Why Weight Management Can Be Tricky for Women with Dr. Karen Cooper

Podcast Transcript

Nada Youssef: Hi. Thank you for joining us. I'm your host, Nada Youssef. As we continue our celebration of women this month, we're putting you first by talking about your weight and how to manage it properly. Weight management can be a very tricky thing with chronic illnesses, poor diet, lack of sleep, stress, pregnancy. Today, our featured expert is the director of weight management at the Women's Health Institute, Dr. Karen Cooper.

Nada Youssef: Before we get started, please remember this is for informational purposes only and it's not intended to replace your own physician's advice. Thank you so much for being here today.

Karen Cooper: Thank you for asking me.

Nada Youssef: Sure. If you want to just introduce yourself to our viewers real fast.

Karen Cooper : Okay. As Nada said, I'm Dr. Karen Cooper and my specialty is in obesity medicine. I am a primary care physician but I focus on women who are having issues with weight management in relation to a variety of issues, so, polycystic ovarian disease, menopause and fertility, metabolic diseases like hypertension, diabetes, sleep apnea, sometimes pregnancy before pregnancy, during pregnancy, after pregnancy, and it's fun. It's a lot of fun. I get to meet a variety of wonderful people and we usually have a great time.

Nada Youssef: Oh, wow, we have a lot to cover then. I'm going to start with pregnancy because I always hear the term, "I'm pregnant, so I get to eat for two." Then, you're thinking, "Two plates of the same thing?" What is the normal weight gain for a pregnant woman?

Karen Cooper: This is the thing, there's the conception out there that once I get pregnant I can eat as much as I want to and all the weight's going to come off, but it's actually not true. We really don't need that much extra weight. As much as maybe 300 extra calories per day when we're pregnant will be more than enough for a growing baby. That could easily be something as simple as an extra apple, piece of fruit and slice of bread with peanut butter, maybe a little bit extra rice along with some protein. It's really not that much more.

Karen Cooper : NIH has specific guidelines in terms of where your weight is right now and how much weight you should gain. You can certainly talk to your doctor about it, but there's a certain amount of weight that should be gained through your pregnancy just to make it optimal for you and for your baby's health.

Nada Youssef: So, don't go for ... What about the cravings?

Karen Cooper: I know, I know.

Nada Youssef: I'm craving pasta, I'm craving pizza.

Karen Cooper: I know, and that's the thing that you can't really turn off. It's not that you shouldn't give in, but you need to do everything with moderation. If you really have that craving that you cannot turn off, sure, go take a bite of something, just knowing that, okay, you don't want to finish the whole tub of ice cream.

Nada Youssef:  Sure. What I heard you say is it's about 300 calories, so that could be just one apple.

Karen Cooper:  Well, no, that would be a couple pieces of fruit if you really have a fruit craving.

Nada Youssef: Sure, a little bit of sugar.

Karen Cooper: Yeah.

Nada Youssef: Okay, great. What about some exercising tips for pregnant women? I know that's something that you want to keep healthy, but they tell you if you weren't exercising that much before pregnancy that you should not exercise as much, so how does that work?

Karen Cooper: Typically, you can follow, within reason, the same exercise activity that you were engaging in before. If you were horseback riding, you don't want to do that. You don't want to engage in any exercises that will put you in a place of instability. Your exercises should be low impact and they should be where you're stable, where there's not a chance. 

Nada Youssef: Okay, safe.

Karen Cooper: Yes, exactly, should be safe, where your weight is supported because you have this growing baby, and so that takes the whole frame off balance. It's really important to have both feet planted on the ground, and just make sure you're in a safe environment. If, for some reason, you were to fall, that it wouldn't be something that would be very traumatic, but really, making sure that you're avoiding things that can actually hit the stomach. Just be very safe.

Nada Youssef: Great. All right, so, the ultimate diet for weight loss. I was going to ask that. For pregnant women, should they be eating more fat or less fat, and then just for any woman, not just pregnant women?

Karen Cooper: Pregnant women need good nutrition. We all need good nutrition. There are a couple things that are focused on during pregnancy like folic acid and so on. Obviously, we always tell our pregnant patients to make sure you take a prenatal because that has extra vitamins, iron and things that we really want them to have so the baby can get those nutrients during pregnancy. We do not place our pregnant moms on diets. That's a no no, but we will look at your diet and we will make sure that you are eating the foods that you should be eating to get the best nutrients, and that you're eating them in the correct portion sizes.

Karen Cooper: No, no diets for pregnant women. There's really no ultimate diet, period.

Nada Youssef: There's so many trends out there. How do we choose? How do we know?

Karen Cooper: There are tons of trends. There are tons of trends out there. The first thing you want to do is make sure, in conversation with your physician, that it is a safe diet. It's not something that's going to throw your physiological system out of whack.

Nada Youssef: Sure, sure.

Karen Cooper: It has to be a safe diet, something that's not going to put you in the ER, but then, also it has to be something that you can manage. Some people are vegetarians, for instance, but there is the trend now to do more high protein, low carb, and most protein is fish and chicken and steak and things like that, and vegetarians, they're not going to indulge, so it's really about, what are the types of foods that you eat, what do you feel is suited for you, and what do you think you can give up? Most importantly, it's got to be healthy, it's got to be a safe diet for you.

Nada Youssef : The word diet can be very tricky, because it always sounds like it's something that we just get into in a temporary state, but if we're talking about a lifestyle diet, what we should be eating, there's Mediterranean diet, there's the keto diet, there is fasting. What do you recommend? What do you eat?

Karen Cooper : What I recommend is, you have to be very aware of your portions.

Nada Youssef : Right.

Karen Cooper : If you can get a variety of foods, that means that you're getting a wide range of nutrients for your body's needs. Typically, if we restrict or reduce a particular food, we're going to see weight loss. When we use the word diet, you tend to think of it as something temporary, but truly, everything we eat every day on a regular basis is our diet. When you're looking to lose weight and you say, "Oh, I want to go on a diet," you should consider it from a temporary standpoint because that's not something you're going to continue the rest of your life.

Nada Youssef : Right.

Karen Cooper : Okay? Some people will go on a particular diet type to get a larger amount of weight loss, perhaps, or a faster amount of weight loss based on the diet type, but really, if you do continue eating the way you normally do, if it's a healthy, eat that type diet, and you reduce your calories proportionally per day you will get some weight loss, you just won't get the 20 pounds in two weeks that you're looking for.

Nada Youssef :  Right, it won't be as fast as we want it to be.

Karen Cooper : Yes, exactly.

Nada Youssef : Let me ask you this. Weight loss medications and pills that are ... Are those safe? Because, it's something that it almost sounds too easy that I can take a pill that will make me not hungry or that will make my fat go away. Are those safe and what do you have to say about those?

Karen Cooper : There's no pill that will make your fat go away.

Nada Youssef : There's no magic pill.

Karen Cooper : There's just nothing that will make fat go away. We wish.

Nada Youssef : Yeah, right, exactly.

Karen Cooper : Yeah, yeah. What, I think, everyone needs to understand about weight loss is that you're losing weight, whether it's through a diet or medication or surgery, because what you're taking in is being reduced. Some people do need the help of medication to get from point A to point B, because when we gain weight it's not just about the way we look or the way we feel, but it's also, what diseases are we putting ourselves at risk for because of the increased weight?

Karen Cooper : There are times when medication is really necessary just to help that person get the weight off so that they can be at their optimal health, and then, medicines are also very good in terms of an eating disorder. We do have eating disorders and so that needs to be evaluated by a psychologist and a physician, and medications can be incredibly helpful in terms of eating disorders.

Karen Cooper : The patient always needs to be monitored. It shouldn't be medication that you bought off the internet.

Nada Youssef : Right, right. If you're a healthy person and you're able to exercise and eat well, you shouldn't be going for medications.

Karen Cooper : I don't say shouldn't. It really depends on your body mass index. The NIH has specific guidelines in terms of what your body mass index should be when we're prescribing medications. As medical care providers, we have to follow that, otherwise we're putting your health at risk, right?

Nada Youssef : Sure, sure. Before I go forward here, can you talk a little bit about BMI, what it means, what's healthy, what's not, when we should see a doctor?

Karen Cooper : The body mass index is an average of your height and your weight. We get this number and it tells us ... It's really more to give us a range of where you are in terms of health. It is not accurate. I think a lot of people get so hung up on that number. Normal is between 18 and 24. 18 and 24.9, and overweight is from 25 to 29.9. Obese is 30, and it keeps on going. You can get to morbidly obese, where you're a hundred pounds or more overweight, and your body mass index would be around 40.

Karen Cooper : The only reason we're looking at those numbers is to determine what you're at risk for in terms of disease processes, because we want to dive in and we want to take care of it. Also, if you already have a disease process, the increased weight is going to make it worse, so we also want to address it, just based on that. Do you have diabetes and is your body mass index 35?

Karen Cooper : We know that if we help you with the weight loss, your diabetes is going to improve. It might even resolve, if it's diabetes type 2. However, if your weight keeps going up, you may get to the point where you need insulin, if you're not already on insulin at that time.

Karen Cooper : It's really important to look at it from a full range perspective of how healthy am I? Am I putting my health at more risk, but not, "Okay, I've got to get between these two numbers, because if I don't ..." It's that type of thing.

Nada Youssef : Then, you mentioned, type 2 diabetes, you can take your insulin number down with diet?

Karen Cooper : Type 2 diabetes, you can bring your body mass index down, if you are losing weight with a medically supervised diet plan or a healthy non-medically supervised diet plan and with exercise activity. The one thing people don't realize is how terrific exercise is for us. Even if you don't lose weight with exercise, and most of the time you do not, it helps maintain your weight, it is going to lower the blood glucose. It's going to bring the blood pressure down. It's going to make you feel great. It's just going to do so many great things.

Nada Youssef : Yeah, the happy feeling, right?

Karen Cooper : Yes, yes.

Nada Youssef : Great. I'm going to jump onto a little game. I'm just going to throw out a statement out there and I want you to tell me if it's a myth or a fact, and then just explain a little bit about it.

Karen Cooper : Okay.

Nada Youssef : First one is about skipping breakfast. Can skipping breakfast cause me to gain weight?

Karen Cooper : Yeah. That's a myth. We are pushed all the time, eat your breakfast, eat breakfast.

Nada Youssef : The most important meal of the day.

Karen Cooper : Yeah. It is important, because you haven't eaten for several hours, if you've gone to bed at the right time.

Nada Youssef : Right, that's true.

Karen Cooper : It is important. However, a lot of us are not breakfast eaters, so our bodies might naturally want to eat later in the day. It is perfectly okay to eat later in the day. What I like to tell my patients is eat when you're hungry. If you eat when you're hungry, not when you're starving, if you eat when you're hungry, not only are you going to enjoy your food better or you're going to eat the right amount of portions for you.

Karen Cooper : Sometimes, if we're not breakfast eaters and we try to fit into that mold of you must eat breakfast, we're really taking in more calories during a time when it's not really registering that, hey, you're hungry, we're filling ...

Nada Youssef : Right, your body's not asking for it.

Karen Cooper : Right, you're getting filled. Let's just say you're an 11 o'clock eater. You get up at six o'clock ...

Nada Youssef : How'd you know?

Karen Cooper : You get up at six o'clock and you're like, "Okay, I need to have breakfast," you're still going to be hungry at 11:00. That's your norm, and so you've taken in these extra calories, so unless you reduce what you eat at 11 o'clock, you've now added more calories to your day that you may not want.

Nada Youssef : Okay. You made my day. I skip breakfast all the time, because I'm not a hungry person in the morning.

Karen Cooper : Yeah, and in defense of the registered dieticians who I adore, one of the reasons that's said is because skipping meals can cause you to over eat. If you're going to over eat because you skipped breakfast, you do need to skip your breakfast.

Nada Youssef : And that's why you eat when you're hungry. Whether it's morning at 11:00 AM or 12:00 PM.

Karen Cooper : Right, exactly, exactly.

Nada Youssef : Great, all right. We got that one. Okay, and, you should eat as much fruits and vegetables as you want and you will never gain weight.

Karen Cooper : Such a myth, such a myth, such a myth. Okay.

Nada Youssef : Is it the sugar content?

Karen Cooper : Fruits are healthy for us, vegetables, too, but they're not free foods. They have calories, so if you require a certain amount of calories to keep your weight a certain weight and you eat more than that, you're going to gain weight whether it's a piece of fruit or some chocolate or lettuce. Because we tend to think foods that are healthy for us, we can eat as much of it as we want, and that's not true. We want you to eat healthy foods, right?

Nada Youssef : Yeah, majority of your plate should be vegetables and some fruit, correct?

Karen Cooper : Not necessarily. It really depends on ... Well, it should be a variety right?

Nada Youssef : Sure, sure. It's always about moderation, variety and portions.

Karen Cooper : Yeah, yeah, exactly.

Nada Youssef : Slow down.

Karen Cooper : It should be about variety, it should definitely be about portions. Get the protein in there. Fruit is a form of sugar. It's healthy. It's got sugar, it's got vitamin C, some of them have vitamin E and other vitamins. Almost all of them have fiber. It's really great for your body.

Karen Cooper : However, it's the sugar components you're looking at. If you go above the amount of servings that are recommended per day, then you're going to gain weight, so it's not a free food. And the same thing with vegetables. We've got vegetables that can be starchy and non-starchy. The starchy ones, potatoes, corn, peas-

Nada Youssef : All the good stuff. It's hard.

Karen Cooper : Right. In moderation but not free foods.

Nada Youssef : Okay, great. How about, I drink black tea but I'm putting honey instead of sugar. Is that better?

Karen Cooper : Honey is fruit sugar, fructose. It's made of fructose, so it's still sugar. Again, there's the understanding that it's healthier, but it's just a different form of sugar and if you have an upper respiratory infection or something, it may feel better going down your throat, whatever. However, it still has, actually it might even have more calories than sugar because we're going to-

Nada Youssef : Really?

Karen Cooper : Most of the time we tend to put more honey than we would-

Nada Youssef : Thinking it's a free food.

Karen Cooper : Yeah, again it falls into that. I think it's a free food.

Nada Youssef : Yeah, I do. I always hear honey is healthy. It's what my mom always told me.

Karen Cooper : It is healthy. Again, you have to measure it.

Nada Youssef : Yeah, exactly measurements and points. So, if I late-night snack I'm going to gain weight for sure?

Karen Cooper : It depends. One of the reasons why the thought out there is you should stop eating at seven o'clock in the evening or whatever is because in the evening we tend to be more relaxed. When we're relaxed, we tend to let our guard down and we tend to eat more. So, the trick if I want to call it that about eating later at night is to again, be aware of how much you're eating.

Karen Cooper : Again, if you've got a certain amount of calories that's going to keep your weight at a certain level, if you eat all of them at eleven o'clock at night, it's not going to make a difference, but if you add more than that, yes. You're remembering that you seem to have eaten more at night and that's why you keep thinking, "Oh, it's probably because I've eaten late at night."

Nada Youssef : And then of course, it's what you're eating. I mean, it could be nachos and cheese or it could be an apple.

Karen Cooper : It's also what you're eating. Well, there we go. Nuts are healthy for you, but they do have quite a bit of fat, so, maybe about 10. Count them out, 1, 2, 3, 4, 5, 6.

Nada Youssef : Wow! Though they never go just for 10. It's a little bit more than 10. I'll keep that in mind for next time. How about lack of sleep though? I've read a lot of studies where lack of sleep causes you to crave sugar or crave junk food, which causes weight gain. Is that true of false?

Karen Cooper : If you are tired, you're going to want to get your energy up during the times when you really need it. If you're feeling tires, you're going to reach for caffeinated beverages or things with sugar because sugar does this so it makes you feel more energetic. That's why we tend to crave more carbs, which are sugar when it's all broken down.

Karen Cooper : We tend to crave more carb, more sugary foods, fore caffeinated beverages when we're tired and that can lead to more weight gain. So, apart from not getting enough rest during the night, that can be a variety of factors, and the one thing I think people really need to know about a lot is the idea of sleep apnea.

Karen Cooper : Sleep apnea is a disorder that does not allow you to get enough rest even if you've slept for eight hours. You're going to be tired during the day and it's going to be that vicious cycle of; I'm tired, I'm eating foods, weight gain.

Nada Youssef : Okay, so sleep longer.

Karen Cooper : Yes, sleep is better.

Nada Youssef : How long is good? Like six hours? Can't answer that one huh?

Karen Cooper : It depends.

Nada Youssef : I mean, I'm guessing [inaudible 00:19:06] how many hours can we really get if we really want?

Karen Cooper : Really it depends on the individual. Some people can function incredibly well off of six. I think the latest literature out there is between six and eight hours and that it changes depending on your age.

Nada Youssef : Does exercising increase metabolism?

Karen Cooper : Exercise does increases metabolism, so when people come in saying, "I have a slow metabolism," my first question is, "How much are you exercising?" The thyroid controls our metabolism, and so that's another thing to look for. If you think your metabolism is not where it used to be, that's something that your doctor can easily do a blood test to determine what's going on with your thyroid.

Nada Youssef : So, to check thyroid is a blood test and that could be slowing down your metabolism.

Karen Cooper : It can have an effect on your metabolism. Depending on what the thyroid disorder is, it's either slowing it down or revving it up, or causing some kind of problem. However, as we get older, our metabolism slows done. So, there are just some things we have to get used to as we get older. That's one of them.

Nada Youssef : We have to find a way to reverse it.

Karen Cooper : How I would love that. Exercise again is one of those things. I can't talk enough about exercise activity. Honestly it's one of the best things you could always do for yourself.

Nada Youssef : What's your tip for someone that's like, "I don't have time to exercise. I can eat healthy, but I don't have time to exercise."

Karen Cooper : First of all you're going to get the eyes. Make time. It's incredibly important. You've got to put that into your day. If you're going to be a successful, effective person, if you're going to be your best, if you're going to have optimal health, you've got to get exercise activity in.

Karen Cooper : Just read a study yesterday that just showed ... We talk about exercise a lot in terms of heart disease, heart attacks, high blood pressure and so on, but we don't talk about some other chronic conditions like heart failure. We don't have anything really that cures heart failure.

Karen Cooper : We can do certain procedures, interventions when you've got heart attacks and arteries that are blocked, but in terms of heart failure, when you're heart is really not working at its beat, that's something that exercise activity can prevent, ward off or moderate.

Nada Youssef : And it doesn't need to be vigorous. It could be walking right? It could be walking a half hour a day. That would do.

Karen Cooper : Sometimes I try to stay away from the E word and I just say move as much as ... Move more than you normally do.

Nada Youssef : I like that, because exercise you're thinking of crossfit and sometimes you're like, "I don't have time-"

Karen Cooper : Or, you just don't want to be that intense. Maybe you've had a rough day and you don't want to be that intense. Just go outside-

Nada Youssef : Go dancing.

Karen Cooper : Yeah, go dancing. Do the fun thing. Move more than you normally.

Nada Youssef : Is gaining weight during or after menopause inevitable?

Karen Cooper : The thing I don't like about menopause is it disrupts those hormones and just sends us into ... Unfortunately, pretty much everyone is going to get the spread.

Nada Youssef : So, everybody's going to gain weight during menopause?

Karen Cooper : Yes. I want to say no, like it's not sealed in stone, but yeah. It's inevitable because it's affecting our hormones, which tend to regulate our fat storage and so on. But you can ward that off, you can be proactive. Being very aware of when you're getting into that phase. You're going to have some time. Make sure you're seeing your doctor regularly so you can start talking about preventive measures for the things to come.

Nada Youssef : And then everybody's different right? What are the first symptoms of menopause? I mean, everybody's different.

Karen Cooper : Everyone is different. It takes us a certain length of time and some people time is shorter, some is longer and so on and so forth. However, I think the number one thing is that for most women, we're going to not quite feel ourselves. The weight gain comes because there's a change in the hormone levels, and so we have less estrogen during that time. Unfortunately, that promotes more weight around the stomach. If we are monitoring what we take in, we reduce our fat content, do more exercise activity, we have a chance of really being victorious around that time.

Nada Youssef : Okay, great, excellent. Increased stress level. Hormones can contribute to weight gain and then, how to cope with stress.

Karen Cooper : A lot of us cope with stress by eating.

Nada Youssef : Cope with stress by eating? So eat more.

Karen Cooper : No, I'm not saying you should. A lot of us do. When we get stressed out, cortisol, which is like steroid, we release more in our bodies and that tends to promote more inflammation. It can promote more of an appetite, and so it's really important to get the stress levels under control.

Karen Cooper : If you know you're going to have a particularly stressful week, if you can make sure that you get more exercise activity in, you get more rest. Or if you have your go-to for stress release. Blast the music in the car all the way to work. Use a few sentence enhancers by yourself. Do what you need to do.

Karen Cooper : Dance, get outside, try to incorporate some things that are stress reducers for you throughout the day maybe if you can't wait until the whole day is over and that going to be pretty effective. But it is important to know hat it does increase our cortisol levels, and so it's going to make us go a little crazy in terms carbs.

Nada Youssef : Yeah, it takes everything [inaudible 00:24:57]. Okay, one last question for you. I'm going into some life questions because we're getting some, but I wanted to ask you, a lot of people are fasting this month for Ramadan. Do you-

Karen Cooper : Oh, that's right.

Nada Youssef : Yeah. So, with fasting or intermittent fasting, any take on that? Is it healthy? There's a lot of research or there's not> what's going on with that part?

Karen Cooper : Let's go to the fact that this is the month of Ramadan and they are observing their faith and they are fasting. It depends on what your conception of fasting is. I believe within that spectrum, it's abstaining from foods until a certain time and then you can eat a certain type of food or amount of food.

Karen Cooper : But, there's fasting from the standpoint of ... There are many different types of fast. You can do an all water fast, you can do just a beverage fast. There's the Daniel fast.

Nada Youssef : Daniel fast?

Karen Cooper : Yeah, which a lot of Christians tend to engage in during the beginning of the year with their churches and things like that. That pulls out red meat and tends to be a healthier way of eating. It pulls out sugar and things. So, it really depends on what the fast is.

Nada Youssef : Well, your body not taking in calories for 14, 18 or even 24 hours. Is that cleansing your body? There's benefits to that? Because I've heard about benefits of fasting.

Karen Cooper : Our bodies are so amazing. We can cleanse without a cleanser.

Nada Youssef : Yeah exactly, we don't need anything to cleanse.

Karen Cooper : You don't have to fast to do that. Drinking enough water, exercising, there's sweating, you're getting all those toxins out and things like that. You don't actually have to induce it. But, people like the idea of fasting because they're thinking of weight loss and they're thinking again like you said, "Maybe I'm going to get healthier." Not necessarily true.

Karen Cooper : You can lose some weight if you're fasting, but again it depends on the type of fast and it also depends on how long you're doing. Some fasts can be dangerous-

Nada Youssef : Right, you have to be healthy to fast as well correct?

Karen Cooper : Well, I think the first question is, what are you doing it for? What's the reason behind it? If you're going to have a surgical procedure, you might have to abstain from food for a certain number of hours. That's a fast until the procedure. So really I think in terms of fasting, you need to be very mindful about the reason behind the fasting, whether it's going to be healthy for you, have a conversation with your medical care provider to determine, is this the right path?

Nada Youssef : Great, all right, excellent. You've been great. I'm going to go ahead and go to some live questions. I have Joan. Can we speak about genetic or epigenetic issues that affect weight?

Karen Cooper : We can talk about epigenetic issues that affect weight. We're born with our DNA and everything, however, certain foods, drinks, even exercise activity can turn switches on or off. Some things that will promote disease can be turned on just be eating the wrong foods or by not exercising enough or intensely enough, or it can turn them on.

Karen Cooper : So, yes. We can manipulate good things or bad things in our body epigenetically just by the amount of exercise that we do, just by the types of foods that we eat.

Nada Youssef : You mentioned bad food. What is bad food? Talked about good food, but what is bad food?

Karen Cooper : I don't like using the term good or bad, but that just kind of slips out. I would say foods that are unhealthy for you.

Nada Youssef : Processed foods, sugar.

Karen Cooper : Absolutely processed foods. Foods that just have, I don't want to say foods that have sugar, but foods that have too much sugar. Again, there's always that amount of electrolytes and nutrients and so on that our bodies need, so just eliminating a particular thing like salt for instance, "I'm not eating salt, I don't want to have a problem with my blood pressure." Your body needs salt. You're going to feel like crap eventually. So, unhealthy foods, processed foods for sure. Foods that-

Nada Youssef : Have ingredients that you can't read, things like that.

Karen Cooper : That would be lots of preservatives to lengthen the shelf life, exactly. Foods that are too high I fat. Again, everything in moderation. It would be really important if you know how to read a label, because then you can determine what you're taking in, what you're putting in your body. Anything that's fresh, that you can pick, that doesn't require too much manipulation is most likely going to be best for you, healthiest for you.

Nada Youssef : Do you think we're reading enough labels in the back of our foods?

Karen Cooper : Oh no.

Nada Youssef : We have no idea what in the back of [inaudible 00:29:55]. I mean, we have no idea what it says right?

Karen Cooper : Well, we trust the FDA.

Nada Youssef : Yeah, we do. Okay, I'm going to go to the next question. Debbie has, ideas for women over 65 for weight loss.

Karen Cooper : The first thing I'm going to push with that is exercise. Exercise activity because 65 or older, your metabolism has slowed down and so the exercise activity is going to promote that, it's going to increase that. So, exercise activity is really important.

Karen Cooper : Monitor your fat intake. As we get older again, it's more difficult to lose weight. Monitor the fat intake because you get double the amount of calories from fat. You don't want to eliminate it completely because fat makes you feel full and if you're not feeling full, you're going to eat more. So, I would say first thing you want to do if you've never met with a dietitian is to meet with a dietitian so that someone can evaluate your diet and can really help you promote weight loss and certainly prevent more weight gain.

Nada Youssef : And then when you're eating fats, go for the healthy fats, so avocados, olive oil-

Karen Cooper : Avocados are awesome. Yes, absolutely.

Nada Youssef : Great, all right, and then I have Joan. Why can two people who eat the same foods and have the same activity level have very different weight loss issues? Are those genetics? That's a very good question.

Karen Cooper : Because we're different Joan. We're different, we're different people. We have different make up, different genetic make ups. Absolutely she was right on that. And then, it doesn't matter that you're eating the same types of food. Your exercise activity also plays a role. But really, it's mostly your genetics. That's going to play more of a role in terms of how you're losing weight compared to someone else.

Karen Cooper : However, there's like an overall. What's the best way to put this? For instance, as medical providers, we know there are certain things that will absolutely promote weight loss. You're going to get weight loss from that regardless of, but you may not just get the same type of weight loss as the person-

Nada Youssef : Sure, results.

Karen Cooper : Exactly.

Nada Youssef : Not as intense as someone else.

Karen Cooper : Exactly, just because of that make up.

Nada Youssef : I know a lot of people do a lot of meal plans and they eat the same thing every day. Is that healthy or should we be rotating foods? I heard you say it's all about variety, moderation. Is it healthy to do a meal plan that like all chicken, all broccoli every day?

Nada Youssef : A lot of people pack their own lunches and I've kind of seen a trend in that, but when you're saying make sure it's colorful, it sounds like we should always rotate our foods. Some days chicken, some day steak, some day salmon, some days vegetarian.

Karen Cooper : Well, the thing about eating the same types of foods daily like you said, number one you're going to get bored. Eventually you're going to get really bored, you're never going to want to eat that food again and that food's probably important. And you're right, there are probably a certain amount of nutrients you might not be getting if you're eating the same things every day.

Karen Cooper : Of course, that can be supplemented with vitamins and minerals. So, it depends on whose meal plan you're following and what supplementing nutrients that you might be missing if you are missing any nutrients indeed. You definitely want to talk to your medical care provider regarding that.

Nada Youssef : Great. Lyn wants to know, how do you lower your BMI? Is there one answer to that?

Karen Cooper : Lowering your body mass index really is saying that you're losing weight. But also what I think we need to understand about the body mass index is that it cannot tell us what our fat mass is, or our muscle mass is. I can tell you that our star of Cleveland LeBron James has tremendous amount of muscle mass, so his BMI would probably fall into what we consider an abnormal range. Does he need to lose weight, absolutely not.

Karen Cooper : So, I would say it's not so much about lowering your body mass index, but is your weight, where's your weight? Is it fitting into what's normal to prevent risk for disease of to prevent exacerbating any type of issue you might have right now? In doing that, you need to look at what you're eating, exercise more, determine if you need medications, determine if you need surgery, those types of things.

Nada Youssef : If you have issues with weight gain, you can just ... There's BMI calculators online that we could just-

Karen Cooper : There are BMI calculators. Again, it's not telling you what your fat mass to muscle mass is. You absolutely need another test to determine that, because if your body mass index is elevated because of your muscle mass, why do you need to lose weight?

Nada Youssef : Right, right unless you're not working out. Okay, great. And then I have Joan, what about some of the current thinking that says the bacteria in your intestines can determine weight issues? I'll talk a little ... I mean, I would like to talk a little about the bacteria, the good, the bad bacteria that we have in our bodies and all that good stuff.

Karen Cooper : There are a lot of studies out there now that are saying that the microbiome or the good bacteria is having an influence on your weight. I am not well versed in that. We have a wonderful center here, Center of Functional Medicine and they will run a gamut of tests to determine what might be abnormal along that spectrum.

Karen Cooper : I do understand that I think if you take certain probiotics and you do certain ... Eliminating diet types based on what the bacteria is, that that would be helpful. But again, you want to go to the Center for Functional Medicine to get that evaluated and assessed.

Nada Youssef : From what I understand, you have bacteria in your body and you want to give them good bacteria, to feed the good bacteria. But, do you consume apple cider vinegar? Do you have anything to say about apple cider vinegar? Because you have people going all over the place with the apple cider vinegar. Is it making you lose weight? Is there enough research? Did I put you on the spot again?

Karen Cooper : No, it's because I can't stand to hear apple cider vinegar.

Nada Youssef : Really? Let's talk about it.

Karen Cooper : The truth is, I don't actually know where that's coming from, the whole thought that ... It's just one of those things that's out there. If you do more apple cider vinegar, you're going to lose weight or whatever. Perhaps it might dull your taste buds or something, perhaps.

Karen Cooper : But, I was supposed to say it's very acidic. It's changing your pH. There are studies that show if your pH is altered too much, you're setting yourself up at risk for other things. I have yet to see one person who's told me that by drinking it, they've lost weight or had-

Nada Youssef :  It's hard to drink. I mean, some people put it in water and just sip on acid all day versus like, sometimes I'll I'll put it in salad dressing because I'll put in vinegar anyway.

Karen Cooper : It's just different. It's just different so yeah, that's a myth.

Nada Youssef : Are any foods free foods?

Karen Cooper : Water.

Nada Youssef : There you go, that's your answer. Not lettuce, not romaine, nothing like that.

Karen Cooper : Again, I think we need to ... We like the idea of free in every aspect. However, I think when we say free, when we talk about free in relationship to food, we're just saying, "How much of this can we eat without a penalty?" So again, it then falls into what amount of food do you need to consume or beverages to not gain weight. I you're going above that, nothing's free.

Nada Youssef : Okay, that's the right answer, so just water.

Karen Cooper : With the exception of water.

Nada Youssef : Yes, water. Okay, great. Sorry if I'm butchering this [inaudible 00:37:36]. Is it true that bananas should be avoided?

Karen Cooper : No.

Nada Youssef : No?

Karen Cooper : No. Bananas are a great source-

Nada Youssef : I'm not sure why, I mean, they're potassium.

Karen Cooper : I'm going to talk about that. Banana is a great source of potassium. It's almost like a starchy kind of fruit. It's got vitamin C also. However, it also has a lot of sugar. And especially the riper it gets, the more sugar that's there. So when people talk about avoiding bananas, they're really talking about reducing sugar. If you are on a low-sugar diet plan or you want to do that, you should definitely reduce your intake of anything that's full of sugar, whether it's a fruit of a processed food.

Nada Youssef : Okay, so bananas should not be avoided.

Karen Cooper : No, they should not be.

Nada Youssef : Everything in moderation right?

Karen Cooper : Yeah, yeah, yes.

Nada Youssef : Okay. Faith; are there foods to avoid while on prednisone or any other steroids?

Karen Cooper : Prednisone tends to increase the appetite. It also reduces inflammation. As far as I know, there's not a problem with consuming any type of food or beverage if you're on prednisone for medical reasons, but you want to monitor your portions, because it does make you feel more hungry.

Nada Youssef : Faith also asks, is decaffeinated healthier that caffeinated?

Karen Cooper : It depends on how it's processed.

Nada Youssef : It gets so complicated.

Karen Cooper : Right. Are we really talking about the effects of the caffeine, no caffeine or are we talking about the effects of how the caffeine is taken out of the coffee and that chemical process could be an issue.

Nada Youssef : How do I know how it was taken out of the coffee?

Karen Cooper : Some companies actually will say at the back if you look. Some, but no. You have to investigate, google, look it up and see.

Nada Youssef : All right, cool. Will wants to know, if weight gain is one of the side effects of your medication, how do you lose weight?

Karen Cooper : That's a really great question because there are a lot of medicines out there that do promote weight gain and that's where there needs to be a conversation with your medical provider whose giving you that medicine to discuss other medicines that can combat that. Because, it makes you not feel so great, you've got to take this medication to support this thing and then it's causing you weight gain, and then the weight gain is going to cause something else.

Karen Cooper : I think as medical providers, we need to be very aware of the medicines that we are giving to our patients, and that if it's going to promote weight gain, we then need to make sure that person has resources to prevent the additional weight gain.

Nada Youssef : Great. And then I have Lyn. I have severe sciatic pain and walking, moving hurts. What can you do to exercise? Also tried the pool so aggravated the nerve. What can I do?

Karen Cooper : Sciatic pain is really, I mean, that's incredibly painful. However, it depends on how it's being treated. Lyn can go to a chiropractor [inaudible 00:40:52] physician and they can do specific manipulations to relieve the pressure off the nerve. It's the sciatic nerve that's causing the pain.

Karen Cooper : But, if you're going to have pain, experience pain when you're walking or moving, that is going to prevent you from ... You're definitely not wanting to do that much. So, treating the source of the pain, she is going to be-

Nada Youssef : Not just the symptom, but the source of the pain.

Karen Cooper : The source, exactly, because you can do both. She can get some things to help manage the pain, but the source of the pain needs to be treated and typically with sciatic nerve pain, the nerve is being compressed or impinged actually. There needs to be manipulation and a few techniques to open up that area to relieve the stress off the nerve, to relieve the pain. So, going to the root of it.

Nada Youssef : Okay, great. Laura wants to know, is eating three to four servings of avocados a week too much?

Karen Cooper : Laura, are you eating avocado toast? Are you paying a whopping $8 for a slice of avocado toast?

Nada Youssef : Well, let's just say avocados, but servings. What is the serving? One avocado a day is probably too much. Are we supposed to eat half of an avocado a day? What is too much?

Karen Cooper : Is have to go look to see what the exact serving is. I mean, avocados come in all different sizes, so I'm not sure what they serving is without looking it up. If she stays within the serving and if a serving is like a quarter of a small-size avocado per day-

Nada Youssef : No toast, or with toast. What do you have against the toast?

Karen Cooper : It's more calories Nada.

Nada Youssef : Yeah, I know, exactly. Stay away from the toast. I agree with that.

Karen Cooper : It means less avocado. So yeah, if she stays within the serving size, and I'm sorry that I don't know what the serving size is, but I trust a registered dietitian would, she would be okay.

Nada Youssef : Faith wants to know, can you ... She's saying, can you explain when a diagnosis is morbidly obese?

Karen Cooper : Can you repeat that again?

Nada Youssef : Can you explain when I diagnosis is morbidly obese?

Karen Cooper : Yes, when someone is diagnosed as morbidly obese, it's because their excess weight has hit 100 or more pounds. That will push the body mass index into the number of 40 and above. We've got 40, morbidly obese, then you get to 50, you get to 60 and then the terms become super morbidly obese.

Karen Cooper : That's a condition that really meets the criteria for surgery and if with all the investigation and evaluation, that's something that that person should do, that's definitely the path to go on. But once you hit the body mass index that reflects a morbidly obese state, it really puts you in this room of all these diseases processes that just makes life more difficult to manage, and it is incredibly difficult to lose that weight non-surgically. But typically 100 pounds or more is what will qualify or classify someone is being within a morbidly obese state.

Nada Youssef : Thomas; when would you recommend bariatric surgery? That kind of ties in.

Karen Cooper : Oh, is that Dr Thomas [inaudible 00:44:25]. I've outed you.

Nada Youssef : So, when do you recommend bariatric surgery? I mean, would you say 100 pounds or more overweight of BMI?

Karen Cooper : From a medical provider perspective, I'll recommend bariatric surgery based on the criteria and I can go off into that criteria, and I will. However, what I have noticed with my patients, you cannot do anything until you're ready for it. And so first, the patient has to be ready. The person who meets the criteria needs to feel that this is the path that they're going on and be ready for it.

Nada Youssef : Because it's mental and physical.

Karen Cooper :  Yes.

Nada Youssef : The mental part is huge.

Karen Cooper : From my relationship with my patient, that what I'm looking for, being ready. But in terms of the clinical criteria and when I would recommend bariatric surgery, if your body mass index is 35 or more and you've got a condition like sleep apnea, diabetes, some other type of chronic disease issue along with that body mass index, you fit the criteria for bariatric surgery.

Karen Cooper : However, if your body mass index is at 40, you do not have to have any other chronic disease issue to meet the criteria for bariatric surgery. Again, people who are 100 pounds or more overweight, it is so incredibly difficult to get that access weight off by manipulating food, because we have to eat food every single day. So, there is that gray area always of, "What can I eat? What can I not what?" And to think that you have to do that for the rest of your life can be pretty daunting.

Karen Cooper : What I love about bariatric surgery is that it is the tool that supports, it is the tool that can give you back a certain quality of life. It is the tool that can do a lot in a shorter of time. But, it also helps you maintain the weight once you've lost it as long as you're following the criteria of choosing the right foods and exercising regularly. I advocate for bariatric surgery for anyone who meets the criteria, but again, you've got to make sure that the person is also on board with that.

Nada Youssef : Right, because it's kind of like a lifestyle change after that right?

Karen Cooper : Yeah.

Nada Youssef : Let's see, I have Diane. Is cheese really a bad food? Is it?

Karen Cooper : Who's calling cheese a bad food? I want to know that. Again, let's take up good and bad and let's go-

Nada Youssef : Well, mac and cheese from the store is probably not a good food I'm guessing.

Karen Cooper : She did not say mac and cheese.

Nada Youssef : No, but I mean there's cheese in the mac and cheese [crosstalk 00:47:22].

Karen Cooper : Cheese is pretty high in fat, very high in fat, fat and salt. However, it's also a good source of protein. Again, it's about how much of it you're eating. You can eat cheese yes if you're not lactose intolerant.

Nada Youssef : Sure. The quality of cheese I'm sure is a big thing.

Karen Cooper : Yes, the quality of cheese from cows that are grass-fed and so on and so forth. So, it's about is it healthy or unhealthy. It is healthy in moderation.

Nada Youssef : Okay, healthy in moderation. Amy wants to know; "Well, I love cheese. I basically put it on everything. Is it that bad for my healthy as well as my weight?" So, in moderation would be the answer?

Karen Cooper : Cheese is a high source of fat, so it depends on how much of it she's eating. She may say she's putting it on everything, but how much of it is she putting on? It may not be that much at the end of the day. Again, it's how much of it.

Nada Youssef : And then Jill wants to know, how can you control menopausal weight gain? The inevitable weight gain.

Karen Cooper : You've got to be really diligent with the exercise activity. I would strongly recommend weight training exercise, which also tends to do a better boost with the metabolism. Particularly in that age range or if you hit menopause surgically or for some other reason, because it also depletes your calcium so your musculoskeletal system is not as strong.

Karen Cooper : And so, it's really important to do some type of strength training or core, yoga, pilates to keep your musculoskeletal frame strong. But then, that also helps increase the metabolism. Watching the diet, bringing the fats down, increasing the proteins, staying away from the processed foods, reducing the sugar. I could go on and on.

Nada Youssef : We can keep going, it's fine. Sandra wants to know, how do you know if you have insulin resistance?

Karen Cooper : That you absolutely need ... First of all, you may have some symptoms Sandra, ad she may have some symptoms, but definitely you need to connect with your medical care provider because there are certain blood tests that can be done to determine that. To definitively determine that you're insulin resistant, which is not a good thing because that means that's setting you up for diabetes.

Karen Cooper : The insulin resistance will spur you into a pre-diabetic state, and then a diabetic stage. It's really important if you're not feeling yourself, to make sure that you get a check to eliminate that as well as other things depending on your symptoms.

Nada Youssef : I'm going to touch about pregnancy a little bit because you can get, was it gestational diabetes?

Karen Cooper : You can get gestational diabetes in pregnancy yes. Again, that's why it's really important to monitor what you're eating, how much you're eating. Really I just think we need to develop great relationships with dietitians. It certainly helps to have someone review our diets every time we're going through a phase of something, or even if we're not.

Karen Cooper : If you want to be healthier, "Well, let me also check in with a dietitian and see if I'm eating the right foods and in the right amounts." Pregnancy is one of those stages where you should definitely be meeting with a dietitian. If you're pre-menopausal, post pregnancy, if you're thinking of having a baby, if you have any disease type, really it's always very good to check in.

Karen Cooper : Some women have a tendency to get gestational diabetes during pregnancy. It's connected also to increased weight. Not always, but it is and that's why what you're eating, how much you're eating and how much you're exercising is also really important during that timeframe.

Nada Youssef : Great, knowledge is power. Okay, one last question. Laurie; can you talk about whether a high, good fat way of eating is more healthy and the big part that insulin resistance plays in weight?

Karen Cooper : That's a twofer Laurie.

Nada Youssef : First let's talk maybe about the high, good fat way of eating. There's like the ketogenic diet, I know that a-

Karen Cooper : I think what she is alluding to is what's out there. Everyone's saying, "Keto, keto, keto, go keto," which I really want to break down that term. You can eat in a way that can promote ketosis. What ketosis is, that state of ketosis is fat storage, fat cells being broken down. It releases ketones in the urine and that's when you're in the state of ketosis.

Karen Cooper : Well, the way you do that, the way the body does that in a normal, healthy way is by using the fat as a secondary source of fuel. So, if we're pulling out the carbs out of our diet, we're pulling out the sugars, then our body's going to turn to the stored fat, utilize that for energy and for fuel. It's going to break it down and release ketones in the urine and that's the state of ketosis.

Karen Cooper : What's happening a lot right now, or the trend is, that also promotes a lot of weight loss. The trend is to do a diet higher in protein, reduce the cards, but then also increase the fat. That's shown to help you lose weight and it's also a healthier way. However, you still have to monitor how much fat you're taking in. It's trending right now to say go high fat, go high protein, less carbs, but you still need to monitor how much fat you're taking in.

Nada Youssef : How do you get to ketosis? Is it taking down your intake of sugar and carbs? Correct?

Karen Cooper : When your body gets to that state yes of, it's utilizing your fat storage as a form of fuel. Most often that happens when we reduce our sugar intake or our carb intake because our bodies really prefer that as its primary source of fuel. If we remove that, it's going to a secondary source, which is the fat.

Nada Youssef : Okay, that was the last question but before I let you go, is there anything you want to tell our viewers that we haven't touched on? I know we talked a lot about a lot of things, but-

Karen Cooper : We've touched on a lot of things. I will always advocate exercise. It is our best-kept secret for optimal health. For those people that have difficulty moving, if there are alternative forms in terms of water, if there is assisted movement like pilates with the reformer, physical therapy, that's really helpful. But really truly in terms of our health, eating a balanced diet and if you don't know what that is, check in with a dietitian.

Karen Cooper : Just making sure more getting enough nutrients, you're taking in enough calories to support your body is one of the best things we can do for ourselves. Oh, also getting enough sleep. That's important. Get enough rest, and get some joy in there.

Nada Youssef : Yeah, happiness is important. All right, well you've been a rock star. Thank you so much. This has been great. As for our next Facebook Live, it will be on Tuesday, May 22nd, 3:00 pm. We will be again putting you first by talking to director or Primary Care: Women's Health, Dr Laura Lipold about women's primary care. Make sure you guys tune in.

Nada Youssef : For more health tips and information, please follow us on Facebook, Twitter, Instagram, Snapchat @ClevelandClinic. See you again next time.