In this video, Mikhail Varshavski, DO, who goes by "Dr. Mike" on YouTube, reviews the reality show "My 600-lb Life," and gives his opinions from a medical perspective.
Following is a partial transcript of the video (note that errors are possible):
Varshavski: We're going to react to another episode of "My 600-lb Life." Again, I'm not a fan of the title, but at the end of the day I think even with episodes like this there are good takeaways that we can all learn from.
Just watching her wake up in the morning, you could tell she is having a difficult time with mobility and part of when we talk about helping patients lose weight is thinking about their quality of life. So yes, we want to decrease risks of cardiovascular disease and development of metabolic disorders like diabetes, but we also want to make them comfortable. We want to make them be able to enjoy their day-to-day lives. And as they get older, we want to make sure that they are able to keep their independence.
Cynthia: When I wake up in the morning, I start hurting because the pain is intense.
Varshavski: Remember, it's exponential. The amount of weight you're carrying in your abdomen is going to be exponentially higher on your hips, on your knees, on your ankles. The number one thing proven to help reduce osteoarthritic pain and other symptoms related to it is weight loss.
Cynthia: It hurts and it's hard to reach around my body.
Varshavski: It is hard, but it is very important because when you have excess adipose skin tissue, that's a place where bacteria can live and fungi can live. Therefore, you can actually develop skin conditions that are not only dangerous, but also very uncomfortable and painful.
Cynthia: Once I get out of the shower, my daughter comes in and she'll clean out the back of my legs because my arms are too short to reach.
Ukiah: Mom, she tries to do everything. She tries not to be lazy and she tries to do a lot, but she can't.
Varshavski: It's important to not just clean the area, but also dry the area thoroughly because a moist environment, again, harbors bacteria and fungi.
Family Member: Size was something that was seen as kind of a birthright in our family. We loved to eat. It was a kind of a running joke that if you were big, you were well.
Varshavski: Culturally, eating is so important to people that discussing one's diet needs to be done in a very thoughtful and careful way. You never know what food means to somebody or what their daily meals with their family means to somebody. I have seen this happen in my clinic with those who are from the Latin American community and how important it is for them to have regular meals with their family that consists of rice and tortilla. Some of these foods, when eaten in excess, can actually be harmful for the patient, especially when they have metabolic conditions like diabetes.
Cynthia: I was gaining weight from a young age and by the time I was in middle school I was already 250 pounds. Then I started having seizures. Every time I had a seizure, it was while I was watching TV or a movie.
Varshavski: I wonder if that has something to do with an epilepsy condition that is triggered by flashing lights or perhaps sleep deprivation. In fact, when we have children that have had a seizure, they come into our inpatient service in the hospital where we actually put an EEG cap on where we monitor their brainwaves and we try to induce the seizure, either through sleep deprivation or flashing lights. When we do that, we are able to have the seizure occur in a safe, controlled medical setting. But then we're able to see what parts of the brain it's coming from and we could actually then medicate the individual, get them in a place where they're seizure-free, and hopefully are going to be safe to go back home.
Cynthia: At 28, there was a situation that occurred that I needed to take custody of three of my cousin's kids.
Varshavski: Oh, wow! That's awesome that she did that for her family.
Cynthia: I didn't want to give up on having children of my own. I dated and got pregnant with my two youngest children. I was too big to weigh on the office scale, so I had to go to the freight scale. At that time, I was about 480 and I spent all my time focused on taking care of everybody else instead of myself.
Varshavski: And I know some people say, "Why were they even weighing her? That doesn't seem like it was sensitive." It's actually really important during pregnancy to monitor one's weight to make sure that there is no fluid accumulation or that the baby is impacting the body in a certain way. Those who carry excess body weight to this degree not only have trouble with scales, but they have trouble in our offices with stools. They have trouble fitting in MRI and CAT scan machines. It's not an easy life by any means.
Cynthia: My weight limits me so much, so I want to lose the weight. But when the cravings come, all I want to do is eat.
Varshavski: I'm sure this was filmed before the introduction of the GLP-1 medications like Ozempic and Wegovy [semaglutide]. The reason why those medications have become so successful is because they work metabolically to some degree, but the biggest benefit that they give people is that it reduces cravings. It slows gastric emptying, so it slows the process of the food through the digestive system, making an individual feel full, therefore experiencing less cravings.
Cynthia: Being a teacher requires being on your feet all day. But when I get to work, I can't even make it in the building into my classroom without stopping. I kind of map my route to where I know there are chairs that I can sit in.
Varshavski: Yeah. The fact that she is getting that short of breath is concerning from a cardiovascular standpoint. Like, is her heart being able to keep up with the amount of body weight she has right now? For her own safety, you want to make sure that she is capable of walking around without posing a risk to her heart.
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, is a board-certified family physician and social media influencer with more than 12 million subscribers.