What does informed consent for GLP-1 medications actually require?

Informed consent for GLP-1 medications should include a full discussion of risks beyond the commonly cited nausea and vomiting, including gallbladder issues, ileus, and documented cases of suicidal ideation following use. It should also include the long-term data on weight regain. A two-year study on semaglutide found that 80 to 90 percent of participants regained the weight they lost, regardless of whether they remained on the medication.

A complete informed consent conversation would also address whether the prescription is for type 2 diabetes management or for intentional weight loss, since dosage and risk profile differ significantly between the two. Currently, screening for disordered eating history is not a mandatory step before a GLP-1 prescription is issued, despite the medication’s direct impact on appetite and the body’s relationship to food.

Dr. Michelle Tubman, an emergency physician who treats patients on GLP-1 medications, compares this gap to how informed consent works in oncology. Before chemotherapy, patients are walked through every potential side effect and the statistical likelihood of treatment success. GLP-1 prescribing conversations rarely include this same depth, in part because of widespread internalized weight stigma among both prescribers and patients.

Resources exist to help fill this gap. The Association of Students of Weight Inclusive Care has published an informed consent document on GLP-1 medications, written in accessible language for people without a medical or research background.

Transcript 

[00:00:01] Stephanie: Welcome to Is Beyond the Food Podcast. I’m your host, Stephanie Dosier, non diet nutritionist, and founder of the Non Diet Coaching Certification. This is beyond GLP one, the Expert series. I created the series of podcast episode because informed consent required the full picture, not just the press release.

[00:00:21] Stephanie: So over the next several episodes, I’m bringing in expert to cover every angle, science, marketing side effect, impact on body image, nutrition, health counseling, and what it all this means for you and your client. Whatever you are, health professional, navigating these conversation in your practice, or someone personally researching your decision, this series is for you.

[00:00:45] Stephanie: Ready? Let’s do this.

[00:00:50]

[00:00:50] Stephanie: Welcome to the podcast, Michelle.

[00:00:52] Michelle Tubman: Thank you so

[00:00:53] Stephanie: I’m

[00:00:53] Michelle Tubman: Super

[00:00:54] Stephanie: freaking

[00:00:54] Michelle Tubman: be here with you, Stephanie.

[00:00:56] Stephanie: happy you’re here. I’m excited to have you, and your [00:01:00] expertise as a medical practitioner. But let me ask you first. Introduce yourself so everybody know who you are and your expertise, and then we’ll get going on the conversation.

[00:01:08] Stephanie: My name is Michelle Marie

[00:01:09] Michelle Tubman: I’m Dr.

[00:01:10] Stephanie: and

[00:01:15] Michelle Tubman: in Canada, and I have

[00:01:17] Stephanie: I have

[00:01:18] Michelle Tubman: interest in

[00:01:20] Michelle Tubman: weight-inclusive medicine because of the

[00:01:22] Stephanie: and obesity because of the studies that I have done being not

[00:01:25] Stephanie: just a medical woman, but also a fat woman and an obese professional. But it’s not easy being

[00:01:26] Michelle Tubman: a

[00:01:27] Stephanie: big and the way that it manifests in our, society. so through nutrition

[00:01:37] Stephanie: through movement, through eating, through trust work, and through training the way she and the relationship I have

[00:01:43] Michelle Tubman: help

[00:01:43] Stephanie: with my body and my expectation of

[00:01:48] Michelle Tubman: extension, help other women

[00:01:49] Stephanie: women in particular and their relationship with theirs,

[00:01:54] Michelle Tubman: that

[00:01:54] Michelle Tubman: training that I

[00:01:55] Stephanie: I took and

[00:01:56] Michelle Tubman: that I’ve

[00:01:57] Stephanie: the access that I’ve had

[00:01:58] Michelle Tubman: has really

[00:01:59] Stephanie: [00:02:00] nutrition

[00:02:01] Michelle Tubman: I

[00:02:01] Stephanie: and healing expert in my practice since then. Hmm. And I have reached out to every niche of the world to teach other physicians and coaching other physicians

[00:02:10] Michelle Tubman: for other physicians

[00:02:11] Stephanie: on what it means to be in a weight neutral or weight inclusive position. Hmm. We need more of you.

[00:02:20] Michelle Tubman: Yes, we

[00:02:20] Stephanie: Yes, we do. Okay. We’re gonna start with the basic and then get into the deeper stuff. Does that make sense?

[00:02:28] Michelle Tubman: Yeah.

[00:02:29] Stephanie: So we’re on this series talking about GLP-1.

[00:02:33] Stephanie: So just so we go through the basic, what’s a GLP-1 and, uh, what does it do for the body, or what is it observed clinically to do for the body?

[00:02:47] Michelle Tubman: Mm-hmm.

[00:02:47] Stephanie: us through the basic?

[00:02:48] Michelle Tubman: Sure. So basically

[00:02:50] Michelle Tubman: GLP-1 medications are a group of medications that were actually developed a long time ago for the treatment of type 2 [00:03:00] diabetes What had happened is during studies examining this particular

[00:03:05] Michelle Tubman: use, they noticed that weight loss was a side effect of this drug. taking advantage of that

[00:03:12] Michelle Tubman: fact, they decided to study this drug

[00:03:15] Stephanie: My name is Michelle Marie Bird, and

[00:03:16] Michelle Tubman: to

[00:03:16] Stephanie: I have a master’s in weight loss and obesity because of the studies that I have done being

[00:03:21] Michelle Tubman: weight loss

[00:03:22] Stephanie: not just a medical woman, but also a fat woman and an obese professional. But it’s not easy being big and the way that it manifests in our society. So through nutrition, through movement, through eating, through trust work, and through training the way she and the relationship I have with my body and my expectation of other women in particular and their relationship with theirs, and that training I took and the access that I’ve had as a nutrition and healing expert in my practice since then.

[00:03:25] Stephanie: I have reached out to every niche of the world to teach other physicians and coaching other physicians on what it means to be in a weight neutral or weight inclusive position. And so now we have this duality, this two purpose for this drug. One is the very legitimate treatment of type two diabetes, but also as we’re all very well aware now, it seems to be the primary use now is for weight loss, and we see it everywhere. I was watching, you know, the Montreal Canadiens play a couple nights ago, and even in the NHL playoffs, we’ve got Ozempic advertisements on the, on the boards on, on the rink.

[00:03:56] Michelle Tubman: So that messaging is, is really, really everywhere. But [00:04:00] the original purpose of these drugs was to teach or to treat type two diabetes. And it does this through many different, um, mechanisms in terms of glucose metabolism. Um, but it also affects multiple different systems in the body, including in our brain and nervous system and in our digestive system, as well as in our metabolic system.

[00:04:25] Stephanie: And this is why we see kind of two group of people taking GLP. Now, be it when 2026, the biggest group is people taking it for intentional weight loss.

[00:04:39] Michelle Tubman: Mm-hmm.

[00:04:39] Stephanie: we have a smaller group that we’re taking and probably still taking GLP-1 long-term as any other medication like metformin. It’s just a medication.

[00:04:50] Stephanie: Is that correct?

[00:04:51] Michelle Tubman: That is correct, and what we’re also seeing now is s– looking at additional uses for GLP-1s, like treating [00:05:00] Alzheimer’s has

[00:05:00] Stephanie: Yeah.

[00:05:02] Michelle Tubman: um, kidney disease and, and other conditions as well.

[00:05:05] Stephanie: Okay. So in, from a practical standpoint, this is a question that I’ve had because I’m not a prescriber. Like I’m not someone who can prescribe, but my understanding is when you do take, we’ll take type two diabetes medication for that particular condition, which is one of the most prominent medical condition.

[00:05:26] Stephanie: When we, if we were to take GLP-1 for type two diabetes versus intentional weight loss, the dosage would be different. Is that accurate?

[00:05:36] Michelle Tubman: Yes, that is, that is correct. So the dosage for type two diabetes is much lower than what people are prescribing for weight loss.

[00:05:46] Stephanie: So to achieve the weight loss, that’s why in the beginning they were seeing benefit without necessarily losing weight because at a lower dose, it effectively reduced symptoms of type two diabetes [00:06:00] without inducing weight loss.

[00:06:02] Michelle Tubman: Well, it’s even at the type 2 diabetes doses, some people do still experience weight

[00:06:08] Stephanie: Okay.

[00:06:11] Michelle Tubman: see weight loss as a side effect at this lower dose, if we make the dose higher, people will make– will, will lose more weight. And of course, the higher the doses, the more money the pharmaceutical companies make as well.

[00:06:25] Stephanie: For sure, because they sell more of the said product that makes them the money.

[00:06:29] Michelle Tubman: Mm-hmm.

[00:06:30] Stephanie: So is it also true to say that the symptoms that people are talking about, right, that we talk about digestive issue, that we talk about constipation, even the loss of desire, these symptoms primarily started to be observed or are observed in higher dose that is used for intentional weight loss and not necessarily at the lower dose for medical purposes?

[00:06:57] Michelle Tubman: Correct. So people still can [00:07:00] experience these side effects at the lower dose as well, but if we increase the dose, of course, we experience more of the side effects as well.

[00:07:09] Stephanie: And so that is why we’re talking more and more or hearing more and more people not being able to stay on the GLP medication long-term, which is what needs to happen in order to maintain the weight loss benefit because of the symptoms that people are experiencing.

[00:07:27] Michelle Tubman: Yeah. So a few things to actually

[00:07:29] Stephanie: Go for it.

[00:07:30] Michelle Tubman: as an emergency doctor, I don’t actually prescribe GLP-1s. It’s not within my, my wheelhouse, but I certainly

[00:07:37] Stephanie: Yes.

[00:07:40] Michelle Tubman: the emergency department [00:08:00] And weight loss over

[00:08:03] Michelle Tubman: time. what

[00:08:30] Michelle Tubman: weight starts to come up regardless of whether you’re still on this, this medication or not. what I I find very interesting is one of the original studies that looked at Ozempic the diet medication, is also known as Wegovy.

[00:08:45] Michelle Tubman: followed

[00:08:45] Stephanie: people over two years.

[00:08:48] Stephanie: And what’s interesting is 90%, almost percent 80 to 90% of the people in that study gained their weight back by

[00:08:57] Stephanie: the

[00:08:57] Stephanie: end of the study.

[00:08:58] Michelle Tubman: this– the And that [00:09:00] was regardless of whether or not they were on the medication.

[00:09:06] Stephanie: And this might be interesting. This might be interesting. many people do drop out. And it assumes one things. One, of One, of course, is

[00:09:10] Stephanie: side effects.

[00:09:12] Stephanie: But two, perhaps people,

[00:09:15] Stephanie: but the

[00:09:15] Stephanie: second is that it just wasn’t working.

[00:09:18] Michelle Tubman: So

[00:09:18] Stephanie: So either they didn’t lose weight to begin with or they lost weight but by the time,

[00:09:23] Stephanie: that

[00:09:24] Michelle Tubman: about two-year

[00:09:25] Stephanie: two-year mark.

[00:09:25] Michelle Tubman: um, comes on, the

[00:09:26] Stephanie: along, weight starts,

[00:09:27] Michelle Tubman: coming back on again.

[00:09:29] Stephanie: come back

[00:09:29] Stephanie: again.

[00:09:29] Michelle Tubman: Um, and so

[00:09:30] Michelle Tubman: in so in studies, people are provided with these medications.

[00:09:35] Stephanie: But in real life, for them, and so it’s left to the individual. and so the financial piece might also be

[00:09:40] Stephanie: a part of the picture as well. What’s interesting is the word you use, people left or stopped taking the drug, left the study because they weren’t working, quote-unquote working, meaning they weren’t working for the purpose that they were taking it, which was purely intentional weight loss.

[00:09:59] Michelle Tubman: Correct. [00:10:00] And so this is just unheard of in scientific

[00:10:03] Stephanie: And you to have a when we talk about the evidence behind these medications, it’s important to keep in mind that the evidence is really centered around weight loss. Yeah. taking the so that’s important to keep in mind. It’s, an it’s an important. piece of information often talked about when we that’s part of what we talked about when we talk about the evidence around these medications.

[00:10:26] Stephanie: So I wanna come back on this piece, being that you are an emergency care physician. I never heard anyone say this before, that you’re starting to see almost at every shift patient coming in, in emergency care for symptoms that are due to GLP-1.

[00:10:43] Michelle Tubman: Correct.

[00:10:45] Stephanie: Can you give us some example?

[00:10:47] Michelle Tubman: sure, and I would say I’m seeing a little bit

[00:10:49] Michelle Tubman: less now

[00:10:50] Michelle Tubman: than I was a

[00:10:50] Michelle Tubman: year or two ago. Um, sure it. Um, one

[00:10:57] Michelle Tubman: see in

[00:10:57] Stephanie: side effect that we see [00:11:00] with these medications is vomiting. Really?

[00:11:02] Stephanie: And so weight, uh, weight, weight loss and vomiting is number one. Most People come in

[00:11:07] Stephanie: because those symptoms are severe enough that they’re just unable to keep any food down. But

[00:11:13] Stephanie: I am also

[00:11:13] Michelle Tubman: seen

[00:11:14] Stephanie: gallbladder issues.

[00:11:16] Michelle Tubman: also

[00:11:16] Stephanie: also seeing ileus, which is when, bowels really really stop moving,

[00:11:21] Michelle Tubman: in the

[00:11:22] Stephanie: in the belly.

[00:11:23] Michelle Tubman: and I and I have seen a couple cases of, um, suicidal

[00:11:27] Michelle Tubman: ideation that

[00:11:28] Stephanie: that started after Ozempic

[00:11:29] Stephanie: loss. as

[00:11:31] Michelle Tubman: well. And that’s gonna lead me into the next part of this interview, which is in the prescription world, we have something called informed consent, right?

[00:11:40] Michelle Tubman: Correct.

[00:11:41] Stephanie: So when those folks comes into an emergency room with symptoms, do they have an idea that it’s due to their GLP-1 medication, or they just are not connecting the two?

[00:11:54] Stephanie: And that’s probably due to informed consent or not being informed

[00:11:59] Michelle Tubman: Yeah.[00:12:00]

[00:12:00] Stephanie: in the side effect. When when it it comes to nausea issue you informed consent- it’s it’s complicated it when it comes to

[00:12:09] Stephanie: GLP-1s. And I say

[00:12:10] Michelle Tubman: that because we have this whole cultural piece where the, you know, the

[00:12:15] Michelle Tubman: predominant narrative in the school of living is that fat fat is bad, being fat is dangerous- Yeah … being fat is going to you, you. So we have to do everything we can

[00:12:26] Michelle Tubman: to

[00:12:26] Stephanie: to help you lose weight. And many people out there in the

[00:12:29] Michelle Tubman: out

[00:12:30] Stephanie: world do not question this.

[00:12:32] Michelle Tubman: They

[00:12:32] Stephanie: They just believe it’s true and listen to that.

[00:12:36] Stephanie: And of course, most of us live in our bodies

[00:12:38] Michelle Tubman: have to

[00:12:39] Stephanie: have to navigate through this, this this world of fat phobia.

[00:12:43] Stephanie: and course

[00:12:43] Michelle Tubman: we want to subjected to weight. stigma as well. And many

[00:12:50] Michelle Tubman: in

[00:12:51] Stephanie: physicians also buy into it and They don’t necessarily understand the the broader broader implications of prescribing these medications because they just [00:13:00] don’t think of it.

[00:13:01] Michelle Tubman: And

[00:13:01] Stephanie: And so

[00:13:02] Michelle Tubman: of

[00:13:02] Stephanie: of the issues that all of us who have concerns about the

[00:13:06] Michelle Tubman: this

[00:13:06] Stephanie: of this medication is actually talking to patients about relationship with with food. And if they have a disordered eating history Because one thing we know for

[00:13:16] Stephanie: can make the situation even worse

[00:13:26] Stephanie: and even if you are not eating because of

[00:13:28] Stephanie: how food triggers works.

[00:13:30] Stephanie: you. And so

[00:13:31] Stephanie: And so you

[00:13:31] Stephanie: you are,

[00:13:33] Michelle Tubman: for

[00:13:33] Stephanie: for example,

[00:13:34] Michelle Tubman: using

[00:13:34] Stephanie: using food as a primary mechanism to cope

[00:13:37] Michelle Tubman: with

[00:13:37] Stephanie: with challenges in life with difficult emotions, and you take a medication

[00:13:42] Stephanie: that takes

[00:13:42] Stephanie: your ability use use food that way away from you, from you, then you’re left with real real skills help

[00:13:50] Stephanie: help navigate these situations.

[00:13:52] Stephanie: Yeah. that you always use food to help you do. And we’re not always

[00:13:56] Stephanie: So you do have to be careful. And I would always want us to be aware that your [00:14:00] relationship with food

[00:14:00] Stephanie: shifts in this way because we’ve

[00:14:01] Michelle Tubman: it

[00:14:02] Stephanie: done it so long, and we do it without thinking. It only comes up eventually. And so

[00:14:08] Stephanie: that often

[00:14:08] Michelle Tubman: leads

[00:14:09] Stephanie: to

[00:14:10] Stephanie: the

[00:14:11] Stephanie: mental health conditions that we sometimes see emerging in people taking these medications.

[00:14:15] Stephanie: And there’s lots of other things we could talk about

[00:14:17] Michelle Tubman: an example of one of

[00:14:18] Michelle Tubman: the things we’re with patients who are prescribe this this medication.

[00:14:24] Michelle Tubman: You know,

[00:14:24] Michelle Tubman: and the the other thing that we often don’t talk about is that

[00:14:27] Stephanie: ninety percent

[00:14:28] Stephanie: drop-out statistic, right? And that

[00:14:31] Michelle Tubman: there is a

[00:14:31] Stephanie: there is a very good chance if you start this medication,

[00:14:34] Michelle Tubman: will

[00:14:35] Stephanie: will lose weight. But there’s an equally good

[00:14:37] Stephanie: chance that you

[00:14:38] Stephanie: will gain it back

[00:14:39] Michelle Tubman: over

[00:14:39] Stephanie: over time.

[00:14:40] Michelle Tubman: And

[00:14:41] Stephanie: And the other thing that many doctors don’t understand is

[00:14:45] Michelle Tubman: dangerous this

[00:14:47] Stephanie: this weight cycling can be. Dieting even if gained for health.

[00:14:52] Stephanie: so for

[00:14:54] Michelle Tubman: that

[00:14:54] Stephanie: health conditions associate with

[00:14:56] Stephanie: may, um, associate

[00:14:57] Michelle Tubman: um, a risk of a

[00:14:59] Michelle Tubman: [00:15:00] overweight,

[00:15:00] Stephanie: of weight, um, is is also

[00:15:01] Michelle Tubman: risk of this

[00:15:02] Stephanie: of this weight cycling. And so if we’re going to give

[00:15:05] Stephanie: patients medications to help them lose weight When after a few years’ I’m thinking about going to a few years down the road to one, two, three, or even five when they come

[00:15:15] Michelle Tubman: them in,

[00:15:16] Stephanie: in and ask if they should be

[00:15:17] Michelle Tubman: cycle.

[00:15:17] Stephanie: know, and then another thing that I think is important, and I

[00:15:22] Michelle Tubman: I think

[00:15:22] Stephanie: think many people think a lot about this a little bit, but whenever we lose weight intentionally,

[00:15:28] Stephanie: whether it’s through,

[00:15:30] Michelle Tubman: you know, diets or a or medication,

[00:15:33] Michelle Tubman: we lose more

[00:15:34] Stephanie: some of us lose mass we

[00:15:35] Stephanie: and we do lose

[00:15:36] Michelle Tubman: fat fat tissue in the body.

[00:15:38] Stephanie: body. And

[00:15:39] Stephanie: And when we start to regain weight afterwards,

[00:15:43] Michelle Tubman: don’t

[00:15:43] Stephanie: don’t necessarily gain muscle with mass back again.

[00:15:46] Stephanie: A lot of

[00:15:47] Stephanie: that weight back is more

[00:15:48] Michelle Tubman: of, of,

[00:15:49] Michelle Tubman: of,

[00:15:49] Stephanie: of fat tissue,

[00:15:50] Michelle Tubman: and

[00:15:51] Stephanie: and contribute to can

[00:15:52] Stephanie: contribute to

[00:15:53] Stephanie: worse fat health outcomes as well. And

[00:15:55] Michelle Tubman: there’s

[00:15:55] Michelle Tubman: a there’s a lot of

[00:15:57] Michelle Tubman: harm that that we do in the long term [00:16:00] with these– with prescribing these medications.

[00:16:03] Michelle Tubman: one

[00:16:04] Stephanie: And one thing I do base my medical practice on is,

[00:16:07] Michelle Tubman: know,

[00:16:07] Michelle Tubman: another another important piece of autonomy in which, you people people get to make their own about what what they want for their body. But the best of those decisions need to be made after truly informed, um, consent is,

[00:16:22] Michelle Tubman: is, is given,

[00:16:23] Michelle Tubman: which

[00:16:23] Stephanie: which means

[00:16:24] Stephanie: people need to

[00:16:25] Stephanie: be told

[00:16:25] Michelle Tubman: all of

[00:16:26] Stephanie: all of these potential issues

[00:16:27] Stephanie: with these drugs

[00:16:28] Stephanie: before

[00:16:29] Michelle Tubman: can can actually make

[00:16:30] Michelle Tubman: an a informed choice for themselves.

[00:16:33] Stephanie: So in the prescription process as a, as a prescriber, what you’re saying is people are– n- it’s not mandatory to screen people for eating disorder, for an example,

[00:16:44] Michelle Tubman: Correct.

[00:16:45] Stephanie: to prescription. Currently, the process does not require that.

[00:16:50] Michelle Tubman: Correct.

[00:16:51] Stephanie: That’s insane.

[00:16:53] Michelle Tubman: Well, it’s, it’s, it’s– look, look at it this way.

[00:16:55] Michelle Tubman: It’s It’s insane. And this way it’s-

[00:16:57] Stephanie: I get disordered eating because that’s not [00:17:00] screenable as effectively as an eating disorder, but- Sure.

[00:17:02] Stephanie: And think

[00:17:04] Stephanie: even in other things, for example,

[00:17:07] Stephanie: let’s say you’re diagnosed with cancer. Yep.

[00:17:09] Michelle Tubman: God forbid,

[00:17:10] Stephanie: with me.

[00:17:10] Michelle Tubman: you

[00:17:10] Stephanie: And you sit down with an oncologist who tells you all the different treatment options, and chemotherapy is one of them.

[00:17:17] Stephanie: Do they tell you about all the potential side effects?

[00:17:21] Michelle Tubman: and

[00:17:22] Stephanie: And they also tell you your likelihood of this cancer

[00:17:25] Michelle Tubman: this

[00:17:26] Stephanie: this,

[00:17:26] Michelle Tubman: know,

[00:17:26] Michelle Tubman: chemotherapy, chemotherapy,

[00:17:27] Michelle Tubman: treating your

[00:17:28] Stephanie: your cancer effectively,

[00:17:29] Stephanie: right?

[00:17:31] Michelle Tubman: of that

[00:17:31] Stephanie: And then and you

[00:17:33] Stephanie: get to take all of that information together and decide what’s what’s best for you and your body and

[00:17:36] Michelle Tubman: what’s in

[00:17:37] Stephanie: what’s in line with values, values,

[00:17:38] Michelle Tubman: right? But when

[00:17:39] Stephanie: But when we prescribe GLP-1s, we’re not having these conversations.

[00:17:44] Michelle Tubman: saying,

[00:17:45] Stephanie: saying, “Well, “Congratulations. I support your intentional weight loss effort,

[00:17:49] Michelle Tubman: Here’s your

[00:17:49] Stephanie: here’s your prescription.”

[00:17:50] Michelle Tubman: Right?

[00:17:51] Stephanie: A- and so as a prescriber yourself, why do you think the same informed cons- consent is not taught and [00:18:00] practiced as it is with chemotherapy, for an example? I think it’s the same as what I mentioned before

[00:18:07] Michelle Tubman: the start

[00:18:07] Michelle Tubman: of this

[00:18:08] Michelle Tubman: conversation,

[00:18:09] Stephanie: conversation about this water

[00:18:10] Stephanie: that’s helpful, less reminders of

[00:18:11] Michelle Tubman: that tells all of us, providers and patients alike, that, um, fat is bad.

[00:18:17] Stephanie: um, that is bad Hmm.

[00:18:20] Stephanie: Talking about internalized fat phobia both on the practitioner, provider, and the patient as well.

[00:18:28] Michelle Tubman: ri-right?

[00:18:29] Stephanie: Like I don’t think any water

[00:18:31] Stephanie: needs to be doctor as a solution is as

[00:18:35] Michelle Tubman: would

[00:18:36] Stephanie: picture of water is it would be

[00:18:36] Stephanie: easier to, you know,

[00:18:38] Michelle Tubman: navigate through this

[00:18:39] Stephanie: the mystery inside the body,

[00:18:41] Michelle Tubman: And

[00:18:41] Stephanie: and also we believe that our health may matter more this way, we’ll live longer maybe this way,

[00:18:48] Michelle Tubman: cetera. cetera.

[00:18:48] Stephanie: Because science actually shows the contrary. No.

[00:18:52] Michelle Tubman: but we believe, we believe all of

[00:18:54] Michelle Tubman: that. And, And, the other

[00:18:55] Stephanie: other thing that we need to recognize that we have this competing narrative all

[00:18:59] Stephanie: all of [00:19:00] these messages we’ve we’ve heard

[00:19:02] Michelle Tubman: our

[00:19:02] Stephanie: our childhood tells us that, we are not

[00:19:05] Michelle Tubman: enough

[00:19:06] Stephanie: enough unless we’re

[00:19:08] Michelle Tubman: thin. And

[00:19:09] Stephanie: thin. Yeah. If we’re not thin,

[00:19:10] Stephanie: then we at least better be doing something to get ourselves thin and then retain our thin and, and our youthful appearance. So n- so if we come back to the, the start where we were talking about incidents presenting in emergency care of people with side effects, Mm-hmm. now the landscape of people not being informed when they’re saying yes to the prescription, then it’s no surprise that people will come to emergency care with said symptoms and not associating it with their use of GLP-1.

[00:19:44] Stephanie: Anything

[00:19:47] Michelle Tubman: people often do

[00:19:48] Stephanie: from

[00:19:48] Michelle Tubman: that,

[00:19:49] Stephanie: two perspectives. Yeah.

[00:19:49] Stephanie: Like the questions,

[00:19:53] Michelle Tubman: health when it comes to mental health how are we they’ve heard it. to think through that? Wow. Okay. So, [00:20:00] and w- if, if I can come back on the conversation about inflammation, because I saw a study this week that came out on cardiovascular benefits of GLP-1 independent of weight. And that was, to me, mind-blowing that they would put the research out sh- demonstrating that the benefits were seen independent of weight loss.

[00:20:21] Stephanie: And the theory behind that is inflammation pathways being positively impacted by GLP-1. And, and then the, a- the reporter in the article was saying as far as like this is so revolutionary that we should potentially in the future, quote unquote, “Put it in the water and put everyone on GLP-1,”

[00:20:44] Michelle Tubman: Yeah. So

[00:20:45] Stephanie: of the benefit of inflammation.

[00:20:47] Stephanie: And to me, like, we’re now going in a very dangerous path. It was already dangerous, but this is, like, extreme.

[00:20:53] Michelle Tubman: And it’s more dangerous than you even think because the media will often misrepresent the data [00:21:00] because they

[00:21:01] Stephanie: they don’t understand

[00:21:03] Michelle Tubman: the

[00:21:03] Stephanie: the statistical properties- Yeah

[00:21:08] Michelle Tubman: on. And

[00:21:09] Stephanie: of what they’re commenting on. But they can sound very scientific

[00:21:12] Michelle Tubman: when

[00:21:12] Stephanie: when they do this.

[00:21:14] Michelle Tubman: And

[00:21:14] Stephanie: And so this is not the first study of its kind that’s been done.

[00:21:18] Michelle Tubman: and I

[00:21:19] Stephanie: I haven’t read the study that about talking about specifically, but certainly that have been done, been done,

[00:21:24] Michelle Tubman: um, recently,

[00:21:26] Stephanie: yes,

[00:21:26] Michelle Tubman: of

[00:21:26] Stephanie: some studies are showing a benefit in terms of cardiovascular benefit, but

[00:21:32] Stephanie: but no more so

[00:21:33] Stephanie: than the other medications

[00:21:35] Michelle Tubman: already

[00:21:36] Stephanie: use for these purposes.

[00:21:38] Stephanie: Ah. You

[00:21:40] Stephanie: And I would say When you’re reading,

[00:21:43] Michelle Tubman: in the the media, um, you, you, you know, you

[00:21:46] Stephanie: you

[00:21:46] Michelle Tubman: ask

[00:21:47] Stephanie: ask first like, what what doses are they using?”

[00:21:49] Michelle Tubman: Because if they’re

[00:21:50] Stephanie: if they’re using diabetes dose, that’s a very different message than if they’re using weight loss

[00:21:55] Stephanie: dose. High, high doses.

[00:21:56] Michelle Tubman: right? And you also wanna look at [00:22:00] role Yeah.

[00:22:00] Michelle Tubman: of Because um, the weight loss dose in

[00:22:02] Stephanie: some, some– in this particular study, it said the other benefit of the weight loss.

[00:22:06] Stephanie: Other studies will say,

[00:22:07] Michelle Tubman: um, it’s

[00:22:08] Stephanie: it’s because it

[00:22:09] Michelle Tubman: of

[00:22:10] Michelle Tubman: the weight loss. So was studied under that. different conditions. you just want to look at who are the researchers. who is funding the

[00:22:18] Stephanie: at the study.

[00:22:19] Stephanie: I think the vast of them of them are coming from obesity

[00:22:23] Stephanie: history, and they’ve designed their studies to send out

[00:22:27] Michelle Tubman: this, this

[00:22:28] Stephanie: this specific, this specific message.

[00:22:31] Michelle Tubman: And then

[00:22:31] Stephanie: And then you also need to look again at,

[00:22:34] Michelle Tubman: h-

[00:22:34] Stephanie: um, what are the other medications or

[00:22:36] Michelle Tubman: lifestyle

[00:22:38] Stephanie: interventions

[00:22:38] Stephanie: we are using to improve cardiovascular health whatever

[00:22:43] Michelle Tubman: condition you’re

[00:22:44] Stephanie: we’re studying and are the GLP-1 medications doing it better?

[00:22:48] Michelle Tubman: than what

[00:22:48] Stephanie: than what already we’ve already been given of the alongside of what’s being, like the overall purpose of these GLP-1s or, that or what are present?

[00:22:58] Stephanie: you. So if we’re [00:23:00] back to informed consent again, are the prescriber understanding of all these variation and the result of the research to be able to effectively give an informed consent to a patient? ‘Cause this… Yeah, yeah.

[00:23:20] Michelle Tubman: No. No. the headline.

[00:23:24] Michelle Tubman: same way you are re-

[00:23:26] Michelle Tubman: reading The thing in the headlines, but trust trust me, there’s no doctor out who there who has the time

[00:23:30] Michelle Tubman: keep up

[00:23:31] Stephanie: keep up with all the studies that are published every week. And so, you know, we are actively

[00:23:42] Michelle Tubman: working in this

[00:23:43] Stephanie: in this particular field We read the results of the research

[00:23:46] Michelle Tubman: more than

[00:23:47] Stephanie: much more

[00:23:48] Stephanie: than the

[00:23:48] Stephanie: average

[00:23:48] Michelle Tubman: practitioner out there would for sure.

[00:23:51] Stephanie: Yeah, the family physician that we go see all the time to get counsel on those particular medication.

[00:23:58] Michelle Tubman: Mm-hmm.[00:24:00]

[00:24:00] Stephanie: Is there a difference? I know we’re both Canadian, so for people listening to that, at the beginning she mentioned the hockey game and having the medication on the, in the hockey rink. That’s abnormal for us as Canadian to have medication or pharmaceutical advertisement out in the world. It’s very different than the United States.

[00:24:23] Stephanie: Do you see a difference in the usage, prescription, the environment of GLP-1 in Canada versus what your colleague in the States are living through and people are living through? I don’t. I can’t call it a living through. And because when

[00:24:41] Stephanie: I go,

[00:24:42] Stephanie: when I

[00:24:42] Stephanie: said …

[00:24:42] Michelle Tubman: know

[00:24:42] Stephanie: watch much TV, but I said … never see anything. Like it’s, it’s,

[00:24:58] Stephanie: I don’t know.

[00:24:58] Michelle Tubman: advertising of [00:25:00] these medications have

[00:25:01] Michelle Tubman: infiltrated everyday life.

[00:25:04] Stephanie: yeah, I think it’s

[00:25:04] Stephanie: Yeah, and we did an interview for people listening to the podcast with Louise Adam, who published a, a paper on that, so I won’t extend myself on that. In, in Canadian medicine, are we prescribing GLP-1 as… Uh, I wanna be careful using, using the word loosely, as what perhaps is being seen in the United States, so there is more rigorous guidelines around it?

[00:25:32] Stephanie: There are. guidelines from Health Canada. I think the difference

[00:25:39] Michelle Tubman: is

[00:25:39] Stephanie: it’s

[00:25:40] Michelle Tubman: gets

[00:25:40] Stephanie: not reaching. Like,

[00:25:42] Michelle Tubman: probably

[00:25:42] Stephanie: the

[00:25:43] Stephanie: diversity of the country, the prescribing practices and

[00:25:50] Michelle Tubman: motivations behind prescribing them

[00:25:52] Stephanie: information that the prescribing community is seeing. Okay. So given that we live in Canada under a national healthcare system, [00:26:00] which most people are used to their medication being covered, what does it look like from a prescription perspective in a practice?

[00:26:09] Stephanie: Do people prescribe it for intentional weight loss in Canada?

[00:26:12] Michelle Tubman: Oh my gosh, of course, yes. Oh,

[00:26:15] Stephanie: There’s no guideline around that more than the United States.

[00:26:19] Michelle Tubman: So There

[00:26:20] Michelle Tubman: um, there

[00:26:20] Michelle Tubman: are guidelines from, you know, Obesity Canada, and there

[00:26:24] Stephanie: there are guidelines from, Health Canada. Yes. They’re very much mirroring what the- Oh, my understanding was that particularly in Quebec, where I’m from, that the prescription of GLP-1 globally could not just be for pure intentional weight loss. There needed to be a case of what they call pre-obesity, like an attached chronic condition to it.

[00:26:51] Michelle Tubman: yes. So when– these guidelines will say that they are indicated for treatment if you have a certain BMI and [00:27:00] if you have one or more associated conditions with it, right? But that doesn’t mean that’s the only time you can prescribe these medications, And so are, people are prescribing it for people who do not necessarily meet that definition.

[00:27:19] Stephanie: These guidelines.

[00:27:20] Michelle Tubman: seeing it all the time. Absolutely.

[00:27:22] Stephanie: Yeah, for just what I call aesthetic intentional weight loss that’s not related to any health condition, just purely reducing the weight on the body.

[00:27:33] Michelle Tubman: Correct. Yes.

[00:27:35] Stephanie: So if there is a provider that’s listening to this, what should they do to get informed consent, I guess education to help their patients?

[00:27:49] Michelle Tubman: Well, yes.

[00:27:49] Stephanie: They need

[00:27:52] Michelle Tubman: that

[00:27:52] Stephanie: to understand that

[00:27:53] Michelle Tubman: there absolutely are

[00:27:54] Stephanie: are a lot more risks to taking these medications in the long term and the short term as [00:28:00] well,

[00:28:00] Michelle Tubman: much

[00:28:00] Stephanie: beyond

[00:28:01] Michelle Tubman: nausea,

[00:28:02] Michelle Tubman: vomiting, and like

[00:28:04] Stephanie: and like gallbladder issues, right?

[00:28:05] Michelle Tubman: They go

[00:28:06] Stephanie: They go much beyond that.

[00:28:07] Michelle Tubman: to

[00:28:07] Stephanie: They need to actually take the time to have these discussions

[00:28:11] Stephanie: with your patients. I

[00:28:13] Michelle Tubman: I had my way, we

[00:28:14] Stephanie: if I have somebody who

[00:28:15] Stephanie: would be prescribing this for intentional

[00:28:16] Michelle Tubman: weight

[00:28:17] Stephanie: weight

[00:28:17] Michelle Tubman: at

[00:28:18] Stephanie: loss, um,

[00:28:19] Michelle Tubman: to,

[00:28:20] Stephanie: there would I still respect this as something they said that they wanted to

[00:28:26] Michelle Tubman: make the decision. But

[00:28:27] Michelle Tubman: making that

[00:28:28] Stephanie: do, um, make a decision. But making that decision means considering

[00:28:31] Stephanie: all of these

[00:28:32] Stephanie: things

[00:28:32] Michelle Tubman: also

[00:28:33] Stephanie: and also really understanding

[00:28:34] Michelle Tubman: why loss is

[00:28:36] Stephanie: loss is

[00:28:37] Michelle Tubman: them

[00:28:37] Stephanie: important to them

[00:28:38] Michelle Tubman: in the

[00:28:38] Stephanie: in the first place and looking at those things

[00:28:42] Stephanie: because Some of those things may not actually change. Yeah.

[00:28:45] Michelle Tubman: Yeah.

[00:28:46] Stephanie: A-and from a patient perspective, what– where should we get information to make our own informed consent?

[00:28:56] Michelle Tubman: So

[00:28:56] Stephanie: So this is where it’s so challenging. Yeah.

[00:28:59] Michelle Tubman: [00:29:00] so

[00:29:00] Stephanie: So much money has been spent

[00:29:02] Michelle Tubman: make

[00:29:02] Stephanie: to make sure that we understand that this is what we need to do

[00:29:05] Michelle Tubman: for this

[00:29:06] Stephanie: for this horrible obesity epidemic that apparently exists

[00:29:10] Michelle Tubman: in,

[00:29:10] Stephanie: in North America.

[00:29:12] Michelle Tubman: And so to

[00:29:13] Stephanie: so to try and find

[00:29:14] Michelle Tubman: Actual study

[00:29:16] Stephanie: study data

[00:29:16] Michelle Tubman: to

[00:29:17] Stephanie: and to understand what that means is really difficult.

[00:29:21] Stephanie: And in fact, for people like me or other people who do research in this area,

[00:29:25] Michelle Tubman: try and

[00:29:25] Stephanie: try and talk

[00:29:26] Michelle Tubman: it,

[00:29:27] Stephanie: it and-

[00:29:27] Michelle Tubman: know, we’re,

[00:29:28] Stephanie: Right.

[00:29:29] Michelle Tubman: either

[00:29:29] Stephanie: let’s

[00:29:30] Stephanie: also like criticize, you

[00:29:31] Michelle Tubman: we’re

[00:29:31] Stephanie: weight-complete or amazing people who want to be on these medications.

[00:29:38] Michelle Tubman: not where

[00:29:38] Stephanie: not where this is coming from at all.

[00:29:40] Michelle Tubman: I’ve

[00:29:40] Stephanie: as I said, I support people if they’re making

[00:29:42] Michelle Tubman: informed

[00:29:43] Stephanie: choice.

[00:29:44] Stephanie: It’s just

[00:29:44] Michelle Tubman: not

[00:29:45] Stephanie: they’re not informed. And so to answer your question, it’s coming to people like you

[00:29:49] Michelle Tubman: and

[00:29:50] Stephanie: and me

[00:29:50] Michelle Tubman: and, you know,

[00:29:51] Michelle Tubman: Reagan

[00:29:51] Stephanie: Regan Chastain is an excellent… She’s on Front Stab if you like her. She is excellent at very neutrally describing

[00:29:59] Michelle Tubman: the

[00:29:59] Stephanie: [00:30:00] studies that are happening in this area.

[00:30:02] Michelle Tubman: so there

[00:30:02] Stephanie: So there are places in, you know, social media

[00:30:06] Michelle Tubman: online

[00:30:06] Michelle Tubman: who are, you know, providing this

[00:30:09] Stephanie: this information.

[00:30:09] Stephanie: You just have to–

[00:30:10] Michelle Tubman: you just have

[00:30:11] Stephanie: you just have to know know where to look because

[00:30:13] Michelle Tubman: to your

[00:30:13] Stephanie: if you go to your doctor and Regan Chastain,

[00:30:15] Stephanie: you’re probably not gonna

[00:30:16] Stephanie: get

[00:30:17] Michelle Tubman: the

[00:30:17] Stephanie: the answers that you need. Yeah, because they probably are not looking beyond their own internalized fear of fatness. In prescribing medication, there’s a principle that I remember studying, which was the, the decision stan- point was the risk versus the benefit, how much benefit were we gonna get versus the risk. When prescriber have their own internalized fear of fatness, is the bias to determining that risk factor ratio is much more likely that people will be prescribed GLP-1 for excess weight than being guided to other resources.

[00:30:59] Michelle Tubman: One hundred [00:31:00] percent. And so physicians prescribe these medications, they, truly believe they’re helping patients, right? They believe if they lose weight, they’re going to be healthier. They believe they’re gonna have less joint pain, right? And so they actually believe that they’re helping the patient. like, how many times have you given a prescription for an antibiotic, you know, for something, and were you actually given the risks and benefits before that?

[00:31:28] Michelle Tubman: No, because people just… You don’t question. If you have a bacterial infection, you need an antibiotic. People don’t question, you’re fat, you need a weight loss medication, right? It’s, it’s unfortunate, but it’s the way that it is.

[00:31:42] Stephanie: Well, the risk-benefit ratio in taking anti-antibiotic, I remember last time I’ve taken it, I had diarrhea. But the benefit of the antibiotic was far greater than the two or three days of digestive issue.

[00:31:56] Michelle Tubman: Correct. Right. The, but the, the point being, were you given the [00:32:00] choice to make that decision?

[00:32:01] Stephanie: No.

[00:32:02] Michelle Tubman: just took the antibiotic,

[00:32:04] Stephanie: Yeah.

[00:32:04] Michelle Tubman: right? Yeah.

[00:32:06] Stephanie: Which comes back to the same thing with the GLP-1.

[00:32:09] Michelle Tubman: Correct. It’s just the… In,

[00:32:11] Stephanie: When we look at the balance

[00:32:15] Michelle Tubman: on the side of harm,

[00:32:17] Stephanie: Yeah.

[00:32:18] Michelle Tubman: long term anyway.

[00:32:20] Stephanie: One of the driving factor of many people deciding to take the medication is prevention or prevention for the fear of getting health condition like heart disease and diabetes. And when I meet people in coaching, right, not necessarily to decide, most people I work with have decided not to take the GLP-1 and they’re doing the work to come at peace with their relationship to food or body.

[00:32:50] Stephanie: But one of the thing that keeps creating a lot of anxiety with them in their decision process is the fear of getting sick and ultimately [00:33:00] the fear of dying.

[00:33:01] Michelle Tubman: Of

[00:33:02] Stephanie: Like they’re… Right?

[00:33:03] Michelle Tubman: Yeah.

[00:33:04] Stephanie: The fear of death, we’ll call it the fear of death for the intent and purpose of this conversation, is driving a lot of people to believe that their fatness is the cause of what potentially could be causing their deaths, and that, and it comes back to that fear of dying.

[00:33:21] Stephanie: And I know that’s what, partly what you do, right? You are an end-of-life provider.

[00:33:26] Michelle Tubman: Yep.

[00:33:27] Stephanie: What are your thoughts on that?

[00:33:28] Michelle Tubman: So I’ve– I think this is such a

[00:33:30] Stephanie: Meaningful

[00:33:35] Stephanie: question, and

[00:33:37] Michelle Tubman: subjects

[00:33:38] Stephanie: I will say here’s why we’re talking about taboos subjects.

[00:33:41] Michelle Tubman: live in a

[00:33:42] Stephanie: Yeah. We, We are aware of what We need to talk about now,

[00:33:46] Michelle Tubman: right? I

[00:33:46] Stephanie: right? I mean,

[00:33:47] Michelle Tubman: push

[00:33:47] Michelle Tubman: it a- we push it,

[00:33:48] Stephanie: push it to the side and we don’t talk about it.

[00:33:53] Stephanie: We don’t we

[00:33:54] Michelle Tubman: to

[00:33:55] Stephanie: don’t

[00:33:55] Michelle Tubman: And

[00:33:56] Stephanie: we have that fear of death is [00:34:00] terrifying when

[00:34:03] Michelle Tubman: it is

[00:34:03] Stephanie: it

[00:34:03] Michelle Tubman: a taboo

[00:34:04] Stephanie: becomes a

[00:34:07] Michelle Tubman: are

[00:34:07] Stephanie: taboo subject. And bodies are actually so taboo

[00:34:11] Stephanie: subject. that

[00:34:11] Michelle Tubman: standards that we’re

[00:34:13] Stephanie: that we’re supposed to meet,

[00:34:15] Michelle Tubman: at least we

[00:34:15] Michelle Tubman: will

[00:34:16] Stephanie: and implicitly by the messages we receive when we go,

[00:34:20] Michelle Tubman: know,

[00:34:20] Michelle Tubman: scroll

[00:34:21] Stephanie: through,

[00:34:21] Michelle Tubman: Instagram and

[00:34:22] Stephanie: and see

[00:34:23] Michelle Tubman: these beautiful, you know,

[00:34:24] Stephanie: all these

[00:34:25] Michelle Tubman: right?

[00:34:26] Stephanie: beautiful people and

[00:34:32] Michelle Tubman: about

[00:34:33] Stephanie: what they’re, what they write When we scroll through Facebook and we see ads for what the perfect version is talking about our needs to- And she was really struggling with this at work.

[00:34:48] Michelle Tubman: never

[00:34:49] Stephanie: And she would say at work that her life seemed to slip away. Right?

[00:34:53] Michelle Tubman: right?

[00:34:53] Michelle Tubman: It’s like there’s

[00:34:54] Stephanie: that’s

[00:34:55] Stephanie: a really scary thing. And I think about putting [00:35:00] somebody in that body of

[00:35:04] Michelle Tubman: carry

[00:35:05] Stephanie: an air with a breathing tube over

[00:35:06] Michelle Tubman: to some, to

[00:35:07] Stephanie: of their nostrils, they’re making shape? to save somebody’s life. so if you combine that with this,

[00:35:10] Michelle Tubman: with

[00:35:11] Stephanie: with this

[00:35:11] Stephanie: fear of death and it’s,

[00:35:13] Stephanie: overwhelming,

[00:35:14] Michelle Tubman: almost

[00:35:14] Stephanie: it’s a paralyzing

[00:35:16] Michelle Tubman: place to

[00:35:16] Stephanie: to be.

[00:35:17] Michelle Tubman: And I

[00:35:19] Stephanie: I think what ends up happening is

[00:35:21] Michelle Tubman: is so

[00:35:22] Stephanie: is so much easier

[00:35:24] Stephanie: to put all of

[00:35:26] Stephanie: that weight because our brains

[00:35:28] Michelle Tubman: we

[00:35:28] Stephanie: hate

[00:35:28] Stephanie: waiting. I can do something, now. I can push that button

[00:35:33] Michelle Tubman: or

[00:35:34] Stephanie: or I can, I

[00:35:34] Michelle Tubman: I

[00:35:35] Michelle Tubman: can,

[00:35:35] Stephanie: I can at

[00:35:35] Michelle Tubman: can at

[00:35:36] Stephanie: least do something and feel

[00:35:37] Michelle Tubman: like I’m, I’m in control

[00:35:39] Stephanie: good. But when you’re swimming in the sea of human life

[00:35:43] Michelle Tubman: um, everything’s

[00:35:45] Michelle Tubman: out of control.

[00:35:46] Michelle Tubman: You know what I mean?

[00:35:49] Stephanie: you see everything else that

[00:35:50] Stephanie: could go wrong. Yeah. That’s such a, that’s such an interesting perspective because that’s what it is about, is wanting to control, right?

[00:35:56] Stephanie: We’re wanting to control death. We’re wanting to control body because we’re [00:36:00] afraid. And when fear shows up, our kind of gut instinct is trying to get control. Right?

[00:36:07] Michelle Tubman: Yeah.

[00:36:07] Stephanie: Like

[00:36:08] Michelle Tubman: y- y- you know, here’s, h- here,

[00:36:09] Stephanie: I will

[00:36:10] Michelle Tubman: here’s the truth of it. Our bodies are not nearly as malleable as we think

[00:36:15] Stephanie: still breathe and I will still have

[00:36:19] Stephanie: shit legs,

[00:36:19] Stephanie: right? Like I feel like so

[00:36:21] Michelle Tubman: and I am still gonna

[00:36:22] Stephanie: there’s so much of your body

[00:36:24] Michelle Tubman: Like, I’m

[00:36:24] Stephanie: that you just can’t really change and, and

[00:36:30] Michelle Tubman: your

[00:36:30] Stephanie: your body’s not in shape

[00:36:32] Michelle Tubman: is

[00:36:32] Stephanie: and more than that, we can’t really

[00:36:35] Michelle Tubman: change

[00:36:36] Stephanie: that

[00:36:36] Michelle Tubman: much,

[00:36:37] Stephanie: And I don’t think we should be. I think we should be embracing the

[00:36:41] Michelle Tubman: that we

[00:36:42] Stephanie: that

[00:36:42] Stephanie: we have, and

[00:36:43] Stephanie: that,

[00:36:43] Michelle Tubman: that’s a

[00:36:43] Stephanie: that position.

[00:36:44] Stephanie: But

[00:36:45] Michelle Tubman: But the other,

[00:36:45] Stephanie: the other thing about this is I have worked as an emergency physician- Oh, yes …

[00:36:52] Michelle Tubman: when it’s your time,

[00:36:54] Stephanie: for

[00:36:55] Michelle Tubman: I’m

[00:36:55] Stephanie: a

[00:36:55] Michelle Tubman: I’m not even

[00:36:56] Stephanie: long [00:37:00] time. And I will never forget. the patients who came after a certain injury just like, getting stitches

[00:37:09] Michelle Tubman: and

[00:37:10] Stephanie: and as only

[00:37:11] Michelle Tubman: went

[00:37:11] Stephanie: one month, right? A child a week

[00:37:13] Stephanie: later,

[00:37:14] Michelle Tubman: that guy had

[00:37:14] Stephanie: guy had come into the emergency department.

[00:37:17] Stephanie: Two days later,

[00:37:18] Michelle Tubman: after,

[00:37:18] Stephanie: in

[00:37:19] Stephanie: that same spot,

[00:37:20] Michelle Tubman: fell

[00:37:21] Stephanie: fell

[00:37:21] Michelle Tubman: and

[00:37:21] Stephanie: and hit his head and died. And like,

[00:37:23] Stephanie: that

[00:37:24] Michelle Tubman: that story sticks with me because

[00:37:27] Stephanie: sticks with me because as a

[00:37:31] Michelle Tubman: is.

[00:37:32] Stephanie: doctor and as, and

[00:37:34] Michelle Tubman: makes me

[00:37:35] Stephanie: me so

[00:37:36] Michelle Tubman: angry, I’m,

[00:37:38] Stephanie: like

[00:37:38] Michelle Tubman: of

[00:37:39] Stephanie: rage,

[00:37:40] Michelle Tubman: angry,

[00:37:41] Stephanie: angry,

[00:37:41] Michelle Tubman: when

[00:37:42] Stephanie: people are,

[00:37:44] Stephanie: and women in particular are living small and hiding

[00:37:49] Michelle Tubman: own lives

[00:37:50] Stephanie: because

[00:37:51] Michelle Tubman: way they

[00:37:52] Stephanie: they don’t like the way they look or they don’t want to

[00:37:55] Michelle Tubman: whatever.

[00:37:55] Michelle Tubman: They just

[00:37:56] Stephanie: They just have these self-imposed glass ceilings

[00:37:59] Michelle Tubman: [00:38:00] knowing that

[00:38:00] Stephanie: that life is short

[00:38:02] Michelle Tubman: it can

[00:38:02] Stephanie: it can

[00:38:03] Stephanie: end, you know, at, at, at any time.

[00:38:05] Michelle Tubman: And

[00:38:05] Stephanie: And it literally, it makes me so angry and

[00:38:07] Michelle Tubman: it

[00:38:08] Stephanie: it breaks my heart to see

[00:38:10] Michelle Tubman: women living

[00:38:11] Stephanie: living small

[00:38:12] Michelle Tubman: hiding because

[00:38:13] Stephanie: of

[00:38:14] Michelle Tubman: this

[00:38:14] Stephanie: this relationship that they have with their body

[00:38:16] Michelle Tubman: it’s

[00:38:16] Stephanie: that’s devastating to me.

[00:38:19] Stephanie: So when we think about the fear of death and its role in kind of skewing people on the medication like GLP-1, would part of the solution be approaching our own fear of death? I know for me, and I was telling you off recording session, that the reason why I’m able to approach this subject so fluently is because I’ve done my own work of, like, thinking about my death and coming to peace with it spiritually, and that I think it’s part of the reason why I’m so comfortable in my body today.

[00:38:53] Stephanie: Like, I’m not afraid of death.

[00:38:55] Michelle Tubman: Uh, Yes, I, I

[00:38:57] Michelle Tubman: agree. And certainly

[00:38:59] Stephanie: [00:39:00] agree.

[00:39:02] Michelle Tubman: has

[00:39:03] Stephanie: And I

[00:39:06] Michelle Tubman: death and how I

[00:39:07] Stephanie: think the best assistance that I can provide is that once I changed how I viewed death and I stopped dead in its… I

[00:39:15] Stephanie: had to

[00:39:16] Stephanie: mourn my dead self. Once I claimed that-

[00:39:16] Stephanie: Yeah …once I decided I was no longer afraid of death, everything changed

[00:39:20] Stephanie: for me,

[00:39:21] Michelle Tubman: including how I

[00:39:22] Stephanie: how I relate to my body and

[00:39:24] Michelle Tubman: priorities in

[00:39:25] Stephanie: in terms of the behaviors I want to engage in to support

[00:39:32] Michelle Tubman: my

[00:39:32] Stephanie: my health and what that means.

[00:39:34] Stephanie: And so

[00:39:35] Michelle Tubman: I

[00:39:35] Stephanie: I am no longer willing to restrict.

[00:39:38] Michelle Tubman: I

[00:39:38] Stephanie: I am

[00:39:39] Michelle Tubman: to

[00:39:40] Stephanie: no longer to

[00:39:40] Stephanie: engage in

[00:39:41] Stephanie: exercise that I hate because it makes me hurt. I lift weights with a trainer, and I love it.

[00:39:47] Michelle Tubman: but you know what I

[00:39:48] Stephanie: I hate

[00:39:48] Michelle Tubman: running. I’m

[00:39:49] Stephanie: I’m not a runner. I do not want

[00:39:54] Michelle Tubman: every second of

[00:39:55] Stephanie: to run. I do not want to hate every single run and every single minute of it. And, um- Heart health, [00:40:00] yeah

[00:40:01] Michelle Tubman: is,

[00:40:02] Stephanie: I want to be

[00:40:05] Michelle Tubman: to be healthy. because I

[00:40:07] Stephanie: in this. I feel I want to be

[00:40:09] Michelle Tubman: live fully

[00:40:10] Stephanie: fully each day,

[00:40:11] Michelle Tubman: day,

[00:40:11] Stephanie: day to day.

[00:40:12] Michelle Tubman: But what,

[00:40:13] Michelle Tubman: What,

[00:40:13] Stephanie: what that means for me, how I define healthy is so different than before

[00:40:19] Michelle Tubman: when

[00:40:19] Stephanie: when

[00:40:19] Michelle Tubman: afraid of my own mortality and that my fat was gonna be the thing that killed me.

[00:40:26] Stephanie: Yeah. Can we talk a little bit? Because very few people are, are wanting or able or willing to have this conversation. So both of us, if you’re not seeing the video, both of us live in fat body, and both of us now realize that we’ve done our own peace with that. And as a ch- when you say changed everything, it’s changed everything in the context particularly of your relationship to your body and how you behave around it.

[00:40:50] Stephanie: Is that what I’m hearing you say?

[00:40:52] Michelle Tubman: Absolutely. And

[00:40:53] Stephanie: And so I came to this place of deciding that my body [00:41:00] is my one true partner.

[00:41:02] Michelle Tubman: for the

[00:41:02] Michelle Tubman: rest of my life, that

[00:41:04] Stephanie: That I could have a great husband. I could have great family, but, you

[00:41:08] Michelle Tubman: that

[00:41:08] Michelle Tubman: could

[00:41:08] Stephanie: that could change.

[00:41:10] Michelle Tubman: I’m

[00:41:10] Stephanie: But I’m gonna have my body It’s the only certainty that I got, and I wanna treat it well.

[00:41:16] Michelle Tubman: And when I

[00:41:17] Stephanie: when I say treat it well, I mean

[00:41:19] Stephanie: respect

[00:41:20] Michelle Tubman: And

[00:41:20] Stephanie: it.

[00:41:20] Stephanie: And so it’s okay that I have good

[00:41:22] Michelle Tubman: sometimes Hell

[00:41:23] Stephanie: I have, bad days.

[00:41:23] Michelle Tubman: ’cause sometimes

[00:41:25] Stephanie: my body

[00:41:26] Michelle Tubman: my

[00:41:26] Stephanie: is my heart and my spirit. And your soul. And I think that

[00:41:35] Stephanie: that

[00:41:36] Stephanie: is an understanding that I

[00:41:39] Stephanie: wouldn’t

[00:41:39] Michelle Tubman: body

[00:41:40] Stephanie: have had then. Um, but there are some days my body’s saying, “Michelle, you’re exhausted. Rest,” and I

[00:41:43] Stephanie: hear that I

[00:41:44] Michelle Tubman: you’re exhausted.

[00:41:46] Michelle Tubman: Rest.” and then I honor that as

[00:41:48] Stephanie: I walk

[00:41:48] Stephanie: right?

[00:41:48] Stephanie: And so I

[00:41:49] Michelle Tubman: And so some of the things that

[00:41:51] Stephanie: that the change is I’ve gotten

[00:41:53] Michelle Tubman: hours

[00:41:53] Stephanie: to that place where I don’t

[00:41:55] Michelle Tubman: I don’t burn the candles

[00:41:56] Stephanie: try to jam myself into a smaller size anymore. I carve out [00:42:00] time to,

[00:42:01] Michelle Tubman: spend time

[00:42:02] Stephanie: time in nature, to

[00:42:04] Michelle Tubman: prepare,

[00:42:04] Stephanie: actually prepare,

[00:42:07] Stephanie: a meal rather

[00:42:08] Stephanie: than just relying on

[00:42:08] Stephanie: takeout all the time.

[00:42:09] Michelle Tubman: all the time,

[00:42:10] Stephanie: and

[00:42:11] Michelle Tubman: I

[00:42:11] Stephanie: I just feel better

[00:42:13] Michelle Tubman: having a

[00:42:13] Stephanie: a slightly slower pace of life.

[00:42:16] Stephanie: And,

[00:42:16] Michelle Tubman: know, that’s

[00:42:17] Stephanie: that’s what this means to me.

[00:42:18] Michelle Tubman: And I

[00:42:19] Stephanie: I don’t care about my weight.

[00:42:23] Michelle Tubman: It’s

[00:42:23] Stephanie: It’s like I, I just

[00:42:24] Michelle Tubman: don’t, and it

[00:42:25] Stephanie: And it took me a long time,

[00:42:27] Michelle Tubman: um, to

[00:42:27] Stephanie: get to

[00:42:27] Michelle Tubman: to this

[00:42:28] Stephanie: this point. And,

[00:42:29] Michelle Tubman: you know, I won’t

[00:42:29] Stephanie: won’t lie

[00:42:30] Michelle Tubman: sometimes I’ll

[00:42:31] Stephanie: I’ll be

[00:42:31] Michelle Tubman: shopping and I’ll

[00:42:32] Stephanie: and

[00:42:32] Michelle Tubman: at an

[00:42:33] Michelle Tubman: outfit

[00:42:33] Michelle Tubman: and

[00:42:33] Stephanie: at

[00:42:33] Michelle Tubman: wish

[00:42:34] Stephanie: my body

[00:42:35] Stephanie: would fit into this outfit or, um,

[00:42:37] Michelle Tubman: you know,

[00:42:38] Stephanie: sometimes I– you know, I was just

[00:42:40] Michelle Tubman: on a

[00:42:40] Stephanie: at a plane

[00:42:41] Michelle Tubman: from a

[00:42:42] Stephanie: for a conference a few days ago, right?

[00:42:44] Stephanie: And, um, people

[00:42:46] Michelle Tubman: people

[00:42:46] Michelle Tubman: look at

[00:42:47] Stephanie: at me and think, “Oh, I

[00:42:48] Michelle Tubman: I

[00:42:48] Stephanie: don’t have a business to sit next to her.”

[00:42:51] Michelle Tubman: And so I have

[00:42:51] Stephanie: And so I

[00:42:52] Michelle Tubman: I

[00:42:53] Stephanie: have moments where I wish things were different, but I

[00:42:58] Michelle Tubman: my

[00:42:58] Stephanie: [00:43:00] don’t want

[00:43:06] Michelle Tubman: not just be that

[00:43:07] Stephanie: to

[00:43:08] Michelle Tubman: I deserve to fly to a conference just like

[00:43:10] Stephanie: change my body. And I, I deserve any of those things. So I can right now and it’s great. It’s amazing. Like I’ll just be at an airport, right? And I deserve to fly to a conference just

[00:43:18] Stephanie: like anybody else does.

[00:43:18] Stephanie: You know, it’s- Suffer in order to be smaller so that I can perhaps delay death. Like you wanna live well right now.

[00:43:33] Michelle Tubman: Well, correct. And just incidentally, if we wanna bring this back, science to support this,

[00:43:39] Stephanie: there? Tell us.

[00:43:41] Michelle Tubman: to

[00:43:41] Stephanie: Their first study was last month or sunny’s month,

[00:43:46] Stephanie: I forget exactly when it was, where they looked at

[00:43:51] Michelle Tubman: four

[00:43:52] Stephanie: different health-related behaviors. I don’t remember them specifically,

[00:43:57] Stephanie: but one had to do with alcohol, one [00:44:00] had to do with movement,

[00:44:00] Michelle Tubman: one had to

[00:44:01] Stephanie: one had to do with vegetable intake.

[00:44:04] Stephanie: And I think something related to the heart. I can’t remember the, the precise details

[00:44:09] Michelle Tubman: of the

[00:44:09] Michelle Tubman: habits.

[00:44:09] Stephanie: habits, But

[00:44:11] Stephanie: they looked at risk of mortality versus weight. And if you are engaging in these four behaviors, the risk of death is the same regardless

[00:44:25] Michelle Tubman: much

[00:44:25] Stephanie: much you weigh. Hmm. There’s also been many

[00:44:30] Michelle Tubman: that

[00:44:31] Stephanie: studies that show cardiovascular fitness, not muscle builder, is a much better predictor of mortality or death than weight is as well.

[00:44:41] Stephanie: So somebody who

[00:44:41] Michelle Tubman: in a

[00:44:41] Stephanie: lives in a bigger body

[00:44:43] Michelle Tubman: but

[00:44:43] Stephanie: but gets movement in has

[00:44:45] Stephanie: a lower chance of death than

[00:44:48] Michelle Tubman: in a

[00:44:48] Michelle Tubman: smaller

[00:44:49] Stephanie: person of a smaller

[00:44:50] Michelle Tubman: move at

[00:44:50] Michelle Tubman: all.

[00:44:51] Stephanie: who doesn’t move much at all.

[00:44:51] Michelle Tubman: And I

[00:44:52] Stephanie: And I know that there are challenges

[00:44:54] Michelle Tubman: when

[00:44:54] Stephanie: movement when you’re

[00:44:55] Stephanie: in a bigger body That

[00:44:56] Michelle Tubman: feel

[00:44:57] Stephanie: be causal bias or unsafe and

[00:44:59] Michelle Tubman: box[00:45:00]

[00:45:00] Stephanie: challenges where

[00:45:01] Michelle Tubman: might

[00:45:01] Stephanie: we might have mobility issues, but there are ways around that.

[00:45:05] Michelle Tubman: And,

[00:45:05] Stephanie: Always.

[00:45:08] Stephanie: And sometimes it is a matter of, um, tuning out the voices that say

[00:45:11] Michelle Tubman: you

[00:45:12] Stephanie: you must get a hundred twenty minutes of cardio and,

[00:45:16] Michelle Tubman: of weight

[00:45:16] Stephanie: weight training every week.

[00:45:18] Michelle Tubman: you have to put those guidelines out and

[00:45:21] Michelle Tubman: look

[00:45:21] Stephanie: I think

[00:45:22] Michelle Tubman: can I

[00:45:23] Stephanie: we

[00:45:23] Michelle Tubman: What

[00:45:24] Stephanie: have

[00:45:27] Stephanie: to put those aside for a bit and look like, look way forward at what body weight do you really enjoy

[00:45:32] Stephanie: And taking that approach will largely result in more benefit than sitting here trying to

[00:45:38] Michelle Tubman: intentionally lose

[00:45:39] Stephanie: lose weight in ways that are making you miserable because if you look at other episodes on what happens to the brain

[00:45:46] Michelle Tubman: when you

[00:45:47] Stephanie: with sermons

[00:45:47] Michelle Tubman: food

[00:45:48] Stephanie: low and fat blood sugar, and other things,

[00:45:50] Michelle Tubman: and, and other things, It just,

[00:45:51] Stephanie: just

[00:45:52] Michelle Tubman: all

[00:45:52] Michelle Tubman: tends to

[00:45:53] Stephanie: all gets

[00:45:55] Michelle Tubman: so focusing

[00:45:56] Stephanie: are

[00:45:56] Stephanie: a lot of health benefits of focusing on the things we feel good,

[00:45:58] Michelle Tubman: good,

[00:45:58] Stephanie: that’s [00:46:00] protection

[00:46:00] Michelle Tubman: to your health, um, way more than intentional weight loss ever does.

[00:46:06] Stephanie: Like you have to now pay more of attention to what your body is telling you We’re wrapping up the episode, but I wanna come back to the informed consent. Um, I know of a tool, and I’m not sure if you heard about it, because I wanna make sure people listening to this podcast have it. It’s the Association of Students of Weight Inclusive Care.

[00:46:26] Stephanie: I can’t remember. It’s a group of student who did an informed consent document on GLP-1. Have you heard about this?

[00:46:35] Michelle Tubman: absolutely have, and it’s an amazing document. I

[00:46:37] Stephanie: I haven’t.

[00:46:37] Michelle Tubman: recommend

[00:46:38] Stephanie: Yeah.

[00:46:40] Michelle Tubman: for sure.

[00:46:41] Stephanie: Okay. So we’re gonna link it in the show notes. So, so people listening to this who do not have resources or skills to read research, this part of this work anyway has been done for you in a more lay terms language.

[00:46:56] Stephanie: So I’ll put that in the show notes.

[00:46:59] Michelle Tubman: Perfect.[00:47:00]

[00:47:00] Stephanie: People listening to this podcast, where can they find you, Dr. Michelle?

[00:47:05] Michelle Tubman: Well, thank you. I am on Instagram @wayzahealth.

[00:47:09] Stephanie: You

[00:47:09] Michelle Tubman: It’s

[00:47:09] Stephanie: can find me on Instagram @fmeating.

[00:47:15] Michelle Tubman: the

[00:47:15] Stephanie: the easiest way. You can find me. And the best place. to find me, you can also find

[00:47:16] Michelle Tubman: find

[00:47:17] Stephanie: me on my website, which is noplaceatall.com.

[00:47:20] Michelle Tubman: Lots

[00:47:20] Stephanie: Lots of resources there,

[00:47:22] Michelle Tubman: a

[00:47:22] Stephanie: including a blog and a podcast. You can

[00:47:23] Michelle Tubman: own podcast, Thrive

[00:47:24] Stephanie: find me on some… and especially on my private membership.

[00:47:30] Michelle Tubman: on May 11th

[00:47:32] Stephanie: What is that membership about?

[00:47:33] Stephanie: Well, I know

[00:47:34] Michelle Tubman: It is called

[00:47:35] Stephanie: already-

[00:47:36] Michelle Tubman: Already.

[00:47:36] Michelle Tubman: And I have learned, um, over

[00:47:40] Stephanie: what my goal um, is working with women is that

[00:47:43] Michelle Tubman: when we

[00:47:44] Stephanie: learn to listen to our bodies, and start,

[00:47:46] Michelle Tubman: approaching our

[00:47:47] Stephanie: approaching our body and mind based on

[00:47:49] Michelle Tubman: asking

[00:47:50] Stephanie: it’s asking for it needs rather than

[00:47:52] Michelle Tubman: what

[00:47:52] Stephanie: what other people are telling us we should need.

[00:47:55] Michelle Tubman: is

[00:47:55] Stephanie: Okay. is we have to feel safe enough and comfortable

[00:47:58] Stephanie: enough to

[00:47:58] Stephanie: stay in our [00:48:00] bodies to

[00:48:01] Michelle Tubman: begin to

[00:48:01] Stephanie: to understand the language that it uses to communicate with us.

[00:48:04] Michelle Tubman: And

[00:48:05] Stephanie: And so

[00:48:05] Michelle Tubman: this

[00:48:06] Stephanie: this membership will be giving them tools to

[00:48:09] Michelle Tubman: come

[00:48:09] Stephanie: come back home to their own bodies and begin

[00:48:11] Michelle Tubman: safe

[00:48:11] Stephanie: safe again. So

[00:48:12] Stephanie: I

[00:48:12] Michelle Tubman: I’m

[00:48:12] Michelle Tubman: also a

[00:48:13] Stephanie: literally play teacher and host and mental health practitioner that attends to their physical And mental wellbeing. Amazing. Letting them feel

[00:48:27] Michelle Tubman: healing our relationship with food and body.

[00:48:29] Stephanie: their bodies. again. Is that the new direction for Dr. Michelle from emergency care?

[00:48:33] Stephanie: Because that’s quite the departure between the two world.

[00:48:38] Michelle Tubman: I still, I still work as an emergency

[00:48:41] Michelle Tubman: physician.

[00:48:41] Stephanie: I actually still work in emergency medicine and I do have a private practice as well. So I see patients in the emergency department And I also see patients, in my private practice. Yeah. And I ask that you work with your brain-[00:49:00]

[00:49:00] Michelle Tubman: you know, the environment is… You know, I’m in perimenopause and dealing with all the things, and the lifestyle that comes along with, with it, it just doesn’t fit with, with what I need anymore. So hopefully soon.

[00:49:12] Stephanie: I think this is the perfect example of the life choices that change once you accept your body, you face that peace with that, you start realigning stuff in your life so you can live it fully now.

[00:49:30] Michelle Tubman: Well, and let me… I… But let me just be honest. I mean, it feels so amazing on this side of it. Hardest thing I’ve, I’ve ever done, right? It’s not easy to say no and, and to

[00:49:40] Stephanie: Oh.

[00:49:40] Michelle Tubman: of the responsibilities, um, away and, you know, to… and to prioritize yourself in such a meaningful and profound way. It was the hardest thing I’ve ever done.

[00:49:50] Michelle Tubman: But am I ever grateful, um, that I

[00:49:53] Stephanie: Girl, I hear you. I was there 14 years ago. I made that choice. Uh, I just posted this morning on [00:50:00] Facebook about that. There was a memory that came up on Facebook of that part of my life where I took a complete leap of faith and was like, lived in fear for like two years, but it’s the greatest thing I’ve done.

[00:50:14] Stephanie: So you’re courageous, and the end of the tunnel’s gonna be beautiful.

[00:50:21] Michelle Tubman: Yes, it is. Yes, it is. I can see it clear as day.

[00:50:25] Michelle Tubman: Yeah.

[00:50:26] Stephanie: Yeah.

[00:50:26] Stephanie: Thank you, Michelle, for having been with us today.

[00:50:29] Michelle Tubman: Thank you. This was great fun.

[00:50:36] wanna coach behaviors, not bodies. Learn the mindset tool and the method that create real changes.

[00:50:44] Join the wait list for the next cohort of the non diet coaching certification at stephaniedodier.com/waitlist. That’s where the real training begins, and I’ll see you on the other side, my [00:51:00] sisters.