Maggie McKay (Host): It's hard to go a day without someone mentioning Ozempic, either on the TV, radio, or among your friends. But what are the facts? And how can you manage your weight without drugs? Today we'll find out with ICHS Nutrition Services Manager and Registered Dietitian Nutritionist, Aliya Haq .

 Welcome to Together We Rise, a podcast from International Community Health Services. I'm your host, Maggie McKay. Thank you so much for joining us today, Aliya.

Aliya Haq, MS, RDN, CD: Thank you. Welcome. I'm glad to be here today.

Host: So we're discussing weight management without the use of drugs, whether because they are prohibitively expensive or other reasons. But first, let's get the 1 billion elephant in the room out of the way. I want to emphasize this is not asking for medical advice, but just your personal opinion. The prescription drugs Ozempic and Wegovy. What are your thoughts on them as effective tools to manage weight?

Aliya Haq, MS, RDN, CD: You described it well, there's an elephant in the room. And yes, we do, as dietitians get this question asked all the time and, patients come to us for weight management. I don't like to call them as obese or overweight, but I like to look at this whole issue as just a management of healthy eating and exercise.

So, I go with that approach when I meet with patients and I like to listen to them as to what they have to say and what information they have gathered about these medications. And yes, I do not have the prescriptive authority, but, I always do a complete assessment of their understanding of why they are looking at these medications.

What have they done? How's their metabolic health or their labs? I'm also a great proponent of health at every size. So I'm looking more at their health. Then the weight. And, that is what I like to emphasize, in the beginning itself. And if they come to me with information on all these drugs, then I explain to them, of course the benefits of it.

It's a very exciting time. And people have these medications to help them take care of their health. And if they have some serious health problem, for example, diabetes or cardiovascular health; then I can see that there is an immediate need for them to do something about that. I also ask them about if they have discussed this with their primary care provider. I do encourage them to read about them, learn more about their side effects, and also you know, explore other ways of managing their weight. So as a dietician, basically, I would concentrate more on learning their view of what is obesity or what is weight management and why are they concerned about that and what's bothering them. So I like to take a holistic approach, basically, and consider the multifaceted aspects of weight.

Host: And how should someone take that first step in starting a weight loss diet plan?

Aliya Haq, MS, RDN, CD: Well, first of all, if they come to me for weight loss, I look at, I ask them about what's their goal weight. And that tells me a lot. And then starting from there, if their, goal is realistic, then I do the other assessment as to what they have done so far and how they can help themselves.

But if their goal is unrealistic, because we do get, see patients who have disordered eating or unrealistic goals and unrealistic reasons why this whole, this body image thing going on that mental health issues. And we have to consider a lot of things when they come and ask us for weight.

So the first step would be to actually assess if they're eating healthy, and getting all the nutrients they need to get. And then I go from there. So I do a complete assessment of their cultural values, their food habits, their access to food, their time, how they spend, their daily schedules, for example.

We have anyone coming from different backgrounds doing, they're on the road all the time sometimes. So it's not like three meals a day and you should eat like this. So we really have to do a complete, thorough assessment before we can recommend anything.

Host: And starting a dedicated diet plan is hard enough, but probably even harder is maintaining it. Any helpful hints on how best to keep your new diet plan going once you've started?

Aliya Haq, MS, RDN, CD: Yes. Like I said, unless you know their daily routine, you cannot make that assumption that people will be able to eat three times a day. For example, I had a patient who was on the road, he was a truck driver. So I had to think of his meals on the go or snacks that he can have with him because he was taking these frequent breaks and, that's when he could eat.

So if you go with their daily routine, daily schedule, and also consider their cultural values, then you will be able to help them maintain what they're doing. But if you set unrealistic goals and push a certain meal schedule or regime, then it's going to be very hard. So maintenance depends on how close you can get to what they do every day and their access to food.

If they do not have access to food, then that's another thing that you have to consider and make sure that they have proper access to food. So maintenance depends on a lot of things that a person does every day. So an assessment of that is really important. And then affordability also.

Host: It sounds like a very customizable process.

Aliya Haq, MS, RDN, CD: Very customizable. Otherwise, you're not going to achieve any success.

Host: So diet and exercise seem to always go together if you want to lose weight, but let's say you have a physical ailment which prevents you from working out regularly. How can diet and nutrition alone help someone on their weight loss journey?

Aliya Haq, MS, RDN, CD: Yes, that's a very good question. And we do have patients who have for example, a problem with arthritis and they can't really, what we do in that case is that again, depending on their metabolic health and based on what other issues are going on, we do a complete assessment and give our feedback to the primary care provider who can then decide if there is any medicine or any way that they can prescribe something that can help them.

So other than that, there are exercises that they can do. Again, depending if they're on their wheelchair, what exercises they can do, or if they have arthritis, there are things that they can do in different positions and sometimes a referral to a physical therapist, makes a huge difference to bring strength to those areas.

 And of course, while they're doing all that, healthy eating is, is the key because we don't want them to lose their lean body mass. And we don't want them to become anemic. For example, people just go on these extreme diets and become unhealthy and that is also not true. So our goal in weight management as a dietician, me and my colleagues, is to make sure that while they're managing their weight, they're also managing their metabolic health and maintaining their labs in normal limits.

And if it's beyond that, if we can't help them, then we do give our feedback to the primary care provider who can then decide if a medicine is needed for, you know, people in that category. But again, like I said, it's a holistic approach. It's a multifaceted thing, and we can't just go with one approach.

And these are exciting tools. I am always a great, I can't say proponent, but a fan, I could say, of technology and new things and new innovations and things coming up. So we should consider them and support them if they come with that and make sure that they can manage the side effects, which all these medications have.

And at the same time, make sure that they are eating healthy and not totally losing that side of the life also. So lifestyle changes are really, really important regardless of whether they are on a medication or not.

Host: Weight loss discussions are so prevalent in our society that certain diets even have official names, such as the Mediterranean diet. Would you recommend some people trying a set diet? And are there any specific diet plans that you like?

Aliya Haq, MS, RDN, CD: Great question. If they ask for a set diet, I would just definitely give them, but at the same time, especially at ICHS, we see people from different cultural backgrounds, so cultural sensitivity is really important to me and to all of us who serve at ICHS for that matter. Sometimes if someone is really, really interested in a diet, I tell them to give it a try for a week and see if they can do it.

 But most often, people like to go back to what they generally eat. So we have to be culturally sensitive at the same time, assess if person who's interested in this diet, will be able to do it. A set diet is not for everyone. It is only for those who really request that. But other than that, we try to customize it to their needs and make sure that within their cultural foods and traditions and all that, that they are able to manage.

Host: Aliya, thank you so much for sharing this invaluable information. We really appreciate your time and expertise in sharing it.

Aliya Haq, MS, RDN, CD: You're welcome. And it's really interesting and I'm always here to answer any of those questions. And, yeah, like I said, it's an exciting time and both medical professionals and all of us healthcare professionals are looking at it closely. And as I said, we get two kinds of patients, one who come with this prescription and so we do an assessment and also help them, guide them, in their journey.

And there are others who come and just ask us, and we do our best to educate them, talk about the long term effects and how long they can take it, the affordability, because, weight affects disproportionately in different races and ethnicities and sometimes income levels. And we also make sure that whoever is going for these things can also afford them. So, that's another big thing.

Host: Well, it's been a pleasure. Again, that's Aliya Haq. To find out more, please check out our website ichs.com. And if you found this podcast helpful, please share it on your social channels and check out our entire podcast library for topics of interest to you. I'm Maggie McKay. Thanks for listening to Together We Rise from International Community Health Services.