Transcription:
Let's DISH About Medically Supervised Weight Loss

Gina Schnathorst (Host): Welcome to the Iowa Specialty Hospitals and Clinics' ISH Dish Podcast, practical Health Advice from Iowa Specialty Experts. We want to connect the members of our communities with the latest healthcare information that's understandable, relatable, and useful to your daily life.

In the studio with me today, we have Jody Horstman.

Jody Horstman: Hi. Hello.

Host: So, I've been waiting for this day. You're so fun to talk to.

Jody Horstman: Well, thank you. I'm happy to be here.

Host: Yeah. Now, we got our radio voices going, we'll be all good. Okay. First thing, so you work for Iowa Weight Loss Clinic in Des Moines. And so, tell our listeners, what are your credentials, what's your experience, what led you to come to where you are today?

Jody Horstman: Sure. I have been a nurse since 2007. I got my associate's degree and my bachelor's degree at Mercy College of Health Sciences in Des Moines. After being a nurse for about 10 years, I decided to go back to school and earn my master's degree through some of the programming that I had in my bachelor's degree and the work that I did at the hospital, I was exposed to weight management and the bariatric surgeries with the program at Mercy in Des Moines and found the experience very rewarding, decided to pursue learning more about that through some projects in my masters, that sort of thing. And upon graduating, stars kind of aligned and the position opened up at Iowa Specialty Hospital. So I started in Belmont in 2017, practiced there for about three years and then my family moved down to Des Moines. And once again, the position opened up there and have been practicing in the Des Moines office since 2020.

Host: Wow. That's a lot.

Gina Schnathorst: Yeah. You're busy.

Jody Horstman: Yeah, it's been fun.

Host: Tell me about your family briefly.

Jody Horstman: I am married to my husband, Bill. We have two girls, eight and 11, Mallory and Sydney. We keep busy with basketball and gymnastics and love going on vacation to warm, sunny places.

Host: So, you're out there doing normal life things.

Jody Horstman: Yes. I do get a little free time.

Host: That's good. That makes you a better person overall, right?

Jody Horstman: Yeah, I hope so.

Host: So, we don't just have Iowa Weight Loss in Des Moines, correct? We have other locations. So, can you just touch on that a little bit? Maybe talk about the team members.

Jody Horstman: Sure. So, we have grown over the last few years from a nurse practitioner in Belmont and in Des Moines to now having sites at Garner, Belmont, Fort Dodge, Ames, and we've grown our provider staff in Des Moines as well. Each of the locations offers consultation with our team of dieticians helping with nutritional goals, things like that. We also have a very robust mental healthcare team. So here at Iowa Weight loss, we recognize the component that mental health has with our food choices; why, when, and how much we eat; as well as addressing past trauma, other mental health barriers that may contribute to our overall health, and very comfortable within addressing that and encouraging our patients to access those services.

Host: I feel like that's something that really sets us apart from maybe other facilities who offer the weight loss surgery because we treat the whole patient. I mean, it's not just come in, get your surgery and "See you later. Good luck with your life." We take care of the whole patient and I think for a lifetime is the goal.

Jody Horstman: Yes, we take a lot of pride in both with our medical side-- we have two different sides of the program. So if you were someone who was interested in behavioral lifestyle management, possibly medications, that sort of thing, you would follow our medical pathway. Then if you were interested in bariatric surgery, that would be another avenue that you could pursue with Dr. Eibes, our bariatric surgeon. He's been in practice for over 20 years, performed thousands of surgeries. All of our surgeries are performed at our hospital in Belmont. I always say I would put our hospital up against any metro hospital, anywhere. We take really good care of people.

Host: Their ratings are so high, especially with the Iowa weight loss patients. They love it up there.

Jody Horstman: Yes. We hear a lot of feedback that people are in almost disbelief over other hospital experiences they have had. So, we are very encouraging of that when we tell people, yeah, "You're going to go up and have surgery in Belmont, Iowa." And most people haven't heard of it, but all of them come back with great experiences.

Host: Yeah, let's put a little plug in because it feels like an appropriate time to do so. If someone is listening or anybody out in the public in general, and they don't know if they qualify for medical weight loss or the surgical weight loss, or maybe they're good, let's put a little plugin for our health risk assessment.

Jody Horstman: Sure. So, there are a ton of resources on our webpage, iowaweightloss.com. On our webpage there is a health risk assessment. So, with mainly insurance, there are certain qualifying criteria to be able to be eligible for surgery. And with the health risk assessment, a patient could access that online and ask some yes or no questions. Are you diabetic? Do you have arthritis? Are there health conditions that contribute to your weight or vice versa? With that, it's a real nice, easy tool to tell you, "Oh, I would qualify." I'll be honest that I do have people in my office, some of the qualifying criteria does go for lower BMIs, really focusing on that health improvement. In some countries, they call weight loss surgery diabetes surgery, for example, because of the resolution of those diseases. It's not so much about the vanity part, it's really about that health improvement and adding quality to your years that you have left and adding to those years.

So, on the website, finding that health risk assessment, we have great resources for our medication list, how we use medication. Another piece on the website would be if you were interested in surgery. One of your first steps is listening to our surgery information class. If patients have surgery as a thought in their mind, I always encourage them to watch the surgery information class. It is non-committal. You are just listening and getting information.

Host: Right. Just because you're curious, it's great.

Jody Horstman: Yes, Dr. Eibes gives the class himself. He is a statistics and numbers person. So if you're that type and you need the very black and white answers in that sense, he does a great job of explaining what we do, what to expect, your long-term effects, your complication rates, all of that sort of thing. And that might help guide you if you are unsure.

I always tell people too, if you're not sure, come in for a consultation, we're happy to talk about it. Some people never want to talk about surgery again. Some people might give themself a timeframe, like, you know, "I'm going to see what I can do over the course of the next six months." And some people, if they're doing great, they might never talk about surgery again.

Host: Well, it's a a huge commitment. So, let's slow it down a little bit, and talk it through.

Jody Horstman: Right. And our team is happy to talk through. I've talked about surgery at every visit. I've had people really unsure about it and decide one way or the other. It's a very personal decision. And is it right for everyone and perfect for everyone? Absolutely not. Is it a great option for health improvement for a lot of people? Absolutely.

Host: There you go. Really, it's a very well thought out process that you really should go through.

Jody Horstman: Yes.

Host: So, what have we not talked about yet about Iowa Weight Loss that sets us apart?

Jody Horstman: So, it's an exciting time to be in weight management. Of course, we've seen a lot of things about medications, availability, that sort of thing in the news, social media, things like that. And in the space that we're in with that right now, it can be really difficult to know what's right or wrong, what's safe for me, my body. All of our providers have dedicated their careers to this specialty. So, you can go to a med spa, you can get medication, that sort of thing. But our team offers that comprehensive approach with treating you as the whole person, addressing all of you as a whole person.

Host: Therapy. That's definitely a piece of the puzzle.

Jody Horstman: Yeah. And that nutritional aspect, we do follow a real food approach through our program. And so, dieting is popular. There's lots of diets out there, and diets work. Diets work really well. I can't lie to you and say, "Nope, that doesn't work." Diets work temporarily. And that's part of the business that makes diets billion dollar businesses, because people need to do them over and over.

Host: Oh, absolutely.

Jody Horstman: We want to teach our people to be able to go down to their local grocery store, get the things they need, they like, and things that fit their lifestyle. And that's where we do take the time to get to know our patients, make those recommendations to hopefully have lifelong lasting health and quality of life.

Host: Perfect. So if somebody were to call in and they wanted to come in for a consultation with you, lead me into that. What does that look like?

Jody Horstman: Sure. You can now access our pre-visit paperwork online on our webpage. So in filling that out, that's then submitted to our registration staff. Once they've built you in our system, they will contact you to schedule an appointment. At that time, if you know you want surgery, you can go right down that pathway of getting a visit with Dr. Eibes, our surgeon. If you're not sure or you're interested in medical weight loss, you would sign up for a visit with one of our medical weight loss providers. In the paperwork, you fill out your medications, your health history, your diet history, and any other pertinent health information which is important to us to treat you safely and appropriately. We'll go over that information. We will chat through what your goals are. Perhaps, you've been to the orthopedic surgeon and they say, "You need a knee replacement, but guess what? You got to lose 50 pounds." We can actually get that done and get you your knee surgery this year during your deductible year, that sort of thing.

So based on what you need, your provider will work personally with you to create a plan that works for you. You'll see the dietician, get going on some of those nutrition and lifestyle behavior things. And then if there's any other services that you would need, mental health, sleep studies, different concerns that might come up through that process, we'll get you in the right place.

Host: So if I were to come in and have a consultation with you and we decide, you know, medical weight loss is the right thing for me at this time, and then I stay with it for six months, a year, however long, I don't know, an average length of time people would be in the program. But am I stuck with that? Or at some point can I decide, "You know what, I want the surgery.

Jody Horstman: Yeah. So, I get timeframe questions all the time. I'll have patients ask me, "How long am I going to be on this medication? How often do I need to see you?" That sort of thing. That is really where the individualized approach comes in, that people do need medication. The community is saying right now that we don't stop blood pressure medicine when somebody's blood pressure gets better. The medication is a tool to hopefully help keep your disease under control. Surgery is a tool to help control your disease. So as far as timeframes, how long people, stay in the program, it really varies by the individual. I have people that I've seen throughout my whole career here at Iowa Specialty, I have people who've come and gone based on their needs. It's always a good idea to take an assessment of considering the other things going on in your life and is now a good time to focus on weight or should it take the passenger seat and maybe we reconnect in a few months when life is a little less crazy or that sort of of thing.

Host: So, I can come back in the program for months and then decide, "You know what, I need to talk to Jody." So, it's okay for me to call in, make an appointment, come in and revisit you and let's kind of regroup, see where we are.

Jody Horstman: Yes. I always say you're our patient for life and it's okay to have times that it's not the best time for you to work on it, and you can float in and out. And I'm always happy to see my people I haven't seen in a while. As far as surgery patients go, I tell people, "You're never getting rid of us. If you try and avoid us, we'll send you letters and call you to remind you to come back in." That surgery after care is something that we have a deep passion for.

Other programs, patients graduate at one year after surgery. I tell my patients at one year after surgery that that's when the real work begins. And that's when they might need the most support. Or, you know, I have patients 15 years out from surgery and I might see them every three months at 15 years after their surgery because they know they need that support or they need another tool in their toolbox to help keep their disease under control.

Host: I I feel like that's why the therapy piece is so important too, even before I knew about you guys when I came back to work for the hospital. Unless you get your mind right, I feel like that's a really super important piece. Like my husband always says, he goes, "I'm not physically hungry, but my taste buds are. I just am bored." All the emotions, the emotional reasons why we eat.

Jody Horstman: Right. And our listeners can't hear my motions, but you know, we fix the stomach anatomically and affecting hormones and things like that, but we don't get to-- I'm tapping on my head-- we don't get to go in and zap the areas of our brain that tell us we're hungry or fix a bad marriage or stress management and things like that. And it's surprising how many times I see patients that access our therapy services that kind of didn't know they needed to. And when they experience that, or some of our patients that go through more extensive therapy before surgery and get to know themselves better or address or unpack an issue that's been there that relates to their self-worth and things like that. It's really amazing and they're always really thankful that they access those services, because we don't know what we don't know. So, that's a barrier that nobody addresses, your crappy marriage when you're following a diet. So, that's the tip of the iceberg on some of the reward with this line of work that I do.

Host: So, we have the mental piece, we have the nutritional part. What about exercise and that, does that kind of fit into the puzzle?

Jody Horstman: Right. It does. So, I will say that exercise is probably one of our biggest challenges. Just with access, living in a rural area not all areas have a big fabulous gym that people have access to. There's a lot of barriers with exercise. A lot of my patients associate exercise with seventh grade PE. And they, you know, don't want to think about it.

Host: Don't make me climb the rope.

Jody Horstman: Yes. We like to work with our patients to come up with individualized plans. What do you enjoy? That's my first question. If you hate every second of exercise, I might talk about creative ways to build in more physical activity. I like movement. And so, yes, the recommendation for exercise from the CDC is 150 minutes a week of intense exercise. Is that realistic for you? Maybe not, but how do we work in that direction and get you more mobile to be able to do the things that you want to do? I love hearing from patients. A year after surgery, just recently had a patient that took a trip to Hawaii. And she said, "It was so amazing. I hiked and I would've never even signed up for a hike two years ago. I would've not been able to do that. And here I was hopping over rocks and enjoying life."

Host: And that just fills your cup right up. That's amazing.

Jody Horstman: Yes.

Host: So, we have a toolbox of things that we use to help the patients with, the really cool scales, metabolic tests. What other things do we need?

Jody Horstman: Yeah. So, some of the tools that we have in our office do set us apart from other programs you might see. First of all, our body composition scale. So in most visits there are some disqualifying factors to get on the body composition scale with implantable devices and things like that. But for the most part, we are able to monitor our patient's weight loss through the body composition scale. Super important with weight loss to monitor what's happening with your muscle and fat loss. The problem with diets is people set their bar way low typically. A diet might involve eating 800 calories a day. When you do that, and you lose weight quickly, which everybody loves, you will lose muscle. Muscle is metabolism. So when you go back to what should be eating normal for you, you will gain weight back very quickly because you've set your metabolism to the toilet basically. So when we are able to put people on that body composition scale, I tell people, "You can lose weight the right way." You know, there's a lot of thin, unhealthy people out there.

Host: Oh, yeah. Skinny fat, is that what they call that normally?

Jody Horstman: Yeah. Or sarcopenic obesity is the medical term for it. So, we're keeping an eye on that. And that's where too, we don't necessarily set weight loss goals. With certain diet plans, Weight Watchers, it's the pound a week, that sort of thing. I don't really care about how many pounds per week you lose. I want people happy, I want them healthy, and I want them to do things that are sustainable for them.

Host: And consistency is key, correct?

Jody Horstman: Yes. Yeah. And so, where that shakes out on a box on the floor with numbers on it, I really don't care. I want that sustainability, that long-term health, quality of life. The scale helps us really measure that we're watching that muscle mass at every visit to make sure that we're keeping that metabolism intact. So, I mean, most people like to eat, so we want to keep you eating the things that you enjoy.

The other thing we have is our calorimeter, our metabolic rate testing machine. So, we have a lot of people that come in, 1200 calories, "I got to eat 1200 calories. That's the only way to lose weight." I love telling people to eat more, sometimes I get to do that with the metabolic rate.

Host: We love to hear it.

Jody Horstman: Yes, that machine measures your resting energy expenditure, resting metabolic rate, BMR, a lot of people have maybe heard those terms and a lot of people I see assume their metabolism is horrible because they've struggled with weight. So, that machine gives us data, which we love data in the healthcare world because it's the truth. And that tells me, "Okay, here is your eating window. Here's where you should be able to eat to lose weight." We also use that as a tool to measure over time. So as we increase activity, as we're getting enough protein, those sorts of things, I can recheck that after somebody's lost some weight after six to 12 months and then we adjust accordingly if that calorie goal needs to change based on the changes to their body.

Host: Wow. And this is such a hot topic all the time. But I don't know, maybe it's because I'm hypersensitive or aware to it, but you open up Instagram and it's just flooded with, "Here's how you should eat. Here's what you should do." I actually follow a gal who said exactly what you do, 1200 calories, where did that number come from? And then, there's the whole how much protein, how do I calculate a macro, what are macros, that whole conversation could be a whole 'nother podcast.

Jody Horstman: Yes. And luckily, for all of us, we have a team of people who have degrees in macronutrients, our dietician team. So, they are such wonderful resources for us to have, and that's included with your visit. When you come to see a medical provider, you're going to see the dietician. And the dietician is going to break that down because there is so much confusion. Keto, low carb, no carb, all of these things that really muddy the waters for people and make it that much more frustrating.

Host: Yeah. So the solution would be just to make an appointment at iowa Weight Loss and get the truth, get the make it specific to you. Because they are talking globally, and I hundred percent agree with you too. There are companies out there, pharmaceuticals, whatever, that are trying to keep you stuck because it betters them. Shame on them.

Jody Horstman: Yeah, you keep coming back. You keep coming back. Yeah, that's the resource. We've got great resources for all of our people. We take good care of our people and create that individualized plan, and I think that's really what sets us apart.

Host: So, what's with the future then for Iowa Weight Loss or you specifically?

Jody Horstman: Well, I don't plan on going anywhere. I love my job. I love my people. There's so many days I go back to my office and I'm like, "Oh, I just love my people." So, future of Iowa Weight loss, we tell Dr. Eibes he can't leave either. So, the growth has been tremendous. We do have the locations in Belmont, Garner, Fort Dodge, Ames continues to grow. And in Des Moines, we've also are now hosting Dr. Nelson at Iowa Specialty Clinic there too. So, finding some of those complimentary services where we can work together in that sense to help iowans no matter what their needs are.

Host: And I would say too, if you haven't had a chance to see the new building and you're in Des Moines, take a drive by.

Jody Horstman: Stop by. Yeah. Yes. It's absolutely beautiful.

Host: It is. It's close to the airport. So, it's 5901 Thornton Avenue is the address. And if anybody's listening to this very timely, we are doing an open house ribbon cutting chamber event.

Jody Horstman: Yes, very excited about that to kind of showcase. We turned a construction office building into a clinic. So, I actually had patient that had seen the building before and she's like, "Wow, you guys really did a great job here." Like, it's hard to imagine the shift over. So, it's been really great.

Host: It was really hard to visualize. I will agree with that. I know the first time I walked in I thought, "Okay, where did we put an exam room?"

Jody Horstman: Yes. It had been great.

Host: They had a lot of drafting tables in it. Yes So, anything else? I do have a few patient comments from our website, the iowaweightloss.com website, that I would like to read. But do you have anything to wrap up? Any other messages?

Jody Horstman: Thank you for listening and we're happy to help.

Host: Perfect. All right. So if you are interested in more information on Jody or any of the services, like I said, you can go to iowaweightloss.com and you can click on the team and you can find any of the providers. Most of the providers now have patient ratings listed and patient comments on their individual profiles. Here are a couple just specific to Jody. "Love Jody. Very kind and willing to listen to my story with my weight. Jody does an awesome job listening and problem solving. Jody is amazing. Jody was great. Took the time to ask me several questions and listened to me before, during, and after." And the final one, "Honestly, Jodi is the best. She really gets the mission of Iowa weight loss and truly cares about each and every one of us. I recommend Iowa Weight loss and Jodi to anyone who is looking for guidance in a healthier lifestyle and weight loss because she truly listens and develops a plan based on the individual person." I couldn't have said it better. You are amazing.

Jody Horstman: That's very flattering and thank you to our patients. It's meaningful work that we do. And our patient feedback, we love hearing from our patients and hearing what we do great and also what we can do better.

Host: All right. Thank you for being here with me today. I appreciate it.

Jody Horstman: Thanks for having me.

Host: Thank you for listening to Iowa Specialty Hospitals and Clinics' ISH Dish Podcast. For more information on the topics we discussed today, visit us on the web AT iowaspecialtyhospital.com or, in this case, Iowaweightloss.com. There, you can read a transcript of today's episode or previously aired episodes, as well as get the latest news from Iowa specialty hospitals and clinics, and explore all of the services that we offer. For the ISH Dish podcast, I'm Gina. Thanks for tuning in.