Can you be Fat and Healthy/ How Many Calories Should I Eat?

Two of the top Googled health questions from the last few years are: "can you be fat and healthy," and "how many calories should I be eating?"

Can you be what some might consider "fat" and healthy at the same time? Our host Chrissy Billau asks Registered Dietician Julie Smith, who works with UTMC Bariatric Surgery, what the risks of being too skinny or obese, signs of an eating disorder, fad diets, and how parents can manage feeding a picky eater.

Learn more about Bariatric Surgery and our Registered Dieticians at http://utmc.utoledo.edu/

Transcript

Chrissy Billau:

Welcome to Prescribed Listening from The University of Toledo Medical Center. On this podcast, we interview our experts to get the answers you need and can trust I'm your host, Chrissy Billau. And today we are diving into some of the top Googled health questions from 2020 and 2021, with registered dietician Julie Smith, who works with UTMC bariatric surgery. Julie, thank you for joining us.

Julie Smith:

Thanks for having me.

Chrissy Billau:

So many people struggle with their weight. It can be such a difficult, confusing, frustrating process and downright inspiring if you find a way to make a transformation work and stick. But many wonder, is it possible to be what some people might consider fat and healthy at the same time? Or maybe dangerously thin? Let's ask the expert. Julie, here are two of the top Googled health questions: can I be fat and healthy? And how many calories should I eat? Let's start with the first part. Can you be what some people would categorize as fat and healthy at the same time?

Julie Smith:

That's a very loaded question. I think first let's talk about "what is fat"? I don't like that term. Medically, we're going to talk about BMI, body mass index. Essentially that's just your weight relative to your height. Many providers use it. It's not an all-encompassing test, but it does give a good indicator of where you are with your weight and how it relates to your height. So a BMI of 24.9... Let me say that again. A BMI of 25 and higher will be considered overweight. Once you get to a BMI of 30, you're considered obese. So for the context of what I'm talking about right now, we're going to talk about that overweight category. So 25 to 29.9 BMI. Yes, you can be metabolically healthy and be considered "overweight". The issue lies when we get to that obesity category, that BMI of 30 or higher. A lot of our obese patients technically at this point are considered metabolically healthy, but all of the research suggests that once you get to that obesity category, you are at higher risk for high blood pressure, diabetes, weight-related diseases that are going to cause long-term complications.

Julie Smith:

To be metabolically healthy and overweight, it's important to know you have to have healthy lifestyle habits. So exercising daily, eating a good variety of fruits and vegetables. Typically, when we say metabolically healthy, that's when your doctor's, make sure that your cholesterol is in a good place, your blood sugar's in a good place, you're not having blood pressure issues. For women, a waist circumference of 35 inches or less. And for men, a waist circumference of 40 inches or less. Once you get past that, we do get into an area where you are metabolically at risk to develop health issues. Just like you can have a very thin person and they're metabolically unhealthy. On the outside they look great, they look healthy, but if you look at their labs, you look at what they're eating, they're not taking care of themselves. So both can be true.

Chrissy Billau:

Okay. That's an interesting answer because for people who battle it, you're always wondering, "I feel great. Why do I not look as great as I feel?"

Julie Smith:

Sure. Absolutely. I think there's a couple things that we need to think about. We live in a very beauty-centered world. So we have all of these advertisements, everything around us telling us that we need to look a certain way. I always like to tell my patients because they could come in, feeling great, but not to the extent that they think it should be, but they're feeling great and they're the healthiest they've ever been. I always like to use this example. You don't put a Rottweiler on a diet and expect them to look like a Chihuahua. Dogs come in all shapes and sizes. So do humans. The issue with weight management is it's more than just eat less and move more. There's so much that impacts the size of our body, our body frame, our bones. There's so much that goes into it outside of just energy balance. So it's important to know that it's not a simple solution and it's not a simple thing. Some people just genetically are a little bit bigger and that's okay.

Chrissy Billau:

What are some ways to help maintain an ideal weight?

Julie Smith:

Sure. I think it's important one, to figure out what your ideal weight is. It's a little bit easier in pediatrics. Anybody that's a parent knows that when you take your kid to the doctor, they put a kid on a growth chart and they measure their growth curve. So a kid that's naturally larger is going to follow the growth curve in a straight line, but they're still always going to be on the higher end of the growth curve. Same with a kid that's maybe a little bit underweight. They're always going to be on the lower end of the curve, but they're going to follow that same line. When we get into adulthood, it gets a little bit more difficult because then we start using BMI. Well, what if as an adult, when you were a kid, you were always on the higher end of the gro growth curve? So you're going to assume that your BMI is always going to be a little bit higher. So one, finding the weight that is appropriate for you and not having unrealistic expectations are the two big things.

Julie Smith:

Now, if you are getting to a place where your weight is causing health issues and you want to find a way to balance and make sure that you're taking the best care of your health, it's important to work with some kind of professional that's going to help you. There's a lot of diets out there. A lot of fad diets that are meant for specific disease states and putting yourself on one of these diets could cause issues long term rather than the health that people want to get.

Chrissy Billau:

What are the risks of being too skinny or obese?

Julie Smith:

So, too skinny, again, In our society, we use a very specific body type to promote products. Now, these people, a lot of them are genetically built like that. Some of them are still working really hard to maintain something that's just inappropriate for their body type. So a risk of being too skinny is a lot of women will lose their periods. They won't be able to conceive children later in life. Women, especially, you're supposed to have a good amount of body fat. It helps protect our organs. So you don't have that protective benefit there.

Julie Smith:

The other thing is if you're one of those people that are significantly underweight and you're underweight because you're trying really hard to get there, oftentimes that lead to disordered eating. So it makes it very difficult to have a healthy relationship with food, making it very difficult to socialize with people. We in our society, we do a lot of socialization around food. And if you're struggling with that food aspect, that's just going to lead to a lot of complications in life.

Julie Smith:

With obesity, all the research suggests that once we get to that place of obesity, we're at high risk for type II diabetes long term, high blood pressure, our cholesterol being out of whack. It can cause... I mean, a lot of our patients that have struggled with obesity have a lot of mental health issues and that's a struggle in of itself and it's like both of them play into each other. You have this extra health complication that leads to mental health issues, and then the mental health issues just perpetuates the eating issues. And then another thing that could happen is cancer. Some cancers come about because you have excess weight.

Chrissy Billau:

Okay. Now, at what point should you consider bariatric surgery?

Julie Smith:

The patients that come to us are patients that have struggled with their weight for all of their life. They've gotten to a place where regardless of what they're doing, their weight is trending up. That happens for a couple of reasons. As I mentioned, we live in this beauty-centered culture. There's a lot of diets around. When we diet cycle, when we put ourselves in this restrictive mindset, what typically happens with people that have struggled with their weight long term is they restrict themselves because they want to lose the weight. They want to tak e care of their health. That restriction only lasts for so long because we're relying strictly on willpower. So they stop restricting. And as soon as they stop restricting, they gain all that weight back. Plus they usually gain more weight than what they've lost. So then what happens is they feel shameful. They restrict again, lose weight, and then they gain more weight and they keep ending up weighing more over time.

Julie Smith:

Bodies are very smart. If you think back to the time where we had to get food and hoard it because there is lots of famine, our bodies adapt to this. So your body gets comfortable at a new weight. And then when you try to lose weight outside of that new weight, your body's going to fight you.

Julie Smith:

It decreases the amount of energy that you're using. It releases hormones to increase your appetite because it's trying to protect you. So typically these patients that come to us for bariatric surgery, their body's just fighting them at this point. They're so frustrated. And the thing that I like to point out with bariatric surgery specifically is we do call it metabolic bariatric surgery because it changes our metabolism. It changes the hormones in your body. So then once you have this tool, your body's no longer fighting the weight loss and you can take control of your health.

Chrissy Billau:

What is bariatric surgery? What do they do?

Julie Smith:

Good question. There are two major types of bariatric surgery. The first is called a sleeve gastrectomy. Basically the doctor goes in and they cut your stomach down from the size of... we'll say a football. They cut the outer part of your stomach out to make it about the size of a banana. So with this surgery, there's a lot of restriction because your stomach is very, very small at this point. The other thing is, is where they cut the stomach, the top part of the stomach releases a hormone called ghrelin. That hormone's responsible for making us hungry. So now that part of the stomach is gone so that hormone's not being released. So our patients don't feel hungry. That's one of the surgeries.

Julie Smith:

The second one is called a Roux-en-Y gastric bypass. This one's a little bit more complicated and it's nice to look at pictures online, but essentially instead of removing the stomach, all of the stomach stays in, but the surgeon goes in to the top part of the stomach and creates a little pouch, basically the size of a golf ball. The rest of the stomach pretty much just hangs out. It's not doing anything, it's just there. And then he reroutes the small intestine to go up and attach to this little golf ball thing.

Julie Smith:

So with the bypass, you're restricted because you only have a golf-ball-sized stomach and you're bypassing a lot of the stomach, a lot of the area that our body absorbs nutrients. So it's also malabsorptive. With the bypass specifically because it is malabsorptive, the supplement regimen is a little bit more aggressive to make sure that over time these patients don't become malnourished. Still, with the sleeve you do have to have supplements because you're not able to get the volume to get all the nutrients that you need, but it's not to the extent of the bypass because you are still able to absorb most of your nutrients.

Chrissy Billau:

So on the other end of the spectrum here, if you're not a person who needs bariatric surgery, at what point do you need to think about consuming more calories if you're too skinny?

Julie Smith:

I think it's really hard to give a broad scope answer without seeing a patient's chart. Because it's really important to take into account the patient's past medical history, if they're currently struggling with anything medically, determining what their end goal is? Why do they need to gain weight? So that's why I think it's really important that you work with a professional that has a good understanding of medicine. Right now it's really popular to have health coaches out there and while they could serve a purpose, they don't have a medical training. So it's really important that you get the right provider on board.

Julie Smith:

The other thing too is it's not usually just one provider that needs to be active with this patient. You typically need a multidisciplinary team, usually some kind of psychologist or social worker, a doctor, a dietician. So it's really important if you're somebody that's struggling with that, that you reach out to get the resources that you need.

Chrissy Billau:

If you're someone who's struggling with weight or you know someone who is struggling with weight, what are some signs of an eating disorder?

Julie Smith:

Some signs would be one, a big one is after you eat, you feel aggressively guilty to the point where you make yourself get sick, using laxatives to make yourself go to the bathroom, having fear around food. So if you're someone that notices that there's a certain food that even thinking about eating makes you really anxious and overwhelmed. Being somebody that kind of hides your eating as well. Binge eating is very real, especially with anybody that's diet cycled. So if you feel that you have to hide your eating and you're eating so much that again, you feel guilty and you don't want to share that with somebody, those are good signs.

Chrissy Billau:

With bariatric surgery, are there any lifestyle changes that people need to make afterwards?

Julie Smith:

Yes. That is a great question. The big thing that we always tell patients when they're coming in considering bariatric surgery is that it's a tool. So the tool is there to help change your metabolism and to help with the restriction, to get you to a place where your body's not fighting your weight loss. But to have long-term success, you absolutely do need to change your lifestyle. Some things that we work with our patients on are portion control. Protein is really important for these patients. They're recovering from a major surgery. They don't have a lot of space to work with so they really need to eat a protein-rich diet. Getting a good variety of fruits and vegetables to make sure that they're getting the nutrients that they need and exercise. We always work on our patients to get some kind of exercise, whether it be 10 minutes of just something in your living room, going for a walk. We try to make sure that people understand that when we talk about these lifestyle changes, they need to be something that fits within you and your lifestyle.

Julie Smith:

Some providers with good intentions will tell a patient, "You need to go exercise 60 minutes a day." And while that's good and well, and that's what we should be doing, if a patient's never exercise in their life, telling them that is going to be really overwhelming and they're not going to be successful. So those are kind of the main lifestyle changes that we expect with these patients.

Chrissy Billau:

You always hear the best exercise is what you'll actually do.

Julie Smith:

Yes. s omething that you'll do and something that you enjoy. It's really kind of fun to help patients explore different ways to exercise from kickboxing, to dancing, to walking, finding something that works for you.

Chrissy Billau:

Okay. This goes back to... We talked about binge culture and binge eating with the pandemic and people binge watching TV, entire series in one day. Are we seeing an increase in eating disorders?

Julie Smith:

I wouldn't say that we're to the place where it's necessarily disordered eating. I do think there probably has been an increase. Whether it's been actually diagnosed or not is a different story, but as humans, it's important to know that we eat for more than one reason. Yes, we eat to nourish our body, but we also eat to socialize, we eat for comfort. And these are really important to kind of acknowledge. A lot of providers don't want to acknowledge that and say, "Well, you should just be eating to nourish yourself." Well, that's just unrealistic. So with the pandemic, we were, a lot of people were turning to food for comfort. They were at home, so they were able to cook more nutrient-dense, energy-rich foods. So I do think some people really struggled with that. And I have seen an increase in patients coming and saying, even if they've had a super healthy lifestyle before say, "Well, I'm really struggling now to find a new guess day-to-day habit, because this has become part of what I'm doing."

Chrissy Billau:

And I'm happy you mentioned that food is a wonderful thing. We grow it, it keeps us healthy, and you want flavor in your life. I mean, it doesn't always have to be like, "Okay, I'm going to get this much protein and this much flavor." Sometimes you just want something sweet.

Julie Smith:

Yes. And that's a really good point because a lot of people think, "Well, if I want to be healthy, I have to restrict myself." Well, that's not the case and this is why it's really important to work with a provider. I eat a very nourishing diet, but I'm a dietician. My favorite food is a donut. And every time somebody sees me eating a donut, they're like, "Well, you're a dietician." I don't eat a donut every day. 80% of the time, I'm eating foods that are really nourishing and great for my body, but I also have found a good, healthy balance with food to where I can enjoy a donut or a piece of cake and not feel guilty about it. And I think that's where it's really important when you're working with a provider to make sure that you're working on your relationship with food as well.

Chrissy Billau:

Well, that brings us to our second of our top Googled health questions. How many calories should people be consuming a day?

Julie Smith:

Ooh, that's a loaded question. So like some of the questions you asked before, it's very hard to give a broad answer to this because everybody is so individualized. How tall we are, our body build, our biochemistry, all of that plays a role of how much energy we need throughout the day. So I always tell people before we even think about considering calories, we need to think about the quality of our food. If you eat 100 calories of diced up vegetables, that's not equivalent to 100 calories of Doritos. So I think before we do anything with calories, we need to look at the quality of our food.

Julie Smith:

The other thing, because we live in such a busy world, we're relying on a lot of quick, easy, convenient food. And what that means is oftentimes these foods don't have the nutrition that we need. They're not very high in fiber. And because of that, they're not very filling. So you might eat a 300 calorie lunch, but it doesn't have what your body needs. So then your body's going to get hungry quicker. Whereas if you eat a 300 calorie lunch that has lots of protein, healthy fats and good fiber, you're going to feel fuller longer. So first step is looking at the quality of our food.

Chrissy Billau:

Should you be tracking your calories or no?

Julie Smith:

Again, this is going to be dependent on your history. If you are somebody that has a history of restrictive eating or any kind of disordered eating, I never recommend tracking your calories unless you're doing it for a medical reason. It just gives us one extra piece for us to either become obsessive over. And even if you're not somebody that's had restrictive eating, it's we live busy lives and it's just one extra thing like, "Oh, I have to do this." So some people, depending on where they're at in their health journey, I might recommend that they keep a food journal just to take a look at the quality of the food, the portions of their foods. And then we can make adjustments that way. There are some people that it does benefit them to track their calories, but it's going to be very individualized at that point.

Chrissy Billau:

What kind of foods are great to keeping in your diet to maintain a healthy weight?

Julie Smith:

Good question. Lots of fruits and vegetables and whole grains. These are very important. Good, healthy fats as well, but fruits and vegetables, we are seriously lacking. Here in our country, in America, our rate of obesity has significantly increased. We are almost at 20% of adolescents with some kind of weight issue. The important piece to that is we've done a lot of studies that have noticed that these kids, even though they have a whole bunch of extra weight are malnourished. Their vitamin levels are low. They're not getting the fiber that they need. So here in our country, we're overfed and undernourished. That's where we want to get back to the basics. We have to get some more fresh fruits and vegetables in. And even if you can't get fresh, can and frozen are perfect. Just get the ones that don't have a whole bunch of additives to it. Salt is fine, but try to avoid the cheese sauces and all those creamy things.

Julie Smith:

And then good whole grains. Again, because we are relying on convenience food so much, most of our food is very highly processed, meaning that the fiber's been taken out. So you're not feeling full after you've eaten something.

Julie Smith:

And then the healthy fats piece. I know a while ago, and most of us '90s kids know that our parents went through a phase where we were all in low fat diets and that was all the rage, but fat, our body very much needs. We just have to make sure it's the right kind of fat. So olive oil, avocados, nuts, all of those are great sources of healthy fat that our body needs. And then of course, good sources of protein. It doesn't have to be meat. I mean lean chicken and turkey and fish. Those are great, but lentils and beans are also fantastic too.

Julie Smith:

I always say a good place to start is if you're completely lost, just look at the MyPlate model. If you guys haven't seen it, the choosemyplate.org, it gives you a visual picture of exactly what your plate should look like. And start there and practice doing that. If it's not for every meal, one meal a day and then work your way up to every meal.

Chrissy Billau:

There are always trendy, super foods like kale or avocados are hot right now. What are some that you would recommend incorporating in your diet and what are some highly nutritious foods that are often overlooked?

Julie Smith:

Good question. I mean, kale and avocados while they are trendy, they are fantastic. Spinach as well. Most of these super foods become a super food because somebody decided that they're going to over-amplify the benefits. But I think when we're looking at our diet, the best thing we can do is get a variety. One thing that we always show our patients is a picture of the standard American diet. It's fried food, all of it's brown, there's no color. So switching to having a very colorful plate. Beans and lentils, I feel like are very widely overlooked. They're fantastic fiber, really good for us and they're cheap ----. They're great for, especially right now with the cost of food going up, they're easy to store. So those are great things to add. They're rich in fiber, protein, good healthy fats. So I always recommend adding some sort of plant protein maybe once or twice a week. And then obviously again of good variety of your other proteins and fats throughout the day.

Chrissy Billau:

If you're trying to cook and eat healthier, what kind of cooking oil should you use?

Julie Smith:

Sure. Again, we try not to villainize foods. We want to get to a place where we can accept that all foods are welcome in our diet to some extent, but if you're trying to do the best for your body and you're like, "Tonight's a really good meal and I want to make it the best," olive oil and avocado oil are fantastic choices. Avocado oil is a little bit easier to cook with because it does have a higher cooking point. Whereas olive oil, we have to be really careful with the temperature that you're using, but either are fantastic.

Chrissy Billau:

When you hear someone say, "I'm thinking about trying this diet," whatever the fad may be. Does that set off any red flags for you? And what's your take on new diets popping up and what should we instead be paying attention to in order to eat healthy?

Julie Smith:

Sure. Again, I mean, because we live in the culture we live in that very much pushes the way that we look, not so much our health. If a patient says this to me, I usually just explore their why. And then over time I help guide them back to just getting up to a place where we're eating a healthy, balanced diet. That my plate's great, where we're getting half of our plate fruits and vegetables, quarter of our plates some kind of lean protein, and a quarter of our plates some kind of whole grain. Oftentimes people come and they're like, "I want to try this," because they're looking for a quick result. And that's why most people don't want to work with the dietician because we always say there's no such thing as a fast result. If there were, we would be millionaires.

Chrissy Billau:

Yes.

Julie Smith:

If we could find some quick solution for patients, everybody would be coming to us. But unfortunately, our health it's so long, it's for our life. You don't just try a diet for a month and then you're healthy. It's something that you take care of and you practice for the entirety of your life.

Chrissy Billau:

Well, yeah. And you'll have some people who say, "Well, I want to do the keto diet or intermittent fasting because so-and-so who I know at work or my friend did it and it worked so well. But your answer is, "You're different people."

Julie Smith:

Yes. Different biochemistry. And then long term, where is your friend at once they can't follow that diet anymore. For whatever reason, something pops up in their life and they have to go somewhere and something happens that takes them off of being on that restrictive pathway. What happens to them after that? Is it, are they still successful or do they see all of their weight come back?

Chrissy Billau:

What supplements should people take?

Julie Smith:

Good question. There's a lot of hype around supplements. And again, I think this is where it's really important that you're working with a provider that knows your health or your health history. If you're getting a good variety of foods, supplements usually aren't necessary. I would say specifically for people that follow a vegan diet, a B12 supplement is important because we get a lot of that from animal products. But outside of that, if you're getting a lot of fruits and vegetables, you're getting your lean proteins, your healthy fats. Most people don't need a supplement unless they have some health condition that's requiring them to have one.

Chrissy Billau:

I'd like to talk with you about the popularity of plant-based diets. America's Test Kitchen just published an entire cookbook of all plant-based recipes, and most of which are made to taste or resemble meat such as tacos, burgers, chorizo. Why is this becoming so popular now? Are there benefits of it? And how would you recommend an omnivore start this diet?

Julie Smith:

Sure. Yes, plant-based is very hot and heavy right now. So there's benefits to increasing our plants. If you look again at the MyPlate, half of our plate should be fruits and vegetables. If you don't have fruit, then half of your plate is vegetables. And this is where we're largely missing the mark here in our country. Limiting our meat consumption is beneficial over time, but it's important to look at the type of meat that you're eating. If you're eating all processed meat, hot dog, sausage, those aren't really great for our bodies. So we need to look at the quality of meat. And then increasing our plant products again, that just gives us the vitamins, minerals, and the fiber that we need. So there is benefit to having some plant-based meals.

Julie Smith:

I would say if you're interested in incorporating this diet at all, I would say just pick one day a week. A lot of people will do meatless Monday and just try it that way. Use beans and lentils. I think there's a lot of controversy with these manmade meat products and from a nutrition standpoint, I wouldn't say that they're any better than the processed meats that we have now. But if you're trying to do plant based and you're actually using plants like beans, nuts and lentils, then that's a good place to start.

Chrissy Billau:

Talking about finding the right quality food for adults, what about kids? And especially ones who are like, "Nope, I'm not doing broccoli or asparagus or any of this today. I just want my hot dog." What do you tell parents to help them give their kids quality food and try to decrease the 20% we're seeing with children in obesity?

Julie Smith:

Sure. Kids are tricky. I actually used to teach a cooking and eating course for kids for this reason, because you do have the extra challenge of, especially in toddlerhood, "I'm not trying it. I don't want it. Textures are a big thing."

Julie Smith:

First thing that I always say is, as a parent, it's important you offer your kids what you're offering yourself. So even if you know your kid hates broccoli, put it on their plate. One day, they may like it, but if they're never exposed to it, they're never going to try it.

Julie Smith:

The other thing is cooking things differently. So whereas some kids may like raw vegetables, other kids won't. So grilling them, baking them, putting them in stews, trying different methods to get your kids to eat it. When we have extreme picky eaters, I always say smoothies and sauces are a fantastic way to get those fruits and vegetables in. Most kids will not know if you put spinach in their smoothie. Most kids, you can make pasta sauces and pizza sauces and put a whole bunch of vegetables in them and puree it down and they have no idea. So there is a lot of creative work required when you have a picky eater, but just offering it to them.

Julie Smith:

And then I always tell parents don't become a short-ordered chef. It's very easy when your kid's like, "No, I'm not eating that." They can have one option that they know of, whatever they're serving for dinner, their kid absolutely won't do it. They can have one backup option, but their kid needs to know ahead of time. If you don't eat that, then you get a peanut butter and jelly or whatever it may be at the home. With kids, it's just a lot of exploring, letting them play with their food. This kills some of my parents, but that's how kids explore textures and stuff. Even if they don't eat it and they're making a huge mess and they're playing with it, that's okay.

Chrissy Billau:

Have bath time after.

Julie Smith:

Yes, it's very hard to do, but that's how kids learn and explore. And then the other really important thing is leading by example. Whether we want to admit it or not, our kids are watching us. And if we're eating a whole bunch of potato chips and pop and we're not trying to include a good variety, our kids see that and they're not going to go off and do it on their own. So you have to make sure that you're a good role model for them as well.

Chrissy Billau:

All right, going back to quality of meat. Do you have any thoughts on grass-fed meat and eggs versus meat and eggs?

Julie Smith:

This is tricky because there is a lot of studies that show that grass-fed beef, especially, is higher in the healthier fats that we need. However, a lot of people can't really reach for that because cost is just absurd. So it's important to, I guess, from a nutrition standpoint, to make sure that people understand that your diet's never going to be "perfect". There's going to be things that are better. There's going to be things that aren't the best. So when you're choosing beef, I just say, choose a leaner cut. So 93% to 7% fat if you can. If you can't, if 80/20 is what you can afford, then just drain out some of that extra fat. So yes, with the grass fed, there is more healthy fats, but it doesn't mean that if you can't eat those that you're not going to be a healthy person.

Julie Smith:

As far as eggs, it's tricky because our food marketing does a good job of trying to get us to buy things. So the only time that we actually truly see a benefit with eggs is if they are pasture raised. A lot of times it says cage free, organic, brown. The only time that we've seen any change in nutrition is if they are truly pasture-raised chickens that are able to wander about freely on acres of land. A lot of times advertisers or companies will use cage free. All that means is they still only have a little tiny space to work with, and they're not actually roaming about to get the healthy fats in them. And again, eggs in and of themselves are a great food source, whether you get regular conventional eggs or you get pasture raised. That's where getting that variety of other things is going to help kind of balance things.

Julie Smith:

Right now, we do live in a world where we like to glorify foods and villainize foods. And it's important to make sure that we're meeting patients where they are. If you can afford those things and that's a value to you and your family, then sure reach for those things. But if you can't, don't think that you can't be a healthy person.

Chrissy Billau:

Piggybacking on all of the popular Google searches, I want to ask you, what is the most common question you get from patients? And what's your answer?

Julie Smith:

I would say I get a lot of questions. I do think that the calorie question is the one I get the most, "How many calories should I be eating?" And a lot of people... And then, "What should my meal plan be?" Those are the two most common. The calorie one I've kind of already answered, but patients get really frustrated when they come to see me, because I'm not creating a meal plan for them. They want me to send them home with exactly what food to eat when. As a provider and somebody that truly understands how significant behavior changes and change does not happen all at once, it takes time, my goal is to help these patients learn how to problem solve. So we figure out foods that they enjoy. We figure out what their usual daily life looks like. And we figure out how to problem solve ways to get the nutrients in that they need.

Julie Smith:

If I sent them home with just a meal plan, "Eat this way." Well, what if something happens and you don't have access to that food or you don't like that food anymore so on and so forth? They haven't gained the skills to problem solve for themselves. So then they're calling me on the phone, "What should I do?" So I think the calories and what is my meal plan are the most common.

Chrissy Billau:

What is the one thing you would like to tell your patients or anyone listening to this podcast out there about your specialty?

Julie Smith:

A lot of people when they think of dietician, they think, "Oh, they're just going to give me a meal plan. They're going to judge me and tell me not to eat things." That's not what we're here for. One, dietitians are human too. We enjoy cake and donuts. And when you come in to talk to us, we're not judging you. We're just trying to find where you are at and meet you where you are to help you create the behavior changes that you need.

Julie Smith:

The other thing too, a lot of people think that I'm just going to tell them, "Do this, do this, do this when you get home." Behavior change is very complex. And it's very important to know that we take small steps to create the behaviors overall that the patient wishes to have. I am not the expert on the patient's life. I'm the expert on nutrition, but they know their life, they know themselves way better than I ever do. I'm just there to meet them where they are and help them practice making behavior change that's going to last. Change does not happen all at once. It takes practice. It takes years of practice and that's ultimately what I'm here for. Is to help you make changes that are achievable and are going to help you get to the outcome that you want.

Chrissy Billau:

When you talk about making behavior changes, do you mean, hey, you know what, instead of skipping breakfast every day, let's do a smoothie for breakfast every day. Or do you mean, I'm going to put out all the stuff in place the night before to make sure it's really easy for me to make my smoothie in the morning?

Julie Smith:

It could be either depending on where the patient's at and depending on what their health goals are. That's why it's really important to work on a patient individually because every person comes from a different background. Some people are perfectly fine eating breakfast. Some people don't even eat until dinner time. So for them, we may just practice including a small snack before dinner. And then as they get comfortable with that behavior change and it just becomes a part of their lifestyle, is when we start adding to that.

Julie Smith:

Well, we could just tell them everything that they should do. Ultimately, if I'm just giving you a list of shoulds and we're not working on the how, it's not going to happen. And a lot of providers come from a really good place where they send a patient home with, "Well, don't eat this and don't eat that and exercise 60 minutes." If the patient's never done any of those things and they don't understand how, it's just not going to happen. So it's very small at the beginning until they get comfortable. And then we add to it to ultimately get to their end goal.

Chrissy Billau:

Well, and they need the support at home too, because you don't know what they're dealing with. I mean, on my journey, my family has been wonderful and they know what I need and I want, and they clear the path and they make it great. But not everybody has that.

Julie Smith:

That's absolutely right. And that's a barrier that we have to address with a lot of our patients.

Chrissy Billau:

Well, thank you, Julie. That is all for this episode of Prescribed Listening from The University of Toledo Medical Center. Subscribe to hear more on your favorite podcast platform and join us next week for another episode where we tackle more of the top Googled health questions.