**Episode Title: "EP387: Obesity, UPF, The Studies, and Sexual Health"**
**Dr. Auric Bishop:** Welcome, my name's Dr. Auric Bishop. I'm a cardiologist, an author, and a keynote speaker. I'm CEO of the Healthy Heart Network. I'm all about trying to help people live as well as possible for as long as possible. Heart disease is huge in Australia. Every 20 minutes, someone suffers a heart attack. Most of these could probably have been avoided if only we knew what to do. This podcast is all about helping you understand blood pressure, weight, and cholesterol for better health. If you enjoy this podcast, I would be honoured by a five-star review. You can share it with your family and friends. It may well save someone you love.
**Warwick:** G'day and welcome to my podcast and videocast station. It's Warwick here. Thanks so much for tuning in. A couple of papers came through recently which I have distilled, and I'd like to share. They're on three main aspects of obesity. One is ultra-processed food. So I'll be talking about ultra-processed food and obesity. I'll be talking about what the weight loss studies tell us and what that space of research has informed us in terms of the success with dietary intervention in particular, together with exercise and sustained weight loss. Lastly, I'll touch on obesity and sexual health. These are all really important components of wellbeing and obesity.
I'm going to start off, as I said, with ultra-processed food. It turns out that there is a growing concern that ultra-processed foods are really starting to take up more and more of the modern diet, up to 50% and even more at times. These ultra-processed foods are strongly associated with high rates of obesity and high rates of metabolic dysfunction. Well, of course, if there is that association and it's real, then it sort of begs the question: how is that interplay occurring? Why and how could ultra-processed foods be contributing to weight gain?
There are a number of reasons why researchers believe that that link may occur. First of all, hyper-palatable ultra-processed food really leads to over-consumption and addiction-like behavior. Some of these foods really are driving primitive responses within the brain, which are addictive-type responses. So people will tend to over-consume them, and that carries a problem.
The other thing is that most of these ultra-processed foods are really dense in calories. They're very high in calories. If you think about eating something without a barcode out of the fridge, for example, reach into your vegetable drawer and pull out a big carrot; there's not a lot of energy density to that. But if you now slice that carrot into fine chips and drop that into fat and oil and deep fry it to make carrot chips, you've now made quite a high-density energy food. You add to that salt and flavourings, and you'll get people addicted.
One of the other things is that the chemical additives and preservatives, including salt, which we know is quite detrimental, can disrupt the gut microbiome and therefore the metabolism. There's a real chance that the gut microbiome may well be quite central to the development of obesity in many of these situations. So the takeaway is that calories really do matter, but the quality of the food really matters as well. These ultra-processed foods seem to be quite problematic in terms of the addictive-like behaviour that people indulge in and their high calorie density.
The feeling actually for many people in this space is that it needs policy change over education to make a difference because it's going to be very, very hard to stop the production of these foods, which are driven from a commercial or financial perspective. So it's going to take policy to really make a substantial difference. I think it's going to be quite a thorny topic to deal with, so watch this space and we'll see what happens in the future.
Now, let's talk about weight loss studies. There's an unfortunate reality check up until very recent times where most weight loss studies fail in the long term, with the majority of dieters regaining the lost weight within two to three years. This is incredibly frustrating, and most of us will have experienced some of this ourselves or know of people that this has happened to. There's no surprise there.
It turns out probably that the body makes metabolic adaptations that counteract sustained weight loss efforts. The body, if you like, adapts to its new shape and makes it really hard to lose weight and return to that original lean body mass that you might be desiring to achieve. What has been shown to be beneficial in the long term is staying on high-protein whole foods. I mean, this makes perfect sense, doesn't it? To make sure you don't lose muscle mass, high protein is important because protein takes a fair bit of energy to burn, and whole foods don’t suffer that artificial caloric density of ultra-high processed foods.
Resistance training is said to be really important because it helps maintain the metabolism. I think some sort of cardiovascular work with that is really valuable, but resistance training keeps the muscles of an appropriate size, doesn’t let the muscles deteriorate, and those muscles are a big contributor to basal metabolism. The last thing that's really important for long-term change is lifestyle consistency over time. Getting in the habit of doing a bit of a walk, getting in the habit of not drinking too much at night, getting in the habit of buying most of your groceries from what's around the outside of the supermarket—the fresh produce cabinets—not all the aisles in the middle of the supermarket where you're dealing with processed foods with their preservatives.
So what does that mean for you if you're thinking about losing weight? Well, the talk is about moving from weight loss to metabolic health changes, which are gradual, slow, and sustained. We've spoken on previous podcasts about trying to improve insulin sensitivity, and fasting really helps with that. So that might be the sort of thing you'd want to do. You don’t want to lose lean mass, which means you don’t want to lose your muscle, and you want quality food as best you can.
I think it's really important to watch the current space with the Ozempic and Mounjaro medications, the GLP-1As, which are really changing the landscape of weight loss. But it looks like individuals who embrace these for weight loss are going to be stuck with them for years. So we haven't really resolved that. Keep an eye on it, and it will be a space to watch.
The biggest issue with the GLP-1A medications like Ozempic, Wegovy, and Mounjaro is the loss of muscle mass. So be aware of that and understand the implications of that in the longer term.
As part of the obesity pod, we're going to touch on sexual health. We do know that obesity is linked to significant hormonal change, psychological change, and of course social factors and social stigmas. We know that erectile dysfunction, for example, is significantly higher in obese men, and we know that this may well be related to testosterone levels as well. We also know that from research, women with obesity report lower levels of sexual satisfaction, and our understanding is that quite possibly the insulin resistance and possible vascular dysfunction reduce blood flow to the sexual organs. Testosterone levels, estrogen imbalance, will all also impact libido, and of course, the psychological, social stigma, and body image issues are all concerns that will affect confidence and intimacy.
Well, weight loss actually has been shown to improve sexual function, particularly fat loss. Exercise and dietary change can also be supportive for the restoration of hormone balance and support that weight loss. In certain cases, psychological support for self-esteem and body image will be central to trying to help individuals who are in this situation deal with it as best as possible.
So in today's pod, we've talked about ultra-processed foods—hyper-palatable, hyper-caloric dense—it's a good idea to try and keep away from them. We've talked about weight loss studies, which are generally not particularly satisfying in terms of outcome, but if you do get that weight down, high protein, whole foods, resistance training, and consistency in the long term will help. Obesity and sexual health is a real issue. Weight loss will help, along with diet and exercise, and where required, psychological support.
Well, I'm going to wrap it up there. I really hope you found today informative and educational. If you've got any ideas for future podcasts, let us know. I do want to bring your attention to the virtual heart check and virtual bone check. For those of you who are listening, particularly men 45 to 50 and above, women 55 to 60 and above, think about getting a virtual heart check done. What is that? Well, it's a platform I put together to allow you to access a coronary artery calcium score without the need to see a GP or a specialist, therefore saving you time and money. But most importantly, it could save your life, so check it out.
My experience with the virtual heart check has made me realise that there's a space for women 55 to 60 and above, and men 60, 65 and above, to think about getting their bone mineral density checked. So I've also created the virtual bone check. That'll be very close to the virtual heart check. So just Google it, "virtual bone check." If you can't find it, drop me a note, and my team will help you find it. But that's to allow you to access a bone scan, which will only be rebatable if you're 70 and above or if you've had a fracture. Both those situations strike me as a little bit late. So I've created that virtual bone check so you can go through, answer some questions, and if ordering a bone scan is appropriate for you, there's a mechanism to do that. Again, to try and save you time and money and give you convenience.
Check those out, and I'll look forward to speaking with you soon. For now, I hope you live as well as possible for as long as possible. Take care and bye for now.
**Voiceover:** Hi. Ever wondered what your risk of heart attack is? You should. It's the single biggest killer in the Western world. We're talking one death less than every 30 minutes in Australia. One death less than every 60 seconds in the United States. Nine million deaths globally per annum. Well, how do you check your risk? You can go to www.virtualheartcheck.com.au. You'll find out about your risk and what can be done beyond that to be even more precise.
