Dan Bessison
speaker
28 appearances
1 recordings
1 series
first heard Jan 2025
last heard Jan 2025
Dan Bessison’s voice in public audio — every appearance, attributed to the second.
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I'm Dan Bessison. I'm an MD by training. I'm an endocrinologist. I'm here at the University of Colorado in Denver, and I do clinical work taking care of patients at our county hospital, Denver Health, and I do research here at the medical school. I'm also the director of this building called the Anschutz Health and Wellness Center.
I think there's always been people with really high weights that doctors thought, well, that's probably a health problem. But I don't think it entered the general public consciousness until sort of the late 80s to the mid 90s.
I think people looked around and thought, what's going on here? There seems to be more and more people at higher weights. And NIH had an expert panel that defined obesity using BMI. BMI is sort of controversial, but that was the point at which we had this accepted standard And shortly after that, the CDC looked at data they had and said, what's been happening with obesity?
And I think they were sort of shocked to find there was just a dramatic increase in the number of people with obesity. And so in 1999, They published these maps, these CDC obesity maps. Maybe some people have seen those. And they really brought a lot of attention to what really looked like an epidemic. If you had looked at those numbers and it was HIV or cancer, people would be quite worried.
And people said, gosh, something is happening here. We should do something about this.
Yeah, I think that the NIH panel had thought about levels of weight and that treatment or what intervention somebody did should be based on how serious the problem was. So people with a modest increase in their weight might change their diet and increase their physical activity. People with a more severe weight problem might take a medication instead.
And those at the highest weight might benefit from surgery. For most Americans, lifestyle is what was suggested. And I think at that point, we were still early in understanding the biologic basis of weight regulation. And we all eat, we all move, and it seems like we choose those things. And so the obvious first step was to say, maybe people just don't know what to eat.
And if they just thought about it some more and ate less and moved more, that this problem might go away. So that was the first thought. And the surgeon general, had a call to action.
Based on these numbers rising of obesity, saying, you know, people ought to move more and eat a healthier diet.
I think there's a couple ways to look at that. One is, around this same time, there was a study published, the Diabetes Prevention Program. And what they found was that a modest weight loss, a 5% weight loss, could... reduce the risk of developing type 2 diabetes by half. It was a really dramatic study.
And so it was really based on that that people said, gosh, this is achievable and it has clear health benefits of 5% weight loss.
Yeah.
It seems like a small change in weight, and yet it had dramatic benefits. I got to tell you, I mean, I see people in clinic, and so I've spent, whatever, 20 years trying to sell the benefits of a 5% weight loss. Most people don't buy it. Most people want more weight loss than that. It's not a weight loss that most people get. see in the mirror or that their friends are going to notice.
But it has clear health benefits and has become a benchmark of what a clinically significant weight loss is. A little bit of weight loss helps.
Most lifestyle studies show that most people regain much of the weight. It's not like everybody regains all of the weight, but much of the weight is regained. What has happened over the last 25 years is a real explosion in our understanding of the biology that underlies weight regulation.
I think now we think of weight much like we think about blood pressure or glucose, that there's complex biology that the body's got its own idea about what it wants to weigh. And what it seems like the body wants to do, it doesn't regulate around a set point. It regulates around a trajectory of gradual weight gain across the life.
So the biology of weight really pushes back against efforts to change our diet. And so that's why people regain the weight is when they lose weight, the body goes, this is not good. And the people become more hungry, their energy expenditure goes down, and these things tend to push the weight back up to where it was before.
Only maybe 1% or 2% of people ever had that conversation, ever got that medication. And there are a number of reasons for that. One is the older medicines had some side effects. There were some bad stories about health problems with fen-phen and other medicines.
And I think two doctors and patients Doctors especially have this idea that, well, Mrs. Jones, you ought to be able to handle this on your own. This idea that weight is regulated, it's taken a long time to get any traction there. Doctors would say things like, you know, if you show me you can stick to a diet, well, then I'll maybe talk to you about a medicine.
We don't do that with diabetes or high blood pressure. We're very quick to go to a medication in those conditions. So I think there's a lot of maybe bias and stigma directed at people living with obesity that we tend to blame them for their health problem. So medicines that weren't super effective and an environment that really thought that people could do this on their own.
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