Episode 38: Health and weight without the shame

Dr. Sophia:
Hello everyone and welcome to the Dr. Sophia ObGyn podcast. So today we're gonna talk about something that's a little sensitive for some people. I really wanted to have this conversation. As a matter of fact, both Touseef and I have been having this conversation for a couple of months regarding obesity and health and how people feel in their own skin. And I'm so glad that we're actually having the conversation today. So, as always, I have Touseef right by my side as my co-host.

Touseef Mirza:
Hi everyone. So like Sophia was saying, this is a subject that, I mean, we talk a lot in general in society. Like a lot of people are weight obsessed or weight is a big obsession, or the food we eat or the clothes we wanna wear or how we wanna look. There's so much around that. But we wanted to sort of go a little bit deeper, but also look at it from different perspectives in terms of the implications of when we talk about weight and weight as it pertains to health, and how we actually are able to connect with ourselves no matter what weight we are at, without shame.

Dr. Sophia:
Yeah. The goal here is to be able to have a conversation and understand that your weight should never be associated with shame. And that's whether you're overweight, underweight, obese, however we wanna put that, although the focus of this conversation is gonna be about overweight and obesity, but it's the concept of simply not having shame around it and understanding the more so what it means to be healthy.

Touseef Mirza:
So if we start there in terms of what it means to be overweight or obese, usually when we talk about weight or overweight obesity, usually we use the denotation of BMI, which is body mass index.

Dr. Sophia:
Yeah. The body mass index.

Touseef Mirza:
Usually, A BMI of 25 and over is overweight and over 30 is called obese. And we were looking at the stats actually, which was-

Dr. Sophia:
Oh, they're, they're astonishing. They're ridiculous. The concept that in the US that at least 30% of people are considered overweight and up to 45% of people are considered to be in the obese category, meaning that they have A BMI of greater than 30. And it seems like that's such a wild number. You know, but at the same time, what does that really mean in term when we bring it back down to the individual?

Touseef Mirza:
Yes. And also I would say that BMI is sort of like a good starting point for a litmus test of where you are, but you do need to investigate a little bit more in terms of its application, that application to your specific case.

Dr. Sophia:
Yeah. Because you can have a BMI of 30 and you could be a super healthy and fit person. I don't wanna play a numbers game. But we also can't ignore it. So at the same time, when we think about it, when someone comes into my office, let's say, even if it's for the first time, I ask them, are they happy with their weight? Are they at the weight that makes them feel the most comfortable in their skin? I ask, is this the heaviest they've ever been? And I ask, are they concerned about their weight? And I feel like where we go wrong in society is that we don't make it a very open conversation that doesn't surround, oh my God, I can't believe you're this weight. It's not supposed to be like that.

Touseef Mirza:
I'm not putting you on the spot when I'm asking you that question. I'm just asking you a question about your health.

Dr. Sophia:
That is exactly right. When I ask someone about their weight, I am absolutely not putting them on the spot. I want to know what their feelings are about their weight. Do they feel like they're at a good weight? Do they feel that they're at, they could lose a few pounds, do they want to gain a few pounds? I, you know, that happens too. And so it's not a place that people should shrink in . But rather, let's have a real talk. Let's have a real conversation. And part of the reason why I think we needed to have this conversation is because, especially like this, the craze of all of the, you know, what we call the GLP-1.

Dr. Sophia:
Ozempic and the Wegovy and, semaglutide, if we're thinking about it from a generic term, types of medications that have now come on the market over the last couple of years and just how widespread we've become with just the use of this type of medications. And though I think that they definitely play a great role. I think that they're making people feel like they have to somehow become skinny. And I just wanna bring it back to the concept of health.

Touseef Mirza:
So I mean, even that is an interesting thing, right? Like when we say health, a lot of people do associate skinniness with health. Absolutely. Like when you think about it. So I think it might be interesting to actually think about what does healthy even mean when it comes to your body composition?

Dr. Sophia:
Healthy to me means you have your hormones in balance. It means that your heart health is great, and your blood pressure is normal. You don't have diabetes, you don't have high cholesterol. When I check just a regular, you know, blood panel, you're not anemic. You don't have deficiencies in terms of vitamin deficiencies. You don't have pain in your body, you don't have gut health issues, you're not constipated, you're not having diarrhea. You don't have something called, you know, irritable bowel syndrome. You have normal fertility. These are the things that I'm thinking about when I'm thinking about you being healthy.

Touseef Mirza:
So healthy, really, from a holistic perspective. Yes. Lemme add. All the different organs are functioning.

Dr. Sophia:
Absolutely. And let me add in that you're not depressed, that you're not anxious. That you're not feeling ashamed of yourself or having self-esteem issues. I mean all of those things. These are what we should be focused on when we're thinking about you and your health. Now, of course, let's go back and relate that to is there a weight issue or are you having a health issue that is related to your weight?

Okay. That can be addressed. We can help you get healthier if we are able to manage your weight in a healthy way. So when I say that, I say that because I don't want people to think that, oh my God, I need you to lose all this weight because, and then to create another health problem such as anxiety or obsessiveness, you know, I'm not helping the situation if I'm creating some type of compulsion. You know, or creating a deeper sense of low self-esteem, for example. I have not helped that situation. I have not helped that person. But instead the goal here is to partner with your patient in order to support them through whatever health goal that they have. And that may include weight loss

Touseef Mirza:
Because the person, if they are quote unquote overweight, they could still be healthy.

Dr. Sophia:
That is correct.

Touseef Mirza:
So I think that's sort of the dichotomy of this is like, you know, because automatically when we think overweight we say, oh, something's wrong. And also, I just wanna go back to what we like to say quickly, just because I know a lot of people are stuck with the BMI connotations. The reason why we said that, you take it with a little bit of a grain of salt, it's a good indication. But for example, people who are really fit, they have a lot of muscle mass.

Dr. Sophia:
Of course. Someone who's very fit can have a lot of muscle and muscle at the end of the day weighs more than fat.

Touseef Mirza:
So your BMI might be high, but it's not because-

Dr. Sophia:
But you could be incredibly lean.

Touseef Mirza:
Exactly. So this is where we need to really understand the connotations of A BMI. Being overweight, over 25 does not necessarily mean that you are unhealthy.

Dr. Sophia:
That is correct. And I mean, we have to think, think about it in different terms too. Like literally fat distribution of your, in your body. You know, we know that in terms of not being healthy and obese, we're talking about truncal obesity for example, as having the highest risks. You're more, let's say, fat. Okay? 'cause I'm not gonna mince words here. Okay. In your belly. Okay. Where you carry all of your weight in your belly. Okay. That, that is gonna have a lot more health implications than someone who has, let's say, a total fat distribution throughout their body is kind of the same, alright. And doesn't have that big belly type of fat. And like we talked about literally just now, is the concept of where we are in terms of your muscle mass versus your fat distribution and fat composition. It's just different.

Touseef Mirza:
So we talked about muscle mass, we talked about fat distribution. And the other aspect that we were talking about before when it comes to weight, is that you could be overweight without necessarily having greater muscle mass, but you could still be healthy. Like your body can still be functioning really well if it's overweight. So the key here is to make sure that your body is functioning well. That's number one.

Dr. Sophia:
Number one is how are you maintaining good health and all the different body functions. It's a lifestyle. It's the way in which you approach your own body and it's the way you think about your body. It's the way you think about how you treat it. It's the way you think about how you feed it. It's the way in which you move your body. And I'm not taking anything away from the fact that we still have to take into consideration health. Just your genetics,

Touseef Mirza:
Your predisposition.

Dr. Sophia:
Your predispositions, right? It's like, for some of us, no matter what we do, we're always fighting an uphill battle. You know, like, just to be completely transparent, me at 145 pounds is basically the biggest I've ever been. This is me literally at eight months pregnant, same weight. Okay. But it doesn't change the fact that I've had high blood pressure since I'm 30. And it doesn't matter if I lose weight, I still have high blood pressure. And so I still have to manage it, you know, by still doing things like eating right. It's hereditary. My mom has it, my grandma had it, my, you know, like I can just go on and on. You know, and so barring everything else, it's a matter of how do I stay healthy?

Touseef Mirza:
So how do you know how to stay healthy? Does it mean then is by going to do our yearly checkups and to see actually what's going on at different levels of your cholesterol and actually seeing the data to then really understand and make the call how healthy we are? Or are there other ways of just every day, you know, doing the normal exercises or moving around and the diet? So like when you say healthy, which one is it?

Dr. Sophia:
Let me tell you, when I think about health and when I think about being healthy, I'm really talking about the avoidance of disease, the prevention of disease. And when I think about diseases, I'm thinking about cardiovascular disease. So do you have high blood pressure? Do you have an increased risk of heart disease? Meaning that you, you know, whether it's coronary artery disease, where you can have plaque formations and that can lead to things like a heart attack or stroke. Do you have something called sleep apnea?

Do you have asthma? Do you have, again, gut concerns? Things like fatty liver, okay, that's non-alcoholic. Do you have mental health issues? Do you have an increased predisposition for depression? Are you depressed? Are you anxious when you come in for your doctor's visit? Is your blood pressure always high? And I'm not talking about those patients who have, there is something for real called white coat syndrome, for which when they come in to see their doctors, they're so nervous that their blood pressures can be very high.

And yet when you check them at home, under normal circumstances, their blood pressures are normal. Those are not the people I'm talking about. I'm talking about the ones who, no matter where they are, they're in their house, their blood pressure is high, they're at your doctor's office, their blood pressure is high, they're having a good time, their blood pressure is high. So I'm talking about how we are managing to make sure that we are avoiding those types of diseases, that we know that obesity can increase the risks of having them, or if you already have them, that obesity can make them worse. And so it's a matter of having an open conversation so that way you know exactly where you stand in terms of the risks of some of those things that we just talked about.

Touseef Mirza:
So for example, if I am overweight and I have high blood pressure, then at that point I should be more careful in not continuing to-

Dr. Sophia:
Gain weight.

Touseef Mirza:
So that is a key thing where I should be like, no, like I, for my own health and maintaining my health, if anything, I should be losing weight.

Dr. Sophia:
At that point. Yes. Because if you're, especially if your high blood pressure is related to your weight, weight. Okay. Now granted, like I said, I have high blood pressure, does it matter because if I do gain more weight than the severity of my high blood pressure goes up. What I'm trying to say is, it doesn't matter if I'm 115 pounds, I still have high blood pressure 'cause that, you know, I was 120 pounds when I was diagnosed. But at the same time, I'm conscious of that. And I know that if I get to a point where I am a lot bigger, I already have high blood pressure, which already increases my chance of having heart disease and having a stroke early or having a heart attack. So I wanna minimize that. I wanna control the things that I can control, and it has to be a mindset shift and a lifestyle change.

Dr. Sophia:
I have to do better, perhaps again be fully transparent about how I sleep and how I manage my stress. You know, I could probably be meditating more, doing a lot more deep breathing in order to help manage my blood pressure. But I have patients who may have a BMI of 35, they don't have high blood pressure, they don't have gut issues. They do the work in the sense that they are exercising regularly. They have normal, what we would consider as hormone balance, because they show evidence of that by having normal periods and having a normal reproductive life, so to speak. I want women to walk away just encouraged at how they are taking their health more seriously. And it should be more than just how much they weigh.

Touseef Mirza:
So lemme ask you a question. Let's say that you have a patient and they are severely obese. Let's say they're about 300 pounds and they're about like five foot five or something like that. Is there a point when we talk about weight that you just really have to lose weight? Because at that point, no matter what, you are just so predisposed to?

Dr. Sophia:
Yes. I would have a very open and honest conversation and I pray that the patient is having an open and honest conversation with me because it then leads me to ask questions. Are you experiencing things like back pain, joint pain? Is part of the weight issue that you have? Is it because you have a size F breast? You know, we have to take it, there are so many different ways in which our weight can be distributed that can be causing such a bigger impact, you know, on our health. Are they having trouble sleeping because they're, they don't know if, you know, they may have something called sleep apnea, where they are losing their breath in the middle of their sleep

Touseef Mirza:
Because of all of these different symptoms and ailments, diseases increase if you are overweight.

Dr. Sophia:
Well, there's severity, certainly severity increases, it increases your quote unquote morbidity and mortality. I mean, it's not, I don't wanna mince words here. I want us to be clear in the understanding that yes, obesity does carry an increased risk of mortality and it does increase your risk of almost all causes of mortality. Okay. Whether that's from cancer, whether that's from heart disease, whether that from an endocrine perspective, such as things like diabetes, you know, and the concept of developing diabetes. But the weight itself is not everything. I want us to think about it in totality.

Dr. Sophia:
So that way we get people more on the mindset of how can I make a lifestyle shift and am I in tune enough with my body to say, let me be honest. And hey, I do feel better when I am 20 pounds lighter. I do feel better when I'm not eating. Whether that's fast food every single day. You know, or drinking every day. Or a combination of both. And, you know, because at the end of the day, there is a very, there is also the link between obesity and inflammation, and inflammation is also a bigger part of disease.

Touseef Mirza:
And I think also what we're trying to convey is all these different aspects, you know, about the foods you eat and inflammation, but it's also to look at your body, at your weight. Like you would look at, for example, almost like if you had a cut and you're just like, okay, you know, I have to fix this. There's no shame in it when we do that. You know, it's like if there's a problem, like, okay, we're gonna address the problem, but weight because of the society that we live in and because of all the messages received there is just such huge shame and guilt all associated around that agreed. That it feels like we lose what we're really trying to focus on. Exactly. Because we're trying to fit in this cookie cutter

Dr. Sophia:
We're trying to fit into this mold, you know, when in fact I want to just change the concept of the mold. And the mold needs to be, how can I be more healthy? How can I understand my body better? What can I do to work with my body, my body type, you know, so that I can just live more fulfilled

Touseef Mirza:
I feel with what you just talked about. It reminds me of all the conversations that we've had in the past few years with body positivity and this whole concept of how do you relate to your body? And that we shouldn't be shamed by our bodies, even if they are big bodies or bigger bodies than what is usually the norm of what is sexy or healthy and so forth.

Dr. Sophia:
Everybody's not gonna be in Vanity Fair, and that's okay. We need to understand that we should feel good in our skin, I want you to have that feeling of body positivity. And if we are not there, because you do have an eating disorder such as overeating, binge eating, right? Is it because you have anxiety? You know, are you overeating or only thinking about food because of some history of trauma that's unresolved or, you know, that needs to be healed? Do you need to be in some form of therapy?

Dr. Sophia:
Do you have an actual metabolic issue such as PCOS, which even when you're eating like everybody else, a bird in the room and you're still gaining weight, PCOS being polycystic ovarian syndrome, which is a hormonal issue that can lead to increases in weight, increases your risk of having type two diabetes, increases your risk of having high cholesterol and certainly increases your risk of infertility. Are you in that transitional period of your life?

You know, because at the end of the day, there's a larger majority of women who are obese or over the age of 40. So are you going through perimenopause, where your metabolism is slowing down? And how are you addressing that in a way that is graceful? It's like we enter that second act of life, right? That transitional period between perimenopause, menopause, and everything, you, you know, you, you, you, you look at food and you feel like you've gained weight.
Touseef Mirza:
As we're talking. Like, one of the things that's coming to my mind is we say body positivity. And the reason why I'm coming back to that is because it was such a mainstream thing, especially with Lizzo, that sort of like, made that all happen a couple of years ago, which is great. The way that I see it is less body positivity is more body love and body love should always be there. Like regardless of

Dr. Sophia:
Where you are,

Touseef Mirza:
Regardless of whether you're skinny, you're healthy, you are obese, or you're extremely obese, it doesn't really matter. Like you have the right to love your body at all times.

Dr. Sophia:
It's just the concept of loving your body no matter what. And then we can still have a side-by-side conversation on your health.

Touseef Mirza:
Yes. So it's like loving your body where you are, and then if there's certain things that we need to do to make you healthier, then that is just what you need to do. But throughout you can love your body. Absolutely. I think absolutely. The problem is, when people, we, when we talk about being overweight or obese, there's this connotation of shame and not loving your body until you are at a certain point. And that should not be the case.

Dr. Sophia:
No. Because people lose weight all the time and still don't love their bodies. People lose weight all the time and still have unhealthy lifestyles and still, you know, whether it's because they've had some surgical procedure in order to help them to lose weight or they are taking, for example, some of these weight loss drugs. But if they are still eating in a manner that is unhealthy, then they will continue to be unhealthy. You know, even if they've lost weight just because their stomach has shrunk and they just can't put any as much into it, but if the thing that they're putting into it is still bad. Then it's still bad.

Touseef Mirza:
And I'm not saying this is an easy thing to do because we've been brainwashed for a long time as women to feel a certain way about our bodies. But number one is to become self-aware that that's how I'm reacting to these things. And then number two is to reclaim and say, no, actually, this is not how I'm gonna feel. I'm gonna feel like my body is able to do so many things for me without me even thinking about it. Right? Like, even like as I'm like, just blinking my eyes or whatever it is or, or breathing or whatever it is, like my body, I'm loving it because of what it can do. And maybe starting from there and building it all the way up to even the weight that you are at, and at the same time recognizing if there are certain issues to love your way through that.

Dr. Sophia:
I love the concept of love your way through. Because the more you love yourself, the more honest you can also be with yourself, the more you love yourself, then maybe it will become easier to tackle challenges. The thought behind all of this is, I am happy with exactly who I am, how I am and how I look. I also want to be vivacious and healthy and live long. And I wanna know what are some issues that I have in my family history and what are the things that I can be doing if I have predispositions to not add the fuel to the fire. I mean, it's like someone who comes into my office, and you are a smoker. We know that smoking increases mortality. It just does. So when I come and I ask, no matter

Touseef Mirza:
What way are you-

Dr. Sophia:
No matter what, it doesn't matter how, how many, how old, how.

Touseef Mirza:
So when you do ask, let's say somebody who's overweight or obese and is or wants to get pregnant, and you do ask these questions in terms of, you know, trying to see how you can reduce the probability of certain complications. Complications, how do people react? Do they feel embarrassed? Do they feel shame? Or are you able to have a more objective conversation, specifically just around health?

Dr. Sophia:
So I would say that people feel many different things. I have women who are, they may feel shame, and they may say, I don't wanna talk about it. I have women who say Doc, I'm so glad you brought it up because I've been trying to lose weight and I just can't, can you help me? So they're happy that we've brought it up. I have women who say, I didn't know that my weight was a problem. I have women who say I have no knowledge of what to do, where to begin. There are just so many different facets, and you just have to meet everybody where they are.

Touseef Mirza:
So we were talking, and Dr. Sophia is also my ObGyn. And so we looked at where I'm at in terms of my health, and she asked me, you know how much you weigh right now? And I said, 174. And then she said, how tall are you? Five three? And then you said-

Dr. Sophia:
That puts you in the obese category.

Touseef Mirza:
And I said, no, but I'm just at the cusp. I'm between overweight and obese. And because I never associate myself with that.

Dr. Sophia:
Right. You just don't. Right.

Touseef Mirza:
I don't associate with my, so when you said that, it literally gave me a chill, I'm like, oh my God, really? I just don't see myself that way.

Dr. Sophia:
Yes. But see, you're one of the healthiest people I know.

Touseef Mirza:
And so then I started to think, oh my God, I have to hit the gym tomorrow. Which I was gonna do anyway. But you know, I am menopausal. I was 140 for a long time in my forties. I'm 53 now. And then three, four years ago I started gaining weight. Meanwhile, I'm still doing the same exact thing that I was always doing. And I've gotten up to this point. But after two years I started to get my life together, and started to just tell it as it is. And I just said, all right, I do feel a little bit overweight, but I still love my body. I said it before, I still love my body because it does everything that I want.

And I'm like, this is amazing. And also in a very concrete turn, I don't wanna change all my wardrobe. Okay. Like, I wanna keep the wardrobe. I have, I wanna keep the size that I have. I love being healthy , vivacious, slightly toned, like a good solid eight. Like I'm very happy. I've always been between six and eight, but eight is good for me and I'm not looking to be skinny. And that's where I feel the most myself, if that makes sense. Like that's really, oh, that's Touseef. Like, you know, that's, that's where I am. A nice medium. I'm good with that. And, so we were talking about considering that I'm in, on the right at the cusp of obese, does that mean that now I should really be more careful about my health? And you said, considering the charts that you have of mine? Yeah.

Dr. Sophia:
I mean, your cholesterol's normal. Your blood pressure's normal. Your hemoglobin A1C, the indicator for diabetes, is super normal.

Touseef Mirza:
My liver was good.

Dr. Sophia:
Your liver was good. You're not anemic. Your liver function is perfect. Your kidney function is perfect. And again, I just wanna say that we are not here to just treat the number.

Touseef Mirza:
Yeah.

Dr. Sophia:
Right. So at the end of the day, you just said it yourself, you said, you know, I feel really good when I'm a good size eight. Yeah. You know, and so it doesn't mean that you're not in love with who you are. And it doesn't mean that you haven't embraced who you are in this menopause that you're in. Right. But it may mean that you have to work a little harder.

Touseef Mirza:
Well, I am because I've been working out more. I know. And I've been going, I mean, lifting, lifting. And can I just say, I told her this yesterday, I can now deadlift a hundred pounds.

Dr. Sophia:
That's incredible. So that's

Touseef Mirza:
Incredible. So I keep pushing myself, 'cause I know after 50 we start losing muscle mass. So I am very in tune with like, how long can I have a full, vital, vivacious body? And I just wanna keep it, you know, the way that it's going right now. And so I'm totally invested in that.

Dr. Sophia:
It's the investment in yourself that I love. Hmm. It's the investment in yourself. You may never budge that number on the scale . But you're doing all the things that still keep you healthy. You're moving, you're, you're, you're socially interactive. You exercise, you eat well, and you take the supplements that are good for you.

Touseef Mirza:
I sleep at least seven hours; seven hours a day is seven hours a night.

Dr. Sophia:
You get quality sleep. Oh, it's so good. Let's talk about it like that. So all of these things play into the role of how we think about you as a healthy person. And so, yes, of course. Why do I, why did I say that you're obese? It's because if I'm just looking at BMI, the answer is yes. And what did it do for you? It at least made you think, alright, let me make sure I stay on track.

Touseef Mirza:
At least. Yes. Right?

Dr. Sophia:
Yes. Let me just stay on track.

Touseef Mirza:
Yes.

Dr. Sophia:
And that's important. That's why I say we have to still have that open and honest conversation. That's why I say, you know, because just knowing automatically puts you in a position not to be anxious about it, but to say, oh, snap. Okay. It's gonna make you maybe double, you know, think twice about having three pieces of cake.

Touseef Mirza:
And even that is okay sometimes, of course.

Dr. Sophia:
Sometimes, but not every day.

Touseef Mirza:
Exactly. So we talked about a lot of different things in different areas. I think really what we're trying to really like to get down to the crux of is to start for us to change how we view weight. And actually look at it more from a place of who you are in self-love. And then look at health, but not just weight for the sake of weight. Did I, did I, did I get that right? It's, it's a little

Dr. Sophia:
I don't want to equate weight and health. Okay. Is, is really where it comes down, what it boils down to. I wanna only have the concept of self-love and then how do I become more healthy? Whether that is to lose weight, whether it's to gain weight, whether it's how I exercise, whether it's if I'm meditating, whether I'm not, I'm having good social interactions in my life. Am I getting enough rest and sleep? Am I eating well? Am I moving my body? I don't want us to just keep equating the concept of weight and thinking about it like we have to fit into this cookie cutter mold. And definitely no shame.

Touseef Mirza:
No shame.

Dr. Sophia:
No shame.

Touseef Mirza:
We, just need to kick that one out like once and

Dr. Sophia:
For all. Yeah. No shame, no shame. Be in your body at all times. Know your body at all times. Feel your body at all times. Love your body. Love your body all the time. Look at us. Who are we? .

Touseef Mirza:
Love your body now and love your body through whatever it is you wanna do. And also that's a more enjoyable way to live,

Dr. Sophia:
Live, enjoy, no matter what your weight is. And then live in health.

Touseef Mirza:
I'm really happy we had this conversation. We really wanted to give space to this because it can feel sensitive and it can feel

Dr. Sophia:
Icky.

Touseef Mirza:
Yeah.

Dr. Sophia:
Not fun.

Touseef Mirza:
But we really wanted to create space for everybody to be included in this.

Dr. Sophia:
We want you to love who you are first and everything else we can just manage. Remember everybody, it always comes from the heart. It comes from your soul. It comes from who you are. It comes from how you embrace your body and embrace yourself. Thank you so much for listening to the Dr. Sophia OBGYN podcast. See you later.

Touseef Mirza:
Bye.