Women's Health Wednesday - Dr. Sathyavani Prabhakar on Weight Loss for Vegetarians, Meal Plans, and Obesity Medicine
“I feel privileged to be in Endocrinology and Obesity medicine right now .It is a great time to provide quality medical care in both these specialties now” For this week’s Women’s Health Wednesday, today’s woman dreamer Dr. Sathyavani Prabhakar is an endocrinologist and obesity medicine specialist, currently working at Beth Israel Lahey. In this informative interview, she answers all your burning questions on weight loss, meal planning for vegetarians, stigmas around weight loss medication, diabetes, obesity, and more. A must read for those looking to make healthy lifestyle changes!
1. You are an endocrinologist and a specialist in obesity medicine. Tell us your journey and what inspired your interest in this area of medicine?
I feel privileged to be in Endocrinology and Obesity medicine right now .
It is a great time to provide quality medical care in both these specialties now , with so many new medications that can help patients deal with many chronic medical conditions and good data to back them up .
Endocrinology fascinated me during my endocrine rotations during my Internal medicine residency . It is a perfect mix of basic and clinical science , it is analytical , precise , yet with just the right touch of ambiguity to test one's clinical skills , people skills and extremely rewarding . It is also very gratifying to help patients with so many chronic medical conditions that are usually lifelong, yet very challenging . Obesity medicine is a perfect transition and expansion for an endocrinologist . Obesity is a chronic medical condition that has many underlying hormonal causes and is associated with many endocrine conditions such as diabetes , hypertension , hyperlipidemia , the list goes on and on . I consider Obesity an endocrine condition with many environmental facets , so I feel very lucky to apply all my endocrine knowledge and experience to help my patients .
I trained for my endocrinology fellowship at SUNY Buffalo - I have extensive interest and experience in management of Diabetes , prediabetes , Gestational diabetes and was lucky enough to train with a stellar faculty team that furthered these focus areas . My program director Dr. Paresh Dandona is a world leader in Diabetes and complications and role of inflammation and was instrumental in building a renowned fellowship program which is a sought-after program to date . When we moved to Boston for my husband's job, I decided to pursue Obesity medicine certification and joined the medical weight loss clinic at Lahey in 2017 . It's been a wonderful professional journey with my current colleagues at Lifestyle health and wellness here at Lahey, especially navigating a global pandemic these past 2 years doing what I love to do.
2. Obesity medicine is a rapidly growing area of medicine. Can you give us your top tips and advice for weight loss prior to being on medication?
Obesity is indeed a rapidly evolving and growing area of medicine . We have learned that treating weight can help improve many many chronic medical conditions and, in some cases, even reverse them. We are learning about that it is an outdated concept to consider that calories in and calories out is over simplification for weight loss, that there are complex neurochemical pathways that affect appetite. satiety, weight loss, weight regain and weight maintenance . A 10 % weight loss can be very beneficial to improve weight related medical conditions like Hypertension, type 2 Diabetes, Prediabetes, hyperlipidemia , Metabolic syndrome , Sleep apnea, osteoarthritis, acid reflux . My goal for my patients is definitely to look for health benefits beyond a number on the scale .
My advice to patients is to focus on a healthy well-balanced diet that is heavy on protein and fiber rich food sources that are less processed , limit sedentary time, move more , practice sleep hygiene and stress reduction as vital adjuncts to medication for weight loss. Weight loss meds are great tools , but managing lifestyle is key and works for long term weight loss goals.
3. There is often a stigma with being on medication for weight loss. What are your thoughts on how, when and which patients should be on medication for weight loss?
Let me start by asking " is there a stigma to being on medication for Hypertension or Diabetes ? " I assume no , so there should not be a stigma to weight loss medications either . Being Overweight or Obese is a medical condition, and once we start with that premise , hopefully the stigma will go away .
Currently FDA approved weight loss medications are approved for a BMI above 27 with a weight related medical condition or a BMI above 30 irrespective of a weight related medical condition. If patients are struggling to lose weight and dealing with increased appetite, food cravings, stress/emotional eating, disordered eating such as binge eating , night eating syndromes and or have weight related medical conditions, weight loss meds are a great tool . Some of these medications are approved for long term use, as we want to treat weight like a chronic medical condition, having said that some patients choose to remain on a medication short term and that's ok too if they are able to sustain the weight loss without a medication.
4. You are a vegetarian yourself and have treated many vegetarian and other patients. Could you provide us with a sample vegetarian Indian menu that you would recommend to someone trying to lose / maintain their weight?
I do have many vegetarian patients who are very apprehensive that weight loss is going to be an uphill battle for them. It can certainly be a challenging to find a vegetarian protein source that is carb free, but vegetarian protein can also be fiber rich and heart healthy .
Veg protein sources are mainly beans , lentils , whole grains like Oats, quinoa, millets , whole wheat , farro , spelt , couscous , low fat dairy products , fiber rich veggies , nuts , seeds . Indian diet has many healthy food choices and substitutions for a vegetarian diet that is easily done and fun to explore.
Here are sample menu choices with Indian and Western foods- aim for protein of atleast 20 g per meal and 10 g per snack , a complex starch /carb under 30-40 gm per meal , and a healthy fat like olive oil/sunflower oil with low carb veggies and low sugar fruits for a balanced meal
Breakfast - Steel cut oats Upma /Idli /Dosa made with ragi /millet batter /Millet Poha / protein waffle with nut butter/ high fiber cereals like Kashi /fiber one /Greek yoghurt with fruit and granola /Protein shake with fruit /high protein and fiber toast ( Dave's killer bread) with natural peanut butter /almond butter /cottage cheese and fruit / protein lassi / whole wheat /multigrain paratha/Pita with avocado and hummus
Lunch and dinner - any kind of mixed salad/veggies with a protein source like Paneer /Tofu /Dal/beans ( chana /rajma with phulka/multi grain pita/roti / and a good grain like millet /oats . There are wonderful protein pastas made of chickpea /lentil flour . Protein pita ( kontos ) and high fiber wraps /tortillas are a great way to experiment and adapt Indian recipes . Try and limit white rice or practice portion control . love using my instant pot , slow cooker and pressure cooker and have experimented with many soups , Khichdis , Pongals , Idlis , Dosas where I have substituted millets, steel cut oats for rice and lowered the carb content of our meals while increasing protein and fiber . These are very filling food choices and great for satiety , keeping blood sugar under control ,while not compromising on taste .
5. Pre-diabetes and metabolic syndrome is a special area of interest for you and a very common diagnosis. Can you talk about what constitutes "pre-diabetes" and what are some resources available to avoid progressing to diabetes?
I am lucky to work with a wonderful team of physicians , dieticians and therapists in my department . A multidisciplinary approach to helping and supporting patients has been a wonderful way for me to work with my patients . I run 2 support/educational groups in my clinic - for Prediabetes and PCOS .( Polycystic Ovarian Syndrome ) I also see many patients individually for both these conditions too. Some PCOS women also have Prediabetes or have higher than average risk of becoming prediabetic or getting diabetes during pregnancy ( called gestational Diabetes ) or progressing to Type 2 Diabetes .
Prediabetes is a very common medical condition and is the precursor to Type 2 Diabetes . There a few criteria to diagnose Prediabetes. It can be an A1c between 5.7 to 6.4, or a fasting glucose between 100-125 mg or a 2hr after meal/glucose load of 140-199 mg . Prediabetes can be reversed in many instances . We know from a large federal prevention program called the Diabetes Prevention program that 5-7% weight loss achieved with diet and exercise ( atleast 150 min per week ) reduced the risk of progressing to Type 2 diabetes by nearly 58%. A medicine called metformin was also studied in this program and use of Metformin reduced the risk of progressing to Type 2 Diabetes by 31 %. Combing a healthy lifestyle with a well-balanced diet, regular movement /exercise , achieving a modest weight loss are great interventions to avoid progressing Prediabetes to Diabetes .
Metabolic syndrome is a cluster of medical conditions- elevated BP, elevated Blood sugar like in Prediabetes / elevated Triglycerides ( higher than 150 ) , Low HDL ( less than 40 in men and less than 50 in women ) , increased waist circumference ( greater than 40 inches in males and more than 35 inches in females ) . Prediabetes and Metabolic syndrome are cardio vascular risk factors and early intervention to reverse these conditions is very important .
Weight loss medications can help some patients achieve up to 10-12 % weight loss that is vital in disease prevention for weight related medical conditions . Some of the newer Injectable weight loss medications like Wegovy have shown up to 15 % weight loss data . Meds always have to be combined with lifestyle changes for weight loss success . The American diabetes association has very good patient information on Prediabetes , here are some links to check out .
Thank you Dr. Prabhakar for sharing your expertise with us. We are excited to have you in our global women’s network!
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