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Is better health simply about eating less and moving more? In this episode we explore more about weight, metabolic health and building healthier habits that fit everyday life.
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00:07Hello, good evening. I'm Amirul Ayman and you're watching It's About Youth.
00:11Eat less, move more, be more proactive. That advice can sound simple when it comes to weight
00:18management but what happens when you keep on trying but the result doesn't get you that far.
00:23So how do we understand what our bodies need and how do we build healthier habits that
00:29fit the lives that we actually lead? So to explore this question, to explore this special episode,
00:35joining me is Dr. Lavanya Narayanan, a consultant internal medicine physician with a special interest
00:43in diabetes care. Doctor, thank you so much for joining us today. Hi Amirul, thank you for inviting me.
00:50Okay, doctor, let's start with a term that comes up throughout this conversation, metabolic health.
00:55Okay, what does that mean in everyday language? Could you explain to the audience in the layman
01:00terms and why should a young person pay attention to it even when they feel perfectly fine with
01:06their lives? Yeah, good question. So metabolic health in simple terms refers to how well your
01:14body actually utilizes energy on a day-to-day basis. So as much as we feel healthy or we appear
01:22healthy,
01:23many times we don't realize that our body is like a machine. So as time goes by, it's how efficiently
01:32we
01:33are utilizing the energy that we are consuming and burning in order for us to be productive, efficient and also
01:42keep away as many health problems as possible. And also we often judge our health by what we
01:49see in the mirror, for example. But how can someone who looks slim or has a normal weight or BMI
01:56have
01:56problems with their metabolic health? Yeah, so most of the time metabolic health when it gets picked up,
02:05they come in with symptoms. But little do we realize that the problem actually starts much earlier.
02:12So in general terms, we would we would just advise people to stay healthy and that's extremely general.
02:18So what is really important is for someone young, they need to identify if they have risks to develop
02:25certain types of metabolic conditions. And that would include if they have family members or first degree
02:30relatives we say, like parents, siblings, who also have metabolic conditions like diabetes, obesity,
02:37you know fatty liver, high blood pressure. So if they recognize that risk early, screening themselves
02:44earlier would really make a change. And then they get to understand their body better. So that's the
02:49whole idea on providing awareness on metabolic health. And you mention diabetes there. From your experience
02:56treating young adults, like what do people most often misunderstand about weight gain and the risk of
03:04developing A, perhaps type 2 diabetes? Yeah. Okay. I think the common misconception is thinking that
03:10they consume a lot of sugar or diabetes only happens in people who appear obese or overweight. Now that's a
03:20misconception because diabetes is an extremely complex condition now since we understand it much more.
03:27It is an interplay of various factors starting from biology which is your genetics and also a strong
03:34correlation of environmental factors. Essentially your lifestyle, the amount of sleep, the sleep quality
03:41that you have, the stresses, the sedentariness, your activity level. So having all that said, I think it's
03:50important to understand that it is not just as simple as eating a lot of sugar or consuming sweetened
03:57beverages alone. It can happen to anyone especially if they have any risk factors. Hence I think getting themselves
04:05identified early would be important. But just to follow up a bit on that if the diabetes runs in the
04:11family right in someone's family it's normal. How should they think about their risk without feeling
04:17that the outcome is inevitable? Yeah. All right. So hopefully among them their family members they get
04:24screened early too. So as soon as they identify that their family members have these conditions at any given age
04:32actually we are advised to get screened. More so if you're overweight or obese. Okay which is a specific BMI
04:39that we follow. We'll talk about the BMI part later because there's also some nuances to it. So internationally
04:47you know the guidelines advice 35 years old onwards but in Malaysia we tend to put the cut-off age
04:54a bit
04:54lesser. 30 years and above we can start screening already for diabetes. So you wouldn't want to just scare yourself
05:00and say okay I think I have diabetes I better go get myself checked. But I think having the awareness
05:04that
05:05I might be you know eventually developing one because my my closest families have them is something
05:11important to know. Okay let's unpack what could be happening inside the body doctor. We hear the term
05:17for example insulin resistance quite often. Could you explain what it is and and how it develops and what it
05:23can mean to someone's long-term health? Yeah. All right. I think there's a lot of information about insulin
05:29resistance now out there on the internet and things are much more simpler as it compared to how it used
05:35to be. Insulin is something like a key we call it where it allows blood sugars to enter cells so
05:44that
05:44cells can utilize the energy in order for them to function. All right and what happens in insulin resistance
05:52is it forms somewhat like a barrier yeah so the insulin is no longer as effective as it should be
05:58and this is driven highly by the fat that's around the organs we call it visceral fat yeah so when
06:05that
06:05is high insulin resistance starts developing and then it slows down the entry of sugar into the cells
06:13hence the body feels constantly tired they don't have enough fuel to function and then eventually
06:18the in the pancreas strains itself by releasing more and more insulin and that's when they start
06:24developing type 2 diabetes. And then one thing that could be anecdotal but my friends you know we
06:30always talk about like weight gain and all that and the familiar advice is to eat less and be more
06:35proactive
06:35or move more per se. Why can sometimes that effort be difficult to turn into a lasting results or even
06:44for
06:45someone who is making a serious effort yeah yeah so I think that concept of eating less and being more
06:52proactive may not be very applicable when we talk about diabetes as a whole of course it's really good
06:59advice but it is not as simple as that because it's frequently looked as as a character flaw or behavior
07:05problem right but as I mentioned earlier there are a lot of factors that that are involved in the
07:12development of diabetes in someone okay given your ethnicity you know where you're from your ancestry
07:17and the type of influences that you're exposed to on a day-to-day basis so predominantly biology is
07:24something that we really look at so if you are you know south asian you know malaysian okay indian descent
07:31yeah you tend to have a higher risk of developing diabetes early right secondly the kind of day-to-day
07:39activities that you're involved in if you're naturally not sedentary at all you're very active
07:45you might spend a chance to delay the onset of diabetes because the way you utilize energy
07:52would be different compared to someone who is rather sedentary so I would say you know comparing
07:56two individuals of the same body size or shape maybe same profile and you know their risk of developing
08:04diabetes may not be the same and then in our culture in our society body shaming is one thing you
08:10know
08:10so doctor how do we encourage people to look after their health but also without making them feel
08:18that their weight is actually some sort of a personal failure to them yeah yeah so this is a continuous
08:24work
08:24in progress now because this is a stigma right so whenever we see someone who's on the bigger size
08:30um we tend to think that they are rather sedentary they're lazy you know they're not they're not
08:36taking care of themselves but little do we understand the changes in metabolic changes in
08:43metabolism that's taking place in their body due to all the factors that I mentioned earlier so
08:47I think what is important is um for people to realize that this is not something to be shameful
08:52of like even for myself I know I stand a chance so I'm open about it I get myself checked
09:00early and I
09:00take the necessary steps that's required so I also share that experience with my patients when I meet
09:06them saying that you know doctors are not immune to diabetes even though we are treating them yeah to
09:12make it a little bit more relatable yeah okay doctor let's talk about this how does this look like outside
09:18the
09:19clinic where people have deadlines you know financial constraints and routines that not necessarily easy
09:24to change and for example for a young adults working out there working long hours doing shifts like for
09:29example myself as well uh where should they start so how can they improve improve their health without
09:37having to overhaul their entire routine yeah yeah I would include myself in that category too actually to be
09:45honest okay okay seated having weird shifts eating erotically long hours yeah so all that so it's very
09:53relatable so what I always tend to do with my patients is first I would sit through with them and
09:59understand their entire routine yeah why is that very important because I need to identify which factor
10:06in their routine is the easiest to tackle first so I can't go on and tell them to you know
10:12change everything at
10:14one go meaning to say you must sleep eight hours hit the gym tomorrow and change your entire kitchen
10:19everything needs to change it's that's just not feasible so what we tend to do is for that specific
10:25individual I would see which is the easiest to tackle so for instance if someone is a shift worker
10:31I try to understand their shift very well and we try to adjust their meal frequencies and you know how
10:38they consume take their meals according to their shifts so we start there first and then it progresses
10:44over time because one change will lead to another positive effect that will then favor the next change
10:50if if you could be a bit more specific doctor if you can help manage this person if they can
10:56manage one
10:56or two changes only in their life for now what would how would they prioritize what would you let them
11:02prioritize like yeah all right so I mean if I were to pick one or two I would start off
11:07with having good
11:08sleep okay yeah and again having good sleep comes from a lot of things that take place during the day
11:15yeah
11:16so from ensuring that your body is physically active I think that is one way to assist with better sleep
11:24I tend to see people my clients who are much more active in their day-to-day activities or those
11:29who actually
11:30exercise they have better sleep quality and when you sleep well you tend to you know favor the hormonal
11:39movements or you know how it changes throughout the day much better because these are all interconnected
11:45yeah so sleep will be something I would really focus on okay and staying active that will be my next
11:53you know next point that I would focus on yeah and then moving on will be assisting them with how
11:59they can
11:59um you know accommodate their meals based on their job their shifts their timing and even their
12:06affordability yeah okay doctor one more topic eating out is very uh familiar to many uh it's part of our
12:14daily life as many Malaysians myself included now how can someone improve their diet while still enjoying
12:21like the familiar food and meals you know that they do day-to-day basis you know because of timing
12:25as well so
12:26they can't really cook they don't really have time for that so how do they you know like improve their
12:32diet while still maintaining that routine of eating out yeah okay so first I would you know first I would
12:38definitely find out a bit more about their eating habits because when we say we we eat out most of
12:46the
12:46time um that would be the most of the days that we are working and the days that we are
12:51at home perhaps
12:52uh there will be someone cooking at home or you know we'll have a potluck or something like that so
12:57looking at the majority of the the kind of meals that they take um I would recommend going with
13:03whatever it is a balanced meal so even if you're eating out for instance if you're going to be having
13:09economic rice or nasi campur things like that um ensuring that your plate is balanced and also
13:16another important point that I put across is that um the kind of carbohydrates that we put on our plate
13:23so of course rice is staple to us right rice and noodles can't run away from that and if you're
13:29eating
13:29out the chances are you're not going to get the very healthy form of rice because that's going to be
13:33costly
13:34so how I go about it is um maybe portioning the rice a little bit lesser I'm saying a little
13:41bit
13:43but but I mean um ensuring that you have you are able to be full with the other lauk and
13:50and and
13:50food that's on your plate so essentially there's going to be tons of vegetables there's going to be
13:55some protein yeah um again um looking at the the choices of their food what do they tend to lean
14:02towards some people they don't eat vegetables at all some people they are vegetarians totally so it's really
14:08uh an art to you know to figure out what would be the best uh combination food and here is
14:16where the
14:17strength of a dietitian also comes in yeah so they they kind of give really practical suggestions for
14:24people from various races or you know financial status and provide them the options where they can do
14:31smart swaps yeah so smart swaps are things like you know swapping certain food which might be high
14:40calorie or high GI glycemic index with something that is lower in glycemic index but you would feel full
14:47as well you know so those kind of things might be very useful yeah interesting you mentioned that you know
14:54some people have different different diet you know for example like some people they don't eat vegetable
14:58like myself i don't even yeah so how how does it work for people like us do we really need
15:04to change
15:04do we really need to eat the greens or do is there something you know some way to work around
15:09like what
15:10would be your advice to me and to audience out there so the nice part about vegetables are they're not
15:15always green yeah okay so you have orange you have red yellow right um so i mean most of the
15:23time i mean you
15:24take pizza right yeah yeah and you have pineapples on your pizza you have capsicums on your pizza you know
15:29that sort of thing so i i would really find out what are the kind of veggies that you would
15:35go to and then i
15:37would suggest preparations or meals that can be made alongside these uh you know choices so that you still
15:45ensure you incorporate the necessary nutrients on your plate so what vegetables provide they provide the source of
15:53fiber they also contain really healthy carbohydrates they contain a lot of vitamins and minerals so you
15:58don't have to really you know do your additional supplements most of the time if you're consuming
16:04something really uh well balanced or whole meal and and often there's the debate out there that
16:12those unhealthy foods are more cheaper or easy to get than those are like healthy foods are more expensive
16:19so how how watch for a person with a budget for a student for example so what should they focus
16:25on
16:25instead and they cannot afford this kind of special meal yeah yeah so the first step i would share with
16:31them is just to go to the mall and learn how to read the ingredient list so normally the the
16:38the the less
16:39healthier ones are the ones at your eye level in the shelves okay so you can grab them easily right
16:46so that's
16:47a that's a psychological trick um so i teach them how to read the ingredient list for them to i
16:52understand if they were to select let's say a pasta choice or a rice option um what would be another
17:00alternative that would taste the same cost about the same but the the amount of starch or carbohydrate or
17:07sugars in it is um significantly lesser yeah so they they need to just be a little bit more aware
17:14on this
17:14uh ingredient content you know the nutrition content and that will help them make certain selection so
17:20they don't really need to change the entire food preference you know like um you know from eating
17:24rice to now i only eat oats i only eat bread or i only eat noodles i stop eating rice
17:30altogether yeah so they
17:32don't need to make that large shift because i tell you why it is not sustainable so something that you
17:37have
17:37been really leaning towards and that's your favorite yeah that makes you happy the comfort food right um
17:45we try to find the healthier version of it okay doctor now we live in an era where it's social
17:52media
17:52is everywhere you know advice people giving advice influencers giving advice about cutting carbohydrates
17:58avoiding sugar so now for people out there how can people judge which advice is actually credible
18:04and suitable for their own needs yeah all right so i would stay away from someone who would say best
18:12this is the best okay this is the only way um that's worst so all these extremes yeah um are
18:22red flags to
18:22me lah in general how i would go about it well first and foremost i would see who is the
18:28one saying it okay
18:29okay maybe do a little bit of uh research on whether is this person registered uh to say it okay
18:36for
18:37example like if they are they claim to be a pharmacist or a nutritionist or even a doctor i would
18:43first
18:43verify if they are registered on their registries now so that's very important because they are selling
18:49through their credibility isn't it okay number two i would say uh what are their claims based on so many
18:57a
18:57times nowadays i see people flashing out a study okay from the you know ever journal and then they
19:03go by saying so this you know this study tells us this is this yeah so the the lay people
19:07out there
19:08may not understand the you know the the complexity of how we analyze a study so there is actually degrees
19:16and tiers of uh credibility of a study so we start off with things like meta-analysis systematic reviews and
19:24then we have randomized control trials cohort studies case control so there is a tier that we follow
19:31in order for us to be sure whether is this really really uh reliable or valid their claims it should
19:38fall on the first two or three tiers of the you know the evidence-based studies we call it evidence
19:45-based
19:45medicine and that would be the second thing i look at and then thirdly of course red flags as i
19:51mentioned
19:52so in their claims if they were to say red flags things that are very extreme most of the time
19:59may not be very reliable because remember we are all of different biology and everything is very much
20:07individualized to us of course there are general concepts that we follow but for an individual to adopt
20:13that specific advice and change entirely for instance going on a complete you know keto diet or intermittent
20:21fasting it may not be safe for that specific individual so i would advise them to see their healthcare
20:28provider and and and you really look at what would be the best method to you know incorporate
20:35yeah and doctor with so much attention on losing weight it's easy for the number on the scale to become
20:44the only result that seems to matter or measure of a success beyond that beyond the weighing scale what
20:50changes should perhaps people look for to understand whether the efforts in improving their own health is
20:57working yeah you know what is really odd um the weight is probably the last thing i look at in
21:04my clinic
21:04now i don't know i mean in my practice now it has just gone the opposite yeah the weight is
21:10the last
21:10thing i look oh you finally lost two kilograms okay so the reason why is that is because we don't
21:16want to
21:17focus on a specific number of course a lot of them um are pinned towards that the weight loss that
21:23they are
21:24looking forward to but what we try to empower them to understand is that how we want your body to
21:32become more efficient we want your body to be able to utilize sugars and energy much better and how will
21:41it
21:41show it starts very subtly very subjectively so they tend to say things like i feel so much more energetic
21:48nowadays i don't feel sleepy after a meal i'm able to sleep well at night i don't wake up in
21:55the middle
21:55of the night anymore to pass urine you know and things like my shirt has gotten looser um i'm able
22:02to
22:02buckle my pants and sit down now without feeling uncomfortable or sucking in my tummy so things that
22:06are so subjective like this right means much more so little we do know that the weight alone um may
22:14not be
22:15very reflective over their journey because when they start building muscles and they lose body fat
22:21their weight may maintain because it's the muscle mass that they are building so some of them come and
22:27ask me doctor i've been doing all these exercises and going through all this but my weight is still 56
22:31you know i'm not i'm not down to 54 yet why so then when we do a body composition analysis
22:36is where we
22:37understand that they have built their skeletal mass and they have lost their body fat percentage and that's
22:43why nowadays when we do a screening right i think many of you all would have noticed everywhere the
22:48in body machine you know people are buying it off from shoppy as well or the simple scales where they
22:54look at your certain other parameters too and that's really important and when we look at overall metabolic
23:00health per se yeah okay doctor you lead the take charge program which brings together medical care
23:08nutrition advice and exercise coaching tell us a little bit more about the program uh and also using
23:13a typical youth or young working adults as an example how would that support work in practice yeah i'm
23:22actually very grateful to have the participation of a wonderful team so take charge is an initiative where
23:28we have a group of practitioners we have dietitians exercise coaches as well as an amazing
23:36uh information portal to supplement all these uh you know advisors that we provide our clients so when
23:44they come in the first step is getting to know them really well so we do a very thorough metabolic
23:50assessment um getting to know their history of course their symptoms and doing the body composition
23:57analysis and also looking into certain um socio-economic uh you know sides of things you know the
24:04affordability their routines their work occupation and any limitations that they are facing and once
24:12the assessment is done we sit together so the the interesting thing about take charge is it's a little
24:16bit different from how traditionally um these kind of treatment uh you know take place whereby they will then
24:23have to go independently to the dietitian then they have to go and find someone to coach them
24:29physiotherapy etc but in take charge we bring all of them to the patient and so all of us sit
24:36together
24:36and we come up with a unified plan that works for the client and this is something that goes on
24:44for
24:44weeks so typically the program is about eight weeks however it never really stops at eight weeks because
24:51the whole aim of this program is uh not to chase a specific uh kpi it's to empower them to
24:59be able to
25:00independently manage their own health condition here on um so in the initial periods what happens is that
25:08with the assistance of medications as well as intense exercise coaching dietary planning
25:15um and also behavioral change uh they are able to now create a new somewhat routine that they can stick
25:23to and that's the transformation that we are planning for you know those who um determined to go through
25:30this journey so first of all you must need to want to do it you know then only you can
25:34start the change
25:35so most of the time when they come in they're already in in a really determined position like that they
25:40want to
25:41change but they just need the right guidance and support yeah okay doctor before we finish what would
25:47you say to a young person watching this episode uh that feels overwhelmed by all the advice and maybe
25:53they have previous attempts that have failed what is perhaps the first realistic step for them to take
25:59to take a better care of their health all right so i always tell myself and others that this is
26:06a journey
26:06so there's there's no way that you know once we have achieved something it's going to be permanent
26:12it's always constantly going to be work in progress and as our body ages um the challenges might be a
26:19little bit different so you might need to put in some additional work later maybe lesser work in the
26:25beginning so it really depends on how the journey is most importantly is not to consider weight regain or weight
26:32plateau or if you feel like you know nothing's really working as a failure yeah these kind of
26:38things are really common but what is important is to be equipped with the right information and tools
26:45and skills to tackle the problem at hand so when that happens during a specific phase in your life
26:52you know that you got it you know what to do you know because in our life you will be
26:57facing a lot of
26:58stresses a lot of events like maybe a family's demise maybe you might be grieving over certain losses so
27:06during these periods you might go out of routine but if you are able to you know take charge basically
27:13that's the whole idea yeah um then you got this so you won't consider yourself as a failure or your
27:19attempts as a failure in fact you'll be much more optimistic to know that this will work again
27:23um thank you so much for sharing your insights and perspective with us today now looking after
27:28your health can raise plenty of questions about your body your habits and advice that you hear
27:33you deserve the chance to ask those questions and understand the options and find what supports
27:38with you now before i go this is my final episode as your host of it's about youth
27:42to the team to every guest who shared their time and perspective i thank you all
27:46very much and have a good evening goodbye