Conquer Your Weight

Dr. Sarah Stombaugh: This is Dr. Sarah Stombaugh and you are listening to the Conquer Your Weight podcast. Announcer: Welcome to the Conquer Your Weight podcast, where you will learn to understand your mind and body so you can achieve long-term weight loss. Here's your host, obesity medicine physician and life coach, Dr. Sarah Stombaugh. Dr. Sarah Stombaugh: Hello everyone and welcome to today's episode of the Conquer Your Weight podcast. I have a guest with me today, Dr. Heather Awad. She is a family medicine physician, turned into a life coach and she helps professional women in their perimenopausal and postmenopausal years to lose weight, which I think it's a topic I talk about every single day. I think it's so important. My patients know I'm in my very late thirties and I'm always saying, okay, I have to learn everything now that I can in order to apply this when it's important for me, and then of course to support my patients with it every day. So Dr. Awad, thank you so much for being here today. Tell us a little bit more about yourself and then we'll dive into our conversation. Dr. Heather Awad: Sure. Thanks so much for having me, and I want to tell your audience that I especially love your Tiktoks. Dr. Sarah Stombaugh: Thank you. Dr. Heather Awad: If they don't know you there, they should come over there. Dr. Sarah Stombaugh: I appreciate that. Dr. Heather Awad: Yeah, they're so good. So I got into this, I'm in my mid fifties now, but I am a family doctor and as you said, and really kind of a food is medicine doctor, always counseling people to eat healthy and if they had high cholesterol I would say, Hey, what do you eat for lunch? And then in my mid forties when I didn't change anything I ate, the number on the scale went up and up. Isn't this the story that all of us have at that age? So I tried the things that worked for me before to lose weight and they didn't work at all. And then I tried some actual diets and worked really hard and yo-yo'd back and felt terrible. And at 50 I was just devastated because I was in a weight range that I knew was unhealthy and I thought, how can this be happening? Is there something totally wrong with me? But because I'm a doctor, I thought there's got to be a secret, there's got to be a secret. So I dove into the research and discovered the issue of insulin resistance at the menopause transition and I thought, oh man, this is it. You just have to know how to feed your body with this in mind and this will work. Then I also got some coaching for the emotional eating I was doing, and then in putting those two things together, it got really simple. I lost 27 pounds, no fear of gaining it back again. And I thought, wouldn't this be a wonderful thing to bring to other midlife women because it's a very crackable code. And so that's my passion now and I really enjoy helping other professional women lose weight for the last time. Dr. Sarah Stombaugh: I love that and I love that you described it as a crackable code because I think for a lot of people it feels completely crackable. That's this acceptance that there will be the weight changes and you just have to deal with that, but it's a crackable code. So tell us a little bit, you spoke to some of the emotional eating, some of the insulin resistance, but what does it mean to crack that code? Dr. Heather Awad: Yeah, so also at this age, people notice other things, right? They notice maybe their skincare routine has to change because their skin has changed or their sleep is different and they need to do some different things there. This is the same thing, your digestive system is different now with your hormones changing. So when our estrogen starts to drop, we get a natural bump in insulin resistance, and insulin is a really familiar hormone to us. We eat, our body turns food into glucose and insulin comes in and takes it into the cells. So if we get resistant to it, then we get more insulin hanging around to process the same amount of food. So that's why you get the story of I ate the same, but things are different. So the thing is that insulin helps us process that food, and what it does is it uses what it needs for the moment, puts a little bit in the liver for storage and then stores fat. So if you have a lot of insulin around all day long, you are telling your body to store fat. It is telling your body to store fat all day long, and that is where we get that midlife weight gain. Also, it is the central weight gain, it's the belly fat and it's also the fat around our organs that causes the increase in risk for disease. That comes also at the menopause transition. So that is a crackable code. Dr. Sarah Stombaugh: And it's like, okay, great. So I know I've got this insulin resistance, but what do we do about that? I think a lot of people understand that that's a thing. We hear a lot about insulin resistance, but what are some of the practical changes to help support your body through that? Dr. Heather Awad: Sure. So what we need is we need our digestive system to work when we need it to work, and we need it to have some quiet time where insulin just naturally drops. So how you do that is you move away from snacking and start eating nourishing meals. So also a very common thing that we do to comfort ourselves or as a habit is eating at night. Again, we want a long time between that dinner meal and the meal, the first meal the next morning. So we want to eat our dinner and we want to move away from having food in the evening except for on an occasion here and there because we need to have that quiet time. Now when we have that quiet time and when insulin drops, if you remember from your biology class, when you use energy and you have not eaten, your body pulls that little bit of energy as glycogen that's stored in the liver and then it starts pulling fat stores for energy just to keep you alive. And so when people can do that, my clients a few weeks in start to tell me, oh gosh, this is really simple. I'm losing weight. And so there are people who will tell me it can't be that eat meals and don't snack. Actually it can. It totally can. So there's some other tweaks there, but that is the basis of it that really makes a difference for women at midlife and beyond. And it's different than what you did at 25 and it's different what you did at 35. So it's a change and that's why it seems mysterious because different than what worked when you were younger. Dr. Sarah Stombaugh: Absolutely. And I think emphasizing this insulin is our energy storage hormone, and our bodies are really not good at burning energy and storing energy at the same time sort of simply put, we're either storing or we're burning. And so anytime that we are consuming food, we are going to be driving up that glucose, driving up that insulin, and our body is now getting that signal to store. And so you can't also be burning your energy at the same time because you've got this active energy available to you. And it's really interesting. I think one of the things I have my patients do food logging for example, and it's really fascinating to see even just that little nibble that you had a quarter of a cookie in the break room and a couple of bites, I'm guilty, I'll be packing my kids' lunch for the day and just popping a few strawberries even. It doesn't even have to be unhealthy food. It can even be something that's healthy, but it's fruit and it has sugar in it. And when we're sort of giving ourselves a little hit there and a little hit here, all of a sudden it starts to add up and our body is just storing all day long rather than having that ability to access our fat stores and start burning rather than storing. Dr. Heather Awad: Exactly. And I hear that same story as well. People will say, well, because we think of calories and we think of healthy foods and healthy snacks, and these things are things we don't actually need to worry about at midlife and beyond, we need to be thinking more about downtime. So I'll have a client to say, well, I walk through my kitchen and on a Saturday afternoon and pop a few cherry tomatoes in my mouth. So good. Not very many calories, very delicious. And actually what they've done is just what you've said, they've turned themselves, turned their body into fat storage mode again. And so something that seemed like it was a fine, good thing to have, they've just turned everything back on again and they weren't actually hungry. They just saw them and they are good and healthy, but they should be eaten at a meal instead of walking through the kitchen. Dr. Sarah Stombaugh: Yeah, absolutely. Well, and it makes me think emotional eating. A lot of times I have patients that very clearly identify with that as like, oh, I'm really stressed and I eat. But I think it's important to point out that the emotion may also just be boredom. It might be, Ooh, that sounds good, or temptation. It may not be the emotion of stress. So talk to me a little bit about how that comes up with your clients. Dr. Heather Awad: Sure. I have a lot of people who have that same story. They'll have just moved to work from home or sorry, yeah, started working from home. And so now they just walking through have that and to entertain themselves in the moment will have that. Or people who just retired will tell me, well, I just go to this one cupboard where the nuts are and nuts are healthy. And honestly, the funny thing is once they notice it, they're often able to easily stop it because they're having a nourishing lunch so they don't need something in the afternoon. But they'll also say, what do I do with myself now? Literally, I dunno what to do with myself now. And the funny thing is, we're also busy. We all have such interesting rich lives, and it's time to look at that list. What do I want to create? Is there something that is on that list? I always wanted to do this. I've had people start businesses take up knitting, literally look at that list and say, well, there are some things I've been wanting to do if I had more time. And literally because they're not eating nuts out of the cupboard, they are now making blankets or have started a new business. And so it's fascinating that it's wasting your time with it as well when you're doing boredom eating. So it's just a good time to take a look and say, gosh, what could I create now that I have time? Dr. Sarah Stombaugh: Yeah. Oh, I really love that. Because I think a lot of times we are both like, oh, I'm so busy all the time, and yet we're finding ourselves bored and eating. And so if you're bored, maybe you're not busy all the time, you may be busy other times, but if you've got these free spaces, what could you create with that? I love that. Dr. Heather Awad: Tell me a little bit. It's a fun way to look at it. It's expansive and joyful and so it's a great way. Dr. Sarah Stombaugh: Yeah. Tell me a little bit about food choices because I agree that sometimes we get really caught up on what's the best food that I can eat, what's the healthiest food? And that doesn't always serve us in the way that we think it does, but there are still foods that are going to be more in line with our health goals compared to others. So tell me a little bit about how you counsel your clients in terms of what type of food choices they're making. Dr. Heather Awad: Sure. I do think especially at midlife and beyond, we need to make sure we're getting enough protein. There are a lot of people online talking about protein. I think some of them actually do counsel higher than what we need, but you do need protein at your breakfast. You do need probably three servings a day. So if you're only having two meals, you need a little bit more. Serving size can be about the size of your palm, including the thickness of it. So a decent amount of protein. It can be vegetable, it can be meat. And I do want to just emphasize that because I still meet a lot of women who eat a pretty low protein eating style in their day. The other thing is you really want some fiber at those meals. So vegetables, berries should really be at every meal. There can be really easy ways to incorporate those if you buy leafy greens and you can throw them into anything that you're cooking or into your smoothie or whatever, or a little bit of regret on them as a side with whatever you're having. So those are really important. And the other thing I would say is to not shy away from healthy fats. They're super nourishing as far as the protein will help you make it to your next meal to feel very satisfied. The fat also will give you that nice full feeling in your belly and help you last longer and olive oil, avocado oil, and then eating the vegetables that have these things in them like avocados and olives, some nuts. The oil itself does not raise your insulin level, so we're all about the insulin at midlife and beyond. And so something like that can be added. And a lot of people, I was a teenager in the eighties and that was the low fat craze. And even though we have research and had many good media articles telling us that that was a lie, it is programming that is very hard to get away from because everyone learned the calorie counts for those different things. And honestly, if you drizzle some olive oil on something, it's fine. It is going to help you stop when you're full and it's not going to add to your, it's not going to raise your insulin. So it's really not adding to your food storage program or problem. Dr. Sarah Stombaugh: Yeah, so I could not agree with all of that advice. I couldn't agree with it more. It is a hundred percent I'm on board with it, especially insulin, as you were saying, when we eat fat, we don't need insulin to store that away. Our fat can be absorbed directly in our GI system. And so the insulin response comes from eating carbohydrates, comes from eating even protein, and not that that's bad. Insulin's probably our most important hormone. I give a talk on this where I'm like, remember insulin's not bad. If you don't have it, you have type one diabetes and without insulin, you die. So it's super important, and we also really want to be cognizant of how it's being used, the amount of it that's being released in our body and how we can support a more natural rhythm of that. And so that's where a really great way to regulate that. And when they're naturally occurring in foods, we shouldn't remove them. If fat free things don't necessarily make sense to me, if we're thinking about avocados and olives and seeds and nuts and the way that those foods stick with you, they have a really good staying power. And so I hear patients all the time that talk about having a salad and they have low fat dressing and then there wasn't a lot of protein on it, and they're ravenous an hour later. It's like, well, if you had a mound of vegetables with low fat dressing on it, of course you're hungry an hour later. You had no protein, you had no fat. Those things really help you feel satiated, not just initially, but for hours to come, which I think is a really important thing, especially when we're thinking about snacking and making sure that our eating is confined to really intentional times. Dr. Heather Awad: Yeah, I'll have a client who will say, I love this low fat dressing. I just love it so much. And I say, okay, go ahead and use it, but can you also drizzle some olive oil on top of that salad? And they look at me like, well, what's the point? I'm like, no, I was very serious about you needing fat in your lunch. [Laughs] Very serious. Dr. Sarah Stombaugh: Yeah, absolutely. Well and I think it's interesting, I always struggle coming to the protein stuff. I struggle to give recommendations about protein to a broad audience because it's going to be so specific to the age of the person, the gender of the person, their activity level especially. And so you hear these recommendations admitting 70 grams a day, a hundred grams a day, 200 grams a day. Some people are really going crazy. But it's interesting because sometimes when I talk to my patients, they're getting 30 grams a day. I mean, they're getting very, very little protein. And so it's valuable to know where that's at. Our body doesn't have a great way to store protein. And so especially when we're thinking about making sure we're maintaining our muscle mass, which is important for anyone, but especially for your clients, for women who are in these perimenopausal postmenopausal years, there is nothing more important than building and maintaining your muscle mass. And then the impact that that has on our bone mass. And so I am so cognizant of for all of my patients, but especially those per and postmenopausal women, we do not want to create a situation where now all of a sudden you have decreased muscle mass, you have decreased bone mass, and those things are very serious consequences that happen commonly in the later years. Dr. Heather Awad: And it's funny because as you come up to this age, you're not feeling it. But when you start to notice what's happening to your aunts and uncles, to your parents and how they look frail and how they've had falls, and this is the time and eating enough protein is the way to avoid that future for yourself. I think at midlife, we start to notice that in our twenties, our frontal lobe of our brain is still kind of becoming very developed, but at midlife, we start to notice those things and we're able to really plan and think in a very good way that can serve us because we do plan ahead and are able to do some more preventive medicine things for ourselves by eating healthier and doing the things that we need. Dr. Sarah Stombaugh: Yeah, I love that. Tell me about the role of exercise. How do you support your patients in their exercise goals? Dr. Heather Awad: Sure. I really do. I bring to it the lens of a weight loss coach and a midlife coach more than a cardiologist, I'll tell you that. So what I tell people is that since we start losing all the humans, start losing some muscle mass in the mid thirties, but when our estrogen starts to drop, we lose more faster. So midlife, this is an issue for sure. So I tell them that we really do need to do some sort of weight training, whether that's with weights or bands or whatever, but we do need to get stronger actively. So the protein that we eat helps us do that, but we do need to do some resistance training and it's time to lift heavier weights. We're not about toning, we're about getting stronger, and you would have to eat in a very specific way to become a bulky bodybuilder. So you also tell people not to worry about that. You're actually just working against loss right now. And then for cardio, I tell them that cardio is not proven for weight loss, but it's good for our health. It is good for our heart and our brain and our mental health. So I suggest that people at midlife choose something that's joyful to them at a level that's joyful to them because it will also be an active de-stressor, which is also extremely important at midlife because our cortisol starts to also get a little wacky at this point. And high cortisol makes us not feel good. It also works against weight loss. So I tell them things like, I like to do sports. So for me, that kind of workout is great when I go on a walk, it's not that fast that also feels good and feels like de-stress to me, but people need to pick what's good for them. Do they love dancing and want to take a Zumba class or a dance class? Do they want to, they're on music and do a dance party for 20 to 30 minutes in their kitchen. What is it? Do they want to walk with a friend because the connection really helps them feel good. Maybe they do love running, and so that's going to be the thing. So I think that choosing something you really like is really the best way to do cardio at midlife and beyond. Dr. Sarah Stombaugh: Yeah, I agree completely. Honestly, I think throughout your entire life, a lot of times we have these different goals, whether it's weight, whether it's exercise goals, maybe some sort of competition that we're going to do. And so we may enroll in a program that's not fully in line with what our interests are, and we may sort of suffer through that for six weeks or 12 weeks. And the interesting thing is we never stick with it if it's not something you actually enjoy, if it's not something that brings you joy that you see the benefits of not just in the long term, but even in the short term, whether it's the connection, whether it's the de-stressing whatever it is providing for you, I think when we look at goal setting and the psychology around anything that we do, we can sort of academically or medically speak about what are the exercise recommendations. But when we talk about applying that in a real life human, we have to think about the psychology there and what is actually going to be exciting for them and therefore able to apply that and implement it in their lives. Dr. Heather Awad: Yeah. So agree. Dr. Sarah Stombaugh: Tell me about the role of hormone replacement therapy, because I know I just had someone tell me yesterday, she was like, I was up late last night googling HRT for weight loss. So tell me how that does or doesn't play a role. Dr. Heather Awad: Sure. It's not really proven to help with weight loss. There is some evidence that for some people it will help with the distribution of fat in your body for a healthier distribution. Some people get less central weight gain and will keep more of their pear shape, which is a healthy shape. The hard part about saying that for everyone is that in 2024, we really customize your HRT, so you're going to work with a doctor who's open to it and they're going to work for symptoms and your other health issues, whether it's bones or other issues that you're trying to target with the hormone replacement therapy. So you may or may not notice that change in body composition, but really it's not something to take for weight loss. Dr. Sarah Stombaugh: And I think that's exactly it. There's a lot of impacts that can be sort of indirect. And so when we think about the woman who's having really severe night sweats, for example, and she's up all or hot flashes and she's up all night long with these night sweats and she's changing her sheets and she's not sleeping well, that and the impact of poor sleep has all these downstream effects of the next day not having the energy to move or not having the energy to be able to do this. And so when it's sort of weight loss by itself, it's really, it's not an indication and it's not appropriate, I believe, to use HRT for that purpose. But when we think about the whole person as you're implying, it makes a lot of sense to use that, and someone who has bone density concerns or who has these really significant hot flashes or is having other things that they and their physician can decide together may make sense. And the interesting thing, I think the pendulum has really been swinging on hormone replacement therapy, and we were really for it. And then, oh my gosh, it was terrible. And I grew up in a generation of physicians. The entire entirety of my medical school and residency training was like, do not do that. And it's really only in the last five years that I'm realizing, oh my gosh, this actually can be a good thing or a right fit for the right person. And so the pendulum's starting to swing. I think there's more physicians who are open to it using methods of hormone replacement that are, like you said, sort of individualized to the person, things that may carry a lower risk compared to some of the treatments we were using three or four decades ago. But yeah, it's not indicated for weight loss in its own. And so I do think that's an important thing to think about. Dr. Heather Awad: And I love that you pointed out the sleep issue because that's really important as well. I mean, that actually was a big change for me personally when I went on hormone replacement therapy because even one day of bad sleep the next day, you actually have a hard time even telling if you're hungry or full. And people tend to eat more overall when they haven't slept well. So it can be a great tool for that. And looking at the whole picture, you'll have a lot of things that each person, if it's an appropriate treatment for you, there will be many things that it will hit and help. Dr. Sarah Stombaugh: When I think the best recommendation I would have for anyone who's listening is go to your doctor and ask them, have a conversation about your own symptoms, your own risk, and make a decision together with them. Because I think whether it's listening to you and I, whether it's a late night Google search, it's really hard to tell. It gives sort of a broad sweeping recommendation that's going to be based on an individual. Dr. Heather Awad: And I also want to say too, that if your doctor says something like hormones aren't safe, or they say, I went to my primary care doctor who I adore, and I said, it's time to talk hormones. And she said, I'm afraid of hormones. And when that happens, if you have someone who can't really discuss it, you're noticing that they can't really discuss it with you because they only say no hormones, then it's time to find a different person on your team. I went to an OBGYN who I knew would be willing to discuss it. Not even all OBGYNs are well versed in this now, but you want to find someone who looks like when you have a discussion with them that they will be able to discuss it with you and give you your risks and benefits. And so if your first person you go to doesn't, then that's not the final answer. It's okay to have another doctor on your team. Dr. Sarah Stombaugh: Yeah, I really appreciate you saying that because I think especially when we talk about my generation of physicians being raised, no, no, no hormones, there was definitely a version of me talking to patients five years ago that even though I was very open-minded to it, I said, that's not something I feel comfortable doing. And that was where I needed to leave the discussion at that stage in my practice. But different people practice in different ways. And so you may hear like you said, oh, that's not a safe option, or I don't do that. And so if you're hearing or even someone who's like, okay, let's just do it and sort of throw something at you, you really want someone who feels like a partner and can give you, as you said, that risk versus benefits. What is my risk of breast cancer? What is this going to do for my bone density? What is my risk of heart disease? Talking through some of these different things and knowing that you have someone who is educated to support you in making the best decisions. Dr. Heather Awad: Right, right. Because all the things that you mentioned as well as brain, as well as bladder and urinary tract, I mean, there is a lot. There's a lot. Dr. Sarah Stombaugh: Yes, absolutely. And so yeah, I hope everyone comes away from this podcast feeling empowered to have some conversations with their physician if that is one of their health concerns right now. So tell me, Dr. Awad, as we're wrapping up today, anything else that we haven't talked about that you really feel like would be important for my listeners to hear? Dr. Heather Awad: Yes. One last thing. If you don't eat a savory breakfast, if that first meal of the day is not a savory meal, then switching that will also be a huge game changer in normalizing your weight and being healthier. Because when we eat the sweet breakfast, when we eat bread, cereal, granola, all these things, it gives us a glucose spike in the morning. And then if you ate the same thing the rest of the day, every day, that sweet breakfast will make your blood sugar higher all day, which makes you have more insulin around to work with it all day and makes a difference in weight loss and health. So if you switch to a savory breakfast, all of your glucose curves and all of your insulin curves all day will be lower. So it's a good time to Google high protein breakfast, savory breakfast recipes if it's not something that you already do. It doesn't have to just be eggs, but that's one of the choices. There are actually many good choices for that kind of breakfast, but that can be a big game changer as well in this kind of insulin resistance cycle. Dr. Sarah Stombaugh: Oh, I love that. Okay. And I'm going to put you on the spot here because a lot of times I'll talk to patients and we'll talk about new dietary ideas and you said Google it. So my patients may do that or my listeners may do that. But I want you to give me a handful of examples of what a savory breakfast might look like. So it starts to trigger our imaginations. Dr. Heather Awad: So the ones that I do are we have an omelet. Sometimes we throw in greens from the fridge and a little bit of cheese and tomato, two egg omelet. Another one I like is a high protein yogurt. It could be a Greek yogurt or a coconut yogurt. And then I add berries and cinnamon because it makes it taste a little sweeter without actually adding sugar. And then I put on things like some sort of nuts or hemp seeds or chia seeds, flax meal, some of these other things that add a little bit more protein and a little more crunch. That's another one I love. One we had today, and I am very fortunate that my husband likes to make a hot breakfast, was a tortilla. Take a corn tortilla, put refried beans on it, a little bit of cheese, some salsa, and then you just actually cook that on low to medium and the skillet till the cheese starts to melt a little bit and then throw a egg on top of that as well. And those are my favorite. Dr. Sarah Stombaugh: I love that. I'm going to add a couple so we get some brains going. I love the egg bites that you can buy, the sous vide egg bites you can get at Starbucks. They also have those, I'm a Costco addict, and so we buy Costco every single week and they come in nice individual packages. So for people who are like, I'm running out the door, I can't cook something, that is one of my favorite. I also want to recommend a leftovers from dinner. I think a lot of times we get really caught up in it's breakfast times, so I should eat a breakfast food, and you totally can, but also if it appeals to you to eat last night's chicken and Brussels sprouts or whatever you had, you could totally eat that for breakfast. And then I recently got turned onto tofu scramble, which I had never had before a couple of months ago. And it can either be something that you make homemade and literally take a brick of tofu and mash it up as you're cooking it, like scrambled eggs. And Trader Joe's makes a really nice prepared one. Also, it's in their frozen section. And so I'm a huge Trader Joe's fan. I'm always recommending them for prepared foods. Dr. Heather Awad: Nice. I'm going to add those to my list as well. Those are great. Dr. Sarah Stombaugh: It's hard, right? We sometimes get in these ruts and our brains. I don't know. We can't always brainstorm things that haven't ever appealed to us. And so I agree with you. Go and Google it. You'll probably be surprised how many different things are out there. I also love recommending people take a grocery or a field trip to the grocery store, kind of walk around, get some ideas, see what appeals to them. And so that may be a good time to do this, but I love that savory breakfast recommendation, so thank you for sharing that. Dr. Heather Awad: Sure. Dr. Sarah Stombaugh: Well, Dr. Awad, this has been so fun. For my listeners who are wondering where they can learn more about you, maybe they're interested in working with you, how can they do that? Dr. Heather Awad: Sure. Well, in May 2024, we do have a group program that's opening. And so if you go to my website, heatherawadmd.com, there is a button there to get in touch with me. And so if you want to work with me that's there. And even if it's not May and you want to reach out to me, there are some other free resources there on the website. So I would recommend people go there. You can also find me a lot on LinkedIn, so that's a good place to reach out to me as well. Dr. Sarah Stombaugh: Okay, excellent. And you have a podcast too? Dr. Heather Awad: I do, yes. It's called the Vibrant Menopause Podcast, and we talk about weight loss and menopause health and things about food. So I would love to have you come listen there too. Dr. Sarah Stombaugh: Yeah. Excellent. Well, thank you so much for joining us today. This was really a lot of fun to talk about. Dr. Heather Awad: Yeah, thanks. It was a great conversation. I appreciate you inviting me.