Conquer Your Weight

Dr. Sarah Stombaugh: Before we get into the episode, I am thrilled to announce we are launching an online course, The GLP Guide. The GLP Guide is a must have resource for patients who have been prescribed any of the GLP medications such as Wegovy, Ozempic, semaglutide, Zepbound, Mounjaro, tirzepatide, Saxenda, liraglutide. There are a lot of them, and this course is available for anyone to purchase. We often hear from people who haven't been given much information about their GLP medications. No one has told them how to handle side effects, what nutrition recommendations they should follow, or what to expect in the longterm. And it can be really intimidating and simply frustrating to feel like you're alone in your weight loss journey. With The GLP Guide, you'll get access to all of the answers to the most common questions for patients using GLP medications, not sure how to use your pen, struggling with nausea, wondering how to travel with your medications. We've got you covered for only $97 for one year access. This is an opportunity you do not want to miss. The course is launching on October 1st. For more information and sign up, please visit www.sarahstombaughmd.com/glp. You don't have to be on this journey alone. We are here to guide you. And now for today's episode, this is Dr. Sarah Stombaugh and you are listening to the Conquer Your Weight podcast. Announcer: Welcome to the Conquer Your Weight podcast, where you will learn to understand your mind and body so you can achieve long-term weight loss. Here's your host, obesity medicine physician and life coach, Dr. Sarah Stombaugh. Dr. Sarah Stombaugh: Hello everyone and welcome to today's episode. I have a guest with me that I am very excited about. I have Jessica Reed joining us. She is a registered dietician and in private practice she is the founder of Balance Health where she supports patients in achieving their health and weight goals. She has a lot of practice in this and I'm so excited because she loves working with patients in the medical weight loss space. And we've got so many questions that we're going to dive in. Jessica, thank you so much for joining us today. Jessica Reed: Thank you for having me. I'm excited to be here. Dr. Sarah Stombaugh: Yeah, tell me a little bit more about yourself and how did you come to be a registered dietician and here in your own practice? Jessica Reed: Oh, wow. Yes, that's a long journey. Dr. Sarah Stombaugh: [Laughs] Tell me your whole life. Jessica Reed: And it's interesting to kind of think back to our path to where we are at this moment, but honestly, I didn't know there was such a career as a registered dietician until I was in college. I actually started out as a geology major, so I've always had, yes, I've always loved science, and while I was there I took a nutrition class and that's when I found out that this could be a career and pursued that further and started out strongly in the clinical space as most dieticians do. And I've just always loved working with people. One-on-one and more a counseling type coaching situation, which can be challenging to find when you're in the larger healthcare systems. There's not many positions for that. So I always knew that I would probably have to step out into private practice to pursue it as a full-time space with the most flexibility to work with people. Eventually I found myself in medical weight loss and there's been many things that have led me there. Growing up, my father actually struggled with obesity and he had gastric bypass surgery back when it was an open procedure. And so I always feel like that's had an impact on me from a young age as far as just understanding the disease of obesity and just wanting to be involved in this space. And I found just through my time in practice, I eventually made my way into bariatric surgery and medical weight loss and then from there ended up going into private practice that I could better support especially medical weight loss physicians who are in need of more help in their practice. Dr. Sarah Stombaugh: Absolutely. And I love, as a physician who is in a space, I have ended up doing a lot of practicing with my own clinic. When I think back to, I was in family medicine before I went into private practice, and it can be really frustrating because there's so many nutrition recommendations out there and depending on, even as a registered dietician, there's sort of areas of expertise. There's people who counsel on diabetes or in medical or in surgical weight loss or in other spaces like in allergies and intolerances like celiac disease. And so you've really developed this area where you help people support through their weight journey. So with that, tell me a little bit about when you've got a patient in front of you and they're asking, what is the best diet to lose weight? What are some of the things that you're starting in a very introductory visit and sharing some of that information with your patients? Jessica Reed: So really the best diet for weight loss is the one that you can continue sustainability. That's where we start from the very beginning, from the very first visit we discuss approach and why it's important to make sure that whatever we're building together, it's sustainable And helping just to identify what are the red flags look out for that this may not be going in that direction. So our very first discussion is just discussing the difference between a diet approach and more of a diet mentality versus a lifestyle approach, which is the way of life. And the markers for that would be it's got to be flexible, it has to be adaptable, it's something you should feel you can apply in any situation, whether you are under a lot of stress and you're feeling a bit overwhelmed or you're in a time of celebration or vacation wherever you are. It's a way of life. It's something that you enjoy and you can utilize wherever. So those are some of the pieces behind it. Dr. Sarah Stombaugh: I love that I share that similar advice with patients in terms of we hear, oh, we should do high protein, you should do keto, you should do Mediterranean. And we sometimes get really attached to these labels in our nutrition or dietary plans. And the reality is there are so many people who have, they kind of find the one that finally clicks. And a lot of times I think it clicks because they finally found one that fit their life, it fit their preferences, it fit their schedule. And so we become really big advocates maybe for a certain plan, but the reality is it will be so individualized for a person. I love that. So tell me, so imagine for a lot of people there's a really big mindset shift when you're thinking about the diet mentality and moving into that lifestyle piece. How do you help people to create that mindset thinking about food, health, weight, all of it. Jessica Reed: One, it's to really start with recognizing that mindset and overall wellbeing are always the target. And so sometimes it's even just getting clear on how you would define health. And health is really a state of being, and there's so many things that impact that. And so a lot of times, if you think about it, the way I teach it to my clients is using a domino effect analogy. So you think about the outer dominoes, which is the day-to-day rhythms of things. So how your eating patterns are looking movement, how the different things that you're building in sleep patterns, all of those habits that we tend to put the most attention on when we're in this space. But the problem is is that those are the last dominoes, right? Those are the ones to be knocked over. And what we want to start looking is upstream and getting to the beginnings of what's leading to those different habits and things in place. So making that connection, that overall wellbeing, the internal atmosphere. I mean, we will start to notice too that there is quite of an impact just by diet culture in itself because there's a lot of weight stigma that's in that space. And so a lot of people that I work with have found themselves in a state of constant tension where they're either very on track, they're on track, it can be quite restrictive, they're having to cut things out, they're having to track everything they eat, they're having to really go all in, or they start to get to the place of burnout, or they start to realize they can't sustain that type of energy and attention towards it. And at some point they're like, I'll start again tomorrow. I'll reevaluate this at some point. And so it's this constant state of tension. And so we start there, we talk about there's a different way, how do you relieve that tension? Because if your strategy for nutrition stress management, if it's creating more overwhelm and it's leading you to feel more burnt out, then you're not actually improving your health in the end, Dr. Sarah Stombaugh: Right? Yeah. Oh, absolutely. I'd love to hear maybe even an example of maybe how that plays out commonly or maybe a patient example that you hear frequently, Jessica Reed: Right? Well, oh, there's so many that kind of come to mind. I guess I'll stick to more of a general way of thinking about it. So that statement I made that health is a state of being, and you can kind of do these internal scans of how am I, do I feel grounded? Do I feel content? Do I feel like I am at peace with my current state of things, or do I feel like I'm literally holding on for dear life and just trying to survive? And the thing is, that takes a lot of energy. And so whenever you're trying to focus on change or doing something new like a new habit around eating or movement, it's going to require energy. It's going to require some sort of focus and attention. And if you're already just tapped out and there's not much left, then it's going to feel like an uphill battle. There's going to be quite a bit of resistance that you may run into. And so that's kind of that way I explained getting further upstream. And instead if we start to focus on why are you feeling burnt out? Why are you feeling overwhelmed? How can we start creating space for this? And my clients start to feel real relief and things become a lot more approachable. So I guess it's more of a broad way of explaining it, but it could be moms come to mind. So it could be the mom with young children who's working full-time, whose husband is on deployment. And so they really are the sole caregiver. They're not around family because of where they live. So they have very little support and literally just from the time they wake up to the time they go to bed, their full focus is on everybody else and trying to make it through the day. And so that's the type of client that I would say, let's start with making some room for this. And really just considering how we can't change your circumstances. There's things that are out of our control, but we can create room for help within it. And that's what we do together. Dr. Sarah Stombaugh: Well, and I love, thank you for sharing that example, because I think so often we enter in a society, there is this diet culture where people will say, go do this six week plan, go do this 12 week plan. There's meal plans, or they're like, you have to eat this food, this food and this food. And so for anybody, but especially if we think about the mom who's totally busy and she's cooking one meal for her children and she's simply cooking a separate meal for herself and she's got no support at home, the idea of let me also go to the grocery store and buy totally new foods and foods that my children hate, she might suffer through that for a week or so because she's like, this is what I have to do to get healthy. But it feels so much worse. It feels so much more challenging, and that's absolutely not creating sustainability in her life. And so yeah, I love that health piece of being more than just what is the weight on the scale? And it's fun because a lot of times we see that as we're thinking about health, there are all these other pieces where our weight ends up being really the end result of so many other changes in our lives. And it's really oftentimes not even about, of course it's about the food, but it's not really about the food. It's about why we eat the food and how we eat the food and are we being mindful and are we enjoying it? Is it fueling our body? All of these other things are so, so much important than a specific food item being demonized from the diet, for example. Jessica Reed: Yes, it's so true. And just you're landing on the complexity of it, the complexity of metabolic health because we know that, the way I explain it to my clients is that it's like a stool with legs. There's different pillars, there's different areas, and stress is a big one. And mental health, emotional wellbeing, it's not benign. It has a physical impact. And so it absolutely impacts how your body is able to metabolize food resistance. And so if you ignore a complete leg of that stool and you're just working so hard at nutrition and fitness and you feel like your body is working against you, well, there could be a reason why this matters that you feel that way. And so that's why in my space we do a total health approach. And then even just in the realm of nutrition, the complexity of the social aspect of food traditions have people I work with that struggle with texture aversions and just severe aversions around food. And then you get into our specialty where some people may be on medical management to help support them, which is a wonderful tool, but now they're trying to navigate that they have very little taste for things that they have a very poor appetite, that their meal volume has significantly decreased. And so there's a fluidity to nutrition, and that's where that word adaptable to learn to be present and to take notice of the needs of the moment and to know how to make decisions based on those needs, not necessarily a prescribed diet plan that has no flexibility and may not even be relevant to those needs. So that's what we do together is helping to empower my clients to take on that autonomy with their nutrition over time. Dr. Sarah Stombaugh: I love that. And tell me, I know one of the things you do is support patients in really building their plates, building their nutrition plan. Share a little bit with me as you're teaching a patient to get this autonomy and feel empowered to build his or own or own plate or nutrition plan. What does that look like? How do you teach that? Jessica Reed: I use a more visual approach, and we put the focus on the food itself. So most people I work with have a long history of dieting. They've done every diet under the sun, and I would say that they're pros often at tracking calories or macros or they've been down that road and where there's some value for that for a time in the long haul, it'll dry up. And so we start to put the focus on the food itself and food groups and just really understanding how they impact metabolism, how to build meals in a way that is flexible but still meets your needs. So that's how I would describe it. It's more of that plate visual food group approach. Dr. Sarah Stombaugh: Absolutely. And if someone had a plate in front of them, how would you break down? There may be different options, but what are sort of standard recommendations of fill this with protein versus vegetables? How do you teach some of that? Jessica Reed: I use a food guide portion list, and that's based on food groups and just teaching the portion per food group to aim for. And then just like you said, there isn't one way to build a plate. There's three different ways that I potentially show it, and it depends on the needs in the moment, but you always start with protein first. That's where we start. Make sure that you have a protein on your plate, mostly veggies. So we talk about the difference of non-starchy veggies versus more of your high fiber carbs, the quality of carb, and then how to know the portion to aim for. But what's nice about that too is just teaching the thoughts behind it for that flexibility. So for example, I'll say, look, if you have zero appetite and you never want to be forcing yourself to eat, and so if you have to, protein comes before anything else and make sure that you're hitting that minimum protein goal in your meal. And that's to avoid malnutrition, right? Because although you need a slight calorie deficit for weight loss, you don't want to be protein malnourished. There's a lot of risk in that. And so hitting that protein goal is most important, especially when you are restricted on how much you can eat. Dr. Sarah Stombaugh: Absolutely. And talk to me a little bit about how you explain the role of protein because especially in the weight loss space, especially in bariatric surgery, but now we're seeing it in the medical weight loss space too, where weight loss is often pretty rapid and that protein goal part becomes even more important that we're cognizant of that. So how do you explain some of that to your patients? Jessica Reed: So specific to that need, that type of patient that's having more rapid weight loss, basically I teach them about body recomposition rather than just losing mass. So it's important when you start on this journey to understand that not all weight loss is the same, and not all weight loss is necessarily going to improve metabolic health. So when you start from step one of always building a sustainable approach, that means making sure that you're losing the right type of mass because our goal is to lose adipose tissue, fat mass and decreased body fat percentage. And what we don't want to lose is muscle. And so ways to make sure that that doesn't happen is one, make sure you're hitting your minimum protein needs. And then also strength training is important as well to support muscle retention and maybe even growth. It is possible to lose fat and build muscle at the same time you can do that. And so when you know how to track body composition estimates, and a big part of my time with my clients is teaching that part so they know what they're watching and what they're looking out for. I will tell you this, it's a lot easier to keep muscle on than to build it back. Putting muscle on is slow. It is a slow process. We're talking five pounds in a year maybe of muscle that you could work towards with consistent strength training, programming and adequate nutrition. It can be a really slow process. And so it's, again, we always want to be on the side of prevention and make sure that we're not wasting muscle in the process. Dr. Sarah Stombaugh: Well, and I love that you said it because I am a huge advocate for let's make sure that we are losing the right kind of mask and we want to lose weight. Everybody says that, but no one means that what they want is to lose that fat mass is their adipose tissue. And whenever I say that to someone, everybody agrees, right? No one disagrees with that statement. And there are things that we have to be really, really intentional about to make sure that we also support ourselves in those goals because it's not magic. It doesn't just happen. We can't will it to happen. The way that we are able to lose preferentially our fat mass and support our muscle mass as much as possible is really by emphasizing protein and resistance training. I love that. And tell me, when you think about the roles of some of these other foods as you them to patients thinking about our really high quality carbohydrates and vegetables, how do you explain the role that those play in a diet? Jessica Reed: So every food group has a purpose. And so they're all important. They all have a role to play, and it's really about finding balance with them and to meet the needs of the moment. And so when it comes to carbohydrates or fiber comes to mind, we know that fiber comes from plants and fiber primarily comes from foods that also provide quite a bit of carbohydrate. And so there is a bit of a balance, and it's depending on where your calorie needs are because you have to make space for it is how I kind of teach everybody that if your protein is primarily coming from animal-based sources, right? You're primarily using meats to meet that protein goal. It's not just protein that's coming in that package. There's protein in fats, and so there's a decent caloric value. You're going to get a lot of protein and a decent calorie load in a small package. That's what we love about meat is that a little bit goes a long way back when I worked in bariatric surgery where intake is severely restricted at the beginning of rehabbing the stomach and healing once they get into solid foods. I mean, not having meat would be very hard to get the protein that they need, how efficient it is. But fiber comes from plants. There is no fiber in meat. And so essentially when you are working within a certain calorie restriction, if you will, to support fat loss, then you do have to honor that and be mindful of it and make space for it. So this is where including some plant-based meals can be really helpful because those foods can provide protein and fiber all packaged together and essentially you're making space for it because that part of the plate that would've been a decent amount of calories from the meat has just been opened up. And so you're able to stay within your calorie goal, but include fiber at the same time. So really when you see nutrition, I often find people struggle with this idea of fluidity. They feel like they have to identify with a certain camp like I am vegan, I am full vegetarian, I am, whatever it may be. And for some that's where they end up for certain reasons, which is good. You should go the direction that you feel is best for you, but you don't have to necessarily completely get rid of it. And so having a combined diet where you know how to build plant-based meals that have adequate protein and learning that piece of it, I encourage as well, because I'd say most people transitioning out of the standard American diet struggle with plant-based meals. It's completely foreign. It's not something that we are used to. And so there's a bit of a learning curve. And so all of that to say is that if you're looking at your number counts and your fiber is very low, but you're hitting your calorie and protein goals, that makes sense. That's the reason why you're seeing that. And so I hope that's helpful just to kind of give an idea of why that can be difficult at times. How do you achieve both? How do you hit a protein and a fiber goal at the same time? Well, you're going to have to learn to expand your options. Dr. Sarah Stombaugh: Absolutely. Well, and I think one of the fun things about fiber is that especially when you talk about the non-starchy vegetables with a lot of leafy greens and things that are very low in calories, but high in fiber, we can start to create these plates that are sometimes humongous. You can have these big loaded plates full of lots of vegetables and grains in their whole form and legumes and that type of thing. And sometimes in the weight loss journey, it can feel really sad to look at a plate and be like, I have this teeny tiny portion of food. And when we're talking about meats and really fats, things that are really calorically dense, the portion size can sometimes be really literally to the eyeball. It is a small portion of food. And so the fun thing about a plant-based meal is you can get this gigantic plate just filled to the brim with all these calorie, or not calorie, but fiber rich vegetables that are not dense in calories. And so if you're missing eating large volumes, which may not be appropriate for the bariatric surgery patient or someone who is on medications where they feel like they have a really restricted appetite, but that day where you're like, I just let somebody fill me up, those plant-based meals can really fill you up. Jessica Reed: Absolutely. And that's a big part of what I teach as well is that that flexibility that you're building is you can build quite a small meal or you could build quite a large meal. And so breaking down this idea that in order to lose weight, your meal volume has to be really small, that's not true. You absolutely could eat, and especially if you're a volume eater, you absolutely could have a large plate and still be within your calorie deficit, and you do it through those non-starchy veggies specifically. That's how you bulk up that type of meal. And so I love that you mentioned that because it's important to know how to do both because we're not stagnant people. Our needs change, our appetites change. And so knowing how to go along with that really matters for sustainability. Dr. Sarah Stombaugh: Absolutely. So tell me, as you're thinking about sustainability, a big piece of this is when we step away from the black and white thinking of, I had a single dessert. I'll try to get better tomorrow, I'll start to get on Monday. How do you help people to build in foods that would typically be off limits in a traditional diet plan? But when we're thinking about a lifestyle and you're thinking about a birthday or a special occasion, how do you help people to build those foods into their diet? Jessica Reed: Yes, this matters so much. So it's really about the mindfulness that you create around it, which is we want to be just as mindful with treats as we are with planning out a balanced dinner and meal planning that aspect. So it's creating mindfulness around all foods and helping to really find a food neutral stance and instead understanding the role of that food, how your body is going to respond to it, and the portion and how to eat it in a way that your body will respond well to. So this is where even the concept of moderation can be skewed by diet culture. And when I say mindfulness around food, it means that you never want to find yourself eating something at the expense of yourself, at the detriment of your health. And self-care is really where you start to meet yourself in that space and know, yes, there are foods that I can include in the recommended amount for that type of food. It's going to be a smaller portion, right? It's going to have a certain impact. I don't want to eat it by itself right before bed. I want to be mindful in that I'm choosing a treat to go alongside of a meal. It's preloaded the protein, fat and fiber. And so some of these concepts that I teach is awareness without judgment, because awareness is key. Mindfulness is based on that. Being able to have that awareness is step one. But whenever judgment is attached, we lose all benefits. That's the first part. And when you're building that food neutral approach, we as humans have vulnerabilities. And so this is something that has to be done on an individual basis and specific to your need. And so if you identify foods that you're like, yes, if this is in the house, I'm going to have a tendency to keep going back for it or I'm going to overeat it. I don't feel I can stay within the recommended amount for this food. Nonjudgmental means that's okay, and that's a vulnerability, and it's okay to be vulnerable. And instead just meet yourself in that space and say, okay, this is a food that is not benefiting me right now, and so I'm not going to keep it readily available, but this is a treat. This is an option I can include in that way. And so I'm going to make sure that that's the one that I'm have around when the time comes. So we all have those types of things, and it's really about maybe even having someone walk you through that process, but that is self-care. Sometimes we do have to set boundaries around certain things, but always remember that it's a boundary for now. It may not be a forever thing. There may be a time where you can be around that food and not struggle with it. And so that's how I walk people through that process is more of a presence with it. Dr. Sarah Stombaugh: I love, especially that last part that you mentioned in terms of having that grace, having that understanding. And I think to normalize it, it is very normal human psychology is that when we have, there are certain foods that we crave and that they're going to be there. And I think we sometimes talk about maybe there's this nirvana where we could sit. For me, it's Oreos that there could be, you could sit with just a package of Oreos and you could just be at peace with a package of Oreos. And maybe that's possible and that's wonderful. And also, I don't need to torture myself by bringing Oreos into my house. I know that if there's Oreos in my house, I've set myself up for this situation where I'm like, they're calling to me from the pantry and why do I need to do that to myself? That's not even helpful. Jessica Reed: The amount of energy, mental energy that it's taking to fight that tension on a regular basis is draining. And I love how we can name it, right? Mine is lime flavored tortilla chips. I don't know why, but lime flavored tortilla tortilla chip are just trouble. So it's one of those things where I don't purchase those or keep them in the house because I'll find myself eating them. And especially when I'm hungry, especially when I step into the kitchen and I'm trying to figure out dinner for the family and my head is still swirling from my work from the day and I am hungry, then those are moments where it becomes even harder when that type of thing is right there. So it, it's normalizing it that this is a very human thing and knowing how to create a space that is supportive of you and encouraging of your needs so that you can start relieving some of that tension Dr. Sarah Stombaugh: To be able to, as you said at the beginning, to really mindfully enjoy those foods. Because eating it doesn't, Oreos doesn't actually feel good 10 minutes later. I don't feel good and pleased with myself about that, but the experience of mindfully really enjoying a dessert that is lovely and it's an appropriate portion size and it was planned for in advance feels very good. And there doesn't have to be that judgment and negativity that comes up after the fact when it's been a very intentional and mindful decision. Jessica Reed: That's right. Dr. Sarah Stombaugh: I love that. So let me ask you, as we're wrapping up our interview here, are there any other things that you really think are important for my audience to hear about? Jessica Reed: I'd say just to consider that domino analogy, and if that's something that you've made into a practice of your own health journey. When I'm working with my clients, these are metrics that we identify and track. When you think about metrics, a lot of times we think about the scale or body composition estimates or how much protein I journaled for the day, or how much water I drank. But we rate, on a scale of one to 10, how would you rate is different than self-esteem? Okay, so you might even have to look up the difference. It's the ability to show warmth and kindness towards yourself even when you're not happy with how something may be going. And so we rate these things, how would you rate peacefulness, contentment, joy, those kind of things. And if that's never been a part of your conversation on your health journey, then I would challenge that because against health is a state of being. If you look at the World Health Organization definition, it's not just the absence of disease. And so just considering that part of you and make sure it's a part of your conversation, Dr. Sarah Stombaugh: I love that. And it's not just about the number, it's not just about our weight, it's about our overall health, which is so, so much more all encompassing. Beautiful. And tell me if my listeners are interested in learning more about you, interested in working with you, where can they find you and learn how to work with you? Jessica Reed: So I am available for free discovery calls on my website, which is balance health for life.com. I think you said you would have it in the show notes? Dr. Sarah Stombaugh: Yeah, I'll put it all in the show notes, yes. Jessica Reed: And I do accept insurance. So what to expect is just an introductory call to hear if this might be a good fit for your goals, and I'll do an insurance check to make sure and verify coverage. A lot of times they cover a majority of the cost, so that's the good news as well. Dr. Sarah Stombaugh: Yes, absolutely. We'll absolutely include that. Thank you so much today. It was really a pleasure to have you on here and sharing with my audience all about nutrition and how they can use that to support their health goals. Jessica Reed: Thank you for having me. Dr. Sarah Stombaugh: All right. Thank you all, everyone, we are so excited to offer the GLP Guide to make sure that you check that out on the website. That is all in the show notes as well. We'll see you all next week.