Mindset Plus Medications And Surgery For Weight Loss With Dr. Pavi Kundhal [Ep. 155]

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This is the Eat Well Think Well Live Well podcast.

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I'm Lisa Salisbury and this is episode 155.

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Mindset Plus Medications and Surgery for Weight Loss with Dr.

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Pavi Kal.

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My guest today is Dr.

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Pbi Kde.

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He is a general and laparoscopic surgeon who specializes in minimally invasive surgeries like keyhole surgery.

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He's a diplomat of the American Board of Obesity Medicine, which is a designation showing his expertise in obesity medicine.

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This is a prestigious designation that very few surgeons in Canada hold.

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He has been a member of the Department of Surgery at William Osler Health System since 2012 and is the site chief of General Surgery at Brampton Civic Hospital.

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He is an assistant professor of surgery at Toronto Metropolitan University.

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Dr.

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Kundal also has a clinical interest in surgical and nonsurgical weight loss, and has completed numerous postgraduate courses in this area.

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Today we discussed Dr.

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Al's belief that one's mindset plays a critical role in health and healthy weight maintenance.

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We dive into mindset shift techniques such as mindfulness, affirmation, gratitude, meditation, and self-reflection through journaling that play a key role in changing your relationship with food.

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It's an honor to have such an expert as Dr.

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Kal here with me today, so please enjoy this episode.

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Welcome to eat well.

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Well, the podcast for busy women who want to lose weight without constantly counting, tracking, or stressing over every bite.

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I'm Lisa Salsbury, a certified health weight loss and life coach, and most importantly, a recovered chronic dieter here.

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You'll learn to listen to your body and uncover the reasons you're reaching for food.

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When you're not truly hungry, freeing you to focus on a healthier, more fulfilling approach to eating.

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welcome back to the Eat Well Think Well Live Well podcast.

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I am so excited to have Dr.

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Pavi Kundal here.

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He is a board certified obesity medicine surgeon and um, I think there's some other titles in there as well.

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I'm gonna let him introduce himself.

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I'm just so excited to speak with you today about, um, some of the weight loss solutions that you offer and get a different perspective.

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So welcome Dr.

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Kundal.

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And, um, if you could just introduce yourself and give us some background.

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Thank you for inviting me on your podcast.

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It's a real pleasure.

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Um, so my name is, uh, Dr.

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Al.

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I'm a practicing in the greater Toronto in.

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I have a clinical interest in obesity medicine and also perform bariatric surgery.

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I've been in practice for over 16 years.

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I performed thousands of surgical procedures and I've had, uh, thousands of patients come through my clinic and we've helped them with both surgical and non-surgical weight loss.

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Um, I have three children, uh, so it's quite busy.

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I have a 8-year-old, a 6-year-old, and 3-year-old.

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Um, yeah, so I got my heads full of both at work and at home, but, uh, I do enjoy it all.

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Um, what I found through my clinical practice.

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Over the years is when I started, my focus mainly was on, you know, obviously the technical aspects, uh, the science, the guidelines.

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And what I found though over time was that, uh, there was often a high rate of weight regain regardless of the different techniques we used.

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And over time, I've, you know, I started to see that despite our best efforts, there were things that were causing patients to go back to their unhealthy eating practices in the past.

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That made me realize that we have to not just focus on the, you know, quote unquote the science.

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We also have to focus on, you know, the individual, the person, what has kind of led them to, you know, this point where they need to make changes and how to identify those factors.

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Um, and one of the things that, um, I found was that, um, you know, in the beginning, sometimes, for example, after surgery, the surgery is, you know, uh, it's a very invasive thing.

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Um, it can, you know, compensate for a lot of things, but over time you can develop strategies to almost, quote unquote beat the surgery.

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And you need to try to understand what is causing people to kind of revert back, um, to their, um, previous eating patterns.

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And that's where I think the mindset comes in.

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It's very important to understand.

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Um, what, what, you know, often when people are, you know, having eating pattern are not good for them.

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It's not, it's not so much that it's that they're just making bad choices.

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They're, it's sometimes compensating for underlying reasons and you need to sort of understand what they are.

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And that's where I think it's very important, um, to introduce the concept of mindfulness in your life in general, but also the concept of mindful eating.

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And, uh, that's something that I've tried to stress my patients.

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yeah, definitely.

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It's like how my intro says, we try and figure out why we're eating when we're not hungry, and it's so much more important than what you're actually eating on some cases.

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You know, like when you figure out what you're trying to solve for.

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When hunger is not the problem, that's when we really get down to like the root of the issue.

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so whether your patients choose a surgical route, a medication route, or a, just a coaching sort of route, like a lot of my clients.

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Stew and I don't like, I've been kind of shying away from using the term, um, losing weight naturally because I think people are pitting, like those that use surgery or medication against those that do it naturally and, and kind of putting the quote unquote natural weight on a pedestal, which I don't agree with at all.

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I think there's a lot of ways to do it, but I, I'm just not sure what the right term is now.

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But anyway, um, without medication I guess would be just the simplest, but in any case.

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Everyone needs to figure out how we eat for the long term.

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because once you get down to your goal weight or natural weight, then we have to figure out, okay, how do I make this stick?

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one of the things that I try to do is help them to lose the weight the way they want to live their lives.

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So I have patience or not patience.

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You have patience.

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I have clients.

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Um, I have clients that I ask, they're like, you know, I just, I just need, I just gotta get off sugar.

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They tell me this, you know, I just, I just eat too much sugar.

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And I say, okay, well, do you wanna never eat sugar again in your whole life?

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Or do you wanna figure out how to eat sugar?

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How to have a, a sweet treat every once in a while without overdoing it?

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And almost without fail, they choose the second option, which means we have to have.

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A way to eat a little something, what they call, you know, a tree or sweet while you're losing weight.

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And I think that is where the mindset comes in.

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So let's discuss some of those mind, that's just like one example, but some of the strategies that you use to introduce some of this mindful eating that you teach to your patients.

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Yeah, that's a really good point.

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Um, when you're trying to change your eating patterns, in some ways it's one of the most, um, uh, challenging areas to work on because unlike, let's say, you're, uh, having struggled.

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With alcohol or you're struggling with, uh, drugs or gambling, you can go cold Turkey on those things.

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You can say that I'm

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Yeah.

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gonna drink again.

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I'm not gonna smoke, I'm not gonna, whatever it may be.

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You can't stop eating, you have to eat the live.

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So that's what makes this particularly challenging because you just, you have to find that way to moderate, like you said, it's not realistic to say that I'm never gonna have a treat again.

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And so I think, um, what I do is I try to educate my patients about understanding the reasons why they're eating at any given moment.

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So really being present.

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So I think the first thing we teach them is the difference between physical hunger.

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And emotional hunger.

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Those are two very different things.

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So physical hunger is when you, your body actually needs energy or needs calories to fuel its functions.

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So it, you may be feeling that feeling in your stomach.

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Lightheaded, I.

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You haven't eaten in six hours, um, you can't concentrate.

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Those are signs that your body's, uh, signaling to your, your brain signal to your body that actually need to eat.

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And now emotional hunger often just, it can be triggered immediately.

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It's often caused by situations that I think people are aware of.

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So I.

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I've entered a social gathering, I'm nervous.

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Um, I'm not sure what to do.

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I'm not sure if anyone's gonna talk to me.

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So you kind of head over to the food table and it just kind of seems like a natural thing to do, or, you know, I've gotten into an argument with someone and I, I want to have that immediate feeling of, you know, satisfaction.

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So it's often triggered by emotions.

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So those are different feelings.

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Now,

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noticed

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what happens, sorry, go ahead.

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Do.

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Do you notice Another trigger that I think is so common people don't, but they don't identify, is transitions.

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When you come home from work, when you beca, when you go from working mom to.

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Mom at home, like when you change roles, it's very uncomfortable for our brain and this is why we grab a snack to go get in the car or why we go to the kitchen immediately upon entering our house.

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Or you, it can also be like when you get to work, you have to go to the break room first to like load up on the snacks or, you know what I mean?

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It's, it's those transition times that people don't realize.

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'cause it's not like supercharged, like walking into that social situation where you're like very nervous.

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It's just this weird like, um, discomfort of switching roles, and I think that's an interesting emotion time as well to catch.

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For sure and, and I think also a lot of our eating habits are unconscious and they're learned.

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So sometimes, you know, we, I.

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We, we have distracted eating.

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So, uh, when you're distracted, you're not actually being present or mindful.

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So if you decide that I'm going to eat dinner in front of the tv, you're being distracted by what's on the screen and you're not actually being present or mindful of how your body's reacting to your food.

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So sometimes you'll be watching a movie or a show, and when it ends.

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You have that feeling like, oh, I overate and you didn't even realize it happened.

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And so these are kind of, and then you have that feeling, oh, I shouldn't have eaten as much.

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And, and, but it just was that you weren't being mindful, you weren't being present while you're eating.

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So we, that's one of the things we stress to our patients is you want to be an intentional eater.

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You want to be a conscious eater, you wanna understand why you're eating at this moment in time.

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So for example, we tell our pa, you know, we tell people, uh, you know, if they're gonna go for a meal, the first question we ask is ask yourself, am I really hungry?

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And just putting that simple question and waiting 10 to 15 seconds, sometimes it can stop you when you're realize I'm actually not hungry right now.

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Maybe I don't need to eat, or I don't need that snack.

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So just kind of, you know, so like you talked about the transitions where you kind of just had this unconscious behavior, just kind of do it.

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It's sort of being present, trying to really understand why you're doing what you're doing, and, uh, just by, you know, almost having that circuit breaker, it can stop those, you know, those, those practices that you've been having for years.

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so that's a good start.

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So we just stop, ask ourselves like, okay, am am I really hungry?

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So then obviously the, we've got a flow chart here, like if the answer's yes, then we eat, and the answer's no.

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Then what if you still feel that urge or that pull towards the kitchen?

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Right, so.

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So we talk about, you know, the first thing is your environment.

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So you need to kind of do an environmental scan, the quote unquote, we live in this kind of weight enabling environment where we know we make things very easy to consume food and sometimes not high quality food.

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So if you determine you're not hungry, what I often tell patients to do is, or if you're not sure, just drink a glass of water.

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Sometimes it's just dehydration that's making you actually feel like you're hungry.

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And sometimes just having that feeling of consuming something makes that feeling go away.

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Um, the other thing I sometimes suggest is a lot of it's distraction to kind of changing the direction that your mind is in.

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Um, so one of the other techniques you can use is, you know, you can just go for a walk.

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I.

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Can do.

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We also promote meditation, so you can do, like, you don't have to sit down for 20 minutes in a quiet room and do meditation, but you can kind of introduce deep breathing, sitting down for 30 seconds.

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Really try to understand what's driving you at this moment in time that where you're starting to think about something stressful at work and then all of a sudden that would, that's been your, um, what that's been, what your go-to is when you start having that stress, maybe you go for a snack trying to really kind of be present and understand what's driving you.

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And let's go back to that social situation, example.

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So.

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You walk in, you're like pretty nervous, not really a time you can go for a walk, not really a time you can meditate.

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What would you suggest in those kind of trickier situations or you know, at work where you maybe don't have that freedom to do those kinds of things?

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I.

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Yeah, so I think that goes back to, um, social settings or social events.

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Often patients will be on these.

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calorie restricted diets.

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For example, they may be taking a meal replacement product or you know, whatever it may be, and then all of a sudden now they have to go to a wedding or a birthday party.

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And I have seen over the years that can sometimes really throw someone off the progress they're making because you kind of.

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You've been very disciplined.

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You've been avoiding certain trigger foods, and now all of a sudden you're in this social situation.

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So I think when you know you're gonna go into those environments, you actually need to think about it before you go.

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So let's say, you know, I'm going to a wedding.

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Okay.

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I.

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The first thing is you need to realize it's not gonna be one of these perfect food days.

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You have to accept that.

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You gotta first tell yourself, I'm gonna try my best.

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You have to accept that you may actually eat more than you're expecting just because of the social setting and the environment.

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And that's okay to, you know, like I always say, we're not aiming for perfection or even for more good days than bad days.

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So you gotta be kind of, kind to yourself reasonable.

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Um, the next thing is you gotta kind of think about your strategy.

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Okay.

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If I am going to, you know, if I'm on a meal replacement program or something and now I'm gonna have to, you know, quote unquote eat regular food, what's my strategy?

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So what I usually tell patients is think about what you're actually going to eat ahead of time.

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So, you know, you kind, if you visualize and think about it, you're more likely to do it.

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Then when the the time comes, you're not gonna have that, um, pressure to make a decision'cause you've already thought it through.

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So you might say, I'm not gonna feed the breads.

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With the appetizer, I'm gonna just have a salad and maybe a lean piece of chicken if it's available.

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I'm not gonna consume liquid calories, you know?

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Or if I do, I'm gonna only have half a glass of wine.

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I'm not gonna, you know, so you have to kind of understand those.

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And sometimes what I tell people too is if you really are feeling stressed out, overwhelmed.

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Go to the washroom, give yourself a break, 30 seconds, a couple of minutes, kind of collect your thoughts.

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And also, sometimes it's not unreasonable, like you have to do what's good for you.

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If you have to leave a little bit early, that's fine too.

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You know, you not, don't be rude, but sometimes you don't need the STA till one in the morning.

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Maybe you leave at 10.

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You, you, you came, you, you enjoyed yourself, you met your friends and family.

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Maybe that's it for you.

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So you, you kind of have to have an approach where social settings can really.

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Um, it puts a lot of pressure on you sometimes also you think everyone's watching what you're doing and then you're like, oh, maybe you know, my aunt's thinking I'm not eating or something's wrong.

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And the reality is people are, and people are consumed with themselves.

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And you know, I try to tell that to people too.

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Uh, people are more interested in their own lives.

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They have their own things they're worried about.

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They're actually not paying that much attention to what you're doing.

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So don't let that be, you know, a self-created stressor.

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Yeah.

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Yeah, definitely.

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I love that, that that sounds like exactly like a worksheet I teach, which is decisions ahead of time.

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There's so many decisions that you can make ahead that have, um, even when you don't know the menu, just like you said, you can decide ahead if you're going to eat the appetizer or not, regardless of what the appetizer is.

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You can just decide if you're going to, and um, are you going to have the wedding cake or not?

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And, you know, making not only a food plan, but a drink plan as well in those social, social situations is also super critical because once we start in with the alcohol, sometimes the food plan can go by the wayside if we don't follow, follow the alcohol plan.

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So it's kind of, you know, making those, all of those decisions.

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Totally.

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Yeah.

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It's just making those decisions ahead.

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It can just go a really, really long way.

00:16:14.094 --> 00:16:24.443
Um, and like you said, other people are often, you know, thinking more about themselves and I find that this is also a great decision to make ahead is who do I wanna connect with?

00:16:24.443 --> 00:16:31.913
Especially when you're talking about a wedding, a birthday party, these are people that you know, you know, and if it's a work function, maybe you wanna network with a particular person.

00:16:32.333 --> 00:16:36.024
Like think about not just the food, but.

00:16:36.609 --> 00:16:40.298
The people, because after all, that's why we go to these things.

00:16:40.359 --> 00:16:47.889
And so if we can shift our focus, like make some food decisions ahead and then let that go and think, who have I not seen in a while?

00:16:47.889 --> 00:16:49.208
Who do I really wanna talk to?

00:16:49.448 --> 00:16:51.249
Whose kids do I wanna ask about?

00:16:51.308 --> 00:16:53.979
And think about those kinds of things people do love.

00:16:54.254 --> 00:16:55.453
To be asked.

00:16:55.543 --> 00:16:55.874
Right?

00:16:55.874 --> 00:17:05.864
They, and when, if you're overly focused on your body and your food, you're not going to remember to ask about that person's child that maybe just started college, right?

00:17:05.864 --> 00:17:11.384
Like, there's interesting things to talk about that are so much more interesting than your weight, right?

00:17:11.384 --> 00:17:20.443
It's, it's so, it's so the least interesting thing about you and, um, very few people are going to notice what you're eating if, if at all.

00:17:21.054 --> 00:17:21.413
Correct.

00:17:21.413 --> 00:17:25.787
And I think those are, a lot of the, ideas we have in our head are often self-imposed.

00:17:25.787 --> 00:17:27.856
They're actually not based in reality.

00:17:27.856 --> 00:17:30.241
They're just things that we've thought up in ourselves and.

00:17:30.826 --> 00:17:34.696
Fears we create in our, in our own heads, but in reality they, they're not there.

00:17:34.906 --> 00:17:42.586
And I think realizing that, and sometimes, you know, one important thing I think also is to kind of do the post-mortem after the social event.

00:17:42.916 --> 00:17:44.477
See what actually happened.

00:17:44.836 --> 00:17:56.057
You know, if you had some I, you know, anxieties or stressors, and then you realize they actually didn't materialize, that sometimes is very informative too, is like you kind of realize, you know, I had these, you know, fears.

00:17:56.432 --> 00:17:58.201
And they, people were happy to see me.

00:17:58.201 --> 00:18:00.152
Nobody was really concerned with what I was doing.

00:18:00.152 --> 00:18:02.326
It kind of, it's empowering when you realize that after.

00:18:03.152 --> 00:18:04.112
Yeah, for sure.

00:18:04.981 --> 00:18:07.711
So I know you use some affirmations as well.

00:18:07.711 --> 00:18:12.481
Can you give us some examples of those that you think are helpful for your clients in different situations?

00:18:13.307 --> 00:18:13.457
Yeah.

00:18:13.457 --> 00:18:32.217
So, uh, affirmations are important because I think, um, a lot of times we have negative self talk that's going on in our head, and a lot of times, you know, patients have tried different, Weight loss programs and they, they haven't had the success they were looking for or didn't have the lasting results they were looking for.

00:18:32.217 --> 00:18:35.606
And then they start thinking, well, this is gonna be like every other time.

00:18:35.936 --> 00:18:37.527
you know, I'm not gonna get the results.

00:18:37.527 --> 00:18:46.557
So those, those, so then when you, when, when you think about doing something new, those thoughts start kind of making you not look at the new approach in a more positive way.

00:18:46.767 --> 00:18:51.027
I think that's where affirmations come in, because over time affirmations kind of can cloud out.

00:18:51.642 --> 00:18:55.541
Or push out those negative thoughts and then you adopt more of a positive mindset.

00:18:55.872 --> 00:18:59.201
So affirmations should be, they should be personal to you.

00:18:59.561 --> 00:19:01.271
Um, they should be also present.

00:19:01.362 --> 00:19:07.316
So in those are what I kind of ask people when they, develop their affirmation to ship, pick some that are good.

00:19:07.316 --> 00:19:16.256
So, um, like one, for example would be, and I don't tie affirmations to like a specific goal, like I'm gonna lose 88 pounds.

00:19:16.256 --> 00:19:19.945
It's more like I'm gonna make healthy food choices today.

00:19:20.740 --> 00:19:22.391
I'm gonna be a healthy person.

00:19:22.901 --> 00:19:29.013
Um, so you kind of just promote sort of, what you want to be and not a specific number or a goal.

00:19:29.463 --> 00:19:29.884
It's to

00:19:30.003 --> 00:19:31.294
More like an identity.

00:19:31.354 --> 00:19:32.074
That's right.

00:19:32.403 --> 00:19:35.433
And an approach to, you know, almost an approach to life.

00:19:35.433 --> 00:19:38.463
And that ties to your personal beliefs and values.

00:19:39.611 --> 00:19:40.090
Perfect.

00:19:40.090 --> 00:19:40.631
I love that.

00:19:40.631 --> 00:19:41.171
Thank you.

00:19:41.770 --> 00:19:46.121
Um, and along with that, you think journaling is also, a helpful tool?

00:19:47.080 --> 00:19:51.641
I think journaling is very important because in, in a way it's a form of reflection.

00:19:52.121 --> 00:19:57.701
It, I think it's something that if you do daily, it lets you why, why I think journaling's important.

00:19:57.701 --> 00:20:00.490
I do it for my own personal life for a number of different reasons.

00:20:00.490 --> 00:20:00.520
I.

00:20:00.926 --> 00:20:05.787
So ultimately the thing that determines our life is our, is our choices.

00:20:06.326 --> 00:20:10.527
And our mindset is ultimately what guides our choices.

00:20:11.007 --> 00:20:13.436
So if you want to change your life, you have to change your choices.

00:20:13.436 --> 00:20:17.576
And in order to change your choices, you need to understand why you're making your choices.

00:20:18.116 --> 00:20:24.896
And journaling to me is, is a forced way of kind of really being critical of why you're doing what you're doing.

00:20:25.477 --> 00:20:32.287
So, you know, for example, like if you, let's say that we're talking about the context of losing weight.

00:20:32.616 --> 00:20:36.967
Let's say you've had a few bad days of not no suboptimal food choices.

00:20:37.477 --> 00:20:42.277
If you start to write down, and I try to understand why did I, you know, why did I not do this today?

00:20:42.277 --> 00:20:43.326
Why did I do this?

00:20:43.666 --> 00:20:53.086
Then you start to realize, oh, it's because, you know, I had an argument with, you know, somebody at work or my, you know, my, I grounded my child and they, you know, they got mad at me.

00:20:53.086 --> 00:20:59.146
And then you start, you know, you start to understand, okay, these emotional triggers are what is making me make these choices.

00:20:59.567 --> 00:21:00.707
You can then reflect on that.

00:21:00.707 --> 00:21:02.836
And also, you know, I also find like.

00:21:03.511 --> 00:21:10.442
That act of physically writing it imprints deeper into you because you're kind of, you know, you're, you're doing that physical action.

00:21:10.471 --> 00:21:16.682
So I, I find, I used to find when I was a student, if I wrote things down, I had, I felt like I understood them and they stayed with me longer.

00:21:16.682 --> 00:21:18.156
So that's why I think journaling also is very helpful.

00:21:19.247 --> 00:21:32.567
Yeah, I like getting, like thinking about getting my thoughts out of my brain too, because sometimes they just are swirling or swirling and you're just like, ah, I just need to see them on paper and just kind of downloading.

00:21:32.567 --> 00:21:40.547
I sometimes call it a thought download onto paper can be so helpful to just see what, really what I'm thinking in black and white.

00:21:41.122 --> 00:21:44.416
And the decompress, and it kind of also, you can look back over time.

00:21:44.416 --> 00:21:45.467
It's kind a written record.

00:21:46.321 --> 00:21:46.801
Mm.

00:21:47.027 --> 00:21:56.446
When you look at maybe your entries from three or four months ago and where they are now, it's kind of a, it's almost like a written record of all the hard work you've done and also how you've changed or grown as a person.

00:21:57.211 --> 00:21:57.692
Yeah.

00:21:59.011 --> 00:22:06.092
So, shifting gears a little bit, there is a term called the obesogenic environment that we live in.

00:22:06.392 --> 00:22:07.771
What does that mean?

00:22:08.102 --> 00:22:09.662
Why do some people.

00:22:10.561 --> 00:22:19.471
Survive in, in this environment and stay a natural weight and some people don't like, what, what is that?

00:22:19.501 --> 00:22:24.420
And, and how do we manage that in our, effort to manage our weight?

00:22:24.922 --> 00:22:27.356
Yeah, that's a, that's a really good question.

00:22:27.416 --> 00:22:27.686
Yeah.

00:22:27.686 --> 00:22:32.336
So I think modern society has, um.

00:22:32.517 --> 00:22:37.106
You know, there are lots of benefits to all of our technologies and, you know, ways we do things.

00:22:37.106 --> 00:22:40.346
But obviously there have been a positives always on negatives.

00:22:40.856 --> 00:22:46.946
I, I feel like the, what the obesogenic environment means is that we're living in, uh, you know, wherever we live.

00:22:47.517 --> 00:22:57.027
Um, there are lots of things that promote us, um, to increase our calorie intake, but also to decrease our calorie expenditure.

00:22:57.781 --> 00:23:03.332
So, for example, food delivery apps, you know, to me that's a, it is a weight gain enabler.

00:23:03.362 --> 00:23:05.192
Something that enables you to gain weight.

00:23:05.656 --> 00:23:13.487
So in the past, if you didn't have time to cook something at home, you'd have to actually drive to the pizza store, walk to the pizza store, get a pizza, wait for it.

00:23:13.876 --> 00:23:19.787
That in and of itself would sometimes be, uh, you know, enough for someone not to get a, to order it.

00:23:19.787 --> 00:23:21.767
Because I had it's winter time, it's snow.

00:23:21.767 --> 00:23:24.737
I gotta, you know, clean my car, put my boots on, go.

00:23:25.126 --> 00:23:27.136
And, but then at the same time, you were being much more active.

00:23:27.166 --> 00:23:29.866
You had to actually be, you know, physically active to go and do that.

00:23:30.301 --> 00:23:34.142
Now with just a few clicks, you can have anything you want at any time.

00:23:34.815 --> 00:23:35.444
Mm-hmm.

00:23:35.551 --> 00:23:41.741
really made, access to food has just really become, and some really fast food has become much more accessible.

00:23:42.342 --> 00:23:48.991
Um, and then also I when, when I talk about the genic environment is like the general, you know, society, the processed foods.

00:23:49.832 --> 00:23:52.892
Many people where they live, they don't have access to nutritious food.

00:23:53.162 --> 00:23:58.382
You know, they're more likely to get, um, a fast food rather than, um, fresh fruit.

00:23:58.382 --> 00:24:02.882
So some people's environments just are such, but then, so you gotta look at the macro environment.

00:24:02.882 --> 00:24:05.942
Then also look at the micro environment, your specific setting.

00:24:06.332 --> 00:24:11.011
So at your work desk, do you have treats, you know, readily available?

00:24:11.011 --> 00:24:12.751
A lot of people keep treats when they're typing.

00:24:12.751 --> 00:24:12.902
Then they.

00:24:13.396 --> 00:24:15.886
They take a snack, they're thinking they take a snacks.

00:24:15.886 --> 00:24:19.547
Again, you're, you're making it easy to have access to unhealthy food.

00:24:19.787 --> 00:24:26.267
And also it makes it easy to kind of snack unconsciously, like we talked about earlier, and then even your own, your own home.

00:24:26.267 --> 00:24:37.487
So I always say like, take stock of, you know, when you're trying to make changes in your house, like take in your home, take stock of what are the things in your home that may be promoting you to make unhealthy food choices?

00:24:37.666 --> 00:24:40.846
And that's again, being mindful, being aware, like, am I, are we leaving?

00:24:41.237 --> 00:24:44.807
You know, bags of chips on the counter so I can grab it right away.

00:24:44.957 --> 00:24:54.257
Or do we, do we have all these snacks that, you know, rather than having like pre-cut fruits as a snack, are we just getting little packets of cookies and things like that?

00:24:54.557 --> 00:25:00.737
So I think that that's kind of, you know, when you're talking about the obesogenic environment, you sort of, there's the broader society factors.

00:25:01.366 --> 00:25:05.957
Which you need to be aware of so you understand that they're happening and you can kind of make strategies to deal with them.

00:25:05.957 --> 00:25:10.997
But then there are also things you control, so your work environment, your home environment, those sorts of things.

00:25:11.309 --> 00:25:12.119
yeah, there is.

00:25:12.190 --> 00:25:18.819
There's a lot of like society things that are a little more, almost government, public health kind of thing that we can vote on.

00:25:19.329 --> 00:25:23.500
And then there are the things that we can do right in our home regardless of.

00:25:23.799 --> 00:25:28.539
What, what is going on in our local or extended communities?

00:25:28.539 --> 00:25:32.140
So yeah, tons to, to practice in our homes.

00:25:32.140 --> 00:25:43.059
And then once we practice in our home environment setting, setting that up, then we're more likely to be successful in the the greater outside world environment.

00:25:43.644 --> 00:25:54.865
Especially too, like if you set up your home as an environment where there is healthy food available or you've, um, even just learning to cook a few recipes, maybe that's, you know, a stretch for you.

00:25:54.865 --> 00:26:05.244
If you don't know how to cook healthy foods, starting to watch YouTube videos, learn how to chop vegetables, like, you know, you start there, then you're less likely to get out into that.

00:26:05.755 --> 00:26:11.184
Um, fast food world if you have things that are ready to go faster at home.

00:26:11.575 --> 00:26:18.535
I like to, um, encourage my clients to buy those sort, sort of convenience foods that make your your life easier.

00:26:18.535 --> 00:26:20.244
Like rotisserie chicken.

00:26:20.244 --> 00:26:32.575
Pre-cooked proteins is like a convenience food that I think is so worth it because it just helps you stay on track, bagged salads, all those kinds of things that are that kind of minimally processed, but.

00:26:34.059 --> 00:26:35.410
Totally help you.

00:26:35.440 --> 00:26:40.839
They end up really being like Whole Foods as opposed to the ultra processed foods.

00:26:41.836 --> 00:26:42.405
That's right.

00:26:42.405 --> 00:26:50.490
And I, and I think that's sort of it, it kind of ties into like the, the obesogenic environment is that, you know, there's been, um.

00:26:51.605 --> 00:26:54.665
Kind of a loss of the separation between the work life and the home life.

00:26:54.665 --> 00:26:56.705
People now are bringing their work home.

00:26:57.096 --> 00:27:06.516
They have so much time demands, and then often what happens is, you know, you don't have the time to actually prepare your own food, whole food, nutritious food.

00:27:06.756 --> 00:27:16.715
And I think that's, and, and one of the things I tell patients or encourage, uh, people, is that you should kind of use like Sunday evening as your meal prep day.

00:27:17.526 --> 00:27:25.836
So, you know, you know, make three or four lunches, um, or say I'm just gonna have the leftover dinner for my lunches.

00:27:26.135 --> 00:27:34.776
So you kind of do all the meal prep where you might make three or four meals and you have the Monday, Tuesday, Wednesday, Thursday, and then you kind of dedicate two or three hours to do it.

00:27:34.776 --> 00:27:37.296
And you may have to eat the same thing one or two times a week.

00:27:37.296 --> 00:27:38.135
And that's okay.

00:27:38.526 --> 00:27:40.776
But that's kind of, you know, those to the strategy.

00:27:40.776 --> 00:27:42.576
You have to kind of look at your specific.

00:27:42.965 --> 00:27:48.155
Lifestyle and try to come up with solutions that work for you because everyone has, you know, we are all busy.

00:27:48.155 --> 00:27:55.415
We got, you know, work requirements, family requirements, um, you know, it is becoming very challenging'cause everyone's so busy.

00:27:56.059 --> 00:27:56.599
For sure.

00:27:57.680 --> 00:27:58.160
Okay.

00:27:58.160 --> 00:28:11.446
I wa was wondering, this isn't something we had talked about ahead, but I was wondering if you could address just a little bit about who would be candidates for some of the things that you offer because, I think that sometimes.

00:28:12.451 --> 00:28:16.531
You know, people don't realize like what the options are for weight loss.

00:28:16.531 --> 00:28:21.156
They just are like, well, I just have to eat less and move more, and.

00:28:22.007 --> 00:28:29.297
While that is from a thermodynamic standpoint, essentially true, there are ways to help us in that.

00:28:29.356 --> 00:28:34.426
And so who would you say would be a, like a good candidate for surgery?

00:28:34.817 --> 00:28:38.146
And who would be a good candidate for medication help?

00:28:38.176 --> 00:28:42.346
And who would be someone who should not choose any of that?

00:28:42.797 --> 00:28:50.086
And I'm gonna lead you a little bit here because what I've been noticing lately is.

00:28:50.513 --> 00:29:03.784
this idea that people that are using assistance for weight loss are somehow ignoring, eating healthy and moving their bodies and exercising like that, that it's, it's one or the other.

00:29:03.784 --> 00:29:08.523
You can either take medication or you can eat healthy and exercise.

00:29:08.523 --> 00:29:16.894
And I just find that to be so untrue that the person that is taking the medication is doing that in order to eat healthy and.

00:29:17.778 --> 00:29:18.558
Move more.

00:29:18.618 --> 00:29:29.989
And so I had said on a podcast a couple weeks ago, like, you're not a candidate for medication if you don't actually want to eat better and change your diet.

00:29:29.989 --> 00:29:34.578
Like if you're a person who's like, I just want to eat cookies, three meals a day.

00:29:35.223 --> 00:29:39.183
Like medication is not going to solve for you.

00:29:39.183 --> 00:29:41.223
You don't actually want to.

00:29:41.253 --> 00:29:42.064
Does that make sense?

00:29:42.273 --> 00:29:49.294
And, and it's not to judge like if, if, if you don't want to change your body, by all means don't, don't.

00:29:49.953 --> 00:29:52.233
But if you do, what?

00:29:52.233 --> 00:29:54.963
Who would be candidates for like each of those categories?

00:29:54.963 --> 00:29:55.713
Does that make sense?

00:29:56.449 --> 00:29:57.199
Yeah, that makes sense.

00:29:57.199 --> 00:30:12.356
So I, I think, um, the first thing is, um, when we talk about, let's say surgery or pharmacotherapy, which is, you know, like GLP one agonist medications, like, or pic, Those are tools to assist the patient to lose weight.

00:30:12.477 --> 00:30:16.047
Um, but they are not the solution in and of themselves.

00:30:16.557 --> 00:30:21.596
So, you know, when we talk about weight loss, the energy and energy out is very simplistic.

00:30:22.106 --> 00:30:32.000
And, it doesn't explain, you know, you can have two people who are identical and they can eat the same amount of calories and do similar physical exercise.

00:30:32.000 --> 00:30:35.480
And someone, uh, one of the patients may, you know.

00:30:35.976 --> 00:30:40.955
Not gain any weight, and the other one may gain weight, and there's lots of factors for that.

00:30:40.955 --> 00:30:49.806
It can be your genetics, your set point, your microbiome, which is the bacteria that exists within your colon, which can change how efficiently utilize calories.

00:30:50.046 --> 00:31:01.836
So sometimes it's, you know, it's things that, it's just your, your unique biology and nature that, um, despite, you know, actually living healthy, you are still struggling with your weight.

00:31:02.915 --> 00:31:10.836
So there are patients who, you know, have tried various weight loss regimens, um, have not had success, are still struggling with their weight.

00:31:10.836 --> 00:31:14.526
So when we talk about surgery, the first thing when I see a patient is.

00:31:15.141 --> 00:31:26.961
I do want to see a commitment to, to actually engage in behavior change and lifestyle modification because it doesn't matter, like if you do a gastric sleeve, it doesn't matter, you know how tight you make the sleeve.

00:31:27.201 --> 00:31:37.881
You can still gain weight if you don't have, um, healthy eating practices and you know, you can ize your food, you can drink your calories if you drink your calories.

00:31:38.391 --> 00:31:40.701
You're never gonna feel full, but you can gain a lot of weight.

00:31:41.030 --> 00:31:46.611
So that's really part and parcel to having a successful surgery is, is a one.

00:31:46.611 --> 00:31:51.590
You gotta do a technically sound surgery, make sure that it's done safely, but you have to couple it with.

00:31:52.536 --> 00:31:54.786
Lifestyle modification and behavior change.

00:31:55.056 --> 00:32:02.736
And that's where I think like we talk about the mindfulness counseling, you know, introducing physical activity in your life are very critical.

00:32:02.736 --> 00:32:09.365
So, you know, they talk about like the body mass index when we talk about surgery, which is a measure of your weight over height, very simplistic.

00:32:09.365 --> 00:32:14.736
But we do have guidelines that kind of direct us towards which patients may or may not be a good candidate for surgery.

00:32:15.006 --> 00:32:17.766
Then you have to combine that with are they ready to make a change?

00:32:18.125 --> 00:32:21.096
Um, because the surgery can only take you so far.

00:32:21.486 --> 00:32:31.326
Uh, then if you want to have that sustained weight loss, that's where you have to really make that commitment that I'm gonna, this is gonna get me over that plateau or hump that I haven't been able to get past.

00:32:31.836 --> 00:32:33.726
And the surgery's gonna be that tool to get me there.

00:32:33.726 --> 00:32:41.135
But then I have to, you know, while I have the aid of that tool, I need to invest in changing my, you know, mindset and the things I do.

00:32:41.395 --> 00:32:42.161
Day in, day out.

00:32:42.760 --> 00:32:47.201
And I think the same thing applies with, um, you know, the pharmacotherapy or the GLP one.

00:32:47.201 --> 00:32:49.330
Medications for sure.

00:32:49.330 --> 00:32:59.800
You know, when you take them initially, you know, you probably are gonna have some weight loss and as it escalates, but as we've seen, you know, when patients stop'em, a lot of patients can regain the weight.

00:33:00.191 --> 00:33:07.030
So, you know, when you are on those medications, take advantage of that tool that's helping you kind of lose weight or even maintain your weight.

00:33:07.401 --> 00:33:11.810
And do the deep work that you need to do to kind of change your behavior and your mindset.

00:33:12.230 --> 00:33:16.730
So one, you know, even if you stay on the medications long term, perfect, you're still changing your behavior.

00:33:16.730 --> 00:33:28.340
But if for whatever reason you have to get offered for side effects, tolerance, cost, whatever it may be, you, you, you have developed that tool set or that skillset to kind of help you continue on your weight loss.

00:33:28.384 --> 00:33:36.602
Yeah, and I'm so hopeful that the costs will go down eventually for those people that do need it long term and you know, if it's still benefiting you.

00:33:37.163 --> 00:33:49.584
I just don't see why it's, and obviously I'm not a doctor, but, um, from what I've read, it doesn't seem like it's a bad thing for those that need it long term or that it's helpful for them to maintain that.

00:33:49.673 --> 00:33:55.943
Um, I've seen people that have just gone down to very, very low doses for maintenance.

00:33:55.973 --> 00:33:58.344
Is that kind of what you're seeing as on

00:33:58.663 --> 00:34:01.513
Yeah, I mean there, there are people who are doing microdosing.

00:34:01.513 --> 00:34:07.304
I we, you know, you typically, like with Ozempic for example, there's a schedule where you slowly escalate it.

00:34:07.394 --> 00:34:12.313
Then you have to balance how they're responding to it, and then you have to balance it against side effects.

00:34:12.313 --> 00:34:13.543
Sometimes when the side effects I.

00:34:14.213 --> 00:34:17.994
Um, not everyone gets some, but some people do nausea, GI upset, those sorts of things.

00:34:17.994 --> 00:34:25.014
You may have to titrate it down and we have had patients also who've been on it, they have to stop it, then they kind of get on it later.

00:34:25.014 --> 00:34:33.204
So it's not that you necessarily have to be on it continuously, you know, there may be periods of time when you go off it and then you might go back on it again.

00:34:33.893 --> 00:34:38.034
Um, but like specifically for maintenance, do you try, do you titrate back down?

00:34:38.034 --> 00:34:44.844
So say you've, you've titrated all the way up and you lost your weight, and now you're like, okay, I just wanna maintain.

00:34:44.873 --> 00:34:52.313
Do they, do you then titrate down and then just stay on like a low, extra low dose for maintenance?

00:34:52.313 --> 00:34:53.063
Is that a thing?

00:34:53.994 --> 00:34:55.284
You can do that for sure.

00:34:55.284 --> 00:35:01.643
And often the, you know, a lot of times if patients get to a steady weight, they may just stay on that dose if they're not having side effects.

00:35:01.989 --> 00:35:08.518
Some patients, you know, they may want to go on a lower dose or, based on side effects, try to lower it and see if they respond to it.

00:35:08.744 --> 00:35:09.103
Okay.

00:35:09.134 --> 00:35:11.923
So lots of options working with your practitioner is the

00:35:11.969 --> 00:35:13.199
And every patient's different.

00:35:13.228 --> 00:35:17.969
Like yeah, you have to kind of individualize it to their, you know, specific circumstances.

00:35:18.858 --> 00:35:22.934
And would there be a person that you would say, you know what, you're not a candidate for any of this.

00:35:22.934 --> 00:35:24.373
What would that person look like?

00:35:24.373 --> 00:35:24.434
I.

00:35:26.244 --> 00:35:32.664
So, for example, if we're talking about surgery, um, there are certain patients we would not offer surgery to.

00:35:33.141 --> 00:35:38.721
there are obviously like the technical situations where they've had lots of abdominal surgery and it may not be safe to do the surgery.

00:35:38.721 --> 00:35:46.990
Lots of scar tissue, um, you know, if they have, contraindications doing a surgery safety such as severe heart disease, those sorts of things.

00:35:47.530 --> 00:35:49.240
But those are sort of the medical end of things.

00:35:49.240 --> 00:35:52.451
But if we're talking more about the non-medical aspect.

00:35:52.931 --> 00:35:59.740
I think if someone is struggling with addiction, that's not someone we would, um, you know, substance abuse, we would not offer surgery.

00:35:59.740 --> 00:36:04.811
They need to deal with that first before doing this if they're not committed to behavior change.

00:36:05.110 --> 00:36:14.800
So that's where the preoperative, you know, assessment and really understanding, you know, are they gonna participate in this because, uh, if they're not, they're not gonna succeed.

00:36:14.875 --> 00:36:15.235
Yeah.

00:36:15.505 --> 00:36:19.375
I would say the commitment to behavior change is probably for, for both.

00:36:19.405 --> 00:36:22.074
Both for surgery as well as for medication.

00:36:22.074 --> 00:36:27.054
You have to be willing, you, you have to be ready to commit to that behavior change.

00:36:27.806 --> 00:36:28.496
I agree with you.

00:36:28.735 --> 00:36:28.976
Yeah.

00:36:28.976 --> 00:36:29.905
Again, it's a tool.

00:36:29.905 --> 00:36:36.996
It's not, um, it's a tool to help you, but it has to be coupled with, behavior change, lifestyle modification, all of those things.

00:36:37.215 --> 00:36:37.565
Yeah.

00:36:37.655 --> 00:36:38.164
Perfect.

00:36:38.855 --> 00:36:39.155
Okay.

00:36:39.155 --> 00:36:40.085
This has been so great.

00:36:40.085 --> 00:36:41.434
Thank you so much again.

00:36:41.434 --> 00:36:46.655
We, um, where can people find you online if they wanna learn more about, um, your practice?

00:36:46.655 --> 00:36:46.684
I.

00:36:47.856 --> 00:36:53.135
That's right, so you can go to my website is www.peelweightlossclinic.com.

00:36:53.570 --> 00:36:59.630
Um, we have lots of, you know, we have blogs and they also give information about the different programs we offer.

00:36:59.931 --> 00:37:05.360
Also, you can, um, visit my Instagram at peel, weight loss, um, at Peel weight loss clinic.

00:37:05.630 --> 00:37:10.371
It has lots of, I, I put up regular posts just to kind of give patients tips and tricks and, uh.

00:37:10.956 --> 00:37:12.186
Information as needed.

00:37:12.485 --> 00:37:14.996
And also I have my, instructive journal that I made.

00:37:14.996 --> 00:37:16.195
It's available on Amazon.

00:37:16.505 --> 00:37:23.945
I created this just, um,'cause a lot of patients can't, um, it's not accessible to do counseling or, uh, cognitive behavioral therapy.

00:37:23.945 --> 00:37:25.565
Those things may not be available to everyone.

00:37:25.565 --> 00:37:33.396
So this is more of a self-directed, um, instructive journal just to kind of use some of the techniques that you and I discussed now in kind of a structured way.

00:37:34.280 --> 00:37:42.260
So patients will kind of, the first part of the book is information about, you know, affirmations, manifestation, um, journaling, meditation, those sorts of things.

00:37:42.260 --> 00:37:46.010
And then the second part is just pages where you can actually do the journaling activities.

00:37:46.400 --> 00:37:54.710
And then I put in, I put inspirational quotes for every day, just to kind of give you something to motivate you to kind of tackle the challenges we all face every day.

00:37:54.994 --> 00:37:55.445
Perfect.

00:37:55.445 --> 00:37:55.804
I love it.

00:37:55.835 --> 00:37:57.844
We'll put all those links in the show notes.

00:37:57.844 --> 00:37:58.625
Thanks again.

00:37:59.271 --> 00:37:59.990
Yeah, it was a pleasure.

00:37:59.990 --> 00:38:00.860
Thanks for inviting me.

00:38:02.702 --> 00:38:11.942
If you want more support with your weight loss, especially if you're navigating appetite changes and side effects with GLP one Medications, I'd love to help you inside my coaching programs.

00:38:12.152 --> 00:38:19.322
Start with my GLP one Success Starter kit, if you are even considering medications or if you are already taking them, but feeling kind of lost.

00:38:19.666 --> 00:38:22.907
Because GLP ones are a great tool to assist you with your weight loss.

00:38:22.936 --> 00:38:29.476
I have developed an entire program that is specifically for people who are on these medications, so be sure to check that out.

00:38:29.686 --> 00:38:34.697
You can always book a free consult call through the link in my show notes to make sure we are a perfect fit.

00:38:34.697 --> 00:38:44.027
And I do still have programs that are for those that are not using medications as well, or would be appropriate for someone who has participated in a surgery like Dr.

00:38:44.027 --> 00:38:45.376
Kundal performs.

00:38:45.757 --> 00:38:47.286
I will talk to you next week.

00:38:47.317 --> 00:38:52.597
And remember, it's not just about the food, it's about empowering yourself with choices that truly serve you.

00:38:52.836 --> 00:38:58.382
Have a great week, and as always, thanks for listening to The Eat Well Think Well Live Well podcast.