Back

EP 24 Obesity Is a Chronic Disease, Part 1

According to the Center for Disease Control and Prevention, obesity affects an estimated 41.9% of adults in the United States. In fact, obesity-related conditions are among the leading causes of preventable, premature death. Obesity is not a condition. It is a complex disease that requires more attention and less stigma. https://www.cdc.gov/obesity/data/adult.html

 

On this first episode of our two-part series, Patty Post of Checkable Health chatted with Physician's Assistant Cody Baxter to share his experience treating obese patients at a family medical clinic. While working with adults, PA Baxter found patterns that harm their progress, including sleeping behaviors and mental health issues. Read more about Cody here: https://www.essentiahealth.org/find-doctor-provider/profile/cody-baxter/

 

"As the saying goes, 'you can't outrun the fork,' and obesity is a chronic disease that cannot be treated with a simple diet or exercise," said Baxter. That is why it is so important to address each patient's needs individually and look at their lifestyle and medical history to help them craft a plan for long-term success. This Checkable Health podcast is a must-listen for everyone, as obesity affects many lives in the US. Tune in to get actionable advice on starting a weight loss journey that will change your life or someone close to you. https://checkablehealth.com/blogs/podcasts/tagged/checkable-health-podcast

 

Topics discussed in this episode:

- Cody Baxter shares how he started his specialty in weight loss management

- How Cody processes new patients to come up with a plan

- Chronic vs. acute obesity

- What factors contributes to obesity

- Sleep hygiene and what it means

- Does Cody recommend taking melatonin for sleep?

- Defining obesity

- The interconnectivity of obesity and mental health

- Cody’s strategy to treat obesity in patients

- Exercise and weight loss

- Recommendations for those without access to a weight loss practitioner Check out our other podcasts selection for valuable info on health, wellness, and more.

 

Connect with Checkable Health:

https://www.facebook.com/CheckableHealth/ https://www.instagram.com/checkablehealth/ https://www.linkedin.com/company/64519751/admin/

 

Connect with Patty Post:

https://www.linkedin.com/in/patty-post/

 

Checkable Health is revolutionizing healthcare with fast and accurate at-home test kits, telehealth services, and a line of wellness supplements designed to keep you feeling your best while saving valuable time and money.

 

At the forefront of home healthcare, Checkable is developing the first FDA-approved https://www.testforstrep.com/. Paired with a proprietary digital telemedicine platform to instantly connect consumers with healthcare professionals, you can skip the doctor's office and start treatment fast, right from the comforts of your home.

 

Along with the at-home strep test, Checkable offers an array of wellness supplements and a multitude of resources, including podcasts and blogs, to help keep consumers in the know about different aspects of their health from top to bottom. And with more home tests coming soon, Checkable puts treatment options at your fingertips, so you can focus on getting better. Visit https://checkablehealth.com/ for more info.

 

Transcript:

 

0:00:04.7 S1: Welcome to the check-able health podcast. We're helping every day mom's rethink how their healthcare begins at home. This podcast is for moms of school age children who are born in the 1900s and would buy an at-home strep test to check their child's Storer symptoms from the conference of home. Hi, I'm your host, Patty post. I'm founder and CEO of Check-able health. I'm a mother to two amazing sons that are teenagers and a daughter who's between... I've been married to my husband, Andrew for nearly 20 years, and we live in Fargo, North Dakota. I believe that we all should be empowered to make healthcare decisions from home, this podcast with my hope will equip you to do just that, make better healthcare decisions for yourself and your family. Today, my guest is Cody Baxter, he's a physician's assistant, and he specializes in a weight loss management. We're gonna talk about obesity and how obesity affects all of us, two out of three Americans are considered obese. And how can we change that number, why is that number increasing as our access to healthy foods or access to... Gyms is actually better than it was 15 years ago.

 

0:01:30.0 S1: Why is the obesity rate gone from 46% in 1980 to 14% in 2019 worldwide? It's actually tripled since 1975. What code talks about is really the underlying things behind the why that makes us gain weight, that makes us editor, that really are things that we should be aware of that we can change in order to change our lifestyle and be healthier, because after all, obesity is a chronic disease, and you do not have to suffer silently, you can do something. You probably have someone in your family who battles with chronic obesity or maybe you do too, and the lifestyle modifications such as quitting drinking, Diet Coke, well, you don't have to start with quitting, maybe it's... Bring it back by four cans versus eight cans, maybe it's taking a walk a couple of times a day when you're at the office, we're gonna talk about some of these things with Cody and how he develops relationships with his patients, and he allows them the freedom to make their decisions, change their lifestyle, but then holds them accountable as well, how you get a lot out of this interview, we did break it into two...

 

0:02:52.7 S1: The second episode, we will be talking about different ways that you can help with your chronic obesity, and that is through the use of medication, and we're also gonna talk about things like how do we talk about our bodies with our kids, how do we talk about losing weight when we're around those that we love, hope you get a lot out of this episode. Cody Baxter is a fantastic clinician, and he happens to be the husband to our fantastic graphic designer, TOLA Baxter, so this was really an honor for me to meet him, I hope to bring him back because he really is a wealth of knowledge, so I hope you get a lot of out of this... And let's get into the episode. Cody, thank you so much for joining me today.

 

0:03:40.5 S2: Thank you so much for having me. I'm excited to talk about this topic.

 

0:03:44.4 S1: So I always kind of mess up the introduction because there's so much to say when it comes, especially with this topic when you have a medical background, so would you please share with the audience

 

0:03:55.2 S2: Well, your specialty is, and what types of patients you work with and what you do every day to get the disclosure part out of the way, this... Anything that I talk about today doesn't represent my employer specifically And hire my own use and opinions, of course, and none of this is to be considered medical advice, of course, but strictly my opinion in my perspectives. So I work in a family medicine practice and started as a primary care provider four years ago, my first job, Product School, and seen people of all ages from birth to death is the way that we describe Family Medicine. When I was in school, I felt that I was especially drawn to an area of medicine that really has not gotten the attention it deserves, and that specifically is Obesity Medicine or weight loss medicine, they're interchangeable in terms of how we talk about it. And I think this is something that fits so perfectly into a family medicine or primary care practice, because it is so prevalent in the United States and around the world right now, and only getting worse, so if we don't incorporate this as primary care providers into what we are dealing with on the front lines of medicine, then I think we are missing the vote, so what I started to do is just incorporate Obesity Medicine as part of my primary care practice, and it really started to take off into more of a specialty niche for me so I still work within a family practice clinic, I still have my own primary care panel, but I am taking referrals from all departments and external referrals to specifically deal with medical weight loss over opacity medicine.

 

0:05:37.1 S1: And you are a hot number locally. How far booked out? Are you... It's hard to get an appointment with you.

 

0:05:44.2 S2: I hear that frequently, I guess business is good, I don't know if that's a good thing or not, but five months out is about where we're at, and that's really not to my satisfaction, either I wish I could on myself or probably more realistically continue to grow and expand the education of other providers and encouraging them to really incorporate these even pieces of this into their own primary care practice.

 

0:06:11.5 S1: How long is each of these appointments with your patients?

 

0:06:15.8 S2: Yeah, the initial consultation is going to be the long one, so to speak, it's scheduled for an hour. It wasn't always that way, but I was taking an hour in the room, so we said, Hey, we better actually give me enough time so that I don't have the nurse knocking on my door telling me I've got patients we know in the hallway. And really the reason why is that weight loss or OPC medicine is comprehensive, there are so many inputs and factors that can make this such a hard thing to deal with, and if we are not comprehensively treating and approaching our treatment plan, we just don't really have a great chance of long-term success, so those first visits, we're going through a lot of things, it's a dietary of recall or dietary intake, it's talking about exercise, it's talking about their sleep, their mental health, any previous non-programs they've tried, any other current medical conditions they might be dealing with and treatments that they are doing for those that may impact their ability to pursue weight loss at that time, and those topics, any one of those can derail me for 20 minutes as far as getting down the rabbit hole of why that might be more important for that individual patient that we spend time on one of those things because it might be a barrier that's keeping them from being able to attack the true problem of the weight.

 

0:07:36.8 S1: And will you explain to us what a chronic condition is versus an acute condition?

 

0:07:43.0 S2: Yeah, great question. So an acute condition would be something that you might go to the walk-in clinic for a sinus infection, or something that you may go to trackable medical for and get a home strep test at some point in the near future. Yelled.

 

0:08:00.0 S1: Your child have symptoms of strep throat, such as sore throat or fever, do you wanna help an innovative North Dakota company validate their at-home strep test? Technical medical is currently enrolling children ages five and up and adults for a strep throat study, go to www test forest dot com to see if there's a site near you. Again, that website is www test for strep dot com. And

 

0:08:30.0 S2: So something that is short-term that can be dealt with and has come up very recently, a chronic condition obviously is something that we deal with longer term, so obesity was defined as a chronic disease back in 2013 by the American Medical Association, so we've known for much longer than that, that that has been the case, and you don't have to even have any medical training, you talk to, or you know people who have dealt with obesity and it did not happen to them overnight, it is something that they have dealt with as far back as they can remember for most people, or for many, many years, and so colliery disease I'd like to tell my patients is not to tell them that they're broken or that We can't help them, is more to give it the seriousness it deserves from a treatment approach. So short-term fad diets or short-term weight loss programs that are very intensive and restrictive are not the best way to treat a chronic condition, everything that we do should be sustainable because chronic diseases require chronic management, so part of our treatment plan should be, this needs to be something you be doing forever.

 

0:09:37.7 S1: So that's where you talk about lifestyle changes and sort of disease management would be changes to actions that you are doing consistently and that are... Taking it a chronic condition.

 

0:09:52.8 S2: Yeah, absolutely. So there are many things outside of our control that really can put us in a difficult position to manage our weight, we can't change our parents, for instance, so our genetics are what they are, so we acknowledge those in the visit and we talk about how that may impact them, but we really try to focus on, Okay, what can we control within our day-to-day life. And so some of the things that we might look at, diet and exercise, or the first thing that always come to everybody's mind, but really they are just a part of the picture, and so beyond that, which I think are very important. I talked about a few other areas that I think don't get thought about quite as directly by a lot of my patients, so I have a lot of patients who get very poor sleep, for instance, and we know there's really good data about... For sleep, and so our ability to lose weight and really going to make things hard if we do not have been sleep, so I screen very aggressively for obstructive sleep Avenue, which is a very high risk for people that may have...

 

0:10:53.6 S2: With conditions, but I also talk a lot about insomnia and improving sleep hygiene, and I can be a US, I say not as I do thing, as we talk about nothing on our phone in bed or things such as that, but that can be a lifestyle change that we focus on... That really is not that direct going to cause weight loss, but if you sleep poorly at life is hard to last, it's hard to begin with. So if we can sleep better, if we can talk about your mental health and ways to manage stress beyond turning to food, which is a good, quick, but not a good long-term solution. Then we are gonna be in a better place to get to the point where we are taking in fewer calories than we are burning, which is the scientific way that weight loss actually over

 

0:11:43.4 S1: Sleep hygiene. I've never heard of that. I, I like that.

 

0:11:47.0 S2: Yeah, yeah, fantastic. Sleep hygiene basically is all the behaviors that affect your potential to get a good night's sleep, so we think about when the last time we had any caffeine for the day, what is our exposure to any kind of blue light from screens, what is our bed time schedule so one that we talk about a lot is people are going to bed at a good time during the week, day that we can come to some to have fun, they are going to bed much later and getting up much later, our body has a circadian rhythm is like structure, it likes consistency. So if half the week we are going to bed at 10 PM and the other half we're going to bed at 20 AM, we're gonna have a really hard time developing a constant rhythm, and our body is gonna have a hard time knowing when is it time to go to sleep and just as importantly, when is it time to wake up? If we're waking up at 5-30 AM during the work week and sleeping until 10 am on the weekend, again, that rhythm is really going to be thrown off on a weekly basis, so those are just a few of those mostly hiking things that we talk about and ways to improve the chances that we're going to get a good...

 

0:12:52.6 S2: Nice.

 

0:12:53.3 S1: Gosh, I have to tell my teenagers that because they love to sleep in on the weekends in the summer, and then we come back to school and they are just wrecked trying to get up in the morning, but then they still wanna stay up at night out of curiosity, do you recommend a melatonin or are you against a Melatonin, all

 

0:13:13.7 S2: Of... That's a wonderful question. So I think there's a role for melatonin, it is probably one of the safer supplements that we do have out there in terms of the side effect potentials below, and I'll talk about in an adult population, I think in pediatric patients or miners and children, it's a different scenario, not that it's unsafe, but I can speak more specifically to the data and adults, very safe overall, we can take melatonin long-term, it does not affect our body's ability then to start producing it if we were to stop taking it. For instance, I think the being is, if I can say one thing about melatonin that I really talk to my patients about is what we think of it is this short-term sleep at Ogata, sleep tonight, I'm gonna take melatonin. For some people, it can be helpful in that regard, but where it is more helpful is to really help reset and restore that circadian rhythm that we talked about, and so it is more often beneficial take in over a period of weeks, or maybe a month, a street and trying to get it into the system at about the same time so that we are regulating entertain rhythm and starting to feel tired when we should, and so one night fashion, maybe you get some benefit from it, but you're more likely to get consistent benefit from it, to use it in a way where you're taking it consistently for a period of at least a few weeks to determine if it's something that's helpful for you or not.

 

0:14:33.9 S1: Okay, so with regularity, try it out for a few weeks to see if it works, and manage that sleep schedule well, yes. Get your sleep hygiene together. That's right, got it. Now, let's talk about the numbers of... When we talk about obesity from your patients, what are we seeing in the US in terms of number of people that could be... I like it that you said that It's not... Don't be shameful. It's not a label, it is what it is, but let's talk about those numbers

 

0:15:04.4 S2: In terms of... Just overall prevalence of obesity. Yeah, there's multiple ways I guess. I think I would start with defining obesity, which I think is important too, because from an insurance or a medical system coding perspective, we use the body mass index or PMI, which we've all heard about, any one of us that have put our heightened read into a BMI calculator, and then I've been told what we should wait for a normal weight might be a little bit depressed by the BMI, and I think for us as Obesity Medicine specialist, it is very much a rough screening tool. Okay, so that's the one you're gonna hear refer to most commonly, just because it's very easy to put in some numbers in Draper, heightened weight are easily measured and can give us a tool, so that definition of obesity is a BMI of 30 or higher with the VI of between 25 and 30 being that overweight category, but it's really not the best tool. I believe the BMI tables are about off of data from about 100 years ago and through life insurance companies at the time, so there's a lot of, I think, improvement that can be made in that regard, and so I like to use...

 

0:16:19.7 S2: When we talk about obesity, some of the other definitions, which would be the American Association of Clinical endocrinologist has a really good term, which is the chronic disease characterized by physiological processes that result in increased fat mass, which can result in increased morbidity or mortality, so increased health conditions or do. And so really what that means is why that differs is really, obesity truly is excess fat tissue that can be harmful to our health long term, and that can happen both in a way that falls within a normal BMI or within a BMI that's elevated. So that's probably a better term for it, so when we re-classify that, I don't know that I have specific data that tells us just how prevalent this is, but somewhere in that 35% to 40% prevalence in terms of true obesity within the United States, and then if we take into account like the overweight category specifically, if you're with a condition or what we call co-morbidity that can have be affected by your weight, those that captures another 25%, 30%, about two-thirds of us who have probably some excess weight that is potentially affecting our health.

 

0:17:37.4 S1: It would seem like everyone would... That scale, I completely can relate to... Well, I look at my BMI, I'm like, Oh, that's crushing... That I was doing so well and I've lost 20 pounds, but yet I'm still on this 22 week, I have 22% fat. That's a really high number to me, that's frustrating, but I'm glad to hear it as it is fat mass, as you're trying to get healthier, we should be increasing our muscle mass, decreasing our fat, so how do you prescribe that to patients, how do you... Start out if I was gonna... If I came in and we did our assessment for an hour, and typically what comes next, how do you manage this? How do you get better?

 

0:18:24.6 S2: It can be daunting because there are times where I can go through that intake questionnaire, that initial consult, and in my head, I can think of maybe four or five things that we could really start with, and oftentimes what happens with weight gain, people have usually had some weight gain, which is why they end up coming to see me, and what had happened is this really this negative cycle, so maybe it's a life event, maybe there was a death in the family, let's say... So then they went through a period of time where their mental health is not in the best place, well, now because that happened, they felt less willing or less motivation to go to the gym, which they had been doing regularly. Now that they're not going to the gym, that doesn't help their mental health either, because we know that working out is such a positive thing physically and mentally for us, and if we don't work out and we typically have been... Or mental health, it in a good place. Now, our sleep starts to suffer, and as you can imagine, all these things start to build up, and then on top of that, our eating behavior tends to follow if we want something that just is gonna give us a quick energy boost, becomes retired, or if we are one of many people who might find ourselves eating our feelings, then our dietary adherence is not gonna be an order, so all that is to say is my favorite strategy is really, let's pick one thing.

 

0:19:46.8 S2: And less of the things that we've identified, maybe the person already has a good idea where they wanna start, a lot of times they're kind of just overwhelmed by it, and it ends up being not my job to pick, but help present a few options, and I'll talk about, Here's a few things I think we might be able to work on, which one of those sounds most reasonable to you, or sounds like something that you are ready to attack, and I think it's so important to individualize that treatment and give the patient power to decide and really have a say in how things go. The last thing I wanted to be is they come to me, I tell them what they have to do, they walk out the door, and I didn't even really ask them if that's something they felt like was reasonable or... That they want to do or that they can do. And so it has to be as a patient-driven approach, so I often say, I'm reading the map and I'm sitting in the passenger seat next to... But ultimately, you are the driver and that gives him power that, Hey, I get to decide, and also once we get some positive results in some weight loss, it is their weight loss, they earned that.

 

0:20:55.0 S2: And I can point back to that same analogy where you took yourself too, right. So getting back to the original question is, I picked something, I identify a few things. Maybe it's something very simple, like they are drinking a couple of cans of pop per day and the regular soda or something like that, and there's a lot of extra empty calories there. So we just talk about, is it realistic to think... We might be able to cut back on that. I could say ideally, none is the answer right, but if you're drinking two or three sodas a day, one is better than two, so... Can we get to one? Is that realistic? Sometimes they exceed and say, No, I think I can cut it out altogether. Great, but if one is all that they feel like they can do, Okay, we're moving in the right direction, and this is a term approach, and so maybe down the road we'll get to zero, but we have to get to on before we get to zero. So let's focus on what is attainable and make that a little bit of a change, and then... Maybe we focus on a few other things.

 

0:21:54.7 S2: I will tell you that one of the first things, oftentimes, I don't really encourage being the first thing is if they are not currently doing a bunch of exercise activity, they are there usually at their heaviest way into their life or somewhere close to it, they're feeling pretty bad about themselves, maybe they have some pain associated with this way, an all that sort of stuff, exercise is really important long-term, but it is something that the data tells us is not a primary driver of weight loss. So I think that's something that's really important to think about the role of what exercise does and doesn't do for us. You may have heard, you can't out exercise a bad diet. Or you can out on the for or... There's all these terms, right? Just as importantly for me, from an evolutionary standpoint, this makes a lot of sense, so if we think back to the cave mandate, if you had, let's say two different Cadman, and all of a sudden not... Who became scarce, let's say a media hit or an ice age or whatever that happens in those days, the cave man who's a hunter and gather for their food, needs to then do what in order to stay alive.

 

0:22:59.2 S2: They need to either expand their reach by increasing physical activities, going further places to find food, and they also are having less of a calorie intake during that time since who... To scare the Cayman who didn't adapt to those conditions, continue diverting calories at the same rate, and then with the increased physical activity was burning more calories in a time where there was less food available at Caveman died.

 

0:23:24.0 S1: Yeah, feel like starvation. Yes.

 

0:23:26.5 S2: Yep. He started and died, and so the genes from that came in that were not adaptable to the environment to nicias along. Unfortunately for us, the ones that got passed along are the one who as physical activity increased, the body reacted by slowing down metabolism to preserve calories, as we recognize Weight Loss was occurring, the body increased hunger, signaling hormones to tell the key man to go get more food you need more in order to maintain what is nutritious for you, so super helpful for the key man, but if we put them in current day America, what we call an obese IC environment where food is at our fingertips and we've automated many things out of many types of movement out of our day, that's not helpful, is a really short answer, So as we increase physical activity, burn 500 calories on the treadmill. We are not 500 calories ahead. The research tells us it's much less than that because the body is adaptable and smart enough to then do little things throughout the day in perceptible changes in hunger, maybe you just have a few extra bytes at lunch, a small changes in our physical activity, or maybe we...

 

0:24:37.4 S2: Don't have as much nervous energy throughout the day, we aren't bouncing or leg, we aren't fidgeting, we don't get up to grab their remote, we just sit there, 'cause not something we physically think about, but subconsciously, it's little ways to save calories because of the increased calorie burn house

 

0:24:53.8 S1: Where that's fascinating. I know that.

 

0:24:57.2 S2: Yeah. So really, really important thing to... I think it's important for people to be able to focus their energy on what doesn't... Doesn't matter for weight loss, and so that's where... That's not a primary thing for me to focus on right away, it is, however, something as we get further into the weight loss journey becomes more important for two reasons, one, we know that people who exercise consistently are less likely to re-gain weight. So when we talk about a chronic disease needing to be managed chronically, that's where exercise comes in, more important is it's going to prevent weight re-gain or further weaken, it's just not going to drive significant ways loss, and as we talked about obesity being that increased fat mass sort of disease, exercise activity, specifically strength training or resistance training activity is super important for maintaining as much of that mean healthy muscle mass, which will help keep our metabolism going and is the type of mass we want to keep preferentially while we lose the fat mass

 

0:25:58.9 S1: So when we're looking at women that are... Let's just say women, 30s, 40s, and our primary listenership is females, how do you recommend the diet, given all of these different diets, I have my boys watching the liver King to... There's carnivore MD to Rich role, who's a vegan. To me, there is just across the spectrum, it is very confusing, and for me, I am an emotional eater, like stress and always have exercised very heavily, but then I would find myself emotionally eating and it felt like if I was running this vegan diet or eating this begin at, I was just choosing fundings and broccoli enrol, that was my diet and rice. Okay, that's not healthy. So given all of the noise in our culture right now, if you have made the decision, and I also think, Okay, what if I don't have access to a care provider like you, how do I listen to this and have actionable advice or take a step... What are some tools that I can access? Googling, what do you recommend? Where do people go? This

 

0:27:24.8 S2: Is a super important topic and one that does have, if you spend enough time researching and listening to and with the different people who are willing to share their own personal advice, you could be convinced that there is nothing that you can eat because there is... Yes, read enough diet books, you're totally paralyzed by over-analysis, and so really, it is the boring basics, and what this comes back to is following the science and the studies of long-term weight loss, and what it shows is that there are no specific diets that have superior weight loss outcomes when used long-term, so what that really just means is that it needs to work for you, and it needs to be something that fits within your life, your family, your other health conditions, your genetics, your ethical importance from like a vegan standpoint or something to that effect. And what you have access to. All that sort of thing. And so to give people a very rigid, You have to do this, this and this. We're gonna miss so many people that aren't able to do this, this, this, and so what do people do in that instance is they're like, Well, I can't do all of these things, so I'm not gonna do any of it.

 

0:28:52.5 S2: Yes, and then they're right back to where they started it as this all or nothing mindset, so my dietary approach is I'm diet agnostic is what I tell people is, there is not one diet, you're gonna hear me say this is the way... What it really is, is finding one of the areas within your current dietary patterns that are probably the easiest for us to address or that are gonna give us the biggest change, and from that, let's work towards what is healthy. I think three foundational things that I talk to people about starting out, one is as many fruits and vegetables as you want, and as often as on, I have yet to have a patient show up in my office and be there for a wet consult and say, I just, I eat too many apples and use broccoli and I've just 100 pounds, offer weight, it's never the thing in your diet that has gotten you in trouble... Yeah, so lots of nutrients, lots of fullness and association signaling for the fewest amount of colors. So that's one. The second would be getting some protein intake from whatever sources that are most accessible and that you like, and trying to do that with some sort of protein starts with each of our main us, so we'll go through and talk about the primary protein sources that are out there and what people like or what they might be able to do or what they don't like specifically, and I'm a big fan of, If you don't like it, don't force yourself, right.

 

0:30:21.7 S2: That's not a... No, if you don't like eggs, you don't have to eat eggs, if you don't like cottage cheese, which is kind of sees a lot... Or hate it, right? Yeah, if you don't like it, you don't have to need it, but if you like, Yeah, it's

 

0:30:33.6 S1: A really great coaching source, so... Yeah, good point.

 

0:30:37.0 S2: Going through and finding what are some things they might be able to do there, and then the third is really trying to limit calories from beverages and that's sugar, sweet and beverages and acolyte. And really from there, if there is some of that, can we reasonably cut back or if we feel like that's not an area where they're willing to make changes to that point, then we have to be a little more diligent with other areas of our diet at that so those three things, if we are doing those on a regular basis, are doing pretty well in those three foundational principles, plants and protein, limiting calories from beverages, you're really gonna have pretty good success. So from there, then it's... Let's work on if there are some more specific issues, so we talk emotional eating, like you talked about, that can be a situation where we do have medication options that can be quite helpful for people, or we have stress reduction techniques, or we talk about what are the triggers for this, and how do we improve our food environment so that we do... That we're putting our future self in a good position, so if we know that the Chaco tips in encumbered are go to stress eating thing, right.

 

0:31:48.1 S2: Maybe we should not keep those there on a regular basis, that sounds really basic, but it's like if that's a trouble thing, we are mentally saying no to those... Yes, hundreds of times a day, whether we know it or not, and eventually we're gonna say yes, if they're not there, the threshold at which we are gonna have to be stressed out to get in the car and drive to the grocery store is probably a lot higher and we're more likely to find something else to replace that.

 

0:32:14.9 S1: That was a great episode. Thank you to code Baxter for all of this useful information, that was a real reality check when we talked about having access to those things that are our stress triggers, like the chocolate chips in the cupboard... Holy cow. Why do I keep them there? It's like, it's the potato chips too, I'm not gonna lie. Having them at the office, having them in my house, it's hard for us moms because I know with kids around and entertaining, we have to have access to those things and you're not gonna put stuff under lock and key, so it's definitely a battle. And there are ways to manage it, and I really appreciate his tactical ways of changing our lifestyle to be healthier, I also have really shifted my way of thinking about exercise, and that exercise is not the driver of weight loss, that was a really impactful comment for me because I have always worked out, so then I can have a calorie deficit, and it's just recently in the last couple of years that I truly work out because I enjoy it, I enjoy how my body feels afterwards, I enjoy getting my sweat out of my body and I feel invigorated and I just feel more confident and I feel overall better, but not having it as the weight loss driver, we can't outrun the fork another goodie.


0:33:47.9 S1: So Cody, thank you for all of those truth bombs, our next episode episode too, I'm gonna talk about with Cody what I have done with medical weight loss and how I have used a prescription and how there are many other forms of medications that can help us with obesity and weight management, unfortunately, they're not as promoted as other weight loss drugs or as other drugs out there, but I will give you a testimony that it is worth it. So tune in for the next episode, Episode 2 with Cody Baxter, physician assistant and weight loss management expert. Thank you so much for joining me. And see you next time.