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 and welcome to this week's episode of the Conquer Your Weight podcast. We are talking about a topic that is arguably one of the most important topics in the weight loss journey, which is progress, not perfection. This is something my patients hear me say very often in the practice because our weight loss journey is often not a linear one and there are often setbacks and learning opportunities and it is so common when we look back at past weight loss attempts that there is this sense of like, oh man, I just messed it up. I'll start again at a later date or I'm sort of all in or all out. So today we are going to unpack this idea of progress, not perfection, and in how working through this can really help you to continually move forward to use challenges that you've had as learning opportunities rather than just, oh my gosh, I have fallen off the wagon completely. I want you to feel like each of these things can be a learning opportunity and how do we normalize these imperfections that should occur? We are only human learning new skills, and so I am really excited to dive into this episode with you all. Before we do, I would love to ask you if you have been listening for a while and you have not yet taken the time to leave a rating or review for my podcast, I would really appreciate that. It has been so fun to watch this podcast grow and the best way for the podcast to continue to grow, to get into the ears of even more people is to have ratings and reviews that allow it to get picked up by the algorithm and shared with others. And so I would really, really appreciate if you could take the time to leave me a rating or review. It takes literally 30 seconds or less to leave a rating, maybe another minute to leave a review and I would really appreciate it. So thank you so much for doing that. If you haven't already, let's go ahead and dive into progress, not perfection, what that means, how that comes up in the weight loss journey, and then how can you start to shift to more of a progress oriented mindset, especially if you've been in this sort of all or nothing perfectionistic mindset in the past. So very commonly, certainly in many areas of our life, but especially in the weight loss journey, it's very common for there to be all or nothing thinking. We often see this come up in even how diet plans are laid out. A lot of times there will be a list of these are the foods you should eat, these are the foods that you should not eat and often laid out in short-term programs. So you're doing this for 12 weeks or for six weeks or for six months, but in a way that for a period of time you are all in. You're doing this thing really intensely. And a lot of people who do those programs have really immense success when they do that. The problem is, is that it doesn't help to feel to heal and fix that underlying relationship that we have with our food. And a lot of times it ends up putting foods into categories of foods that are good for us and foods that are bad for us. And it can make it really challenging when we look at the trajectory of our entire lives. How do we set ourselves up so that we are able to have a relationship with foods that have been off limits for periods of time? And so there's often this idea of I have to follow this plan perfectly and if I don't, then I failed. And we often hear that idea, stick to this and you'll guaranteed to lose a pound per week or two pounds per week or get your bikini body ready by the summer. And all of these things, it's like I have to follow this thing perfectly or not at all. And so this can come up both in the context of food. So let's say you had a really healthy breakfast, you had a healthy lunch, and then in the afternoon you ate a cookie and it was super delicious, and then you had another cookie and you're like, screw it. I've already eaten a cookie. I've already eaten two cookies. This day is just a waste. It doesn't really matter what I do the rest of the day. I will start again tomorrow or I'll start again on Monday. Or alternatively, sometimes we have plans of things that we're going to do like workout for example, and we have an idea that I'm going to go to the gym and it's going to be a one hour long workout, but then all of a sudden something comes up. Maybe we had a work meeting that ran over or we had a family obligation that got in the way and we had this idea that we were going to do a one hour workout, we were going to go to the gym, we were going to get super sweaty, we were going to do all these things and now all of a sudden we have 20 minutes and it's not possible to do the entire workout that we had planned. And it's like, if I can't do the full one hour workout, just forget about it. I'll just do it tomorrow. And it puts us in this mindset where a lot of times kick the can down the road and we're either all in or we're all out and if we can't find an in-between, then we just don't do the thing at all. And that can be really challenging. And having this type of mindset of all or nothing thinking can really interfere with our progress. So there's this self-sabotage piece that comes up and it keeps us from being able to maintain consistency. So when we think about behavioral psychology and we think about habit setting, whether that is starting new habits or breaking old habits that we desire to break, one of the most important things is consistency. And so let's say you had set a goal of, I went to go to the gym three days this week, get in a one hour workout, and you have this idea of what that's going to look like, but then when other things get in the way and you're not able to do the one hour workout, if you're just like, you know what? Forget about it. I'll do it tomorrow. We find ourselves that tomorrow never really comes and let's say over the course of an entire week, you end up having one workout and you start feeling terrible about yourself. You're like, oh, I didn't do the thing that I said I was going to do and I'll try again next week, or I'll try, I'm going to start again later. Life's just really crazy right now. There's going to be some point in the future that I'm going to be able to do this, but this is not the time. And so I'm either doing these workouts in really intense ways or I'm just not doing them at all. But we look at consistency and having consistency in our routines. That is the biggest key to long-term success in habit formation. And so if you want to identify as someone who exercises someone who moves their body regularly, when you have those times that the one hour workout is just simply not going to happen, you had other things that came up and now you're looking at a 20 minute window and you're not going to have the opportunity to get super sweaty because you maybe need to get to an event right afterwards or something. What you can still do is use that 20 minute block and you could still potentially go to the gym and do just upper body and just lower body, or you could do some sort of workout program in your home and just do some jumping exercises, do a quick exercise video on YouTube. Maybe you could go for a walk. So you just get your body up, get your blood flowing and your heart pumping, take a break, which often is a really important part of what a exercise is creating for us. And so even if those three one hour workouts don't happen, if you still then at the end of the week you're like, Hey, I did still exercise three times this week and it looked a little bit different than I thought. Maybe you get to use that as an opportunity to realize, you know what? Actually I rarely have time for one hour workouts in my day. And when I set the goal of one hour workouts, they just simply don't happen. So do I instead set goal of 30 minute workouts and do that more frequently or just start at 30 minutes three times a week and build up from there. Or even starting at five minutes a week or five minutes a couple times a week and building up from there when we get into this pattern of consistency can be really helpful in that long-term habit formation. And so this, I'm all in or I'm all out. It also creates a lot of shame, creates a lot of sense of failure of, ugh, I said I was going to do it and classic me, I didn't do it. Other things are more important or life is just so crazy right now. Right now is not the time for me to start a whole new program. I'm not going to be able to dedicate myself to it. And the reality is a lot of times when we're having these type of thoughts and we're really beating ourselves up, that's because we're designing a program in our mind that involves really intense dietary restriction and really significant time commitment, whether that's in terms of meal preparation, whether that's in terms of the amount of time that we're going to be spending at the gym or in some sort of program, for example. And so we almost set ourselves up for failure because we set ourselves up with unrealistic expectations, then we beat ourselves up when they don't happen. And so it's so important to normalize imperfection in this journey and recognizing that weight loss and more importantly, reconnecting with your body, paying attention to the foods that you like, the foods that are in line with your goals, learning your hunger, learning your satiety, paying attention to if and when you are eating for reasons beyond hunger, like emotional eating, recognizing that this is a skill. And as with any skill, we need to learn those. And so let's imagine that you do not play the piano and you sit down and you're looking at a piano and you're like, I know how a piano works. I know there are people who are world renowned concert pianist, and I know maybe a little bit of music from playing band in high school of a different instrument. And you're looking at this piano thinking, okay, I know that there are people who can do this. Maybe I could learn how to do this, but the first time that you sit down at the piano, you're going to suck. You're going to be absolutely terrible and it's going to take a lot of skill and a lot of practice and learning new things and paying attention to where the areas as you're playing a song for example, are there mistakes that you're frequently making? Do you need to go back and workshop that a little bit more intentionally compared to another part of the song that flows more naturally for you? When we're thinking about our weight and health journey, the reality is this is also a skill that we're learning. And for so many of us, unfortunately, we've been in an environment where we've learned a lot of really not helpful skills along the course of our life. We've had it role modeled from other people in our life, really unhealthy relationships with food, unhealthy relationships with our body. We see in our culture many examples, even just things like food portion for example, where it can be really hard to succeed in the society that we're in. And so recognizing that you were learning a skill and just like you would not expect to learn how to play piano over the course of hours or days or weeks or months, this is something that will take time and it will take practice and you will get better and better over time. But it really is a skill just like anything else. And that progress is really messy at times. And so there are times where maybe you have a week that went really well, you feel like you stuck to your plan, you were eating at home, there was no travel, there was no meals out. You just were able to really be in tune with your body. There was nothing else going on. And then the next week you are traveling for vacation and then the following week you have family in town and then maybe you get an illness and these things throw you off. And the reality is, of course they will. It's life and these things are going to get in the way. And so using those as learning opportunities of what was really challenging during that week, what were the things I'm proud of? What were the wins that despite things that I would have done differently, usually there are wins that we can pick out from those experiences. What are the things that went really well? And let me make sure to point those out so I know, hey, next time I'm in a situation like this, I want to replicate that. And then the things that didn't go well, okay, no big deal. Let's pause. Let's use it as a learning opportunity. And if I were presented with the exact same situation next time, how would I do that differently? And so sometimes this takes a little bit of creative thinking. It takes planning ahead, it takes building and flexibility, but recognizing that our life is rarely going to just hand us the perfect circumstance into which we can just sort of in a vacuum, be fully into every exact food that I want to eat and have all the time in the world that we want to move our bodies and to sleep. Life is messy and our weight and health goals alongside that will be messy. And that's okay. And so normalizing this piece, because I think sometimes we see, especially like these before and after things, we see people and they are just, you're seeing their success and it's so amazing. What we don't often see though is the messy middle. We don't see the years that they went through as they were learning new skills, learning how to reconnect with their body, learning about different food types that they like, or food prepping or different types of movement that they can do. This learning thing takes time, and a lot of times no one's talking about that. We don't always learn about that messy middle, but I will tell you that everybody goes through that. Whether it is the skill of learning health and weight goals or whether it is other skills like learning how to play the piano and sometimes this all or nothing thinking, this perfectionistic attitude can even be a big player in things like binge eating disorder. And so when we look at binge eating disorder, there's often this cycle of binging and restricting. And so there's often a period of time where restriction is happening and you're like, okay, I'm going to be really good and I'm only going to eat vegetables and lean protein. And then after a period of time of only doing that, the cravings for foods that are not on that plan start getting really intense and then ultimately culminate in a binge episode after which there is often guilt or shame that comes up and those factors will derive then another episode of restriction of, oh my gosh, I can't believe I did all that. Okay, tomorrow I'm only going to eat 500 calories. I'm not going to eat breakfast. I'm only going to have a salad for lunch. And then for dinner, I'm just going to have protein and some broccoli. And so there's like, okay, tomorrow I'm going to be really good and restrict, restrict, restrict, which then drives the cravings and can drive binging. And this cycle can move pretty quickly. There's people who nearly every day they're having binging episodes can also be something that happens over the course of weeks or months. So this really can depend over individuals, but this restriction leading to cravings, creating then the binge, then creating the feelings of guilt or shame, driving back into that restriction cycle is very, very common. And often, while binge eating disorder is certainly a medical condition and absolutely not a moral failing, as we think about the treatment of it, while there are medical therapies for it, working alongside the psychological piece of this progress rather than the perfection is so, so important. And so we see this whether it is sort of formal binge eating disorder or just that generally I'm restricting, I'm trying to be so good, I'm putting that in air quotes, and then that derives the binge. And then when that happens, there's often this like, well, I already broke my diet, so I might as well just eat everything that I've been avoiding. And so it can really set us into a spiral where a single cookie turns into a dozen cookies or many types of foods that were not in line with our goal over the course of hours or the course of the next couple of days until we decide to get back on the wagon into this really intense regimen again. And so when we look at the solution for this, it is not having more control and just restricting and gripping, having more willpower to just white knuckle your way through it. The solution is rather building in flexibility, leaning into what are the foods that nourish our body and having self-compassion when we don't align with the goals that we had set for ourself. And so looking at how we shift to more of a progress oriented mindset, this can look like a lot of different things. So for example, we talked about the workout and you've planned a one hour workout and whatever other life factor got in the way, and now you found yourself with 20 minutes, you can, instead of skipping the workout entirely, choose something else. Choose a walk, choose an exercise in your home. I will tell you, I am notorious for a five minute workout. I cannot tell you the number of times where I've gotten really into a project or just gotten distracted with something else and I'm like, oh my gosh, that was my window to work out and now I have seven minutes before I need to pop on my next patient call, for example. And I will literally go and ride my bike for seven minutes if that is the window of time that I have, because being able to like, okay, it did not go according to plan, but you know what? I got my body moving, I got my blood flowing. I still did the thing. And that is a huge win. That type of mindset shift. I am absolutely a recovering perfectionist, and I know that so many of you fall into that camp as well. So recognizing where are the places where I can still show up even if it looks different than what I had intentionally or what I had originally planned, or you were planning to eat a certain meal that you had prepped for your lunch, you walk out the door for work, you get to work and realize, oh my gosh, I left my prepped lunch in the refrigerator. Sometimes that can be a situation where we just spiral and we're like, well, if I can't eat that healthy meal that I prepared, I might as well DoorDash my indulgent meal. Is there something else? Are there backup plans that you could have for when or when that type of situation arises so that you can help yourself to still align with your goal when you have made decisions that do not align with your goals? Instead of, okay, I'm going to start tomorrow. I'm going to restart on Monday, decide to restart immediately. And that can look like a lot of things. So maybe you are eating a dessert that you had not been planning on eating. You could pay attention to what is my satiety here? I'm eating the brownies, but let me at least stop before I overeat. Let me be really intentional about have you ever had the experience? I talked to this about my patients or with my patients about this a lot where when we think about our hunger and satiety, there is this place of fullness where we've had just sort of just enough and it's actually the peak of enjoyment of the meal. So we've had just as much enjoyment as we can get out of that meal. And then from there, if we continue to eat, our enjoyment actually starts to go down. And so I'm sure you've had this experience before of having a super delicious meal and you're just eating it and you're like, oh my gosh, this is so good. I don't want to stop eating it. And then there's a point in the meal where you're like, oh, I should stop, but oh, it's so good. I can't. And then a couple more bites, and you end and you're like, oh, gosh, I really overdid that. And now I actually, maybe psychologically I'm not proud of myself, but more importantly, physically I feel unwell. I feel uncomfortably full like, Ugh, my body feels sluggish, my body feels heavy, and physiologically my body does not feel good. And so when we look at paying attention to our satiety, whether we're talking about healthy foods or unhealthy foods, it doesn't matter if you're paying attention to what is the amount, if you've stopped it, which you've had just enough, and you're stopping right at the peak, rather than tipping over to this place of there is no more, no more return that you were getting on that investment, it starts becoming a negative experience. So paying attention, okay, I'm going to at least stop at the place where I'm feeling appropriately full. Or if I'm eating something and let's say a snack for example, and you've grabbed some pretzels and now all of a sudden you've eaten 20 pretzels and you're like, oh my gosh, I didn't really mean to snack, or I can't believe I just ate pretzels. I was planning on eating something different at this time, deciding, okay, is there something I could add to this that would at least balance this out? I had an episode a couple of weeks ago about no naked carbohydrates. The idea that if you are eating particularly a simple carbohydrate, but honestly even more complex carbohydrates like a fruit or a vegetable for example, when you can balance that out, particularly with a protein, but even with a fat, that can help create a more well-balanced response to it, both in terms of the way that meal sits in our body and creates satiety for a more lasting period of time, as well as even our blood glucose response and what insulin response it takes to store that energy away for later. When we can take a simple carbohydrate and pair it with a protein and or a fat, it helps to balance out that meal really nicely. So if you've recognized, oh, yikes, I started snacking on pretzels and that's not really what I had planned. Is there something else that I can add to it? Can I add a little bit of chicken breast? Can I add a little bit of nuts to this? Can I add something else that's going to help balance this meal out for me? So I'm restarting immediately. I'm not just like, oh my gosh, I can't believe I'm snacking on pretzels. I wasn't planning on eating simple carbohydrates today. Okay, let me at least balance this meal out. Let me pair something else with it. And then also in this progress, stopping to celebrate our wins, our mind so frequently is focused on the things that went wrong. And oftentimes when I'm reflecting with patients about a vacation or having family in town or these things that really throw their schedule off, it's so easy for our brain to go to the place where, okay, this thing went wrong and that thing went wrong, and I would do this thing differently. But a lot of times when we pause and reflect on it, there's actually quite a few wins that are built in and they end up getting overshadowed by the challenges that we've had. So training our brain to see what the wins are, because a lot of times there's winds there that can be really powerful. So this can look like I was really intentional about the amount of water I consumed, and I wanted to make sure that I stayed really well hydrated because I know that I'm likely to overeat if I have not been drinking enough water throughout the day. And I'm so proud of myself because I drank three large water bottles. Imagine you have a large jug of water, and I had three large water bottles throughout the day. That was my goal, and I stuck to it. That's amazing. If you were someone who had not previously done that, recognize that when I'm dehydrated, I overeat because I eat instead of recognizing my thirst signal, paying attention to thirst, setting a goal like that and acknowledging it is a really huge win. Sometimes it's wins. I didn't have any idea what was going to be on the, but I decided that I was going to build a plate of half vegetables or three quarters of vegetables and a quarter lean protein, for example. And so I had no idea what it was, but I built the vegetables and protein and then I stopped eating when I felt full. These type of wins and pausing to celebrate those, even if the number on the scale has not shifted downwards, even if it shifted upwards, which I'll tell you, if we're talking about vacation happens all the time. You get on an airplane, you get swollen, you're going to see the scale shift up because you're going to retain fluid. And so when we can stop and focus on what are the things that went well, what are the things that I'm really proud of pausing to recognize those before moving on to what were the challenges? That's so, so important because you do need to celebrate those wins and that can help build momentum for the next time you're in a difficult situation. Then there's this practical mindset of what's the next best choice that I can make? So when you've had a snack that was not in line with your goals, when you find yourself at dinnertime, what is the next best choice that you can make? If you're eating with a family, maybe that means you're checking in on your hunger and recognizing, okay, I'm not super hungry. I had a huge snack earlier today that I didn't intend to, so I'm going to sit down and have dinner with my family, but I'm going to eat a portion that aligns with the hunger that I have right now. Or thinking about the one meal does not define your success. If you imagine the course of the rest of your life, there are going to be meals that do not align with your goals. And when you look at people who live in bodies that have fluctuated weight over years, and now they're in a stable place where they're feeling really good, those people do occasionally eat meals that are not worthy of posting on Instagram the other day ate chicken nuggets and they were a high quality chicken breast, just like sliced and breaded sort of real food. But I ate chicken nuggets. Is that something I do every single day? Of course not. And those type of foods are going to make it into 99% of people's regular or maybe not regular diet, but make it into their diet. And that's okay. And so when one meal is then going to define how we feel the rest of the day or the rest of the week, it can really throw us off. And so recognizing, you know what? Today was a really tough day and I'm going to make a simple choice right now. That may mean making air fryer chicken nuggets, and maybe that's okay. I often ask instead of what people ask all the time, is this food healthy for me? And I get really frustrated because we often see this all or nothing mentality on social media where they'd be like, oh my gosh, this protein shake is just terrible for you. And look, it has this product in it and is that product in it? And sure, if we could line up 10 different protein shakes and say, okay, which one is the absolute best for you and has the cleanest ingredients, maybe that one would not be the top of the list, but we compare that to what was that person going to eat? Instead, we find ourselves really demonizing a food that was much more aligned with their health goals compared to the alternative. And so anytime you're looking at a food choice instead of what is this good for me? Instead of what were you going to do otherwise? And the answer to that can be really freeing. Another thing is this, what can I learn? So taking that practical mindset, I've taken the pause to reflect on the wins. What are the things that went well and the things that didn't let me actually allow myself to learn from this experience because I'm going to find myself in similar situations again. So when we think about how do we break that all or nothing thinking, there can be this pre-planning of flexibility, recognizing what are the days that are challenging for you? How do you build in simplicity in those days? How do you build in just a backup plan for a day that things went out the window? I've shared with you all before, we have a saying at our house, TAE, there's always eggs. And so on a day where life has just gotten totally crazy, we know that we always have eggs in the house. And so that can be scrambled eggs or omelets or fried eggs or something. But it's like, okay, we know that we have this option for a healthy light protein that all five people in our household enjoy. So we have that pre-plan backup plan in place if we need to do it. We can also journal and check in with ourselves regularly. It's really helpful to have an accountability partner in this space. And then to think about things where we're setting progress goals. So one thing I will often say with my patients is we have to lose the emotional weight before we lose the physical weight. And so reflecting on the things that have gone well, the decisions that over time as those accumulate are really going to accumulate in the direction of your goals and recognizing that we don't always see the shifts on the scale that we desire to see, but I promise you, if you are looking at progress, those shifts are going to come. And sometimes we're not seeing the shifts for very clear reasons or even really good reasons. Like we're seeing body recomposition where we're losing fat mass, but we're gaining muscle mass. And so of course we're not going to see the shift on the scale in the same way. And so really being intentional about what are the goals that we're setting? How are we supporting ourselves in those? And are there goals that can look different than just what is the number on this scale? So this can look like adding something into the diet of, okay, I'm going to be really intentional about how much water I'm drinking throughout the day, for example. Or I'm going to make sure to eat a vegetable at lunchtime and eat a vegetable at dinnertime doing these things that all of a sudden we start to see, Hey, every single day this week I incorporated a vegetable into my lunch. That may be a really huge win. And starting to see the compounding effect of those type of changes over time add up in a way that you are just guaranteed to have success. And so it can be challenging when you're in a journey of knowing like, oh my gosh, I have done this before. I've lost weight before, and then I've gained it all back. What is going to be different about this experience? Having someone who can support you in that is hands down one of the most important things, someone who can help you when you need the accountability or when you feel like, oh my gosh, just things are not moving forward. Someone who has a more objective point of view to help reflect where things are going. Well, that piece can be so important. If you live in Virginia, Illinois, or Tennessee where I'm licensed to practice medicine, I would love to be the one who supports you with that. You can learn more about me at my website at www.sarahstombaughmd.com. Thank you so much for joining us today. I will see you all next week. Bye-bye.