Episode #41: How Weight Loss is Different for Women Over 40 with Guest: Dr. Lisa Oldson

Dr. Sarah Stombaugh:
This is Dr. Sarah Stombaugh, and you are listening to the Conquer Your Weight Podcast, episode number 41.

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.

All right. This morning I have Dr. Lisa Oldson with me, and I am so excited to have you here. Thank you so much for being with me.

Dr. Lisa Oldson:
It is my pleasure. Thank you for having me.

Yeah, this is super fun for me probably for both of us. We have known each other professionally for the last couple of years, and Dr. Oldson has provided a lot of mentorship for me. And so I’m so excited to bring you on today, and I will let you just tell us a little bit about yourself and your practice, and I know you’ve got some fun, exciting stuff coming up too. So I’ll let you tell us about all of that.

Oh, thank you so much. Well, as you said, I’m Lisa Oldson. I’m a physician. I’m on staff at Northwestern in Chicago, and I have been board-certified in obesity medicine since 2013. I think I was in the second cohort of people to take a board certifying exam. It was a brand new specialty. And before that I did primary care internal medicine for many years. So I’ve been practicing weight loss medicine, helping people find their happy, healthy weight for a decade, a little over a decade. And it’s been amazing. My interest in this field started when I was really young, like so many people. I was probably a 12 year old girl when I decided I think I, you know, I have to lose weight. And so, you know, I was very influenced by societal pressures and images of beauty and what we should aspire for our bodies to look like. I think it’s even harder today for girls with all of the social media, but I was influenced by that, that toxic diet culture where I was always, you know, punishing myself when I would eat something off plan, and it wasn’t a very healthy way of addressing weight.
And as I got older, I certainly became more interested in the appropriate healthy ways to address weight. And I’ve seen how excess weight impacts people. I love people in my family, friends, and I myself have been 40 pounds heavier. I’ve been in maintenance of, you know, after losing those 40 pounds for many years other than a little blip right after pregnancy when it was hard to get that last 20 pounds off. Sure. But yeah, so I’ve experienced some challenges there. I myself struggled with binge eating disorder as a teenager and young adult. I consider myself in remission from that, but I will say I do get a little bingy when my husband makes lemon bars. And so yeah, I really understand what that feels like to not always feel perfectly in control of your relationship with food.

Well, and I feel like that’s the case for so many people, even if they’re at a healthy weight or maybe society perceives them, like, oh, look, they’re slender , they’re healthy. And then even if that’s the case, there’s a lot of people who struggle with their relationship with food. And so learning all of these tools that we’ll be talking about today can be really helpful, certainly for our patients who are struggling with excess weight, struggling with binge eating disorder. But honestly, I find it’s helpful for so many people.

Yeah, I think that’s really true. It’s so interesting. So I have, in my business, I have two parts. I have my medical practice, Oldson medical, where I see people one-on-one, and I really help them one-on-one that’s in Illinois. I might prescribe medication for weight loss medication for binge eating disorder and give people personalized counseling. But I really find what is so interesting is the piece that I do in my group coaching program called Smart Weight Loss Coaching, and thank you, you invited me to mention that I have the Smart Weight Loss coaching podcast launching on Friday, May 19th, 2023. So I’m very excited about that. In the Smart Weight Loss Coaching Group program, that’s where I really have discovered the complicated relationship that so many women have with food, with their bodies, and how much our mindset and our feelings about ourselves, our weight, our stresses, our relationships, how much all of these different things impact our weight. I mean, our weight is not just like one little piece of our health. Our weight is influenced by every single thing we think and do for anyone who’s listening to your podcast. Right. And for people who work with me, it, that’s probably not true for people who have never struggled with their weight, but we understand that the struggle is, it is not just an isolated part of their life. It touches everything. It touches your relationship with your parents, with your children, with, you know, how you show up at work, how, how you feel about yourself, your self-esteem that impacts your relationships, that impacts your sexuality, and on and on and on the ripple effect.

So it’s so amazing to be able to help people with their weight because, and their relationship with food, because then it has this positive ripple effect on those around them and on every aspect of their life.

Well, and I think so often weight loss programs focus on all of the downstream things. They focus on, you should have this diet, maybe take this medication, you should do this exercise program. And all of those things are important and all of the upstream stuff that leads us to feeling stressed about food, wanting to eat because we’re bored or emotional, you know, any of our beliefs around food in terms of don’t waste food. Things that we don’t even realize that have become such a part of our belief system, that impact then how all of that downstream stuff is able to be implemented. You know, it’s really easy to say, oh, you should follow X, Y, Z diet, but then how do you actually apply that to your life? And that’s a lot of what you and I focus on in our work. And especially it sounds like what you’ll be focusing on in your group program.

Yes.

And I would love to hear, we’re planning to talk today about women over 40 and how their weight loss journey may be different. And correct me if I’m wrong, but your group is focused on this age group. Right?

Right. So, I mean, nobody’s excluded, but I think the sweet spot for our group is first of all, women or people identifying as women 40 and up. And that really wasn’t by design initially, but I just find those are kind of my people like <laugh> they relate to me, I relate to them. They invite their friends, and suddenly our group is growing, growing, growing with women in this age group. And so it’s a, I think it’s a very nice home for people in that demographic. They find their people, they feel comfortable, and they can relate to one another’s challenges.

Well, and I find that in my practice, I often see patients, women who are in their forties or in their fifties, and they find that their experience of weight loss is a lot different at that stage of life compared to maybe previously. And it’s more challenging for a lot of them. And so I would love to hear about what your experience is with that, and maybe some of the most common misconceptions about weight loss over 40.

Oh, thank you. Well, here’s what’s really interesting to me. We have, I mean, I think you and I are both in love with the science, right? There are so many myths out there and so many people talking about weight loss who are well intended, but not informed about what we really know to be true from the science.

So one example of a myth is that our metabolism comes crashing down in midlife. And it’s interesting because I try to tiptoe around this in some ways, women feel like, oh, my metabolism is so awful. Ever since I hit menopause or since I got toward perimenopause, things are really slowing down. Well, I’m not saying, “Ah, no, that’s not the case. It’s all your fault actually what you’re putting in your mouth.” It, that’s not the message I wanna give, but I will say that the science tells us our metabolism actually does not come crashing down at midlife.

Right.

There are other things at play, and I think we can explore those things without judgment. but we know this perception that it’s all downhill with metabolism and weight from the age of 30 onward or 40 onward. Eh, that’s not really true. We’re mostly stable during that time. There’s a very slow, steady decrease in metabolism, or the amount of energy or calories that we burn throughout the lifespan. You know, we kind of, we have the most revved up metabolism as babies. And you know, in infancy, there’s not a drastic change at puberty, which a lot of us think there is, there’s not a drastic change at menopause. The slowdown is very gradual. you know, maybe less than 1% per year in terms of the decline in metabolism through midlife. So eventually, if you add up that 0.7%, less than 1% decline in metabolism that we have in our forties, in our fifties, and beyond, by the time you get to 90, sure, your metabolism is maybe 25% slower than it was when you were younger or when you were in midlife. But that is a slow, gradual decline. And so the decline is due to, you know, most of us are less active in middle life.
Most of us do have a decrease in our muscle mass as we get older, unless we’re actively doing some kind of strength training or sports resistance training to keep our muscle mass up. But it’s, you know, it’s more than just that. We just have our cells behave differently. Our cells burn less fuel, they are more fuel efficient as we get older. And then these, this slow steady decline in our metabolism is worsened if we have a sedentary lifestyle. I mean, the great news is, I think the really great news around knowing that our metabolism doesn’t come crashing down, is we have a lot more agency and power than we might think we do.

Yeah. I agree with that completely because I feel like so often people talk about their metabolism as a thing that’s happening to them. Like, well my metabolism just crashed down and now, you know, now I can’t do anything about it. And recognizing when I first say that to people, they’re often really caught off guard that that’s true. They don’t believe me and we talk about what that experience is because even, you know, in my mid-thirties, I feel like among my peer group, there’s this conversation of like, oh, ever since high school, you know, things just aren’t the same. Ever since my twenties, things just start the same. And that narrative continues from, you know, every decade of life. I feel like we embrace that narrative as a society more and more. And like you said, there’s an activity level that often changes. So many of my patients tell me, in high school, I was an athlete in college or in my twenties I was super active. And we see there may be a change in the number of calories burned because they are being very active in their teens, in their twenties.

But that doesn’t mean that there’s necessarily a change in metabolism. And so getting a little bit nuanced of how much energy does your body actually burn and recognizing, like you said, as babies and childhood, it is shocking to me. My listeners know I have young children how much food, my eight-month-old is like 15 pounds. She’s tiny. And this teeny tiny little thing has just, she’s doing baby-led weaning sort of inadvertently. She watches her older brothers eat. She is very enthusiastic about it. And this teeny tiny little human is like gobbling up strawberries, you know, gobbling up cheese and pancakes. And she is all about it. And so that metabolism is very active in young children through grade school. And then we see it’s really pretty stagnant for most of our adult life, which is shocking to most people with whom I have that conversation.

And so I agree, I think that’s one of the biggest myths in general. but certainly for those women in their forties and fifties, and then perimenopause, menopause, there’s a lot of conversation about how our weight journey changes during that time. And so I’d love to hear from you just with the hormonal changes that are happening in perimenopause and menopause, how does that impact our weight? We talked a little bit, you mentioned some body composition, but what are the things that women can do to address those changes that they feel like they’re experiencing?

Mm-hmm, thanks. So definitely we do see a change in body shape. You know, my feeling about that is I’ll accept some thickening around the waist and, you know, like the redistribution of where our fat and muscle and skin is all located to me, I just embrace that.

Like, I embrace my wrinkles. Like, okay, I’d rather have that and still be aging, still be here to enjoy the journey. I think it’s the very rare person who has the lucky genetics to retain the same silhouette of their body shape in their seventies as in their thirties. You know, that’s just not typical. So we rearrange a little bit, but what we, and that’s hormonal, you know, we really see that that starts to change even in women who aren’t changing their weight at all. So your weight can stay exactly the same every decade of life. There will be some shifting in your shape, but all of this can be addressed and can be modified to some degree. I mean, I’m just such a big fan of loving ourselves at every size, at every shape, while striving to be our healthiest selves.

So here’s one example. When we look at, I’m really interested right now in longevity, living longer, living healthy to a hundred is what I always call it. So not that I really am hung up on the number 100, I just love the sound of it living healthy to a hundred, I’m fine if I live healthy to 98 and a half.

Sure. Right.

The idea is there is a lot understood that there’s a lot that we understand about the science of longevity. And the super fun thing is the same things we might do to help us live healthy to 100 are often dovetailing with the things we need to do to manage our weight over the lifespan. And so when we look at centenarians, people who live to be a hundred, first of all, one really interesting thing to me is 85 to 90% of people who live to be a hundred are women.

And I’m sorry for your male listeners. I am really female focused in my practice, in my group. I do see some men, but as a woman myself, and with most of the people I work with being female, I like to just say, okay, we’re already at an advantage. Like, let’s take that. It’s, let’s look at the science, let’s embrace it, let’s dial it up because we know what we can do. The calendar is marching on to bring us closer to a hundred, but we can do a lot to the biological aging the physiologic aging of our body. So when we study people who live in areas of the world where they are more likely to reach 100 and reach 100 in a healthy way. One of the things we know, you asked about hormones, so I’m circling back to that. Insulin is a hormone that we all have in our body, and insulin is involved, it’s made by the pancreas, and it’s involved in managing our blood sugar.

And that’s not just sugar that we eat. Like, did you eat some candy today? That kind of sugar. But our liver makes sugar. We make our own sugar, even if we’re not consuming added sugar. So we get sugar that we make ourselves. And sugar is, as you know, insidious in our food supply. So many things that never had sugar before have sugar today. So we need insulin to manage our sugar in our bloodstream and to help our cells utilize that sugar. So I always think of insulin as kind of like a guest that’s bringing the sugar, or a host that’s bringing the sugar guest to the cells, knocking on the door, hello, hi, here’s some sugar. You know, go on in. Yeah. The insulin opens the door to the cell, kind of shows the sugar the way in, closes the door so that the cells get the sugar, can use the sugar.

We need insulin to do that. The problem is we’re often flooding ourselves with so much sugar that our cells are like, whoa, please, can you stop bringing me so much sugar?

No more!

No more! So we make fewer doors, fewer entrances for the insulin and sugar to come and get into the cells. The cells just kind of lock down and make themselves less available. So it’s more like there’s a secret door, but there’s so much insulin floating around because we have so much sugar, most of us floating around the cells resist the insulin, they resist the insulin. In response, the body’s making more and more insulin to try to find those doors, bang on those doors to get the sugar in. And so what we know is that all of this extra insulin is contributing to weight gain. Insulin is an obesogenic hormone, a weight gain hormone.
So we would rather, instead of ourselves being so resistant to the insulin because they feel flooded with it, we want to reduce our insulin. And there are different ways we can do that. And people who live longer and live longer, healthier seem to handle their sugar better. And they’re also more insulin sensitive. Not only more insulin sensitive than young people, but then other slightly less old people. So people live to be a hundred, manage their sugar and are more insulin-sensitive than people who already have some chronic diseases when they’re in their seventies. You know, you don’t have to be on medicine and have chronic disease just because you’re 75. People live to a hundred often don’t, they’re not taking any medicines. They’re living well, they’re healthy, they’re disease-free. And one of the ways that they get there is, you know, maybe inadvertently, maybe this is not on purpose managing their insulin sensitivity, but they do things that make them more sensitive.

So one of the most important things, as you know, Sarah, that we can do to improve our insulin hormone in our body to increase our insulin sensitivity is exercise. And this is even if your weight doesn’t change at all. Yeah. So this is also true for people with pre-diabetes who are at risk for going into diabetes. They can increase their insulin sensitivity with exercise. Again, even if your weight doesn’t change at all. We know exercise is not really a weight loss tool. It’s good for other things related to weight and health, but it’s amazing for halting that progression from insulin resistance pre-diabetes into full-blown diabetes. So exercise, both cardio where you get your heart rate up a little bit and resistance training. So I hope your listeners don’t feel like, oh, the cardio, I hate that. Or resistance training. I don’t wanna go lift a bunch of weights with a bunch of sweaty guys in a free weight gym.

Like, ah. I don’t think people, I think people get a little scared sometimes if they’re not exercisers. You could just take a walk. You know, brisk walking, and I’ve heard you say this before too, the science really supports that brisk walking’s a great thing to increase our insulin sensitivity. When I talk about resistance training, just start where you’re at. If you have done zero resistance training, your muscles aren’t very strong. There’s nothing wrong with getting little two pound hand weights. I think that’s fine. That’s where you can start your resistance training.

Absolutely.

Or just with your own body weight. You know, just try a plank, get on the ground, do one plank. If you’re not sure, if you really aren’t an exerciser, you don’t know what a plank is or how to do one, that’s what Google’s for. Just check it out or Safari or whatever.

Absolutely. Mm-hmm.

So exercise will improve that insulin hormone. Sleep. I mean, these are all the beauty of this. These things that help with longevity help with our weight too. So we know exercise, while it’s not a weight loss tool, it’s critical to prevent that inching up of weight that we get with age. It’s critical to maintenance of weight loss. We’ll never maintain our weight loss. I shouldn’t say never, but very, very difficult to maintain weight. It’s harder weight loss unless you’re getting a lot of exercise. And then sleep is really critical for so many things. Our cognitive function, our mood, our productivity, our weight is certainly impacted by sleep, but also our insulin sensitivity. And there was a great study that looked at people who weren’t getting enough sleep and assessed their insulin resistance, and then they had them get an hour more of sleep a night, and their insulin sensitivity improved just with that extra hour of sleep a night.

I mean, with all of this conversation with insulin resistance, I think that thinking about insulin as the primary hormone that is driving weight is so important and so freeing for my patients. Because a lot of times we talk about hormones and hormones have been really popular recently, right? There’s so so many conversations around, you know, oh, going through menopause, there’s hormone clinics popping up. And that is maybe a separate issue for a separate time. But we talk about hormones, like we’re talking about estrogen, we’re talking about progesterone, we’re talking about testosterone. And people get really hyper-focused on those. And all of those have their role, right? In managing hot flashes, managing this transition through perimenopause into menopause. But when you look at what is actually the most important hormone in terms of weight, it is insulin. And it is also not this thing that happens to you, right?

This thing like, oh, your insulin is resistance now. And like, oh, too bad for you. You’re destined to be overweight. Right? Oh wow. For the rest of your life. Right? But instead that insulin resistance, there may be a role for medications and helping with that, but also we can address that completely on our own. And that’s really empowering. So doing things like making sure you’re exercising, making sure you’re getting enough sleep. Tell me, what do you counsel your patients in terms of the dietary role in insulin resistance?

Okay. I figured we should probably get to nutrition.

Yes. Let’s do it.

Okay. So here’s some of the things for insulin resistance. And again, the beauty is it helps for longevity, it helps for weight loss. It, you know, all of this is related. One of the things we know is that when we replace saturated fats with some unsaturated fats, that’s helpful.

That’s specifically helpful for insulin resistance. So I think it can be very confusing for people. I don’t, I like to keep, yes. Weight loss nutrition, very simple. I don’t ask my people to count their calories. I don’t ask them to have a certain percent of carbs and fats and protein. Why? Because I think that’s not how we want to manage our weight through the lifespan. We don’t want it to take up so much brain space. So I like to keep it very simple, but I will just for one brief moment, give some examples of what are saturated fats that we want to have fewer of? And what are unsaturated fats? I don’t think your listeners need to, I mean, they’re welcome to, but they don’t have to worry, which are monounsaturated fats, which are polyunsaturated fats, who cares? This is like, keep it super simple.

Fewer saturated fats really means fewer animal fats. I think that’s a simple way to think about it. Yeah. and certainly less of the ultra-processed kind of fats. So absolutely ultra processed foods are really killing us. And I’m not just talking about, you know, Twinkies, Skittles, and Doritos, Coca-Cola, although all of those things ultra-processed are certainly killing us. Those aren’t food. You know, in my mind, I have really come to understand that is an edible. Those are edible chemical products. It’s like,

That’s interesting.

Dandelions

I love that.

Dandelions are edible. Pansies are edible. Did you ever go somewhere and there’s like a little dessert with a little top, right? You can eat a pansy, but I still wouldn’t consider a pansy food. On the other extreme. At least it’s a plant, right? It’s natural. On the other extreme of that are a lot of things that we eat that are not actually food also.
So just like, I wouldn’t consider a pansy food. It’s something I can eat, but it’s a pansy is not food. A dandelion is not food to me. I mean, that’s my interpretation. It’s, yeah. also I would say I don’t believe that Skittles are food. I don’t believe that Coca-Cola is food or Diet Coke is food. I don’t believe that Doritos are food. Flaming hot Cheetos. That’s not food.

Totally. So I, yeah, go ahead. That’s so amazing though. I really, I have not heard someone say it quite like that before. And I think that that is such an interesting way to think about it, because it’s not, those Doritos do not fit into our food and nutritional needs at all. The Skittles do not fit into those needs. They are edible. You know, you can put them into your mouth and ingest them, and your body is amazing.

Our body has adapted to be able to eat Skittles and Doritos and Coca-Cola and all these things. But it wasn’t really designed to do that. That was, you know, it’s not part of

No.

The world. It’s not part of our natural food chain.

It really isn’t. And I think, I’m just gonna call myself this. I’m not calling any of your listeners this, but when I look back on how I sometimes ate as a younger person, I was eating more like a goat. How a goat will eat like

like underwear, shoe,

Dr. Lisa Oldson:
underwear,

Oh my gosh. Yeah.

At least in the children’s books a goat will eat anything. A tin can…

Because I can eat it. If my body can ingest it, I’ll put it in my mouth.

That’s right. Doesn’t mean it’s food.

Interesting. I love that.

Yeah. So I think one of the issues when, when I think about nutrition, there are so many things that we put in our mouths. We chew them, we swallow ’em. They’re not food. They give us absolutely zero nutrition. These types of ultra-processed food-like products are nutritionally bankrupt. Yeah. They do nothing for us. And so when we eat those things, you could say we’re not poisoning ourselves in an immediate way. Like we don’t tip over and we’re not gonna die that moment. Yeah. Right. From an Oreo cookie. But it’s a completely nutritionally bankrupt food-like product. So <laugh>, when my kids, here’s just a little side note that might I don’t know, might crack you up a little bit. When my kids were little, I made myself laugh. My tired, overworked mommy self. Like all moms of little ones like you probably, I had to do things to make myself laugh. So one thing I did is I didn’t tell my kids that this product was called American cheese.

Mm-hmm.

I called it American cheese-like product. And so. So my kids would say we’d be at the grocery store and they’d say, “Mom, can we get that American cheese-like product?”

And other people are looking at you like, what is she doing to those children? You’re brainwashing your children.

Okay, so coming back though to nutrition. So one thing is simply, I’m not saying any food has to be forbidden. Listen, everybody loves Oreos. I don’t know how some miracle happened and I didn’t like Oreos ever, but I like plenty of other foods that are not,

You don’t like Oreos?

nutritionally dense. No, I never liked Oreos even as a kid.

That’s my, that is my one food. If I had to choose any junk food item, it’s an Oreo. That’s it.

Yeah. Don’t let me give the impression that I am a perfect eater. I’m having a very complicated relationship with some lemon bars that my husband made on Sunday and that have been sitting in our,

They’re calling from the kitchen.

Oh my gosh. The calls coming from inside the house they’re so yummy. So yeah, for sure. I’m not a perfect eater. I don’t wanna give that impression at all. And I don’t think we should ask ourselves to be, you know, if we try to be perfectionist in our nutrition, if we’re so perfect and restricted, who can stick to that? We have to have some flexibility. We have to build in some planned treats that are not too frequent, that are not over the top filled with chemicals, giant chemical bombs that are, you know, our portion should be reasonable. And I also think with whom and how we eat these matters, I do not feel great about standing at my kitchen island shoveling something like, you know, I don’t know, let’s just say some ultra-processed ice cream, Deans’ ice cream into. That’s not a good feeling. I wouldn’t want that to be my treat. Instead, I would much rather have my treat be on a warm summer afternoon that I grab my family and say, let’s walk to the ice cream store and all get an ice cream together. This, you know, this afternoon or this evening.

Absolutely.

So I’m having it with them. I’m ordering the smallest size. It’s a joyful situation. I’m not punishing myself or shaming myself for having it. I’m choosing to have it not too often, not too much. I always think to myself, I order the size I want to be. I’m just gonna order a small, whatever the smallest size is, that’s fine. I have room for that. So allowing treats, but planning them, curating them, what kind of treats, and then getting away from the ultra-processed foods, increasing our unsaturated fats. I think that’s where I started all of this. I got excited by.

Yeah. I got, yeah, I got excited with you.

Thank you.

We can talk forever about this stuff.

Couldn’t we? I know. We really could. So unsaturated fats, we want things like nuts and seeds and extra virgin olive oil. We want avocados, we want salmon. you know, we just wanna, we want to reduce ultra-processed types of fats and we want to, you know, just watch our portions. I don’t think you have to be vegan or vegetarian to be healthy or to lose weight. But I do like the idea of being plant-forward. In fact, this morning, I was going to make some plain Greek yogurt with berries, nuts, seeds, you know, like just a, I could already picture my portion being too much. And then I just paused.

I was like, you know what? I’m trying to eat fewer saturated fats, even pretty healthy ones, like plain Greek yogurt. And is there a plant? I just asked myself like, what’s a plant I could eat that would taste just as good as that? And then I was like, oh, I have an apple and I have some almond butter just freshly ground where I pushed the button myself and it was just almonds crushed.

I love that.

Yeah. So just more plants. More real food, getting away from the ultra-processed food. Fewer animal products, but they don’t have to be forbidden. And then the big thing is more fiber. Fiber, fiber, fiber. That is so critical. So I’m sure you talk to your people about that too.

People talk about, oh, low carbohydrate. Low carbohydrate. And I think what we really mean, or at least when I interpret that low carbohydrate to me means low flour, low sugar.

Yes.

Low of these processed foods in that way. And so there is no reason to eliminate nuts from your diet. There’s no reason to eliminate fruits from your diet or vegetables from your diet. All of those things are carbohydrates. That’s right. And when we have those in a controlled setting, when we are having them in the context of a nourishing meal that includes some fats or includes some proteins, those are really important part of our diet. And so you might say, okay, I’m having a low carbohydrate breakfast quote unquote. And that can mean that you’re not having cereal for breakfast. That’s great to move away from that processed thing, but is it really bad to have a small bowl of steel cut oatmeal or quinoa with some nuts on top and a little bit of seeds on top. That’s a very, quote, heavy carbohydrate meal that also has some fat, it has some protein and it has a lot, a lot of fiber.

And just, it’s so nutrient dense. That’s, I love that you said this. I couldn’t agree more wholeheartedly. I violently agree with you, Sarah.

I love it. Violently.

I just think this idea that we should be afraid of carbs. No. And also, how often do you hear in your practice, oh, I’m trying to stay away from fruit because of the sugar. Oh my gosh, come on. That’s awesome sugar. That’s the kind of sugar you want. You want your little sweet treat to be fruit because it’s, it’s packaged with the fiber that slows the absorption of the sugar. In fact, some of the sugar doesn’t ever get absorbed because of all the fiber in fruit. And we should never, even the American Diabetes Association has learned from the science. I mean, not to sound like they were stupid, I didn’t mean it like that, but you know I think when I was in my training in the nineties, there was this feeling like, if you have diabetes, you know, be careful with the fruit.

But now even the American Diabetes Association is like, oops, sorry, let’s dial that back. Because actually you have to think about fruit instead of what? Like I guess if you are a vegan, you know, marathon running triathlete, you know, like 0% body fat. Okay. Maybe you wanna get into the nuance of, you know, I’d rather have berries than bananas or pineapples or something. I don’t think that applies to us normal humans. I think we can all eat fruit. Fruit has fiber, the natural sugar in fruit is fine. And if we made that our sweet treat, that instead of the ultra-processed, nutritionally bankrupt ultra-processed foods come on, that’d be amazing for us. Yeah. So good for us.

Absolutely. And I want to, you know, you were talking about saturated fats and unsaturated fats, and one thing we’ve been thinking a lot about in our household recently is how do we bring in animal fats in a way that best serves our body? And it’s amazing. If you look at the nutritional value of, let’s say beef for example, and you look at a cow that has been raised on a factory farm, it has been fed grains, it is sort of the ultra-processed cow, right?

Right.

Great fat in it. It’s given hormones. And you have this cow that develops really quickly, develops maybe more fat than it should. And then you look at a cow that is raised quite literally on a grass pasture, it eats grass, which is the natural diet of a cow. And you bring both of those animals to the butcher and they are slaughtered and they are cut into meat. And not only is there less fat, but the fat type is actually different. So a healthy animal that was raised on grass and ate that has more unsaturated and healthy fats for us compared to this factory-fed animal.

And so that’s been something we’ve been thinking about a lot recently, is when we eat these animal products, how do we choose the ones that are highest quality so that we can get the optimal nutritional value from them? But it was just so amazing to me. I don’t even think I understood until the last couple of years that there was such a big difference. Like meat is not just meat. There is a huge world of difference between these two types of meat products that may on the surface look the same, but are actually wildly different in their nutritional content. And so I think, you know, when we think about more like, okay, we should reduce our animal fat. Yes. And when we’re choosing it, let’s make sure that we’re choosing the highest quality.

I couldn’t agree more. And similarly for fish, wild caught fish are the grass fed version of that cow you were describing, right?

Yes.

And the farm raised fish. I, I think there are, I mean, I have read about this very small number of conscientious fish farmers who are trying to do it right, just like there are cow farmers and chicken farmers who are trying to do it the right way so that they deliver a healthier animal product. so I don’t mean to lump everyone in together, but generally speaking, a wild caught fish will be a healthier fish than a farm raised fish where they, they actually put food dye into the fish’s food to make it look more the color of salmon. Or they give animals, we’re giving animals, I just think about this. We give animals antibiotics, growth hormones. We breed them in such a way to make them bigger and to increase their adipose tissue.

They’re fat tissue. So if we are raising these animals that we find in the grocery store, we’re raising them to be, to develop the disease of obesity, basically.

Right.

Raising animals to develop obesity. And then we’re consuming these animals who have themselves been deprived of appropriate nutrient-dense foods, but instead are eating nutritionally bankrupt feed. It’s, you know, you are what you eat. Right. I think that’s basically what it comes down to. So yeah.

That’s such an interesting perspective. Absolutely. Well, so we think about, you know, bringing it back to this hormone disorder of obesity and thinking about insulin as that primary hormone that drives obesity, that drives just, or diabetes and pre-diabetes and insulin resistance, longevity insulin, which can be managed completely through lifestyle alone for most people is, is really underlying this. And so if you can move, if you can sleep, if you can choose foods that are going to help support your insulin resistance or to support your body such that you are less insulin resistant, that you’re more insulin sensitive, that is the ultimate thing that you can do overall for your health. And then the fun thing is you might just see weight loss as a side effect. And so

That’s right.

It sort of comes along with all of it, which I just love.

It’s amazing how, and that’s why I like the idea of not giving people a diet to follow. I mean, we can look at the science that says the Mediterranean diet is so healthy, the mind diet is so healthy. What do we see when we look at at the dash diet? You know, and so on. What we see when we study diets is the healthiest diets are plant forward have a lot of fiber and don’t have many, if any ultra-processed foods. They’re light on sugar, they’re light on alcohol, they’re light on animal products, they’re very heavy on plants. But we don’t have to like, and I just really believe you don’t have to pick a diet, research the diet, spend, you know, invest your precious time analyzing exactly what you’re going to eat every day for the next three months on this perfect diet. I just say make your next thing you eat the healthy choice. Look, you know, what can I eat today, like I said earlier, what can I eat that’s a plant, I just like to eat a plant. Or like you described, what’s a healthy breakfast? I don’t have to analyze what my breakfast is going to be on Monday, Wednesday, Friday. During the winter, I’m gonna have steel-cut oats with flax seeds and chia seeds and berries and blah, blah, blah. And then on Tuesday, Thursday, I’m gonna have avocado toast. You know? I think we could just all chill out. Not you. You’re chill.

Dr. Sarah Stombaugh:
Yeah. I love that.

In general, as a society, we put so much pressure on ourselves to do everything perfect.

Right.

And we’re not even stepping in to take some action because we’re so busy researching and analyzing and planning. Like, just give yourself a little peace and calm and take your time. And it’s not a race that you change everything today. Just like what’s, you know, okay, whatever your listener is about to eat next, how could they healthy that up a little bit?

Absolutely. That’s a really, that’s a great attitude for it. And I love thinking about it. I always name my diets like the Lisa diet, the Sarah diet. And so I’ll have my patients think about like what serves them best. You know, if I say you should eat salmon and Brussels sprouts for dinner and they hate salmon and Brussels sprouts, that’s not, they’re not gonna do it. They might choke it down for a few meals because Dr. Stombaugh told them to. But the reality is we need to choose food that serve our body, foods that we enjoy. I a hundred percent believe you should enjoy every single thing that you eat. And so if there is a quote unquote healthy food that you hate eating, just don’t eat it. There’s hundreds of thousands of other foods that are out there or you can experiment with. I used to hate broccoli actually. And my New Year’s resolution last year, like getting my years confused here in 2022, I was like, I’m gonna figure out how to like broccoli. And I cooked it in so many different ways and I will still tell you it’s not my favorite food, but I love it roasted. I love it roasted. Roasting anything.

Love it.

It just brings out all those caramelized flavors.

Yeah.

And I love broccoli, I dunno if you’ve ever had broccoli stems, but you cut the tops off and then just eat the stem like a carrot stick. One of my patients introduced me to the idea and like, huh, I actually like broccoli right now. Which is a total, excuse me, a total tangent. But to say you should eat foods you love, you should embrace those foods and then foods that also serve your body.
So let me ask you, we have been having so much fun chatting here, but as we wrap up, are there some things that you would love to share? Things that you wanted to make sure we talk about that we haven’t talked about yet?

Thank you for asking. I mean, I feel like this could be an eight hour podcast ’cause it is so much fun.

We could talk forever. Yeah. I’m like, Ooh, I could go on about that some more.

I know. It’s so much fun. One of the things that I think is so fundamental to understand about the chronic progressive relapsing remitting disease of obesity or excess weight is that this is not a disease of willpower. And there’s a study that tells us 48% of people who carry excess weight and are trying to lose weight think that if they just tried a little harder they could lose the weight. Yeah. It’s a very self-blaming situation, but it’s actually not a disease of willpower at all. There are so many different factors. So we talked today, we barely scratched the surface of the hormonal things, the genetics, the epigenetics, all these biological functions.

Neuromodulators, neurotransmitters in our brain, neurobehavioral changes that influence our weight. Immunologic changes, endocrine changes, environmental things like all of these chemicals in our food like products, cultural norms, societal pressures or norms. There are just so many things, medications that cause weight gain. We’re having a mental health crisis in our country. A lot of mental health medications that are so critically important do impact our weight. And there are ways to get around that. But you know, that’s a factor too. And so when you look at the trajectory of weight gain in the United States over years, and the CDC has, I know you’ve seen it, Sarah, but I don’t know how many of your listeners have ever seen this. The CDC, Centers for Disease Control, they have this map system where you can see the map of the 50 United States and it’s color coded based on having what the BMI is the average BMI is in the state.

So if you look back in the seventies, the states were all pretty average and healthy in terms of the body mass index, which we all know is not the perfect measuring tool. But that’s what this map looks at. And then each decade that goes by the average BMI, you see the states go from blue to or green, blue, yellow, orange, red. Yeah. Like this dark brown maroon color as weight, average weight is going up, up, up, up, up across the country. Some states struggle more than others, which is really interesting. Like Colorado’s always got the lowest BMI there.

Right. They’re so active. Yeah.

That’s right. But what, what we know is that people in the United States did not suddenly lose their willpower in the eighties, nineties and two thousands. Right. We didn’t all forget how to be organized and motivated and have willpower. That’s just not true. What did change during that time is we are on computers. Most of our jobs involve sitting all day long in front of a computer. Most of us are not moving. You know, some of us are sitting all day commuting and sitting and then we might go work out for half an hour. We can’t undo all the sitting, even if we work out for an hour on our way home from work doesn’t undo all the sitting. So the more we can incorporate movement into our everyday life, walk to the mailbox down the road instead of just sticking the letter in your mailbox at your house, walk to the grocery store if you’re only buying five things that you could carry home, walk to the post office, walk to visit your friend. The more we can walk, that’s helpful. Our communities aren’t really built for that.

But there are so many changes. So one is that we have less movement in our everyday lives. Another is the fact that our food supply has been inundated with these weight gain ultra-processed chemicals, monoglycerides, maltodextrin, xantham gum, you know, sulphate potassium. Just read the ingredient labels of food and you’ll have a very clear idea why we’re all gaining weight. And then so many other things are going on. But really just to drive home the point, excess weight is not a disease of willpower deficiency. And that’s why people shouldn’t just take it upon themselves. I just need to try harder. If I tried harder, I would lose these 50 pounds and keep them off. I think you’re welcome to try and I wish everyone the best, but like do it with find your people. Maybe Sarah, you are their person.

Maybe I am their person. Maybe our podcast will help people. But maybe they go to the American Board of Obesity Medicine and find a provider in their community. Maybe they join a group, maybe they have a neighbor that they partner with to set goals, go over their goals. Maybe they talk to their primary care doctor about weight loss medication. maybe they end up having metabolic surgery, which is what we should all be calling weight loss surgery or bariatric surgery. Now metabolic surgery. What I think is we should all stop going it alone. Yeah. People do better when they have support and the more support the better. And our support should come at least in part from experts who can help share the latest science. Yeah, so. Like you.

Absolutely. Well, and my patients know, so I am in Illinois and Virginia. I’m doing everything by telemedicine. But tell us if someone is interested in working with you, how can they learn more about you, get in touch with you, learn about your group, all of that?

Thank you. So my group program can be found at smartweightlosscoaching.com. And that’s the name of my new podcast, the Smart Weight Loss Coaching podcast. And to work with me personally, you can find me by looking up Lisa Oldson, O-L-D, with a D in the middle there, S, S-O-N and Oldson Medical is my private practice where I meet one-on-one with people. I take a really limited number of clients every year. Like I really cap at 10 new clients in a year because I wanna make sure I’m giving lots of attention to the few people that I work with and then to my small group. But I would love to meet people who are in my area and interested.

And like you, Sarah, it’s a new age. I’m practicing telemedicine. It’s amazing. I think I had a lot of concerns if I could really help people the same in that way, you know what I can. I used to do walking appointments. I would meet people and this was before the pandemic. Yeah. Which I loved. I would meet people at local parks or forest preserves and we would walk while we talked, which I thought was amazing. So I do something similar when I’ve been working with someone for long enough and we don’t have to focus so intensely that we both have to be sitting and staring at the computer. You know, we’ll stand up. I just use a standing desk and, you know, put my computer up and I’ll stand while I’m talking with someone. I invite people, you know, don’t do a massive workout while you’re-

I love that.

But you know, if you wanna have some little three or five pound hand weights that you lift every once in a while while we’re talking, why not? In fact, I almost stood up for o call today and then I was like, no, this falls under the category of I need to focus.

Need to focus. Yeah.

Just a bit.

I love that though. I think, I do all sorts of walking meetings, but my patient visits I always do sitting in front of the computer. And it’s funny because it’s opposite of what I preach. So I think I’ll take a page out of your book and at least stand and get some wiggles out, even which is valuable.

Why not? Why not? We actually do pop-up walks too, because I do miss the face-to-face human contact with the telemedicine.

Yes.

So we just post it for the group for anyone on my mailing list. We post on Instagram sometimes at Lisa Oldson MD when we’re doing a pop-up walk. And I just do them where I’m at locally in the northern suburbs of Chicago. And anyone is invited, their friends and family are invited, their dog is invited. We just make it like a stroll, but an opportunity to meet one another. Mm-hmm. just have a healthy, joyful hour together. So yeah.

I love that so much. Well, I will make sure, especially with a name like Oldson, you’ve got the D, it’s S-O-N. We’ll make sure to have all of your links in the show notes so my listeners can check it out there. Thank you so much for joining me today. This was really a pleasure.

Thank you so much, Sarah. The pleasure was mine.

SARAH STOMBAUGH, MD

Episode #41: How Weight Loss is Different for Women Over 40 with Guest: Dr. Lisa Oldson

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