[SPEAKER_01]: Hey, it's Elizabeth McGan, the holistic GLP1 podcast.
[SPEAKER_01]: That would do it.
[SPEAKER_02]: This is the first medication we have that really takes control biologically of your appetite, your hunger, your fullness, diminishing the food noise, reducing the cravings.
[SPEAKER_02]: It just takes that burden that how hard it is to work to get your weight on a control and it does that for you biologically, which then gives you freedom.
[SPEAKER_02]: to think about and actually get engaged with eating a nutrient-dense diet, reduced cravings, reduced food noise, being more physically active feeling publicly healthier in your body.
[SPEAKER_01]: And if you're new here, I'm so glad you found us.
[SPEAKER_01]: You've joined thousands of women who are discovering there's a more holistic way to use JLP ones, one that helps you heal and release weight, body, mind, and soul.
[SPEAKER_01]: Now let me ask you something.
[SPEAKER_01]: If you're on a JLP1 or thinking about starting one, have you ever wondered what the best way to approach it really is?
[SPEAKER_01]: And when you see so many people having completely different outcomes with these peptides, do you wonder how you can become one of the success stories instead of a cautionary tale?
[SPEAKER_01]: If you've ever asked yourself either of those questions, today's episode is for you.
[SPEAKER_01]: because here's the truth.
[SPEAKER_01]: A GLP1 may help you lose weight, but the choices you make while you're on it will determine whether this becomes a temporary fix or a lasting transformation.
[SPEAKER_01]: And if there's anyone who's spent a lifetime trying to answer the question, what actually helps people succeed at long term weight management?
[SPEAKER_01]: It's my guess today, Dr. Robert Kushner.
[SPEAKER_01]: We're so fortunate to have him share his wisdom with us today.
[SPEAKER_01]: Dr. Kushner is one of the pioneers of modern obesity medicine.
[SPEAKER_01]: He's a professor at Northwestern Universities, Fineburg School of Medicine, Medical Director of Northwestern Medicine Center for Lifestyle Medicine, a founder of the American Board of Obesity Medicine, former president of the obesity society, and the author or editor of more than a dozen books in over 200 scientific publications.
[SPEAKER_01]: For more than three decades, he's helped shape the way we understand weight management.
[SPEAKER_01]: What I love most about Dr. Kushner is his incredible ability to turn decades of science into practical strategies that actually work.
[SPEAKER_01]: In today's conversation, you'll discover how to get the most from your GLP-1.
[SPEAKER_01]: Why some people succeed?
[SPEAKER_01]: Well, there's stay stock.
[SPEAKER_01]: how his powerful six factors to fit framework can help you uncover your unique weight loss personality so you can finally build a strategy that works for you.
[SPEAKER_01]: If you're serious about creating lasting success, not just losing weight, but keeping it off while becoming the healthiest version of yourself, I think this may be one of the most valuable episodes you'll ever hear.
[SPEAKER_01]: So grab your notebook, settle in, and please join me in welcoming Dr. Robert Kushner to the Holistic JLP1 podcast.
[SPEAKER_02]: Thank you for having me.
[SPEAKER_01]: It's so cool.
[SPEAKER_01]: I'm really excited to have you here as I was sharing before we we pressed record, reading your book and I'm excited to read your, the new one you have out.
[SPEAKER_01]: You've spent your career helping people understand not just how to lose weight, but how to create lasting success and better health by optimizing lifestyle habits and mindset.
[SPEAKER_01]: and today we're living in one of the most exciting and transformative times ever seen in the field.
[SPEAKER_01]: And the women that listen to this podcast are wanting a holistic approach to GLP ones so they can release the weight and shift out of the patterns that have kept them stuck so they can create sustainable results.
[SPEAKER_01]: So I'd love to begin with one question.
[SPEAKER_01]: If someone listening today took to heart, all the wisdom you're about to share with us about successful weight management and began putting that into practice, including how a GLP-1 could fit into that journey.
[SPEAKER_01]: How might it transform her life?
[SPEAKER_02]: Ooh, a start a big question, then go smaller.
[SPEAKER_02]: I would say it is to riff off a white, your introduction, it is revolutionary.
[SPEAKER_02]: I'm not want to say grandiose statements like it's magical and it's overpowering, but we really are living in a paradigm shift, not only for individuals trying to get the weight on a control, but also
[SPEAKER_02]: also in society.
[SPEAKER_02]: Ripple effects are amazing of what's happening, but the interquestion specific specifically, if you are someone who's been trying to address and control your weight for years if not decades, getting hungry, food noise, counting calories, it's a struggle in which the weight is lost but always comes back.
[SPEAKER_02]: This is the first medication we have that really takes control biologically of your appetite, your hunger, your fullness, diminishing the food noise, reducing the cravings.
[SPEAKER_02]: It just takes that burden that how hard it is to work to get your weight on a control and it does that for you biologically, which then gives you freedom to think about and actually
[SPEAKER_02]: reduced cravings, reduced food noise, being more physically active, feeling publicly healthier in your body, reduced medical complications, like heart disease, and diabetes, and sleep apnea, arthritis of the knees, and allow you to have more social conductiveness, and more really freedom to live perhaps the way you want to live, but you have to burn in.
[SPEAKER_02]: of dealing with your weight for all these years.
[SPEAKER_02]: It is helping you to deal with that more successfully.
[SPEAKER_02]: I think that's the best way to summarize what I have seen as a clinician and as a researcher in this field.
[SPEAKER_01]: Yeah, it's really exciting.
[SPEAKER_01]: It's so, it's powerful.
[SPEAKER_01]: I was listening to one of the recent podcasts you did, the level's health podcast, I believe that's the name.
[SPEAKER_01]: And you said something that really stuck with me.
[SPEAKER_01]: And I'm gonna paraphrase a bit.
[SPEAKER_01]: You said, I spent 25 years treating this condition without a decent pharmaceutical option.
[SPEAKER_01]: And five years with one, that's so interesting.
[SPEAKER_01]: So what's changed when GLP ones entered the picture?
[SPEAKER_02]: Well, from, and I said that, okay, I'll take ownership of that.
[SPEAKER_02]: I really spent decades talking to patients in my office, trying to encourage them to think about taking a medication for their access weight or their obesity.
[SPEAKER_02]: they in one of the part of it, it's my fault, it's my responsibility.
[SPEAKER_02]: I don't want to take a medication for something I could solve myself in the medications we had, although still effective we're not effective enough.
[SPEAKER_02]: Now let's go, you know, jump forward to last five years.
[SPEAKER_02]: What is the scenario?
[SPEAKER_02]: Patients come in, goes, I've heard about GOP ones, tell me a little more about them.
[SPEAKER_02]: It might I can't take for it and when can I get a prescription?
[SPEAKER_02]: I mean, it is 100 and 80 degrees,
[SPEAKER_02]: different now.
[SPEAKER_02]: And the reason for that is because these drugs are highly effective and they take care of all things I mentioned before, you know the food noise and cravings and so forth.
[SPEAKER_02]: And it's the amount of weight loss that we never envisioned one
[SPEAKER_02]: would have ever be able to achieve the fact that I've been in my practice for four years and now now I am concerned now about someone taking off too much weight and to tell them the slow down because I'm concerned about you know loss of muscle mass and nutrient deficiency and so I never thought I would find that in my clinic.
[SPEAKER_02]: It is an incredibly exciting time for not only patients, individuals but also clinicians who are treating patients.
[SPEAKER_01]: Yeah.
[SPEAKER_01]: It's fascinating.
[SPEAKER_01]: What surprised you the most, this when it came on, what was a, what weren't you expecting?
[SPEAKER_02]: Well, I guess I wasn't expecting that the secret sauce to treat obesity was within us all along.
[SPEAKER_02]: and they really weren't that effective had side effects and dry mouths and changes and mood and so on.
[SPEAKER_02]: And all along, but we didn't know that the secret to this treatment lied within us.
[SPEAKER_02]: These are God's hormones.
[SPEAKER_02]: GMP wants a gun hormone.
[SPEAKER_02]: Amalan, Glucagon, GIP, these are all the alphabet step people here.
[SPEAKER_02]: They're all God's hormones.
[SPEAKER_02]: So what we didn't realize, that if we just harness the effects of these naturally occurring gun hormones,
[SPEAKER_02]: and give them back to people now, not only by injection but by pills, at pharmacologic doses, we can actually achieve the effects that we are looking for for decades.
[SPEAKER_02]: And the best example is insulin that I could think of right insulin to an edge occurring hormone, someone would type to diabetes, how are we treating?
[SPEAKER_02]: We give high doses of insulin, something within us.
[SPEAKER_02]: So it's a nice way of thinking about this.
[SPEAKER_02]: I have this gut hormone,
[SPEAKER_02]: GIP, let's take that one.
[SPEAKER_02]: But the signal's not getting my brain.
[SPEAKER_02]: I'm not getting the full effects of what I should be getting when I'm eating and feeling fallen and say, shoot it.
[SPEAKER_02]: But if I take that same gun hormone pharmacologically manufacturer, give it back as high doses.
[SPEAKER_02]: I can feel it, I'm full, I'm not hungry, I'm contented between meals, I'm not thinking of food, I only have food noise, I'm not, I don't know if he's cravings of eating things around me, it's all because of GOP wants to get hormone but we're giving it very high doses.
[SPEAKER_02]: So the surprising fact is that we can have such profound effect by using a naturally curing hormone, but using it pharmacologically.
[SPEAKER_01]: And you also on that same interview said something that I think is going to be at the heart of this podcast, which is how to merge the old way of doing it with JLP ones.
[SPEAKER_01]: You said the forgotten treatment is what we've done for decades.
[SPEAKER_02]: Yeah, I said that.
[SPEAKER_01]: Yeah, I'm pulling it.
[SPEAKER_01]: Yeah, I had a good day.
[SPEAKER_02]: I had a good day.
[SPEAKER_01]: Close out of you.
[SPEAKER_02]: Well, let me unpack that a little bit.
[SPEAKER_02]: Yeah, and I've lived through it, so I feel like I'm ownership of that statement.
[SPEAKER_02]: For decades, the only instrument I had is my hands, like encouraging people to do things, you know, like counter calories and plan your meals, and know what's in your food, and how many fats and carbohydrates, and you stimulus control, you know,
[SPEAKER_02]: you can take a different route to work instead of going by the donut shop, you know, all these behavioral approaches, we've done that for decades.
[SPEAKER_02]: And now we have GOP ones, which I've said before, biologically affects appetite, which makes it easier.
[SPEAKER_02]: But that's no reason to get to not use everything we've learned for decades, which are behavioral approaches at diet, physical activity, behavior change, sleep hygiene, stress management, and so forth.
[SPEAKER_02]: and apply them, but think of them differently.
[SPEAKER_02]: So when I'm giving talks to other clinicians, I'm telling him, it's not a choice of lifestyle medicine versus medication.
[SPEAKER_02]: The answer is both of course, but we need to think about using lifestyle counseling in a fresh way.
[SPEAKER_02]: So for an example, we don't have to ask people to count calories anymore.
[SPEAKER_02]: Medication already reduces how many calories you consume it, but the fresh way is the quality of the diet and the healthy eating pattern and the importance of adding resistance training to hold on to our muscle mass.
[SPEAKER_02]: in the value of social connections so we feel better about what we are doing.
[SPEAKER_02]: So it's taking what we know, but kind of repackaging it with GOP1 doing the heavy lifting to helping us lose weight.
[SPEAKER_01]: Yes, and I even want to push back even a little bit is the heavy lifting part wouldn't it be interesting if we also had the lifestyle, the habits, the behavior change, also doing the heavy lifting.
[SPEAKER_01]: together.
[SPEAKER_01]: Do you see what I'm saying?
[SPEAKER_01]: Because I, the only downside, and I'm curious your thoughts on that, is especially when people are just, they think it's just a magic pill, and they take it, and it does so much for them, right?
[SPEAKER_01]: Basically, they don't want to eat, which, you know, that's not always a good thing.
[SPEAKER_01]: But it works so well in that front that they do lose the weight and a disproportionate amount of muscle, but they don't
[SPEAKER_01]: are motivated to do all the other things right.
[SPEAKER_02]: Well, let me, let me just emphasize the word heavy lifting so we're using the same definition.
[SPEAKER_02]: Okay, let me say heavy lifting without GOP ones heavy lifting is is I consider hard work.
[SPEAKER_02]: It's hard work to track your diet every day.
[SPEAKER_02]: It's hard work, maybe to plan everything you're doing and think about what am I going to do, every minute of day regarding my diet and my activity and it could become exhausting and hard to develop habits.
[SPEAKER_02]: If it's not as hard to eat healthier, you're letting go of some of the heavy lifting.
[SPEAKER_02]: That's what I mean.
[SPEAKER_02]: So you can actually eat healthier if you don't have this
[SPEAKER_02]: It's not as hard because that is now gone because of the GOP one.
[SPEAKER_01]: I see what you're saying.
[SPEAKER_01]: Yes, and how great is it to make this easier because it's been such an uphill battle for so long.
[SPEAKER_02]: Yeah, the healthy waste easy way, really.
[SPEAKER_02]: It's like, that comes up a lot when I'm counting individuals on getting exercise to e-work, exercise.
[SPEAKER_02]: I don't like it.
[SPEAKER_02]: I sweat, I get short of breath, my high-field, my heart rate pounding.
[SPEAKER_02]: I don't get enjoyment in it.
[SPEAKER_02]: Enjoyments to keyword.
[SPEAKER_02]: If you can't find something you enjoy and is rewarding, it's not gonna last.
[SPEAKER_02]: It's not gonna turn it to habit formation.
[SPEAKER_02]: So a GOP one allows people and I have patients who never exercise because they didn't feel healthy in their body and it was uncomfortable and they would have, they would sweat a lot, they'd be uncomfortable being with others, you know, for all the reasons that we know.
[SPEAKER_02]: Now they actually start in jokes, they could see their muscles, they could see their benefits, they could see how it makes them feel healthier and more fit.
[SPEAKER_02]: So the burden, it's not as a heavy lift exercise that I mean because they're enjoying it now.
[SPEAKER_01]: Yeah, that makes sense.
[SPEAKER_01]: And that we're an inch to enjoy it.
[SPEAKER_01]: I feel like that's the magic piece.
[SPEAKER_01]: This is if you enjoy what you're eating, if you enjoy how you're moving your body, you'll do it.
[SPEAKER_01]: There's only so much time you can do things that you can't stand.
[SPEAKER_02]: You know, people will do things that's good for them.
[SPEAKER_02]: And I'm going to give some personal reflection.
[SPEAKER_02]: I, for the past year and a half, I'm doing resistance training with a personal trainer.
[SPEAKER_02]: It's something I really don't enjoy.
[SPEAKER_02]: I do a robe, I can ride bike and ride and all that.
[SPEAKER_02]: But I never really got into weight training.
[SPEAKER_02]: But I started it because I knew I had to.
[SPEAKER_02]: And I do it all the time because I know I have to.
[SPEAKER_02]: It would be better if I really enjoyed it, getting there but it's slow, but it's just very important.
[SPEAKER_02]: And enjoyment for walking can be done with a pad, a dog, a neighbor, a partner, you know, enjoy the outdoors.
[SPEAKER_02]: So there's ways you to learn to enjoy activities that don't don't have to be solitary.
[SPEAKER_01]: Okay, cool.
[SPEAKER_01]: And when I was researching you, I went to your Instagram
[SPEAKER_02]: Yeah, I was.
[SPEAKER_01]: A really good one.
[SPEAKER_01]: Yeah, there's this picture of you.
[SPEAKER_01]: I don't know.
[SPEAKER_01]: I believe you were like in your 20s, maybe?
[SPEAKER_02]: Yeah, high school.
[SPEAKER_02]: So he took 17.
[SPEAKER_01]: I mean, that's strength training.
[SPEAKER_02]: Yeah, it is, but what I've lost it over the years, I used to be quite a different body composition when I was 18, 20 years old.
[SPEAKER_01]: Yeah, but if you have all that muscle memory, maybe you need to get start doing the gymnastics again.
[SPEAKER_02]: Yeah, flips again, you think at my age, sure.
[SPEAKER_01]: Or maybe I don't know, just like what are those like hanging bars.
[SPEAKER_01]: I'm clearly not a gymnast, but it's hard.
[SPEAKER_01]: I mean, respect.
[SPEAKER_01]: That is, that's, that's your fitness fund.
[SPEAKER_01]: Yeah, I mean, could you, I don't, then we won't turn this into an exercise counseling session for you.
[SPEAKER_01]: But, uh,
[SPEAKER_01]: Maybe that would be fun for you.
[SPEAKER_01]: Who knows?
[SPEAKER_01]: Okay, so let's talk about you said, you know, these medications change the biology.
[SPEAKER_01]: And I know that there's, there's so much research happening.
[SPEAKER_01]: We already have research, there's more research coming and I know you're deep in all of that.
[SPEAKER_01]: I know it works on the brain.
[SPEAKER_01]: There's a addiction that it can treat.
[SPEAKER_01]: It's so fascinating how deep this goes.
[SPEAKER_01]: But if we rely just on shifting the biology and they don't do the behavior change, could that be potentially dangerous?
[SPEAKER_01]: And especially for someone who might, and I know it's controversial to talk about getting off of a GOP one, a lot of doctors are like, it's impossible, you'll gain all the way back.
[SPEAKER_01]: And
[SPEAKER_01]: I mean, you'll definitely gain the weight back if all you do is take a GLP one, right?
[SPEAKER_01]: But if you are also changing your behavior, is it possible to be able to sustain the results without a GLP one?
[SPEAKER_02]: Well, let me back up to whole idea of lifestyle counseling or lifestyle behaviors, why you've taken a medication.
[SPEAKER_02]: It is important to never think of it as a either or it's a false dichotomy.
[SPEAKER_02]: It's not one or the other.
[SPEAKER_02]: It's always the both medication as I said many times.
[SPEAKER_02]: Now repeat by logically, it doesn't have anything by reducing appetite.
[SPEAKER_02]: And it does guide you by the way to eating certain types of food because of the changes in the brain.
[SPEAKER_02]: So things that are really salty or really sweet in general, not for everybody.
[SPEAKER_02]: Gracie are not tolerated as well, so it does shift people often to fruits and vegetables and health of your foods.
[SPEAKER_02]: How do we know that?
[SPEAKER_02]: We know that one by patient care, but number two even more importantly, if you look at what is going on in our society in the food industry.
[SPEAKER_02]: So what are people, we have to eat on this?
[SPEAKER_02]: What are people shopping for?
[SPEAKER_02]: What is going up and in spend?
[SPEAKER_02]: What's going lower and spend?
[SPEAKER_02]: What are the, how the food manufacturers are spending?
[SPEAKER_02]: We know now the things like cookies and cakes and ice cream and sweet foods are going down in sales.
[SPEAKER_02]: from the grocery store.
[SPEAKER_02]: What is going up for fruits, vegetables, real foods like the government is talking about now.
[SPEAKER_02]: So we've been trying for decades to change American diets.
[SPEAKER_02]: Who knew that a medication is changing America's diets?
[SPEAKER_02]: So it is naturally shifting the preferences of what people eat.
[SPEAKER_02]: However, medication doesn't teach you how to eat healthy, how to put a meal plan together, have a healthy overall diet, and it doesn't know whether you have diabetes, heart disease, fatty liver disease, all of which have nuances regarding what you're eating.
[SPEAKER_02]: And so it's important to you eat healthy.
[SPEAKER_02]: When you start a medication,
[SPEAKER_02]: All of the, even though all of the GOP medications are different, this kind of class effect, each one has their own nuance, you know, about how they work.
[SPEAKER_02]: But there is a generalization among all these medications.
[SPEAKER_02]: They have a gastrointestinal side effects when you start to medication and you dosescalate nausea, vomiting, diarrhea, constipation, or heartburn.
[SPEAKER_02]: If anyone's taken to GOP medication, you know what I'm talking about.
[SPEAKER_02]: So there diet is extremely important to mitigate or reduce those side effects.
[SPEAKER_02]: We learned that when we did the trials of these trucks, we didn't know.
[SPEAKER_02]: But we did the trial.
[SPEAKER_02]: People are having these symptoms and side effects.
[SPEAKER_02]: We would experiment with different diets and we found out that time we can significantly reduce the side effects.
[SPEAKER_02]: So there's just a good example.
[SPEAKER_02]: that during dose escalation diet is important.
[SPEAKER_02]: When you're on a medication, we know from grocery shopping and sales and talking to people, diet changes.
[SPEAKER_02]: So it's kind of jumps on you.
[SPEAKER_02]: Well, we need people who need more dietary counseling on what to do, and you get that from a dietitian or a health care provider or prescriber.
[SPEAKER_02]: The second question is extremely important.
[SPEAKER_02]: And I'm going to spoil a little bit, I don't have the answer right up front.
[SPEAKER_02]: We do not know.
[SPEAKER_02]: which individual to be able to get off this medication, we don't know really how to get them off the medication, and we don't know how to manage people long-term other than staying on the medication.
[SPEAKER_02]: We just don't know that right now.
[SPEAKER_02]: But I think it's easy to think about that the health theory you are in your diet, your physical activity, don't use substances like excess alcohol, smoking, and everything like that.
[SPEAKER_02]: You are going to be overall healthier.
[SPEAKER_02]: It doesn't make sense just to take medication.
[SPEAKER_02]: Why not limit your saturated fat?
[SPEAKER_02]: Why not increase fruits and vegetables and whole grains?
[SPEAKER_02]: Why not get aerobic activity that's good for your heart?
[SPEAKER_02]: It all makes sense.
[SPEAKER_02]: I think we can debating it seems silly to me.
[SPEAKER_02]: It all makes sense to work together.
[SPEAKER_02]: But I'm going to let me in one more thing, Luzbith, and that is what gives me some pause.
[SPEAKER_02]: Is the direct and consumer
[SPEAKER_02]: companies.
[SPEAKER_02]: And that's signaling amount, and I'm not saying it's a bad thing.
[SPEAKER_02]: But if you're an individual who's getting a medication through a direct consumer company, and all they're doing is send you a file and a syringe and a needle, and they say basically good luck, here's how many CCs I want you to take, and you get nowhere to guide it.
[SPEAKER_02]: I'm concerned.
[SPEAKER_02]: of micronutrient macnut deficiency, you know, could be like protein and vitamin D. I'm concerned about these side effects that we just talked about.
[SPEAKER_02]: I'm concerned about bone health and muscle health, particularly as you age, and other other deficiencies we may not even know about.
[SPEAKER_02]: So I'm concerned about that.
[SPEAKER_02]: And if anyone's going to take this medication, and you want to do to optimize your health, that's really what people want to do.
[SPEAKER_02]: Why would you not optimize it with lifestyle as well?
[SPEAKER_02]: It doesn't even make sense.
[SPEAKER_01]: Yeah, it makes, yes, it doesn't make sense to do it without the lifestyle.
[SPEAKER_01]: And while they're still figuring out how and if and the best way to maybe come off the medication or come lower on the dose or what would be the best way to maintain it,
[SPEAKER_01]: It would make sense that working with this time on the jail P1 just strengthened all of your best practices would just make so much sense.
[SPEAKER_01]: And that is what you wrote, this wonderful book about.
[SPEAKER_01]: This is what you've been doing for, did you say is 30, 40 years of your career?
[SPEAKER_02]: I've already plus years practicing, which you could do the math and you could age me, but the book that you're referring to came off actually during COVID.
[SPEAKER_02]: So it's like six years old now.
[SPEAKER_01]: Yeah, it's such a great book.
[SPEAKER_02]: And I wanted to talk for COVID, by the way, that's how we did that.
[SPEAKER_01]: well spent for sure.
[SPEAKER_01]: I want to get into that in just a moment, but let's just talk about this.
[SPEAKER_01]: So what does success on a GLP-1 really look like?
[SPEAKER_01]: In your experience, what separates the people who truly thrive on this medication from those who struggle?
[SPEAKER_02]: Good question.
[SPEAKER_02]: I can start off by telling you that currently we do not have any predictions before you start a medication of who's gonna do well on a medication but we'll talk about what that means and who's not gonna do well.
[SPEAKER_02]: So there's no predictive model, there's nothing about your age or your body weight or how many years you live with obesity or so-so economic background.
[SPEAKER_02]: None of these have really turned out to be predictive.
[SPEAKER_02]: which means there's a huge variety of differences in responses and it's hard to predict.
[SPEAKER_02]: The only way we know how someone's going to do well on is to follow them in the first few months, and we can look at wait curves if you're looking at wait as your outcome, you go look at wait trajectories, and you can kind of see how you follow what I would predict based on the trials.
[SPEAKER_02]: If you're not, then we could change drugs or do something else.
[SPEAKER_02]: So what we're looking for for optimal outcome though, one is a weight loss that is going to be meaningful to the patient, not only psychologically and their personal health, but also clinically.
[SPEAKER_02]: And I'm speaking in general, it is now everyone's different, but in general, if you're able to lose about 10% body weight a lot of things get better.
[SPEAKER_02]: So that's kind of what we're looking for.
[SPEAKER_02]: We're looking for a medication that is maximally tolerated.
[SPEAKER_02]: So in other words, we want someone on a medication that they're nauseated all the time or don't feel well.
[SPEAKER_02]: So a medication dose that's giving you that 10% weight loss or so, but you're tolerating it really well.
[SPEAKER_02]: The other is what we did to dip back into what we just talked about, someone who is engaging in self-care and that kind of gets into my book as well.
[SPEAKER_02]: What would you actually do?
[SPEAKER_02]: And just put on my clinical hand, someone who's obesity related complications are improving, or actually resolved completely.
[SPEAKER_02]: Like diabetes, they're sleeping out near arthritis, pain in the knee joints, their heart failure is improving.
[SPEAKER_02]: Things that we're studying now, their alcohol intake is coming down if they're suffering from alcohol misuse.
[SPEAKER_02]: breath smoking cessation has occurred.
[SPEAKER_02]: So all these things were starting to look at.
[SPEAKER_02]: So clearly it's holistic picture and it's something that's decided in between the prescriber and the patient.
[SPEAKER_02]: That's called shared decision making.
[SPEAKER_02]: That's the term we use, right?
[SPEAKER_02]: It's never like I think you've done well.
[SPEAKER_02]: You're good to go.
[SPEAKER_02]: It's never that.
[SPEAKER_02]: I will give them my opinion, your diabetes under better control, all of your numbers in the blood look better, your waste or conference coming down.
[SPEAKER_02]: Now, you tell me how you think you're going and it's coming together and that's sure decision making that we decide, you know, you're really doing well.
[SPEAKER_01]: Yes.
[SPEAKER_01]: Beyond the number on the scale, what would you?
[SPEAKER_01]: What could people measure?
[SPEAKER_01]: In addition to that, what else is success on a job?
[SPEAKER_02]: That's good.
[SPEAKER_02]: We always wanted to get people off this scale.
[SPEAKER_02]: Like it just doesn't anecdot.
[SPEAKER_02]: I can't think of a number of people.
[SPEAKER_02]: I will see to them.
[SPEAKER_02]: I usually bring them in a room first.
[SPEAKER_02]: I don't know when you're first, because I don't want that to color everything.
[SPEAKER_02]: How you do and how you're feeling, you're diet, you're active, and you start, then we'll go off to the scale.
[SPEAKER_02]: And they find out they didn't lose a much ways.
[SPEAKER_02]: They thought, all of a sudden, everything changes.
[SPEAKER_02]: I'm not doing as well as I thought.
[SPEAKER_02]: What do you mean we just had this conversation?
[SPEAKER_02]: So you do want to get off of the scale.
[SPEAKER_02]: But what would that look like?
[SPEAKER_02]: It's really function and feeling.
[SPEAKER_02]: Climbing of fly to stairs with less shirt and subreth.
[SPEAKER_02]: Going out dancing, feeling, feeling more comfortable in crowd.
[SPEAKER_02]: More intimacy with your partner.
[SPEAKER_02]: Putting on clothes that make you feel just good about yourself.
[SPEAKER_02]: Maybe giving a presentation in front of people, not feeling everyone's looking at you
[SPEAKER_02]: blood pressures down because you're measuring it at home.
[SPEAKER_02]: So all of these things off the scale.
[SPEAKER_02]: So I can't agree with you more.
[SPEAKER_02]: We want to get off of the scale and think about what really matters, which is feeling in function of how you're living your life.
[SPEAKER_01]: Yes.
[SPEAKER_01]: And if someone wanted to maximize the benefits of being on a gelp one, from day one, what habits would you encourage them to begin building immediately?
[SPEAKER_02]: Okay, kind of reinforcing, I think a little bit we're talking about healthy eating from day one, healthy eating patterns, and we talked about reducing grace and saturated fat, and an ultra-processed food and refined foods, and then eat the opposite fruits, vegetables, whole crates, and so forth, planning your meals in advance.
[SPEAKER_02]: So don't go without eating, because you're not hungry.
[SPEAKER_02]: No, which you're going to be doing in advance.
[SPEAKER_02]: And when you feel comfortable, starting to increase your physical activity and exercise, it usually comes in stages, by the way.
[SPEAKER_02]: At first, people don't feel that well.
[SPEAKER_02]: They have this whole legacy of, I don't want to go out.
[SPEAKER_02]: I get sure to breath at her.
[SPEAKER_02]: My knees hurt.
[SPEAKER_02]: It's not fun to be physically active.
[SPEAKER_02]: So I say, start wherever you want.
[SPEAKER_02]: I often encourage them to wear a pedometer or tractor steps on your smartphone, because sometimes you want to measure progress.
[SPEAKER_02]: objectively, action, addition of feeling and function.
[SPEAKER_02]: So once you start losing weight to go, you know, I got this.
[SPEAKER_02]: I actually can walk a few times around the block or walk at my dog or actually go to the gym or something.
[SPEAKER_02]: So start those habits very early, early, start cooking healthier or frequent restaurants a little bit differently.
[SPEAKER_02]: You know, if you're a meat eater, reduce that, start to experiment with cooking at home and preparing foods.
[SPEAKER_02]: So those are the types of things we talk about really from the beginning, but knowing people progress their diet and their activities, in stages and different from person to person, and that's where that personalized care comes in.
[SPEAKER_01]: Yeah, personalized.
[SPEAKER_01]: And there's so, there's so many places we could go.
[SPEAKER_01]: I want to talk a little bit about metabolic adaptation.
[SPEAKER_01]: I was hearing you.
[SPEAKER_01]: I know it's that's it's a very sophisticated term.
[SPEAKER_01]: You're probably going to have to explain it to us what that means.
[SPEAKER_01]: But it's, would you say that that's what people come again, come up against when they lose the weight that, could you explain what that is?
[SPEAKER_02]: Sure.
[SPEAKER_02]: So metabolic adaptation is the body's resistance
[SPEAKER_02]: So the body kind of resisted in the depths so that you continue to put your weight back on.
[SPEAKER_02]: That's what you're up against.
[SPEAKER_02]: So all the, before we know what this was, which is actually how started practicing at that time, the prevailing thought is that people didn't have enough willpower to keep their weight off.
[SPEAKER_02]: Like, you know, you took off the weight early on, why can't you keep it off?
[SPEAKER_02]: Lutin did we know that your body is conspiring against you to put your weight back on?
[SPEAKER_02]: And if you kind of think about it from a historical point of view, let's go back millennia, let's go back millennia with me.
[SPEAKER_02]: All right, is that, you know, when there were famine, when there were droughts and there weren't a lot, there wasn't a lot of food around.
[SPEAKER_02]: The way we were biology engineered is to survive famines.
[SPEAKER_02]: So, if food wasn't around, you would lose weight, but the body had this ability that one's food was available, we were going to go for it, put that weight back on, because it's not healthy to be underweight, and that's just back millennia.
[SPEAKER_02]: Wow, problem is we don't live in policing in this country with famines and droughts and starvation.
[SPEAKER_02]: So when your body is, you start, you're, you're, you're on decision to lose weight.
[SPEAKER_02]: The body stinks, oh, oh, it's a famine.
[SPEAKER_02]: You know, we, we got to resist this as much as possible.
[SPEAKER_02]: So it doesn't allow you to keep losing weight.
[SPEAKER_02]: It puts you back to where you were.
[SPEAKER_02]: And that's metabolic adaptation to put you back to where you were.
[SPEAKER_02]: is either biologically with medication.
[SPEAKER_02]: That's why medications work.
[SPEAKER_02]: It kind of kind of fights against that the body's conspiring against you, keeping away.
[SPEAKER_02]: And the other is bariatric surgery.
[SPEAKER_01]: Ah, okay, interesting.
[SPEAKER_02]: So these are two interventions that we know.
[SPEAKER_02]: We don't yet know how to deal with this metabolic adaptation by diet and physical activity alone.
[SPEAKER_02]: It doesn't seem to be a powerful enough approach to fight something biologically.
[SPEAKER_02]: And I wanted one more way to think about this, which I find patients find it helpful.
[SPEAKER_02]: And I'm going to use a comparator disease or condition that's diabetes.
[SPEAKER_02]: And if you had diabetes, and they would say, well, what medication should I take because I've been watching my diet and my sugar and so on and so on and so I, well, we have diabetes medications.
[SPEAKER_02]: Diabetes medication works biologically, brings the blood sugar down, hemoglobin A1C is normal.
[SPEAKER_02]: No prescribed would say, you know, a hemoglobin A1C is going to under control now, you can go off your medication.
[SPEAKER_02]: Nor would a patient say, well, wait a minute, it's the medication that brought it under control.
[SPEAKER_02]: If I go off my medication, well, my diabetes come back.
[SPEAKER_02]: and probably will.
[SPEAKER_02]: The obesity is the exact same thing.
[SPEAKER_02]: Yes, we can treat it, except instead of blood sugar, it's your body weight.
[SPEAKER_02]: We can bring your body weight down under control with medication.
[SPEAKER_02]: If you stop the medication, it's very likely your weight's gonna start going back up just like diabetes, hypertension, high cholesterol, same thing.
[SPEAKER_02]: Yeah.
[SPEAKER_02]: Body has set points if you will of where things are and it could be offset and medication brings it under control.
[SPEAKER_01]: I am curious.
[SPEAKER_01]: Are there studies that, or are you aware of some that are coming, that are testing, whether people can come off of these medications if they do the lifestyle interventions?
[SPEAKER_01]: For example, the diabetes.
[SPEAKER_01]: what you were talking about with insulin.
[SPEAKER_01]: If someone, it's my understanding that someone could, if they were willing and knowledgeable, they could eat a lower glycemic, lower carbohydrate diet, ketogenic even, and start to reverse their A1C from
[SPEAKER_01]: diabetic to normal or diabetic to normal.
[SPEAKER_01]: And without a met, a medication.
[SPEAKER_01]: So if someone was willing to eat like that long term, to strengthen, to do all the things we're about to talk about all the lifestyle and behavioral habit changes that are in your book,
[SPEAKER_01]: wouldn't it make sense that they be able to come off of these drugs and wouldn't that be something worth studying or not going to put on my tinfoil hat or are they're not going to be a lot of studies by pharmaceutical companies to teach people how to be less dependent on meds.
[SPEAKER_02]: Well, they, well, they are doing other studies.
[SPEAKER_02]: They aren't, you're already doing studies where if you go to an oral medication or reduce the dose, what happens?
[SPEAKER_02]: We have those medications.
[SPEAKER_02]: Those studies and they're not as, they're helpful, but people tend to regain weight.
[SPEAKER_02]: You bring up a perfect sample, and we kind of walk through that as best as I can.
[SPEAKER_02]: It is true if you have someone let's say with high blood pressure or diabetes,
[SPEAKER_02]: And you tell them if you lose some weight, you know, let's say, let's take high-pretentium, bring your salt down, eat more foods and vegetables, higher fiber foods and everything else.
[SPEAKER_02]: And you do all that.
[SPEAKER_02]: It's chances are blood pressure will go down, and you can go off your blood pressure medicine, and we all have patients like that.
[SPEAKER_02]: With obese, it differences, and you can make those changes with obesity.
[SPEAKER_02]: The problem is what any, and you can continue those eating habits,
[SPEAKER_02]: but what is hard to control is appetite.
[SPEAKER_02]: It's not a behavior.
[SPEAKER_02]: Epitite is biologic.
[SPEAKER_02]: I am hungry.
[SPEAKER_02]: I'm not as full.
[SPEAKER_02]: I have cravings.
[SPEAKER_02]: I have thoughts of food.
[SPEAKER_02]: Those are not behaviors.
[SPEAKER_02]: Those are from the inside.
[SPEAKER_02]: And you could take someone who has obesity's lost weight in a still eating a healthy diet in every way.
[SPEAKER_02]: But if they're hungry, they're going to need more of it.
[SPEAKER_02]: and if they have cravings, he can only fund cravings for so long before you choose that food to satisfy that craving, then you hit up the reward center and you have more of it.
[SPEAKER_02]: So you're trying to fight biology, not just continue a behavior, so that's what's a little bit different with hypertension or diabetes.
[SPEAKER_01]: I feel what you're saying.
[SPEAKER_01]: So you're saying that someone who truly has the disease of obesity and I,
[SPEAKER_01]: I realize that's a really large conversation about what is obesity, who has it, clinical, all the things, subclinical, you were talking really interesting things there, which that could be a whole podcast.
[SPEAKER_01]: But if someone, let me see if I can stay on this thought here, if someone, is it true that, okay, some people might have that food noise, that thinking about food, that craving more, and is that the biology of obesity,
[SPEAKER_01]: rather than someone who maybe was somewhat normal most of their lives up or down five ten fifteen pounds.
[SPEAKER_01]: They think about food sure if they eat a standard American type of the less sugar and they're spiking and they're craving more.
[SPEAKER_01]: But if they were to get into a healthier diet, less sugar, less cravings, they're not
[SPEAKER_01]: thinking about food the same way someone who has the disease of obesity has that well we're getting at.
[SPEAKER_02]: Yeah and that's a very important point number one it highlights that everyone has to own story to tell you know we can't we can't paint everyone with one brush that's very important.
[SPEAKER_02]: We know people, movie stars who put weight on for movie parts, right?
[SPEAKER_02]: Then they take it off and they're fine.
[SPEAKER_02]: Women who develop have pregnancy, right?
[SPEAKER_02]: Put on weight, take it off.
[SPEAKER_02]: So people go up and down.
[SPEAKER_02]: It doesn't mean they have to disease obesity.
[SPEAKER_02]: Life circumstances, either by choice or not, put weight on and took it off.
[SPEAKER_02]: Someone who has what we're describing that disease will be see where the gut hormones are not.
[SPEAKER_02]: The brain is not receiving those signals.
[SPEAKER_02]: Despite eating, they're still hungry, right?
[SPEAKER_02]: Despite eating, they still have cravings for more food.
[SPEAKER_02]: that is really the biology within their body.
[SPEAKER_02]: That's causing them to do it.
[SPEAKER_02]: How many people do you know that they've just finished breakfast and already think about where am I going to have lunch?
[SPEAKER_02]: Where am I going to have dinner?
[SPEAKER_02]: They start thinking out where am I going to be when I have dinner?
[SPEAKER_02]: That's really important to me.
[SPEAKER_02]: Not everybody thinks that way.
[SPEAKER_02]: all of us thoughts and emotions and in the rewards are what we think is what we call the disease of obesity or dysregulated appetite.
[SPEAKER_02]: That's what we call it.
[SPEAKER_02]: The only way to treat a dysregulated appetite that we know of now is through medication.
[SPEAKER_02]: So we're not talking about from a public health point of view, putting everyone in this country on the GOP1.
[SPEAKER_02]: That's not what we're talking about.
[SPEAKER_02]: People can weigh more, but can weigh more because of social circumstances, they work at night, the food available in their community, the community is not safe to walk all kinds of reasons.
[SPEAKER_02]: They may not have a disease of obesity or dysregulation.
[SPEAKER_02]: We're talking about the people come into a clinic, it's from my point of view, who said, I've been dealing with my weight for two decades now.
[SPEAKER_02]: I've tried to get my weight off more times
[SPEAKER_02]: it just keeps coming back and I'm a good soldier.
[SPEAKER_02]: I mean, I'm a good person.
[SPEAKER_02]: I'm responsible.
[SPEAKER_02]: I have a good job.
[SPEAKER_02]: I'm dependable.
[SPEAKER_02]: I take care of myself and I can't control my weight.
[SPEAKER_02]: That is an example of someone where medication can be very, very helpful.
[SPEAKER_01]: Yes, absolutely.
[SPEAKER_01]: Yeah, and you know, it's not a one-size-fits-all.
[SPEAKER_01]: It's so, the deeper you go into this, it's, there's so much to it.
[SPEAKER_01]: And let's talk about your amazing book, the six factors to fit weight loss that works for you.
[SPEAKER_01]: I'll have you describe it, because you can describe it better than me, but what I liked about it is you described six different types.
[SPEAKER_01]: Would you, are there phenotypes?
[SPEAKER_01]: uh, which is another fancy word, um, but and categories of people that you've seen and and what I love about you tell us.
[SPEAKER_02]: Okay, Ashina, how did you start?
[SPEAKER_01]: So so the you want the origin story, I think is why I love what I loved when I was reading it just like how thoughtful you were with like the way you studied it and the way you went about it, it's just I mean it's it's such a valuable resource.
[SPEAKER_02]: So I'm going to do this quick because it's on a podcast, but I've been in practice a long time and I'm seeing patients day after day after day and focusing on obesity care so it's the same kind of group and what I'm hearing is different stories everyone is different stories, but they fall into themes.
[SPEAKER_02]: And one thing would be, I've cravings for food.
[SPEAKER_02]: It's hard to turn food down.
[SPEAKER_02]: Even though I'm full, I still want to eat that food.
[SPEAKER_02]: I find it rewarding.
[SPEAKER_02]: So I got to a point where people in the end are six of these different themes that I came up with.
[SPEAKER_02]: So that I started seeing patients, they would start describing their history and I would finish their sons.
[SPEAKER_02]: because I know where this is going, because I've heard it before, but yes, that's me.
[SPEAKER_02]: So out of that, and I did research, and all that kind of stuff, I came up with six phenotype.
[SPEAKER_02]: So phenotype is a way of segmenting your population.
[SPEAKER_02]: So marketers do this.
[SPEAKER_02]: So I didn't even listen to who's a marketer and knows this.
[SPEAKER_02]: How do I segment my consumers, right?
[SPEAKER_02]: So I can market to them separately.
[SPEAKER_02]: You do that too as a podcast or probably, right?
[SPEAKER_02]: You segment your listeners.
[SPEAKER_02]: So phenotype is a fancy word to segmenting populations by different characteristics.
[SPEAKER_02]: So I came up with six and this was done through different research and perspective kind of work and I gave them Clopio names, so people would have to scratch your head and say, what are you talking about?
[SPEAKER_02]: So one is called easily a tie-steater.
[SPEAKER_02]: I just described that.
[SPEAKER_01]: Yes
[SPEAKER_02]: Another one is convenient diner, someone who eats most of their food either out of package or are a carton or out of an arrest rod, which is typically higher in calories, higher in meat fats, lower fruits and vegetables.
[SPEAKER_02]: Another one is exercise strong one, right?
[SPEAKER_02]: Someone that doesn't like or it like delicious.
[SPEAKER_02]: Another one which is one of the most common is called a fast pacer.
[SPEAKER_02]: So what would that sound like?
[SPEAKER_02]: You know, Doc, I, I, I, I, I'm a smart person.
[SPEAKER_02]: I, I know what to do, but I got so much going on in my life.
[SPEAKER_02]: Life is, life gets in the way, whether I'm a mom.
[SPEAKER_02]: I'm working full time.
[SPEAKER_02]: I got three kids at home.
[SPEAKER_02]: I don't have time for myself.
[SPEAKER_02]: So that's kind of a fast pace or, you know, type of a person self critic.
[SPEAKER_02]: Someone who's it is.
[SPEAKER_02]: you know, I just feel bad about myself.
[SPEAKER_02]: I'm embarrassed, you know, being a woman to see me in a clinic and she keeps her coat on, puts her purse on her lap and doesn't want to be kind of looked at and she self-conscious and it's getting away in a way ever happiness and so on.
[SPEAKER_02]: And the last one is all or nothing, all or nothing do
[SPEAKER_02]: I'm a perfectionist.
[SPEAKER_02]: I'm going to do it.
[SPEAKER_02]: If I'm going to do it, I'm going to do it 100%.
[SPEAKER_02]: It's kind of like, you belong to a PTA and you're going to do everything possible to volunteer, but when you don't do it, you do nothing.
[SPEAKER_02]: So it's all or nothing, kind of a person.
[SPEAKER_02]: So those six phenotypes actually captured a lot of people I see.
[SPEAKER_02]: So the way, just a financial story, the way I use this in practice is I have a patient fill out the questionnaire.
[SPEAKER_02]: And each of these six phenotypes, your segments have like three to five different items, you know, kind of like a liquor scale hot, do a career now to create.
[SPEAKER_02]: And it gives me and I get and I score it and they could score they could score themselves and you do that in a book and instantly you can see your own.
[SPEAKER_02]: behavior, your psychology, the way you think, and it gives me and them a starting point of where I want to focus on.
[SPEAKER_02]: So if they are, as an example, a convenient diner.
[SPEAKER_02]: How's OK?
[SPEAKER_02]: Let's work on strategies to make your eating out of the house healthier.
[SPEAKER_02]: or conversely help you prepare foods in your home healthier.
[SPEAKER_02]: If you're an exercise stronger, we're going to talk about how to start exercise routine.
[SPEAKER_02]: What kind of gear you need, how to do it safely.
[SPEAKER_02]: So give us a starting point with each individual and what caused them to gain weight in the first place from a behavioral point of view.
[SPEAKER_01]: love that and I could we just because it's so valuable and I feel like the women listening to this podcast what I love about it just they're going to hear themselves in one of these six types and when I was going through it I I was like oh maybe I'm a little bit of all of these like I think I got oh there's a reason why maybe I do this for a living I had a lot of problems of
[SPEAKER_02]: It's going to be either, and you can be multi-way way.
[SPEAKER_02]: It's not like, you know, pick your phenotype.
[SPEAKER_02]: Keep it as you can imagine.
[SPEAKER_02]: People are, you know, a little of everything.
[SPEAKER_02]: Well, the pick are the predominant phenotype, or the one that they want to work on immediately.
[SPEAKER_02]: That's how we do it in practice.
[SPEAKER_01]: Yeah, I can see how that and like maybe some standout is like those those are my strongest ones that can be worked on and maybe I identify with a little bit because I'm a human and maybe I've got to touch of all this.
[SPEAKER_01]: So so could we go through it one by one so people can maybe I know they're going to want to like take out a pen and paper and maybe even write down some of this if when they identify more one more than the other and maybe what they could do to change some of this.
[SPEAKER_01]: Um, so you mentioned the convenient diner and you told us a little bit about that.
[SPEAKER_01]: That's someone who, um, just likes package foods.
[SPEAKER_01]: They like their microwave.
[SPEAKER_01]: They like fast food restaurants.
[SPEAKER_01]: It's easy.
[SPEAKER_01]: Yeah.
[SPEAKER_01]: Modern.
[SPEAKER_01]: Yeah.
[SPEAKER_01]: And well, what's, that person's biggest challenges they're eating, it's, what's their, their biggest challenge?
[SPEAKER_02]: Biggest challenges is generally a fat and calorie laden.
[SPEAKER_02]: We don't use that word enough.
[SPEAKER_02]: I think laden.
[SPEAKER_01]: Yeah.
[SPEAKER_02]: Too high in calories and fat in general.
[SPEAKER_01]: Yes.
[SPEAKER_02]: So one of the things I tell them is, do you know how to read a food label?
[SPEAKER_02]: Do you know anything about your food?
[SPEAKER_02]: But example is, you know, Doc, I go to a salad bar every day.
[SPEAKER_02]: I eat healthy.
[SPEAKER_02]: I go, you know, do you ever look at the little panel up there, tell you how many calories are on that cell?
[SPEAKER_02]: Not really.
[SPEAKER_02]: Or when you make your own salad, you happen to know how many calories in the cheese, the olives, the salad dressing, the croutons you add.
[SPEAKER_02]: Not really.
[SPEAKER_02]: So I usually happen to a deep dive.
[SPEAKER_02]: Not not not not long time, but to a deep dive.
[SPEAKER_02]: 1200 calories in sales depending on what you in.
[SPEAKER_02]: So it begins with knowledge.
[SPEAKER_02]: Do you know what you are eating because you still need to bring your tonal calories down.
[SPEAKER_02]: And once you know that the next thing is understanding where the calories come from and how to do substitutions.
[SPEAKER_02]: So instead of going for a double cheeseburger, you know, with fries, maybe and so like a meat,
[SPEAKER_02]: regular hamburger, you know, with keroton to size as an example and stop dipping it in the, in the, you know, in the, in the sandwich, rushing and things like that.
[SPEAKER_02]: So that's where it often begins playing your meals out in advance.
[SPEAKER_02]: Also, what are your cooking skills?
[SPEAKER_02]: And what could you do food in the home?
[SPEAKER_02]: So that could take you in a different direction, as well.
[SPEAKER_01]: And if we were to layer a GLP one on top of it, let's say there can be a dire,
[SPEAKER_02]: So a GOP one would naturally bring, it would be two things in general.
[SPEAKER_02]: We already talked about how there's variety of responses.
[SPEAKER_02]: But in general, a GOP one would reduce how much of that food you can eat to the whole idea of ordering a double cheese.
[SPEAKER_02]: cheeseburger would be like, I just know way I can do it.
[SPEAKER_02]: I'm going to bring a lot of it home or better yet.
[SPEAKER_02]: I'm not going to order that anymore.
[SPEAKER_02]: So you would bring the total volume of food down for sure.
[SPEAKER_02]: They can't eat that much because they're appetites now.
[SPEAKER_02]: Number two, it would most often change the preference for that food.
[SPEAKER_02]: They may not want a greasy meal anymore because it's slow gastric emptying.
[SPEAKER_02]: That's how that works.
[SPEAKER_02]: And it makes them really feel full and can actually increase nausea.
[SPEAKER_02]: So it's like a double approach here how a GOP one can help that individual and I think it's going to drive them naturally to healthier foods but they may not know what to eat and that's what we're meeting with a dietitian reading the book or talking to your prescriber would help.
[SPEAKER_01]: Absolutely.
[SPEAKER_01]: Okay.
[SPEAKER_01]: And it also maybe works on the brain a little bit or because you were talking about it changes even what you're hungry for.
[SPEAKER_01]: So maybe part of wanting all this food is you've been craving all this like package fast food and maybe you stop it stops tasting is good.
[SPEAKER_02]: Yeah, well, you know, if I dip back into the information of what people are shopping for grocery sales or changing, we have that data now, fruits and vegetables are starting to go up, among geopen users, or geo people on users.
[SPEAKER_02]: So the sweet taste or just the reduction in fat, maybe it's the opposite of that is what's driving people to try more fruits and vegetables, because they're tolerated better and I think they'd like that sweet taste.
[SPEAKER_01]: Yeah.
[SPEAKER_01]: And I work with a lot of people that are, you know, successful people, they're on the go, they're busy, executives running around, planes, and this and that, and the fast paceer.
[SPEAKER_01]: How would you describe that?
[SPEAKER_01]: You described on it.
[SPEAKER_01]: How would they know if they have the fast paceer type that's getting in the way?
[SPEAKER_02]: Yeah, for that individual, I would ask them to keep a diary.
[SPEAKER_02]: So there is some work involved in these phenotypes as you can tell, because you need self-discovery.
[SPEAKER_02]: The only idea of the phenotype is I can guide you, based on your self-administered answers.
[SPEAKER_02]: what segment or phenotype you are.
[SPEAKER_02]: Now we need to kind of unbutton our shirt a few overall up our sleeves and really get better understanding of who you are in the visual.
[SPEAKER_02]: So I would ask them to keep a
[SPEAKER_02]: a diary of how they spend their time during the day.
[SPEAKER_02]: And from that they get start learning, well why do I have so many things going on?
[SPEAKER_02]: We're kind of relegate responsibility, we're kind of delegate responsibility, could I ask my kids to clear the table instead of me doing it every night?
[SPEAKER_02]: Could I ask my
[SPEAKER_02]: partner to help out a little bit more.
[SPEAKER_02]: If I'm at work, are there things that I could put on the back burner or take off my to-do list and carve out some more times?
[SPEAKER_02]: Number one is, where is my time being spent?
[SPEAKER_02]: Number two is, where do I need to spend more time?
[SPEAKER_02]: If I, if I know I need to get more physical activity, where can I get that in?
[SPEAKER_02]: Is it a morning walk by my self or with a friend?
[SPEAKER_02]: Can I take walking meetings with a lot of people do now?
[SPEAKER_02]: Right, either on the phone or in person, instead of just sitting in a room, conference room can actually do that, just called multitasking.
[SPEAKER_02]: So it's combination of where am I spending my time that I don't have time to do it and what do I want to spend more time doing?
[SPEAKER_02]: And it book gets into much more, you know, nuances about it.
[SPEAKER_02]: But fundamentally, you need to understand what is going on.
[SPEAKER_02]: You can't just say, I have no time.
[SPEAKER_02]: I have no time.
[SPEAKER_02]: You have to unpack that.
[SPEAKER_02]: Well, what is going on here?
[SPEAKER_02]: And ask for help, right?
[SPEAKER_02]: Ask for help to give you that time.
[SPEAKER_01]: Absolutely.
[SPEAKER_01]: And the GLP-1, how would that fit in?
[SPEAKER_01]: Would it just be that you they're on this new medical intervention and it's going to give them a new way of thinking about all of their life and they could do a time audit and a stress audit?
[SPEAKER_02]: Yeah, I think it comes in more on the second part of what I said and that is what is it that you are not doing that you need to carve out time for.
[SPEAKER_02]: So if the GOP one does the heavy lifting, we're going to be defined that term already to allow you to lose what without counting your calories, you are more likely to want to be more physically active.
[SPEAKER_02]: So if you want to be more physical active, where am I going to find the time to do it?
[SPEAKER_02]: So I think they go together, but it kind of more sets the stage of what do I want to do more up and then how do I then find the time to do it?
[SPEAKER_02]: Right, GOP 1 is nothing to do with being more physically active.
[SPEAKER_02]: It just allows you perhaps to do that.
[SPEAKER_01]: Yeah, and perhaps gives you a new directive to be physically active.
[SPEAKER_01]: You're being told, hopefully, being told, get out there and move your body and do some strength training to keep your muscle.
[SPEAKER_01]: So it might motivate you more to figure it out and.
[SPEAKER_01]: That makes sense.
[SPEAKER_01]: The easily enticed eater, I, it's such a nice way of saying it.
[SPEAKER_02]: You know, at the original, their original colloquial term is something like, I don't know, like, consistent crave or something like that.
[SPEAKER_00]: Yeah.
[SPEAKER_02]: Yeah.
[SPEAKER_02]: When we worked through that and got some feedback from people, and this is a very interesting teaching point for me as researcher, people don't want to be labeled.
[SPEAKER_02]: like who wants to be labeled, you know, it's kind of like you're a diabetic, you know, or something like that.
[SPEAKER_02]: In this case, they'd want to be labeled a consistent craving.
[SPEAKER_02]: So we came up with a term that had different, you know, not as obviously labeling.
[SPEAKER_02]: And we also used to term consistent craving tendencies, or convenient, dinosaur tendencies rather than labeling them that.
[SPEAKER_02]: So we learned that through our research and it makes sense.
[SPEAKER_02]: I mean, it's more humanistic, you know, to do it that way,
[SPEAKER_01]: Yeah, it's a great term and so does that that's someone who I when I meet with people they'll often self label.
[SPEAKER_01]: I'm a foodie Elizabeth.
[SPEAKER_01]: I'm a foodie.
[SPEAKER_01]: I just I love food.
[SPEAKER_01]: I can't how can I just eat protein and vegetables like ah, I would that be an easily enticed eater.
[SPEAKER_01]: They have a hard time pass down the pie.
[SPEAKER_02]: So do you see it?
[SPEAKER_02]: Do you see a tight cray for is the one?
[SPEAKER_02]: phenotype or pattern that is squashed and has the rapid, the most significant rapid improvement gel p1s.
[SPEAKER_02]: Because it's a, a, a, a, a, a, a, a, a, a, a, a, a, a, a, a, a, a, a, a, a, a, a, a, a, a, a, a, a, a, a, a, a, a, a, a, a, a, a, a, a, a, a, a, a, a, a, a, a, a, a, a, a, a, a, a, a, a, a, a, a, a, a, a, a, a, a, a, a, a, a, a, a, a, a, a, a, a, a, a, a, a, a, a, a, a, a, a, a, a, a, a, a, a, a, a, a
[SPEAKER_02]: It is very common patients will say, you know, for years it was hard to walk past, I guess some people walking, working more in the workplace than they do now, but I work past my secretary's desk or the food pantry and I just always grab food.
[SPEAKER_02]: I had such a habit that when you're thinking about it.
[SPEAKER_02]: Now they go, you know what, I'm not just thinking about it.
[SPEAKER_02]: It's not calling out my name.
[SPEAKER_02]: And even I could leave it on the counter at my home.
[SPEAKER_02]: And it's not calling out my name.
[SPEAKER_02]: I still would tell people, don't put it on the counter.
[SPEAKER_02]: Whether it's a geoport, a geoport, don't leave it on the counter.
[SPEAKER_02]: That doesn't make sense.
[SPEAKER_02]: Why be a tyse?
[SPEAKER_02]: But the GOP wants to reduce cravings and entice them in food.
[SPEAKER_02]: So when I see some wine and I repeat these scores by the way, like every three to six months, that's how you know progress.
[SPEAKER_02]: And we're talking about getting off the scale.
[SPEAKER_02]: This is another way to look at progress, because these phenotypes are improving.
[SPEAKER_02]: That is the one that improves the most rapidly.
[SPEAKER_02]: Okay, cravings are on a control.
[SPEAKER_02]: Enticement is on a control.
[SPEAKER_02]: And what that gets for a person is more
[SPEAKER_01]: Yeah, would you say that the easily enticed eater phenotype is someone who might be more on the egg, the more have addictive relationship with food so that the GLP one, the reason it calms it down so much is it's literally working on that part of the brain that makes them more addictive.
[SPEAKER_02]: Correct, it changes, you know, food addiction is kind of a funny area and there's a lot of debate whether it's really, you could be addicted to food, but I think we can both agree that the relationship with food changes when you're on a GOP one doesn't have the same reward value and for some people that can be a problem, by the way, if you want to turn the dark side, maybe a GOP ones, some people get so much joy.
[SPEAKER_02]: from the just sharing a bottle of wine with their partner or sharing a deserted table with another couple.
[SPEAKER_02]: And that's part of the ritual and it's part of their enjoyment.
[SPEAKER_02]: If that enjoyment is taken away and they can't tolerate it, they have really can't affect some people.
[SPEAKER_02]: And then if you have to displace that reward and enjoyment elsewhere, or, you know, kind of move on.
[SPEAKER_02]: I have some people that keep testing it.
[SPEAKER_02]: Like, I always share the half, you know, half a craft of lying with my partner.
[SPEAKER_02]: It's such an important relationship thing.
[SPEAKER_02]: I just push myself to have the ego feel well.
[SPEAKER_02]: But that person needs probably a little more help, you know, to really, really get a different way.
[SPEAKER_02]: But to answer your question directly.
[SPEAKER_02]: a foodie who has this relationship with food regarding reward at GOP wanted to likely to change that relationship and how they feel about eating that food.
[SPEAKER_01]: Yeah, it's so interesting.
[SPEAKER_01]: And I, I would love to talk more.
[SPEAKER_01]: It could be a whole podcast on food addiction, just or
[SPEAKER_01]: I don't know.
[SPEAKER_01]: People usually aren't addicted to chicken breasts and eggs and broccoli, but the sugar or the white flour and there's plenty of meetings, you know, 12 set meetings were a lot of people.
[SPEAKER_01]: I've researched this.
[SPEAKER_01]: Are sitting in the room talking about their favorite foods like they're talking about cocaine.
[SPEAKER_01]: And so it's interesting that a GLP-1 can really soften that, you're saying that's the first
[SPEAKER_02]: correct.
[SPEAKER_02]: And it has just extrapolated upon what we're saying and I mentioned this earlier is there a very interesting studies coming out now using it in heavy alcohol users.
[SPEAKER_02]: So it gets not food in this case, but it's a substance misuse which can be very dangerous to liver disease and our disease and so forth.
[SPEAKER_02]: And we don't have really good treatment for it.
[SPEAKER_02]: We use what's called cognitive behavioral therapy, right?
[SPEAKER_02]: Behavioral approaches and stimulus control and apps, like avoidance, avoidance, or of harm.
[SPEAKER_02]: And so forth, from a drug point of view, with the interviews and a few others that really are OK, GOP ones are actually showing premise in individuals of heavy alcohol use to reduce not only the days consumed, consume me alcohol, but the number of drinks as well.
[SPEAKER_02]: that can have a huge impact on someone as they had kind of an abuse.
[SPEAKER_02]: Food is different.
[SPEAKER_02]: You know, it certainly have other psychological implications as someone, but the one I'm really aware of our things like an alcohol smoking as well, all same parts of the brain.
[SPEAKER_01]: So interesting.
[SPEAKER_01]: So let's get in.
[SPEAKER_01]: We talked a little bit.
[SPEAKER_01]: So it sounds like the fast pacer and the exercise struggle or might be a little similar.
[SPEAKER_01]: How are those different?
[SPEAKER_01]: So the exercise struggle or it kind of makes sense that they struggle to exercise.
[SPEAKER_02]: They do.
[SPEAKER_02]: I mean, you could be both where you said they're right.
[SPEAKER_02]: You can bridge both, but you have say stronger, particular is someone where being physically active was never really an important part of their life for a variety of reasons.
[SPEAKER_02]: They can have physical disability.
[SPEAKER_02]: Let's say pain.
[SPEAKER_02]: They they they they grow up at high school and where school high school really never being an athlete or learning how to do weights.
[SPEAKER_02]: never gave them joy, never in situations that they're it be able to get more physically active either where they live or environment.
[SPEAKER_02]: So that would be an extra say, and they just don't enjoy it.
[SPEAKER_02]: However, it's an important part of health.
[SPEAKER_02]: So how do we get someone who really is uncomfortable doing it?
[SPEAKER_02]: Don't don't, is not have any joy.
[SPEAKER_02]: It doesn't know what to do, how do we move them forward?
[SPEAKER_02]: And it's where that's where story begins, right?
[SPEAKER_02]: If they don't know anything about it, we have to
[SPEAKER_02]: to educate them with different resources, maybe a personal trainer, give them guidance in the home.
[SPEAKER_02]: Go for Prisquax, you have a dog, it's a great way to take your overweight dog for a walk as well.
[SPEAKER_02]: Body up is really good, like the social, connectiveness and accountability helps.
[SPEAKER_02]: If you're gonna take, if you want to go for a walk and you don't do it, body up with a commitment neighbor.
[SPEAKER_02]: Now you have accountability to do it.
[SPEAKER_02]: That's where personal trainers come in because you're accountable, you're paying for the personal trainer if you get afforded.
[SPEAKER_02]: If someone is a risk of osteoporosis, we're going to talk about resistance straining, I'm going to read your brain and say, how does GOP one come into this whole thing?
[SPEAKER_02]: And there it comes in very important, because when you lose a large amount of body weight,
[SPEAKER_02]: you're going to be losing muscle as well.
[SPEAKER_02]: You can't avoid it.
[SPEAKER_02]: Anytime you lose a lot of body weight, regardless of the method, diet, bariatric surgery or medication, you're going to lose muscle mass as well.
[SPEAKER_02]: More fat mass, but also muscle mass.
[SPEAKER_02]: The only way to reduce the reduction in muscle mass, or preserve it, if you can, is through resistance training.
[SPEAKER_02]: That's strength training.
[SPEAKER_01]: Yeah, it's so important.
[SPEAKER_01]: And there's more, so I know people are taking notes.
[SPEAKER_01]: The self-critic, you know, I feel like so many women struggle with this, you know, just being hard on themselves, that just that, we call it that rent-free roommate in your head that just tells you terrible things about yourself, the lives of rent-free, it's a big problem on many levels.
[SPEAKER_01]: But how does that, how do you shift that if you know you have that?
[SPEAKER_02]: I mean, I mean, I'm going to introduce two new terms to you as well, this case.
[SPEAKER_02]: We haven't talked about them.
[SPEAKER_02]: In that state versus trait, I don't know how common people are, but a state is something that could be changed.
[SPEAKER_02]: So, for example, if someone is a convenient diner, I can change them to not be a convenient diner, so I've changed their state, so we can we can change that.
[SPEAKER_02]: A trait is something that's more innate, perhaps personality driven, you know, from long history of thinking that way, and that's where a self-critic is, because that's how you think about yourself, you know, it's always the negative, the always the butt, looking in the mirror, all I see is my body contouring away, I look at how can anyone look at me and so on.
[SPEAKER_02]: That is harder for a clinician,
[SPEAKER_02]: who's not trained in cognitive behavioral therapy or acceptance-based treatment or psychologists to help with depending on how deep seated it is.
[SPEAKER_02]: So part of it, Elizabeth, is identifying that and labeling it and giving it definition to the patient.
[SPEAKER_02]: and say it doesn't have to be this way.
[SPEAKER_02]: You do not have to look into Mary every time you think about your weight and your in your in which body part and how can I look at me.
[SPEAKER_02]: So there are some exercises that one can do.
[SPEAKER_02]: Biblio therapy could be helpful like give them a book to understand that.
[SPEAKER_02]: Another one is a cognitive restructuring.
[SPEAKER_02]: These are all behavioral techniques.
[SPEAKER_02]: where every time you think that I want you to pair with a positive thought, like I may not like the way my hips look, but I am a good person that I'm a good mother and if I get myself in a better control that my hips can also change.
[SPEAKER_02]: Just an example.
[SPEAKER_01]: Yeah.
[SPEAKER_02]: It's for
[SPEAKER_02]: There's some people we will refer them to a behavioral therapist because it goes beyond my skill set as an internist, no BC metonspecial.
[SPEAKER_02]: So part of it is identifying it and understanding how severe it is.
[SPEAKER_02]: Does it blend over or spill over and things like depression or anxiety or other psychological conditions?
[SPEAKER_02]: GOP-1, it is interesting, GOP-1's probably have changes in cognition as being looked at for dementia, actually, interestingly, it reduces inflammation, so it may have some effect on thought processes, or although I don't know about something that we have, um, um, body, um,
[SPEAKER_02]: disparagement and so forth, but certainly just by the success of a GOP-1 losing weight, they physically may feel more empowered, physically may look at themselves as more attractive.
[SPEAKER_02]: I have more agency because of that and may have an effect on their self-criticism, but a lot of folks I see really do need either help by further reading or sing somebody else.
[SPEAKER_01]: Absolutely, you know, bringing it, takes a whole team sometimes and awareness being the first step.
[SPEAKER_01]: If you realize you really got that, that there is a solution and it's a beautiful perfectionist.
[SPEAKER_01]: The all or nothing do or this is the last one of six, so many people are, I think, can identify that, a lot of successful people, tell us more about that.
[SPEAKER_01]: What are the all or nothing do or how does that show up?
[SPEAKER_02]: Yeah.
[SPEAKER_02]: So the first thing I asked them in a lot of that is through the question, each has items, you know, which defines these phenotype.
[SPEAKER_02]: So, but one of the first things I explore with them is, are you and all or nothing do or is that your personality has to trade?
[SPEAKER_02]: Is this your personality, like no matter what you do, whether it's a sports event, whether it's it work, whether you're volunteering for some, you know, none, you know, for a nonprofit organization,
[SPEAKER_02]: don't write because you're in.
[SPEAKER_02]: Or is it related only to your body weight or your behavior?
[SPEAKER_02]: Because it's different.
[SPEAKER_02]: Some people, though, I don't know why I've left this.
[SPEAKER_02]: Everything else I'm moderate and I understand that I use rational thinking.
[SPEAKER_02]: Both my weight, I either do it or I don't do it.
[SPEAKER_02]: Or people go, yeah, that's my personality, you know, you got me, I, I'm just an all-in-nothing and everything.
[SPEAKER_02]: It's called a weakened warrior type of thing, you know, you're in, you're in, you're not.
[SPEAKER_02]: It's that's the first thing I do.
[SPEAKER_02]: If it's a trait, meaning that's their personality, then I have to take a broader view of how to treat them.
[SPEAKER_02]: And you're really teaching them more about
[SPEAKER_02]: progress and there's there's gray and that everything is black and white.
[SPEAKER_02]: Slow down.
[SPEAKER_02]: Maybe track what you're doing, divide it up into into different steps rather than doing everything at once.
[SPEAKER_02]: With body weight again, I we challenge them that it isn't you had you're not going to lose 20 pounds in one week.
[SPEAKER_02]: you have to go through different steps and measure the success of each step, not just the goal when you get there, but it actually slow down and measure the benefits that you're saving along the way like changing of a belt or a dress size or picking up your step and walking faster.
[SPEAKER_02]: So they're starting to understand you don't have to go all the way before you actually see benefit.
[SPEAKER_02]: There's an old saying, like, California or bus driver, you're trying to the coast enough.
[SPEAKER_02]: Well, you're not seeing the country along the way, you know, when you say California or bus.
[SPEAKER_02]: So, so we tell them how to measure progress along the way.
[SPEAKER_02]: And if you don't get to the end, it's okay.
[SPEAKER_02]: This is what you've actually accomplished so far.
[SPEAKER_02]: 80% is okay and that lastly, we talk about 80% rule, right?
[SPEAKER_02]: So, you know, 80% is fine, not 100% and that's what you want to shoot for.
[SPEAKER_02]: You can always set up, you know, ambitious goals, right, or stretch goals.
[SPEAKER_02]: But if you're a 80% you're doing just fine, 80% of B, it's a B student and that's what I tell them to do.
[SPEAKER_02]: You can't be an A student and everything in your life.
[SPEAKER_02]: It's okay to be a beast doing when it comes to your body weight and if you get a B plus that's great But it doesn't have to be in A and everything that you do see so different ways and in the way I explain to those But the people is try to use terms that are familiar to them.
[SPEAKER_02]: So if they're a school teacher I use things like lesson plans and you know getting yourself prepared
[SPEAKER_02]: care before the next day because that's the world.
[SPEAKER_02]: You know, if I have someone to come to a pocket pen, you know, that kind of thing, I'll talk about, you know, measuring your weight and tracking your diet and tracking your steps because they're analytical.
[SPEAKER_02]: You know, they like they like to measure things.
[SPEAKER_02]: So, always try to match their world with how I'm talking to them.
[SPEAKER_01]: Yeah, that's so powerful.
[SPEAKER_00]: It's a good way to do it.
[SPEAKER_00]: Yeah.
[SPEAKER_01]: Yes, okay.
[SPEAKER_01]: I could literally talk to you all day.
[SPEAKER_01]: So I'm going to I'm looking at the time and I know you're a busy doctor.
[SPEAKER_01]: So I'm let's see.
[SPEAKER_01]: Let's see closing closing questions here.
[SPEAKER_01]: I'm looking ahead.
[SPEAKER_01]: The future of GLP wants.
[SPEAKER_01]: If we zoom out and look toward the future.
[SPEAKER_01]: Where do you see obesity medicine heading over the next five to 10 years?
[SPEAKER_02]: Yeah, so we are at the end of the beginning.
[SPEAKER_02]: That's the way I look at it.
[SPEAKER_02]: You know at the end of the beginning of the story.
[SPEAKER_02]: So if you think you saw a lot, you haven't seen anything yet, that whole thing like wait for it, you know.
[SPEAKER_02]: And we are on the verge of having dozens of medications to choose from.
[SPEAKER_02]: We already have oral medications in addition to the weekly injection.
[SPEAKER_02]: So they have to huge advantage.
[SPEAKER_01]: in addition, so the weekly injecting and in oral.
[SPEAKER_02]: Right, so we have two oral medications right now that are after the approved, in addition to the weekly injection, but we're we're we're we're going over the next five years is harnessing more of these gun hormones that we've mentioned at the beginning of the show.
[SPEAKER_02]: So right now it's mostly GOP one we talked about that to accept a tied another drug on a market is a combination of GOP one
[SPEAKER_02]: we are now starting to explore and harness the effects of two more.
[SPEAKER_02]: It's like a treasure drove down there in our gut.
[SPEAKER_02]: The other two you're going to looking for and it's going to be new names that people are going to learn about is amolin produced in the pancreas and glucogon also produced in the pancreas.
[SPEAKER_02]: These are all natural occurring hormones that all are also affected
[SPEAKER_02]: So pharmaceutical companies are now starting to mix and match single agents, double agents, triple agents, combination agents, single molecules, all this stuff.
[SPEAKER_02]: So that's one thing because not one treatment is going to treat all patients, right?
[SPEAKER_02]: We don't, you know, not one size fits all.
[SPEAKER_02]: Same thing with drugs.
[SPEAKER_02]: The other is that we are going to slightly see, not just
[SPEAKER_02]: Daily pills or weekly injections, we're probably going to buy weekly injections, monthly injections, perhaps even less frequently than that.
[SPEAKER_02]: So because when they learn to have these medications last longer, you could reduce the frequency of administration.
[SPEAKER_02]: So any of your listeners who were on a pill for osteoporosis, they often will take an injection every three months or a pill once a month that's kind of common for osteoporosis.
[SPEAKER_02]: That's probably where obesity is going as well.
[SPEAKER_02]: So it's going to be almost in the background.
[SPEAKER_02]: when people are taking a medication for obesity, which allows more time to take care of yourself, I hope.
[SPEAKER_02]: So those are the things that we're really looking forward to over the next five to 10 years.
[SPEAKER_01]: So great and with more time to take care of yourself more time to go all in on what we talked about today with with these different phenotypes and where they see themselves in this and how to go about and and and change some of those long standing habits patterns lifestyle.
[SPEAKER_02]: and they can go and I'm going to get this and you may have wanted to do it yourself.
[SPEAKER_02]: Dr. Robert Christianer.com.
[SPEAKER_02]: I want to say, so Dr. is DR Robert Christianer.com.
[SPEAKER_02]: And it's where that book is located.
[SPEAKER_02]: We also have blogs, newsletters, a lot of the stuff that I'm saying and you quoted some of those things.
[SPEAKER_02]: They're all in blogs and newsletters.
[SPEAKER_02]: You can get from Dr. Robert Christianer.com.
[SPEAKER_01]: Thank you for sharing that and we'll put that in the show notes so people can click through and see all of your wonderful information.
[SPEAKER_01]: What are you most excited about in the next 18 months, personally, or professionally?
[SPEAKER_01]: What's on the horizon for you?
[SPEAKER_02]: Um, I do a lot of education and being on your podcast side in my world is kind of really also education and I'm looking forward to really talking to more groups, stakeholders individuals who are involved in your BC space.
[SPEAKER_02]: To really get more people involved in obesity care.
[SPEAKER_02]: And often, of course, the start with consumers, which you're reaching, to go into their healthcare professional and and say, I want to have this conversation about my weight, how can you help me or where can you refer me to?
[SPEAKER_02]: But also, on the other end, is I do a lot of education to the healthcare professionals.
[SPEAKER_02]: they have to be part of the solution, they have to be right out there proactively and a passionate and empathetic way, have this conversation that's not stigmatizing and judgment-free to help people manage their weight because we have a lot of treatments available now.
[SPEAKER_01]: Yeah, beautiful.
[SPEAKER_01]: Thank you so much, really.
[SPEAKER_01]: It's really- I enjoyed this.
[SPEAKER_01]: Yeah.
[SPEAKER_01]: Thank you.
[SPEAKER_01]: It's going to help so many people and I really just want to applaud just the work that you do.
[SPEAKER_01]: It's so clear that you really know people and understand how they're wired and how to work with them and help them.
[SPEAKER_01]: I can really feel that and really grateful to all the work you do in the world.
[SPEAKER_02]: Thank you for inviting me.
[SPEAKER_00]: Cause now I can do it like this