Dr Mick Crotty - Obesity Medicine Specialist in conversation with Paddy & Belinda [S2E5] - The Dose with Paddy and Belinda

Episode Transcript
Available transcripts are automatically generated. Complete accuracy is not guaranteed.
(00:22):
Belinda, Belinda, welcome to another week.
It feels like only yesterday that I was hearing that music
and we were recording how the time flies.
By Huh When you're having fun, Imust say, Paddy, I love our
tune. I just love it.
Yeah, I think our our producer did a our producer did a good

(00:44):
job, an editor. Yeah, our team.
Yeah, love it. I I do love in the.
Studio. Yeah, in the studio, I do love
when people tell me their perception of what they think,
how this happens and and like the fact that they think that we
work full time at this at like the podcast and social media,

(01:06):
like it amazes. Me we have.
We have to cover this as well Paddy, because we have massive
full time jobs. Yeah, like as.
Well as this. So like you've a full time home.
Mental. Like.
Mental. Yes, like multiple humans that
you were caring for. Yeah, I work one full time job,

(01:30):
another job. Part time, yeah.
And a part time job and then I have two different Instagrams.
Go follow the Irish Paddy as well if you're not on my main
page which is a dose of Paddy tofollow up.
Well, you can also follow at GLP1 Insights.
All right, and then on TikTok, TikTok as well.
So like I, I, so this is when wewere touched on this last week

(01:53):
when we were talking, but like about the volume of messages we
get from people looking for support and it's just not
feasible. Like in the early days.
I always reply to everyone. Always, always reply to
everyone. But it's with the volume of one
there and the complexities of the questions that we're getting
asked, as we're saying last week, it's too hard.
It's it's just not. If this was a full time job for

(02:13):
me, absolutely, absolutely. I could, I could lean and reply
to everybody and, you know, guide them on, hey, go to Doctor
Harry, do dietitian or whatever.But just with our full time
lives that we have, it's, you know, yeah.
But do you know what they say, Paddy?
Yeah, if you want something done, ask a busy person.
Yeah, this thing. Yeah, yeah, yeah, yeah, yeah.

(02:35):
So how have things been since welast spoke?
Brilliant, brilliant. It's been so long ago, Paddy.
Yeah, I how has the week been for you?
I've had the best week ever. Really anything.
Nothing. Nothing stands out.
Yeah. No, nothing stands out.
Of course I'm, I'm on holidays now, so I am.

(02:57):
That's correct. Yeah.
Yeah, I'm obviously. Back because.
You were back last week. Yeah, but I'm currently in
Majorca, you know, which is, which is a lovely holiday.
Yeah, how is it? It's it's it's lovely to be
away. So it is.
Yeah. Very.
The forecast is good. But we're so, so looking forward

(03:22):
to this week's guest, aren't we?And I don't think we've told
anyone up to now. We said at the end of last
week's podcast, Oh, did we? Yeah, we did.
But of course, that was a week ago.
I don't expect you to remember. OK.
Yeah, context here folks, is because I'm going to end
holidays and stuff. We're recording the intro for
this podcast literally 5 minutesafter we recorded last week's

(03:42):
podcast. So we're common clean.
We're common clean. Yeah, but.
Anywhere he's in his front room.Yeah, but I am actually on
holidays but I am actually stillin Ireland.
Whilst we record this intro, I did allude to a weight check in.
Yes, you did. And I didn't have to wait.

(04:02):
So this is amazing. Go for it.
You did it, didn't you? I hit 100 lbs today.
Fucker. Patty, I'm so jealous.
I'm just delighted for you. I will say that, but I'm
extremely jealous. Like congratulations, mate.
Like honestly. I I800.

(04:23):
Pounds 77 stone, 2 lbs. And Belinda, I only weighed
myself before we come in to record the podcast.
So I literally only. Was the middle of the day.
Yeah, I literally because I thought, well, I want to give an
update to people on how things are going.
I literally, I literally only record, like I literally only

(04:44):
waved myself before I started talking to you. 4:00 That's two.
Hours ago, yeah. So I it hasn't fully sunk in.
I have not sat with it fully yet.
The fact that I have actually. No, because you've jumped right
into this, Yes, so. Yeah, like I lived your shit, I
lived your share to post, but all I've hits, you know my 7
stone lost because I was delighted with that.

(05:05):
I hit it like only a day ago. And now you got to 100 lbs.
£100. Can I just ask you a quick
question, Paddy? Yeah.
Say if you weren't on Monjaro and you had lost this weight
through slimming rooms, yeah, Yeah.
Any of Yeah. What would you have done now
after hitting 100 lbs? What would be in your first

(05:27):
thought? Probably to go and get a
Chinese. Yeah.
Honestly, has that crossed your mind?
No. Not a hope.
No, no, no, no. Brilliant.
And. That in itself is a win as well,
isn't it? Massively, massively, Yeah,
Yeah. So like I, I, you're, you're,
you're are the first person to know.

(05:49):
But I've hit my. Apart from all the hundreds of
people listening to us as well. No, but like they won't hear
till next week. Yeah, like, you know what I
mean? Yeah.
Are you going to share that on social media or have you already
done it? Now I haven't shared it.
So by the time this by the time this podcast will have come out
and people are listening, I willprobably have shared on social
media by then, umm, because I want to an update because this

(06:09):
is it. Proper update.
This is something that is meaningful to me.
So this, yeah, this is my, as I said in last week's podcast,
this is my first big milestone that I had had, I've had for
years. And The thing is like when we
spoke two weeks ago, maybe it was or three weeks ago about, Oh
my God, wouldn't be great if I hit the £100 for my birthday.
Yeah, it's my birthday in 2 days.

(06:30):
It happened before, yeah. 2 daysand the the mental thing is
Belinda I have hit it to the ounce.
Oz. To the Oz.
I started my journey at 336.4 lbs three three, 6.4 pence.

(06:53):
Wow. Today I am 2-3.
Sorry. Yeah, 236.4 pence.
That's wild to the to the ounce.To the ounce.
That's crazy. Yeah.
I'm like, I'm not going to remember the point there, but it
is literally to the point of what it was when I started.
Like can you? Still, you still have so much

(07:15):
left in your journey. I do.
Are you calling me fat? You've no, are you no.
Oh my God, you. Bitch, what are you?
Saying I've so much left in my journey.
Oh my. Do you know we did this last
week too, folks? But you know what?
That is a weird on Belinda. Rock off, you old bitch.

(07:40):
I've so much left on my journey.No, I didn't mean it.
Like that? Wow, stop.
No, I'm not that. Bitch, I'm not.
That girl right, but I meant. It Lindsay Lohan.
Yeah, what I meant was you stillcan lose so much.
Well, you haven't. You haven't hit any kind of set

(08:03):
point. Well, I mean, like, and this is
an interesting thing because thelowest weight I have ever been
before was 14 1/2 stone, right? Right.
Umm, which is, I don't know, I, I, I don't know how many pounds
that is, but so, and this is where I was trying to ask my
endocrinologist before, is it possible that that is my set
point? 14 1/2 stone, Yeah or like is it

(08:24):
possible that sepunk can change and all this kind of stuff and
they didn't have a clear answer for me, so I don't know.
Now again, just to call out here, I am not aiming to like to
get to 14 1/2 to one or again, Istill don't have a number in my
head. I would have a ballpark kind of
probably very loose idea but I would say that like a stone and
a half to two stone ish is the Max more that I will be looking

(08:48):
to lose on my journey before I then flick into right.
I need to change my approach nowfor maintenance.
Yes. And again, as as you know, as we
touched on last week that like stone and 1/2 or whatever that
could take me the rest of the year, Belinda.
Yeah. You don't know and particularly
the way my my journey has been like I.

(09:09):
Like it took me Paddy a whole year to lose 2 1/2 stone.
Yeah, Yeah. Do you want to know my average
losses have been since I startedmonth on month.
Yeah, go on then. The average?
Sorry, not the average actually,no.
The actual loss month on month. Yeah, yeah.
Go on. So month one I lost just over a

(09:30):
stone. Month two it was 10 1/2 lbs.
Month 3 was about 16 months. The next month was about 8, the
next month about 8, the next month about 8, the next month
about 8, the next month, 8, the next month, 6.
The next month I went up over 10lbs.
That was month of surgery and then the recent one I yeah, kind

(09:53):
of dropped uh, kind of sense in.So like there has been the thing
that I need to stress in there. First of all, that's not normal.
That is not normal. Those losses, they, my losses
are abnormal, okay. They're not what people should
expect, Um. Are aspired to.
No, absolutely not 100%. And the reason we're saying that
is because there are three typesof people within the umm, within

(10:16):
taking medication for weight loss.
Umm, there's people who are who it doesn't affect at all, who
has no umm. What's the word I'm looking for
Paddy. So you'll have people that can
be a fast responder, which is normality.
You'll have people that will be,say, a slow, a slower, a
moderate responder like myself. Yeah.

(10:37):
And then you might have people that just don't respond as well.
Yeah, but you're a super responder.
Well, well, I'd say I was a fast.
I would say yeah, yeah. I would say that because it's
not. Average, it's not even it's not
even near a fast loss and. You know, and like The thing is
that I would say is like say, for example, this past week I

(10:58):
have lost like I don't know, 4 lbs or something like that,
which has got me to here. But in the previous weeks I've
been pretty much staying the same or just going up and down
the 1 LB. And that's the way my journey
seems to go now is that I could have 5-6 weeks where I stall or
go back up a little bit and thensuddenly I'll have a week or 10
days where boom, I'll just. Drop something, yeah.

(11:20):
And that's the way it's been fora long period of time.
Umm, for me maybe since late last year.
Yeah, see, I don't do that. I don't weigh myself anymore.
I just weigh myself in the gym every, I don't know, 9 weeks or
something. Umm and like I tried to stay
away from the Wayne scales as much as I could because it was

(11:40):
such a trigger for me and I stayaway from it now because it
doesn't affect me. I don't, it's, it's an anonymous
object on the floor. Umm, I worked through that with
my health coach that I had Nikki, and it took a long time,
you know, and that's what I try and tell people when they start
out, you know, don't put all of your worth into those objects.

(12:01):
100% And I will say this time and time again, I don't care
what number that's shows on the scale.
It's irrelevant to me. It is you just like charts.
It is a data point. It is, yeah, just a data point
and that. And some people struggle to
understand that. But like, I don't care about the
number. It's just informing, OK, how's
my journey going at the moment? It's not like, Oh my God, I'm up

(12:21):
a pounder. Oh my God, it's not that.
Doesn't matter. But the 100 lbs thing is, is is
a thing. That's huge so.
Like, I don't know how like I, I, I've been thinking about this
for more recently over the past maybe two months when I've kind
of thinking, OK, I'm getting near that kind of place for
three months actually, whatever it was.
And what kind of content do I want to play out?
Because I've talked with this somany times over the past and

(12:43):
stuff like that about wanting tolose 100 lbs.
So it's fairly momentous for me.The, the next and the only
holder milestone I'm touching this in last week's part is the
velvet jacket. So the velvet, you can't see it,
but the velvet jacket is literally behind me.
It hangs in this room the whole time on display.
So every time I. Walk.
Oh my God, your background, Paddy.
No no uh this is fake. Umm because the room is messy,

(13:06):
although I did start hiding it because my sister is coming to
stay in my house my way so. You can't beat my.
Background. You're a super Yeah, super
background. But anyway, so that is my update
for this week. But umm, so it is.
Which I'm absolutely, yeah, delighted to share with people
and such a massive thing to, yeah, finally achieve.
Congratulations again, I'm so proud of you.

(13:26):
Thank you. Umm, but so this week, Belinda,
who are we talking to? This week we have Doctor Mick
Crotty on our podcast. I just like fanboys.
We're just so delighted and so delighted.
You're about to hear me fanboying hard at the start of
this interview. It's actually quite

(13:47):
embarrassing. It is, but also we do on the
back of that I do that embarrassed Belinda as well,
just to make sure that it's shared embarrassment based on
yeah, other stuff. So we really hope that you enjoy
this podcast. Uh, Doctor Mccrotty is somebody,
umm, that we are huge fans of that.
We love his advocacy, the work he does, umm, and how consistent

(14:09):
he has been with that advocacy as well.
Yeah umm, and the work that he does at his clinic, which is my
best weight and again, we have 0affiliation with my best weight
whatsoever. We've not even been patients up
there or anything whatsoever like that.
Yeah but like over, you know, the time watching them and
showing the content they put outand the way the position things.
Umm, really like the work that they do umm.

(14:31):
But anyway, so folks, sit back, relax and enjoy the conversation
with Doctor Mccrotty. We are delighted to be joined
this week by Doctor Mick Crotty.I am going to jump straight in
and what we've done to our guestbefore, Mick, is what is your
elevator pitch about who you areand what you do?

(14:54):
Elevator pitch. Oh God.
I'm Mick Crotty. I'm AGP by training and for the
last 10 years I have specializedin the treatment of obesity,
particularly, I suppose community based medical weight
management will be the kind of fancy way of looking at it.
Realistically, I talk to people each and every day about how

(15:15):
their life might or might not beaffected by weight and talk to
them about treatment options. And I have a few other hats that
I wear as well. I'm I'm a dad, I'm a husband,
I'm an amateur cook and Baker and a few other things, but
that's that's going to mean a nutshell.

(15:35):
Did I see hashtag new boy band as well?
Oh yeah, yeah, yeah. I'm, I'm thinking myself and
Professor Karl Leroux and Josh Personal were half thinking a
set of a boy band. I don't think we'll be very
successful. It might be a certain
demographic we're kind of pitching to, but.
Oh, but they're there. They're there.
Well, actually, you know, talking about demographics that

(15:56):
are into things. What you didn't hear before you
joined into this recording, we were talking about how you were
on a previous podcast, Belinda'sgoing to Kill Me.
But what we were saying was yourwas your prep before Mick hopped
into that. There was 3 girls.
Yeah, there was us. There was Seth, Kim, Kaf and
Bearcat's husband or Kim's husband and the three girls.
We were sitting here putting on lipstick before you came on

(16:19):
because Paddy brushed his hair before this one.
But on this side, I'm busy barricading the door so dog
children don't. Can't come in.
So it's kind of a preparation iskey.
Yeah. One of the things I have to say,
and I don't know if I've said this to Blinda before, but
myself and some of my friends have been from many years, big

(16:44):
fans of Doctor Mccrotty. Because I would say going back,
the first time I ever heard you talk would maybe have been, I'm
going to say maybe, maybe 3:00-ish years ago, talking
about obesity. And you were the first medical
professional ever. That made me feel like I wasn't

(17:05):
doing something wrong and that Iwasn't.
That I wasn't a failure. And that there was the potential
that there was something more atplay in relation to the last 30
odd years of obesity that I had been kind of living with.
And you were the first person that was able to that said words
that resonated with me, that made me feel more human about my

(17:28):
weight. And that was massive.
And I'd say nearly emotional when I was listening, I remember
was listening to the car of the conversation or having one day.
And it was just it just blew my mind.
So from the get go, like I'm fanboying, fanboying hugely
because that conversation you had had such a profound impact

(17:48):
on my, I guess, mental awarenessabout myself and about the years
of living with obesity and otherpeople around me that that heard
that conversation as well. So just from the gecko, just to
say that the the the words you speak and have spoken over the
years have had a huge impact on people.
Huge. Thanks very much.

(18:08):
I suppose I say the same thing over and over again in the same
way, and I say the same thing inclinic when I'm seeing patients
as if anybody gives me any kind of a platform, I say exactly the
same thing. So I know what I've said because
I say it over and over again. But for me, I think the just the
key to trying to change the narrative in society and change

(18:29):
how we kind of treat obesity is,is to share an understanding
with people. And it's interesting people who
live with obesity, they get it straight away, umm, because when
you understand the biology, whenyou understand how our body
regulates weight, it explains why we have lost weight and we
gained it. It explains us why we feel
hungrier when you're on a diet. It explains why, uh, we have all

(18:51):
lost huge amounts of weight and it comes back over time, not
because we run out of work, our motivation because of biology.
So I think really for me that that's the key is, is sharing
and understanding with people. And actually, it's probably
easier to share an understandingwith people who have the
experience of it. Talking to sometimes other
healthcare professionals who don't have obesity or don't live

(19:12):
with obesity can be more challenging because people
people don't get it as much. And, and that that's where the
challenge is. So it's really easy to talk to
people who. Can relate.
They get it straight away. Yeah.
And it's profound. It is profound when people hear
that for the first time. As Paddy said, haven't lived
with it for three decades, you know, So, yeah.
Yeah. Definitely.

(19:33):
So you, you, we touched on the boy band there a moment ago, but
I'm going to take that back a step in relation to where that
kind of form from. So one of the areas of your life
is my best weight. And I'd love to know, you know,
know a bit more about what is mybest weight or what is the
mission of my best weight or yeah, what's the purpose of it?

(19:54):
Yeah. So I suppose I I was AGP in
Ireland up until about 2014. I work in regular general
practice and myself and my wife then decided we'd go on a bit of
adventure. We moved to Canada.
We spent five years living in Edmonton, in Canada.
And at that stage I had no particular interest or knowledge

(20:14):
of obesity because I didn't get the understanding in college or
or in my GP training. I I thought about obesity the
same way as as many people in society think about it, and then
moved to Canada and started, unbeknownst to me, obesity.
Canada was kind of centered in Edmonton, So one of the most
profound kind of medical education Centers for obesity

(20:36):
ended up going to a few talks and was absolutely flabbergasted
by hearing kind of these expertstalking about obesity in a way
that I understood and helped me understand because again, I've
had challenges with Waite my whole life and, and I understood
it and it actually made sense. And I was flabbergasted as to
why I'd never heard this before in, in college.
And I was pretty good for going,but I didn't think I missed that

(20:57):
day in, in lectures when they, when they talked about it.
So, umm, to hear, to hear about it kind of just by accident
almost while I was there was, was profound.
And then I got more, more and more interested and started
educating myself and meeting with different experts, going to
conferences, doing different kind of training to kind of
upskill and then started seeing patients and treating patients.
And eventually after five years,I was told we were going back to

(21:21):
Ireland. And I generally do what my wife
tells me to do. So, so I said, OK, well, how,
how am I going to make this work?
I, I had actually developed a very nice obesity service in, in
the general practice I was in, in Canada.
So I'm going to come home now and how, how will I do it?
And to me at that stage, I suppose it wasn't something that
was done. And, and I I checked and there
wasn't any clinics in Ireland. So I started reaching out to

(21:43):
people and I had met Professor Karl Le Roux at a couple of
conferences and I knew he was kind of world renowned obesity
expert and a bit like a lot of things in Ireland, probably
under appreciated in his own country, but internationally is
this kind of superstar in, in obesity.
So we started having the chats and very quickly realized we
were very much aligned in how wethink about obesity, how we

(22:05):
treat obesity, how we approach kind of management.
And so we said, look, well, why don't we set up a service
ourselves, something that doesn't exist, you know, at the
moment, so. Exciting.
Then that's that's very exciting.
Yeah. We start off very small and we
start off kind of seeing small numbers of patients and I think
mostly kind of it was word aboutthat.

(22:27):
It started spreading and gradually then we added extra
services. So we added the dietitian
exercise specialist, we refer out to psychologists, we added
admin staff and just kind of graduating.
We're still a, you know, very much a kind of like a family
type small operation. We're not trying to scale things
and. Real the world.

(22:48):
This kind of, you know, multinational, I think we're
just looking to kind of treat people the best way we can.
And, and we've added some more doctors, which is fantastic.
And I suppose it, it happened tocoincide then with a huge, I
know it's a revolution. It's a bit of a strong word, but
with a much bigger awareness of new treatments becoming
available, uh, much more conversation.
And we were, I suppose, doing this.

(23:10):
And I suppose in my view, beforemany other people were kind of
doing it and and talking about these things, we're very
comfortable. It's really kind of gone from
there. So I, I think it was about
2020-2021 that we kind of started very small and it's kind
of grown over the last four or five years.
Can I? So what what's the difference

(23:31):
between coming to you in 2020 and coming to you in 2025 with
this big, you know, revelation of all of the GLP one meds?
To be honest, I still have the same chats with people.
So when somebody comes to me, what I'm interested in is I want
to listen to them. I want to listen to what's been
happening for them, what's theirstory because everybody's, I'm a

(23:53):
bit old fashioned. We get people to fill out these
kind of 12 page questionnaires that are really detailed, but
there's actually no replacement for, for listening to people and
chatting to people. So hearing, you know, for me,
it's, it's understanding what has been happening for them.
Umm, and then I suppose, you know, uh, mostly I'm interested
in if or how excess weight is affecting somebody.

(24:14):
Does it affect them medically, physically, psychologically?
I really care, uh, what somebodyweighs.
I couldn't give a tuppence aboutwhat somebody's body mass index
is. I want to know if their health
is affected because I might meetone person whose weight is here
and their health is not affected.
And maybe somebody else's weightis exactly the same.
It was every complication that can go with it.
So, hmm, you know, we can't makeassumptions about people's
health, about their lifestyle, about I think based on size or

(24:35):
weight. We need to talk to them.
And it's interesting, most people who come and see me,
they're not on the surface particularly concerned about
their HB1C, their systolic bloodpressure, their, you know, the
these metabolic markers. They're concerned about their
movement, their mobility, you know?
Longevity. For kids and grandkids, they're
concerned about, you know, how they feel in their own body,

(24:57):
energy levels, kind of very practical stuff.
And it's a mental health. Yeah, because you know, we're,
when you're treating somebody that that's what you're
treating, you're treating their health and well-being.
You're not treating them to get them to a certain number.
Because when they come in, I don't care what they weigh when,
you know, when they're going out, I don't care what the way I
care about how they feel or how their health is and how they're

(25:18):
experiencing things. So.
That's so, that's just so refreshing to hear though.
That's why we want to just talk to you about my best weight,
because that's what people need,isn't it, you know?
It's, it's a challenge because Imean, people come in, they want
to lose weight and I know they want to lose weight.
And, and again, like I'm, there's nothing wrong with that.
Like if that's their perspectiveand goal and things, then that's

(25:41):
where we find I'm very health focused and I focus on health.
Now, you will often find that significant weight change is
associated with significant health gain.
But if we're chasing a certain number, we probably will never,
none of us will probably ever see the number we want to see.
None of us may ever be the size we want to be.
We may or may not be the size weneed to be, but but we can be

(26:02):
healthier. We can be more functional, we
can be more active. I suppose myself and Carol, very
much like I, I, I say to people every day, I will not make you
thin and I will not make you happy because that's not what's
going to happen. We can make you healthier and
that's not to say you're not healthy starting.
We can make you healthier. We can make you more functional.
We can give you more quality of life and what people decide to

(26:22):
do with that function and quality of life that that's down
to them how how they use that. So if I was safe there someone
listening and they're trying to figure out what kind of path
they are going to take for looking for extra support where
they are right now. What does that kind of I guess
process looks like in terms of I'm assuming somebody sends an

(26:43):
e-mail or gets in contact with you.
How do you then determine what is the right treatment path to
prescribe for them in terms of if it's nutrition or movement or
is the case that all of that youhave to take it all or is it
more bespoke and can ad hoc based on the person or yeah.
I'd love. More about the the the kind of
patient journey once they contact you.
Yeah, I'm very thick and simple.Uh, and the approach I take to

(27:06):
obesity care, weight management is the exact same way that we
treat blood pressure, cholesterol, diabetes,
depression, any other medical issue.
So somebody comes in and we listen to them, we listen to
their story. We, we do an assessment of their
health and their background and different things and what's
going on for them and what's important to them.
Uh, and then really for me, it'sto topple all the treatment
options that are available. And that's nutrition options,

(27:29):
life interventions, sleep, stress, patterns of eating,
behavioral strategies. It's to talk about medication
options that might or might not be applicable.
It's to talk about surgical options.
And you know, for me, it's aboutfinding the right treatment for
the right person at the right time.
Something might be a fabulous medical treatment.
It might be the best medical treatment available, but it
might be right for that individual depending on where

(27:50):
they are in their life, what they can afford and, and what
their perspective on things are.So really my job is to give
people information and it's up to them that people are smart.
If you give them enough information, they'll make the
right choice for themselves. And really then it's a case of
saying, look, well, the approachwe're taking for this is the
same as we would to hypertension.
Let's choose somewhere to start.Let's treat you.

(28:12):
Let's see how you get on. Let's change the plan depending
on how you respond and likelihood in five years time
we'll be talking totally different because the evidence
might be different, the what's available might be different.
You know, again, for me, like many people who come to me might
end up having bariatric surgery and that's brilliant.
You know, I again, no more than you know, I don't care about

(28:33):
weight. My job is not to give somebody
medication. My job is to give them
information and then to help them with the decision making
process to see if that's right for them.
But people need accurate information.
They need to know what to expect.
They need to know the costs, they need to know how long they
will take this far. They need to know the potential
risks and benefits and then decide is it right for them.

(28:55):
And a lot of people would would kind of leave with information
and say, OK, look, I just want to process that because, you
know, I suppose increasingly it's not the first time people
are hearing these things. People are more educated when
they come. In coming in.
Because they've listened to yourselves and they've listened
to, you know, videos on our website, they've listened to
various podcasts, you know, and there's.
Books out there about it now that has never been out before.
And yeah. Exactly.

(29:16):
So they, they're, they're comingarmed with more information, I
suppose. I, I would commonly hear people
say, you know, I've done everything in the past.
And what they might mean is they've done every diet that
there is and they've lost weight.
You know, maybe they have never had supportive nutritional
therapy, you know, with a dietitian, Maybe they, they
certainly probably or may or maynot have had medication.

(29:36):
They may or may not have had surgery.
And, and really that's what's helping people understand this
is we're not curing a problem. We are treating a problem.
This is going to be a lifelong treatment, even if somebody's
weight comes from here down to what might be considered, and I
hate the word normal, but they come down to a body mass index
within a normal range. That person still has the
chronic disease of obesity. They're just well treated.

(29:57):
So. So again, that person over the
course of time is going to need different supports.
Yeah. And when, sorry, just when we
were planning the service, there's there's lots of
different ways you can kind of go at this and you can have
packages of care. You can have this that the other
you can have, you know, here's the all singing, all dancing for
me. Everybody's journey is a bit
different and depending on what somebody has done in the past,

(30:19):
depending on what they are like.Again, if I meet somebody and
they're they're a trained personal trainer and you know,
they have done degrees in nutrition, they're a dietitian.
You know, maybe that person, youknow, doesn't need to see the
dietitian. Maybe they need the medication
to treat the biology. Maybe you can have all the
knowledge, but actually applyingthat day-to-day is challenging.
So you need support and, and kind of, you know, help over

(30:42):
time. So it's to me it's not about
saying you have to have this, that and the other in case of
saying this is what's available,what do you feel would benefit
you? Most people kind of might come
to see me. They come see me probably from
medication. So they might consider
medication and then we're kind of saying, OK, well, you know,
how is this going? How is that going?
Would you benefit from this helpor that help and?

(31:03):
And it's all really emotional, isn't it, For people, for your
clients that come into you, for your patients that come into
you, because being obese and living with obesity for
generation or decades is an emotional thing.
I'm just wondering what's like the most emotionally memorable
thing for you having had this business for how many years did

(31:24):
you say 6 years, 4? Or five.
I think we're going now. Right.
I make everybody cry. It's my talent to life, from
patients I see to my wife to my kids, Everybody cries underneath
me. So we think about the tissues
and it's sometimes tears of remembering traumatic events in

(31:45):
the past, particularly as it relates to weight.
Comments from people, the amountof people I meet who bring up,
you know, getting their communion dress or a teacher in
primary school or a comment fromthe family member, you know, it
might be a thing, you know, in talking about how weight is
affecting them, they might be talking about the things that
they're restricted in doing or, you know, their life.

(32:07):
Being on hold will not start my life when I get to a certain
weight. It might be, you know, tears of
joy. That depends.
Then actually for the first timenow I understand why my
experience has been my experience and.
Tears of hope. Yeah.
And, and actually on that side, it might be that, that, you
know, many people that I mean, you know, they don't start the

(32:27):
medications, perhaps because they're afraid that it's not
going to work, because they feelin their own head, I have and
their word failed every, everything.
And this is another thing I can fail.
Whereas to me, like nobody failed an intervention.
If somebody doesn't respond, it's not the right intervention
for that person. For them, yeah, it's.
There's a lot of what you've said that resonates with.

(32:49):
Me. I'm from like years ago and I
had lost so back in like 2011 I was, I don't know, like 21 stone
or something like that. And I went on and we're going to
loop back to this in a in a second, but I mean, Tom, the
biggest news or the TV show whenI was over in the UK living

(33:09):
there, I lost. I think it was 6 1/2 stone or
something like that stage. I thought I'm fixed now the way
it's gone. Fantastic.
Went and qualified as a personaltrainer and I would say within
18 months, um, I take at least 50% more.
The weight that I had lost was back on maybe more actually.
Um, and I, I stopped doing personal training purely because

(33:32):
of that. Such a strong feeling of being a
failure and I just could not figure out.
Why? What?
And I went through some therapy then with a CPT therapist in in
Dublin, and we looked at kind ofthe relationship with food and
stuff like that. And that was a big help in
relation to understanding some of the behaviors and triggers

(33:53):
and how I was responding with food.
And that was fantastic. And for one part of my
relationship with food and things.
But yeah, but yeah, a lot of a lot of what you're saying there
is definitely resonating. Yeah, and for me as well.
And you know, you, Doctor Quarty, you talk about the
different methods that you can offer people.
Have you ever had any of your patients like push back and

(34:18):
disagree with you or? Absolutely.
And, and again, I suppose I'm long enough in the tooth now to
kind of come at this. It's not my job to try and
convince somebody to do XYZ. I don't want to convince people
it's, it's, it's actually my, myblood pressure's too important.
So like really for me, it's a case of saying this is what the

(34:38):
evidence says. It might or might not be what
you want to hear. It might or might not align with
kind of what you feel yourself. But this is what the evidence
says when we, when you look at the right evidence, this is how
we approach things. That's not to say that that how
we do it is the only way to do it.
It's not to say it's the right way to do it, but it works for
me. And again, I suppose I spent

(34:59):
years, you know, talking to different people, listening to
different healthcare professions, how they approach
this, how they talk about the words they use.
And, and you start off by kind of parroting other people and
then you find your own voice andyour own way of discussing this.
And, and like I said, to me, it's, it's very much like we
have to share an understanding. So it's using the language
people understand. It's it's talking about in the

(35:21):
way that people can kind of get.So, so it's not to me like it's
not a failed confrontation. It's so he doesn't leave on a
medication. I not that I don't care, but
like, that's not my job. My job is say, look, this is
this is the information that I'mgoing to provide you.
These are the benefits, these are the risks.
This is what's appropriate. This is what's not appropriate
treatment. So somebody comes to see me and
they're not living with obesity to say, look, you know, these

(35:42):
medications have not proven to be safe or effective or kind of,
you know, in this context. They might be in years to come,
but but that's not where we're at at the moment.
And then, and then it's for people to decide and people will
often leave and come back with further questions.
I suppose people will self select out.
They'll come and see me because they know how I talk and, and

(36:02):
they've seen me chatting and, and they'll come with certain
things in mind. But I'll often stop and say,
look, you know, again, that's where the communication element
is vital. If I'm kind of chatting to
someone and saying, no, this is not that they're, they're not
kind of reading off the same page as me.
This is not what they're interested.
I'll, I'll stop and say, look, what should I be talking about
here? Now, somebody said, I don't want
medication, I don't want surgery.

(36:22):
Happy days, Grant. That's easier for me because
then I can say, look, this is, you know, OK, let's talk about
the treatments you're interestedin.
And I, I'd always want to plan to see most people that come and
see me don't want surgery. And I'd say absolutely
brilliant. I utterly respect that.
It doesn't mean that surgery is not a fabulous treatment for
somebody else. And, and in the future, it may

(36:42):
be a great treatment for you, but you know, and I'm going to
tell you I'm a huge fan of surgery, even though I'm AGP and
a medical doctor, I, I think surgery is a fabulous, safe,
effective, much maligned, misunderstood and stigmatized
treatment. And I'll always plant those
seeds. But, but my role is to talk to
people about why they want to come and see me.

(37:03):
And, and for some people like ifI can simply use that word kind
of a little bit incorrectly, butif I can kind of help somebody
understand their journey, if I can help them understand that
internal bias and stigma that they and the blame and shame
they've lived with like that, that's a successful encounter to
me, whether or not somebody goeson medication or not.

(37:25):
When you're thinking about like we, we spoke a lot there, but
like about language and terminology and stuff like that.
And obviously there's been a huge amount of talk about
various measures or words to. Describe.
Yeah. And I'd love to know, when
you're sitting there in your clinic, from your perspective,
what do you see as being the most helpful or compassionate

(37:48):
way to define obesity? Yeah, I suppose I'm, I'm kind of
the language police when it comes to obesity.
And I will, I will hear things in language that may not exist
because I'm just so kind of downthe rabbit hole on it.
But for me, I think language is incredibly important for me, but
equally the person who comes andsees me, they may have a

(38:09):
different understanding of language or, or different
approach language. So, uh, I, uh, there are many
words that I find very stigmatizing, Uh, things like
morbid obesity, I think we could, should just expunge from
medical nomenclature. Uh, I don't talk about fat.
Uh, I don't talk about, I talk about the chronic disease and
obesity, living with obesity. It doesn't define people.

(38:31):
Uh, person first language. Uh, but I'll often say to
people, you know, again, I, I probably use the word weight a
lot because I think in Ireland it's, it's kind of, it's
probably a common one to talk about.
Yeah. And I might talk about excess
weight, higher weight, uh, we'lltalk about weight affecting your
health. Uh, but equally, some people
don't like these words. A lot of people don't like the
word obesity. Uh, they prefer the word fat or

(38:54):
they might identify with that. So, so again, it's, it's
different for everybody. I talk very similarly and I have
my way of kind of talking and that, that's just normal for me
now. Uh, and it's interesting when
you go outside your own little bubble and silo and hear other
people talking, then you're kindof, you're kind of actually,
maybe they talk about that a bitbetter and the way they explain
that, that's clear. And, and maybe I'll adopt a bit

(39:15):
of that. And then other people are
thinking, well, that needs to change.
Yeah. But language is is important.
And I suppose I say very similarthings repeatedly over the
course of the day. So, yeah, even though.
So somebody come and see me, they're an individual.
Their journey is different. But again, in explaining things,
I'll probably explain it very similarly.

(39:35):
And one of the challenges is, you know, I might have the same
conversation multiple times in the day, but that person sitting
in front of me, this is the first time they're seeing me.
This is a huge important potentially event in their life.
And, and to not underestimate the, the journey it has taken,
the bravery, the fear, the anxiety, everything that they're

(39:58):
going through to be there. Even though it might be kind of
the 10th person I'm seeing in the day, to still stay present
in in the room and, and acknowledge what that person has
gone through to get there and they have waited to see me and,
and to be kind of there for the conversation.
That's why at the end of the day, I'm just absolutely flat to
the mat. Like I'm just.
Emotionally kind of drained and exhausted because you're you're,

(40:19):
you're shit. You're hearing people's stories,
you're kind of sharing with themand it's.
It's hard, yeah. It's, it's, it might be, it's
hard, but it's an incredibly privileged position to be in.
I'm very lucky. It's something I'm obviously
kind of passionate about. If I was kind of talking in and
talking out, it'd be, it'd be like much easier.

(40:40):
But, but for me it is, it is important and, and I suppose
building that relationship with people, then I suppose it makes
it easier then when you're kind of following up because, you
know, if we, we, I, I tend to, in our clinic, we tend to invest
a lot in that first visit in kind of, you know, understanding
things from people, kind of taking notes, kind of noting
their history, making a plan. And, and the plan might be the

(41:02):
same for 20 different people. But equally then we still need
to kind of, you know, have kind of the safeguards.
We still need to have the understanding of things And
look, if this happens, get back on to us.
You shouldn't experience that. We don't want you to have to
have this and, and just make sure people are, are kind of,
we're all on the same page, you know?
And so when you hear, I guess onparticularly, particularly

(41:26):
probably social media, but also media in general or society
referring to the skinny jab, what emotions is that?
Stir up. Yeah, I, I in any media
encounter, iPad, I will always take the opportunity to kind of,
you know, say these are not skinny jabs, quick fixes, not

(41:47):
Hollywood's worst kept secret. Like, I say that in everything.
I'm anybody I'm talking to just to put it out there.
But yeah, I, I, I have been quite active on social media and
in media in the past and that has led to good opportunities
for me. It has also led to negative
experiences for me as well. At times it kind of pull back

(42:09):
when there's, as I was saying kind of earlier, sometimes you
kind of tend to be a little bit kind of wasn't picked out.
You're kind of a little bit kindof there's just too much noise
going on. But really for me, what
frustrates me most is, is kind of the, the discuss the
inappropriate kind of use of these medications, the

(42:29):
misrepresenting of these sorry medications treatments will be a
better way of saying it, you know, and, and that kind of is
challenging or when you, it's, Ithink it's hard for anybody
who's passionate and maybe educated in the area to hear
somebody else talk about their area, you know, maybe when
they're not coming with the samekind of understanding of it or.

(42:52):
Empathy. Yeah, yeah, like empty vessels
in the most noise and all that kind of stuff sometimes, so.
This feels like a perfect momentto play a small clip.
So you may have already heard orseen this clip, so it might be
surprise you but. It's not you, you're OK.
I'd. Love to get your medical or just
your even your personal. Personal reaction, yeah.

(43:12):
As I say, I was on The Biggest Loser in the UK.
For me it was actually a phenomenal experience being on
it. But I would win someone that
grew up watching The Biggest Loser USA.
I am religiously, absolutely religiously, and somewhat in awe
of seeing people having this opportunity as I thought to fix

(43:32):
their lives via a TV show and off the trainers and off the
trainers that they got the got to use.
And one of the people that I would have idolized would have
been studying Michaels. Would have been.
Would have been. Past tense Jillian Michaels so
this she is one of the. Most.
Well known biggest platform helppeople and I'll use that word

(43:57):
very loosely. But anyway, this was I'm saying,
you may have heard this already,but it's about 30 seconds or so
and I'd love to get your action afterwards.
It does slow the progression of chronic kidney disease, but
that's in patients with chronic kidney disease.
We all know that kidneys filter medication out of the body, so

(44:17):
the bigger question is how is itimpacting the people that take
it who don't have chronic kidneydisease?
On top of that, you can lose weight by eating less, using
some common sense with your foodchoices, and moving more with no
negative side effects, all of which do include pancreatitis,
intestinal blockage, stomach paralysis, thyroid cancer,

(44:39):
gallbladder issues, biliary disease, vision problems.
Yeah, this was on like one of the national kind of TV shows in
America. And obviously, look, they'll be
there to start things, but, and again, that's probably a a
narrative. You're probably used to hear
them. But again, what?
What does that kind of stir up for Doctor Mccrotty when he
hears it? Yeah, it's not surprising.

(45:01):
It's disappointing. It it immediately lets me know
she hasn't an absolute clue about obesity or the biology of
obesity or evidence based treatment for obesity conflating
and over like there there are side effects of any

(45:21):
intervention. There are side effects of
dieting, there are side effects of excessive exercise.
There are side effects of knee replacement.
There's side effects of medication, there's side effects
of surgery. And that's where you know people
need to go in this with kind of informed consent that they have
the information to make a decision for themselves.
But conflating or or exaggerating kind of side

(45:44):
effects and adverse effects, notunderstanding why these things
happen is is kind of disappointing and
scaremongering. I.
Think that's it's a challenge? About that, I'm sorry.
Go ahead. No, I think that's one of her
big biggest things though, isn'tit?
She's just scaremongering and that's what she she's just

(46:04):
riding along on that. This is what we hear kind of in
the media very commonly, Umm, and it's, it's often people who
don't understand the treatments.Uh, and it, it's interesting we
see it MO the, the most profoundstigma that I see, and I suppose
there's, there's two groups, umm, and kind of one of the most

(46:25):
profound stigma is from, you know, maybe somebody from the
fitness industry who themselves has never had any concerns about
weight. Uh, who in their own
personality, in their self work,in their whole, you know, value
of themselves is inbuilt. This idea that I'm better
because I don't have weight and I can manage my weight and I'm

(46:47):
better than another person, well, we tell that person,
actually, Joe might learn the genetics.
It's biology, it's life experience.
It is complicated. It is chronic and progressive.
It's not something's fault. It's not lack of willful
motivation. Then it does something to that
person on a visceral level because you're essentially

(47:08):
telling them you're not better than another person.
So their self worth takes a hugekind of blow and then they will
immediately kind of, you know, backlash against these things.
And like in, in science, we're constantly studying these.
We're constantly coming up with hypotheses and, and changing our
mind about things based on the evidence.
A lot of these people have an inability to look at these

(47:32):
things kind of from, from a logical, rational evidence based
way because again, of bias and stigma.
That is instant. Interestingly for me, I, I also
see a huge, uh, stigma and bias from people who are perhaps in a
group who have, uh, lost significant amounts of weight
with diet and exercise and maintain it off long term.

(47:52):
So there is 10 percent, 20% of people who, who, who lose weight
with diet and exercise and maintain it off from, we don't
know why. We don't know why that person
can keep it off, why their set point has never perhaps been
elevated, uh, why they respond to diet and lifestyle
interventions, uh, more, uh, strongly than another person.
But those people sometimes I think come from a place where

(48:14):
maybe they feel they've put in the hard yards, they've had the
pain and misery and, and, you know, there can't be, as they
would say, an easy way out, a quick fix for this.
Yeah, and. Like, like that's a ridiculous
idea, you know, Because you know, taking a medication for
the rest you like, there's not aquick fix for anything.
Having bariatric surgery is not a quick fix for anything and we
don't think about other things like that.

(48:35):
But that, but that is the narrative, isn't it?
That's out there on social mediaand in the media that this is a
quick fix. And I think myself and Paddy are
the living embodiment of this isnot a quick fix.
Like I'm still working just as hard right now as I was for
those 30 years when I couldn't shift the weight.

(48:56):
Do you know what I mean? I still have to be careful of
what I'm eating, get my protein in, go to the gym, go to
platies, go swimming, go no walk.
And I still, I'm doing all of those things.
It's just that biologically now I'm on the same playing field as
everybody else, you know, which I wasn't previously.
Yeah, it's interesting. A lot of those, a lot of those
people wouldn't have the same thought process about

(49:18):
depression, about diabetes, about hypertension, about other
medical issues, the way it has held to a different.
Standard and again. It's it's society, it's diet
culture, it is the cultural desire to be thin.
It is kind of lots of different things.
But but people, yeah, like it's,it's hugely challenging.

(49:42):
But you know, again, you can't argue with like if I see a
patient and they have a strong response to a treatment, like
you can't argue with that. You know, when you see and, and
really for me, you know, it's, it's seeing the improvement in
health. You know, people come back to me
and I say, how are you getting on?
First thing they'll tell me is how much weight they've lost.

(50:02):
Immediately and I'd say. OK, let's park that.
Not that I don't care, but let'spark that.
What I want to know is how are you feeling?
Are you having any side effects?How is your health?
Let's go back to those things that we identified on your first
visit as to how your life is affected and how are they doing?
How is your mobility? How is your pain?
How is your sleep? How is your quality of life?

(50:23):
How is the food lies, you know, how are these things, you know,
because that's why we're treating you not to get you to a
certain size. And, and again, you know, I know
everybody is driven by differentthings, but having a kind of a
health focus that that's the keybecause like I said, we're not
making people happier skinny, we're making them healthier, you
know? Yeah, absolutely.
And Doctor Crotty, is there anything about the popularity of

(50:47):
GLP one medications now that's kind of worrying you?
I suppose in the misrepresentingis, is people understanding what
they're for and what they're notfor, you know, and for me, like
obesity care is not transactional.
That's what we started talking about.
It's not kind of the the commodity when somebody comes to

(51:09):
see me is not a prescription. The commodity is, I suppose
maybe my experience, my knowledge, sharing that
understanding, understanding their journey, making a plan.
It's not all about the medication or the nutritional
therapy or the surgical treatment.
It's it's kind of having that understanding of what's, you
know, what's going on and then supporting that person if

(51:30):
they're having side effects or having issues perturb.
So when I see, let's say somebody and, and I know, um, I
might be on an island with this,as far as, you know, everybody
has different approaches, but aswell, I get concerned if
somebody, uh, gets a treatment without an adequate

(51:50):
understanding of it, without adequate assessment, without
knowing. Okay, well, you know, other than
the medication, what else do I need to be doing for my health?
What else do I need to be doing to make this, you know, to
reduce side effects and, and getthe maximum benefits to help
from it? Umm, if somebody doesn't have
the understanding, they shouldn't become pregnant.
If somebody doesn't have the understanding that this
medication will need to be takenlong term.

(52:12):
And if it's not taken long term,like we're just falling into the
same pit. We fell into it with kind of
restrictive diets kind of if people are using these things
short term. So, so access to, to these
treatments and, and that might be, you know, whether people are
getting them online, you know, in different ways.
So it's it for me, it's the understanding is the huge part.

(52:33):
Uh, the medication is kind of another part, but it's not the
only part, you know, So, yeah, that terrifies me.
I particularly see the side effects that people it's, and
again, I say this everywhere I'mallowed to talk, but it is, it's
scary what people put up with when they're losing weight.
Like it's terrifying and, and they shouldn't.

(52:53):
And there's no value in side effects.
And you know, we're treating people hopefully for the next 50
years of their life. It's not about getting weight as
low as possible as quick as possible.
This should be different than dieting.
And you know, somebody's losing weight because of side effects
like that. That's just a negative.
Like that's, that's not, there'sno benefit to that.
You know, yeah. And I think that's huge, isn't

(53:14):
it? It's just about having the right
person to talk to and getting the right medication and the
right treatment because out there now is just, it's not
looking good, is it, you know, online.
Yeah, I think like it's interesting.
There's some people who, you know, it doesn't matter if you
get the medication from me or they get it from, you know,
somebody else in, you know, somewhere else that the

(53:37):
medication might do, will do thesame thing for them
biologically. But their journey, their quality
of life, their side effects, their expectations, you know,
their health might vary. And again, like, like I said,
not that I'm doing anything magic like this is, is not
complicated medicine, but it's just having the time and having
the experience you're going to have have those chats.

(53:58):
Yeah. It's scary or it's not scary
isn't the right word. Well, maybe a bit, but it's
interesting. I am, I would know like from say
chatting to Belinda as well. I would say on a weekly basis I
probably get somewhere between easily, maybe 50 to 100 messages
of people either asking about what do I do with ABC.
How how do I work this pen? How do I work the pen?

(54:21):
I've had this side effect. What do I do?
Is this normal? I'm looking at this and my goal
to answer every single time is what is your doctor?
Prescriber said what? What does your prescriber say?
And 90% of time people like I haven't, haven't spoke to them
yet. And that would be whether it is
their local GP, whether it is not online, whether it's another

(54:42):
service they're using. And I haven't figured out yet
why, you know, if they've gone to the effort of actually
getting the medication from or atreatment from somewhere that
then they don't go back when they're having those side
effects. They're.
So common. Yeah, it's massive.
Demand. Yeah, it's huge.
It's huge. Yeah, yeah.

(55:04):
Yeah, lots of, lots of clearance.
Why that might be the case? Yeah.
Some people go in to their doctor and they'll be advocating
for themselves and the doctor might not want to prescribe the
medication, you know, for various different reasons.
And they'll be given kind of theprescription.
But again, not having those chats, people may not have a
good line of communication. You know, again, people might be

(55:25):
charged they're engaging with somebody, so.
That's. Different reasons, you know, but
it's it's charming like this is this is care, this is, you know,
people need support and. Care and treatment.
Emails kind of trying to terrifythings that that I've said.
And like, you know, we welcome that because you know, we don't
want anybody sitting at home. Like if you're not sure, I'm

(55:47):
here and I can answer that. Like I've heard there is
literally nothing. I haven't been asked at this
stage. I've heard it all.
And if I haven't heard about it,it hasn't.
It hasn't. It hasn't, yeah.
Nobody's thought of it yet. Obviously it's big for that
person, but I've answered these questions before.
Yeah, it's very easy. But but again, again, and I, I

(56:10):
think I said this when we chatted before Belinda about,
you know, in the same way that people will tolerate side
effects, they almost feel like they should be going through
some sort of misery to lose weight, like it's perverse that
they will feel, well, I deserve this on some level because of
that blame and shame they live with.
And you know, it's it's it's interesting.
I'll use the word interesting aswell, but but maybe kind of

(56:31):
scary that that people feel thatway because, you know, it
shouldn't be easy, you know, because again, we've, we've been
conditioned to think, you know, that this, this is misery.
Yeah, yeah. And we and we should be
suffering, yeah. One things I do say are choice
as much as I can in in terms of like saving any of the videos I
do players like this is my livedexperience.
Please never take your personal medical advice from a content

(56:53):
creator, from somebody online and that they're not your
doctor. They're.
Certainly not on TikTok. With something that they have
experienced, your medical history, your current status,
your other medications, all thatkind of stuff is going to be
really different. And that's why the per the
medical professional that you'reworking with is the right person
to try and re engage with on those queries that you're.
Having Yeah. Absolutely.

(57:14):
And like that. And again, I suppose people are
desperate for treatment, they'redesperate for information and
they're seeking it in lots of different ways.
And if they can't get in the convention where they're going
outside of that. And I sort like a lot of, I
would meet a lot of people who are on various forums and you
know, again, but you know, sometimes the information you
might get again, it, it might bevery well-intentioned, but it

(57:34):
may be misguided or yeah, you know, again, it might be
hearsay. It might be.
There's just so much out there. Their lived experience, but
their lived experience is different you.
Know yeah so Doctor Crotty you're one of the few doctors in
Ireland that's like openly treating obesity as a chronic
condition what kind of pushback if any have you gotten from your

(57:56):
peers are like the wider system makes.
The sense I'm I'm one of the only openly obesity treating.
No, no, there, no, there. It's plural, doctors.
I know, I know, I know exactly. But it's it's, it's funny.
It's this, Yeah, it's, I think, I suppose it, it varies, but

(58:18):
it's, I think the narrative is changing slowly.
I think things are improving. But I have gone, I have driven
across the country to give an educational talk to GPS and
experience some of the most challenging encounters
professionally again, because ofI suppose like frankly

(58:41):
aggressive, you know, people challenging what I'm saying.
And and you know, I don't, I have no problem being
challenged. But you'll often get a situation
where somebody has wilfully not listened to you for 40 minutes
and then come come back with theE Class and move more so well.
Did you not see what have you know?
For 40 minutes, I suppose the the common things would be, you

(59:04):
know, that I'm just money grabbing.
I've got my own clinic and I'm just kind of, you know,
advertising that. But yet you're out there trying
to educate other GPS. Yeah.
And and you know, I again like we a lot of us do a lot of stuff
when it's with the Association for study of Obesity with the
ICPOECPO kind of given time cancelling clinics to go to

(59:26):
different kind of events and stuff that you're not being
reimbursed for. And like, again, I'm, I'm, I'm a
self-employed business, like if I take a day off, I have no
income. So, so again, like a lot of us
are doing these things and that's not a bleeding heart kind
of thing. But I'm just saying it's, it's
if, if I was getting all the money under the table that the

(59:48):
media suggests that I'm getting from pharma companies, I'll be
driving much nicer car than I actually I'm driving and going
on nicer holidays. The other one is that you know,
your shell for big pharma. You're just promoting these
medications and like I will talkabout.
Therapies I will talk about surgeon and therapies I will
talk about medications like I'm not just kind of talking about
medication. So it's very much kind of, you

(01:00:09):
know, shill for big pharma, justtrying to make money out of it,
right, You know, is is a lot of it.
But again, we still we still pull.
Go on. Yeah, yeah.
Even at this point, like myself and Paddy have had people like
message us and blatantly say to us you're definitely working for
Ozempic, for Northern Ordisk or something like that.

(01:00:32):
It's like, I wish my God, like honestly, you've had that as
well, haven't you Paddy? Even like anytime I do like say
a radio interview or the recent TV show with with Katherine
Thomas got a good few message after that and he's.
Obviously name dropping. To go and and do that kind of

(01:00:52):
stuff and it is gas. But the only thing that I find
interesting about this is like, there's nothing like as you say,
you're a self-employed, like, you know, you're a business
owner. And there shouldn't, that
shouldn't also be sigmatized thefact that you have a right to
earn money from making a living the same way the mechanic has a
right to go and earn a living from fixing cars or a personal
trainers right to go and make a living from helping people with
their health and fitness. And there does seem to be

(01:01:14):
sometimes people being like, oh,they're making money off the fat
people. Do you know that?
Kind of thing, like ethically I sleep very well at night.
I have no concerns ethically because again, I know I'm
providing evidence based, non judgmental, non stigmatizing
care to people who need it and deserve it.

(01:01:34):
Again, none of these issues are brought up by patients of mine
who I'm seeing. They're just glad to be kind of
treated fairly. So I think there is kind of an
agenda and anybody who puts their hand up and and shouts
about something is going to get kind of backlash and I've come
to expect it and I have no problem.

(01:01:54):
I am 100% open about my disclosures, conflict of
interest. If I drive from Dublin to, I
don't know, Middleton to give a talk, well, you know, I mightn't
be paying for my own petrol or my own dinner.
And again, you're cancelling things to do it.
So, so again, you know, for me, it's a case of, you know, people

(01:02:17):
are making them, but you're not,you know, it's, it's not we do
enough stuff gratis and, and kind of this, this is not a
money making exercise. Yeah, yeah.
So do you like Doctor Carter, doyou think then medical education
of doctors in Ireland are failing people with the disease

(01:02:40):
of obesity? And like, what would you change,
if anything, about the educationof GPS and doctors where obesity
is concerned? It's funny over the last year I
am now the clinical lead for obesity with the Irish College
of General Practice. So education of GPS around
obesity, that's my remit now. And we have just launched

(01:03:04):
blended learning kind of module for GPS and GP trainees.
We've got our general practice update on obesity coming.
I, I'm speaking at their annual conference kind of next week.
I've written articles for GP, the GP kind of monthly kind of
medical education magazine. So there's, there's a huge
amount of stuff going on to educate people.

(01:03:25):
I suppose the challenge is many of us in medical training didn't
get education in college. We didn't get in our GP
training. We haven't had the education and
now, you know, this is new kind of information to to many
people. So, so we're kind of starting
kind of from a little bit of a not a blank slate, but also then

(01:03:47):
we're kind of meeting it. You know, I might be speaking to
GP and they're really keen to treat obesity and what they kind
of want to know is, you know, how do I prescribe this
medication? One of the side effects saying
absolutely, that's really vitally important.
We also need to understand why obesity is a disease, why it is
stigmatized, how to have a, a conversation with somebody about

(01:04:08):
it, how to carry out an assessment, how to talk about
nutrition therapy, how to talk about surgical therapy.
You know, so it's it's. Again, not just.
Kind of the the medication. So so absolutely I'll talk to
her about how you use the medication side effects, but
want to give them my bit as wellabout stigma and bias and
biology and long term treatment too so.
Yeah, so, so you're rolling all of this out now, Umm, what?

(01:04:32):
What will it take for this to bewidely available to every GP in
the country? Or is it widely available
already and is it being picked up?
I. Suppose that the challenge is
GPS are looking after everything, every disease area.
And, uh, this week there might be an update on asthma, an

(01:04:53):
update on COPD, an update on Crohn's disease, an update on
this medication. Uh, there might be this, uh, uh,
specialist group that's looking for people to treat XY and Z in,
in general practice. And, and every week there are
different kind of demands and, and general practice is kind of
at capacity that, that people are working kind of above and
beyond kind of flat out in general practice, putting out

(01:05:16):
fires, kind of, you know, looking after sick people and,
you know, trying to kind of provide the best care they can.
And then I suppose this is another disease then that people
are being asked to treat on top of all the work they're already
doing. And, and there is often kind of,
you know, if somebody comes on and says, look, you know, we
want you to work 20% harder and we're not going to support you
with that, then there, there is kind of sometimes a pushback.

(01:05:39):
So it's not my role. I haven't got capacity for it in

primary care in GPG PS (01:05:43):
are not resourced, so they don't get
practice nurse time access to kind of referral pathways.
Uh, they don't get kind of resourcing for treating obesity
the same way as they would for diabetes or hypertension.
Because again, in the, in the healthcare system, obesity is
not considered in, in the same way.
Uh, so again, this, this is kindof care that GPS are really

(01:06:05):
asked to provide without actually getting the support,
the referral pathways, without actually getting kind of
remuneration for, you know, the,the extra work that, yeah, that
all needs to change as well in the healthcare system.
So, so it's, it's education, it is kind of resourcing, giving
people the manpower, giving themthe time, giving them the
financial ability and the accessto specialist care to treat

(01:06:28):
this. But then it's also a case that,
you know, if you go into a practice in let's say inner city
Dublin or Cork or, or any, any deprived area, these medications
are not reimbursed. So so you know, oftentimes the
people who need. The.
Most for their health are least able to access it.
So the that inverse care kind oflaw that the people who need it

(01:06:49):
most are are least likely to be able to get it.
So that's. A huge 1 of contention, isn't
it? Yeah.
Yeah, one of the things like that is about pricing and stuff
like that as well. Like I'm literally 25 minutes
from the border here and I again, nearly every week,
particularly from like corked inthat part of the country, say

(01:07:11):
with the treatment that I'm on, I can go across the border with
my prescription and like the dose I'm on will be 180 lbs or
something like that. If I go that go and get that in
a pharmacy down here, it's goingto be probably the guts of like
500 and something. And like that disparity in in
the pricing is something that I don't.
Know it's crazy yeah we're. Going to like or how the needle
gets shifted on that, but it's. Yeah.

(01:07:33):
Over the last month, it's something that has been feedback
that's coming out, yeah. And I think that's that's
probably because more and more people are on the medication,
you know? Yeah, yeah.
But that's not what we'll be able to solve tonight.
You'll see that, you'll see the media reports of X treatment is
now available. Y treatment is now available.
Yeah. But then it's, I think,

(01:07:56):
brilliant. Yeah.
And then? This is the cost and, and again,
like it is, I get to my mind, unfair, you know, like, again,
you know, there's always going to be patience for me to treat,
but like I have a big role in educating GPS to provide this
care, in scaling care because I,I can't see every person in the

(01:08:16):
country, umm, nor they mightn't want to see me.
And, and again, like that again,I work in private medicine, so
people would have to pay to see me.
So these are kind of challenges.So, you know, we need to be
upskilling healthcare professionals.
We need to be, you know, giving them the support, remuneration
resources that they need. We need to be supporting people
to access treatment. And that's, that's nutritional

(01:08:38):
treatment, behavioral treatment,surgical treatments, not just
kind of medication. And, and we need to be doing it
across people's life. And and that's, that's a huge
challenge, you know, like at themoment probably treating the the
tip of the iceberg. And if we think then maybe
shifted to think about what doestreatment or supportive

(01:08:59):
treatment look like specificallywithin the home and within the
community. So I guess in your experience,
how does that home environment influence a person's ability to
be successful with their treatment?
Yeah, I think it's it's so I would say as far as kind of the
home environment, a lot of people I meet their biggest

(01:09:20):
barrier is biology. And once you treat the biology,
a lot of the other things kind of.
Fall into place? Yeah.
So, so again, but like, if I'm on a medication and I live with
other people in my house, again,they need to have an
understanding of, you know, whatthis medication is for me and,
and the side effects I'm going to have and why I'm on it and
how I'm using it. Uh, unfortunately not everybody

(01:09:41):
communicates these things. Uh, we did a straw poll, uh,
last year and, and we found 25% of people that saw me, uh,
didn't tell anybody in the worldthat they were on these
treatments. So I knew and the pharmacist
knew, but nobody else knew theirpartner, uh, their, uh, closest
friends didn't know. Uh, a further 50% of people said
that they would tell, uh, their closest friend or the partner,

(01:10:03):
but nobody else. Yeah, I think 10% said they
would tell their wider friend group and about 15% are you guys
are kind of screaming it from the rooftops.
Yeah. So when you boil that down, you
know, 25% of people, one in fourpeople are talking about the
being on these treatments. 3 outof four people are not talking.
Yeah, again, because of the the statement stigma and that's a

(01:10:24):
huge issue. Yeah.
Two things on that. The first one is we did a
similar thing, asking people a slightly different slant, but
and it might feed into why they're not telling people, but
about have you ever been, have you ever been made to feel
shamed because of your weight bya friend or family member
specifically? And I don't know if you have an

(01:10:45):
idea for what number you might expect to hear, but the number
that we got on this, I think we got about, I know from sample of
four or 500 people that actuallyreplied to us.
So healthy enough amount of replies.
And I think it was 91% of peoplereplied back saying yes, that a
friend or family member had shamed them, made them feel
shame because of their weight. I.
Was going to say 90%, yeah. Yeah.

(01:11:07):
So we can we can understand why people aren't going around
saying that they are actively taking these medications because
I think the first thing instanceis fear of failure, you know,
and that's a huge thing when youdo start these medications.
And again, it's a bit like in healthcare and, and again, I say

(01:11:27):
the same thing, but like, no doctor goes to work to be an
asshole, to try and be nasty to people.
Like people are, are just livingtheir lives and they're trying
to do their best. And, and you know, if they are
sometimes naming and shaming andstigmatizing people, it's, it's
often not coming from a place of, of nastiness.
It's coming from that internal kind of, you know, uh, uh,

(01:11:50):
intrinsic bias that people have that they're not even aware that
they're doing it in the first place.
And again, a lot of family members might make comments and
it might be coming, you know, from a place of love and, and
concern and caring. But, but how it comes across or
how it is perceived or, or how it is delivered is kind of
challenging. So, so again, that's where I

(01:12:12):
think, you know, I when somebodycomes and sees me, I welcome,
you know, their partner or family member coming in with
them for the chats because number one, it saves them, you
know, and they leave their, you know, try and get in the Spanish
Inquisition. What can he say?
Can't. Remember.
So it's easier when they've heard it.
And again, people would actuallykind of understand that kind of

(01:12:33):
when they've heard it straight from the horse's mouth.
So, so I kind of welcome that because it often makes it easier
and the amount of times I would see somebody and, and then kind
of, you know, a couple of monthslater, I see their husband, I
see their mother-in-law, I see their sister, I see their
friend, you know, kind of, you know, word of mouth.
But but because you know, they it's often the the wives were

(01:12:54):
tested out first and then the husband will be kind of
railroaded in a few a few monthslater.
Yeah, we had. We had that scenario.
And so, but, but again, like in,in families, again, it's
interesting, a lot of people, one of the reasons they want
treatment is because they don't want, let's say they're kids,
you know, growing up in a house where there is dieting and
restriction and you know, where there is this constant kind of,

(01:13:18):
you know, issues with body imageand, and kind.
Of food and yeah. So, and, and again, most, many
people I meet kind of have grownup, you know, in an environment
of diet culture and, you know, go on with their mom to, to
Weight Watchers when at whateverage and, and starting.
So, you know, it starts very young.
So a lot of people, that's the cycle they want to break
because, you know, we know excess weight and obesity is

(01:13:40):
highly genetically linked. You know, somewhere between 40
and 70% of your risk of obesity is, is confirmed in your gene.
So, you know, if, if you have a parent who's living with
obesity, their child is at, at higher risk and you know, you
will see a lot of parents then, you know, repeating some of the
the things that have happened then in the past because they're
so concerned that they see theirtheir child's kind of having a

(01:14:01):
similar experience. And it's yeah, you know, it's
heartbreaking for people. So I think with within families,
it's, it's having the conversations, having the
understanding, you know, having the focus on health,
irrespective of our size, we should all be focusing on
healthy eating. We should all be focused.
On sleep and stress. Yeah, regardless of what size we
are, they may not be effective treatments for obesity for for

(01:14:23):
some people, Umm, but they're incredibly important for help.
So you know, and sorry, go on. Sorry.
Raj, I just said, like I, I talked to everybody about
nutrition and sleep and stress, uh, not to lose weight, not to
change, you know, their body size, but to be healthier, to
live longer and, and to feel better.
Umm, like that, That's a non negotiable.

(01:14:44):
So even if somebody's coming to see me and they want medication,
saying absolutely, but this is what we're also going to kind of
look at because that's importantand many people have the tools
to do it. And by treating their biology,
you're just giving them the toolbox.
So it's it's a case of, you know, if we treat that
biological element for many people, they have, they have the
knowledge, they have the information and it's easier for
them to apply it, but they stillneed to keep their eyes on the

(01:15:06):
road. Yeah, exactly.
Yeah. It's not there is no one
treatment. You know, there is, uh, there,
there is lots of different treatments.
Yeah. And so how closely do you think
do you see mental health and obesity tied together and do you
think that we're doing enough tokind of treat them as linked

(01:15:27):
conditions or what's your opinion on that?
Yeah, I think we know in somebody living with obesity,
the rates of mental health issues are higher, rates of
depression, rates of anxiety arehigher.
We know the associations betweenADHD, binge eating disorder.
We know, you know, there there'slots of different kind of

(01:15:48):
associations. And sometimes it's a case of,
you know, chicken, chicken and egg.
Did I have a severe issue with my mental health?
Went on a certain medication that caused weight gain?
Yeah. You know, it's interesting.
Some people have an episode of severe depression, They will
lose weight because their appetite disappears.
They might have a similar episode 6 years later and their
appetite increases. Like it's, it's interesting,
there's definitely a bi directional relationship going

(01:16:09):
on there. They are definitely linked.
But again, I would never assume that, you know, if I meet
somebody in there on, on my questionnaire or in their
history, their report history, depression, I wouldn't assume
that that was anything to do with their weight.
I would ask them, listen, you know, does excess weight or
obesity have any bearing or is that a separate issue?
And that happens. They're not that separate.
OK. Like it's just because I'm not
assuming that one thing is causing another.

(01:16:32):
They might kind of, you know, when they look at kind of
patterns of change in weight over time, they might see
certain things siding Umm, so they might see, you know, well,
that happened and my weight change and this happened and my
weight change. You kind of often see that, you
know, but irrespective of how I've gotten here, once I'm here,
then that's where my thermostat is set.
You know, this, this idea that we need to understand how people

(01:16:52):
have gotten here, but the treatment is still the same
once, once I'm here, you know, so umm, but you know, for Med
lab, people need support. And again, there are case
reports of mental health kind ofdeteriorating in people on
certain treatments. We know after bariatric surgery,
uh, on medication treatments, uh, mental health changing.
Uh, we know that if I'm treatingsomebody, uh, their medical

(01:17:15):
metabolic health may have responded fantastically to, uh,
let's say a pharmacotherapy or surgical treatment, their
physical functional health quiteimproved significantly.
Psychosocial health is a little bit more nuanced because again,
you know, is it excess waste that's causing me issues with my
body image or is it diaculture society?
Is it, is it the fatty cells themselves?

(01:17:35):
It's, it's probably not, it's, it's how that's perceived in
society. And you'll often see when
somebody's in that kind of I, I,I can't see them doing this all
day with my hands. But when when we treat somebody
and they're in that dynamic phase, that response phase, and
weight is changing. Oh, happy out, Doctor Crotty is
a genius. This is the greatest treatment.
That's the honeymoon period. And then, oh, shit, what's

(01:17:58):
happening now? This is slowing down.
Oh, I'm, I'm starting to stabilize.
My weight is not going down anymore.
Yeah. And I'm actually feeling a bit
hungrier, but less satisfied. Some thoughts about food is
coming back. Oh, Christ, am I, you know, is
this not working anymore? But yet my weight is not going
back up. It's just staying at this level,
but it's not where I want to be anymore.
And my body image, my and different things are, are kind
of, you know, under pressure again.

(01:18:18):
And you know, again, I'm, I lookin the mirror, I still see the
same person as I saw on my way was here.
I don't see any difference. Other people might comment on a
difference, but I don't see any any difference and I'm still not
where I want to be. So again, I, I failed and this
that all this kind of negative narrative comes back.
So in different, I suppose increasing we're seeing that in
different phases of treatment the goal posts move.

(01:18:41):
And I can and I can, sorry, I can attest to that because I've
been on this medication, this journey for over 2 1/2 years
now. And I've met all of those, you
know, the stabilization, they'removing again, you know, the, the
dropping of the weight and the stabilization again.
And you just have to just have to keep going.
And sometimes it's hard, it is hard to keep going, but it's.

(01:19:05):
Probably 1 of the commonest questions I get asked.
Uh, and I'm going to use the dreaded word the plateau.
How do I break the plateau? How do I get past the plateau?
And I've actually stopped using the word plateau in practice.
I talk about stabilization and just the negative connotations.
It's kind of a plateau is not a negative word in in English
language. But it is now when you're

(01:19:25):
talking about weight. It's associated with this kind
of negative connotation about not where I want to be.
So I don't talk, I don't talk about plateaus anymore, which I
want response and then stable stabilization.
And, you know, again, this idea that that, you know, is that
where I'm going to be now? So if you continue on that dose
of that treatment, yes, uh, you know, but if that's not where
you need to be for your health or for your well-being, then

(01:19:48):
then you might need to change treatment.
And I suppose where I, where I will be versus where I want to
be versus where I need to be, uh, there are different.
Places. Very different places.
And that's where I suppose we, we, you know, and again, I
suppose it's interesting. I, I talk about weight all day,
but then I'm not actually bothered by weight.

(01:20:10):
And yet weight is in the name ofmy clinic.
And you're thinking around you're kind of you're talking
about both sides of your ass at this stage for me, it's against
I we, we talked this idea best way.
Yeah. And that's what that's where I
will be when I'm living my healthiest life that I can enjoy
and sustain. Yeah, because it's my nose.
Yeah, I was with my, my own GP recently and they were checking

(01:20:35):
my weight and like, oh, quite a significant change here.
And I was like, yeah, I'm on a vacation.
I told the other doctor last time was here.
She was like, Oh yeah. It's like, oh wow.
They're like, what, what weight is it you want to get to?
And I was like, yeah, I I don't have a number.
I'm not working that way. I'm not bothered by the number.
Like I'm more so on to get my bloodstone.
I want to see what's my fitness.I don't want to see what kind of

(01:20:55):
what is. Yeah, how is kind of help for
me. That's what my driver is, not
whatever the scale is saying. So I was actually surprised then
because he came back with and hewas something like, yeah, you
know, like if you're supposed tobe a my that would have you done
It says like, don't go by that. That's it.
I think of something like 117 kilos, whatever he's like, look
at maybe, maybe pause and come in and we'll reassess when

(01:21:17):
you're like 105106 and see how do you feel then at that.
And it felt like a very refreshing conversation.
Oh. You need to get to like 80 kilos
or something to be healthy. Was like, oh OK, he's seen that
at that weight I would still be overweight but was able to
understand. But you could still be
considerably healthier or healthy at that.

(01:21:38):
I guess I for me, like there isn't a goal with, there isn't a
target with, there isn't an ideal way because a person's
weight is influenced by genetics, by biology, by life
experience, by all the shit that's happened to them, by all
the diets they've done, by all the positive and negative
experiences and mitigate and lots of different things
influence where my weight will be.

(01:21:59):
And it's not within our conscious control as much as we
would like to be. So we treat somebody, their
response to treatment is not within their control.
And that's hugely frustrating because there is a degree of,
although I keep my eyes on the road, inspire nutrition and
sleep and stress and the things that I can somewhat regulate,
there is a little bit of kind ofclosing my eyes and then go on

(01:22:19):
the steering wheel because, you know, as when it comes to
numbers, because I will be whereI will be.
Again, for most people I meet, that is not where they want to
be. Yeah.
Is it where they need to be? Again, this is health is
relative. There is no healthy and
unhealthy. It's it's a spectrum.
So we know a 5% body weight change is is good for your
health. A 10% body weight change is more

(01:22:42):
impactful for health, 1520% evenmore.
But again, you know, if somebody's weight continues to
go down, they, they, you can actually make their health
worse, you know, muscle mass, bone density, disordered eating
and different things. So what I would talk about is
like, if if I'm here with whatever intervention, whether
that's nutritional intervention,medication intervention,

(01:23:03):
surgery, then that's where I am.Yeah.
Can I get lower? Absolutely.
But you may be stealing from health.
You may be stealing from sustainability.
You may, you may be stealing from your ability to enjoy life.
And again, that's not going to be sustainable.
So, you know, and, and we often see it when somebody is, is kind
of starting to reach that stableweight, not plateau weight, but
stable weight, you'll see them leaning back towards maybe some

(01:23:26):
of the strategies they used in the past and the dieting
restricting. I'll just cut out carbs for a
few weeks, a while, you know, I'll just skip that meal and,
and things and, and then we may go down further.
But when that becomes unsustainable, even with the
medication, and it's probably easier with the medication, but
when it becomes unsustainable, they'll come back up to where
they were before. So, so again, it's, it's
challenging and I'm fascinated by, we ask everybody and not

(01:23:50):
because it changes our treatment, but we ask people,
you know, how much weight do they think they want to lose or,
or where would they like their weight to be?
And it's fascinating to and ask people, where did you come up
with that number just out? Of curiosity.
And giggles, where did you go with that number?
What? Where do you think they they get
the number from? That's where they want to be.
I don't know when they got married or when they're in

(01:24:13):
school. It's interesting.
It's it's most commonly a weight.
They were at a time in their life and they were happy.
Right. And and again, kind of that
might have been when they were 21 and they didn't have
stresses, stresses kids and theydidn't have this that.
Mortgages and. Elderly parents, they associate

(01:24:33):
being happy with being that size.
Yeah. If I can get back to that size,
then I'll be happy again. You know, like it's this.
I think as well that sometimes Ifeel other people do be
disappointed when I answer. When they ask me what's your
goal weight? I'm like, I don't have one.
Yeah. Pampoozles them.
They're like what? What you're trying to what you
mean? Yeah, it's like what?

(01:24:54):
You don't know what weight you want to be.
Is like you have a I'm not looking at it through the same
as. You are weight as such.
Do you know and? It's interesting.
This was on the medical side, like for most other chronic
diseases, we treat to target, Yeah.
So we want somebody's systemic blood pressure to be a certain
number. We want their HBA 1C average
blood sugar level to be a certain number.
We want their cholesterol to be a certain number.

(01:25:16):
And we treat because we have evidence to say that at that
level, their risk of cardiovascular disease or
whatever is, is, is minimized. And, and again, you know that
that's how we treat other diseases.
I suppose with weight, it's, it's not because it's not
bringing conscious control. And everybody's response to
treatment is different. You can't kind of say what I
want you to be XY and Z, but there there is.

(01:25:37):
There was the bite, the BMI, BMIthat was, you know, what
everybody was looking to. I suppose and and that's again,
some people, their goal wave might be a certain BMI and, and
that's one of the things that I'll be asked a lot, you know,
well, what do you do when somebody gets to BMI 25 then?
Do you stop the treatment? No, like they're at 25 because
they're on treatment. But to me like the difference

(01:25:59):
between 25262427, like again on an individual base it's going to
hugely again that doesn't tell us about distribution of weight,
body composition, it doesn't tell us about health really.
It's muscle mass and. Surrogate marker.
It's a surrogate marker for for excess fatty tissue, but it's
not a direct. Indicator.

(01:26:20):
And so when we think about say some other disease that people
might be living with, we know that quality of life or maybe
success can be our progress can be enhanced based on community
support and how the community around them is maybe rallying
around them or has measures in place to support them from that.
Yeah, community space. I'd love to know, have you seen

(01:26:43):
I, I don't see that in Ireland yet.
I see a small number of some kind of advocacy groups that are
definitely out there. But in terms of say, you know,
my local town or village or whatever, like, you know, in
terms of advice to look for support with maybe the journey
that I'm on or that I would say there's very little if if
anything there. Have you seen any good or any

(01:27:05):
attempts at community based initiatives elsewhere that you
think we we could learn from in Ireland?
I suppose the answer is no, I haven't.
Like, again, we kind of think all these magic things are
happening in other countries, but they're dealing with the
same issues we're dealing with and we inherently think kind of
that, well, in America or in Canada, they're doing better.

(01:27:26):
And whenever you come back from American Canada, you're a great
lad altogether. But but again, they're dealing
with the same challenges. I see a lot of people, you know,
for me, peer-to-peer support is hugely impactful.
You know, I can talk to them blue in the face about what
somebody might expect to see with bariatric surgery.
Uh, but it's not until they've, they've talked to somebody who

(01:27:46):
has that lived experience, can they actually hear, you know,
the good, the bad and, and, and the up and the downs of it.
And so I think that, that's huge.
But I think again, the more people you can talk to you,
you'll realize that, uh, everybody's experience is, is
different. I think a lot of people are
probably getting that, uh, on social media, a lot of people
are getting it from listening toinfluencers like yourselves,

(01:28:07):
from listening to maybe doctors who put their head up and shout
about things. Online forums I think are a big
thing, but challenge with forms is I think they they sometimes
start to lean into kind of a glorified Weight Watchers type
kind of, you know, people givingunsolicited advice.
Very much how? Much weight have you lost this
week and how much weight have you lost that week?
And, and again, not through Vadnais just because that's the

(01:28:29):
patterns that that people have seen over the course of their
life. So, umm, so you know, I think
peer support is vital. You know, more people
understanding this, your doctor understanding it, your family
understanding it, you understanding it yourself.
You know, we do a lot of what I call bread crumbing as far as
you know, on the first visit, I'm talking to somebody about

(01:28:52):
when their weight stabilizes and, and again, you're kind of
dropping bread comes. This is what you should expect.
This is what you you might navigate.
So when they do encounter it, it's not as much of A shock.
They'll still kind of be kind of, you know, up, down or around
when it does happen, but at least they have been forewarned
about what's what's kind of coming.
It's. Coming.
Understanding the journey is, iskind of vital and that that's

(01:29:13):
for any area of, of help, umm, managing my own, you know, our
own expectations of what might happen is huge.
And again, the more people, the more talking that can be, the
better. I suppose the, the challenge is
if I'm, let's say I'm doing thisand, and people are listening to
it, people will say, well, you're advertising this and

(01:29:35):
you're advertising that and you're promoting this program.
I'm just. Saying we're not.
Yeah. So, so again, these are the
challenges and that's what you've been accused of.
But but again, I think even, andI myself and Carl Leroux are
very much on the same page and we've kind of set up, you know,
we're not actually talking and Isuppose we're not actually

(01:29:58):
talking to skinny people. We're talking to people with
obesity. That's who I'm talking to.
So I don't really care what anybody else kind of thinks,
because the people. Who are?
Listening to listening is, is somebody who's living with
obesity needs support, you know?So that's all that matters.
Exactly. Yeah, yeah.
If if we think of the the kind of the future, then a little bit

(01:30:21):
more I guess where I look at safer the medication I'm on if I
look at. What's coming down the line?
Yeah. Well, what's coming down the
line? But also I guess to see is there
anything not, not community driven, but just in general in,
in terms of the, the, the treatment of obesity?
I would have looked a lot at theUS.
What's been happening there? Like it's a whole other kettle

(01:30:42):
of fish there, like with their compounds and all this other
stuff that's happening. The UK have a slightly different
market in terms of treatment andor, or sorry, access to
treatments and. And availability, yeah, and.
Availability, yeah. I'd love to think for anything
that you think in general, the US or the UK or even other
countries have done well in terms of obesity care in itself

(01:31:04):
that we should either do or avoid.
That's another question. That's our Paddy.
I think for me, and again, my perspective, my opinion, my
experience, I want this treated like other chronic diseases.

(01:31:25):
I don't think we need to reinvent the wheel.
I don't need think, you know, Sohow do we manage hypertension?
You know, you go into your GP, you're even either having
symptoms. You're not it's picked up.
It's diagnosed properly with theblood pressure monitor.
Absolutely. Of course, they talk about
nutrition, they talk about salt,they talk about exercise, about
stress, about sleep. And if your blood pressure is

(01:31:46):
still high, then they'll put youon a tablet.
And and again, that doesn't meanthat you don't still focus on
all the kind of life interventions and you're not
seeing them every week. You're not seeing them every two
weeks, you're not seeing them every once a month.
You probably don't have health coach and the dietitian and, uh,
physiotherapist and all these bells and whistles, uh, because
for your blood pressure, we haveeffective treatments that kind

(01:32:09):
of, you know, fit with your life, well tolerated and, and
good for your health. Yeah.
And my hope is in that in the future, uh, uh, it will be
similar with obesity. Uh, at the moment, uh, again, I
thought because medications can have side effects, because
people's relationship with food is because of lifelong dieting,
because most of us are kind of paralyzed when it comes to food

(01:32:32):
as far as well. This guy is saying do this
thing. That guy is saying do this
thing. You know, he's saying the fats
are bad. He's saying the carbs are the
devil. You know, we're just kind of,
we're just so misinformed or disinformed or, or, you know.
Overwhelmed where? Where to start?
So, So again, I suppose, you know, if I see somebody in

(01:32:52):
practice, you know, with arthritis and you know, we've,
we've, you know, given them, uh,an injection in their knee and
we've done anti inflammatories, but they will benefit from
physiotherapy. We send them off physiotherapy.
So we use these, uh, you know, services as they're needed.
Uh, but there isn't A1 size fitsall.
So I would like to see obesity treated the same way.
Umm, again, you know, there, there's lots of people in, in

(01:33:13):
the US, there's a little bit of a race to the bottom as far as
how care is care is a is a very loose term how treatment is
provided. And you know, like I see lots of
people online by video consultation and you know, I'm
happy that there's nothing I do in person that I don't do on a
video. But again, I'm not sure
everybody else is, is the same. So, you know, does everybody

(01:33:37):
need an app? Do they need different things to
kind of track? Again, I'm not sure, but if
we're doing these things, we need to be studying them, we
need to be researching them, need to follow them up.
We need to look at where are thepain points, where do people
need support and provide that support.
But again, sometimes we're trying to apply model.
So, so I would see a lot of kindof eat less, move more that has

(01:34:00):
been polished up, renamed, refurbished, and you stick a bit
of GLP one on top of that, you know, so, so it's, you know.
It's interesting, I was having aconversation with someone
yesterday, actually my own coach.
I worked work with a strength coach once a week and has a plan
done for me for the other days as well.
Even though I'm a personal trainer or qualified person
trainer myself, I still like to lean on someone that's knows a

(01:34:22):
lot more about this area than meand he's the expert in.
But one of the conversations we're literally having yesterday
was I was saying a guarantee it within the next 12 months,
you're going to see a surge off from the high protein foods to
like the GLP 1 booster foods aremarked.
Yeah, because. You can see it already in the
US. In the States.
One or two products starting to pop up with that kind of stuff.

(01:34:43):
And yeah, and also, yeah, oh, absolutely.
It'll have to, it'll have to umm, I've also seen like PTS
with absolutely massive platforms that would have, when
the GLP one medication started becoming, umm, really popular,
they would have gone against them completely.

(01:35:04):
And now they're offering GLP onemedication programs within their
personal training programs. You know, it's everyone's
pivoting. I sometimes I'm by nature
cynical and miserable, so I kindof sometimes have to park that
and kind of say, you know, well,the scientific process is a

(01:35:25):
curmudgeon. Seeing seeing what seeing what
works and changing what we do based on the science 11 That's
what I'm I'm fully the opinion 10 years time what I'm doing
will I look back and I look backat presentations I gave five
years what Jesus Christ. How do I say that?
Like absolutely shocking, like what I was saying five years
ago. And, and we will continue to

(01:35:46):
change and that's, that's a goodthing.
And you know, there will be people going at this genuinely
and then there will be people going at it kind of more
disingenuously. Some people are, are in this for
the long haul. Some people are not.
And again, I, I don't begrudge anybody, but all I can control

(01:36:07):
is what I do and what I do in practice and what I would advise
people to do. But again, like I would see
people, people seeking care for BCE are vulnerable, they are
desperate. And, and again, you know,
somebody may not be aware of kind of what's the difference
between seeing me versus, you know, a different provider that

(01:36:30):
maybe has a different approach. And maybe the, the other
provider might be much more aligned with what they need or
maybe they need to see me now and kind of, you know, let's say
kind of a year or two years downthe line, they will see their GP
for follow up. And I, I welcome that.
Like that's not me versus this guy or me versus that guy.
It's about we're all here to support the patient and in the

(01:36:50):
same way as I should be talking about what's the best treatment
for them. Now then I would say, look, you
know, you know, would your GP, you know, have you had a chat
with your GP about this? You know, are they happy to kind
of prescribe and they might kindof head off and I might not see
them for a year or two. And and then next time you come
back to me if they have a challenge or an issue.
And and we see it a lot, you know, when there was, let's say,
shortages of medications and people stop treatment.

(01:37:13):
And then people were kind of, you know, almost embarrassed,
you know, to come back because they've been off treatment and
they'd regained weight. And I'll be kind of, you know,
high fiving them as they come back in the door saying this is
brilliant that you come back to have these chats because this is
what we see with all chronic diseases that adherence long
term, you know, treatment long term is very, very challenging.
There's always going to be speedbumps.
Yeah. And I'll never give out to

(01:37:33):
somebody for stopping medicationbecause it's obviously a very
obvious reason why they've mighthave had to stop.
It's a case of well done you forkind of coming back and, and
having that kind of courage to kind of, you know, engage again.
And it does take, it does take courage, especially if in the
obesity, you know, if you have regained, it takes a lot of

(01:37:53):
courage, you know. Well, Linda, will we move on to
our final 2 questions? So yes.
We've kind of yeah we we have kind of two wild card questions
for you make the finish up. So you do so OK, your your one's
a bit more sensible than mine, so I.

(01:38:15):
So, Doctor Crotty, let's say you're made Minister for Health
for 48 hours. What's the first policy you'd
push through for people living with obesity?
Give the give the fellow the keys to the toy shop.
Yeah, I think that's that's a tough one, to be honest.

(01:38:42):
Yeah, I think I would want. I think that we should be
creating, uh, regional hubs where people can access
treatment so that somebody couldsee, let's say AGP who has a
specialist interest in obesity medicine and Cork and Slivo and
Limerick and Leitrim and Cabin, uh, in the same way as we have

(01:39:03):
these chronic disease hubs for hypertension, for diabetes.
Uh, so I would love to see that kind of a, uh, uh, especially on
a hub and spoke kind of umm, umm, situation where somebody
might be referring from their GPto this kind of local specialist
be treated, go back to their GP.Uh, because I can't at the

(01:39:23):
moment. I, I think it's, it may be
unrealistic to expect every GP in the country to be treating
obesity just with the, the stress and healthcare system.
Uh, so, so aligning to other kind of chronic diseases, I
would love for obesity to be included under chronic disease
management program in general practice to, to get resourcing
for people. I think it's, it's, it's

(01:39:46):
unrealistic, if I'm honest with the cost of treatments to make
medication available to anybody and everybody.
I don't think that, that from a healthcare economic point of
view. And we saw that in the UK where,
you know, it was going to bankrupt the NHS and they had to
kind of pull back. So I think treatment for those
who need it most for help is is kind of vital.

(01:40:10):
And again, I suppose you know I've done a lot in this.
How many days did you give me asminister for help?
Just just 48 hours. Calm down, Yeah.
OK, All right. Yeah, we've, we've, we've, well,
I've probably sent a few emails about all that stuff being being
debated and. That was an awesome answer
though, well done. Fantastic.

(01:40:31):
That's what I think, you know, that that is, it's realistic.
Yeah. You know, I think it's also, you
know, the easy answer would be everybody who.
One is going to get medication. Yeah.
You know, everybody who who needs surgery should get
surgery. But again, that's not realistic.
And and actually then it's you know, it need to be considered,
you know. Yeah, well done.

(01:40:51):
Doctor Mick Crotty is stranded on a desert island.
What one meal do you bring with you and what album or artist is
on your playlist to keep you sane?
Large that's that's a good one hot meal now.
This is the most important question of the night, so.
I have yet to find a film I don't like.

(01:41:14):
We thought we found one back in about 1996 that we were
mistaken. So I'd literally eat other than
under the sun. But when I'm cooking here at
home for the kids, my specialityis pizza, homemade pizza.
So I bring my my uni pizza oven to be very kind of fancy.
That's my meal. With with pineapple or without

(01:41:36):
pineapple. Well to depends who's eaten, I
have I. Oh no, you're totally on your
own. I throw it on out in bowls and
the kids throw it on to the pizza, whatever, whatever they
want. And some of them, some of them
are Hawaiian fans. But, but again, like I said, I,
I, I haven't found a food I don't like.
What am I listening to? So that really depends what kind
of a mood I'm in because if I'm,if I'm annoyed, if I'm stressed,

(01:42:02):
I listen to certain things. But my five years in Canada, I
got myself an addiction to ice hockey.
So my go to is actually listening to kind of hockey
podcasts is yeah. So it's a bit odd here because
you have to stay up from 3:00 inthe morning.
I. Thought you were going to say
Alanis Morissette there for a minute.
No, or just don't mind a bit. Or Justin Bieber.

(01:42:22):
I don't mind a bit of an, actually, to be honest.
Yeah. Do you know who I want, Tron?
A bit of David Gray. Oh yeah.
The real, the old. You know, yeah, yeah.
That's showing my. Age now, yeah, that's OK.
That's who I put on. Yeah, love it, love it.
Brilliant. Thanks.
Like it has been a pleasure. Like when we started the podcast

(01:42:44):
last October as a half baked idea to do.
Something. Oh yeah.
And like from those early days, we're like want to get doctor
credit, I want to get my credit.I want to.
Get you were the first, yeah. And we didn't think we we could
get you last season. So we thought, we'll just wait
now and we'll get a little tiny,tiny name for us and a tiny bit
of the Internet. Oh Lord God, yeah, I'm a legend

(01:43:05):
in my own little household here,but not not much harder.
Oh, I don't know about that. But I said I'll wrap up and just
by saying again, kind of I guesswhat I started with, first of
all, thank you so much for your time.
But secondly, thank you for giving a man in his late 30s a
few years ago now, unfortunatelythat belief that obesity wasn't

(01:43:26):
his fault and that there was potentially a route forward and
that there was people that believed me when I said I was
making an effort that that stillsticks with me.
So on a. Personal thank you so much.
For that. Very kind to say the non and
again, like fair play talking about your experiences that
you're leaving yourselves open like a lot of people to

(01:43:48):
negative, but I hope a lot of positive as well.
Like it is very impactful for people to like I said that
peer-to-peer support is vital and it's.
Crucial. People talking about these
things. So fair play and all, all that
you do as well. But yeah, thanks very much.
The biggest problem with me is shutting me up.
Those three of us here, it's OK.It's OK.

(01:44:11):
Doctor Crotty, thanks so much. Thanks for coming on.
Thank you. OK, folks.
So hopefully you enjoyed that asmuch as we did.
Like that was one of our amazingthat was like one of our, I'd
say like a bucket list interviews we wanted for the
process when. We started.
You know, yeah. We have, we have two kind of big
bucket lists and Mick is was oneof them, yes.

(01:44:33):
Yes, yes, the other one. Is on its way.
It's on its way. Yeah.
We don't be this season or next season.
What we'll see anyway. Yeah, so and again, thank you so
much to Doctor Cardi for being so generous for his time.
Yeah, we kept him so long, like.I know just for sure you
couldn't shut us up and listen. Umm, Mick is really, really

(01:44:54):
generous with his time for us onInstagram as well.
You know, if we ever have queries or anything.
He's brilliant. He's so good, Yeah.
He's brilliant. And again, if you're not
following, uh, Doctor Mcrotty, it is my.
My best. Weight dot IE umm is the handle.
I'm just going to make sure thatit's the right one.
Yeah, so my best weight dot IE on Instagram as well.

(01:45:17):
And and that's our website as well.
You'll find him there, eh Belinda?
Anything else for this week before we finish up?
I think that's it. I don't think we could possibly
talk any more than we've talked.We've only been here a short
period of time. Yeah, exactly.
Yeah. Okie, Dokie.

(01:45:38):
Well, Belinda, what do we want people to do if they're enjoying
the podcast, by the way? Oh, we want you to go on and
follow us. Follow us.
And if you could possibly write a review, that would be amazing.
It would be amazing. And as we always say as well,
please don't take your medical advice from strangers on social

(01:45:58):
media. Go to a doctor, a registered
dietitian, a pharmacist, somebody like that please who is
qualified and will will try and help you Yeah on your journey.
But from me Paddy IE at a dose of Paddy and.
Belinda at GLP One dot Insights.Adios, we will talk to you again

(01:46:21):
next week. Bye bye.

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Dr Mick Crotty - Obesity Medicine Specialist in conversation with Paddy & Belinda [S2E5]

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.css-14f5ked{margin:0;word-break:break-word;display:-webkit-box;-webkit-box-orient:vertical;box-orient:vertical;-webkit-line-clamp:2;overflow:hidden;}Dr Mick Crotty - Obesity Medicine Specialist in conversation with Paddy & Belinda [S2E5]