February 26, 2025 • 49 mins
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What To Do When You Overeat–During Weight Loss!
This is the episode you’ve been waiting for–all things weight loss medications! Not only will we deep dive on the GLP-1 class of medications but Dr. Ogle, a double board certified family medicine and obesity medicine specialist, will also detail out the other options out there.
You will learn what you would need to do while on these medications, the 4 pillars of obesity medicine, as well as the options for weaning off. Although Dr. Ogle isn’t your physician, you will gain tons of insight as to whether or not you should speak to your physician about adding a medication to your weight loss plan.
You’ll hear us speak several times during the episode about how coaching and support is still vital, even if you decide to add medication–so this isn’t an either/or type situation as far as coaching vs. medications is concerned.
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- Schedule your free consult session: wellwithlisa.as.me
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More from Dr. Lindsay Ogle:
- Website: missourimetabolichealth.com
- Instagram: @dr.lindsayogle
- YouTube: Here
About Dr. Ogle:
Dr. Lindsay Ogle, MD is a board certified family & obesity medicine physician who is passionate about preventative health. Her goal is to help patients stay healthy so they may live longer and fuller lives. She recently started a telehealth clinic called Missouri Metabolic Health where she helps adults all throughout the state of Missouri treat and prevent metabolic conditions (ex: diabetes, fatty liver disease, metabolic syndrome, overweight and obesity) through lifestyle optimization and utilizations of safe and effective medications.
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Transcript
Episode Transcript
Available transcripts are automatically generated. Complete accuracy is not guaranteed.
(00:00):
This is the eat well, thinkwell, live well podcast.
(00:02):
I'm Lisa Salisbury, and this isepisode 136 weight loss
medications with Dr.
Lindsay Ogle.
This is the episode I have beenwanting to do with the perfect
person and Dr.
Ogle.
is the one.
She is a double board certifiedphysician in family medicine and
obesity medicine.
We are going to dive deep intothe pillars of obesity medicine,
(00:26):
what the options are in weightloss medications these days,
what you need to do while onthem.
And at the very end, we willtalk about the possibility of
weaning off and how that looks.
We also get into who is a goodcandidate for these medications
and just a lot of deep dive.
On the options.
I just wanted to offer you thisepisode so that you have a lot
(00:48):
of good information to decide ifalongside coaching, talking to
your physician about some ofthese options would be right for
you.
Welcome to eat well.
Well, the podcast for busy womenwho want to lose weight without
constantly counting, tracking,or stressing over every bite.
I'm Lisa Salsbury, a certifiedhealth weight loss and life
(01:11):
coach, and most importantly, arecovered chronic dieter here.
You'll learn to listen to yourbody and uncover the reasons
you're reaching for food.
When you're not truly hungry,freeing you to focus on a
healthier, more fulfillingapproach to eating.
Lisa (01:27):
Welcome back to the eat well, think well, live well
podcast.
I am so excited to beinterviewing Dr.
Lindsay Ogle today.
She is a double board certifiedin family medicine and obesity
medicine.
And, um, just, she reached outto me and I was like, yes, yes,
yes.
You may have been noticing as alistener that I have been
leaning more towards evidencebased guests lately and really
(01:48):
trying to get away from peoplethat are termed, um, functional
or holistic or things like that,that really aren't science or
evidence based.
And so I could not be morethrilled to have a double board
certified doctor here on thepodcast.
So welcome Dr.
Ogle.
Please give us a littleintroduction to you and what you
do.
Dr. Lindsay Ogle (02:07):
Yeah, thank you so much for having me on
here, Lisa.
I'm very excited for thisconversation.
So, um, as you said, I'm Dr.
Lindsay Ogle.
Um, I went into medicine reallyto help people achieve and
maintain their health.
And I chose family medicineoriginally to practice primary
care and build those lastingrelationships with my patients.
(02:30):
And quickly I realized that manyof our chronic conditions that I
was seeing and my patients wererelated to lifestyle.
And I actually did some electiverotations during residents.
and worked with an obesitymedicine physician, and she
really introduced me to thisfield, and I fell in love with
(02:51):
it very quickly because of itsemphasis on lifestyle,
nutrition, exercise, mentalhealth, and then utilizing safe
and effective medications, um,when appropriate or referring to
surgery when appropriate.
And I just saw the benefits thatthese patients were having with
improving.
their health and well being longterm.
(03:13):
And so I, after I finishedresidency, I did some additional
training, um, and then sat forthose obesity medicine boards,
um, as well.
Um, I did a couple of years inprimary care and now I'm really
focusing on weight managementand metabolic health, um,
through my telehealth clinic.
Lisa (03:31):
Perfect.
You are the perfect person to beasking all of these questions.
So if you notice from the title,we are going to be diving into a
little bit on the GLP 1medications.
But before we talk aboutmedicine, let's talk about the
four pillars of obesitymedicine.
I think it's really importantthat we hear from you on this
(03:52):
because I have been seeingseveral, um, I, I'm on
Instagram, love it or hate it,you know, I, I'm on there to, to
let people know what I do.
And so I, of course I'mscrolling and so many times I
see things like, Oh, thesedoctors, they just only want to
(04:13):
put you on medicine.
They just only want to prescribethings.
And it goes not just forobesity, but for everything.
I think doctors get a really badrap in that way.
Um, I don't believe that, but Iwant to talk about the four
pillars because medicine isonly.
One of them.
So if you could introduce those,what those four pillars of
obesity medicine are under yourtraining.
Dr. Lindsay Ogle (04:34):
Yeah, thank you so much for bringing this
up.
I think this gets overlooked,especially in popular media and
the general public, but anyonewho is trained in obesity
medicine is taught these fourpillars and it is nutrition, and
physical activity, behavioralmodifications, and then
(04:54):
medication management, includingum, medications or the surgical
interventions.
And so medication and surgery isjust one of those pillars.
We spend the rest of ourtraining and our focus on those
lifestyle interventions.
And so if you are working withan obesity medicine physician,
(05:14):
then you are able to, um, havethat all encompassing, um, you
know, full picture evaluationand treatment.
Um, if you don't have the accessto a obesity medicine physician,
because there are not.
Um, a, a lot of us out there,um, we're a minority of the
physicians and you, if youhappen to be prescribed, um, a
(05:37):
GLP one, then that is when it isso beneficial to work with, um,
either a dietician, a trainer,or a coach, or one of each to
really.
Touch on all those pillarsbecause they are so important
for us to really focus on yourhealth and well being long term.
Lisa (05:56):
I love that.
I, um, I of course specializemore in the behavior
modification section of those.
Uh, on those pillars and helpingpeople to figure out why they're
eating when they're not hungryand it's such a still important
piece, even if you're onmedication or if you've had
surgery, you still have this,you know, you still have a brain
(06:17):
and that brain is still in, youknow, going to be stuck in some
habit loops and that, you know,you're not maybe aware of and so
that's where, you know, coachingcan really come in.
So let's dive into reallyattacking some of those.
Yeah.
Yeah.
Yeah.
information as well as somemisinformation on the GLP 1
medications.
Can you start with somebackground, some context, um,
(06:40):
you know, things like how longthey've been around.
I think because of the increasedpopularity recently, it feels
like they're brand new drugs.
And spoiler alert, I'm, I knowthey're not.
She, she, we're both laughinghere.
Um, but if we could just Kind ofget into that.
That would be great.
So
Dr. Lindsay Ogle (06:59):
Yeah, absolutely.
And that was perfect timing.
I actually just did a post onsocial media.
on on Tiktok actually, and I'llpost it on Instagram soon about
how I need to stop myself.
I need to stop saying our newweight loss medications are new
injectable medications because Istill catch myself doing that.
(07:19):
And this class of medications,the GLP one agonist have been
around since 2005.
And so we have been using GLPone agonist.
Um, initially for type twodiabetes only, but we have been
using this class of medicationsnow for 20 years, and they were
studied for years and yearsprior to that.
So we have a lot of data andreal world data, real life data,
(07:45):
um, proving that they are safeand effective when used
appropriately and for the right,right patient.
And so, like I said, they'vebeen around for a long time, um,
I heard this great analogy,which I am going to continue to
use moving forward.
It's like, uh, our iPhone.
So we had the iPhone version onethat came out and then every so
(08:07):
often they have a new versionand it's an upgrade and it's
better, more efficient, it hasmore features, um, in it, and
it's very similar to this classof medication.
So we started with, um, it wasByetta was the name of the brand
name of the first one.
And then we've had new inneriterations.
Um, there's been severaliterations over time, and now we
(08:31):
have our weekly injections on.
And we have a couple of brandnames that are now FDA approved
for weight management ratherthan just type 2 diabetes.
Lisa (08:43):
that's why they feel new then is because of the recent
approval to use this class ofmedication strictly for weight
management and not just for typetwo diabetes.
Dr. Lindsay Ogle (08:52):
absolutely, yes, yes.
Lisa (08:54):
I just think that's really, like, good to know as to
why they feel new.
Dr. Lindsay Ogle (08:59):
right, right.
It wasn't that, you know,doctors or the healthcare field
was hiding the medications orkeeping them, um, for certain
uses.
they just were not FDA approvedfor that reason.
They were very effective fortreating type two diabetes, and
we were seeing such greatresults.
Our patients were feelingbetter, having more energy, um,
(09:21):
they were losing weight, um,just seeing great outcomes, and
then While we were watching howgreat patients with type two
diabetes were responding tothese medicines, then they were
studied for patients withouttype two diabetes and we saw
very similar outcomes for thosepatients and then that's when
(09:42):
they were approved, for weightmanagement.
Lisa (09:45):
Okay, perfect.
So, all medication comes withrisk, as we know.
Everyone has seen, you know, thejokes about the, I mean,
Saturday Night Live has parodieddrug ads forever about all of
the different risks.
So, of course there's risks.
Um, but again, I think socialmedia and popular culture has,
confused people as to what therisks are.
(10:08):
So from somebody who is, again,board certified in this, totally
qualified to prescribe thesemedications, what are the risks?
And, and then of course we'lltalk about the benefits and why
that is of course outweighingsome of those risks.
Dr. Lindsay Ogle (10:24):
Yeah, absolutely.
And every physician, like yousaid, with any medication we're
prescribing, we are alwaysthinking about risks and
benefits because with anythingwe do, um, there are risks and
benefits.
And so we are wanting to makesure that, that those benefits
are outweighing the risk.
For for patients and for anybodywho qualifies for the medication
(10:45):
for the most part for themajority of people, those
benefits do outweigh the risksand I don't blame anybody for
maybe being nervous about tryingto medications because there are
very scary.
about what can happen if youtake these medications, but in
reality, if you are beingprescribed appropriately by your
(11:05):
physician or your provider, um,the, the side effects are fairly
mild if they happen at all.
So on average, about a third, ofpeople have GI side effects.
So GI side effects are by farthe most common.
and that is Um, and really aresult of how the medication
works.
So one of the ways that themedicine affects our body is
(11:28):
that it slows the GI system downthe GI tract down.
And so food sits in the stomachlonger.
And while that's happening, thatcan trigger nausea or acid
reflux, and the slowing can alsothen lead to constipation or
changes in bowel habits.
and those can really be.
(11:49):
managed by making sure thatwe're eating small, frequent
meals, staying really wellhydrated, avoiding greasy or
sugary foods.
and then making sure we'regetting enough fiber to offset
that constipation.
And then we always start at ourlowest
Lisa (12:05):
I'm going to, sorry, I'm going to interrupt you right
here for a second, Dr.
Ogle, and just point out thisis, this is where that one of
those pillars of obesitymedicine comes in into play.
We have to have behavioralmodification along with the
medicine.
You don't just get to take themedicine and have it like, quote
unquote, do its job.
Like that was a lot ofbehavioral modification that you
(12:25):
just listed.
And so,
Dr. Lindsay Ogle (12:27):
Yes.
Lisa (12:28):
I just, anyway, I just think it's interesting.
Carry on.
Dr. Lindsay Ogle (12:31):
No, that's it.
That is a great point.
Um, uh, yeah, a great point.
Absolutely.
Um, so I, I do think that that'svery important to highlight
because there's a disconnectbetween, you know, taking a
medication.
I think that people think thatit medicine just like Burns the
fat off the body or increasesmetabolism and automatically
(12:55):
leads to weight loss that wayand and that is just not the
case.
There are, the medications areimproving biologic changes that
happen when somebody has obesityand and so that is what the
medicines are correcting.
They do not by themselves.
It's a tool to augment thosebehavior changes that you are
(13:18):
working on, um, to, help you tobe successful.
Um, but yeah, but we start atthe lowest dose and then slowly
work our way up, over time.
And if at any point you'rehaving, you know, side effects
on a regular basis, uh, wealways hold off on increasing
the dose and maybe back down onthe dose, uh, and address that
(13:39):
until Uh, Um, and then we can goback to adjusting the dose if
needed.
the more serious side effectsthat we hear about are really
rare.
and a lot of them are related toweight loss in general.
So I'm referring to, um, thegallbladder disease, gallstone
development, pancreatitis.
(14:01):
We see this happen with anyamount of significant weight
loss, especially if it happensin a short period of time.
So it's less from the medicationitself.
It's more from the fact that weare more people are losing
weight on the medicine.
And then the one not really anythat we are very strict about is
(14:22):
any personal or family historyof medullary thyroid cancer.
in animal studies, there hasbeen an association of an
increased risk of that specifictype of cancer, medullary
thyroid cancer.
So we're very cautious ifanybody has that in their family
history or personal history,then they should not be taking
these medications at all.
Lisa (14:41):
Not a candidate.
Yeah.
Okay.
So another risk I think that wesee a lot, which isn't so much
listed on, you know, on thelabel is the risk of losing more
muscle than fat and this, youknow, people are very worried
about this.
And I think it's, again, commonto be shouted in the grocery
stores from wellnessinfluencers, like, don't do that
(15:02):
because you're going to lose allthis muscle.
And it seems to me like it'sjust along those lines with the
gallbladder that we see thiswith any rapid weight loss.
if I was able to just snap myfingers and change your
lifestyle overnight and youstarted losing weight, you would
see this if you weren't activelycombating what causes that.
And I believe that that's thecase with these medications that
(15:26):
people are not doing the twothings, eating enough protein
and strength training.
Would you agree?
Dr. Lindsay Ogle (15:31):
I totally agree.
Yes.
Yes.
Those are so important foranybody who is losing weight If
you're losing weight from anymeans, then that is a concern.
We want to make sure that we aremaintaining your muscle mass as
much as possible.
but There is no way around tolose some amount of muscle mass.
So when we are carrying moreweights, we need bigger muscles
(15:53):
to carry that weight.
Um, and so sometimes even justthe ratio, um, maybe that main
maintains the same, you know, aswe're losing weight, but you're
going to lose some muscle, um,with that.
But yeah,
Lisa (16:06):
Yeah.
If you have a hundred pounds tolose, you can't possibly make
that all fat.
That's just not, it's just not athing.
You can't do that, but thatdoesn't happen.
Cause yeah, like you said,you're going to have smaller
muscles when your body issmaller because that is what you
need to function.
Dr. Lindsay Ogle (16:22):
yes, absolutely.
The only way to do 100 percentfat loss is liposuction.
Lisa (16:28):
Okay.
Okay.
So, um, let's talk about whysomeone would choose, um, a 1
medication.
I have had clients, I've hadboth.
I've had clients that are like,You know, I would never, I would
never do, and for some reasonthey just think that that's, I
think there's some, uh, stigmawith it being quote unquote
(16:51):
cheating, which I think isridiculous.
If my clients are open to it, Ialways say, ask your doctor.
Um, and I have coached clientsthat have been on medication.
And so when someone asks mewell, should I work with you or
should I get medication?
I'm like, yes, but what would besome of the indicators that
(17:11):
would be like, yeah, thisperson's really a, a good
candidate for asking theirdoctor about, getting on a
medication.
Dr. Lindsay Ogle (17:18):
Yeah, and I really appreciate your approach
there.
And I try to have a similarapproach of really
individualizing recommendationsfor for that person and working
with you know what somebody'sgoals are and what they're
comfortable doing.
And I definitely agree with yesand let's do both let's let's
use.
Let's focus on the health andmedicine side and then let's
(17:41):
focus on the mental health andbehavior side as well.
Um, And so I really think that,um, medication should be
considered maybe more stronglyif somebody has really the
majority of their life struggledwith their weight and, as for
(18:02):
decades, really not been able toeither.
Lose a significant amount ofweight to be able to get them
into not even a a normal BMIbecause we know there's a lot of
Problems with BMI and that's notour goal our goal is to help
somebody improve their healthand to function in a lot in
(18:23):
their life function andparticipate in their lives in a
way that they want to andsometimes our weight can hold us
back from that and And so wewant to, um, help you find, you
know, that best weight for you.
And if you have not been ableto, to do that over, like I
said, years or decades, thenmaybe it's time to talk to your
(18:44):
doctor and think aboutcorrecting those, um, biological
changes that are underlying.
Also kind of maybe taking a lookin your family and if a lot of
people in your family strugglewith weight, then there's a high
chance that there's a geneticcomponent going on.
And these medications can, canreally help with that.
(19:04):
Um, if you've done a lot of yoyo dieting back and forth, these
medications can also really helpjust stabilize, those ups and
downs, and really again, focuson, on health and nutrition and
it can, I know there's a lot oftalk about the food noise.
and I know I'm, yeah, and I knowyou do a
Lisa (19:27):
about that for
Dr. Lindsay Ogle (19:28):
yeah, and I know you do a lot of work with
that with, with coaching and,and our thoughts around food,
which could be so powerful.
but there, there, for somepeople, I would say even for
most people, when you lose asignificant amount of weight,
Your hunger hormones and thosesignal hunger signals to your
brain increase because your bodywants to maintain the weight
(19:52):
that it was at because it'strying to protect you.
It thinks that you're starving.
We, you know, food used to bescarce.
And so it's trying to conserveenergy.
So hunger signals and thosehormones go up and it can be
very, very difficult over asustained period of time to
fight those hunger signals.
And that is where medication canreally be powerful because it
(20:15):
can help lock those.
Those hunger signals and then itcan allow you then to follow the
healthy nutrition plan that youhave set on and this ties back,
you said something in the verybeginning about when we were
talking about mental health andI forget, forget exactly what
you said.
But I was talking with somebodyabout using food to help, um,
(20:40):
cope with certain emotions andwe all do it.
And that's a normal human, youknow, coping strategy, but
sometimes it gets out of handand difficult to control and can
lead to a negative healthconsequences, whether physical
or mental.
And if you're on a GLP one.
Your hunger signals are going tobe suppressed.
(21:00):
Your cravings are going to dropdown significantly, and you're
going to lose that copingmechanism of food that you were
turning to before.
And so it is so important tohave the support and strategies
in place.
So then you can Learn how youcan cope with that stress and
those negative emotions that aregoing to come up when you don't
(21:23):
have food to turn to like, likewe used to.
Lisa (21:28):
so on this topic of who it's appropriate for, that's a
lot of good, you know, I thinkpeople can see themselves in, in
that, but what about strictly interms of weight to be lost?
Is there.
an appropriate amount of, like,if you have this much weight to
lose, you're a candidate, but ifyou only have X amount of
(21:48):
pounds, you're not a candidate.
Is there a cutoff guideline
Dr. Lindsay Ogle (21:53):
Yeah, so, um, medically, uh, we are still
using BMI mostly.
Um, so, A BMI of 30 or abovequalifies medically for for
medications or BMI of 27 orabove with a weight related
condition like high bloodpressure, diabetes, cholesterol,
(22:15):
sleep apnea, and you cancalculate your BMI really easily
by searching BMI calculator andthen putting in your height and
weight and it'll tell you.
so those are the, medicalcutoffs.
That does not mean that yourinsurance will cover the
medication, though, which isvery frustrating component.
(22:35):
Right now, insurance companiesare not required to cover
medications for obesity.
There are a lot of people.
I know, I know it will beactually only been recognized as
a chronic medical conditionsince 2013.
And so it has not been that longthat we have the medical
(22:57):
community as a whole has seen itas something that needs to be
treated directly.
And so there it does take timeto make those changes, but there
fortunately are a lot of peoplewho are, you know, supporting
supporting the cause andhopefully insurance will will
start covering it moreconsistently moving forward.
Lisa (23:18):
Yeah, hopefully that's, that can be the case.
So it's not necessarily a, Ihave 20 or 40 or 90 pounds to
lose.
It really, at this point, still,you need to go off of your BMI,
which.
I know like every time you'vesaid it, you've kind of like put
it in air quotes and so whichpeople aren't seeing.
So it is, it is still achallenge.
(23:39):
So it sounds like stillsomething you need to just have
that conversation with yourprovider.
So let's talk about, GLP 1s arevery obviously popular, there
are certain types that areapproved just for weight loss
and you don't have to have a, asecondary diagnosis like type 2
diabetes, but there are othermedications.
(24:01):
So, can you speak to some ofthose options?
Dr. Lindsay Ogle (24:05):
Yeah, absolutely.
So, outside of the class of GLP1s, there are really, I would
say, three main medications thatare used.
The first is Phentermine, andPhentermine was FDA approved in
1959, and so it's been aroundfor 66 years.
(24:27):
Um, so another one that we havea lot of data on its safety for,
um, it gets a bad rep because atone point it was combined with
another medication that hadsignificant side effects, but by
itself it has been proven to besafe.
Again,
Lisa (24:42):
Yeah, so, I'm just going to say for those, I, I was, um,
kind of, I think in my earlytwenties when this happened, so
you might be familiar with thecombo.
They called it Fent Fen becausethe other one also started with
the, with the prefix Fen.
So
Dr. Lindsay Ogle (24:55):
Yes.
Yes.
Fen.
Fen.
And so that is no longeravailable.
but fentamine by itself is stillan effective appetite
suppressant.
And so that's really where ithelps a lot.
So, if somebody is having thatincreased hunger, you know, when
they're cutting calories thatthis can be helpful, um, this
should really be done with, uh,or prescribed by an in person
provider because we want tomonitor your vitals closely, um,
(25:19):
because it is a stimulant and itis technically a controlled
substance.
Although I always say, you know,people are not selling
phentermine on the streets.
People don't really becomeaddicted to it Um, but it is a
stimulant so it is controlledthen really great thing about it
is it's very inexpensive Even ifyour insurance does not cover
weight management medicationsWith a good or x coupon you can
(25:41):
get it for around 20 a month.
So very very affordable.
Yeah compared to the GLP 1agonist, which without insurance
can be closer to a thousanddollars a month.
So huge difference there.
Qsymia is a brand name thatcombines Phentermine and
Topiramate.
And it's just, it's a little bitmore effective with that
(26:02):
combination.
Also helps with appetitesuppression, um, helps with some
of the, uh, reward feedback,that we see with, with food.
this one is really important foranyone who has the potential to
become pregnant.
They should either not take itor, um, need to be on a really
effective birth control because.
Topiramate just itself has beenassociated with, cleft palate
(26:25):
development in the, in thefetus.
So that's a very importantthing.
there's some other potentialside effects that your doctor
would go over, but, that one isfairly effective and also, not
as expensive for the brand namewith the coupon last time I
looked, 75 a month.
so again, on the more affordableside, And then the third one is
(26:46):
Contrave, and Contrave isanother combo medication.
It combines a medicine calledBuproprion, which its brand name
is Welbutrin, and thenNaltrexone.
Um, this medication togetherreally helps with emotional
eating, stress eating, and itreally helps with that food
(27:06):
reward pathway.
The Bupropion or Wellbutrin weuse for depression.
It's a nonstimulant, A DHDmedication.
It helps people cut back onsmoking.
So we use it for a lot ofdifferent things.
And then the Naltrexone is ananti opioid, and so it is, it is
not an opioid, but it blocksthose opioid receptors.
we use it mostly for, reducingalcohol cravings.
(27:31):
so this is a also a great optionif somebody is having, you know.
Depressed mood or are drinkingmore than they want to this
medicine can help with thosethings as well As helping with
weight loss
Lisa (27:45):
Okay, good.
Yeah.
So there are, there are optionsout there.
I think one of the majordeterrents for the GLP one class
is the cost.
And so of course we have, Idon't think we have time to get
into all of the issues with the,compounded pharmacies and the
direct, you know, people thatjust get them directly.
And I think, this is where a lotof people are getting them that
(28:07):
shouldn't be, and they're notgetting them.
You know, they're notcandidates.
They're already, you know, quoteunquote thin and they're trying
to get even thinner and so Um,that's just like a whole other
conversation really, but, um,along with the medications, of
course we talked in thebeginning about the four pillars
(28:28):
of obesity medicine, but let'stalk a little bit more in depth
about what role does the diet,the exercise and the mindset
play when you are.
Also including some of thesemedications because I think for
so long, again, physicians havegotten a bad rap for just
saying, oh, well, just lose someweight.
(28:48):
Your knees will feel better orwell, you know, just eat less,
move more.
and especially too, I thinkthere's a lot of, really
negative information aboutdoctors don't know anything
about nutrition, which yes, thatthey, you know.
Your typical sort of quoteunquote family doctor doesn't
get the training that you do.
(29:10):
So it is very important I thinkto go to someone board certified
in obesity medicine if this issomething that you are really
struggling with.
so I would just like for you tospeak a little bit about, kind
of why that that happens forphysicians, like why, why that's
kind of been the case for solong and what role that plays
alongside these medications.
Dr. Lindsay Ogle (29:30):
Yeah, there is that stereotype that we do not
know much about nutrition.
And it probably, it varies, youknow, with any, with any field,
you know, what people's expertlevel is, where they trained and
what they were exposed to.
I also, you know, talking aboutinfluencers on social media, you
(29:52):
know, people can make it seemmore complicated than it needs
to be.
I think we just.
Um, I think most doctors areaware of that.
and I could sum it up here asreducing added sugars as, as
(30:13):
much as possible.
And so just, I always recommendstarting to look at labels and
choose options that have lessadded sugar or no added sugar.
and then making sure we'regetting enough protein and
fiber.
Um, and then water.
those four things are, if you dothat, you're going to be in a
much better place.
protein goals, I think, can varyfrom person to person.
(30:35):
Um, and it could be helpful toget individualized
recommendation.
But a general recommendation isthis.
Yeah, it's the shoot for around100 grams a day.
Um, for some women, it may beless for some men, it may be
more, but that's a good roughUm, and that's the goal.
Um, for fiber.
another good goal would bearound 25 to 30 grams per day.
(31:01):
Um, and then water.
it's enough.
So this one is you can reallyindividualize.
So you want to drink enoughwater.
So where your urine is clear or,you know, light yellow.
So you get that feedbackconstantly.
Um, so if you do those fourthings, like I said, you're
going to be in a great placefrom a nutrition standpoint.
And then to get.
Protein and fiber ideas.
(31:24):
We have Google, we have chapGPT.
They're amazing and such greattips.
and so I highly recommendutilizing those resources.
Lisa (31:34):
it's so true.
Like it's not a lack ofinformation that, that we have
on nutrition.
It's, it's really clear.
And again, I think, and I don'tknow why I keep attacking the
wellness influencers in thisepisode, but I think that people
try to complicate it in order tosell their product in order to,
and which is why I think I.
Kind of struggle with gettingclients because I'm not flashy.
(31:57):
I'm not saying, Oh, this is theone thing that you have to do.
You've got to cut out this, thisone thing you didn't know was
making you sick and all of thatgarbage.
Like, no.
And I, I think a really goodway.
Uh, I'm sure you've heard thisas well to sum up those
nutrition guidelines is the 30,30, 30 rule.
30 grams of protein per meal, 30grams of fiber per day, and less
(32:18):
than 30 grams of added sugar perday.
And.
I think it's just, which is kindof really what, what you said,
other than the actual number ofadded grams of sugar.
That's a little high.
I mean, I'd love to see itlower, but also I like to add in
a lifestyle food, you know,quality of life food, whatever
you want to call it, pleasurefood once a week, twice a week.
(32:40):
And so that's going to push meover that 30 grams of added
sugar, but then.
On other days of the week, I'mgonna be in the 5 or 6 grams,
and so I'm looking at thatnumber over the course of the
week, divide by 7.
Does that make sense?
Anyway, but I just like that 3030 30 rule.
Dr. Lindsay Ogle (32:56):
Yeah, I love that.
And that is so sustainable andso reasonable that and straight
forward.
We all can follow that.
And I totally agree.
I see that all the time wherethings are kind of advertised.
Yeah, you're missing that onething.
You didn't know this.
I'll tell you just sign up formy email list or something.
(33:17):
Uh,
Lisa (33:17):
no secrets.
So that's, and I think this isto the point of like, it's okay.
If you see the statistic thatdoctors didn't have, you know,
62 billion classes in nutrition,because it's just not that
complicated.
It's the doing it.
It's not the knowing theinformation.
It's that third pillar of thebehavior modification of turning
(33:40):
the package over and looking atthe added sugar and making a
conscious effort to includeprotein.
And where am I going to getfiber and how can I eat more
beans?
And you know, that kind ofthing.
And that's all the behaviormodification.
It's the nutrition piece isactually not complicated.
Dr. Lindsay Ogle (33:56):
Yeah.
And I will also say, um, so wedidn't mention this earlier,
but, I found Lisa through, acoaching program, that I was,
uh, I guess a student of, and,and she ended up, um, being
certified as a of the life coachfrom there.
And something that was sopowerful that I learned from
being coached myself was just.
(34:18):
not beating yourself up afteryou made a quote unquote
mistake.
And once I was able to learnthat through the help of my
coach, that was a life changing,skill that I developed.
And we see that all the timewith diets.
And so if we set out Our bestlaid plans, we are going to
(34:41):
follow these strictly andsomething happens and we overeat
or we bring something in thatwasn't in our nutrition plan or
our protocol, whatever we'recalling it, um, and then we beat
ourselves up.
We say we're never gonna get ourresults.
We're You know, not disciplinedor not worthy.
And then we over eat and, youknow, go off the rails.
(35:04):
if we are able to stop ourselvesat that moment and give
ourselves some compassion, thenwe can accept what happened,
which is normal that happens.
And then we can move on andcontinue moving forward.
And so I'm sure you see that allthe time with your clients.
Lisa (35:20):
Yes, that's definitely a major thing, that I teach.
And if my listeners haven'tgotten, haven't signed up for my
what to do when you overeat,three part video series,
actually, that's one of themajor things I talk about is.
You know, we, we're just goingto be kind, we're just going to
be kind.
Dr. Lindsay Ogle (35:38):
It goes a long way.
Lisa (35:39):
start there.
Yeah.
Okay.
So we were, I kind ofinterrupted, we kind of got a
little off the rails, but wewere talking about the role that
diet exercise and mindset playas far as, when you have a
patient on these medications,like, what is your advice to
them?
We spoke about the nutrition.
So let's get back on track onthat question with the exercise
(36:01):
as well.
Dr. Lindsay Ogle (36:02):
Yeah, so for exercise, same thing.
It does not have to becomplicated.
And I want to meet everybodywhere they're at.
So if you are not exercising atall, then it is not reasonable
to expect, you know, you totomorrow start exercising an
hour a day every day.
Um, what our goal would be wouldbe five minutes.
(36:26):
twice a week.
It could be as simple as that.
And I always encourage people tochoose something that they enjoy
doing.
Exercise is not a punishment.
It is not to make up forcalories that you consumed.
Exercise is for your physicaland mental health.
We all need to do it no matterwhat our body size is.
It is extremely unlikely thatyou're going to lose weight from
(36:49):
exercise alone.
It is very important to exercisefor your health and for weight
maintenance.
And like I said, start whereyou're at and then work your way
up.
Well, the recommended amount ofexercise for all Americans is at
least 150 minutes a week.
And you can split that uphowever you like, whether that's
(37:11):
30 minutes, five days a week, orhowever fits in your schedule.
And ideally, it's a combinationof cardio and resistance
training and the resistancetraining portion the goal for
there would be at least 20minutes twice a week and that it
can be bodyweight exercises.
(37:32):
It does not have to be CrossFit.
Um, we can do what you arecomfortable and able to do and
there are so many.
Any apps available.
I just signed up with Pelotonand I've been very happy with
their app and you can choose a20 minute exercise body weight
and you can do it.
You can do as short as fiveminute exercises with them with,
(37:54):
and they're so positive.
It's been, I really like theirapp.
and then I have a mentor whocreated GLP Strong, which is
created for people who are onGLP One Agonist, but you don't
have to be.
it could be for anybody and it'salso tailored for people who are
new at resistance training andit's just 20 minutes.
(38:14):
It's that 20 minutes twice aweek.
So very accessible.
You can do it in your home.
So those are my, those are myrecommendations for, for
physical activity.
Lisa (38:24):
Perfect.
Yeah, pretty standard.
Again, not complicated.
Just get out there and move.
I, I just want to add that,walking counts.
Dr. Lindsay Ogle (38:33):
Just thinking that.
Lisa (38:34):
okay.
I just think some people arelike, oh, well, all I can do
right now.
That's all I'm physically able.
That is perfect.
Do that.
Start there.
Get going.
and hopefully too, if you livein a place where you can get
some sunshine while doing it.
even, I mean, it's raining heretoday, so I actually took a
(38:55):
walk, um, at my gym.
On the treadmill today becauseit actually was my day for
walking.
So I was like, Oh, um, so it'snot as fun, but, um, walking
counts.
And I, and the other thing Ijust want to add to is I
typically, when I go to do mylifting, um, strength training.
Workouts.
Typically it takes me about anhour to do the, assigned
(39:18):
regimen.
I have an online trainer that Iuse.
And this past week, actually,um, on Tuesday, when I was
lifting, I did not get to thegym on time.
That's my fault.
And I, you know, I hadappointments backed up to that.
And so I was like, this is all Ihave time for.
And so I didn't do everyexercise that was prescribed.
And I still was like, it stillwas like 40 minutes.
(39:41):
I'm like, this was still totallyworth my time.
And I think that's anothermindset piece is to do what you
can, even if it's not what youdid in your twenties, or even if
it's not a full hour, sometimesI think because fitness classes
tend to be a full hour, wethink, well, that's how long you
should quote unquote.
exercise.
(40:02):
And that's just not the case.
If you have 20 minutes, spend 20minutes.
If you have 15, if you havefive, whatever you have, and
then also just try to getmovement throughout the day.
And that's not part of your 150minutes, but just that NEAT
portion, the non exerciseactivity thermogenesis, the
acronym is NEAT, N E A T.
Um, you know, do try to try tomove around during the day,
(40:25):
taking the stairs.
It's, you know, the proverbialexample, but there's lots of
ways to get some movementthroughout the day.
Dr. Lindsay Ogle (40:31):
Yeah, and I was just looking at these
recommendations recently, andthey did make a comment about,
you know, if somebody is notable to dedicate time right now
for exercise, then getting atleast 5, 000 steps a day was,
um, pretty similar to that 150minutes per week.
So yes, you can move throughoutthe day and that counts as well.
(40:54):
And definitely walking andcounts.
Um, I love that.
Lisa (40:58):
Good.
And then that last piece, justthe mindset, what do you
recommend there?
Do you recommend that yourclients, or sorry, you have
patients, I have clients.
Do you recommend that yourpatients seek out, mindset,
behavioral modification,coaching support?
Do you provide that as a boardcertified obesity, specialist,
(41:19):
or, you know, if somebody isgetting these medications from
just their family doctor ortheir.
You know, gynecologists, I don'tknow who all can prescribe
these, but if they're gettingthem from someone who's not
board certified, then would theywant to seek that out, um, in
another form?
Dr. Lindsay Ogle (41:34):
I think this is another one that's
individualized and I don'tdirectly do like coaching or
therapy, but I, when I'mlistening to my patients and how
they are.
Talking about themselves or theterms that they're using or what
they're focusing on.
I definitely try to redirect onetowards health focused goals And
(41:57):
reminding them where they'vecome from I think a lot of times
we get to a certain point in ourjourney Whatever that is and we
forget where we started and kindof that new spot is our new
normal And we don't See howamazing, you know, we have, we
have become, or I mean, wealways were that amazing, but
(42:18):
the amazing, uh, accomplishmentsthat, that we have had.
So, I always am remindingpatients about that and
reminding patients to be kind tothemselves.
Screening for eating disorders,depression, anxiety, adverse
childhood events, those are verycommon in people who have excess
weight.
(42:39):
That's really important, so if Iever identify that, then
definitely, um, therapy can behelpful.
for my patients who are very andhave maybe already gone through
therapy and are looking for kindof that next level, then that's
when I recommend coaching andthat can be very, very helpful,
(43:01):
um, along with, with, you know,their medication.
Lisa (43:06):
Great.
So the last question I want toask you, and let's obviously, if
there's something we missed, besure to add it.
But, what about coming off themedications?
I think that that's another bigdeterrent is like, okay, I could
maybe swing 1, 000 a month forthis health modification for a
few months or for, you know,nine months or something, but
(43:28):
it's I think a lot of people arelike, I can't do that for the
rest of my life, and Obesity isa chronic condition that does
sometimes need to be treated fortheir whole life.
So, what are the options therefor people when the cost is such
a big deal, and is itappropriate for people to start
these medications knowing thatthey are not going to do them
(43:50):
for life?
Dr. Lindsay Ogle (43:52):
So.
In the specialty of obesitymedicine, um, we recognize
obesity as a chronic medicalcondition and anything that we
do to treat that chronic medicalcondition, then we are going to
need to continue to do tomaintain it.
And I think a really greatanalogy is with high blood
(44:13):
pressure.
And so we start someone on ablood pressure medicine.
If they have high blood pressureand their blood pressure is now
in a normal range.
What would happen if we take theblood pressure medicine away,
the blood pressure would go backup, we need to continue that
medicine and we all accept that.
But for some reason withobesity, that connection just
isn't made.
And we think that the medicinecan be used short term for the
(44:37):
vast majority of people.
If you start a medication andlose weight that way, I suspect
you're going to need to take itlong term.
And it is likely that that isit.
Best for your health rather thanhaving those ups and downs in
your weight.
that being said, what I do withmy patients is when we get to
our goal weight, whatever wedetermine that to be for them,
(45:02):
and we're, you know, we're atour best weight and we're
feeling healthy, then I doslowly wean the dose down, as
tolerable and able.
Or we sometimes space out theinjections a little bit, um, and
if we space out the injections alittle bit, then, especially if
they're paying out of pocket,that can save a little bit of
(45:23):
money because they're, they'relasting longer.
I definitely would not base outmore than every I typically
don't go longer than every 10days and they're typically every
7 days.
So it's not a big difference,but it can add up over time.
I think this also ties back towhen I, we were talking about
earlier about who should be onthe medications with, you know,
(45:45):
if somebody has really struggledwith their weight for over a
decade or more, and their familyalso all struggles with their
weight, then this is.
a very high chance that you'regoing to be on the medicine long
term.
But there are some people whosomething happened in their
life, um, they went through about of depression or they were
(46:06):
started on a medicine thatcaused weight gain or, you know,
postpartum way or perimenopausalweight gain, and it was
relatively short, um, induration that somebody has had
that excess weight, I think, andI believe some of my colleagues
believe this too, is that themedication then, in that case,
(46:27):
it's a higher chance that wecould use that medication short
term, in those situations,because it's less that that
person has it.
What we are calling the diseaseof obesity.
It's more that they're carryingexcess weight because of some
other trigger that caused theweight gain to happen.
So if we're able to bring thatwith the medication, help bring
(46:48):
their weight back to where theywere before, then with
continuing on their newlifestyle changes.
That they, you know, worked withand developed while on the
medicine, then they're able to,you know, succeed in and
continue, um, those healthbenefits moving forward off of
the medicine.
But definitely I would want ineither scenario would wean off
(47:09):
of the medicine and then alwayskind of go back if we need to.
Lisa (47:13):
perfect.
That is so helpful.
Well, I think this has reallybeen, enlightening and really
informative for people to beable to just kind of have this
background to decide if theywant to approach their
physicians about this option.
And certainly you can alwaysstill use someone like me for
the, the behavior modificationas well as touching on the,
(47:35):
helping you with making changesto your nutrition and physical
activities.
So, Dr.
Ogle, could you just tell peoplewhere to find you online?
I know you have a certain placewhere you practice, obesity
medicine.
So it's not applicable foreveryone, unfortunately, but, I
think you, you, um, share onsocial media though, right?
Dr. Lindsay Ogle (47:53):
Yes, yes.
So I practice out of Missouri.
So my telehealth clinic iscalled Missouri Metabolic
Health.
And if you go to that website,you'll see links to all of my
social media, but they're allDr.
Lindsay Ogle.
I'm on Instagram, TikTok, andYouTube.
Um, and I Definitely recommendfollowing on on those platforms.
(48:14):
I try my best to share, youknow, evidence based education
to the general public for thosepeople who I cannot serve in my
telehealth clinic.
So that's something that I'mdefinitely passionate about.
So again, I appreciate youhaving me on here so I can reach
more people and, you know, talkabout this important health
topic.
Lisa (48:34):
Yes.
Thank you so much.
It's been a pleasure meetingyou.
I'm so glad you tuned in todaybefore I sign off.
I want to remind you of the whatto do when you overeat free
three part video course that Ihave.
We chatted a bit about this inthe episode, but if you are
trying to lose weight and youfind yourself overeating too
many times to see lastingsuccess, be sure to check out
that free course.
(48:55):
It also comes with a reset andrecover guide that will help you
put everything you learn in thevideos in writing and really
clarify each step so you canfeel confident moving forward.
If today's insights resonatedwith you and you're ready to
make lasting changes in yourhealth journey, I'd love to help
book, a free consult sessionwith me to see if my full 12
week one on one coaching programis right for you.
(49:17):
You can schedule it at the linkin the show notes.
Remember, it's not just aboutthe food.
It's about empowering yourselfwith choices that truly serve
you.
Have a great week.
And as always, thanks forlistening and sharing the eat
well, think well, live wellpodcast.
This is the eat well, thinkwell, live well podcast.
(00:02):
I'm Lisa Salisbury, and this isepisode 136 weight loss
medications with Dr.
Lindsay Ogle.
This is the episode I have beenwanting to do with the perfect
person and Dr.
Ogle.
is the one.
She is a double board certifiedphysician in family medicine and
obesity medicine.
We are going to dive deep intothe pillars of obesity medicine,
(00:26):
what the options are in weightloss medications these days,
what you need to do while onthem.
And at the very end, we willtalk about the possibility of
weaning off and how that looks.
We also get into who is a goodcandidate for these medications
and just a lot of deep dive.
On the options.
I just wanted to offer you thisepisode so that you have a lot
(00:48):
of good information to decide ifalongside coaching, talking to
your physician about some ofthese options would be right for
you.
Welcome to eat well.
Well, the podcast for busy womenwho want to lose weight without
constantly counting, tracking,or stressing over every bite.
I'm Lisa Salsbury, a certifiedhealth weight loss and life
(01:11):
coach, and most importantly, arecovered chronic dieter here.
You'll learn to listen to yourbody and uncover the reasons
you're reaching for food.
When you're not truly hungry,freeing you to focus on a
healthier, more fulfillingapproach to eating.
Lisa (01:27):
Welcome back to the eat well, think well, live well
podcast.
I am so excited to beinterviewing Dr.
Lindsay Ogle today.
She is a double board certifiedin family medicine and obesity
medicine.
And, um, just, she reached outto me and I was like, yes, yes,
yes.
You may have been noticing as alistener that I have been
leaning more towards evidencebased guests lately and really
(01:48):
trying to get away from peoplethat are termed, um, functional
or holistic or things like that,that really aren't science or
evidence based.
And so I could not be morethrilled to have a double board
certified doctor here on thepodcast.
So welcome Dr.
Ogle.
Please give us a littleintroduction to you and what you
do.
Dr. Lindsay Ogle (02:07):
Yeah, thank you so much for having me on
here, Lisa.
I'm very excited for thisconversation.
So, um, as you said, I'm Dr.
Lindsay Ogle.
Um, I went into medicine reallyto help people achieve and
maintain their health.
And I chose family medicineoriginally to practice primary
care and build those lastingrelationships with my patients.
(02:30):
And quickly I realized that manyof our chronic conditions that I
was seeing and my patients wererelated to lifestyle.
And I actually did some electiverotations during residents.
and worked with an obesitymedicine physician, and she
really introduced me to thisfield, and I fell in love with
(02:51):
it very quickly because of itsemphasis on lifestyle,
nutrition, exercise, mentalhealth, and then utilizing safe
and effective medications, um,when appropriate or referring to
surgery when appropriate.
And I just saw the benefits thatthese patients were having with
improving.
their health and well being longterm.
(03:13):
And so I, after I finishedresidency, I did some additional
training, um, and then sat forthose obesity medicine boards,
um, as well.
Um, I did a couple of years inprimary care and now I'm really
focusing on weight managementand metabolic health, um,
through my telehealth clinic.
Lisa (03:31):
Perfect.
You are the perfect person to beasking all of these questions.
So if you notice from the title,we are going to be diving into a
little bit on the GLP 1medications.
But before we talk aboutmedicine, let's talk about the
four pillars of obesitymedicine.
I think it's really importantthat we hear from you on this
(03:52):
because I have been seeingseveral, um, I, I'm on
Instagram, love it or hate it,you know, I, I'm on there to, to
let people know what I do.
And so I, of course I'mscrolling and so many times I
see things like, Oh, thesedoctors, they just only want to
(04:13):
put you on medicine.
They just only want to prescribethings.
And it goes not just forobesity, but for everything.
I think doctors get a really badrap in that way.
Um, I don't believe that, but Iwant to talk about the four
pillars because medicine isonly.
One of them.
So if you could introduce those,what those four pillars of
obesity medicine are under yourtraining.
Dr. Lindsay Ogle (04:34):
Yeah, thank you so much for bringing this
up.
I think this gets overlooked,especially in popular media and
the general public, but anyonewho is trained in obesity
medicine is taught these fourpillars and it is nutrition, and
physical activity, behavioralmodifications, and then
(04:54):
medication management, includingum, medications or the surgical
interventions.
And so medication and surgery isjust one of those pillars.
We spend the rest of ourtraining and our focus on those
lifestyle interventions.
And so if you are working withan obesity medicine physician,
(05:14):
then you are able to, um, havethat all encompassing, um, you
know, full picture evaluationand treatment.
Um, if you don't have the accessto a obesity medicine physician,
because there are not.
Um, a, a lot of us out there,um, we're a minority of the
physicians and you, if youhappen to be prescribed, um, a
(05:37):
GLP one, then that is when it isso beneficial to work with, um,
either a dietician, a trainer,or a coach, or one of each to
really.
Touch on all those pillarsbecause they are so important
for us to really focus on yourhealth and well being long term.
Lisa (05:56):
I love that.
I, um, I of course specializemore in the behavior
modification section of those.
Uh, on those pillars and helpingpeople to figure out why they're
eating when they're not hungryand it's such a still important
piece, even if you're onmedication or if you've had
surgery, you still have this,you know, you still have a brain
(06:17):
and that brain is still in, youknow, going to be stuck in some
habit loops and that, you know,you're not maybe aware of and so
that's where, you know, coachingcan really come in.
So let's dive into reallyattacking some of those.
Yeah.
Yeah.
Yeah.
information as well as somemisinformation on the GLP 1
medications.
Can you start with somebackground, some context, um,
(06:40):
you know, things like how longthey've been around.
I think because of the increasedpopularity recently, it feels
like they're brand new drugs.
And spoiler alert, I'm, I knowthey're not.
She, she, we're both laughinghere.
Um, but if we could just Kind ofget into that.
That would be great.
So
Dr. Lindsay Ogle (06:59):
Yeah, absolutely.
And that was perfect timing.
I actually just did a post onsocial media.
on on Tiktok actually, and I'llpost it on Instagram soon about
how I need to stop myself.
I need to stop saying our newweight loss medications are new
injectable medications because Istill catch myself doing that.
(07:19):
And this class of medications,the GLP one agonist have been
around since 2005.
And so we have been using GLPone agonist.
Um, initially for type twodiabetes only, but we have been
using this class of medicationsnow for 20 years, and they were
studied for years and yearsprior to that.
So we have a lot of data andreal world data, real life data,
(07:45):
um, proving that they are safeand effective when used
appropriately and for the right,right patient.
And so, like I said, they'vebeen around for a long time, um,
I heard this great analogy,which I am going to continue to
use moving forward.
It's like, uh, our iPhone.
So we had the iPhone version onethat came out and then every so
(08:07):
often they have a new versionand it's an upgrade and it's
better, more efficient, it hasmore features, um, in it, and
it's very similar to this classof medication.
So we started with, um, it wasByetta was the name of the brand
name of the first one.
And then we've had new inneriterations.
Um, there's been severaliterations over time, and now we
(08:31):
have our weekly injections on.
And we have a couple of brandnames that are now FDA approved
for weight management ratherthan just type 2 diabetes.
Lisa (08:43):
that's why they feel new then is because of the recent
approval to use this class ofmedication strictly for weight
management and not just for typetwo diabetes.
Dr. Lindsay Ogle (08:52):
absolutely, yes, yes.
Lisa (08:54):
I just think that's really, like, good to know as to
why they feel new.
Dr. Lindsay Ogle (08:59):
right, right.
It wasn't that, you know,doctors or the healthcare field
was hiding the medications orkeeping them, um, for certain
uses.
they just were not FDA approvedfor that reason.
They were very effective fortreating type two diabetes, and
we were seeing such greatresults.
Our patients were feelingbetter, having more energy, um,
(09:21):
they were losing weight, um,just seeing great outcomes, and
then While we were watching howgreat patients with type two
diabetes were responding tothese medicines, then they were
studied for patients withouttype two diabetes and we saw
very similar outcomes for thosepatients and then that's when
(09:42):
they were approved, for weightmanagement.
Lisa (09:45):
Okay, perfect.
So, all medication comes withrisk, as we know.
Everyone has seen, you know, thejokes about the, I mean,
Saturday Night Live has parodieddrug ads forever about all of
the different risks.
So, of course there's risks.
Um, but again, I think socialmedia and popular culture has,
confused people as to what therisks are.
(10:08):
So from somebody who is, again,board certified in this, totally
qualified to prescribe thesemedications, what are the risks?
And, and then of course we'lltalk about the benefits and why
that is of course outweighingsome of those risks.
Dr. Lindsay Ogle (10:24):
Yeah, absolutely.
And every physician, like yousaid, with any medication we're
prescribing, we are alwaysthinking about risks and
benefits because with anythingwe do, um, there are risks and
benefits.
And so we are wanting to makesure that, that those benefits
are outweighing the risk.
For for patients and for anybodywho qualifies for the medication
(10:45):
for the most part for themajority of people, those
benefits do outweigh the risksand I don't blame anybody for
maybe being nervous about tryingto medications because there are
very scary.
about what can happen if youtake these medications, but in
reality, if you are beingprescribed appropriately by your
(11:05):
physician or your provider, um,the, the side effects are fairly
mild if they happen at all.
So on average, about a third, ofpeople have GI side effects.
So GI side effects are by farthe most common.
and that is Um, and really aresult of how the medication
works.
So one of the ways that themedicine affects our body is
(11:28):
that it slows the GI system downthe GI tract down.
And so food sits in the stomachlonger.
And while that's happening, thatcan trigger nausea or acid
reflux, and the slowing can alsothen lead to constipation or
changes in bowel habits.
and those can really be.
(11:49):
managed by making sure thatwe're eating small, frequent
meals, staying really wellhydrated, avoiding greasy or
sugary foods.
and then making sure we'regetting enough fiber to offset
that constipation.
And then we always start at ourlowest
Lisa (12:05):
I'm going to, sorry, I'm going to interrupt you right
here for a second, Dr.
Ogle, and just point out thisis, this is where that one of
those pillars of obesitymedicine comes in into play.
We have to have behavioralmodification along with the
medicine.
You don't just get to take themedicine and have it like, quote
unquote, do its job.
Like that was a lot ofbehavioral modification that you
(12:25):
just listed.
And so,
Dr. Lindsay Ogle (12:27):
Yes.
Lisa (12:28):
I just, anyway, I just think it's interesting.
Carry on.
Dr. Lindsay Ogle (12:31):
No, that's it.
That is a great point.
Um, uh, yeah, a great point.
Absolutely.
Um, so I, I do think that that'svery important to highlight
because there's a disconnectbetween, you know, taking a
medication.
I think that people think thatit medicine just like Burns the
fat off the body or increasesmetabolism and automatically
(12:55):
leads to weight loss that wayand and that is just not the
case.
There are, the medications areimproving biologic changes that
happen when somebody has obesityand and so that is what the
medicines are correcting.
They do not by themselves.
It's a tool to augment thosebehavior changes that you are
(13:18):
working on, um, to, help you tobe successful.
Um, but yeah, but we start atthe lowest dose and then slowly
work our way up, over time.
And if at any point you'rehaving, you know, side effects
on a regular basis, uh, wealways hold off on increasing
the dose and maybe back down onthe dose, uh, and address that
(13:39):
until Uh, Um, and then we can goback to adjusting the dose if
needed.
the more serious side effectsthat we hear about are really
rare.
and a lot of them are related toweight loss in general.
So I'm referring to, um, thegallbladder disease, gallstone
development, pancreatitis.
(14:01):
We see this happen with anyamount of significant weight
loss, especially if it happensin a short period of time.
So it's less from the medicationitself.
It's more from the fact that weare more people are losing
weight on the medicine.
And then the one not really anythat we are very strict about is
(14:22):
any personal or family historyof medullary thyroid cancer.
in animal studies, there hasbeen an association of an
increased risk of that specifictype of cancer, medullary
thyroid cancer.
So we're very cautious ifanybody has that in their family
history or personal history,then they should not be taking
these medications at all.
Lisa (14:41):
Not a candidate.
Yeah.
Okay.
So another risk I think that wesee a lot, which isn't so much
listed on, you know, on thelabel is the risk of losing more
muscle than fat and this, youknow, people are very worried
about this.
And I think it's, again, commonto be shouted in the grocery
stores from wellnessinfluencers, like, don't do that
(15:02):
because you're going to lose allthis muscle.
And it seems to me like it'sjust along those lines with the
gallbladder that we see thiswith any rapid weight loss.
if I was able to just snap myfingers and change your
lifestyle overnight and youstarted losing weight, you would
see this if you weren't activelycombating what causes that.
And I believe that that's thecase with these medications that
(15:26):
people are not doing the twothings, eating enough protein
and strength training.
Would you agree?
Dr. Lindsay Ogle (15:31):
I totally agree.
Yes.
Yes.
Those are so important foranybody who is losing weight If
you're losing weight from anymeans, then that is a concern.
We want to make sure that we aremaintaining your muscle mass as
much as possible.
but There is no way around tolose some amount of muscle mass.
So when we are carrying moreweights, we need bigger muscles
(15:53):
to carry that weight.
Um, and so sometimes even justthe ratio, um, maybe that main
maintains the same, you know, aswe're losing weight, but you're
going to lose some muscle, um,with that.
But yeah,
Lisa (16:06):
Yeah.
If you have a hundred pounds tolose, you can't possibly make
that all fat.
That's just not, it's just not athing.
You can't do that, but thatdoesn't happen.
Cause yeah, like you said,you're going to have smaller
muscles when your body issmaller because that is what you
need to function.
Dr. Lindsay Ogle (16:22):
yes, absolutely.
The only way to do 100 percentfat loss is liposuction.
Lisa (16:28):
Okay.
Okay.
So, um, let's talk about whysomeone would choose, um, a 1
medication.
I have had clients, I've hadboth.
I've had clients that are like,You know, I would never, I would
never do, and for some reasonthey just think that that's, I
think there's some, uh, stigmawith it being quote unquote
(16:51):
cheating, which I think isridiculous.
If my clients are open to it, Ialways say, ask your doctor.
Um, and I have coached clientsthat have been on medication.
And so when someone asks mewell, should I work with you or
should I get medication?
I'm like, yes, but what would besome of the indicators that
(17:11):
would be like, yeah, thisperson's really a, a good
candidate for asking theirdoctor about, getting on a
medication.
Dr. Lindsay Ogle (17:18):
Yeah, and I really appreciate your approach
there.
And I try to have a similarapproach of really
individualizing recommendationsfor for that person and working
with you know what somebody'sgoals are and what they're
comfortable doing.
And I definitely agree with yesand let's do both let's let's
use.
Let's focus on the health andmedicine side and then let's
(17:41):
focus on the mental health andbehavior side as well.
Um, And so I really think that,um, medication should be
considered maybe more stronglyif somebody has really the
majority of their life struggledwith their weight and, as for
(18:02):
decades, really not been able toeither.
Lose a significant amount ofweight to be able to get them
into not even a a normal BMIbecause we know there's a lot of
Problems with BMI and that's notour goal our goal is to help
somebody improve their healthand to function in a lot in
(18:23):
their life function andparticipate in their lives in a
way that they want to andsometimes our weight can hold us
back from that and And so wewant to, um, help you find, you
know, that best weight for you.
And if you have not been ableto, to do that over, like I
said, years or decades, thenmaybe it's time to talk to your
(18:44):
doctor and think aboutcorrecting those, um, biological
changes that are underlying.
Also kind of maybe taking a lookin your family and if a lot of
people in your family strugglewith weight, then there's a high
chance that there's a geneticcomponent going on.
And these medications can, canreally help with that.
(19:04):
Um, if you've done a lot of yoyo dieting back and forth, these
medications can also really helpjust stabilize, those ups and
downs, and really again, focuson, on health and nutrition and
it can, I know there's a lot oftalk about the food noise.
and I know I'm, yeah, and I knowyou do a
Lisa (19:27):
about that for
Dr. Lindsay Ogle (19:28):
yeah, and I know you do a lot of work with
that with, with coaching and,and our thoughts around food,
which could be so powerful.
but there, there, for somepeople, I would say even for
most people, when you lose asignificant amount of weight,
Your hunger hormones and thosesignal hunger signals to your
brain increase because your bodywants to maintain the weight
(19:52):
that it was at because it'strying to protect you.
It thinks that you're starving.
We, you know, food used to bescarce.
And so it's trying to conserveenergy.
So hunger signals and thosehormones go up and it can be
very, very difficult over asustained period of time to
fight those hunger signals.
And that is where medication canreally be powerful because it
(20:15):
can help lock those.
Those hunger signals and then itcan allow you then to follow the
healthy nutrition plan that youhave set on and this ties back,
you said something in the verybeginning about when we were
talking about mental health andI forget, forget exactly what
you said.
But I was talking with somebodyabout using food to help, um,
(20:40):
cope with certain emotions andwe all do it.
And that's a normal human, youknow, coping strategy, but
sometimes it gets out of handand difficult to control and can
lead to a negative healthconsequences, whether physical
or mental.
And if you're on a GLP one.
Your hunger signals are going tobe suppressed.
(21:00):
Your cravings are going to dropdown significantly, and you're
going to lose that copingmechanism of food that you were
turning to before.
And so it is so important tohave the support and strategies
in place.
So then you can Learn how youcan cope with that stress and
those negative emotions that aregoing to come up when you don't
(21:23):
have food to turn to like, likewe used to.
Lisa (21:28):
so on this topic of who it's appropriate for, that's a
lot of good, you know, I thinkpeople can see themselves in, in
that, but what about strictly interms of weight to be lost?
Is there.
an appropriate amount of, like,if you have this much weight to
lose, you're a candidate, but ifyou only have X amount of
(21:48):
pounds, you're not a candidate.
Is there a cutoff guideline
Dr. Lindsay Ogle (21:53):
Yeah, so, um, medically, uh, we are still
using BMI mostly.
Um, so, A BMI of 30 or abovequalifies medically for for
medications or BMI of 27 orabove with a weight related
condition like high bloodpressure, diabetes, cholesterol,
(22:15):
sleep apnea, and you cancalculate your BMI really easily
by searching BMI calculator andthen putting in your height and
weight and it'll tell you.
so those are the, medicalcutoffs.
That does not mean that yourinsurance will cover the
medication, though, which isvery frustrating component.
(22:35):
Right now, insurance companiesare not required to cover
medications for obesity.
There are a lot of people.
I know, I know it will beactually only been recognized as
a chronic medical conditionsince 2013.
And so it has not been that longthat we have the medical
(22:57):
community as a whole has seen itas something that needs to be
treated directly.
And so there it does take timeto make those changes, but there
fortunately are a lot of peoplewho are, you know, supporting
supporting the cause andhopefully insurance will will
start covering it moreconsistently moving forward.
Lisa (23:18):
Yeah, hopefully that's, that can be the case.
So it's not necessarily a, Ihave 20 or 40 or 90 pounds to
lose.
It really, at this point, still,you need to go off of your BMI,
which.
I know like every time you'vesaid it, you've kind of like put
it in air quotes and so whichpeople aren't seeing.
So it is, it is still achallenge.
(23:39):
So it sounds like stillsomething you need to just have
that conversation with yourprovider.
So let's talk about, GLP 1s arevery obviously popular, there
are certain types that areapproved just for weight loss
and you don't have to have a, asecondary diagnosis like type 2
diabetes, but there are othermedications.
(24:01):
So, can you speak to some ofthose options?
Dr. Lindsay Ogle (24:05):
Yeah, absolutely.
So, outside of the class of GLP1s, there are really, I would
say, three main medications thatare used.
The first is Phentermine, andPhentermine was FDA approved in
1959, and so it's been aroundfor 66 years.
(24:27):
Um, so another one that we havea lot of data on its safety for,
um, it gets a bad rep because atone point it was combined with
another medication that hadsignificant side effects, but by
itself it has been proven to besafe.
Again,
Lisa (24:42):
Yeah, so, I'm just going to say for those, I, I was, um,
kind of, I think in my earlytwenties when this happened, so
you might be familiar with thecombo.
They called it Fent Fen becausethe other one also started with
the, with the prefix Fen.
So
Dr. Lindsay Ogle (24:55):
Yes.
Yes.
Fen.
Fen.
And so that is no longeravailable.
but fentamine by itself is stillan effective appetite
suppressant.
And so that's really where ithelps a lot.
So, if somebody is having thatincreased hunger, you know, when
they're cutting calories thatthis can be helpful, um, this
should really be done with, uh,or prescribed by an in person
provider because we want tomonitor your vitals closely, um,
(25:19):
because it is a stimulant and itis technically a controlled
substance.
Although I always say, you know,people are not selling
phentermine on the streets.
People don't really becomeaddicted to it Um, but it is a
stimulant so it is controlledthen really great thing about it
is it's very inexpensive Even ifyour insurance does not cover
weight management medicationsWith a good or x coupon you can
(25:41):
get it for around 20 a month.
So very very affordable.
Yeah compared to the GLP 1agonist, which without insurance
can be closer to a thousanddollars a month.
So huge difference there.
Qsymia is a brand name thatcombines Phentermine and
Topiramate.
And it's just, it's a little bitmore effective with that
(26:02):
combination.
Also helps with appetitesuppression, um, helps with some
of the, uh, reward feedback,that we see with, with food.
this one is really important foranyone who has the potential to
become pregnant.
They should either not take itor, um, need to be on a really
effective birth control because.
Topiramate just itself has beenassociated with, cleft palate
(26:25):
development in the, in thefetus.
So that's a very importantthing.
there's some other potentialside effects that your doctor
would go over, but, that one isfairly effective and also, not
as expensive for the brand namewith the coupon last time I
looked, 75 a month.
so again, on the more affordableside, And then the third one is
(26:46):
Contrave, and Contrave isanother combo medication.
It combines a medicine calledBuproprion, which its brand name
is Welbutrin, and thenNaltrexone.
Um, this medication togetherreally helps with emotional
eating, stress eating, and itreally helps with that food
(27:06):
reward pathway.
The Bupropion or Wellbutrin weuse for depression.
It's a nonstimulant, A DHDmedication.
It helps people cut back onsmoking.
So we use it for a lot ofdifferent things.
And then the Naltrexone is ananti opioid, and so it is, it is
not an opioid, but it blocksthose opioid receptors.
we use it mostly for, reducingalcohol cravings.
(27:31):
so this is a also a great optionif somebody is having, you know.
Depressed mood or are drinkingmore than they want to this
medicine can help with thosethings as well As helping with
weight loss
Lisa (27:45):
Okay, good.
Yeah.
So there are, there are optionsout there.
I think one of the majordeterrents for the GLP one class
is the cost.
And so of course we have, Idon't think we have time to get
into all of the issues with the,compounded pharmacies and the
direct, you know, people thatjust get them directly.
And I think, this is where a lotof people are getting them that
(28:07):
shouldn't be, and they're notgetting them.
You know, they're notcandidates.
They're already, you know, quoteunquote thin and they're trying
to get even thinner and so Um,that's just like a whole other
conversation really, but, um,along with the medications, of
course we talked in thebeginning about the four pillars
(28:28):
of obesity medicine, but let'stalk a little bit more in depth
about what role does the diet,the exercise and the mindset
play when you are.
Also including some of thesemedications because I think for
so long, again, physicians havegotten a bad rap for just
saying, oh, well, just lose someweight.
(28:48):
Your knees will feel better orwell, you know, just eat less,
move more.
and especially too, I thinkthere's a lot of, really
negative information aboutdoctors don't know anything
about nutrition, which yes, thatthey, you know.
Your typical sort of quoteunquote family doctor doesn't
get the training that you do.
(29:10):
So it is very important I thinkto go to someone board certified
in obesity medicine if this issomething that you are really
struggling with.
so I would just like for you tospeak a little bit about, kind
of why that that happens forphysicians, like why, why that's
kind of been the case for solong and what role that plays
alongside these medications.
Dr. Lindsay Ogle (29:30):
Yeah, there is that stereotype that we do not
know much about nutrition.
And it probably, it varies, youknow, with any, with any field,
you know, what people's expertlevel is, where they trained and
what they were exposed to.
I also, you know, talking aboutinfluencers on social media, you
(29:52):
know, people can make it seemmore complicated than it needs
to be.
I think we just.
Um, I think most doctors areaware of that.
and I could sum it up here asreducing added sugars as, as
(30:13):
much as possible.
And so just, I always recommendstarting to look at labels and
choose options that have lessadded sugar or no added sugar.
and then making sure we'regetting enough protein and
fiber.
Um, and then water.
those four things are, if you dothat, you're going to be in a
much better place.
protein goals, I think, can varyfrom person to person.
(30:35):
Um, and it could be helpful toget individualized
recommendation.
But a general recommendation isthis.
Yeah, it's the shoot for around100 grams a day.
Um, for some women, it may beless for some men, it may be
more, but that's a good roughUm, and that's the goal.
Um, for fiber.
another good goal would bearound 25 to 30 grams per day.
(31:01):
Um, and then water.
it's enough.
So this one is you can reallyindividualize.
So you want to drink enoughwater.
So where your urine is clear or,you know, light yellow.
So you get that feedbackconstantly.
Um, so if you do those fourthings, like I said, you're
going to be in a great placefrom a nutrition standpoint.
And then to get.
Protein and fiber ideas.
(31:24):
We have Google, we have chapGPT.
They're amazing and such greattips.
and so I highly recommendutilizing those resources.
Lisa (31:34):
it's so true.
Like it's not a lack ofinformation that, that we have
on nutrition.
It's, it's really clear.
And again, I think, and I don'tknow why I keep attacking the
wellness influencers in thisepisode, but I think that people
try to complicate it in order tosell their product in order to,
and which is why I think I.
Kind of struggle with gettingclients because I'm not flashy.
(31:57):
I'm not saying, Oh, this is theone thing that you have to do.
You've got to cut out this, thisone thing you didn't know was
making you sick and all of thatgarbage.
Like, no.
And I, I think a really goodway.
Uh, I'm sure you've heard thisas well to sum up those
nutrition guidelines is the 30,30, 30 rule.
30 grams of protein per meal, 30grams of fiber per day, and less
(32:18):
than 30 grams of added sugar perday.
And.
I think it's just, which is kindof really what, what you said,
other than the actual number ofadded grams of sugar.
That's a little high.
I mean, I'd love to see itlower, but also I like to add in
a lifestyle food, you know,quality of life food, whatever
you want to call it, pleasurefood once a week, twice a week.
(32:40):
And so that's going to push meover that 30 grams of added
sugar, but then.
On other days of the week, I'mgonna be in the 5 or 6 grams,
and so I'm looking at thatnumber over the course of the
week, divide by 7.
Does that make sense?
Anyway, but I just like that 3030 30 rule.
Dr. Lindsay Ogle (32:56):
Yeah, I love that.
And that is so sustainable andso reasonable that and straight
forward.
We all can follow that.
And I totally agree.
I see that all the time wherethings are kind of advertised.
Yeah, you're missing that onething.
You didn't know this.
I'll tell you just sign up formy email list or something.
(33:17):
Uh,
Lisa (33:17):
no secrets.
So that's, and I think this isto the point of like, it's okay.
If you see the statistic thatdoctors didn't have, you know,
62 billion classes in nutrition,because it's just not that
complicated.
It's the doing it.
It's not the knowing theinformation.
It's that third pillar of thebehavior modification of turning
(33:40):
the package over and looking atthe added sugar and making a
conscious effort to includeprotein.
And where am I going to getfiber and how can I eat more
beans?
And you know, that kind ofthing.
And that's all the behaviormodification.
It's the nutrition piece isactually not complicated.
Dr. Lindsay Ogle (33:56):
Yeah.
And I will also say, um, so wedidn't mention this earlier,
but, I found Lisa through, acoaching program, that I was,
uh, I guess a student of, and,and she ended up, um, being
certified as a of the life coachfrom there.
And something that was sopowerful that I learned from
being coached myself was just.
(34:18):
not beating yourself up afteryou made a quote unquote
mistake.
And once I was able to learnthat through the help of my
coach, that was a life changing,skill that I developed.
And we see that all the timewith diets.
And so if we set out Our bestlaid plans, we are going to
(34:41):
follow these strictly andsomething happens and we overeat
or we bring something in thatwasn't in our nutrition plan or
our protocol, whatever we'recalling it, um, and then we beat
ourselves up.
We say we're never gonna get ourresults.
We're You know, not disciplinedor not worthy.
And then we over eat and, youknow, go off the rails.
(35:04):
if we are able to stop ourselvesat that moment and give
ourselves some compassion, thenwe can accept what happened,
which is normal that happens.
And then we can move on andcontinue moving forward.
And so I'm sure you see that allthe time with your clients.
Lisa (35:20):
Yes, that's definitely a major thing, that I teach.
And if my listeners haven'tgotten, haven't signed up for my
what to do when you overeat,three part video series,
actually, that's one of themajor things I talk about is.
You know, we, we're just goingto be kind, we're just going to
be kind.
Dr. Lindsay Ogle (35:38):
It goes a long way.
Lisa (35:39):
start there.
Yeah.
Okay.
So we were, I kind ofinterrupted, we kind of got a
little off the rails, but wewere talking about the role that
diet exercise and mindset playas far as, when you have a
patient on these medications,like, what is your advice to
them?
We spoke about the nutrition.
So let's get back on track onthat question with the exercise
(36:01):
as well.
Dr. Lindsay Ogle (36:02):
Yeah, so for exercise, same thing.
It does not have to becomplicated.
And I want to meet everybodywhere they're at.
So if you are not exercising atall, then it is not reasonable
to expect, you know, you totomorrow start exercising an
hour a day every day.
Um, what our goal would be wouldbe five minutes.
(36:26):
twice a week.
It could be as simple as that.
And I always encourage people tochoose something that they enjoy
doing.
Exercise is not a punishment.
It is not to make up forcalories that you consumed.
Exercise is for your physicaland mental health.
We all need to do it no matterwhat our body size is.
It is extremely unlikely thatyou're going to lose weight from
(36:49):
exercise alone.
It is very important to exercisefor your health and for weight
maintenance.
And like I said, start whereyou're at and then work your way
up.
Well, the recommended amount ofexercise for all Americans is at
least 150 minutes a week.
And you can split that uphowever you like, whether that's
(37:11):
30 minutes, five days a week, orhowever fits in your schedule.
And ideally, it's a combinationof cardio and resistance
training and the resistancetraining portion the goal for
there would be at least 20minutes twice a week and that it
can be bodyweight exercises.
(37:32):
It does not have to be CrossFit.
Um, we can do what you arecomfortable and able to do and
there are so many.
Any apps available.
I just signed up with Pelotonand I've been very happy with
their app and you can choose a20 minute exercise body weight
and you can do it.
You can do as short as fiveminute exercises with them with,
(37:54):
and they're so positive.
It's been, I really like theirapp.
and then I have a mentor whocreated GLP Strong, which is
created for people who are onGLP One Agonist, but you don't
have to be.
it could be for anybody and it'salso tailored for people who are
new at resistance training andit's just 20 minutes.
(38:14):
It's that 20 minutes twice aweek.
So very accessible.
You can do it in your home.
So those are my, those are myrecommendations for, for
physical activity.
Lisa (38:24):
Perfect.
Yeah, pretty standard.
Again, not complicated.
Just get out there and move.
I, I just want to add that,walking counts.
Dr. Lindsay Ogle (38:33):
Just thinking that.
Lisa (38:34):
okay.
I just think some people arelike, oh, well, all I can do
right now.
That's all I'm physically able.
That is perfect.
Do that.
Start there.
Get going.
and hopefully too, if you livein a place where you can get
some sunshine while doing it.
even, I mean, it's raining heretoday, so I actually took a
(38:55):
walk, um, at my gym.
On the treadmill today becauseit actually was my day for
walking.
So I was like, Oh, um, so it'snot as fun, but, um, walking
counts.
And I, and the other thing Ijust want to add to is I
typically, when I go to do mylifting, um, strength training.
Workouts.
Typically it takes me about anhour to do the, assigned
(39:18):
regimen.
I have an online trainer that Iuse.
And this past week, actually,um, on Tuesday, when I was
lifting, I did not get to thegym on time.
That's my fault.
And I, you know, I hadappointments backed up to that.
And so I was like, this is all Ihave time for.
And so I didn't do everyexercise that was prescribed.
And I still was like, it stillwas like 40 minutes.
(39:41):
I'm like, this was still totallyworth my time.
And I think that's anothermindset piece is to do what you
can, even if it's not what youdid in your twenties, or even if
it's not a full hour, sometimesI think because fitness classes
tend to be a full hour, wethink, well, that's how long you
should quote unquote.
exercise.
(40:02):
And that's just not the case.
If you have 20 minutes, spend 20minutes.
If you have 15, if you havefive, whatever you have, and
then also just try to getmovement throughout the day.
And that's not part of your 150minutes, but just that NEAT
portion, the non exerciseactivity thermogenesis, the
acronym is NEAT, N E A T.
Um, you know, do try to try tomove around during the day,
(40:25):
taking the stairs.
It's, you know, the proverbialexample, but there's lots of
ways to get some movementthroughout the day.
Dr. Lindsay Ogle (40:31):
Yeah, and I was just looking at these
recommendations recently, andthey did make a comment about,
you know, if somebody is notable to dedicate time right now
for exercise, then getting atleast 5, 000 steps a day was,
um, pretty similar to that 150minutes per week.
So yes, you can move throughoutthe day and that counts as well.
(40:54):
And definitely walking andcounts.
Um, I love that.
Lisa (40:58):
Good.
And then that last piece, justthe mindset, what do you
recommend there?
Do you recommend that yourclients, or sorry, you have
patients, I have clients.
Do you recommend that yourpatients seek out, mindset,
behavioral modification,coaching support?
Do you provide that as a boardcertified obesity, specialist,
(41:19):
or, you know, if somebody isgetting these medications from
just their family doctor ortheir.
You know, gynecologists, I don'tknow who all can prescribe
these, but if they're gettingthem from someone who's not
board certified, then would theywant to seek that out, um, in
another form?
Dr. Lindsay Ogle (41:34):
I think this is another one that's
individualized and I don'tdirectly do like coaching or
therapy, but I, when I'mlistening to my patients and how
they are.
Talking about themselves or theterms that they're using or what
they're focusing on.
I definitely try to redirect onetowards health focused goals And
(41:57):
reminding them where they'vecome from I think a lot of times
we get to a certain point in ourjourney Whatever that is and we
forget where we started and kindof that new spot is our new
normal And we don't See howamazing, you know, we have, we
have become, or I mean, wealways were that amazing, but
(42:18):
the amazing, uh, accomplishmentsthat, that we have had.
So, I always am remindingpatients about that and
reminding patients to be kind tothemselves.
Screening for eating disorders,depression, anxiety, adverse
childhood events, those are verycommon in people who have excess
weight.
(42:39):
That's really important, so if Iever identify that, then
definitely, um, therapy can behelpful.
for my patients who are very andhave maybe already gone through
therapy and are looking for kindof that next level, then that's
when I recommend coaching andthat can be very, very helpful,
(43:01):
um, along with, with, you know,their medication.
Lisa (43:06):
Great.
So the last question I want toask you, and let's obviously, if
there's something we missed, besure to add it.
But, what about coming off themedications?
I think that that's another bigdeterrent is like, okay, I could
maybe swing 1, 000 a month forthis health modification for a
few months or for, you know,nine months or something, but
(43:28):
it's I think a lot of people arelike, I can't do that for the
rest of my life, and Obesity isa chronic condition that does
sometimes need to be treated fortheir whole life.
So, what are the options therefor people when the cost is such
a big deal, and is itappropriate for people to start
these medications knowing thatthey are not going to do them
(43:50):
for life?
Dr. Lindsay Ogle (43:52):
So.
In the specialty of obesitymedicine, um, we recognize
obesity as a chronic medicalcondition and anything that we
do to treat that chronic medicalcondition, then we are going to
need to continue to do tomaintain it.
And I think a really greatanalogy is with high blood
(44:13):
pressure.
And so we start someone on ablood pressure medicine.
If they have high blood pressureand their blood pressure is now
in a normal range.
What would happen if we take theblood pressure medicine away,
the blood pressure would go backup, we need to continue that
medicine and we all accept that.
But for some reason withobesity, that connection just
isn't made.
And we think that the medicinecan be used short term for the
(44:37):
vast majority of people.
If you start a medication andlose weight that way, I suspect
you're going to need to take itlong term.
And it is likely that that isit.
Best for your health rather thanhaving those ups and downs in
your weight.
that being said, what I do withmy patients is when we get to
our goal weight, whatever wedetermine that to be for them,
(45:02):
and we're, you know, we're atour best weight and we're
feeling healthy, then I doslowly wean the dose down, as
tolerable and able.
Or we sometimes space out theinjections a little bit, um, and
if we space out the injections alittle bit, then, especially if
they're paying out of pocket,that can save a little bit of
(45:23):
money because they're, they'relasting longer.
I definitely would not base outmore than every I typically
don't go longer than every 10days and they're typically every
7 days.
So it's not a big difference,but it can add up over time.
I think this also ties back towhen I, we were talking about
earlier about who should be onthe medications with, you know,
(45:45):
if somebody has really struggledwith their weight for over a
decade or more, and their familyalso all struggles with their
weight, then this is.
a very high chance that you'regoing to be on the medicine long
term.
But there are some people whosomething happened in their
life, um, they went through about of depression or they were
(46:06):
started on a medicine thatcaused weight gain or, you know,
postpartum way or perimenopausalweight gain, and it was
relatively short, um, induration that somebody has had
that excess weight, I think, andI believe some of my colleagues
believe this too, is that themedication then, in that case,
(46:27):
it's a higher chance that wecould use that medication short
term, in those situations,because it's less that that
person has it.
What we are calling the diseaseof obesity.
It's more that they're carryingexcess weight because of some
other trigger that caused theweight gain to happen.
So if we're able to bring thatwith the medication, help bring
(46:48):
their weight back to where theywere before, then with
continuing on their newlifestyle changes.
That they, you know, worked withand developed while on the
medicine, then they're able to,you know, succeed in and
continue, um, those healthbenefits moving forward off of
the medicine.
But definitely I would want ineither scenario would wean off
(47:09):
of the medicine and then alwayskind of go back if we need to.
Lisa (47:13):
perfect.
That is so helpful.
Well, I think this has reallybeen, enlightening and really
informative for people to beable to just kind of have this
background to decide if theywant to approach their
physicians about this option.
And certainly you can alwaysstill use someone like me for
the, the behavior modificationas well as touching on the,
(47:35):
helping you with making changesto your nutrition and physical
activities.
So, Dr.
Ogle, could you just tell peoplewhere to find you online?
I know you have a certain placewhere you practice, obesity
medicine.
So it's not applicable foreveryone, unfortunately, but, I
think you, you, um, share onsocial media though, right?
Dr. Lindsay Ogle (47:53):
Yes, yes.
So I practice out of Missouri.
So my telehealth clinic iscalled Missouri Metabolic
Health.
And if you go to that website,you'll see links to all of my
social media, but they're allDr.
Lindsay Ogle.
I'm on Instagram, TikTok, andYouTube.
Um, and I Definitely recommendfollowing on on those platforms.
(48:14):
I try my best to share, youknow, evidence based education
to the general public for thosepeople who I cannot serve in my
telehealth clinic.
So that's something that I'mdefinitely passionate about.
So again, I appreciate youhaving me on here so I can reach
more people and, you know, talkabout this important health
topic.
Lisa (48:34):
Yes.
Thank you so much.
It's been a pleasure meetingyou.
I'm so glad you tuned in todaybefore I sign off.
I want to remind you of the whatto do when you overeat free
three part video course that Ihave.
We chatted a bit about this inthe episode, but if you are
trying to lose weight and youfind yourself overeating too
many times to see lastingsuccess, be sure to check out
that free course.
(48:55):
It also comes with a reset andrecover guide that will help you
put everything you learn in thevideos in writing and really
clarify each step so you canfeel confident moving forward.
If today's insights resonatedwith you and you're ready to
make lasting changes in yourhealth journey, I'd love to help
book, a free consult sessionwith me to see if my full 12
week one on one coaching programis right for you.
(49:17):
You can schedule it at the linkin the show notes.
Remember, it's not just aboutthe food.
It's about empowering yourselfwith choices that truly serve
you.
Have a great week.
And as always, thanks forlistening and sharing the eat
well, think well, live wellpodcast.
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