Conquer Your Weight

Dr. Sarah Stombaugh: This is Dr. Sarah Stombaugh, and you are listening to the Conquer Your Weight Podcast, episode number 35. 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: Hi everyone. Thanks for joining me today. I am so excited for today's episode because we have a guest, Dr. Manzur Moidunny, and this is really fun. We didn't realize this when we were recording, but on the day that this podcast airs is actually his birthday. So happy birthday, Dr. Muny. I'm glad we can share this on your birthday. And to all of my listeners, I hope you enjoy our conversation. Hi, everyone. Today we are going to welcome our guest, Dr. Mansour Moi. He practices obesity medicine and lifestyle medicine, and we're going to talk a bit about exercise and how that plays a role in the weight loss journey. And I'm so excited to have you here today. Thank you for being here. Dr. Manzur Moidunny: Thank you for having me, Dr. Stombaugh. Dr. Sarah Stombaugh: Yeah, so start by telling us just a little bit about yourself, how you got into obesity, medicine and lifestyle medicine. Dr. Manzur Moidunny: Yeah. I've started practicing about three years ago now, about three, four years ago during my residency in training before I even knew obesity medicine was a thing. I thought it was, Hey, let's let's help some of my patients lose weight the same way I've lost weight and let's see if I can get 'em off some of these blood pressure and diabetic medications. And let's be frank so many of our patients are interested in weight loss and just living a better quality of life. And I think we, like we discussed before, like my personal journey, I was able to lose 70 pounds just diving deep into, you know, how to lose weight and getting into shape and everything I've learned I wanted to share that with my patients. And I've started doing so, and it just became part of my practice. And it wasn't later until I saw an ad for obesity medicine and the person who I actually interviewed with, you know, there's an obesity medicine association and you should check it out. Yeah, so that's how I discovered there was an actually a field of this and this practice. So I kind of discovered it kind of just, Hey I want to use, you know, these tools and techniques that I've learned to help my patients. And here we are. Dr. Sarah Stombaugh: Yeah. Well, and it's so interesting, I think for those of us who come from a primary care background, things like obesity medicine or lifestyle medicine, it encompasses really a little bit of everything, right? It encompasses the preventative, it encompasses taking care of the high blood pressure or the diabetes, or whatever other medical problems a patient may be having. And it's such a fun way to be able to address it from the root cause rather than addressing sort of the end symptom of what may be the result of excessive weight gain. Dr. Manzur Moidunny: Yeah. And and I've kind of doubled down on that a little bit and realizing how much of lifestyle medicine that I use in my approach to obesity medicine, just getting that root things that people need to be doing for a better quality of life and health. And it's a big part of my approach. Dr. Sarah Stombaugh: Yeah. Well, let me ask you, if I was a patient in your clinic and I'm coming for my first appointment and we're talking about weight loss, what are the biggest things that you're going to take away for some or give to someone to take away if they're saying, Hey, I've never done this before. I wanna get invested in diet or exercise, or whatever it is. What are you sharing with them? Dr. Manzur Moidunny: So I think like, the biggest thing right off the bat I kind of try to convey is that it's very much possible. I think in kind of like just, just being so, so much more educated on the field, I've also realized that there's so much confusing information out there. Yeah. With all the products with the techniques. it, it just, it's like, I feel like sometimes, like when you probably, you know experience this too, you hear something in the news and you're like, wait, what? You are like is this, and I have to go do my research and ask some experts, my specialist friends, Hey, have you heard about this? Like, and if it's as confusing for you and I, can you imagine actually the, like the regular person who's hearing all these news about all this type of weight loss fads and everything, they, it, it's hard to navigate all of that. So I kind of let them know, Hey, this is very much possible and we're gonna, we're gonna figure this out slowly. it takes some time and sometimes it's not slow. Sometimes it's, it's fast if they pick up right away but I convey that. So, and then, and then it, it's a slow process of collecting some information and I kind of in my head plan things out short term and long term and expectations, and it's easier to do that when you have good rapport with your patients. And part of me ability, my ability to have rapport with many of my patients and earn their trust is especially during my residency training, they've seen me when I was day one, an intern or you know, day 60, and I was a little bit, I was always been like a hefty guy. People thought I was big guy. I played sports, I played basketball and soccer, and it just thought, you know, I had a lot of muscle on me. But over the years with sedentary lifestyle med school and everything that turned into mass and maybe not muscle mass. Dr. Sarah Stombaugh: Sure, that happens. Dr. Manzur Moidunny: Yes, that happened. That very much happens without us knowing. And they've seen me shed a lot of that. And I remember during COVID, COVID very much took place during my residency years, and there's a period of time where they didn't see me. And that was a big portion. I had kind of went from losing about 30 pounds to like 50 pounds during that period. And when I came back, they, they asked me. Dr. Sarah Stombaugh: What? Dr. Manzur Moidunny: No, actually many of them didn't recognize me. They're like, wait, is that Dr. Manzur Moidunny? So they've seen that transformation and like they didn't question what I had to say. So that was the biggest thing I convey is it's like, this is very much possible, and then I plant the seeds because I have that rapport with them. I can give out like small homework assignments of information collecting right away and that's often just tracking their steps and tracking their weight and tracking the number of vegetables they're eating. So that's how I start out for new patients for, for new patients that, that know me, just simply, Hey, this is what we're gonna do, trust me, and they trust me. And they come back in a month tracking all that. And just by tracking alone, sometimes with some small tweaks, they've lost one to two ponds with small changes. Dr. Sarah Stombaugh: Yeah. Well, absolutely. I think that it, that's so compelling to be able to say, not only have I studied this as a physician, I am, you know, board certified. I work in primary care now. I've studied obesity medicine, I've studied lifestyle medicine. I have all of this knowledge from a medical standpoint, and I applied it for myself. So let me show you, like I, I know from both the patient side, from the physician side, and then using that, I love how you, you use the language we a lot, which I think is so powerful because it's not like, Hey, I'm the expert and you don't know anything. Or like, you know, we're coming in this together, we're collaborating, let's talk about you and what's working. Let's get some logging going on. And that's so important to bring that intentionality. Tell me, you mentioned steps, and we've talked about from an exercise standpoint, that's really something you make sure to work with in your patients. What kind of step goals are you giving them at an initial visit? Dr. Manzur Moidunny: So it all depends. So what I do is sometimes I do some, you know, info finding right there with the patient if they have an iPhone, you know, sometimes I'll start by how many steps do you think you're getting daily? And most folks actually do not know so I, you know, if they have an iPhone which is the easiest to do. I it is just do you know you can track your steps on your iPhone? Most will say no. And then I'll just have them pull it out in front of them. And usually there's a health app right there. And sometimes it's already set up, but if it's not, it takes like 30 seconds to set up. And then we took it has been logging since they've gotten the phone, so they'll take a look at the logs. I'll take it right there. This is what you've been walking around while you've had your iPhone on you. So most patients, now here's a little shocker, like most patients are getting less than 3000 steps per day. And we, we know that's, you know, basically that's inactive. and so I kind of, and, and usually there's a little bit of a pause, it's like, huh, you know, I didn't know I was not moving that much. So I kind of get them to an understanding. And usually so many of us have iPhones that's more than half my patient, maybe 60%. So it's just an assessment of where you are. Really, the goals I set is, you know, we hear the, the numbers like 10,000 and everything, which is great, you know, if we can get there. I try to get my patients there. It's really an extra one to 2000 by the time I see the next. So if they're at like 1500 or 2000, I'd least say, let's, let's bump up, you know, how many more steps in just 2000 more steps, you know? Yeah. Or 1000 and, and sometimes 1000 steps is extra is an appropriate goal because some are patient of arthritis and, you know, c o P D 1000 steps is, is, is a significant amount for them. And, and it's also a significant amount to cause positive change just enough. Yeah. Dr. Sarah Stombaugh: So I agree. And especially in the setting of sometimes we set these really lofty goals, like, oh, I should be getting 10,000 steps every day. You are getting 3000, now you're getting 4,000, and you're like, oh, man, I can't believe I didn't get my 10,000 steps. Feels really kind of crummy compared to let's set a goal and build up to that slowly. Dr. Manzur Moidunny: Yeah. And I tell them- I kind of gauge who I'm speaking with, you know, something I often table. You don't need to do anything different. I'm not asking you to do anything different. Usually I have this philosophy I think many of us have adopted in the field that we focus on increasing positive habits and kind of hope to build them up and they kind of clear the table and create these positive habits and clear the table of the negative ones slowly. Most of our patients know what's bad for them without, and talking about it sometimes causes, we're focusing on the negative, so just, I tell don't do anything differently, but I'd like for you to get 1000 more step in maybe one more serving a vegetable per day, and let's focus on just getting that. And literally, if they get just that 1000 step in, don't do anything different. They're in a calorie deficit from where they were previously for their maintenance energy intake, and they're losing weight. Dr. Sarah Stombaugh: Well, I love that positive spin because I feel like so often we are focused on the negative, even just like evolutionarily, right? Like, we are designed to remember negative things that happen to us because it helps us to remember like, oh, don't eat that berry because someone else in the tribe died when they ate that, or stay away from this cluster of trees because that's where the lions hang out. And we remember these negative things, and that has continued through such that we have this negativity bias. And so when we can instead sort of force ourselves to, or not force, but practice the positivity and remind ourselves over and over again, what are the things that we're doing that's working, I think that really develops that relationship with yourself and you start feeling confident that, you know, okay, I'm figuring this out. Dr. Manzur Moidunny: Yes. And I also think it helps because, you know, a disclaimer that I like to make, you know, when I talk about these topics is that I don't think I'm an expert yet in, in the field of obesity, that even though I'm good at helping patients lose weight and improve their lives, but there's so much involved in the field of obesity and what contributes to it. And one specific area that I could, you know, I could be better at is a lot of eating disorders and a lot of everything that comes with that. And I have to tread carefully with how, what type of conversations I have. And I think I found it easier to enforce some of these positive habits and grow on them. It allows me a little bit more, a little bit more a platform to create better things. Because I feel like if I would long term, I will be going in depth into the, all the pathologies that causes you know, obesity, but it takes time to get there. And we have such limited time during our, like, visits for hypertension and diabetes that like, I have to be careful of how much I choose to engage in with a patient, and I wanna make sure I am, I'm using having conversations that are productive. And something I think in the grand scheme of medicine that we do is even with screening, we, we try to only screen for things that we can actually realistically also address during that visit. Absolutely. And while I try to keep building up positive habits, it allows me to be practical with, you know, the conversation and the advice that I give because I ultimately cannot solve everything in one visit or two visits or three visits. And while I've built a rapport with patients and create these positive habits, we can later establish more rapport and have them speak with someone else that we can go dive in deeper in areas that I may not be an expert in. Dr. Sarah Stombaugh: Yeah. Well, and tell me, you know, you're talking about all these different screening things. One of the things that you and I had talked about before we started recording here was walking as the fifth vital sign. So tell me how, how do you utilize that in your practice? Dr. Manzur Moidunny: Yeah, so I have a tracker that I have all my patients try to do. And something I've noticed is that patients who do the tracker and take the time to fill it out is also it's correlated with a lot more progress with weight loss and overall improvement in, in blood pressure control and diabetes. And the first thing, well, the second thing actually I track is a number of steps and I put a lot of emphasis on that. And I've later found as I've become more, more more knowledgeable about the lifestyle medicine field as it's developing, as they recommend it, as like, you know, the next vital sign of activity. So my version of activity tracking is steps. And I think it's underutilized in, in medicine really. And it's something, it's actually one of the gold standards that many personal trainers use. And this is an area that I feel like we have so much to learn from personal trainers, and this is one, you know, golden nugget that I took away. because there's, they're, they're great at not only many of the sciences, but behavioral techniques. And I see this as a great way to keep patients knowledgeable about their activity levels and a great way to, to just lose fat so it's been an an incredible way for patients to be aware when they're, when they're logging in, how much activity am I getting daily and how much have I progressed and see their correlation with how much weight that you lose. Dr. Sarah Stombaugh: Yeah. And I don't know studies off the top of my head, but I know in a lot of the psychological literature, when we look at goal setting, one of the most important things we can do is check back in on those goals. And so when we're tracking whether it's steps or whatever the goal is, reminding myself, Hey, this is my goal, checking in with that keeps you on track. Dr. Manzur Moidunny: Yeah. Dr. Sarah Stombaugh: Yeah. I love that. So tell me, I know that steps are really easy to track compared to a lot of other things, especially like you said on your phone when it's tracking it for you. I will say, I have an iPhone too, or an iPhone also, , can you imagine an iPhone version too, , from many, many years ago. And that health app, like you were saying, is on everybody's phone. And so for our listeners, if you don't know what that looks like, it's a white icon and it has a little heart in the upper corner and it's automatically installed sometimes, like you were saying, you have to set it up, but it is automatically there. There is a similar one for Android. I don't remember it off the top of my head, but Android phones, if you've got your phone on you, it is tracking your movement. And so that is such an important thing. So even if you're not, you know, Dr. Moidunny's patient, if you're not my patient, this is something that any of my listeners could start paying attention to on their own. So I wanted to put that out there. I wanna ask you too, tell me a little bit about strength training, because I know for you, strength training is something that's been really important in your personal journey, but we know it can play such a big role in the weight loss journey of our patients to build up muscle and approach weight loss from that standpoint as well. So tell me about your approach to it and how you utilize that with your patients. Dr. Manzur Moidunny: Yeah. So I have to be mindful of where my patients are at. Many of them who've come to me during my residency training are not very active from a string training aspect, and there's a lot of education involved. And so I first kind of just kind of info finding, seeing where, how comfortable they feel with string training how knowledgeable they are with different type of workouts and go from there. And, you know, the biggest thing I found is that many people feel like there's a huge burden of entry into working out. And something that I felt myself as someone who's being active, like I felt the need to spend, you know, almost up to, you know, hour to two hours in the gym when, you know, long story short, like you can get a great quality workout in 40 minutes, and for the average patient, you don't even need a step in the gym to get, you know, activities, strength training, using body weight workouts to, you know, get where you need to be for diabetes and hypertension control. So, you know, I do a little fact finding, see where the patients are at, and then I slowly start educating them. Like like there's so many studies out there that show that like your, the amount of muscle mass that you have, lean body mass muscle. Mass is correlated with, you know, longevity. And also not only longevity, but safety especially for eligible patients, especially for post-menopausal female patients being safe, being able to ambulate and get where they need to go, protect themselves from falls hip fractures and increase mortality from that. And I go into that and, and after I go into it, I go into, there's so much, you know, around that talking points, I kind of cover about 40 to 60% of it based on I'm speaking with, and kind of make them aware for the general picture. And then see, and usually when I engage with my patients to give them instruction about strength training, it's usually on visit three or four that I do that. At that point, they're picking up their steps they're eating a little bit better. They've seen about three to four pound weight loss. And then I kind of emphasize, Hey, let's do this too to, for your long longitudinal health and also to retain your muscle mass. Dr. Sarah Stombaugh: Well, and I love, I think a lot of times when we're in our weight loss journeys or really any sort of goal that we're working towards, it's easy at the beginning to be like, I'm gonna do these 10 different things, and then we get really overwhelmed and we end up doing none of the things. And so I love your approach of, okay, let's layer on some food logging and some step logging and increase those goals. And now that a patient feels like they've mastered this aspect, let's layer on the next thing, which may be strength training. Yeah, that's great. Well, and especially strength training plays such a big role both in the weight loss journey as well as, like you were saying, longevity and overall health. And my husband is a critical care physician, and there are so many studies to say that your grip strength, which really isn't about your grip strength itself, it's really, you know, a conduit to be able to talk about what is your overall muscle strength and physical fitness in that way. But your grip strength is correlated with your ability to recover from a major illness. And so when patients are hospitalized, that takes so much out of them. And so patients who come into a serious illness or a hospitalization or a surgery or anything like that are going to recover so much more quickly when they have increased muscle mass and strength. Dr. Manzur Moidunny: Yes. Absolutely. Dr. Sarah Stombaugh: Well, and tell me from a diet standpoint, one of the things we worry about is that when you are in a calorie deficit, simply from an eating standpoint, so if you've just cut your calories down, and if you're not necessarily paying attention to where your calories are coming from, when we lose weight, it's easy for that weight loss to come from all of our components, right? We can lose fat, but we may also be losing lean muscle in the weight loss process. And so tell, I mean, tell me your perspective on that, because strength training and diet stuff, that can play a really big role in how we preserve our lean muscle mass in that weight loss journey. Dr. Manzur Moidunny: Yeah. So this is a big thing that, again, I, sometimes I try to wait, you know, I'll discuss this kind of like 10, 15% of like the whole, you know everything that I could discuss with my patients, I'll kind of throw it in there. The first couple of visits, the importance of that wait a few visits before kind of emphasizing that, hopefully not trying to overwhelm my patients because there is like an aspect of discussing macronutrients with patients, especially getting adequate protein. And sometimes patients aren't, you know, familiar with how, how a calorie works. Like I don't wanna overwhelm them with how a macronutrient works, so I gotta be very mindful about that. And let them leave each visit with simple instructions. Like it's kind of go along with like the smart, you know smart technique of getting, having very actionable items and actionable goals. So around visit three or four I talk about it. So like, I tell 'em, you know, what's on your body that's worth its weight in gold? You know, it's muscle. So like, how do we maintain it? So I tell them that the, one of the first things that we could do is now, you know, we talk about training a little bit. That's a way for the, our brain, you know, when we work out it, it signals to our brain that this person is using, you know, muscle in their body and they need to use it. So make sure when you're breaking down your body, you know, sources of energy like fats and muscles, try to lean more towards the fats and not the muscles because the work tells our brain, Hey, keep the muscle because this is a person who is active and, and needs this muscle. And then the second thing is, you know, make sure you have adequate protein. So when you're breaking these, you know, your sources of energy down, you're not breaking down too much muscle. So if we get a good amount of protein in, it will keep most of our muscle reserves there. So I use, try to use the simplest words to kind of highlight those two concepts. And it's slowly, you know building on top of that and you, when it comes to kind of getting those macronutrients in, I struggle with a little bit about, you know, if I want to emphasize adequate protein intake or, you know, adequate, you know, like whole foods, like plant-based diet and vegetables. 'Cause I'm very big on trying to increase the number of servings of vegetables patients eat. And that does not always correlate with, you know, the amount of protein intake. So I feel like I have to choose my battles a little bit each time. And I try to push for, you know, vegetables that are higher in protein, like broccoli, cauliflower, asparagus. And I go there first because I like the metabolic, you know, benefits with, you know, like a whole food plant-based diet and don't want overwhelm them again by trying to incorporate a certain amount of protein in their diet right away. I wanna just focus on that, like plant-based a little bit more. Dr. Sarah Stombaugh: Well, and I think, you know, I think one of the things that's so important is that I'm sure you do this a lot in your practice. In my practice, it ends up being so spa patient specific, because a lot of times you look at these general, you know, I'm gonna do this diet plan or this exercise plan, and a person looks at that and like, but how do I apply that to my life? Like, if someone is telling me that I should have X amount of protein and I'm vegan, or I'm vegetarian, how am I applying that to my life? And being able to work with someone like you or work with someone with me who can help look at, okay, what does your lifestyle look like? What are the foods you like? What are your preferences? What are your dietary choices? You know, religiously or culturally or other preferences that you have for whatever reason, how do we fit all of that into for you? Right? And I think the protein thing, it's so important to be able to emphasize healthy fats, to emphasize proteins, to emphasize carbohydrates in their full form. And sometimes you know, I, at least in my practice, I feel like we're so focused sometimes on let's eliminate processed flour, let's eliminate sugar and let's move towards whole foods. And then starting to bring in that macronutrient conversation and how do you make sure, maybe you're not measuring every single gram, but how do you make sure you're incorporating it throughout your day? Is you're protein match matching your different exercise goals? Because protein, when it's broken down, breaks down into amino acids, and those are the building blocks of our muscles. And so those help to maintain our muscles and to strengthen our muscles. And what is the point of losing weight if you've just withered away and now you can't even, you know, lift a 10 pound weight off the floor, you wanna be able to lose your fat, like you were saying, but maintain all of your lean muscle mass and potentially even more one of the things that always have you seen some of the pharmaceutical companies have and for our listeners, we're talking on video, so I'm like, gesticulating with my hands here, but there are these models of what five pounds of fat looks like, and it's this huge globular, like, you pick it up and it's like huge, right? Yeah. And then you compare it to five pounds of muscle, and it's like this splendor little brick. And it's so fascinating to compare those two things because a lot of times, even when our weight doesn't change, just having more muscle has totally changed our body composition. And that can make such a big difference metabolically, but also like what we look like in the mirror. Dr. Manzur Moidunny: Yeah, absolutely. And you know, it, it's, it's, it's nice to have that schematic and especially as people noticing can correlate, you know, losing five to 10 to 15 and, you know, the shifts in how much mass they're actually losing overall and need, you know, lower size clothing. That's one of my favorite things, you know, best problems to have is, you know, when my need new clothes. So it's very fascinating to see that phenomena. And going back to like what you were saying about body composition, everything, I think, you know, one of the things when I talk about protein, one of my points that I start with and kind of maybe the first two visits is kind of highlighting like the difference between weight loss and fat loss. Dr. Sarah Stombaugh: Yeah. Dr. Manzur Moidunny: Like, I joke that, you know, my Instagram handle is Weight Loss Doc MD and it's that way because it's catchy, you know, it's weight loss. Yes. You know, it's not body composition doc, you know, it doesn't have quite the . Maybe it could it's weight loss Doc md, you know, I thought I had a nice ring to it, but I have some education about like, hey, we we're trying to target a specific thing. We're trying to tar target that big glob, you know, which looks golden. It's not, its worth its weight in gold. It's really the, you know, the red side totally. Lean the brick, you know, the bricks. That's what we wanna maintain that is the gold standard. So I think that's like the biggest thing. And, and then kind of hold their hands, you know, not, maybe not quite hold their hands, but guide them through how do we do that? And unfortunately, I think as the study shows, we all know there's gonna be some level of, you know, muscle loss during the process and what we have is just like, we minimize that, you know? and there's so many benefits with just weight loss, you know, even if they lose muscle, like we know that like, there's so many cardiovascular me benefits, there's so many benefits to your joints, you know, if it's just simply weight. But, you know, it's like our overall goal is to let's maintain as much muscle mass as possible taking individual, you know, patients and how we can guide them to, you know, preserve that. Dr. Sarah Stombaugh: Mm-hmm. . Well, and I think from a body composition standpoint, being able to, a lot of my patients describe like, wow, I just feel better, right? My clothes fit better. I'm buying smaller size clothes, but being able to measure that there are body composition meters, I don't have one. I practice completely telemedicine based. I don't know, is that something that you do with your patients at all? Dr. Manzur Moidunny: You know that's something that, you know, I've begun to do. I do primary telemedicine now myself and it's a challenge. It's a little bit more challenge as we know to track some of that stuff. But we can do that with, you know, like measuring if we use calipers or, you know, like a waste measure, patient's waste and everything. And that measures a lot of fat you know, percentage that we have. But I think it's more challenging and I would, like, long term, I would like to have a brick and mortar practice, and I do plan to have a body composition machine, at least one or variations of that. So yeah, that would be the gold standard. I think being able to. Dr. Sarah Stombaugh: But you're right. I mean, there's a lot of other things we can do, right? And with all my patients, I like wanna get out and demonstrate for you, but , I have one of those retractable tape measures. So if you were go to the tailor and you have those cloth tape measures, I have one that retracts just like a, you know, a standard tape measure. And I have my patients measure their waist circumference because that is a really good proxy for what is happening from a body composition standpoint. And sometimes, you know, we're talking about the scale shifting. People love stepping on the scale. It gives them this immediate, well, a lot of people don't wanna stepping on the scale, but when you step on the scale, whether you like it or not, it gives you a lot of feedback, right? You step on the scale, you see a number and you make that mean something for good or for bad. And, but it doesn't always correspond, right? If you have been doing a lot of strength training and resistance training, and if you are at a point, maybe you're further into your weight loss journey, and so now it's not as much weight loss, but you're working on changing your body composition, or even if you're early in your journey and you're bringing strength training on early can be so frustrating for my patients when they step on the scale and the numbers the same and they're like, wait, wait, wait. Like I feel amazing. I feel stronger, my clothes are fitting better. Why is the same number on the scale? And so I love to use the waist circumference as a proxy for body composition because even when the scale's not budging, it's so common that people are like, whoa, I'm two inches narrower around my midline. And that's another way that we can track maybe not the weight loss journey, but the fat loss journey. Dr. Manzur Moidunny: Yeah. And you know, I don't know how to reference it off the top of my head, but with the cardiovascular risks and everything like that, there's a direct correlation, you know, with the, the waste measurements and mm-hmm. Dr. Sarah Stombaugh: absolutely. Dr. Manzur Moidunny: Talking to them about that helps as well. Like it's there. Yeah. Dr. Sarah Stombaugh: Yeah. I love that. Well, let me ask you from over the last, you know, 15 years, we've seen weight loss medications start to come into the market a little bit more, but really in the last five years or so that we've seen, especially the GLP one medications have been FDA-approved, and they are all the rage, right? Everybody is talking about Saxenda and Mogo and manjaro. They're using things off label, you know, Ozempic and Trulicity and where , US weight loss docs are tried our best to help our patients with that. So tell me, how does that end up playing a role for you with your patient? Dr. Manzur Moidunny: So it has significantly changed you know, my practice, I'd have to say. whereas I, you know, a lot of this wasn't available and especially, I, I'm out of training a year and a half and last, you know, four or four and a half years with, you know, I just started training and there's so much not available and I wasn't very knowledgeable about it. I think some of the medications were taken off market, you know, during my training and I was learning how, you know, how to treat practice medicine, let alone obesity medicine. Totally. So I relied and then when I learned how, you know, a lot through personal trainers of how to, you know, how there's a science, there's a clear science of energy metabolism and, and helping my patients with that, I use purely lifestyle methods to do that energy and minus energy out. and now, and I didn't touch a lot of the medications unless they had diabetes. and I used a lot of the GLP ones like Victoza for, you know, indication I had now fast forward just two years out of, you know, a year and a half as a residency, there's so many medications that especially the ones, GLP ones that were indicated for diabetes now for weight loss by itself, it's making huge waves. And we see so much success and, you know, to be frank with you I partially felt like they might, you know, put me outta business a little bit, you know? Right. Dr. Sarah Stombaugh: Yeah. Dr. Manzur Moidunny: Because I felt like I got so good at the lifestyle side of things. Now you, and, and I think there's some studies that show that, like, like, you know, with the medication and then, you know, with all these other factors including lifestyle, medication intensive coaching and stuff, these medications are just kind of like doing so well. So I can't ignore them. And partially because now I, my patients, how I see patients is they come to me requesting medications. Yeah. because they hear about it. And it's not usually me talking, Hey, I do this I, this, this is something I do, I can help you with it. I'm getting more patients be like, Hey, I know about this medication. Can I get the medication? And, you know and that kind of changes the patient demographics that I get and usually use, I used to get patients that have struggled with obesity for a while, they can't find solutions, and they know that I am good at it. I've lost weight myself. So, and they really trust me. And instead of that I'm, you know, I, it's more, Hey, this patient wants this medication, can I help them with that? And I have to kind of reel them in to a lot of the lifestyle stuff now, okay, this medication. And I try and I've had to grow and become more comfortable with these medication and realize that, hey, these are a great tool. And when you think about the benefits and risks that the benefits, I think, you know, greatly outweigh the risks and side effects of it. And we still have to make sure they're appropriate candidates. But you know, why not? Because there's so many benefits to weight loss. And I'm trying, and, and my new approach is that like, yes, these medications exist, I can help you with them, but I hope you'll allow me to discuss all the lifestyle things that we can do. Because long term, I think these will be incredibly important for your success because we do see many patients regain weight if they're off the medications. Many do. Many are able to adopt lifestyle modifications and, and not maybe gain all the weight back but still have, you know, a healthy lifestyle. But like, it doesn't, again, like we talk about the body composition, if you're not working out, you know, if you're not getting the macronutrients you need, you're not, you're not optimal with your health. So it has changed the landscape. And I think for those of us who are in this field, I think we need to be able to wield it more responsibly than others because anybody can almost prescribe these medications now Yeah. Because they're available. So hopefully we can just bring it full circle and become more holistic and make it part of our, you know utility belt. Dr. Sarah Stombaugh: Well, I think that's exactly it, right? It's medications. And so when you look at all of the medications that have been FDA-approved for weight loss, it requires the patient who have done the medication and lifestyle intervention. So no, none of these people are just being given the medication and then just told, like, do whatever you want. If, hey, take the medication. And then the different pharmaceutical companies have their different programs by which they're getting dietary and exercise and all this other lifestyle intervention. And so I think what you and I can provide another obesity medicine or lifestyle medicine physicians is that we can provide all of that lifestyle aspect in addition to it, because there's not a magic pill or, you know, some of these medications or injections, right? A magic injection that's just going to solve it all. If you want to have long-term weight loss success, that can absolutely make a huge difference. We know that when you've got long-term obesity, long-term excess body weight, that there are physiological changes that happen that can make it challenging to lose weight. So let's help you with this medication and we need that lifestyle component because that's what's going to help you to be successful long-term. Dr. Manzur Moidunny: Yeah. Yeah. I think there's, like, I think we can also help kind of bridge the gap because, you know, I've learned a lot of my methods of, you know, helping patients lose weight through personal trainers like industry, I've learned so much from them from their, you know, behavioral techniques and everything, but there's, there's an aspect of society who are, you know, re hesitant and resistant to medication. Yeah. And I think it's important that we try to bridge that gap of understanding that, you know something that's been brought up is stigma, you know, about these medications that, Hey, should we stigmatize some of these medications? Are they an easy cop out or like easy way of losing weight without doing the work? Do we, if it's and I think it's an important question to ask is, well, if this, if these medications do help patients lose weight decrease their cardiovascular risk, decrease the amount of weight they're carrying on their joints every day and wearing their joints down, like should we not be open-minded to that? Like, you know and I think we should be because that patient could be our family member who has struggled and, you know, didn't quite click. And with this medication, if we're able to alleviate 10, 20% of their body weight and they become more mobile, more, you know, active with their children, grandchildren like why were we creating a barrier? Isn't that benefit enough? You know? Yeah. Dr. Sarah Stombaugh: Well, and I think, you know, at least at the time of this recording right, it's February, 2023. There unfortunately is a bit of a stigma. Even if we look at insurance coverage, for example, of these medications. And it's so disappointing to me how often my patients, their insurance plan may cover bariatric surgery, but their insurance plan does not cover weight loss medications. And regionally it's different. But in the private insurances, I'm seeing about 50 50 coverage. And I've confirmed that with one of the pharmaceutical reps that I talked with recently that like 50% of the patients have, who have private insurance, have coverage for some of the GLP one medications specifically. And it's so frustrating 'cause it's like, oh my gosh, what about those other 50%? What about patients on Medicare or Medicaid? but we're seeing some of that is it's changing it. A few years ago it was 30% and 20%. And so we're seeing that number come up and up and hopefully over the next couple of years we'll see that number come even higher. So that if a patient wants to have, have that as part of their weight loss journey, that it's an option for them. But it doesn't have to be. Right. There's a lot of times where patients come to me because I do so much in lifestyle and in coaching. I have a lot of patients who come to me who are like, look, I don't wanna take a medication. How can you help me to lose weight without a medication? And I feel like that's something I can uniquely offer to my patient. Dr. Manzur Moidunny: Yeah, absolutely. Dr. Sarah Stombaugh: Alright, so in the last couple of minutes here, is there anything else that you wanna make sure to add for my listeners? Dr. Manzur Moidunny: Yeah. You know, the one thing that I would actually like to double down on is walking and how Yeah. Be like incredibly beneficial for fat loss and a tool for us to use. And I kinda wanna like, you know, talk about a story that I had with one of my senior residents and an experience with it. I was shadowing one of our senior residents in my residency program when I was an intern, kind of trying to get a feel for his pro for his approach to patients. And he had this, you know, annual physical with the patient. Who, you know, she was in her fifties or sixties of BMI 35 to 40, and he was trying to get her to increase activity levels. And he had such a kind doctor and had a great rapport with his patients and she was trying to tell him that, you know, well doc, I've been trying to walk more, you know in terms of that. And he was like, well, you know, so and so I don't think that's enough, you know, we want to do some, yeah. Yeah. So he did say that. And, you know, even during that time, you know, I, in my head I was like, well, you know, it's not too bad. We can work on that. You know, it's, it's an opportunity. but, you know, knowing what I know now, I, I felt like that was the golden opportunity to talk more with the patient and kind of seeing where she was at and build from there. Because like walking is, it's so, so beneficial in so many ways. So it's an example of like low intermittent steady state activities, which I think is great for fat loss. It taps into your fat stores more than your glycogen compared to other activities. Most people can do it if you don't have severe, you know, joint musculoskeletal deformities or degenerations, like you're able to go out there and get 10 to 30 minutes of extra steps a day. it taps into your fat does not make you as tired as like other activities. You can do it with a friend, another family member. I love, you know, if a patient comes in with their family member and be like, I'm really worried about their weight, you know and I says, well, you know, what you can do on your end is to ask your family member to join you for walks and that will help their weight. So I am able to get whole families on board and you know, this is something that almost all the best personal trainers, like if you're not having your patients track their steps, like the personal trainer's not doing something right and this is what bodybuilders do, they do the stair climber, you know? Yeah. You think it's because they love the stair climber? No, it's an act, it's a low intermittent steady state activity that, you know, targets fat and preserves muscle. And this is so important in our elderly patients that need to retain that muscle and let's just focus on the fat. It increases their mobility. And so many of our older patients have back pain, you know, and walking programs are indicated for back pain and you know, so much else, you know, with diabetes metabolic disorder. So please track their steps, you know, consider it if it Dr. Sarah Stombaugh: Was get walking, Dr. Manzur Moidunny: Get walking, it's, it's little things go so far and that's not a little thing. It's just happens to be little barrier entry. Yeah. Dr. Sarah Stombaugh: Yeah. Well I think it is, right? There's such a low barrier to entry. If you wanna go for a walk, you can literally walk out your front door. Yes. Or if it's the middle of winter, wherever you at, you don't even have to walk out the front door. You can like walk circles around your house. It doesn't have to be out the front door even. And that, yeah, I think every, I agree with you. I think walking is such, you can do it for five minutes. Five minutes of walking, walking after meals. We know that when you've got all of that glucose from a meal active in your bloodstream, that if you go and utilize that glucose while it's circulating your bloodstream, you can keep it from being stored away from later. You can redu reduce insulin resistance and reduce some of that energy that's getting stored away. Dr. Manzur Moidunny: You mentioned about five to 10 minutes, you know, getting those walks in. Like I think when you start quantifying to your patients how much those matter and how much you can do, it goes a little longer way. Like I tell my patients, do you know how many steps are actually in a mile to cover a mile? And most people don't know. It's really about, for the average person, it's about an extra 2000 steps to get a mile in and that if you walk in between two to three, you know miles per hour for the average person, you can cover a good amount of distance in just half an hour. And that 20 to three minutes or just five to 10 minute when you get a break, you know, at you're at work, you get that 10 minute break and you could cover almost a thousand steps in that in that break. if you walk in miles per hour, 10 minutes, that's a thousand steps and you get two of those, you know, 10 minute things in that's a mile a day. Yeah. That's an extra 2000 steps and you've already increased everything you need by two 10 minute walks, extra walks. So quantify that, having our patients understanding and then just building off of that, you know, really goes a long way. Dr. Sarah Stombaugh: Well I love, one thing I used to do all the time was if I had, you know, I was a busy primary care physician practicing traditional outpatient family medicine, my schedule would be jam packed. I was really good at staying on time, which I'm super proud of. still to this day. All my patients, especially now will say, Hey, she's always on time. And one thing I would do is if a patient no-shows for an appointment, I would have this 20 minute slot and I might do a little charting, but I would almost always use that as an opportunity to take a walk. And I would set my timer for five minutes on my phone and I would literally just walk out the office front door and I would walk for five minutes and then my timer would go off. But I would turn the timer off, I would turn back around and I would walk back to the office. And that 10 minute walk was usually not only physically great, but more than anything was so mentally refreshing for me. Dr. Manzur Moidunny: Yes, yes. So many stones. So Dr. Sarah Stombaugh: Many, yeah. Right. Dr. Manzur Moidunny: Stones in with that just one activity. Dr. Sarah Stombaugh: Yeah. Well and just anecdotally, I have to say, anytime I would talk to my patients who were in their nineties, right? You see this like adorable little 90 year old woman and she's in phenomenal health and you're like, how are you 95 years old? And she's like, wow, you know, Dr. Moidunny, it's 'cause I walk every single day and I swear to you, every single patient who lives into their nineties and these 100 year old patients, their secret is walking. So like anybody should start walking. Dr. Manzur Moidunny: Yeah. And is directly correlated with the pace as well. And you know, it's the brisk walk that does, it does like, you know, slightly above your normal pace. It's correlated with increased longevity of life, you know, at the studies show it. So you know, if you want to go the extra, maybe not the extra mile but the extra, just increase that pace by a little bit more. You know, it's kind of like similar to that grip strength and you know, we talked about it's an, it's a conduit. It's like, you know, it's reflective of where our health is at and how we maintain it. Dr. Sarah Stombaugh: Yeah, absolutely. So I'm gonna leave my listers with that. Everybody get out there, get walking is your assignment from me and Dr. Morani today. Thank you so much for joining me. I really, really appreciate it and I'm sure my listeners do as well. Dr. Manzur Moidunny: Absolutely. Thank you for having me on. It's been a pleasure. Dr. Sarah Stombaugh: Alright. It was so fun to have Dr. Moi on the podcast today. If you would like to connect with him, he is a physician who is practicing both obesity medicine and lifestyle medicine in Michigan and Ohio. You can check out the show notes for all of his social media and website information. His website is www.manzurmoidunnymd.com. It's M-A-N-Z-U-R-M-O-I-D-U-N-N-Y-M-D dot com. And if you live in Illinois or Virginia where I am licensed to practice medicine, I would love to see you as a patient in my telemedicine based weight loss clinic. My website is www.sarahstombaughmd.com. That's S-A-R-A-H-S-T-O-M-B-A-U-G-H-M-D dot com. You can come on over to my website, fill out the information, and I would love to do a free 30 minute meet and greet visit with you to see if you might be a good fit for my practice. Thank you so much for joining me today. I look forward to seeing you next week. Bye-bye.