Weight Loss Medications with Dr. Lindsay Ogle [Ep. 136]

0:00 This is the eat well, think well, live well podcast. I'm Lisa Salisbury, and this is episode 136 weight loss medications with Dr. Lindsay Ogle. This is the episode I have been wanting to do with the perfect person and Dr. Ogle. is the one. She is a double board certified physician in family medicine and obesity medicine. We are going to dive deep into the pillars of obesity medicine, what the options are in weight loss medications these days, what you need to do while on them. And at the very end, we will talk about the possibility of weaning off and how that looks. We also get into who is a good candidate for these medications and just a lot of deep dive.

0:43 On the options. I just wanted to offer you this episode so that you have a lot of good information to decide if alongside coaching, talking to your physician about some of these options would be right for you. Welcome to eat well. Well, the podcast for busy women who want to lose weight without constantly counting, tracking, or stressing over every bite. I'm Lisa Salsbury, a certified health weight loss and life coach, and most importantly, a recovered chronic dieter here. You'll learn to listen to your body and uncover the reasons you're reaching for food. When you're not truly hungry, freeing you to focus on a healthier, more fulfilling approach to eating.

1:27 Welcome back to the eat well, think well, live well podcast. I am so excited to be interviewing Dr. Lindsay Ogle today. She is a double board certified in family medicine and obesity medicine. And, um, just, she reached out to me and I was like, yes, yes, yes. You may have been noticing as a listener that I have been leaning more towards evidence based guests lately and really trying to get away from people that are termed, um, functional or holistic or things like that, that really aren't science or evidence based. And so I could not be more thrilled to have a double board certified doctor here on the podcast. So welcome Dr. Ogle. Please give us a little introduction to you and what you do.

2:07 Yeah, thank you so much for having me on here, Lisa. I'm very excited for this conversation. So, um, as you said, I'm Dr. Lindsay Ogle. Um, I went into medicine really to help people achieve and maintain their health. And I chose family medicine originally to practice primary care and build those lasting relationships with my patients. And quickly I realized that many of our chronic conditions that I was seeing and my patients were related to lifestyle. And I actually did some elective rotations during residents. and worked with an obesity medicine physician, and she really introduced me to this field, and I fell in love with it very quickly because of its emphasis on lifestyle, nutrition, exercise, mental health, and then utilizing safe and effective medications, um, when appropriate or referring to surgery when appropriate.

3:05 And I just saw the benefits that these patients were having with improving. their health and well being long term. And so I, after I finished residency, I did some additional training, um, and then sat for those obesity medicine boards, um, as well. Um, I did a couple of years in primary care and now I'm really focusing on weight management and metabolic health, um, through my telehealth clinic. Perfect. You are the perfect person to be asking all of these questions. So if you notice from the title, we are going to be diving into a little bit on the GLP 1 medications. But before we talk about medicine, let's talk about the four pillars of obesity medicine.

3:48 I think it's really important that we hear from you on this because I have been seeing several, um, I, I'm on Instagram, love it or hate it, you know, I, I'm on there to, to let people know what I do. And so I, of course I'm scrolling and so many times I see things like, Oh, these doctors, they just only want to put you on medicine. They just only want to prescribe things. And it goes not just for obesity, but for everything. I think doctors get a really bad rap in that way. Um, I don't believe that, but I want to talk about the four pillars because medicine is only. One of them. So if you could introduce those, what those four pillars of obesity medicine are under your training.

4:34 Yeah, thank you so much for bringing this up. I think this gets overlooked, especially in popular media and the general public, but anyone who is trained in obesity medicine is taught these four pillars and it is nutrition, and physical activity, behavioral modifications, and then medication management, including um, medications or the surgical interventions. And so medication and surgery is just one of those pillars. We spend the rest of our training and our focus on those lifestyle interventions. And so if you are working with an obesity medicine physician, then you are able to, um, have that all encompassing, um, you know, full picture evaluation and treatment.

5:24 Um, if you don't have the access to a obesity medicine physician, because there are not. Um, a, a lot of us out there, um, we're a minority of the physicians and you, if you happen to be prescribed, um, a GLP one, then that is when it is so beneficial to work with, um, either a dietician, a trainer, or a coach, or one of each to really. Touch on all those pillars because they are so important for us to really focus on your health and well being long term. I love that. I, um, I of course specialize more in the behavior modification section of those.

6:04 Uh, on those pillars and helping people to figure out why they're eating when they're not hungry and it's such a still important piece, even if you're on medication or if you've had surgery, you still have this, you know, you still have a brain and that brain is still in, you know, going to be stuck in some habit loops and that, you know, you're not maybe aware of and so that's where, you know, coaching can really come in. So let's dive into really attacking some of those. Yeah. Yeah. Yeah. information as well as some misinformation on the GLP 1 medications. Can you start with some background, some context, um, you know, things like how long they've been around. I think because of the increased popularity recently, it feels like they're brand new drugs.

6:48 And spoiler alert, I'm, I know they're not. She, she, we're both laughing here. Um, but if we could just Kind of get into that. That would be great. So Yeah, absolutely. And that was perfect timing. I actually just did a post on social media. on on Tiktok actually, and I'll post it on Instagram soon about how I need to stop myself. I need to stop saying our new weight loss medications are new injectable medications because I still catch myself doing that. And this class of medications, the GLP one agonist have been around since 2005. And so we have been using GLP one agonist.

7:29 Um, initially for type two diabetes only, but we have been using this class of medications now for 20 years, and they were studied for years and years prior to that. So we have a lot of data and real world data, real life data, um, proving that they are safe and effective when used appropriately and for the right, right patient. And so, like I said, they've been around for a long time, um, I heard this great analogy, which I am going to continue to use moving forward. It's like, uh, our iPhone. So we had the iPhone version one that came out and then every so often they have a new version and it's an upgrade and it's better, more efficient, it has more features, um, in it, and it's very similar to this class of medication.

8:18 So we started with, um, it was Byetta was the name of the brand name of the first one. And then we've had new inner iterations. Um, there's been several iterations over time, and now we have our weekly injections on. And we have a couple of brand names that are now FDA approved for weight management rather than just type 2 diabetes. that's why they feel new then is because of the recent approval to use this class of medication strictly for weight management and not just for type two diabetes. absolutely, yes, yes. I just think that's really, like, good to know as to why they feel new.

8:59 right, right. It wasn't that, you know, doctors or the healthcare field was hiding the medications or keeping them, um, for certain uses. they just were not FDA approved for that reason. They were very effective for treating type two diabetes, and we were seeing such great results. Our patients were feeling better, having more energy, um, they were losing weight, um, just seeing great outcomes, and then While we were watching how great patients with type two diabetes were responding to these medicines, then they were studied for patients without type two diabetes and we saw very similar outcomes for those patients and then that's when they were approved, for weight management.

9:45 Okay, perfect. So, all medication comes with risk, as we know. Everyone has seen, you know, the jokes about the, I mean, Saturday Night Live has parodied drug ads forever about all of the different risks. So, of course there's risks. Um, but again, I think social media and popular culture has, confused people as to what the risks are. So from somebody who is, again, board certified in this, totally qualified to prescribe these medications, what are the risks? And, and then of course we'll talk about the benefits and why that is of course outweighing some of those risks. Yeah, absolutely.

10:25 And every physician, like you said, with any medication we're prescribing, we are always thinking about risks and benefits because with anything we do, um, there are risks and benefits. And so we are wanting to make sure that, that those benefits are outweighing the risk. For for patients and for anybody who qualifies for the medication for the most part for the majority of people, those benefits do outweigh the risks and I don't blame anybody for maybe being nervous about trying to medications because there are very scary. about what can happen if you take these medications, but in reality, if you are being prescribed appropriately by your physician or your provider, um, the, the side effects are fairly mild if they happen at all.

11:12 So on average, about a third, of people have GI side effects. So GI side effects are by far the most common. and that is Um, and really a result of how the medication works. So one of the ways that the medicine affects our body is that it slows the GI system down the GI tract down. And so food sits in the stomach longer. And while that's happening, that can trigger nausea or acid reflux, and the slowing can also then lead to constipation or changes in bowel habits. and those can really be. managed by making sure that we're eating small, frequent meals, staying really well hydrated, avoiding greasy or sugary foods.

11:59 and then making sure we're getting enough fiber to offset that constipation. And then we always start at our lowest I'm going to, sorry, I'm going to interrupt you right here for a second, Dr. Ogle, and just point out this is, this is where that one of those pillars of obesity medicine comes in into play. We have to have behavioral modification along with the medicine. You don't just get to take the medicine and have it like, quote unquote, do its job. Like that was a lot of behavioral modification that you just listed. And so, Yes. I just, anyway, I just think it's interesting. Carry on. No, that's it. That is a great point. Um, uh, yeah, a great point. Absolutely. Um, so I, I do think that that's very important to highlight because there's a disconnect between, you know, taking a medication.

12:47 I think that people think that it medicine just like Burns the fat off the body or increases metabolism and automatically leads to weight loss that way and and that is just not the case. There are, the medications are improving biologic changes that happen when somebody has obesity and and so that is what the medicines are correcting. They do not by themselves. It's a tool to augment those behavior changes that you are working on, um, to, help you to be successful. Um, but yeah, but we start at the lowest dose and then slowly work our way up, over time.

13:28 And if at any point you're having, you know, side effects on a regular basis, uh, we always hold off on increasing the dose and maybe back down on the dose, uh, and address that until Uh, Um, and then we can go back to adjusting the dose if needed. the more serious side effects that we hear about are really rare. and a lot of them are related to weight loss in general. So I'm referring to, um, the gallbladder disease, gallstone development, pancreatitis. We see this happen with any amount of significant weight loss, especially if it happens in a short period of time.

14:09 So it's less from the medication itself. It's more from the fact that we are more people are losing weight on the medicine. And then the one not really any that we are very strict about is any personal or family history of medullary thyroid cancer. in animal studies, there has been an association of an increased risk of that specific type of cancer, medullary thyroid cancer. So we're very cautious if anybody has that in their family history or personal history, then they should not be taking these medications at all. Not a candidate. Yeah. Okay. So another risk I think that we see a lot, which isn't so much listed on, you know, on the label is the risk of losing more muscle than fat and this, you know, people are very worried about this.

14:56 And I think it's, again, common to be shouted in the grocery stores from wellness influencers, like, don't do that because you're going to lose all this muscle. And it seems to me like it's just along those lines with the gallbladder that we see this with any rapid weight loss. if I was able to just snap my fingers and change your lifestyle overnight and you started losing weight, you would see this if you weren't actively combating what causes that. And I believe that that's the case with these medications that people are not doing the two things, eating enough protein and strength training. Would you agree? I totally agree. Yes. Yes. Those are so important for anybody who is losing weight If you're losing weight from any means, then that is a concern.

15:40 We want to make sure that we are maintaining your muscle mass as much as possible. but There is no way around to lose some amount of muscle mass. So when we are carrying more weights, we need bigger muscles to carry that weight. Um, and so sometimes even just the ratio, um, maybe that main maintains the same, you know, as we're losing weight, but you're going to lose some muscle, um, with that. But yeah, Yeah. If you have a hundred pounds to lose, you can't possibly make that all fat. That's just not, it's just not a thing. You can't do that, but that doesn't happen. Cause yeah, like you said, you're going to have smaller muscles when your body is smaller because that is what you need to function.

16:22 yes, absolutely. The only way to do 100 percent fat loss is liposuction. Okay. Okay. So, um, let's talk about why someone would choose, um, a 1 medication. I have had clients, I've had both. I've had clients that are like, You know, I would never, I would never do, and for some reason they just think that that's, I think there's some, uh, stigma with it being quote unquote cheating, which I think is ridiculous. If my clients are open to it, I always say, ask your doctor. Um, and I have coached clients that have been on medication. And so when someone asks me well, should I work with you or should I get medication?

17:05 I'm like, yes, but what would be some of the indicators that would be like, yeah, this person's really a, a good candidate for asking their doctor about, getting on a medication. Yeah, and I really appreciate your approach there. And I try to have a similar approach of really individualizing recommendations for for that person and working with you know what somebody's goals are and what they're comfortable doing. And I definitely agree with yes and let's do both let's let's use. Let's focus on the health and medicine side and then let's focus on the mental health and behavior side as well.

17:45 Um, And so I really think that, um, medication should be considered maybe more strongly if somebody has really the majority of their life struggled with their weight and, as for decades, really not been able to either. Lose a significant amount of weight to be able to get them into not even a a normal BMI because we know there's a lot of Problems with BMI and that's not our goal our goal is to help somebody improve their health and to function in a lot in their life function and participate in their lives in a way that they want to and sometimes our weight can hold us back from that and And so we want to, um, help you find, you know, that best weight for you.

18:36 And if you have not been able to, to do that over, like I said, years or decades, then maybe it's time to talk to your doctor and think about correcting those, um, biological changes that are underlying. Also kind of maybe taking a look in your family and if a lot of people in your family struggle with weight, then there's a high chance that there's a genetic component going on. And these medications can, can really help with that. Um, if you've done a lot of yo yo dieting back and forth, these medications can also really help just stabilize, those ups and downs, and really again, focus on, on health and nutrition and it can, I know there's a lot of talk about the food noise.

19:24 and I know I'm, yeah, and I know you do a about that for yeah, and I know you do a lot of work with that with, with coaching and, and our thoughts around food, which could be so powerful. but there, there, for some people, I would say even for most people, when you lose a significant amount of weight, Your hunger hormones and those signal hunger signals to your brain increase because your body wants to maintain the weight that it was at because it's trying to protect you. It thinks that you're starving. We, you know, food used to be scarce. And so it's trying to conserve energy. So hunger signals and those hormones go up and it can be very, very difficult over a sustained period of time to fight those hunger signals.

20:11 And that is where medication can really be powerful because it can help lock those. Those hunger signals and then it can allow you then to follow the healthy nutrition plan that you have set on and this ties back, you said something in the very beginning about when we were talking about mental health and I forget, forget exactly what you said. But I was talking with somebody about using food to help, um, cope with certain emotions and we all do it. And that's a normal human, you know, coping strategy, but sometimes it gets out of hand and difficult to control and can lead to a negative health consequences, whether physical or mental.

20:54 And if you're on a GLP one. Your hunger signals are going to be suppressed. Your cravings are going to drop down significantly, and you're going to lose that coping mechanism of food that you were turning to before. And so it is so important to have the support and strategies in place. So then you can Learn how you can cope with that stress and those negative emotions that are going to come up when you don't have food to turn to like, like we used to. so on this topic of who it's appropriate for, that's a lot of good, you know, I think people can see themselves in, in that, but what about strictly in terms of weight to be lost?

21:39 Is there. an appropriate amount of, like, if you have this much weight to lose, you're a candidate, but if you only have X amount of pounds, you're not a candidate. Is there a cutoff guideline Yeah, so, um, medically, uh, we are still using BMI mostly. Um, so, A BMI of 30 or above qualifies medically for for medications or BMI of 27 or above with a weight related condition like high blood pressure, diabetes, cholesterol, sleep apnea, and you can calculate your BMI really easily by searching BMI calculator and then putting in your height and weight and it'll tell you.

22:25 so those are the, medical cutoffs. That does not mean that your insurance will cover the medication, though, which is very frustrating component. Right now, insurance companies are not required to cover medications for obesity. There are a lot of people. I know, I know it will be actually only been recognized as a chronic medical condition since 2013. And so it has not been that long that we have the medical community as a whole has seen it as something that needs to be treated directly. And so there it does take time to make those changes, but there fortunately are a lot of people who are, you know, supporting supporting the cause and hopefully insurance will will start covering it more consistently moving forward.

23:18 Yeah, hopefully that's, that can be the case. So it's not necessarily a, I have 20 or 40 or 90 pounds to lose. It really, at this point, still, you need to go off of your BMI, which. I know like every time you've said it, you've kind of like put it in air quotes and so which people aren't seeing. So it is, it is still a challenge. So it sounds like still something you need to just have that conversation with your provider. So let's talk about, GLP 1s are very obviously popular, there are certain types that are approved just for weight loss and you don't have to have a, a secondary diagnosis like type 2 diabetes, but there are other medications.

24:01 So, can you speak to some of those options? Yeah, absolutely. So, outside of the class of GLP 1s, there are really, I would say, three main medications that are used. The first is Phentermine, and Phentermine was FDA approved in 1959, and so it's been around for 66 years. Um, so another one that we have a lot of data on its safety for, um, it gets a bad rep because at one point it was combined with another medication that had significant side effects, but by itself it has been proven to be safe.

24:42 Again, Yeah, so, I'm just going to say for those, I, I was, um, kind of, I think in my early twenties when this happened, so you might be familiar with the combo. They called it Fent Fen because the other one also started with the, with the prefix Fen. So Yes. Yes. Fen. Fen. And so that is no longer available. but fentamine by itself is still an effective appetite suppressant. And so that's really where it helps a lot. So, if somebody is having that increased hunger, you know, when they're cutting calories that this can be helpful, um, this should really be done with, uh, or prescribed by an in person provider because we want to monitor your vitals closely, um, because it is a stimulant and it is technically a controlled substance.

25:22 Although I always say, you know, people are not selling phentermine on the streets. People don't really become addicted to it Um, but it is a stimulant so it is controlled then really great thing about it is it's very inexpensive Even if your insurance does not cover weight management medications With a good or x coupon you can get it for around 20 a month. So very very affordable. Yeah compared to the GLP 1 agonist, which without insurance can be closer to a thousand dollars a month. So huge difference there. Qsymia is a brand name that combines Phentermine and Topiramate. And it's just, it's a little bit more effective with that combination.

26:04 Also helps with appetite suppression, um, helps with some of the, uh, reward feedback, that we see with, with food. this one is really important for anyone who has the potential to become pregnant. They should either not take it or, um, need to be on a really effective birth control because. Topiramate just itself has been associated with, cleft palate development in the, in the fetus. So that's a very important thing. there's some other potential side effects that your doctor would go over, but, that one is fairly effective and also, not as expensive for the brand name with the coupon last time I looked, 75 a month. so again, on the more affordable side, And then the third one is Contrave, and Contrave is another combo medication.

26:51 It combines a medicine called Buproprion, which its brand name is Welbutrin, and then Naltrexone. Um, this medication together really helps with emotional eating, stress eating, and it really helps with that food reward pathway. The Bupropion or Wellbutrin we use for depression. It's a nonstimulant, A DHD medication. It helps people cut back on smoking. So we use it for a lot of different things. And then the Naltrexone is an anti opioid, and so it is, it is not an opioid, but it blocks those opioid receptors. we use it mostly for, reducing alcohol cravings. so this is a also a great option if somebody is having, you know.

27:35 Depressed mood or are drinking more than they want to this medicine can help with those things as well As helping with weight loss Okay, good. Yeah. So there are, there are options out there. I think one of the major deterrents for the GLP one class is the cost. And so of course we have, I don't think we have time to get into all of the issues with the, compounded pharmacies and the direct, you know, people that just get them directly. And I think, this is where a lot of people are getting them that shouldn't be, and they're not getting them. You know, they're not candidates. They're already, you know, quote unquote thin and they're trying to get even thinner and so Um, that's just like a whole other conversation really, but, um, along with the medications, of course we talked in the beginning about the four pillars of obesity medicine, but let's talk a little bit more in depth about what role does the diet, the exercise and the mindset play when you are.

28:39 Also including some of these medications because I think for so long, again, physicians have gotten a bad rap for just saying, oh, well, just lose some weight. Your knees will feel better or well, you know, just eat less, move more. and especially too, I think there's a lot of, really negative information about doctors don't know anything about nutrition, which yes, that they, you know. Your typical sort of quote unquote family doctor doesn't get the training that you do. So it is very important I think to go to someone board certified in obesity medicine if this is something that you are really struggling with. so I would just like for you to speak a little bit about, kind of why that that happens for physicians, like why, why that's kind of been the case for so long and what role that plays alongside these medications.

29:30 Yeah, there is that stereotype that we do not know much about nutrition. And it probably, it varies, you know, with any, with any field, you know, what people's expert level is, where they trained and what they were exposed to. I also, you know, talking about influencers on social media, you know, people can make it seem more complicated than it needs to be. I think we just. Um, I think most doctors are aware of that. and I could sum it up here as reducing added sugars as, as much as possible.

30:14 And so just, I always recommend starting to look at labels and choose options that have less added sugar or no added sugar. and then making sure we're getting enough protein and fiber. Um, and then water. those four things are, if you do that, you're going to be in a much better place. protein goals, I think, can vary from person to person. Um, and it could be helpful to get individualized recommendation. But a general recommendation is this. Yeah, it's the shoot for around 100 grams a day. Um, for some women, it may be less for some men, it may be more, but that's a good rough Um, and that's the goal. Um, for fiber.

30:55 another good goal would be around 25 to 30 grams per day. Um, and then water. it's enough. So this one is you can really individualize. So you want to drink enough water. So where your urine is clear or, you know, light yellow. So you get that feedback constantly. Um, so if you do those four things, like I said, you're going to be in a great place from a nutrition standpoint. And then to get. Protein and fiber ideas. We have Google, we have chap GPT. They're amazing and such great tips. and so I highly recommend utilizing those resources. it's so true. Like it's not a lack of information that, that we have on nutrition.

31:38 It's, it's really clear. And again, I think, and I don't know why I keep attacking the wellness influencers in this episode, but I think that people try to complicate it in order to sell their product in order to, and which is why I think I. Kind of struggle with getting clients because I'm not flashy. I'm not saying, Oh, this is the one thing that you have to do. You've got to cut out this, this one thing you didn't know was making you sick and all of that garbage. Like, no. And I, I think a really good way. Uh, I'm sure you've heard this as well to sum up those nutrition guidelines is the 30, 30, 30 rule. 30 grams of protein per meal, 30 grams of fiber per day, and less than 30 grams of added sugar per day.

32:21 And. I think it's just, which is kind of really what, what you said, other than the actual number of added grams of sugar. That's a little high. I mean, I'd love to see it lower, but also I like to add in a lifestyle food, you know, quality of life food, whatever you want to call it, pleasure food once a week, twice a week. And so that's going to push me over that 30 grams of added sugar, but then. On other days of the week, I'm gonna be in the 5 or 6 grams, and so I'm looking at that number over the course of the week, divide by 7. Does that make sense? Anyway, but I just like that 30 30 30 rule. Yeah, I love that. And that is so sustainable and so reasonable that and straight forward.

33:03 We all can follow that. And I totally agree. I see that all the time where things are kind of advertised. Yeah, you're missing that one thing. You didn't know this. I'll tell you just sign up for my email list or something. Uh, no secrets. So that's, and I think this is to the point of like, it's okay. If you see the statistic that doctors didn't have, you know, 62 billion classes in nutrition, because it's just not that complicated. It's the doing it. It's not the knowing the information. It's that third pillar of the behavior modification of turning the package over and looking at the added sugar and making a conscious effort to include protein.

33:46 And where am I going to get fiber and how can I eat more beans? And you know, that kind of thing. And that's all the behavior modification. It's the nutrition piece is actually not complicated. Yeah. And I will also say, um, so we didn't mention this earlier, but, I found Lisa through, a coaching program, that I was, uh, I guess a student of, and, and she ended up, um, being certified as a of the life coach from there. And something that was so powerful that I learned from being coached myself was just. not beating yourself up after you made a quote unquote mistake. And once I was able to learn that through the help of my coach, that was a life changing, skill that I developed.

34:33 And we see that all the time with diets. And so if we set out Our best laid plans, we are going to follow these strictly and something happens and we overeat or we bring something in that wasn't in our nutrition plan or our protocol, whatever we're calling it, um, and then we beat ourselves up. We say we're never gonna get our results. We're You know, not disciplined or not worthy. And then we over eat and, you know, go off the rails. if we are able to stop ourselves at that moment and give ourselves some compassion, then we can accept what happened, which is normal that happens.

35:13 And then we can move on and continue moving forward. And so I'm sure you see that all the time with your clients. Yes, that's definitely a major thing, that I teach. And if my listeners haven't gotten, haven't signed up for my what to do when you overeat, three part video series, actually, that's one of the major things I talk about is. You know, we, we're just going to be kind, we're just going to be kind. It goes a long way. start there. Yeah. Okay. So we were, I kind of interrupted, we kind of got a little off the rails, but we were talking about the role that diet exercise and mindset play as far as, when you have a patient on these medications, like, what is your advice to them?

35:56 We spoke about the nutrition. So let's get back on track on that question with the exercise as well. Yeah, so for exercise, same thing. It does not have to be complicated. And I want to meet everybody where they're at. So if you are not exercising at all, then it is not reasonable to expect, you know, you to tomorrow start exercising an hour a day every day. Um, what our goal would be would be five minutes. twice a week. It could be as simple as that. And I always encourage people to choose something that they enjoy doing. Exercise is not a punishment. It is not to make up for calories that you consumed.

36:39 Exercise is for your physical and mental health. We all need to do it no matter what our body size is. It is extremely unlikely that you're going to lose weight from exercise alone. It is very important to exercise for your health and for weight maintenance. And like I said, start where you're at and then work your way up. Well, the recommended amount of exercise for all Americans is at least 150 minutes a week. And you can split that up however you like, whether that's 30 minutes, five days a week, or however fits in your schedule. And ideally, it's a combination of cardio and resistance training and the resistance training portion the goal for there would be at least 20 minutes twice a week and that it can be bodyweight exercises.

37:32 It does not have to be CrossFit. Um, we can do what you are comfortable and able to do and there are so many. Any apps available. I just signed up with Peloton and I've been very happy with their app and you can choose a 20 minute exercise body weight and you can do it. You can do as short as five minute exercises with them with, and they're so positive. It's been, I really like their app. and then I have a mentor who created GLP Strong, which is created for people who are on GLP One Agonist, but you don't have to be. it could be for anybody and it's also tailored for people who are new at resistance training and it's just 20 minutes.

38:14 It's that 20 minutes twice a week. So very accessible. You can do it in your home. So those are my, those are my recommendations for, for physical activity. Perfect. Yeah, pretty standard. Again, not complicated. Just get out there and move. I, I just want to add that, walking counts. Just thinking that. okay. I just think some people are like, oh, well, all I can do right now. That's all I'm physically able. That is perfect. Do that. Start there. Get going. and hopefully too, if you live in a place where you can get some sunshine while doing it. even, I mean, it's raining here today, so I actually took a walk, um, at my gym.

38:56 On the treadmill today because it actually was my day for walking. So I was like, Oh, um, so it's not as fun, but, um, walking counts. And I, and the other thing I just want to add to is I typically, when I go to do my lifting, um, strength training. Workouts. Typically it takes me about an hour to do the, assigned regimen. I have an online trainer that I use. And this past week, actually, um, on Tuesday, when I was lifting, I did not get to the gym on time. That's my fault. And I, you know, I had appointments backed up to that. And so I was like, this is all I have time for. And so I didn't do every exercise that was prescribed.

39:37 And I still was like, it still was like 40 minutes. I'm like, this was still totally worth my time. And I think that's another mindset piece is to do what you can, even if it's not what you did in your twenties, or even if it's not a full hour, sometimes I think because fitness classes tend to be a full hour, we think, well, that's how long you should quote unquote. exercise. And that's just not the case. If you have 20 minutes, spend 20 minutes. If you have 15, if you have five, whatever you have, and then also just try to get movement throughout the day. And that's not part of your 150 minutes, but just that NEAT portion, the non exercise activity thermogenesis, the acronym is NEAT, N E A T.

40:21 Um, you know, do try to try to move around during the day, taking the stairs. It's, you know, the proverbial example, but there's lots of ways to get some movement throughout the day. Yeah, and I was just looking at these recommendations recently, and they did make a comment about, you know, if somebody is not able to dedicate time right now for exercise, then getting at least 5, 000 steps a day was, um, pretty similar to that 150 minutes per week. So yes, you can move throughout the day and that counts as well. And definitely walking and counts. Um, I love that. Good. And then that last piece, just the mindset, what do you recommend there?

41:02 Do you recommend that your clients, or sorry, you have patients, I have clients. Do you recommend that your patients seek out, mindset, behavioral modification, coaching support? Do you provide that as a board certified obesity, specialist, or, you know, if somebody is getting these medications from just their family doctor or their. You know, gynecologists, I don't know who all can prescribe these, but if they're getting them from someone who's not board certified, then would they want to seek that out, um, in another form? I think this is another one that's individualized and I don't directly do like coaching or therapy, but I, when I'm listening to my patients and how they are.

41:46 Talking about themselves or the terms that they're using or what they're focusing on. I definitely try to redirect one towards health focused goals And reminding them where they've come from I think a lot of times we get to a certain point in our journey Whatever that is and we forget where we started and kind of that new spot is our new normal And we don't See how amazing, you know, we have, we have become, or I mean, we always were that amazing, but the amazing, uh, accomplishments that, that we have had. So, I always am reminding patients about that and reminding patients to be kind to themselves.

42:29 Screening for eating disorders, depression, anxiety, adverse childhood events, those are very common in people who have excess weight. That's really important, so if I ever identify that, then definitely, um, therapy can be helpful. for my patients who are very and have maybe already gone through therapy and are looking for kind of that next level, then that's when I recommend coaching and that can be very, very helpful, um, along with, with, you know, their medication. Great. So the last question I want to ask you, and let's obviously, if there's something we missed, be sure to add it.

43:13 But, what about coming off the medications? I think that that's another big deterrent is like, okay, I could maybe swing 1, 000 a month for this health modification for a few months or for, you know, nine months or something, but it's I think a lot of people are like, I can't do that for the rest of my life, and Obesity is a chronic condition that does sometimes need to be treated for their whole life. So, what are the options there for people when the cost is such a big deal, and is it appropriate for people to start these medications knowing that they are not going to do them for life? So.

43:53 In the specialty of obesity medicine, um, we recognize obesity as a chronic medical condition and anything that we do to treat that chronic medical condition, then we are going to need to continue to do to maintain it. And I think a really great analogy is with high blood pressure. And so we start someone on a blood pressure medicine. If they have high blood pressure and their blood pressure is now in a normal range. What would happen if we take the blood pressure medicine away, the blood pressure would go back up, we need to continue that medicine and we all accept that. But for some reason with obesity, that connection just isn't made. And we think that the medicine can be used short term for the vast majority of people.

44:39 If you start a medication and lose weight that way, I suspect you're going to need to take it long term. And it is likely that that is it. Best for your health rather than having those ups and downs in your weight. that being said, what I do with my patients is when we get to our goal weight, whatever we determine that to be for them, and we're, you know, we're at our best weight and we're feeling healthy, then I do slowly wean the dose down, as tolerable and able. Or we sometimes space out the injections a little bit, um, and if we space out the injections a little bit, then, especially if they're paying out of pocket, that can save a little bit of money because they're, they're lasting longer.

45:26 I definitely would not base out more than every I typically don't go longer than every 10 days and they're typically every 7 days. So it's not a big difference, but it can add up over time. I think this also ties back to when I, we were talking about earlier about who should be on the medications with, you know, if somebody has really struggled with their weight for over a decade or more, and their family also all struggles with their weight, then this is. a very high chance that you're going to be on the medicine long term. But there are some people who something happened in their life, um, they went through a bout of depression or they were started on a medicine that caused weight gain or, you know, postpartum way or perimenopausal weight gain, and it was relatively short, um, in duration that somebody has had that excess weight, I think, and I believe some of my colleagues believe this too, is that the medication then, in that case, it's a higher chance that we could use that medication short term, in those situations, because it's less that that person has it.

46:36 What we are calling the disease of obesity. It's more that they're carrying excess weight because of some other trigger that caused the weight gain to happen. So if we're able to bring that with the medication, help bring their weight back to where they were before, then with continuing on their new lifestyle changes. That they, you know, worked with and developed while on the medicine, then they're able to, you know, succeed in and continue, um, those health benefits moving forward off of the medicine. But definitely I would want in either scenario would wean off of the medicine and then always kind of go back if we need to. perfect. That is so helpful. Well, I think this has really been, enlightening and really informative for people to be able to just kind of have this background to decide if they want to approach their physicians about this option.

47:26 And certainly you can always still use someone like me for the, the behavior modification as well as touching on the, helping you with making changes to your nutrition and physical activities. So, Dr. Ogle, could you just tell people where to find you online? I know you have a certain place where you practice, obesity medicine. So it's not applicable for everyone, unfortunately, but, I think you, you, um, share on social media though, right? Yes, yes. So I practice out of Missouri. So my telehealth clinic is called Missouri Metabolic Health. And if you go to that website, you'll see links to all of my social media, but they're all Dr. Lindsay Ogle.

48:07 I'm on Instagram, TikTok, and YouTube. Um, and I Definitely recommend following on on those platforms. I try my best to share, you know, evidence based education to the general public for those people who I cannot serve in my telehealth clinic. So that's something that I'm definitely passionate about. So again, I appreciate you having me on here so I can reach more people and, you know, talk about this important health topic. Yes. Thank you so much. It's been a pleasure meeting you. I'm so glad you tuned in today before I sign off. I want to remind you of the what to do when you overeat free three part video course that I have. We chatted a bit about this in the episode, but if you are trying to lose weight and you find yourself overeating too many times to see lasting success, be sure to check out that free course.

48:55 It also comes with a reset and recover guide that will help you put everything you learn in the videos in writing and really clarify each step so you can feel confident moving forward. If today's insights resonated with you and you're ready to make lasting changes in your health journey, I'd love to help book, a free consult session with me to see if my full 12 week one on one coaching program is right for you. You can schedule it at the link in the show notes. Remember, it's not just about the food. It's about empowering yourself with choices that truly serve you. Have a great week. And as always, thanks for listening and sharing the eat well, think well, live well podcast.