Dr. Nikhil Dhurandhar is one of the nutritional science specialists available to the public through the new Nutrition and Metabolic Health Initiative.
Dr. Nikhil Dhurandhar is a big believer in doctor-patient confidentiality. As he says, you could stand in a room talking with him and one of his patients and you'd never know their relationship unless the patient brought it up.
And that doesn't happen much. In fact, as one of the world's foremost nutritionists, he's been invited more than once to the wedding of a patient who – because of his work – finally got the body she wanted. Of course, the bride's family then usually asks that he not tell any other wedding guest how he knows her.
Dhurandhar, chair of the Texas Tech University Department of Nutritional Sciences, takes it all in stride. It's expected, he admits, because of the stigma normally associated with nutritional counseling.
Perhaps that's why Dhurandhar's recent exposure has come as such a surprise. One patient in particular wanted to show off Dhurandhar's work to the whole world – and he had the platform to do it, because that patient is a movie star.
Aamir Khan is an Indian actor, producer, director and talk show host. During the course of his 30-year career in Hindi films, Khan has become one of the most popular and influential actors of Indian cinema. Because of his large global following, especially in India and China, Newsweek described him as “the biggest movie star” in the world.
Several years ago, Khan was chosen for a very physically demanding role in a film called “Dangal,” about a former professional wrestler who defies society's expectations and trains his daughters to follow in his footsteps. In the lead role, Khan had to portray a wrestler at both his peak physical condition and later in life after he's gone slightly to seed.
According to the filming schedule, Khan needed to shoot the later-life scenes before those in the wrestler's prime. Originally 154 pounds, Khan began gaining weight and muscle so his portrayal of the older man would show both the strength he once had and the large gut he gained after retiring.
He knew he would have only months to lose the weight he'd gained and build a stronger-looking physique. So he called Dhurandhar.
Well, technically, he called Dhurandhar's father, widely known as the “father of the Indian obesity practice,” who had served as Khan's nutritionist on previous films. But Dhurandhar's father had recently given up his medical practice after a decline in his health. So Dhurandhar took the call.
“He said he wanted to lose weight and gain muscle; nutritionally speaking, this is an extremely challenging situation,” Dhurandhar said. “If you want to lose weight, you have to be in a negative energy balance – you have to eat less than what you require. But if you're in a negative energy balance, you cannot build muscle because the body wants a surplus. The body wants stores before it can build muscle. These are paradoxical situations, and that's what he wanted to do – and on a timeline.
“So I took it on, knowing full well I was walking into a big challenge.”
When Khan filmed the later-life scenes, he was 214 pounds and 38 percent body fat. For the earlier-life scenes, his goal was to be under 10 percent body fat.
Dhurandhar brought Khan to the United States for three intense weeks, and then Khan returned to India to continue his work on his own, with regular consultations from Dhurandhar.
The strategy was to alternate several weeks of losing fat and several weeks of gaining muscle.
“To lose fat, I would cut down his calories so he's losing fat while exercising so he's not losing muscle as a result,” Dhurandhar said. “After those weeks, we brought up his calorie level in the borderline-surplus range so he was doing muscle building at that time.”
On weight-loss days, Khan worked out for seven hours. Dhurandhar estimated Khan was burning as many as 4,500 calories each day.
“If you're just in a negative energy balance, you lose muscle also; there's no way to exclusively lose fat,” Dhurandhar explained. “To make sure he didn't lose muscle, he had to maintain a level of physical activity and get enough protein – enough, not excess protein.”
After five months of training and exactly one day before he began filming as the younger wrestler, Khan reached 9.67 percent body fat. He was 176 pounds because he had gained so much muscle, and muscle weighs a great deal more than fat.
He was so pleased with the results Dhurandhar helped him achieve that he shared them with the world.
“He wanted to publicize it,” Dhurandhar said. “He put out videos on YouTube and gave talks about how I helped him. Once he did that, I was able to freely mention him.”
On Dec. 23, 2016, Dhurandhar arrived in India for a visit to his parents. Unbeknownst to him, it was the day “Dangal” was opening. Learning Dhurandhar was in India, Khan organized a media event and presented the nutritionist to the world.
“The emails have not stopped since,” Dhurandhar laughed.
Dhurandhar is quick to point out he wasn't the only professional involved: he worked closely with both Khan's fitness trainer and his personal physician to ensure the actor's health and safety throughout the process.
“Of course, that's not just for celebrities,” Dhurandhar said. “When it comes to individual people, I do the same thing.”
Nutrition and Metabolic Health Initiative
The public can now find out these facts for itself, thanks to the Nutrition and Metabolic Health Initiative (NMHI), operated through the Department of Nutritional Sciences.
“I have a good success rate and people improve,” said Dhurandhar, who has treated more than 15,000 people for obesity during his 35-year career. “But that is because I don't go by the one-size-fits-all approach. It would have been easier to give every person a 1,200-calorie diet, but that's not how it is. It is about understanding your likes and dislikes, your lifestyle and needs and desires, medical conditions, current and past history, family history, your various values. Is your cholesterol high? Are your triglycerides high? Does your blood sugar need to be lowered? Does your blood pressure need to come down? After understanding all this, I like to plan a diet by working with you on all that. That's my approach. It is very highly personalized.”
And now Dhurandhar and his colleagues are bringing that approach to the people of Lubbock.
The NMHI has three components: education, with hands-on experience for undergraduates and graduate students alike; research, through studies and clinical trials; and service to the community, through its newest offering – clinical services for the public at times that are convenient for the clients.
“The goal is to offer services related to nutrition and metabolic health to the general Lubbock and South Plains communities beyond just Texas Tech,” said Dr. Martin Binks, director of the NMHI and an obesity and metabolic disease research scientist and clinician for more than 20 years. During that time, he has assisted literally thousands of patients with behavioral, pharmacologic and surgical weight loss, health and wellness and quality of life improvement.
The NMHI offers state-of-the-science body-composition testing to show clients their body fat and muscle mass, and metabolic testing using equipment than can accurately determine a patient's calorie requirement. And, of course, the basics of weight and blood pressure are monitored as well.
Patients also can participate in nutritional counseling with registered dietitians and both individual and group-based comprehensive weight-loss treatment. That comprehensive treatment includes nutritional counseling, but it goes a step further, helping people identify and connect with the proper medical care associated with their obesity.
“We're not actually providing that medical care, but we're working closely with their primary care physicians and primary health care providers in the community for comprehensive care for obesity, which might include nutritional counseling, behavioral support and coaching, and guidance on physical activity,” Binks said. “Where needed, we can provide information and guidance for selecting medicines and understanding options about medicine and bariatric surgery.”
Although nutritionists in the NMHI may specialize in treating obesity, that's not their only focus.
“For people who need nutritional support for things like diabetes or hypertension, we provide nutritional counseling to address any health issues that are influenced by nutrition,” Binks said. “We're not going to replace people's doctors – we're not treating diabetes. What we're looking for is, when a doctor has a patient who needs some diabetes counseling involving nutrition, physical activity and general behavioral change, we can provide an adjunct to their work.
“Whether it be Texas Tech University Health Sciences Center physicians or community physicians and health care providers, we can assist them with anything related to nutrition and also improving overall health habits like stress management, sleep and overall healthier lifestyle. When it comes to obesity, we're treating top to bottom because that's our expertise, and in the other areas we're focusing on the nutritional and lifestyle factors associated with other medical conditions.”
And yet, as comprehensive as the NMHI is now, just wait until it's fully realized.
The program has been promised 20,000 square feet of space in which it will eventually house wider clinical trials, demonstration kitchens to teach healthy cooking and meal preparation, exercise facilities to help people with medical conditions learn to exercise in the most effective ways for them, science facilities where staff can complete blood testing and genetic analyses, a metabolic kitchen where food science researchers can develop healthier foods and telemedicine facilities that will allow clinicians to work at a distance with patients who can't come to Lubbock.
“Our department has basic scientists, clinical scientists, community nutrition scientists and clinicians,” Binks said. “They'll be housed here, too. It's a very comprehensive support system in place with a clinical-services-in-the-community mission.
“By having this comprehensive facility that can provide everything we need scientifically for clinical trials, we also have the advantage of being able to offer this cutting-edge treatment to our community.”
Binks and Dhurandhar are both excited to bring such world-class tools to the people they interact with every day.
If Dhurandhar has learned one thing during his 35 years in nutrition, it's that people have a lot of wrong ideas about fat.
During the many years he worked in India, one patient told him she had become fat by riding a scooter and filling up with cold air. Another patient arrived to her appointment covered in bruises after another health care provider had beaten her with a cricket bat to “break the fat.”
Needless to say, air does not make a person fat any more than being beaten can stop a person from being fat. Or is that needless to say?
Dhurandhar doesn't think so. That's why his newly released book – “Dr. Dhurandhar's Fat-Loss Diet,” for which Khan wrote the foreword – shares not only what a person can do to lose weight but also what a person shouldn't do.
For people with obesity, pulling themselves up by the bootstraps and working their way thin again falls in the latter category.
“Over the years, obesity was never recognized as a disease,” Dhurandhar said. “It was just, ‘Push yourself away from the table, stop eating, walk a little bit – you'll be fine.' If you want a parallel for that, it's very similar to depression. In the past, people told somebody who was depressed, ‘Why are you sitting on the couch? Get up. It's just a matter of deciding to go to work.' Those who understand depression know it's more than just deciding to do it. It's the same in obesity. In the mainstream, it's been taught for years that it's just greediness and laziness.
“None of that is true. Obesity is a disease.”
He's heard a lot of pushback on that stance over the years, but the science is on Dhurandhar's side, showing how factors outside of willpower and control can influence body weight. As a doctoral student in biochemistry in late 1980s, he discovered the first virus that contributed to obesity. And just a few years later, a hormone called leptin was discovered that tells the brain how much fat is stored in the body.
“Nature tries to keep you within a range of body fat,” Dhurandhar explained. “Leptin production is proportional to fat in the body. If the brain sees too much leptin, it assumes there's too much fat and makes you less hungry or increases your metabolic rate. If the brain sees too little leptin, it makes you more hungry.”
Of course, that means if the body is producing too little leptin – or none at all – that person's brain will assume there is no fat in the body and it will be in a constant state of hunger.
“In those cases, there is something beyond your fork and your mouth,” Dhurandhar emphasized. “There's something in your physiology that you don't have control over.”
Similarly, he said, people whose bodies are functioning normally are unlikely to ever become obese.
“Your body may be happy to keep you between 100 and 110 pounds. Someday, if you indulge, that may go to 120 pounds or 135 pounds,” Dhurandhar said. “But unless you have the disease obesity, you're not going to become 200 or 300 pounds. Gaining one pound is not a disease. Gaining five pounds is not a disease.
“If I said, ‘I'm going to eat enormous amounts of food,' I don't think I'll become a 600-pound person ever. There are checks and balances in my body that will keep me from becoming 600 pounds. Somebody who becomes 300, 400, 600 pounds, there's something different in that body.”
Treatment is possible, both for individuals with obesity and those who may just want to lose a few pounds, but Dhurandhar said it's important to set realistic goals.
“Weight loss is achievable,” he said, “but it depends on lots of variables: the weight the person is, where the person wants to go, what's involved, what's the time duration, what's the number you're looking at.”
And to really get results, it's important to see a professional.
“Suppose somebody gets diagnosed with diabetes or cancer. That person goes to a doctor for treatment,” Dhurandhar said. “Obesity is one of those rare diseases that people go to their friends or family or loved ones or neighbors for advice and not a doctor. Your friend says, ‘I did this, this and this and lost weight. You should do that.' Don't do that. It's not a trained health care professional you're getting a consultation from.”
To find out more about the NMHI and the expert services it offers, visit its website.