Conquer Your Weight

Dr. Sarah Stombaugh: This is Dr. Sarah Stombaugh and you are listening to the Conquer Your Weight podcast. Announcer: Welcome to the Conquer Your Weight podcast, where you will learn to understand your mind and body so you can achieve long-term weight loss. Here's your host, obesity medicine physician and life coach, Dr. Sarah Stombaugh. Dr. Sarah Stombaugh: Hello everyone and welcome to today's episode. As promised, we are continuing a conversation about binge eating disorder and talking a little bit more about the role of emotional eating. Binge eating, there's sort of the formal diagnosis of it, but there are so many people who feel like they don't really have a good grasp on why they're eating. They feel really compelled to food, they feel like they eat in response to different emotions. And so I have a special guest with me today, Dr. Megan Melo. She is a family medicine physician, obesity medicine physician out in Seattle, Washington. And we are going to continue this conversation. Dr. Melo, thank you so much for joining me today. I'm really excited to have you here. Dr. Megan Melo: Yeah, thank you so much for inviting me. This is just, I think it's an important topic to tackle that has been left out of so many conversations about weight management that had been happening in the doctor's office and just in general, we kind of throw around the term binge, but what does that actually mean when we're really sort of diving in? So I'm excited for us to talk today. Dr. Sarah Stombaugh: Yes, thank you. And one thing I failed to mention is that Dr. Melo is a life coach, as am I. And I think that piece of this conversation is really so valuable and there are many phenomenal physicians in this space doing wonderful work, and that psychological piece absolutely has to be a part of our weight loss journey. Understanding not just what to do. We talked about this sort of academic, a lot of patients are given dietary guidance. I have patients who come to me and say, I feel like I could write a book on nutrition, but I'm actually struggling to implement it into my life. And that's the piece that I love being able to work on and I know you do as well. And so we'll really get a dive into that today. Dr. Megan Melo: Yeah, yeah, no, I completely agree with you. It's just been not part of the conversation and so many of my patients who come in who are socialized as women, like, yeah, I know what the right things are. I have studied nutrition in my own way. I've been handed all the things. I've tried all the things, but how do I do it? How do I follow through because this or this happens? So yeah, let's get into it. Dr. Sarah Stombaugh: I'm so excited. So tell me, if you were to define emotional eating, how would you define it? Dr. Megan Melo: I like the simple definition that comes out of our mutual coach training, which is eating for any reason other than hunger. And I like that that encompasses, because sometimes when we talk about emotional eating, people imagine the stock image of the sad woman crying into her tub of ice cream. She likes spoons it straight into her mouth. That is one flavor of emotional eating. But we can also eat because we're irritated, stressed, bored, excuse me, excited or celebrating something when we have a piece of birthday cake and a scoop of ice cream and we're not hungry, but it's somebody's birthday that is emotional eating. We might choose not to vilify that in any way, but it is eating for reasons other than hunger. Dr. Sarah Stombaugh: Yeah, absolutely. And I love that you point that out because I think a lot of people that could be problematic, even the positive emotions, there's often as a result of a positive emotion, we're often in community, there's often group celebration, and so we often feel like we sort of have to eat or need to eat in that situation because it may be socially unacceptable or we feel that it's socially unacceptable not to, Dr. Megan Melo: Right? We don't don't want to stand out, we don't want to not participate. Again, kind of the group culture is, oh, I go out with my friends and we sort of routinely overeat. We order too much food, we order too much alcohol. We're having this great time. When we start talking about restriction and dieting, it's like, oh, that becomes off the table too. Or I'm being weird about it in a way that socially doesn't seem acceptable to people. That's such a common experience, but it's also something that I think we don't talk about really how to navigate that. Dr. Sarah Stombaugh: Yeah, absolutely. And actually it may be worth to spend a couple minutes talking about navigating that aspect of when we are in social situations, how to best navigate that aspect of eating for reasons beyond hunger. And then we'll kind of come back to the negative emotions, which I think is more commonly what we think of. So tell me a little bit, if you're talking to a patient and they're saying, I'm out for a celebration, I'm out at a bar, I'm out at a dinner, what do I do? What are the advice or what's some of the advice that you often give there? Dr. Megan Melo: Yeah, I mean I think about there might be times when we're in that situation and we want to participate. We want to eat whatever it is or have some drinks or whatever. And I think when we are doing this work in a healthy way, we can choose to give ourselves permission there. Where we come into problem is if I go into that situation sort of hoping that I won't fall off the wagon, hoping that I'll make a good choice, but then feeling like it wouldn't be socially acceptable to do that, that I need to order the french fries that everybody else is getting or other people will think I'm being weird when I'm putting it through kind of the lens of other people, that's usually when I would start to run into trouble. We can run into this all over different circumstances. We might have a family gathering and someone, our aunt is pushing food in our face and being like, you need to eat this. You need to eat this. Learning to be able to say, oh, thank you so much. I'm actually not hungry right now, or that looks delicious, but I need to hold off. Finding language can be really helpful there, but just recognizing and learning to be comfortable, do I actually want the thing or do I not want the thing? And sometimes practicing, like I said, practicing beforehand sometimes. My husband is a huge baker and for a long time I always felt like I had to eat whatever he was making regardless if it was my favorite or not. But he bakes a lot and what I've had to tell him, and I tell him this each time, is just so you know, I'm choosing not to have that and don't be offended. It's nothing to do with you. But cookies aren't my favorite. Pie is not my favorite. So most of the time when he makes those things, I just choose not to have them. But I set it up of it's not about him, it's about me. Dr. Sarah Stombaugh: I love that. Dr. Megan Melo: But it is kind of working through our own people pleasing sort of parts that feel compelled to be nice, be polite, accept the food that people are offering. We have to have a little awareness around that. I think especially in those sort of more positive or celebration type settings, you might tell your friends like, Hey, I'm so excited to go out with you. Just so you know, I'm making some changes in the way I'm eating and don't read anything into it, but I'm probably going to eat in this way. I'm going to choose not to have a drink tonight. I'm trying to cut down. Whatever that is, practice that. Dr. Sarah Stombaugh: When I think in a way that's really drama free as you're sort been playing. A lot of times when we have a lot of mental drama that ends up showing up in the way that we talk about it and we're like, oh, it looks really good, but I'm not supposed to. I'm on a diet, but oh, maybe just a bite. Oh, I really shouldn't. And it's not even just that thought process. It's quite literally sometimes saying those type of things out loud and then your poor friends are like, let me rescue this woman and just have a bite. It's just a bite. So it's interesting because sometimes if we're not clear with what we want, we invite even more drama in. Dr. Megan Melo: And we sort of create just emotional fatigue in that also, right? Again, if that dialogue is kind of constantly spinning in our brain of like, oh, I shouldn't, but I want to, but I shouldn't want to, that's exhausting. Dr. Sarah Stombaugh: It's easier to just give in. Dr. Megan Melo: There's so much work there. Dr. Sarah Stombaugh: And I love talking about that intentionality and what do you want for that evening? And we can eat for reasons that aren't hunger. You can be at a celebration and eat and enjoy it, and that's great. There's no reason we have to say no and be a hundred percent perfect in line with our goals all of the time, but a very specific intention rather than just hoping, what do I want this evening to look like? What would be the number of drinks that would be in line with my goals? What would be the amount of dessert that would be in line with my goals? What type of food choices am I going to make? And then just having that going in. I love that. Let's turn and flip a little bit to the negative side and this eating in response to a negative emotion even in this. So there's eating in response to a positive emotion, but even in that negative emotion space, I often find that patients identify things like stress or sadness as obvious triggers. And sometimes as you were saying, that example of a sad woman who's eating ice cream, that sort of stereotypical example that we think of, but even triggers like boredom, which you did mention that is also an emotion that is actually probably one of the most common drivers of emotional eating. So I would love to hear a little bit when you're having conversations with patients and even identifying, how do they start to recognize if this is happening in their life? Dr. Megan Melo: Yeah, I think the place where it probably comes up the most often is I ask people a lot about what happens in the evening and nighttime. Do you snack after dinner or do you snack before dinner? Where do you feel like things really go wrong for you? Because of course everybody's pattern is a little bit different. Sometimes people eat pretty healthy and their choices of foods, but they eat large portions and whether they're paying attention to their hunger or not, it's kind of an issue. But for people who do a lot of evening and nighttime sort of eating and snacking, that's almost always not driven by hunger. And so that's usually a good entry point to these conversations of, yeah, tell me what's going on. Are you eating because it's TV time and you feel like you always need something to do with your hands? Because sometimes people will, that's kind of the most that they can say, if I feel fidgety and I need to do something that sitting eating chips or popcorn or something kind of gives me that, I dunno that satisfaction even though they're not hungry. So I think where a common sort of trigger for boredom is it's not quite boredom watching tv, but it's like they're not fully satisfied by the TV and they need something else. And that seems very much like a product of our busy culture. Why can't you just sit and be present and watch tv? But when we identified that in particular, it's like, okay, well what else might we try? Is there some other way that we could tackle that boredom that you feel kind of in your body? Because if we continue to solve that with food, we're probably not going to make our goals and then we're going to have some emotions about that of like, oh, I wish I didn't do that. So that's one place that it comes up. And then yeah, stress, anger, unexpressed, frustration. I think that comes up a lot, especially for people who work in healthcare in particular that I've noticed is that we have to go through our day and we're socialized to always sort of appear on and we need to be helpful and we need to put our own needs aside and take care of the person in front of us. Meanwhile, we might be really frustrated by the patient who shows up late or the extra patient who got booked on your schedule or the list of concerns you're supposed to address or the amount of stuff in your inbox. And we're carrying that frustration home with us. And ultimately we find ourselves deep in the snacks before too long because we don't like the feeling of that and we don't know how else to let it out. Dr. Sarah Stombaugh: When I think that whether it's healthcare, any other field, a lot of times our days are just so go go go that we don't actually, we feel those emotions or maybe we barely feel those emotions. We're aware that they're there. Dr. Megan Melo: We're not paying attention to them. Dr. Sarah Stombaugh: Right. And they're building up. And so for so many people, the emotion builds up, builds up, builds up, and then we get to the evening, which is our quiet part of the day for most people. And there's at least whether it's once the kids have gone to bed or after dinner, whatever the situation is, when we finally have a moment to ourselves, a lot of times all of those emotions have not yet been processed. And a lot of times we aren't even necessarily taught or learned in how to process those things then. So we bury them with a flood of, it could be plenty of things, but certainly for patients who are seeing me or seeing you in a medical capacity, it's often food because that really can numb and drown out what can be a really overwhelmingly negative experience. Dr. Megan Melo: And the other part of that too is that often because we have been go, go, go and usually putting other people's needs above ourselves, we're so eager for dopamine at that part of the day for a hit of something good, and we can get a very quick intense hit of that by opening the Oreos, getting some really salty chips. Those foods are literally designed and tweaked so that they really give us a huge flood of dopamine, and we feel that immediate reward in response to the taste in our mouth and the texture. And so it gives us what we've been sort of withholding from ourselves all day because we've been pushing ourselves so hard and usually in service of other people, and it's like, we're so thirsty, we're going to overdrink. If we paid attention throughout the day and took care of ourselves, we wouldn't have that desperation. Dr. Sarah Stombaugh: Right, exactly. And I think it's important to point out the dopamine piece. Sometimes we think about it as a psychological thing because it certainly has psychological impacts for us, but this is a physiological thing that happens in our brain when we look at functional MRI studies, we literally see the reward centers of our brain, which is where that dopamine is released and targeted. We see those light up in response to many things, but including food and especially processed foods, it does make us feel good. When we feel bad, it reliably makes us feel good. But the problem is albeit very temporarily. Dr. Megan Melo: Very temporarily. Dr. Sarah Stombaugh: Then it's gone. Dr. Megan Melo: And often with the tale of, I wish I didn't do, there's a tale of regret or shame or something else that doesn't come till later. Dr. Sarah Stombaugh: Exactly. Because when that hit of dopamine, because those floods of dopamine come from maybe not our true pleasures in life, but these things that are highly processed, whether it's foods, whether it's sugars, whether it's alcohol, whether it's scrolling, social media, yeah, all of the things, we get these floods of dopamine and then we feel badly afterwards. There's that dip and below baseline then where we feel worse. If you were trying to eat healthy and lose weight and now you've unloaded into a bowl of your favorite snack, you feel worse afterwards. Both physiologically and then psychologically. A lot of times there's a beating ourselves up that can come after that. So it's interesting. Talked about the mindfulness piece of it. A lot of times that step is huge just in paying attention both to why we're eating. Are we hungry? Is there some sort of emotion that's happening right now as we're eating? Are we even experiencing that food in our mouth, feeling the flavor and the texture and having the experience of it? Because a lot of times these paths happen so quickly, there's such well worn paths in our brain because we've repeated these behaviors over and over again. And so when we look at starting to change that behavior, I find it's often really frustrating for people because they want to just flip a light switch and for it to be completely different, okay, I know I'm emotional eating, so now I'm not going to do that. And when we look at sometimes there are certain medications, like many of the medications that we use for the treatment of obesity or the treatment of binge eating disorder that can be supportive in reducing some of these cravings, reducing some of these urges or food noise. Those can certainly be part of the picture. But even without that, there are people for whom they feel like they reestablish that relationship with their food and feel less compulsion towards Dr. Megan Melo: That. Yeah. Yeah. It's really interesting because, and I think you overlap with me a little bit in this. My obesity medicine training and my coach training were fairly close together, and what I observed is that neither one had the complete approach, but the blend of the two is really a more full toolbox because yes, I've got medications and those can help. And what they often do is people describe with binge eating disorder that it creates a little space for them to be able to notice that they're not really hungry to be able to decide, I don't actually want to keep going with this when they're kind of at the beginning of a binge. And that doesn't come immediately, but it comes with some space. But when we approach it from the other side, from kind of the mindset and sort of the curiosity about our emotions and checking in, that adds a lot of power as well. I noticed that for myself, when I started learning coaching tools, I was also launching my business and doing a lot of things that created a lot of anxiety. I remembered the day that I launched my website. Now I'm sure nobody actually saw it on that day, but I like, okay, I had to click the button and it's live in the world. And I found myself all day reaching for chocolate, and I'm literally reaching for the chocolate, which is a pioneer cupboard, and I'm like, what's going on here? Because I haven't generally been eating this much chocolate before, but with the coaching tools, I could ask myself like, oh, I noticed that I'm feeling anxious. I'm feeling anxious because I've just put this thing out into the world and my body's used to responding to anxiety with food and food that I don't necessarily eat as much of it other times or in a different way than I would like to be eating. And that was really powerful for me. And I don't think that's enough for all people either, but it might be enough for some people, and medicine might be too much for some, and medicine might be necessary for others. So having that wide spectrum of knowing that there's not one answer in either the medical side or the coaching side, but really a blend. Dr. Sarah Stombaugh: Yeah, I could not agree more with you. I think that having either the coaching and the psychological work and then layering on medications if needed, that is, it's such a powerful tool the way that you describe it. I love, there's just this sort of curiosity as you're talking about taking away the emotion. Because a lot of times when we found ourselves in that situation, and I can think back to being in similar type situations a decade ago versus a couple of years ago with and without those tools in my toolbox and the beating up of oneself of like, oh my gosh, I can't believe I just did that tomorrow. I'm going to get back on the horse or on the wagon, I guess tomorrow I'm going to get back on. Yeah, exactly. I'm terrible at all of those, but if tomorrow I'm going to get back on it and I can't believe I did that, and it's drama that comes up as a result of the behavior and we create this huge response, that's where whether as a therapist, whether it's a coach, that ability to sit back and look at it is a neutral thing. And so often, isn't it interesting that my brain wants to do that right now? The number of times, especially when I was pregnant, it's so fun for me. My kids just had birthdays. My boys did. So they're six and four, and then my daughter is one and a half. And it's so interesting because I got coach certified also similarly timing around doing obesity medicine 2020, 2021. And so I had my first and my second before any of this. And then during my pregnancy with my third, I was both a board certified obesity medicine physician, and I was a life coach and seeing the way pregnancy cravings come up and my response to them, I mean, we know that pregnancy cravings are real physiological cravings that happen, and our response to them, it feels like it just happens. It feels like it is this automatic behavior in our culture Dr. Megan Melo: [Cross-talk] Control here. It's just my thought. Dr. Sarah Stombaugh: Totally. I'm eating for two in our culture, we totally accept these behaviors, but I remember literally walking into the ice cream aisle, and I wish I could say this happened once, but multiple times. I love ice cream. It's a huge, if I could unwind it would for sure be ice cream. Dr. Megan Melo: Ice cream is my ride or die dessert. Dr. Sarah Stombaugh: Totally. Yeah. And so walking into the ice cream aisle and looking at, oh, am I going to get this one or that one, and maybe I'll get popsicles, and I'm like, whatcha doing? And not in a mean way, but just in this like, oh my gosh, brain, girl, you do not need ice cream right now that isn't it interesting that you're responding to an emotional trigger, a physiological trigger? Is this really something that I need right now? And that's where sometimes we're able to do that on our own, but oftentimes doing that with the support of a therapist of a coach, because when we're in the thick of it in ourselves, a lot of times we just bring this judgment. We get really caught up and frustrated with it. And so that ability to step back, look at your life, it was on a movie, for example, and think about, okay, what was the emotion? Because you're not going to flip that switch, right? You're going to look back at, okay, what was the last overeating episode, binge eating episode? What was the last time that you felt sort of out of control with your food? And let's really get granular and look at what happened there. And that ability to do that and start paying attention to was there hunger? Was there an emotion? What was the environment? And realizing all these things and bringing that awareness. Then we start getting to apply some of those failures. We start learning from those such that we can apply that to future situations. Yeah, Dr. Megan Melo: I think that's really powerful too. And I'll throw out there as well is that I think too sometimes we also need to start with medicines and go the opposite direction of starting with medicines to lower the episodes, lower the distress about how frequently they're occurring, how big they are, and then we can come to that emotional piece. And I think it nicely can go both directions, and especially for people like us who have the training to do it on both sides. Because in my medical practice, well my medical practice and my coaching arm as well, where I see a lot of physicians, people have different needs and it depends on all the things going on in their life. If they're deep in burnout and stress and these are really recurrent patterns and they feel very helpless, me talking about mindset and emotions isn't probably going to have much purchase because they're so distressed by what's going on. And someone else who has done a lot of the mindset work and has just not quite felt that that was enough might go the opposite way of starting with the emotion part and figuring that stuff out, but then also notice that they might need medications. I love that both of these things exist because like I said, each sort of side of it on its own to me felt incomplete. And I think that comes from my lived experience as somebody who grew up in a house where I haven't really thought about anybody else in the family sort of fall into the diagnosis of binge eating disorder, but probably there very much was a culture of overeating in my family of origin, and it was almost ritualized, but it was accompanied by parents who were working high stress jobs and constantly struggling with their weight and their bodies and their self image. And growing up in that environment, binge, restrict, overeat sort of cycles felt very normal. Dr. Sarah Stombaugh: It's very common, right? Dr. Megan Melo: And I think that that's a lot of people's lived experience in my age group having been a kid in the eighties and nineties and as we had more diet culture and low fat stuff. But just really thinking too that some of those eating patterns are so socialized that it's hard to tell what's normal. Dr. Sarah Stombaugh: You've learned them so early in your life and then practiced them. I mean, until you imagine even leaving for college at 18, you have 18 years of being socialized into a certain environment. That's hard. I think even it's like, oh, you don't make the soccer team. Let's go out for ice cream. Oh, your boyfriend broke up with you. Let's get a bottle of wine. These things that are so normal in our culture that they become the new normal. They're such common behaviors. And so it's funny because a lot of times we beat ourselves up when we're doing it, but everybody else is too. That's sort of how we've been socialized and taught to behave Dr. Megan Melo: Every single time. Makes me think of the dollar section at Target, because I think that's kind of where we see ultimately these messages show up and it's the little cheapo stemless wine glass that says it's wine o'clock or little other sort of very simple messaging about first I have coffee, then I talk to people or something about eating. Where are the treats? [cross-talk] Give you chocolate, right? I'm hangry. I mean, it's so embedded into things in a way that it wasn't before that again. Yeah, it's hard to tell what's normal. And then I find for a lot of my patients, when they start to try and make changes in how they're eating, they feel very isolated and stigmatized because they're suddenly and moving to eating in a way that I would call normal. They're suddenly abnormal because everybody else is emotionally eating. Dr. Sarah Stombaugh: Exactly. Dr. Megan Melo: And eating for reasons other than hunger, overeating. I was recently talking with a patient and she had started on Vyvanse for binge eating disorder and some metformin, and it was finally helping to decrease her appetite, so it felt good to eat less. It felt not hard. And she shared with me that she was out with her friend eating and they went to a place that they frequently went and where there's kind of individual pizzas and for the first time she didn't eat the whole thing, individual sort of servings. And her friend kept asking her, are you okay? Are you all right? You never not finish that. And she had to really convince him like, no, I feel good. I feel full, I feel satisfied. I'm going to take the rest home. But convincing them that it was like she wasn't going to continue to eat it just because that was a normal amount of food. She was tuning into her hunger in a way that she didn't usually or now could because the support of the medicine. Dr. Sarah Stombaugh: I love that example. And I think it points to, even as we're having success and feeling like we're becoming more aware of our emotions and our cravings and are experiencing treatment for these conditions, we're still in an environment a lot of times where there are triggers where there are other people who are maybe pressuring us and it can be a little bit uncomfortable. And so the awareness that may happen and being prepared for, and if the situation doesn't go as well as planned, I think about, I was having a similar conversation with my patient who was out with her friends and they commonly will go out for ice cream and they were on one of their regular ice cream runs and they had gone out to dinner and then they were going out for ice cream afterwards. I simply wasn't hungry. And I said, no, thank you. And they looked at me like I had 10 heads. I was like, what do you mean you're not going to get ice cream right now? And that shift sometimes we then feel really pressured into the situation. And even if that happens, even if you give in and end up getting in that situation, there's still so much valuable information to be taken away because if I was a betting woman, you'll find yourself in a very similar type situation again in the future. And so how would you handle that? What would be the solution to that problem? Because it's so embedded. Dr. Megan Melo: And it's sort of like I'm coming up with this weird term of it's socially sanctioned overeating. It's like this shared experience of it's more comfortable if I'm going to overeat if everybody else overeats as well. Dr. Sarah Stombaugh: Yes. Dr. Megan Melo: And of course we can't see into other people's stomachs and know if they're full or what they're feeling, right? But if you go out to a modern standard American restaurant where the portions are huge and people are getting multiple drinks and we know what stomach capacities look like and we know that that's probably more food than most of us need to feel satisfied, but we're so used to overeating. If everybody's plates are empty at the end and everybody's kind of leaning back and they're like, oh, so full, then we can see that we really have this shared culture where we routinely overeat and we routinely overeat together, and it sort of ties in this piece of it being sort of necessary for togetherness. And if I eat less, someone's going to notice or if I say, can we not do an eating focused get together? I dunno. Can we play a board game or something or go to a movie or movies always happen. You know what I mean? Dr. Sarah Stombaugh: Go for a hike. Dr. Megan Melo: Go for a walk. We're going to go for a walk. It can create some social awkwardness and sometimes too, I will talk to people about having those conversations with people that they normally eat with and that might be a partner at home because certainly partners can routinely overeat together. I take care of a number of couples, interestingly, in my practice. Dr. Sarah Stombaugh: I do too actually. Dr. Megan Melo: I start with one partner and usually we start some medicine and then not too long later I start seeing the second partner. And interestingly, they often end up on the same medicine because it's like, oh, that's what we take in our house, but we ate in social groups, so it might be a conversation with a partner of, I'm going to be making some changes to my eating, checking in, or do they want to make that change with me or do I just need to be clear that I'm changing the way I'm eating and it has nothing to do with you. It's not a reflection of my feelings towards you. It's a thing I'm doing for myself. I think especially for women, we are used to deferring to other people, and so sometimes we have to have those conversations, but it might also be with friends of I really want to spend time with you. Normally we go out and we eat and we have drinks, and I usually end up just eating too much or drinking too much. I'm wondering if we could do something different, could we go for a walk or a hike or maybe just saying, I'm going to choose to eat less and I'm going to stick to one drink and I don't want you to think that that means I'm not having a good time or I don't want to be with you. Dr. Sarah Stombaugh: I think that's such an interesting thing for the people in our lives with whom we're really close when it's partners, when it's really good friends to be able to set those expectations and almost boundaries around food and drinking in advance. I mean, what a phenomenal tool to be able to use. And I think being able to practice that, being clear with ourselves and then being able to share that, I love that. That's a great piece of advice. Dr. Megan Melo: It comes up in families of origin a lot as well. So let's say you're going to visit your parents and you're going to be staying in their house. A lot of people will share the experience and then my mom always makes all this food, or we have these big meals, or my aunt brings over such and such and everybody's sort of pushing food on me, recognizing that we are an adult now that we are actually in charge of what goes into our bodies, and we can choose to speak up for ourselves in those ways and let people know in a gentle way. I feel comfortable and maybe we have to have that conversation even before we get on the plane or the car. Just so you know, I'm changing the way that I'm eating, and I notice that every time I come home, there's always all this great food. It's fine if you want to make that, but just I don't eat that. And I'm choosing to eat differently now. I don't have to ask them to do anything different, but I do want to be clear on sort of what my intentions are the same way. Let's say I have an eating preference or a dietary restriction. I might let the host know if I'm going to a dinner at their house, but ultimately I can also choose to be responsible and not depend on them to come up with something that I don't know, gluten-free, vegetarian, whatever sort of thing. I can choose to have my own agency there so that I stay in control of what I'm choosing to eat. We don't think like that. We often think that we just kind of defer those eating decisions to other people. And that can be a huge barrier here, again, in reference to overeating or sanctioned social binging, if you will, but also just in so many of our relationships Dr. Sarah Stombaugh: And holding that boundary can be very simple. I don't want to say easy, but simple. So it can be a no thank you. Could be, I've been well served, that food looks amazing. Why don't I take some home for dinner? I ate before I came. Dr. Megan Melo: [Cross-walk] We can do a little line if we need to, or maybe we did eat before we came. Dr. Sarah Stombaugh: And maybe that's the way you get around it, right, is you eat before you come because you know that if you go to xyz event, the foods are not going to be in line with your goals. But then the holding of that boundary, and it's a practice thing, there's likely to be many situations. You show up and you sort of give in, and that's okay, right? You find yourself in those same patterns and you're human and you've practiced those behaviors for usually decades. And so take notes and apply it next time. Dr. Megan Melo: And sometimes this work ends up giving us more agency to navigate other places in our lives where we may need boundaries. So say you're in relationship to somebody who is constantly pushing food or alcohol or pushing something on you that you are trying to change for yourself. And let's say you have that polite conversation, you keep it centered and you of like, I'm trying to make this change and you don't have to do anything differently, but just so you know, this is what I'm going to make choices about. If you're getting a lot of criticism back, if you're getting a lot of, I don't know, negativity and lack of support for something that you're trying to do, that's a message for you, and that's important information, and that really dips deep into more of the coaching side of things. But I mean, how often does that happen for our patients in our medical practices, whether we're talking about food and eating and obesity, any of those things or not, but there's so much socialization that happens that influences our behaviors and doing this work in relationship to this particular instance. I think when we can start to see how are the other people in our lives responding to our boundaries, are they respecting them? Are they respecting our goals for ourselves, or are they trying to tell me, no, you're beautiful and perfect the way you are, and you should just eat this food. Or that's dumb that you have that goal or you're never going to lose weight. Why are you even trying? If that's somebody's vibe, that may be someone that need to set some limits with if they can't respect your boundaries, if they're going to continue to push back at you all the time, you get to ask yourself, how am I going to handle this dynamic in our relationship? And I think especially for those of us socialize as women where we're so used to deferring to other people's choices and other people's feelings and other people's needs, this is a big area of being able to recognize, I need to put myself first here. I may still go home to visit mom and dad, but if mom and dad are constantly sort of belittling my choices and not respecting my ability to make my own decisions, maybe I go visit them, but I don't stay in their home. I don't know. And then when we think about trying to tie this back to sort of binge eating, thinking about where this dynamic comes up as well, and binge eating ends up being something that is typically done in a little bit more privacy, but it still, it's still often connected with boundaries and difficult emotions they're often being dealt with afterwards. Dr. Sarah Stombaugh: Right? No, that's exactly it. Dr. Megan Melo: I didn't speak up for myself. I didn't get my needs met earlier and in response when I get home, I'm going to overdo it. Dr. Sarah Stombaugh: It's two different sides of the same coin, right? This sanctioned overeating, eating in response to all of these socialization factors and learning how we use food for any reason beyond hunger and how that plays out then in much more significant ways in our life. Yeah, I love this. Wow. What a fun conversation. Maybe not fun, deep and powerful conversation we just had. Tell me, Dr. Melo, as we're wrapping up, are there other things that we haven't talked about that you feel like would be really important to share as part of this episode today? Dr. Megan Melo: I think whenever I get the opportunity to participate in these wonderful conversations that really take a deep dive into the complexity, and we're not really deep diving in the medical complexity here, we're really talking about all the challenges that can present ourselves. It just goes to speak of you need the right supports in place in order to be able to navigate these challenges in your life. You and I have both had coaching, we have been coached through some of these experiences ourselves, and now we are a support person for people in that capacity using those tools in our capacity as obesity medicine physicians, we have advanced knowledge and tools that really help people to navigate some of these tricky issues. And like I said, I'm so grateful that it's informed by this coaching arm. I think that that really is powerful for people, but just for people who are listening to the conversation, just knowing that weight loss is so much more complicated than the magazine would have you believe, and it takes more than just showing up in a space, showing up in your primary care doctor's office and just saying, I want to lose weight. Tell me how to lose weight. And I think there's been so much tension in that particular space in the sort of primary care visits, which you and I are both family medicine doctors as well. We have that experience of the primary care room where we've got 15 minutes and 17 problems to address. We're not going to solve it in one little go like that. And I don't say that to have people lose hope, because I do think that there's so much power to working with someone who has some skills and training to be able to help navigate whatever challenges are going on in a person's life. But just to say that we should all take it out of our brains that weight loss should just be easy, straightforward, and any idiot can do it what we've been fed. And that's still what a lot of people are out there barking about. We shouldn't even have these medications and you should just be able to do it. And it's like, no. As you can see, it's so much more complicated and nuanced, and it can go really deep. Dr. Sarah Stombaugh: And it's the psychology and it's the physiology and the changes that come with our physiology after chronic excess weight, especially when we've had weight cycling, that regain and loss and regain and loss, it really takes a toll on our body. And in terms of our ability to be able and our brain, yes, I mean, absolutely. And so all of these new medications are such a phenomenal tool, and I think it shows the majority of our adult population in America is overweight and obese. And the reason why it's so challenging is because going against losing weight right now really means going against cultural norms. And it's been fun to see that message start to shift just slightly. There's still a lot of pushback, but starting to realize, wow, as a society, we don't really support the health and wellness physically, psychologically of our people in the way that we need to. And I love that there's been more conversation in that area. I am so excited. I think about my entire medical career ahead of me, and all of it's starting to change, and it starts with messages like this, and I'm so glad we got to have this conversation today. Dr. Melo, let me ask you if people are interested in learning more about you. A lot of work you do is in the physician burnout space, but tell me a bit about your practice where people can find you, where are you sharing all the good information? Dr. Megan Melo: Yeah, so on my physician coaching side, I'm at www.healthierforgood.com, and that's, I'm also on Instagram at MeganMeloMD. And that's really more kind of the mindset stuff and the challenges that we face as physicians in my medical practice in a small private practice where I do my obesity and family medicine care. And that's located in Seattle, Washington at Phinney Primary Care and Wellness. And so it kind of depends on what people are looking for, but both are out there. And actually I do have a YouTube channel for patients as well, and if you ask me what it's called, I don't know off the top of my head Dr. Sarah Stombaugh: We'll put it in the show notes. Dr. Megan Melo: Because I'm also starting to create more content that's geared towards these conversations about obesity and the complexities, including medications, but including some of these lifestyle and mindset matters as well. Dr. Sarah Stombaugh: Absolutely. I love that. Well, thank you so much for joining us today. This has really been a phenomenal conversation. Dr. Megan Melo: Yeah, thank you so much for the work that you do. As you know, I follow you as well, and I'm just always so impressed by just seeing how, in particular, it feels like women physicians are going out there and they're just changing the conversation. We aren't going to just sit back anymore and accept the way that we've been told to do things. It's like, no, we're getting out there and sharing information and sharing valuable content with people in a way that works for them. So thank you for the work you're doing. Dr. Sarah Stombaugh: Yeah, I love that. Yeah, you can find me all over social media. I'm on TikTok on Instagram, and of course, my weekly podcast. We're all listening right now, and I like to be a source of legitimate information in this really crazy world. So thank you for expressing that, and we'll see you all next week. Dr. Megan Melo: Oh, I'll say one thing I keep forgetting. I'm a fellow podcaster and you have been on my podcast, and the episode is coming out shortly, but my podcast is ending physician overwhelm, so I really sort of dive in from the lens of our work as physicians, but all that mindset stuff is there, and all this navigating and boundaries and burnout and the shared human experience of the difficulties of being an adult, frankly. Dr. Sarah Stombaugh: Yeah. I'm so glad you shared that. I have a lot of physician listeners, so go check out her podcast. Thank you all so much for joining us this week. We will see you all next week.