Core Bariatrics
Welcome to Core Bariatrics, the podcast dedicated to walking your bariatric journey with you. Hosted by a bariatric surgeon and her very first bariatric patient. Their paths crossed as patient-doctor, but now they work and lead together. This podcast is your trusted source for valuable insights, expert advice, and inspiring stories that will empower you to make informed decisions about your health. In each episode, we explore the world of bariatric surgery, covering a wide range of topics such as different types of procedures, pre-surgery preparation, post-surgery care, nutrition, exercise, mental health and much much more.
But Core Bariatrics is more than just a podcast—it's a supportive community where you can connect with real people who have walked the same path you're on now. Listen to personal testimonials from individuals who have undergone bariatric surgery, sharing their challenges, triumphs, and the incredible impact it has had on their lives.
We will discuss the importance of post-surgery lifestyle changes, including healthy eating habits, regular exercise, and mental wellness strategies, ensuring your weight loss journey is sustainable and fulfilling.
Join us on Core Bariatrics as we foster a sense of community, providing a platform where you can find encouragement, motivation, and practical tips to navigate the challenges of obesity and achieve lasting weight loss success. Whether you're considering bariatric surgery, are in the post-surgery phase, or simply interested in learning more about this life-changing option, our podcast is here to support you every step of the way.
Remember, your path to a healthier, happier life starts here at Core Bariatrics. Subscribe now and embark on a transformative journey towards a better you.
Core Bariatrics
Episode 19: Genetics and Obesity
Our journey doesn't stop at genetics; we traverse the complex terrain of hormones and their delicate dance with our weight. We unpack how obesity can disrupt this balance, affecting everything from fertility to metabolic health. Learn about the link between conditions like PCOS and hormonal harmony, and how thoughtful weight management can bolster fertility and overall well-being. Plus, we highlight cutting-edge treatments, from receptor agonists to the staggering potential of CRISPR gene editing and the transformative power of fecal transplants. Join us for this enlightening exploration of weight, health, and the pioneering science that's shaping our approach to both.
Welcome to Core Bariatric's podcast, hosted by bariatric surgeon Dr Maria Iliakova and Tami LaCoste, bariatric coordinator and a patient herself. Our goal is building and elevating our community. The Core Bariatric podcast does not offer medical advice, diagnosis or treatment. On this podcast, we aim to share stories, support and insight into the world beyond the clinic. Let's get into it, maria. It's all. Eat less, move more. Right, that's it, that's all 100%.
Speaker 2:Yes, it is all that. Yes, 100%, tami. Okay, why wouldn't you even ask? Of course, ins and outs, hello.
Speaker 1:Because that's what everybody thinks.
Speaker 2:That is what everybody thinks and everybody's wrong, anyway. So no, but you're actually right. So today we're going to be diving into genetics and weight genetics and obesity. And the reason why is because guess what, if it were simple, everybody would not be asking us, not be wondering about this and not be struggling with this, because we'd have it all figured out. If an after-waste killer in a mile run was a mile run, we'd all be the same size, exactly. So I am always really curious about the why and the behind the scenes, and I think you are too. So I wanted to create a podcast episode that was all about genetics and obesity, and the reason why is because I actually have a background in molecular biology, genetics, studying proteins, all that fun stuff. What. So I love this. It is so exciting and I think you're going to find that.
Speaker 1:Look, I've known you for how long and I did not know that.
Speaker 2:Yeah, and so I am really jazzed about this.
Speaker 1:And you're 34.
Speaker 2:Well, you know, sometimes we do, sometimes people have good childhoods and sometimes they have.
Speaker 1:actually I don't really get childhood, but I mean I got three kids and I'm 30 and you, just you have degrees and you're 34.
Speaker 2:Yeah, so instead of having kids, I had degrees, and so yes, anyway, but I am really really jazzed about genetics and about all of the ways that our bodies actually regulate how things work, and how that changes over time and how it relates to weight is pretty, I think, fascinating. So you're going to go on a little bit of a journey with me today. Yes, please. Hopefully we will not bore the pants off of everyone listening today.
Speaker 1:I want to add that, so we're doing video. Yes, maria is all dressed up in a minnowsuit shirt.
Speaker 2:Oh please, I'm just like a t-shirt. I'm in a t-shirt, I'm in a t-shirt.
Speaker 1:Well, red is your color. Well, thank you Anyway genetics, yes, genetics.
Speaker 2:So anyway, let's talk real quick about weight and metabolic change. We have talked a lot about in other episodes the fact that surgery and other ways that people can lose weight can have impacts on your signaling and impacts on your metabolism, and today we're going to talk into the weeds a bit more about what that means. On a cell level, and even smaller than the cell, is the genes, and we're not talking about, like Levi's genes or gas genes. We're talking about the genes that get expressed and create all the different parts of your body, all the different cells and all the different proteins and all that. But what do you Into the thick of it? Into the thick of it, tammy, what do you know so far about genes and weight, or genes and obesity?
Speaker 1:I know that most people that are obese their kids are obese, their parents are obese there has to be a connection there. I love that.
Speaker 2:And, honestly, a lot of what we know about genetics comes from those observations of people going wait a second. There's got to be some kind of link here, because this runs in families. And actually I remember I had one patient that was pretty funny and I said what runs in your family? And they said nobody runs in my family and we laughed and we had a great time, but anyway, but you're obviously right, these things do run in families and, however do we do genetic testing on a regular basis for our patients. No no, we do not.
Speaker 1:I don't think anybody really does right, Because genetic testing isn't covered by insurance.
Speaker 2:Well, there's that. We run into our age old theme of it's not covered by insurance, yes, but here there's also a basis for that, because a lot of weight isn't just genetics and isn't just known genetics, meaning like we know exactly what gene is being affected, and that's why people have weight struggles or weight challenges more than other people. It's a lot more factors than just that and we're going to talk about today some targets of treatment, how things work on the sort of gene and cell level, and basically what kind of treatments exist now, and it's a little bit about in the future where things are going to. So that's kind of how we're going to structure today. So, yeah, there is actually one medication on the market called in Crevy or in Crevy, depending on how you pronounce it, and Sivri, I think some people say to and it specifically targets one gene that gets expressed and can cause overeating or the desire to overeat, and can cause obesity in some people. Right, and I think we've actually seen some of the reps for that medication in our own office before. Yeah, the light bulb went off. Sorry, that's right. No, no, that's totally fine, and there is genetic testing that can be done that their company actually covers at this point for patients, yes. However, that affects way less than 1% of people who have excess weight or obesity, so it's not common, and that's kind of the theme behind a lot of these things. Let me just run through a list of a couple of things that can be related to excess weight that are genetic syndromes, and those are things like melanocortin for receptor deficiency, which is what that medication targets, leptin deficiency, leptin receptor deficiency, brain-derived metropic factor deficiency and prohormone convertase 1 deficiency, cohen syndrome, bartopetal syndrome, beckwith Wiedemann syndrome, and there's more. I won't go through all of them, but there's over a dozen different syndromes and specific genes that are thought to be directly related to obesity. All together, all of those things, all the more than dozen of those syndromes and specific mutations still account for less than 1% of obesity. So it's still 99% of the time. There's still way more factors than just genetics involved. So one big takeaway is, yes, it can be genetics, but oftentimes it's not just genetics, but we still need to look at it Exactly. So I think if you're having someone who isn't, for instance, like from a healthcare perspective, if you have someone who is trying everything, including surgery, they're still not losing weight. They're trying medications, they're still not losing weight. Or you have a kid, for instance, under the age of 16, who's having a lot of issues with weight, even though their diet and exercise is well-controlled. They don't have really have other medical conditions. Really really important to consider some of these syndromes and genetic considerations. So things to think about. So when we're talking about adults, yeah, these things are pretty rare.
Speaker 1:So I'm just thinking about someone in our family. The mom and dad are not big. The man is very big and not like he's very active, he's on a paving crew, it's a very active, he's just big guy, and his son, who is only 12, baseball, all the things very big. But how did we get from two not so big people, sure, to a son who is very large and then a grandson that is very large? It just makes me think.
Speaker 2:Absolutely. That's a good way to think about it, because sometimes, if it is genetics that is playing a role, those don't necessarily get expressed in every generation. So, if you think about it, yeah, you don't have to look further. Yeah, if you think about it, you can actually like dwarfism, for instance, being a dwarf and I hope I am not saying anything that is offending anyone. This is just sort of something people are aware of. You can actually have completely regular adult-sized parents and have a dwarf child, or vice versa, you can have a dwarf parent and still have a regular-sized child from, yeah, depending on who they mate with. So not all genes, even if inherited, and gene mutations, are expressed and not everything is just straight heredity Like your parents have this and therefore you have this and therefore your kids will have this. It also depends on who your partner is when you have a child and it depends on what their genetics are and it depends on what's dominant and what's recessive, what gets expressed more than other things, and what gets masked by having a dominant gene that gets expressed instead. So, for fear of getting too into the weeds on this one, suffice it to say that there's a lot of different targets, in fact, over 60 different genes that are thought to have an impact on people's weight and metabolism, and they control a lot of the same pathways that we actually target with medications and with surgery. So, interestingly enough, we were talking in another episode about how surgery works and we were talking about like PI3K pathways and leptin and ghrelin and GLP1s and things like that. And guess what? Those are the same kind of targets, that the same kinds of genes and the same kinds of pathways that affect weight to begin with. So the very things that we're targeting with medications and surgery or other approaches are also things that contribute to what someone weighs.
Speaker 1:All right, it all comes together.
Speaker 2:It all comes together eventually, and there are a couple of things that are pretty interesting just as a global, so big picture here. When people have extra weight, especially weight over a BMI of 30, typically you can actually cause the cells to behave differently than they would otherwise. So some stem cells are not as strong, essentially, as others in this situation, and so they don't different, they don't become as many cells as well as they do in people who have BMI under 30, for instance, and what that leads to is think of it this way you have a pool of goo, and that goo can become brain cells, it can become heart cells, it can become muscle cells, it can become bone cells or joint cells or something like that. When your weight, when your BMI, is over 30, the ability for those cells to become healthy, adult cells that are these different kinds is less. So even the ability to heal and especially when you're recovering from injury, trauma surgery, those kinds of things is less good at higher weights than it is at lower weights on average. So that's, I think, kind of interesting and that's absolutely yeah it very much so is. And that's impacted by genetics, but it's also impacted by how those genes are getting expressed, and we'll get into something called epigenetics, which is one level above genetics. So not even what genes you have, but how they're actually getting used in the real body and how they're, whether they're showing up or whether they're being masked, is something that happens on a day to day basis, on a minute to minute, second to second basis, in all of our bodies at all time. Very interesting stuff? No, it is. It is so, moving on from there, there's also something called genomic instability, and that's not like being psycho or unstable or a little different. I got that. Oh well, we all got that, so I get it. But genomic instability is basically when genes are in an environment to stay what they are without any further changes and they can be then used to be expressed in a certain way without changes. When there's instability, it means that the genes that you have even can be changed actively, and that change is rarely a positive change. It typically means that those genes aren't getting expressed properly or some other error is happening and it can again cause cells to be unstable or things just not to signal the way that they're supposed to. And that is more common when people have BMI is over 30, and when people have BMI is under 30 in general. So that's just an Wow. So that's a very large kind of way that things work. Another thing to think about is that obesity in general, or that weight being over especially 30 BMI means that your mitochondria aren't working as well. And guess what mitochondria are? I remember it in anatomy, yes, yes, I think that's like the only thing that people ever remember from biology class, but they're considered the powerhouse of the cell, the powerhouse, yes, yes. The powerhouse of the cell. Yes, they're very, very important in how your cells deal with energy and deal with nutrients coming in and how those things are then processed further. If they don't work very well, then you're creating a process that leads to something called oxidative stress, and oxidative stress is basically you've got these molecules throughout your body that are causing sometimes reactions in other molecules that destabilize them, and sometimes those can be chain reactions. So not only one thing is getting destabilized, but that's causing things to spiral out of control in different processes. So there is some evidence actually that people over BMI's authority have higher rates of cancer earlier in their lives and even more severe forms of cancer or other disease, like heart disease and lung disease, and Well, does cancer cells feed off like weak cells, doesn't it? Well, and sometimes this kind of dysfunction or this kind of like, especially chain reaction of changes, can create an environment in which cancer cells can develop easier. Okay, so it's a bit of like think of you've got a train on a track but now you're taking the guardrails off and so that train can stay on the track, but if it derails, it'll go. It's easier too. It's easier for it to go flying into the neighborhood next door as opposed to running into that guardrail and being stopped from causing even more damage. So pretty interesting so far.
Speaker 1:It is.
Speaker 2:And then the other thought is that there's basically a theory or a belief and some and there's some data around this that there's healthy fat and then there's fat that can become not so healthy, and what this is called basically is it's called a bunch of things, but adipose tissue is fat tissue, and that adipose tissue can have ways of being produced in an unhealthy way or signaling in an unhealthy way too, to contribute to things like the oxidative stress that then destabilizes other molecules and cells potentially. So all of it altogether. Think of it like it's not different parts, different unrelated things. This is all a web and all together. Having a BMI of over 30 creates a state in your body where things are not working as well as they could, and oftentimes that doesn't necessarily mean that things are going to cause disease or they're going to go way off the rails, but it means that there's less protection for things. Yeah, because mutations like changes are happening all the time to us. We live in an environment that has lots of pollution in it, lots of other factors that can cause these kinds of problems, but when you take guardrails off, it just means that the problems can get really worse, really bad and faster when there's less protection, right? Ok, so let's talk. Does that kind of make sense so far?
Speaker 1:It does.
Speaker 2:Yeah.
Speaker 1:Just my head. I think deeply about these things.
Speaker 2:I love it.
Speaker 1:They talk about things.
Speaker 2:I love it. And then, specifically, when we're talking about endocrine function. A lot of times we talk about hormones and endocrine function and what is that? I would say that's even complex for people who are in health care, and so I'm going to try to break it down in a way that it doesn't it's easy to think about, but this is really that signaling and the pathways. Endocrine and hormones are really important themselves, but they're even more important in how they interact together and what kind of impacts they have on other signaling. So think about steroids and I'm not talking Well, I am talking about the things that make you like really big. But in our own bodies, steroid hormones are things like testosterone, for instance, or estrogen, and the way that our body regulates these things is very heavily impacted by what genes we have, the epigenetics, which means how the genes get expressed and used, and they are extremely sensitive to weight and metabolism changes overall, which is why fertility is very strongly impacted by weight at certain, at that BMI of over 30, and the same thing for sexual function. It all makes sense yeah, starting to make sense and in fact, the endocrine system is extremely heavily reliant on lipid, meaning fat metabolism, and how we metabolize fat and how that signals is extremely strongly related to how our hormones work. And our hormones work a lot less good when we have a system with fewer guardrails and with more errors happening in it than it does at BMI under 30, when those things are typically working a little better.
Speaker 1:So that's potentially why I might be off the wall saying this, but like PCOS, yeah. Usually Obese, yeah, women.
Speaker 2:Yeah, absolutely so. Pcos Polycystic Ovarian Syndrome there's a lot of still research into exactly how it happens, but absolutely we know that when estrogen and testosterone and other hormones are out of whack with each other in women, it's really difficult to have a baby because those hormones have to be in really good balance and there's luteinizing hormone and follicular stimulating him hormone and other hormones too that play into this. But unless those things are in really good balance with each other, it's really difficult to be fertile and have a pregnancy and even if you have a pregnancy, your rate of miscarriage and things like that is higher if those things are not in balance with each other. Exactly when you have a BMI over 30, it's much more likely for those things to be out of balance with each other and therefore your ovaries may not even be able to produce eggs or may not be able to release them appropriately, and your chances of having a viable pregnancy, even if you do, are lower. So it all makes sense, yeah, so what happens when we actually lower people's weights, especially in a sustainable way, especially not in a crash tie at way, and we're actually changing how these hormones are getting regulated and how these hormones are getting produced in appropriate levels with each other, we're actually creating the sustainable changes that allow people to be fertile, and even on the men's side this applies to, because sperm counts. Libido, ability to have erections and keep them, is all very finely tuned as well. Just like fertility is in women, fertility in men is very similar. So having the ability to actually have all these hormones regulated appropriately with each other under a BMI of 30 is the reason that people have more fertility and better sexual performance when people go through the process of weight change and metabolic change with surgery, right, yeah, so pretty interesting, I think.
Speaker 1:Very much so is.
Speaker 2:Yeah, because it's like well, there's a reason for everything, there's a reason, it's not magic.
Speaker 1:And we can't, or surgeons can't talk about these things in a 15 minute appointment?
Speaker 2:Not at all, and so that's the frustrating thing is like I don't even think a lot of medical providers necessarily know a ton about this and I will say I know some about this and I read a lot and I work on some of the research, but there's still a lot we don't know and we don't know all of the exact mechanisms, like I wish it were, like a car engine that you're like okay, well, there's this many pistons and they work in this specific way with physics and it all works together this way, because we know exactly all the steps here. We don't know all the steps. We know approximately, we think we know approximately how these things are interacting with each other and how these different secondary impacts, that different hormones and different molecules and all these things are impacting each other, but we don't know exactly how.
Speaker 1:So potentially, as time goes by, how those things react can change. So even if you're like, oh yeah, right on the ball. Oh yeah, a month later, it could be totally different.
Speaker 2:Exactly and that's also another reason that we've talked about this a little bit too when people go through pregnancy or menopause or other changes. That's why, anytime the system changes, you may experience weight gain, you may experience weight changes period, you may experience things that now we have an offset happening in one side. In order to balance things out, we kind of need an offset somewhere else too. So it's not super straightforward, but we're starting to understand like you can't like a web, like you can't touch one place and not have an impact throughout the whole system, right? So let's talk about some targets actually for treating weight. We've definitely we know about GLP ones, which are like Sixendom and Jarrow would go the ozempic, all those things. So GLP ones are GLP one. Receptor agonists is specifically what that class of medication is, and it helps the body be more sensitized to insulin. It helps the body process insulin better so that you can actually capture more of the bloodstream sugar and put it into cells instead of keeping it in the bloodstream. It has some other effects too, like slowing down the emptying of the stomach and things like that. But that's actually a major genetic target technically for a medication and that's very, very important. All of the different things that are involved in how we process blood sugar are huge targets for medications that happen, that are useful for adults, but also even the one that we talked about earlier, that in in civry, which is a target for MCF receptor, is also part of that pathway too, so pretty interesting. There's other genes in that pathway that are really important, like leptin, leptin receptor. There's a bunch of others and, yeah, there's a lot of research going on in terms of how we target these kinds of genes and how they work with medications. You've probably also heard of CRISPR. Maybe you've heard of it, maybe not, I don't know.
Speaker 1:I don't think so.
Speaker 2:Okay, so CRISPR is a form of gene editing and it specifically stands for clustered, regularly interspaced, short palindromic repeats for living organism gene editing, yeah, and so that's a really long term, I know, I know. But the idea of basically being in human beings like you and me, or in living organisms, you can actually go in and target very specifically little sections of genes that we want to change for whatever reason, and you can actually go in and change them and have an impact. That right now there's CRISPR technology that's FDA approved, I believe, for sickle cell disease, but there are targets in fact over 60 of them that potentially could be used in the treatment of obesity. Okay, yeah, so like even gene editing in living people could be, down the road, a target, right, yeah. So literally going in, snipping out the part that doesn't, that we don't want, and putting in something we do, could be a target for helping people lose weight in the future. Now, science is crazy, science is crazy. But we talked about the one that already exists on the market, the Msevri and Sivri. I'm so sorry, I'm so mispronouncing that one, but that's the one that's on the market. Now Other targets we talked about even in another episode, things like fecal transplants, for instance. That target, yeah, that target the microbiome. You totally predicted all of this, tammy. I love that you're so curious. Yes, you're so curious I am. It's great. But the microbiome, so all of the bacteria and more, not just bacteria but viruses and things that live in our bodies, alongside us and sometimes are helpful to us, sometimes are harmful to us. And again, it's all about balance, right? So it's not that bacteria is bad or good, it's that the balance of what kind of bacteria we've got in our bodies is bad or good. There's a lot of looking into. Can we target specifically obesity with essentially what's going on in the gut of a person who has healthy weight and the gut of a person who has not so healthy weight and is having impacts from that? Can we bring the healthy stuff into the less than healthy body and make a difference even in the microbiome, even in the bacteria that's happening in it? So that's one thing, and then there's even some potential for targeting how genes are controlled. And how genes are controlled, if you think about it, is actually something we do a lot. When you're growing fruits or vegetables, you grow them in a specific like. You can grow them in a hot house, right, like, even if you're in the middle of the winter in Iowa in a blizzard, but you have a beautiful right now, right, but you have a beautiful hot house, you have great lamps, you have warm, moist environment, you have great soil all that stuff. You can grow tomatoes in the middle of a blizzard, right. So if you think about it, you can also put people into environments that either help or harm how their bodies express certain genes, right, and that is impacted by the food we eat, by how much sleep we get, by how much stress we have, by all the things that we've talked about in other episodes. All of these lifestyle factors, how we move our bodies those lifestyle factors are having an impact in how we express our genes on a daily basis. Crazy, yes, and so some, yes, some of the treatment here, some of the ways that we actually deal with this. When we talk about diet and exercise as lifestyle, we're not really just talking about like, ooh, it's nice to eat healthier, ooh, it's nice to move your body. It's quite literally having an impact on how you are expressing your genes every day, and that actually should be encouraging to people, because these are things that are not set in stone. When you do physical activity today differently than you did yesterday, or when you make a choice to eat differently now than you did this morning, your body is constantly updating based on what you're doing. Now there is some evidence that, yes, there's memory, and of course, it's not like you run a marathon and all of a sudden you know you weigh 50 pounds less. That's not how it works, but the way that you're actually expressing your genes absolutely does get updated on essentially a minute to minute basis. Isn't that fascinating?
Speaker 1:It very much so is.
Speaker 2:Right. So the impact that you can have on your body by making a different choice, through even lifestyle changes like diet or exercise, your body responds to that immediately. It might take a little bit more than immediately to start to see results, but do not underestimate the impact that those things are having on your body immediately. So cheat meals, not going to kill at all, it's not going to kill at all, and that's backed by science. That is backed by science. Some other things to think about, you know, and that's super interesting to me, because we can't go in and, like, edit people's genes right now. We can't go in and like, tammy, I'm going to, you know, find this and then fix it for you. And even if we could, that would probably cost hundreds of thousands of dollars at this point It'd be super expensive. But guess what? We can have an impact on how much we're sleeping and we can have an impact on what kinds of foods we're choosing to eat and when. A little bit more. I wouldn't say like we're perfect on that. We can't totally change our environment, but it's to say that environmental change can be really, really important. There's also some studies that go into looking into like probiotics and how else we can change our gut bacteria, gut health, and we don't have a ton of evidence there or ton of research there, but in the future I think that's going to be a really big target of understanding how to help people manage their weight too.
Speaker 1:Yeah, I think gut bacteria has a lot to do with it.
Speaker 2:Oh yeah, absolutely.
Speaker 1:And that's what I'm learning.
Speaker 2:Oh yes, and it also changes over time. Another kind of the main takeaways from this is one very little of set in stone Because you have a certain gene or just because you have a certain syndrome, that really is only making an impact, that set in stone for less than 1% of people and then for the rest of us, 99%. It's the combination of things. It's a combination of lifestyle and our genes and how those genes are getting expressed on a day to day basis, and I think what also is interesting is that all of these things are related to each other. Yeah, you have enough things that push you one way and it's very difficult to not gain weight and not have weight. That then becomes really, really difficult to lose over time, and for some folks they're genetically lucky. Okay, that happens, so telling. I think also having this understanding that, like people are totally responsible or to blame for whatever weight they have, is kind of ludicrous, because obviously not. There's a lot of impacts we can't control, and the ones that we can have some impact and they can even have an impact the second you start doing them it's kind of interesting too. So those are my takeaways. There's a lot of targets here. There's a lot of things we don't know. There's things that we're starting to understand. In the show notes for this, I'm going to put in a lot of links and a lot more details. For those folks who want to dive into the genetics in more of obesity and weight and, believe me, this is absolutely just scratching the surface of what's out there Absolutely. I wanted this to not be the most boring section like lesson we ever have, or was boring podcast we ever have.
Speaker 1:No, I think the people that understand that a calorie is not calorie my runs on my hand want to know why, and this is why why.
Speaker 2:This is why Because ultimately, even though we all have the same kinds of pathways in our body, how those pathways get used and how those pathways get expressed are extremely unique. They are extremely individual.
Speaker 1:I feel like you can compare that to. You know, we all live in the world. Let's say we all live in Iowa. We all have the same resources, but we all live very different lives. Our body is choosing to go down this rope. Sometimes we can't control it. Right and there's things, but if we figure out how we can, Exactly, exactly.
Speaker 2:And there's things we can control, there's things we can't. So absolutely figuring out how to leverage the ones that we can control and then the ones that we can't, well, screw it, we can't control it anyway. So let's not blame people for the things we can't control, but actually focus on the stuff we can. And that's where, absolutely yeah, and that's exactly where some of these treatments like medications and things like that, have a role. But even I think this is the most fascinating thing surgery, like a surgical procedure that we do on people, has an impact on how their genes are expressed down the road.
Speaker 1:Yeah, that is the crazy part.
Speaker 2:Isn't that crazy. And it's so cool because I think everyone who goes through this process sees that in action and this is a little bit of that under the hood, why it happens.
Speaker 1:Right, absolutely.
Speaker 2:Yeah.
Speaker 1:Well, thank you, for I know you're like going to that was a lot, but no, for the people that really are trying to figure out why. Yeah, and that I talked in the previous episode about your old dad was at the gym and got judged for having bariatric surgery. She could listen and be like man. This is this is why, yeah, Shut your mouth.
Speaker 2:Yeah, shut your mouth because, like, your body is basically becoming a laboratory, you're turning your body into a factory for changing and for becoming healthier and for converting what things have made it challenging for you and for your body to be where you want it to be and making those things work better. And I think people should be congratulated for converting their body into a laboratory honestly and allowing those changes to happen. I think it's really cool?
Speaker 1:Yeah, absolutely. Thank you for the science lesson.
Speaker 2:Oh, you're so welcome. I promise not to do too many of these.
Speaker 1:I promise Because, yes, I definitely want to know why we are the way we are. People that are obese don't want to be obese.
Speaker 2:Well, and the thing is, obesity isn't something to want or not want or something like that. Really, even I think it's weight is complicated, as we are learning, and for some people, even if they do the exact same thing that somebody else does, their body is going to interpret it very differently and carry it out very differently and they're going to have a very different weight as a result. And it is, I think, true that when people have a BMI over 30, if they're not, like professional athletes or otherwise, super heavy with muscle mass and things like that, there are things that are happening in bodies that make it more difficult to avoid certain kinds of metabolism diseases and then make it easier for people who have BMI under 30 to have more healthy cells and have more healthy gene expression and things like that. But to say that it applies to everyone across the board is not correct, and certainly to say that it's anyone's fault that their bodies are doing that is completely bogus, absolutely so, if nothing else, I hope that's the takeaway that hey, guess what? We've got some things that we can do about it with medications and surgery and lifestyle, and that we're constantly developing more, because this is a growing field in every possible way, and I'm thankful for it, because the more we know, the better we can all do.
Speaker 1:Absolutely Thank you for all of that, because I know it took a while to figure out exactly how you were going to explain it to people that may have no medical or science background. So thank you for making that.
Speaker 2:I hope that wasn't totally gobbledygook for everyone. No, no.
Speaker 1:And for those that don't want to go that deep, they don't have to.
Speaker 2:Not at all. They can skip an episode, skip this episode and just go. No, thank you, that is right.
Speaker 1:Well, thank you all for listening and we will be back again. Thank you.
Speaker 2:Yeah, thank you.
Speaker 1:Bye.