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 to sign up, please visit www.sarahstombaughmd.com/glp. You don't have to be on this journey alone. We are here to guide you. And now for today’s episode. This is Dr. Sarah Stombaugh and you are listening to the Conquer Your Weight podcast. Announcer: Welcome to the Conquer Your Weight podcast, where you will learn to understand your mind and body so you can achieve long-term weight loss. Here's your host, obesity medicine physician and life coach, Dr. Sarah Stombaugh. Dr. Sarah Stombaugh: Hello everyone and welcome to today's episode. We are continuing on a series working with some providers in the Obesity Action Coalition space. I am so excited. The Obesity Action Coalition reached out to me and said, Hey, we'd love to partner with you, bring on some people who could talk about some really interesting topics in the medical weight loss space, and then talk about how they are as the Obesity Action Coalition working to target and support some of these areas. So I'm so excited to bring on today Dr. Robyn Pashby. She is a licensed clinical health psychologist, the founder of Health Psychology Partners, and this group of psychology practice specializes in the psychological behavioral treatment of weight and weight related chronic health conditions. And so today we are going to be diving into the treatment of weight, how mental health plays a role in this. Dr. Pashby, thank you so much for joining me today. Dr. Robyn Pashby: Thank you for having me. I'm so excited to be here. Dr. Sarah Stombaugh: Wonderful. Well, tell us, it was kind of a brief introduction. Tell us a little bit about yourself, how you came to be in this space. Dr. Robyn Pashby: Well, I have been interested in obesity care for ever since. I mean, I wrote my master's thesis on it many, many moons ago now. And so it's just been a thread that has really, I've followed throughout my whole professional career. But in the last maybe 10 or 15 years, I've really gotten involved in a variety of different organizations. So the Obesity Action Coalition, I'm on the national board of directors for that organization and it's a patient advocacy organization because I really believe that the patient voice should be our North star that guides us in terms of treatment, decision making and even guideline development and other things. So that's one of my true loves. And I'm the chair of the mental health committee for the OAC, but I'm involved in a variety of other things as well related to obesity and weight related issues. So I'm on the Obesity and Weight Management advisory board for the American Diabetes Association. I'm actually working with a group of 22 physicians for the Endocrine Society to develop the new clinical practice guidelines for the pharmacotherapy treatment of obesity. And I'm on the clinical practice committee of the Obesity Society. So the list goes on and on. I'm just, my hands are in a lot of different committees and organizations all with the idea that when we treat people living with obesity, we have to look at them as a real people, b whole people, which means physical health and mental health. And that's sort of the mission of my whole practice. Dr. Sarah Stombaugh: I absolutely love that and I love that you've been involved in all of these pieces because as you said, we think about the pharmacotherapy and we were chatting a little bit before we were recording here. When we look at the explosion of the GLP space, the Ozempic and Wegovys and Zepbound and Mounjaro, I'm really excited in some ways of what that's done to this space because I think it's opened up conversations, it's gotten people thinking, oh, is this an option for me? And it's still just one part of the picture. So having pharmacotherapy may or may not be part of your journey, but can be a really important part of treating underlying metabolic health. But then there's still this behavioral and mental health component that we really want to make sure to support people alongside. And so I'm excited for us to dive into this today. Dr. Robyn Pashby: Me too. Me too. Dr. Sarah Stombaugh: All right. Well, tell me, when we think about mental health disorders, things like anxiety, depression, other health conditions, how do these contribute to our eating behaviors? Dr. Robyn Pashby: So great question, and I want us to be really clear that these are bi-directional relationships. So with obesity and mental health conditions or disorders or psychological diagnoses, these both can be causal of one another and consequential. So let me give you an example. Someone who might be diagnosed with a significant anxiety or depressive disorder might have some somatic symptoms, changes in appetite, changes in energy level sleep, really low energy and feelings of low interest in engaging in life. And all of those factors contribute to the person's nutritional intake, movement patterns, mood and interpersonal relationships, which can really contribute to weight gain over time. On the other side, if you're a person that has lived with weight related issues, obesity or overweight for a long time, you've probably been stigmatized or discriminated against in society. You've probably experienced weight bias. You might have internalized weight bias, you might have shame about how your body looks or you might feel like a failure because of all of these fad diets that have been tossed our way for decades upon decades. And they sort of wrote people into this feeling of if you just do the right thing or you just try hard enough, then you will be cured or fixed or whatever words they like to use. And of course, over time when you give people broken tools and the tools don't succeed, what happens is unfortunately people end up feeling broken instead of recognizing that the tool is the problem, people internalize it. And so that then can contribute to shame, depression, anxiety, people withdraw from social situations because of body image concerns or maybe eating restrictions or things like that. People avoid medical care, for example, because of experiences of weight bias in a physician's office or with a nurse practitioner or whomever. And so over time, people can get sicker because of their obesity, because of the sort of contributions that it makes to their mental health. So those are just two examples, but the bi-directional relationship is what's really important to remember. Dr. Sarah Stombaugh: Absolutely, and I think as we think about obesity as a really both chronic and complex condition, I think there's a lot of, over the last many decades the way we think about our metabolic health, the way even just things like calories in calories out, for example, in these very simplistic models, that certainly may be a small piece of the puzzle, but when we look at the condition as a whole, there's so many other pieces of what has led to this for a person. So as part of an intake recognizing it's not just what is your weight and how do we treat that, but it's the whole past medical history, past weight history, past psychological history as part of that. And certainly too, a lot of people, or maybe every person that comes into my clinic, certainly it's not the first time that they're considering losing weight. Oftentimes this is a repeat attempt after prior ones in the past, which can be really challenging as well. Dr. Robyn Pashby: And I think there's some maybe under-recognized psychological conditions that can contribute to weight also. So I think a lot of people think of emotional eating or even binge eating disorder. It's sort of singled out as the eating disorder to look for in people living with obesity, which in my mind reflects a bias that eating more is what is the only factor contributing to weight gain. But that aside, things like ADHD or executive dysfunction are really significant contributors to people's weight over time, both in terms of regulation of behavior, in terms of planning and meal planning and initiation of eating and time awareness and ability to organize your schedule and your treatment plan and follow through with treatment protocols and things. This just executive function alone is a whole, we could have a whole podcast just on executive function and weight and how those two things relate. Then we look at trauma and of course when I say trauma, people think of very significant, maybe childhood trauma or veterans or things like that. But there's also microtraumas that can accumulate really over the course of time. And I've really come to see living with a larger body, an American society, at least in people in my generation and older, really is a risk for trauma because there is so much bias and so much stigma. People living in larger bodies don't even feel welcome in their doctor's offices because of the size of the chairs and the idea that people have lived decades feeling like they don't belong or they aren't welcome. That is a cumulative trauma. It's just these microaggressions over the course of time and sometimes outright aggression from family members or from colleagues or strangers on the street for that matter. So there's so many pieces of this puzzle beyond just anxiety or depression or emotional eating. We could go on and on. Dr. Sarah Stombaugh: Absolutely. And so when you look at someone and thinking about how am I supporting them in this more comprehensive way, what is the process of diagnosing and understanding some of these different conditions that may be contributing to weight or even as you said in this bidirectional either can be contributing to the other? Dr. Robyn Pashby: Well, so in terms of diagnostic tools, I think any mental health provider can help assist physicians in terms of screening for those. Although there are a few decent screening tools that even primary care physicians or other obesity medicine physicians can use to screen for things like eating disorders, anxiety and depression in just in general practice and then make appropriate referrals. But I think honestly, when you have a relationship with the person sitting in front of you and you give them permission to have had these awful experiences, you give them space to share that they've had these experiences. Hopefully anyone sitting there with compassion will have a flag go up in their mind and think, boy, that must make someone feel like a victim of an abusive situation. In a lot of cases, a lot of times if I could have a nickel for every traumatic story I have heard from my patients just about their body size from everyone in their lives. I mean, it is really astounding how little obesity medicine has seriously considered the role of bias and stigma and trauma on people living with obesity and how that affects their mean brain function at a anatomical level really. And then of course, behavioral follows from that. Dr. Sarah Stombaugh: Okay, I love that. And thinking about really understanding for one and recognizing where there's a lack of understanding. And so exploring with partnering with your patient to listen to their story, believe their story, right? Because there's so much bias where these stories gets brushed over. For example, you shared a little bit about how maybe some of these conditions being untreated or undertreated can contribute to challenges. When we think about mental health treatment, whether that's therapy, whether that's medication, a combination, how can that be supportive of someone's weight goals? Dr. Robyn Pashby: Well, I think there's a lot of people that I work with over time have been nervous to treat their depression or anxiety with classic antidepressants. Let's say SSRIs come to mind because there's an idea that they contribute to weight gain. And in some cases that is true. I mean, we have to be honest and upfront with our patients about that because people go untreated because they don't want the side effect of weight gain. Some of the more serious mental health conditions that might require anti-psychotics for example, those have very significant weight gain indication. And so I think we have to be talking to our patients and weighing risks and balances. So I'm not saying that they're off the table by any stretch, but I want people to know that they can advocate for themselves when they're working with a prescribing mental health provider to say, I'm aware of the weight indications of these and let's do a cost benefit analysis together and figure out what is the lowest weight risky medication that I can use to treat my current condition. So that's one. But secondly, therapy in general I think really can, I mean there's treatments that we can talk about, cognitive behavioral therapy and interpersonal psychotherapy that can really give people some tools to challenge their own inner critic that develops because of the weight bias that we face, that internalized weight bias is what it's called. And we can certainly help people challenge that, which can help elevate people's mood, lower their anxiety a little bit, and that can sometimes get people really much more engaged in their lives. And usually people that are engaged in their lives and feeling better are taking different care of themselves. They're out there in the world socializing and having fun. Maybe their sleep is improved, maybe they're sleeping on a more regular schedule, maybe they're eating meals on a more regular schedule than if they're having trouble sleeping at night, sleeping until two or three in the afternoon, just waking up sort of feeling disoriented and out of it. Those are all behavioral things that we would work on with patients in a therapeutic setting. But besides that, I think if we see people living with obesity as having likely an exposure to this microaggression, this trauma, that is the underlying theme that we do so much work on. And when I bring a new team member onto my team at Health Psych Partners, I'll say, we have all these evidence-based tools to help people with weight management and obesity care. But often what we're really doing is treating chronic shame. And if we don't address that in our therapy rooms and honestly even in medical appointments, then I think there is just this barrier there to real change because people, that's really hard to unlock. For a lot of folks. Dr. Sarah Stombaugh: One, experiencing an emotion like shame can drive, there could be this cycle that happens. We look at this as, of course, it's a very negative emotion. And then how are we responding? Sometimes I've seen with my patients sometimes that shame can be sometimes a driver of than even turning to food in order to sort of escape that feeling. And there can be this just really challenging cycle that comes up. Dr. Robyn Pashby: Of course. And I mean truthfully, emotional eating is almost everyone in our culture emotionally eats. When I say birthday, you think cake. That's what happens. And so it's nothing to be ashamed of. I think if we see it as a very normal part of living, certainly in America where we have a lot of access to food in many communities, and then we also see it as our brain searching for a way to numb a little bit some of the painful emotions that we might experience and doing that in a way that doesn't harm other people. Emotional eating fits the bill really readily. I mean, it's a really adaptive survival response from an emotion regulation standpoint. So I try to sort of demystify that. It's not like we're saying, oh, you must stop all emotional in order to manage your weight. That's not true at all. It's understanding that we all have emotions and we all use food to manage it, but how do we do that in a way that supports the health goals and the health outcomes that you want as well? And that's possible. Dr. Sarah Stombaugh: Okay. I love that because the emotional eating, when we look at all of these sort of escapism behaviors, things that can drive us feeling good, that can look like a lot of things. It can be overeating, it could be overspending, it could be drugs, it could be alcohol, it could be a whole myriad of things. And overeating or emotional eating is very socially endorsed, as you said. We all do it. And I define emotional eating in my practice as any eating for a reason beyond physical hunger. And as you said, birthday cake. I mean, I think there are plenty of people who would say, oh, it's my birthday. I'm going to have a slice of birthday cake. And it's okay. That's absolutely okay. Yes. But yeah, recognizing where are the places where this is serving me and I'm sort of choosing this in a very intentional way versus where is it just the default pattern, for example, or where it's happening in a way that I feel out of control, feel disconnected from my body. Dr. Robyn Pashby: And so you just said out of control, which I think in our practice is that's the hallmark that we use to really differentiate when someone is experiencing emotional eating in the way that we just talked about. I mean, I'm a big hockey fan. We just went through the hockey playoffs and I mean for sure I was emotional eating, watching those games and things like that. But there's a difference when people are emotional eating and feel that loss of control, that is the really uncomfortable feeling. And honestly, that's sort of the differentiator between emotional eating and binge eating, I would say. And it's honestly the thing that people feel the most uncomfortable about. So if I talk to my patients, they don't really care about eating birthday cake on their birthday. What they care about is the feeling of not being able to stop eating it. And one of my clients years ago said, it feels like I'm a train going into a tunnel and there's this moment where everything is sort of black, I can't see out. And then suddenly I come out the other side and I come back to, and it wasn't someone that had significant dissociation or something, but it's like we sort of get in this place where you just feel like you wish you could stop eating, but you can't quite stop or you can't stop until the unit of food, the package, the bag, the whatever, the box is gone and sometimes not even then. And that's the really uncomfortable spot for most folks. Dr. Sarah Stombaugh: And tell me, of course, this is probably months or maybe even years of psychotherapy and working through that, what does that journey look like from a psychological standpoint of helping support patients in understanding that, exploring that and working towards finding a solution that's more in line with their goals? Dr. Robyn Pashby: So honestly, the first thing that we usually do is look at all of the eating outside of those episodes and try to get a handle on that because so much of mean, so many of my patients experience this where they have an experience of emotional eating or binge eating or that loss of control eating, and then they spend the next however long, five hours, 24 hours, two weeks trying to make up for it. And so what happens is people tend to over restrict because again, we've been programmed that weight loss is the ultimate goal. And so if I eat a lot of calories in this loss of control episode, then I better only have a salad for dinner or I better skip breakfast the next day, or I better have salmon and rice for dinner the next night or whatever it is. And so people get into this restrict, overeat, restrict, overeat, sort of up and down cycle. And so before we look at any loss of control episode or episodes, we're really going to look at the overall patterns of eating and hopefully normalize those. So sometimes that means people eating more than they're used to because it involves taking down the restriction. One of the things I often say to my clients is, I want you to think of restriction. And what we call it in my practice is cognitive restriction, which means attempt to restrict what you're eating even if you don't actually physically restrict what you're eating. But the cognitive restriction, the I shouldn't be eating this or that, or I can't eat this or that. I always say it's handcuffed to binges for people that experience binge eating. The more you restrict, the more you pull along with you, the binging. And so what we try to do is actually decrease the restriction. And once we start to do that, you'd be amazed at how much easier it is to manage some of those episodes of loss of control eating. There's more involved in it than that, but I think that's a hallmark that listeners could take away and really think to themselves, what rules do I have about food after I feel out of control? Am I trying to restrict, am I cutting back? Am I only eating certain things? Am I pulling out my food tracker and swearing I'm going to track again today? All of those are these unwritten rules that we have about managing our eating that often need to be rewritten. Dr. Sarah Stombaugh: Absolutely. I love that. And thinking about this, it's both the psychological piece and then even some physiologically when we look at a binge episode, so much of this is driven by the cycle. And interestingly, I find a lot of times my patients are even hungry during those episodes too, especially if they've been restricting in a very intentional way that there is maybe this decrease of protein or fiber. And so they're both now psychologically and physiologically driven towards that episode, which of course it just makes logical sense that your body would then be asking to move towards that type of behavior. Dr. Robyn Pashby: And I think, again, when we approach it with this type of information, what we're saying is, this is not because there's something wrong with you, right? We're saying this is because your brain is telling you to do certain things. It's like our brain, if we have an itch on our arm, our brain tells us to scratch it. It doesn't mean there's something wrong with you. It means your body is telling you something and our behavior usually follows. So what we want to do is try to manage that almost like preemptively by really smoothing out the eating in the beginning. And another thing that tends to happen that we do a lot of, I mentioned those unwritten food rules, and there are so many, but they're not just about food, they're also about social engagements and exercise or physical activity related to weight. So if someone's feeling out of control, whether their eating, what tends to happen is we have this rule that if I'm exercising, then I have my food in order. So if my food sort of falls off as people will say, then it's just why bother exercising? Why bother going for the walk? That's not going to do anything if I'm trying to lose weight. And so what we do again, is try to break that association between eating and exercise being joined at the hip. What we want is people to engage in movement that feels good to them psychologically, because we know, and you and I know this for sure, the number one treatment we have to manage stress is exercise, But it doesn't have to be burning X hundreds of calories. It's like a walk outside in the afternoon on a sunny day is a really helpful thing in terms of managing stress. So if we can separate it from weight loss, then what we get is people who are engaged in more physical activity because they like it and because it feels good. And then we start to alleviate some of the depression, some of the anxiety, we improve sleep, and then that also fuels people's ability to manage their eating a little differently too. Dr. Sarah Stombaugh: Yeah, absolutely. And seeing, I love this conversation as decoupling and stepping away from this all or nothing thinking to, I'm sort of all in or I'm all out finding what is it that bring you joy? We often talk about as joyful movement in the practice in the same way of walking is exactly. We have woods in our backyard and sometimes if I have 15 minutes in between patients, I'll just step out there. I have a five minute loop or a 10 minute loop that I can do really quickly. And it's just amazing seeing that decompression that can happen so quickly. And we think about if I could put anything, any sort of intervention that we have into a pill and give it to every human, it would be exercise. Exercise has this just amazing role, but so many people are stuck in this like, oh, I get beat up by it. I'm sore, I'm achy. I've injured myself because I've done it in such an extreme way. And so I love that sort of relearning that relationship. And how does it bring you joy? How does it serve you and decoupling those? That's wonderful. Dr. Robyn Pashby: Well, and I think unfortunately exercise is also one of those places where bias and stigma runs wild. So I mean, when I was growing up, we didn't have sports bras that fit people in larger bodies. We didn't have athletic whatever, leggings and things. I mean, companies are doing a much better job in the most recent 10 years or so. But it wasn't that long ago that it was walking into a gym, living in a larger body was something you didn't want to do. And still some places are like that. So I think we have to be aware too when we're talking with clients that we're also sort of sending people out into a world that hasn't been exactly friendly to people who live with obesity, being active. What we think of when we think of exercisers are very small framed people. And I think that's another issue. So I have many clients that don't feel comfortable being out even for a walk in their neighborhood because they don't want the judgment of others like, oh, look, so-and-so is getting back on her exercise routine. Right? It's so paternalistic in a really negative way. Dr. Sarah Stombaugh: No, absolutely. Well, and tell me, I want to spend a minute thinking about some of the strategies that we can use unrelated to food, things that maybe some good coping strategies. A lot of times I talk about this joyful piece, whether it's joyful movement. A lot of times when patients, we recognize the role that food is playing in terms of can create this sort of dopamine hit, it makes us feel temporarily good, for example. And this, I often say to people, you deserve to feel joy. You deserve to have goodness in your life. You deserve to feel joy. And are there ways that we can do that beyond food? What are those other things? So I'd love to spend a minute thinking about some of these coping strategies, other things that we can do outside of food that can help us to feel joy, to feel good in our bodies. Dr. Robyn Pashby: I love that. I will say that I often ask people to think and at first, So let's build in a bunch of really great coping skills and understand that you might still need to use food to for a while. Because I think when we pit against one another, go through your same routine of comforting yourself with X food at night or go out for a walk, call a friend, take a bath, all of these other things, we're just, our brains are designed to take that sort of well-worn path, that whole idea that neurons that fire together wire together. There are these patterns that get really ingrained. And so sometimes I ask people to just think and can I maybe go for a walk in the evening after dinner and still allow myself to eat emotionally if I need to because then at least we're experimenting with building the coping toolbox. So in the coping toolbox are all the usual suspects, time outside exercise, of course we talk about. But also I try to think of things that we can let go of that might be triggering us in ways that we don't even think about. So for example, I have almost all the notifications on my phone turned off. I just can't take the barrage of buzzes and beeps and lights and things, and it just helps calm my nervous system. I have not watched a scary movie in literally 20 years. Why? Because I have enough cortisol. I don't need any more sort of pushed down through the screen that I'm watching. So I try to think of little things that we might be able to just let go of that are going to allow us access to a calmer nervous system. So maybe we don't need to fill our plates with a thousand other ways of coping. But other things, like I really encourage folks to lean on social connection. And I think, I mean, I'm sure you have thoughts on this too, but technology is such an amazing gift. It's how we're having this conversation today. But in all honesty, I would much rather be sitting in the same room as you having a real conversation. And I think if we can encourage people to get out there and to be more connected to people that matter to them in their lives, it just fills us in a way that is so different than scrolling our phones before bed. So sleep hygiene is everything also. And so I work with a lot of patients on how to shut down your phone at night. I use a coping strategy. I use, honestly, is I use my automatic phone timers to limit the time I have on various apps and things just reminds me gently, is this how you want to be using your time right now? And almost always the answer is no. What? Wait, what just happened? Where did that 15 minutes or 30 minutes go? Or something like that. But I mean, the list goes on and on. But I think most importantly what we talk about is figuring out ways that people can calm their nervous system. Dr. Sarah Stombaugh: I love that you say that because we look at the inputs in our life, and in 2025, it's coming to us from every different direction. And so recognizing, do I get to choose what is coming into my life versus is it happening to me? And as you're saying with the cell phone stuff, from a media standpoint, you have to really intentionally choose to set up these barriers. I have the same on my cell phone in terms of I'm allowed X amount of time, and after a certain time of day, just in general, everything's shut off except for a couple of rare things. My assistant and I were even laughing this morning. I made my son's lunch last night, and I took a picture of it and I wanted to give it to her for social media, and I couldn't even access on my phone the way to do it. I was like, oh, shoot, I've restricted myself too much. But really having the choice rather than feeling like it's just coming at me from every direction, what am I allowing into my life? I talk to people who have the TV on all day and just see this constant stream of news in terms of things that are being emailed to us. We're all on so many newsletters or we have friends or family that well-meaning a lot of times, well, oh, did you see this thing happened in the government? Oh, this thing is happening in science right now. And of course we're going to have a reaction to that. And so choosing very intentionally if, and then if so, how are we bringing that? I love that you bring that up because why are we creating an environment that then we need to escape from? And so how do we control that input and to the and thing? I want to circle back to you said, instead of this, or I'm going for a walk, or I'm having a emotional eating episode. When we look at human behavioral change, a lot of times those coupling can be a really powerful way to just bring the new behavior alongside of it. And so really neat, thank you for bringing that up, because you don't want to just be another failure for someone, oh, I've tried this thing and it didn't work for me. Dr. Robyn Pashby: Well, and I always say to people, quite honestly, if you ask 99 out of a hundred people, do you prefer to eat ice cream at night or finish your taxes? What is the answer, right? I mean, or because often the other thing people will do is say, well, what I really should do is stuff on my to-do list. And I think, but that's not actually the same as figuring out how to calm your nervous system. So if we can think in that terms, food is trying to calm our nervous system, so we need to add something to it that is equally calming rather than overstimulating or aversive, quite honestly. Dr. Sarah Stombaugh: Yeah, absolutely. Well, and tell me, so for the person listening to this episode and they're thinking, oh my gosh, that's what I need. But where do I get started in terms of, am I having a conversation with my primary care physician? Maybe they have an obesity medicine specialist, they're interested in learning more about this type of work and how it could be beneficial. What are maybe some specific resources, but even just words of encouragement that you would give to that person of how they're moving forward and exploring this? Dr. Robyn Pashby: Well, words of encouragement always start with every single human being is worthy of respectful and dignified care. And so anyone listening, I hope that they will hear that. And that's from their physicians, from their mental health providers, from their physical therapists, from their trainer at the gym, right, from every single interaction they have. And unfortunately, we know enough based on the data that are out there that isn't always universal. So I do a lot of work with people around self-advocacy because figuring out how to have hard conversations with your doctor or your other healthcare provider is really part of the toolbox. Again, in terms of coping with some of this weight stigma that's out there, the Obesity Action Coalition, circling back to where we started, has a ton of really great resources like actual handouts that people can get, both physicians who might be listening who want to stock some things in their offices to inform patients about how to have respectful dialogue around weight, but also training materials for patients and healthcare providers. So more specifically, I'm going to be speaking live at a conference for the OAC. It's called Your Weight Matters National Convention. And it's actually to celebrate our 20th anniversary, which is super exciting this summer in July, the end of July in Arlington. And I'm going to be talking about the differences between mental health treatment in obesity care and behavioral health treatment in obesity care. And that may seem like wordsmithing, and I think it kind of is. But here's the thing. So often people get assigned in a weight management program to intensive behavioral counseling or intensive behavioral therapy. And as a psychologist who does a lot of behavioral change with patients, I find that so offensive because to me, it's sending the message, patients just learn to behave better and your obesity will be no problem. I really, really do not agree with that statement. As you can probably guess, one of the things I'm hoping to do at this talk is really help people understand what does behavior change look like? PS everyone, no matter body size, can benefit from some behavior change strategies. And then what does mental health care look like in obesity treatment? And lots of people independent of body size can use mental health care too. So not stratifying it by body weight, but really helping people understand what those two things are and how they interact. So I'm going to be talking about that live at the convention, and I would love listeners to come and meet me there. Dr. Sarah Stombaugh: Yeah, absolutely. And I think one of the things I shared on last week's episode was that the release episode that will have been released the week previously is that this is really, the OAC is such a wonderful organization because it is designed for patient advocacy. And so when we look at many of the other resources out there are designed for clinicians to learn more, to be able to share, to be able to treat and take care of their patients, which is wonderful, and certainly we need that. But the OAC is really designed the Obesity City Action Coalition for patients. And so especially I'm in Charlottesville, Virginia, so for people who are in Virginia Close, wonderful that the conference this year is in Washington DC end of July. We'll put everything in that for our show notes for today so that people can access that and learn a little bit more. Go here, Dr. Ashby speak. This has been wonderful. Let me ask you, Dr. Ashby, before we wrap up, anything else you'd like to add or make sure that my listeners know? Dr. Robyn Pashby: I guess that obesity really is complex, but mental health is complex too. And so many of my patients who have been living with both of those feel so stigmatized because each of those various conditions has a whole stigma associated with it. And so I hope people understand that there really are providers out there that understand how complex it is, understand that it's not any person's fault that they're struggling and want to partner with them. That's why my whole practice is named Health Psychology Partners because we believe in partnerships with people to work toward whatever goals they have, not mine, theirs. And I hope that they'll search for that. Dr. Sarah Stombaugh: I love that you shared that, and one of the things too we were speaking about earlier is just with the popularization of GLP medications, the wonderful places that that's been in terms of advocacy that we talked about early on, but then also, or just in patients being aware and understanding that, oh, there's much more to this and it's still just, it's that piece, right? And so do you have that comprehensive support that you need in order to really treat and support you in your journey, not just now, but really in the longterm as well? And so that's what this, especially the health support, the mental health support, what that piece is looking like. And tell me, you shared that your practice is licensed in over 40 states, is that right? Dr. Robyn Pashby: Yes. Yes, we are. I was just going to say, to jump on what you just said, the blog post that I'm posting this month is actually on GLP and what's coming. And basically navigating all of that from a psychological side of the house. So even just navigating changes in insurance coverage and what that means and how much anxiety that folks, and so really looking at it full picture, I talk to my patients every single day about these sorts of things. But yeah, we're licensed in 40 plus states around the US and we do a lot of virtual care. We see people live and in person in Washington, DC also, but do a ton of virtual care in the local DMV area, but throughout the United States as well. Dr. Sarah Stombaugh: Okay. And that's wonderful. We'll make sure to have all of that information in the show notes for any of our listeners who are interested in connecting with you. Dr. Robyn Pashby: Thank you so much. It's been such a pleasure. Dr. Sarah Stombaugh: Yes. Thank you for coming on today. Alright everyone, we will see you all next time.