Conquer Your Weight

Dr. Sarah Stombaugh: Before we get into the episode, I am thrilled to announce we are launching an online course, The GLP Guide. The GLP Guide is a must have resource for patients who have been prescribed any of the GLP medications such as Wegovy, Ozempic, semaglutide, Zepbound, Mounjaro, tirzepatide, Saxenda, liraglutide. There are a lot of them, and this course is available for anyone to purchase. We often hear from people who haven't been given much information about their GLP medications. No one has told them how to handle side effects, what nutrition recommendations they should follow, or what to expect in the longterm. And it can be really intimidating and simply frustrating to feel like you're alone in your weight loss journey. With the GLP Guide, you'll get access to all of the answers to the most common questions for patients using GLP medications, not sure how to use your pen, struggling with nausea, wondering how to travel with your medications. We've got you covered for only $97 for one year access. This is an opportunity you do not want to miss. The course is launching on October 1st. For more information and sign up, please visit www.sarahstombaughmd.com/glp. You don't have to be on this journey alone. We are here to guide you. And now for today's episode, this is Dr. Sarah Stombaugh and you are listening to the Conquer Your Weight podcast. Announcer: Welcome to the Conquer Your Weight podcast, where you will learn to understand your mind and body so you can achieve long-term weight loss. Here's your host, obesity medicine physician and life coach, Dr. Sarah Stombaugh. Dr. Sarah Stombaugh: Hello everyone. I have a really fun episode planned for today. This was inspired by a situation that I found myself in this weekend and I wanted to share this funny story with you and then talk a little bit about some of the lessons we can learn here and how we think about our food choices and how we can be really intentional about eating all of the foods that we love. But like I said, in that really intentional way, so let me tell you the story. Last weekend or the weekend before I was recording this, I was out to dinner with my children and it was just me and my children. My husband was out of town for a work event and we went to the dairy market. If you are local to Charlottesville, Virginia, you will know the dairy market is a cafeteria food hall. And so you can order from different restaurants and so many great restaurants there. My kids of course, love pizza and typically if I'm there with also my husband or other adults, we might get additional food or different foods than just pizza, but my kids love pizza and it sounded good. And so we ordered pizza, got a cheese pizza for them, a Mediterranean pizza for myself, and then when we were done, we ordered ice cream because there's a great ice cream store that is there as well. And so we were sitting there enjoying our ice cream. We had a box on the table of all our leftover pizza they were going to bring home with us. And I ran into one of my patients and I wanted to share this story with you because this may go a little bit differently than you think. I was not embarrassed at all. I was eating pizza, I was eating ice cream. I saw one of my patients who I see to support them in their weight loss journey. And we had a very lovely conversation. And I want to tell you a little bit about my mindset and when I incorporate these foods and how I support my patients in incorporating foods like pizza and ice cream into their diets. Let's talk about this a little bit because I think one of the most common misunderstandings, and maybe it's not even a misunderstanding, but one of the most common parts of many diets and diet culture is this very all or nothing thinking that certain foods are good, certain foods are bad. Maybe we are on a diet where foods or entire food groups even are demonized and restricted from the diet or foods that we are particularly emphasizing for a period of time. And when we have practiced that type of thinking, often for decades, for many of us, we've been doing this since teenage years or even younger, we would hear our mothers or older sisters or other people in our lives that we're talking about certain diet behaviors. We start to develop these beliefs about what are good foods, what are bad foods? Now, the interesting thing is that we both a lot of times have these idea of what bad foods are and eat those same foods all the time and then just live in this sort of cycle where we feel like we're being bad, we feel guilty, and we feel shame about eating those foods, even if they're foods that we really enjoy. And sometimes they may not be foods that you enjoy and that's an entirely different issue, but I want to focus on these foods that we really enjoy. So thinking about things like pizza, thinking about things like ice cream. I'll tell you, I really, really, really, really love pizza. I think that a great chewy bread crust with sauce and cheese and some vegetables on it, I love that. And it's for sure in my top five meals, I won't rank it, but a really high quality pizza is honestly one of my favorite foods. Even as an adult who has mature taste buds and likes plenty of other things, I really enjoy a high quality pizza. And so when we think about our dietary goals, we think about the food choices that we're making. Sometimes when we're embarking on a weight loss journey or in any sort of health journey, we just take a red sharpie marker and start slashing all of these things out of our diet. And the question that I will often ask my patients is, do you want to eliminate that food from your diet for the rest of your life? Now, sometimes, see the answer to that question may be a resounding yes, and I think that there are times when that is appropriate. So when I think of patients, for example, who have developed allergies, I have a patient who developed an allergy to seafood later in life. And that was really challenging for her because she really enjoyed that food, but it made her deathly ill. And so it makes sense that she should avoid that food for the rest of her life. But for a lot of other people, they may sort of hesitantly like, yeah, I should probably never eat that food again. And that's where it's really, really worth exploring. So I want to talk a little bit, we'll say that the food is pizza. There are often foods that people feel are really big triggers for them. It is hard for them to eat a appropriate amount of it once they start eating it, they feel like they just eat and eat and eat. They may feel cravings for that food, especially certain type of foods are readily available at events like at events that they go to, for example. And so it's something where they're presented with the opportunity to eat it. And especially when that food has been really restricted from the diet, we have this belief that that food is bad, that if I eat that food, I will gain weight and it will not be healthy for me, so therefore I'm never going to eat it. We end up really putting that food item on a pedestal and we spend some time, a lot of time thinking about the fact that we can't have that food. And so if we're thinking about pizza for example, and then we're presented often with opportunities like at kids' birthday parties or at work functions or wherever we see that pizza and we get sort of hyperfocused on the pizza and thinking about, Ooh, that sounds good. I wish I could have that. That's not good for me. But the funny thing is, then we end up eating pizza that maybe actually isn't that good. It's from a fast food chain, for example, or pizza that's cold that's been sitting out for hours and indulging in or overindulging in a pizza. That's honestly not even that exciting. Just because we spent all this energy focused on pizza is bad, I shouldn't be having that and this restrictive cycle that we're thinking, thinking about it over and over again. And so what I want to offer to you is that with these type of foods where we know that they can cause a lot of cravings for us, and I'm talking about pizza here, but this could be anything, and everybody has their own food that is just really kind of like a kryptonite. It's going to be this food that sets off a lot of cravings for them that they spend a lot of time thinking about that maybe at times in the past they've significantly overeat and feel like they just don't have control around this food. It may make sense to pause that food in your diet for a period of time, but what is so much more valuable and what is really required in the longterm is to learn how can I have a healthy relationship with this food? So I want to think a little bit about what does it mean to have a healthy relationship with a food like pizza or whatever the food is to you that is really a special treat, may not be a hundred percent in line with your health goals. So it could look like a lot of things. Most importantly, it looks like an intentional decision to eat that food. So when we think about, we haven't talked about this in a while, but we think about the human brain, we think about our ability to plan, our ability to decide. We have this primitive brain that is going to make sure that we do not starve. It's going to sort of have these urges and cravings and like, Ooh, that sounds good. Ooh, that sounds good. And then we have our more developed human brain. That's what makes us unique from other animals is that we have this very developed prefrontal cortex and that allows us to really think and plan and make decisions that make sense for us is this ability to really have this planfulness that goes into our day. So when we make food decisions, we can make decisions from either of those two places. And so the difference between allowing your primitive brain to make a decision versus your prefrontal cortex, that logical brain to make a decision a lot of times is the time when you make the decision. So for example, with pizza, if you are at a work event and there is pizza in front of you deciding to have the pizza right then and there is a decision that's coming from your primitive brain, I see pizza. Pizza looks good. I think about pizza. Pizza sounds good to me. I eat the pizza. And not that there's anything wrong with that. Our primitive brain serves this very important role in that we're not going to starve. We're going to be seeking all of these dopamine foods and other things that are giving us pleasure in our life. That's amazing and important. And in the developed world where we have access to food all of the time, we do not need to rely on our primitive brain for the sake of eating. And so what eating pizza looks like when you're relying on your primitive brain is a decision. How often realistically, can I eat pizza and be in line with my health goals? Can I do that once a day? Can I do that once a week? Can I do that once a month? Can I do that a couple of times per year? The answer will be unique for you, but you get to decide how often do I eat this food? It looks like deciding in advance. So maybe earlier in the day, maybe the previous day when you're making a plan of, Hey, what is tomorrow going to look like? Or Hey, what are we going to be doing for dinner later this evening? Having a decision right then and there, okay, I'm deciding I'm going to have pizza and I'm going to eat this number of slices, or I'm going to have pizza and I'm going to pair it with a salad, or I'm going to have pizza and I'm going to listen to my satiety cues and decide to stop based on the way that my body is feeling. So planning for a food like that in advance looks very different from in the moment just deciding to have it. And what that honestly allows you to do is that when you're going to have the pizza, you get to have the pizza that is your favorite flavor that is from the restaurant that you're really excited about, rather than sort of giving into that craving and eating like the stale cold cheese pizza at a kid's birthday party. I don't know about you, but that does not appeal to me. And sometimes we will say things like, oh, but I was hungry and that was the only choice. And that's fine, right? You get to decide what makes the most sense for you, but you probably aren't starving to death. You probably could have waited another half an hour, hour until the end of the party. Maybe there was another choice that was more in line with your goals. Maybe you decide to eat the pizza this time, but recognize, hey, every time I go to a kid's birthday party, they have cupcakes and pizza, and next time I'm going to make sure that I eat in advance. The pizza's not so tempting to me. That can look like a lot of different things. But the fun thing is that when you plan in advance, it feels really, really good. You've made the decision and then when you're eating the food and afterwards, there doesn't have to be any guilt or shame or anything that comes up. You may still notice that those things come up because a lot of times, especially if we have been conditioned to believe that pizza is bad and it's going to make us gain weight anytime that we're eating that food, we may notice those thoughts coming up. But when those thoughts come up, if they do what you get to say to yourself, it's like, Hey, brain, it's no big deal. I actually decided in advance that I was going to have this pizza and it was really, really good and I enjoyed it, and maybe I paired it with a salad and I stopped eating when my body felt comfortable, and that felt really, really good. And so I know we used to think that pizza was bad for us, but we're actually going to pause and give ourselves a high five here because that was awesome. And I know that all of that sounds totally silly, but sometimes it's really important to talk to your brain with this loving voice, with this reassuring voice because all of those beliefs that you have from the past, those will come up and those you've practiced thinking those for many years or many decades even. And so when those beliefs come up, just know that that is normal. Your brain is just practicing having the same belief patterns that it's had over and over and over again. And you can decide that, hey, I'm doing this in a very intentional way. Now the other thing that I will add here is that I also had ice cream with my pizza. And one of the things we've talked about before is planning ahead in terms of dessert. And I think that this is honestly also so important, both in terms of how often am I eating dessert? How can I do it in a way that's going to be most in line with my health goals least likely to impact my weight? And that can look like a lot of different things. But what I want to think about in the context of having dinner and dessert is that that needs to be something decided in advance. Our body is very good at processing carbohydrates, things that are really high in sugar, things that are really high in flour, such that even when we have satiety, we are often able to squeeze in a few bites or even the entirety of a dessert. And so what this sometimes looks like is that we have dinner, we eat the amount of dinner that brings us to an appropriate amount of satiety, and we are feeling perfectly adequately full where we could go the rest of the evening, we could go to bed, we could wake up the next morning, we could still be feeling adequately satiated and feeling like that meal served our needs, and then maybe somebody else in the party, or for whatever reason, dessert has been offered and we still eat that dessert. So we felt like, yes, I was comfortable at the plus four. If you want to go back and review any of the podcast episodes about food logs and the hunger scale, we have a couple of episodes on that. You can search back on those in the episodes. But let's say you finish the meal and you're at a plus four, you're feeling appropriately satiated. You do not need to have dessert. Your body is appropriately comfortable and you should be done. But when we decide that we're going to have dessert because it was presented to us, we have some cake, we have some ice cream, we have this sweet, those simple carbohydrates kind of slip in and are easy for us to eat even though we had the appropriate amount of satiety. And sometimes the interesting thing that happens is that we cross over, maybe a single bite or two won't make us feel this way, but let's say we end up having the entire dessert. We finish the meal feeling appropriately, satiated, feeling like appropriately amount of plus four, I feel comfortable. And then we have an entire dessert and we cross into this territory of now I'm uncomfortably full and I've actually made my overall meal experience less enjoyable because I had dinner and dessert and ended up overeating. So in a similar way, when you are going to have dessert, deciding in advance that dessert will happen after a meal is so, so important. Coming back to the pizza, when I ran into my patient with this pizza in front of us and the ice cream in my hand when I ordered a pizza, I'd ordered a, it's a 10 inch pizza, and I ate two slices. They're pretty small slices. And I looked, that was half of this 10 inch pizza. And I was like, Ooh, I could totally put down a third slice of pizza. And I reminded myself though, that I wanted to have ice cream. And so when I finished the meal with pizza, I still felt like there was room in my stomach. I still knew that I could eat more. That eating dessert would bring me to an appropriate levels of satiety rather than sort of pushing me over the edge. And so this is where that planning in advance is the most important thing that you can do. And over time as you start to make these decisions, the really fun thing is that you start to reestablish this relationship with yourself, reconnect with your body to learn, okay, maybe I can actually eat pizza once a month and really enjoy it and pair it with ice cream, but the rest of the month I am eating in a different way. Or you get to decide and you get to see what is the response on the scale. How does my body feel? I've had patients throughout their journey that realize, even though they like the way pizza taste in their mouth, they realize that they actually have a gluten sensitivity. And so anytime they're eating bread products, they feel really bloated or achy or other things afterwards. And so they get to make this decision of, okay, I thought I really liked this food and I really enjoyed this food, but it turns out it's actually really not serving my body in the way that I thought it would. And so the fun thing is between food logging, between paying attention to the hunger scale with planning our food in advance, we are able to put absolutely anything onto that plan. We get to decide what it is that we are going to fuel our bodies with. And when we've made that decision in advance, when we made the decision from our thinking, planning, logical prefrontal cortex, that is the best thing that we can ask for. And we know that we have our best interest in heart taking in mind, not just our weight loss goals, but what are our food preferences? What are the things that we really, really love and we have as a treat from time to time? And that is absolutely okay. And so there are times, if you run into me at the grocery store, I may have food in my grocery cart like ice cream. I may also have a bunch of vegetables and lean protein, but I choose what makes sense for me, what makes sense for my family, what makes sense for our bodies and what our needs are right now. And that's it. My journey is different than your journey, which is different than anybody else's. And I love to connect with people and help them to be able to reestablish what it is that they need and how can we make those decisions so that they are best in line with their overall health goals and starting to see weight loss as a result of that as well. So I wanted to share this really fun example with you. It is okay to eat those foods. It just has to be done in an intentional way, and I would love to support you with that. We are enrolling patients in our practice right now. We see patients in the state of Illinois and to Virginia, and you've heard about our GLP Guide. For any patients who are taking a GLP medication, we would love to support you. It's a series of online videos on demand so that you can get answers to all of the most common questions. For patients who are taking any of those GLP medications, we would love to support you so that you feel like you have the support. You are not alone in this journey. We are here to guide you. Thank you so much for joining me for today's episode. I'll see you all next week. bye-bye.