OH2016 Session: Dr. Sameer Murali – Weight Regain: Mind & Body
February 23, 2017Check Out Dr. Murali's Session, Weight Regain: Mind & Body
[Chatter and applause in the Audience]
There's a campaign; I had no idea.
[Dr. Murali & the Audience Laugh]
In the spirit of campaigning, I'm not here to get anything from you so you can relax.
The majority of my practice is seeing patients before and after bariatric surgery at Kaiser Fontana. I'd say it is about 80% of my practice, and then maybe about 20% is helping people to lose weight through other means outside of surgery. I don't do surgeries.
Obviously today, I'm going to be talking about weight regain, but I want to tell you a little bit about myself and who I am other than my professional credentials.
I find it important to share especially with my patients that I've struggled with my own weight since I was a child. I've done Weight Watchers, been to Overeaters Anonymous meetings, I've had dietitians at some point, I've had personal trainers at some point, and I'm pre-diabetic. I have severe sleep apnea and use my machine every night.
So why do I say that at the top of my talk? I think it is important because I think those of us that struggle with weight, are very used to judging ourselves and also being judged. I think its very helpful for us, in order to have a conversation, to start out with what we share.
I can't say that I understand every single person's weight struggle, but I do know what it's like to struggle with weight. And, I don't really think that struggle ever ends. Lots of times, people ask me "Dr. Murali, what did you do to lose all the weight?" I'm perplexed by that question because it is almost a like happily ever after type of question. [Audio muffled.]
It is very common where, if you, for example, not to say anything negative about the vendors, I haven't even looked at the vendors, but often times you see booths at conferences like these, or you see advertisements where you see these before and after pictures.
The things about before and after pictures, they don't tell the after-after story. It just tells you a very short snapshot in time what happened with that person, but there's always an after. I'm perplexed by that question because I'm like, I'm not dead. My weight loss story hasn't ended, I don't know what tomorrow is going to bring and that brings me to this topic. Because this topic is an important one because clearly lots of people are in here that are interested in it.
This topic is titled about "Weight Regain: Mind and Body" but it really is about weight maintenance. Because the struggle with weight regain is really one of maintaining weight loss. So, I think there are two different ways to think about it. I'm not just going to show you one slide for the whole talk.
[Dr. Murali & the Audience Laugh]
Those that know me, know I tend to ramble on so, I'm going to stop doing that.
[Dr. Murali & the Audience Laugh]
That's what they're here for...they are being my referees.
So, what's the problem, we're talking about weight regain, what's the problem? The problem is, and I'm going to show you several different ways of weight loss.
One is the old-fashioned way. The old fashioned way is behavioral, diet and exercise, that whole thing, right? So, what are the stats in terms of weight regain when we're talking about just behavioral weight loss?
People that lose about 10% of their weight, so let's say, start at 250 pounds and lose 25 pounds. 80% of those people that lose about 10% of their weight will regain all of it within one year. Those are the stats. This is about people that actually achieve the weight loss, 10% weight loss, and we know that's not always easy to come by. Nobody just drives-thru and gets 10% weight loss, that's really significant. But the people who achieve and made all the significant changes, behaviorally or what have you, within a year, 80% of them regain their weight back.
Then we have either something that really isn't old-fashioned, but kind of old-fashioned, on steroids was The Biggest Loser competition.
[Dr. Murali & the Audience Laugh]
Did anybody see there's a study recently published on the winners of The Biggest Loser competitions? Over 16 seasons, they actually looked at their weights six years later, and 70% of the weight that these 16 winners had lost, 70% of the weight loss was regained over a six-year period. So, these are people that got a tremendous amount of support and a tremendous amount of resources for their weight loss journey and got a lot of encouragement, they were on tv, they won something, but despite all that investment, there is a 70% weight regain and that translated to about an average of 90 pounds or 41 kilos for each one of these individuals. A 90 pound weight regain.
So, these are people that got a tremendous amount of support and a tremendous amount of resources for their weight loss journey and got a lot of encouragement, they were on tv, they won something, but despite all that investment, there is a 70% weight regain and that translated to about an average of 90 pounds or 41 kilos for each one of these individuals. A 90-pound weight regain.
Then, of course, we have bariatric surgery, which is something I deal with a lot. Something that I feel is kind of unfortunate, is a lot of times when patients get operated on, nobody really gives them a realistic picture of what weight loss looks like after bariatric surgery and what is the expected weight regain there actually is.
I think that is problematic because if you don't have an idea about what an average result might be, and you somehow have this idea that might be slightly, I would say dream-like, and you fall short of that, then you feel like you're a failure, and that actually emotionally impacts your outcome.
The average weight loss here, so the peak weight loss doesn't matter if it's for the Band or Sleeve, sorry, Bypass or Sleeve, we really don't do very much in terms of Bands with Kaiser. At 18 months, the average weight loss is anywhere between 30% to 25%, not excess weight loss but 30% to 25%, of what your initial weight was.
Over a five-year period, people will regain about 20% to 25% of that peak weight loss. Does that make sense? So, if you're about 250 pounds, let's say when you started out and you had surgery, that might be about a 15 to 20-pound weight regain from 1-1/2 years out to five years out. That's actually what we would expect, some degree of weight regain over a five year period from when someone is 1-1/2 years out from surgery to five years out.
In all of these scenarios, there's some phenomenon of weight regain, right? And so one of the questions might be, why does that happen? Why does weight regain actually happen? There are so many theories about this.
There are theories about your gut hormones, Ghrelin, and Leptin. There are theories about your metabolism and how your metabolism slows down as a result of weight loss because when people lose weight, they also lose muscle and bone mass, and so that all impacts your, energy expenditure and metabolic burn rate.
There are theories about the psychology of weight regain and what happens when, for example, some kind of stressful life events might occur or when somebody gets depressed and how that might interfere with a person's weight. And then there are also the issues with behaviors, of course. And challenges sticking with behaviors. So, all of these might play a role but ultimately what is the solution? How to solve this problem of weight regain, right?
[Dr. Murali & Audience call out potential solutions]
Yell a couple of things out. "Exercise. Go back to basics in terms of nutrition or eating."
[Dr. Murali] Anyone else?
And so what's the solution? The solution usually ends up being something like this "we're going to go back to basics, eat right, exercise, we're going to do all this stuff, drink water."
The question is, we already know what to do. The answer is basically reflected in this picture [pointing to the slide above]. What are we talking about? What's the big deal? Why is this room full of people interested in what I have to say about weight regain.
Because this is our ultimate experience. Right?
[Dr. Murali & Audience chatter]
So, we know this is not some kind of voodoo knowledge or something you have to climb up some mountain and this guy with a long beard says, "Yes, eat the fruit of whatever Dr. Oz berry." I'm not a big fan of Dr. Oz.
[Dr. Murali & the Audience Laugh]
So, it's not as though we necessarily don't know. But there is this kind of perceived gap between Knowing and Doing. Right? When some of my patients come to see me "Dr. Murali, I know what it is I need to do. I'm just not able to do it." And the size of this gap is our perceived sense of failure, in judgment. All that negative self-talk is really what we're talking about for this gap. So, this is the answer to this talk.
I'm not going to pass along some kind of brain knowledge to you that is going to make a miracle out of the resulting weight regain. Many of you are here because you're having trouble with actually implementing what you already know. Really the question is, what is in the middle here? What is in this gap? What can bridge this? [Referring to the slide above]
And that's the thing that we, in the medical field, are so poor at making you realize. I feel like this idea is what makes my life a unique preparation for my job. Because ultimately, the gap between Knowing and Doing can very easily be bridged.
Disneyland is a stone's throw away from here. And any of you that have children, if any of us told our kids, "Hey Johnny, (inaudible)." "Well, mom, dad, I don't really feel like it." But if you said, "Johnny, I just tripped over $1,000, let's go to Disneyland." Whatever Johnny has going on, if it's meeting his friends to talk about how terrible we are as parents, or you know, doing something on the Internet, texting whoever, that is a very odd thing. You'll see teenagers now days in malls, and they're sitting together but texting each other. I don't understand it. You're right there.
[Dr. Murali & the Audience Laugh]
But, if you offered that to this kid, what do you think he'd do? Do you think he'd drop his phone and pop up and say "Yea, let's go?" More times than not, yes. Why? Because he feels like doing it. Right? So, what are the keys to unlocking this? What is the mystery of that?
I don't know but its the end of my talk.
[Dr. Murali & the Audience Laugh]
Three slides, yea.. schedule an appointment, everyone has my number.
[Dr. Murali & the Audience Laugh]
Yea....no.
So, that's mainly what we're going to talk about. What's the time? So, we have half an hour to get into it. [Not audible]
There are some poor types of very basic things that I think about. If you were to come see me, these would be the things I'd evaluate. Why do I evaluate them? Because they each speak to this gap.
The most important factor when it comes to bridging this gap and if you're my patient, don't say anything. Alright? Those of you that have not heard my Ted talk or whatever, I want those people only to think about this because otherwise, everyone knows the answer.
So what do you guys think would be the number one factor in bridging the gap between Knowing and Doing?
[Comments from Audience] Planning, motivation, discipline, support (that's a good one), education, accountability.
[Dr. Murali] A very common topic would be motivation. Motivation and feeling are kind of the same thing. What I'm thinking of is a concrete thing you can walk out of here and do....motivation, discipline, inspiration, planning, realistic goals?
It's sleep! Get some rest. This gentleman said it. That's the first time that has ever happened in the history of this talk which has been only like 20 minutes.
[Dr. Murali & the Audience Laugh]
It's sleep. Sleep is the most fundamental, foundational, health behavior that you can engage in. Think about those causes of weight regain that we just mentioned. The gut hormones, Ghrelin, Leptin, the idea about your metabolism, the idea about your psychological health. Sleep touches on every single one of those things.
Believe it or not, people that are sleep-deprived have bigger appetites. Their Leptin and Grehlin levels are impacted by inadequate sleep as it turns out. Whoa, that's impressive.
What about your metabolism? There's a little bit of controversy, not really controversy, but people who are awake longer tend to burn more calories because they are awake longer, but in terms of what their food preferences are when you don't sleep, you crave carbs, you crave starches, you crave sweets.
In a former life when I was a resident training to be a physician, I really wanted to be an ICU doctor because I thought that would be a cool, sexy thing. [Dr. Murali & the Audience Laugh] You're up there, you're surrounded by people crashing and burning, you're saving the day, people will carry you around on their shoulders. In the morning, that part never happens.
[Dr. Murali & the Audience Laugh]
One thing that did happen was I used to trade my outpatient clinic months for these inpatient ICU months. And so when you're on call, the call schedule for those months was every third night you're on call. Every third night, you're up for 36 hours straight or more. And, you better believe I experienced an issue with sleep deprivation because what do you think the post-call team, the team that comes to relieves you brings you in the morning?
[Audience calls out items] Donuts! Yes! Right! Oh my goodness!
[Dr. Murali & the Audience Laugh] I became a donut connoisseur, a donut fiend. I used to troll the other call rooms looking for donuts.
[Dr. Murali & the Audience Laugh]
It is absolutely true, I gained about 30 to 40 pounds doing that. So, sleep will impact your food preferences, sleep will impact those hormones that we've talked about, sleep will also impact your psychology, people who are sleep-deprived have a 500% increased risk of depression.
If you're tired, do you think you're going to be hitting the gym? Do you think after I ate those donuts, do you think I wanted to go to the gym? No! You're not going to go to the gym. You're not going to cook a healthy meal. You're dog-tired. Do you want to go to the grocery store for all these fresh ingredients, watch a YouTube video, try to get everything, assemble all of it, cook it, do all the dishes afterward? Are you going to do that? No! You're going to do something convenient and fast. Drive-through. This concept actually impacts, touches every single health behavior that would impact your weight.
Another little anecdote. If one of us in here, not going to say who because I don't know yet, but if one of us in here were accused of being a terrorist, it's okay for me to say that because I'm a brown man, post-9/11 America. I've done my fair share of random screenings at the airport.
[Dr. Murali & the Audience Laugh]
But if one of us were pegged to be a terrorist, what do you think the CIA does before they ask you one question. Sleep-deprivation. There's no water-boarding, they don't have to do any of that stuff. Political candidates get very excited about these things and, I'm not going to say who, but you don't have to pull peoples' fingernails out or waterboarding or anything. What they do is make you stand in weird positions, blast very annoying music at you, probably "Let It Go" from Frozen. There's something in that song that is addictive.
[Dr. Murali & the Audience Laugh]
They'll keep you up for hours, days even, two or three days. Before they ask you a single question, then they sit you down, and this guy is just totally strung out, tired and guess what, that's the best time to ask this guy, "Hey, what are you up to? Who are your buddies? Did you do this by yourself?" That's what they do. The CIA knows it, so you should know it too.
Sleep is really important when it comes to managing our health behaviors. Because you're not going to feel like doing a whole lot if you're tired. What are we talking about when we're talking about sleep? We're talking about quantity and quality of sleep. All too often, people are laser-focused on quantity.
[Dr. Murali using a different voice as another person] "I got six hours of sleep and thought that was pretty good."
It's not just how much sleep you're getting but what is the quality of that sleep? I told you that I have sleep apnea. I diagnosed myself because I was tired. Some of my patients in here might be able to tell you, until about four months ago, my eyes were burning, I was yawning in the office, it was kind of embarrassing. Now, I'm using my sleep apnea machine so that's good. You can get plenty of hours of sleep but if the quality is poor and that would impact this as well. Quality and quantity.
These are probably the three most important factors to evaluate if you're not getting good sleep.
- Environment: If you're working nights, for example, and you have to sleep during the day, your room should be completely dark, use black-out curtains. I even have a black-out curtain on the front of our door. The door that enters the bedroom so on the outside of that door, I have black-out curtains so there's no light that comes in front of the door.
- Pre-Sleep Routine: You should have a good pre-sleep routine. Often times this might mean taking a bath and raising your body temperature, as your body cools, it releases more Melatonin out of your brain. That's a quick and easy kind of thing. Also, something we're all pretty guilty of is looking at screens before going to bed. Each of our screens emits a blue wave length of light that reduces the amount of Melatonin that is increasing in your brain so the Melatonin surges right before you're supposed to go to sleep. It's like surfing so you want to ride that wave into initiating sleep. One of the things that will trump that is the blue wave length. Does anyone know why it is blue and it is the color that does that? The way the sun rises, the way the atmosphere refracts the sun's light in the morning is a predominantly blue wave length. As the sun is setting, the sunset is setting is a red wave length as the atmosphere warms over the course of the day.
- Timing: Especially the people that work nights are very much guilty of this. They'll work their whatever work shift, and then when they're off, on their days off, they'll switch their sleep hours to match their family, be up with the kids, and switch back. Having the proper timing here, because as I said, the Melatonin surge and you want to ride that wave into bedtime. If your sleep hours are all over the place, your brain isn't going to be releasing that Melatonin in a predictable way.
All of these factors are what we call sleep hygiene. If you want to learn more about it and want to have a search term, search for sleep hygiene to get what you're looking for. The National Sleep Foundation has a lot of good articles for improving your sleep.
The second most important factor, if you've been previously initiated into this Jedi knowledge, stay silent.
[Dr. Murali & the Audience Laugh]
Sleep is number one so what do you guys think is the second factor?
[Audience calls out] Food and water.
[Dr. Murali] Very important, but no, it isn't food and water.
Anybody else?
[Audience member suggests] Exercise?
[Dr. Murali] No.
Yes, Support [repeated by Audience]. Support is very important.
Support is:
- Shared goals and challenges
- Sincerity
- Mutual trust and respect
Yes, support, it's very important. What's the topic of this talk? Bridging the gap. Bridging the gap. Food, water, and exercise are already on the Doing side. Sleep is very important, support is very important and your team. Losing weight and keeping it off, it should be said is a team sport.
Meaning, that if you try to play football, basketball, baseball, softball, soccer and your team doesn't show, are you winning or losing that day? You're losing. You may have a really winning attitude, you may be very motivated and disciplined, you may be highly skilled, you may have all the important elements required to win that day, but if your teammates don't show up, you've lost before the umpire says "Play Ball" or whatever they say, they aren't going to say anything of that. It's a loss. Why? The very essence of the game is that a group of people are required for you to win, for you to be successful.
Now, weight loss is very much that kind of game. Why? First of all, most of us who struggle with weight, this is like kryptonite to us [pointing to the slide]. Because what is the big fantasy? The big fantasy is "You know what, I'm going to do this magical thing and going to lose all my weight, it'll go away, do it by myself, in a corner, by myself, a secluded island of a place where nobody can see me." Hush, hush, top secret. Then, there's going to be this big reveal. I'm going to walk out and say "Hey, what's up" [Dr. Murali has his hands in the air]. I did it! Just to show you that I could do that. I'm awesome.
[Dr. Murali & the Audience Laugh]
How do we know this fantasy exists? There are t.v. shows dedicated to this fantasy.
[Dr. Murali trying to think of the name with the Audience contribution, The Biggest Loser?]
[Dr. Murali - Not The Biggest Loser]
[Audience - Extreme Makeover?]
[Dr. Murali - Extreme Makeover]
Extreme Makeover, because that's what they do. They find this person with the story, blah blah blah, and they bring him over here and show him to these people to help him out. Then, there's this cocktail party at the end, with a curtain, and they come out, and everyone is raising their glass saying "Yay" - America, Home of the Brave and the Thin.
[Dr. Murali & the Audience Laugh]
What is this? Who would watch it? We watch it, and they know we're going to watch it, because that's what we want. We want that experience. Why? Because being overweight is a visual thing. People can see it. It isn't like we're heroin addicts or alcoholics, we can hide that.
I had a patient, this is an interesting story, I don't know if I should tell it but I will.
She worked in the entertainment business, she had to be around people a lot, lets put it that way. She didn't want people to know she was an alcoholic and smell the alcohol on her breath. I don't want to give people any ideas here.
[Dr. Murali] Let's skip that story.
[Audience comments]
[Dr. Murali] You have to promise not to ever do this, it isn't a good thing. Very, very, very bad. I want it stricken from the record [Dr. Murali points at the camera]. She would soak tampons in alcohol. That's how hardcore she was. Yea, I know. See, now you wish you didn't know.
[Dr. Murali & the Audience Laugh]
But, that's the end of the story. The point is that people with other behavioral issues, they can find ways to mask it. They can find ways so it's not obvious that they are struggling with whatever their issue is. But, when you're struggling with your weight, everybody can see it.
As a kid, I was usually in the top three of heaviness in all my classes. What did that mean? That meant I wasn't really picked for athletics stuff so to this day, I could care less about sports, I don't know very much about them. My wife loves them.
That's no homecoming dances, Sadie Hawkins, whatever this, whatever that. Many of you might have experienced this. Your own friends may have nicknames about your weight and those types of things. Whether or not you lose weight, those things stick with you. Struggling with weight is a visual thing, and we're sensitized to our presence, maybe not everyone, but it is our physical presence often.
It's natural that people would shy away from interacting with other people around this issue. It's natural that we would want to feel like "You know what, this is something I feel very vulnerable about. I'm confident about other aspects of my life, but this is something I'm vulnerable about. I don't want people to know how much I'm struggling."
Many times about 20-30% of patients who get bariatric surgery, some of you may have heard about this, have struggled with some kind of abuse. Either raped or molested as children. Unfortunately, it is very common in the bariatric population. If that's happened to you, are you going to be very trusting and wanting to partner with people? Wanting to trust other people? Probably not.
That's not going to be you, but I will say this is extremely important when it comes to maintaining weight loss and avoiding weight regain. If you have regained, to get back on track, guess where motivation and inspiration and all this other stuff comes from? Where do you think it comes from? It's a feeling, is it not? Right? What are the things that probably influence our feelings the most? People. Probably the screen on your phone, on 90% of your phones, has your kid, sister, mom or some relationship that is important to us.
[Dr. Murali & the Audience Laugh]
Because relationships drive us, relationships impact our lives in ways that are very foundational and very fundamental. What are we looking for in a good team? We look for people that share our goals and challenges.
Because if my goal is to lose "X" number of pounds, and I'm like "I need to get on a team. And the U.S. Water Polo Team lives down the street? Should I hang out with them? Are they going to be very helpful for my weight loss journey?
No, they can't relate to what I'm trying to do. They have completely different goals and challenges. They're playing in a different league altogether. We're trying to play Little League ball, and we're hanging out with Pro Ballplayers, that's not going to work. We're going to feel this big (making a small space between his thumb and index fingers). Right? It isn't going to be a great thing for our motivation.
Second, would be sincerity. If you're on a team and you guys want to win games and everything else, then the sincerity of the people on your team, whether or not they show up to practice, whether or not they're at your side when you're having a tough time. That's really important.
Having mutual trust and respect. If you have very sincere people who have the same goals and challenges around you but you hate these people, they are lying, egotistical maniacs. This is not going to work very well for you.
This is something I often see, especially post-op bariatric patients, one of the things I'll ask "Have you been going to support group?" Someone will say "I've tried it a couple of times, but the people there are always crying, people have problems, I come out and feel depressed." Well, guess what, that probably means one of these three items were not resonating with you. That doesn't necessarily mean you throw away the concept of support.
If you go shoe shopping and you try on shoes that are two sizes too small, you're going to walk out of there saying "Shoes, I don't get this concept. I'm off of shoes. All you shoe people, no. I can't go there with you.
[Dr. Murali & the Audience Laugh]
[Dr. Murali] You can't do that. That's ridiculous.
Just because that particular group, on that particular day, didn't make you feel....the clouds didn't open [Dr. Murali outstretched his arms], a wonderful shining moment, that's doesn't necessary mean the entire concept is invalid, you're throwing the baby out with the bath water. Don't do that.
It's a Team.
Now, what do you think this is? I'll be very impressed if someone knows what this is.
[Audience laughing & making suggestions]
What is this? This is Philadelphia. Anyone from Philadelphia? You can recognize it. [Audience chatter]
This map is a map of recidivism of criminals in the City of Philadelphia. In the City of Philadelphia, Metro area. Why do I show this map? Because this was a study that was trying to figure out what are the factors that can predict whether or not if somebody' going to go back to jail.
They looked at what kind of crime they did, they looked at how old they were, they looked at their race, if they're married, they looked at if it was some kind of drug-involved issue, they looked at several factors. 160% of the time, the factor that was most significant in all of those factors, that predicted 160% of the time whether you'd go back to jail was where you came from, where you lived. For the blue people, the recidivism was very low, for red folks was very high.
Where you live, nothing about your gut hormones, metabolism, you're depressed or whatever. All that stuff - no. Where you live. Guess what folks, where you live, your zip code, in the United States of America predict how long you'll live, how much education you'll have, how much money you'll make, whether or not you're going to get diabetes, very significant predictor of your life.
This is the one factor that you can tell it really gets my goat. This is the one factor that we, in the medical community, choose to ignore. After five minutes, great, damn [Dr. Murali laughing]....sorry. The idea that obesity is a disease and there are all these biological factors and all this sort of stuff. What leads us to medications, surgeries and things like that which will help but if this is the primary issue that is going to really, really matter, the question is what are we doing about it?
I've got one more story. I have lots more slides, but I have to stop.
If you broke your leg, and it's pretty severe, what do you think your first priority is after you break your leg?
[Audience offering answer but not audible, Dr. Morali repeats the answers he hears]
"How am I going to get around?"
"Don't put weight on it."
"Get it fixed."
Has anyone broken a limb? [Audience have a few hands raised] What's the first thing you experience? Pain! That thing hurts. It's extremely painful. Not a pleasant thing. Before you get on Angie's List trying to find the best orthopedic surgeon if somehow you broke your leg in front of an orthopedic surgeon. That guy's like "You know what, we could set this thing right up. I got this wooden block here, just bite on this thing and we'll fix you up right." Would you go for that?
[Audience says "No"]
Pain relief is your priority when you break your leg. Before getting it fixed, before doing anything else, pain relief. All the options that we have, all the options vendors have out there that will be showing you, and everything you'll experience, surgeries, medications, programs, all of those things, guess what they are. They're pain relief. If the doctor gives me that shot of morphine, are you fixed? Are you going to run out of there? No. Everything that we can offer you, the medical establishment, when it comes to managing your weight is giving you space to fix what is broken. Very important point.
What's broken? What is that thing? [Brief period of muted sound of Dr. Murali]
Because that is the one factor that was necessary for you to gain weight and regain after you lost weight. If you moved to some third world country in some impoverished place, would you have a weight regain problem? No.
Where you live is extremely vital to answering that point. So, when you get bariatric surgery, when you go through some program, when you do whatever it is that you're going to do to lose weight, know that the program, that surgery, that medication is only giving you space to manage your environment.
What environment is most important? The environment of our relationships, who we're hanging out with, [two minutes? Thank you] who we're hanging out with is the most vital thing other than sleep.
Because that is the thing that is going to help us repair what is broken. Really, what is broken, I'll tell you what's happening under the hood here, I think about it all the time, what is really broken is our relationship with ourselves. You know why? Because when we gain weight, the reason for weight regain, the reason why we gain is because we stopped investing time in ourselves. Everything that is important, all that doing stuff is all very time-consuming. The moment we stop investing time in ourselves is the moment we're going to start regaining weight.
Guess what time is, folks? Time is the currency of relationships. If you don't have time for your mom, your dad, your husband, your wife or your kids, what's going to happen to that relationship? When we stop having time for ourselves, that's when our relationship begins to crumble. It begins to break (sound low), and we start searching for things to make us feel better. So remember these two factors, sleep, and routine? (Sound low) Those are the most important elements to bridging that gap.
[Audience clapping]
[Dr. Murali] Can I take one question? So, one question.
[Audience member asking a question but not audible]
So the question is when it comes to a team, would I advocate for a 12-Step Program. What I would say is, it depends. I wouldn't say absolutely yes because if you have all three of these elements, what you do, it doesn't matter. Whether it is a 12-Step program, Weight Watchers meeting, support group for bariatric surgery or an exercising group. What matters is these three elements [pointing to Team slide]. You can say, if you can check off every one of these things when you're thinking about your team roster, then you found the right environment for you.
I'll hang around up here if anyone wants to ask questions.
[Referring to another slide, asked from an audience member] What's the four?
[Dr. Murali] Exercise and eating right. The idea there is each one of these builds on each of the others like a pyramid. Sleep would be the foundation, your team would be the next layer, exercise the next layer and then what you're eating would be the last. Why? Because each one of these builds on the other making it more possible
[Audience question but not audible]
[Dr. Murali] Sugar-free beverages. Sugar-sweetened beverages. Drinking sugar is a fast way to gaining weight.
[Audience question but not audible]
[Dr. Murali] Sleep? It's variable. It can vary anywhere between from 4 to 10 hours in terms of sleep. How much sleep does someone need? The average adult needs anywhere from 7 to 8 hours but if you listen to a previous speaker who was here around four years ago, Dr. Ara Sharma, who is one of my mentors. I consider him a mentor. He doesn't know he's mentoring me.
[Dr. Murali & the Audience Laugh]
He'll say that if you need an alarm clock to wake up or if you need caffeine or some stimulant to stay awake, you're not getting enough sleep.
They're giving me the hook, so thank you, everybody.
(Transcript lightly edited for ease of reading.)
