Prescribing Lifestyle Medicine with Anti-Obesity Medications [Podcast Series]

Dr. Jonathan Bonnet is an Obesity and Lifestyle Medicine Physician at the U.S. Department of Veteran Affairs.
Dr. Bonnet is also a Clinical Associate Professor at the Stanford University School of Medicine.

“It’s what you do with your feet, your fork, your fingers, which is physical activity, what you put in your bodies or your diet, nutrition. Fingers is really your substance use and hopefully minimizing your use of risky substances. And then sleep, stress and love are sort of the other three, that sort of round out, really not not just the length of life, but also just the quality of life.”

“So part of it is just having a good honest discussion with yourself and with the other person of saying, Where are you at? Where have you been? And what do we think is the right tool to use right now to hopefully get where you want to go?”

“Yeah, and another really important point with any of the anti-obesity drugs that we're talking about nowadays, within the package insert, it tells you it should only be prescribed along with diet and exercise or increased physical activity and reduced caloric consumption. So it makes it explicit that it's actually inappropriate to give them without those things.”

“To me, I think there should be a major shift in what we focus on exercise providing you with in terms of health benefits because there are almost an innumerable number of wonderful things it does for your brain, your body, and virtually every organ system that you have. And I think when people recognize all of the wonderful health benefits they're getting, they realize that exercise really is doing the thing that they want, which is improving their lives.”

“And so you actually are at risk for starting to utilize muscle for fuel and losing lean mass. And so, the most potent thing we have to do to keep your lean mass around is to resistance train and use your muscles. So, again, I think another important combination of what we really should be sending a message to patients on if you are trying to lose weight, one prioritize your protein intake. But two, you really want to prioritize resistance training so you keep all of the lean mass that you have as you are losing the fat mass.”

“And so I've still always felt that like the gym was like one of the best places to find health. And so I mean, I've even written some articles about the idea of putting medicine into health clubs and fitness facilities, because I feel like that is where we were actually promoting and creating health, not necessarily in hospitals, where we're trying to save people from not dying, or mitigate disease.”

“I think this is one of the challenges that I'm sure you've come up with with the PAA, is that typical insurance and payers don't reimburse for exercise services, really outside of things like PT and OT, maybe some exercise testing for like stress testing, or things like that. But it falls off very quickly, where there is this gap where they can go to a personal trainer, if they want to pay out of their pocket, but there's not really a good payer that's going to help foot the bill for them.”

“But I think more importantly, there is going to be a ton of interest from the population as a whole wanting to do this, because three quarters of the United States are basically struggling with being or having overweight or obesity. And so I mean, just think about the number of people that would benefit from the services. So I think again, just really a good time to think about how you can be part of the solution versus trying to fight against it, because it's here, and it's going to be happening, whether you like it or not.”

“I think we're going to have a huge audience that really is going to be ready, and hopefully willing and also engaged. I think that's the one thing I really enjoy about my job is that most people who show up to a weight loss clinic, they kind of have the idea that hey, I'm probably going to have to change my diet some and I'm probably going to have to start exercising. So it's almost sort of inferred and implied.”

Learning the Language of Movement [Podcast Series]