Dr. Paul Rivas, who treats overweight patients, is not optimistic about the national trend toward obesity.
Written By Scott Braden, Photos by: Crystal Griffiths
Dr. Paul Rivas doesn’t mince words when he talks about how obesity affects one’s general health.
“It’s a disaster,” said Rivas, who practices in Westminster. He was voted one of America’s Top Physicians in 2009 and won the Patient’s Choice Award that same year. “It increases your cancer, diabetes, heart disease, and stroke risk. The psychological and social effects are enormous. It’s just a disaster. You name an illness, and it increases your risk for it.”
Now that we know obesity is bad for body and spirit, how does the local population stack up against national trends toward overweight adults and children?
According to Rivas, we are in the middle. In fact, the Centers for Disease Control and Prevention reports that Maryland’s obesity rate was 26.2 percent in 2009, bringing it in at mid-range between thinner states like Colorado (18.6 percent ) and more robust ones like Louisiana (33 percent).
Rivas also said that obesity has been dramatically increasing in adults and children since the ’60s.
“Nothing is stopping it. The whole push to eat less fast food, to be more active, to watch less TV, hasn’t even put a dent in it. In fact, it’s going up – it’s constantly going up. Right now, over half the country is overweight, and experts are projecting that in 20 years 80 percent of the country will be overweight. Nothing is stopping it because that’s not where the money is. It’s the same old story: what we’re doing isn’t working so let’s do more of it. And that’s what we’ve done for decades.
“We keep saying we’ll eat better and exercise more, but we just don’t do it. What we’re missing is that obesity is essentially a genetic predisposition illness like hypertension. Look at it just like high blood pressure. If we had just kept saying, Ôeat less salt and exercise more,’ and we hadn’t come out with blood pressure pills, people with hypertension would be dropping dead of heart attacks and strokes at an enormous rate. Instead, we caught on quickly that hypertension is very genetic and very chemical, and said, ÔOkay, keep watching your salt intake and exercise, but we’ve got to throw in the pills.’”
Rivas feels that obesity is not generally regarded as disastrous as hypertension and diabetes. But, he said, it kills more people than both. Bigger and better medications are not the answer. The answer, he believes, is the medications that are already available, and that the illness is chemical as well as behavioral, and should be treated just like hypertension, diabetes and cholesterol.
“We’ve got to do it,” he said. “I still use medications from the Ô50s. Then, we often – but not always – mix them with newer medications that raise the serotonin and dopamine levels a little bit. So we like the old ones as a baseline because they have been around forever, and we know they are safe.
“We use combination therapy. So we can use a little of two or three [medications] instead of relying on one, and we get a much better response.”
According to Robert Huddler, chief operating officer of Mobility Rehab Products, LLC, in Westminster, people’s eating habits contribute to the nationwide obesity epidemic. It all comes down, said Huddler, to starting the day like a king and ending it like a pauper.
“People should eat a large breakfast and lunch, a small dinner, and then they’re done,” Huddler said. “But they do the opposite: they skip breakfast, eat a small lunch and a large dinner, and then go to bed or sit on the couch. All the food just sits in their system and is not burned off.”
Dr. Kimberly Johnston of Johnston Family Medicine in Westminster believes that the obesity problem has to do with portions, and that we are served meals that are much more than we could – or should – eat.
Restaurant meals, said Johnston, are a case in point:
“I tell my patients that you are going to be served two to three times the amount of food than you should have” she said. “We just get trained – and our brains get trained – that this is the amount of food that should fill us, and we ignore the signals that our brains tell us when we’re full.
“The body sends hormonal signals that tell us that we’ve had enough calories, and it’s easy to ignore. We start very young ignoring them, and society has trained us to do that. Like the Ôbig kid’s meal.’ Food sellers play on our kids’ desire to be big kids, when most adults shouldn’t have more calories than are in a Happy Meal, anyway. It makes children feel grown up, but it’s more food than a child should have; it’s more food than any adult should have. If people just cut their portions down, they are successful.”
Rivas, on the other hand, does not believe people’s eating habits are contributing to the obesity problem.
“What’s happened now,” he said, “is that, say, you have a genetic predisposition, and things are triggering that predisposition that did not trigger it in the past; factors like poor sleep, increased stress, and the use of many medications. Those things have gotten worse, and they’re triggering the genetics. So we may eat the same garbage we always ate, but now we’re getting bigger and bigger.
“Are more and more people are eating at fast food restaurants? No, it’s less. That is why heart disease has declined. What has changed are the things that are triggering the genetics. The stress in our society, the poor sleep that we all get, the meds that we take, are unfortunately weight-gaining.
“I’m not saying, Ôdon’t take your meds,’” said Rivas, “but unfortunately a lot of them make you gain weight. In the ’50s, people were on nothing. It was unusual to take Aspirin. Now, everyone is on something. Most of those somethings are weight-gainers that trigger genetics. So then you have things triggering the genetics, and you are eating lousy. Boom: There it is. In our society we only look at eating, and it does not work. Just addressing one factor does not work.”
Rivas and Huddler believe that vending machines may contribute to the problem, but Johnston does not agree because the food is offered in portions.
“Obviously,” Johnston said, “most of the stuff in vending machines is portion-controlled. So from my perspective, it’s not on the terrible side. The choices aren’t fantastic by any means. I would rather someone chose a yogurt as their 100 calorie snack because it has a lot [more] protein in it than three Oreo cookies.”
“Vending machines contribute to the problem,” said Rivas, “but why is obesity going up so exponentially? Is it because we have more vending machines? No.”
Moreover, said Rivas, people are not overweight simply because they are inactive. Exercise alone does not take weight off. Exercise helps, but if the chemistry is wrong, no matter how much you go to the gym, you won’t lose.
Do diets work?
“All diets work,” said Rivas. “That has been proven over and over again. Low cal diets are just as good as a low carb diets which are just as good as high protein diets which are just as good as low fat diets. There are no differences whatsoever. The problem is that if you don’t fix the chemistry first, none of them will work. But if you fix it, all of them will work.”
