Ted Kyle's Insider Strategies to Unlock Better Healthcare

Jim Hill: Welcome to “Weight Loss And…”, where we delve into the world of weight loss. I'm Jim Hill.

Holly Wyatt: And I'm Holly Wyatt. We're both dedicated to helping you lose weight, keep it off, and live your best life while you're doing it.

Jim Hill: Indeed, we now realize successful weight loss combines the science and art of medicine, knowing what to do and why you will do it.

Holly Wyatt: Yes, the “And” allows us to talk about all the other stuff that makes your journey so much bigger, better, and exciting.

Jim Hill: Ready for the “And” factor?

Holly Wyatt: Let's dive in.

Jim Hill: Here we go. Welcome to another episode of Weight Loss and I'm Jim Hill with Holly Wyatt. Holly, I'm really excited about today's podcast.

We're going to talk about how our healthcare system supports or maybe fails to support people with obesity. To do that, we have a guest, Dr. Ted Kyle. I'm in the Ted Kyle Admiration Fan Club and Ted, I think you can confirm that I constantly send you emails congratulating you on something you post.

Ted's involved in many different projects. In the obesity research community, he's well known as the author of Conscien Health (that's [conscienhealth.org](http://conscienhealth.org/)) and he posts really cool information about research, about what's going on in the weight loss community. He really tackles so many timely issues about weight and health. Ted was also instrumental in starting and leading the Obesity Action Coalition. Ted more than anyone I know is in touch with people out there managing their weight. The problem for me has been just deciding on one issue to focus on. So welcome to Weight Loss And, Ted.

Ted Kyle: I'm just really grateful to be here and appreciate your kind words and for the chance to chat with you and Holly.

Jim Hill: So Ted, you and I have known each other for a while. Before we get started, give our listeners a very, a Cliff Notes version of how you got where you are.

Ted Kyle: Sure. Well, I am a pharmacist and I started my career working for a pharmaceutical company called Burroughs Wellcome, which was owned by the Wellcome Foundation. I spent years doing market research, doing new product development. I moved over in 1995 to Smith Klein Beecham Consumer Healthcare and while I was there, worked on tobacco control issues, helping people quit smoking, and then moved into working on applying some of those insights about consumer behavior to weight management. And that led to the switch of oral stat from prescription to non-prescription status.

And that's when I got to know Holly and Jim. Then in 2008, I left GlaxoSmithKline and got the chance to pursue just whatever I wanted to do at that point. And that was when I formed Conscient Health and connected with thought leaders in obesity, but more importantly, connected with Joe Nadglowski and the really dedicated folks who had started the Obesity Action Coalition.

I joined the board of directors and chaired the board for a few years and spent a dozen years on that board of directors. And it brought me to the realization that really focus on elevating, educating, and advocating for people living with obesity was the key to making better progress.

Jim Hill: Well, I really want to put in a plug for the Obesity Action Coalition. I've had the opportunity to speak to that group. And if you're interested, you can go out on the internet and look at Obesity Action Coalition, but it's a fabulous group. So Ted, before we start, tell people what we mean when we say the health care system. I hear that term all the time. What does that mean?

Ted Kyle: Well, good question. To me, it's every part of the professions ranging from businesses to health care professionals that serve the needs of people seeking better health. And some parts of that system are more functional than others. One of the very difficult things about that in the US is how we finance it and how people get access to care. And, you know, sometimes it's more about the money than it is about health. And that comes into play a lot when you're talking about health plans and health insurance. It becomes very convoluted. And I'm sure you guys could cite chapter and verse on what you've observed.

Jim Hill: So it's doctors, it's hospital, it's insurers, it's all that.

Ted Kyle: Yeah, it's pharmacists, it's dieticians, it's physical therapists, it is exercise physiologists, it is health coaches. And the quality of what you get from that system can vary all over the place.

Holly Wyatt: Yeah. So I'm ready, Jim. Are you ready? I have a long list of questions. I think that was, can I go first? All right. We fight over who gets to ask the first question, Ted. So I get to ask the first one.

So I wanted to start by asking how people with obesity currently interact or maybe fail to interact with the health care system. What's out there through your lens?

Ted Kyle: Well, broadly speaking, a lot of people living with obesity in here, I'm thinking about people living with significant, really high burdens from obesity, simply avoid the system because we have decades during which we have approached obesity by thinking, boy, these people have really screwed up and we need to give them a little religion about how to eat right and move more. And as a result, when they interact with health care providers, often any symptom that they have is ascribed to their obesity, whether or not it's directly related.

Any visit opens you up to a lecture about how to eat right and live an active life. And oftentimes these folks have spent their entire life thinking about this. But too many providers, and I'm not saying all providers by any means, people are getting much, much better about this. But too many providers, even today, start with the presumption these people don't know what to do, otherwise they wouldn't have all this excess weight. And it's just not true.

Jim Hill: It doesn't love a good lecture about what you should be doing with your life.

Ted Kyle: Right. And no, doc, I'm having this symptom that I need your help with and you don't need to tell me that I'm having obesity pain. You need to help me with the source of my pain.

Holly Wyatt: Yeah, I agree that. And I think when I see that, I can see people coming in to talk to me and they're defensive. And I understand why, you know? So they come into a situation because of that past history. And when they sit down to talk about it, they already have the walls up. So it really hinders the conversation that could happen because of that interaction in the past.

And it totally makes sense why they feel that way. But hopefully we can start to move through that because it really is a barrier out there to a good relationship with the health care system.

Jim Hill: So a lot of people are missing out on important care they could get because of this. And you totally understand. I mean, the first thing you do when you go in doctor's office is they weigh you. So right away, you start focusing on weight. So I can totally see how this is not something a lot of people look forward to.

Ted Kyle: Absolutely right. And that experience for many people started way back in elementary school when the whole class was lined up to be weighed. And a friend of mine who is a nursing professional who, you know, won the genetic lottery and has lived with obesity since an early age will still tell you about, you know, that experience of being weighed and having the smart alec boy in the class hold up her hand after she got on the scale and introducing her as the heavyweight champion of the class.

Holly Wyatt: I have struggled with weight my whole life. And I can remember just being terrified, terrified of standing in line and one right after the other and weighing in and someone seeing or someone saying something.

It was a really bad experience. And you start out with that and then it makes sense. Here you come and you get on the scale in the doctor's office and you almost have flashbacks to that.

Ted Kyle: And for a decade or more, it became fashionable to weigh kids at school and send letters home to children's parents to inform them that their child was heavy. As if, you know, those children's peers had not already done them the courtesy of telling them that. Yeah.

Holly Wyatt: I mean, I think the intention was good. It just didn't kind of come off that way. I think we were trying, you know, to some degree, I think maybe the intention was maybe the parents didn't know. I don't know that that was necessarily true. But did they not realize this? And so it was kind of under the guise of education. But it missed the mark. It missed the mark completely.

Ted Kyle: And speaking as a parent and someone who has observed parents in families where obesity is intergenerational, it's not a question generally of not knowing. It's a question, OK, so teacher, doc, whoever is interacting. Tell me what I can do about that. And they're like, OK, eat less and move more. Well, OK, yeah, that had occurred to me. And I've tried that and that didn't exactly solve the problem all by itself.

Holly Wyatt: And I think that kind of comes back to even today when people say, oh, we just need to educate the public about this. And I'm like, no, I don't think education is exactly the only thing we need. We always need education, but education alone, I don't think solves the problem. So we're on the same page today.

Jim Hill: So Ted, in your experience talking and working with a lot of people trying to lose weight, are they getting the needed help from the health care system?

Ted Kyle: Well, some people are and some people aren't. You know, the typical experience with a primary care provider is either sympathetic but unhelpful or downright stigmatizing and accusatory. And I'll just speak from my own experience as someone who comes from a family history of excess weight and living with the complications of that.

I've had two primary care physicians in the last 30 years who really didn't understand the condition. And because of my work, I kind of knew some of the things to do. And I had prescription medicine that I was taking to help me manage my weight. And then I had to get a reauthorization. And the doctor told the pharmacy for the preauthorization that this was at the patient's option.

He didn't believe it was necessary. And the pharmacist said, you know, you really ought to go talk to your doctor because your insurance isn't going to improve that under those conditions. And so I did.

And he said, well, it's the truth. I don't think you need it. And they're not going to approve it anyway. I said, well, you know, they've been approving it until you said this and you're going to cost me a lot of money.

And he said, okay, well, I'll change that. But when they deny your prescription, don't come back talking to me about this and don't ever bring this subject up with me again. Well, that was two doctors ago. And now I'm seeing a primary care physician who is studying for the American Board of Obesity Medicine exam, and it's a world of difference.

Holly Wyatt: And Ted, did you change physicians because of that? Because that's one thing I tell people, you know what? If you get a physician like that, that's not supportive, find another one.

Ted Kyle: Yeah, I'll be honest with you. It took a while. I stuck with that first physician for probably 15 or 20 years, because when I first started seeing him, he was pretty smart guy in many ways, a pretty good physician. I'm not a dumb consumer of healthcare. And he actually prescribed oral stat for me and it's pretty sympathetic.

I found that as he got older, he got crankier and less interested in listening to people and more interested in lecturing them. And, you know, I told about this experience to my friends and peers and they said, well, you need to be looking for another doctor. And I finally got around to finding another doctor. And the next one was a little bit better. And, yeah. And then finally, I wound up with the one that I currently got who is just wonderful and provides good sound, empathetic care, and we have great conversations.

Jim Hill: Well, Ted, and just in my career, which is, it's been a while, a few decades, I've really seen things go from the belief that obesity is a personal issue. If you could just step away from the table or get out and exercise more to understanding this is a condition influenced highly by genetics, by physiology. It's not a willpower thing.

And my hope is as that's out there more and more, the next generation of physicians is going to be more open to working with the patient around some of these issues.

Ted Kyle: That's right. And I'm seeing that. And this physician is a younger physician and she is more open.

Jim Hill: So, Ted, and one of your recent posts, you discussed an obesity bill of rights. Can you tell us a little bit about that?

Ted Kyle: Well, the need for it is because of all these things that we've talked about. And that is really the need to start with patient-centered care. And that's a great phrase. It's hard to do, but it's all about starting from a perspective of respecting the person with obesity and giving that person seeking healthcare the expectation that they should find respect. And it's necessary because it's all too common to explicitly dehumanize people living with obesity.

Jim Hill: So how would things change if we adopted an obesity bill of rights?

Ted Kyle: Well, I would say a couple of things. I would say that health systems would provide better access to evidence-based care instead of defaulting to a position where patients have to prove that they deserve care. I would also say that health systems would respect and welcome the needs from beginning to end of people living in larger bodies. Starting with: is the clinic equipped to accommodate someone who is larger? Do they have scales for weighing patients that are reasonably private so that they're not shouting weights down the hall? Do they have gowns and equipment that will accommodate larger patients? I've heard terrible stories about the physical facilities for larger patients, all the way down to sending a patient to an animal facility for diagnostic work.

Jim Hill: Think about how embarrassing that would be. I can't imagine it.

Ted Kyle: Well, yeah. I have a good friend who needed a cardiac ablation procedure, and she has a complicated medical history, but the procedure table would not accommodate her weight. And her weight was not exclusively to obesity but to other complications but in order to preserve her health, which had been remarkably good, surprisingly for her or for what people might expect, but to accommodate her weight and get that cardiac ablation procedure, she had to lose something like 60 or 80 pounds, and she managed to do it. It wasn't easy with insurance blocking the way.

Holly Wyatt: Right. So an obesity bill of rights, how would that specifically help, Ted, for the listener? If we have that, I mean, that's a terrible story. How will this bill of rights change that?

Ted Kyle: Well, it's really a model to say this is how health systems ought to behave. When you go to the doctor right now or to a health system or a hospital, there's a patient bill of rights saying, what can you expect from your providers? And so the patient that goes into a health system goes in with a patient bill of rights that actually covers them explicitly and says, no, your doctor has no right to assume and put you in a second class status and tell you, you can't have this procedure unless you lose weight. And if they instruct you to lose weight, they're there to help you instead of just saying you're on your own.

Jim Hill: Is there anything our listeners can do to support efforts by you and others to get this thing out there widely?

Ted Kyle: I think it's important to lift up your voice and share your experience because of our unfortunate history of shaming and stigmatizing people living with obesity. People have learned to just kind of keep their mouth shut. And there is nothing more powerful in 20 years of advocacy that I've seen than lifting up the voice of the lived experience with obesity. I sit on a group called the National Academy of Sciences Roundtable on Obesity Solutions. And these are all good, well intended people trying to do the right thing and solve an important health problem. But until people came and shared their personal experiences with this disease, their life experiences, they really didn't understand what faced people with obesity because the norm had been to discount them. When patient advocates came and told their life experiences, it was as if the scales fell from their eyes. And they said that is the most important session that we have had in this. We now have a working group on lived experience.

Holly Wyatt: It's like increasing awareness and at the same time kind of having a whole new insight when you see it differently. And I think that's interesting and doing that through that perspective is a great way to get there, I think.

Ted Kyle: And Holly, I want to go back to something you said, which most of these people, professionals, go into healthcare because they want to help people. And so it's not as if people have explicitly been trying to demean people with obesity. It's just that everybody has brought in assumptions that obesity results from bad behavior. And so it says, if we just need to teach these people better behaviors, and that will solve the problem.

Holly Wyatt: Yeah. And I also find your personal insight to this disease, whether you have struggled with it or whether it's not been as much of a struggle for you plays a role because that's what you live. That's what you know. That's what you feel.

And so you think that's the only way. And now I think about, I may not understand how someone, when they have food in front of them, the appetite signals that may be going on, that may be influencing them to want to eat more or eat constantly or eat, think about food, may be very different for me than from someone else. And then it also may be very different from a another healthcare provider that has very few signals about wanting to eat or their satiety signals are turned on really quickly. And that's the insight they bring to the table. And if you're not aware of that, then you think that's the only way and then you just don't get it. And that's kind of how I think about it.

Ted Kyle: That's absolutely right. And even for people who have lived with obesity for many, many years or even a lifetime, even within that population of people, if you've met one person with obesity, everybody's journey is very different. And sometimes people can have an outstanding experience in overcoming obesity and think, oh, this is the answer. Well, it was the answer for you. It might be the answer for a few or a lot of people, but it's not going to be the answer for everybody.

Holly Wyatt: Yes. That's one thing Jim and I talk about all the time. There's not one solution. There's not one answer. There's not one journey. And really, this podcast, Weight Loss And is kind of about that. It's not one way, not one thing. There's a lot and dot, dot, dot is really what I think is about.

Jim Hill: So Ted, Holly and I did a previous podcast on these new GLP-1 medications and talked about how they're game changers for people trying to manage their weight. Are they going to be game changers for the healthcare system?

Ted Kyle: Well, the best description of that comes from a doctor named Stephen O'Rahilly who spoke at the close of, I think it was a three day session over at The Royal Society on speculation and evidence about the causes of obesity. And he said, you know, when I started training in medicine, hospitals were filled with patients suffering the consequences of uncontrolled hypertension in organ failure, all kinds of problems. Fast forward to today and we have all kinds of medications to manage hypertension. Those people are not seen in the hospital very often and all of those medications are cheap as chips. And uncontrolled hypertension is really not a common problem. And he said, we're just at the beginning of that with care for this complex chronic disease of obesity. And yes, today they are expensive and health systems and insurers and payers and employers are all sweating bullets over how am I going to pay for all this?

There's so many people that need it, want it, demand it. But the truth is that over time, the options are going to multiply, the costs are going to come down. And we're going to be in a very different place. Hopefully, looking forward, we will be in a better place in terms of understanding why we have so much more obesity, understanding the factors that have contributed to that. So far, we haven't been very good at that. Lots of people are convinced that they know the answer.

Jim Hill: Ted, I love that. I love that. Everybody I talk to has the answer. And meanwhile, obesity rates go up and up and up every year.

Ted Kyle: We've gone through periods of applying the answer and finding that even with the application of the answer, it keeps going up. I've been getting stern lectures the last couple of days. How could I dare publish a post on my website about ultra-processed foods not being the only cause? Because it clearly is the primary driver. And I said, A driver? Sure. The driver? Eh.

Jim Hill: I love that. I often get asked, what's the one or two things you can do to reduce obesity? And the answer is quit narrowing it down to one or two things. There are probably 10 things or 20 things or 30 things we need to do.

Holly Wyatt: And then once again, that's the And. If we keep thinking it's one or the other, we're not going to get very far. If we start thinking And and things adding together and for different people, I think we'll move the needle, hopefully.

So I'm going to switch just a little bit. Let's go beyond the healthcare system. And let's just say these new tools that are coming out lead to substantial reductions in the number of people with obesity. How do you think that's going to impact different sectors of society? I'm thinking like food companies and restaurants and fitness centers and, you know, I don't know, even clothing, you know, companies. Have you thought much about that?

Ted Kyle: I have. And you guys have probably been aware of all of the press that has flourished around the idea that, oh, this is going to change all kinds of businesses starting with the food industry. And I think we will be surprised at how this all plays out, because right now we're at a tiny fraction of the people living with obesity, having access to actual obesity care and and being able to manage it.

And so how this plays out is a little bit of a mystery. But I would be hopeful that the business environment for the food industry would shift from a model where food businesses prosper by selling people ever greater quantities of food to selling people ever greater quality of food that is more nourishing and satisfying and pleasurable. Pleasure is an important function of food, but the pleasure doesn't come from large quantities. The pleasure comes from the quality of what you're consuming. And the social context for it.

Jim Hill: See, I think you're exactly right. I think where some people are going to see this as a problem, other people are going to see it as an opportunity. And those are the people that are going to innovate. And I think it would be great if it is a game changer for some of these industries that forces them to think a little bit more about maybe quality over quantity.

Ted Kyle: But that's easier said than done. You know, take the example of Ruby Tuesday, which came out with menus all about, you know, healthy options. And Ruby Tuesday has had a really rough ride from a business perspective that really didn't work out for them.

Jim Hill: And yet when you put more patties on the burger, it sells really well.

Holly Wyatt: And that's not the only company that when it has come out with options that haven't sold. And so that kind of led me to think, you know, not only do the companies have to shift our kind of value proposition as a society may have to shift. I think there's a lot of people who do think, well, how much food do I get for the money versus what is the quality of that food?

Jim Hill: I love that, Holly. The value equation has to change. Rather than more for less, is there another equation that we can equate with value? Exciting times. Ted, how optimistic are you right now about weight management? Are you pessimistic, optimistic? Where are you right now thinking about the future?

Ted Kyle: Oh, I think we are just scratching the surface of what is possible. And I do think that the best days lie ahead for understanding and helping people manage and ultimately overcoming the high prevalence of obesity that we have. But only if we are curious and objective and bring compassion to the care for people with obesity.

I mean, it really takes all three of those things. We have suffered for a long, long time from a lack of curiosity and objectivity. People are convinced that they know the answer. And so they're not curious about other ways of looking at the problem. And they are not particularly objective about new data. If the data comes along that supports their point of view, then it's great. And if it doesn't support their view, it is junk.

Jim Hill: Wow. Well said. Holly, you know what time it is right now?

Holly Wyatt: Yes. Ted, it is when we get vulnerable. We ask a personal question. Have you ever tried to lose weight? How did it go? What has been your personal experience with weight loss? Or maybe that isn't something you've experienced?

Ted Kyle: So I have gone through a period of time of trying to lose weight. I guess when was it? In my 40s, as my children were growing up, I managed to follow the typical pattern for a male and gain additional weight, very consistent with the pattern of weight gain for my family and for the population there in the late 90s. And I did about the time I was starting to work on obesity around 2000, 2001, really put some effort into it, really tracked my weight and managed to lose some weight. And if I recall correctly, I was probably about 10 pounds lighter than I am now.

You know, at the most. But I would say that my mindset around that has shifted from one of losing weight to a longer term horizon of figuring out how I'm going to manage the health aspects of my weight over time. And so I know that some of the research you've done, Jim, says that people who track their weight do better. And I have realized that I do better when I do pay attention to my weight. That doesn't work for everybody.

I'm quick to say, you know, for some people that that's just really a bad thing. But for me, it's helpful to know where I am and pay attention to interactions with my day to day life and know when things are kind of pushing me up. Not beat myself up over it, but just be self aware. So I continue to pay close attention and, you know, and try and keep things under control. But by no means do I think that even though I'm not at a BMI that confers obesity to me, I'm at a lower I'm at a lower weight than my than my highest lifetime weight. But I don't think I can stop my awareness of the excess adiposity that I have.

And I'm particularly aware of how as you age, you lose muscle and gain abdominal fat. And that's kind of on my mind. What do I do about that? How do I gain some muscle mass?

Jim Hill: We always end our show with what Holly likes to call pie on the plate rather than pie in the sky. Talk to our listeners and give them a couple of recommendations that you might have if they're managing their weight, if they're looking at interacting with the healthcare system.

Ted Kyle: Well, I would say, first of all, it's going to be different for different people. But I'm thinking of somebody who is living with significant excess weight and concerned about the impact on their health. And I would say that the first most important thing that they can do as they interact with the health system is to expect respect. And if you have a provider who is not respectful, remember that that is a problem of the provider across the table from you.

It's not a problem of yours that you don't deserve respect. Secondly, I would say, seek out helpful providers. It took me 20 years to find a provider who would be helpful to me. And then the third thing I'd say is go in informed. Arm yourself with information from the Obesity Action Coalition if you feel inclined. Read my daily posts and you might find an occasional tidbit that's helpful to you. I try and keep in mind the people who are living with this condition as well as the people who devote their careers to it. So those would be the three things that I'd suggest.

Jim Hill: Fantastic. And again, Holly, go ahead. You wanted to say something.

Holly Wyatt: Well, I was going to say, I really like that. And I think that's empowering to realize you have a choice and to use that choice. So remind our listeners how they, you said that you might, they could hear something from you, how can they make sure they understand how they could connect with you?

Ted Kyle: Well, you can Google my name and you'll find my website pretty quickly. It's [conscienhealth.org](http://conscienhealth.org) You can find me on Twitter and LinkedIn and Facebook and even Instagram. And you can even subscribe to an update every time I put out a new post. And I do put out a new post every day at 6 a.m., which is kind of insane. But when people ask me why I do it, I just say it gives meaning to life.

Holly Wyatt: Yeah, I love that.

Jim Hill: I read your posts every day and I highly recommend that you do that. There's a lot of good stuff in there. Ted, thank you so much. It's been wonderful talking with you. And we'll see everybody on the next podcast of Weight Loss And…

Holly Wyatt: Thank you. Bye.

Jim Hill: And that's a wrap for today's episode of “Weight Loss And…”, we hope you enjoy diving into the world of weight loss with us.

Holly Wyatt: If you want to stay connected and continue exploring the “Ands” of weight loss, be sure to follow our podcast on your favorite platform.

Jim Hill: We'd also love to hear from you. Share your thoughts, questions, or topic suggestions by reaching out at [weightlossand.com](http://weightlossand.com/). Your feedback helps us tailor future episodes to your needs.

Holly Wyatt: And remember, the journey doesn't end here. Keep applying the knowledge and strategies you've learned and embrace the power of the “And” in your own weight loss journey.