Conquer Your Weight

Dr. Sarah Stombaugh: This is Dr. Sarah Stombaugh, and you are listening to the Conquer Your Weight Podcast, episode number 58. 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: Today is a really special episode that I am really excited to share with you for the very first time. I have one of my patients joining me to share about her weight loss journey and what it has looked like working with me. So what I want you my listener to do, I want you to imagine that this is you. Maybe this is you. Two years from now we've been working together. Hear yourself in her story, hear if there are tools that would be helpful in your life, things that resonate from her story. And if you hear that and you're like, wow, that's a really unique perspective, I would love to work with someone in this way. I want you to reach out and for us to connect to decide if this is a way that I can support you in your weight loss journey. I see patients throughout the state of Illinois and Virginia and in person in my Charlottesville, Virginia office. So if you were interested in working together, fill out the form on my website. It's www.sarahstombaughmd.com on the individual visits page. I'll see you there soon. Enjoy today's episode with my patient. Hi. Good day everyone. I am so excited because I have a guest with me today. This is the first time that I am bringing a patient onto my podcast to talk about her experience, about working with me, what that has looked like from the tools that we use to medications. And this I think is going to be really fun to learn a little bit for all my listeners about how your journey may be similar and what are the things that I often do with my patients. So I'm going to introduce Laura. This is actually a pseudonym, not her real name. Laura's been my patient for a while. And Laura, thank you for being here. I'm going to have you introduce yourself and tell us a bit about your journey and what it has been like working with me. Laura: Yeah, well, thank you for having me. I'm excited to be on here. A little bit about myself in general, as I'm in my early thirties, I live in the Chicago land suburbs and I work in digital marketing. But going back in time, I did not have a problem with weight growing up. I was in sports year round. It was kind of a running joke in my family, how skinny I was. I was a stick, but also being called flat chested or you have no hips. And so growing up it was like, oh, being skinny is weird. It makes you so odd because you stand out from the rest in my family because they weren't stick skinny, which is fine. It was interesting how they would call that out growing up, but I wasn't doing anything but participating in sports and when you're young, you just have a really fast metabolism. And so I was like, okay, I'm the odd one out, but whatever happens. And so I remember the first instance of thinking maybe I have an issue with food is in high school I was running cross country and that required a lot more energy than when I did other sports, like volleyball and softball. And so I was not feeling great one day on a long run, like six, seven miles, and I just felt like I didn't have a lot of energy. And my cross country coach was running with me, happened to be running with me and is asking, what are you eating during the day? And I was telling her, and she's like that is not enough. That is not nearly enough. And it was literally I was having frozen waffles and peanut butter for breakfast, a peanut butter sandwich and goldfish crackers for lunch. I was eating a lot of peanut butter. So in my head I was like, I have so much peanut butter. But she was like, no, that is not it. Dr. Sarah Stombaugh: That's not a vegetable. Laura: She's like, that's not enough calories. You're burning a lot on these runs. You need to eat more. And it wasn't like I was afraid of food. I wasn't trying to restrict myself. I just didn't think much about it. And then in college, I didn't really play a lot of sports, but I had to walk everywhere. I went to Northwestern, which is a notoriously long campus spread out along that lake, yes, along the shore. And so I lived on one end of campus and my classes were always on the other end, so I walked a lot. And again, my eating, I wasn't necessarily eating healthy, but I was eating not a lot. And oftentimes I didn't trust the cafeteria food. I would eat salad and a slice of pizza for a meal, and that was it. I think I also had a lot of anxiety that just made me not want to, I just wasn't hungry as much. So again, I was still stick skinny, didn't have that freshman 15. And so I think in my head I thought, oh, it's going to be like this forever. That was not the case. Once I hit my late twenties, those curves started showing up that everyone was talking about. And I do think part of that was due to the pandemic of just less activity, less moving about. I worked, lived and breathed in my apartment, and I was also in a long-term relationship at that time, and we ate out a lot. And then when the pandemic hit, we were getting delivery or takeout a lot. It's just like we just didn't want to cook, I guess. And so what ended up happening is we'd share food. And so his belief then was like, we should eat the same amount of food. We get sushi rolls, we have the same number of pieces, and I would get so full and he would still push it on me because he wanted it to be fair. I don't have hard feelings on that. He wasn't trying to make me overeat, he just wanted it to be fair. But I was eating more than I wanted, but that was a decision I was making. But again, I just didn't have good boundaries with food. And so as I was eating more and not being as active, the weight started coming on. And that was just again, the first time I'd ever experienced weight gain. I think my confidence took a real hit, especially because of everything going on in the world, everything felt really rough. So then he started making fun of my weight one day, and that's when it really hit me like, oh, it's not just me that's noticing. Someone else is noticing too. And so I started, Dr. Sarah Stombaugh: It's so hard. Laura: It is. Having my family call it out when I was skinny was just as awful as being called out for being chubby, as he would say, because I just don't want my body to be talked about. Dr. Sarah Stombaugh: Yeah, it's such a private thing, but we wear our weight on the outside of our body. Laura: Exactly, exactly. So that was when it was clear to me, oh, okay, he can tell. So I would then try and hide it with baggy clothes, sweatpants and hoodies. And he didn't like that either. He would make fun of me like, oh, you're wearing those pants. You're wearing pants. You know what? I'm like, what? Dr. Sarah Stombaugh: Yeah, that's so hard. Laura: Yeah, I felt like, okay, I'm being really objectified here. And it was a no-win situation. And so long story short, our relationship ended at the end of 2020, and that's when I really finally hit my low point of everything coming to a head. And that's when I ended up meeting you in 2021, I think. And it was just by chance I was supposed to meet my regular primary care physician, but she was unavailable. And so I just happened to pick the next one and it was you, which was so crazy. Honestly, that changed my life that day right then and there. I didn't know it, but it did because being in such a rough spot mentally and physically, and then being in a doctor's office is already kind of nerve wracking, I think, for me and maybe a lot of other people. And so to have someone sitting next to me listening to my issues and giving me good advice, but not only listening, but giving good advice and giving me things to take away from that appointment. It wasn't just like, well, you should lose weight. That was not going to be helpful. But it was like, Hey, let's talk about the food you're eating or how much you're eating. And then you also helped me with other medical issues like allergy stuff I was dealing with. So I felt so much more hopeful when I came out of that appointment for the first time in a long time. Thank you. Yeah, I still, I'm like, oh, so I was so sad when you left that practice because being able to see you for primary care was just amazing. I have no words, so I'm still thankful for that. Dr. Sarah Stombaugh: I appreciate that. Thank you for sharing that. Laura: But yeah, so then yeah, like I said, I was sad, but then I just happened to be Googling you one day and I saw your name come up. And thinking back to some of the weight loss, like food tips, you'd given me Googling your name and finding your podcast, we're talking about more things, similar topics that you had talked with me, but then in more depth and then also your practice, I was like, oh, this is a sign. Dr. Sarah Stombaugh: Yes. And I love that because I'm in Virginia now and you're back in Illinois, but I still do see patients in Illinois. And so to see your name pop up was really special. And we had a pause and then we got to start working together again, which has been really fun. Laura: Exactly. Yeah. Dr. Sarah Stombaugh: So tell me a bit, I appreciate you sharing all of that because I think we all have our backgrounds, and for someone like yourself who hadn't struggled with their weight at all, when you start to, sometimes it can be especially challenging. I have never even thought about this. I thought I was just naturally slender. I was someone who wasn't ever going to have to worry about this, and it turns out that my body is a human body and it can gain weight and it can lose weight, and I need to work through some of this as well. And so recognizing a lot of times if you don't have any of those healthy habits in place, sort of implied that you haven't. And I know from our experience together that you hadn't developed those growing up, your family didn't necessarily always support some of those healthy behaviors. And then to always be this slender person in a family of people who were dealing with excess weight, that's an interesting place to be because in a lot of ways, having excess body weight probably feels somewhat normal to sort of fit in within your family. And so weighing those two things of what is best for my health physically, psychologically, and then how do I learn to take control over this because it turns out I actually do need to learn about how my body's functioning and how I can best serve that. So tell me a little bit from when we've been working together again now for about two years, which is really fun. And over that time you have been working through a lot of your beliefs around food. We've talked through a lot of different tools. So I'd love to share if you could share with my listeners what that's looked like for you, both psychologically, physiologically, what are the things that you have been working on in order to support your weight loss? Laura: So I do think it has been a combination of those mental tools, but also actual action items. I think one, which is something you had recommended I think when you were my primary care doctor, is just journaling what I was eating. And so that was just a really simple way to just see what you're doing. And I remember you were very clear about don't go into extreme details. You don't have to calorie count. And I thought, oh, that's really good, because I would never have stuck with that for very long if it had been 50 calories of peanuts. So I think that part was really helpful because it was just, I'm trying to think of the word, I don't know. It was casual, it was easy to follow, but then also those talking through the mental tricks we play in our mind. Like I said, I grew up in a family where weight was an issue and you had to sit at the table to eat those last few bites because food couldn't go to waste. That was a generational habit, I think, in my family. And so eating more than you want, but also I think there were many families at the time in the nineties and early two thousands of having reduced fat foods better. And I also, we have in my family, my sibling is diabetic, and so we had all the diet stuff or sugar-free stuff, and Dr. Sarah Stombaugh: She has type one diabetes, just for clarification, Laura: Type one diabetes, she had got it when she was a kid. And so that just changed what food we had in our family versus other people. I remember I grabbed a Diet Coke out of my friend's fridge once and they're like, oh, you can't have that. That's for our mom. And I'm like, but I don't drink Coca-Cola. So a lot of it was just those thoughts and beliefs we have about food that really, I think did have to change my mind. I could food journal for the rest of my life, but if I still have these unhealthy thoughts about food or not eating enough or overeating, I don't think I would be successful. And I was going to say also that it was funny that as a kid growing up, I was, my family called me out for being skinny and flat-chested. And so then once I did gain weight, I wasn't flat chested anymore. And so I did have thoughts of like, oh, yay, I'm not flat chested anymore, but I still was called flat-chested. Even funnier is even though I had gained weight there, my chest was bigger. It wasn't as big as other people in my family. So it was like no matter what, I felt like I couldn't win. And that's when I really realized, oh, it doesn't matter what I look like, they're probably going to call me out anyway. Dr. Sarah Stombaugh: Yeah, what are their beliefs? What impact does that have on me? And then starting to move beyond, do I care what their beliefs are? Are those really the beliefs that having those swirling around my mind, are those really serving me? Laura: Yeah, exactly. That's where I really had to, you and I are stepping back and really looking at those comments and thinking, well, it has nothing to do with me. This has nothing to do with me. Even though it has always felt like it, it actually had nothing to do with me. Dr. Sarah Stombaugh: It's reflections when people make comments about others' bodies, it is almost invariably a reflection on their own thoughts about their own bodies. And that's true for you. And honestly, that's true for anyone who's listening. People who are making those comments are really addressing their own insecurities. And so when we can recognize it, it's really freeing because it's like, oh, actually they're going to make comments about it regardless. And it doesn't have to mean anything about me. I would love to talk about, so one of the things that comes up with food logging sometimes is it takes what is somewhat subjective and makes it more objective, gives me as a physician and us in our appointments, some substance to be able to work through sort of day-to-day. What are the food choices that you're making? What are the timings at which you're eating? One of the things that came up really pretty early on in us working together was late night snacking. And you were very often, no one else can see your face, but you're making a fun face right now because you were snacking a lot in the evening, and that was a habit that your family had always had. And so you had adopted that. And I would love to hear about working through that habit and give us an update about where you were and what that looks like for you now. Laura: Yeah, it's so funny you bring that up because it doesn't even cross my mind anymore as a habit I have because I just don't anymore. But growing up it was, you had three meals plus a bedtime snack, and it was usually ice cream or cereal, and that was usually like Reese's Puff cereal, not to name drop, but it wasn't healthy cereal or anything. And so that was just standard. And I can't even remember a time when I didn't do that growing up, even through college, I'd have a little pint of Ben and Jerry's in my freezer and I'd have a few bites. I wouldn't overeat that, but I'd still have it because it just was part of my routine. You eat dinner, do something for a few hours, you have your snack, you go to bed that you don't even think if you're hungry or not. And so when you had me started food journaling and we were talking about that habit, I would look in, so I used, rather than physically writing down, I would use a spreadsheet in my phone, and so I'd have a cell for each meal of the day. And so it'd be filled from breakfast through snack time, bedtime snack. And so we talked about it and it kind of blew my mind when you're like, but do you need to have it? Are you hungry at that time? And at first I was like, I must be because I'm eating. Dr. Sarah Stombaugh: Of course, why else would I eat? Laura: Why else would I eat? And then it was like, oh, well, I'm having strawberries or something. I was trying to justify that, oh, I was eating not too bad of stuff, but then it was like, okay, maybe try not having a bedtime snack every day. Let's start to whittle it down. And eventually there were a few days for a few weeks where it was like, oh, I really, really want one. And it was urges. I thought I was hungry, but really it was just like I was craving that routine, not necessarily needing ice cream. No one needs ice cream, and that seems, it's funny to laugh at, but at that time I was like, that is just part of it. That's just part of my life. There was always a gallon of ice cream in my family's freezer. So to then cut it back down, cut it down to just a couple a week to now, if you were to look at my food journal, I don't food journal right now, but when I do that column is empty. I do not have bedtime snacks. It is not part of my routine at all. Dr. Sarah Stombaugh: Well, and I love if you had looked back two years ago and said, should I drop out this bedtime snack? I think the answer might be very different than it is right now and looking back where you were at. So it's both psychological and physiological. Actually. If we eat at the exact same time every day, our bodies does start to anticipate that physiologically we start to ramp up our digestive hormones. And so if you're eating at the same time, your body's sort of preparing for that. And so for someone like yourself who's been eating at that specific time every day, there definitely is a physiological aspect of I need to sort of move beyond my body is in some ways telling me it's hungry. And also when I look at the food that I eat in throughout the day, I know that I've really nourished my body adequately and maybe I don't need that. And so that transition, it didn't happen overnight, but it happened slowly and gradually and just using that curiosity to explore, I mean even the transition, like you said, of eating ice cream or cereal to then there was a while you were doing strawberries and the brownie batter hummus for example. And totally a better option. And I think when you look at something like that as a stepping stone in the direction of your goals and then just starting to try, okay, what if I didn't do it for a night? What if I didn't do it for two nights? Do I really even need this? And just seeing over time how that has evolved has been really fun for me to see in you as well. So thanks for expanding on that a little bit. I'd love to hear about your use of medications if you feel comfortable talking about those. We have used some medications as tools to support your journey. So if you feel comfortable sharing a bit about that, I would love for you to share that with our listeners, Laura. Laura: Yes, definitely. So yeah, right now I'm on Bupropion and Sertraline for mental health as well as Bupropion for weight as well. Dr. Sarah Stombaugh: And tell me how long have you been on those or I'm happy to fill that in as well. And do you feel in adding the Bupropion especially, did you feel any adjustment? Did you have any drama come up about using medications to support your weight? Tell me about any thoughts that you had around that and maybe it was not super dramatic for you. I'm not sure that it was, actually, Laura: It wasn't. And I think that's because I already had had my dramatic period before you and I were meeting, I want to say five or six years ago, I hadn't been on any medication, but I was seeing a therapist and she kept bringing it up and it would scare me a lot of like, Hey, maybe you need to be on an antidepressant. And I just refused. I had thought, I had heard horror stories of it not working. And so I really put it off, put it off, put off, and then it got to a point where it's like I got to try something. And so I wasn't on sertraline at that time. I was on something else. And then I think once I was seeing as primary care, I switched antidepressants. So I think that's when I then went on sertraline. So I had already been used to trying medications and doses, different dosages that by the time you recommended Bupropion, it was not. Yeah, like you said, it was not dramatic at all. It was just like, okay, yeah, let's see what happens. Dr. Sarah Stombaugh: Yeah, let's do it. Well, and I think it's an important thing in the conversation around medications, people are really wrapped up in Wagovy, Ozempic, Manjaro, Zepbound, Saxenda, all these really novel injectable medications that can be really an important tool for weight loss. And I certainly use those with my patients, but that doesn't necessarily for one, those aren't the only medications. And it's often we can use even sort of just regular medications, and I should put that in quotes, but not medications that are supposed to be directly for weight loss, but that we can use in combination in order to support a healthy weight. So for the treatment of depression, for example, we often use SSRI medications. Those are selective serotonin reuptake inhibitors. Common medications like Zoloft, Sertraline, Lexapro, which is Escitalopram Celexa, which is Citalopram. There's a lot of different medications in this category and they're all related to one another, and they are hands down in medical treatment, sort of our mainstay of treatment for depression, for anxiety, and we know that those can be really helpful. What we also know though, is that some of those medications can promote weight gain. And so one of the things that I do as a obesity medicine physician is that I'm looking at my patient's medication list and seeing are there medications on here that are sort of shooting them in the foot? You're working on all these dietary exercise, whatever interventions, and then if you have a medication that's causing weight gain or is a weight promoting medication that's kind of dumb, is there another medication we could use that would also support you in this case, in your mental health, while also supporting you in your weight loss goals? And so that sertraline tends to be a very weight neutral medication. And so that's something we've been using to support your mood and then to also support your health goals over time. We have adjusted that medication. And one of the things we realized was that, okay, you may be able to get additional benefit for the treatment of your depression. If we bring on a second medication, which was the Bupropion medication, and that medication is nice, it works differently than the Zoloft Sertraline medication, and it can be really a weight loss promoting medication. So it does not directly cause weight loss, but it helps to really decrease cravings. And that tool can be really supportive when you add it on with some of the food changes, some of the exercise changes, some of the stress and psychological work that we're doing together. Those two things can be really supportive. And so why would we not be able to support your body comprehensively in that way? And that alongside everything else that you've done has been really helpful. And I think a lot of people are fearful that, oh, if I do medications, it's the easy way out or it's cheating. But I think you can attest to, no, I was doing a lot of other stuff alongside of that to support my weight. Laura: Yes, exactly. And similarly dealing with some mental health issues that I was putting in the work with a therapist already. And so to me, I got to a point where it was like, oh no, this is not an easy way out. This is I need some additional support. And finally, my therapist had said that to me for a long time and finally sunk in that that was true. And so by the time that you and I started working together and you said something similar, I was a believer, so I didn't take as much convincing, but I do feel that as well. And so I am also on Trazodone to take as needed very low dose to help for sleep. And I think that also just because I was taking the other bupropion and sertraline, but I wasn't sleeping very well. And so that can only do so much. And so to then add just a little bit of Trazodone when needed, that also just changed things as well because then I have the energy to do things during the day. So I think, yeah, I understand people's hesitation to take medication. I think there is that hill to climb over of anxiety, and then now I don't feel that anymore. I'm willing to try some things. Dr. Sarah Stombaugh: Yeah. Well, and I appreciate you sharing that. I think our society has such a bias both against mental health treatment as well as obesity and overweight treatment, and it can make it really hard sometimes for us to want to use medications to support us. And so I'm glad that over time between your therapist, between me, between your own, just sort of sitting with it, that it was something that you were able to move in the direction of supporting your health in that way. I would love to hear in the last few minutes that we have, what is your favorite tool that we have talked about that you either have implemented even if it's in the past or that's something you're still doing, what is your favorite tool that we've worked on or maybe a favorite lesson that you've had? Laura: I think if I could give both. I think favorite lesson is the bedtime snack if you don't need it. And having that spelled out, it's so obvious to me now, but it wasn't then. So it's like I don't feel dumb. It just is so funny how those beliefs, decades of having certain habits just go away eventually once you really sit down and question it. So I think that was certainly something that was mind altering. And then also, like I said, having a spreadsheet. I am an Excel dork. So to me, when you first said food drilling, I was like, I don't think I'm going to be someone to write stuff down. I had tried that in the past and it just wasn't for me, but I'm like, okay, I can do it in my phone. And I like to not only track the food, but then that's also where I put my hunger signals. That has also been a really helpful tool to be like, I think that also helped with bedtime snacks of like, do I actually need one? Am I actually hungry? No, then I don't need it. And so to actually visually see the evidence that I didn't need a bedtime snack was really helpful. But then also over time of doing that day after day, taking it one day at a time, day after day, then I can look back at my spreadsheet and see, oh, look, I survived the last week without a bedtime snack. I am fine. So seeing it that way, and then also I'll add to that is figuring out what foods might upset me. Also, my concern is I'm not trying to restrict food. I'm not trying to only eat broccoli or whatever. That's just not realistic. But there are certain foods maybe with flour that are going to upset my stomach. I'm not going to eat a lot of pasta or things like that. And so if I have bad reactions to food, I also make a note of that in my spreadsheet as well by I added conditional formatting. So if I, Dr. Sarah Stombaugh: She's a real dork, you guys, Laura: I'm a real Excel dork, I am loud and proud about that. So I had it so that all I had to do was put an asterisk in that cell and it would change it to red. So then I could just see over time as I'm scrolling through day after day, I could see, okay, what are the things that were upsetting my stomach? And eventually those go away because I wasn't eating them anymore. I was realizing what was causing pain. So yeah, that works for me. I'm a visual learner in that way. And so I think that really helped to see it in a overall big macro way. Dr. Sarah Stombaugh: Yeah. Well, thank you for sharing that. And I know you had mentioned it's not something you're doing as consistently right now because you're really pretty far into this journey. And so some of my patients, when they start doing food logging, they're like, do I have to write it down every day for the rest of my life? And I'm like, no, I promise you do not. But it's really a great tool that if you start to see weight regain, you can start to do it again for a period of time. And it's usually pretty obvious what is causing that weight regain. So I just want to say thank you for joining us today. I am so proud. We talked about a handful of the lessons, but I could pull out probably dozens of things that we've worked through. And yeah, it's been so fun to see how your mind has evolved alongside your weight. Your weight has decreased about 30 pounds at this point. Your BMI was 27 and change. Now, 22 and change, you're still losing some weight, getting to a place where your body's sort of settling into what is going to be the long-term stable weight. And it's been so fun and such an honor to work alongside of you. So thank you for coming today on my podcast to share your journey. I really appreciate it. Laura: Thank you so much for having me, and thank you so much for being on this journey. Me. It really, like I said, has been life-changing since the day I met you. Dr. Sarah Stombaugh: Yeah, I love that you share that. And if I have anyone listening who is wondering, what would it look like to work with me, come on, do a free call. I'd love to do a free 30 minute meet and greet with any potential patient just to review what their goals are, how I might be able to support them, and I would love to do that. So reach out on my website. I'll have all that information in the show notes.