Overcoming Obesity and Health Disparities: A Personal Journey with Sergio Zepeda

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Coming up on this episode of the
Healthy, Wealthy and Wise podcast.

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A lot of times it's your mom
and dad or grandma and granddad.

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It is not your fault.

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Now that doesn't say that you
can't do things, but you didn't

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not necessarily create this.

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And so you aren't this kind of
person or that kind of person.

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Welcome to the Healthy, Wealthy
and Wise podcast with Dr.

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William T.

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Choctaw, MD, JD.

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This podcast will inform, educate
and motivate you to live a more

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healthy, wealthy, and wise life.

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It's powered by the over 50 years
of medical experience of this Yale

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University Medical School trained
surgeon, who also received his Juris

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Doctorate from Western State Law School.

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He has executive experience as a
former mayor of Walnut, California,

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as a chairman of the non profit
Servants Armed, and as president of

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Choctaw Medical Group, Incorporated.

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You've got questions or concerns,
he's got answers for both.

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So let's listen in on his story.

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Good morning, ladies and gentlemen,
we're so happy to have you with

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us on this beautiful morning.

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We have a very unique and a
very special guest with us.

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Mr.

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Sergio Zepeda.

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Sergio is a friend of mine.

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He and I actually worked together In
another organization where we both are

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members of the board of directors, uh,
of this organization called Servants

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Arms, which is a community based
organization in Southern California.

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Sergio is actually vice chairman of that
organization, vice chair of the board.

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Uh, and so I've worked with him for
a number of years and, and we were

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absolutely delighted, uh, when he.

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Was available and willing to come
in and spend some time with us.

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Good morning, Sergio.

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Good morning.

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I'm very happy to be here.

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And so glad you thought to invite me.

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I'm happy to participate.

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And gosh, it's been up.

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I was thinking how long it's
been since we've been on.

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I think it's been eight years.

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Is there?

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Yeah.

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Yeah.

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I mean, in a blink of an eye,
it doesn't seem like that.

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No, it doesn't.

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In about eight years.

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We've been, uh, I've been on the board.

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I know you've been on much longer.

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No, actually, I think, I think we, we all
joined pretty close about the same time

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or, you know, around about that time.

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Yeah.

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Yeah.

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So from, from you and I've had
some preliminary discussions and

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from what I hear, you, you had a
lot of unique experiences and that

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you were interested in sharing
some of those experiences with us.

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So, so tell us about that.

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So, um, well, I'm.

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I'm going to tell you a
little ice professionally.

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I am a human resources director.

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I work in public health.

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We are a public health advocacy
organization statewide.

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Um, we go into organization
into communities what are

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High risk or considered high risk or,
uh, more, uh, communities that have

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less resources and we pass policies
or laws at whatever level they want,

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depending on whether it be the county
or the city or we even do state, uh,

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legislation that promote public health.

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And I think a lot of, especially
underrepresented communities,

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communities of color.

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Yes.

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Don't know that you, this is, I mean, you
have the right to tell your city council.

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This is, I want a green space.

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I want to limit the amount of fast food
places that you guys that are keeping

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built, why are you keep building so much?

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I think, um, especially, um, people of
color, I don't think they realize that.

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There are these corporations that
target us because we have this

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affinity for, I don't know if you've
ever noticed, uh, that if you go

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into a fast food restaurant in a more
well to do middle class community

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versus in a community of color, the
offerings of soda are vastly different.

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Sugar sweetened beverage, they,
and there's a huge panoply of sodas

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available in the lower community, in
income communities, which are primarily,

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primarily communities of color.

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Uh, and then the basic, uh, middle class
white community, there's Diet Coke Sprite.

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And, but, you know, the communities that
are impacted the most by, uh, the access

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to sugar, to sweetened beverages are us.

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So we are trying to, to
bring awareness to that.

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Um, some don't like it, um, but you
know, I like to be liberal and, uh,

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champion the cause and be part of it all.

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Also, um, I'm 50, uh, 49.

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I'm, uh I found myself a dad of three,
a grandfather of one, and I'd have been

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focused on building this professional
career, but, um, the pandemic hit, no one

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left their house and my health spiraled.

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I didn't get COVID, but,
um, my health spiraled.

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Uh, I found myself.

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About to turn 50, and I was, I'm 6'4 I'm
a tall guy, but, um, I was 410 pounds.

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I've been diabetic.

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My A1C was at 6.

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7.

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My triglycerides were 567.

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So I was like a time bomb, you know,
just It was inevitable that it was just

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a matter of time that I was going to
have some type of crisis and I knew I

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knew I had to reset and it was especially
pressing because I was about to be 50.

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I was like, I cannot enter 50.

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Down this same path.

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So I was thinking about what I was going
to do I started dieting working out

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joined the gym, but I was so far gone
that it was really difficult for me Yes,

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you know, it was painful actually, you
know Just because I was so out of shape.

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I was so heavy And I thought
to myself now I need I need a

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medical intervention, some help.

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So I looked into, um, gastric
bypass and, um, my insurance

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plan would have covered it.

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Um, but they said you would have to
participate in a treatment program

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for a year, lose 10 percent of your
weight, no guarantee that you would be

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approved for the surgery at the end.

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And so I thought to myself, Hmm,
I don't want to wait a year.

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And so I paid out of pocket.

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Okay.

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And it has been,

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I think I was at a place where I was,
had a lot of clarity about what I wanted.

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So it wasn't a difficult
person decision for, for me.

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However, I will say that there are
many people who judged it as a poor

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decision and I don't understand it.

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Yeah.

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How could you take such a drastic
measure and alter your body?

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So permanently, uh, aren't you afraid?

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Why are you doing, why
don't you just exercise?

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Um, hopefully they were people
that, uh, are naturally thin.

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You know, that natural, right?

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Oh yeah.

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, but never gain.

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And they

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said, I don't understand your problem.

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You

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never gain five pounds.

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You know, they struggled to gain , the
skinny ones, you know, they were.

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And so I got to a point where I
just in telling, you know, I just

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stopped talking about it because, um.

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I said this is my decision, it's my path.

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But Sergio, you bring up an important
point and let me jump real quick and I, I

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gave a talk about a year ago, uh, because
as a physician, as a general surgeon, and

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I've, I, I, uh, this type of surgery was
not my specialty, but I assisted on a lot

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of cases because we, we help each other.

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So I'm very familiar with it, but one,
one of the issues that I think our

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society doesn't appreciate is that
obesity is more than just behavior.

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A lot of it is genetic.

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Yes.

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It is genetic, but yet in our
culture, I'm talking about the U.

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S.

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culture, we sort of look this way at
the person who's Skinny, skinny, skinny,

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and the other person who's obese, and
we make value judgments about them.

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We don't know them, but we just
make value judgments about them.

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So one of the things I tried to say in,
in, in the little podcast we did on this

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some time ago, a lot of times it's, it's
your mom and dad or grandma and granddad.

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It is not your fault.

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Now, that doesn't say that you
can't do things, but you didn't

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not necessarily create this.

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And so you aren't this kind
of person and that kind of

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person, but go ahead, go ahead.

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Predisposition, whether it
be the diabetes, obesity, you

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know, it's a very real thing.

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Yes, it runs in families and it's a lot.

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People think it's not, but eating,
being healthy, isn't inexpensive.

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You can try.

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That's right.

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That's right.

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You know, but eating organically.

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Isn't inexpensive.

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You can grow things.

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Sure.

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But that's a lot of work.

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And if you're lower income, you
probably work long hours or very shifts.

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So, you know, it's when you have a nine to
five job, it's a little bit easier, right?

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Like you can have, make some
time to garden or, you know, more

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flexibility in your work, but.

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Working last people, it's harder.

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And I think people, we
don't, you're right.

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We're very quick to judge.

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And as I found myself judges by
many people, uh, in this experience,

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which was very surprising to me, but
nonetheless, I took the jump and I

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did it and, um, I was actually very
surprised at the recovery of it.

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So.

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One of the most striking,
uh, secondary effects of it.

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And no one told me this until
the day of surgery that my

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diabetes went into remission.

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Yes.

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Immediately following surgery,
and I have had my diabetes

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in remission since surgery.

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I am processing glucose normally, but it
never appears in any of the information

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because I under, from what I understand,
it's not a guaranteed side effect.

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Some very happens very often,
but not always, and they

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still don't know for how long.

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That's true.

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It's not, it's not a guarantee, but I
suspect that it's getting more and more

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and more like that because we know we
physicians know other things that we

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can do to augment the surgery and that
sort of thing to help patients to, to

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move in a, in a, in a proper direction.

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But, but a number of people do go
in remission and that's just great.

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And what I don't understand,
doctor, is given.

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Given the cost of diabetes treatment,
the secondary effects that will come

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with poor men's management, that poor
management of the condition, which

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is very common in people of color.

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We don't manage it well at all.

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Why isn't it offered more
frequently as an option?

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I get that the surgery is, um,
but it's a 10, 000 surgery.

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Yeah, it's

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basically, well, I'm gonna, this
is just my own personal opinion.

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I think there are a number of reasons.

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One is that I think healthcare
disparities do exist.

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Meaning that I'm physician A, you
come in as my patient, I look at

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you and just say I look at you and
automatically I put you in a category,

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psychologically I put you in a category.

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And what I mean by that is we know, we
know, I've been in medicine for 50 years

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as a surgeon, we know that sometimes
things are offered to one group, not

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always maliciously, but it may be, well,
I know he can't afford, blah, blah, blah.

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So I'm going to do it this way, whatever,
you know, all sorts of discussions occur.

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Um, and so a lot of times the, the,
the, uh, opportunities or the, the

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remedy that's offered to the patient is
limited and patients don't know that.

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Patients aren't doctors.

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Uh, and you have to, you have to notice
it, but you know, my friend did ABC.

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Why, why, why didn't you tell,
why don't you tell me about that?

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Um, and so a lot of that is intentional.

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A lot of it is unintentional,
but it doesn't matter.

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It.

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It ends up not being in the
best interest of the patient.

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So I tell my patients, I say, go
in and ask a lot of questions.

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Go online, read stuff, write down
those questions before you go in.

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If you're uncomfortable, take a
friend who can ask them for you.

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But you, you're already at a
disadvantage if you're in certain

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groups, be they financial, be that,
be the ethnic, et cetera, et cetera.

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And that, that's just a reality.

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Health care, health care disparities.

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Exists, uh, and it's real and it's not
in the best interest of the patient.

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And even the profile, like I've had some
people mention that, you know, they, it

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upsets them that when their profile comes
up on their doctor's medical screen,

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it says they're a Medi Cal patient.

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They receive different care.

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I, I, I've never been in a Medi
Cal patient, patient, but I

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heard that many people do that.

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They experienced this.

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Oh, then you don't qualify
for this because of that.

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Yes.

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Yes.

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But that's a part of that disparity where
I get an attitude about you, you know, um,

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and I may say that attitude doesn't affect
how I treat you, but I have the attitude.

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So maybe subconsciously it
doesn't, but you know what I mean?

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And I think that that's why the whole
issue of health care disparities is such

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a big deal because there is a difference.

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There's a difference
between men and women.

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And I.

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I.

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To.

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Tell the story real quick, the way we
used to treat patients with heart attacks,

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you know, uh, back in the seventies,
when I graduated from medical school,

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we were taught that a heart attack
was crushing substernal chest pain.

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They radiated down to the left arm.

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And that's it.

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No, go ahead.

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I was going to say, is it true
that heart disease treatment is

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based on studying men and so they

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That's right.

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That's it.

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You, you, you, you, you know this.

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That's where I'm going.

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And so those studies that we were taught
at Yale and other schools in the seventies

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were based on men because men were
the only ones in the clinical trials.

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Women weren't allowed to
be in the clinical trials.

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So then what happens?

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We then come out with a distorted
view of, of heart attack.

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Women may not have that question.

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Substernal chest pain that
radiates to the left arm.

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They may come in complaining
of dizziness or nausea or blah,

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blah, blah, blah, blah, blah.

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So I think there's that.

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It is intentional and unintentional,
but it exists that disparities end

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up causing some patients not to get
the very best care they should get.

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Thank you for listening to this
episode of the Healthy, wealthy

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and Wise Podcast with Dr.

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William t Choctaw, md.

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We hope you now feel more equipped
with tools and actionable information

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that will help you live a more
healthy, which includes the

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mental, physical, and spiritual.

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Wealthy, which includes the
financial, health, and spiritual.

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And wise, which includes the practical,
theoretical, and emotional life.

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For this one and past podcast
episodes, blogs, books, and

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news you can use, go to www.

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thw.

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00:15:43,595 --> 00:15:43,625
org.

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00:15:43,845 --> 00:15:45,645
wwp.com.

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That's www.thwwp.com and you've got it.

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In the meantime, remember, you too can be
the change you want to see in the world.

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You've been listening to The Healthy,
wealthy and Wise Podcast with Dr.

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00:16:02,880 --> 00:16:03,885
William t Choctaw.

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MDJD.