Destigmatizing Obesity and the Four Rules of Health Model w/ Dr. Priti Parekh

Episode Information

March 17, 2021

Obesity Medicine Physician Dr. Priti Parekh talks about growing up in India, moving to America, specializing in obesity treatment, her holistic approach to chronic health issues and more

Topics Include:

• Moving to America from India and doing her residency in California
• Her holistic approach to chronic health issues
• How obesity has recently been recognized as any other chronic disease and how this reduces the stigma attached to it
• How doctors need to take a multidisciplinary approach when treating obesity
• The importance of continuous care and follow up when dealing with a patient who suffers from obesity
• That you need a team of specialists to treat obesity, including an obesity medicine physician, a nutritionist and a psychologist.
• How patients fail to lose weight or to maintain their weight loss because both patients and doctors give up and because doctors don’t address many issues surrounding obesity,
• How treating obesity requires patience on the part of the patient and the doctor
• That even if obesity or being overweight runs in your family, you can make lifestyle changes and change the way that some of the genes causing obesity work
• That most symptoms can be solved by following her Four Rules of Health model, meaning sleeping well, eating well, keeping your stress levels under control and exercise
• That not moving enough can cause low energy and fatigue
• That Doctorpedia is an amazing platform because it provides information directly from doctors and specialists and it’s also evidence-based information.
• That losing weight is more about taking baby steps and less about obsessing about your end goal, because that will just make you frustrated.
• That weight loss is not only about the amount of pounds you lose, but it is about the life you gain along the way, including improved physical and mental health.
• How she goes to sleep early and how she loves hiking with her family.

Highlights

• “Biology has always fascinated me since high school and it just fascinated me how a human body worked. It’s just a miracle. It’s one of those creations of God, which I have no words for.”
• “I realized that 70 to 80% of chronic issues are caused by lifestyle choices. And so that’s when I thought, ‘Rather than being at one end of the spectrum, when I just treat people when they’re very sick, how about going to the other end, which is the preventative aspect?'”
• “Obesity is considered a disease and it’s not just that you lack motivation to exercise or that you don’t eat right. There are so many other factors that contribute.”
• “Obesity is not just a symptom, it’s a disease by itself. And I believe it was 2013 or so when WHO announced this as a chronic disease and then other organizations like Obesity Medical Association, Obesity Society, they started recognizing this and more and more organizations are now coming out and supporting this fact that it’s a chronic disease.”
• “There are 230 diseases that are associated with obesity. That’s huge. That’s a huge number.”
• “Some patients who come to doctor feel like doctors are for quick fixes. So medications, for example, let’s get on the medication and that’s it. And so when I start lecturing them about lifestyle choices and lifestyle changes they can make, sometimes it’s quite a shock because they’re like, is that what they came here for?”
• “In my opinion, most symptoms can be solved by taking care of four things. And I call it my Four Rules of Health model, which is taking care of what you put in your mouth, taking care of how you move your body, taking care of how you rest your body and taking care of how you rest your mind, which is nutrition, exercise, sleep, and stress management or taking care of your mental health.”
• “Between all the social media and the internet, people can access information readily, but a lot of them access wrong information and that’s where Doctorpedia comes in. We have experts, we have specialists, we have these awesome doctors on this platform. So you’re basically hearing it directly from doctors who know their subject well. First of all, you’re getting great information and secondly, you’re getting evidence-based information.”
• “If they tell me that they’ve learned to take charge of their health, if they tell me they’ve learned to thrive and not just survive, they’ve learned to flourish, then I would think that my job is done.”
• “It’s not only about weight. It’s not only about the pounds you lose. It’s about the life you gain. So sometimes patients are frustrated that their goal was 30 kilos, and they only lost 10 kilos, but they probably have improved numbers like their diabetes goes away, their blood pressure is good. They feel good. They feel happier. They feel less anxious, less depressed. So that’s also the life you’re gaining during this journey.“

Relevant Links

• Doctorpedia Profile
• Wellness Channel
• YouTube Channel
• Pretty Healthy with Dr. Priti

Episode Transcript

Daniel Lobell: (00:00)
This podcast or any written material derived from its transcripts represents the opinions of the medical professional being interviewed. The content here is for informational purposes only, and should not be taken as medical advice since every person is unique. Please consult your healthcare professional for any personal or specific needs. Hello and welcome to the Doctorpedia podcast. I am your host Daniel Lobell and I’m honored to be joined on the line today by Dr. Priti Parekh. How are you?

Dr. Priti Parekh: (00:39)
I’m good, Daniel, thank you for having me.

Daniel Lobell: (00:41)
Thank you for doing the show, and I’m very excited to talk to you and to really get into everything that you do. But I always ask the doctors to start at the beginning and go back to when you were young and what possibly prompted you to want to become a doctor in the first place. Where did you grow up?

Dr. Priti Parekh: (01:01)
I grew up in India in a place called Ahmedabad in the state of Gujarat and that’s where I was born. That’s where I was raised. That’s where I went to med school. So everything in this one town called Ahmedabad it’s one of the metro cities of India.

Daniel Lobell: (01:22)
For reference, that’s probably not a lot like the metro cities in America, correct?

Dr. Priti Parekh: (01:27)
What do you mean by that?

Daniel Lobell: (01:31)
I’ve never been to India. I have this American sort of fantasy idea of what India is in my head. Maybe the better way to do it is rather than to impose my assumptions, to just straight out ask you, what was that like?

Dr. Priti Parekh: (01:48)
What was it like to to be in the city? Is that what you’re asking?

Daniel Lobell: (01:57)
Yeah. What was that city like? And what was your childhood like there?

Dr. Priti Parekh: (02:02)
So when I say Metro cities, it means an urban area, a big city with all the facilities, there are great hospitals and great schools and great entertainment centers and it’s a big city, well populated. So that’s where I was born and that’s where I went to school. At some point when I decided to go to med school, I got lucky enough to get into a med school in that same city, which actually was considered the best medical school in the state at that time. So I got lucky enough and I got to go to med school from home. I didn’t have to move anywhere. I got a chance to stay with my parents while doing med school. So it was all good.

Daniel Lobell: (03:07)
Can you give me a feel of like what the city itself is like?

Dr. Priti Parekh: (03:10)
It’s one of the oldest cities, and in some sense, it’s also young and there are a lot of folks now moving to that city from other parts of the state, because it’s now one of the fastest growing cities in the country. So people from, for example, rural settings now migrating to be there. It’s kind of like the area where I live, people from all over the country want to come here because of opportunities. So that’s how that city was and is, people coming from all over the state and all over the country too, so kind of a cosmopolitan culture also, we got exposed to different kinds of people because of that. So that’s how I grew up amongst people from varying cultures and different religious beliefs. So it was a cosmopolitan area and at the same time advanced and what I loved about that city was it’s actually been now considered one of the safest cities in the country. So you can go out at midnight and hang out with friends and it’s still considered very safe for girls, especially. So if I have to go back someday, that’s the city I would go back to.

Daniel Lobell: (04:47)
And what about your parents? Did they also work in medicine there?

Dr. Priti Parekh: (04:51)
No. My dad was an engineer in an agricultural field. My mom was a lawyer. My dad passed away a few years back. My mom’s still around. I think that I am the only doctor in the family.

Daniel Lobell: (05:11)
What do you think made you want to become a doctor?

Dr. Priti Parekh: (05:17)
Biology always fascinated me since high school and it just fascinated me how a human body worked. It’s just a miracle. It’s one of those creations of God, which I have no words for. So that always fascinated me and the fact that it kind of felt nice to have some power, to some extent, to be able to help others and heal their problems. I think high school is when I started thinking about these things. And I think I was in 11th grade when I decided I wanted to be a doctor.

Daniel Lobell: (06:10)
So you’re in 11th grade in high school in India and you decide you want to become a doctor. And so you pursue it there, right? At what point do you come to America and start practicing here?

Dr. Priti Parekh: (06:22)
So I moved here after I got married to my husband who had settled down here. So I met my husband over there when he had come out to India because he still had his family there. He still does. And so that’s how they met. And he was clear that he wanted to be here in America. And I had no intention of moving, but it just happened, I guess it was destiny. And so I got married to him and then I moved here on a spouse’s visa. And then eventually I became a citizen here and applied to go to residency here in California. Again, I got lucky to get into California because it’s hard to get into residency in California, but here, once again, I could do it from home. So that was good.

Daniel Lobell: (07:24)
Yeah. That’s always good. So I thought it was interesting. I was doing some research on you and I saw that you’re an internal medicine doctor, but you also specialize in obesity medicine. I am somebody who would be clinically considered obese. So it’s a subject that I’m not completely foreign to, with regards to the fact that I’ve been to so many doctors and nutritionists, dieticians and weight loss specialists since childhood. And I wonder what makes somebody gravitate first of all, towards helping or trying to help people like me in this situation. Let’s start with that question.

Dr. Priti Parekh: (08:14)
So before I decided to do obesity medicine, I was always interested in doing integrative medicine, which is having a holistic approach to health issues, especially chronic issues. So that’s an interest I developed even before residency, but mostly during residency. I did a month of yoga therapy programming in India. That was one of my electives. We were allowed to do one international rotation. And so I decided I wanted to learn some yoga. And so that’s what I did in my second year of residency. And that’s when I realized that 70 to 80% of chronic issues are caused by lifestyle choices. And so that’s when I thought, “Rather than being at one end of the spectrum, when I just treat people when they’re very sick, how about going to the other end, which is the preventative aspect?”

Daniel Lobell: (09:16)
I like that quote that you had up on the web that you said, “I believe that health is the state of complete physical, mental, and emotional wellbeing and not merely the absence of disease.” I like that.

Dr. Priti Parekh: (09:31)
Exactly.

Daniel Lobell: (09:32)
And that’s sort of what you’re conveying right now. But obesity is a disease, isn’t it?

Dr. Priti Parekh: (09:41)
Yes. And so little by little, I came to know that in lot of these issues, one common factor was obesity. And then I decided to dive deeper and did my board certification in obesity medicine. And that’s when I learned that now, it’s considered a disease and it’s not just lack of motivation for exercising or not eating right. There are so many other factors that contribute. And I just wrote a post on stigma obesity stigma and bias yesterday, that sometimes, even the doctors or the healthcare professionals blame the patient that, “Okay, you probably are not doing this right and that right.” And although this could be some part of it, there are so many other factors affecting a person’s weight, it’s multifactorial. And that part mostly doesn’t get addressed. And so that’s when I got more interested that it’s not just that exercise, that a lot of other things in play and patients’ symptoms get lost because all they hear is diet and exercise, but there are other things that can help them. So that’s what I integrate in my practice.

Daniel Lobell: (11:02)
Before we get into what those other things are – and believe me, I’m sitting on the edge of my seat – I’m fascinated. I want to just reiterate what you’re saying is it’s so frustrating as a patient because this is my situation, but I’m just fascinated by the fact that there is so much study, so much research done into this and yet people seem to know so little about it. How it’s possible, I don’t know. Maybe the research is poorly aggregated or maybe some people dismiss some of it, whereas they elevate others. I don’t understand it, but initially before I even did this podcast, I wanted to do a podcast just on this topic. And I did record a few episodes and what I found was astounding. I never put it out, but it was astounding. If you talk to five different professionals, you get five completely different approaches. There’s no uniformity to it. What do you attribute that to?

Dr. Priti Parekh: (12:13)
Like you said, little is known in this area. It wasn’t that long ago that they started recognizing this as a chronic disease. It’s not just a symptom, it’s a disease by itself. And I believe it was 2013 or so when WHO announced this as a chronic disease and then other organizations like Obesity Medical Association, Obesity Society, they started recognizing this and more and more organizations are now coming out and supporting this fact that it’s a chronic disease.

Daniel Lobell: (12:56)
Once it’s considered a disease, is anyone like pumping their fist going, “Yes, we made it. We’re in the big time”, like who’s benefiting from it being a disease? Does that open it up to funding? Does it open it up to special treatment or is it just like an insult, like “You’re diseased”? Where is the benefit in them announcing it as a disease?

Dr. Priti Parekh: (13:21)
So the benefit is that now we’re treating this as any other chronic disease, like diabetes or hypertension. And like I said, part of it could be a person’s lifestyle, but we never tell a person with hypertension that this is all your fault, just because you’re not exercising or eating right, you have hypertension. I feel like a lot of avenues will open up now, because the the blame is not just on the patient now, we just treat it as any other chronic disease with serious health implications.

Daniel Lobell: (14:11)
Gates such as water are going to open up now, what do you anticipate will happen that will benefit the patient?

Dr. Priti Parekh: (14:19)
First of all, before I answer that question, I would say that the other nice thing that happened was that I believe it was 2017 that we recognized that I’m going to open up and just as we are speaking, I just emailed somebody, somebody reached out to me to be quoted in USA news. I don’t know if they’ll go ahead and do that, but yeah. So yeah, in 2017 AME, which is the American Medical Association house of delegates, they approved a resolution altered by OMA or Obesity Medicine Association that seeks to de-stigmatize obesity and improve obesity treatment by educating physicians and other healthcare providers to engage in a non-biased dialogue and to use first person basis language, meaning, instead of saying obese patients, patients with obesity kind of like patients with diabetes. So that’s one good thing that also happened out of announcing this as a disease. Now we don’t say obese patients, we say patients with obesity, that removes a lot of stigma associated with it. And that kind of helps us treat obesity like any other chronic disease with serious implications and stop blaming the patients.

Daniel Lobell: (15:56)
Well, it’s always nice not to be blamed. I don’t know if that’s the most exciting news to me as somebody who’s looking for solutions, but it’s certainly nice not to be berated when you go into the doctor’s office.

Dr. Priti Parekh: (16:11)
Yeah. I mean, that’s just one aspect of it.

Daniel Lobell: (16:16)
I’m not trying to minimize what you’re saying. I’m only teasing a little bit because that’s my job, [Laughs] I try to keep it light. But I am kind of on the fence when it comes to that, to some extent, because I feel like it is kind of my fault, right? It’s a disease, but maybe I’m not managing it. I mean, it’s up to the patient to manage their disease correctly and you can’t remove all the blame from the patient. I don’t know. I always kind of go back and forth on that kind of stuff. Cause I’m like, “Yeah, be kinder. On the other hand, don’t be so kind that you tell me everything’s okay and then I walk around for five minutes and then God forbid drop dead from a heart attack.”

Dr. Priti Parekh: (17:08)
Right. Like any other chronic disease be it diabetes, hypertension, and obesity, patients do need to take some responsibility, right? We can’t just say, “Okay, it’s a chronic disease and that’s it. You’re off the hook.”

Daniel Lobell: (17:22)
You have the disease and now you better do what your due diligence is. But the question is what is the due diligence? I was just telling my wife, we’re watching the news the other night. I said, “During every other commercial break, there’s some ad that says, “You’ve been on diet after diet. You’ve tried them all.” And I said, “There’s so many people like me who have tried and tried and tried again, it’s not like they’re not trying.” I dismiss these commercials anyway cause I feel like this is all snake oil, but as somebody overweight, snake oil might be good. I prefer olive.

Dr. Priti Parekh: (18:08)
[Laughs].

Daniel Lobell: (18:11)
I don’t know, that’s a dumb joke, but I’m open to it. I want to try it. It’s just that it’s obvious that this is not being treated properly because if it was, we wouldn’t have commercials like that. You don’t see that for asthma even, “You’ve tried inhaler after inhaler, after inhaler. Well, this one actually works.” No, they have an inhaler and it works. So what the hell is going on that they can’t seem to diagnose proper treatment for obese people? And this is such a passionate topic for me, and I hope I’m not being too passionate that I’m being off putting to you.

Dr. Priti Parekh: (18:54)
I’m enjoying this, you’re asking all the right questions.

Daniel Lobell: (18:58)
It’s almost like there’s this tug of war. It’s like either they’re going to be really mean to you about it, or they’re going to be overly nice to you about it. And both of those things can be detrimental because you go, all right, well, if you berate someone for being overweight, they may just go and eat and try and manage their feelings through food because it’s an addiction as well. And if you’re overly nice, then they may dismiss it as not as threat. And then they’ll just go eat. So if I was on your end of thing, I don’t know what I would tell the patient to best help them. What’s your answer to that?

Dr. Priti Parekh: (19:32)
Yeah. Well it is a complex disease because by default, our body likes to be in homeostasis, which means it does not like any major changes. So it likes to hold on to whatever’s there. I joke with patients when they tell me, “Oh, you know, I keep losing weight, but I gain it back , I’m like, “Yeah, you keep losing weight, but it keeps finding you.” That’s unfortunately the reality, so it requires a lot of dedication and motivation on the part of the patients and some patience on the part of doctors, because it’s a long process. Once you lose the weight- to maintain that weight is also a process. So you can’t say, “Okay, you lost 10 pounds. … Now I’ll see you in a year.”

Dr. Priti Parekh: (20:41)
You have to keep seeing that patient just like any diabetes or hypertension patient. You have to keep seeing them, make sure their numbers are okay. It’s just the same thing for obesity. You have to continue to follow them for years to come and make sure that they maintain it once they lose it. I guess a lot of failures are because number one, patients try for a little bit and then they give up and doctors probably give up. Probably the other reason is we don’t address a lot of other things around it, like you just mentioned, it’s an addiction. Sometimes that can be an addiction. So that part, if it’s not addressed, you can’t just tell a patient, “Okay. Don’t eat hamburgers and eat apples and oranges or whatever. If it’s hardwired in their brain, it’s not going to be easy for them to make that choice. So it’s a multi-disciplinary approach. You need a primary care physician, you need an obesity medicine physician, you need a nutritionist, you need a psychologist. You need somebody who is comfortable prescribing medications, if need be. And you need social support, good support at home, maybe a health coach, somebody who follows up with you on a regular basis.

Daniel Lobell: (22:22)
So you basically need an entire team of people like a NASCAR driver. You pull in and they all just come and swarm you.

Dr. Priti Parekh: (22:29)
A disciplinary approach.

Daniel Lobell: (22:33)
You mentioned ‘hardwired in the brain’. When you say that, are you talking about neural pathways that form in the brain, because I think about this in terms of Alzheimer’s patients who are basically losing neuro-pathways in their brain, as I understand it, and in doing so losing memories. Is there a way we can target the areas in the brain that are habits that are unhealthy and stop feeding them whatever electricity is fueling them to destroy the rest of the body? What do we know in terms of what part of the body is trying to get back to homeostasis? Can we reset it like a meter? Is there any of that being talked about?

Dr. Priti Parekh: (23:25)
This is such a wonderful question, Daniel, and this requires another call, I think.

Daniel Lobell: (23:32)
[Laughs].

Dr. Priti Parekh: (23:32)
[Laughs]. But yes, there are certain things that psychologists can help, there are cognitive behavioral therapies, there are different forms of meditation. And those kinds of conservative therapies that are drugs that also help with some of that, that you just asked. So, yes, again, I’m looking at a disciplinary approach to that. That can also happen – a slow process, but surely it can happen over time, which is why I said that treating obesity requires patience at both ends, the doctors and the patients.

Daniel Lobell: (24:24)
Yeah. So let’s get into your specialty in terms of obesity medicine, what is obesity medicine, and what are some of those exciting things that you teased upon earlier, besides diet and exercise, which people don’t realize could be beneficial to a patient who is trying to get out of a state of obesity?

Dr. Priti Parekh: (24:45)
So like I said, like you said, sometimes it could be a food addiction. It could be a feel good thing when somebody’s down in the dumps. So it’s very important to be working with a psychologist, because no matter what you tell patients, if that part is not addressed, then it’s hard to sustain weight loss. There are lots of other things, there’s a small percentage of obesity that could be because of some alterations on genes. So although it’s only a a small percentage, if that’s the case, things can be approached a little differently.

Daniel Lobell: (25:34)
Talking about genetic mutations, is there a way that you as a doctor can find a specific gene, target it and go and delete it?

Dr. Priti Parekh: (25:45)
Well, that’s specifically meant for kids who are really overweight, out of proportion to what they’re eating and their activity level. So that applies more to kids than adults. But there are certain therapies that can be helpful in those extreme situations. Other than that, there could be some genetic component in adults also – if your parents are overweight, if your mom was overweight when she was pregnant, those are the things that can affect one’s weight as an adult. Now, the good thing about that is by making some lifestyle changes, you can actually change the way some of those genes work. You can’t alter the DNA, that’s still going to be there. But epigenetics is what we talk about these days, which is the environment, by making changes in your lifestyle and the environment you can alter a lot of those factors. So even if your parents were overweight, even if you say, “Okay, I’m overweight because this is how my family is”, you can change some of that. It runs in families, but you can work on that if you start running.

Daniel Lobell: (27:22)
Yeah. Well, let me ask you some more specific questions. Insulin resistance is something I’ve learned a little bit about, and that it makes it more difficult for somebody to lose weight when they’re overweight, because the body will resist insulin. Is that a fair description of it or am I missing?

Dr. Priti Parekh: (27:43)
Yes, absolutely. Insulin resistance is kind of a vicious cycle. People can gain weight because of insulin resistance and when they gain weight, they become more insulin resistant.

Daniel Lobell: (27:59)
And those are the worst kinds of cycles, the vicious ones.

Dr. Priti Parekh: (28:02)
Yes, absolutely.

Daniel Lobell: (28:05)
So basically the thing that’s making it harder is also making it harder as it gets harder.

Dr. Priti Parekh: (28:14)
Exactly. And so it’s very hard to break that cycle – it’s possible, but again, you need to work with somebody closely.

Daniel Lobell: (28:24)
Is that a medical thing to break the cycle? How is that cycle broken?

Dr. Priti Parekh: (28:32)
So again, lifestyle changes and there are certain medications that we can give to improve insulin sensitivity. And then at the same time you make some lifestyle changes.

Daniel Lobell: (28:43)
And those medications, have they been proven to be effective at this point? Or are they more experimental?

Dr. Priti Parekh: (28:56)
No, for example, there are medications like Metformin, that’s been used for ages. Now again, there are certain guidelines. We can’t use Metformin on everybody, so there are certain guidelines to follow.

Daniel Lobell: (29:15)
I think I was on Metformin. When you say that, it sounds familiar to me.

Dr. Priti Parekh: (29:19)
Did you have diabetes or pre-diabetes?

Daniel Lobell: (29:23)
At one point I was pre-diabetic, thankfully I’m not anymore, I’m still not out of the woods. What about this? What is the relationship between insulin resistance and metabolism? Are they the same thing? What is the metabolism, what controls it and how do we crank it up?

Dr. Priti Parekh: (29:47)
Insulin resistance is definitely one thing that slows your metabolism. What controls metabolism is, again a very broad topic.

Daniel Lobell: (30:03)
Another phone call. [Laughs]. Is that another phone call, are you and I about to just do our own podcast together?

Dr. Priti Parekh: (30:11)
You are asking some great questions.

Daniel Lobell: (30:14)
Thank you.

Dr. Priti Parekh: (30:14)
No, but these are great questions, we can definitely talk about this in future, these are topics by themselves.

Daniel Lobell: (30:24)
Yeah. Interesting stuff. Just reading about what you work on online, it talked about the relationship distress, I realized that all of these topics could be their own podcast. One of the things you mentioned, nutritional deficiency, is something that I thought was really interesting from a book that I had read, which I’m sure you’re familiar with – Dr. Michael Greger’s book. I think I’m attributing the quote to him correctly, that he said most people are overfed and undernourished. So I think that’s a big part of it as well. Is that right?

Dr. Priti Parekh: (31:13)
[Laughs]. Yes, because they’re eating all the wrong foods. Eating mostly empty calories that don’t serve any purpose – there’s no nutrition there. So I haven’t read that book or heard of his work, but that totally makes sense.

Daniel Lobell: (31:32)
Yeah. You’d like him, I think. He advocates a plant-based diet. Are you a proponent of that kind of thing as well?

Dr. Priti Parekh: (31:40)
Oh, big time. I’m a big time proponent.

Daniel Lobell: (31:44)
You talk about hormonal imbalance, inflammation, food sensitivity, sleep disturbance. There’s so many components to weight loss that you literally could obsess yourself with it all day long, get all worked up, eat a sandwich and you’re back to where you started. [Laughs].

Dr. Priti Parekh: (32:06)
[Laughs]. Yeah. Which is why you need somebody to hold your hand, you need professionals to guide you through this process. Mostly it’s not something you can do by yourself. So reach out, ask for help. Like I said, it’s a multidisciplinary approach. What’s that saying? You know, it takes a village.

Daniel Lobell: (32:35)
To help someone lose weight? [Laughs].

Dr. Priti Parekh: (32:35)
[Laughs]. To raise a child. Yeah.

Daniel Lobell: (32:42)
What are some of the biggest misconceptions that you think patients have coming into you?

Dr. Priti Parekh: (32:46)
Well, first of all, it’s not just with obesity, but with anything. There is a thing that when you go to the doctor, it has to be a quick fix, “Oh, she just told me to eat well”. “He tells him no meat.” That’s not why I came to the doctor, if I come to you, you’ve got to fix this. So that’s not everybody, but some patients who come to doctors, they feel like doctors are for quick fixes. So medications, for example, let’s get on the medication and that’s it. And so when I start lecturing them about lifestyle choices and lifestyle changes they can make, sometimes, for some of them, it’s quite a shock because they’re like, is that what they came here for?

Daniel Lobell: (33:41)
Yeah. They just want a quick fix. It goes back to the whole patience that you were saying, if it’s something that requires extreme patience. I know because I’ve had to be patient through it my whole life. I’ve been trying every single thing you can imagine, but maybe there’s more out there and it seems like you certainly know a lot of things that I don’t know. So it’s always exciting to me, maybe we’ll crack the code on this thing and just find the exact equation that makes people not have to deal with this disease anymore. That would be an exciting shift in humanity.

Dr. Priti Parekh: (34:24)
Yes, I’m very passionate about this topic. I feel like we can do so much here. A lot of work needs to be done, a lot of work is being done, which is thankfully due to bigger organizations, like Obesity Medicine Association, for example, Obesity Society. So yeah, a lot of work is being done and I am really excited to be part of this great initiative.

Daniel Lobell: (34:53)
Well, it is exciting. And if you guys can crack the code on it, it would improve not just the health of overweight people, but you’d be treating so many illnesses that come out of obesity in the process. You might shut down the whole medical profession. If you crack the code on obesity, you may actually put everyone out of business.

Dr. Priti Parekh: (35:20)
I’m sure most doctors wouldn’t mind. [Laughs].

Daniel Lobell: (35:22)
[Laughs].

Dr. Priti Parekh: (35:22)
I was just posting this the other day on my social media platform, that there are 230 diseases that are associated with obesity. That’s huge. That’s a huge number.

Daniel Lobell: (35:45)
I’m surprised it’s only 230. I was thinking probably more. [Laughs].

Dr. Priti Parekh: (35:51)
[Laughs]. Yeah, it’s possible, but it’s also high time that we do something about obesity.

Daniel Lobell: (35:58)
I agree. I’m with you on that. Certainly it would be good for me. I also thought it was interesting on your website, you talked about treating people with regards to low energy and helping them in that respect. What are some of the things that you’ve found help people to have more energy? Obviously, I think eating the right foods and exercise are obvious, but more than that, what are some great ways to stimulate one’s energy?

Dr. Priti Parekh: (36:26)
My personal opinion is that it comes down the fact that most symptoms can be solved by taking care of four things. And I call it my Four Rules of Health model, which is taking care of what you put in your mouth, taking care of how you move your body, taking care of how you rest your body and taking care of how you rest your mind, which is nutrition, exercise, sleep, and stress management or taking care of your mental health And so when somebody complains of being fatigued, there could be a medical condition too. So obviously when somebody complains of low energy, besides asking them detailed questions and doing the review of systems, the first thing that I do is labs to make sure that I’m not missing anything like anemia, low hemoglobin or a thyroid issue.

Dr. Priti Parekh: (37:29)
It could be host of medical problems that could cause low energy, but if everything comes back fine, then like I said, taking care of these four things: if you don’t sleep well, your body rejuvenates and body repairs itself at night. When you’re not sleeping well, your body doesn’t get repaired adequately and you don’t have enough energy the next day. So are you sleeping well, are you eating well? Like you said, and eating well means not just the the quantity – are you eating quality food? Are you putting good nutrition in your body? So not just, what are you not eating? What are you eating, like are you eating processed food? Are you eating lots of sugar, carbonated food? So that’s one aspect and then stress management. Are you stressed out, because all these hormones, cortisol and other hormones that are released when your body’s under chronic stress have a huge impact on your energy levels. So are you stressed out? Do you have strategies to work around that? And then are you moving enough, especially these days in this pandemic, when everybody’s working from home, there are some people who find that they have no time to exercise, but most of my patients tell me that since working from home, they haven’t been moving enough and not moving enough can also cause low energy fatigue.

Daniel Lobell: (39:19)
That’s another one of those ones. You can move a lot and then you have no energy or you don’t move anything and you have no energy. You have to move exactly the right amount.

Dr. Priti Parekh: (39:20)
That’s exactly what I told my one patient the other day. You can move a lot and have no energy, but in this case it’s the other way around, you probably don’t have energy because you’re not moving enough.

Daniel Lobell: (39:37)
It’s fascinating. And I have so many more questions. I hope we will do another one of these. This is obviously for the great Doctorpedia podcast. So I do want to ask you, what way do you feel Doctorpedia can best benefit the online health space and what is your opinion on patients going online for information?

Dr. Priti Parekh: (39:56)
One thing is there’s lot of misinformation out there. When patients have a health issue guess who they go to first? They go to Dr. Google, right? And when they come to us, they already have five diagnoses in mind. [Laughs].

Daniel Lobell: (40:27)
[Laughs].

Dr. Priti Parekh: (40:27)
“Doctor, do I have cancer?” “No, it’s just indigestion.” It’s good that between all the social media and internet, people can access information readily, but a lot of them access wrong information and that’s where Doctorpedia comes in. We have experts, we have specialists, we have these awesome doctors on this platform. So you’re hearing it directly from doctors who know their subject well. So first of all, you’re getting great information and secondly, you’re getting the right evidence-based information.

Daniel Lobell: (41:15)
What are you taking on in Doctorpedia and how can people find you through them?

Dr. Priti Parekh: (41:20)
I will be the CMO of the Wellness Channel. So mainly I’ll be hanging out there.

Daniel Lobell: (41:31)
What kind of things can we look to seeing?

Dr. Priti Parekh: (41:34)
Like I said, my four rules of health model, I’ll be talking about things that you can do, that are in your control to take charge of your health, which is I think 80% of it. If you need medications or surgery, of course you need a primary care provider to help you with that, but there are some things that you can do, which are nutrition, sleep, exercise, and stress management. And again, there’s a lot of information out there. Every day you hear all sorts of things, this oil is bad, and that one is good and the next thing that changes completely by 180 degrees. So here you find research-based, evidence-based, trustworthy information on these topics. And basically, like I tell my patients, we are here to thrive. We are here to flourish, not merely survive. And so come out of survival mode and learn to try. And Doctorpedia is just an amazing medium for that.

Daniel Lobell: (42:50)
I agree, a hundred percent. What is the best compliment that a patient can give you?

Dr. Priti Parekh: (42:59)
If they tell me that they’ve learned to take charge of their health, if they tell me they’ve learned to thrive and not just survive, they’ve learned to flourish, then I would think that my job is done.

Speaker 3: (43:23)
Yeah. But it’s never done. Like you said, because as soon as you stop maintaining, you’re back to where you started.

Dr. Priti Parekh: (43:31)
It’s a continuous process. It’s a work in progress and you do just take one step at a time and not to focus on the end goal so much but rather enjoying the journey.

Daniel Lobell: (43:46)
That’s a good piece of advice because it is very hard to enjoy this journey – when it comes to the journey of weight loss anyway.

Dr. Priti Parekh: (43:52)
Yeah. Every day, just take one day at a time. Because if you look at your scale and think, “Okay, I have 30 kilos or 60 pounds to lose. How am I going to do it? And how long is it going to take me?” You should have an end goal in mind. But if you keep your eyes on that, your attention on that, then it’s going to be very frustrating. Just take baby steps and one day at a time. And it’s not only about weight. It’s not only about the pounds you lose. It’s about the life you gain. So sometimes patients are frustrated that their goal was 30 kilos, and they only lost 10 kilos, but they probably have improved numbers like their diabetes goes away, their blood pressure is good. They feel good. They feel happier. They feel less anxious, less depressed. So that’s also the life you’re gaining during this journey. So you have to enjoy every step of that and just take one day at a time, you do your best. That’s all we can do. Not just in regards to weight loss, but in regards to anything in life, you can only do things that are in your control. At the end of it, you just enjoy where you are.

Daniel Lobell: (45:27)
I like that sentiment. Doctor, it’s been an absolute pleasure talking to you. I want to ask you that same question I ask all the doctors to round these interviews off, which is what do you personally do to stay healthy?

Dr. Priti Parekh: (45:40)
I’m a vegetarian and I think that really helps me. I like to cook vegetarian meals. It is very helpful to have a daughter who is interested in cooking. So we cook together as a family, sometimes she motivates me rather than the other way around. And I try to sleep well. My friends joke with me that you’re the first one to leave the party, and this was in pre-COVID times, which is true. By 9:00, 9:30, I have to be in bed.

Daniel Lobell: (46:32)
9:00 to 9:30. Wow. That’s much earlier.

Dr. Priti Parekh: (46:36)
It is early. Because I like to get up early and the other thing is that I get up and I meditate. I pray in the morning when I get up. And so if I don’t get my morning hour before the rest of the family wakes up, then I don’t get to do that. And basically that’s the day I’m skipping that because then the day goes by fast. So I like to go to sleep on time, wake up on time, meditate, eat well. I’m a bit lazy when it comes to exercise, but I love to hike as a family. My husband loves to hike. So we hike a lot. And fortunately we are in this area in California where there are tons of hiking trails around. So we hike a lot outdoors, but yeah, I’m not much of a gym person – we had this gym membership for two years and I barely went. And so I can do better there. We have an elliptical at home and I’ve barely used it. I can do better there.

Daniel Lobell: (48:00)
[Laughs]. You don’t have to tell me everything you’re doing wrong. [Laughs].

Dr. Priti Parekh: (48:04)
[Laughs]. Well, I want everybody to know that doctors aren’t perfect. Doctors are human beings too.

Daniel Lobell: (48:13)
Right. I felt like I was in a position where I was going to start diagnosing you though. I was kind of like, “All right, well, let’s see if we can get your exercise up at least two to three times a week.” [Laughs].

Dr. Priti Parekh: (48:23)
[Laughs]. Yeah. I know. But I do get my exercise. I move a lot throughout the day.

Daniel Lobell: (48:29)
No, I appreciate your honesty. It does help to hear that kind of thing because we realize we’re not alone. And even somebody like you, who’s made a career out of this, still has your challenges.

Dr. Priti Parekh: (48:44)
I have my own struggles. At the end of the day, it’s just recognizing your weaknesses and just focusing on your strengths and that’s it.

Daniel Lobell: (48:52)
I think that’s great advice. Thank you so much, Dr. Parekh. I really enjoyed talking to you and I learned a lot and I hope to be able to do more of these together.

Dr. Priti Parekh: (49:00)
Yeah. Thank you so much, Daniel. This was really refreshing. I totally enjoyed this and yes, we should do more of this. This was fun.

Daniel Lobell: (49:10)
Thank you. Have a great day. And thanks again for doing it.

Dr. Priti Parekh: (49:14)
Sure. Bye-bye.

Daniel Lobell: (49:17)
This podcast or any written material derived from its transcripts represents the opinions of the medical professional being interviewed. The content here is for informational purposes only and should not be taken as medical advice since every person is unique. Please consult your healthcare professional for any personal or specific needs.