Monu Khanna, MD: Essential Lifestyle Changes for Managing Obesity and Cardiometabolic Risk Factors

In treating obesity, lifestyle interventions such as diet, exercise, and stress management play a pivotal role in improving cardiometabolic health. In a recent interview, Monu Khanna, MD, a board-certified obesity medicine expert, highlighted the importance of addressing not just nutrition but also factors like movement, sleep, and stress in managing chronic diseases. In the video above, Dr Khanna—who is also the current chair of the Obesity Medicine Association’s Diversity, Equity, and Inclusion Committee—explains how comprehensive lifestyle changes can significantly reduce cardiometabolic risk factors and improve overall health outcomes for patients with obesity. She also discusses how dietary patterns like the Mediterranean diet and low-carb approaches can improve cardiometabolic risk factors. "The cleaner we eat, the better we do on cardiometabolic risk," Dr Khanna said.

The following transcript has been edited for clarity, flow, and style.

Patient Care: How effective are certain lifestyle interventions like diet, exercise, and managing cardiometabolic diseases in patients with obesity?

Monu Khanna, MD: In my experience and practice, lifestyle changes must be the first and most important step. It's essential to ask, "What kind of lifestyle changes does this patient need?" Are they more sedentary? Do they need to incorporate more movement? Or perhaps they're dealing with unique stressors, like working night shifts, having military experience, dealing with hypervigilance, working in a high-stress environment, or managing toxic relationships. For these patients, addressing stress through techniques like breathwork is crucial. Managing stress can help calm the sympathetic nervous system, which, if left unchecked, can lead to high blood pressure, elevated heart rate, and an increased risk of plaque buildup, all of which contribute to the development and progression of cardiovascular disease.

Lifestyle changes are not limited to nutrition. They encompass everything: how we move, how we sleep, how we eat, and how we function socially. All of these elements come together to shape how we function on a daily basis, and they are crucial for managing any chronic disease. This is particularly important when it comes to cardiometabolic risk factors, as many of these can be modified through lifestyle interventions.

Patient Care: Are there any specific dietary patterns, like the Mediterranean or DASH diets, that are more effective in managing both obesity and cardiometabolic diseases?

Dr Khanna: Medical research has shown good outcomes for patients following the Mediterranean diet. But as we understand more now, the Mediterranean diet isn't just about the food—it’s really about the Mediterranean lifestyle. This includes eating fresh, locally grown produce, non-starchy fruits, and fish, while limiting processed foods. People in Mediterranean countries also spend a lot of time in their communities, volunteer, and take time for activities like the siesta. It’s this combination of clean eating and a balanced, active lifestyle that can be beneficial.

When we look at the blue zones, we see that a Mediterranean-style lifestyle can have a positive impact on health. Additionally, a plant-based diet has been shown to lower cardiovascular risk. Low-carb diets and ketogenic eating patterns have also demonstrated significant improvements in cardiometabolic risk factors.

What I’ve found is that any of these diets, when they focus on clean eating, can help improve risk factors. It’s really about eliminating processed foods—those hyper-palatable, addictive foods. Once we clean out those foods and focus on real, whole ingredients—foods that don’t come with barcodes or packaging, but those that grow naturally—I believe that the cleaner we eat, the better we do in terms of managing cardiometabolic risk.

For more of our conversation with Dr Khanna, check out Treatment Options for Obesity-Related Cardiometabolic Diseases: Clinician Insights for Primary Care