In part 3 of this Exclusive Interview, Dr. Ken Fujioka talks with Diabetes in Control Publisher Steve Freed during the ADA 2017 Scientific Sessions in San Diego, CA about the most effective exercises and best method for patients who want to monitor their weight loss.
Ken Fujioka, MD is director of the Nutrition and Metabolic Research Center and the Center for Weight management in La Jolla California at the Scripps Clinic.
Transcript of this video segment:
Steve: I always wondered, even for a person who does not have diabetes, what is the best ratio of aerobic to anaerobic [exercise]? I used to think that aerobic was more important, cardiovascular; if you’re going to die, it’s going to be mostly from a heart attack. But, then the more research that I’ve done, I see that building muscle mass is also very important. And, it increases your metabolism, so you can burn more calories; especially for weight loss. Any thoughts about that?
Dr. Fujioka: I will confine myself to type 2 diabetics. There have been wonderful studies on what is the best exercise, how much cardio, how many weight, which is very complex. As you said, you can preserve your lean tissue if you do resistance training. Generally speaking, diabetics will be on elderly side. The older the patient is, 65 and up, you are looking at a fair amount of resistance training. If you can get a couple of hours in a week, that would be fantastic. Younger folks, maybe they can get by with 20 minutes twice a week. It really varies with the patient but we do not this, and I wish you can gain metabolism, and we have no way of doing that, short of doing crazy things that unfortunately some people do. But, you can preserve your lean tissue, keep your metabolic rate from dropping. So, if I can get a patient to do 20 minutes twice a week, I am happy with that. If I get somebody that enjoys it, and they do two-three hours a week, great! But, they still have to have some cardio in there too. Between the two, now we are talking about 300 minutes a week if you want to lose weight. If you want to maintain weight, it’s lower. But again, you will get benefit from as low as 70 minutes per week.
Steve: With all the advances, and all the technology, and we have wearables now that can track every aspect of your sleep, your waking hours, sometimes it’s just overpowering. It’s just too much information. What do you see as one of the more important recent advances that has helped you to be more successful?
Dr. Fujioka: You bring up an interesting point, about everything from activity monitor to being able to record your food intake. It turns out, we are getting too much data, as you said. There actually is a published study, big time journal, JAMA, showing that when patients follow these things, they can actually gain weight. Unfortunately, the formulas are not correct in these things. They’re looking at, okay you exercise 500 calories per day and you only ate a thousand, so you can actually eat an extra 400 calories tonight. Turns out that’s all wrong. It’s not a correct way of figuring out metabolic rate, figuring out how much you burn. The best thing we know, step counting is still the best. It doesn’t have to be 10,000 steps. It’s somewhere around maybe between 6000-7000 steps. But, if you can just count steps, that’s great, do it! If you record food intake, that great. Now, we know it’s going to be off; a guy named Coby Martin has shown that you will be off by 37%. That’s a huge error rate. But if you’re record your food intake, you will be off, but that is okay. Rather look for trends, look where you are going, and that will then steer you in the right direction. Don’t look at those two together. Just ount your steps, or your minutes of exercise and the other one is look at your trends of food intake, but don’t let them merge, because it will give you wrong information.
Steve: I put together a whole program called Know Your Healthy Steps that Bayer picked up on. It got sent to over a couple hundreds of thousand people along with a free pedometer – that was the important part. I was doing a presentation at a large corporation, two hundred employees. I did half-hour presentations, every 8 hours, three 8-hour shifts. During the first presentation, they were giving out prizes for good work. For their best employee, who did most of the work, they provided him with a parking spot right in front. And I said: why do you want to kill your best employee? But you see that today in the hospitals, Reserved for Doctor, for cardiologist. And I always thought that it would be a really good impression if you put those signs ‘reserved for doctors’ all the way in the back, people would start to wonder why is that. If the cardiologist is going to get few steps two-three times a day, five days per week, over 20 years that’s a lot of steps. I am a firm believer, that as a medical professional, if you talk about physical activity, you better be doing it yourself, because patients will pick up on that if you are not doing it. You have to be really active and passionate the way you talk about it.
Dr. Fujioka: I agree. You need to walk the walk. It’s true. Literally, up to two-thirds of healthcare givers are going to struggle with weight themselves. We need to look at ourselves. I feel lucky, because I have been able to keep my weight down. That’s why I switched from an ER doctor to doing endo and doing weight, because it helped me keep my weight down. But with that said, doctors that are overweight, NPs or PAs that are overweight, shouldn’t feel afraid to talk to a patient about their weight. As it turns out, there are studies showing that, patients will listen to them, regardless of what the weight is. They will listen to you. Because they realize, they want to address it, they want to bring it up; 80% of patients want to bring it up. 20%, sure, they don’t want to deal with it, and that’s okay. And that’s why we say, ask, if they want to deal with it – great, if they don’t – that’s fine.