Announcer:
0:00
Welcome to MedEvidence!, where we help you navigate the truth behind medical research with unbiased, evidence-proven facts. Hosted by cardiologist and top medical researcher, Dr, Michael Koren.
Dr. Michael Koren:
0:11
Hello, I'm Dr. Michael Koren, the executive editor of MedEvidence! Our learning library, where we get into the truth behind the data and also talk about research as a care option and I have the great fortune of being joined today by Dr. Randy Nunez, who's an expert on obesity, particularly childhood and adolescent obesity, and he's agreed to join us today on MedEvidence! Welcome, Randy, thanks for being part of this program.
Dr. Randolph Nunez:
0:39
Thank you for inviting me.
Dr. Michael Koren:
0:40
Yeah, so what we like to do in this program is we like to let the listeners and the viewers know your pathway to how you got interested in your area of medicine number one and number two, to talk about some of the preconceived notions in your area. So I'm going to just throw it right out there. In terms of preconceived notions, there's some people that think, hey, if you get three squares a day and have a gym membership, you should be skinny and lean, but maybe it's not quite that simple. So, with that quick introduction, tell us a little bit about yourself and tell us how you got here on your journey as an obesity specialist.
Dr. Randolph Nunez:
1:17
So I was practicing pediatrics for a very long time and actually a friend of mine introduced me to it was a possibility of going to obesity medicine and it really was something I was curious about and excited about at the same time, because I've had my own struggles when it comes to lifestyle and weight and consistent exercise .
Dr. Randolph Nunez:
1:44
And you know, when I started to look into that path, it really resonated with me on multiple levels. Number one is I always love to learn new things. Number two is when you start learning about something that you yourself struggled with for a very long time, it just gives you a new perspective on how you can address it. And then the third is looking at a particular part in someone's health. You know, when it comes to nutrition and exercise and sleep and seeing how a simple adjustment of one of the key pillars of someone's health and you address that and you're able to give them a solution for it how it makes a big impact on different parts of their life. I don't know if you're familiar with Keystone Habits.
Dr. Michael Koren:
2:33
Yeah. So let's get into that. But first of all, you look very fit and trim to me, so it's hard for me to imagine that you struggle with this, but maybe you can tell us a little bit more about that and also just tell the audience a little bit about your physician training background so they have an idea that you're a very, very well-trained guy and you're here now in Northeast Florida helping us with our healthcare needs, and just give people a little bit of a perspective about that please.
Dr. Randolph Nunez:
2:58
So I'm a triple board certified physician in pediatrics, obesity and lifestyle medicine, and it's a it's a great combination of different uh pieces of knowledge, right.
Dr. Michael Koren:
3:11
So you're training was in New York
Dr. Randolph Nunez:
3:12
That's right, so I was I actually trained in the hospital I was born in, so I was born in the Bronx yeah and uh, born at Lincoln hospital yeah,
Dr. Michael Koren:
3:19
I was also born in the ronx, at Bronx, Lebanon, just right down the street
Dr. Randolph Nunez:
3:23
Yeah, right down the street, and and I recently found out that not only my mother was born there, which I knew about, but my grandmother was born there, so I've got a long legacy of people that I know at Lincoln Hospital. So I trained there and I actually continue to work there.
Dr. Michael Koren:
3:38
That does not give people permission to give us a Bronx cheer, by the way, just to be clear. But go ahead.
Dr. Randolph Nunez:
3:43
Yeah, so that's where I received my pediatric training and then I branched off and worked in different areas in different hospitals and there was something missing because I worked more in primary care, then I moved on to more acute, like hospitalists and ER, and there was always that personalization, that continuity of care that I missed. So then I got trained in obesity and then lifestyle medicine simultaneously, and that is what kind of led me to the path of where I'm at now, which is really, as you said, focusing not only on my patients but on myself and looking at the-
Dr. Michael Koren:
4:20
Yeah and triple boarded.
Dr. Michael Koren:
4:21
Wow, that's impressive.
Dr. Michael Koren:
4:22
So congratulations on that.
Dr. Randolph Nunez:
4:23
Thank you.
Dr. Michael Koren:
4:24
So you were talking about the keystone concepts or habits. So explain that.
Dr. Randolph Nunez:
4:30
Yeah, so I believe it was one of the habit books that I had read and talked about the keystone habit. It really resonated with me. I don't know if you remember those old bridges were made out of stone before we had steel and all these things. Well, one of the most important stones was a particular stone that went in the middle and it kind of held everything together like the way, the pressure. And when we talk about keystone habits, those are habits that if you're able to change that one thing, it's going to have ripple effects. Or, as we talk about in processes of medicine, where you have a synergistic effect, where it's not just one plus one, but one plus one equals 10. And some of those are, for example, sleep.
Dr. Randolph Nunez:
5:09
When we do an assessment of someone's health and they talk about their weight, well, we have to take a look at all aspects of their life and to give you an example of a keystone habit is I've had patients where they struggle with fatigue and weight and when we look at, one of the main areas is that they're not sleeping well, right, so they're sleeping less than seven hours a day and you look okay, what's the cause? And when we start looking at the cause of that? There are multiple reasons. One is not very good sleep hygiene, right, so they have their cell phones right before they go to bed. They don't have a routine, they don't have a set time, they don't start to wind down at any point. And you start to think, okay, let's establish that.
Dr. Randolph Nunez:
5:53
And when you establish these changes, they say you know, I'm still not sleeping. Well, well, you find out more about it, tell me more about it. Well, I have this back pain and okay, have there been situations where you don't have that? And when you start fixing that one aspect, you help them in their sleep. So, right, so you start sleeping eight hours a day. They wake up energized, they're able to exercise better, their mental health is better because they feel better about kind of what they're accomplishing. And it just has all these effects because of one simple thing.
Dr. Michael Koren:
6:22
Interesting.
Dr. Michael Koren:
6:23
Yeah. So sleep is one of those keystone habits that requires some thought. We have had other speakers talk about sleep and I thought it was fascinating to learn that 100 years ago, the average person slept for about 10 hours a night Wow, I didn't know that. And now it's about seven or seven and a half hours a night. So with the stimulants in modern society and the distractions, we're just not sleeping as well, and part of the obesity epidemic and the blood pressure epidemic and the cholesterol epidemic is due to poor sleep hygiene. So jump in a little bit more about your approach to people and particularly clarify for the audience this concept that it's more than just willpower. You could have three squares a day, you can have a gym membership, but you still may be overweight and there are reasons for that. So why don't you delve into that a little bit?
Dr. Randolph Nunez:
7:15
Yeah. So it is difficult when you don't have a particular struggle to look at another individual where, objectively, you're able to say all you got to do is work out three times a day, all you got to do, don't eat the sweets.
Dr. Randolph Nunez:
7:32
And actually, it's one of those. The particular area where I've decided to focus on my practice besides the medication and general advice is to look at the habits that someone has, because when you look at willpower and you break it down like a mathematical equation, you know the people who are able to have strong willpower in a particular area. It is because they are able to do it through distractibility. They're able to focus on something else.
Dr. Randolph Nunez:
8:07
If I was to look at a cookie while I'm absolutely hungry and you got my favorite cookie in front of me, if I keep staring at it and I say don't think about the cookie, my willpower is going to drain.
Dr. Randolph Nunez:
8:16
It's like a battery and the key part to that is don't look at the cookie, talk to you during your podcast, and that way, by the time, the cookie could be there, but it's not draining any willpower.
Dr. Michael Koren:
8:29
Gotcha
Dr. Randolph Nunez:
8:29
It's the same scenario where I'm not eating the cookie but I'm also not using willpower. So when it comes to willpower, it's a word that's kind of thrown out there very, very half-assedly, but the reality is is we all have a certain amount of willpower during a day. So there's a difference between starting something when your appetite is full, when you're well rested, your stress levels are at zero versus how I would respond to the same stimulus later on in the day when I've had a stressful day. I'm starving, I'm tired and exhausted. The willpower battery is going to be almost zero. So the likelihood I'm going to resist something at night is going to be very different from when I'm fully charged.
Dr. Michael Koren:
9:11
Interesting.
Dr. Michael Koren:
9:13
So some people may be just more predisposed to having higher levels of willpower battery and other people less. Is that an accurate assessment?
Dr. Randolph Nunez:
9:22
It could be. I mean, when it comes and keep in mind, when it comes to willpower, what are we talking about? Like, is it the willpower to work out? Is it the willpower to eat? Is it the willpower to maintain calm during a difficult conversation? So every different area is going to determine how much willpower you have, even though willpower as a whole, you know you have a certain amount per day in general, but each area, your tolerance level, is going to be different. Like, how much willpower is going to drain to have a conversation about the fact that I didn't do you know, a child didn't do their homework Right Versus you know, why didn't you go out to the gym and work out? The conversation is going to be different, sure, so, in essence, willpower has a- You have one battery for that, but different topics will affect it differently.
Dr. Michael Koren:
10:12
Okay, so let's break it down for the audience in terms of the type of people you see as a physician and a typical situation where you're helping somebody who has childhood or adolescent obesity. How do you approach things? When do you just prescribe diets and when do you prescribe medicine, if ever?
Dr. Randolph Nunez:
10:31
So every situation is different and I actually treat from child, adolescent to adult, and when it comes to the approach, it has to be individualized right. One of the key parts when it comes to pediatrics is twofold. I mean, a lot of the times in pediatrics and in adolescent medicine the parents bring them, so it's not that the child wants to be there. Sometimes that is an obstacle that you don't encounter in the adult world. So it's one of those that you have to have an approach where you're empowering the child. You're making sure that it comes from them.
Dr. Randolph Nunez:
11:09
If you look at any individual treatment that is successful for anybody, the individual that's in front of you has to be motivated within themselves, because if you're trying to tell somebody about diet and exercise and they don't really want to change anything, then it's not really going to happen. So with pediatrics, that's one of the key parts. The next approach is to making sure that we use motivational interviewing to empower the patient when it comes to change. I rarely tell anybody what foods they have to eat, what exercises they have to do, what habits they need to change. It is more about getting the individual to identify what those things are. Once a patient lays out what their standards are what they like and what they don't like. Then we start to expand upon that. But it comes from the person itself. We have to empower our patients, especially in this topic. One thing is to give them medication, and you can look at it. The other thing is when it comes to changing our lifestyle. Sometimes I think that that could be a bigger challenge in the clinical encounter.
Dr. Michael Koren:
12:21
Now do you write out a menu for people? Do you send them to a program? What's the first step in terms of the specific action item, when somebody comes in and you determine that, in fact, they need to address their weight?
Dr. Randolph Nunez:
12:35
So the challenging part and the simple part about what I do is that I don't do it by myself.
Dr. Randolph Nunez:
12:44
So there's you know, if someone has a significant psychological issue where you know, you see that the treatments that you're recommending, that they've come up with themselves, are not being followed through and they see resistance, there's usually something there that's holding them back and it you, you know it would take somebody with a psychological background to really break that down. The other thing is you have nutritionists, right, so you have someone who has an extensive amount of knowledge of foods that that the patient can have options to. That I wouldn't know about, especially the breakdown in the macro and micronutrients. And then you you have, you know, personal trainers rehab like physical therapy. So there's a multitude. There's a team that has to be established when it comes to just one patient so that you can make sure that whatever their needs are, that they're being taken care of.
Dr. Randolph Nunez:
13:35
Now, to answer your question, there is something called like an exercise prescription, where you have the patient fill out these particular parts about the exercise prescription so that you can lay out what the patient's going to do specifically, at what time and what location and how much intensity. Because it's been shown and proven through studies that if you can be specific about an activity that the patient actually might enjoy doing that, the likelihood that they're going to accomplish that is going to be higher. If I tell them hey, listen, go run, you know, for five minutes or 10 miles a day, they're going to go. Yeah, yeah, yeah, and they're going to do nothing.
Dr. Randolph Nunez:
14:17
But if I get a patient to establish what they're going to do, then you start to kick in a different part of the brain, which is did you know that there is a person out there that you will almost never contradict? Mm-hmm, and that is yourself, sure. So if I get you to verbalize I'm going to do this and this is my specific plan and this is when I'm going to do it and this is how long? Right, then the likelihood that it's going to be accomplished is higher, exactly.
Dr. Randolph Nunez:
14:44
Not 100%
Dr. Michael Koren:
14:44
Yeah, of course, yeah.
Dr. Randolph Nunez:
14:45
So, yes, there are prescriptions about diet, sleep, and I break everything down into the micro to make sure that it's. You know, the likelihood that it's going to be accomplished is high but, at the same time, understanding that there are going to have to be adjustments. Just because we went through that little exercise doesn't mean it's going to happen, sure.
Dr. Michael Koren:
15:07
So talk to us about when you make the decision to prescribe medication for people who are overweight, particularly younger people, where it may be a little bit more controversial.
Dr. Randolph Nunez:
15:14
Yeah, so it's controversial because it's an age group that it just brings about different emotions and perspectives on it. When it comes to an individual decision, everybody can understand that. It's up to the person. When it comes to pediatric age, it's a whole different dilemma, based on our perception of who the patient is. Rightfully so, we see children - and the younger they are - as vulnerable and want to be careful that we're not making decisions on someone that can have effects down the road.
Dr. Randolph Nunez:
15:48
When it comes to kids, you have to take the whole patient and take a look at what's the best next steps for this patient. The guidelines clearly state that in pediatrics, lifestyle changes are the first way to go and you have to make sure that you're doing a comprehensive assessment and evaluation as well as a treatment that fits them. You know, with the things that we already spoke about Once, those things that you've shown that either have not worked or failed down the road then you start bringing in the introduction of medications, because you know, when it comes to appetite and willpower, some of the things you talk about you know it is not just something that you could tell somebody. You know stop eating. You know a hot dog every day or a pizza.
Dr. Randolph Nunez:
16:35
That okay, because you said it. It's going to work. So you need a medication sometimes to help bring someone back to a reset point or pause to start taking away some of what you know some people call the food noise.
Dr. Michael Koren:
16:52
Right.
Dr. Randolph Nunez:
16:53
Where you know if you're able to get someone to just focus on what are the best choices versus I'm starving, I'm going to eat, because who really thinks about what are the macronutrients of a food when you're absolutely ready to eat anything?
Dr. Randolph Nunez:
17:11
I know I haven't. I just think about eating
Dr. Michael Koren:
17:13
There you go. So you brought up this concept of food noise, which I think is a brilliant concept that helps people understand it. Tell me a little bit about how drugs can affect the food noise. That's something that we've seen here in the research office, where we do a lot of obesity studies, and people will uniformly say that some medications really help them with that issue. So maybe you can describe that a little bit more a little bit more.
Dr. Randolph Nunez:
17:37
Yeah, so I mean food noise is just an easy way to verbalize how much thought process thinking about eating takes place in an individual. I mean, everybody's different. For some people, thinking about food is 70% of their day, right. So you wake up and you're hungry, and sometimes you wait, and half hour hour it doesn't mean you're not thinking about food, You're hungry, Sure. Then you eat, maybe last half hour hour, and then an hour kicks in and you start thinking about food again.
Dr. Michael Koren:
18:13
Okay.
Dr. Randolph Nunez:
18:13
And it's just okay. Where am I going to eat? Maybe you know I remember Dunkin' Donuts is right there. Maybe I should just grab a donut.
Dr. Randolph Nunez:
18:27
It's usually those high carb foods that are things that we want to think about the most.
Dr. Michael Koren:
18:29
So, Randy, so tell me about what medication you would typically start in somebody that fails lifestyle interventions and you believe needs something to help them.
Dr. Randolph Nunez:
18:39
So there, I mean, there are different medication classes that we can consider, and it all depends on you know what the ultimate goal is right. So, for example, if you have somebody who is, you know, mildly obese and they really don't have a big issue with losing 5-10% of the weight, then you can start with medications that may not affect them as much like even Metformin is not approved for weight loss, but it's a very good medication for certain situations, especially if you think insulin resistance is a problem. And then you have medications Phentermine, Topiramate, Bupropion. So there are multiple classes besides the GLPs that have taken a front seat in everybody's attention, but ultimately it's how much weight does this patient need to lose? If they need to lose 100, 200 pounds, the options are going to be different versus somebody that has to lose 20, 30 pounds, based on their metabolic health.
Dr. Randolph Nunez:
19:43
So what the ultimate goal is will play a huge role in what direction we take. If you need more than 15%, then a GLP has to come into play. If you have someone who's already having physical or metabolic consequences to what's going on, like hypertension, liver disease, kidney disease, then that's someone that you have to accelerate the process. In pediatrics we have the fortunate benefit of usually not having that problem. There are children with fatty liver disease, there are children with blood pressure issues, but usually that's not the case and we have time, as an advantage, to try multiple different options before we get to a GLP type situation.
Dr. Michael Koren:
20:30
Sure. And then, of course, when medicines fail, there's also surgery. So maybe comment on surgical interventions for people who are overweight bariatric surgery.
Dr. Randolph Nunez:
20:41
yeah, bariatric surgery.
Dr. Randolph Nunez:
20:42
I mean, as we said, if you have someone who wants to lose above 25% of their weight, then medications at this time, even though some are making some very good headway, it's just not really feasible to go from 500 pounds to 200. I mean, it's unfair for anybody, including the patient, to believe that that is something that you're going to be able to accomplish. Now you can take the medication approach in those patients, but you just have to be open and honest about what are the possibilities. So that has to be at the forefront of a conversation when it comes to is this patient a candidate for surgery? Is this patient a candidate to start with medications? But usually you would start with some type of intervention. That's not surgery and the insurance is actually required before they approve it.
Dr. Randolph Nunez:
21:37
So there's a whole protocol that has to be followed.
Dr. Michael Koren:
21:39
Do you have any feelings about which surgical procedures are best? We talk about gastric sleeves and Roux-en-Y procedures and what you're feeling are sort of neutral, and what type of procedure is done.
Dr. Randolph Nunez:
21:52
I mean, I leave it up to the surgeon because, as you know, when it comes to surgeries, it all depends on their hands. From the bariatric surgeons I've spoken to, gastric sleeve seems to be the one they like the most. It has the least amount of complications, but it does have recurrence rates that are higher than the others. I actually spoke to one of the renowned bariatric surgeons in the area and he was talking about alternatives from gastric sleeve that that he approaches.
Dr. Randolph Nunez:
22:22
He's had good results with it
Dr. Michael Koren:
22:23
yeah, and people are looking at more and more other types of devices. For example, right now we're looking at some work doing ablation of the small bowel to try to change the absorptive qualities of the of the bowel and maybe reduce the uptake of sugars and other nutrients. Are you familiar with that research?
Dr. Randolph Nunez:
22:44
I'm not. I mean it does make sense, you know there are multiple aspects where you can go when it comes to the treatment. You know, like gastric band was a procedure that a physician I spoke to, there's actually these different surgeries that we talked about. The part that I always go back to is what was the original cause of the issue? Because you can do surgery on an individual, but if you don't identify what the underlying cause is, then that's where you start to see the recurrence rate of even after surgery and I'm sure even after ablation, that they're going to have a recurrence of their weight.
Dr. Randolph Nunez:
23:27
Now what situation is one of the most common? A binge eating disorder. So if you don't address a binge eating disorder patient and for the audience, a binge eating disorder is a patient who's not able to control the amount of food that they eat. And before you say that, you know that doesn't exist. You know, trust me, there are situations where it is very difficult for the individual to stop eating and sometimes it's not just a mental process, it's a physical process, it's a hormone process. It is that the hormones that are available to the body are not working properly to tell the patient hey, you're at a point where you can slow down and stop eating.
Dr. Michael Koren:
24:12
Yeah, I think that's an important point to make is that you have to address some psychological issues as well as lifestyle issues.
Dr. Randolph Nunez:
24:20
Of course
Dr. Michael Koren:
24:20
Yeah, really important piece of the puzzle. So take us on a little bit of a discussion about what's the hot research right now for obesity medicine and, in particular, we do run studies here in Northeast Florida and elsewhere and what are people talking about in terms of understanding the most effective approaches for helping people with this problem?
Dr. Randolph Nunez:
24:43
So I have multiple answers to that question. Obviously, GLP's and the different GLP's that are coming on the market. One of the studies that, one of the type of studies that we're seeing, is what are the other benefits, besides weight loss, of these medications? What is the safety protocol in the pediatric age? Right now, the cutoff is 12 years old, but there are some studies that are starting to bring it down to six and that, for some people, could be controversial. The other part is these GLP's medications are showing overall morbidity and mortality rates have decreased, as you, as a cardiologist, know about the decrease in cardiac events in these patients, which is significant, and that's where a lot of these studies are going. When it comes to knowledge of these new classifications, we call them new, but a lot of them have been around for 20 years and that's where, right now, the focus on Obviously, you had told me about this new ablation study I'm not sure what other new medication classes besides the GIP GLP-1 agonists are coming down the road.
Dr. Michael Koren:
25:47
We get approached by different companies on a lot of things and we always will go to experts like you to see does this make sense? You know, certainly a lot of people have their ideas because of the success of drugs like Ozempic and Mounjaro would have been absolute blockbusters. Other companies are going to try to find their space, but we see some really interesting things. So, for example, something that's a little bit different than a standard pharmaceutical is this concept of the microbiome, and there have been studies that suggest that if you transfer the microbiome of a skinny animal to an animal that's overweight, that animal becomes skinny. So I don't know if you have a comment on that, but we've been approached those type of for for companies that are trying to commercialize that approach
Dr. Randolph Nunez:
26:35
So two parts of that.
Dr. Randolph Nunez:
26:37
Number one it just shows the importance of what you're eating, right, because that's ultimately what's going to affect your microbiome besides genetics, right? The other part is I've seen those studies. I just wonder about the feasibility of making that an enlarged scale when it comes to stool transplant or to that nature.
Dr. Michael Koren:
26:55
Yeah, so for the people that are not familiar with the term, microbiome that's all the bacteria that are in your gut and if you actually weigh all that bacteria that's in your gut, it's the size of a big organ and this has a big influence on health, and we believe that obesity may be one of the manifestations of having an unhealthy microbiome.
Dr. Randolph Nunez:
27:15
No, it's an incredible discovery. Actually, I was introduced to the importance of microbiome through my wife, who's a neonatologist, studying GBS.
Dr. Michael Koren:
27:24
Oh interesting
Dr. Randolph Nunez:
27:25
-and learned that there's a lot of people think that there's two nervous systems, one in the brain and one in the gut and the importance of that. It just shows you the power of what's going on in an area that you have no idea about as an individual
Dr. Michael Koren:
27:41
And GBS just for our audiences
Dr. Michael Koren:
27:42
Guillain-barre syndrome, I assume.
Dr. Randolph Nunez:
27:44
So it's group B strep.
Dr. Michael Koren:
27:46
Group B strep, I'm glad I asked.
Dr. Randolph Nunez:
27:48
Yeah, yeah.
Dr. Randolph Nunez:
27:55
So neonatologists know what GBS is because it is a bacteria that's tested in pregnant women in order to determine their risk of developing a sick baby after they're born. So it's an important area of research right now that, if they can find a treatment or a cure for that it'll be very important.
Dr. Michael Koren:
28:11
So, Randy, I know that you have a strong opinion about building muscle mass and how important that is. Why don't you elaborate on that a little bit for the audience?
Dr. Randolph Nunez:
28:20
Yeah, so I think that the Mounjaro, the Ozempic, has honestly distracted us from kind of the main issue in individuals, or one of the main things that we can do about this epidemic that's affecting so many Americans, where I think the latest number was 60% of adults.
Dr. Randolph Nunez:
28:37
It's incredible and increasing.
Dr. Michael Koren:
28:40
By the way, it's not just cosmetic. These have really important health consequences for the rest of your life
Dr. Randolph Nunez:
28:45
Exactly.
Dr. Randolph Nunez:
28:45
So you know, we have a machine that is able to break down the composition or the pieces of the body and the main two that we look at is percentage of body fat and percentage of muscle mass and that just tells us kind of where the individual's body composition is, in order to track.
Dr. Randolph Nunez:
29:06
And if we're able to increase the muscle mass of the patient and naturally it'll start to decrease the percentage of fat, that's an individual that is going to have a higher likelihood of having a longer life and a life that they'll be happy living, Because one thing is to live to 100. The other thing is to live to 120. And in a physical manner and mental manner that's very healthy. So that's one of the key parts that I want to make sure is thrown out there to your audience is, even though we're talking about weight loss, it's important to start getting their exercise in Right now. The recommendations are 150 minutes a week of moderate to intense exercise and two to three days of resistance training. The reason for that is, if you're able to build your muscles, then you're able to get the most important organ that is able to absorb and use the glucose that you have
Dr. Michael Koren:
29:57
Right your muscles.
Dr. Michael Koren:
29:58
That's right. There you go. So final thoughts. Why don't you summarize it for the audience?
Dr. Randolph Nunez:
30:03
So final thoughts is when it comes to overall health, there are multiple aspects that you have to look at that we talked about when it comes to sleep, nutrition, exercise. Those are the key ones and we want to take a look at those and figure out where in our life we can start to make a difference and we start as small as possible. When it comes to exercise, don't think about the hour. Start with five minutes. Don't do anything that's going to make you feel stressed. You have to make it easy on yourself. The foods that I make sure that I recommend for my patient are foods that they enjoy, they like, but that it's consistent. So, looking overall at what changes can you make that are easy and positive would be one of the most important steps that I would tell your audience to take a look at.
Dr. Michael Koren:
30:53
Yeah, so great insights. So that what I'm gleaning from what you're saying is number one is evaluate the overall circumstance of each individual, including sleep and stress issues and other psychological issues. 2: come up with a lifestyle program that has a schedule that has some very specific guardrails, so that people stick with it as best as possible and hopefully make it something that you like.
Dr. Michael Koren:
31:19
Then, if that doesn't work, look at certain medications not necessarily the GLP-1 agonists, but other medications as well, but GLP-1s are effective. And then, finally, surgery for those that fail the medicines or don't get where they need to get with that.
Dr. Randolph Nunez:
31:33
Yeah, every individual has a different treatment protocol that's going to work for them, and it's definitely about trying to figure out what that is.
Dr. Michael Koren:
31:41
And then, finally, research is a nice option for people.
Dr. Randolph Nunez:
31:45
Yes.
Dr. Michael Koren:
31:45
Either because they haven't done well with other things or they want to have the structure of a program that helps them achieve their objectives.
Dr. Randolph Nunez:
31:55
I think we all want to figure out what works, and sometimes we need guidance as to what that is. I mean, no one goes out there trying to fail. So when you look at someone who's struggling with a particular aspect of their life, whether it be weight or mental health, it would be to empathize with that individual and not give them a solution to what you think may work, but more just try to get to a place where you can collaborate with them and figure out what exactly is it that they need?
Dr. Michael Koren:
32:25
Randy, this has been fabulous. Thanks for educating me. I truly enjoyed our lecture and for a homeboy from the Bronx, I'll give you a knuckle knock there.
Dr. Randolph Nunez:
32:34
I appreciate it.
Dr. Michael Koren:
32:36
Thank you for being part of MedEvidence!
Announcer:
32:37
Thank you for inviting me. Thanks for joining the MedEvidence! podcast. To learn more, head over to MedEvidence. com or subscribe to our podcast on your favorite podcast platform.
