Weights and Plates Podcast - #31 - The Emotions Behind Eating Disorders, Body Dysmorphia with Dr. David Puder

Episode Date: July 1, 2022

Dr. David Puder, a psychiatrist, psychotherapist, athlete, lifter, and fan of the Starting Strength model, joins the podcast to discuss the emotions and drives that underly eating disorders, body dysmorphia, and the subclinical dissatisfaction with food and body composition that we often encounter in the gym.   In addition to seeing patients and doing therapy, Dr. Puder hosts a highly successful podcast about psychiatry, psychotherapy, and the broader world of mental health called Psychiatry and Psychotherapy: https://www.psychiatrypodcast.com https://podcasts.apple.com/us/podcast/psychiatry-psychotherapy-podcast/id1335892956     Weights & Plates: https://weightsandplates.com Robert Santana on Instagram: @the_robert_santana   Trent Jones: @marmalade_cream https://www.jonesbarbellclub.com [e-mail]

Welcome to the Weights and Plates podcast. My name is Robert Santana. I am your host along with Trent Jones, my co-host. Good afternoon. Today we brought a guest. Would you like to introduce him, Trent, or should I? Yeah, sure. I guess, you know, I've worked with him for the longest here. So, today on the podcast, we have Dr. David Pewter, a psychiatrist, a former D1 college athlete, a strength lifter, and a fan of the starting strength model as well. So he's well-versed in our kind of little world of the fitness industry as well as a vast range of other things. So Dr. Peter is joining us in the

podcast today, and we're going to talk a little bit about eating disorders and disordered eating, which I think are two different things, but we'll get into that. So welcome to the podcast, David. Yes, good to be here. And I actually started going to a physical starting strength gym, which I've been to two, let's see, camps, like weekend seminars. I've been coached online for a long time, but I've never been to a physical gym, but I just started going to the Orlando starting strength gym. Oh, right on. Very cool. Which is really good. It's really good to have people to do it with. So definitely who's, uh, who runs the Orlando gym? Pete Truppos. Truppos. All right. Yeah. I love Pete. That's right. I forget that he's, uh, I think he actually lives, uh, somewhere

in your neck of the woods out there. He's a's a great guy. And it's so nice to do it with other people. You know, after, I think at the start of COVID, I stopped my normal routine of having people come to my garage. Yeah. And then we moved to Orlando where it's like, you don't want to hang out in your garage. It's like humid and hot. It's like, so yeah, that's how it is here. Yeah, absolutely. So before we get started, David, tell us a little bit about your fitness background as well as your medical background, because I think you have a really interesting perspective in both worlds. And you've actually been on the Starting Strength Radio podcast with Rip in the past, right? Yeah. So I did football, wrestling in high school. I did rowing at UC Berkeley under some pretty amazing coaches, Jeff Bond, Steve Gladstone. Steve Gladstone has won more national championships than any other school. Steve Gladstone was also the athletic director. So we

had the top football strength and conditioning coaches, like our strength coach. So we were in this sort of really elite, well-coached program. Our team won the national championship my senior year. I won second. You know, as a team, we, all of our boats put together, we won first place. So it was a very competitive environment. And then, you know, went to medical school four years and basically did some running, did some, like when I would go to the gym, it was just like get something done in 15 minutes and then get out and study. And then I did residency in psychiatry for four years and got married somewhere in there. And then when I got out, you know, had some kids, you're busy with life. And at some point,

one of my friends was like, Hey, why don't you, you know, lift with me? And he broke down the program, starting strength. He was just a fan and he got me into it, coached me. And then I went to a couple of camps, got connected with Matt Reynolds. He coached me for a while online. Oh, right. Yeah. And he introduced me to you, actually. You were doing his podcast at the time. Oh, that's right. Yeah. He introduced me to you, too. Yeah. And I was coached by him as well.

Reynolds alumni. Yeah. So, yeah, I've been blessed with great coaches for a long time. And then I have a podcast, Psychiatry and Psychotherapy, which is one of the top mental health podcasts out there. And I've done a couple episodes on the virtues of strength and conditioning for the mind and for depression, for anxiety. And so I've kind of looked at a lot of the research on how this can be very helpful, but I think today you want to talk about more of the disordered eating and maybe body dysmorphia, which is kind of like an offshoot of obsessive compulsive disorder. Yeah. Yeah. So let me kind of lay a little bit of background to something that's come up on this show a couple of times. We actually recently did an episode about how you should be measuring your body composition if you are actually seeking to change your body composition, whether it's to lose weight on the scale or to lose body fat or to gain weight or just gaining muscle size, whatever it is, whatever your particular goal is with measuring your body composition, we talked about some different ways to track progress because I think most people in today's world, their default method of

seeing if they're making any progress with their physique is to look at the scale. And generally speaking, people want to see the scale going down. Now, our end of the world is a little bit different. We often, when we start working with people that have never strength trained before, we often want to see the scale go up as they gain muscle mass. But the point of that episode was basically just to point out that there are many ways to track your body composition besides just the weight on the scale. And one of the, one of the things that came up in that episode, and I think one of the things we run into often in the, in the coaching world is people that have a fixation on their body weight.

And, um, I think it manifests in many different ways, but that's just, that's just one of the things that we see very commonly, the people that can become somewhat obsessed with the idea of weighing a certain weight or getting to a certain target weight that, from our perspective, may seem arbitrary. I just had a guy, Trent, that was 5'8", 158, and he wants to be even leaner, and then he wants to get stronger, and he's's squatting sub body weight and barely dead lifting over body weight. Right, right. And so we sort of know from experience that, you know, that you're going to have to put on some size and body weight on the scale in order to get the performance gains. So that's just one of many ways this manifests, but that's what I wanted to talk about today is, you know, where's the line between what I call disordered eating, and I don't know if that's a technical term or not, but people who are not eating to support their goals and their athletic performance,

and then people who are maybe in a more of a clinical eating disorder kind of space, right, that have a problem that needs medical attention. So I wanted to talk about kind of where that line is and then maybe some of the ways that we could, you know, build a healthier mindset towards our body composition as it relates to training and athletic performance and just general health. Yeah. I mean, I wanted to add a few things here because I've dealt with it on both ends of the spectrum. On one end, I have guys and I work with a lot of females and males alike. There was a time, and Rips mentioned this, where this used to be an issue more with the females, but now it's irrespective of sex is what I've kind of noticed.

It's just that manifests differently depending on the goals. But I it's irrespective of sex is what I've kind of noticed. It's just it manifests differently depending on the goals. But I've worked with a lot of people where they come in and they want to basically lose weight at all costs, but then they want to look like they train, you know? And then on the other end of this, basically, they just want to be lighter and lighter and leaner and leaner, and they're obsessed with their body fat percentage and all that stuff. Then on the other end of the spectrum, I have guys with this idea that they need to be above a certain threshold. They need to be, you know, for instance, they have to be – if they're under 200, they're too skinny, you know? And there's this, you know, I'm proud to be big type deal.

Hasn't Rip said that multiple times? Like, has that become like the gospel of like Mark Replita? Like, you have to be above 200. What kind of man are you if you're not above 200 pounds? If you're not above 200 pounds, you got to like, you got to like seriously, like, you got to drink a pound of pure butter every day. Just drink it. I wouldn't even eat it. Liquefied butter. Just spoon that thing

into your mouth. Well, I get that shit from him all the time. He says I need to be 242, but that's a whole different topic, because he also says, you know, a grown man should be able to pull 500 pounds, and then 500 turns into 550, then it turns into 600, and the number only goes up for body weight and the amount you're lifting. What I'm talking about is

the fat guy who's 250, and he's squatting, you know, 185 pounds, you know, and he guy who's 250, and he's squatting 185 pounds, and he needs to lose weight. And he's like, I think 220 or 230 would be good. And meanwhile, he's really overweight. Then you also get guys that are beanpoles. They're 6'2", 150, and they do want to get bigger. And they're like, I want to be as big as Dwayne the Rock Johnson. And they have no concept of how much genetics plays into this how

little muscle mass relatively speaking we can gain through strength training alone and diet and how much drugs are involved in a lot of these recommendations that they get from fitness magazines instagram etc that nobody talks about everybody leaves out the most important ingredient yeah like if you're on the wwe like your cocktail can be upwards around ten thousand dollars a month you know like oh yeah your human growth hormone testosterone you're cycling in and off like not only that but like painkillers i mean injecting insulin so i think and and to start with yourself selecting like the top one percent strong people who are naturally skinny anyways right into that sort of or not even maybe top one percent maybe and they're all six five or taller right so yeah it's people, I think where this conversation may get interesting is the level of the insight people have into like, are there, is their current body as unattractive as they imagine?

Right. Yeah. Right. Right. imagine right yeah right right so i think a lot of people have like and this is where like body dysmorphia becomes um you know it's like something that starts around in in the teenage years and then people get there's there's something called muscle body dysmorphia where people have this undue attention to their muscles or to how they look in some way. And they may spend three hours a day focusing on this. And so when you're a coach and you're starting to see this person,

like there's a history here, you know, and they're heavily influenced by media and media now, which is not even like, it's not even like I I'm flashing anger on my face as I say this, because it's heavily Photoshopped media. So you're not even like comparing yourself to like a realistic view of like an ideal, but it's more like an ideal that is an ideal that exists like a platonic ideal. It's like an ideal that exists outside of space and time that you've kind of been told that you should sort of start to emulate by tens of thousands of pictures. And I have guys, the guys that are, and the girls that see me, it's like, I don't know if I can get

married or attract a person unless I am this certain way. And then the, so the delusion is, and the insight into it is actually a whole lot less than like OCD. So although it's kind of like similar to OCD, the insight into it is like nil. Like you could have like a very attractive female, for example, or attractive male, and their attractiveness physically will not stop them from finding a member of the opposite sex. Right? Yeah. yeah. And yet they believe it will, right? Like this is the one thing, like if I could change one thing and it was this,

then I could find a meaningful life, right? I could find a member of the opposite sex. I could find myself attractive. And the picture that I like to look at when I look at my ideal is, it's called the Giga Chad. Have you seen this one? No. It's like this Russian model. It's actually probably not even a real person. I got to show you this. Crack up. The Giga Chad? Yeah. It's called the Giga Chad. Yeah. It's like, here, let me share my screen so I can show Robert this. Yeah. Chad Thundercock.

Oh, yeah. That's the original name, I think. Yeah. It's like, if you look at his physique, it's like... They put Walter White on him. Absolutely. So, anyways, the idea is that when you're a young guy, you're looking at like pictures.

And when you're a young girl, you're looking at tens of thousands of pictures of, of people who get attention, right. We're attracted to sort of like notice who gets, who's getting the attention and our, our minds start to create like a list of shoulds that, that go along with this,

like attention barometer, you know? And so, so then this manifests as like behaviors and focus. And what I think you're linking on to is that their belief about the steps that they need to take to get to a healthier place are not even the right steps, first of all. It's like, no, you're not going to lose weight and gain strength at the same time. And secondly, the amount of time it might take to get into a better place.

But then also like the satisfaction may never come, right? It's like there's real cases of people with body dysmorphia killing their plastic surgeon, okay? 20 surgeries later, right? It's like, when I see these people, it's like, 20 surgeries, they're still unhappy, and they're like, maybe it might be psychiatric, but I don't think so, okay? And so, it's like, the mental health work is not being done, and it's not a focus. It's like I'm going to focus on my body because that's something concrete. I can focus on my body.

Well, they also think that they have more control over it than they do, and that's what I kind of run into. So I have the interesting experience of working with two very different demographics. So I get a lot of people that have found me through startingstrength.com, either the forums, the podcasts, or the content that want to get stronger and want to be less fat. You know, that's the most common client that I get. It's like, oh, I want to lose the belly and get stronger. I don't care about abs. Great. Easier to deal with, right? Then on the other end of the spectrum, I get a lot of commercial gym type clients that'll go into, that you would typically find at a local LA Fitness, typical personal training client that wants to be lean at all costs, does not care about performance. And if I try to train them in

the way that we all train, they will complain because it's not hard enough. And they don't, why are we spending all this time with lightweight doing technique, I'm not getting enough work in, I'm not earning my, I'm not earning my right to eat through exercise. And it's not about, you know, technical proficiency of the movements, it's not about adding weight to the bar, it's about going in there and chasing a high, you know, that dopamine rush, they maybe get from running or, you know, the muscle burn from doing high reps and circuit training, right? They want to feel like they're about to have a cardiovascular event. They do not care about the process or the performance aspect of it. Like I can explain it all day long. Yes, you need to get stronger. It has to get heavier. I don't care if you do fives, tens, fifteens,

or twenties, it has to get heavier. The overload is the principle. They don't care about that. They want it to feel hard that day. And it's all about getting the scale to move. It's all about looking better, right? And this type of client has been in commercial gyms for decades. When I first got out of school, that's what I dealt with working at this commercial gym in the Midwest. And it's exhausting because for some of them, their goals are incompatible. Actually, not for some, for many of them, their goals are incompatible with their lifestyle. They want to basically weigh nothing. They want to beat themselves up for an hour every single day of the week because if they don't exercise, they're gaining fat. And then they want to eat out two to three times a week, probably more than their day's worth of calories, certainly more than what a deficit would call for.

more than their day's worth of calories, certainly more than what a deficit would call for. And they go through this cycle every week where it's like they might follow, you know, a structured diet for a few days and then go out and eat out on the weekend, not lose any weight, complain that the scale went up and act surprised. And then if I give them anything shy of shooting their heart rate up close to max in the weight room, they complain that it's not hard enough, you know. Or if they are willing to commit to some barbell training, they complain that it's too hard. It gives me anxiety. I don't want to squat, you know? Or, you know, whatever. Squatting gives me anxiety. Yeah, yeah, yeah. Something like that, you know? Like, it's either too hard, it's too easy,

or it's too simple, you know? They want to have 15 exercises that are mindless that they can go in and, you know, treat it like a nice jog down the street, not to think about it too much. I feel like they're about to have a heart attack, get out, go home, and then starve for five days, and then overeat for two days. I mean, that's me paraphrasing here, you know, based on my years of experience with this demographic. But that's one challenge. On the other end, I get guys that are very overweight, and obviously larger men tend to do better with strength training, larger humans in general, but especially men because we tend to put more up top and you get better leverage. And we have more muscle mass, more testosterone, all those fabulous things that Rip likes to rant about at least once a week on his radio show. But I get those guys that they want to lose body fat, but then they don't want weight to come off the bar.

And then there comes that challenge, right? And they start feeling weak and then they start complaining about that. Then once in a while, I get the guy, this is typically a male, that is probably on, not probably, I rarely get these guys because I typically won't hire somebody, but occasionally I get them. And sometimes they're on drugs, sometimes they're not. But they want to be super ripped all the time. They're working out every single day of the week, three hours in the weight room, 20,000 steps a day, cardio six days a week. And everything revolves around food and exercise. And then, you know, they will not do anything that requires them to do less than what they're doing. And they will not do anything that requires them to do less than what they're doing. And same thing. So they basically want to starve and move all day long. And it's all part of like the same umbrella of issues.

You know, this is probably more in your area to get specific with that. But, you know, we say, okay, this guy probably has full-out body dysmorphia and eating disorder. The first person that I described probably more disordered eating. But I don't know where the terms have went over the years. This is back when I was in my nutrition program. There was a difference between the two. But that's typically what I see day-to-day when I'm working with a global gym client versus a performance-based client. Yeah, there's a lot there. First of all, weight. I want to get back to this. Okay, you talked about weight. I think weight is finicky, and it's a difficult measurement of success

because of the fluctuations. You know, if you go keto, you're gonna lose five to 10 pounds in a couple of weeks. Like, did you just lose fat? No, you just lost all the water weight from eating carbohydrates. If you eat a big meal, if I go eat ribs this weekend, I may gain five pounds.

Did I gain five pounds of fat? No, I gained five pounds because I just ate a bunch of salty food and you ate out. And so water balance is such a large fluctuating thing. And then stress, right? If you have a lot of stress, you're going to gain weight just from stress. If you drink a lot of water, you could lose salt from peeing it out. So you may lose some weight temporarily. So there's so many fluctuations with that. And then if you gain strength while you're losing weight, or if you are doing strength exercise while you're losing weight, you'll lose less muscle, which is a good thing. But you won't lose the weight maybe as fast as you would otherwise. So you could lose one pound in a week and 75% of that is fat, but you may not feel the reward of when you lost five pounds a week when a lot

of that was muscle. And then if you're not strength training in the right way, when you lose weight, you'll lose muscle and then you'll gain weight back and that weight you gain back will be fat when you do a diet. So you lose muscle, back fat lose muscle gain back fat and and then you know when by the time you're in your 60s like a lot of my patients you have sarcopenia and you're like why do i have such severe sarcopenia despite having exercised most of my life um so that's where i think like some of this logic like you almost have to convert people to a logic of, you know, there's going to be a season of getting strong. And then there may, then there's going to be a season of focusing on your diet and having that be a priority and focus on your diet in a way that

you might lose inches around your waist. Right. I think that's the ideal that I've seen. And I think that ideal is not something that starting strength has like, oh, here's the LP of weight loss. I haven't seen that in a very clear way, which I think maybe you've worked on that and maybe that's something that you have. I've been working on it. Yeah. Yeah. And that's what we talked about last week, actually, in our podcast episode. Yeah, exactly.

Yeah. Like periodizing your training and your nutrition at Yeah, exactly. Yeah. Like periodizing your, um, your training and your nutrition at the same time. Yeah. I think that was a great concept you brought up there. Yeah. So I think, so I think just to kind of connect, uh, connect some dots that both of y'all have been talking about that I think is interesting here. So there's, there's clearly a, an education problem, you know, so there's a lot of folks that just don't realize, an education problem. So there's a lot of folks that just don't realize how human physiology works and how the muscle gain and fat loss equation works in terms of body weight on the scale. So yeah, I'm totally with you on that, that body weight is a poor metric for tracking progress.

But I think there's also kind of an interesting disconnect with what you said, Dr. Pewter, that people are looking for those that get attention out in the world. And that's often who ends up influencing us. And I think one of the interesting things is, you know, not many people have the chance to do this, but if you've ever met a celebrity in person, like someone who is an actor or is a fitness, I guess nowadays Instagram celebrity, there's Instagram celebrities. So like a fitness influencer, you see them in person and they're actually pretty strange looking, or I think they are because often like what gets attention in social media or, or in the broader media is people who are outrageous looking to an extent or extreme looking, you know? And so that's, they always say like, you know, the camera adds 10 pounds, right? So you're the actor that you meet actually looks maybe smaller and skinnier than they do on camera. Um, which, which I think

is, is kind of interesting. So there's,. So there's this distortion of what a normal, healthy-looking person actually looks like because we're only seeing it through the filter of media. So yeah, so I think that's really interesting. There's kind of two pieces here. One is an education piece, which hopefully our podcast is helping to address a little bit. But then there's the expectation piece as well. Right. So first of all, I would say, what are your shoulds? Like, just write them down. Like, what are the things that you believe you should look like, or you should be doing? Or what are the beliefs? And then can you challenge those a little bit? You know, like, do they have, like, are those really what you value?

You know, and then so you have to look through like a value lens at the shits. Like the values can be like, I value family or I value, you know, my work or I value my spirituality or I value this or I value that, right? So it's like these values, then you can start to look at the shits that you believe implicitly from tens of thousands of images and you can compare those with your values and can you then create a set of ideals or aspirational ideals that are maybe beyond what sort of these shoulds that have been environmentally influenced say you should be like yeah yeah yeah so like maybe um for instance maybe a should for a 17 year old kid is i gotta have a six-pack i should have a visible visible abs but maybe we can look through that a little bit with with some more maturity and it's hard to do at 17 but maybe with a few more years experience of life, you can look through

that and say like, well, what do I really want here? That's, um, am I looking for, if, am I trying to make myself physically attractive to a potential mate in the future? Okay. Well, so, you know, does the should now, is it have to involve a specific body part or a specific sort of, you know, signal of, um know, signal of body composition, right? Or maybe it can be like, I just want to have a nice looking physique, which can be many different things. It doesn't have to be visible abs, which may or may not be achievable for everyone. You know, I'm remembering, Trent, the picture of you before and after you started strength training. And I think you met your wife before when you were like a super skinny dude.

But I bet your wife now would be like, no, I don't want you to go back to being that dude, right? Oh, no way, no way. Yeah, she's like, she gets mad whenever I drop down below like 190 pounds. She's like, you're looking skinny. She's like, I gotta fatten you back up. It's like, so sometimes I like, I like think when i'm like talking to my patients who are like you

know young and dating and want you know all these things i'm like i was kind of an i was kind of a dork when i met my wife and i was super skinny i was like i was the kind of guy who would wear flip-flops with socks you know like and i would do it on purpose because like, I thought, you know, rocking the mullet and having the flip-flop with salts, socks was like, that was like. Oh, I haven't seen the mullet. I gotta see some pictures. I had a wig, a party mullet that I would rock at like parties,

but it looked real. So like it would take people off guard, you know? It's your Billy Ray Cyrus. Oh, geez. That was the mullet of all mullets. Or was it Roadhouse mullet? it would take people off guard, you know? It's your Billy Ray Silas. Oh, geez. That was the mullet of all mullets. Or was it Roadhouse mullet? I had the Rockstar mullet.

I had like this black mullet, yeah. Okay, yeah. You know, it's funny though, because like as you talk about this, like Santana, I'm like, I could be like a bunch of those different people throughout my life, right? Oh yeah, me too. And I still struggle with like,

same here, at times wanting to lose weight and you know you know monitoring success in the correct incorrect way or not about not living up to like some sort of bigger ideal like okay it's good to be healthy it's good to be fit so if you're listening to this i want you to realize like we're we're preaching to ourselves maybe a little bit here too. Oh, yeah. 100%. My biggest frustration has always been – my baseline was not a whole lot of muscle up top and not really fat but soft enough for me to notice. But in clothes, I look like a skinny guy.

and clothes look like a skinny guy, you know? And the biggest letdown was that I can train for years and years and years and I'll lean out up top, but I'm not going to gain a bunch of muscle mass because there's so many drugs involved. And that's something I didn't understand because I didn't do drugs. I wasn't in a sport that would have required those types of drugs. I was a swimmer, so I wasn't in football or wrestling or baseball or some of those other sports where a lot of the kids in my high school were on drugs. I learned this years later, right? So just not something I was around. And, you know, you'd read these fitness magazines and they'd put in all these articles about, oh, do this 12-week program. You're going to gain a pound of muscle a week or some bullshit, you know, or take this supplement page after page after page after page. And my whole thing is I'm

scientifically minded. So I'm like, okay, how do I do this right? And then I went through all these phases where I did stupid shit, found starting strength. That was the first thing that got my upper body to develop because I started deadlifting and pressing essentially. Before that, I was just benching like everybody else. I did chin-ups because I was a swimmer and was forced to at a young age. And I squatted because you're a pussy if you don't squat. So that's why I kind of was drawn to rip, you know, because I felt guilty ever removing the squat out of my workout. It's like, you have to do it because it's miserable. So therefore, I must do it because if I don't, I'm cheating or something, you know. Anyways, I still, you know,

still squat 20 years later. But no, I just, you know, I started pressing, I started deadlifting, I started pushing high intensity for longer. Most importantly, I started learning 20 years later. But no, I just started pressing. I started deadlifting. I started pushing high intensity for longer. Most importantly, I started learning how to move. But in terms of like I keep getting stronger over the years, but I'm not getting much bigger. I can gain a bunch of weight and lose a bunch of weight and end up in the same place. Not in the same exact place, but statistically speaking, the magnitude of change isn't that great at this point because i've been lifting for so long and uh you know that just the the uh the drug variable was just always left out because in part it's illegal but in part these guys want to boast themselves to be more than what they are and sell themselves as superheroes and you can do it too

and all that you know it's just the era we all came up in what uh hulk hogan say it's like uh drink your milk eat your vitamins vitamins, say your prayers. Yeah, I believed all this shit, you know? You can look like me. Right. I believed all this shit. I didn't know what a steroid was when I was 16, 17, 18, you know? And then, you know, you get Arnold's book, and he's saying don't do them when he was loaded up on them as he was writing the fucking thing, you know?

I'm like, this is just a disclaimer so, you know, he didn't get criminal charges against him, but I didn't understand that either. So it's just, you know, for me, it was informational. You know, I kind of followed the information that I would locate to try and get closer to where I was trying to get. And then I learned what I needed to learn. And I've come to accept a lot of these things, you know, I'm not getting, I'm not getting much bigger without taking drugs. And I don't want to do that, necessarily. But I've noticed, this is where, you know, I've had to like, evolve as a coach, I've noticed for a lot of clients, it's very emotional. And that's like, the whole reason I wanted to do this episode is, I find these goals are highly emotionally driven, and no amount of information kind of moves them in the

right direction, unless they're ready to hear it. Occasionally, I get somebody who, you know, by the end of it, they say, you know, I feel a lot better about myself, about life, about doing this. You know, my expectations are lower because I'm not going to sit here and starve myself or train, you know, for 50 to 75% of the day. You know, I'm exaggerating, but I'm not going to train all day or starve myself to maintain this physique. It's not practical. It's taken away from other things in my life that are more important. That does happen, and that's very rewarding when that does. But a lot of the time, this stuff's emotionally driven.

I've had guys that are so obsessed with maintaining leanness and constantly moving, and they literally will hire me and not follow a damn thing I say for months and months and months. And then I say, okay, what are you doing? You're paying me to babysit you while you do what you want. So why don't you just do what you want without me babysitting you? I already told you it's wrong, you know? And that's a logical thing to say. The thing is not driven by logic, it's driven by emotion. And that's really what I want to come to understand here. Well, I think, why does it take months? Probably because the attachment, the connection and the trust, you know, it's like you have to gain that with people. So, you know, maybe that's okay to be part of the process of like, you know, it's gonna, maybe someone who is a little bit more forceful can get the trust faster, but maybe it's better to have that sort of open dialogue, their ability to challenge you or to go against your plan.

Maybe that has value in reducing the internal shame that they feel that would allow them to change right i had that kind of experience with uh with a nutritionist i work with jillian ward like i feel i feel like she's like a very empathic like i would come and i think i felt like food carried a lot of like shame for me and i feel like just talking to her about food over the course of like a couple months really helped me have less shame and more enjoyment when i was eating good food and then also like not like comfort eating maybe as much although i still do um food for me has always been about like comfort and about community and connection. And so it's kind of like, okay, how can I curtail that just a little bit so I can meet some goals here of being a healthier version of myself?

So I don't know. I think it's okay to have the patience process with this too. And then that's sort of like, hey, what are your goals? Are you meeting your goals? Where are you not meeting your goals? And let me show you kind of how my plan will help you meet your goals in a way that maybe you don't know, right? I mean, the whole thing about getting a coach is you've been trying something by yourself for a long time, and it's not working. And so how do you change your outcome? You change your environment.

How do you change your environment? You hire someone who's an expert. The thing is, like, men are horrible at general, at, like, wanting to believe that they need input from other men. Yeah. That's why I said that the male extremes are more rare. I have gotten them, but not as often as the female extremes. Yeah, yeah.

Yeah, I'll get with, you know, I do like coaching, psychotherapy across the world at this point because the podcasts, I bring in a lot of good clients. And I think that a lot of them begrudgingly come at first, maybe. Like the men, like the archetypal strong man, the tribe leaders. It's got to get pretty bad. And it's almost like they need it, but they don't want to need it. Right. Yeah. And then like they grow from it,

but they may not want to continue to grow from it, even though it's been helpful. And then value wise, like how much value to provide, provide to them. Like if you make, if you make a person who's not in shape, very strong,

like you've provided them years of life, less depression, less anxiety. The value that you've provided them years of life less depression less anxiety um the value that you've provided them far exceeds the value of them driving a sports car yet i imagine they don't want to pay you the same amount it would cost them to buy a sports car or the difference between like a sports car and a h Civic, right? Right, right. But the value you brought to them is more than that. So it's hard to understand value when it's like your relationship is what's healing me and your relationship is what's allowing me

to change over time. Yeah, I think so on your podcast, you've done several episodes about psychotherapy and the importance of the therapist establishing an empathic connection with patients and how that empathy can really improve outcomes almost regardless of the model of therapy that's used. Like whether you're doing EMDR or some other kind of model, the empathy kind of trumps all. And if you can establish that connection, that can be very healing in and of itself. So I think that's a really interesting point. And I'd like to maybe dig in a little bit more about what you mentioned, like maybe there's

shame around food and food habits and dietary habits that people have. And how have you seen that manifest in your own therapy and experience working with athletes as well and lifters as well? And then maybe how have you seen people break down that shame and come to be more trusting and following others' advice or coaching? Okay, first of all, I use the word shame in like a technical sense of like people, they may have a sad expression. They look down, they want to cover themselves. It's like, if you've never had the conscious awareness of having shame, then you definitely have had it. And it's just been unconscious. It's like men, a lot of men only have like a couple emotions that they can identify, like anger and frustration, right? Or like maybe anger and sadness and frustration.

But really like there's a whole constellation of emotions going on, which I think I like to utilize like micro-expression as like, you know, created this website emotionconnection.com to identify and sort of label these small tenth of a second emotions that flash on the face and Santana I want to get you access to this if you haven't if you haven't studied this because it's gonna blow your mind oh I'd love to it's like seeing in color like it's like the best thing for someone like um if if emotion is like not even in your vocabulary it's like seen in color and then what do you do when you do start to see in color be me um so okay you have you have these emotions shame is one of them and then what what a lot of people do is like they're freaked

out about having emotions so we have like emotion affect, fear. And so then what do you do when you're stressed? You don't have a good way of processing your emotion congruently with another person. That would actually allow you to get out of the stress in a positive way. It's like I go lift or I go exercise, and that helps me get rid of my stress. Until you have an injury and then you're in bed and you're like, then what do I do? And that's when people start to get a little crazy, right? It's like, I have all this emotion. I want to exercise, but I can't. And that's driving me nuts. Okay. But let's say they can exercise and that's great. And that's serving them well. But then they have this like shame and they have this emotion. They

can also consume food, right? Because it's comforting. So it's like, you know, if you're a young kid and you're stressed out, like you go to the candy store, you get some candy, you feel better. And you just spiked your sugar for a little bit, that instant dopamine release, it's just like, boom. I feel awesome. It's like a little bit of like dopamine jolt, right? Which is why sometimes we give naltrexone which is a dopamine blocker for like binge eating disorder and stuff because then it decreases the pleasure of the binge so maybe they can stop using it interesting didn't know about that um or you know what's a really a good drug right now is uh i don't know if you've seen the wagovi studies or the semaglutide ozempic

this is like the next level stuff man i gotta like i gotta talk to you about um in the wagovi study it was a 20 weight loss at one year compared to placebo for about 50 of the people so if you have a 300 guy pound guy he's losing 60 pounds in one year. Wagovi, semi-glutide, very expensive. I ordered for some of my clients from Canada. And so it's a lot cheaper there, but okay. So I'm getting off course here. So they got this shame. And so you go eat, you, you, you either binge eat or you have a, this kind of like sugar rush and then you feel better for a little bit. It's comforting.

So what I've seen with some of my clients over time is they handle stress better without food and they can cope and they can process stuff in better ways than necessarily binging on food. I think this is really interesting because I think we're getting a little bit closer to what's driving the behavior, the negative behavior behind overeating,

eating the wrong things. And even in the face of information that you now know, it's like, oh, I know now that I need to increase my protein and I need to find carbs. I need to eat carbs from, uh, whole food sources rather than processed food. Uh, and I need to reduce my fat intake. Right. So that, you know, as you can kind of intellectually understand the, the macro components of a good diet, but maybe be drawn to certain comfort foods because of, you know, because of emotions that you're dealing

with. And, um, um, I, I think that's, that's super interesting because, um, it does seem like there is a lot of shame around people's, um, behavior or the behaviors that led them to the state to want to seek help with changing their body composition. Yeah. And then you're, you're coming up against that and beliefs and, um, it's exhausting maybe. Yeah. It's, it's, it's exhausting because like you have a hammer, which is a linear progression and gaining slightly while you do it. And you can get someone strong doing that. You know, you could take the average man with no athletic performance, get them squatting in the 200s, deadlifting in the 300s, if they run it right, and then they're strong.

The thing about strength is that you have that then for the rest of your life. It doesn't go away very quickly. And if you're in the ICU someday, a little bit of strength is going to be very, very helpful. Absolutely. Hand grip leads to longer outcomes. It's, you know, like the whole idea of you're harder to kill is true with some strength. I worry about some of my older patients that they don't exercise. have had some success in the last couple of years of getting trainers to come to their house to exercise them in the middle of COVID, right? Where no gyms were open. So I get trainers, go to their house, exercise them. Some of them I put on testosterone if they're like older

and they have serious sarcopenia. It's like, they can make all the difference, man. Especially like post-menopausal women, just a microdose of testosterone can make a huge difference. Yeah. That's interesting. It's a little aside. That's how, um, yeah. How, how frequently do you encounter, uh, clients that are over 60, let's say that, that need some help from testosterone replacement therapy or is that a pretty common for you it's maybe like a once maybe once every two months i'll get in a client that that is a good fit for them yeah um and there's been a couple where like it's the it is the fit which is funny because like rip rip would call me up man and i had to i had to talk stop like answering his phone calls after walks dr pewter why aren't you putting all your patients on testosterone yet?

I'm like, dude, like psychotherapy is where it's at, okay? For the majority of patients, it's psychotherapy. Right. But if you're like, like I have this guy, he has a ruin, he has something more complicated than a ruin-wise. So that means like he's missing a big portion of his stomach and intestines.

And for him, gaining weight is super hard. So, when he was super depressed, he weighs like 120. And for a 120, 70-year-old, like, the weight is the issue. Like, he's not going to get less depressed until he can get out of that sort of anorexic weight. Like, most people don't realize, like, once you are a certain level of anorexia, like low body weight, like your mood is not going to improve on medications. It like you actually need to gain weight. Like that's the first step to feeling better. So this guy, I mean, squatting at home, body weight squats and a micro, you know, small dose of testosterone and then like encouraging him to eat all the time. Yeah. And he slowly has gotten up to about 150. Oh, wow. Which that's amazing for him is like the difference between life and death. Awesome. Okay. Like if you get,

if you get ill with COVID and you weigh 120 and you're severely sarcopenic, your chances of death is so much higher. Oh, yeah. Sure, sure. With a 20% weight gain, that's pretty good. Yeah, that's interesting. I do work with some older clients that are 60 plus. And so I've run into that a few times where some of them are just kind of so low in body weight. I don't know that I could call them anorexic,

but very low in body weight. And it's kind of like, yeah, it does seem to be the keystone for everything else. So that leads me to one other thing I wanted to ask you. And what are some of the red flags that people could look out for if their behaviors around food and training are borderline clinical let's say or that you know they might be headed towards an eating disorder

that is that that needs medical attention you know i would say is it getting in the way of your life and is it um like how many hours per day are you stressing about this or thinking about this? So if you're somewhere around, like, beyond an hour, right, becomes more clinical. So if someone is, like, having obsessions three hours a day, like, it's of time it's a lot of your life and that's every day that's you know 24 7 so um a deep unhappiness if it's there you know like with your body or with how things are going it's like you know to some degree like how much of this is solvable with exercise, right? There may be some things that therapy or other places where you can find meaning and purpose in life

solve better than just exercise and diet. It's easier to focus on the physical, you know, with so many patients. It's easier to just focus on like that, which we see, touch, taste, have our senses wrap around. So as a coach, you're kind of like seeing these people and maybe you work with them for six months. And it's like, before they fire you because their unhappiness with how things are going, maybe this is something where it's like, hey, I think we're making progress. hey, I think we're making progress. I think if you consider this as part of the treatment, right, focusing on good diet, healthy exercise, it's part of the treatment, but psychotherapy alongside of it and like looking at some of these kind of like deeper things, I think could be very

important. Sure, sure. And that sounds like something that could be important for someone, even if you don't have a a clinical grade eating disorder Um, but maybe just something that you struggle with you do find yourself thinking about this, you know for multiple hours a day then that's It can be a good thing to get some uh, get some help and get some therapy and just uh, And work through some of maybe the underlying issues there All right. Well that concludes part part one of this two series episode. Might be three. We'll see what happens. So thank you for tuning into the Weights and Plates podcast.

You can find me at weightsandplates.com and on Instagram at the underscore Robert underscore Santana. My gym is located on Instagram at weights double underscore and double underscore plates. Very good. You can find me at jonesbarbellclub.com if you're interested in online coaching or in-person coaching if you're in or near the Chattanooga, Tennessee area. And you can find me on Instagram at marmalade underscore cream. We'll definitely look forward to having Dr. Pewter back on the show again to continue this discussion and to dig into the emotional side of eating and training as well. So we'll stay tuned for next time. Thank you.