Conquer Your Weight

Dr. Sarah Stombaugh: This is Dr. Sarah Stombaugh and you are listening to the Conquer Your Weight Podcast, episode number 47. 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: Good morning everyone. Thank you so much for joining me today. As always, we've had a little break in the episodes here, so thank you for your patience. I have been working through some new and exciting stuff for my medical practice. As most of my listeners know, I have a telemedicine based weight loss practice. I see patients in Illinois and Virginia, and I am getting ready to move into an office space to start seeing some patients in person. And so if you live in Virginia in the Charlottesville, Virginia area and you have been skeptical about seeing someone by telemedicine, interested in seeing someone face-to-face, well, good news. I have a new office in downtown Charlottesville and I will be seeing patients there one day per week. I will still be doing mostly telemedicine, but I am really excited to be able to offer this to all of my patients. Today we are going to be talking about something, I always say this right, something really fun, which is calibrating your hunger scale. We have not talked about the hunger scale a lot recently, but I want to come and revisit it, both the basics and then how you can change and evolve that over time because the hunger scale, as far as I'm concerned, is one of the most valuable tools to be able to get in tune and in touch with what is happening in your body. So many of us are born with this very innate ability to know when we're hungry, to stop when we're full, and that over time we lose that connection because of all of these other factors eating because it's convenient eating, because our family is eating, being encouraged to finish our plate for whatever reason. We are eating beyond, we start eating before we're hungry, we stop eating. It may be way after we're hungry and we have completely forgotten what it feels like to feel normally hungry, to feel normally satisfied, and we often feel very extreme hunger or very extreme fullness. So I want to take some time today, revisit the hunger scale and then talk about how we can use that to our advantage in our weight loss journey and how you can start to hone in on that because it is going to evolve over time. So to start out, I want to take a minute and just go back and review the hunger scale. So if imagine this going back to third grade math, imagine a number line. So you've got this horizontal line across a piece of paper. You've got the ticks across it, starting at negative 10, progressing to less and less negative to zero, and then coming into the positive numbers up into positive 10. So if zero is our neutral point, imagine that negative 10 is as empty as ravenously hungry as you could possibly be, and then plus 10 is full to the brimm, like cannot imagine another bite of food you would give you physically ill. So this wide extreme, and then what does it look like in the more middle range? So working our way from what is the most extreme hunger, negative 10 feeling ravenously hungry, you are on a desert in the island, maybe you would eat your arm off of your body, anything in sight, it doesn't even matter. Like starving to death, negative eight, very, very hungry. I can't even stop to prepare. I'm eating anything that is in front of me. Anything that is convenient, negative six being oops, like I'm hungry. I should have eaten a little bit while ago. I am having trouble preparing dinner without snatching little bites here and there. I'm not going to make it to the next meal. I feel like I need to have a snack. I'm really pretty hungry. I should have eaten a little while ago. Negative four is the tolerable amount of hunger. This is the time where you want to start eating. Your stomach is rumbling, you're feeling hungry, but there's no sense of urgency to that at all. Negative two, the very earliest signs of hunger, if you're thinking like I could eat right now, and maybe this is a convenient time to eat because it's when you are out to a meal or you're sitting down with your family, but it's not a time that if you were just listening to your own signals that you would necessarily start neutral is going to be zero. So maybe you're partway through a meal, maybe it's been an hour or two after a meal, but really hunger isn't on your mind. Fullness isn't on your mind, not even thinking about food at all right now. Now we're starting to move into the positives. So plus two, we're starting to fill up. A lot of times this is partway through a meal. We know we want to eat more. We're very comfortable. We have desire to eat more bites. You could move briskly. You could go for a jog if that's something you could usually do. Plus four is feeling comfortably full. You've had just enough you could go for a brisk walk and feel comfortable. There's no discomfort. You feel like you've eaten the amount that satisfies you, you certainly don't need anymore. Plus six is like, oh, maybe I eat too much. Probably should have stopped a couple of bites ago, maybe a little bit of discomfort, but it's nothing serious. Plus eight is like, oh yeah, I definitely ate too much here. This is unbuttoning your pants changing into comfy sweats. And then plus 10 is, oh my gosh, I ate so much. I feel physically ill. I want to lay down, roll me down the hallway. I feel awful. So with that as our entire scale, negative 10 to positive 10, I want you to imagine that the ideal is that we are eating between negative four and positive four. So if you were left completely to your own devices, you didn't have any sort of external pressures like time or other people's schedules, you could just eat according to what you were feeling. You would start eating at a negative four when you have this tolerable amount of hunger and then you would eat until you felt a plus four where you feel comfortably full, there's no discomfort, you haven't overdone it at all. So when we start to pay attention at the very beginning, I will often give my patients the assignment of logging their hunger skill with their food. So I will encourage them at the beginning of a meal to check in and say, okay, how hungry am I right now? And assign a number to that. At first it feels a little bit arbitrary because you're taking something that is fairly qualitative and you're putting a quantitative value on it. So at first it feels arbitrary, and I would encourage you to just embrace that and choose the number anyway. So if you're debating like, oh, am I a negative four or negative five? It doesn't matter. Write a negative four, write a negative five, knowing that over time you can and should adapt this scale as you learn more and as your body changes. So you'll just choose. So this goal of starting with your negative four and moving until you're positive four. Now what the fun thing is, is that you can start to pay attention to how to hone in on that over time. So we talked about you should just assign that number in the beginning, it doesn't really matter. It's just about the practice of paying attention and assigning that value over time, though you may realize that what felt like a plus four? So feeling like, oh, I'm comfortably full. This was the appropriate amount of food six months from now, you may actually realize, oh, that's more like a plus five. What I thought was a plus four is actually a plus five. By the time that I am feeling full, maybe I've over eaten because I'm so used to overeating at meals. So six months from now, if you are feeling the same way you feel right now, you would call that a plus five and something new maybe the way you describe plus four. So plus four might now feel like I've had just enough. I've had enough to satisfy me, but I haven't gone overboard here. Another thing I really like to think about is units of food. So again, thinking about that number line just laid out on a page in front of you, if you imagine eating from a negative four to a plus four and you counted each of those values along the way, you are counting eight, right? So negative four, negative three, negative two, negative 1, 0, 1, 2, 3, 4. So there's eight between negative four and positive four. So if you imagine each of those as a unit of food, imagine that it takes you eight units of food to move from a negative four to a positive four. So as you get used to what is the appropriate portion size for my body when I am feeling this tolerable hunger, when I'm eating to a comfortable point, you can use that. Then when you find yourself in situations where you can't eat exactly to that negative four to positive four. So a common reason is we are at the mercy of some sort of external stimulus, whether that is our job, whether that is our family schedule, whether that is just going to a party sometime where you go out and if you were on your own, you may not have eaten right now, but you recognize that right now is the most logical eating opportunity you should be eating right now because of your schedule, and so you're going to choose to eat, but maybe you're not a negative four. So let's say that you go out to dinner with your family and you are a negative two on the hunger scale right now, but this is the time that it makes sense to eat. You're not really going to have an opportunity. Let's say you're going to a show afterwards. So you're going out to dinner with your family, you're a negative two. You're going to eat right now. One of the things you can do with a hunger scale is imagine if I'm starting in a negative two and I want to get to a positive four, that simply means I'm going to need less food. So the difference between negative two and positive four is six. So you are used to eating eight units of food, and in this meal you were going to choose six units of food because you weren't quite as hungry to start out with. Similarly, if you started at a more hungry number, being really cognizant of, okay, I'm starting at negative six, I want to eat to plus four, maybe you're going to need slightly more food. That can be a really interesting pattern to notice though, is that over time, as you start to log your hunger signals, pay attention to this hunger scale. You may notice that there are certain patterns arise. So for example, let's say you're going out to dinner and you get there and you're a minus six, so you're really pretty hungry, you're feeling a little bit of urgency. You wished you would've had the opportunity to eat sooner. It is very common in this situation that people will overeat. So when we are too hungry, we are likely to eat more quickly, to maybe feel a little bit sorry for ourselves, and all of a sudden we have eaten beyond that plus four. So this is the thing that you can pay attention to as you're logging your hunger scale. Okay, if I'm starting at a plus six, am I able to end at a plus four after I've had let's say 10 units of food getting to that comfortable fullness? Or is it a time where I'm going overboard because many of my patients will tell me that they are more likely to go from a negative six to a plus six, for example. They are likely to overdo it when they started out as too hungry. So paying attention to those units of food can be a really great way of calibrating that so that you're not going to overdoing it. Another thing you can do, I love being able to combine the hunger scale with the food log because this can start to give you feedback as to what foods are helping to make you feel full as well as keep you feeling full. So I'm going to give two examples of what we would perceive as a healthy lunch. So if you imagine that you make a salad and let's say it's a salad with romaine lettuce, it's a Caesar salad, it's got a little bit of cheese, a little bit of chicken, but you try to go light on the dressing, you don't do any croutons because you're trying to do low carb and you have a salad at the end of the meal, you feel plus four, you feel like you ate to a comfortable fullness. Now it's lunchtime. So let's say this is 12:30. By the time you finished lunch now that afternoon, maybe you were feeling ravenously hungry like I need to eat a snack right now. As opposed to if at lunchtime, even if you had the exact same salad and you had maybe a larger amount of chicken on it, you made sure there was plenty of cheese, you had a good serving of dressing, which had lots of fat in it. A lot of times we're talking about olive oil, really healthy fats, but even some saturated fats are going to be okay because they are playing a role to help us feel satiated longer. And so you may feel very similarly at the end of the meal in terms of fullness because the volume of food may have been very similar. But what happens is when we've had more fat, when we've had more protein, those help with delayed satiety. So when you've had those, those are more likely to help you continue feeling full through the afternoon to dinnertime, and so you can start to pay attention to, wow, even though I thought I was making a healthy choice and I did make a healthy choice, it ended up being a problem down the road because I was so hungry that I ended up having a snack that I really didn't need, or a snack that I wish I wouldn't have had to feel like was important for me because I was so hungry. And so then you can use that over time to say, okay, isn't it interesting when I am more satisfied at lunch because I'm having more fat, because I'm having more protein that helps carry me over until dinner without needing that afternoon snack? So that can be a really good way to combine both your food log with your hunger scale to be able to pay attention there. One of the things I want to think about specifically for today and what we haven't talked about before is recalibrating our hunger scale. So we talked about it briefly in the context of you're just going to have better awareness as you practice doing this over time, but there are other reasons that your hunger scale will calibrate as well. And two of those main reasons are, one, you have lost weight and your new body has a new hunger scale, and two, maybe you're taking weight loss medications. So let's talk a little bit about your weight loss journey. If you imagine the amount of energy that it takes to move a 300 pound body, for example, more energy is required to move a 300 pound body than the amount of energy required to move and run a 200 pound body. So if you start your weight loss journey at 300 pounds, for example, and you think about how hungry you are, how full you are over time, it is going to require a different amount of food to feel satisfied and a different amount of food to run your body. When we look at calories, people think about calories in the context of food, but calories are really just a unit of energy. So when we eat food that is providing us with energy that our body can utilize in order to fuel our activities, whether that is our basic activities like just breathing and sitting and existing, or whether that's talking about exerting ourselves in a more physical way, like an exercise or manual labor, for example. And so when we look at calories, when we look at that as energy, simply a larger body requires more calories and a smaller body requires less calories. So people talk about, oh, my metabolism has decreased and it will, and that's okay. It shouldn't plummet, right? There are people who go on very low calorie, very restrictive diets where they're not paying attention to macronutrients, they're not paying attention to the time in which they're eating. Their body really plummets its metabolism because it feels like it's dying. But assuming that you are emphasizing proteins, emphasizing healthy fats, emphasizing fiber in the diet that you are maintaining a physical activity level, there will be a drop in energy need, and that is normal, and that is to be expected. What's important though is that your food amount will change over time as well. And so you can use your hunger scale to realize, okay, the units of food here are shrinking, so it might take me less food to move from that negative four to that positive four, as I have success on my weight loss journey. Similarly, when we look at medications that suppress the appetite, whether we're talking about medications like phentermine, whether we're talking about some of the newer GLP one medications like Ozempic, Wegovy, those medications all work to suppress the appetite in different ways. And what happens with that is that our hunger scale is also going to shrink down. So if you could imagine maintaining that same 20 point number scale from negative 10 to positive 10, and let's say that that is 10 inches long, if you are on a weight loss medication, your appetite is suppressed, your hunger scale is going to shrink down. Let's say it shrinks down to a five inch long number scale. And so each of those units between each those dashes is going to be a smaller amount, and it's simply going to require less food to move across your hunger scale compared to when you are not taking weight loss medications. And so it's really important to be able to hone in on what am I feeling right now, and then being open to allowing that to change. Because so often, especially if you have any perfectionism tendencies, you want to sort of get it right from the beginning. We want to hone in on it at the beginning. We want to just assign these numbers. We want to get it perfect, and then we may have trouble adapting it over time. So recognizing that if you are doing the hunger scale and you are doing it appropriately, it should be changing over time. If it doesn't change over time, there's probably something that you're doing wrong in order to something that you were doing where you were paying attention to what it looked like before as opposed to allowing the evolution that will naturally occur. So I wanted to share this with you all. If this is something that resonates with you, many of my patients love the Hunger Scale. It can be a tool that you use while you're at mealtime. It can be a really good tool if you're just checking in. Let's say you walk down the hallway at work, you see some cookies in the break room. If you can just check in with your hunger scale and be like, oh, no, I'm not even hungry. I'm a plus two right now. I ate lunch an hour ago. That can be a really good way to just check in at any point. Oh, yep, not even hungry. That means I'm not going to eat right now. You can use this tool in many different contexts in order to help you in your weight loss journey. If you are interested in learning more about tools like this, go ahead and come on over to my website. I would love to connect with you. It's www.sarahstombaughmd.com. That's S A R A H SS T O M B A U G H md.com. The link is in the show notes. If you're in Illinois or Virginia where I'm licensed to see patients, I would love to see you either by telemedicine or in person at my Charlottesville, Virginia office. I look forward to hearing from you soon. I'll see you all next week. Bye-bye.