GLP-1s, Bariatric Surgery & the Uncomfortable Truth About Eating Disorders

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*This episode discusses eating disorders, disordered eating, substance use, body image, and other sensitive topics. Please take care of yourself while listening.

In Part 2 of Kat's conversation with Nanette Adams, MEd, LPC, LMHC, they have a candid discussion about eating disorders, substance use, and obesity care from both a professional and lived-experience perspective.

Nanette is a therapist specializing in obesity and eating disorders, an obesity advocate, and a person living with obesity who has experienced both bariatric surgery and GLP-1 treatment herself. Together, she and Kat explore how our relationships with food, movement, our bodies and other coping behaviors can change throughout obesity treatment, and why eating disorders can be particularly difficult to recognize when weight loss is being celebrated.

You'll leave with a better understanding of how eating disorders and substance use can intersect with obesity treatment, why they can be missed in higher-weight bodies, and when you or someone you love may need additional support.

Connect with Nanette:
Weighted Wisdoms: https://weightedwisdoms.com
Substack: https://weightedwisdoms.substack.com
Instagram: @nanetteadamslpc
TikTok: @weightedwisdoms
Facebook: Weighted Wisdoms

Support & Resources
If you or someone you love is struggling with an eating disorder, disordered eating, substance use or mental health, support is available.
National Alliance for Eating Disorders
Therapist-staffed helpline: 866-662-1235
Monday–Friday, 9 a.m.–7 p.m. ET
Find treatment and eating disorder support:
https://www.findedhelp.com/
https://www.allianceforeatingdisorders.com/
SAMHSA National Helpline
1-800-662-HELP (4357)
Free, confidential treatment referral and information, available 24/7.
https://www.samhsa.gov/find-help/helplines
https://findtreatment.gov/
If you are in crisis: Call or text 988 for the 988 Suicide & Crisis Lifeline. If you are experiencing a medical emergency or are in immediate danger, call 911.

Transcript

SPEAKER_01 0:01

Hey, plus science community. Before we jump into the podcast, do me a favor, like, subscribe, and share if you haven't already. This helps us get referred up in the algorithm so we can find more people that need our help and guidance from our doctors. Thanks so much for supporting the show. Let's jump in. Friends, the GNLP1 math is just not mathing. When I look and see 104 million people in America are struggling with a disease of obesity and about 11,500 obesity specialists, that breaks down to like one obesity specialist per 9,000 patients. I saw the stat that said 72% of GLP1 users say that they want more support on their journey. Because I think we all realize you start on these medicines and you think, oh, it's just going to be like Venomine or anything else ever taken in the past. This ain't like that, bro. Like it's not. It's different, you know? And I provide a lot of that here by interviewing doctors and things like that. But I've had people been asking me, emailing me for years, asking me to do one-on-one consults, which I do do, but they're expensive, right? So I decided to make a group where 10 people at a time would come in with myself and with Kat. We could talk about recipes. We could talk about exercise. We can talk about side effect management. Um, we could talk about, you know, ideas on breaking stalls or things that we've tried. None of it's medical advice, but it is community support. It costs $50. If you're interested in that, there's a link in my bio. You just fill out that form. If you're not and you just want to go this route, that's okay too. I love you. And not alone, it's not your fault. And hopefully you'll sign up to hang out with us. All right, now back to the show. Are you interested in understanding GOP1 medications like Cosempic, Wolfie, or Manjaro? Then join us on the Plus Tide Cracking the Obesity Code, the groundbreaking podcast helping people change their lives one episode at a time. The Plus Sides podcast is Destructor. We're breaking down barriers, smashing stereotypes, and sharing inspiring stories that will leave you feeling enforced and empowered. Join us every week to learn from doctors who are specialists around GLP1 medications like OpenStack and Manjaro. We'll provide you with science and facts to validate these incredible stories. But that's not all. We'll also bring you the voices of the GLP1 Manjaro 6 community, real people who face the challenges of obesity-related diseases and disorders, and discover the incredible plus sides of GLP1 medications. Our episodes are filled with heartwarming stories, laughter, and moments of triumph. You'll connect with our amazing community members who are reclaiming their health and experiencing their fullest lives. Are you ready to embark on a journey of discovery and empowerment? Tune in to the plus sides cracking the obesity code, and together we'll change the narrative around obesity and in the stigma. Subscribe now on YouTube or your favorite podcast platform and join our incredible community. Let's celebrate the plus sides of life together because every story deserves to be heard. Every life deserves to shine, and everyone deserves access to expert knowledge and medication. The Plus Sides Podcast. You're not alone. It's not your fault.

SPEAKER_03 3:03

Welcome, welcome. Hi everyone. Welcome to the plus sides. And it is me, Kat Carter. I am flying solo here. And if you haven't been following us, if you haven't left your five-star reviews, uh wherever you get your podcasts, why haven't you? I'm just flying solo. Kim's got some things. Of course, um, what does Kim not soldier through? She has some things she has to take care of. So I stepped in and I said, hey, I can cover. I have lost 100 LBs on a GLP. I did experience regain, but way back um a couple of years ago, I've been on a GLP for four years. Um, lost 100 LBs um very slowly. Um, and I am a slow responder. All of slow responders unite. And um it has in essence been like probably the best thing for me. So I'm very thankful that I was not a fast responder for me and for my journey. Before we get into today's, before we start today's conversation, um I want to make name up front um that we're talking about two very difficult things eating disorders and substance abuse, substance use and people living with obesity. We're going to talk about them honestly, but we're not going to walk through specific behaviors or numbers because the show is for people who may be in the middle of it uh right now and they're not watching it from the outside. That's you, it's okay. There's no shame in stepping away from this episode, and there's real help, which will point to you throughout this episode. Here's why we wanted to do this episode. In part one, we talked about how weight regain drives people to hide from their care. Eating disorders and substance use work the same way, they thrive in shame and secrecy, and they get missed, especially in higher weight bodies. It's a conversation about what these look like, why they're so easy to hide, and how to actually get help. All right. And so, with that being said, I'm going to introduce our guest, Nanet Adams. Could you give us an overview of what you do and how you help people?

SPEAKER_02 5:25

I'm a licensed professional counselor and a licensed mental health counsel counselor in 13 states. And I primarily work with people affected by obesity in obesity care. And I began that specialization about 15 years ago after I had my bariatric surgery and had an experience in a sport group where um one of my fellow support group members had a substance use disorder, and um her life ended tragically. And that led me to specializing in this patient population because I was part of it and I saw that there was a knee. Um, I have gone on to train in eating disorders and recognizing eating disorders. I've worked in uh substance use disorder clinic, particularly inpatient and intensive outpatient. And I am passionate about helping people who are affected by obesity get the appropriate psychotherapy and care to live happy and full lives. I think it's important to refer to resources for people who may be struggling with these issues. And the National Alliance for Eating Disorders Specialized in Eating Disorders Monday through Friday, 9 a.m. to 7 p.m. Eastern Time. Um, it can help direct people to treatment referrals at all levels of care. Um, you can also find them online at fineedhelp.com. Um, so since this is not a 24-hour price line, we do need to pair that with uh 988 or if you're in imminent danger, um, calling 911 to get immediate care.

unknown 7:14

Yes.

SPEAKER_02 7:14

The use also uh want to point that direction to SAMSA. Uh the S A M H S A National Hotline. Um, so their helpline is 1-800-662-4357. It is free and confidential, and that one is 247-365 days a year, both in English and Spanish. And they can provide treatment referrals and information to help people locate the appropriate care. And they are at findreatment.gov.

SPEAKER_03 7:51

Okay, great. And those will be in the notes. Um, we'll definitely highlight those resources um in this episode. That's very, very important. I'm so excited to get into this with you. Um let's talk about how things travel in PACs. Um, specifically when we're talking about like obesity eating disorders and substance use disorders. Let's just let's um kind of just um let's talk about how and why they travel together a lot of times.

SPEAKER_02 8:25

So we see obesity eating disorders and substance use disorders often run parallel. Um, you know, all three kind of sit in the same shame, blame, fighting behaviors and get worse when concealed from care teams. And people often are ashamed of how under troubles are. So a lot of what we have to do is establish those patterns, like helping people see and have insight toward the patterns in their lives and understand that building capacity to better manage emotions, stress, anxiety, sadness, improve relationships, and identify those patterns in your life will benefit you for from the long-term management of the disease of obesity.

SPEAKER_03 9:16

Great. I totally get that. I feel like um when when we talked about previously when it when things travel in secrecy, I remember um, you know, I I talk about it a lot on this podcast where I did go to OA, I went to over Years Anominus for a while trying to get on top of my my compulsion, my binging. Um, before we I discovered um the a GLP and the secrecy, the secrecy of of the of the disease, right? Um it is it is uh it's it's an insidious little thing where like you want to be alone and you want to be in secret, and that's where the perfect storm hits. Um, and so could we kind of go go over that um on like how isolating um both having the ED and the SUDs or the substance use disorders, um, and how we can detect that, like say externally like a friend or a family as well.

SPEAKER_02 10:20

I think uh like the overview of this is obesity in society has been shamed for so long, and people who internalize the blame, you know, the restrictive dieting, dieting culture, and you know, all of these things that we try and try, and we have these stop-start cycles so frequently, and we blame ourselves, not realizing that the biology is running behind it. But the patterns of behavior that we establish can often become very disordered, very maladaptive, especially with bariatric patients. I think, like, you know, we are prescribing a very restrictive pattern to get them into the lifestyle changes and the reduction of calories, which is like subscribing to the diet culture and then getting them to it and a lot of mixed messages that lead to maladaptive coping mechanisms, you know, and we we see high rates of substance use disorder, particularly with alcohol and people struggling with adapting to the new internal design of their organs, right? And in the GLP1 space, an opposite of suddenly, oh, the desire for alcohol does go away, though. I think that is conflictual and it's not a hundred percent going to just completely make us stop thinking altogether, right? You know, and it'll be completely restrictive if you don't have a substance use disorder, then you know, okay, maybe I should be able to enjoy a glass of wine or a cocktail when I go out to dinner, but not letting it completely fall off only add in the sudden attention and the anxiety and social anxiety, it becomes a perfect storm. You know, I'm not gonna rule out that uh substance use disorder can exist in GLP1 use because I see it and I treat it clinically, but helping people learn to regulate behavior and not adapt to maladaptive behavior and learn what what does normal look like, right? Because normal looks different than all this, and it's like this oh normal, like we we use the term oftentimes, uh the neurodivergent, but we're all neurodivergent. We all have brains that look different from each other. It's the word you fall on that you know, spectrum to kind of sidetrack. But we talked in the last episode particularly about orthorexia and the kind of kind of follow-up because it is an extreme, but an extreme that's promoted within obesity care for good reason, right? For the bariatric patient side for good reason to get them back to nearly eating patterns as a reset. Um, but with GLP1s, you can go into GLP1 and you can not adapt to more nutritious, better choice the eating behaviors and continue to eat the same way you always did and lose weight, but that's eventually going to catch up, right? Yeah, we have to meet the I'm changing my health and changing my choices for the better to improve my health in a way that makes sense and is not maladaptive, you know, and I'm taking care of my body with intention and feeding it at appropriate times, appropriate amounts, and moving it appropriately regularly as I build more mobility, more strength. And people who may have not had those behaviors at the beginning, right? So the building into coping mechanisms, right? Learning the new coping skills and working with a dietitian to make you know good food choices and integrating what maybe food intolerances someone might have for a balanced lifestyle. But anytime you're trying to create a balanced lifestyle, there will be outliers of extremes and there will be new uh the newness of a new body, right? And a smaller body and more attention that doesn't feel comfortable, that could spiral into a substance use disorder or could spiral into restrictive eating behavior patterns. So I think it's important to be aware of what that might look like, and then know that there are resources out there to help. And um in the age of there being a lot of coaching available online, right? Yeah, vetting the person you choose to work with, but also knowing that there needs to be re resources and referrals to licensed professionals when behavior falls outside of your scope.

SPEAKER_03 15:10

Yes, most definitely. Could you could we back up this a little bit and provide what is the definition of you said orthorexia?

SPEAKER_02 15:17

Okay, so orthorexia, actually, we we talked about this in the last episode, but it is the extreme eating like restriction behavior, like food choice restriction behavior. Um, and it's one that doesn't get a lot of highlight because often it runs under the radar, but it's this set of extreme behaviors to um you always eating organic and not you know eating out or eating at somebody else's house and having to have like extreme control over dietary choice um to the point where it becomes very difficult, you know, to make those choices, right? Like they're they're like setting up really refined restrictive rules. So it's defined by a lot of restrictive rules. And so kind of diving deeper into that, we you might see somebody, okay. I'm only eating uh grass-fed, uh grain-free cows. Yeah, from yeah, very, very restrictive, uh, or like uh free-range chicken that are only fed this particular type of grain, whatever, right? Without some medical basis behind it, like, oh, I have an allergy to this or an intolerance to something else. It's defining very restrictive food rules that limit choice, that limit enjoyment of food. Because a patient may have had bariatric surgery or is on a GOP1, food should still have some enjoyment. We should be able to say, you know, I don't restrict myself from eating a certain food group. I know that I can't have that all the time. I know it has a place in my choice sometimes, and I am aware of the you know, choice might be. Oh, I want to have cake. I think we talked about this in the last episode. Yeah, we cake, but I want, you know what? I want really good cake. And I'm gonna slate that for this weekend, and I'm not gonna be impulsive about it, and I'm going to make it an experience, but it's an experience I don't have every day. It's an experience I might have once or twice a month, you know, and it's special. So it's a smaller percentage of the time in my dietary choice that I might have a piece of cake. Yeah, I'm sure it's reasonable and rational, but we become so, so restricted, the moment you say this is off limits, it's exactly what we want, right? And then we can spiral out. And I remember I'm gonna tell a story of myself, uh, post-bariatric surgery and really struggling with um, you know, keeping things down at one point, and that ice cream was something that oh, I could keep down, which spiraled out into me buying two half gallons of ice cream, and then for like three days, that was the only thing I ate because it was the only thing I could keep down at the time, and getting so sick from the sugar and the milk fats, and being like, no, this is not normal. This I can't do this. So I like literally took both the cali gallons of ice cream and walked them to the dumpster at my apartment complex. It's like 15 years ago, and I was like, I can't ever have ice cream again, and like, no, that's not reasonable. I like ice cream. Ice cream can fit into a healthy diet, and so confronting you know the extreme behaviors in yourself, right? And then relearning how to have a healthy relationship with the foods that often we eat too much of sometimes.

SPEAKER_03 18:46

Yeah, it's I think it's definitely a journey. It's a journey that I've gone through, definitely trying to like finding the balance. But um, especially I say with like bariatric surgery patients, I mean, how do you advise any of your patients like how because I I I can see how orthorexia can develop where you're you are, especially a lot of us at the beginning of our journeys, like, oh, I'm gonna be so little, or I'm gonna everything is going to take everything away when I get to this certain size. And we know that that doesn't happen. But how do maybe you advise some of your patients that um how do we get to a point where we can find balance if you're with we are such like an extreme at first?

SPEAKER_02 19:31

Well, there's the the limitations, right? In bariatric surgery, we have to worry about dumping syndrome. And so dumping urgency syndrome is a kind of extreme reaction to certain foods, um, particularly happens with sugar and milk fats. Uh, it can happen with other types of food, to happen with carbs, carbohydrate, like you know, pasta, rice. Uh, we also have the physical discomfort that can occur. And so, one thing I find is like teaching people to slow down and work through the impulse and to regulate. Regulate is huge because you know, much smaller meals, you know, more is not the intuitive, not what we've been taught. And for bariatric patients, that can be a big struggle. Um, and then like, you know, the food rules we get with bariatric surgery, protein first, which across the board for most GOP win patients, that's pretty common. The uh, okay, now I have restricted amount, I have types of foods or types of food categories that I need to focus on. Learning to listen to your body is really important because a lot of us have missed hunger cues and hunger signals. We have um, you know, are not able to feel fullness until we're over full. And then, you know, if with a sleeve, you put out 80% of the stomach with gastro-bypass, you have like very small pouch, you know, we're doing bands much less. I had a ban and that was very detrimental and actually promoted a lot of disordered eating behaviors. And so the learning how to care for your adjusted organ in bariatric surgery is important, right? Yeah. The eating more slowly and with intention and making good food choices is just built into post op bariatric programs and you know, people learning that. But the long term, the further out, you know, like the further we get out, I think a lot of people will think their bodies have gone back to normal. And no, these are permanent changes that we have to sustain in order to maintain the health benefits of surgery with GLP1s, learning how to maintain the sustained nutrition choices, the uh care and intention we spend within our body, the learning how to sense when we're full, right? To get to that 80% full. I think like that's kind of what I tell my clients. Like, how do you sense you're like 80% full? So you can stop, you know, and monitor. How does that feel in my body? Because a lot of us have numbed from the neck down, and we are not that in touch with our bodies, and we have to really work that connection, then it's integrating all of the lifestyle changes. You know, the other piece of the puzzle is emotions, right? And being in touch with your emotions and knowing how you feel and knowing how people around you make you feel. Yeah. You know, from my own experience that uh having um Thanksgiving dinner at my mom's house is a huge trigger, but that got disrupted one year, and I um got the wrong time for dinner. Like everybody was there at 11 and they started eating without me. And I got there at 12, and I was like, well, this makes me mad, and I was angry. And so I ate so much less for the very first time. I felt like I was like, I was fuming, and I'm like, I don't want to eat this food now because you guys told me the wrong time. And like I sat there and was like, this place is the environment where all my disorder eating behavior patterns were triggered in childhood into adulthood. Um, my body image issues and my relationship with my mom and my relationship with food originated in this environment. And it was this aha moment of you have control over yourself, and you are acknowledging the emotions that come with this disruption, right? Now you get to take control and do things differently. And so that insight and aha moment was a catalyst to change. But the people around us, the relationships we have are all influencing our behavior toward our food relationships and ourselves, right? And if someone makes you feel uncomfortable in your you know emotion, emotional dynamic, yeah, we might eat, right? We might eat because we are upset about something that happened, which is not a favored way to handle your emotions, right? Like we have to learn how to handle our emotions while not using food, and food can be a substance of abuse, and in the leading to the eating behaviors and the substance use disorder, it can spiral out when the relationships around you are not healthy and your relationship with yourself is unhealthy.

SPEAKER_03 24:38

Yeah, it's just kind of like if you just block off one part or one part of alleviating that sensation or those feelings that you have not addressed it. Um, it's what the I've we've heard it called like transfer addiction. So if you're not addressing the core process of emotions, then it will just show up all over places.

SPEAKER_02 24:58

And speaking of, it's like drain whack-amole, it's like you know, you hit one and pops up. I think with that too, when it comes to both GLP1 and geriatric patients, extreme change very quickly suddenly in appearance, how people treat you can trigger some of coping with that attention, yeah, which leans into substance use issues, even with the identified path of GLP1's curbing alcohol desire. If somebody is determined to use alcohol to cope with anxiety, that may not be able to stop the behavior.

SPEAKER_03 25:48

Yeah, yeah. I if I I always say like if there's a will, there's definitely, you know, a way. Um we also I see in here in our notes as well is that um I do want to touch on um higher weight bodies and eating disorders not being found um in a higher weight body, or um how maybe medicine uh or your healthcare provider kind of misses the mark on that. Um so what are your what's your feedback on that as far as um with healthcare professionals being able to pick up on um eating disorders being detected in higher weight bodies?

SPEAKER_02 26:24

I think we get underserved in the healthcare environment because they just say, you know, move more, eat less, of course. You're definitely shifting the narrative on that, but actually screening for eating disorders might be missed uh when someone is even saying bluntly to a provider that um they are restricting, it might not trigger actually assessing that or a referral to someone who specializes in eating disorders or substance use disorders. Um, you know, so that space where providers can do better is not just assuming, but directly asking, hey, what does your day look like? What are your choices? How are you making them? Um, you know, are you restricting throughout the day? I mean, that's a red flag for me. If somebody's restricting all day long and only eating in the evening, yeah, that's gonna be problematic. If somebody is intermittent fasting without good medical reason for it, right? You know, that's gonna be a red flag of okay, tell me about why that resonates with you and what you're trying to achieve. And looking at that through the lens of is this benefiting or harming the patient? But catching that is really important and um purging behaviors, right? Like people are ashamed of those kinds of patterns of behaviors, so they might not name it to their provider. Um particularly, I had a client one time tell me that she feels uncomfortable telling me about the restricted eating behavior patterns andor purge patterns that it has. And this is across the board with a lot of my bariatric patients, they feel like they can be honest with me because I am one of them. Yeah. Yeah. Building rapport with your, you know, for me on my side and other clinicians, building rapport so they feel open to be able to be honest that hey, oh, I've been throwing up at the end of the meal because it didn't feel comfortable or I ate too much or I ate too fast. Okay, we talk about that. We use screen for and look and see if maybe you need a level of care because we don't want this to spiral out into being a pattern that you repeat all the time and your body's not getting enough nutrients, and you know, you are potentially causing more harm. So we catch it in the beginning, uh, it's hidden, and you know, people have shame toward it, and so they don't talk about it, and a provider might not catch it.

SPEAKER_03 29:00

Yeah, there's so much shame around uh I would say this oh three obesity, period. Like, yeah, um, and it is a matter of you up.

SPEAKER_02 29:09

Obesity, eating disorders, substance use disorders all have shame attached because people want to say that's your behavior, that's your fault. No, it's not your fault. There's something else going on psychologically with both substance use disorders and eating disorders. Something's going on there internally in identity and in anxiety and in emotional management that we need to be more curious about where is this coming from?

SPEAKER_03 29:39

Yeah. Yeah, most definitely. I think it's to, and it's just a matter of like what we always talk about on the show is being comfortable enough with your practitioner when it comes to that. You know, and you said that yeah, you were also a patient yourself. So that does open up the comfort, the comfort level. Um, I did want to touch on this because there was um I had a I had a sponsor in OA and her um her, I I guess her her disorder was um exercise purging. Um, so how would we just as a person, like we may be, well, I guess we don't want to self-diagnose ourselves, but how would that be um identified, for instance, in an individual?

SPEAKER_02 30:23

So on the clinical side, assessing how frequently, how much, how often, um, you know, is it reasonable? Um, is it getting in the way of living the rest of their life? So if somebody comes to me and they tell me they're at the gym for six hours a day, I'm like, are you a personal trainer? Is that your career? Or are you going to the gym because you're you are immersing yourself in this because you want to feel like you have control, but it's gotten out of control and it's extreme. Your body is going to be exhausted when we have to leave space in life to live, not just obsess over it. So if it becomes an obsession, exercise can become kind of obsessive, but those of you go us who go from sedentary to now being able to move because there is the you know, space between somebody might not be able to mobility and they're building into it, yeah. But we don't want to burn out, so we have to strike balance. I always tell my clients that the all or month nothing mentality is how we approach it, but the gradual staging into it and building up so you don't burn out is the best way, but you're gonna fall off, you're going to stop for a little while, you're gonna get back up. It's gonna be an all or nothing until you create balance and setting it what is reasonable for me. So for me, um, you know, I'm a Pilates instructor and I, you know, profess Pilates usually between six and ten hours a week, like I have on a studio in my house. But I am also getting my hours for my comprehensive uh PLAD certification, which is 500 hours, which I'm like not trying to do that in a year. At first I thought I was gonna do it in a year. That would have been extreme. So the slowdown and the saying, you know what, this is my goal every week. I want to put forth, you know, teaching four hours. I want to um, you know, practice myself for six hours. That's my 10. That's my cap. Two hours a day every day of the weekdays, right? Or the shift to I have more time on the weekends. So if I have more time on the weekends, I might shift two or those hours. But I give myself a break. I always will take a day off in between after two days straight. I try to skip a day, but that's not always practical. So it's like, yeah, I didn't work out yesterday, I'm gonna work out today. Try not to exceed three hours of both my training and training other people each day. That means burnout and so balance. And I think that's gonna look different for every single person in the type of exercises they do, both you know, weight training or other types of you know, cardiovascular training, everything putting the pieces together. But if you start out, you haven't been exercising, and suddenly you're like, I'm gonna exercise, you know, 12 hours a week, that's an extreme. Let's start with maybe uh you know 20 to 30 minutes, two to three times a week, and then build into it. So with a personal trainer or an exercise physiologist to get to that place, and knowing that you don't have to get there next week or next month, that like any year, but it might be reasonable in a year for me to be investing in my physical fitness for you know 10 or 12 hours a week. But right now, when I've been sedentary for the last you know 20 years of my life, I need to slow down and build into it. So scaling into I often ask my clients, what is the life you want to live look like?

SPEAKER_03 34:00

Right? Oh yeah, absolutely. I want to be so simple, but so profound, right?

SPEAKER_02 34:07

Yeah, I want to be physically fit, I want to hike, I want to go to the gym regularly. I want to invest in my interest of Pilates or yoga or uh rock climbing or you know, hiking, whatever that is, right? Okay, well, you don't get there tomorrow or next week. You build into it by starting with a regular walking routine, regular weight lifting. You don't go from lifting five pounds to lifting 50 pounds, you go gradually five pounds, 10 pounds, 15 pounds. You don't do that, you know, starting at five pounds today, 10 pounds tomorrow. You stick with the five pounds for the first couple of months, maybe, or even you know, a month, and then you go up to 10 and then you stay there for a while. But when we have lived within these extremes, it's hard to scale into that regulated pattern.

SPEAKER_03 35:04

I think so. It's it's definitely, especially if like you're new to all of it, it can be very overwhelming, and it can also definitely trigger that focus and I have to do this right. I if you start missing like say life, life events because I I can't eat this certain food or I gotta do this certain workout, that's where um, I guess where that that balance that um we're talking about here does does come into play. Um since we are focusing or we're speaking on um regain, um, and I know that our bodies love to be in this cozy little set point and they're are they get cozy and comfortable at like um a certain, like I could say it, am I doing it correctly, a metabolic rate? Um but a lot of us in this community are have or are experiencing regain. And how can that be the danger zone for a lot of people who are on this journey, both either uh GLP or bariatric or both?

SPEAKER_02 36:06

So regain happens as somebody who has had probably five rounds of regain over 17 years and finally put all the pieces together, I never take for granted that it might change and that I might have to change what I'm doing up a little bit. Um, but navigating where you are is always maintenance, right? How far you've come. If I pounds on a GLP one and I've gone from 300 to 250, right? I am learning maintenance of keeping that 50 pounds off. Okay, well, I've put a little bit of it back on. What's changed? Did something in my life change? Did my stress level change? Did my hormones change? Perimenopause or menopause appeared the picture. Um, it did my lifestyle or my sedentariness change, right? Okay, did I change what I was eating? You know, do I have a food intolerance to something? Is there something else going on behind it? Do I need to seek a medical professional? Do I not have labs ordered because suddenly something's spiked and there may be something wrong? Question it with curiosity. Okay, what's going on here that is you know perpetuating this pattern of regain? How can I get on track? Not next week, not Monday, but right now in this moment. What can I do differently? Yeah, I can wait for tomorrow. Write out what your food plan is because if it's expected, you're generally gonna follow it, right? Focus on the important nutrients, you know, whatever your dietitian says, certainly go with that. But primarily we're gonna focus on protein, fat, and fiber. So protein, veggies, you know, good healthy fats, things that are gonna create a balanced diet. Carbohydrates are important. We're never gonna like completely oust it, but you may, depending on your needs, need to look at how much is good for my body. And that's something to talk to a dietitian about. Um, you know, sugar. Sugar is going to be problematic for most of us, right? And with bariatric patients, it's likely going to um, you know, be a spiral because it's just liquid inside us, it goes right through us and it might cause um dumping syndrome. So being aware of that, right? And you know, not completely like ostracizing it, but if your body reacts poorly to it, knowing and taking note of that and saying, Hey, I know my limits, I know what I can and can't have. I stay within that, I understand my body's needs, I know what my body feels like when I eat an appropriate amount of food, I know the discomfort when I don't, and I value not feeling that discomfort.

SPEAKER_03 38:55

I like that. I love that. That is that is that's that's fantastic. Um, also, so keep that in mind. What is what is the the balance for you, um, your food, your intake, your activity level, um, when it comes to regain. Um I did, I think we talked with about this with one of um another practitioner a couple of episodes back. Um could regain kind of if we're not speaking about it, if we're not speaking up to like say our practitioner, we're we're you know, a lot of people the the reaction is to to draw inward um and be silent about regain because there's so much shame around it.

SPEAKER_02 39:37

Um does that open things up also for like a perfect storm of maybe lean on something else or lean on a substance or something like that to help um um help with the regaining their minds or yeah, it can sort of spiral out because of the dis disappointment and the frustration we might feel. And so being aware of I need to find the pattern, I need to find what's going on here. So I'll give an example. My dad died last year. We mentioned this in the first episode, and within like two or three months, I had put on 40 pounds. And the environment I was in, being living with my mom a year after he passed away to be there to support her. She's 84, but she certainly gets, you know, she's mobile and she can do all the things and she's got her mind. Uh, but she loves to cook, and she was cooking because that's her therapy. Yeah, she's written three cookbooks, she's an amazing cook, but I was living in the house with indulging in everything she possibly could because she was sad, and the stress and anxiety of it skyrocketed my horror as all I was like convenience eating whatever she was cooking rather than really paying attention to the things that I knew, and I didn't have control in the environment because she was cooking, like you know, yeah, she really truly at 84 years old, probably needs to open a restaurant because she's got so much energy. And that environment like was putting it on, and it did not take a whole lot with the stress and the cortisol spike and the uh further away from my Pilates studio that I go to, so I wasn't working out as much. Uh, the loss of coverage of my GLP1 medication and trying to phase up going on a compounded at the time, put me in the space where the tools that I was using dropped off, and I didn't have the order and the control in my environment to be able to regulate. And I had just lost one of the most important people in the life, exactly. Right. So the sudden changes spiraled out, and so I had to catch myself in that and uh reel it in and you know go okay, I need to get back on track. Luckily, I was with her for a year and then moved in my own house and like you know, get resettled and you know, things fell back into place, but sudden changes certainly can, and it it means a lot to recognize what's going on, to make the adjustments, to get back on track because there's no shame and regain. It's gonna happen. Yeah, it doesn't matter how much you control for every little bit, life is going to happen. And being able to get to a place where, oh, hey, I'm seeing a shift upward, I'm seeing the trend, what's changed? Okay, I need to get back to my basics. I need to get back to tending to and taking care of myself in difficult situations and stressful environments, divorce, relationship changes, death, um, loss. We might lean into, oh, I'm gonna have a drink, and that drink becomes two or three drinks, and then you're coping with alcohol. Yeah, when does it trigger a referral to you know either an inpatient program, an intensive outpatient program therapy, AA meanings, smart recovery, having the right providers before that happens. Yes, having to reach that. So I tell everybody you should have the therapist, and that's just not me promoting my profession. I have a therapist, I see her every Friday. We'll tell it. She calls me out on my stuff. So I think it's important because stigmatized mental health care, right? In society, oh must be crazy. Absolutely not. No, you're invested in growth for yourself. You want insight, you want to change the patterns that have gotten you there. And it's really important to see it through that lens of comprehensive care all around. And having a regular therapy session, even if it's just once a month, my my once a monthers will tell you like they could disclose that. They would say, That's my check in and that's my accountability, and I won't let my therapist go. And as many times as let my. Good, you're in a good space. Just contact me. No, no, my once-a-month check-in is important. We need it, yeah. And I value that when they tell me that I'm like, okay, no, no, you you are the expert in yourself. We have our monthly once-a-month check-in. I'm reading but being in practice for so long, I have a number of those, and they are, you know, I'm always surprised the insights that happen in that once a month because most of them are keeping a journal, keeping notes, or they've e only only throughout the month to say, hey, this happened, and I just want you to know going in. And I'm like, awesome. We don't have to have the yeah, and that we can hit the ground running in therapy and get to the nitty-pretty. And I already told them and I've worked with them for a long time. So it's so much easier when you have an established provider, and then something happens in life that triggers a need for a higher level of friends. The GLP1 math is just not mathing.

SPEAKER_01 44:51

When I look and see 104 million people in America are struggling with a disease of obesity, and about 11,500 obesity specialists, that breaks down to like one obesity specialist per 9,000 patients. I saw the stat that said 72% of GLP1 users say that they want more support on their journey. Because I think we all realize you start on these medicines and you think, oh, it's just gonna be like Venomine or anything else ever taken the past. This ain't like that, bro. Like it's just not. It's different, you know? And I provide a lot of that here by interviewing doctors and things like that. But I've had people been asking me, emailing me for years, asking me to do one-on-one consults, which I do do, but they're expensive, right? So I decided to make a group where 10 people at a time would come in with myself and with Kat. We could talk about recipes, we could talk about exercise, we can talk about side effect management. Um, we could talk about, you know, ideas on breaking stalls or things that we've tried. None of it's medical advice, but it is community support. It costs $50. If you're interested in that, there's a link in my bio. You just fill out that form. If you're not and you just want to go this route, that's okay too. I love you. You're not alone, it's not your fault. And hopefully you'll sign up to hang out with us. All right, now back to the show.

SPEAKER_02 46:02

Care is it weekly therapy? Is it an intensive outbreaking program for a specific problem? Or has life happened a loss, a death, you know, a change in job, divorce? Okay, you can change the level of care and the amount you know, frequency you're going to therapy because you already have a provider date.

SPEAKER_03 46:22

Yes. And it sounds like also journaling, writing, finding ways to kind of uh process cope and look at your emotions and where you are um from day to day. Finding something, writing or or I don't know, taking a walk and thinking, um, some of the tools, I guess, to lean back on to realize like what where you are, what I what am I doing? And then, you know, bringing those notes to you.

SPEAKER_02 46:50

Yeah. Recognizing it and being able to get help. And if you already have helped established and it's just a monthly check-in when they'll practice, then the detour is oh, I need more frequent check-ins. I need to really work on the tools that I use to cope with the stressors of my life. Uh, the moving toward intervention support groups, excellent place to be able to identify that maybe you might need more help, right? And then sharing your story because sharing your story with other people builds community and they realize that they're not alone. Then you're you just say, Hey, I hear you and I see you, and I see you struggling, and I want you to get the help. Let's help you find a therapist. Yeah, that community piece is is very, very important. Um, especially community is the intervention, right? And providing the opportunity to build community and know that you will meet people that you identify with, that resonate with you, that will be there to lift you up and support you when tough times come, like when regain happens, or when there's a substance use issue. And you know, somebody who's a really good and valuable friend will say, Hey, I've noticed that you've made more and that you're struggling and I'm concerned about you. Let's talk about it, let's figure it out.

SPEAKER_03 48:10

Yeah, that community pieces the prevention of the secrecy, or like pull them into yourself and you know, um engaging in those behaviors in secret, right? And so the community, when you when you go public, when you walk into your, I mean, then talk about it, you know, it is is such it's such a good prevention, proactive, it's it's an important piece. I find that extremely important. I do want to kind of it's gonna kind of go back a little bit because I wanted to cover um why it's also very easy to hide substance use disorders, um, specifically in larger bodies. Um and how can I I guess how how it gets missed by our practitioners and what like say if you're a practitioner listening, um what are some of the signals that um they can they can look out for? But also why though is is it so missed in um obese bodies?

SPEAKER_02 49:20

Because the weight is often the focus, right? Right distraction that, oh yes, you need to reduce your weight. Well, then once the weight is starting to come off, it's the celebration of the weight coming off. Yes, well, is the weight coming off in a healthy way? In you know, lifestyle changes, nutrition and exercise, and uh, you know, the emotional tending too, you know, and for providers, knowing what assessments might be important. So oftentimes in therapy, I will have I will send out the normal screenings of the um PHQ and um the GAD, uh that's an anxiety and depression screening, but I also will send out um the eating disorder screening um or the adverse childhood events screening to understand what might be going on from childhood, where those come from. Um, and there are a number of other ones, or binge eating disorder screening tool, which I use frequently, but I find that the physicians don't always screen for those, right? They're not always using this tools, which some of them the screening tools very simple to use and can be relied upon. Um but a lot of things get overlooked for us. And in the work I've done with eating disorders and bariatric patients, and now many influx of GLP1 users, um there are subtle signs that other clinicians might miss. So a therapist who just works in the general mental health space might not notice an eating disorder, right? They might not see it or the patient might hide it. And so asking those questions, especially if somebody is on the GLP one or has had bariatric surgery in the past, asking questions about their relationship with their relationship with exercise and knowing which tools to use is an important part of getting the help that they need because we cannot be everything to everybody. And sending someone to a specialized treatment professional. I actually just wrote a guide for coaches in the GLP space. I haven't released it yet. It's coming out on my sub stack. Probably next week. I'm kind of refining some of it, but it's identifying when someone needs a referral to a licensed mental health professional and understanding that there are limitations to coaching and the coaching relationship. And we want people to get the help they need when they need it. So if you are seeing something that seems off, knowing when to refer is really an important piece of the work that they're doing as coaches. Right.

SPEAKER_03 52:08

Yeah, I've I noticed um with a lot of my practitioners before I started uh yeah, my GLP journey, um, I would just self-disclose or self-report um with most of my doctors. But the only there's I think there was yeah, one doctor actually um did say, like, is it okay if we talk about it? Um, so and um I've always said it's on a lot of our episodes. I do see that there is a gradual shift. Um, I see a lot of practitioners becoming more and more open or an aware of it. Um, so there's there is that that positive side, but I always just self-reported, like, hey, I step from binge eating disorder.

SPEAKER_02 52:47

Asking asking permission to talk about weight is really important. It's crucial. It's so crucial. And the emotionality that happens, right? Because if you just come in on that and that's not what somebody was there to talk about, it can become very contentious to the rapport you're trying to build as a provider. And so, you know, even if somebody comes to me knowing what I do, I will ask permission. Hey, is that something you want to talk about? Yeah, are they talking about people that they know that are on medication like on weight loss medications and projecting outward, the confrontation there, the intervention will become, hey, I noticed that you've been talking about you know, people in your life who are on weight loss medications. How is that something you want to talk about? And how can we have that conversation in a way that things are safe for you?

SPEAKER_03 53:45

Yeah, I think it's all about safety, feeling safe, feeling seen. I just remember that moment. I felt so seen. And she laughed at me. I just remember my doctor's like, I've never, no one has ever asked for permission, and I'm just I'm thank you.

SPEAKER_02 54:02

So it needs to become more common, right? In every interaction with every physician, if weight is going to be a subject matter on the table, they need to start with Do I have permission to talk to you about your weight today? Is that something that you would be interested in talking about? No, is it complete flint's in it? Had an experience with my mom a few months ago. We went to a um cardiologist, she had a follow-up appointment, and the nurse brought her back. The weight was in the scale was in the hallway, and she uh told her to get on the scale, told her, not asked her, hey ma'am, would you like to get on the scale? And my mom, you know, knowing having me as a daughter, knows that it's an inappropriate place to have the scale and that she can opt out. And she said, I don't want to be weight today. And the nurse pushed back, and I'm sitting there with her at the end because I don't want to embarrass either like in attraction. But when the doctor came into the office, my mom said to her, I did not feel comfortable with the weigh-in process. And so I refused weight. And I think you need to talk about your noses about asking permission to weigh your patients, and you should probably move your scale into a private area on you know in the office on the floor.

SPEAKER_03 55:20

Yeah. I mean, that yeah, I feel like sometimes, like if I'm going in to be seen for like an allergist, like, oh, why do you need my weight? Um, and it's it's very triggering for a lot of people. Um, and I I don't I know that the medical community is catching up with that, but it can just sometimes it can send somebody into a triggering tailspin, especially if they're recovering from um eating disorders or substance use disorders. That that that could be that point, you know, not just talking about weight, but just having to take your weight, you know. Um it, I know personally, I I when I was heavier, I remember and it was just something small. Um I don't know if she was a medical assistant or a nurse, but she said, I have to go get the bigger one for you to take your blood pressure. And that was just like I I know maybe she was saying it um casually and it didn't mean anything, but to me, it just it made me feel poopy the rest of the day, you know, like things like that are so isolating, it's very isolating, and we become avoidant to those environments.

SPEAKER_02 56:32

I mean, I had it's about incident, about 10 years ago. It wasn't with my own um client, it was with a friend who went to a doctor and she hadn't been there in 10 years, and it took a lot of courage for her to work herself up to go to the doctor, and then the interaction was really stigmatizing regarding her weight, and she shut down and she didn't go to the doctor again for another couple of years. Um, that you kind of helped her find an appropriate provider who was trained in obesity medicine, and that was the game changer because they were sensitive about that. But it would have been so much easier to say to you, hold on a minute, I need to go get a different piece of equipment, right? You she wouldn't have said anything about the size of the cuff, or she could have said, Let me go get the appropriate equipment. And just it wouldn't have felt the same, it wouldn't have landed the same. You may have known, right? It would have been inferred, but just the words you choose are so impactful.

SPEAKER_03 57:36

And so it's it's so true. I just and yeah, and I think about it for myself as well. Like I have to like think to myself, like, okay, the words I'm choosing with somebody else, like how am I because we all do it. Um, we all can make an impact with whatever sort of conversation that we're having with anybody at every any point in time. It's um it's just so profound. But I am I'm still so like I know I am a little bit Pollyanna when it comes to um uh to health care, is because uh when it comes to medical professionals, I do see that that that shift.

SPEAKER_02 58:11

Um so wonderful shift to see. And I'll tell you the care that we receive can define how quickly we get to the goals we set. And that's that weight loss is not a goal, it's an outcome. You know, and it's important to understand that the goals don't have to be about the number, the goals can be about mobility, about emotions, and about regulation, about improving health conditions because that number on the scale can change and you can still be healthy.

SPEAKER_03 58:43

Yeah, it really uh yeah, it just makes such a big difference. I think sometimes it could also kind of arguably be part of your community as well. Um, your practitioners. They could, you know, if you have to come out, you gotta you gotta either go in public or get on your mobile device and um speak to your practitioner. So that's it's a big piece of that as well. Um, and it makes me think of um is it's this funny like flow chart I or it's a little um an animation that I have in my house. It's like the the um the warriors of mental health, and one is like, you know, take your medication, your um see your therapist, um, because this is all everything is all integrated, especially even with your GLPs as well. It's not just one one part of the puzzle, right? Um community activity, getting vitamin D, touching the grass, like your coping skills, right?

SPEAKER_02 59:37

Yes. One of the like pivots too is wow, I don't have the food noise that I'm used to. I have food apathy. Oh, let me list what the the best choices I could make could be in this moment. Because that could be the pivot to changing your choice and moving toward taking care of your body better. But if someone doesn't say that, some someone they keep on repeating the same things they've always done, you know, it might spiral into more restrictive behaviors, avoiding eating, not taking care of and tending to yourself. You know, I'll tell people, hey, you can write out the food plan for the day, you can follow it perfectly. Yeah. And then something goes sideways and you go back to coping with food rather than engaging in, you know, doing a puzzle or you know, singing a song or playing music or engaging in your hobbies before you go to the, oh, I'm gonna go have a snack, right? Do something first to tend to your mind. And then if you still want to snack, hey, have a snack, right? You know, maybe your body needed that. Maybe your body was telling you, oh, I need a few more calories. I'm infamous for if I I have eaten throughout the day, but at eight or nine o'clock, I'm like, oh, I seem hungry. Okay, right. Let me go, you know, tend to something around the house. And then if I still feel hungry, I'll get a small snack, right? Because maybe my body needed that, but I want to make sure that my body needed it, and I just did need some kind of enrichment.

SPEAKER_03 1:01:12

Yeah, no, I I always I always have that. I call it it's it's the special witching hour late at night. So I always determine like if I do, do you want like something healthier or are you like craving something else? And if so, like okay, you're probably tired. Um, but if you want to say, you know, if you still want something, um, still be compassionate. Um, I know that Dr. Rentia talks about like a the passionate pause. Um, either way, if you have something or if you don't have something, you're not an evil person. You're not throwing the baby with the you away with the bath water. It's it's all about being compassionate with yourself. So yeah.

SPEAKER_02 1:01:52

So identify patterns that we have because if it's a problematic pattern that's leading to a binge late at night or night eating syndrome, then yes, I need to confront it and figure out where it's coming from. You know, is it from stress about work tomorrow, right? Like, you know, Sunday evening, I'm finding myself and you know binging on Doritos because I'm nervous about work tomorrow because my job is really stressful. Then I need to look at how I can lower my stress and anxiety level and I can confront my job issues. Yeah. And sometimes the best solution is to find another job, right? Like, but we don't ask because the the market's terrible right now. Well, it's the I work in an unhealthy work environment, it's causing me lots of stress. Uh, I either need to confront my boss and say, hey, I've got too much on my plate, but we have a hard time speaking up about those things because we're very insecure in our job situation. Uh, markets are not great right now, it's harder to find a job. You know, you look at that as information and then coming up with a plan to change those circumstances so it's not spiraling out one before I have to go back to work. I just want it to be the weekend. This is the grime. You have to look at like how we are managing our life and our stress levels.

SPEAKER_03 1:03:22

Yeah. I I I remember uh we call it that yeah, the Sunday scaries. I can tell I totally identify with that, especially if you start to like to avoid going to bed, because if you have to go to bed, that means you have to get ready for work in just a little bit, right? Because it's the after you wake up, and so um we do whatever we can to avoid.

SPEAKER_02 1:03:43

We're like these devices all the time, right? Like in this section too, like recognizing where consuming media and social media may also spiral out into excessiveness, balance is key, and navigating balance and understanding I need to have time away from the screen, I need to spend time with people I love, I need to tend to my hobbies, um, I need to have things outside of work. A lot of folks just dive into work because it helps them stay focused and you know they're very serious about their jobs because balance, because if you have nothing outside of your job and you're ignoring and neglecting your family, eventually it's gonna catch up with you. And life is not gonna feel as fulfilling or joyful if you're constantly neglecting other parts that should bring you joy and happiness.

SPEAKER_03 1:04:35

Yeah, it's all about finding that balance, or like I say, uh finding your groove in this entire journey. So as I always say, is the weight between the ears, right? So it's it's the whole person. We have to take care of the whole, the whole person, you know, that that GLP, uh, what we we talk about so much on this show, um, that is just one piece, and there's so much more to us. Um, so many more things, and that weight between the ears is so crucial.

SPEAKER_02 1:05:04

So definitely the thoughts we think shape our reality too. And so if you are in a negativity spiral and you are internalizing weight bias narratives, and you have a more negativity around you about your weight in your body, or internally, right? That can affect regain, right? We are used to the I've been trying and trying and trying, and it's not happening for me. I'm gonna throw it all away, right? Yeah, you know, the staying consistent, the taking care of intending to yourself, both your body and your mind, you know, and spirituality and showing up for yourself because you want to love and care for yourself, which helps you love and care for the people you love around you.

SPEAKER_03 1:05:49

Yeah. You're you take better care of others when you're you love yourself first. You take care of yourself first. So um, this has been a really powerful conversation. Conversation. I do want to touch on again all the resources that are available to all of us out there that are suffering with any sort of eating disorders or substance use. Could you touch on that again for us? Sure.

SPEAKER_02 1:06:16

Okay. Number of resources. And I think being aware of the co-occurring issues or both binge eating disorder and ADHD often, you know, are seen to go. That's that's one that I like to kind of bring up to people. Also, uh sensory issues uh fed. So there are specific um eating disorder diagnosis, um, other specified feeding and eating disorders, and avoidant restrictive food intake disorder to look at um and can cause impairment in life. So, you know, we hear about anorexia and balenium and binge eating disorder and talked about orthorexia, but there are other things that might be coming into play. The other part about it too is the sensory part, which our fid avoidant restrictive food intake disorder covers is the sensory relationship we have with food. And so being aware of those things existing, right, and understanding that, you know, if it looks off, right, if the start to go to an extreme or there's certain sensitivities to be aware of that and get appropriate diagnosis and get appropriate treatment. But the resources will certainly tag in the comments or in the um bullet listing. And I think it's important to know that if it's an extreme and someone is engaging in self-harm to get them help or to get yourself help. And sometimes that means calling 911, right? Sometimes that means an immediate referral and um action with urgency. Uh, but the National Alliance for Eating Disorders Helpline, again, I'll repeat, is 866-662-1235. They are staffed Monday through Friday with therapists who specialize in eating disorders, 9 a.m. to 7 p.m. Eastern time. Uh will help people find referrals. And then the Substance Abuse Mental Health Association, um, that helpline is going to be 1-800-662-4357. And that is free, confidential 24-7, 365 days a year. English and Spanish available, and they are available at findreatment.gov. And then in Crisis 988, the suicide and crisis prevention line, um, you can call or text that line 24-7. And so it's important to know that those resources exist, not just for yourself, but for the people you love. If you notice, you know, unusual behaviors with food, eating, relationship with their body, um, body image issues. Sometimes helping people get help can really make a difference. And saying, hey, these resources are available. Call and talk to somebody, get a referral. If it's nothing, then fine. But if it is something and you get the help you need, you can live a better life on the other side of treatment. Yeah.

SPEAKER_03 1:09:17

There is no shame, no harm in asking, and asking for help. You did mention uh I I know that we we were mentioning all the resources, but I when you mentioned ADHD, that is so very much like argumentatively like linked to BED and other other impulsivity and you know the commonalities too, the impulsivity and relationship with food.

SPEAKER_02 1:09:41

And sometimes we see them running together, we certainly see them separately, but being aware that they can run along the lines together and that there is treatment, there is medication that can help, but being in therapy and working on the stills and behaviors run alongside with medication treatment. But the first step is actually having the care team in place so you can get the help you need to make sure you're on the appropriate medications and you're getting the treatment so you can live your best life because heck yeah. All of this, right? And it feels overwhelming constantly. We don't have a space for living life and enjoying life.

SPEAKER_03 1:10:27

Yeah. So make space to enjoy life. Your community, um, and reaching out. There's no shame, not at all. So well, it's been a great conversation with you, uh, Nanette. And of course, we will definitely um put all your contact information in the show notes. Also uh we'll reiterate sure. Absolutely. Places where you can get help. It's not your fault. Asta La Pasta. Oh, also shameless plug. Um, leave us delivers wherever you get your podcasts. Five stars, I appreciate. Um, and we will chat with you next time. We appreciate it. Bye for now.

unknown 1:11:12

Bye.

SPEAKER_01 1:11:13

Are you interested in understanding GOP1 medications like Osempic, Wolfovi, or Manjaro? Then join us on the Plus Sides, cracking the Obesity Code, the groundbreaking podcast helping people change their lives one episode at a time.

SPEAKER_00 1:11:26

The Plus Sides podcast is a Destructor.

SPEAKER_01 1:11:29

We're breaking down barriers, smashing stereotypes, and sharing inspiring stories that'll leave you feeling informed and empowered. Join us every week to learn from doctors who are specialists around GLP1 medications, like OSINT Pogonia Manjaro. They'll provide you with science and facts to validate these incredible stories. But that's not all. We'll also bring you the voices of the GLP1 Manjaro TikTok community, real people who face the challenges of obesity-related diseases and disorders, and discover the incredible plus sides of GLP1 medications. Our episodes are filled with heartwarming stories, laughter, and moments of triumph. You'll connect with our amazing community members who are reclaiming their health and experiencing their fullest lives. Are you ready to embark on a journey of discovery and empowerment? Tune in to the plus sides cracking the obesity code, and together we'll change the narrative around obesity and in the stigma. Subscribe now on YouTube or your favorite podcast platform and join our incredible community. Let's celebrate the plus sides of life together because every story deserves to be heard. Every life deserves to shine, and everyone deserves access to expert knowledge and medication. The Plus Sides Podcast, you're not alone. It's not your fault.