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Welcome back everybody. Today I wanted to talk about weight loss and motivation because I feel it's a critical component that many weight loss programs don't address. And specifically the mindfulness aspect of weight loss is very, very important.
Many times when patients present to my office, I'll ask them, well, why do you want to lose weight? And there are kind of two camps. The first one is they want to improve their overall health. That's their main focus. And they'll say like, well, I want to lose some weight to maybe get off some of my medications and possibly reverse some of my chronic diseases.
I'll usually go, okay, that sounds really great. And then they'll also say, I just generally want to be happier. And at that point, I'll have to take a second with them and talk about, well, weight loss may not exactly make you happier. There are many things in life that make people happy. And weight loss could be one of them, or you may find that after you lose 20, 30 pounds,
that you are still unhappy and that's a realistic possibility. And then I'll say, what do you think is motivating you? In other words, are there certain very high factors that you can say, okay, this is why I'm doing this for sure. If they can articulate this pretty well, then I'll help them
to transition to the next part, which is actually writing these things down. I'll have them go and open up the journal and write down in explicit detail why they actually want to lose weight. So I'll ask them to describe the why's they wanna lose weight, but also how they will feel afterwards. Maybe will their clothes change? Will they be a different person? How will this new person
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look different in very big detail down to like, you know, this person is gonna eat and eat fresh smoothies every morning, you know, for the rest of their life. Or this person is going to choose smaller portions when they go out to a restaurant. So I kind of ask them to picture themselves as a healthier version and write this down in crystal clear detail.
I also explained to them that this first writing down part is very significant in creating their own mindset for weight loss. So many times programs for weight loss will not address this initial mindset, which usually can occur either you can do it through journaling or discussing maybe with your doctor if you have enough visits with them.
but also with other parts of the weight loss community, including a dietician, as well as a counselor, and as well as a mindfulness -based practitioner, because you can also do mindfulness -based eating, and that also improves weight loss outcomes. And even just a single motivational interview,
can actually help people lose weight. So there's a really good study done in Japan by a professor Nakata. And this was a randomized controlled trial with 145 participants and they look for body weight change. And this was an adult's age 40 to 64 with BMI 25 to 40 and a metabolic syndrome component. Now this was
a single motivational lecture on PowerPoint slides and they actually list the slides they use in the study, which is why I think it's so great. They also do the population 40 to 64, which in that population, it's a lot more difficult for weight loss to occur because one, they may have other responsibilities at that age and they have a slower metabolism as they get older.
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partly due to loss of muscle mass. What they found was a single motivational lecture led to a 1 .83 kilogram greater weight loss compared to no intervention. And to know how many pounds they lost, you just multiply that by 2 .2. Interestingly, this was done across three months. And besides the motivational lecture, there was no other lectures or textbooks provided.
Now obviously one drawback of this study is that it is so short and the sample size is somewhat small of 145 people. But I think this can be looked at as a single piece of the weight loss journey where the physician may even lead one motivational lecture and then they get handed off to a dietician or maybe a counselor.
and where they can have repeated visits, because we know that repeated visits lead to more sustained weight loss over the following years and months. Now, another important part to weight loss is discovering the forces that work against you. So in general, there are four main forces.
There's your own kind of relationship with food and habits you've established with it. There's the hormonal driving forces. And then there is the cultural driving forces. For instance, you go out to eat and you eat some chicken and guess what? You pair wine with that of the white wine variety. And so now you just add it on 300, 200, 300 calories in liquid form. The last one is
social economic. So understanding the social determinants of health play a really big part in weight loss as well. Hey, just a quick message. If you live in Michigan, I'd like to offer you help beyond this podcast. In my clinic, I use a coach -based approach instead of the typical overbearing one to discuss evidence -based up -to -date nutrition, weight loss strategies, and helpful medications.
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you also get all of the advantages of direct primary care, which includes the ability to text or video chat with me, an hour long appointment, same or next day availability, as well as having someone in your corner to help you through difficult times. If you'd like to learn more, you can go to www .mycarerocks .com. Now back to the show. In order to understand your own connections,
with food, it may be important to look at how you were brought up by your caretakers. So if you had caretakers that always said, hey, you need to finish your plate, right? And I remember this as a kid, I remember my own grandma would tell me this. And the problem with that is not listening to your own body's response to eating food. And so you may eat past the point of being full.
and now you've been regulated to that point. So you may feel it's necessary, maybe on like Thanksgiving or Christmas dinner or comparatively that you now have to have the feeling of being over full, which means that you've ate really well and you ate something that was really good. And so instead of just having a single portion of it, you go back for seconds and thirds.
Now there are overeating triggers like social activities, emotional states, and availability of unhealthy food that also have to be managed through certain self -regulation strategies. Personally, I think the mind -body connection really needs to be taught in school. And there are many mindfulness programs which have been developed. And interestingly, there is a program called Mind Up.
And I think it's by Goldie Hawn, which is a famous actress when I was growing up. And she, her program actually teaches kids and adolescents how to make this connection. And if you think about it, the more you can sense your body changing, the more you can take action to drive that change in the direction that you want.
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Now there are hormones that you also fight against during weight loss and these include things like thyroid hormones, appetite related hormones like Grailin, Leptin, GLP -1, as well as testosterone and glucocorticoids. So I think one of the major revelations we've had in medicine is the GLP -1 agonist, which help control our appetite. And
This is really important because this is probably one of the hardest things to overcome, especially if you become slightly more stressed. And this in turn raises your glucocorticoids and causes you to become hungrier. So one of the other things I talk about with my patients is if you are significantly stressed right now, like let's say you're going through a divorce, you may not have the weight changes that you
have set out to accomplish. So in that instance, what will happen is you may be stressed and you'll fail at reaching your goals. So then you become even more stressed and it becomes kind of a cycle that is hard to escape. So I may say in the beginning, are you going through any stressful changes in your life? And if they say, no, I'm doing good and I kind of list out examples and they say no to those,
And I say, okay, I think it's a little bit more safe to proceed with trying to lose some weight. Then the next piece we'll discuss is the surrounding kind of culture and society, which includes things like the fast food restaurants that might be right down the road. So in this instance, this has been termed a food swamp.
where people are surrounded by these horrible fast food restaurants that allow them to consume large quantities of food that are high in calories. And I think this is a very good point to make that these foods in general, if you eat low enough calories, they may not be as harmful. However, it's very easy to eat large amounts of these foods.
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based on the calories because they may add things in like being fried. So in that instance, they're adding an oil which has a high calorie count. So instead of that, the other alternative is eating high volume foods like salads and fruits and vegetables that contain better nutrients and better ingredients than fast foods, but yet they are at a
higher volume, so the idea is that it takes up more space in the stomach and sometimes can take longer to digest. And we know from certain studies that if a food is high in fat, then it's less satiable, so you'll be hungry sooner than if you ate some food with less fat. So the things that work against, or that work for satiety that...
actually keep you fuller longer are things like fiber, water, and protein. So these three components play a big part in keeping you satiated longer. So if you're eating out in a food swamp, then these may not be present in sufficient quantities to keep you full, and then that's why you're snacking at night, along with stress. So people may be surrounded by these food swamps,
but yet at the same time live in what's called a food desert. And a food desert is where they don't have access to high quality nutritious foods like certain produce in a grocery store. And you may feel that there's a grocery store right down the street, but in many parts of the country, especially like in the Midwest, where there's large areas of land,
and very small towns, these types of food may not be present. And so it can be very difficult to get access to these foods. And so that's one part of the cultural aspect. Another part can be where, let's say you live in a city and I can remember this happening to me where people will go out and they will say, hey, come eat out with us. And...
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It's just a social gathering and in social gatherings, people can in general eat more. So if they have some type of mindfulness training, they can recognize that this is happening and kind of put a stop to it for themselves. And also people will say, hey, let's go out to the bar and drink where you can drink a thousand calories within an hour without even missing a beat.
So recognizing that these influences are present is another part and another thing that I ask my patients to write down.
And so these are cultural and sociological things that you can be on the lookout for. The other thing is social determinants of health. And a big part of this is the economic factor. So you're not going to ask someone who makes hardly any money at all to always go and eat fresh produce because the produce may be
a lot more expensive than it is just to get it in the can where they can keep it there. Maybe they don't have transportation to the store as well. So they can't always go to the store every week and get these fresh produce foods that have now expired in their home. So asking them, hey, do you have transportation? And if they say, not really, sometimes I take the bus, well then you may switch to a
canned goods kind of approach, as well as say frozen vegetables that they can keep in the freezer. And so them knowing these alternatives because they're maybe bombarded with the fact that they just, people want to eat organic all the time, which is more expensive and they simply can't, they may feel like they're a failure. And again, this just adds to their stress.
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And of course, as always, if they don't have access to food, you can refer them to like a food bank or something like that, which is what I do. usually refer them to a food bank if they can get there. So recognizing these different forces, which is personal relationship with food, as well as hormonal changes, as well as society and culture, as well as the social determinants of health, all four of these play
really huge role in how people are able to lose weight. And I think that really having them write these things down and then come back with this understanding that, these are the forces that are fighting against my why, can really help them and motivate them to, one, make change, but also to recognize when these forces arise,
so that they themselves can make decisions around them. Now, if you remember at the beginning, I said there were two camps. One is the person who has never really been introduced to nutrition or exercise, and they're trying to improve their overall health and maybe come off their medications. The second person is somebody who has probably already gone through this journey and is now looking for a physical.
fitness routine that may be a lot more strenuous and they're trying to maybe cut weight because they're trying to either compete or just get back down to a weight where they were, and many of them mentioned this to me, in high school. So the first camp has no knowledge of nutrition, exercise, sleep, all the other things of lifestyle medicine, but the second one,
has some knowledge of this, but is looking for advanced understanding. And so for that one, I'm gonna leave a second part to this talk because I think it's really just a complete other camp that requires a really big different approach. And they seem to have a lot more motivation to get to where they want.
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and they're looking more for the scientific kind of evidence and tools that will actually get them there. So I really hope that this podcast was helpful for those trying to lose weight as well as those people helping people to lose weight. And if you'd like to check me out, my website is www .mycarerocks .com and I'm a family physician located in Clinton Township.
Michigan and I wish everybody good luck on their weight loss journey if you're going through it right now and as always have a happy and healthy day. Thank you so much for tuning in. Please note that Clear Health Podcast is for general informational purposes only and does not constitute the practice of medicine, nursing or other professional healthcare services including the giving of medical advice.
and no doctor -patient relationship is formed. The use of information on this podcast or materials linked from this podcast is at the user's own risk. The content of this podcast is not intended to be a substitute for professional medical advice, diagnosis, or treatment. Users should not disregard a delay in obtaining medical advice for any medical condition they may have and should seek the assistance of their healthcare professionals for any such condition.