EP25 Obesity Is a Chronic Disease, Part 2Checkable Health
Obesity is a complex disease that affects almost half of all adult Americans. In fact, 42% of the US population is considered obese. Obesity can't be treated with one single method. It requires a holistic approach specific to each patient based on individual needs but generally includes prescription medicine, lifestyle changes, therapy, and sometimes surgery.
On this second episode of a two-part series, Patty Post of Checkable Health is back to discuss combating obesity with Physician's Assistant Cody Baxter. In this podcast, PA Baxter describes different medications currently used to treat obesity, including the new and successful class of injectables. As our guest says, "We have to have the intervention meet the intensity of the problem."
Along with weight training and exercise, Cody Baxter also talks about the importance of finding the inner strength to accept progress and not strive for unattainable perfection. With mental health issues and shame often intertwined with obesity, it's easy for one wrong decision to cause you to lose hope and slip back into old habits.
Body image and self-acceptance are key when battling obesity. Negative feelings and self-talk typically begin in childhood for many people, and the patterns surrounding us as adults are often adopted into our lives. Weight loss management doctors like PA Baxter aim to address these underlying issues that come with battling obesity to help people find a path to a healthier life.
This Checkable Health podcast is a must-listen for everyone. Tune in to learn more about obesity and get actionable advice, so you can help break the stigma and find help! Part 1 can be found here.
Topics discussed in this episode:
- What the drug CONTRAVE is, and how it works
- Patty’s success with CONTRAVE
- Telemedicine sites giving more access to medication
- Cody and Patty discuss the new injection medication class for weight loss
- Injectables vs. traditional medications
- Why aren’t more people prescribed these new medications?
- Do you have to take anti-obesity medication for life?
- Online resources for obesity treatment
- Cody shares his thoughts on weight loss surgeries
- Misconceptions about bariatric surgery
- The danger of getting back into bad habits
- Childhood trauma and obesity
- The benefits of strength training
- Environment and the importance of support
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Along with the at-home strep test, Checkable offers an array of wellness supplements and a multitude of resources, including podcasts and blogs, to help keep consumers in the know about different aspects of their health from top to bottom. And with more home tests coming soon, Checkable puts treatment options at your fingertips, so you can focus on getting better. Visit checkablehealth.com for more info.
0:00:04.6 S1: Welcome to the Checkable Health Podcast, where we're helping everyday moms rethink how healthcare begins at home for themselves and their families. This podcast is for moms of school age children, born in the 1900s, and would buy an at-home strep test to check their sore-throat symptoms from home. Hello, I'm your host, Patty Post. I'm founder and CEO of Checkable Health. I'm a mother to two amazing sons and one amazing tween daughter, and I'm wife to Andrew for almost 20 years. I truly believe that your healthcare does begin at home. I'm equipping you through this podcast to make educated decisions from the comforts of home, to help you make better health decisions for yourself and your family. If you are new to this podcast, this is a second episode from a two-part series with physician assistant Cody Baxter, who specializes in weight-loss management, so I encourage you to go back to Episode 1, and hear how he works with his patients on weight-loss management and how obesity is affecting all of us, but really easy tactical things to do to change your lifestyle. In this episode, we're talking about medications that can be taken to help us with weight management. I'm gonna talk to you about my own journey with the prescription Contrave, and we're gonna talk about some telemedicine and as well as bariatric surgeries, and really the list of options that we have to manage obesity other than diet and exercise. I think that this episode is very informative, and if we are looking for ways to really help with the mental side of overeating, anxiety eating, stress eating, I think that there's a lot of learning to be had in this episode.
0:02:03.7 S1: So again, thank you to Cody Baxter. He's an excellent guest. At Checkable Health, we are really excited because we're hoping that he's coming on board more to give us some tips and tricks of how he works with his patients, and then we can provide to you via our YouTube channel and all of our social channels, more of his great information as a subject-matter expert. So with that, let's get into the second episode with Cody Baxter. I told you, when you and I met, that I started taking Contrave back in May, and for me, that really helped me, I think on a number of things. One from almost like the addiction side of wanting to eat in the afternoon, it just totally went away from me to... I didn't have the feeling of hunger anymore. I still feel hungry, but sometimes I feel like I was telling myself I was hungry and maybe I really wasn't, but because of first hand, I've done it, I feel okay sharing that, but would you share with the audience what Contrave is?
0:03:19.1 S2: First of all, think for sharing that info and your experience with it, and... So Contrave is a combination medication of two generic drugs, bupropion and naltrexone. So bupropion is most commonly known probably as Wellbutrin, which is an anti-depressant medication, but it also has applications for tobacco cessation. So having used it in those areas, we know that it's got activity within the brain, it works on a few different neuro-transmitters within the brain, but dopamine is probably one of the ones that people have heard of that it has some effect on. Naltrexone on the other hand, is used in a lot of substance-use disorders, so opioid-use disorder and alcohol-use disorder. It is an opioid antagonist, which means that it blocks the opioid activity, so a person who is taking naltrexone likely does not get the same high or feeling from the use of opioids and helps them avoid problematic opioid use. So if you think about all of those potential activities when we put bupropion and naltrexone together, and you're really working pretty powerfully on that reward-pathway dysfunction in the brain, and the people who tend to do really well with the use of Contrave as the name kind of implies, Contrave would be against cravings, or counter to cravings, and so people who are eating maybe not necessarily because they're truly physically hungry, but because they have craving for type of food or they feel the instant feedback or reward from that eating behavior is something that they struggle to control on a regular basis. So Contrave is a good medication currently brand only, but we use it quite frequently to make it more accessible for some patients, just letting it into generics and prescribing separately, and I use it quite frequently with good success.
0:05:11.3 S2: It is one of many options out there right now as far as anti-obesity medication goes, and that's probably a whole separate podcast topic altogether, but oftentimes the short answer I'll say about that is it can be the difference between that consistent success or feeling like our efforts and our success match, rather than feeling like we're putting all this effort in for very little results.
0:05:35.6 S1: Yes, I have lost 14 pounds since then, and I am just maintaining now, but I still feel really good, and I think I needed that antidepressant as well. I didn't know and had never, I had Zoloft after my daughter. My OB-GYN had prescribed it the day that I delivered and that was a totally different postpartum experience. It was so much better because I had taken it, but I didn't know that it would affect me, but... Gosh, I just feel better overall. I think the big sticker of it is that you cannot have any alcohol when you're on Contrave, that's what... When I was prescribed it, and I am alcohol free, so that's fine with me, but is that what you prescribe to your patients as well? No alcohol use?
0:06:25.1 S2: My advice with Contrave or probably with lots of medications would be, I would take it easy, as far as the first time you may try alcohol after being on it. Contrave is one that you have to start at a certain dose and work your way up, so probably not a great idea as you are adjusting to the medication to mix alcohol in. But part of being, I think, realistic about what patients are going to tell me in the room, but what they might actually do is for me to tell them, Hey, if we wanna be absolutely safest, we would not mix it with alcohol. That being said, it's not something that is going to, in healthy doses, likely cause lots of issues. What people might find is if because of the Contrave, if you have lost weight or you are eating less throughout the day, then you might metabolize alcohol a lot differently, so your tolerance may change as well, which is why it's really important to... I wouldn't make someone's 21st birthday or a birthday party or some time where you're going to have maybe more than one drink to be the first time that you give a test drive to alcohol on a new medication.
0:07:36.0 S2: So for me it's caution, but you might find that within moderation you are able to incorporate some of that, and some people might find that it just makes me... That treats me differently when I'm on this medication, so I'm just going to avoid it, but I don't think it's an absolute no.
0:07:52.3 S1: Got it. Okay, that was a misconception that I had been... I do know that the first month was hard, getting on it, I did not... You do feel sick to your stomach at times, and that is something to fight through, but once that subsides and I did have to cut back my dosage a little bit 'cause I was getting tired in the afternoon. So I think it was too much for me, the recommended dosing. And I've never really had a long-term prescription before, so having someone that... I use telemedicine instead of talking with a provider in person, which is really nice because on contrave.com, you can see a telemedicine provider, they'll give you a half an hour consultation, and for me, I've now used it three times, it was really an enjoyable experience, actually, it's probably my most... I've done telemedicine for strep quite a few times, but for that... That was good for me.
0:08:55.6 S2: Yeah, I think one of the things that covid-19 pandemic really accelerated was the telemedicine platforms and what kind of care we can give on it. I think the vast majority of that is a positive thing, there are a few stories out there that some of the telemedicine sites become an easy way to really churn through patients. Overall, what your experience was and the experience of a lot of other telemedicine places is we are increasing access to anti-obesity medication, and I am 100% on board with that. So there are some physicians who I look up to in the field that I know are on advisory boards or help with some of these sites specific to weight loss, but there's other ones for primary-care meds or all sorts of other medication options. So I think that's been a positive thing overall, and hope that people are able to access some of the things that they just haven't been able to traditionally.
0:09:50.9 S1: There's a new injection for weight loss, have you been prescribing that to your patients?
0:09:56.6 S2: I always joke, I've been on these streets for years when we're talking about the injection. So the injectable medication class is the single most effective class of medications when we look at potential weight loss rates. And one of the reasons... There's multiple reasons why, but I think it's one of the medication classes that truly is addressing some of the underlying, what we call pathophysiology, or what is the underlying issue that can have someone to be struggling to maintain healthy weight and really has different targets within the body that help benefit of the vast majority of people who are struggling with it. So something like Contrave, if you are a patient who has, let's say you make less of a hormone in the gut, that signals for fullness, and this is part of what these injectables do, but if you are taking Contrave that might not do any effect for that person because if you are physically hungry more often than other people are, or you are hungry an hour after eating, then addressing the brain pathway, that Contrave does isn't going to do much, and vice versa, so if physical hunger is that something you struggle with, than really taking a medication that increases fullness signaling is not gonna be helpful because you'll feel full, but you'll still have the cravings to eat.
0:11:19.7 S2: Right, so getting back to the injectables, these medications originally developed for diabetes, type 2 diabetes, but then really saw great weight loss benefits for those types of patients and started being studied than just with weight loss for treatment of obesity, and they continue to hone and develop these even more. And so the latest one, which is the generic name is tirzepatide, that is a medication that is now approaching over 20% weight-loss potential in a long... Most recent long-term studies.
0:11:52.8 S1: Wow, 20% weight loss. So I would lose 20% of my weight.
0:11:58.0 S2: So yeah, the average patient who was on this medication, it was just over a year, I think it's like a 14 or 15 month study was the most recent obesity study that had come out from them. Yeah, it was about 21 or 22% average weight loss. That's incredible. And being that it was originally, right now it's only on-label for diabetes use, this specific one. You can use it off label for weight loss, and we have. And so for people who have type 2 diabetes, it really, really helps blood sugar, and more importantly, when we think about... This is a whole separate topic, but with diabetes, the blood sugar number matters for sure, but why does it matter is because of all of the risks that are increased when your blood sugar is not well managed, which is the chance of heart attack, kidney disease, all these other sorts of things. So some of the older diabetes medications, they lowered your blood sugar, which is great, but the long-term studies did not show major changes in terms of your chance of a heart attack or stroke or kidney disease, and so at the end of the day...
0:12:59.4 S2: What is the point of the medication if you're not living longer or improving your quality of life? And so this class of medications does both, it helps with the blood sugar, but it also lowers your risk of heart attack and stroke, it improves kidney, the disease outcomes in all these other sorts of things. Interesting, so that's the most recent one, but there are probably five or six different ones within this class that can be used. Wegovy is the one that is on-label for weight loss treatment that is the most effective medication. And Mounjaro was the one that I had just talked to about as far as the most weight-loss potential.
0:13:38.5 S1: So injectables that mean that you come in once a week, or you're giving yourself an injection... What does that mean?
0:13:46.2 S2: They are self-administered. Most of these medications are a once-weekly injection, there are a couple of them that are once daily, and then with this, they come... They look just like an insulin pen, if anyone's ever seen what one of those looks like. But a little device, some of them are auto-injectors, so it's just a pressure activated in you push it against your abdomen and it dispenses in about five seconds and you're good for the week. Others have a dial system where you dial up the dose that you're going to use on a little pre-set dial, and then you use a disposable needle and re-use the pen multiple times.
0:14:22.7 S1: Why don't we see commercials for these drugs... Don't you think that's kind of crazy?
0:14:29.0 S2: Yes, the percentage of people who qualify for anti-obesity medication based on their weight or their weight plus their other health conditions that are actually offered these medications is about 1%.
0:14:43.8 S1: Why so low?
0:14:45.8 S2: That's part of that “how long do you have” sort of thing, but if I get a patient who is coming to me and they are on two or three diabetes medications, two or three blood pressure medications, a cholesterol medication, an antidepressant, and then some of these other things, these are very typical patient populations that I might get. The minute they turned around then and asked for a weight-loss specific medication from the same provider who's willing to manage all of those other ones, sends them to me or a weight-loss specialist of some sort to deal with the weight loss. And so the fact that we've treated weight loss medications as a niche or a specialty versus a true bread-and-butter primary care issue is probably one of the biggest things. And then when we don't do that, and it's a chicken or the egg sort of thing, because if we don't prescribe them regularly, then insurances don't see them being prescribed regularly and are less likely to cover them. If we don't prescribe them regularly, then the people who are coming out of school that we are training in as new doctors and physician assistants and everything else are not going to get exposure to learning how to prescribe these…
0:15:54.7 S2: It doesn't make its way into the medical education curriculum, and then if we don't have long-term studies on lots of patients being on these medications and showing benefit, then there's really the argument for covering them more from the insurance side of things again is less. And so it's one of these things where someone has to make a change. Someone's gotta just jump in, I want off this ride, is kind of the way I describe it to when people ask like, How do we change things? It’s that you just have to jump out of the cycle and more people have to jump out of the cycle.
0:16:28.1 S1: And by losing... Let's just use the 20% of your weight. You would lower your likeliness of heart disease, diabetes, high cholesterol, all of these things. Even, I think mental health, when you're feeling better and you are more likely to get to the gym, you're more likely to take the walk, you just feel better in your clothes, in your own skin, so then that mental health improves as well, so it seems like those nine prescriptions that you were saying, the first one should be the weight-loss one.
0:17:07.2 S2: You're 100% right... I think of anti-obesity medication as a root-cause treatment versus a lot of these other ones that certainly have genetic components to it, but they all have a common theme of ways that we could prevent or reverse some of these things by treating weight specifically. So really, my thought is a treat weight first approach should really be where we think from rather than, Oh, you have high blood pressure, here’s a high blood pressure medication. And I use high blood pressure medication all the time, and I'm not against it by any means. It’s life-saving, but it's part of a treatment plan that should also then address the lifestyle aspect or risk factors that get them to a place where their blood pressure is high, and so that's the holistic comprehensive approach and how it comes into play
0:17:55.6 S1: On these medications, once you start taking them, would you...or the anti-obesity medications, will we have to be on it for life? I've never even asked that, will I have to be on Contrave the rest of my life?
0:18:07.4 S2: Another fabulous question because this is, I don't wanna say a misconception, but it's a question that a lot of people have, especially once they've had some success. And they're like, Okay, this is the one thing that's really helped me get over the hump or be consistent for a period of time when I've struggled. And so really, treating this as a chronic disease, tells us that chronic management is required. That might look different at different points in our lives, so my thought is, you should continue to use it as long as you feel it is part of a treatment plan that is helping you be the happiest, healthiest version of yourself. For many people who have struggled with severe obesity, or have obesity that also then has been dealing with other downstream effects such as diabetes, high blood pressure, all that other sort of stuff, my thought is, I'd rather get rid of your blood pressure medication before I get rid of your anti-obesity medication. Or for most people, if this is helping you in that respect, I will never be the one, and I shouldn't say never, if someone's having unintentional weight loss even after meeting their goal or something to that effect, we'll have that conversation, but...
0:19:13.8 S2: That's very, extremely rare. Most often it is, I'm not gonna be the one to initiate the conversation of, I think we should get off this medication if it's working well for you. It's up to the individual to say, Hey, maybe I've been on it for a handful of years, and during that time now, okay, my life's in a better place, I changed jobs and was way less stressed. Maybe a kid graduated, or I don't have kids in the house, and X, Y and Z are all different now. I’m in a good routine, I'm in a good place, I have systems in place that are helping me manage these things, I don't think I need to support of the medication at this point. Awesome, let's try scaling back, let's see if we can come off of it and if you can maintain, but we have a plan of if things start to go haywire, let's not wait until you were where you were when we started before we do something. And if it needs to be the medication that is something that we continue, then so be it, but some people might be able to come off of it. Others generally, particularly if this is to a more severe aspect, should be thinking about this as a long-term management sort of thing.
0:20:19.3 S2: And I always tell them, Well, the only reason I'm gonna take your office is if something better comes along...
0:20:24.2 S1: Yeah, yeah. And you'd have a higher success rate, and hopefully they're already having success, so the conversation is unneeded...
0:20:32.2 S2: Yeah, even in my four years of practice, when I first started, the highest percent weight loss that we could expect from a single medication on average was about 8 or 9%, and so that doubled about a year ago with approval on a different injectable medication, and then with this newest one that has just come out and will be continuing to be more accessible, has gone up again. and then if you really wanna find me nerding out on a Friday night reading studies of weight loss medication trials, there are ones even further advanced in terms of what we're gonna be able to do and mechanisms or pathways of which we can target to really fight back against the disease of obesity. So as we continue to go like anything else, we are scratching the surface, but we're going to have so many more things that we can offer patients from a treatment standpoint.
0:21:21.9 S1: That is so cool, so is this... I mentioned telemedicine, but if someone's listening and they are, let's say, in rural America, and it's hard to find a family physician that they might be five months out. How is obesity treated, can you do this in telemedicine? That would be a nice consultation.
0:21:42.7 S2: Yes, there is a number of sites that are going to be willing to treat and are guided towards that. Some sites are more of like a subscription-based, and then the medication might be included, others are more of a pay for the visit and then you still need insurance to pay for medication or different sorts of things. Most of them have some sort of infrastructure to ensure medication that they choose is going to be affordable to the person, because when we go back to that whole sustainability aspect of, if the medication is telling people you can't pay cash for this, 'cause the price has a comma in it, right, it's like that's not a good thing. Or if it's not something that's covered by insurance, then we’re really not gonna be able to use it for some of these ones that have not gone generic yet, but most of those sites are pretty good about figuring out what can and can't be used, what’s going to be easy enough to pay for out-of-pocket versus submitted through insurance, and so there are definitely ones out there. I don't have any that I'm tied to or have a specific one. There's lots of them. A quick Google search will show people at least a few different ways to get started in that respect.
0:22:48.1 S1: Would you recommend that over going... Would that be under the knife, there's so many weight-loss surgeries, not so many, but there are weight-loss surgeries, and what do you practice? Healthy lifestyle?
0:23:03.5 S2: Yeah, that's another conversation I think is so important to have when I first meet a patient and talk to them about how this is a chronic disease, and diseases have a spectrum of treatment approach. And we need our treatment approach to meet and support the patient at whatever intensities needed at that time. So for a patient who is overall generally pretty healthy, has some family risk factors of things they want to avoid and looking to lose 20 or 30 pounds, they're probably not a bariatric surgery candidate, and that's not an intervention I would consider for them. If I have a patient that shows up and they’re say 200 to 300 pounds over what would be a healthy weight for their height and has multiple other things going on that may be causing increased risk of having really poor health outcomes, I'm not doing a service to them by trying to just talk about strictly lifestyle modifications that are going to get them to a place where they're healthy. The research shows that intensive lifestyle and behavioral therapy alone is going to be somewhere around 5% on average in terms of expected weight loss. And that's if you're at a pretty good place that you're seeing regular intervals, you're getting dietary and exercise advice and all that sort of thing, which from an access standpoint is not every patient for sure.
0:24:24.2 S2: Medications then, are a step up from that, and that percentage is changing and increasing at all times, but again, right now, tops out at 20%, let's say. Bariatric surgery is somewhere in that 30 to 50, sometimes even 60% of body weight loss. And so if you're a person who weighs 500 pounds, really just trying to diet and exercise your way to a weight of 200 or 250 pounds where you might feel happiest and healthiest, it's like having a blizzard here in North Dakota and going to your kitchen, grabbing a soup ladle and going on trying to shovel the driveway with that. We have to have the intervention meet the intensity of the problem, and so bariatric surgery is life-saving for the right people. Oftentimes it is not the first thing that we talk about, I don't do bariatric surgery until when they're coming to see me, there's generally a lot of things somewhere in between what they've tried and bariatric surgery that we can really work hard on, but I also think it's important for me to ask what their goals are and be honest with them, if what I can offer them is enough support for that. And so there's a lot of misconceptions about bariatric surgery, some that are, I think, grounded in evidence, others that are just misconceptions in general, but the two that I think I hear the most, one are that I know someone and then they had really bad complications or something happened. In terms of surgical procedures, bariatric surgery is pretty new, when you think about...
0:25:51.1 S2: Some surgeries have been done for 100 years or more, whatever it might be. Bariatric surgery really didn't get popular until probably the 90s, and so we are just now getting to a place where we are really, really good at doing bariatric surgery. You learn from as time goes on and different techniques, and so when we look at the 90s compared to now, that complication rates for bariatric surgery are about 10% of what they were in the 90s. Really? Yeah, so the severe outcomes, just a slide last year at a conference talking about bariatric surgery, how the mortality or death rate from bariatric surgery is actually lower than a gallbladder removal. Really? Yeah.
0:26:34.9 S1: And gallbladder is super routine, right?
0:26:38.2 S2: Yeah, yeah, and you think about it with gallbladder, sometimes it might be more of an emergency thing or maybe there's some cancer in there or whatever else might be going on, or we think of... That's just a straightforward take it out, you're good to go. But when we compare them head-to-head, the complication rate is lower. And so we've gotten a lot better at bariatric surgery would be the first thing that I would say, that if you knew someone had it in the 90s or 2000s or whatever, their experience is going to be different than yours. The pre-surgery process has been expanded, so you have to go through a psychological consult, you have to do multiple consults with nutrition, with a registered dietician, you have to get screened for all kinds of different deficiencies or things going in that need to be addressed before you can go through the surgery, so by the time that you actually get to surgery, you are ready, and we've screened out people who maybe aren't ready, and it's okay if someone’s not ready, and it's more important that we identify that before we cut them open than after.
0:27:33.2 S2: Right, right. So that process has gotten a lot better, and then the third part of it is... Or the thing that I hear is people say, Well, everyone that I know has gotten it, they just re-gain the weight back anyways, or something to that effect, right? And I use that really as an opportunity to advocate about the disease of obesity and take the blame off of the individual person, but talk about the insidiousness of a disease process that we can cut open someone and re-route their guts and physically make their stomach smaller, and they are still prone for this disease to relapse. Right, so when you think of it that way, that speaks to us of how seriously we need to support and treat obesity and realize that this is a chronic disease, we do have some control over it, not nearly as much as control as we'd like to do...
0:28:23.6 S1: It's not like a knee surgery, take out the meniscus and suture it up and you'll be fine. It is very complex. Deeply seated, right?
0:28:36.2 S2: Absolutely, and then it does help in some ways, but there are other commitments to having to take vitamins very regimentedly, otherwise you're at risk for some vitamin deficiencies. Or really having to get comfortable with the fact that you can only eat a few bites initially and if food has been the comfort for you for a long time, then that's something that you're gonna have to deal with. So it's hard in a lot of different ways, and I see a lot of post-bariatric surgery patients who are then coming to me and have had some weight regain and we can use either getting back to some lifestyle changes or incorporating some these newer medications that maybe weren't around or they didn't try prior to surgery, and that is the whole like comprehensive approach. Just because you've had bariatric surgery doesn't mean medication might not work for you afterwards. And so maybe they lost 100 pounds and then regained 50 of it, they're still down 50 pounds, and 50 pounds of weight loss is so, so much more beneficial for someone's health, so even if they are technically in that obesity category or have excess weight that they still need to lose...
0:29:40.8 S2: That does not mean the surgery was a failure because they had some weight regain. And just the same thing with long-term obesity management, we have people that they come in like, Oh my gosh, I gained seven pounds… They feel like such a failure. Right, and we pull up their weight chart and we go back and it's like, you've lost 70 pounds over the past year and a half, what you just regained is a blip. That is not a failure, and so we talk about what happened and et cetera, et cetera, but people, it never comes off fast enough, any regain has them worried about failure or going back to where they were. And what we know is, hey, this is the reality of dealing with a chronic disease that tries to fight back against you, going back to the caveman example that we talked about.
0:30:29.2 S1: And one step backwards doesn't mean that you're a failure. Take a step backwards, and I think with habits, what I've seen personally is I'm so good at my habits and then just one day something will trigger me, and then you get back to your old way of life so quickly. And it's like, Okay, you had a mix-up or you decided to be a little lax, get back to it because remember how good you felt when you were practicing those habits that you consciously knew were gonna make you feel better, and as it turned out, they do.
0:31:07.5 S2: Yeah, and that all-in or all-out mindset, right, that we think we have to be on point 100% of the time, and if we can’t, we might as well not be. When really, going back to that progress, not perfection sort of thing, it's what we just did has no bearing on what we do next. And easy to logically tell ourselves that, but I talk to patients about this as a mental muscle, you're going to have to use and exercise is not letting one decision, yeah, there was a donut in the break room and it wasn't on your plan today and you ate it, well, what can you do about it now, other than say, Hey, that was pretty good, and now I'm gonna get back on track. It was delicious! Right. Beating yourself up about it is not going to be helpful and saying, okay, the rest of the day is shot, so I'm gonna have two more or I’m gonna start over on Monday, I'm gonna start over on the first of the month, and all these other things just give us grace to have further decisions that we need to reverse or get back from, and so really telling ourselves that it's okay and normal to struggle and just getting back to a good decision the next time around is the best thing you can do.
0:32:10.6 S2: On the flip side, you have some of these Type-A people who are like, I need to go to the gym and work out for an hour 'cause I had the donut, and that's not helpful either, right? That is not a long-term solution, and that is not a healthy way for us to have a relationship with food. We should be exercising because we enjoy it and we can benefit from it, not as a punishment for eating a donut.
0:32:32.0 S1: Yeah, it's fun. And I think if you are a parent to have a healthy way of verbalizing it too, I know women that have said, Oh, I had such a bad weekend, and now look at how fat I look. I'm like, No, you do not. You look just the same as you did last week, you might feel like you look that way, but we need to practice healthy way of talking about ourselves and about managing our weight and managing our lifestyle if we are trying to lose weight, because those little ones are listening, and it's a very sensitive topic and their little sponges.
0:33:09.9 S2: Oh, you're so right. And so as I get to know these patients and see them back and they're having progress, or they just talk to me about what areas of struggle might be, the overlapping similarities of something in childhood that still affects them now, whether it's true trauma, which there's plenty of that or there are just, “I can still remember my grandma when I was six, said this to me at a family get together about my weight and…” That's a six-year-old, right? And they remember 50 years later, and it still is still affecting their behaviors to this day, and so you're exactly right. They are listening, and the way that we talk about ourselves is so important in how they develop their own self-worth and sense of self too, and it's a really good reminder for parents.
0:34:03.9 S1: Do you or your child have symptoms of strep throat, such as sore throat or fever? Do you want to help an innovative startup validate their at-home strep test? Checkable Medical is currently enrolling children ages five and up, and adults for a strep throat study. go to www.testforstrep.com to see if there's a site near you. Again, that website is www.testforstrep.com. So I know I have you until five Cody, I'm just gonna squeeze every minute out of you here. The last thing I wanted to talk to you about was weight lifting and the importance of getting in the gym or getting some weights at home and incorporating that into your exercise regimen and what your belief is in that.
0:34:58.6 S2: The joke I always have is that everybody needs an iron prescription. It's so important for so many different ways, so when we think about weight specifically, I touched a little bit on how exercise won’t drive weight loss as a primary driver from the body composition standpoint. More importantly than is what is the number on the scale or our BMI is, how do we feel, right? And how do our clothes fit and what are we happy that we can do? So when we ask someone, what is the reason why you want to come in here and have weight loss? Things like, I went to Disney and I couldn't fit on the roller coaster, and we go there every year and next year, I wanna fit on the roller coaster, this is a real story, and he went back a year later and he fit on that roller coaster and life was good, right?
0:35:45.2 S1: That's so cool.
0:35:47.0 S2: So it is like that, or it is, I fit into a pair of pants that I have not worn since before I got married, and they have been married a long time.
0:35:57.3 S1: But why do you have them in your closet is what I would ask. Throw that away.
0:36:03.1 S2: So really it is, and so then we think about strength training, why does that matter, is that we might be able to get a really good benefit from the strength training. And we might look and feel better 10 pounds heavier than we did prior to starting some of that and so the number on the scale really isn't applicable, but now all of a sudden, I can carry my kids up the stairs when they fall asleep in the car. I had one woman who told me her next goal is I wanna be stronger than my husband, and I'm like... I love it, it's wonderful. And so, strength training is, if we can pick one, my first thing I would say, what exercises do what you enjoy, do what you have access to, because that's what you're gonna be most likely to do. Beyond that with... We're talking ideal, the reason I push strength training is I would say 80 to 90% of my weight-loss patients are females, and so that just probably speaks a little bit to our society in general. Anyways, but within that, there is a lot of misconception about what strength training might do in terms of, I just wanna tone and I don't wanna get bulky, or I'm going to exercise, I'm gonna go get on the treadmill for an hour or things like that.
0:37:16.2 S2: Those can be really helpful, but the most important thing though, I think that I want women to know is: you don't have the hormonal makeup, and particularly if you are trying to lose weight or in a calorie deficit, as part of weight-management program here, you are not going to be able to put on slabs of muscle and turn Arnold Schwarzenegger or whoever, because between your hormonal makeup and the fact that you don't have a bunch of extra calories laying around to turn into muscle, it's just not gonna happen. The goal really would be to preserve as much lean, healthy muscle mass as possible while losing the fat mass, or as you get closer to that maintenance weight, maybe now putting on a couple of extra pounds of some good healthy muscle mass would be important. And so the other part of it too is how we lift weights. So I always tell people, don't be afraid to lift heavy, it should feel heavy for you. You do not have to stick to the two to five-pound dumbbells and just do lots of reps to tone. There are a lot of misconceptions when it comes to strength training that are out there. You can lift heavy, it needs to feel difficult for you wherever you're at in your weightlifting journey, but continuing them to push yourself to get stronger, whether that's more reps or sets, less rest time, different exercises, there's a million different variables, but really pushing yourself to get better and get stronger is super important because sitting there doing two and five-pound dumbbell curls is really only gonna take you so far in terms of what you wanna get out of it.
0:38:46.9 S1: Right. I'm gonna do my maxes tomorrow that I'm back, 'cause I talked to Teila about it, and she's like, Yep. Cody really believes in weights. And my 19-year-old is back from the Army and he is always in the gym, and I see physically how he's gotten so strong. I'm like, I wanna be strong. Just 'cause I'm a woman, doesn't mean I can't be strong. You can still be feminine and strong.
0:39:15.0 S2: Absolutely, absolutely. It is one of those things where... And then the confidence that you carry yourself with when you feel strong is so important, and then that carries over to everything else in your life. Or the sense of accomplishment of like, wow, when I started, I can only do the bar and now I can do this much or the goal setting that you can do in that respect, maybe right now, my situation is such that I'm just not gonna be able to make a lot of changes in this area in my life, but strength training is something I enjoyed and really get after pretty good, and that's wonderful, and that's the part of the comprehensive approach is, I'd love to say we're gonna be able to put everything first all the time, but that's just not realistic.
0:39:56.6 S1: Some of the things of lifestyle changes, Cody, when we're talking about this, I have someone who said an analogy once to me of if you hang out with partiers, you're gonna party, if you hang out with overweight people that don't have a healthy lifestyle, then you're going to have that same type of lifestyle. And for me personally, when I gave up alcohol, I shed some friends from that because just naturally, I didn't find going out as enjoyable. I find going to yoga or walks or coffee is much more enjoyable than sitting, having wine until 12 o'clock at night, and from a lifestyle change, do you ever have that conversation with your patient that... Hey, look at who you're surrounding yourself with. That's a tough conversation.
0:40:51.9 S2: Yeah, so that brings up two good points, so one of the points in my consultation template is I just have to…the family situation, so I remind myself to ask, I just say, who lives at home? And then within that, I'll ask what their dietary habits are like, if there's anything, whether there’s special diets that they need to follow, or if like frequently...it's like, well, my spouse brings home pop and whatever else. And so if you have someone who is constantly putting you in a bad food environment or has bad dietary habits, the chances you're gonna be able to stick with changes on your own are a lot more difficult. Knowing that, then we can open a conversation about... Have you had that conversation with your spouse, have you had that conversation with them about, Hey, this is what I'm trying to do, and what are you going to help me with? And unfortunately, sometimes it is like they don't really care, and that's tough, but we work with it, and then other times it's like, yeah, actually they wanna lose weight too, and then four months later there in my office as the other half of the spouse and wanna give rolling on the same program.
0:41:55.4 S2: And so that's the best is when you guys are going in the same direction, now we can really rock and roll. And then the other part of that is, if you think about how do people end up where they're at as adults is, if you as a child grew up in house of a couple parents that have struggles with weight and you are spending the majority of your life with them, and learning your habits from what you observed with them, the likelihood that you then are going to have obesity from a genetic but also from just an environmental exposure to those behaviors is that much higher too. So when your family history has that, we have to think about, well, yeah, the person who grows up with two parents that are super fit and going to the gym and doing all the right things, just has that as their normal. Whereas the person who has a bag of McDonald's washed down with a glass of orange juice as their normal…good luck, we have a lot more work to do to really untrain those habits. And so really, yes, it's important for us to have favorable environments in all sorts of things, whether it's what types of foods are we bringing into the house, who are the friends that we're associating with and do you have an accountability partner that you can exercise with? What are your systems that are keeping you on track when you're not at your best?
0:43:12.6 S1: Good advice. Accountability partners. Those really help, I think. It's always helped me when I've set out for a goal and I still... I have a coach now. That's my accountability partner.
0:43:24.3 S2: Yeah, so when people show up and they’re like, “I didn't wanna come in today because I gained weight, I didn't lose as much as I thought,” or something, and that's one of my favorite visits to have, because it's gonna be the most beneficial visit that we have. And so I tell them, if you show up, I'm never gonna be mad at you, and [they say] “I thought you'd be mad at me for this.” It's like, why be mad? What is the purpose of me being mad or shaming? Hopefully this is the one place you do not get the shame about your weight or have every problem that you have turned back on to maybe if you lost some weight or whatever, all these stories that I hear about weight bias, which is a whole nother topic. But what I tell them is you come by showing up, we can work on it. I only worry about you when you don't show up, because if you don't come back, I worry about you and I can't help you. Weight gain, weight loss, doesn't matter to me. If you're here, you've already told me that it matters to you by showing up.
0:44:14.7 S1: Cody, you are helping so many people and I love that you have a passion for this... You're so knowledgeable. I think I'm gonna put this into four different mini episodes 'cause we covered some really nice categories.
0:44:28.3 S2: I have other ideas too, so I’d hate to invite myself back already, but I have some other ideas we can certainly talk about too, so like I said, put a quarter in me and here I go.
0:44:38.5 S1: Perfect. You know what really is good, I think a lot of people are going to TikTok Lives to listen to these types of conversations, especially in the evenings, and I really wanna get to that, and especially in a topic like this, mental health. I think that's what I would like to get to. So you are invited back, You are welcome any time. When we'll make it happen, for sure. Make it happen. Well, Cody Baxter, Physician Assistant, extraordinaire when it comes to weight loss and management, obesity management, thank you for the work that you're doing with your patients. And thank you for being on the Checkable Health Podcast.
0:45:17.1 S2: Thank you for having me, Patty..
0:45:18.3 S1: You are welcome. That was just a great two-part series with Cody Baxter. Cody, thank you so much for joining us. I hope all of you were able to really see what a transformation can happen from just changing your overall lifestyle as well as accessing some tools out there that you might not even have been aware that exist. There are weight-loss specialists out there within our healthcare system, there are medications that are available to us through telemedicine that can help us with really the mental side of overeating as well as how is it that we are perceived by others in our family when we are constantly battling and talking about our body image. As moms, our kids look up to us, they're watching everything that we do. We need to start, or we need to continue to love ourselves and treat ourselves with really the grace that we give to everyone else in our family. Through weight loss management tools that Cody shared with us, it is achievable. So I thank you for tuning into the Checkable Health podcast, and I truly hope that Cody comes back. I think that we will be able to have some YouTube Lives and even some things on social media with Cody, 'cause he truly is an expert. If you have questions and would like to stay connected, follow our channels.
0:46:52.3 S1: We are Checkable Health on all social channels, I am Patty Post CEO on Instagram and on TikTok, so send me a message. And we have a new group that is on Facebook, and it's called Hero Moms Social Group, so if you wanna continue this conversation that we had on these last two episodes, we're gonna bring that over to Hero Moms, so you can post on there, join the group, and then you could post on there anonymously, or you could post yourself, it's a community of moms of school age children, and it is a great place for us to dig deeper and have conversations about real ways that your healthcare begins at home. So with that, on to the next episode. And make it a great week. Take care.
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