh man, that's beautiful, okay, so first let's finish. So what actually happens? Right? And so this is getting back to the question of like. You know, what do we need to teach? And it's the simple fact of like that we are trying to maintain our set point. And when we do that, you know like, if you go like okay, I'm gonna like it's january 1st, like I'm going on my diet, you know whatever, when you know, when you hit that like whatever amount of weight loss that is for you, then appetite, appetite go up. That's gonna be a meme too. Then, yeah, I know right, yeah, I can't like, I guess gonna be me, me, me, and like appetite go up those are the mo can memes.
Eder Garavito:There you go oh for sure.
Matthew Lindquist:And and so that's like your hunger hormone, gh, ghrelin, like that goes. And then this huge bucket, like all these other hormones that regulate our satiety and or what we want to eat, and that feeling of fullness, it's just tank. So now you're more hungry throughout the day. When you do eat, it takes more food to stay full or to feel full, and then you will get hungry again sooner, and then our metabolism drops, our resting metabolic rate drops. So all of the things that we don't want to happen when we're trying to lose weight happen. And that's why, throughout our entire weight loss diet programs you know studying, we see, you know 90, more than 90% of people fail, at least you know, and when I say fail, I mean just in the setting of long-term weight loss and treating obesity like 93% fail at these because of biology and homeostasis. So that's when I say like, don't compete with evolution, like you can't stop, you know, your body from trying to maintain homeostasis. You know that's just a, it is a frustrating losing battle. So you know so. So then you get to that. You know your question of like. Okay, well, how, how do I offset that? It kind of, you know it's, it's very individualized, you know one. So so think, if you're, you know, like last year, if you're like, okay, I lost my job or, you know, got divorced or something, and I was like super depressed, you know, and I was like kind of stopped all my normal things, my exercise, laying in bed half the day and then, and then I go see my doc and they put me on this, you know, antidepressant, another weight gainer and maybe diet kind of, you know, got a little worse too. Now, all of a sudden, you have like you got less exercise, less, just like daily energy expenditure with just like you know, laying around more. Oh, okay, then we added a medication that's going to set it, you know, bring your set point up further. And then you know, and then your diet kind of got worse. So now it's up a little further, okay, so now we got like four things supporting a higher set point. So let's say, okay, we stopped the like super weight gaining medication. Okay, now we're down to here.
Matthew Lindquist:But your set point was here Like, okay, we get, let's go back to like our healthy diet. Okay, now it's back down here, you know, and then okay, but then we get back to like a normal, like our normal exercise routine. Okay, so now you might be back at your normal set point. So now let's say, okay, you're like man I've been struggling with my whole life, right so now, like I need to go see an obesity doc. Not, you know as much as I love my med spa, you know much as I love my like Botox, let's leave them to cosmetics. Then at least start you on an FDA approved anti-obesity medication or something with some data. Then now you've got a new lower set point and it's offsetting or it's preventing that increased hunger. That hunger go up. All the memes. Now hunger stay normal.
Eder Garavito:I want to make sure that I understand this correctly, not only for our listeners, but even for myself, because the of the message that I just received from what you were talking about which is brilliant is that if somebody wants to change their set point after, let's say, a lot of changes happen in their life positive or negative, whatever and they start seeing changes in their body that they don't appreciate, aka weight gain they need to go to an obesity doc to change their set point, aka you know where their homeostatic weight is, their perfect weight? Are there things that people can do on their own, without having to go see an obesity doc, to change their set point and alter it without medications?
Matthew Lindquist:yeah, oh for sure. So you know. So the big thing, I I mean, let's look at the classic, I don't know, stereotypical American in 2024. We've got fast food everywhere. Everything is ultra processed, right. So even if that's low-fat chips, you know, it's still like ultra processed trash. Soda energy drinks, you know, oh my God, don't get me started on like Starbucks coffee, not even just black coffee, it's an ice cream shake.
Eder Garavito:OK, but black coffee is still kosher, then Good.
Matthew Lindquist:Oh my God. So as an aside, since you mentioned it, so black coffee, black tea, green tea, like after water, those are like the elixirs of life for, especially for people with like obesity or metabolic disease, because they can help. They can help like all of you. It's just it's the sweeteners that get us on the wrong side of the mortality curve with those.
Eder Garavito:And when we talk about sweeteners because I mean, I agree that those are milkshakes Are you talking about like simple sugars or even sweeteners? Clearly the worst is the sugar.
Matthew Lindquist:So, man, I love this. So if you can just like look in my brain right now Etter, please, it's not that big.
Eder Garavito:I don't know if I could.
Matthew Lindquist:There's no space.
Eder Garavito:Small head, small brain. That's just how it is.
Matthew Lindquist:It's a tiny crevice behind my eyes. There was a good study a couple years ago looking at like a, and it was really just like all-cause mortality with just coffee. And it was black coffee, coffee with sugar sweetened and then artificially sweetened, and I can't remember the dose, if you will, of how much sugar and how much artificial sweetener. But we want to be lower, right. So number go up, that's increased mortality, number go down, that's improved mortality risk, like ie, less death, which is typically a good outcome in medicine For most people, right, typically.
Matthew Lindquist:Yeah, so the sweet spot was two cups of coffee a day and that was the max, like the nadir of the mortality curve. Then the coffee with artificial sweeteners that nadir was a little higher, so not as good. And then the data got super messy. So it's not really clear what happens from there. Like with, especially with like more than two cups, and like artificial sweeteners, but we know those are associated with heart disease, cancer et cetera. So like, right, basically there's no such thing as like a healthy sweetener if it's sugar, like artificial, and then, and then the sugar sweetened coffee, like two, you know two, I think was like just below you know the mortality curve, and then like three or above, and you're on the wrong side of it. Ie you ain't gonna.
Eder Garavito:You ain't gonna make it as long, yeah for real, for reals, I mean I I find this whole set point thing so interesting because I think the term that we use often in society is like your ideal weight is, and oftentimes it's derived by the stupid BMI thing.
Matthew Lindquist:What a garbage term, by the way.
Eder Garavito:What a garbage term, right, but okay. So set point we can change our set points, both with medical help and advice and then by doing things like you mentioned, by ourselves. But then you also mentioned set point goes up, mortality rate goes up, morbidity and mortality, which I think many of us understand. That Morbid obesity means a plethora of comorbidities and likelihood of shorter lifespan. But if somebody who's in that, say, scenario, they're trying to lower their set point, become healthier, eat better, drink the coffee without sweetener, all those things, how much can they lower? Drink the coffee without sweetener, all those things, I mean, how much can they lower? Or is there a data point? Because also, if we are cachectic and starving ourselves, our mortality, morbidity rate goes up too right. So what's the sweet point?
Matthew Lindquist:There's the problem is starving yourself right.
Eder Garavito:Maybe I used the wrong word, but like.
Matthew Lindquist:No, but you're not. You're not Because a lot of people, people, especially if they're, you know, if they're on so and and this goes. You know, this goes for any, like almost any, weight loss medication, you know, at least the ones that lower your hunger, but as good as the these like glp ones, and then the. So the new, and have you heard?
Eder Garavito:noosh I have not nutrient stimulated hormones.
Matthew Lindquist:So it's kind of the new term for this class, because now we've got so like triseptide, for example, is you know, glp-1 plus gip and then, and then there's like retatratide coming down the pipeline. That's like glp-1, gip and glucagon. So, like these are all kind of like nutrient-stimulated hormones. So we're trying to kind of change their class name, because GLP-1 doesn't, you know, it doesn't catch all right now, but as good as these are and as effective as they are, like, dude, I could you know, if you come over here tomorrow and you give me the access to the right dose, like you will, I can make sure that you do not eat anything for a week.
Matthew Lindquist:Like that's how effective these are. If you know, if I can like go as high as possible and you're not used to them, I can completely take away your hunger. And that's where, like, most people don't really know the kind of limitations with these. And, again, if they're just looking for number go down, they might not see the patient who's like if they didn't ask. Like, hey, I've been nauseous all week, vomiting a couple of times, and they're malnourished and losing way too much muscle mass, and so that is not a good outcome.
Eder Garavito:In your practice, just like any healthcare professional and this is a really hard question to answer, I think, even for me when I think about it evaluations and treatment plans are 100% specific to the patient, the scenario, the condition, the need. But, like in general, can you give us like a just super generalized sort of like? Let's say, somebody comes and sees you for their, for for obesity, like what kind of tests do you run, what kind of things do you use, what kind of data do you use to derive a treatment plan?
Matthew Lindquist:Yeah, that's a really good question. You know I have kind of certain you know certain questions, screeners that you know I want to go over with, like every single person. So that's you know. One I want to know, like what's your, you know what's your family history? Like Everyone in your family have, you know pretty much have obesity and like diabetes and heart disease, okay, well, like we're going to get aggressive, you know, even if you're like a teenager and that's that's your family history. Like, okay, if you have class one or class two obesity and your labs look fine otherwise, but that's the setting for your health, I'm going to be way more aggressive in treating them than the teen or young adult that follows them. And they're like, no, I'm like the heaviest in the family, but there's no cancer, no diabetes, no heart disease. And they're like, yeah, no diabetes, no heart disease.
Matthew Lindquist:And you know, and they're like yeah, I exercise, I eat healthy, like I may just say, keep rolling, man, you're doing great. So that you know that the family history is so critical to understand, like, what is your expectation for treatment here? Because, yeah, if, like, three people in your family had bariatric surgery, like you're not going to, you're not going to be the winner from Weight Watchers. And then I always go over meds, the vast majority of meds, if they have any action on weight, be it positive, weight gaining or weight losing or weight negative, usually weight gaining right, negative, usually weight gaining right. So you know.
Matthew Lindquist:So the number I see that you know maybe they're like a beta blocker used for, quote, like essential hypertension with like no other, like absolute indications for beta blockade, like that's a not, you know, that's not a great drug to treat, just like basic hypertension in someone with obesity because they can be waking or limit the ability to lose weight. So right. So there you know we got another thing, you know another barrier for that patient. And then you know I always screen for like eating disorders, vastly under-evaluated in patients with obesity. Because again, coming back to bias and stigma is like, oh, how could this patient with obesity have anorexia? I'll tell you how they have obesity and they also have anorexia. You just didn't take a history. And then you're. I feel like we keep not getting to your questions of like what can we do? I mean, it was a broad question.
Matthew Lindquist:You know. I want to know, like you know, what are the fundamentals right. So how's your sleep? What do you do for exercise and just activity throughout the day, Because that's got me all jacked up.
Eder Garavito:I'm all jacked up.
Matthew Lindquist:I'm out and do All jacked up talking about obesity, as I do. So, yeah, man, we got to come back to exercise. If not, you know, if not today, man, we got to talk about more, because it's so misunderstood when we talk about weight regulation, I think we do Versus general health.
Eder Garavito:I think we do, because, also, you know again the message that I received from that PCP decades ago and with my background in exercise, physiology and things, I guarantee I'm just more knowledgeable than that dude ever was. But it's like if you don't go out there and run miles a day, you're not going to be skinny and thin or whatever, whereas I think let's definitely leave that for another day, because we'll have you back for that day, because we'll have you back for that. There are certain types of exercise durations, frequency, intensities, right that really can target that patient-specific goal, which is what I heard you say in the beginning what is your goal? Because you need to make sure that the goal is realistic. Because if you come in here with all that family history and plethora of comorbidities and you say I want to be skinny, let's make sure that we're realistic. So I think setting realistic expectations for your patients is huge.
Matthew Lindquist:Yeah, that's like me showing up and be like, hey, I want to be a linebacker, like 5'10", 150. And it's like I think someone would appropriately say good for you, matt, but that might not be in your genetic potential. So someone, someone comes in. They're like 400 pounds, but you know, but we don't do that with obesity, right? It's like, hey, you need to lose like 200 pounds.
Eder Garavito:okay, tell me how and that's the thing too, like the tell me how thing, because I tell my students this often when they're learning and they're learning, you know they're so in depth in learning and then they forget that because all that they're doing is learning and they're they're so in depth in learning and then they forget that because all that they're doing is learning and they're they're privileged to be in school and to have this information that, for a lack of a better example, there are thousands of thousands of americans out there that genuinely and I mean genuinely do not understand or know that eating mcdonald's is unhealthy because they don't have access to that information. So we know, when we talk about like this, like you know, this is obvious.
Matthew Lindquist:It's like it's not obvious to everybody or take like low-fat yogurt, right oh let's go there, yeah you know, I mean and granted, that's for the most part, to be clear like yogurt's great option. But you know, but you look at it and so you take away the fat, which is like really good fat's fine, we need healthy fat in our diet. And you know, and what happens when we took that away, like we just replaced it with sugar so you get like that taste. So you, there's like you know little, like four to six ounce. You know things of yogurt that have the sugar content of like coca-cola, like 12 ounce coke Coke. It's insane. So a lot of this is just really good marketing. Right, I was going to say it's marketing 100%. Oh, my veggie straws my wife and I get into like Veggie straws are delicious.
Eder Garavito:Don't get me off of veggie straws.
Matthew Lindquist:The hint of vegetable that somehow allowed them to put veggie on their brand. Stop it it starts with veggies.
Eder Garavito:veggies the name says veggies, so I buy those instead of doritos therefore yeah, right, so therefore is it is carrot cake, not a vegetable, come on oh, absolutely, it's vegetable.
Matthew Lindquist:Yes 100 right that's how I get my vitamin a it's carrot cake. You know clearly like we have jack stack. You know we've got this barbecue place in talamese unbelievable carrot cake and I'm right, right right right.
Eder Garavito:So here's the cool thing, matt I've known you for gosh way too many years and probably many more to come, and we talk crap all the time. Recently, at least last year, we've been talking a lot of business and investments, but I've never really had the opportunity to sit down and talk to you about what you're super passionate about, and that's probably my fault. It's been so cool to listen to you and also to debunk the myth that you are not intelligent, so apparently you are smart. You know what you're talking about, so, which is awesome. Yeah, right, right. He just doesn't look smart.
Eder Garavito:Everyone Just kidding One. I would love for you to help us debunk the goods pros, cons if there's any pros to fad diets like paleo diets, keto diets and all those things, because I'm sure you got opinions on that and then opinions I own. Yeah, the last thing I want to finish on in this just just your opinion on this man is what is like your overarching opinion on shows like you know, the biggest loser, or my 600 pound life so first you know the god who's this like.
Matthew Lindquist:Yeah, was it my 600 pound life? Like that's like it's so bad guy. Yeah, yeah, yeah.
Eder Garavito:He's in a lot of memes to most of it. I hate, but what do you hate about it? That's what I'm curious.
Matthew Lindquist:Yeah, it's. You know how. Like how obesity is portrayed and like kind of hearing the stories of like what the producers wanted, like the surgeon to say, and like, and kind of carrying forward this like the message that obesity is like the person's fault 100.
Matthew Lindquist:I don't think that show ever says like it's not their fault and you know, and then so, okay, so, then so let's look at the big let's-year study on biggest loser contestants, and so, oh, I love this study and I'm going to note here that Jillian Michaels may have forgotten that there was a study on her show because she butchered this recently with Bill Maher, with Bill Maher and and so so one of the you know like this particular study is like is going back to our like homeostasis, right, so, metabolic adaptation and and obesity as a disease, right, and so so this one they looked at like resting metabolic rate, okay, and so so he tested it at baseline pre, you know, pre intervention, pre, you know, show, and you know, and I think it was around, like you know, their average was around like 2,600 kilocalories per day, which is, you know, pretty high, but you know they have higher, you know higher lean mass.
Matthew Lindquist:Then tested to get it one year, you know, a lot of weight loss, and already at that one year mark, we started to see a difference between their calculated so right, what we would expect and their actual measured, okay, so their measured was now starting to get a little bit lower than their calculated or expected resting metabolic rate, okay. So fast forward six years where they all regained within like, I think, in total, like within like a percent of their starting weight. Okay so, so now they're, you know, you know, you know, day zero in year six. They're pretty much at the same exact weight, but that resting metabolic rate actually dropped further from where it was at year one. So I think at that point it went down to 2,000 or something like that at year one. And then, yeah, year six, it was like 1, was like 1900. So we're talking about set point again yes, and biology so they.
Matthew Lindquist:So you know, biology remained, evolution remained, so that was not changed. And and they removed that intervention. Right, that got them to this lower weight, but nothing about their biology or set point was changed. And then it takes over, gets them back to basically their initial weight, but now their resting metabolic rate was almost 30% less than it was when they started. So now try losing that weight again. Started, now try losing that weight again.
Eder Garavito:Right, not only losing that weight, but regaining that weight. They've gotten screwed with their mental health so badly. Yeah, yeah, it's horrible.
Matthew Lindquist:We're going to end this on what can people do?
Matthew Lindquist:Yes, absolutely, at least some tangible stuff of what you can do as a human to really just have, at the very least, have good energy, good mental health, see some weight loss potentially. And this is kind of all the problems in our society in 2024, which is we don't sleep enough. We're on our screens, you know, up until bedtime, like me included sometimes, and I get so pissed at myself. So we need enough sleep, right. So you know, ideally turn your phone off like an hour before bed, aim for that like seven, eight hours, you know, for for most of us, teens need way more seven, eight hours, you know, for most of us, teens need way more. Elderly need actually significantly less. But we need good sleep and we got to get the screens out, get your TV out of your bedroom like whatever.
Matthew Lindquist:And then exercise. So you know the couple of things you know. So, like main thing, like what people get really wrong about exercise is it's a terrible predictor of weight loss. So even an hour of exercise a day, what most people will see in about a month is your weight is probably going to be the same, but your energy is better, your sleep is better, you're like man, I'm looking sexy, but then you step on the scale, you're like what the hell? So that's you know? So like, as you probably know, like that's gaining muscle, burning fat. But if you're only like you know, if you get your blinders on, you're only looking for the number go down.
Matthew Lindquist:You know like you're gonna be pissed and so you know, a bunch of people stop working out because they are looking for the wrong outcome. And then where most of us again, as we talked about, I'm in my comfy chair. I'm pretty much totally supported here. We just need to move more throughout the day, and that just regular daily movement. And if you really want to make that a superpower, you do it right after you eat, and so that helps like literally bringing like our glucose receptors up to the cell membrane to get like ready to utilize that sugar instead of like feed me, feed me, yes, yes, so it gets our like you know muscles, like ready to take that in and like utilize it and grow and have energy. Like it's super cool, so that I mean that could literally be like after you know, after you eat, like you walk around the house, you know.
Eder Garavito:It doesn't have to be like amazing things yeah, see, that's what I want to definitely talk about actually sometime, because that's realistic and some people might think that, oh, like this sounds like a really cool concept. Like you know, I eat and then I have to go exercise, but I have to eat and run a mile. No, you might just walk your dog.
Matthew Lindquist:Or do a walk, do calf raises? There's studies to support that. That's wild. Yeah, it's really interesting. And one of the biggest things, man, is our fast food, ultra processed foods and sugary drinks. Oh God, especially sugary drinks. Like I, oh god, especially sugary drinks. Like there is not, like I cannot compete with. I like I tell people all the time like there's nothing I can do to compete with, what is that? What that's doing to your metabolism and just your general health. Like I have people all the time like I don't eat anything, you know, and I keep getting weight. That like soda, sugary coffee, energy drinks, like it's it's.
Eder Garavito:It's insane what that does to like our metabolic health it's america man, it's marketing, it's diet and I think at least you know one and dr link was at a time will hopefully start changing the outcome of many people. But yeah, let's have you again talk about exercise and debunking myths about diets and all those little things that you, just little pearls, that you just shared with us. It's been awesome talking to you. We're going to continue these conversations and I'm just lucky that I have a direct line to you, because you are a brilliant dude and you're kind of cool too, and your children are just absolutely stunning.
Matthew Lindquist:Yeah, mainly my kids and my wife.
Eder Garavito:Yeah, 100% 100%, it was absolutely stunning. Yeah, mainly my kids and my wife, your kids, yeah, yeah, a hundred percent, a hundred percent.
Matthew Lindquist:Right behind my kids, my wife and my dog. I'm right there in my house, your car first and then you.
Eder Garavito:For sure, your car first and then you, but yes, yeah, yeah, yeah. All right, man. Well, we appreciate you. We'll link MoCan Weight on the show notes so people can get a hold of you if they need to. But it's been awesome brother.
Andrea Kessler:Appreciate you, brother. Thank you for joining us on the Iconic Scholar podcast. If you enjoyed today's episode and want to continue the conversation, don't forget to connect with us on social media, as at ScholarNetics360. Make sure to hit that subscribe button so you never miss an episode. And remember always consult with a health care professional for medical advice. Until next time.
