Conquer Your Weight

Dr. Sarah Stombaugh: Before we get into the episode, I am thrilled to announce we are launching an online course, The GLP Guide. The GLP guide is a must have resource for patients who have been prescribed any of the GLP medications such as Wegovy, Ozempic, semaglutide, Zepbound, Mounjaro, tirzepatide, Saxenda, liraglutide. There are a lot of them and this course is available for anyone to purchase. We often hear from people who haven't been given much information about their GLP medications. No one has told them how to handle side effects, what nutrition recommendations they should follow, or what to expect in the longterm. And it can be really intimidating and simply frustrating to feel like you're alone in your weight loss journey. With the GLP guide, you'll get access to all of the answers to the most common questions for patients using GLP medications, not sure how to use your pen, struggling with nausea, wondering how to travel with your medications. We've got you covered for only $97 for one year access. This is an opportunity you do not want to miss. The course is launching on October 1st. For more information and sign up, please visit www.sarahstombaughmd.com/glp. You don't have to be on this journey alone. We are here to guide you. And now for today's episode, 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. You guys, we are celebrating episode 100. I'm so excited to be here. Thank you for being my listener and celebrating today with me. I'm going to spend the first couple of minutes here sharing why I started this podcast, what you can expect over the next time to come, and then we'll talk about what are some of the biggest lessons I've learned that I think are most important for you to get started on your weight loss journey today. So first of all, I just want to say a big thank you. If you have been listening to me since the very beginning or if you are a new listener and everyone in between, I am just so, so grateful for you, for your listenership every week. Thank you for being here, for sharing on this journey with me, for especially those of you who have reached out and asked questions or those of you who've been doing the work all alongside quietly and celebrating those wins on your own. I am just so grateful for your listenership and if you would do me a huge favor as a present to me for 100 episodes. If you have not yet left a rating or review wherever you listen to podcasts, I would really appreciate you taking just a minute to do that so that this podcast can get into the ears of even more people for whom it could be helpful. And let's talk a little bit about where things have gone and why I started this. I can hardly believe when I decided to start this podcast that here I would be 100 episodes later and still going. I started this podcast to be able to be a platform to share my voice and be clear about what it is in the medical weight loss space, how I'm supporting patients, both thinking about their medical history and medications, but really thinking about that comprehensive support, making sure that people have nutrition guidance, exercise guidance, sleep guidance, all of these things that can be related to our weight that we need to make sure without getting the support in our weight loss journey. I wanted to people to know, hey, this gal is legit. She has a message that makes a lot of sense and for a place for both people who were getting to know me to learn more about me, decide if my message was in line with their goals. And then for people who have been working with me for a long time, for my patients, sometimes when they are on vacation for example, or they've got a specific topic, will say, Hey, I think you need to go back and listen to whichever podcast episode is in line with a question that they might have. So it's been a fun way that I've been able to support people, whether they are my patients or whether it is a much more broad audience. And one of the things going into private practice, I see patients in Charlottesville, Virginia in person. I see patients by telemedicine throughout the states of Illinois and Virginia. And there's a lot of people in a lot of places that right now I cannot see. And so this is my opportunity to help a much broader audience. And those are from some of my favorite stories. I have patients reach out at friends or family who I didn't even know had been listening who will reach out to tell me that they have been listening to my podcast and starting to implement some things and have been able to lose some weight on their own. I've had people who've lost 10 and 20 pounds before starting to work with me. And that's really fun for this to be a great way for you to jumpstart some of your weight loss goals. And I'm so grateful to have been a part of that for many of you. Now, one of the questions that has come up is what is happening with the podcast? Will this continue to be out there? And I will tell you, I have no plans to stop. I certainly will at some point. I don't think I can do a podcast forever, but at this point that is in the far, far off future. I will be keeping up this podcast for a long time and it's kind of amazing that I continue to think of topics. Thank you for those who have reached out and shared ideas with me. I love getting those ideas from you, my listeners, to be able to answer the specific questions that you have. It's really funny. This is a huge topic that there's all of these nuances, questions that we're answering specific circumstances, and I'm so grateful to be able to dedicate the time to talk about each of those different things. I still have to laugh. I had someone who's very close to me after about, I dunno, 10, maybe 15 episodes. They're like, okay, so are you done? I think you've addressed it all. And I was like, am I done? What do you mean? I'm just getting started. And over the last couple of years you have seen that that's true. We've got all sorts of different episodes. I'm always thinking about new answers for questions. People bring things up on social media that we want to address. And I don't know, I think I'm going to come up with ideas for a long time and I appreciate your support with that. So with that in mind, if you have a podcast episode that we have not yet addressed, something that maybe needs a little bit more detail, even if it's a question that feels really specific to you, it's common that many, many people are struggling with something similar or some variation of. And so reach out, shoot me an email at info@sarahstombaughmd.com. I would love to create a podcast episode just for you addressing the questions that you have. We'll put that email in the show notes so you don't have to remember it or learn how to spell stombaugh correctly. That will be for you in the show notes, but we're still going and I have no plans to stop. So what I want to do to today is talk about, as I reflect back over the last couple of years, what are the things that I have learned and really stand out to me as the most important pieces in the weight loss journey? And the piece that I have known from the beginning and believe even more so to be true today is that losing weight is comprehensive. We talked about this just at the beginning, but whether it's nutrition or movement or sleep or stress management, maybe it's our other health conditions, maybe it's learning about medications to support our weight loss goals or surgery to support our weight loss goals. Losing weight in a permanent way is going to require a comprehensive approach. And any approach that is not comprehensive, if you're thinking about any one intervention alone, just overhauling your diet or just just taking a medication or just working on one thing is not going to create that for you. And that's not to say that starting out on this journey, you need to just change every single thing about your life. We often will take a very layered approach where we're working on one topic at a time and building that or rebuilding that foundation of all of these different pieces. But all of these pieces make sense and are really important to incorporate. And it's common that I find with people that they are working on one or two of these things, but if they have an area that's really challenging for them that it can make the rest of it just not fall into place. So for example, people for whom have very, very stressful lives or living in a state of just chronic stress, chronic overwhelm, anxiety, it is challenging to apply the nutritional principles to get adequate sleep. Your body is in this constant state of sort of fight or flight. And it's very common that for people who are sort of doing all of the right things, if they have this chronic stress or poor sleep that can throw the rest of it completely out of whack such that none of it really works in the way that they need it to, or people who start a medication without working on lifestyle intervention like movement, like nutrition changes, that it doesn't allow us to make the comprehensive change that supports the most robust change that is possible. And so we know that patients who start on GLP medications or the GLP GIP medications like Wegovy, Ozempic, Zepbound, Mounjaro, semaglutide, tirzepatide, that for patients using these products, they have much more significant results when that is combined with nutrition changes, when that is combined with movement changes, when that is combined with sleep and stress management and all of it is really important. So each of these tools is important and they're just one tool in the toolbox. And so that comprehensive piece is super important. Again, it doesn't mean that everything has to change at once, but it can be layered on in this sort of stepwise fashion to make sure that we are addressing all of those things. Now, the role of medications, whether we're talking about the GLPs that I just mentioned, whether we're talking about other medications, because even though the GLPs are the most popular kids on the block, there are certainly other medications used for the treatment of weight management that can be really valuable as well. And one of the important things here is that for people who've had chronic excess weight, there's a lot of hormonal changes that come with that. So whether we're talking about insulin resistance or leptin resistance, we know that once someone has struggled with their weight for a chronic period of time, a lot of times lifestyle interventional alone like nutrition changes, like exercise changes, that those alone may not be enough. And so the combination of those with medications can really make a big difference for people and that these may need to be chronic medications. This is a conversation that I would have one-on-one with any one of my patients to help them decide what makes the most sense for their body and for their goals. But these are designed as long-term medications and we have really great safety data to show that, especially when combined with all those other lifestyle pieces that they can make a really huge difference and shift those physiological changes that have become sort of out of whack over time. Now, throughout all of this stuff, I think one of the pieces that has become most crucial in my opinion is the mindset and understanding both why do you want to do this and what are the things that come up as obstacles, as roadblocks as you're going. So with that mindset piece, I really like for my patients to tap into what is their why. We have an episode in the podcast at the very beginning talking about your big why. And if you haven't stopped to explore, why do I want to lose weight? I think that this piece is really, really important because at the beginning it's really exciting. You're making all these changes, you're starting to see some weight loss, you're feeling really good, but depending on your weight loss goals and your rate of weight loss, it takes time. Let's imagine a person who has a 100 pound weight loss goal. For example, I will often advise my patients to lose about one to two pounds per week on average. Now, for some people that may go faster that for some people it may go slower, but this is a really good sort of average middle of the road mark that a lot of my patients are in this range. And at one to two pounds per week, if you had 100 pounds to lose, for example, that would be about two years, one to two years, but let's say about two years to lose that 100 pounds. And so in the beginning when it's super exciting, you see five pounds down and 10 pounds down and 20 pounds down, all of that feels really good. But it's very common where maybe we hit a plateau and we're like, oh my goodness, am I ever going to move past this thing? Or maybe it's still working, but we're just getting kind of bored. Maybe six months have gone by and you're like, okay, I've been doing all the things. It's been six months, but I've only lost 30 pounds. I guess I keep doing this. And it's funny because it's hard to imagine that we would ever take that for granted or feel bored during this process, but that very frequently comes up for people where they're like, oh my gosh, can I just be there already? And so going back to that underlying, why do you want to lose weight? Are there short-term goals that are important for you? And more importantly, are there long-term goals that are important for you? Is there something specific about your health that would be different if you lost weight? When you think about your longevity and your ability to be around there for children or for grandchildren, when you think about your movement or you think about hobbies, does this change the way that you're able to travel or bring up old hobbies like horseback riding for example, or maybe to have a surgery and improve orthopedic problems. Maybe it means for pregnancy's sake and then for being a role model for your children, what are the reasons that it's important to you? Now, you may be thinking about this and your reason might sound kind of silly. You might not want to share that with anyone, and you don't have to. That can be something that is really private and I totally get that, but I want you to tap into it to know it and to understand it because reminding yourself of your big why when you're bored, when you're at a plateau, that is one of the biggest factors that will keep you going is just like, Hey, this is why I'm doing this thing. I know I'm hitting this challenge or this obstacle right now and this is my why. This is why I'm going to keep going. This is why it's so so important to me. The other piece of it is having a open mind and starting to understand our belief systems around food. And it's really amazing. So many of my patients say almost these exact words to me of, I know so much about nutrition, I could write a book upon it, yet I don't implement those things in my life. And if that is you, I just want to say it's okay. You are a human with a human brain who was raised by parents and in a society with friends that had other belief systems around food that you have probably inadvertently adapted into your belief system. So let me give you a couple of examples of things that in your weight loss journey are likely to come up and are really, really important to tackle. So things like wasting food, for example, what does it mean to waste food if you don't eat your entire portion? For example, if you are out and about and given a much larger portion than you would typically eat if you are a guest somewhere and a portion is different than you would typically eat, what does that mean to you when you have a certain amount of plate on your food, when there is more plate on your food than you would typically eat? How do you handle that situation? Are you open to exploring this idea that it's really pretty wasteful to eat food that your body doesn't need? When you think about starving children in other parts of the world, for example, does you eating every bite on your food or every bite of food on your plate, does that do anything for the food chain, for food supply in other parts of the world that are really struggling and starting to question, how is this serving me to eat? Behave in this way? Because you may be really surprised to find out, oh, it's not actually helpful for me and there are other solutions to this problem. I have an episode about wasting food, for example. But can you take home leftovers? Can you share or split a meal with somebody? Can you make a donation to an organization that supports hunger in other parts of the world? If you're feeling guilty, what are the things that are better in line with your goals and are supporting you rather than eating food that you don't necessarily need? Or thinking about portion sizes, for example, a lot of times, especially if someone else has served us a food, we aren't stopping at the beginning of the meal to think about how much food we actually need. Our brain plays a trick on us by which we see an amount of food sat down in front of us and we commonly eat the entire thing if we're not being mindful about that. So tapping into what is our hunger? What is our fullness at the very beginning of the meal, eyeing the amount of food in front of you and saying, okay, how much of this do I really think that I need right now? And maybe taking your fork and knife and separating that out so that you can see, okay, this is the amount that I need. I have patients who ask for a to-go box with their meal being delivered at the table and from the very get go, put half of the portion into A to-go box so that it is both out of sight. And so then out of sight and hopefully out of mind because sometimes when it's on our plate, we get wrapped up in conversation, we're not really thinking about it, and that food can quickly disappear into our mouth. So thinking about what is the portion size and how does that make sense for me, maybe it's thinking about our role as a guest or our role as a host. A lot of times we think that we need to eat certain foods if we're a guest at somebody's home and they've prepared dessert that we need to eat that dessert. Now, I'm not saying that you can't. If you are hungry and it's in line with your goals and you've planned for it, go for it. I do not believe that we should eliminate whole food groups from our diet. But if you find yourself in a situation where maybe you don't even like the dessert that much, maybe you were completely dissatisfied with your dinner and didn't realize there was going to be dessert, so now you're perfectly satiated and dessert is being offered to you. Maybe it's like I said, a food that you're really not even that excited about it, but it's like, ah, it's sweets. I won't turn that down. Starting to think about why is that challenging for you? Is it because you want it or is it because you feel like there is an expectation about your role as a guest in a situation that you should be eating something? Anytime that you feel like you should do something, it's really good to question, okay, why am I actually doing this? Am I doing it because somebody else told me to or wants me to? Or am I doing this because it's actually in line with my own and my own belief system? And there's dozens or hundreds of more examples that we could probably talk through, but just starting to pay attention to as I go about my life, what are the times that are really challenging for me? And a lot of times it will be these belief systems that we're bopping into that are just not in line with what we need for our future goals. The other piece here is learning to reconnect with our body. I talked briefly about hunger and satiety signals thinking about portion sizes, but one of the things I've taught from the very beginning and continue to teach every single one of my patients is about their hunger and their satiety, tapping into what it is their body's asking for when their body's asking to stop. Recognizing that many people who've struggled with their weight chronically may be these signals may be really out of whack. And not even just because we've been ignoring them because of signals like insulin resistance or leptin resistance. These signals can be really out of whack. But starting to pay attention to are there certain foods that make me feel more satiety? For example, are there certain times of day where I'm likely to experience hunger or where I'm likely to feel less sat tidy? Are there things that I really need to pay attention to? And how do I start to hone back in on that and redevelop that connection over time? Because reconnecting with your body is absolutely one of the most powerful things that you can do. The other thing I want to share is that how can we just get 1% better every day? And I say this to say, we talk about that comprehensive approach, making sure you have nutrition and movement and sleep and stress management, maybe weight loss medications or surgery and other health things are addressed, and it becomes a lot. And when we think about just totally overhauling our lives, that can be really overwhelming. And so what I will often encourage patients to do is think about how can I get just 1% better every single day? And when I say better, I don't mean morally better. You're not a better human because you're in a certain body size or because you've eaten a certain way, but just more in line with your goals, how can you do that 1% more in line with the direction of your goals every single day? Because every single day, if you just make this little shift, all of a sudden it starts to add up in a really explosive way such that after six months, after a year, you'll become completely unrecognizable both mentally and physically. And that is such a good challenge, just, okay, yesterday, this is how I approached it. What is something I could do today? What is something that would be a little bit more in line with my goals? What is something I really want to think about, have has of a priority front of mind for today? And just starting to focus on how can I just every day take steps in the direction of my goals? The other piece is that you don't have to do it on your own. Our society's obesity bias is such that there is often this narrative that you should be able to lose weight on your own. That if you need support from someone like myself or another physician or another planner program that you have in some way failed, that you're not able to do this and that, okay, now because you failed, you need support from someone else. And I will say that is our society's obesity bias. The reality is that chronic excess weight is a medical condition, no different than any other, no different than high blood pressure, no different than diabetes, no different than asthma, no different than heart disease or cancer or anything like that. We would not expect patients to tackle those things on their own. We would expect them to have the help and support of a physician. And so if you have been in this journey alone, and maybe it's even been going well, but you feel like, Hey, I'd just love to check in and see if there's anything I could be doing differently. Or maybe you've hit a plateau and you're feeling a little bit frustrated, or you feel like, man, if you're some of my patients who are like, I could write the book on nutrition, but I can't implement it. It's time to get support. And it's absolutely okay to ask for support. And if you are someone who's been listening to this podcast alongside another physician or another program or something, I think that is phenomenal. But if you've been listening to this podcast and you're like, gosh, I really wish I had someone who could help me with these type of things, I'm going to tell you that that is absolutely possible. And if you are in Charlottesville, Virginia, or anywhere in the states of Illinois or Virginia, I would be so happy to support you in my practice. And you can learn more about my practice at www.sarahstombaughmd.com. But if you are somewhere else, if you are elsewhere in the country and looking for support, you can look for a board certified obesity medicine physician or reach out to me. I would love to connect you with someone I know who is geographically in your area because it's okay to ask for help. And whether it's me, whether it's someone else, can help you to start to tackle each of these things to make your health in line with everything that you've been trying to do. And so I am so excited for you, my listener. Thank you so much for being with me in today's episode throughout this journey. Thank you for celebrating 100 episodes together. I will be here next week and the week after that. And if you have questions, you let me know because I would love to answer those for you. Thank you for joining me today. I'll see you all next time. bye-bye.