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 everybody and welcome to today's episode. We are talking about a topic when we think about our weight versus our health and what is the difference between those things, what are the similarities between those things? And this is honestly probably the crux of what I do. And when we start to look at the treatment of weight, the treatment of obesity and why we do this, what are the goals that my patients have? What are the impacts that it has on their life? I think that over the last, well many decades, over the last period of time, our society has such a bias towards obesity that we don't even fully understand what is the point of treating it. And as we're having this conversation today, I hope that it is really powerful for you for recognizing what are your own goals, why do you have those goals, and what are the impacts that your weight is having on multiple different of your life? So let's go ahead and dive into this. Like I said, this is a topic that's been sort of bopping around my head for a while and I've been trying to put into words, and it really came to a head recently with a couple of different conversations that I had. But I was meeting with a gym owner in my town recently and she said to me, well, I don't think working with a weight loss clinic or recommending for our patients to see a weight loss doctor makes sense because we want our clients, their gym attendees to feel comfortable in their bodies of every size. And we are not about helping them to lose weight, we're helping them to approach their health. And it struck me at that moment that she and many people look at weight and health as separate things, and I think this is actually rooted in our society's obesity bias. And so she and I went on to have a very lovely conversation. I won't bore you with the back and forth details of that, but when we think about weight and health, there are places where those things may be separate, but the reality is there's a lot of places where those two things do run parallel to one another. And so let's unpack this a little bit. What are the similarities between our weight and health? Where do those things differ? Because certainly being at as low of a weight as possible does not mean that you're going to have the best health possible, especially when we look at eating disorders, for example, as an extreme example, we look at someone who is in the throes of dealing with anorexia, for example, and their body weight is very low. Of course their health is not at their peak. And so lower weight does not necessarily mean better health, but this is all really based on what is the composition of our body, how much of that composition is serving our health versus are there aspects of that that are detrimental? So when you think about the entire human body, there's a lot of things that contribute to our body mass. There are things that are completely out of our control. So for example, our bones, for example, our skin, the water weight in our body, this weight of our organs, all of these things, if you're tall, you have more bones. If you're short, you have less bones or the same number of bones, but the weight of those may be different, for example. And then we have our muscle, there's a certain amount of that that everybody will have in their body, although of course that can fluctuate. You could have people with very large muscles or people whose muscles have sort of shaken away and can be really metabolically damaging actually to not have enough muscle on their body. Similarly with fat, there is fat that our body must have. We have fat that surrounds our organs. We have fat that helps to sort of hold things in place and fat is a very important thing in our bodies. And we have fat that serves a sort of essential role. And then we have excess fat that is in a storage role and it is our excess fat that is metabolically active but can end up having those detriments on our health potentially. So when we look at what the human body is composed of and we look at from a population level, we can say, okay, if the average person's body has this much muscle mass and this much bone mass and the average fat mass, then a person should weigh between this number and that number. And that's really how we came up with metrics like the body mass index. You hear the BMI all of the time and you hear things like, okay, a BMI of 18.5 to less than 25 is considered normal from 25 to 29.9 is considered overweight, and then anything greater than 30 is considered obese. And people get really upset about the BMI because there's certainly many examples where someone may be characterized as overweight or even characterized as obese. And then you look at their body clinically and maybe they're a huge strong power lifter. For example, I often give the example of my husband to his body weight characterizes him in the obese category, his body mass index is greater than 30. And if you looked at his body and the muscles on his body and then his health metrics, if you were even privy to all of his labs for example, you would look at this guy and say, well, he is totally healthy. And so this BMI thing doesn't fully make sense. And that's absolutely right. So when we look at the broad population and we think about body mass index versus health, there's a correlation. But when we start looking at individuals, that correlation sometimes goes away because there are plenty of people who have very strong muscles and live in bodies that are metabolically quite healthy. And then there are people even who may be characterized in the normal BMI category that are seeing metabolic effects of the excess fat mass. So that's where a body composition starts to become really important. And there's been a lot of conversations about this in social media and in the media recently. You're hearing a lot about measuring body composition for example. And that can be a very valuable tool because when we think about body composition, the reality is it is that storage fat mass, that is what has the most proportional effects to our health. So when we think about fat, sometimes people think about this blob of tissue on their body that's just this sort of blobby thing. But the reality is fat is actually quite metabolically active. Fat plays a role in things like insulin resistance and things like leptin resistance. We went into this a little bit, a couple of podcast episodes and we were talking about what are the roles that these medications serve because they're helping to combat that. So fat is very metabolically active and can contribute to poor metabolic health when we have excess fat mass. It also from a biomechanical standpoint, so you think about just the weight of fat mass, for example. You can imagine how for arthritis or even just sort of general aches and pains that carrying around more weight on our body just physically can be challenging and can create things like osteoarthritis and can create people just feeling like their joints are hurting. They're kind of achy at the end of the day. And that is related to the biomechanical effect of caring around excess mass. But we look at the metabolic piece of it. It is our excess fat mass that actually correlates most with things like diabetes, even pre-diabetes, those earliest stages of insulin resistance conditions like PCOS or polycystic ovarian syndrome, fatty liver, high blood pressure, high cholesterol, other aspects of cardiovascular disease like risk for heart attack, risk for stroke. There's the correlation with sleep apnea, with cancers, with depressions, with so many different conditions that are actually correlated to our underlying fat mass. And so when we bring this back to some of the conversations that I've been having recently is that it is often our society's bias then that we need to eat less and we move more. That treating and supporting someone in that will mean that they're eating well and that they're moving their body. And when I look at this conversation with a gym owner for example, and she said to me, will we support our patients and bodies of every size? Totally. And I think that she's missing the mark because when I look at supporting my patients with the treatment of their obesity, we're looking to help support reducing fat mass. And that doesn't happen in a vacuum. We look at all of these tools such as movement, such as nutrition, such as sleep, such as stress management, and we may need the support of medications to help with that underlying metabolic derangement that has happened. And because we are working to decrease the fat mass and increase our muscle mass, we know, as you've heard me talk about before, that in our weight loss journey, we often will lose both fat mass and muscle mass together. And what we want to make sure that we're preventing is we're not setting people up for a situation where they're disproportionately losing muscle mass in their weight loss journey. Because when we start to look at the metabolic effects of that, if we're losing too much muscle mass, our body fat percentage doesn't really change as much as the weight on the scale. And so the number on the scale is lower and people may be excited about that. But then what happens is we get labs, for example, or we're keeping an eye on someone's blood pressure and we don't see the improvement that we expect it to, or people are feeling weak or we end up sort of down the road creating other issues, especially as we look at the transition to later in life, we're making sure that we've adequately supported our muscle mass is one of the most important things we can think about from a longevity perspective, thinking about our muscle mass, thinking about our bone mass, those two things are very highly correlated with one another. And so in the weight loss journey there is supporting reduction of fat mass while then working with nutrition, with movement to make sure that we are supporting muscle mass. And for the person who is trying to do it all themselves, I think that's great. I think it's important that using and understanding those tools are excellent and for everybody, it may not simply be enough. We may need medications, for example, or specific interventions in order to support that reduction of muscle mass. And all of it ends up going together. And so when I think about health and weight, as we bring it back to that piece, health and weight are often correlated. And there's so much more to the picture. When I start to think about my patients, we start to look at what their goals are. A lot of people perceive sort of from the outside that the goal in a practice like mine is let's help the patient to be as small as possible. Let's help them to fit back into their size four clothing that they wore in high school, for example. And while that may be in line with some of my patient's goals, when I talk to my patients about their goals, the goals that I hear more often are things like, I want to have more energy. I want to feel strong. I want to not have knee pain or hip pain or foot pain. I want to be able to keep up with my children or keep up with my grandchildren. I want to sleep well and feel rested at night, not be dealing with my sleep apnea. I want to work on my fertility. I want to be able to perceive joint, pursue joint replacement surgery. I want to be able to reduce my risk of cardiovascular disease because a family member passed away from that at a young age. I want to reduce my risk of diabetes because many people in my family have that. And we start looking at all of these other things and those are the things that end up being the most important. And I often work with patients who have been eating well. They have been moving their bodies doing cardiovascular training, doing resistance training, working to improve their metabolic health from those factors. Yet they are still seeing that they have high blood pressure or high cholesterol or high fasting blood sugar and deciding to support their bodies with medical therapy in order to help support reduction of their body mass while we keep or their body fat mass while we keep on their nutritional changes and their exercise changes and the coaching piece to think about sort of their day-to-day life and how are we best supporting them as they go about that, that's where the magic can really happen. And of course in their journey, they will find that they live in a smaller body, that they are losing weight. But what we're really seeing is the improvement of health metrics of people who come back to me, able to get pregnant, able to pursue their knee replacement surgery or their hip replacement surgery or their shoulder replacement surgery. People who are like, oh my gosh, I just feel like myself again, no longer seeing signs of pre-diabetes on labs. We've reversed people's blood pressure issues completely. They were having hypertension and now we've been able to wean them off of blood pressure medications, seeing signs of fatty liver, for example, either on labs or on imaging testing that they've done, and that those conditions have disappeared completely because those were conditions that were related to their obesity or overweight related to really the fat mass on their body. And so treating that becomes part of the whole picture. And so we see this improvement of health that for so many people that seeing it on labs feeling stronger, feeling more energized, that is where it's actually so important. And so for people who are listening, if you feel like, I just want to be able to do this on my own, I don't think that I want to do those medications. I'll share with you that there are patients in my practice who don't take medications to support their weight loss goals, and that may be possible, but we're thinking about the nutrition, we're thinking about the movement. And when we decide to layer on medications, which I often do at the beginning, but sometimes, like I said, if people want to hold off for a period of time for a multitude of reasons, and we customize that to what makes sense for the individual in front of me, we look at what is the role that this medication is playing, what would be the reason that we're doing that and is using that medication any sort of failure for example, because that's where, again, our society's obesity bias. We have this idea that you can eat less and move more, that you shouldn't need to take a medication. I should be able to do this on my own. And what I will offer to you is that whatever stage of life that you're in, if you are just feeling so frustrated and feeling like a failure, you're like, I've been trying so hard to do this on my own and it is not working. There are people out there like myself, like other board certified obesity medicine physicians who would love to help support you because you do not have to do this on your own. When we look at any other health condition, we would not recommend for patients to do it on their own. Even when we're talking about the management of high blood pressure, for example, something that's very simple. And we often will prescribe dietary changes or exercise changes, for example, alongside management. We look at those lifestyle things as a very important piece of the picture, and somebody may also need the support of medications in order to help their blood pressure. And we look at cholesterol, for example. It's important to eat well with cholesterol. It's important to make sure that you're moving your body and reduce these other risk factors in your life. But there are conditions like familial hyper cholesterolemia where patients may need to take a blood pressure or a lipid lowering medication in order to reduce their cholesterol because these are conditions that despite doing all of the lifestyle, despite doing eating well and moving their bodies and sleeping well and managing their stress, they have these genetic factors that predispose them to having elevated cholesterol and therefore taking a medication to support reduction of that makes sense for them in conjunction with all of this other piece. And so I would just encourage you to reach out to a physician who can support you. And one of the things I will also say, the ABOM, the American Board of Obesity Medicine is really a phenomenal tool to find a provider that can support you, a physician, or another experienced provider, because the weight loss industry, which is honestly half of where our bias comes from, the weight loss industry has been for decades riddled with people who were just looking to make money while they may want to be able to support patients with their goals, the underlying thing is actually just to have as high of profits as possible. And so whether it was dietary fads of the eighties and nineties and early 2000s, or whether it's now with some of these compounded GLP medications that I feel like you can just pick up on every corner, I see them everywhere. I saw them advertised at a mall the other day on a little folding chalkboard, for example, just sitting outside of, I dunno, a med spa I guess. And you can pick up those medications. And so while those medications may be effective, I would also encourage you to be thinking about working with someone who can help you with that whole picture so that if you're having a side effects or you're having doubts or you're wondering, okay, as I'm losing weight, maybe I don't need as high of a dose of my blood pressure medication or my diabetes medication, what should I be doing? Working hand in hand with someone who is board certified in obesity medicine is one of the most phenomenal tools that is available to you. And so I will put that link in my show notes. The ABOM, the American Board of Obesity Medicine has a provider finder tool. So you can put in different things like your city or different zip codes and say, search within however many miles and start to look for people who are in your area who may be able to support you. There are a lot of telemedicine practices as well. And I will say that tool doesn't necessarily always support best with telemedicine practices because someone's physical practice may be in one state, but they may be able to support you from a telemedicine standpoint in other states. But it is a really good starting tool. So I just want to encourage you, when you're thinking about health, when you're thinking about weight, while there is so much overlap between those two things, the metric of health working towards improve someone's health and seeing alongside that, usually a reduction in body fat mass, that is where it's at. Paying attention to health, paying attention to strength, paying attention to energy, and that may mean that you need medical support in order to do that. Like I said, maybe yes, maybe no. Only you and your doctor can have the conversation about what makes the most sense for you and your individual situation, but it's really a both and situation. And so if you've been feeling discouraged, I encourage you to reach out. If you are in Virginia, Illinois, or Tennessee, I would be so happy to see you as a patient in my clinic. You can visit www.sarahstombaughmd.com. It's S-A-R-A-H-S-T-O-M-B-A-U-G-H md.com. In order to learn more about our practice and go ahead and get started today, we'll put that information in the show notes as well. If you want to go ahead and just click the link in there. Thank you so much for joining us today. We'll see you all next week. Bye-bye.