January 8, 2025 • 38 mins
Dr. Falquier chats with obesity medicine specialist, Dr. Nisha Patel, who is also certified in culinary medicine, about the latest tools and strategies for sustainable weight management. From the rising use of GLP-1 medications to the powerful role of culinary medicine, Dr. Patel breaks down the science of how these medications function, whether they’re to be taken long term, and why what we eat still matters. If you’ve been wondering if medication for weight management is right for you, this episode is a must listen!
In this episode you’ll hear:
3:00 – Medication and lifestyle changes for weight loss.
5:30 – What is a GLP-1?
8:50 – The effects of GLP-1 Receptor Agonists on appetite regulation and cravings.
12:45 – Weight management dream team.
15:15 – How culinary medicine fits into Dr. Patel’s practice?
18:00 – Are GLP-1 medications taken for the long term?
25:45 – Negative side effects of GLP-1 medications.
29:40 – What we eat still matters with medication.
34:10 – Thoughts on RFK Jr. leading the Department of Health and Human Services.
35:40 – Health and wellbeing beyond the number on the scale.
Thank you to our episode sponsor, Auguste Escoffier School of Culinary Arts.
Credits:
Host - Dr. Sabrina Falquier, MD, CCMS, DipABLM
Sound and Editing - Will Crann
Executive Producer - Esther Garfin
©2025 Alternative Food Network Inc.
Become a supporter of this podcast: https://www.spreaker.com/podcast/culinary-medicine-recipe--3467840/support.
In this episode you’ll hear:
3:00 – Medication and lifestyle changes for weight loss.
5:30 – What is a GLP-1?
8:50 – The effects of GLP-1 Receptor Agonists on appetite regulation and cravings.
12:45 – Weight management dream team.
15:15 – How culinary medicine fits into Dr. Patel’s practice?
18:00 – Are GLP-1 medications taken for the long term?
25:45 – Negative side effects of GLP-1 medications.
29:40 – What we eat still matters with medication.
34:10 – Thoughts on RFK Jr. leading the Department of Health and Human Services.
35:40 – Health and wellbeing beyond the number on the scale.
Thank you to our episode sponsor, Auguste Escoffier School of Culinary Arts.
Credits:
Host - Dr. Sabrina Falquier, MD, CCMS, DipABLM
Sound and Editing - Will Crann
Executive Producer - Esther Garfin
©2025 Alternative Food Network Inc.
Become a supporter of this podcast: https://www.spreaker.com/podcast/culinary-medicine-recipe--3467840/support.
Mark as Played
Transcript
Episode Transcript
Available transcripts are automatically generated. Complete accuracy is not guaranteed.
Speaker 1 (00:00):
Thanks to our episode sponsor Iskafia, a school of culinary Arts.
Have you ever dreamed of a career in the culinary world,
but wonder how to make it work with your busy schedule.
Iskafia's online culinary program could be the perfect fit. Imagine
building the skills of a professional chef right from your
own kitchen. Each week, you'll dive into course content with
readings and videos, join live discussions with chef instructors and classmates,
(00:24):
and submit assignments complete with photos and feedback. You'll also
complete an externship in a professional kitchen, giving you real
world experience before you graduate. To take the next step
towards your dream career, download Askafia's culinary school preparation guide
to see if it's right for you. Just head to
iskafier dot edu slash culinary Medicine. That's ees c O
(00:45):
F f I E R dot e d u slash
c U l I n A r y m E
d I c I n E. And now for today's episode.
Speaker 2 (00:56):
If we want to live full lives, we want to
live lives with purpose, and I tell patients please separate
your happiness from the number on the scale from the weight,
because you're allowed to be happy no matter what body
you're in.
Speaker 1 (01:09):
Welcome to culinary Medicine Recipe. I'm so happy you're here.
I'm your host, Doctor Saprina Falke. I was a primary
care doctor for sixteen years and went to school for
four years to specialize in culinary medicine. In this work,
I get to combine my passionate expertise in both medicine
and food to teach people about food is medicine and
to empower them to understand what ingredients optimize health and
(01:31):
also how to cook those ingredients to make delicious meals.
On the show, I interviewed top chefs, doctors, healthcare visionaries,
and food service professionals who are making great strides in
the field of culinary medicine. Join me as we continue
to explore the amazing world of culinary medicine, where I
will empower you to make changes to your health and
wellness with great food. Right away. Welcome to season two
(01:58):
of the show. Today's episode is a weight management Did
you know that in January is when forty percent of
people start dieting. January is often a time to make
good on those New Year's resolutions, and if weight loss
is one of them JLP ones such as what goovi
and no zempic may be on your mind. So today
we're going to be talking about weight loss and what
has become a commonly used tool to achieve that weight loss,
(02:20):
weight loss medications, and also to clear up some of
the misinformation that's out there. I welcome doctor Nisha Patel,
who trained in the same hospital as me in San Dieo,
California and has gone on to become a specialist in
multiple areas with an extensive resume and bio that is
quite impressive. Today we will dive into her specialized work
and obesity medicine as well as culinary medicine. Welcome doctor Patel.
Speaker 2 (02:44):
Thanks so much for having me. I'm so excited to
be here and talk to you about all of this.
Speaker 1 (02:49):
I'm really excited. I know it often takes a while
to get on the same schedule, and I really appreciate
us being able to have this conversation. Yes, absolutely, we're
going to dive in. So the conversation surrounding weight loss
medications can be quite triggering for people. What is your
opinion on medicated weight loss and prescription medications for this
(03:11):
and do who would you recommend it.
Speaker 2 (03:14):
That's a really great question. And so you know, we
are really fortunate to have multiple different tools to help
our patients improve their health outcomes. Our patients with obesity,
their health outcomes and their quality of life. Both of
those are very very important. And you know, I often
see a lot of dichotomy and conversations around weight management.
(03:37):
You know, is it lifestyle factors only, is it medications only?
And I would really challenge everyone to understand that these
are all tools that work together to help people improve
their health and achieve their health goals. And so, you know,
as an obesity medicine doctor, I definitely use medications for
weight management, medications to treat obesity, the chronic disease of obesity,
(03:58):
in conjunction with head health promoting lifestyle. It's very important
to understand that health is just more than a number
on the scale. It's about our physical and our mental
well being. It's about what we eat, the way we move,
our sleep, how we interact with others in society, and
so I definitely you look at all of those different aspects,
but medications are absolutely a tool because we understand that
(04:21):
there's underlying neural hormonal dysregulation that makes it difficult for
people to really achieve weight loss, and specifically, when we
talk about weight we're talking about reducing the percentage of
body fat that we have, especially visceral at apocity. That's
a medical term for the fat that sits closest to
our internal organs and our abdomen. That is particularly problematic
(04:44):
when we talk about diseases like heart disease and diabetes. So,
you know, these are a tool. They're definitely not, you know,
an end all be all. They're treatment for chronic disease,
and so we have to make sure that they are
used appropriately and correctly. And unfortunately, there's just still a
lot of misinformation, which I'm hoping that we can bust
(05:06):
in this podcast episode so your listeners can really understand
how these are a tool to really help them.
Speaker 1 (05:13):
Thank Anisha, I'm going to use your first name because
we're friends.
Speaker 2 (05:16):
Yeah, the other way, Yeah, I know exactly.
Speaker 1 (05:20):
Yeah, So I appreciate that you're having our listeners here
that obesity is a chronic disease, because often that's not known.
And when you talk about this tool of the medications.
Let's start from the beginning, So how woul do you
explain what a GLP one.
Speaker 2 (05:34):
Is so GLP one is actually a hormone that our
body produces in response to eating food. Unfortunately, though, our
own GOLP one actually breaks down really quickly, meaning that
it's not active for very long and so it really
can't do the same things as what a medication like
(05:56):
a GLP one receptor agonist can do. You know, this
is a pharmacy medication that has a very long half life.
I mean, there's definitely ones that are daily dosing, but
the ones that we really think about when we talk
about weight management are the ones that are once a week,
and so the medications are lasting for the entire week
(06:16):
in most people. So that's just again something not our
own body can do. We have GLP one receptors all
over our body, but we know when it comes to
weight management that one of the primary places that it's
working is actually our brain. You know, our appetite regulation
systems are in our brain and they're receiving signals from
all different parts of our body, our gut, and unfortunately,
(06:40):
you know, and people with obesity, the signals might not
be they might be just regulated or they're not really
working as efficiently, and the medications actually help restore some
of that signaling or what I often call level the
playing field, so that people can feel like they're in
better control around food they're craving, are improved, they feel full.
(07:03):
We understand again that you know, this is helping that biology.
It's not taking away the biology, it's not reversing the biology,
but it's really trying to help all the playing field,
and so, you know, these medications are definitely a very
useful tool. We also understand that they're just you know,
they often get dubbed into the category of weight loss
medications or they're you know, they're that that's what they're
(07:26):
used for. But we're actually learning that they're helping improve
a number of different health outcomes. So it's not just
about the weight or the body fat percentage. They could
help conditions like sleep, up nea, massoled which is termed
fatty liver disease kind of colloquially, help high blood pressure.
Of course, we know that they help diabetes, and so
(07:47):
we are really starting to understand and get that data
to help support you know, the improvements and these other
health outcomes and hopefully you know, broaden the availability and
insurance coverage that patients can have. So I call these
medications actually cardio metabolic medications, and that's not a term
that a lot of people are familiar with, but we
do use that term because we understand that conditions like diabetes,
(08:10):
heart disease, obesity, fatty liver disease, chronic kidney disease in
some cases often travel together in patients. You know, they
might have multiple these conditions, and when we treat the
underlying excess body at a post your body fat, we're
really helping improve many of these conditions. And they're also
working in these different areas in our body to try
(08:31):
to also help too. So definitely want to emphasize that
they're not just weight loss medication, but definitely want to
think about all these other quality of life improvements and
health outcomes.
Speaker 1 (08:42):
Often what gets people in the door is wanting that
weight loss and realize the conversation is much much broader
than that. And one of the first things you mentioned
is how it affects the brain, and I want us
to dive into that a little bit more. There's a
lot of really interesting information that's really come out how
people using the drugs have been I say inspired. I'd
(09:04):
love to hear what does it change in the brain
that often you hear people changing their relationship with food
to be healthier. I've heard anecdotal stories of people now
being able to who live in big cities, of being
able to walk from work to the subway where they
pass multiple fast food restaurants and could not resist going
in there, and now with the medications they can. So
if you're willing to dive into what's the science behind
(09:26):
some of those findings that we're seeing, Yeah, we know that.
Speaker 2 (09:29):
You know, no two people are the same, and there
is definitely a lot of individuality in experiencing obesity and
how that manifests in our body. So we know that
when we look at genetic variations or you know, what's
the difference is from person to person. There's actually quite
a few genes that play a role in that appetite regulation.
(09:51):
And you know everyone's different, right, Like, no two people's genes,
unless you're identical, times are completely the same. So we
understand that it it does decrease what we call food
noise for a lot of people. So you've probably seen
that term thrown around. You know what is food noise?
It's that constant chatter about food. What am I going
to eat. When am I going to eat it? What's
(10:12):
it going to taste? Like? Oh, that thing is on
the table, I really want that. It's that constant rumination
about food that a lot of people have. And you know,
when we talk about we talk about taking somebody who
is vulnerable, who has that biology, and we put them
in the current environment that we all live in, which
is a really challenging one to navigate. Right, there's food everywhere.
A lot of it is calorie dense or had you know,
(10:34):
tiring calories. It tastes really good. It's very easy to overeat.
Like I always joke and say, no one's overeating apples,
but they're over. You know, we could overeat brownie pretty quickly, right.
You know, it helps with leveling the playing field and
really cutting through that biology so that people, you know,
they're not having these strong cravings. For example, like I
have patients tell me like, you know, I went to
(10:55):
a holiday event recently and I was able to walk
past a table of desserts and I felt I had,
you know, a small piece of something and I felt
satisfied and I didn't want anything else on the table.
And that is not something that they were able to
do previously, and so as you can see, that really
did help to make more health promoting, mindful eating habits,
(11:16):
even though they were around all of this food. Some
one of the other things that often people are surprised
by that they get fuller quicker. I have patients that
have told me, like, you know, I just come from
a family where it's like really hard to feel full,
Like you know, we have to eat a certain amount
of food, which would make them uncomfortably full to feel full.
But now they're able to actually eat a small portion
(11:38):
of food and actually feel full and satisfied. And so
it's actually really liberating for people because they're like, whoa,
I have never experienced this, is this what it's like
to be normal? Like I've actually heard multiple people say
that to me or patients say that to me, and
it really does help them because they see that the
weight is coming off, and so they're even more motivated
(11:59):
to start moving more, to exercise more, to work on
their sleep hygiene, to set those boundaries, and there's work
on stress, like all of those things come into play
when they start seeing the results. Because it's you know,
a lot of people grew up in strong diet culture,
like in the ninet eighties and nineties, even before that,
and there was a lot of you know, really negative
(12:20):
messaging about weight and a lot of marketing of weight
loss supplements, treatments, programs to even children, Like many of
our patients have adverse childhood experiences where they were bullied
or they were you know, taken to certain organizations when
they were younger. So it's really it really helps them
improve their relationship with food so that they can make
(12:42):
those help promoting any habits.
Speaker 1 (12:44):
So as you're talking about using this as a tool
and somebody is using it and seeing these changes, what
is the ideal team of professionals and setup to help
Because it's not just a piece of paper you're giving
them as they walk out the door. What does that
look like while they're on the medication? And then part
(13:05):
B of that is going to be how do you
bridge them off the medications.
Speaker 2 (13:09):
I always say, in the ideal world, I wish that
every patient had access to a medical professional, a doctor,
another healthcare professional it's very comfortable with prescribing medications and
understands a science of obesity, a registered dietitian who feels
very comfortable with, you know, helping patients improve their relationship
with what I would say largely many dieticians feel that way,
(13:31):
especially helping patients from a wide variety of backgrounds with
weight management. An exercise physiologist that can help them, you know,
patients at all different physical activity levels find what works
for them. You know, many of my patients can't do
certain types of activity. The weight loss will help improve
their activity levels, but they can't do certain things. But
(13:51):
maybe they can, you know, do seated exercise, but again
you need guidance to be able to do that a therapist.
A lot of my patients again have suffered from at
first childhood experiences a lot of stigma, bullying that they've
experienced because of obesity, and so they are still working
through a lot of that. And of course there's life stressors.
I mean, there's a lot going on, you know, in
(14:13):
the world, and it's especially you know, I just became
a parent over the last year, and I can now
fully appreciate the struggles of working parent and trying to
not only take care of their family, but take care
of themselves. It's really really hard, and it's hard for
me even with all the resources. So definitely, you know,
somebody that they can actually talk to and kind of
(14:33):
help work through some of those things. And then I
would actually say somebody who is trained in cognitive behavioral
therapy for insomnia. You know, many of our patients actually
struggle with sleep disorders and difficulties with sleep, and I
would say that I wish, you know, people had that
access to individuals that could help them work through that.
(14:53):
And so that's something that I'm very interested in that
pursuing some sort of like pursuing some training in next year,
but you know, trying to bring that at scale. Now
that's the ideal world. I will say most healthcare systems
and clinics and programs don't have all of those resources.
But at the minimum, we definitely need a registered dietician
and so you know, I would love to have everyone else.
(15:15):
And that's something I've been working on as well.
Speaker 1 (15:18):
And how does your culinary medicine specialty fit in your work?
Speaker 2 (15:22):
Oh yeah, it's an everyday thing. I mean I am
constantly talking to patients about food. And it's not just
like eat this, eat that. That's kind of been you
know traditionally, what patients have heard, whether they read something
on social media or the internet, it's like what not
to eat right. It's really about celebrating the joy of health,
promoting foods, finding ways to improve your relationship with them,
and learning how to prepare foods that are enjoyable and
(15:46):
just tasty and something that you look forward to. And
I often tell patients in my own story, I grew
up as a vegetarian, but I did not eat like
ninety percent of vegetables. I think, like carrots and like
a few other vegetables were like what I and you know,
I just didn't know like how to prepare them. I
never cooked, I never did any of that. And it
wasn't until like this big, beautiful journey in culinary medicine
(16:07):
where I'm like, my sister still looks at me to
this day and she's like, I can't believe you eat
all of those vegetables now, like what, you know. It's
such a big change for me. And so I love
talking to my patients about I give them little recipes,
I give them little tips and tricks to try. I'm
hoping to actually incorporate some more culinary medicine education and
a more formal capacity. I mean, I've done a lot
(16:28):
of teaching to trainees, to the general public, to kind
of patients outside of this capacity, but definitely working on
curriculum for my patients and clinic because I think that
is a missing piece of the public. And you know
this more than anyone, Sabrina, with your wonderful work that
you've done over the years. I mean, when patients get
that confidence in their culinary literacy, their life changes and
(16:52):
it's so beautiful, and like, how do we bring that
to health systems? How do we bring that to our
future generations of healthcare professional? I mean that is not
a dream, and so definitely doing things in more of
a bite sized fashion right now. But I mean I
just love like I have all these things that I
make and bring to work, and I put them on
my desk and I show patients. I'm like, look, I
(17:13):
may overnow it out, So I like, risted these veggies
and this is what I did. And then you know,
patients will come back and say, hey, talk to T
how I tried that you know chili recipe with all
those vegetables that you recommended, and it was really good
and they get a little confidence. And then that's how
I mean I went from zero cooking. Like if you
looked at my fridge in residency, you'd be like, oh
my gosh, there's just caffeine in there to like making
(17:35):
ninety percent on my meals at home. I mean, that
is a huge change.
Speaker 1 (17:39):
It makes me think of that target of no matter
where you are in your training or life, of having
to start at the center with yourself and then trickling
it out. So from your life experience, how your patients
are able to learn from that and that word celebratory
because yes, there's so much restriction and to come from
a place of empowerment. And I'm hearing that in how
you're working with your patients. So how speaking of empowering,
(18:02):
so you're empowering And then these medications are not forever
I assume or so good question.
Speaker 2 (18:08):
You know, in the majority of individuals, these are going
to be long term medications. In fact, you know, we
know it's a chronic disease, and we're not treating the
under like we're not changing we're not rewiring their brain,
We're not you know, changing the underlying biology. I wish
we could. I think that there's some you know, potential
for therapies and that range that maybe we'll see in
my lifetime hopefully, But you know, once you stop medications.
(18:31):
It's like it's like taking medications for diabetes or high
blood pressure. Like if you just stop them like things,
they're potentially going to get worse. I mean, we know that.
I always say weight loss is really hard, but keeping
your weight off in the long term is actually harder
because of those changes that happen. Our body doesn't really
love weight loss. You know, whenever people lose weight, they
might feel hungry, or their food seeking behavior increases, they
(18:53):
feel less full. My table of them also does slow
down to some degree, and that could vary, you know,
from individual to individual, based on number of factors. So
it's not a free for all, like you just kind
of take it for three six months, lose the weight,
and then like stop it, and then you're going to
keep the weight off in the long term. I would
say that the majority of my patients that have been
on medications for years now don't want to come off
(19:14):
of it. They're like, nope, don't walk the boat. My
life is so different now. I can go on that
you know, ten mile hike in the Sierras with my
best friend because I've lost forty pounds and they don't
want to rock the boat. So there are long term medications.
I would say that if for any reason somebody has
to go off of them, definitely want to do it
under medical supervision. There have been situations where you know,
(19:38):
people might stop medications without informing their healthcare provider and
there are at risk of you know, re gaining weight,
and we don't want that to happen either. We want
to have a plan. But I would I always counsel
my patients when I'm starting medications that they're they're long term.
You know, these are not something that I can never
promise you can stop medications and then you know, keep
(19:58):
the weight off in the long long run. So yeah,
it is sometimes it's hard to really kind of think
about taking something long term for weight management, although I
would argue that a lot of people wouldn't maybe think
about that for blood pressure or something else. And it's again,
I think it's because of the stigma associated with our
(20:18):
body weight, shape and size and kind of societal expectations
on what is healthy and what is not based on
what somebody looks like. And we're really trying to move
away from that and help people understand that, no, this
is not about just the number on the scale or
the way you look like. There are other things to
consider here, a lot of health outcome improvements. I think
that if somebody were to stop medications for any reason,
(20:42):
could there be a period of time where they were
able to keep that weight off in the long term. Sure,
But then just like in a situation if somebody is
experiencing depression, and of course external factors, I mean, there's
true biology there, and then obviously there's environmental factors. If
this individual that is now off of medications, maybe they've
been maintaining their weight off for six months, twelve months, now,
(21:03):
they encountered a stressor, they had a baby, somebody died,
there was a car accident. I mean, when I talk
to patients about their contributors to weight gain, oftentimes these
things come up and you can see that they've lost
some weight, they've tried, and then something happens and it
comes back on. So you know, this is where the
medications can help, at least in the setting of a
(21:25):
stressor really help keep a cap on the biology from
you know, wrecking havoc. Again, unfortunately, because it's hard, like
if you have an injury, I mean, that's a really
common cause for weight gain. Your physical activity has now
gone down, which is a part of your total energy expenditure,
and you're not burning as many calories. And so now
(21:47):
that equation in a shift is not a simple like
you know, eat less calories, move more situation. Again, there's
hormones and biology at play, but you're clearly not burning
as many calories. And then people notice that the weight
comes on or they have a stress or like if they
do have depression, right, Like you know, people may use
food as a coping mechanism and it could be hard
on them when they have depression or seeing waking, which
(22:10):
could exacerbate their depression so further potentially. So I think
it's important to again go back to the point of
like these are this is why this is the long
These are long term medications for the majority of people,
because that biology is still there and life happens. That's
the thing. We live in a really stressful world. It
is a very stressful world. I mean, you know, again,
(22:32):
I'll use the parent example because I have a special
thing for my parent patients because now, like I said,
I understand what they're going through. But it's like you
drop your kids off to school, you go to work,
you forget your lunch at home because you're running out
the door and now you know you're at work and
you're hungry, and like there's nothing in the breakroom, and
like it's just it is really challenging, not impossible, but
(22:53):
definitely more challenging. So we have to understand that this
is real life. In an ideal world, we'd all have
five hours for our wellbeing, but we don't.
Speaker 1 (23:03):
When patients come to you, how often does a conversation
take place of helping the patients understand what we've been discussing,
that it's a chronic medication rather than kind of that
three month to get to the ideal goal for an
upcoming wedding, or to fit into genes that haven't fit
in twenty years, or whatever the impetus is for wanting
(23:23):
to lose weight.
Speaker 2 (23:24):
Yeah, I have that conversation with every patient. So when
I meet a new patient for the first time, you know,
we go through their history, We understand their health history,
kind of what were the contributors to weight gain. Then
I actually pull up pictures of the brain, the gut
and at a post or fat cells, and I explain
that there's these communications that are happening. This is what's happening,
(23:49):
and you can see in many of the patients like
the light bulb at the aha moment, like oh, I
had no idea that this was happening inside of my body.
And then that's when we launch into the conversation about medications,
what their places in their treatment plan, and that they're
long term. And so I always have that discussion. I
never you know, I'm never here to push medications on
(24:11):
people or say you shouldn't take medications. I really want
to be a partner in my patient's care. So if
patients need time to think about it, I give them
that time. It's not like we just prescribe and I
send them on their way. They come back and follow up.
I also support patients that are like, hey, rip to
tell I really just want to try, like with lifestyle changes,
to you know, work on weight loss. And I still
(24:31):
follow those patients. It's not like Okay, bye, see you later,
like you know, come back to me when you want
a medication, Like that's not the conversation that I'm having.
I will see them, will try things. I would say
the majority of people end up wanting to go on
medications eventually, but I make sure that patients have this
space to make that decision for themselves, because I don't
(24:53):
want them to ever feel like, you know, it's it's
we're a partner in their care, and so it's shared
decision making, which is you know that medical term for
being a partner in your patient's care. So it is
really important. But I have it with them every time,
you know, I meet them for the first time, and
then also periodically talk you know, the number of medications
are long term or if it comes up, maybe they forgot,
(25:15):
because again there's a lot of information that's given in
that first visit. It's something that I continue reiterating. And
like I said, when you're you know, when patients are
in their weight loss maintenance mode, which is where they're
just trying to keep their weight off. Now, they definitely
don't want to rock the boat.
Speaker 1 (25:31):
I imagine in that conversation a lot of it has
to do with diving into the person's why, right, So
why why are yes? Why are they there to discuss
weight management weight loss options?
Speaker 2 (25:44):
Yeah? No, absolutely, Yeah, So now.
Speaker 1 (25:46):
We talk about all the amazing things about these medications,
but I assume there are some negative side effects. Will
you go into those a bit please.
Speaker 2 (25:54):
Yeah, So side effects are real, and you know, we
never downplay them. I also have that converse with patients too.
You know, they'll ask, you know, what are the most
common side effects, and you know they are typically what
you see reported in the clinical trials for these medications.
They're GI side effects, naudia, constipation. I tell patients I
never want you vomiting. You know, if you're vomiting, I
(26:15):
need to know diarrheal less often but still can happen.
And then there are others. So I definitely counsel patients.
But just like there's inter individual variability between our biology,
there's also interindividual variability and response to medication. So no
two people. You know, just because this person I have
side effects doesn't mean that this person's going to have
(26:36):
side effects. And so I wish there were a way
for me to predict based on certain characteristics of that
patient's history and maybe they're just who they are, but
I can't. So I go through all of it, and
then I tell patients, like, just take a note if
you think you know, if something's happening to you, like
after you started the medication, Like I need to know.
This is where that open line of communication is really important,
(26:57):
and we try to work through some of the side effects,
like the nausea. Some of the gi side effects tend
to get better with time. We just have to give
the body some time to adjust to the medication, and
some people it doesn't and then we stop and we
try other medications or we try alternative treatments, and so
you know, I never downplay the side effects of the medication.
I think that's doing a disservice to patients because they
(27:17):
should understand that no treatment is without its downside. But
I often put it into the context of we know
what happens to people when they have access what we
call body adapacity, especially visceradiprocity. Long term. We know that
that raises their risk of many many conditions. Many of
my patients already have those conditions, and so you know,
(27:38):
I think in most people the benefits outweigh the risk,
but understanding that there is still risk.
Speaker 1 (27:44):
So if somebody is having a side effect like nausea,
and that's something that they want to stop right away,
how long and I realize each individual's individual, but what's
the usual time course to see if it gets better?
Speaker 2 (27:57):
Usually within a month or two that people start noticing improvements.
Everyone's a little different, Like some people only have it
with like their first injection, and then it kind of
goes away, and then some people notice that it's getting better,
like over the course of a month or two, and
then some people are like, okay, with each every single injection,
they're really starting to feel it, and so, you know,
we try different things. Sometimes we definitely go through their
(28:18):
dietary history and make sure that there's not any dietary
contributors to the nausea. We know that if people eat
past their new satiety, if they eat you know, to
kind of that more not thanksgiving full, but if they
eat more than they intend to or can, I should say,
because they're on medications, like they're not going to feel
very well. We know that people don't really tolerate higher fat,
(28:40):
really greasy foods on the medications. Sometimes changing the injection
site anecdotally, I don't have a study to prove this
can help with some of the symptoms like from the
abdomen to like the arm or thigh. Sometimes we have
to support them intermittently with medications for a nausea, but
just understanding that we you know, really don't want them
just to be on the nausea medication forever and ever.
(29:00):
So there's definitely things that we can do make sure
there's other medications that are contributing. So a lot of
this is why, you know, the prescriptions have to be
and people are written by people that feel comfortable with
managing these side effects and really thinking critically about the
side effects too, instead of just kind of like you know,
handing a patient of medication and saying, Okay, I'll see
you in like six months or a year, because that's
(29:21):
not really the longitudinal care that patients with obesity needs.
So we try to work through them. But again, you know,
small subset of people and no matter what we do,
won't tolerate it. And that's okay, right, the medication's not
for them, and we stop. We're not here to just
like continue it or push it on people.
Speaker 1 (29:36):
So nishe, I'm picturing this scenario and I know when
I in primary care for sixteen years, I we see
this all the time. So you have some patients that
are all in, help me understand what the tools are.
I want to use all the tools. And then there's
also some patients that say, give me the medicine, and
that's all I want. So, how do you continue in
your scenarios, especially with all your expertise, to bring in
(29:58):
these other pillars wellness, the evidence based nutritional information, the
increased culinary literacy. How do you weave that in there
to truly empower the patients to use all those tools
that are available.
Speaker 2 (30:11):
Yeah, I think it's important to also explain that you know,
what we eat matters, and that it's not just again
always like going back to what I was saying, it's
not just about the number on the scale, right, we
want to make sure that we're eating for that term.
I always say optimal cardio metabolic health, right, And it's
very important. I mean, everyone's in different stages of change
that they're willing to make, and I think we have
(30:34):
to meet our patients where they're willing to meet us.
And some people will be able to take bigger strides
towards making lifestyle habits more upfront, and they're able to
do that they have the time and the resources, the
finances to do that. And then there are people that
are not going to be able to take those big strides.
So what can we do like to you know, I
was recently just talking to a patient about Hey, let's
(30:55):
pay attention to the added sugar line on some of
these foods that you're eating, because we do want to
make sure that we're still limiting the amount of added
sugar that we're eating. I know you and we're talking
about medications, but this is still very important, right because
we don't want people eating a diet even on medications
that's higher and ultra process more calorie dents foods that
are higher and sugars aalt in fat that's like the
(31:16):
perfect combination that's very appealing to our brain. We still
want to be able to get you know, the lean proteins,
the plant proteins, the fruits, the vegetables, lentils, beans, you know, nuts,
and moderation and seeds. All of those are so important.
And this is where that conary medicine aspects come in
because again, these are minimally processed foods. You're not going
(31:37):
to go eat raw kidney beans or raw pinto beans
or something, right like, we want to be able to
flavor them and cook them. A lot of patients may
not be able to tolerate certain foods like beans in
higher amounts, so how can we help them prepare the
food so that they can you know, soaking them overnight
using an instant pot. How are we going to flavor them?
Are we going to put them into like an Indian dish? Sure?
(32:00):
Are we going to make top gos? Like all of
those things are really those conversations are still really important.
So I definitely emphasize what we eat still matters, because
also it's going to be easier to stick to a
healthier diet and healthier weight when you're eating these foods.
I go go back to what I said, like, no
one's over eating broccoli, right, It's I mean, maybe there's
somebody out there that's doing that, but I doubt that
(32:21):
they are, you know, creating a calorie increase with just
broccoli alone. But let's find ways to make broccoli enjoyable.
And my little one won't eat steam broccoli, but if
I saw tay it with some garlic, you know they'll
eat it.
Speaker 1 (32:33):
I'll eat it.
Speaker 2 (32:34):
So it's really that same concept, like you may not
like steam broccoli, but could you air fry it? Could
you put it into a baking sheet? And like actually
learning how to properly roast vegetables and not crowding the
pan and making sure that you're using, you know, the
proper spices that are not going to burn like in
the oven. So it's just those things are still incredibly important,
(32:56):
and I think that's oftentimes the missing piece of a
puzzle all when we talk about nutrition changes. I mean,
we could, you know, talk about what to eat, why
to eat it, But it's the how am I going
to do it in my busy life that people really
struggle with, and how am I going to do it
where it doesn't feel like a punishment, because I mean,
you ate just like chicken and broccoli all day long.
(33:19):
I think that would get old over time. So like,
how can we help you incorporate a variety of foods
that's still also very important too, right, we want to
make sure that we're meeting our nutritional needs by incorporating
that variety of food also respecting cultures and customs and
family traditions and not demonizing somebody as food as you know,
(33:40):
unhealthy because they're of a certain culture, Like that's just
not fair. We can all find ways to make our
cultural foods more health promoting. I mean, there's a lot
of vegetables that are native to the South Asian culture
that I encourage my own parents to eat more of
you know, or trying to help them get more of
those on their plate. So incredibly important and definitely not
(34:03):
a piece of the conversation that we should ever forget about.
Speaker 1 (34:06):
Now, as we wrap up, I'm going to ask you
how do you feel about Kennedy and his appointed role
as Secretary of the Department of h CHESS.
Speaker 2 (34:15):
Yeah, that's a really great question. You know, as a physician,
it is my goal and job to take care of
a wide variety of patients regardless of, you know what,
any type of political affiliations they have, and I will
always stand by that. And it's the same thing here, right.
Public health is not a partisan issue. It's not a
(34:37):
one political party versus another. We know that we have
increased rates of cardi metabolic health conditions in the country.
We know that we live in food environments that are
really challenging to navigate, and I welcome meaningful changes that
will help improve that food environment. Oftentimes, when we fixate
on one ingredient or one specific aspect of food, we
(35:00):
really don't drive like significant, meaningful change. We need to
understand all of the contributors that make it difficult for
people to you know, eat more, healthfully, move their bodies, sleep.
All of that is very important. There's a lot of
different factors, but I do hope that we see some
meaningful improvements in our food environment. It's too soon to tell.
(35:20):
I think there's a lot of awareness about improving public health.
It's just a matter of how well that happened. That's
to be determined.
Speaker 1 (35:29):
Now as we're finishing. Is there anything I didn't ask
you or anything you want to share in this conversation
that we haven't done so far.
Speaker 2 (35:38):
Yeah, I definitely want people to think about their health
and their well being beyond just wait. You know, it's
really about and often the term holistic gets thrown around.
It's a little you know, like oh, holistic well being,
but it's really thinking about all aspects of your physical
and mental wellbeing. You know. It's not just like I
see patients that literally their lives change, right like, set boundaries,
(36:01):
They take care of themselves, They say no to things
that don't serve them. I mean, that is a part
of their health and well being. And that's something that
i'd fully encourage and actually talk to patients about setting boundaries,
because every time they say yes to something, they're saying
no to something else, and what are they saying no to?
Are they saying no to their twenty minute workout after work?
Are they saying no to you know, eating their health
promoting meal that they made. So it's so important to
(36:23):
emphasize that our well being is just way way beyond
the number on the scale. It's all of these things
that are so important because we want to live full lives.
We want to live lives with purpose. And I tell
patients please separate your happiness from the number on the scale,
from the weight, because you're allowed to be happy no
matter what body you're in.
Speaker 1 (36:44):
To finish, how can people find you either social media
or your practice web?
Speaker 2 (36:49):
Yeah, so you can find me on social media on
x and Instagram. That doctor Plantel, it's doctor Patel. So
I love getting helping patients get more plans on their plate.
So that's where that doctor Plantel came from. Definitely do
a lot of education and adcacy on my social media
pages and so definitely come check it out.
Speaker 1 (37:08):
Wonderful. Thank you so much, Nisha. I've really enjoyed our
conversation and truly appreciate you.
Speaker 2 (37:13):
Thank you.
Speaker 1 (37:17):
I hope you feel motivated by this episode. Please leave
us a rating and a review, and mention our show
to others who you think could use this information. That
could be your doctor, It could be somebody who works
in the food service industry who's interested in the health components.
It could be a friend that is working on their
health journey. If you want to hear more, please remember
to follow Culinary Medicine Recipe on your favorite podcast listening platform.
(37:40):
Until next time, Sandu and Bona Pettie. All content provided
or opinions expressed in this episode are for informational purposes
only and are not a substitute for professional medical advice.
Please take advice from your doctor or other qualified healthcare professional.
Thanks to our episode sponsor Iskafia, a school of culinary Arts.
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F f I E R dot e d u slash
c U l I n A r y m E
d I c I n E. And now for today's episode.
Speaker 2 (00:56):
If we want to live full lives, we want to
live lives with purpose, and I tell patients please separate
your happiness from the number on the scale from the weight,
because you're allowed to be happy no matter what body
you're in.
Speaker 1 (01:09):
Welcome to culinary Medicine Recipe. I'm so happy you're here.
I'm your host, Doctor Saprina Falke. I was a primary
care doctor for sixteen years and went to school for
four years to specialize in culinary medicine. In this work,
I get to combine my passionate expertise in both medicine
and food to teach people about food is medicine and
to empower them to understand what ingredients optimize health and
(01:31):
also how to cook those ingredients to make delicious meals.
On the show, I interviewed top chefs, doctors, healthcare visionaries,
and food service professionals who are making great strides in
the field of culinary medicine. Join me as we continue
to explore the amazing world of culinary medicine, where I
will empower you to make changes to your health and
wellness with great food. Right away. Welcome to season two
(01:58):
of the show. Today's episode is a weight management Did
you know that in January is when forty percent of
people start dieting. January is often a time to make
good on those New Year's resolutions, and if weight loss
is one of them JLP ones such as what goovi
and no zempic may be on your mind. So today
we're going to be talking about weight loss and what
has become a commonly used tool to achieve that weight loss,
(02:20):
weight loss medications, and also to clear up some of
the misinformation that's out there. I welcome doctor Nisha Patel,
who trained in the same hospital as me in San Dieo,
California and has gone on to become a specialist in
multiple areas with an extensive resume and bio that is
quite impressive. Today we will dive into her specialized work
and obesity medicine as well as culinary medicine. Welcome doctor Patel.
Speaker 2 (02:44):
Thanks so much for having me. I'm so excited to
be here and talk to you about all of this.
Speaker 1 (02:49):
I'm really excited. I know it often takes a while
to get on the same schedule, and I really appreciate
us being able to have this conversation. Yes, absolutely, we're
going to dive in. So the conversation surrounding weight loss
medications can be quite triggering for people. What is your
opinion on medicated weight loss and prescription medications for this
(03:11):
and do who would you recommend it.
Speaker 2 (03:14):
That's a really great question. And so you know, we
are really fortunate to have multiple different tools to help
our patients improve their health outcomes. Our patients with obesity,
their health outcomes and their quality of life. Both of
those are very very important. And you know, I often
see a lot of dichotomy and conversations around weight management.
(03:37):
You know, is it lifestyle factors only, is it medications only?
And I would really challenge everyone to understand that these
are all tools that work together to help people improve
their health and achieve their health goals. And so, you know,
as an obesity medicine doctor, I definitely use medications for
weight management, medications to treat obesity, the chronic disease of obesity,
(03:58):
in conjunction with head health promoting lifestyle. It's very important
to understand that health is just more than a number
on the scale. It's about our physical and our mental
well being. It's about what we eat, the way we move,
our sleep, how we interact with others in society, and
so I definitely you look at all of those different aspects,
but medications are absolutely a tool because we understand that
(04:21):
there's underlying neural hormonal dysregulation that makes it difficult for
people to really achieve weight loss, and specifically, when we
talk about weight we're talking about reducing the percentage of
body fat that we have, especially visceral at apocity. That's
a medical term for the fat that sits closest to
our internal organs and our abdomen. That is particularly problematic
(04:44):
when we talk about diseases like heart disease and diabetes. So,
you know, these are a tool. They're definitely not, you know,
an end all be all. They're treatment for chronic disease,
and so we have to make sure that they are
used appropriately and correctly. And unfortunately, there's just still a
lot of misinformation, which I'm hoping that we can bust
(05:06):
in this podcast episode so your listeners can really understand
how these are a tool to really help them.
Speaker 1 (05:13):
Thank Anisha, I'm going to use your first name because
we're friends.
Speaker 2 (05:16):
Yeah, the other way, Yeah, I know exactly.
Speaker 1 (05:20):
Yeah, So I appreciate that you're having our listeners here
that obesity is a chronic disease, because often that's not known.
And when you talk about this tool of the medications.
Let's start from the beginning, So how woul do you
explain what a GLP one.
Speaker 2 (05:34):
Is so GLP one is actually a hormone that our
body produces in response to eating food. Unfortunately, though, our
own GOLP one actually breaks down really quickly, meaning that
it's not active for very long and so it really
can't do the same things as what a medication like
(05:56):
a GLP one receptor agonist can do. You know, this
is a pharmacy medication that has a very long half life.
I mean, there's definitely ones that are daily dosing, but
the ones that we really think about when we talk
about weight management are the ones that are once a week,
and so the medications are lasting for the entire week
(06:16):
in most people. So that's just again something not our
own body can do. We have GLP one receptors all
over our body, but we know when it comes to
weight management that one of the primary places that it's
working is actually our brain. You know, our appetite regulation
systems are in our brain and they're receiving signals from
all different parts of our body, our gut, and unfortunately,
(06:40):
you know, and people with obesity, the signals might not
be they might be just regulated or they're not really
working as efficiently, and the medications actually help restore some
of that signaling or what I often call level the
playing field, so that people can feel like they're in
better control around food they're craving, are improved, they feel full.
(07:03):
We understand again that you know, this is helping that biology.
It's not taking away the biology, it's not reversing the biology,
but it's really trying to help all the playing field,
and so, you know, these medications are definitely a very
useful tool. We also understand that they're just you know,
they often get dubbed into the category of weight loss
medications or they're you know, they're that that's what they're
(07:26):
used for. But we're actually learning that they're helping improve
a number of different health outcomes. So it's not just
about the weight or the body fat percentage. They could
help conditions like sleep, up nea, massoled which is termed
fatty liver disease kind of colloquially, help high blood pressure.
Of course, we know that they help diabetes, and so
(07:47):
we are really starting to understand and get that data
to help support you know, the improvements and these other
health outcomes and hopefully you know, broaden the availability and
insurance coverage that patients can have. So I call these
medications actually cardio metabolic medications, and that's not a term
that a lot of people are familiar with, but we
do use that term because we understand that conditions like diabetes,
(08:10):
heart disease, obesity, fatty liver disease, chronic kidney disease in
some cases often travel together in patients. You know, they
might have multiple these conditions, and when we treat the
underlying excess body at a post your body fat, we're
really helping improve many of these conditions. And they're also
working in these different areas in our body to try
(08:31):
to also help too. So definitely want to emphasize that
they're not just weight loss medication, but definitely want to
think about all these other quality of life improvements and
health outcomes.
Speaker 1 (08:42):
Often what gets people in the door is wanting that
weight loss and realize the conversation is much much broader
than that. And one of the first things you mentioned
is how it affects the brain, and I want us
to dive into that a little bit more. There's a
lot of really interesting information that's really come out how
people using the drugs have been I say inspired. I'd
(09:04):
love to hear what does it change in the brain
that often you hear people changing their relationship with food
to be healthier. I've heard anecdotal stories of people now
being able to who live in big cities, of being
able to walk from work to the subway where they
pass multiple fast food restaurants and could not resist going
in there, and now with the medications they can. So
if you're willing to dive into what's the science behind
(09:26):
some of those findings that we're seeing, Yeah, we know that.
Speaker 2 (09:29):
You know, no two people are the same, and there
is definitely a lot of individuality in experiencing obesity and
how that manifests in our body. So we know that
when we look at genetic variations or you know, what's
the difference is from person to person. There's actually quite
a few genes that play a role in that appetite regulation.
(09:51):
And you know everyone's different, right, Like, no two people's genes,
unless you're identical, times are completely the same. So we
understand that it it does decrease what we call food
noise for a lot of people. So you've probably seen
that term thrown around. You know what is food noise?
It's that constant chatter about food. What am I going
to eat. When am I going to eat it? What's
(10:12):
it going to taste? Like? Oh, that thing is on
the table, I really want that. It's that constant rumination
about food that a lot of people have. And you know,
when we talk about we talk about taking somebody who
is vulnerable, who has that biology, and we put them
in the current environment that we all live in, which
is a really challenging one to navigate. Right, there's food everywhere.
A lot of it is calorie dense or had you know,
(10:34):
tiring calories. It tastes really good. It's very easy to overeat.
Like I always joke and say, no one's overeating apples,
but they're over. You know, we could overeat brownie pretty quickly, right.
You know, it helps with leveling the playing field and
really cutting through that biology so that people, you know,
they're not having these strong cravings. For example, like I
have patients tell me like, you know, I went to
(10:55):
a holiday event recently and I was able to walk
past a table of desserts and I felt I had,
you know, a small piece of something and I felt
satisfied and I didn't want anything else on the table.
And that is not something that they were able to
do previously, and so as you can see, that really
did help to make more health promoting, mindful eating habits,
(11:16):
even though they were around all of this food. Some
one of the other things that often people are surprised
by that they get fuller quicker. I have patients that
have told me, like, you know, I just come from
a family where it's like really hard to feel full,
Like you know, we have to eat a certain amount
of food, which would make them uncomfortably full to feel full.
But now they're able to actually eat a small portion
(11:38):
of food and actually feel full and satisfied. And so
it's actually really liberating for people because they're like, whoa,
I have never experienced this, is this what it's like
to be normal? Like I've actually heard multiple people say
that to me or patients say that to me, and
it really does help them because they see that the
weight is coming off, and so they're even more motivated
(11:59):
to start moving more, to exercise more, to work on
their sleep hygiene, to set those boundaries, and there's work
on stress, like all of those things come into play
when they start seeing the results. Because it's you know,
a lot of people grew up in strong diet culture,
like in the ninet eighties and nineties, even before that,
and there was a lot of you know, really negative
(12:20):
messaging about weight and a lot of marketing of weight
loss supplements, treatments, programs to even children, Like many of
our patients have adverse childhood experiences where they were bullied
or they were you know, taken to certain organizations when
they were younger. So it's really it really helps them
improve their relationship with food so that they can make
(12:42):
those help promoting any habits.
Speaker 1 (12:44):
So as you're talking about using this as a tool
and somebody is using it and seeing these changes, what
is the ideal team of professionals and setup to help
Because it's not just a piece of paper you're giving
them as they walk out the door. What does that
look like while they're on the medication? And then part
(13:05):
B of that is going to be how do you
bridge them off the medications.
Speaker 2 (13:09):
I always say, in the ideal world, I wish that
every patient had access to a medical professional, a doctor,
another healthcare professional it's very comfortable with prescribing medications and
understands a science of obesity, a registered dietitian who feels
very comfortable with, you know, helping patients improve their relationship
with what I would say largely many dieticians feel that way,
(13:31):
especially helping patients from a wide variety of backgrounds with
weight management. An exercise physiologist that can help them, you know,
patients at all different physical activity levels find what works
for them. You know, many of my patients can't do
certain types of activity. The weight loss will help improve
their activity levels, but they can't do certain things. But
(13:51):
maybe they can, you know, do seated exercise, but again
you need guidance to be able to do that a therapist.
A lot of my patients again have suffered from at
first childhood experiences a lot of stigma, bullying that they've
experienced because of obesity, and so they are still working
through a lot of that. And of course there's life stressors.
I mean, there's a lot going on, you know, in
(14:13):
the world, and it's especially you know, I just became
a parent over the last year, and I can now
fully appreciate the struggles of working parent and trying to
not only take care of their family, but take care
of themselves. It's really really hard, and it's hard for
me even with all the resources. So definitely, you know,
somebody that they can actually talk to and kind of
(14:33):
help work through some of those things. And then I
would actually say somebody who is trained in cognitive behavioral
therapy for insomnia. You know, many of our patients actually
struggle with sleep disorders and difficulties with sleep, and I
would say that I wish, you know, people had that
access to individuals that could help them work through that.
(14:53):
And so that's something that I'm very interested in that
pursuing some sort of like pursuing some training in next year,
but you know, trying to bring that at scale. Now
that's the ideal world. I will say most healthcare systems
and clinics and programs don't have all of those resources.
But at the minimum, we definitely need a registered dietician
and so you know, I would love to have everyone else.
(15:15):
And that's something I've been working on as well.
Speaker 1 (15:18):
And how does your culinary medicine specialty fit in your work?
Speaker 2 (15:22):
Oh yeah, it's an everyday thing. I mean I am
constantly talking to patients about food. And it's not just
like eat this, eat that. That's kind of been you
know traditionally, what patients have heard, whether they read something
on social media or the internet, it's like what not
to eat right. It's really about celebrating the joy of health,
promoting foods, finding ways to improve your relationship with them,
and learning how to prepare foods that are enjoyable and
(15:46):
just tasty and something that you look forward to. And
I often tell patients in my own story, I grew
up as a vegetarian, but I did not eat like
ninety percent of vegetables. I think, like carrots and like
a few other vegetables were like what I and you know,
I just didn't know like how to prepare them. I
never cooked, I never did any of that. And it
wasn't until like this big, beautiful journey in culinary medicine
(16:07):
where I'm like, my sister still looks at me to
this day and she's like, I can't believe you eat
all of those vegetables now, like what, you know. It's
such a big change for me. And so I love
talking to my patients about I give them little recipes,
I give them little tips and tricks to try. I'm
hoping to actually incorporate some more culinary medicine education and
a more formal capacity. I mean, I've done a lot
(16:28):
of teaching to trainees, to the general public, to kind
of patients outside of this capacity, but definitely working on
curriculum for my patients and clinic because I think that
is a missing piece of the public. And you know
this more than anyone, Sabrina, with your wonderful work that
you've done over the years. I mean, when patients get
that confidence in their culinary literacy, their life changes and
(16:52):
it's so beautiful, and like, how do we bring that
to health systems? How do we bring that to our
future generations of healthcare professional? I mean that is not
a dream, and so definitely doing things in more of
a bite sized fashion right now. But I mean I
just love like I have all these things that I
make and bring to work, and I put them on
my desk and I show patients. I'm like, look, I
(17:13):
may overnow it out, So I like, risted these veggies
and this is what I did. And then you know,
patients will come back and say, hey, talk to T
how I tried that you know chili recipe with all
those vegetables that you recommended, and it was really good
and they get a little confidence. And then that's how
I mean I went from zero cooking. Like if you
looked at my fridge in residency, you'd be like, oh
my gosh, there's just caffeine in there to like making
(17:35):
ninety percent on my meals at home. I mean, that
is a huge change.
Speaker 1 (17:39):
It makes me think of that target of no matter
where you are in your training or life, of having
to start at the center with yourself and then trickling
it out. So from your life experience, how your patients
are able to learn from that and that word celebratory
because yes, there's so much restriction and to come from
a place of empowerment. And I'm hearing that in how
you're working with your patients. So how speaking of empowering,
(18:02):
so you're empowering And then these medications are not forever
I assume or so good question.
Speaker 2 (18:08):
You know, in the majority of individuals, these are going
to be long term medications. In fact, you know, we
know it's a chronic disease, and we're not treating the
under like we're not changing we're not rewiring their brain,
We're not you know, changing the underlying biology. I wish
we could. I think that there's some you know, potential
for therapies and that range that maybe we'll see in
my lifetime hopefully, But you know, once you stop medications.
(18:31):
It's like it's like taking medications for diabetes or high
blood pressure. Like if you just stop them like things,
they're potentially going to get worse. I mean, we know that.
I always say weight loss is really hard, but keeping
your weight off in the long term is actually harder
because of those changes that happen. Our body doesn't really
love weight loss. You know, whenever people lose weight, they
might feel hungry, or their food seeking behavior increases, they
(18:53):
feel less full. My table of them also does slow
down to some degree, and that could vary, you know,
from individual to individual, based on number of factors. So
it's not a free for all, like you just kind
of take it for three six months, lose the weight,
and then like stop it, and then you're going to
keep the weight off in the long term. I would
say that the majority of my patients that have been
on medications for years now don't want to come off
(19:14):
of it. They're like, nope, don't walk the boat. My
life is so different now. I can go on that
you know, ten mile hike in the Sierras with my
best friend because I've lost forty pounds and they don't
want to rock the boat. So there are long term medications.
I would say that if for any reason somebody has
to go off of them, definitely want to do it
under medical supervision. There have been situations where you know,
(19:38):
people might stop medications without informing their healthcare provider and
there are at risk of you know, re gaining weight,
and we don't want that to happen either. We want
to have a plan. But I would I always counsel
my patients when I'm starting medications that they're they're long term.
You know, these are not something that I can never
promise you can stop medications and then you know, keep
(19:58):
the weight off in the long long run. So yeah,
it is sometimes it's hard to really kind of think
about taking something long term for weight management, although I
would argue that a lot of people wouldn't maybe think
about that for blood pressure or something else. And it's again,
I think it's because of the stigma associated with our
(20:18):
body weight, shape and size and kind of societal expectations
on what is healthy and what is not based on
what somebody looks like. And we're really trying to move
away from that and help people understand that, no, this
is not about just the number on the scale or
the way you look like. There are other things to
consider here, a lot of health outcome improvements. I think
that if somebody were to stop medications for any reason,
(20:42):
could there be a period of time where they were
able to keep that weight off in the long term. Sure,
But then just like in a situation if somebody is
experiencing depression, and of course external factors, I mean, there's
true biology there, and then obviously there's environmental factors. If
this individual that is now off of medications, maybe they've
been maintaining their weight off for six months, twelve months, now,
(21:03):
they encountered a stressor, they had a baby, somebody died,
there was a car accident. I mean, when I talk
to patients about their contributors to weight gain, oftentimes these
things come up and you can see that they've lost
some weight, they've tried, and then something happens and it
comes back on. So you know, this is where the
medications can help, at least in the setting of a
(21:25):
stressor really help keep a cap on the biology from
you know, wrecking havoc. Again, unfortunately, because it's hard, like
if you have an injury, I mean, that's a really
common cause for weight gain. Your physical activity has now
gone down, which is a part of your total energy expenditure,
and you're not burning as many calories. And so now
(21:47):
that equation in a shift is not a simple like
you know, eat less calories, move more situation. Again, there's
hormones and biology at play, but you're clearly not burning
as many calories. And then people notice that the weight
comes on or they have a stress or like if they
do have depression, right, Like you know, people may use
food as a coping mechanism and it could be hard
on them when they have depression or seeing waking, which
(22:10):
could exacerbate their depression so further potentially. So I think
it's important to again go back to the point of
like these are this is why this is the long
These are long term medications for the majority of people,
because that biology is still there and life happens. That's
the thing. We live in a really stressful world. It
is a very stressful world. I mean, you know, again,
(22:32):
I'll use the parent example because I have a special
thing for my parent patients because now, like I said,
I understand what they're going through. But it's like you
drop your kids off to school, you go to work,
you forget your lunch at home because you're running out
the door and now you know you're at work and
you're hungry, and like there's nothing in the breakroom, and
like it's just it is really challenging, not impossible, but
(22:53):
definitely more challenging. So we have to understand that this
is real life. In an ideal world, we'd all have
five hours for our wellbeing, but we don't.
Speaker 1 (23:03):
When patients come to you, how often does a conversation
take place of helping the patients understand what we've been discussing,
that it's a chronic medication rather than kind of that
three month to get to the ideal goal for an
upcoming wedding, or to fit into genes that haven't fit
in twenty years, or whatever the impetus is for wanting
(23:23):
to lose weight.
Speaker 2 (23:24):
Yeah, I have that conversation with every patient. So when
I meet a new patient for the first time, you know,
we go through their history, We understand their health history,
kind of what were the contributors to weight gain. Then
I actually pull up pictures of the brain, the gut
and at a post or fat cells, and I explain
that there's these communications that are happening. This is what's happening,
(23:49):
and you can see in many of the patients like
the light bulb at the aha moment, like oh, I
had no idea that this was happening inside of my body.
And then that's when we launch into the conversation about medications,
what their places in their treatment plan, and that they're
long term. And so I always have that discussion. I
never you know, I'm never here to push medications on
(24:11):
people or say you shouldn't take medications. I really want
to be a partner in my patient's care. So if
patients need time to think about it, I give them
that time. It's not like we just prescribe and I
send them on their way. They come back and follow up.
I also support patients that are like, hey, rip to
tell I really just want to try, like with lifestyle changes,
to you know, work on weight loss. And I still
(24:31):
follow those patients. It's not like Okay, bye, see you later,
like you know, come back to me when you want
a medication, Like that's not the conversation that I'm having.
I will see them, will try things. I would say
the majority of people end up wanting to go on
medications eventually, but I make sure that patients have this
space to make that decision for themselves, because I don't
(24:53):
want them to ever feel like, you know, it's it's
we're a partner in their care, and so it's shared
decision making, which is you know that medical term for
being a partner in your patient's care. So it is
really important. But I have it with them every time,
you know, I meet them for the first time, and
then also periodically talk you know, the number of medications
are long term or if it comes up, maybe they forgot,
(25:15):
because again there's a lot of information that's given in
that first visit. It's something that I continue reiterating. And
like I said, when you're you know, when patients are
in their weight loss maintenance mode, which is where they're
just trying to keep their weight off. Now, they definitely
don't want to rock the boat.
Speaker 1 (25:31):
I imagine in that conversation a lot of it has
to do with diving into the person's why, right, So
why why are yes? Why are they there to discuss
weight management weight loss options?
Speaker 2 (25:44):
Yeah? No, absolutely, Yeah, So now.
Speaker 1 (25:46):
We talk about all the amazing things about these medications,
but I assume there are some negative side effects. Will
you go into those a bit please.
Speaker 2 (25:54):
Yeah, So side effects are real, and you know, we
never downplay them. I also have that converse with patients too.
You know, they'll ask, you know, what are the most
common side effects, and you know they are typically what
you see reported in the clinical trials for these medications.
They're GI side effects, naudia, constipation. I tell patients I
never want you vomiting. You know, if you're vomiting, I
(26:15):
need to know diarrheal less often but still can happen.
And then there are others. So I definitely counsel patients.
But just like there's inter individual variability between our biology,
there's also interindividual variability and response to medication. So no
two people. You know, just because this person I have
side effects doesn't mean that this person's going to have
(26:36):
side effects. And so I wish there were a way
for me to predict based on certain characteristics of that
patient's history and maybe they're just who they are, but
I can't. So I go through all of it, and
then I tell patients, like, just take a note if
you think you know, if something's happening to you, like
after you started the medication, Like I need to know.
This is where that open line of communication is really important,
(26:57):
and we try to work through some of the side effects,
like the nausea. Some of the gi side effects tend
to get better with time. We just have to give
the body some time to adjust to the medication, and
some people it doesn't and then we stop and we
try other medications or we try alternative treatments, and so
you know, I never downplay the side effects of the medication.
I think that's doing a disservice to patients because they
(27:17):
should understand that no treatment is without its downside. But
I often put it into the context of we know
what happens to people when they have access what we
call body adapacity, especially visceradiprocity. Long term. We know that
that raises their risk of many many conditions. Many of
my patients already have those conditions, and so you know,
(27:38):
I think in most people the benefits outweigh the risk,
but understanding that there is still risk.
Speaker 1 (27:44):
So if somebody is having a side effect like nausea,
and that's something that they want to stop right away,
how long and I realize each individual's individual, but what's
the usual time course to see if it gets better?
Speaker 2 (27:57):
Usually within a month or two that people start noticing improvements.
Everyone's a little different, Like some people only have it
with like their first injection, and then it kind of
goes away, and then some people notice that it's getting better,
like over the course of a month or two, and
then some people are like, okay, with each every single injection,
they're really starting to feel it, and so, you know,
we try different things. Sometimes we definitely go through their
(28:18):
dietary history and make sure that there's not any dietary
contributors to the nausea. We know that if people eat
past their new satiety, if they eat you know, to
kind of that more not thanksgiving full, but if they
eat more than they intend to or can, I should say,
because they're on medications, like they're not going to feel
very well. We know that people don't really tolerate higher fat,
(28:40):
really greasy foods on the medications. Sometimes changing the injection
site anecdotally, I don't have a study to prove this
can help with some of the symptoms like from the
abdomen to like the arm or thigh. Sometimes we have
to support them intermittently with medications for a nausea, but
just understanding that we you know, really don't want them
just to be on the nausea medication forever and ever.
(29:00):
So there's definitely things that we can do make sure
there's other medications that are contributing. So a lot of
this is why, you know, the prescriptions have to be
and people are written by people that feel comfortable with
managing these side effects and really thinking critically about the
side effects too, instead of just kind of like you know,
handing a patient of medication and saying, Okay, I'll see
you in like six months or a year, because that's
(29:21):
not really the longitudinal care that patients with obesity needs.
So we try to work through them. But again, you know,
small subset of people and no matter what we do,
won't tolerate it. And that's okay, right, the medication's not
for them, and we stop. We're not here to just
like continue it or push it on people.
Speaker 1 (29:36):
So nishe, I'm picturing this scenario and I know when
I in primary care for sixteen years, I we see
this all the time. So you have some patients that
are all in, help me understand what the tools are.
I want to use all the tools. And then there's
also some patients that say, give me the medicine, and
that's all I want. So, how do you continue in
your scenarios, especially with all your expertise, to bring in
(29:58):
these other pillars wellness, the evidence based nutritional information, the
increased culinary literacy. How do you weave that in there
to truly empower the patients to use all those tools
that are available.
Speaker 2 (30:11):
Yeah, I think it's important to also explain that you know,
what we eat matters, and that it's not just again
always like going back to what I was saying, it's
not just about the number on the scale, right, we
want to make sure that we're eating for that term.
I always say optimal cardio metabolic health, right, And it's
very important. I mean, everyone's in different stages of change
that they're willing to make, and I think we have
(30:34):
to meet our patients where they're willing to meet us.
And some people will be able to take bigger strides
towards making lifestyle habits more upfront, and they're able to
do that they have the time and the resources, the
finances to do that. And then there are people that
are not going to be able to take those big strides.
So what can we do like to you know, I
was recently just talking to a patient about Hey, let's
(30:55):
pay attention to the added sugar line on some of
these foods that you're eating, because we do want to
make sure that we're still limiting the amount of added
sugar that we're eating. I know you and we're talking
about medications, but this is still very important, right because
we don't want people eating a diet even on medications
that's higher and ultra process more calorie dents foods that
are higher and sugars aalt in fat that's like the
(31:16):
perfect combination that's very appealing to our brain. We still
want to be able to get you know, the lean proteins,
the plant proteins, the fruits, the vegetables, lentils, beans, you know, nuts,
and moderation and seeds. All of those are so important.
And this is where that conary medicine aspects come in
because again, these are minimally processed foods. You're not going
(31:37):
to go eat raw kidney beans or raw pinto beans
or something, right like, we want to be able to
flavor them and cook them. A lot of patients may
not be able to tolerate certain foods like beans in
higher amounts, so how can we help them prepare the
food so that they can you know, soaking them overnight
using an instant pot. How are we going to flavor them?
Are we going to put them into like an Indian dish? Sure?
(32:00):
Are we going to make top gos? Like all of
those things are really those conversations are still really important.
So I definitely emphasize what we eat still matters, because
also it's going to be easier to stick to a
healthier diet and healthier weight when you're eating these foods.
I go go back to what I said, like, no
one's over eating broccoli, right, It's I mean, maybe there's
somebody out there that's doing that, but I doubt that
(32:21):
they are, you know, creating a calorie increase with just
broccoli alone. But let's find ways to make broccoli enjoyable.
And my little one won't eat steam broccoli, but if
I saw tay it with some garlic, you know they'll
eat it.
Speaker 1 (32:33):
I'll eat it.
Speaker 2 (32:34):
So it's really that same concept, like you may not
like steam broccoli, but could you air fry it? Could
you put it into a baking sheet? And like actually
learning how to properly roast vegetables and not crowding the
pan and making sure that you're using, you know, the
proper spices that are not going to burn like in
the oven. So it's just those things are still incredibly important,
(32:56):
and I think that's oftentimes the missing piece of a
puzzle all when we talk about nutrition changes. I mean,
we could, you know, talk about what to eat, why
to eat it, But it's the how am I going
to do it in my busy life that people really
struggle with, and how am I going to do it
where it doesn't feel like a punishment, because I mean,
you ate just like chicken and broccoli all day long.
(33:19):
I think that would get old over time. So like,
how can we help you incorporate a variety of foods
that's still also very important too, right, we want to
make sure that we're meeting our nutritional needs by incorporating
that variety of food also respecting cultures and customs and
family traditions and not demonizing somebody as food as you know,
(33:40):
unhealthy because they're of a certain culture, Like that's just
not fair. We can all find ways to make our
cultural foods more health promoting. I mean, there's a lot
of vegetables that are native to the South Asian culture
that I encourage my own parents to eat more of
you know, or trying to help them get more of
those on their plate. So incredibly important and definitely not
(34:03):
a piece of the conversation that we should ever forget about.
Speaker 1 (34:06):
Now, as we wrap up, I'm going to ask you
how do you feel about Kennedy and his appointed role
as Secretary of the Department of h CHESS.
Speaker 2 (34:15):
Yeah, that's a really great question. You know, as a physician,
it is my goal and job to take care of
a wide variety of patients regardless of, you know what,
any type of political affiliations they have, and I will
always stand by that. And it's the same thing here, right.
Public health is not a partisan issue. It's not a
(34:37):
one political party versus another. We know that we have
increased rates of cardi metabolic health conditions in the country.
We know that we live in food environments that are
really challenging to navigate, and I welcome meaningful changes that
will help improve that food environment. Oftentimes, when we fixate
on one ingredient or one specific aspect of food, we
(35:00):
really don't drive like significant, meaningful change. We need to
understand all of the contributors that make it difficult for
people to you know, eat more, healthfully, move their bodies, sleep.
All of that is very important. There's a lot of
different factors, but I do hope that we see some
meaningful improvements in our food environment. It's too soon to tell.
(35:20):
I think there's a lot of awareness about improving public health.
It's just a matter of how well that happened. That's
to be determined.
Speaker 1 (35:29):
Now as we're finishing. Is there anything I didn't ask
you or anything you want to share in this conversation
that we haven't done so far.
Speaker 2 (35:38):
Yeah, I definitely want people to think about their health
and their well being beyond just wait. You know, it's
really about and often the term holistic gets thrown around.
It's a little you know, like oh, holistic well being,
but it's really thinking about all aspects of your physical
and mental wellbeing. You know. It's not just like I
see patients that literally their lives change, right like, set boundaries,
(36:01):
They take care of themselves, They say no to things
that don't serve them. I mean, that is a part
of their health and well being. And that's something that
i'd fully encourage and actually talk to patients about setting boundaries,
because every time they say yes to something, they're saying
no to something else, and what are they saying no to?
Are they saying no to their twenty minute workout after work?
Are they saying no to you know, eating their health
promoting meal that they made. So it's so important to
(36:23):
emphasize that our well being is just way way beyond
the number on the scale. It's all of these things
that are so important because we want to live full lives.
We want to live lives with purpose. And I tell
patients please separate your happiness from the number on the scale,
from the weight, because you're allowed to be happy no
matter what body you're in.
Speaker 1 (36:44):
To finish, how can people find you either social media
or your practice web?
Speaker 2 (36:49):
Yeah, so you can find me on social media on
x and Instagram. That doctor Plantel, it's doctor Patel. So
I love getting helping patients get more plans on their plate.
So that's where that doctor Plantel came from. Definitely do
a lot of education and adcacy on my social media
pages and so definitely come check it out.
Speaker 1 (37:08):
Wonderful. Thank you so much, Nisha. I've really enjoyed our
conversation and truly appreciate you.
Speaker 2 (37:13):
Thank you.
Speaker 1 (37:17):
I hope you feel motivated by this episode. Please leave
us a rating and a review, and mention our show
to others who you think could use this information. That
could be your doctor, It could be somebody who works
in the food service industry who's interested in the health components.
It could be a friend that is working on their
health journey. If you want to hear more, please remember
to follow Culinary Medicine Recipe on your favorite podcast listening platform.
(37:40):
Until next time, Sandu and Bona Pettie. All content provided
or opinions expressed in this episode are for informational purposes
only and are not a substitute for professional medical advice.
Please take advice from your doctor or other qualified healthcare professional.
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