The I Love CVille Show With Jerry Miller! - The Kyle Miller Show: Sarah Stombaugh, MD Joined Kyle Miller

Episode Date: June 13, 2024

Sarah Stombaugh, MD of Sarah Stombaugh, MD Personalized Weight Loss joined Kyle Miller live on The Kyle Miller Show! The Kyle Miller Show airs live Thursday from 2:15 pm – 3 pm on The I Love CVille Network. Watch and listen to The Kyle Miller Show on Facebook, Instagram, Twitter, LinkedIn, iTunes, Apple Podcast, YouTube, Spotify, Fountain, Amazon Music, Audible and iLoveCVille.com.

Welcome everybody to the show. I'm your host Kyle Miller and thank you for joining us today. Every week we sit down with an entrepreneur, business person, somebody who's doing something great in the community that's right here from Charlottesville. And today is no different. Today we have personalized weight loss coach, Sarah Stombaugh with us today. I know I was sweating. I really am. I was sweating over here. And Sarah, I'm really excited to talk to you today and kind of learn more about our body, the food, weight loss, kind of everything that goes on along with that process. So I'm just super thankful to have you here today. Yes, thank you so much for having me. I'm excited to talk about this space and shed some light on what has been a very popular topic

recently. Right. So how did you even get into this space? Yeah, absolutely. So I am a physician and my background is in family medicine. I was practicing primary care and patients were coming to me over and over again and asking for support with their weight. And I felt like I didn't really have the answers to be able to support them in the way that I wanted to.

And when I think back about my medical training, whether it was medical school or even through residency, there was very little time dedicated to talking about nutrition, talking about wellness. How do we not just treat disease, but how do we prevent these diseases? And when we look at obesity or chronic excess weight, we know that that can be implicated in so many different health conditions. And so I wanted to learn more. And so I went through additional training and became board certified in obesity medicine. And for a while, I was doing both primary care and obesity medicine. And since moving here to Charlottesville about two years ago, I've been practicing just in

the obesity medicine space. I have a weight loss clinic here in town, and I take a very comprehensive approach to be able to support my patients with their nutrition, with exercise, with medications, think about other health conditions that they may have, diagnosing, treating, and evaluating those so that they feel like they have a personalized plan that can really support them where they may have had a lot of challenges before. I love it. With what you're doing, I'm sure you talk to so many different people. Everybody comes in. It's the whole thing. Everybody wants to lose weight. They don't know why they're gaining weight. They don't eat a lot. They eat very little. What are some of the common misconceptions that you

find that you hear from most people when they come in about weight loss? Yeah, absolutely. I think there's quite a few. I think as our society, we still have a really big obesity bias. So a lot of times we look at people who have excess weight and think that maybe they're lacking willpower, or maybe they just need to try harder. They need to eat less. They need to move more. And we know that obesity is so much more complex than that. And so there's often a lot of shame, both from others. And then sometimes that we've put onto ourselves where we're starting to understand and feeling just really disconnected from our bodies. I think there's a lot of ways in which we have become disconnected from ourselves. And so people feel like they've done everything, feel like,

gosh, I just don't know what to do next. And the weight loss industry, I mean, it goes back decades, but we're constantly getting different advice. And so there's a lot of confusion because you'll hear someone say, oh, you should do a ketogenic diet. And you'll hear someone else say a plant-based diet. And you'll hear someone else say a Mediterranean diet. And how do you tease out those different things and understand what is actually right for me? And so I feel like there's often this misperception that there is a one size fits all solution. And I don't know that any one plan will fit two people. I think everybody's plan is going to look slightly different. And so that's where we really need to learn how to reconnect

with ourselves and what it is that your own body actually needs. Yeah. You said it very concisely on that. It's so interesting how, well, let's, let's think about it. They're all marketers, right? They want you to think like they have the program so they can sell you the program, they can sell you the weight loss, they can sell you whatever it is. And that's where the confusion sets in. And when confusion sets in, when we don't take any action, it's like going, you know, sometimes I'll take my wife to Cheesecake Factory and there's 9,000 things on the menu, right? And she's like, I don't know what I want to have, right? Because there's so many different options. But if you go to a really nice restaurant, like really nice, there's only like three, right? And it's easy. I'll have that,

whatever that is. I'll have the filet or whatever. So by having and hearing all of that, that confusion sets in. People then don't take action and then they stay in their thing and then they feel like they're helpless. Yes, absolutely. That's kind of where it ends up. And so how do you help people with that and kind of bring them in? How would you onboard somebody coming in with you? Yeah, absolutely. So every patient who comes into our practice has a pretty

comprehensive intake where we're looking at their medical history, looking at attempts that they've made to lose weight in the past, what sort of things have worked, what sort of things have not worked, what things did they enjoy, and then really starting to pay attention to what it is that you're doing now, and then how do we evolve that in a way that's going to be most in line with your health goals? So it's really interesting when we think about food logging, a lot of different weight loss programs will encourage food logging. And I think that's a very important part. And not even just, I think we have really great evidence to say that patients who are paying attention to what they're eating, logging and tracking, that they're more aware and starting to make changes based on that. Even the act of writing food down makes us stop and think before we eat the food, like,

oof, do I really want to be writing that down? So every patient, I recommend food logging. Interestingly, I don't do calorie counting, macro counting, points counting. There are times and places where those make a lot of sense. But the interesting thing is a lot of us just starting to pay attention to what is actually happening. What are the times I'm eating? What are the foods I'm eating? What are the factors that make it challenging? Whether it's work or kids or whatever is a crazy schedule. What does this routine look like?

Then starting to layer on just understanding what is my hunger? What is my fullness? I have all my patients do a satiety and hunger scale. It's a 20 point scale where we take something that's really pretty qualitative and make it quantitative. And so starting to understand, am I hungry? Am I full? Paying attention to certain foods, like, isn't it interesting on the day where I had a blueberry muffin for breakfast, an hour later, it was really ravenous, versus the day that I had a couple of eggs and a fresh bowl of fruit, I felt full for hours afterwards. Starting to pay attention to foods that give us satiety, foods that feel good in our body, I feel like they are supporting both our goals, but also just fueling our body in a way that we need it.

So it's really interesting, even with tools as simple as that, people start to reconnect with and learn what are the times that I'm eating for reasons beyond hunger. That might be because of a work schedule. That might be because other people are eating. That may be for an emotional reason. And as we start to see some of those things, we can start making changes that are specific to that individual. And so that reconnection piece, I think, is really important for anyone in a weight loss journey and then starting to tailor what are one's individual needs. But then we're also thinking about when we look at chronic excess weight and especially weight cycling, where people have lost weight, they've gained weight, they've lost weight,

they've gained weight, they've lost weight, they've gained weight. We really have to be thinking about not just what is your weight, but what is your body composition? And so a lot of people who feel like they're not really eating anything, a lot of times it's because their body composition has changed and their metabolic rate may be very low. So they may feel like, especially compared to others, that they're not eating anything. Right. So there's a lot you just said there, and I'd like to kind of go back with that. Totally. Your food logging. Yes. Right. So I hired a trainer last year. I'd been focused on the business a lot and just pushing, pushing, pushing. And I was just kind of, I was a college athlete, worked out, was in good shape. And then it's just kind of kids, life, everything. So I got to the point where I was like, I was a little pudgier than I would have liked, right?

So I got with a coach and then he started saying, all right, Kyle, I want you to take a picture of every meal, everything that you eat and send it to me. And it was like, no, I probably not. Let me not do that. Or let me, you know, and where I had to have that accountability of somebody is going to be looking at what I'm eating instead of just me, you know, eating it. I felt like that made a huge difference of having that, Oh, I better not do that. You know? Exactly. Yeah. Um, and then going into, you know, some of the other things that you said, as far as, um, the different foods that you're eating, the metabolic rate. Somebody with more muscle, they can eat kind of a little bit more, whatever, because they're burning those calories no matter what. Somebody who's a little bit more active, somebody who

works outside, that kind of stuff. But my wife, she's training and she's learning a lot about this stuff too. And she's like, well, she sees girls sometimes do like a 10,000 calorie day for the bodybuilding type chicks and then come back down. But they're able to do that, and they spike their metabolism. The body's like, oh, I want the food, and they'll take it. Not saying that I would do that, but I think people don't realize with that muscle mass, with the activity that they do, that's only kind of like helping them to burn more fat because the higher, and I always used to refer to this as a furnace inside, like you have one log on there and it's like burning down, burning down

to where it's just like nice and simmering, right? That's not what you want to have inside your body, you know, and you're not putting any other fuel on top of it. It's just simmering down and it's just, it's just there, but you throw a bunch of wood on that fire and it burns and your whole body is going. I mean, that's where you want to be. You want to increase that. Is that? Absolutely. And I think that's a great analogy when we think about the role that muscle mass has. And it's interesting because a lot of times we talk about weight and we think about what is the number that we see on the scale, but that is really not the best measure of our health. And so it's interesting. A lot of times, if we have a higher body fat percentage and our muscle mass isn't as high, we can start to, if we shift that, where we start to decrease the body fat and

increase the muscle mass, we may see that the number and the scale looks very similar, but our body feels more energized. Our clothes may be fitting differently. Like our clothes may be looser. And so it's interesting because it's not so much about losing weight as it is about losing that body fat and making sure that we're supporting and even gaining our muscle mass if we can. So you also mentioned this in regards to if you have that blueberry in the morning, an hour later, you're like wanting to go, but then you have the eggs and the fruit in the morning. Why is that? Yeah. So when we think about macronutrients, we have carbohydrates, we have fats, we have proteins. The way that those are absorbed and used in our body are all slightly different from one another. And when we think about foods that have really good staying power, keep that satiety for hours, we're thinking about

things that have protein, thinking about two things that have fat, and then also thinking about things that have fiber. A lot of times when we can have, especially all three of those components together, a meal that is going to both provide satiety early on, but then keep that satiety, that is really valuable compared to something like a more simple or processed carbohydrates, things that are high in sugar, things that are higher in flour, or honestly, sometimes even a bowl of fruit,

which has lots of fiber in it, but may not have any protein, may not have any fiber, that doesn't last and stick with you in the same way as something that has some of those other components. And so when we're having those things, trying to build a more complex meal can be a great way to support our satiety and keep us eating during a certain windows and then not feeling like we need

to snack all day long. So when you're saying that, like if you were to give somebody an example of like a good breakfast to kind of like help with that. What would you say? And do you recommend three meals a day, five meals a day, two meals a day, intermittent fasting? And I know you said each person's different. So yeah. So generally speaking, meals consumed sort of in a meal time. So grazing, we know on average is not going to be as good for people compared to eating in more solid meal times. Now, it's going to be really specific to the individual, like we were saying. So there are people for whom grazing all day, they feel good, their body's functioning for them in the way that they need to, they're at a great weight, and if it's not a problem, great, you know, keep doing what you're

doing. But generally, when we can eat in more discrete periods of time, that tends to be better for our metabolism. Intermittent fasting can be a good fit for some people. So intermittent fasting can look like, you know, we have a set of eight hours in which we eat and 16 hours in which we don't. So people will often say they eat from 11 a.m. to 7 p.m. or noon till eight. Some people even have smaller windows or may do longer fast. And that could be the right fit for the right person. But generally speaking, eating in discrete windows, like it's breakfast when it's breakfast time, it's lunch when it's lunch time,

it's dinner when it's dinner time. And also not eating when you're not hungry. So if you wake up in the morning and you're like, I'm not hungry, it might make sense to eat if you know that there's not going to be another opportunity to for six hours. But if you're not hungry and you work from home or you have flexibility in your schedule, can you wait until nine, 10, 11 o'clock in the morning? You know, great. Give that a try. So, but coming back to the breakfast idea, I will often encourage my patients to have a

breakfast that is a little bit more savory. It doesn't necessarily have to be, but when we start our day off on the right foot, so to speak, it's not just psychologically, but even physiologically when we're having protein early in the day, having foods that promote satiety, it helps to regulate some of our hormones like insulin, for example, that help us to feel just more even keeled throughout the day. So breakfast, things that include eggs, things that include tofu, even like a plain Greek yogurt, for example, with berries or nuts or seeds on it. You know, a lot of times we get into a habit of eating breakfast food at breakfast time, but there's also really no reason you can't eat last night's leftover dinner. And so if you want to eat leftover

chicken and broccoli, you can do that as well. Which is so funny. I am not a huge breakfast food person. I would much rather, I'll heat up a burger in the morning and just, I don't usually do a bun, but I'll just heat up a burger because I like that better than I do like breakfast. Yeah. And who says you have to eat sausage and eggs? If you want a burger, you can have a burger. Right. Right. So the, um, one of the other things that you said, uh, in that, in that last go around, you were talking about kind of the habits that we get into, right? And we were kind of, kind of hitting on this. Where do you, where do you think that most people get these habits?

Is it, or create these habits? Because if we can stop a habit before it becomes a habit, it's better. So are there things that we can like realize, oh, you know, maybe I, I not go to, you know, Chick-fil-A every afternoon for lunch, or maybe I, you know, change some different things up in my lifestyle. What are some of the things that you've seen that could be, you know, minute changes on a day to day, but like have long-term effects over a course of period? Because let's be honest, that's the part that matters. You're not getting fat in a day. Exactly. You know? Yeah. So I think really that asking yourself the question, am I hungry right now is such a simple

question and you can still choose to eat or not eat. That doesn't have to mean there's no food being consumed then, but it's really interesting. I think all of the time we were talking before we recorded about children and my children are five, three, and one. And it's so fascinating to watch the way that they eat food. And, you know, my daughter, especially she's 20 months and there are some days that she can consume a larger breakfast than I do. You know, she'll eat three scrambled eggs and like a dozen strawberries. And I'm looking at this like 24 pound human being, like, where does it go? Right. How do you possibly consume that much food? And then there's other days where there's, she'll eat three bites of food and that's all her body needs. And children

are so in tune with, am I hungry? Am I full? I can give my three-year-old a cookie and he'll eat half of it. And like, I don't remember the last time I ate half of a cookie, right? Like someone sets a cookie in front of an adult, you eat the whole thing. And so this disconnect of, am I hungry? Am I full? Simply asking yourself that question and paying attention to, are their habits good or bad? Am I eating breakfast because I feel like I have to,? Am I eating breakfast because I feel like I have to or am I eating breakfast because I'm hungry? If I'm not hungry, do I have to eat right now? You're saying that and then I kind of go into some of your TikToks, but check her out on TikTok, guys. She's got a bunch of other stuff on there. She talks about specific things,

but my kids will do the same thing. So my um, my 13 year old will be like, I'm not hungry. I'm not eating dinner tonight. And so I think whenever I was growing up, my parents would have been like, Oh, sit down at the table. You're eating. You need to finish everything that's on your plate. And I'm like, here I am throwing like broccoli off the table to the dog. Right. And cause I didn't want to eat it. Um, but, and my wife is the one that's kind of like, listen, if they're not hungry, they don't need to eat it. We don't need to force them to have this, this, I have to finish. Right. Yeah. And that habit though is so hard to break, but just bringing that awareness of, am I feeling full right now? And, you know, it was always, there's children starving in the world.

And so you should eat all your food, but it's interesting, you know, when we think about our food supply, this is silly. And of course, as I say this, you're like, of course, there's nothing. Once the food's on your plate, you eating it or not eating it does not affect a starving child anywhere in the world. You know, that is a major issue. And your consumption of food doesn't change that at all. Right. And so I talk a lot with my patients about beliefs like wasting food, for example, and that it's bad to waste food.

And sure, I think anybody agrees we shouldn't just be throwing food in the trash can. And besides overeating food when your body doesn't need it, are there other things we can do to reduce waste? Can we save leftovers for later? Can we buy less food at the grocery store, be really intentional with our shopping list so that we're not having to throw away produce that's gone soggy in the drawer because we ignored it for two weeks? There are certainly other things that we can do to reduce food waste besides eating food that our body actually doesn't need right now.

And if you care about starving children in another part of the world, there are organizations to whom you can donate and actually make a difference. Right. Right? It's so funny. That used to always be the running joke or the running thing. There's people starving in China. Yeah.

We'll send it to them. I'm done. I don't want this. Kind of, it leads into, we're talking about food. The food nowadays, genetically modified, like grown in a lab, all this stuff. What are your thoughts on that? Yeah, it's edible, right? Right.

It's a food-like substance is a lot of times what I will describe these things as. And honestly, it's not fair. When you think about all of the hormones in our brain, in our guts that promote hunger and satiety and cravings for things, these foods that are created in the lab are made to really hijack that. You know, a lot of the- Which is nuts. It's nuts, right? Like the lays, like you can't have just one. Yeah, you can't.

And not because you have anything wrong with you, it's because they've created this perfect mouthfeel and the salty and the crispy. And of course you want more. Yeah. And so, yeah, it's really interesting. I think I was sharing with you before, I went to college in Omaha, Nebraska and ConAgra Foods was based there. They are no longer, but I have friends from college who went on to work with them. And literally I was a biochemistry

major. So these are fellow biochemists who were literally sitting in a lab in all white sterile gear making quote food, right? It wasn't even food. And so these types of things, not that we have to eliminate from the diet, not that we should be restricting them from our diet in a way that feels, you know, in a way that psychologically we're craving it even more, but just that cognizance of what is the role that these things are serving in my day and what are they doing for me? And the role is they're not serving you. Right. They're only serving the people that are selling the product to make money. Yeah, exactly. And you feel most of those foods, they're very highly processed. And so our body can utilize the energy very rapidly, which sounds good on the surface, but it means

that every calorie is being absorbed. When we think about calories, the way that we determine it is literally by burning a food object and seeing how much energy it took to do that. But our bodies are not incinerators. When we eat an apple versus a donut, and if we think about a small donut and we think about an apple, like a large apple probably, if we think about a small donut and we think about an apple, like a large apple probably, if we imagine they had the same caloric content, let's say 250, 300 calories, the apple, because of all of the fiber, all of that's not being absorbed. So there might be 250 calories in that apple, but you're not actually absorbing all of that. Compared to

a processed food, your body can break that down and process that energy completely. And so you absorb all of that energy and then it doesn't stick with you because it was so processed. You've got no fiber, you've got no protein, you've got no fat, um, or maybe some of those components, but certainly not all of them. And so they just don't, they don't really support our bodies in the way that we need them to. Yeah. No, I, when you start going down the rabbit hole of figuring out how they make food and they, they, they make it to your taste buds so that you cannot put it down. And then you realize that, oh, I'm just buying it. And that's, they, they've just created consumer out of me for their product. There's no health benefits. There's nothing. They don't care.

There's stuff in our food now that's banned from Europe. They won't even sell it in Europe on the shelves, but then they can put it in the food here in the United States, which is wild. It is completely. And so many of the things aren't even needed, like certain food colorings, for example. It's just so that it's more visually appealing. There's literally, it serves absolutely no role besides aesthetics. It frustrates me. But then people think that it's, you know, there are healthy choices out there that aren't that healthy, right? They're good marketers. They like to get on a box and tell you that this, I mean, let's look, grass-fed cow. When did cows stop eating grass? Right. You know?

And so do you realize, do you know, okay, maybe it was grass-fed the first, you know, six weeks of its life. Well, not first six because then they're nursing. But thereafter, yeah. Yeah, thereafter, eating grass. And then they're on feed for the next you know year and a half and so you don't you don't know um and it's frustrating uh when you really look into some of these companies and they're just the food companies are for profit and it's it's just it makes me angry sometimes and then people don't know and then that makes

me angry even more because they they don't know. And then that makes me angry even more because they don't realize that they're doing this to themselves and then they're getting bigger. It's the cycle. I remember literally being in high school. I worked at CVS Pharmacy as a technician and I was walking back to the pharmacy one day

and I walked through the candy aisle and there was a whole Twizzlers display. And it said, Twizzlers, a fat-free food. And I was like, huh, I mean, technically yes, Twizzlers have no fat. They're all sugar. And when you eat sugar that your body doesn't need, it can turn that into fat that it stores on your body. And it's wild though, because that type of marketing, I mean, it makes it seem like it's not that bad of a choice right exactly wild yeah oh and then they do um sugar-free drinks sodas all that stuff i i haven't had a soda or calf caffeine caffeinated drink like that in i used to be big on um energy drinks sure

yeah like three years ago i think it's probably been three years that I haven't had, I've just had water or lemonade that I do sometimes do lemonade, but that's it. Yeah. Well, and you read the ingredient list and you're like, Ooh, yeah, there's a lot of things in here. Right. And then you look at how many calories are in a bottle. So it's not on your 12 ounce bottles. It's not the, I used to like Dr. Pepper. It's not the 250 for the 12 ounces. It's 250 for the eight ounces. Exactly.

Now you got the other four ounces in there and then you're adding that. And so. When, especially in soda, I mean, all of that's coming from sugar and it's interesting. I'm a very visual person. And so if you look at a can of soda, for example, there's often depending on the brand, but let's say 50 ish grams of sugar in it. There are four grams of sugar in a teaspoon. And so if you imagine taking, you know, four times 12, 48, and if you took a teaspoon full, you know, from the sugar jar and just measured 12 of those and putting it into a soda, it's kind of wild to think about.

That is a lot to be consuming. After they've come to you, after your clients have come to you and they've got on the process with you, right? And they're starting to lose their weight. What are some of the biggest things that you hear from them in regards to how they're feeling? What's going on in their life? What do you typically see? Yeah, absolutely.

It's interesting how much time a lot of us spend thinking about food, whether that's preparing food, eating food, cleaning up food, thinking about our next meal, planning the next day. It can be really all-consuming. And it's interesting, as people start to step away from that, realizing how much time they have to be able to do other hobbies, to just have brain space, to think about anything else that's not food. So it's really interesting to learn how much and for people to start to see how much time

was spent in that. I also, it's really fun to see, we talk about wins at every visit and thinking about, you know, there's the scale of victory, but a lot of times we're seeing other things as well. We're seeing that our clothing fits differently or a family member or colleague said something to us, you know, other people are starting to notice or our body fits differently in space. You know, we feel when we're in an airplane seat, we notice that our body fits in it in a different way or sitting in a movie theater, how our body feels in the chair. So it's interesting to start seeing these things and how over time there's so many things

that we can celebrate beyond just the number and the scale. And a lot of times, you know, if you think about a 20 pound or 30 pound weight loss, it can be really significant. And if someone has a lot of weight to lose, and that's just part way in their journey, sometimes it doesn't feel like that big of a milestone, but it's interesting. I always think about if you go to the store and you pick up, especially dog food, you know, it's often sold in 20, 25, 30 pound bags. If you pick that up and you imagine carrying, let's say a 30 pound bag of dog food and carrying that around with you all day long,

it takes a toll. And if you're able to set that down, how much differently your body feels. And it's really fun to be able to celebrate those type of victories with my patients because it's really, it's meaningful and it makes a difference in their day-to-day life, even when their goal seems like it's still a little while

away. Right. That progress, because that's what I lost. I lost a little over 30 pounds. And I got into the best shape ever. And I was just feeling like on top of the world, the clarity in my head, everything that was going on. I was just like, on top of the world. The clarity in my head, everything that was going on, I was just like, man, I feel great. I can feel like I can do everything. I can run. I can jump. I can like everything. I felt like Superman. Sure.

You know, and I think because one, I was stuck on good food. I was eating. I was very strict. No, well, I had one like a cheat day, but it was like a cheat meal where I could have like whatever I wanted and then we'll just get back on the plan. It was usually like ice cream or a pizza. But it helped me along that process

to continue on like, oh, look forward to the next cheat day or to, you know, oh, I can have that then. And then it got to the point where I started eating on that cheat day and I was like, I don't like that. Sure. So we don't realize how bad we feel until we start to feel really good. And then you eat one of those foods or you, you know, eat a bunch of pasta and it just like, just sits on you and you just feel like, oh. When it's interesting, when we bring mindfulness to food and thinking about the flavors and the textures,

sometimes foods that we think we really enjoy, I was talking with one of my patients earlier today about Hershey's Kisses, and I used to love any chocolate. I mean, Hershey's to something from a phenomenal chocolatier, anything in between. And when I really stopped and tasted the Hershey's and let it melt in my mouth, I'm like, this isn't even good. Like it's kind of leaving a film. It's really sweet. And when you can bring that awareness to it, sometimes even in the moment, you're like, oh, I'm not even actually enjoying this. I'm just eating it out of habit or, you know, whatever the reason is.

Yeah. And I think we do that. And so, you know, a lot of times, and I say this, um, not in the position that you've been in, but just noticing how people interact and go about their day and things happening to them. But people usually don't make a change until something big happens. Yeah. It's never, Oh, you know, I'm a little until something big happens. Yeah. It's never, oh, you know, I'm a little overweight. It's that scare. It's the doctor said, hey, you know what? You might want to lose some weight. You're not looking too good on the artery side. You know, your cholesterol is higher, whatever, right?

That's the scare. But people don't even realize how bad they're feeling up until that point. It's like this compounding of, oh, this is how I feel every day. But when reality, you're sitting at like a 50% feeling where you could, and you think that's normal baseline. And it is, right? It is your normal baseline. And so you're used to feeling the way that you feel. Yeah.

And, yeah, you know, it's interesting when we think about behavior change psychology and we think about what drives people to change a very compelling why, you know, so often it can be something that scares a person, whether it's being told that they have diabetes or high blood pressure or seeing a certain number on the scale that they thought they never would. But it can be a lot of other things as well. But whatever that why is, you know, wanting to be around for the children or for grandchildren or recognizing that my body's just not functioning for me in the way that I needed to, you know, sometimes people just wake up with a conviction one day of, I might not know exactly what I need to do, but something needs to change. And that, when you have a powerful why,

it makes the rest of it so much, I don't want to say easy, but simple. It's a purpose. It's a purpose, exactly. You have something like, I got to change. Like, I can't keep living like this. Yeah. What's your thoughts on some of the new stuff?

And maybe it's been out for a while, but this is what I've been hearing about it, is like Ozempic and some other weight loss drugs to help people lose weight. Absolutely. So when we look at Ozempic, it's funny that that is the medication that's picked up, you know, sort of the poster child for this group of medications, the GLP-1 receptor agonist. And interestingly, these medications have been around for a while for the treatment of type 2 diabetes. And only in the last, well, really last decade, some of them have started to be approved for the treatment of obesity. But we've seen some of the

more long-acting ones. So Ozempic and Wagovi, those are actually the exact same medication. So Ozempic and Wagovi, they're both semaglutide ozempic is fda approved for the treatment of type 2 diabetes where wagovi is fda approved for the treatment of obesity so exact same medication but they have this role by which they target the glp-1 receptor we have that throughout our body but we primarily have it in our brain and in our gi system and so some of the impact that it has it helps helps to reduce insulin resistance. It helps to slow down movement through the GI system. So foods sit with us longer. We feel satiated for longer. We may feel less hungry. And then it works also in the brain, really in that sort of craving pathway.

And so it turns down some of the urges and cravings for food. Interestingly, it's also being studied in some of the substance use disorders. So whether that's alcohol or other substances, we see it really turns down that craving center. So you've got Ozempic and Wagovi. There's also Zepbound and Manjaro, which are sort of the newer kids to the block. That is a medication. Again, Zepbound is FDA approved for the treatment of obesity. Manjaro, exact same medication. They're both tiracepatide. Manjaro is FDA approved for the treatment of type 2 diabetes. And it's really interesting because these medications, for people who have had chronic excess weight, they really support some of the underlying physiological changes. Our body, when we adapt to having chronic excess weight, can be

really challenging to lose that. And so these medications really help. They're really just part of the toolbox and they help patients such that the changes that they're making, the dietary piece, the exercise piece, all of it is still important. And sometimes these medications make it more feasible for those things to happen. Yeah. It's when they're doing that, like, do you, so that lot of medical aspect there, right? Like how it works, are you seeing, you know, how do people use it? Yeah. So one of the things, so they're once weekly medications, they're designed for people when they're used for the treatment of weight loss, it's designed for people who have a BMI of 27 with an obesity-related comorbidity.

So that's things like high blood pressure, high cholesterol, arthritis, diabetes or prediabetes, these type of conditions, or for patients who have a BMI of over 30. So when we look at the prescribing guidelines, those are the patients for whom it's recommended. But we see that these medications work, right? And so there's a lot of people who are really interested in using them in order to support their weight loss goals. But I think it's when we think about prescribing and use of them, the reason I talk about it as a single tool in the toolbox is all of the other stuff has to be in place. For one, these medications are designed to be used long-term, and a lot of people desire to use them as a short-term medication. And we know that for some people that may work,

but the reality is that that medication is filling a certain role. And if it's no longer able to do that, will you see a weight regain off of the medication? There's really a good chance that, yes, that could be the case. So when we think about whether it's short-term use, whether it's long-term use, it's really important to support our body with plenty of protein. It's really important to support our body with plenty of resistance training. And that comes back to the piece of that muscle mass versus fat mass.

When we're losing weight, it can feel good to step on the scale and see a lower number, but you want to make sure that as you're losing weight, that you're really promoting that fat mass loss. Because if we're promoting muscle mass loss, which if you're not eating protein, if you're not doing resistance training, you may have a disproportionate decrease in your muscle mass. And the impact of that in the long run, there may not actually be improving your health as much as you think you are. And you're also lowering your metabolic rate with less. And so you think you're eating less and your body's not even burning the same amount. Right, exactly. And so that I worry about some of

the, when patients are taking it without appropriate guidance, are we finding ourselves in a position where years from now they're sarcopenic, meaning they have decreased muscle mass. And then especially for any patient, but especially for women, finding that they have decreased bone density. So osteopenia or osteoporosis. And so using these medications without appropriate dietary and accessory changes or exercise changes may have long-term consequences. Yeah, absolutely. Absolutely. Sarah, thank you for coming in. This has been very eye-opening, very informative.

I've learned a lot on here in just this short conversation where if somebody's looking for you and wanted to hook up with you and connect with you as far as hiring you as a coach following you on tiktok uh for your tips and stuff that you're doing on there which i think you give great tips on there where do they find you yeah absolutely so i have a practice locally in charlottesville virginia sarah stamba personalized weight loss in that practice i had myself and a health coach, we see patients to support them in a program that's going to provide regular check-ins, provide accountability. So they can find me at www.sarahstambamd.com. It's S-A-R-A-H-S-T-O-M-B-A-U-G-H-M-D.com. And then as you said, I'm on TikTok. I have a podcast. My podcast is called

Conquer Your Weight. You can also find me on TikTok at Conquer Your Weight on Instagram. I love to be a source of just legitimate evidence-based medicine. There's a lot of stuff out there on social media and I want to make sure that I'm providing some great information that patients can feel like they're getting real answers and not just an opinion. And you're real, you know exactly what you're talking about. I feel like some of the people that you find on TikTok or Instagram and they're marketing and they're doing all their stuff, they're great marketers. They may not be, you know, I always use this analogy, right? The best author, right, has not been found, you know? The best, the only reason why they have the best selling author, like they've sold the most books, which does the most

marketing, and that's it, right? So people who know their stuff and like yourself that are local here, connect with you, you know exactly what's going on just from our conversations uh i've learned a little bit but i also i know a little bit about the the industry and just the health and eating and that kind of stuff as well but it's always good to have a accountability partner there too because you may be tough you may be able to think you can do it but on those days that you don't want to do it you can will yourself but you're not going to be able to think you can do it, but on those days that you don't want to do it, you can will yourself, but you're not going to be able to will yourself every day. So having that one person there is great. And then also, if you also have an accountability partner,

you might be that inspiration for somebody else. You might be that reason why that person gets up, gets out of bed and comes and meets you. So it may not be just for you. You may be an inspiration for somebody else. Thank you, Sarah. Yes, thank you so much for having me today. This was really a lot of fun.

Cool, I appreciate you coming on. Guys, next week we'll have another entrepreneur, somebody from Charlottesville, in here, and we'll have that conversation then. So until then, thank you, and have a great week. Thank you.