Gretchen Zimmermann, MBA, RD, LDN, CDCES, CSOWM is a healthcare executive, registered dietitian, and thought leader in digital health innovation. With over 15 years of experience in clinical care and leadership, she is committed to transforming healthcare through cost-effective, outcome-driven, and patient-centered care models.
Her expertise is nationally recognized, with publications in academic and industry journals on diabetes, digital health, and nutrition... and today she joins me to talk all things GLP-1.
Let's get all the facts, shall we?
Connect with Gretchen:
https://www.instagram.com/gretchenzimmermann.rd/
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Kindal Boyle has been a personal trainer for nearly 20 years focusing on women's strength and fitness. She'll teach you how to combine strength training and cardio for a hybrid approach to build the fittest body and life no matter where you are in your fitness journey.
---
❤️ INSTAGRAM: www.instagram.com/KindalBoyleFitness/
🎙️ YouTube: www.youtube.com/@Fit-Womens-Weekly
🔗 Webtsite: www.fitwomensweekly.com
☕️ Buy A Coffee: https://www.buymeacoffee.com/fitwomensweekly
Need Magnesium?
Try RnA ReSet Magnesium: https://rnareset.com/?ref=FWW
Use Code "FWW" for 10% Off!
---
Kindal Boyle has been a personal trainer for nearly 20 years focusing on women's strength and fitness. She'll teach you how to combine strength training and cardio for a hybrid approach to build the fittest body and life no matter where you are in your fitness journey.
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Transcript
Episode Transcript
Available transcripts are automatically generated. Complete accuracy is not guaranteed.
(00:00):
(Transcribed by TurboScribe.ai. Go Unlimited to remove this message.) What's up, guys?
Welcome to a brand new episode of the
Fit Women's Love Day podcast.
I am so excited for this episode, which
we're going to jump right on into because
I'm not by myself today.
I am joined by a lovely lady.
I'm joined by Gretchen Zimmerman, who is a
registered dietician and has so many titles and
accolades that I could never do you justice.
(00:20):
So welcome to the show, Gretchen.
And please do a quick little rundown of
where you are in the world, what it
is that you're doing and give the explanation
that I am not able to provide you
with.
I know there's I yeah, there's a lot
of letters behind your name.
I don't know what that says about me.
But yeah, I mean, I've been in the
(00:42):
health care field for 15 years.
I'm a registered dietician.
And those those letters are just my areas
of expertise.
So I've worked in a lot of different
trials, obesity management.
I've worked in various settings inpatient outpatient settings
when I lived in San Francisco, kind of
(01:03):
on the you know, the clinical side and
then have, you know, worked in like the
leadership side.
And so I've been all over the space,
but really consistently, I've always been kind of
focused on the chronic conditions, obesity and diabetes
and weight management, some personal ties, right, to
those conditions as well.
And so, yeah, so I currently I work
(01:25):
at Vita Health, that's my full time job,
VP of clinical strategy there.
I've been there for 11 years, I started
actually as a health coach, and I've just
grown with the company and, you know, kind
of most recently have kind of co led
the development of our clinical programs, specifically obesity,
you know, GLP one management, it's the thing
(01:46):
that it's all anyone wants to talk about
now.
So that's kind of my area of expertise.
And I'm excited to be here with you
and have a conversation.
Awesome.
And one thing and correct me if I'm
wrong, but I feel like you're also not
tooting your horn well enough, because I think
I saw something that you really helped to
establish like law large scale online training for
dietitians around the country.
(02:08):
Yeah, so a lot of that has, I
used to kind of be more on like
the managing the clinical team at Vita.
I had a team of registered dietitians kind
of reporting into me, and some really wonderful,
you know, directors and managers and, and we
did, we built a diabetes program, and it
(02:29):
was provided and still is provided nationally.
So we, you know, kind of serve all
50 states.
It's evidence based.
And so yeah, I did, I played a
big role in that.
And, you know, me and my team really
making sure that all of our dietitians and
clinicians were providing that evidence based care and
through ongoing training and education and, and all
(02:51):
of that.
So yeah, that's that was kind of like
another little thing that I did.
I love it.
I feel like when I was in college,
gosh, 20 something years ago at this point
diet, nutrition as a major and becoming a
dietitian was very slim.
It wasn't really a well known thing.
And I feel like nowadays, it is, it's
(03:13):
not a surprise if you're talking to your
friend, and they're like, Oh, I'm working with
a dietitian, or my dad's going to a
diabetic nutritionist to help.
And so I really think that just the
job field in itself has really blossomed.
I think that's a beautiful thing.
And I think that online space has really
helped with that.
Absolutely, I couldn't agree more.
(03:34):
And it is, you know, it is an
exciting field to be in because you really
get to kind of choose your your passion
and where you want to go from, you
know, the different, you know, areas of specialty,
much like physicians, right, dietitians typically specialize and
in an area or two.
And so we do tend to choose that
and really kind of, you know, hone in
(03:55):
on that.
But you can do it, you can do
in those inpatient settings, you can work in
private practice, a lot of dietitians will work
in private practice.
A lot of us have just kind of
multiple little side hustles, right, different streets of
income.
And it really does lend well to I
think that entrepreneurial spirit that I think, you
know, a lot of us have in this
kind of the reason that we go into
(04:16):
the field.
But yeah, it's you really can make it
your own thing for sure.
Now, when I first reached out to you,
I had found a health article talking about,
I want to say muscle memory, because that's
such a prevalent word in my field, but
fat memory almost like the fat cells have
a memory and they want to expand.
And you're like, Yeah, I would love to
talk to you.
(04:36):
But, you know, GLP ones are also my
passion.
So we could talk about that too.
And I was like, you know what, I
actually have not done a dedicated post about
that or a podcast.
And I personally have a close family members
that have experienced like been on GLP ones
over the past couple of years.
But I would love to pick your brain
a little bit more and help educate people
(04:57):
that are listening, because I definitely feel to
in the society that we're living in, people
say, Oh, my God, you look amazing.
What did you do?
And then someone will be like, Oh, I've
been on ozimpic.
And immediately you can see that person that
they were talking to their face just kind
of goes like, Oh, you cheated.
Or, you know, it's not the same respect.
And it's just, which is very, very sad.
(05:17):
So first off, what is a GLP one
for people that are like, don't truly understand?
Yeah, so GLP ones are a type of
hormone, they're a gut hormone, they're produced by
our gut, and they're naturally made by us.
And they play a few key roles.
One is in regulating blood sugar.
(05:40):
So GLP one medications like ozimpic, for example,
one that probably almost everybody is familiar with
at this point, were originally intended for the
treatment of type two diabetes because of the
role that they play in regulating blood sugar.
And kind of, you know, found over the
years and then clinical trials is that they
(06:00):
also had this other wonderful side effect of,
you know, supporting, promoting and enhancing weight loss.
So the GLP one agonists that we hear
about ozimpic, sexcenda, wagovi, zepbown, manjaro, you know,
a lot of those are some are prescribed
and for diabetes, right.
(06:24):
And then some are used off label for
weight loss, but then we have our own
class of GLP ones now that are approved
for weight loss.
But those are really probably the most common
ones or several others in development as well.
But those medic those those GLP one agonists
are medications that essentially mimic or boost the
effects of the natural hormone that we produce
(06:45):
the GLP one.
And so what that GLP one does when
we're thinking about weight loss is it slows
the rate at which the stomach empties.
So really going to slow down digestion, which
is why, you know, you might off people
eat less, right, people are eating less when
they're on GLP one.
And that is, you know, one of the
(07:06):
kind of physiological effects and reasons for that.
They also suppress appetite.
So they're lowering food intake, they're promoting that
feeling of satiety and fullness.
And then they also have an influence on
our brains, hunger centers, right?
It's like, we can't talk about appetite and
(07:26):
gut health and digestion and weight loss without
also talking about the mind body connection and
that kind of neural connection.
And then the other thing that they do
is they get rid of food noise.
So food noise, I think, you know, it's
a lot of us have experienced this, I
think, to some extent.
People who are living with obesity probably tend
to experience it a bit more.
(07:46):
And it's just really this constant preoccupation with
food and thinking about food and, you know,
what's what am I gonna have for breakfast?
What am I gonna have for breakfast?
And then all of a sudden you're already
thinking about lunch and then already planning what
should I take out of the freezer for
dinner?
Exactly.
And it's like very consuming for people and
it takes up a lot of space in
(08:07):
the mind, space that we could be using
an energy that we could be using for
other things, other productive things in life.
And so I think that's one of the
key benefits that we're seeing too with these
GLP one agonists is that they're helping to
reduce that food noise, which I hear from
from patients and people is just liberating that
they're not thinking about food all the time.
(08:29):
Right.
That's actually exactly what my close family member
said to me as well.
Yeah, it's like, I'm just not, you know,
I eat and then I'm done and I
don't think about my next meal until it's
time to eat again.
Yes, yes.
And I think, you know, it's hard unless
you've lived with it.
It's like really hard to appreciate just how,
like I said, kind of all consuming that
(08:49):
is.
So, and that's not just with GLP ones,
you know, we tend to just talk about
GLP ones, but there are a whole host
of other medications that can be used for
weight loss that are not GLP ones.
Some of those other agents also can have
this effect in really quieting the food noise.
Just out of curiosity, has there been any
(09:10):
type of research that shows that people, because
you said it's a hormone, so people taking
it, I kind of like think of the
same thing as, you know, testosterone is really
big right now for men as they are
getting older or estrogen replacement for women.
So, you know, hormone replacement therapy.
But those are people that are also low
in the hormones.
So is there any correlation between people who
(09:31):
are obese?
Do they have naturally occurring levels of GLP
one?
That's a great question.
I don't know for sure.
I know that we are studying that.
I know that there are also other hormones
and peptides that we produce that kind of
influence some of that natural GLP one production.
(09:52):
And so to a smaller, much smaller extent,
we can kind of regulate that with the
foods that we eat, like more protein and
more fiber and things like that, that kind
of act on the small intestine.
But yeah, I definitely think that is one
theory that people who are living with obesity,
(10:12):
you know, are certainly there are hormonal imbalances
and influences there.
Yes.
I do want to talk a little bit
too about people, once you start taking a
GLP one, kind of the fears of like
what happens when it's done, because like obviously
this is still a new thing and people
are saying, well, if you take it, you've
got to be on it forever.
Or it, you know, you get the the
(10:36):
osympic face or you lose all your muscle.
But before we get to that, just speaking
on the more obesity side, I recently read
an article that you wrote talking about how
society looks at people who are obese as
a laziness issue.
And you're very much from a very empathetic
standpoint being like, this is not a laziness
issue.
This is a health issue.
So can you talk about that a little
bit more and explain it for people?
(10:58):
Yeah, absolutely.
And this can be a little contentious.
Like I've noticed that a lot of people
don't necessarily fully align on this.
And that is that obesity really needs to
be thought of as a disease like type
2 diabetes or any other chronic condition.
The American Medical Association defined it as a
disease back in 2012 or 2013, but it
(11:20):
was never really kind of fully accepted.
And and so when we kind of frame
it in that way and we think about
treatment for obesity, I think about it as
treatment for type 2 diabetes.
Some patients might need to be on a
medication to manage their type 2 diabetes for
life.
Like diet and exercise is not going to
(11:42):
be enough because there are these, you know,
actual physiological changes in their body happening with
their pancreas and things that are changing and
not going to reverse over time.
That mean they're going to need a little
extra help in the form of medication to
manage that condition.
And obesity is no different.
(12:02):
So I think, you know, you and I
probably both know and have heard this so
many times before that people like to really
oversimplify the treatment of obesity to eat less
and move more.
A lot of times I wonder how many
of those people have actually really struggled with
weight because I am also a 40 something
thing and getting into perimenopause and look, my
(12:25):
God has it just, it's, it's my, I
don't want to say my metabolism had changed.
I think it has though.
It's a lot harder to maintain weight, right?
No matter.
And you're doing the same things that you
used to do in your thirties or your
early forties.
Right.
And so I really appreciate that on a
different level now.
And so and even just talking about like
(12:45):
we did before where you have that sound
of food in your ear all the time,
obviously makes it very, very hard or like
I had an eating disorder in my early
twenties.
So that made me very hyper focused on
food, which as I got older could cause
huge issues when you're always thinking about food.
It's really hard.
And it's one of the hardest things to
(13:07):
treat and a lot of people do really
benefit from going into therapy, cognitive behavioral therapy
in particular, which addresses the thoughts and the
behaviors and the patterns around food and how
we think about food and, you know, emotional
eating, right, isn't another one.
And so, so yeah, it's, and so, so
(13:28):
obesity, you can see, right, all of the
complexities that make it hard to maintain a
healthy weight.
It is a disease and there are genetic
influences.
There are obviously metabolic, there are hormonal shifts,
especially as we get older, right?
Like we're just talking about now.
There are, you know, social and social determinants
(13:49):
of health and where people live and the
type of food that they have access to.
There are cultural influences.
It's just, it's not enough to say it's
about willpower to eat less and move more.
It's not, it's not enough, right?
Some people might respond to that, but I
think obviously our obesity rates are so high
(14:11):
now that that, that advice is just, it's,
it's not correct.
Right.
I think one of the issues and something
that does concern me again, I'm not trying
to out, I don't want to out this
person, but the person in my life, we
worry that my, for example, my dad, I
will call my dad out because I know
he doesn't listen to my podcast, but my
(14:32):
dad has high cholesterol, high blood pressure.
And so he's on medicine for that.
He's on all the things.
And because he is under control of medicine,
he goes, I'm on medicine.
It doesn't matter to me about, he doesn't
try to make his nutrition better.
He doesn't try to exercise because to him,
the medicine is controlling it.
So how can we make sure to stress
the importance of yes, while you are on
(14:52):
GLP ones and you are losing weight, it
is still important to create a healthy lifestyle
outside of that as well.
How do we balance that and educate people?
Because I don't think doctors, at least a
lot of doctors are doing a good job
of that.
Right.
Right.
With all not just weight loss with obviously
like my dad's health or type two diabetes.
Yes.
Being on medication is important, but so is
(15:13):
exercise and maintaining a balanced nutrition plan.
Yeah, absolutely.
I could not agree more.
Um, and, um, and I know that, you
know, as a site society, we do tend
to be quick, right?
So to prescribe and certainly these GLP one
medications, they were being overprescribed, right?
Because they work.
And there is going to have to be
if you felt that too.
Yeah, absolutely.
(15:34):
Yeah.
I mean, there's a demand for these medications
like I've never seen before and might never
see again in my career, right?
Because they really are effective for the majority
of the population.
Um, but the, but the problem and the
concern that I always have in the, and
the thing that we're, you know, trying to
solve for at VITA that we're solving for
is that the medication is not a silver
bullet, right?
(15:55):
Like you can't just take the medication.
Yeah, you can for a little while.
You can watch the weight melt off maybe.
Um, but there will be side effects that
will need to be managed.
There is a risk of malnutrition.
If you're not eating properly, there is a
risk of a very rapid weight loss, which
is kind of like not to sidetrack when
we talk about like osemic face and, and
(16:15):
the loss of all of that muscle mass,
um, you know, due to that fast weight
loss, like that is problematic.
Um, and then there are just other things
that we need to consider as well.
So how do we set people up for
success long-term?
Like this is really how I want to
think about things.
And it goes back to your, your question
that you had before is do we think
(16:38):
that people will get off of these medications?
Like what's the mindset around that?
Um, and before I talk about the lifestyle
management, I mean, obesity being a disease, we
might expect that some people need to be
on these medications for life.
Sure.
Maybe we can titrate them down and get
them to a lower dose and they can
sustain that over time.
Um, but that's just the weight, right?
(17:00):
You need to think more about cardio metabolic
health.
And so what influences cardio metabolic health exercise,
right?
The cardio, cardiovascular health exercise, the cardiovascular training,
um, the physical activity that is also play
an effect on increasing the body's natural ability
to have GLP ones.
(17:20):
Uh, great question.
I don't know.
I would have to get back to you
on that seat.
I'm so focused on the nutrition piece.
And I just popping up with these, like
kind of as we get into pulling it.
Yeah.
Yeah.
Exercise plays a role on testosterone production and
estrogen production.
So just kind of throwing it out there.
And it does help to regulate imbalance or
(17:43):
hormones.
And so I would imagine that there is
a positive effect there as well.
Um, but yeah, nutrition certainly, right?
So we know that exercise is really key
here.
So is stress management.
So is sleep health.
Um, but when it comes to, to nutrition,
it's like, if we take away the focus
from just the number on the scale and
overall metabolic health, how are we then fueling
(18:05):
our bodies, right?
And how are we, um, kind of thinking
about nutrition?
We need to make sure we're getting enough
protein, um, to maintain that muscle mass.
And we need to make sure we're eating
our fruits and vegetables and our whole grains
so we can get enough fiber because that's
going to be good for GI health and
cholesterol and kind of other cardio metabolic conditions.
(18:27):
Um, we need to think about choosing foods
that are anti-inflammatory.
So salmon, nuts, um, you know, olive oil,
kind of those healthy fats, because when we're
in a state of inflammation, like a lot
of people who are living with obesity are
that just contributes to other diseases down the
road.
And so the nutrition is really kind of
(18:49):
the key, the, the, the, the, the, the
thing that in physical activity, they're going to
really translate to long-term metabolic health, uh,
and overall health and just getting away from
just the number on the scale.
Right.
Which is so sad because at least in
America, obviously nutrition is not something that's really
taught to us in health schools where we
(19:10):
learn what we see in our, in our
family and in our life.
Um, so do you think, and I don't
know if there's ever been a medication that's
where this has been required, but I know
things like bariatric, like gastro, when you get
your stomach, what's the word I'm looking for?
Very, I'm sure surgery.
Thank you.
Yes.
A lot of times people are required to
(19:31):
go through like counseling beforehand, make sure they're
in the mental headspace for it, to know
how they're going to handle it when the
procedure is completely done in their recovery.
Do you think that people that are getting
ready to go on something like GLP one
and go, let's say, if you've got, I'd
say anything 50 pounds and over is a
significant amount of weight loss.
Um, should those patients possibly have to go
(19:53):
through some sort of counseling program before getting
started so that they learned these things?
Yeah, absolutely.
Um, and of course I am biased and
I think that everybody should have access to
and work with a registered dietitian so that
they can get medical nutrition therapy, which is
going to be very personalized and prescriptive for
them and their body and their life circumstances.
(20:15):
Um, but yeah, I mean, what you're kind
of thinking about with, I used to work
in bariatrics and, and I do think there's
a lot of parallel, um, in terms of
how we should be providing care between patients
who might be undergoing a gastric surgery versus
patients who are going to go on a
GLP one, which is potentially a treatment for
life, similar to, to bariatrics.
(20:36):
And, um, one of the things that I
used to see in working with bariatric patients
is, you know, you can, you can go
through this very extreme surgery, right?
This, and it's a big deal, right?
To, to have to go through there's risks,
there's potential complications.
Um, but if we're not managing the behaviors
(20:56):
and the, the mental health, right?
And the depression and the anxiety and some
of those other kind of disordered behaviors, people
aren't going to be successful and they'll gain
the weight back and they'll stretch their stomach.
Some of them might need to have a
revision surgery, uh, all because they, you know,
they kind of, obesity was a symptom versus
symptom.
(21:16):
Exactly.
Right.
Exactly.
Yeah.
And it's like, I think we need to
shift to thinking about these things as tools.
They are not the magic bullet, the GLP
one, the bariatric surgery, they are a tool
for managing obesity and we need all of
the other surrounding lifestyle modifications.
So the, the nutrition, again, I like, I
(21:37):
like to think a lot about long-term,
like a year down the road and two
years down the road, because what we typically
see with patients who have been on diets
is yo-yo dieting, right?
Like they lose the weight, they gain it
back.
And then some, then they go on another
extreme fat diet, they lose the weight, they
gain it back.
And then some metabolically, that's terrible for us
(22:01):
because you probably know from working with people
over the years, like generally when people are
gaining weight back after losing it, it's, they're
not gaining muscle mass, right?
It's probably more fat.
Um, and fat is not metabolically healthy.
And so, um, we want to prevent that
as much as possible, right?
We want to prevent people from just going
(22:22):
off of these medications, not having had the
right lifestyle support while they were on it.
And then just gaining all of that weight
back.
Sure.
Now let's talk about that.
You mentioned about muscle loss.
Why is it, um, that we see the
ozimpic face or a lot of tone, like
a lot of times, yes, they've lost weight,
but you can tell that a lot of
people, because they've lost weight so fast, they
(22:43):
look frail.
How can anyone that's even thinking about taking
ozimpic or whatever thing their doctor wants to
prescribe, what should they kind of consider before
going into it?
Yeah.
So it is totally normal.
First of all, when you lose weight, you
lose muscle mass, you lose fat, here's water,
(23:05):
right?
Especially initially, there's a lot of water loss.
Um, and it is normal to a certain
extent that when you lose overall body weight,
you're going to lose those different components.
Um, but the question is how, you know,
how much can we prevent and hold on
to that muscle mass as much as possible?
Um, you know, a lot of people, sometimes,
especially patients who are living with more severe
obesity and have been living that way for
(23:27):
a long time and are carrying that excess
muscle mass, or I'm sorry, fat, fat, um,
if they lose a drastic amount of weight,
especially if they're older, the skin just doesn't
have the elasticity to really like, kind of
bounce back.
Um, and so there's that, right?
There's that aspect.
Um, and then I think what we're seeing
(23:48):
with the GLP ones is that there's such
a severe reduction in caloric intake.
Like, so I've heard, you know, just kind
of, and I can see it in patients
that sometimes patients will not even have a
cat, getting a thousand calories a day.
Right.
And that is just, it's too low.
It's not sustainable.
Your body needs energy.
Body needs energy.
(24:08):
Yeah.
And so, um, that goes on for too
long.
You run into the malnutrition, but then you're
also seeing rapid weight loss and you can't
help but lose more muscle mass when you're
experiencing rapid weight loss, uh, than you would
if it were like a slow steady weight
loss where you're working with a dietician or
someone who specializes in nutrition, you're getting in
(24:30):
enough calories, getting in enough protein to maintain,
and you're doing the physical activity to maintain
as much of that mass as possible.
But, but the, but the point is, is
to a certain extent, it's normal.
We need to really kind of monitor the
weight, the rate at which people are losing
weight.
Right.
And talking, you're obviously bringing from the nutrition
(24:51):
side.
I'll quickly speak for the exercise side.
You know, when you're in a caloric deficit,
your body doesn't want to be in a
caloric deficit.
So it's trying to figure out, I don't
want to be here.
How can I bring my caloric needs down
to what I'm being given and muscle being
more metabolically active than fat?
Obviously it's like, well, you're not using this
muscle if you're not working out.
(25:11):
Right.
So let's just go ahead and burn some
of this down.
That way I need less calories.
So you guys listening.
This is why strength training is so important
because if you use your muscles on a
regular basis, your body goes, well, I can't
get rid of the muscle because it doesn't
know if you're lifting a weight at a,
you know, in a gym or if you're
trying to build a house in the woods,
all it knows is that you're using your
(25:33):
muscles.
So in order for your body to go,
Oh my gosh, I need to maintain this
muscle mass so that I can survive and
lift up this tree tomorrow.
It goes, okay, let's focus a little bit
more on the fat instead.
Yes.
Agree.
Yeah.
Thank you for saying that.
I think that's the other really important piece.
Exactly.
It's why the two go so hand in
(25:53):
hand together.
And I think it's really important that, you
know, if doctors are going to talk to
their patients about getting on any kind of
medicine, it's like, we got to make sure
that their nutrition is balanced and they're moving
their body in the right way.
Why is it that you think that people
are embarrassed to tell people what their weight
(26:14):
loss rate.
I know some people that have lost over
a hundred pounds and they have never actually
admitted to the fact of how they went
about doing it.
Why is it something that's almost we want
to put it, push it under the rug.
Yeah.
And there is that stigma for sure.
And that is, I think why a lot
of people who are going on these medications
also go off at some point because of
(26:37):
whatever it is, the embarrassment, the shame, the
stigma.
And I think that, you know, at the
root of it is like, we're just afraid
that people are going to judge us for
taking the easy way out.
And it is by no means the easy
way out, especially if you're doing it the
right way.
But I really, I think that's what it
comes down to.
And unfortunately, a lot of that does still
(26:58):
persist.
And I think, I think what's also unfortunate
now, and I don't know if you agree
with me or not, but like the mindset
is that when we do see someone who's
lost a lot of weight, now we just
automatically think they must have done it with
a weight loss drug.
They couldn't have done it, the exercise and
diet route on their own.
(27:19):
Yeah.
And I think that's really unfortunate.
And it is like, we have to catch
ourselves, right?
Because that is a judgment.
These are medications that have a lot of
potential benefit, not just for weight loss, but
for improving overall health.
And when they're used correctly, they're, they're, they're
(27:40):
very, they're a very appropriate treatment.
You know, the, the, not to get too
clinical or whatever, the FDA does say that
for patients who are going on these medications,
they need to be delivered in tandem with
the lifestyle management.
So we need to, I think, when we
see people on these medications, like, you know,
shift our mindset a little bit and hope
(28:01):
and think that they're also doing the work
they're putting in the work, they're changing their
nutrition, because it makes them feel better.
And they're doing that physical activity because it
makes them feel better.
But certainly, I think we have, it's like
a new stigma that we're seeing.
Yeah.
Which is so sad because the point that
they, not the only reason, of course, a
(28:21):
lot of people want to get healthier for
that's the reason for weight loss, but at
the heart of it as well as they're
embarrassed, right?
People are judging me because I'm quote unquote
fat and I'm obese.
And so then they finally start to lose
this weight and they're working to do that.
And then they're feel shame and embarrassment again,
because they're on a GLP one, right?
(28:42):
It's like, you just can't catch a break
and that's really makes my heart sad.
I mine too.
And it's such a good point.
And it's so important that you said that
because yes, our, you know, people who are
living with obesity do experience that shame and
that judgment and they feel it in all
sorts of ways that people with thin privilege
(29:02):
don't and can't understand because they haven't lived
it.
Um, they experience it when they, you know,
when they go to their two different medical
providers, right?
Um, I think our some of our medical
providers are not intentionally that way, but, um,
can, can definitely throw some kind of shame.
Um, and just eat less, move more and
(29:24):
really like perpetuate that whole, um, idea that
it's just a matter of willpower.
And, you know, it's all your fault.
You're lazy.
You're not doing this right.
And so we, there's a, this is why
I like to talk about obesity as a
disease because I really, I, I hope that
it can start to remove some of that
shame and stigma.
(29:46):
Yeah.
Uh, I know that we are starting to
get close on time.
The last thing I won't talk about is
you had mentioned that you agreed that it's
being overprescribed, right?
Like I had a friend who is not
overweight at all.
(Transcribed by TurboScribe.ai. Go Unlimited to remove this message.) What's up, guys?
Welcome to a brand new episode of the
Fit Women's Love Day podcast.
I am so excited for this episode, which
we're going to jump right on into because
I'm not by myself today.
I am joined by a lovely lady.
I'm joined by Gretchen Zimmerman, who is a
registered dietician and has so many titles and
accolades that I could never do you justice.
(00:20):
So welcome to the show, Gretchen.
And please do a quick little rundown of
where you are in the world, what it
is that you're doing and give the explanation
that I am not able to provide you
with.
I know there's I yeah, there's a lot
of letters behind your name.
I don't know what that says about me.
But yeah, I mean, I've been in the
(00:42):
health care field for 15 years.
I'm a registered dietician.
And those those letters are just my areas
of expertise.
So I've worked in a lot of different
trials, obesity management.
I've worked in various settings inpatient outpatient settings
when I lived in San Francisco, kind of
(01:03):
on the you know, the clinical side and
then have, you know, worked in like the
leadership side.
And so I've been all over the space,
but really consistently, I've always been kind of
focused on the chronic conditions, obesity and diabetes
and weight management, some personal ties, right, to
those conditions as well.
And so, yeah, so I currently I work
(01:25):
at Vita Health, that's my full time job,
VP of clinical strategy there.
I've been there for 11 years, I started
actually as a health coach, and I've just
grown with the company and, you know, kind
of most recently have kind of co led
the development of our clinical programs, specifically obesity,
you know, GLP one management, it's the thing
(01:46):
that it's all anyone wants to talk about
now.
So that's kind of my area of expertise.
And I'm excited to be here with you
and have a conversation.
Awesome.
And one thing and correct me if I'm
wrong, but I feel like you're also not
tooting your horn well enough, because I think
I saw something that you really helped to
establish like law large scale online training for
dietitians around the country.
(02:08):
Yeah, so a lot of that has, I
used to kind of be more on like
the managing the clinical team at Vita.
I had a team of registered dietitians kind
of reporting into me, and some really wonderful,
you know, directors and managers and, and we
did, we built a diabetes program, and it
(02:29):
was provided and still is provided nationally.
So we, you know, kind of serve all
50 states.
It's evidence based.
And so yeah, I did, I played a
big role in that.
And, you know, me and my team really
making sure that all of our dietitians and
clinicians were providing that evidence based care and
through ongoing training and education and, and all
(02:51):
of that.
So yeah, that's that was kind of like
another little thing that I did.
I love it.
I feel like when I was in college,
gosh, 20 something years ago at this point
diet, nutrition as a major and becoming a
dietitian was very slim.
It wasn't really a well known thing.
And I feel like nowadays, it is, it's
(03:13):
not a surprise if you're talking to your
friend, and they're like, Oh, I'm working with
a dietitian, or my dad's going to a
diabetic nutritionist to help.
And so I really think that just the
job field in itself has really blossomed.
I think that's a beautiful thing.
And I think that online space has really
helped with that.
Absolutely, I couldn't agree more.
(03:34):
And it is, you know, it is an
exciting field to be in because you really
get to kind of choose your your passion
and where you want to go from, you
know, the different, you know, areas of specialty,
much like physicians, right, dietitians typically specialize and
in an area or two.
And so we do tend to choose that
and really kind of, you know, hone in
(03:55):
on that.
But you can do it, you can do
in those inpatient settings, you can work in
private practice, a lot of dietitians will work
in private practice.
A lot of us have just kind of
multiple little side hustles, right, different streets of
income.
And it really does lend well to I
think that entrepreneurial spirit that I think, you
know, a lot of us have in this
kind of the reason that we go into
(04:16):
the field.
But yeah, it's you really can make it
your own thing for sure.
Now, when I first reached out to you,
I had found a health article talking about,
I want to say muscle memory, because that's
such a prevalent word in my field, but
fat memory almost like the fat cells have
a memory and they want to expand.
And you're like, Yeah, I would love to
talk to you.
(04:36):
But, you know, GLP ones are also my
passion.
So we could talk about that too.
And I was like, you know what, I
actually have not done a dedicated post about
that or a podcast.
And I personally have a close family members
that have experienced like been on GLP ones
over the past couple of years.
But I would love to pick your brain
a little bit more and help educate people
(04:57):
that are listening, because I definitely feel to
in the society that we're living in, people
say, Oh, my God, you look amazing.
What did you do?
And then someone will be like, Oh, I've
been on ozimpic.
And immediately you can see that person that
they were talking to their face just kind
of goes like, Oh, you cheated.
Or, you know, it's not the same respect.
And it's just, which is very, very sad.
(05:17):
So first off, what is a GLP one
for people that are like, don't truly understand?
Yeah, so GLP ones are a type of
hormone, they're a gut hormone, they're produced by
our gut, and they're naturally made by us.
And they play a few key roles.
One is in regulating blood sugar.
(05:40):
So GLP one medications like ozimpic, for example,
one that probably almost everybody is familiar with
at this point, were originally intended for the
treatment of type two diabetes because of the
role that they play in regulating blood sugar.
And kind of, you know, found over the
years and then clinical trials is that they
(06:00):
also had this other wonderful side effect of,
you know, supporting, promoting and enhancing weight loss.
So the GLP one agonists that we hear
about ozimpic, sexcenda, wagovi, zepbown, manjaro, you know,
a lot of those are some are prescribed
and for diabetes, right.
(06:24):
And then some are used off label for
weight loss, but then we have our own
class of GLP ones now that are approved
for weight loss.
But those are really probably the most common
ones or several others in development as well.
But those medic those those GLP one agonists
are medications that essentially mimic or boost the
effects of the natural hormone that we produce
(06:45):
the GLP one.
And so what that GLP one does when
we're thinking about weight loss is it slows
the rate at which the stomach empties.
So really going to slow down digestion, which
is why, you know, you might off people
eat less, right, people are eating less when
they're on GLP one.
And that is, you know, one of the
(07:06):
kind of physiological effects and reasons for that.
They also suppress appetite.
So they're lowering food intake, they're promoting that
feeling of satiety and fullness.
And then they also have an influence on
our brains, hunger centers, right?
It's like, we can't talk about appetite and
(07:26):
gut health and digestion and weight loss without
also talking about the mind body connection and
that kind of neural connection.
And then the other thing that they do
is they get rid of food noise.
So food noise, I think, you know, it's
a lot of us have experienced this, I
think, to some extent.
People who are living with obesity probably tend
to experience it a bit more.
(07:46):
And it's just really this constant preoccupation with
food and thinking about food and, you know,
what's what am I gonna have for breakfast?
What am I gonna have for breakfast?
And then all of a sudden you're already
thinking about lunch and then already planning what
should I take out of the freezer for
dinner?
Exactly.
And it's like very consuming for people and
it takes up a lot of space in
(08:07):
the mind, space that we could be using
an energy that we could be using for
other things, other productive things in life.
And so I think that's one of the
key benefits that we're seeing too with these
GLP one agonists is that they're helping to
reduce that food noise, which I hear from
from patients and people is just liberating that
they're not thinking about food all the time.
(08:29):
Right.
That's actually exactly what my close family member
said to me as well.
Yeah, it's like, I'm just not, you know,
I eat and then I'm done and I
don't think about my next meal until it's
time to eat again.
Yes, yes.
And I think, you know, it's hard unless
you've lived with it.
It's like really hard to appreciate just how,
like I said, kind of all consuming that
(08:49):
is.
So, and that's not just with GLP ones,
you know, we tend to just talk about
GLP ones, but there are a whole host
of other medications that can be used for
weight loss that are not GLP ones.
Some of those other agents also can have
this effect in really quieting the food noise.
Just out of curiosity, has there been any
(09:10):
type of research that shows that people, because
you said it's a hormone, so people taking
it, I kind of like think of the
same thing as, you know, testosterone is really
big right now for men as they are
getting older or estrogen replacement for women.
So, you know, hormone replacement therapy.
But those are people that are also low
in the hormones.
So is there any correlation between people who
(09:31):
are obese?
Do they have naturally occurring levels of GLP
one?
That's a great question.
I don't know for sure.
I know that we are studying that.
I know that there are also other hormones
and peptides that we produce that kind of
influence some of that natural GLP one production.
(09:52):
And so to a smaller, much smaller extent,
we can kind of regulate that with the
foods that we eat, like more protein and
more fiber and things like that, that kind
of act on the small intestine.
But yeah, I definitely think that is one
theory that people who are living with obesity,
(10:12):
you know, are certainly there are hormonal imbalances
and influences there.
Yes.
I do want to talk a little bit
too about people, once you start taking a
GLP one, kind of the fears of like
what happens when it's done, because like obviously
this is still a new thing and people
are saying, well, if you take it, you've
got to be on it forever.
Or it, you know, you get the the
(10:36):
osympic face or you lose all your muscle.
But before we get to that, just speaking
on the more obesity side, I recently read
an article that you wrote talking about how
society looks at people who are obese as
a laziness issue.
And you're very much from a very empathetic
standpoint being like, this is not a laziness
issue.
This is a health issue.
So can you talk about that a little
bit more and explain it for people?
(10:58):
Yeah, absolutely.
And this can be a little contentious.
Like I've noticed that a lot of people
don't necessarily fully align on this.
And that is that obesity really needs to
be thought of as a disease like type
2 diabetes or any other chronic condition.
The American Medical Association defined it as a
disease back in 2012 or 2013, but it
(11:20):
was never really kind of fully accepted.
And and so when we kind of frame
it in that way and we think about
treatment for obesity, I think about it as
treatment for type 2 diabetes.
Some patients might need to be on a
medication to manage their type 2 diabetes for
life.
Like diet and exercise is not going to
(11:42):
be enough because there are these, you know,
actual physiological changes in their body happening with
their pancreas and things that are changing and
not going to reverse over time.
That mean they're going to need a little
extra help in the form of medication to
manage that condition.
And obesity is no different.
(12:02):
So I think, you know, you and I
probably both know and have heard this so
many times before that people like to really
oversimplify the treatment of obesity to eat less
and move more.
A lot of times I wonder how many
of those people have actually really struggled with
weight because I am also a 40 something
thing and getting into perimenopause and look, my
(12:25):
God has it just, it's, it's my, I
don't want to say my metabolism had changed.
I think it has though.
It's a lot harder to maintain weight, right?
No matter.
And you're doing the same things that you
used to do in your thirties or your
early forties.
Right.
And so I really appreciate that on a
different level now.
And so and even just talking about like
(12:45):
we did before where you have that sound
of food in your ear all the time,
obviously makes it very, very hard or like
I had an eating disorder in my early
twenties.
So that made me very hyper focused on
food, which as I got older could cause
huge issues when you're always thinking about food.
It's really hard.
And it's one of the hardest things to
(13:07):
treat and a lot of people do really
benefit from going into therapy, cognitive behavioral therapy
in particular, which addresses the thoughts and the
behaviors and the patterns around food and how
we think about food and, you know, emotional
eating, right, isn't another one.
And so, so yeah, it's, and so, so
(13:28):
obesity, you can see, right, all of the
complexities that make it hard to maintain a
healthy weight.
It is a disease and there are genetic
influences.
There are obviously metabolic, there are hormonal shifts,
especially as we get older, right?
Like we're just talking about now.
There are, you know, social and social determinants
(13:49):
of health and where people live and the
type of food that they have access to.
There are cultural influences.
It's just, it's not enough to say it's
about willpower to eat less and move more.
It's not, it's not enough, right?
Some people might respond to that, but I
think obviously our obesity rates are so high
(14:11):
now that that, that advice is just, it's,
it's not correct.
Right.
I think one of the issues and something
that does concern me again, I'm not trying
to out, I don't want to out this
person, but the person in my life, we
worry that my, for example, my dad, I
will call my dad out because I know
he doesn't listen to my podcast, but my
(14:32):
dad has high cholesterol, high blood pressure.
And so he's on medicine for that.
He's on all the things.
And because he is under control of medicine,
he goes, I'm on medicine.
It doesn't matter to me about, he doesn't
try to make his nutrition better.
He doesn't try to exercise because to him,
the medicine is controlling it.
So how can we make sure to stress
the importance of yes, while you are on
(14:52):
GLP ones and you are losing weight, it
is still important to create a healthy lifestyle
outside of that as well.
How do we balance that and educate people?
Because I don't think doctors, at least a
lot of doctors are doing a good job
of that.
Right.
Right.
With all not just weight loss with obviously
like my dad's health or type two diabetes.
Yes.
Being on medication is important, but so is
(15:13):
exercise and maintaining a balanced nutrition plan.
Yeah, absolutely.
I could not agree more.
Um, and, um, and I know that, you
know, as a site society, we do tend
to be quick, right?
So to prescribe and certainly these GLP one
medications, they were being overprescribed, right?
Because they work.
And there is going to have to be
if you felt that too.
Yeah, absolutely.
(15:34):
Yeah.
I mean, there's a demand for these medications
like I've never seen before and might never
see again in my career, right?
Because they really are effective for the majority
of the population.
Um, but the, but the problem and the
concern that I always have in the, and
the thing that we're, you know, trying to
solve for at VITA that we're solving for
is that the medication is not a silver
bullet, right?
(15:55):
Like you can't just take the medication.
Yeah, you can for a little while.
You can watch the weight melt off maybe.
Um, but there will be side effects that
will need to be managed.
There is a risk of malnutrition.
If you're not eating properly, there is a
risk of a very rapid weight loss, which
is kind of like not to sidetrack when
we talk about like osemic face and, and
(16:15):
the loss of all of that muscle mass,
um, you know, due to that fast weight
loss, like that is problematic.
Um, and then there are just other things
that we need to consider as well.
So how do we set people up for
success long-term?
Like this is really how I want to
think about things.
And it goes back to your, your question
that you had before is do we think
(16:38):
that people will get off of these medications?
Like what's the mindset around that?
Um, and before I talk about the lifestyle
management, I mean, obesity being a disease, we
might expect that some people need to be
on these medications for life.
Sure.
Maybe we can titrate them down and get
them to a lower dose and they can
sustain that over time.
Um, but that's just the weight, right?
(17:00):
You need to think more about cardio metabolic
health.
And so what influences cardio metabolic health exercise,
right?
The cardio, cardiovascular health exercise, the cardiovascular training,
um, the physical activity that is also play
an effect on increasing the body's natural ability
to have GLP ones.
(17:20):
Uh, great question.
I don't know.
I would have to get back to you
on that seat.
I'm so focused on the nutrition piece.
And I just popping up with these, like
kind of as we get into pulling it.
Yeah.
Yeah.
Exercise plays a role on testosterone production and
estrogen production.
So just kind of throwing it out there.
And it does help to regulate imbalance or
(17:43):
hormones.
And so I would imagine that there is
a positive effect there as well.
Um, but yeah, nutrition certainly, right?
So we know that exercise is really key
here.
So is stress management.
So is sleep health.
Um, but when it comes to, to nutrition,
it's like, if we take away the focus
from just the number on the scale and
overall metabolic health, how are we then fueling
(18:05):
our bodies, right?
And how are we, um, kind of thinking
about nutrition?
We need to make sure we're getting enough
protein, um, to maintain that muscle mass.
And we need to make sure we're eating
our fruits and vegetables and our whole grains
so we can get enough fiber because that's
going to be good for GI health and
cholesterol and kind of other cardio metabolic conditions.
(18:27):
Um, we need to think about choosing foods
that are anti-inflammatory.
So salmon, nuts, um, you know, olive oil,
kind of those healthy fats, because when we're
in a state of inflammation, like a lot
of people who are living with obesity are
that just contributes to other diseases down the
road.
And so the nutrition is really kind of
(18:49):
the key, the, the, the, the, the, the
thing that in physical activity, they're going to
really translate to long-term metabolic health, uh,
and overall health and just getting away from
just the number on the scale.
Right.
Which is so sad because at least in
America, obviously nutrition is not something that's really
taught to us in health schools where we
(19:10):
learn what we see in our, in our
family and in our life.
Um, so do you think, and I don't
know if there's ever been a medication that's
where this has been required, but I know
things like bariatric, like gastro, when you get
your stomach, what's the word I'm looking for?
Very, I'm sure surgery.
Thank you.
Yes.
A lot of times people are required to
(19:31):
go through like counseling beforehand, make sure they're
in the mental headspace for it, to know
how they're going to handle it when the
procedure is completely done in their recovery.
Do you think that people that are getting
ready to go on something like GLP one
and go, let's say, if you've got, I'd
say anything 50 pounds and over is a
significant amount of weight loss.
Um, should those patients possibly have to go
(19:53):
through some sort of counseling program before getting
started so that they learned these things?
Yeah, absolutely.
Um, and of course I am biased and
I think that everybody should have access to
and work with a registered dietitian so that
they can get medical nutrition therapy, which is
going to be very personalized and prescriptive for
them and their body and their life circumstances.
(20:15):
Um, but yeah, I mean, what you're kind
of thinking about with, I used to work
in bariatrics and, and I do think there's
a lot of parallel, um, in terms of
how we should be providing care between patients
who might be undergoing a gastric surgery versus
patients who are going to go on a
GLP one, which is potentially a treatment for
life, similar to, to bariatrics.
(20:36):
And, um, one of the things that I
used to see in working with bariatric patients
is, you know, you can, you can go
through this very extreme surgery, right?
This, and it's a big deal, right?
To, to have to go through there's risks,
there's potential complications.
Um, but if we're not managing the behaviors
(20:56):
and the, the mental health, right?
And the depression and the anxiety and some
of those other kind of disordered behaviors, people
aren't going to be successful and they'll gain
the weight back and they'll stretch their stomach.
Some of them might need to have a
revision surgery, uh, all because they, you know,
they kind of, obesity was a symptom versus
symptom.
(21:16):
Exactly.
Right.
Exactly.
Yeah.
And it's like, I think we need to
shift to thinking about these things as tools.
They are not the magic bullet, the GLP
one, the bariatric surgery, they are a tool
for managing obesity and we need all of
the other surrounding lifestyle modifications.
So the, the nutrition, again, I like, I
(21:37):
like to think a lot about long-term,
like a year down the road and two
years down the road, because what we typically
see with patients who have been on diets
is yo-yo dieting, right?
Like they lose the weight, they gain it
back.
And then some, then they go on another
extreme fat diet, they lose the weight, they
gain it back.
And then some metabolically, that's terrible for us
(22:01):
because you probably know from working with people
over the years, like generally when people are
gaining weight back after losing it, it's, they're
not gaining muscle mass, right?
It's probably more fat.
Um, and fat is not metabolically healthy.
And so, um, we want to prevent that
as much as possible, right?
We want to prevent people from just going
(22:22):
off of these medications, not having had the
right lifestyle support while they were on it.
And then just gaining all of that weight
back.
Sure.
Now let's talk about that.
You mentioned about muscle loss.
Why is it, um, that we see the
ozimpic face or a lot of tone, like
a lot of times, yes, they've lost weight,
but you can tell that a lot of
people, because they've lost weight so fast, they
(22:43):
look frail.
How can anyone that's even thinking about taking
ozimpic or whatever thing their doctor wants to
prescribe, what should they kind of consider before
going into it?
Yeah.
So it is totally normal.
First of all, when you lose weight, you
lose muscle mass, you lose fat, here's water,
(23:05):
right?
Especially initially, there's a lot of water loss.
Um, and it is normal to a certain
extent that when you lose overall body weight,
you're going to lose those different components.
Um, but the question is how, you know,
how much can we prevent and hold on
to that muscle mass as much as possible?
Um, you know, a lot of people, sometimes,
especially patients who are living with more severe
obesity and have been living that way for
(23:27):
a long time and are carrying that excess
muscle mass, or I'm sorry, fat, fat, um,
if they lose a drastic amount of weight,
especially if they're older, the skin just doesn't
have the elasticity to really like, kind of
bounce back.
Um, and so there's that, right?
There's that aspect.
Um, and then I think what we're seeing
(23:48):
with the GLP ones is that there's such
a severe reduction in caloric intake.
Like, so I've heard, you know, just kind
of, and I can see it in patients
that sometimes patients will not even have a
cat, getting a thousand calories a day.
Right.
And that is just, it's too low.
It's not sustainable.
Your body needs energy.
Body needs energy.
(24:08):
Yeah.
And so, um, that goes on for too
long.
You run into the malnutrition, but then you're
also seeing rapid weight loss and you can't
help but lose more muscle mass when you're
experiencing rapid weight loss, uh, than you would
if it were like a slow steady weight
loss where you're working with a dietician or
someone who specializes in nutrition, you're getting in
(24:30):
enough calories, getting in enough protein to maintain,
and you're doing the physical activity to maintain
as much of that mass as possible.
But, but the, but the point is, is
to a certain extent, it's normal.
We need to really kind of monitor the
weight, the rate at which people are losing
weight.
Right.
And talking, you're obviously bringing from the nutrition
(24:51):
side.
I'll quickly speak for the exercise side.
You know, when you're in a caloric deficit,
your body doesn't want to be in a
caloric deficit.
So it's trying to figure out, I don't
want to be here.
How can I bring my caloric needs down
to what I'm being given and muscle being
more metabolically active than fat?
Obviously it's like, well, you're not using this
muscle if you're not working out.
(25:11):
Right.
So let's just go ahead and burn some
of this down.
That way I need less calories.
So you guys listening.
This is why strength training is so important
because if you use your muscles on a
regular basis, your body goes, well, I can't
get rid of the muscle because it doesn't
know if you're lifting a weight at a,
you know, in a gym or if you're
trying to build a house in the woods,
all it knows is that you're using your
(25:33):
muscles.
So in order for your body to go,
Oh my gosh, I need to maintain this
muscle mass so that I can survive and
lift up this tree tomorrow.
It goes, okay, let's focus a little bit
more on the fat instead.
Yes.
Agree.
Yeah.
Thank you for saying that.
I think that's the other really important piece.
Exactly.
It's why the two go so hand in
(25:53):
hand together.
And I think it's really important that, you
know, if doctors are going to talk to
their patients about getting on any kind of
medicine, it's like, we got to make sure
that their nutrition is balanced and they're moving
their body in the right way.
Why is it that you think that people
are embarrassed to tell people what their weight
(26:14):
loss rate.
I know some people that have lost over
a hundred pounds and they have never actually
admitted to the fact of how they went
about doing it.
Why is it something that's almost we want
to put it, push it under the rug.
Yeah.
And there is that stigma for sure.
And that is, I think why a lot
of people who are going on these medications
also go off at some point because of
(26:37):
whatever it is, the embarrassment, the shame, the
stigma.
And I think that, you know, at the
root of it is like, we're just afraid
that people are going to judge us for
taking the easy way out.
And it is by no means the easy
way out, especially if you're doing it the
right way.
But I really, I think that's what it
comes down to.
And unfortunately, a lot of that does still
(26:58):
persist.
And I think, I think what's also unfortunate
now, and I don't know if you agree
with me or not, but like the mindset
is that when we do see someone who's
lost a lot of weight, now we just
automatically think they must have done it with
a weight loss drug.
They couldn't have done it, the exercise and
diet route on their own.
(27:19):
Yeah.
And I think that's really unfortunate.
And it is like, we have to catch
ourselves, right?
Because that is a judgment.
These are medications that have a lot of
potential benefit, not just for weight loss, but
for improving overall health.
And when they're used correctly, they're, they're, they're
(27:40):
very, they're a very appropriate treatment.
You know, the, the, not to get too
clinical or whatever, the FDA does say that
for patients who are going on these medications,
they need to be delivered in tandem with
the lifestyle management.
So we need to, I think, when we
see people on these medications, like, you know,
shift our mindset a little bit and hope
(28:01):
and think that they're also doing the work
they're putting in the work, they're changing their
nutrition, because it makes them feel better.
And they're doing that physical activity because it
makes them feel better.
But certainly, I think we have, it's like
a new stigma that we're seeing.
Yeah.
Which is so sad because the point that
they, not the only reason, of course, a
(28:21):
lot of people want to get healthier for
that's the reason for weight loss, but at
the heart of it as well as they're
embarrassed, right?
People are judging me because I'm quote unquote
fat and I'm obese.
And so then they finally start to lose
this weight and they're working to do that.
And then they're feel shame and embarrassment again,
because they're on a GLP one, right?
(28:42):
It's like, you just can't catch a break
and that's really makes my heart sad.
I mine too.
And it's such a good point.
And it's so important that you said that
because yes, our, you know, people who are
living with obesity do experience that shame and
that judgment and they feel it in all
sorts of ways that people with thin privilege
(29:02):
don't and can't understand because they haven't lived
it.
Um, they experience it when they, you know,
when they go to their two different medical
providers, right?
Um, I think our some of our medical
providers are not intentionally that way, but, um,
can, can definitely throw some kind of shame.
Um, and just eat less, move more and
(29:24):
really like perpetuate that whole, um, idea that
it's just a matter of willpower.
And, you know, it's all your fault.
You're lazy.
You're not doing this right.
And so we, there's a, this is why
I like to talk about obesity as a
disease because I really, I, I hope that
it can start to remove some of that
shame and stigma.
(29:46):
Yeah.
Uh, I know that we are starting to
get close on time.
The last thing I won't talk about is
you had mentioned that you agreed that it's
being overprescribed, right?
Like I had a friend who is not
overweight at all.
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