Going Beyond The Food Show-Episode 372-Fat & Pregnant with Michelle Mayefske

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We’re on. Welcome to the show, Michelle. Thank you for having me. I’m so excited to be here. I’m excited to meet you because Michelle is one of those person that I’ve Apparently, we’ve known each other for three years, but only one way. So, um, and this is the joy of having a podcast that’s been around for a while is finally meeting my listeners.

And Michelle has a fantastic stories. And that’s the reason why she’s on the podcast. We’re going to talk about. Being fat and pregnant and all the things that can come alongside to that, but I want you to share the story You started telling me when we started this interview about how you heard my voice and my message for the first time Do you mind sharing that for the listeners?

Absolutely. So I was postpartum. I’m a mom of five living in Ireland and I was trying to practice what I preach, which is relax, rest. You don’t have to jump into all the things that you want to after having a baby. So I was enjoying my time reading, looking up different resources, scrolling through social media on occasion.

And there was a. There was a person, someone who’s obviously interested in fat liberation and anti diet work, and they were talking about body positivity and body neutrality. And I had never heard those 2 terms side by side and your. Podcast whatever episode that was because now I don’t even remember at this point was something that was linked and it was one of those things where I bookmarked it because I was just thought I have to listen to this.

I have no idea what this actually means, but I need to listen and I put my baby. And to the stroller, we went for a walk, we went up to the park, and she was at that age where she can sit in a swing, and I remember having my headphones on, pushing her in this swing, tears streaming down my face, in the middle of this park, on a cloudy afternoon.

And it was… There was a quote from that podcast that I ended up putting in my book, Fat Birth, because it obviously moved me at that time, and it was something I needed to hear. Because up until that point, the books I’d been reading and so many of the other resources were chatting about body positivity, and I really did not understand the difference at that time.

So it was like a huge sigh of relief, if I’m being quite honest, to just know that. You don’t have, you don’t ever have to get to the point of loving your body that you can be working on accepting what it is that you see and feeling, having these really neutral feelings about your body and that’s okay too and it’s not, it’s valid.

was a big thing that I took away from it. So yes, that is how we met. I’ve been listening on and off ever since, dipping in and dipping out when I have, when I have the time. Usually I’m driving in the car, but yes. So, that was my introduction to you. It’s nice to put a face and nice to meet you and I want you to help us understand, because that’s your specialty, how diet culture, and we can even extend to wellness culture, um, plays into pregnancy and birth.

I have a lot of listeners that have had children or want to have children. And not enough people talk about diet culture from that perspective. Let me open the interview with this. How does diet culture impact pregnancy and birth? I think diet culture is a perfect primer. In getting people to feel really compliant within maternity culture, because diet culture essentially tells us that we’re, we’re doing something wrong.

We definitely definitely should be if we’re not a small person, we should be, or we should be working towards that as a goal and. I truly believe it can create this mistrust within ourselves because if you are a fat person or a plus size person, however you identify, we’re told, we’re given these beliefs and these messages over and over that you’re not doing the right things.

your fat because you aren’t eating a certain way, you aren’t moving your body a certain way, you’re making all the wrong choices. You definitely shouldn’t trust your hunger cues because you can’t trust your body. And then what do you do? The, the solution for that is then here are all these experts, all these people who are going to tell you how to eat, who are going to tell you how to count calories.

And they’re the real experts because you just don’t know your body that well. And that completely transitions into maternity care, where, where we have all these really scary, what I would say, inaccurate depictions of birth and the maternity system, which really is focused on efficiency and productivity.

And let’s face it, income, revenue, it is a business that if, what If that mistrust of your body continues, what do you then do you turn to the experts, the doctors, the nurses, the midwives, whoever it is, who then says, I know your body better than you do. I know what it is that you need to do for your birth.

And the reason this is problematic is because it reinforces this idea of compliance that we shouldn’t be questioning anything. And the. The reason I have a problem with this. I think this matters is because we now have a maternity system in crisis where we have so many people experiencing birth trauma.

It’s up to at the highest is 45% of people are leaving their births, feeling unheard, feeling disrespected, feeling like they weren’t at the center of their own care like they did not matter. And this is. Extremely problematic. We have more higher intervention rates than ever before. These intervention rates that that we are told are necessary for life saving measure measures, which they are, but now we’ve gotten to a point where these interventions are now just being recommended routinely because they’re convenient.

Or they make more money. Or you won’t be in the hospital as long. Because again, that’s part of the efficiency productivity is kind of let’s get people in and out. And there’s no individuality there. And there’s a real lack of trust. So I think diet culture and maternity culture, if you put them side by side, there’s a lot of similarities.

I love this, like, compliancy. I never thought about it this way. Never. And probably because I don’t have any children. So I never, like, lived the experience of being pregnant. But it is a mindset. So if you’re compliant with every other part of your life, obviously you will continue to seek compliancy when it comes to pregnancy and birth.

Makes so much sense. Yeah. This kind of good girl, good girl behavior of, I don’t want to disappoint anybody. I don’t want to ruffle any feathers. I don’t like confrontation. So I’m just going to do everything that they tell me. Where, I mean, it’s, it’s completely fine. I’m all about bodily autonomy. If you want to do everything that is recommended for you, absolutely go ahead.

The problem is, is we’re not creating any space where people can actually ask questions or they can take a step back and say, hold on a second. Why are 60% of people going to this hospital having a cesarean? Why, why are, why are 50% of people being induced? when labor is started with medications versus waiting for spontaneous birth.

So there are so many scary similarities. So this, this is an, I see clients from all different types of backgrounds where they may be plus size. They may not, they may have struggled with body image or they may have dieted during their, their lifetime so far. And A lot of people, this is not something that they even think about, especially, you know, it’s when they become pregnant and then they start and then you encourage them to take a look at the maternity system, then they start to have more questions, but it can take a while for people to even get to that point if they ever do.

So, I have a question then for you. What you’re saying, in a way, is that if we choose to not be compliant, then we should be asking a lot more questions, and we have options in both our pregnancy and our birthing process. We don’t have to obey all that is being offered to us. Is that correct? Correct. It’s, it’s.

Looking inward and even accepting like I’m the only person who’s been living in this body for this length of time. I’m the expert on my body. Just like I know when I’m hungry. I know when I’m full. I know what movement feels good. Hey, I also know. whether I want to have extra ultrasounds. I also know whether I want to have additional blood tests or, you know, one of the, one of the things that can come up for plus size folks, especially during pregnancy, is they may be treated like a And I’m using air quotes here, high risk patient.

Yes, I heard that a lot, by the way. Yes, there’s definitely this weight equals complications. Having a higher weight equals complications risks. It can be a lot of fear based conversations. What I encourage people to do is just. Take a step back and I have this really I’m going to share this with you because at your listeners because I feel like this should be shared in elementary school, you know, grade school kids, this acronym brain.

So whenever you’re making a decision about pregnancy or birth. Use your brain. And B stands for what are the potential benefits? If this test or procedure is being recommended, well, what are, number one, what is it that you’re recommending, right? If this is a blood test or if this is some sort of invasive procedure, what is, what actually needs to be done?

Why are we doing it? So what are those potential benefits? And even going a step further, how likely is it that It’s going to work. And then R is what are the potential risks? There’s potential risks for everything, right? Walking outside your door, getting into a car. There are risks to everything. So, and then weighing up the potential benefits, the potential risks in the short term and the long term.

A stands for alternatives. Because there’s always an alternative, even if that alternative, you know, it comes up and you’re like, I don’t know why anybody on this planet would choose that there is someone there’s someone who would that would feel right for them. And I is intuition so that comes into again knowing yourself trusting yourself what feels good for me.

And n stands for now and nothing. So I always like to remind people that doing nothing. is an option. If you have a doctor who says, okay, you’ve been in labor for a really long time, we need to do A or B. C, which is nothing, is usually left off the table. So usually it’s an option. It’s always an option. And now is, do I need to make a decision about this?

Right now, and in the vast, if it’s during pregnancy, most people are going to have some time. 99% of the time, you’re going to have some time to think about it. And that can really be helpful. If you are someone who’s a people pleaser, and you’re 1 of those people who’s more likely to smile and nod and agree because you don’t want to upset anybody.

But then you go home. And you think, oh, I don’t know why. I don’t know why I agreed to this. I don’t know why. That’s me. That’s, I’m definitely, you know, I’m, I’m, I’m in recovery, but I’m definitely moving away from my people pleasing tendencies. So, and even in labor, I support people in labor. There has not been a single situation in five years where somebody had to give an answer immediately.

They always had a couple minutes to ask questions, think about it, and come back. So, this is, and this is really popular within the birth world, this is nowhere, this is not something I created, but It is a process that I teach people who are pregnant and whoever’s supporting them in labor because these things are going to come up and it might be something unexpected.

So to have a tool that you can pull out and say, hold on a 2nd, we just these are the things we need to think about going forward. I love this because it’s really specific. To our people listening to this, when you talk about people pleaser, that’s one of the side effects of that culture, right? We get validation from pleasing other people, but you said something and I want to talk about weight stigmatization and care because you talked about this whole ideology that as soon as you’re plus size or higher weight, you’re automatically high risk.

A, is that true? And B, how are other ways where weight stigma comes in during pregnancy and birth? So being someone with a high, and we all know BMI is problematic for one, so I always like to start with that, highly problematic, like in, in the United States, for example, you have the American College of gynecologists and obstetricians, they don’t give a specific BMI that would classify someone as being high risk.

And every single country is different. And some explicitly will say a certain BMI, some won’t. But what I have found is a vast majority of people, when they go to their first appointment, their height and weight is taken. And I talk to people about, hey, you don’t have to be weighed if you don’t want to. So there’s advocacy bits and pieces that I inform people on.

But when you go to that first appointment, as soon as they calculate your BMI, The vast majority of providers are going to they may not tell you, but it might be put into your chart that this person is now a is now a complicated case or more likely to experience different complications. And the reality is.

Is that yes, plus size people are more likely to develop things like gestational hypertension, high blood pressure, preeclampsia, which can then lead to eclampsia, which is serious, and they’re more likely to experience gestational diabetes, and there are other things, but this. Is what I tell everyone. We don’t actually know from the research if people develop are more likely to develop those conditions because of their weight or not.

It’s the whole causation versus correlation. Right? Exactly. And I’m a big, I would argue. That if we have plus size folks who have experienced really awful care during their life, they’ve gone to different medical professionals, they may be already feeling like these micro aggressions related to our weight, right?

If we have this accumulation of negative experiences, or some would even say traumatic experiences, what does that do to our stress hormones? Which then has implications for our hormones, which then has implications for all of the things I just listed. High blood pressure. So that’s where the question is, is, you know, is it because, is it because of their weight?

Is it because of something else? And so I always tell people, for example, if somebody goes to their doctor and their doctor says, and this is what, I call and many other professionals would call a relative risk if their doctor says, hey, you’re 4 times more likely to develop gestational diabetes just because of your size.

What does that tell you? Not a whole lot. Four times more likely. But what is the actual number? Right? So it’s comparing a lower BMI group to higher BMI group. This is the absolute risk. So the actual numbers is somebody who has a lower BMI. They have a 6. 7% chance of developing gestational diabetes. And then the highest BMI group, which is Anything over 40 has a 20% likelihood.

So, about 3 to 4 times. But then we have to look at how is that being presented. You have a 20% chance of developing gestational diabetes. You also have an 80% chance of not developing gestational diabetes. And what’s often left off the table is a conversation about hey, gestational diabetes actually isn’t that big of a deal.

It’s something that can be managed. Doesn’t mean you or your baby are going to have problems. And there are things you can do like reducing your stress levels or getting in some movement where you get your heart pumping a few times a week and you reduce the likelihood. So that is something Those conversations are very typical, but there absolutely can be more serious and more awful cases of experiencing weight stigma.

So there, there has been research on this, thankfully, and it only came out within the last three years. There’s been a couple studies looking at weight stigma during pregnancy, and they found that people were more likely to have disrespectful comments, such as, I can’t believe you actually got pregnant at your size.

Yeah, or how could you do this to your baby? So these beliefs that you’re a bad person or a bad mom just for getting pregnant because of your size and you know, other things like a provider saying. If, if you go in and say, this is, this is what I envisioned for my birth, you know, this is what I’m hoping will happen.

Of course, I know there’s some unpredictability, but this, these are the things that are important to me to then have that provider turn around and say, well, actually, this is what we’re going to do. We’re going to do A, B, C, D. You’re not going to create a birth plan, or you’re not going to have any room for decision making here.

So, it can present, yes, yes, because you’re now fat and you’re high risk. And this is where I think a lot of the weight bias or anti fat bias comes in is providers also treating plus size folks Like a risk that has to be managed. You lose your autonomy to decide how you want your birth because you’re quote unquote fat.

Yes. Yes. Now, there are wonderful providers out there. I don’t want to forget about them. This isn’t a guarantee, but when I started my Instagram and I was pretty much documenting my own plus size pregnancy, I then started having people come in and be like, have you ever experienced this? Or did your doctor say this to you?

Or, you know, the The amount of people that I had come to me with these really horrible, horrible situations was shocking, you know, like people leaving their ultrasound, which is supposed to be a wonderful, joyful experience, right? Where you get to hear your baby’s heartbeat and see them. And that tech is pressing down so hard that they leave in pain with bruises with their like the top layer of their skin like in an abrasion from it dragging and it’s just like all of this is unacceptable and we need to be talking about it because there are so many people experiencing and they may feel Shame or embarrassment and I always turn that around and say you have nothing to be embarrassed about the person that did this to you or said this to you.

That’s what’s unacceptable. So I try to educate. Every way I educate people of all sizes, but if somebody is plus size, and I know that they’ve had negative experiences. One of the first things I do is educate them on this is what weight stigma may look like in maternity care because they may not be aware of that.

Well, they may think it’s normal because of their weight. And that’s what I get. I don’t coach on pregnancy, but I, I get people say, well, this is what should happen, isn’t it? I’m like, I don’t think so. It’s cool. Find somebody who knows, but I don’t think so. Right? Exactly. Exactly. And that’s, that’s what I, that’s what ends up in my inbox is this is what happened to me.

Is this normal? And most of the time, the answer is no, like the average, a really good example of this is. Being tested for gestational diabetes. Yeah, when you’re around 28 weeks pregnant if you’re plus size and you’re done and you and you Quote unquote past that like it’s not a test like an exam But if you if your blood sugar levels were fine at 28 weeks, and then your doctor is saying at 34 weeks 38 weeks that you need to keep doing this test That’s weight stigma.

That’s them That is their belief system saying you are going to develop this at some time because you’re a fat person or someone who is plus size and pregnant being told. Oh, no, no, no, no. You’re not being classed as high risk. And then from 32 weeks, they’re being told that they have to do these procedures or they’re called non stress test.

They’re being told from 32 weeks, twice a week, they have to go into the hospital and have all of these tests done and. It can create additional fear in people and a lot of times they’re just confused. Like, hey, everything’s going really well with my pregnancy. Why are all these tests being done? And are they normal?

So let me ask you this because I’m a coach. That’s what my specialty is, right? I coach people on integrating peaceful eating and body neutrality. Is that what you do, is helping people navigate their pregnancy? Safely with autonomy as a fat person. Yes, absolutely. So when people contact me, I have, and now that I’m open about, I think now that I’m, I, when I used to say that I was a birth and postpartum doula, I had not niched down.

I was like anybody and everybody of course I’ll offer support and I still do that for anyone and everyone. But so much of my passion now lies with plus size expecting parents because I know how they’re treated differently. And they actually are more likely to experience different interventions simply.

because they’re a plus size person. And I think that has everything to do with provider bias and nothing to do with their actual body size. So when people contact me, they, they really are looking for someone who, whether we want to call it a coach or a guide, someone who can help them navigate the terrain of pregnancy.

When. They’re, they want to have, obviously, everybody cares about their baby. Everybody wants to have a safe experience. So we talk about like, what does maternity culture look like? How do providers have different attitudes? What is weight stigma and how might that crop up in your pregnancy? And then what can you do about it?

If you’re working with a provider. Who clearly is weight biased and maybe you can’t change providers because in an ideal world, we would just get out of there and choose somebody else. Yeah, but if you’re in public care, it doesn’t work like that. Like Canada, you can’t just do that. Yeah, exactly. So some, and I’m in, I’m originally from the United States, but now I’m in Ireland.

So I’ve, I’ve seen the private sector of health and the public. So, yeah, we talk about how to set boundaries. how to work with a provider that you really don’t connect with or who clearly is viewing your body as some sort of risk. And then we talk about like birth, what’s important to you, and how can you stack the odds in your favor of having that type of experience.

With the knowledge that you still have to be open minded, there may be some decisions that you have to make that you wish you wouldn’t have, but what’s really important to me is that people leave that experience with their autonomy intact. So even if things are challenging, even if things are difficult, you come out the other side and go, you know what, Michelle, what was the shit show?

Everything that went wrong. Everything that could go wrong did go wrong, but I still felt listened to. I still felt like I was making the decisions, and I still knew how to ask questions to make sure I was involved every step of the way. And that’s the most important thing to me, and I say that to everybody.

I’m lovingly saying this. I don’t care what you decide. Just so long as it feels good for you. As long as you’re in a position of choice, that’s what quality decision is. As long as you know you have a choice, you can choose to do all the tests, but from a place of autonomy, not a place of compliance.

Exactly. Exactly. You, I was, I was scrolling through your Instagram and I want to ask you this, because I think that was a brilliant post and I want to talk about this. It said, being nice doesn’t make you inclusive. And I know there’s a lot of professionals listening to this podcast. And they want to do the good thing.

They want to, like, be fair to everyone and be inclusive. But tell me why being nice doesn’t make you weight inclusive. And what should we do instead? The reason I posted that was because this is one of the things. I hear after somebody has come to me after they’ve had a negative experience, they’ve got to know their doctor.

They’ve seen them multiple times. Their doctor has always been smiling and nodding, saying all the right things. And then they go into labor and that doctor who had been smiling and nodding suddenly is saying all the wrong things and trying to control that experience. And it’s one of those unfortunate situations.

And I always tell people that you need to explore further, right, when you get a provider or you’re looking that you can ask more. This is why you prepare for any scenario for starters, right, is if you’re in a public system, sometimes. Your doctor is on call and you may end up with somebody else, but When I share this about birth professionals and any type of professional really, being nice does not mean that you are inclusive.

Welcoming people to your program and saying everybody’s welcome does not make you an inclusive coach or guide or provider or educator. Because you actually have to do the work yourself to unpack and unearth the biases that you have. And… It can, it can be a very emotional, very difficult journey to do, and even Someone like me who’s plus size and has, you know, my weight has gone up and down my whole life and it’s been up, it’s been up for the most part of my life.

That doesn’t mean that I don’t have some level of anti fat bias. That doesn’t mean that I can walk around going unchecked because there will be times when I’ll watch something or I’ll say something. And I take a breath and I go, Oh, Michelle. That was coming from the past, wasn’t it? Some belief that I’m now has now become external.

You know, it’s been unconscious, my subconscious for however long. So I really believe that everybody has to do this work, that we have to look at what biases we do have and what it absolutely being nice. is not enough. If you’re educating folks, you actually have to consider what is important to them, not what’s important to you, which is being nice and getting along with everybody.

What is important to them? What is the information that they need to know to have a better experience or more autonomous experience? And thinking about like for a birth professional, for example, one of the things I would say is if you’re educating folks in person, What are the chairs in that room look like?

What is the equipment in that room look like? Is it suitable for any type of body that’s going to walk through the door? What about your materials? Are you using stigmatizing language? Is there any representation in your materials? Are you, if someone’s educating a big group of expecting parents, have you included anything about weight bias in your materials, even if you have 10 couples and there’s one person who’s plus size?

So it goes so much deeper than just having a smile and treating people with respect on the surface. You really have to think about the content that you share and if you really are thinking about their needs and ensuring that they’re met. And I’m gonna, I’m gonna share a personal example, not about pregnancy, but about medical.

A doctor, my physician, who was being nice, but she had never thought about the impact of placing her table for a gynecology exam with fat people, which is me. Like, we have to spread our legs differently and wider. And the table was right against the wall. I had to tell her, like, This is not going to work for me.

And she felt terrible that I could not sit properly on the table, but because she had not examined. Her environment ahead of time, because she wasn’t aware of her own bias, she thought everybody spreads their like the same way. That’s what you mean, or not having the proper cough for blood pressure. Yes.

Yes. Right? That happens to me every, now I’m at the point where I go for blood pressure and I say. Where’s the bigger cuff like I just don’t don’t let them put the small cuff. I mean, it’s just I need the big cuff But people don’t mean some people don’t mean arm. They just don’t think about it. Is that what you mean?

exactly exactly and I was I went through a training recently where One of the questions they they threw out was yes, you need to think about your intent My intent is to be nice, is to be respectful, but what impact are you having? Being nice is not enough. The impact is almost zero. Because anybody can be nice.

And I’ve had I’ve had clients who, you know, have worked with doctors who on the surface were very, very nice, appeared very, very respectful. And then when they’re very close to giving birth, that’s when all this weight biased information comes out. Or they realize that their doctor, it’s sometimes, you know, whether we want to call it a bait and switch or not, sometimes it is completely unintentional.

But I also think there are times when it’s very intentional. Well, I think if you look at the nervous system, when people are in a high state of Like activation, giving birth, that’s when all the bias will come, like there’s no more filter to be nice. It just comes out. Yeah, exactly. Exactly. And there’s no time.

Yeah, there’s no filter. There’s no time in those situations. I’ll, I’ll say this and I’d love to have your opinion on this. So I’ll come back to my example of the table placement in the cuff. When I went to the next appointment, the table was moved and the cuff was there. Right. So she clearly didn’t know what she didn’t know.

Yes. For me, I’m okay with educating the doctor on those matters. But at the same time, I know there’s a lot of people listening to this who get frustrated of having to do the education. What’s your thoughts on this and how do we navigate this? I am very much in the camp that you have to do what, what feels right for you and what you have the capacity for and what you have the energy for, because I have some people in my life.

They’re not doctors. They’re not professionals in any way. They’re family members that I love very much. And if they say something or do something, there are times when I have the capacity to say, hold on a second, I don’t want you saying stuff like that in front of my kids. I don’t want you talking negatively about bodies in front of my children.

So there are situations like that, but then there are absolutely situations where, you know, somebody says something to my daughter, like, Oh, she’s getting a bit of a belly on her. And I’m like, I don’t care, capacitor of the energy. I’m going in because this is something that’s very important to me. So, and again, as is a, uh, people pleaser in recovery.

That’s also part of my process is. Do I just do I have the energy do I have the energy now I will say I’m I’m taking more of those moments and opportunities to educate definitely, but I would never say, you know, as far as my clients that it’s an obligation. For example, if they’re setting boundaries with a provider saying, hey, I don’t want to be weighed or I need the bigger cuff or.

Do you have, like in labor, people might sit on those exercise balls, sometimes called birth balls. There are people who will absolutely advocate and tell the hospital. I need a bigger ball, but there are also people who say, hey, I brought my own. I don’t want to put up with asking. Yeah, I don’t want to put up with asking.

I don’t want to educate. I’m not I’m not even going there. I’m just bringing my own. So I think. Do whatever, do whatever you have the capacity for, but I 100% don’t think it should be on fat folks or plus size folks to do that education. I just wish there was more of a willingness for people to find those answers and to learn themselves ahead of time.

And that’s where I know you work with professional on this. of time so they don’t have to come up with the situation, but they go in and examine this stuff ahead of time, clean up their practices, their physical environments, so they don’t have to come up with their patient, educating them. Absolutely.

There’s, I think there’s a lot to be said for people who are proactively going in and saying, I want to learn everything I can because I want to make, I want to invite everybody. I want to think about their needs and I want to make sure they’re being met versus being reactive where now there’s this really uncomfortable, awkward situation where you’re educating folks and you don’t have equipment that’s suitable for them.

How somebody listening to this, who is fat plus size want to get pregnant? Or is pregnant, what could be 3 things that you would coach them, tell them, guide them on to practice more body respect and acceptance and autonomy during their journey of having a child? The 1st thing. I would encourage them to do is to learn about their body and learn about all the changes and what to expect and what is normal.

Because I think that’s where a lot of plus size folks can have a bit of a wobble during pregnancy is because your appetite might increase. You may gain weight, you may not gain weight, but learning what is normal, I think is part of is Absolutely helpful and I, I know it’s cliche, but I do think knowledge is power and just knowing what to expect throughout the pregnancy process and birth process can help you eliminate or reduce any doubts that you may have.

The second thing I would say is, this is what I would recommend to everybody, is of course intuitive eating, find somebody if you’re struggling to reach out for support sooner rather than later, and of course to find someone who is Not going. Unfortunately, there are folks who are telling people to diet during pregnancy or telling people that they should maintain their weight during pregnancy, like avoid all of those people at all costs and find someone who can help you.

And sometimes that also is with intuitive eating, but if you need help with anything else. Mental health stuff, right? That is a part of our health and part of body respect is taking care of all of you, including your mind. And the last thing I would say is there’s there’s a lot of things I could say. The last thing I would say is make sure that the people around you are clued into what it is that you need to because I think one of the.

One of the struggles of our modern world is so many of us have left our village. You know, I truly think we were not meant to parent alone by ourselves, hundreds, thousands of miles away from our family and friends. So pull in your village, whoever that is. Because they can absolutely support you during pregnancy, but also don’t forget about that postpartum piece and making sure that you’re thinking about your recovery and who’s going to be there following birth to help you during that time.

And that’s why you wrote the book. That’s why I wrote the book. Where can people find your book? What’s the title of your book? Because I think that should be the first step. I was hoping you were going to hit that on number one, get my book, because it’s going to address all the specialty. Like all the things that thin provider don’t know to think about you thought about that in your book.

Absolutely. So yes, number one, I’m teaching her how to sell right now. It is called fat birth. Confidence, strong and empowered pregnancy at any size and there’s paperback, ebook, the audio book will be coming out hopefully yet in 2023 and you can find me online at fatandpregnant. com. That’s where you can also get my assigned copy of my book if you like and on Instagram, same name, fat and pregnant.

Yeah, get people that like, follow people that look like you, get advice from people who look, feel and are like you. So, you know what to expect and what to think about. And you have a podcast coming out in October. I do, yes, coming out in October. I’m very excited about it because I will have experts like yourself, Stephanie.

And I’m also going to have plus size parents on who are sharing their experience through fertility, pregnancy, birth, and postpartum. So, lots of stories and journeys that people can relate to there. And will it be the same name, the podcast? Yes. Fat and pregnant. Amazing. Well, thank you very much for the time you spent with us and the education and talking about a topic that we don’t talk enough of.

Thank you for having me.

Going Beyond The Food Show Ep361 – 361-Wellness Culture with Christy Harrison author of the Wellness Trap

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This is episode 361 of the Beyond the Food Show, and today we’re gonna talk about wellness culture. We’re all familiar with diet culture, but there’s a new phenomenon that is evolving from that culture, and that’s wellness culture. And have a expert in the field of wellness culture, christie Harrison, who just released the book, well-researched book on that topic, the Trap of Wellness. And we’re gonna have this beautiful conversation also including one of my student, Joni O’Donnell. So if you wanna understand wellness culture and how it plays a role in your life, stay tuned.

Stephanie: Welcome to the podcast, Christy.

Christy: Thank you so much for having me.

Stephanie: It’s been two and a half years. We’re just talking about that. The last time I had you on a podcast was like during the pandemic, or right before the pandemic what’s your first book, the Anti-D diet book.

Christy: That’s right.

Stephanie: The world has changed since then.

Christy: Such a different world. I know. It’s wild.

Stephanie: But the topic is something I’ve been wanting to talk about for a very long time, which is wellness culture, and you just wrote a book on that. And I have a co-host, by the way, for everybody listening, Joni O’Donnell.

Joni: Hi everybody.

Stephanie: She is one of our student and she’s also a mastermind with me so sh I ask her to come in and, lead this interview with me. And she’s gonna get us started with a context question that’s gonna set up the rest of the conversation, so I’ll let you go first, joie.

Joni: Great, thanks Stephanie. Hi, Christie. I’m so happy to have you here and have this chance to talk with you today.

Christy: I’m happy to be here.

Joni: Great. So I was wondering if you could just start, just to kind of start our conversation, is to tell us a little bit about in general what wellness culture is and what we’re talking about because we’re familiar with diet culture at this point, and we’ve all read your book, anti-D Diet, which is amazing and changed everything for me and my work, but if you could tell us a little bit about what wellness culture is, I think that would help to kind of set the tone for people who are listening.

Christy: Sure. Absolutely. So, you know, wellness, like, I think it’s helpful to start off by defining wellness itself. And wellness is really defined as and conceived of as this practice of seeking to prevent illness and prolong life, not just treat disease, although people with diseases make up a significant portion of the wellness market. And in wellness there’s really a clear emphasis on individual choice and responsibility and the sense of optimization. It’s like this active pursuit of the most optimized you can possibly be.

Christy: And so it’s really defined by like this constant pursuit and the things that you do, and doing all those things typically requires a fair amount of privilege and is inaccessible to most people. And so wellness culture is the belief system that really underlies the concept of wellness. And it’s a set of values that equates wellness with moral goodness and, pos certain behaviors in a certain type of body as the path to achieving that supposed goodness. It overlaps with diet culture, which I described in anti-D diet is a system of beliefs that equates thinness, muscularity, in particular body shapes with health and moral virtue, promotes weight loss and body reshaping as a means of attaining higher status, whether that’s health status, moral status, or social status, demonizes certain foods and food groups while elevating others and oppresses people who don’t match that supposed picture of health.

Christy: And wellness culture, more or less incorporates all of those values into its belief system, but it also adds several other major tenets of its own. So some of the ones that I focus on in the book are that it denigrates conventional medicine and idolizes alternative integrative, and supposedly holistic approaches to healing that are supposedly more natural. And there’s this particular reverence for methods that are perceived as ancient or non-western, even if those characterizations aren’t always accurate, even if the thing in question is actually just being sort of cherry picked or stripped for parts, and it’s not really the ancient tradition that it’s made out to be.

Christy: And in fact, I think in wellness culture, there’s this emphasis on the individual’s ability to pick and choose what works for them, what wellness practices to adopt, and that often results in taking healing modalities out of context and really creating cultural appropriation and fetishization. And this like lionization of individual choices that we see in wellness culture also downplays or outright ignores the social determinants of health, which have a much greater impact on population wellbeing than individual behaviors. And the way that wellness culture is set up to value those things, I think gives anecdotes and social media testimonials more weight than sound scientific evidence, which, enables the spread of myth and disinformation and, conspiracy theories and scams and a lot of things that I cover in the book. And, I think the, social media and the structure of the internet also has really facilitated that spread and sort of intertwined with wellness culture in interesting ways that I unpack in the book.

Joni: Yeah. Well thanks for that description. I just wanna say too, for anybody listening, you go into such depth about the cultural appropriation and the, different types of medicines in the cherry picking and it’s so interesting that I highly recommend. I know we don’t have the time to go into it in detail here, but I highly recommend, reading the book just for that, even that history information, is really fascinating and really ties into what we’re dealing with today. [Thank you. ]

Stephanie: One other thing that for me, fascinated me in the way you described and presented wellness culture is this praise or how it prays on our desire for control. [Mm-hmm] When we have in fact very little control on our health and on our weight and wellness culture just proposed to a solution that pretend we will have control. And that’s really an angle that I knew was there, but I didn’t realize that was one of the prime value or foundation of wellness culture. It’s really interesting perspective.

Christy: Yeah, I think it’s really,praise on, like you said, the ways that people are unserved by the conventional healthcare system, the ways that we all, we all want and deserve to feel happy and well and, have wellbeing. I think that’s the thing that we’re all really seeking. But, wellness culture sort of promotes and packages this idea that we can achieve wellness and this like, optimized state and constantly be striving for it by doing these things that, really don’t have a good evidence base behind them. In a lot of cases, in some cases they’re just kind of totally made up by some influencer who’s out for their own benefit. And it’s preying on people who are vulnerable, have maybe chronic illnesses. I myself live with multiple chronic illnesses that are often targeted by wellness culture. So that was part of what inspired me to write this book because I have autoimmune diseases, I have hormonal conditions, I have skin issues, I have digestive issues, you know, all of these things that wellness culture promises you can fix with, often with food and then supplements and potentially other regimens and protocols that are really not evidence-based and in many cases are actually harmful.

Stephanie: And at the end of the day, it’s about accepting, not having control. And here’s where I see a pattern, and you tell me if you see the same thing. We’ve been in this world of the non-AI approach for me, eight years. And what I see people is they come in, they release diet culture, they stop dieting, and then there’s a stage where they go into wellness culture, [mm-hmm] again, trying to seek the control that they had to like accept with their way. They’re thinking there’s still a hope to get control and not have to accept. Do you see the same pattern in your world as well?

Christy: Definitely. Definitely. And that’s one of the reasons I wanted to write this book is because I see so many people, I’ve had a lot of people in my audience and clients come to me over the years and say like, I’m in recovery from disordered eating, I’ve given up diet culture, I’ll never diet again, but I’m really interested in gut health. Or I really, [yes] I went to see a naturopath and they told me I need to cut out all these foods or I was feeling fatigued and kind of diagnosed myself online with adrenal fatigue. And I’m looking up diets for that and how do I do this thing for self-care, like to take care of myself without spiraling back into disordered eating?

Christy: And when I look into the, those conditions that people are supposedly diagnosed with or the diets that they’re recommended, I see again and again, there’s no good evidence base for them. There’s certainly not enough scientific evidence, if any, to recommend individuals go on a diet. Maybe there’s like animal studies or studies in a population level, but not at the individual level. And so, I’ve been seeing again and again, like the lack of good evidence behind those things, but how people are so vulnerable and get sucked in so easily, because, like you said, there’s this desire for control. There’s this desire for feeling better and I get it. You know, as someone with all these chronic health conditions, like I’ve had periods in my life where things were really flared up and really intense and I just wanted relief and I was desperate. And even being a science-minded person and a journalist, I’ve been a journalist my whole career and like have learned, learned early on sort of how to find sources and get good evidence and good information. I’ve learned a lot more I think in the years since I started about like research methods and media literacy and, going to school to get a master’s of public health, I think really took that to the next level that, that many, science and nutrition journalists don’t have. But, but still, I have been vulnerable and gotten sucked into these false promises of wellness culture and thought, well, I don’t know if this has good evidence behind it, or I don’t have the time to research it. I’m just exhausted from my chronic conditions, but let me try this because what’s the harm?

Christy: And personally and in my professional life as well, I’ve seen again and again that, that there is tremendous harm that can happen from just trying something. I think these methods are wellness methods are framed as being gentler and having fewer risks and more natural or whatever than conventional methods. And so people feel like they can trust them or they can take the risk because even if it’s not gonna work, like what’s the worst that could happen? It’s just a waste of money or something. But actually in many cases there’s tremendous harm that can happen. Sometimes the protocols that we use exacerbate the very conditions that they’re meant to solve. So like celery juice, which I talk about in the book, can actually cause digestive issues even though it’s promoted as this, like cure all for gut health. There’s lots of things like that that can really worsen what you’re coming in with and set you back and your healing for various conditions.

Christy: And then, the disordered eating risk I think is so huge, and especially for anyone listening to this podcast, anyone who has their own history of disordered eating and is trying to recover, I think it’s really, really slippery slope and really dangerous territory to go into wellness culture and expect to find healing that isn’t going to exacerbate the disordered eating. I’ve had people tell me, they even went to like a functional medicine doctor or a naturopath or something and said, I have a history of disordered eating, so I really don’t wanna do any diets. And still they got pushed into doing something restrictive or taking foods out or doing an elimination diet or something like that.

Christy: So, I think it’s really important to kind of shine a light on this. And it’s something that I don’t think enough people are talking about in the anti-D diet space or in sort of the culture at large. I think there’s so much trendiness to a lot of these diets and wellness protocols and, wellness on TikTok has become really huge and, and functional medicine has become really huge. And I think, there’s a lot of downsides to all that stuff that we need to be talking about.

Joni: Well, Christie, I am so glad to hear you talking about all of this and it resonates, for me on a personal level, both, personally in my own life, recovering from an eating disorder, living with chronic conditions and chronic pain and autoimmune diseases. And this, also resonates deeply with the clients that I work with. And, As you described in your book, we live in this world of information overload, which is filled with misinformation, disinformation, and that can be really overwhelming for the average person. You talked about your history as a journalist and your master’s in public health and all of your, clearly you have a lot of research history and scientific knowledge, but for the average person who may not have that kind of time, energy, the skills or even the resources available to do that kind of deep dive, what steps could you recommend for the average person to discern between what’s trustworthy and helpful and what’s harmful, bs?

Christy: Yeah, such a good question because we can’t all be experts, right? We can’t be expected to know everything, and even people who are experts sometimes just don’t have the time or the resources to research everything. So I think it’s important to have some kind of like shortcuts to figuring out what’s useful and what is potentially a scam or just misinformation. I think one thing to really understand is that social media algorithms are designed to maximize engagement because that’s what keeps people on the platforms getting served more ads, which is how the platforms make money. That’s literally their business model. And what drives the most engagement is content that is novel, that is extreme, that provokes moral outrage, it’s controversial. And misinformation really hits all those notes and we see that really driving so much of the wellness misinformation. So one thing to do is just stepping away from social media and not getting your health and wellness information from social media, looking at all of it with a really skeptical lens, even, from licensed healthcare providers, right?

Christy: Like credentialed providers are on social media doing good work. But I think also the incentives of social media and the business model often drive people to frame things in ways that are more black and white and less nuanced. And certainly a provider on social media isn’t working with you one-on-one as a client, and so, there’s a lot of nuance that gets missed. And so I think, not getting your information from social media is one big thing people can do. I think people don’t necessarily fall for claims because they’re gullible. They are, often very smart, very science minded. But sometimes that science mindedness and like trust in science can actually work against people because there’s research showing that people who have like a broad trust in science, if they’re presented with misinformation that has scientific references and scientific sounding language, they’re gonna be more likely to be taken in by that because of their trust in science.

Christy: So I think, it’s not to say don’t trust science, but I think we need to be critical consumers of science and look at science with the same kind of skepticism that we would look at other things and in general to look at health and wellness claims with a very high degree of skepticism, not take things at face value, you know. And if something has supposed scientific references listed to actually click through and see, does that say what it purports to say, does that actually support the claim that someone is making or is that a totally different topic? Right. Oftentimes I’ll see that with wellness influencers, whether they’re, they’ll link to a supposed piece of evidence or study that supports what they’re saying, and it actually has nothing to do with what they’re saying at all.

Christy: I think also looking out for kind of red flags, like doctors don’t want you to know, or other kind of conspiratorial sounding language. The idea of like healing yourself naturally is so appealing, but that kind of language is also often associated with things that aren’t as evidence-based. Dubious diagnoses that I talk about in the book, like adrenal fatigue, chronic Canada, leaky Gut syndrome, all of those things really don’t have good evidence behind them. [Mm-hmm] And you know, if something is purporting to be a miracle or a cure-all, or it’s like one thing that cures all ills, be very, very wary of that.

Christy: There’s systemic issues here. And so not all of this is an individual responsibility, right? Like there are, things that need to be addressed at the societal level, including regulating technology companies and social media so that the proliferation of wellness, misinformation and disinformation isn’t allowed to happen. Regulating the supplement industry, which is kind of the wild west, like there’s really very little regulation that happens there. No pre-market testing for safety and efficacy, so things can go on the market that really shouldn’t be there. But you know, that said, even as we’re working towards these individual or these societal level changes that need to happen, there are things individuals can do as well. So, like I said, the skepticism, right? Treating integrative and alternative medicine and the wellness industry in general of as much critical thinking and skepticism or more than you would to conventional medicine. With any given wellness treatment or practice, just knowing that the placebo effect is likely very strong. And that’s not to say it’s all in your head, but actually there are powerful mind body connections at play where if you believe something is gonna help you or you’re getting empathy and support from a care provider, that goes a long way to helping relieve pain and relieve symptoms and it’s understandable that you might feel better at first, but what often happens with the placebo effect is that it wears off over time.

Christy: And so if something might seem like it’s working at first and then over time you’re like, I don’t know, my symptoms are coming back, or now I’m having new symptoms and the, the solution proposed in wellness culture to that is often, okay, we’ll just do that harder or just add these other supplements, or just add these other dietary restrictions, just keep doing it, keep pushing, like get more and more extreme. And actually, that can just compound the problem and make things a lot worse and worsen disordered eating, take people down that slippery slope of orthorexia and just, and, eating disorders. It can also worsen the symptoms that you came in with because now you’re taking a whole bunch of supplements or a whole, doing a whole bunch of dietary restrictions that have their own side effects on physical health. And so

Christy: just being aware that placebo effect is often at play in wellness practices and if you start to feel like I just don’t know if something is working,having that kind of skepticism and maybe instead of going harder, instead of like adding more protocols and doing more wellness treatments, stepping back and letting go of the stuff that you’ve been trying andpotentially working with a conventional healthcare provider, if you can find one who is less likely to prescribe those kinds of things.

Christy: And of course, conventional healthcare has its own pitfalls and its own problems, and I think that’s why people are vulnerable to wellness culture in a lot of cases, why they’re attracted to it and oftentimes there still is a better evidence base and better care that you can find, if you can sort of wade through some of like the weight stigma and the other stuff that, that is often there. There’s a method that I really like called the Sift Method, which is developed by Mike Caulfield, who’s a researcher at the University of Washington who studies media literacy. And that stands for four Steps. So it’s stop, investigate the source, find better coverage, and trace claims quotes in media back to their original context. And so with wellness claims, wellness culture stuff that you might encounter, especially on social media, stop, just take a breath, don’t share, don’t act, don’t spread the information. Even spreading, sharing content to say, look at this bogus thing, can actually spread it farther to vulnerable audiences. So really just thinking about quarantining the misinformation or the potential misinformation, not spreading it until you’ve investigated. Then investigating the source. look into who’s sharing that content, who’s responsible, who tends to benefit, what their credentials are and their reputation is. And just because, someone is like selling something doesn’t mean they’re automatically wrong or spreading misinformation, right? Everybody has to make money in this capitalistic system, but you know, it’s helpful to take into account like what their agenda might be. Then, finding better coverage means, if you don’t necessarily trust the source of the information, or even if you do, but you just want like a second or third opinion and they’re saying something unusual, look for other coverage and see what other reputable sources or just reputable sources in general are saying on the subject.The concept of reputable can feel really tricky in this day and age because mainstream media has been really denigrated in certain corners and science does have its problems and stuff. But I think,thinking about mainstream news outlets, the fact that they’re held journalistic standards and they could actually be sued for making false or unsubstantiated claims. So they’re often a good source for information and cross-referencing information and claims that seem too good to be true because, lawyers would definitely, like block the publication of certain things if it was, not true. Right. Mainstream media outlets also tend to be really interested in health and wellness information and health and wellness trends. And speaking as a journalist who, got her start in health and wellness reporting, when I was like very disordered myself and looking for diet advice and wanting to lose weight and all of the things, journalists in this space I think are very interested in quote unquote natural methods or healing things with food. Like, if there was something that was that good, journalists in that space would be all over it if it was really true. Right? If there was like, an effective alternative to chemotherapy for cancer, or a natural method for treating ibs or whatever it is, so if they’re not covering something, I think that could be a good sign that, it’s the science isn’t really there, right? And then finally tracing claims, quotes, and media back to their original context, just thinking about,whether the scientific references are really there to support something, as I said. Or whether citations are being taken out of context or sometimes entirely fabricated. And if there aren’t any legitimate outside sources that are being cited, that’s also a red flag. So if someone is like, have it on authority from a spirit that, doing this thing is gonna help you, which, like the medical medium has said about celery juice. It’s like, like the spirit tells me that celery juice is gonna heal all your ills and science just hasn’t caught up with it yet. So yeah, don’t worry about the fact that there’s no science. I’m the one to trust. Like that’s a huge red flag, I think head for the hills when you know someone is making a claim like that. And then one other thing to think about is just noticing the emotions that come up in you when you’re reading and absorbing content. [Mm-hmm] You know, if you end up feeling fearful, anxious, activated, feeling like I have to do this now, this is the key, this is the solution. Or you have this sort of outsized sense of hope, like this is finally gonna be the thing that cures all my ills but you can’t verify the facts and you’ve like done this sift method and you’re like, I don’t know, I’m a little skeptical, nobody else reputable seems to be reporting on this, it’s just this one person don’t know if they have great credentials, I think be really aware that manipulation might be afoot in sort of how they’re trying to stir up your emotions and get you to act.

Stephanie: In talking about this, in reading the book, the other piece that really struck me is the concept of wellbeing, which is in part where we’re talking here, wellbeing versus wellness. And can you share your perspective on that and how it informs what we can do then. If it’s not to buy into this claim, how can we approach wellness from a different land?

Christy: Yeah, that’s such a good question. I really see wellbeing as,in a way, the antithesis of wellness, right? So, wellness is about optimization and constantly striving, and you can never quite get there. It’s this thing that’s always like receding in the distance. And wellbeing is more about acceptance, doing the best you have with what you’ve got, doing your best to find some measure of like mental and emotional and social support and feeling as connected as possible to people around you and having like, a more holistic sense of wellbeing than just pursuing this physical thing and constantly trying to optimize. Cause I think wellness culture really, it, it talks a big game about being holistic, but actually it’s really prioritizing the physical and it takes away so much from the mental and emotional and social aspects of our wellbeing.

Christy: So, pursuing wellbeing I think is about kind of coming back to those more truly holistic aspects of ourselves and our connections with others and our wellbeing. And so, I think pursuing wellbeing is what we ultimately need to be striving for at the social level, at the societal level, supporting people’s wellbeing, not putting so much emphasis on individual behaviors and shaming people for what they do and don’t do. We need to be emphasizing social determinants of health more and sort of thinking about ways of collectively caring for people and not just putting it all onthe individual shoulders. And that’s a really tall order I know in this society because, for so many reasons and so many historical roots of this. America and the western, western culture in general, I think is very individualistic and very shaming of people who have illness or struggle in some way or have disabilities or are larger bodied and all of those things.

Christy: So, it’s a really is a tall order at the societal level, but I think we can work towards that. And as individuals we can just do our best to bring some measure of acceptance and thinking about mental and emotional wellbeing as sort of primary and not prioritizing the physical over and above that.

Stephanie: What for me has, and I’ll get Jonie to go after that, but what for me wellbeing meant is that true quote, holistic nature, like mental and wellness, and what I have seen in my practice is that people move from that culture to wellness culture, finding the solution in wellness culture, that it’s still physical. [Mm-hmm] And when you can think about wellbeing and the way you’re presenting it in the book, you’re really, kind of have to dig into what you’ve been avoiding all along, which is mental and emotional and spiritual wellbeing beyond the physical body.

Christy: Mm-hmm. Yeah. Yeah. And I think that’s really hard and that’s something that, you know, people with disordered eating, [yes] sometimes they’re trying to outrun, right? [Yes.] Disordered eating has benefits in some ways to people, or it’s a coping skill. It’s a coping method that people have developed for difficult things in their lives and a way of trying to control situations that might feel out of control and to find some measure of relief from outside forces like weight stigma and [Yeah] other forms of discrimination. It’s a way of trying to like combat some of those forces. And so, when you drop that and when you drop the pursuit of wellness and optimization, I think sometimes you’re faced with like this overwhelming fear and anxiety and pain and just grief that comes from feeling like, I don’t know how to sort of fight back against these forces within me and outside of myself, and it can feel really, really painful.

Joni: So I think finding support for that in whatever way that looks like, it could be finding a great mental health therapist, which I know can be a process and involves access issues for a lot of people. It can mean leaning on your community and finding people in your life who get it, connecting with people online and maybe forming some offline relationships from that, doing your best to get connected with others who can support you. And really, I think therapy is amazing and has been so healing and important in my life that people who can and have access to therapy, just putting in that unfortunate work to like, of trial and error to find the right therapist, I think can have really immense payoffs too. So Christie, everything you just said, there’s so, so much good information. I wish we had all day to talk about this. Some of the things that you brought up, about individual responsibility and dubious diagnoses, I know that they’re two different topics, but they’re so intertwined, I think.Somebody goes to the doctor and they’re presented with this diagnosis, that just doesn’t seem quite right, or it may have been given hastily without a lot of diagnostic testing and follow up, then we’re faced with this weight stigma and this anti-fat bias in the medical community. And a lot of it then just comes back onto us as an individual, right? So both wellness culture, diet culture, they seem to both push this idea that we’re solely responsible for all aspects of our health and wellbeing. And that nosha can really feel insurmountable. It can and feel like such a burden that leads to feelings of moral failure and thoughts like, I’m not good enough, I’m not strong enough, I don’t have enough willpower or commitment. And that list can go on and on. And those feelings often get reinforced, like you said, by families, social circles, even in the medical community. Right.

Joni: So yeah, so how can someone just really kind of advocate for themselves in order to be heard and understood and taken seriously and provided appropriate testing and care in the medical setting, when they’re faced with all of these factors. And what else is at play here besides just, you know,this is all your responsibility and this is all your fault, that you’re in this, that you’re in this situation.

Joni: So if we’re working with people who we wanna kind of help free them from that, from the grip of that individual responsibility, can you share a little bit about what other factors are affecting the health and wellbeing that are not in the individual person’s control?

Christy: Sure, yeah. So, genetics plays a huge, huge role in chronic conditions that people might have, in people’s weight and body size, that’s really largely heritable and largely determined by genetics. And then, people’s social determinants of health I think can also really have an impact on their health outcomes, on chronic conditions, on the health challenges that they might face. So, there’s research at the population level showing that 70% of population health outcomes are attributable to social determinants, like housing security, food security, income level, education level, experiences of discrimination and racism that they might face in the world,access to healthcare, all of these things that are affecting the conditions in which people live and can affect their wellbeing.

Christy: And so just being aware of that and being compassionate with yourself for the fact that those things are so influential in our lives and that only 30% of health population, health outcomes are attributable to all behaviors and then only 10% to food and exercise combined. And I think that number really staggers a lot of people because they might think, you know, in a wellness culture, we’re sort of conditioned to believe that like 90% of the pie is food and exercise, right? And that like maybe only 10% is other things, and it’s actually the reverse, you know? And so recognizing that we have so much less control over our outcomes then we are led to believe and very little control when it comes to food and exercise and that if someone is proposing those things as the solution to all your problems, it’s really missing the bigger picture here. It’s really missing this context of what goes into our wellbeing, kind of on average as a whole. And, if you can find a healthcare provider who is empathetic and willing to set aside some of their own biases, maybe set asidepressure to put you on a diet or lose weight and look at other factors that could be contributing to what’s going on for you, and look at solutions that don’t have anything to do with weight loss or diets. In many cases there are, really I thinkto me, pretty much in all cases there are solutions that can be adopted and practices that people can do to promote their wellbeing that have nothing to do with losing weight or with going on a restrictive diet, but that can maybe bring some measure of relief. And I know that there are chronic conditions that are really understudied and populations that are really underserved and certain conditions are contested and like don’t have a lot of great evidence or support, or you might even get doctors sort of being skeptical that even exists. And in some cases there are things that don’t really exist, like supposed adrenal fatigue or chronic Canada or things like that, that are like sort of wellness cultures invented terms. But if you think you have that, it’s not that you don’t have anything. It’s like you, you have a real problem. There’s things that really need, you really deserve help for what you’re going through. And what you’re going through is real, and your symptoms are real, but the label that you’ve gotten for them is wrong and it’s been misidentified and so you deserve to get actual support and actual diagnosis for what’s really ailing you.

Christy: And I know that can take years in some cases and a lot of trial and error and working with different providers and we shouldn’t have to do that. We shouldn’t have to go through all that to get the appropriate care. But unfortunately, that’s the system we’re in right now. And again, that’s where wellness culture sort of preys on people’s vulnerabilities, I think. Because the system is so broken in so many ways, there’s a real void where good healthcare should be for many people. And so that’s where, people start getting seduced by or sucked into these wellness paradigms that, are just leading them in the opposite direction of where they wanna be going, of the healing that they seek.

Christy: And so think it’s really complicated and I have so much empathy and compassion for people going through it. And I just wanna sort of put in a plug for like, continuing to push and continuing to try to get the care that you need and deserve to the extent that you’re able to with whatever else you’ve got going on, symptom-wise and stuff like, there are really empathetic providers out there who at the very least will agree to say, okay, I’m not gonna talk about your weight, I’m not gonna put you on a diet. Let’s look at other potential solutions for this. Or who maybe are like beyond that, just super empathetic providers who are willing to do a lot of work and testing and keep supporting you as you find what’s gonna work for you. [Mm-hmm.] So, it’s again super complicated and I wish everybody had access to the kind of empathetic providers that I’ve eventually been able to find after two decades of like going through different providers and working to find a good team.

Christy: And if I move or go on a different insurance, I might lose them, right? So it’s like, it’s all very precarious in this healthcare system. But I think that’s what we’re really aiming for is to find that sort of team that’s gonna be empathetic and compassionate and not put us on diets or promote weight loss, or stigmatize people for the size and shape of their bodies and actually give evidence-based care for the things that we are struggling with.

Stephanie: Did you have a last question, Joanie? Because we need to wrap this up at this point.

Joni: You know what, I just wanted to, there was something you said in your book at the very end you talk about healing from wellness culture and I just wanna kind of add this in because I think it’s important for people to hear. I think they’re gonna hear themselves in something that you said in the book. So, and I’ve been working with clients for a long time on unlearning and healing from the harms of diet culture and I imagine that is similar to healing and unlearning wellness culture. [Mm-hmm.] But specifically, you stated in the book that at some level you thought you needed to be free from symptoms and functioning optimally in order to be worthy. And that deep down you felt that you needed to completely erase your chronic conditions in order to fulfill and live the life that you had driven for yourself. So this resonates deeply with me. I’m sure it resonates with a lot of people listening who are already susceptible to all or nothing thinking, or black and white thinking and perfectionism.

Joni: [Mm-hmm.] So if you could share your biggest takeaway on how you began to kind of live in that gray zone of imperfection, I think that would be helpful for some of our listeners to hear.

Christy: Yeah. It’s been such a winding path and I think it didn’t happen overnight. So it takes work and it takes practice and support, but I think it was just this like little by little letting go of, for me, it started with food, right, started with letting go of the perfectionism about food and letting myself be a little more and letting myself, of be aware of and honor my hungers, my desires, my satisfactions, and starting to trust my body more through that process and just knowing that like, my body is gonna have these consistent ways of making its, or eventually consistent, right? Sometimes they’re very inconsistent, but my body’s gonna have ways of making its needs known. And if I listen to them and fill those needs, I’m gonna feel good. My body’s gonna thank me in some way. And that took a lot of time to get to that point, I think. But then, sort of starting to become aware of that at an embodied level [mm-hmm] helped me also become aware of like, Other ways that I was being perfectionistic and holding on really tight and forcing myself to do things that were, not listening to my body’s needs, right. Pushing myself beyond my limits, not getting enough rest, not taking the downtime I need as someone who’s like, got mental health challenges as well and introverted and just needs to cocoon sometimes, and starting to accept those things about myself through talking to other people who went through similar challenges, reading,consuming content from other people who struggle with similar issues and realizing that like feeling at peace with myself and having a certain measure of wellbeing, well, a isn’t gonna be consistent through all time, like I’m gonna have ups and downs with that and sometimes I’m not gonna feel at peace with myself and I’m gonna feel frustrated with my conditions and maybe lack of ability to do things that other people can do and compare myself and all that stuff. But, but recognizing that like in order to feel some measure of greater peace, I don’t need to be entirely symptom free or medication free or disease free, right? That it’s possible to be in a state of relative wellbeing even while living with chronic conditions and managing them and doing my best to just take care of my body and make accommodations for it and recognize its limitations and embrace those things actually, right? Like, to get to at least a place of neutrality with them was one thing. but then to get to a place of like real care and compassion for myself in struggling with those challenges, I think was kind of another level of healing.

Christy: And so it’s not easy. It’s, it takes a lot, I think, of constant effort and work to, to remind yourself of that acceptance that you need to have for yourself. But, over time and with enough practice and support, I really was able to let go of so much of that perfectionism about my wellbeing and wellness in general and not get so caught up in things that purported to make me symptom free or reverse disease or put things into remission. I’ve stopped believing in those magic bullets and started to really just accept that these are things I’m gonna live with and I don’t know why I have them really. Some of them are genetic, some of them who knows. But,this is what it is. This is what I’ve been given, this is the body I live with, and there are strengths to it and there are limitations to it, and I’m gonna do my best to embrace all of it.

Stephanie: I just kept shook my hand. I’ve been, I’ve been singing that song for years now because I have chronic pain as well, and people always want to know like how, why are you seem to be living a full life and somewhat happy? [Mm-hmm.] It’s not because I found the magic pill. [Mm-hmm.] It’s because I’ve accepted that my life is with chronic pain. [Mm-hmm.] So thank you for saying that out loud.

Stephanie: I’m going to wrap us up and say thank you so much, Christie, for being here and highly recommend the book. We are gonna link it in the show notes. I think it’s a game changer and it can not in the sense that wellness culture one tell you can change your life, but it can really change your perspective on life.

Christy: Hmm. Thank you so much.

Stephanie: Thank you.

Going Beyond The Food Show Episode 359 – Overcoming Chronic Pain with the Non-Diet Approach with Dr. Andrea Moore

This is episode 359 of the Beyond the Food Show

and today we’re gonna talk about chronic painand how to overcome and reduce chronic pain in a non diet way, because many of us have been told that if we quote just lose weight, our pain will go away. My guest expert today as a whole different perspective, you ready stay tuned.

Hello my sisters and welcome back. This is a special episode. I have been looking for an expert to enlight us on chronic pain for more than five years. And today is the day after 357 episode that I’m bringing you, this magical person. Her name is Dr. Andrea Moore and her entire specialty revolves around chronic pain. Now, I wanna catch that very wide on this because her approach,a non-AI approach to chronic pain, catches all forms of chronic pain, that it is knee pain, low back pain, that it is fibromyalgia pain or idiopathic pain, pain without a cause. Her approach, her doctorate thesis on pain is about helping you find the solution and first, find the reason why you’re experiencing that pain and then overcoming that pain.

I’m so excited to share with you this conversation. For some of you who’ve been listening to the podcast for a long time, you know my personal journey with chronic pain. I have been exposed to chronic pain since my mid twenties and I use my personal story in this interview with Andrea to really bring it to a concrete level of how I have changed my relationship to pain, reduced the pain that I’m experiencing every day, and Andrea sharing how she’s approaching it as well.

I have to tell you this: my personal journey to overcoming healing chronic pain has been since the last 10 years, and it’s really on the last three years where really reduced the pain that I’m experiencing on a daily basis. And I have to tell you this, if I had met Andrea 10 years ago, I would’ve skipped through seven years of me trying to figure it out on my own. And that’s what Andrea does for people is she skips through what I had to experience was just trying a whole bunch of different things before figuring out what works for me and funny enough, as I’m sharing during the interview, what worked for me is what she teaches to people she work with.

So, If you experience chronic pain, this is a must listen. Or if you have anyone in your life that experienced chronic pain who’s been seeking a solution, this is the episode you want to get them to listen. So without any further ado, my team will patch through the interview with Dr. Andrea. Enjoy.

Stephanie: Welcome to the podcast Andrea.

Dr. Andrea: Thank you so much. I’m so excited to be here, Stephanie.

Stephanie: I am the same way and I am because we’re gonna talk about a topic that’s near and dear to my heart, which is pain cuz I’ve been living with chronic pain and as I was mentioning to you, I’ve been talking about pain from a non-AI approach mainly by illustrating my own lived experience but never been able to speak about pain from a factual and science based. I’m really excited to be able to put a resource out there for my client to understand pain and chronic pain differently so they can have a conversation with their caregiver to get them

a non-AI approach to chronic pain. [

Stephanie: Yes.] So I’m excited to have that conversation.

Dr. Andrea: Oh, me too. I love this so much and I love what you’re doing and I think it’s abso totally amazing and phenomenal. So just thank you for doing the work that you do. It’s so important.

Stephanie: Same thing for you. So let’s talk about pain. [Yes.] What is pain? Let’s start with the basic and what build from there.

Dr. Andrea: I know, right? Alright. So the way I always like to start out is, pain, one is crucial to our lives. It sounds so counterintuitive, especially if you’ve been in pain, but ultimately we first need to recognize that we do need pain. If you stepped on a rusty nail, would you wanna know about it? Yeah. Kind of important, right, because you want to be able to clean your wound, not bleed out from your foot without realizing it, right? You put your hand on a hot stove, you want to know about it. So we first wanna recognize where pain is important. And what pain is, is a message from our nervous system to our brains about what’s, what it’s experiencing. There actually are no pain receptors in the body, which is really important. There are temperature detectors, which is why a hot stove will set them off, right? There are movement receptors that can like feel how much stretch is being put on, but ultimately what happens is this nervous system response gets sent up to the brain and the brain interprets it based on what else is going on.

Dr. Andrea: And so the brain can then choose to be like, Hey, ooh, this is important, let’s pay attention, which is pain. It’s like, ding, ding, ding, yikes, threat or ehh, we can ignore this, not important, which is also why you could be running from a bear and step on a rusty nail and not feel the rusty nail because the brain is literally me being like, feeling pain in that moment would not be helpful for your survival. Right.

Dr. Andrea: So your brain is always interpreting the message. This can unfortunately though be misunderstood as pain is in your head, which is what some people also could have heard. So let’s just be real clear that that is not about this. Like can I swear on this podcast? [Oh yeah.] Okay. Good. [Used to that] Or say it appropriately, I always tell, because I speak to mainly women and often we’re gonna make sweeping generalizations, right now. Often the doctor that is telling the women that the pain is in their head is a male. I always like to tell them, you can kick your doctor in the balls and be like, that pain is also in your head. [Yeah.] Cause all pain is the brain’s interpretation of what happened. So like, come on. It’s stupid. So anyway,

Stephanie: [is that over? And you’re,] it’s in your head, but it hurts.

Dr. Andrea: Exactly. So like, yes. Like technically yes it is the braids interpretation, but like it’s become kind of useless to talk about it in that sense because it’s missing out on the entire context and the fact is it freaking hurts, okay. So like it doesn’t change that.

Dr. Andrea: So anyway, so we need pain, but what can often happen is pain becomes a threat detection. And the threat that pain is interpreting can be subjective. [ Okay, tell me more.] Yeah, so first I’m gonna back up and give another, ex I love analogies is, I’m sure we have all walked past that car the whose alarm goes off we’re no freaking, it’s like you just looked at it the wrong way, right? There was always that car in the parking lot. That car has a threat detection that is too sensitive. It is no longer useful because it is responding too heavily, but the car alarm is just as loud based on whether or not we are seeing, a threat there.

Dr. Andrea: So it is responding in the same way to a leaf blowing by it, or you giving the car a side eye as it would to somebody trying to break in. And so it becomes very difficult then to interpret what is an actual threat versus what is your system interpreting as a threat? [Hmm.] Both result, again, in levels of pain that are felt and lead to suffering and that we don’t want to feel, okay. And so just because your body is misinterpreting something as a threat when it not isn’t actually a threat, again, doesn’t make it any less valid or real. It makes it just as important to attend to as if there was an actual threat.

Dr. Andrea: So what happens whether there was an injury or not, after pain has been going on for more than three months, up to six months, right past the six month mark, this is for sure, what we see are changes in the nervous system and of how it’s wired, that it is actually increasing the number of receptors in a certain body part to like know about anything that’s going on. This leads to nervous system sensitization, which leads to pain. Because the brain is now getting just all these messages even if it’s like, wow, your knee just bent a certain way. Your brain’s like, oh my God, it’s, I’m being told about this over and over and over. This must be bad. And it’s interpreting it as something bad because there’s just so much information coming in at it do this increased sensitization that the pain, even if there was a point where there was tissue damage, or an injury, the pain now is due to nervous system sensitization, not due to tissue damage.

Dr. Andrea: And from an injury, when they’ve studied this happens in 25% of people, which is a massive amount of people, like it’s not a small thing that happens or you’re some like rare thing that this is like person that this has happened to. It’s like this is a massive thing that happens in the population. And so again, this can be in response to an actual injury, then that just felt like it never healed. Often the tissues have healed, but what remains is the nervous system sensitization. Or if you’re someone who’s like, I just woke up with a pain, there is no clear response, this can still be the case. Either way if you’ve had pain for more than three to six months. [Mm-hmm.] These nervous system changes have been found to be like universally true. It is just then about the more complicated matter of what’s the nervous system detecting us threat and how do we get it to calm down?

Stephanie: That’s fascinating.

Dr. Andrea: Yeah. That’s my very long mis overview on pain. Yeah.

Stephanie: It is fascinating because that’s not at all what we’re being taught [No] in mass communication, right? [Mm-hmm.] And the first thing that came up to my brain is the shame that we feel for having the pain [Yes] because we shouldn’t be having the pain. And I’ll layer in our particular conundrum because of our size or our body, or yes, our refusal to diet, then we carry the shame and I’m sure that carrying the shame sensitized the nervous system and create more pain.

Dr. Andrea: Oh my gosh. You are freaking brilliant. Yes. You are so spot on because what can happen within the system when we have shame, which is, you’re right, it is such a common emotion, whether it is something that we have internalized based on, maybe there is a parents at a young age or putting a lot of emphasis on what you should be able to do with your body athletically, [mm-hmm] or what you should be able to live up to or whether it is a doctor making comments about your body, or it is just internal pressures you’ve put on yourself Probably based on what society has taught you. Let’s be real, right? What it teaches then that every time we’re feeling pain, it increases the threat response because it’s like pain itself becomes a threat because pain is preventing me from being accepted by society, from having love, from feeling worthy, right? And so what happens is we start pitting against ourselves. Because what I love to really emphasize is that pain ultimately is a part of you. It is a part of your body and so when we hate on it, when we fight it, right, when we are like desperately trying to make it go away, when we feel like pain is ruining our lives, if you just imagine saying all those same things, let’s even take it out of your, like to your best friend, right? Like it doesn’t feel good. But it’s like we are saying that kind of to a part of ourselves.

Dr. Andrea: Now, I also like to add any time I say that, it never means that you have to like love your pain or be like, I’m so happy you’re here, like, okay, we don’t have to get Pollyanna about it. [No] But it’s just about seeing it as a part of our whole selves and that it gets a seat at the table. But it doesn’t mean it runs the show. It doesn’t mean it gets to dictate our lives for us, but it is a part of us.

Stephanie: Yeah. It’s an alignment to what we teach with body image, which is body neutrality. [Mm-hmm.] We don’t have to love our body. [Yes.] It’s a vehicle to use and experience my life, that’s it. [Yeah.] Don’t have to love it, but you can’t like hating it, it’s not gonna serve you. You just gotta be neutral and make friend with it. [Yes. Yes. Exactly.] So it’s the same place with pain.

Dr. Andrea: Perfect analogy. Yes, exactly. 100%.

Stephanie: Because as you’re teaching us that, I’m relating to my own experience of pain, and I’m gonna ask you a question about this. So, for the listener who’ve been around, there’s a number of episodes on the feed about pain and health and pain and my own story around pain and I was sharing recently that the work that has been the most profound in reducing my pain has been accepting my pain. [Nice.] And part of that was in parallel to the this, the concept of healthism, the obsession with being optimum health and thinking I should be able to not be in pain. I should be able to have a body that’s not in pain if I work hard enough and when I accepted that not all humans have a perfectly functioning body that I made peace with that, my pain reduce. And it’s not a promise to say, if you do that pain’s gonna reduce. But that’s what my experience was. Does that make sense in relationship to your teaching?

Dr. Andrea: Yes, absolutely. 100% goes with what I teach because it is about coming into this acceptance. And I think the word acceptance can feel so loaded to people [Yes] because acceptance can often feel like, oh, I’m just giving up and it’s not. Acceptance can be the most empowering thing in especially the way you’re describing it, right, of it’s actually seeing your body for exactly what it is. It’s not rejecting your body. And even what you were describing of like this, yes, this healthism, this obsession with being perfect or having a body operate in a certain way, it’s like, who even defined that in the first place? [Mm-hmm.] Like what does that, what does that even mean? What is the optimum, like what? Like it’s just so, it’s just so ridiculous. And it’s like, what if we were just allowed to be in the body we were given exactly as it was, meeting it exactly as it is right now. And often when we can do that, you’re absolutely right, pain levels will decrease because we’re no longer seeing our own body as a threat. So everything calms down. Your pain’s like I don’t need to yell is loud. You’re like hearing the message.

Dr. Andrea: And so everything often does calm down and it’s like this really like funny side effect that happens by being like, actually I’m just gonna accept that I have pain.This is a formed analogy, but it’s like, it’s part of the body neutrality piece, right? It’s like being like, my body is the size it is, so I’m gonna find clothing that feels amazing [Yes] for it, right? It’s like I am going to give it exactly what it needs right now. And when we do that, we just feel better, right? You just feel better when you’re wearing something that feels amazing on your body exactly as it is. And then you’re just like, ah, right. And so it’s the same thing for pain. It’s like when we can meet our bodies exactly where they are, maybe our body needs more rest. [Mm-hmm.] Maybe our body doesn’t wanna do a certain type of workout that everybody’s been saying we should do to lose weight, right. It’s like, no, my body wants to just do this one movement practice that feels beautiful for me, and we can respect our bodies and meet its needs from that way. Nervous systems are like, they feel so much safer. We just start to achieve nervous system safety, which brings down that sensitization, which will then decrease pain.

Stephanie: And I wanna make sure I’m like, I’m going to the place where some people are going right now [oh yes] in their heads.

Dr. Andrea: Yes. Yes.

Stephanie: So pain is not in my head [mm-hmm] but it modulate itself through my head, my nervous system, my brain. [Mm-hmm.] Does that mean that, we’ll take the classic knee example, because that’s probably like 50 to 70% of the people listening to this. [Mm-hmm.] They have knee problem [mm-hmm] because their joint is getting older. And they’re not in a thin body, so they’re have more weight. Now, is it true that more weight impacts the joint of the knee and causes pain, [so] or was it just in their head?

Dr. Andrea: Yeah, right. So here’s the thing. I’m a physical the, I work for the clinic and saw hundreds and hundreds of people. I saw zero correlation to between body size and pain, and knee pain. [Wow.] I myself am in a thin body that is the body that I genetically was given. [Yeah.] And I had all kinds of joint pain and knee pain [hmm] when I was a teenager. Like, and when I was like 16, 17 years old, like I had all kinds of knee issues. I was like probably 95 pounds when I was a teenager. Like, please. Right.

Stephanie: So, so it’s not true anatomically that the weight causes joint pain?

Dr. Andrea: No, not, here’s what I’ll say from a, like, I will get physical therapy about this for a second. I’m gonna step into physical therapy. The biggest correlation is how well supported is that joint. [Okay. Tell me more.] So, yes, and I do think this is important, right, is what, the biggest, the thing that I wanna like ooh, get, so like, just get on a soapbox about, is this concept of like, if somebody comes in with knee pain, often they are told, oh, you should stop exercising or you should stop squatting, you shouldn’t climb up. Like you should do all whatever. And ultimately the way the joint works, the more muscle we have around the joint, the more supportive the joint is. It actually sounds very counterintuitive, but it actually creates more space in the joint to have more muscle around it. [Hmm.]

Dr. Andrea: So that part is important. But even I, with that, even if you’re somebody who hasn’t been able to build up strength because there has been pain. [Yeah] Right, cuz that’s the reality for money. It doesn’t mean one that you can’t obtain that, but it still doesn’t mean you have to have a lot of pain. And so that’s the thing is I would see people who were really weak and like, yes, we do wanna build up strength just so you can feel more independent in your day. You can do that in a way that doesn’t involve shaming, that doesn’t involve a lot of pain, that doesn’t mean anything about you as a person. It’s just as like, it feels good and loving to just give my joint more support. And it’s possible to do that again without likethe hyposensitization piece. [ Tell me more about this.] Yeah. I also wanna make, one more thing before I go into that is often those who carry more weight are some of the frigging strongest people I know because you’re literally carrying more weight.

Stephanie: I have the calf of a machine, like [yes] I cannot, like I’m back into the gym lifting weight, and I just keep like I’m at like 150 pounds on my caff and I cannot get [yeah] high enough just because it’s supporting 200 plus pounds of weight. These sh, these muscles are strong as hell.

Dr. Andrea: Exactly. Like I, I feel like that was like a very, that was a consistent thing I would see is I would get these very thin bodied people who were very weak and they have a lot of knee pain, right. Because they’re, they have no, have no muscle around it. And again, that’s not shaming them for, [no] for, for having that. It’s just, it is the reality. And so we wanna give them more strength.

Dr. Andrea: Most people who I worked with who had a larger body, they were so strong, it wasn’t about the muscle, you know, sometimes it was more just gi pick more love to their muscles and actually more of like almost the self-care piece of like, maybe they were tight and were working so hard, so it’s just like giving them love and massage [Stretching, yes] and stretching. Yes, exactly. And then teaching them more about this piece of bringing down the sensitization because if every step, if you have been told that your weight is causing [yep] pain, then imagine what you are thinking either consciously or at a subconscious level that, ah, I’m going up the stairs. How much weight am I putting through my joint right now? [Mm-hmm.] Weight is bad to put through my joint. If weight was bad to put through your joint, why are we promoting weightlifting. Like it doesn’t make, [no] like, it’s not our joints. There’s something called wolf swa. The more force you put through something, the stronger it gets. Like we want to weight through joints. I’m like a massive advocate of strength training for that purpose.

Dr. Andrea: And so if every step you take, every time you have pain, every time you’re going up and down stairs, every time you’re squatting, you’re thinking, oh, I’m creating damage. Yeah. Oh my gosh, I’m creating damage. Your body is like, I’m creating dam. Right. It just takes on that message you’re sending and it’s, and what your body will do, what your brain will do is like, we are worried about creating damage, therefore we need to know more about what is going on in this joint. And so how does a brain learn more? It puts in more receptors and so it’s literally, a person with pain will have a significantly more receptors within a joint, which means your body is feeling every movement you do at a much greater level.

Dr. Andrea: So the best way to describe this sensitization is if you’ve ever had the flu, right? You know how you like just like laying under the sheets, you feel it on your body that’s just like, oh my God, it’s sore. If you like bump up against a doorway, it’s like, oh my God, like it doesn’t hurts. That is literally, that’s sensit and that’s like a chemical sensitization that happens cuz they detect chemicals too. So it’s like things just hurt more, but there’s not more damage being caused. You bumping against the doorway when you have the flu, is it more likely to lead it a bruise right. It’s just your body was more sensitive to it, you felt it more, and then once that sensitization decreases, flu goes away, it disappears.

Dr. Andrea: So in the knee joint, it’s literally just feeling more and then your brain is like, it’s like a self-perpetuating cycle. So your brain’s getting more information and it’s like, oh my gosh, wow, this joint’s moving and we’ve learned that moving is bad. Oh my gosh, we must be concerned about this. Let me throw in more receptors. And so it just creates this vicious cycle when instead if we can be like, it is safe to put weight through my joints because that actually is what increases my bone density. That is what brings nourishment to my joints because that is true when we put, when we use our joints, that brings in the synovial fluid that lubricates them, that, that tells our body, we are using this, so we must take, like, that helps it take care, to take care of it, to send in the healing when we can be like, yeah, I might be sore, but I’m safe. It is safe for me to go upstairs. I’m not creating more damage. Then our brain can be like, okay, this is safe. And slowly the receptor starts to replace themselves and start to fade out.

Stephanie: Are you saying the word taught work?

Dr. Andrea: Yes. It can be part of,

Stephanie: because people are familiar because that’s part of our process.

Dr. Andrea: Yes. You have to believe the thought work though, just like right,so yes,

Stephanie: But the same process as we use for body image. Right? You have to start slowly, like, it’s possible for me to accept my body, blah, blah, blah. Right.

Dr. Andrea: Exactly. And I work with a combination of like thought work isn’t partially thought work, but then you [cognitive] use thought work to, yes, go on a body level. And so then I also take people through a process of like also getting to know pain, partnering with pain. Like, hey, what are you here for? [Yes.] What’s going on? So like the knee can be a great example of like, is there fear of moving forward in life? Right. Or your back, where do I not feel supported? Right. Like things like that, I find, sometimes it can be helpful to have a global generalization of a body part, but sometimes the message can be so unique so I never like to assume anything. [Yeah.] But it’s like we are, we’re always working from both levels. We wanna make sure we’re taking out the layers of beliefs that were put on us by the medical community. [Yeah.] But then we have to remember that the paint also was present. So it’s almost like these two, I know it’s a podcast and I use my hands so much. Okay, so it’s like almost like two layers, right? There’s the, like here we had paint, there was an moment of when pain started and then there was all these layers and beliefs that got built on top of it. I find those layers and beliefs are often, they work really well with thought work. But then it’s like, why did the pain come on in the first place? So at first we have to clear the thoughts and beliefs that came on of like, that we’re holding onto that movement is bad, or just walking around and being in your body is a problem. Right.

Stephanie: That’s hyper desensitizing the pain. [Yes.] You have to remove that part.

Dr. Andrea: Yes, because that’s keeping us in the cycle. And then it’s like, okay, now we can be with our pain. [Okay.] Hey, what’s going on? What? Why did you come on in the first place? And really then deep deepening into the body and getting to know,is there a message here for us? What does our body need to feel loved and supported and cared for? What would feel respectful to our body, and working in from a much more somatic level and an embodied level.

Stephanie: What’s fascinating is I’m hearing you explain your methodology and how you help people release pain. It’s what I did in a very disorganized way. [Yeah.] Would I have known like you were existing, I would’ve fast tracked my result to pain because I did it, but like poking over here and poking over there. So you’re like taking that process, organizing it in step one to five [mm-hmm] in a very systematic way to fast track people, [yes] reducing their pain and hearing the message yes] in a awesome way, not just like from [yeah] quote unquote weight loss, but like from a, what is the whole big picture behind this?

Dr. Andrea: Exactly, yes. Cause I don’t talk about weight loss at all. [Yeah, exactly.] Because it’s not needed.

Stephanie: That’s why you’re here. Because you wouldn’t be here if you were.

Dr. Andrea: Yeah, exactly. Like literally, I’ve never talked about that. Right? Like it’s not required at all.

Stephanie: So why do you think that is, when we go to the doctor, we get told it’s our wait. Like you are a specialist. You have a doctorate in that, like you’re the ultimate up-to-date level of information, but that message is not what the thousands and thousands of doctor gives to patient every day.

Dr. Andrea: Yeah. So what I first wanna start with is what I am saying about pain in terms of the sensitization and all that is evidence based and backed by the neuroscience. [Yes] Like the is, it’s not debatable. Like, it’s not like a, oh, this is some woo French thing. [Mm-hmm] It’s like, no, no, no,go read the research papers, this is what it says. The other thing the research papers say is all about bringing it back to your body and the mindfulness piece and the being with your body and it, the research 100% shows how harmful it is to like, speak about certain ways in pain to be like, oh, being in this body is creating damage and oh, like all of that type of language is so [stigmatization.]

Dr. Andrea: Yes, the research knows all of this [mm-hmm] yet it is not carried over at all in practice. Now, from talking to, you know, I’ve had some doctors on my podcast, from what I hear from them, they don’t learn any of that in medical school.

Stephanie: Oh, so it’s just generalized fat phobic [yep] socialization of the population that’s carried over in their practice.

Dr. Andrea: Yes. And in, in like defense to be like, not all doctors are terrible people at all, so much because of insurance and things like that. So many doctors are limited to this like seven minute visit, where they have to get through way more than they can ever do. They are stressed. They are burned out, and at the end of the day, I think it’s very easy to say you should lose weight. [Okay.] It’s so easy because it’s such like a, an accepted thing to say [okay]. To sit with someone and go into the deeper things takes a long time. I wanna be like, your doctor cannot do this type of work with you. And what I’m actually seeing now, it’s funny because it’s like, oh my God, this needs to get into the medical field, but I’m actually seeing it. It is getting into the medical field slowly, and it’s actually really problematic because what’s happening is doctors are like, I mean, it’s better. It’s better. It’s a step up. But when it happens,

Stephanie: we get in the right direction

Dr. Andrea: They’re moving. It’s just slow. As long as insurance is dictating these seven minutes, we’re kind of fucked. Like it’s never gonna look good. Yeah. But what’s happening is doctors are like, you need to have less stress. That’s right, so that they’ve moved from weight loss to, okay, well you need to just have less stress in your life. Well, you should just do this, but what the, like, come on, like it’s not helpful. Oh, you should be more mindful here. You should meditate more. And they’re just doing the same thing where they’re just throwing a, like this blanket statement without ever sitting with a person and letting the person be heard and loved on, and just have a chance to express what is being held in their body and in their system because it takes time and spaciousness and a relationship and being heard and seen to move through a lot of this work.

Stephanie: So, we understand pain better, we understand sensitization, I’m someone with pain, [mm-hmm] I go to the doctor, I’m being told it’s weight. I told the doctor I don’t want to talk about weight. Then what do I do? [Yeah] do I go to someone like you or is there anything else in the medical system that can help me?

Dr. Andrea: So chances are, if you have tried a bunch of things, if you have been, like either told, hey, there’s really nothing more we can do, you just need to lose weight, or maybe they’ve taken x-rays and they’re like, either it looks fine, or we could get into a whole nother conversation about, just because it says something in an image does not mean that there has to be pain present because that’s again, proven by research that what we see in an image does not correlate. [That’s fascinating] The pain levels at all, like it is so fascinating, like it is insane and I’ve had so many good stories of this. So, so just know that because I’m like a whole other conversation. Stay focused, Andrea.

Dr. Andrea: Okay. So what can you do? I think, it is a knowing that the medical system can be there to rule out something that does need to be medically treated. And that’s tricky because like I’m talking from a place of like, I’m not gonna say some things, and I really don’t mean to like throw anyone’s fear detectors up, but it’s like at the end of the day, there is some back pain that comes in and it’s an early sign of, a kidney thing or right, there’s bone cancer. Like, there, there are things we can’t live in fantasy world [no] right. There are some times where pain can be an indicator of a deeper medical problem that does need to be attended to by the conventional field. But here’s the thing, chances are if you’ve had pain for more than six months and years likely, like they would’ve seen that. Like know that the medical field tends to do a very good job of catching an acute emergency issue like that. And so if you’ve been to a bunch of doctors and they haven’t had it, know that they’ve done their job. [Okay] You’ve gotten what you need and now it is like, okay, I’m never gonna get what I need from them because not only have they not been trained to it, even the ones that might be aware and are aware, they can’t do it in a 15 minute visit.

Stephanie: They’re not structured to give that kind of care.

Dr. Andrea: Yeah. When I was working in the clinic, I was very aware of what it took. It as the reason I came out of the clinic because even working in a clinic that I was able to have 45 minute visits with people. [Okay.] I felt like I could not do what I knew would help people because as long as it is covered by insurance, there are literally restrictions on what we’re allowed to do. Okay? So I moved outta the clinic because I was like, I cannot do the things that I know will help. And this is the case for a lot of doctors who might have the knowledge. They can’t do it in practice. So it is yes, finding people like myself who are going to walk you through it and be with you through the process, whether it’s group or one-on-one. I do both depending on the needs of the person. I have a podcast, the Unweaving Chronic Pain Podcast, which of course I’m delighted to have you on as well, that, you know, I start to talk about it. And so just like getting yourself in your brain to hear a different side of things is amazing. There are so many,books and apps and things like that, that do help with this as well. Curable is one that I’ve heard. I,I’ve never like gone through what I’ve heard. There’s some limitations of having an app, but it’s like the overall messages, at least giving your brain different messages

Stephanie: And it depends where you’re on the scale of affordability. The apps will help you to the extent which you can, right?

Dr. Andrea: Exactly, yes. And especially if you’re like, man, I really can see where I need to reprogram my beliefs about pain. Alan Gordon has an amazing book called The Way Out, I Believe, and same with, Howard Schumer. They both, I think Shuber stuff, I think he’s got some YouTube videos and things like they, he really does a great job of if you’re like, I just need to hear more about, wait a minute, wait an x-ray, does it mean, if you’re, like, some of these things are like, holy crap, I’ve never heard this before. Like, I recommend actually following some of those guys cuz they speak really, well about the like, medicalization of these things and how it just doesn’t add up.

Dr. Andrea: Again, I will say they’re men and they do have a certain perspective sometimes that I find, there’s no reason women tend to come to me. [Yeah.] But no, I think like their information is like spot on. Like, it’s so good. It’s so good.

Stephanie: And I wanna be sure that we include the conversation around the fibromyalgia thing, like, I don’t wanna call it a disease, Like it’s an association of symptoms. Yeah. But when we talk about chronic pain, we’re not only talking about knee pain, we’re talking about pain that people can explain like fibromyalgia.

Dr. Andrea: Yes. Fibromyalgia 100% falls into this category. It is literally a sensitization of your entire nervous system and I’ve, rather than it happening at a joint level, often when we’re talking about something fibromyalgia, there is something that the body is detecting as a threat that’s much more external, like global in your life. [Yeah.] Like, let’s use you as an example, right?[ Yeah] You are someone who is operating against status quo. You’re coming here and being like, fuck diet culture. That is anti societal, like norms. Your body, sometimes for some people, their body can actually develop fibromyalgia like thing because it’s like this is unsafe for you to be speaking out against. Do you know what happens to women when they use their voice? And so it’s your body actually trying to protect you because guess what? What’s, guess what a great way to stop you from using your voices, being in pain.

Stephanie: Yeah, but not being able court and do nothing because you’re,

Dr. Andrea: Yeah, your body’s not stupid. So if you’re doing something where it’s like, man, every time it feels like I’m making these big strides, or I’m making myself more visible or doing something I love, it’s almost like the more aligned to life you get, if you have more pain, chances are, is because your body is seeing that as a threat. And we can rewire that. That can be shifted. Again, that’s not gonna be the case for everyone, but it’s definitely, if you’re like, man, nothing makes sense or like, the better I feel internally, the worse my body feels, like that’s why.

Stephanie: Yeah. Anne, it’s often, like I’m thinking of a student recently who was a health coach with fibromyalgia, and part of her healing process was to stop being a health coach because it, it was very unsafe for her to be a health coach [mm-hmm] while being sick. And since she’s [fascinating], since she changed her career and went back to an office corporate job, [mm-hmm] the pain, 70% less.

Dr. Andrea: Fascinating. It’s so fascinating. Right? A body is just,it’s amazing. Yeah. And I also wanna even say that logically, just because you’re like, well, I don’t see that as a threat. I feel like I’m sitting as a woman to speak. Oh, no, you’re, you’re nervous. Generational trauma, that’s the thing that we work with, [Yeah] it doesn’t, and societally, just you watch the news for five seconds, like your body’s gonna be picking up on all kinds of threats. So like, often it can be, it’s held at a subconscious level. Yeah.

Stephanie: That’s amazing. So you’ve named your podcast as one of the resource. [Mm-hmm] What’s the name event again?

Dr. Andrea: Unweaving Chronic Pain

Stephanie: Okay. So we can go there getting to know you, and then you work with people to do this work [Mm-hmm] 1 0 1 or in a group setting. [Yep. Absolutely I do.] That’s amazing. And Andrea’s here because she’s fully aligned with our value system. Because I often tell people, you have to investigate the people you work with. You don’t need to investigate. She’s proofed. [Thank you.] She’s not gonna like, trigger you into having to lose weight. So it’s somebody that aligns with my work. A hundred percent.

Dr. Andrea: Mm-hmm. Yes. And then,the link that I’m including [yep] to will be a replay of a three day masterclass that I worked through, which is the first day is all about breaking the cycle of pain. So really looking at how we’re responding to pain within our bodies to understand why our body like to help break down that threat response. Yeah.

Dr. Andrea: And then day two is all about reclaiming your body back from pain, so getting to know how to go deeper, like what we were talking about, going deep into the body to hear what it has for you. And then day three is how to integrate it, this into your life and reclaiming your life back from pain and starting to expand it back out again. So you can have access to those videos that will walk you through the process, in day two is this really deep, beautiful somatic process and embodiment process that, oh, it’s just so magical.

Stephanie: So that’s gonna be in the show. [That will be] You guys can go and grab that, and again, it starts your journey to feel more safe to then take the next step and do your own personal work on this. [Mm-hmm. Yes. Yes.]

Stephanie: Thank you for being here. I have been looking for somebody to talk about pain without including fat phobic message for years. [Mm-hmm] And the podcast has been running close to six years and you’re the first one [oh] my years. [ It’s horrifying. I’m sorry.] Yeah, about that, that couldn’t find anybody that would tackle this message without blaming the weight on the body.

Dr. Andrea: I have literally, like, been working with pain since 2011 and I have, don’t think I have ever mentioned anybody’s weight. Because it’s so irrelevant.

Stephanie: Yeah, but it’s so rare, unfortunately.

Dr. Andrea: I just think I’m like in my own little bubble sometimes.

Stephanie: You are, but you’re needed. Okay. Thank you very much for with us.

Dr. Andrea: Thank you. Thank you for having me.

Dr. Andrea:

Ozempic: The Conversation We Need to Have First with Dr. Natalie Gentile

Stephanie: This is episode 358 of The Beyond the Food Show, and today we’re gonna talk about the drug called Ozempic, and this is the conversation you want to listen to first, are making your own decision or having your own conversation about Ozempic. You ready? Stay tuned.

Welcome back, my dear sister, and today is the day we’re having a conversation about Ozempic. This podcast was born from all of you reaching out to me and asking me, or have, wanting from me my personal opinion about Ozempic and I have refused to give an opinion because of two things. Number one, I am no longer in clinical practice. I no longer see patients one-to-one. I’m now into working with clients under a coaching structure, so I cannot formulate ethically an opinion on ozempic. However, what I did is I found a prescribing physician, so someone who sees patient day to day and has prescribing right, has actually work with real people and a medication called Ozempic, and I asked her a bunch of question.

So we have a guest today on the podcast. Her name is Dr. Natalie Gen. She’s a board certified family medicine and lifestyle medicine physician who owns a primary care practice in Pittsburgh in the Us. She, as you will hear in the interview, practice medicine very differently. She has a weight neutral practice and interact with her patient under a different formulation, which is what we call primary care practice. I discovered that lifestyle medicine while doing the interview with her. She is an amazing person, and we kept the conversation neutrally because I want this to be a resource for years to come on Ozempic, that it is for you to formulate your own opinion, or that is for you to contribute to a friend, to a sister, to someone who’s considering ozempic, that you can have an educated decision.

The second reason why I don’t formulate my own opinion is I’m a coach and I want to empower the people that I work with to make their own decision because I trust that you can make your own decision. I trust you. I am handing out my belief in you. So this conversation’s gonna be very neutral. We’re gonna explore every side of Ozempic and other medicalized treatment for weight loss in order for you to make your own decision. And if you are in Pittsburgh, I would highly recommend you reach out to work with Dr. Natalie, and she also has this amazing website called Rebel Wellness, which is a weight neutral facilitator of healthcare that you should look up to. And my last thing, before I roll you the interview in the show note, we’ve put the link to the directory, to find a practitioner or physician or your medical team in the US that are under that same structure of primary care practice. If you are in other country, I cannot advise you, if you’re on Canada, that doesn’t apply to us. And in Europe, I’m not sure about the healthcare system there.

I titled this podcast Ozempic, the Conversation we need to have first. Let’s roll in the interview and hope this serves you well.

Dr. Natalie: Welcome to the show, Natalie.

Dr. Natalie: Thank you so much for having me, Stephanie.

Stephanie: I’m so grateful for you to be on the show today because we’re gonna talk about a hot topic around my podcast listener, my client, which is the medication call ozempic. So I’m gonna go right into it because I have so many questions and I want to start by first laying out the base, what it is, what it should be used for, what it should not be used for, and then we can get into more conversation around it. Is that good for you? Absolutely.

Stephanie: So what is Ozempic?

Dr. Natalie: Ozempic is a medication that is an injectable, so it’s something that you are injecting into a part of your body, a solution that’s in a pen. And it is indicated for people with diabetes as a way for them to help control their diabetes. It’s generic name is Semaglutide and it’s of a drug class that’s been used for a long time for treatment of diabetes.

Stephanie: Oh, long time.

Dr. Natalie: Yes. So the ozempic itself with the injectable form is newer, but using this type of drug class for diabetes is not a new thing.

Stephanie: Is it similar to what many people know as metformin? Is it the same class of medication?

Dr. Natalie: It’s different than Metformin and it works at a different, physiologic way. But metformin tends to be our first line for diabetes management. And then these medications like ozempic tend to be something that we add on or use for different indications depending on the patient.

Stephanie: Perfect. And so the reason why I am bringing this up on the podcast is because many people that are not diabetic have encountered ozempic, but not as a diabetic medicine, but instead as a weight loss tool or medication. Is that a use of ozempic as well for weight loss?

Dr. Natalie: So as of right now, specifically, Ozempic is diabetes. It has a effect of weight loss as well. We govie is a brand name of the same medicine as Ozempic, the same generic medication, different brand name. That is indicated for weight loss. But same drug, just different approvals right now between those two brand drugs.

Stephanie: But the same [effects], the, the same effects.

Dr. Natalie: It’s same effects, different dosing for each of them. So the amounts that you’re getting for Wego V versus Ozempic start at different levels, but the literally the same drug, just branded with different names and currently, one is diabetes and one of course also will treat diabetes, but has been branded as a weight loss medication.

Stephanie: Okay. I’m gonna come back to the conversation around marketing and pharmaceutical [Yes.] because I think that’s a one thing. But in most layman terms, how is a diabetic medication, I’m assuming was created for diabetes management create a weight loss result, [mm-hmm] in the most simple term.

Dr. Natalie: Yes. So, to break it down, when we eat, there are so many different hormones released in our body that go all over the body to have different effects, including going to your brain, so tell us about satiety or fullness. Going to your pancreas to affect insulin secretion. Going to your gut, your GI tract, to slow things down and affect the way that you process the food that you’re digesting. Those are just a few of the examples. It’s a very multifactorial, very intricate process when we eat and all those hormones that are excreted.

Dr. Natalie: When we take these medications like ozempic for diabetes, it’s affecting your pancreas and insulin secretion. So it can be helpful for the way your body responds to blood sugar. What’s other effects of this medication include slowing the way that food moves through your GI tract and affecting what your brain is signaling as full. So in a sense, you are feeling full off of very little food, and food really isn’t moving as quickly through your digestive system as it normally would without this medication.

Stephanie: Okay, so therefore this medication sends signal to your brain to say you’re full when you’re not really full. And the food stays longer in the digestive system, again, increasing feeling of fullness. Is that it?

Dr. Natalie: Correct. Yes. And it’s interesting because this has happened throughout ages with other medications. I think a great example is the medication wellbutrin. It’s an antidepressant, but then we also found that it can be really helpful with motivation and it can be a second line for A D H D and you know, la, la, la, la, la, there’s all these other things that it can do, and that’s science, right? We find different effects of medications that maybe weren’t what we were initially looking for, and that’s what appears to have happened with this medication ozempic, because now it’s showing to be on par in some people with bariatric surgery, these medications with their weight loss effect.

Stephanie: Okay, so let’s go back, while you take the medication, you mimic the signal to the brain that you’re full, the digestion moves slower, but if you stop taking the medication because you don’t have type two diabetes, therefore it’s not a long-term lifelong treatment, you’re taking it for weight loss. When you stop taking it, then you will go back to normal satiety signaling. [Correct.] I want everybody to be clear on that. This is a, the effect is only present while you take the medication.

Dr. Natalie: Right? So think back to what I think a lot of us are more comfortable with, knowing about and hearing about, bariatric surgery. It’s been around for a long time, okay, also known as weight loss surgery. And there’s different ways to do weight loss surgery, but in the end, how can we make it so that less food makes it feel fuller? [Mm-hmm.] Right? [Mm-hmm.] It is a lot of what that is mechanically. And this is doing that in a sense, but [yes] with bariatric surgery, you eat more than what that, you know, mechanical pouch can hold. You’re gonna get stretching of it, you’re gonna be able to eat more again and more, or you might get sick from it. With these medications, we take away the effect that we’re giving with the medication, we’re going to go back to what our body was doing before. It may not be to the full extent of weight regain, for example, as you had loss, but it can be close. And a lot of times with these meds, we do counsel patients, you might be on this forever. It’s possible that you will be on this forever if this is something you wanna sustain as an achievable, you know, outcome.

Stephanie: Got it. So what you’re saying is, let’s say the patient wants to have a zenix for weight loss and they wanna be sure to maintain the weight loss, they would have to take a Zix, quote unquote, for the rest of their life. In the same way we think of diet. if you lose weight with a diet, you’re gonna have to be on the diet for the rest of your life. [Yes.] Same pH is there side effect. Now I’m sure there is side effect, but in the case of diabetes, the side effect are less than the long term benefit for diabetes patients. But what about weight loss people?

Dr. Natalie: That’s a great point, right? Because yeah, for that category of diabetics who, who very well should have access to this med as an option, [yeah] the benefits of controlled diabetes are high. When we’re just talking about our patients with weight loss, it desire, it’s possible that the risks outweigh the benefits for some people. And again, this is such a personal choice, right? In our country, we have this obsession with, if only we could get everyone thin, then all would be well, right? So like, here’s yet another tool or way that diet culture can help you get there. This med is not without risk. This is not like, I’m gonna restrict calories for a few weeks. This is, I’m gonna take a medication that I inject long-term for weight loss. So it’s something that needs to be taken very seriously. I’d say the most common side effects that I see in clinical practice and that are reported in the clinical trials are nausea, very decreased appetite, almost to the point of discussed around eating at times, like lack of desire and you have to force yourself to eat, in some people. Constipation, you see thatslowing of the GI tract. It’s, it can be uncomfortable. And those are the main ones that are most commonly talked about are very much gi, gastrointestinal issues. There has been discussion about pancreatitis. It’s questionable if that’s really something that we can put a stamp on yet. Again, this, these are new uses. We’re gonna have to have years of data before we can see that. And then there also is discussion about people with histories of thyroid cancer not taking this medication or strong family histories of thyroid cancer not using meds like Ozempic. And that also is, that’s on the box kind of warnings, but again, it’s gonna take time for us to collect that kind of data.

Stephanie: So I want people to understand, because in my brain it’s evident, but I want people that are not in the science world to understand this drug was tested for diabetic patient with type two diabetes, I wanna be clear on that, type two diabetes. It was not tested for weight loss in a patient that doesn’t present diabetes. Is that what I’m hearing?

Dr. Natalie: Yeah, that’s, we don’t have great evidence for it just being a weight loss med. Wego V is indicated for that and has trials out there and papers that are out there on that, but,there’s so much to, T B D, right, [Yes] like to be determined. Because just like with every weight loss thing we’ve got in this world, things work in the short term. You know? [They work until they don’t work.] Exactly. They work until they don’t work. Look back at Fen F. Look at all of the diet meds that have been out there over time that in the end we’re looking back like, oh, crap, you know, maybe,

Stephanie: did we do that

Dr. Natalie: Right. And I’m not saying that that’s gonna be the case with Ozempic. We go the, even the newest one, Manjaro, like, I’m not saying that’s gonna be the case here. These truly, if you are practicing medicine and helping people with their desire to lose weight, this is the best option we have right now, the most [at this point], correct. At this point, this is the most effective medication option that we have.

Stephanie: Because when we think about Fen, that is, I’m assuming, is no longer prescribable, correct? That’s been taken off the market because of the side effect?

Dr. Natalie: Yes. Because of the cardiovascular effects, yes.

Stephanie: And that’s, when you say it’s the most valuable offer for weight loss, [yes] it’s because there’s not a lot of choice out there for medication because as soon as we find one, we find side effect and we pull it out. People have to be clear about that.

Dr. Natalie: Yes. And there are other medications that are out there, oral type medications for weight loss that are effective. But again, we’re not talking substantial weight loss. Right. We’re not talking to the degree of these injectable meds. And there are some people who desire that amount of weight loss. And so if we’re going to help our patients with shared decision making, we’ve gotta show them the different options that are out there.

Stephanie: So one of the question that some of my clients and listener have asked is, knowing that this medication was created for type two diabetes, very little research on weight loss, how can physician doctor ethically prescribe this drug for people not knowing of the result and not knowing about the weight loss side effect of it.

Dr. Natalie: Mm-hmm. The fact is, it’s F D A approved right now through the brand name Wego V to be a weight loss drug. So first of all,We know it’s working. If not, you know, let’s define what short term is versus long term. Right. We know it’s working from the data and the clinical trials that we have now, and it’s approved to be that. So it’s not even off label with something like W Wbi. With Ozempic, technically until it’s approved also for weight loss, we are prescribing it technically off-label, you could argue. Even though it’s the same exact medication as webi, like let’s remind ourselves again, it’s the same med at a lower dose than Webi, and I will say it’s working. I see it in patients all the time. The weight loss is very clear. The side effects are there though. And what are we gonna do in the long term with this? Are we gonna stay on it forever? And that’s a tough conversation to have with patients because honestly, there’s very, very few meds I can think of that I would be comfortable with prescribing forever.

Stephanie: For life, lifetime.

Dr. Natalie: Exactly. I mean, think about the population that is starting these meds. It is people probably thirties to fifties, [Yes] maybe, who have theoretically another 30 plus years to live. And so we’re committing someone to long-term medication use, with, which in itself is not without risk. It’s not just the side effects. There’s the cost. There’s the fact of being on a med and medication burden and potential for interaction with other medications and on and on and on.

Stephanie: Just so that you can maintain the amount of loss of weight you’ve lost during the first few weeks and months of taking the medication, [correct] then the weight loss all, and then you have to maintain the medication if you wanna maintain the weight loss. [Correct.] Is that something that the physician have to outline clearly to the patients?

Dr. Natalie: I believe. So it’s our job to do no harm. We’ve gotta have that very clear decision and discussion with a patient, you know? I think that just to say, we’ll have you tried Ozempic, you should try it, is not enough. There’s gotta be a big conversation and arguably multiple conversations, about all of the different options. And another thing that we aren’t touching on here is the counseling around everything other than medications when it comes to weight.

Dr. Natalie: And it’s interesting when I talk to my patients who have gone through counseling prior to weight loss surgery, bariatric surgery, and whether they went through it or not, but they tell me about some of the counseling, and there’s mandatory counseling you have to go through. And they’ve, the resounding information I’ve heard from them is like, it didn’t really tackle my underlying issues. So then I got the surgery and then I was still having those issues, you know, my disordered eating, my body image disorder, et cetera. It’s the same thing with these meds. I mean, we’re about to enter a medication that might drastically reduce your weight. It is going to significantly impact your relationship with food because now we’re gonna have to force you to eat. Like you have to force people to eat and get the amount of nutrition that they need to not have, you know, nutrient deficiencies in this case. So, hey, we’re gonna mess with your relationship with food a little bit more. So I think that there needs to be discussions around that, not just around medication side effects.

Stephanie: Is there, I mean, that’s my world. What you just outlined is my world, right? Dealing with the real problem. So I’m in it [mm-hmm] a hundred percent of the time I took myself out of clinical practice to be just in that world. [Mm-hmm.] But is that the world you live in, where people are counseled at that level?

Dr. Natalie: I, I don’t know what it’s like in every other clinic. I’m gonna be honest with you. [Yeah] I, if I had to venture a guess, when you only have seven to 15 minutes with a patient in primary care and have a ton of other things to cover, I would guess it’s challenging. One so time. Two, even if you were to see a specialist in these specialty settings, like for example, there are clinics that are straight up weight loss clinics within some of these big health systems. I don’t know what the counseling is like. I’m, I’m assuming it’s great. I’m hoping it’s great, right? [Mm-hmm.]But time is always an issue and so is education around these medications. So if you’re gonna be prescribing them, you’ve gotta know how to have that conversation and not every primary care doc might have gone through the, you know, reading, training, understanding of it to comfortably have it.

Stephanie: How do you address it in your clinic?

Dr. Natalie: So I have an interesting setup. [please] I have a direct primary care practice. So in my practice, my patients pay a monthly membership and have full access to me. So they have hour long visits if they need it. We have multiple touchpoints. And it’s not like concierge medicine, so it’s not exorbitantly expensive. It’s a, I see every walk of life. I see every body, everybody who comes in is welcome here. Different socioeconomic statuses, different backgrounds in general, different neighborhoods, communities. Therefore every conversation has to be tailored to that person. And so I take the time to have those conversations and a lot of time we touch on disordered eating behaviors that they never had a name for before. They never really were given the opportunity to feel comfortable talking about some of their relationships with their body image. And it’s interesting when you start to have these conversations, it’s like, man, we gotta tackle those first. You know, we’ve gotta tackle those things. However, I always try to be cognizant of an empathetic cord. If you have looked in the mirror for 20 years and hated what you saw, that is huge. [Yes.] That is deep and we cannot discount that and we cannot belittle that down to like, then let’s get rid of that problem now by talking about all of your history and your relationship, you know, relationships with food and six months of therapy. Like some people really want something that’s gonna help them now. So it’s a, it really is such a tailored individual discussion.

Stephanie: So your formulation of your practice, I’m Canadian, so we have social healthcare, we have people from Europe, we have people from the state. It doesn’t seem to be as problematic for my client unless they’re in the state, then state medication and medical care is a big puddle. So your formulation of your practice, is that something that can be accessed in any city around the us, you just have to look for it?

Dr. Natalie: Pretty much. So we, direct primary care movement, which operates outside of the insurance system. So like I don’t bill insurance, therefore I have control over what I’m doing with my patients. It is happening across the country, across the United States. So you just, if you just look up direct primary care in my city, you can likely find a practice

Stephanie: Direct primary care. I’m gonna put that in the show notes.

Dr. Natalie: Yeah. It’s harder in rural settings, just because rural health access is challenging. But honestly direct primary care thrives in rural settings too. So I wouldn’t, you know, even discount those in rural areas to, to look it up.

Stephanie: Because that’s widely different from when I have to coach client that go into doctor’s visit, like this is not the kind of visit they’re getting with their physician or their medical team. They’re getting five, 10 minutes of consultation and it’s all about losing the weight. So I sent you a reel of one of our client. I sent you, like people walk into their doctor’s office and the first thing on the list is how we’re gonna help you lose weight.

Dr. Natalie: Correct. Think about a general primary care clinic and how huge it is and all of the bells and whistles and how everyone’s behind. It’s like you’re always late, you’re always running behind. It’s a nightmare. It’s challenging to work in that and you get hustled in, you get your vital signs taken immediately, and one of those things is always the weight. And in my practice, like I’m the one greeting them when they walk in the door and they aren’t waiting and we walk them back to my consultation room and sit on a couch and talk. I don’t weigh my patients most of the time. If I’m planning to, I ask them first. And so it’s a very different vibe where all of a sudden the front and center is not your weight, it’s all of the other things.

Stephanie: So what I’m hearing is that it’s possible to practice medicine in the United States without centering weight. [Correct.] Huh. Interesting. Because my clients are being told they don’t have a choice. They, the doctor have to center the weight as they’re protocol or process to help them, which is not true.

Dr. Natalie: So when you operate outside of the insurance-based model, [yes,] you are not having to bill insurance. If you have to bill insurance, you are going to be talking about weight a lot of the time and trying to treat it with some kind of medication if possible, because it’s hard to get appropriately paid for lifestyle medicine counseling. It’s hard to, bill without putting diagnoses down. And, you and I talked about this word, obesity and [yes, that is a diagnosis, that is a medical diagnosis that you can bill for. So like, boom, right there, I can bill for that. And so all of a sudden we’re just, we’re trying to bill for things, we’re trying to do things that are gonna get the clinic paid, because that’s what the higher ups are pushing you to do. And oh, by the way, doing lifestyle counseling, it takes a lot of time. So if you don’t have that kind of time, it’s really hard to get someone to wanna invest the time to learn it, to be able to do it right, if it’s not gonna like realistically be part of your practice in a general insurance-based primary care setting.

Stephanie: I wanna get into the business side of this because we kind of put aside the marketing of Ozempic and Vigo V, but people have to understand medication in the United States is a business, the same way medical care is a business. So they’re taking the same drug ozempic, they’re slapping a new label on it, and now that becomes a weight loss drug, which was in the first case, a diabetes drug. So that, because they know if they put weight loss on it, it’s gonna sell more and then it’s gonna be prescribable. So now it gets into the medical care, like there’s a whole business behind weight loss and physical care.

Stephanie: Am I correct?

Dr. Natalie: Absolutely. You can’t ignore that at all. There’s a whole business around it and I, the side of me that loves practicing medicine so much and believes in humanity, wants to think that there is more to it than that. That there are people out there making medications to hopefully help people, you know, but I start to get itchy when I, when, you know, the big craze around this ozempic situation has been all of these celebrities, you know, in this like whole push in Hollywood of people being like, I wanna lose not that much weight in the scheme of things. You know, when we look at the rest of our country and the majority of people being at a size that is higher than what we consider normal weight, quote unquote, normal weight, right?

Dr. Natalie: These people are what would be called small fat. Right. [Yeah.] Right. Like, like not [very small fat], exactly. And they’re taking these meds.

Stephanie: Well, and that was one of the question that I had was how does a, as a doctor, you deal with Influencer and Kim Kardashian being behind this ozempic to fit an address at the Met Gala. How does that impact you and how do you deal with that in your practice?

Dr. Natalie: It’s a lot of breaking the news to people that there’s more behind it, you know, than what we see on TikTok. Just trying to tell them like, this is why they are called influencers because they’re influencing things that a lot of times they don’t know anything about, but they’ve got the money to do it. And think about all the other things that go around managing somebody’s weight, personal trainers, access to fresh food that’s cooked for you, access to all of the other things that help your mental health, including therapy and acupuncture. The list of things when you have money is endless to keep your body the way it quote unquote should look. What’s, [a full-time job] it’s a full-time job. It’s a full-time setup and system. And oh, by the way, for those of you who are working two jobs, good luck. You know, for those of you who are just trying to make ends meet, like probably not gonna happen.

Dr. Natalie: It’s really the gap here in our society is so big and when that’s who you’re seeing on TikTok is those people who have all those resources and they’re like, it’s just the ozempic, that’s a load of crap, frankly. And that’s what I tell my patients because I’m not gonna sugar coat it for them, and I’m not gonna prescribe something just because they saw it on TikTok and think that it’s gonna help. We’re gonna have a full-blown conversation about this.

Stephanie: So another question that was submitted to me that goes into the line of that is Weight Watcher. Weight Watcher has bought a telehealth company that is connecting Doctor, and I’m assuming in an attempt to lose weight, and prescribing Weight Watcher as a way to lose weight. Has that hit you yet? And, and how are we proceeding with that from your perspective?

Dr. Natalie: I think this is being done in so many different settings. I mean, we saw it with a D H D. Like some of the, especially with the pandemic, when things, you know, we had limited access to mental health, a drastic need for it. We saw a big emergence of telehealth, psychiatric companies that then could just prescribe meds over a computer. And we’re seeing this with weight loss in a bunch of different companies. So Weight Watchers, which is now WW by the way,

Stephanie: Yes, wellness that works, I think it’s called.

Dr. Natalie: Yeah. So, it’s not shocking,that they’re bringing this into things and I wouldn’t be surprised if medications are being prescribed along with these WW plans.

Stephanie: Well that’s what these, the person said, there’s also a medication soon that will come out, or weight watcher bot share in a company.

Dr. Natalie: Why not? I mean, it’s the wild, wild west. Really? Why not? I’m not surprised by that. And again, it’s all back to, we’ve gotta get your body looking like we want it to as a society. That is the ultimate goal. We cannot put in the time to make things more accessible to people of different body sizes. Why would we do that? Right? Like, that’s the thought here. It’s like, we just are gonna keep coming up with ways to get you smaller instead of addressing the underlying actual societal, cultural, socioeconomic issues that are at hand.

Stephanie: Yeah, because adapting life to fit all bodies is this expense and selling weight loss as a revenue. Like I’m from the corporate world, so that’s a clear reason why, like expense versus revenue. We live in a cap society, we’re gonna pick revenue.

Dr. Natalie: We’re gonna pick revenue and can I bring something else up that, that has been really remarkable for me as a physician and I’m a young physician, right? I’m not super far out from training. I’ve been in practice long enough now that I have an established practice and, have learned a lot but I’m an, I’m an ever learner as we always should be. And something that has been challenging for me in the best way possible for my journey as a doctor thus far is challenging my weight bias and challenging weight stigma in healthcare. And when you said that changing things is an expense, it’s not only a money expense, but it is a, now I’ve gotta sit and think about this. Now, I, as a physician, need to think about how I treat patients. And, I’ve had this conversation before. I, I had it on a podcast with Dr. Maggie Lambda, which was, we both had gone through a transformation of that, where we all of a sudden said, Man, all I’ve learned is kind of going out the window now, and how I’ve approached patients, I look back and I’m thinking, it’s not that I was blatantly being disrespectful, rude, hateful, ever. It was, I didn’t know any better that the things I was prescribing and recommending were not enough and they weren’t through a lens that was gonna actually help my patients.

Stephanie: They were through the lens, I always say that they were through the lens of our training. My training was extremely fat phobic, right? All I learned is to prescribe calories and macros. I never learned a concept of eating Q and I’m a freaking nutritionist. Like think about that. Three years of post-graduate where, and never one time did we talk about eating cues. [Wow.] Like, so, it’s not quote unquote your fault, it’s the lands of your training.

Stephanie: Let’s ask this question. I asked this question to Maggie on the podcast, but I’d love to hear your perspective. For a patient that goes into a doctor that wants to weigh them, that wants to tell them to lose weight, what could they say? What is the best way of approaching that fat phobic doctor who doesn’t know any better.

Dr. Natalie: One question you can ask is, how would you treat somebody who is of a, a thinner weight, a smaller weight? So what would the prescription be for them? That would be an interesting answer. I’m sure and also you can advocate for yourself. It’s hard, I would imagine it is challenging, but can you say, I don’t wanna be weighed today. Period.

Stephanie: Yeah. You have the right not to be right. You have the right for anybody. Like it’s a right. You’re not forced to go on the scale, but you have to have the emotional courage [yes] to stand for yourself. You shouldn’t have to, but you have to.

Dr. Natalie: Yeah. And all the emotional courage it took you to even show up in the doctor’s office in the first place may have been just about enough, you know? And you’re kind of tapped out at that point.

Stephanie: And that’s the many of the question came in is, Doctor prescribing or suggesting ozempic and people being at their with him and thinking they have to take the ozempic medicine to comply with their doctor so that they can get the care that they want for the other issue they have. [Sure.] That’s a pretty sad situation.

Dr. Natalie: It’s a very sad situation, I would imagine. It’s not, out of the realm of possibility.

Stephanie: Well, specifically for my audience, which is women 35 to 55, that have dieted most of their life. So there’s a lot of weight conversation because they’ve stopped dieting, they’ve gained the weight back, and now everything is centered around the weight.

Dr. Natalie: Mm-hmm. And it’s interesting because I talk about this a lot on my social media is, we go by b m I, you know, we’re, we just love B m I and healthcare as a way that we can stratify people and identify people who are at risk for certain conditions. And when we go by that we are missing a big part of the population that need to be screened for issues that could come up. I always think about how, as somebody who struggled with disordered eating for most of my life at this point, I never was screened for that. Are you kidding me? Because I was an athletic thin white female. Why would anybody think that any could, anything could be wrong? I’m conforming to exactly how I should look. So how could I possibly have disordered eating that was tearing away in my mental health and could have potentially gotten worse. And so we’re missing that population talking about these things.

Stephanie: And even if you are like, I am in the range of B M I that’s supposedly very dangerous for my health, to all the other metrics, I am like in the top tier, right? But the only thing, if I let my physician do what she wants to do, that’s the only thing, we’re, we’re gonna disregard everything why I class on like the top percentile and we’re just gonna focus on this. [Mm-hmm. Oh yeah.] That’s fat phobia at play, [it is] everybody.

Dr. Natalie: It’s, it’s fat phobia and or complete ignorance to the other factors that are important to someone’s health and what is considered healthy. Right? It’s not just the body shape that you have. It’s not just the weight on a scale. It’s, are you able to get down and play with your kids? Are you able to carry around groceries, from your car to your house without feeling winded, painful joints. How is your cholesterol panel, what’s your a o b? What’s your, H S C R P, like all these labs? What’s your glucose like? Let’s, let’s get a little bit broader here on our definition of one’s health. And I think that people would find it fascinating to then see how many people that are considered fat are exercising very regularly and kind of killing it and very much engaged in their life and comfortable. And how many people have significant disordered eating behavior that are not fat, and we’re not even talking to them about this, right?

Stephanie: So it is, I know that from my lived experience, but I want to hear it from you and help women get that message reinforced. It’s possible to have the conversation about your help with your physician in a fat body and not make it about the weight. There’s plenty of other things we can talk about and assess your health on beyond the weight.

Dr. Natalie: Yes. I think one interesting thing would be, before you go into a doctor’s visit, is writing down your activities of daily living and how does your body, whatever it looks like, play into that. Do you find that you are comfortable? Do you find that you’re doing the things that you love to do and feeling well with that? And just to say to somebody, listen, you’re talking about my weight, I’m doing fine. Like, I’m doing well, so can we stop talking about my weight and start talking about these other things that I wanna discuss, and these other things that I think should be reviewed and kept an eye on.

Stephanie: Well, and then specifically again, for my niche, the whole perimenopause and menopause and all the side effects. That comes along with that, but that gets brushed away [yes] to make room for the wait conversation, unfortunately. But you can, as a patient, redirect the conversation to where you want it to be.

Dr. Natalie: And I think there will be, if somebody hears what we have just said, [yeah] they might say, why isn’t my responsibility to do that? The doctor should do that. And I, I hear you. And so another route, if you’re not comfortable with the redirecting or you think it’s not, your problem to do it, it’s not your thing to have to do, finding in your community a doctor who is comfortable with health at every size. And finding a resource through the grapevine word of mouth is a powerful thing. And people talk about healthcare settings where they feel safe. And so asking around about that is absolutely okay as well.

Stephanie: I wanna come to a NA of the conversation. We’re gonna close back on this whole ozempic and wait, I think we make the case that health is possible beyond the weight and how to manage our conversation with our medical team on this Ozempic Vigo V, which people will hear about shortly, I’m sure, through advertisement in the us, what would be your parting word for somebody who hears about that and think, oh, maybe that’s the solution to my weight issue.

Dr. Natalie: I would recommend having an educated conversation with a healthcare professional whom you trust and talking about all of the options that are out there medication wise, outside of just these two specific or three now that are out there, medications. And having a discussion even with a mental health professional about your relationship with food, about your relationship with your body, because regardless of taking these medications, that is something that’s gonna need to be addressed most likely, and the medications are not going to fix those issues. So having a trusted physician, having a trusted dietician, a trusted mental health professional in your court will give you a better chance of long-term success regardless of what medication you do or do not choose to take.

Stephanie: That’s brilliant. Thank you very much Dr. Natalie for having had this very good conversation with us and helping forming ideas and brains of people and then they can take the next step, more educated from a neutral perspective instead of an engage on either side perspective.

Dr. Natalie: Thank you.

Dr. Natalie: