Michael Smith, MD (Host): Welcome to Meaningful Medicine, a podcast by Novant Health. I'm Dr. Mike. And with me today is Dr. Rhonda Mough from Novant Health's Weight Management and Wellness Clinic. Together, we're going to dive into the topic of how to curb late-night snacking, and I know I need this one. Dr. Mough, welcome to the show.

Rhonda Mough, MD: Thank you so much for having me today.

Host: So, start with, why? Why do we love that late-night snack? Where did this start with us as humans? I got so many friends, myself, we love that evening popcorn, you know, whatever it is. What's going on there?

Rhonda Mough, MD: So, there can be a lot of contributing factors to late-night snacking. One of the biggest contributors is not eating consistent meals throughout the day. So, we're busy in the morning. We got up late, so we skipped breakfast. Maybe we're busy at work and don't have time to really stop and eat lunch, and so we'll snack. And so, we're saving up a lot of our food intake for later on in the day because our bodies will get that nutrition one way or the other. And so, we would definitely want to try to focus on having consistent and balanced meals throughout the day to help limit some of those cravings at night.

Also if we don't drink enough water throughout the day, so we're dehydrated, you know, again, we got busy and just kind of forgot to reach our water goal, that can definitely have an impact and our body can actually mistake the dehydration for hunger and lead to some cravings.

Beyond that, there's kind of some emotional and behavioral aspects to this as well. Maybe at the end of the day, we're kind of feeling stressed. We had a difficult day at work, or there's some sadness or loneliness that's kicked in in the evening and sometimes we can turn to food for comfort to help relieve some of those negative emotions. And the other aspect is just behavioral. We are creatures of habit. And so, a lot of times we associate snacking or eating certain types of foods with watching TV or a movie or scrolling on our phones. And so, there are a lot of different things going on that really can contribute and sort of thinking that through and teasing it out can definitely be helpful in changing some of those habits.

Host: Great advice in there. I love that balanced diet, hydrate, that maybe helps the nighttime snacking. In between meals, having that little snack, you know, a lot of people love that, it helps them emotionally, like you said. So, we know people are going to snack. I mean, we're not going to take that away from them, but it would be nice maybe if we all make some healthier choices, right? So, can you help us there a little bit?

Rhonda Mough, MD: Absolutely. And so, this again comes back to balance. You'll hear that word often today in my talk. When we talk about balance, we mean in terms of the building blocks of our diet and our food. So, protein, carbs, and fat, most people are familiar with those terms. So, we want to try to craft our meals and our snacks with balance in those areas as best we can. And there's actually good scientific reason for that. We know that protein actually suppresses ghrelin, which is the hunger hormone that causes us to feel hungry. And so if we're having protein with our meals and with our snacks, it's going to help regulate our appetite throughout the day to a much better extent.

The other two macros are healthy fats and carbs, specifically high-fiber carbs. And we know that fiber and fat also help us by making us feel full more quickly and helping us stay satisfied between meals. So, having all those components is really helpful. Beyond that, we want to try to choose foods that are minimally processed that don't have a lot of additives like sugar and salt and fat, because those are empty calories that really aren't giving us a whole lot of benefit. You know, things like added oils and added sugar. So, we want to read the labels and really try to choose more whole foods that are minimally processed and don't have a lot of those additives in them.

And just to set ourselves up for success, certainly prepping healthy snacks like fruits and vegetables ahead of time is really beneficial. When we're hungry and we're looking for a snack, we're going to go for whatever's convenient. So if there's a bag of chips in front of us, that's going to be what we grab for. But if we have alternatives that are healthier, we've washed our vegetables and fruits and we have those in the fridge and ready to go, that can definitely help us to make those healthier choices.

Host: Yeah, I like that. For me personally, I'm more on the salty side of things. That's just kind of the way I like it. I'm not really sweet person-- well, when it comes to food. And chips were easy. They were satisfying, crunchy, that's part of the snacking experience too. So, I switched over to kale chips, and it was great. Yeah, it was great. It's crunchy. It still has a little bit of that salt. And there's a lot of good nutrients. You get some iodine. So for me, it was also kind of trying to find, you know, here's what I like, what's a better option, right? Like you mentioned, if you're a sugar person, maybe the fresh fruit a better choice.

Rhonda Mough, MD: Exactly.

Host: Yeah. Yeah, I love that. This is fantastic. But when you talk about balanced diet, right? There's a lot of diets out there and a lot of different ways to approach a lifestyle of eating, right? And I'm not just talking about weight loss either. You know, there's Mediterranean type diets out there. There's more like the carnivore diets. There's all this kind of stuff. How often is it good for somebody to talk with somebody like you to walk through this or maybe even find a registered dietician that can help them navigate so many choices out there?

Rhonda Mough, MD: Right. So, certainly, a healthy, balanced diet is critical to the success of any weight loss strategy. And just for health reasons, even if patients are not looking to necessarily manage weight. Diet is just so critically important. It can't be overstated. And so, you're right, there is a lot of information out there. And it can be difficult to sort through what is best for an individual. Some of that just depends on things like age, or other medical problems can certainly impact what type of specific diet is best.

You mentioned the Mediterranean diet. That is one that has been very heavily studied and demonstrated to have significant benefits in terms of reducing cardiovascular risk as well as diabetes risk. And so, that is one that we talk a lot about. There's the DASH diet for people who are struggling with high blood pressure and that can be helpful in reducing blood pressure through dietary means. So, there is a lot of information out there. But certainly, speaking with a dietician is very beneficial.

We are very fortunate to have one on our team here at Novant. And she's a wonderful resource for helping patients just plan meals, just to have some basic nutrition education, talking about macros and calorie goals and that sort of thing, and just having that encouragement and support along the way as patients are making changes to improve their health.

Host: So, the Mediterranean diet is one I guess you talk with patients a lot about. What does that look like? Just to help the listening audience, if I'm looking at a plate, right? And I'm trying to eat Mediterranean. What should the food on the plate look like?

Rhonda Mough, MD: Again, going back to balance, there is certainly a focus on high-fiber carbohydrates, so things like beans, vegetables, and fruits. And so, we really want fruits and vegetables to make up about half of the plate. And then, protein sources are lean and low in saturated fat. As I mentioned, Mediterranean is a heart-healthy diet. So, watching our intake of saturated fat is really critical for cardiovascular risk. So, the protein sources tend to be more along the lines of seafood, fish, poultry.

And then, healthy fats, I've mentioned that a couple of times. And just to sort of reiterate what that means, saturated fat, as I just said, is things like butter and ice cream, whole milk, dairy products. And beef and pork tend to be higher in saturated fat. So, we want to limit those fat sources and focus more on fatty fish that's high in omega-3s, like salmon or nuts or avocados as healthier sources of dietary fat. So, those are some of the main components of the Mediterranean diet.

Host: I'm getting hungry. That's going to be a problem. Now, I want a stack. No, that's great. I love that visual of the plate. And you said you like 50% though of that plate to be the fruits and vegetables, right? Yeah. So, that means the other 50% is the healthier carbs, the protein, because you know, that's not how most Americans plates look like. It's completely-- it's way off of it, I think. Oh, that was fantastic.

Let's talk a little bit about the importance of staying active in all of this, right? We know exercise obviously is important. Tons of studies showing the benefit of it. Even just walking 30 minutes a day. What are some of the practical things you tell people to become more active every day?

Rhonda Mough, MD: So, just at a very basic level, I think starting with a step count goal can be a great place to start. it's fairly easy these days with all of the trackers and iPhones to be tracking our steps get a sense of where we are. And then, setting goals around that, trying to increase that goal.

Ideally, we want around 10,000 steps a day. That's a pretty active lifestyle, but that's not always a reasonable for step goal for patients depending on how active they are at baseline. So, that's just a simple place to start.

A lot of patients I talk to really don't want to go exercise outside of their home. They're more comfortable at home. And YouTube is a great resource. There are all kinds of classes there, or videos that can demonstrate how to do different types of physical activities. And so, I think the important thing is just starting somewhere, starting with 10 or 15 minutes if someone has not really been exercising.

Certainly, talking with your healthcare provider about what types of exercises are safe for you is also really important, because patients deal with different types of medical conditions that can limit their physical activity and limit the safety of certain types of exercise. You know, they have chronic knee pain, maybe a lot of walking or anything that's higher impact isn't ideal for them. So, perhaps seated exercises or maybe water exercises would be a better choice. Likewise, if someone is dealing with some balance problems and falls, we don't necessarily want to initially set a goal of taking so many steps or going for walks. So, it really has to be tailored to the individual, but that's the benefit of talking to a professional and getting some advice in that regard.

A lot of patients do struggle with motivation, especially getting started in the beginning. And so, having an accountability partner, exercising with a friend, going for a walk with friends or, you know, even considering a group class. Some people don't want to do that, but others do. They really find support in that group environment and a lot of motivation. So again, I think it's just important to talk it through. We're all different in terms of what works for us and just really trying to find what that starting point is and go from there.

Host: Yeah. And it is okay to experiment with different things too, right? You can try a walking class once. If that's not working for you, maybe swimming. To find that thing that I think is enjoyable for you, because I think that's going to be more sustainable down the line.

So, you mentioned it's hard to get started. It's hard to get started eating a healthier diet exercise. And you touched on a few things, but what are some tips you can give people to take that first step and do we manage that progress so that it continues to motivate us?

Rhonda Mough, MD: Right. Well, you know, we were just talking about exercise. I think getting started with that. Other than the things I mentioned, just scheduling some time for it. Sometimes it can be helpful to just put it on your calendar like you would any other appointment or any other priority, because it is important.

And I think having support from a team can definitely be beneficial, going back to the dietician and taking those initial steps. Keep in mind that even small changes can really have a big impact in the end. And so, maybe we need to break down a long-term goal into some more achievable, shorter term goals. So, we want to set those short-term goals that we feel confident we can achieve. And so, I think that that is really the key and always keeping that long-term goal in mind.

The other thing to keep in mind is that even relatively small degrees of weight loss. Even as little as 5% can have a lot of beneficial health impacts. So, blood pressure improvements in blood sugar. We can start to see those types of changes reflected in the office in blood pressure measurements or in labs with even small degrees of weight loss. So again, maybe a 5% weight loss is all that patients need or are looking for. Maybe they're looking to lose a lot more than that, but even losing that smaller amount can make a big difference.

Host: I love that. I love breaking that up, right? I think that's great advice. Speaking of weight loss, right? A lot of people do experience once they get started and things are going pretty good, they hit that plateau, right? Or they even have a setback. What's your advice to those patients when that happens?

Rhonda Mough, MD: So, I think that the number one piece of advice I give is don't beat yourself up about it. Plateaus are a natural part of the weight loss process, and I think it's important to go into it with that expectation that it's going to happen.

There are good reasons for why that occurs. There's this concept of metabolic adaptation. Our bodies are really designed to hold onto weight and not lose it. And we have a set point weight that our body wants to stay at, and that set point can increase throughout our lives. And so when we do lose weight, our body responds by increasing our appetite and decreasing our metabolism. So, the net result of that is that weight loss slows down and, in a lot of cases, stops. So, I think just kind of anticipating that can be helpful.

So, what do we do when it does occur? There are a few different interventions that can be helpful. Just changing up your routine. You know, we are creatures of habit. Our bodies can kind of get into a bit of a rut. You know, if we have been walking, maybe we change up our exercise routine. Try a class or maybe start to do some strength training with resistance bands or some light hand weights just to sort of trick our body and kind of reboot and get started again with some weight loss. Sometimes we just need to adjust our exercise goals. Maybe we need to add another day or exercise a little bit longer, something like that.

Dieticians can be very helpful here as well when plateaus happen. They can do a deep dive into your diet. You take a look at what you're doing there with your macros. You know, do we need more protein? Do we need to adjust a calorie goal? That sort of thing. And so, I think just don't give up. Goals can always be adjusted and we can get things going again. But yeah, just allow yourself some grace.

Host: I love that. You started with that and you end it with that. Be nice to yourself, right? You're doing a good job. And keep that focus and keep going as best you can. Now, I have to ask you about this coming up, right? The GLP-1 medications, right? They are all over the place, as you know. What do you think about them?

Rhonda Mough, MD: So, they are a very powerful toll when they're used along with a healthy lifestyle, particularly for patients who need to lose a little more weight. Typical weight loss in a lot of cases, not everyone, but a lot of cases is 15-20%. So, we can lose up to 15-20% of our weight on these medications over a period of a year to a year and a half. so for patients who need to lose that degree of weight in order to really see the improvements in their health that they need, they can be a good choice. The indications are very BMI-specific. So, patients with A BMI of 30 or above, or between 27 and 29 along with a weight related condition, like high blood pressure or diabetes, will qualify someone for these medicines.

So, I think just focusing on that foundation of a healthy lifestyle. And then, if we need something else to help with getting some additional weight loss or to overcome a plateau, they can be a great choice. These medicines are a very avid area of research. And so, I think there will probably be some additional indications for them coming out in the near future. But in addition to weight management, they are also indicated for several other conditions, diabetes, cardiovascular disease, as well as sleep apnea. So, lots of applications of these drugs.

Host: Are you concerned at all about some of the online sources of these medications, where somebody can-- without really seeing a professional like yourself or an RD-- hop on? I guess they talk to some doctor and then they can get the meds. What do you think about those?

Rhonda Mough, MD: I'm not terribly familiar with what kind of counseling happens in those visits. But as we've been talking about all along, it's not just medication, it's really the whole comprehensive picture of managing diet as well as physical activity. And we didn't talk much about mental health, but that is another big part of it, is dealing with emotional triggers for eating, and really helping patients feel more in control of that and helping them find alternative coping strategies.

So, given that there are all these different contributors to our body weight, addressing all those different aspects is really important to really holistically treat the patient. And so, that is what we aim to do here in our clinic. We do have a dietician, as I mentioned. We have a social worker who helps out with some of the mental health aspects. So, it's not just the medications. And my concern-- to get back to your question-- would be: Is that holistic approach being applied in the setting of those online providers or pharmacies?

Host: Well, thank you for your insight to that. I really appreciate it. Weight loss and weight management misconceptions. Any things out there that you hear a lot that you kind of want to share with the audience?

Rhonda Mough, MD: There are a couple of things that I hear frequently. One is, if I had willpower, I could lose weight on my own. And I think this comes back to a lot of self-blame and it can just be very counterproductive. And it's really not reality. You know, we talked about how metabolic adaptation happens, how our bodies are designed to hold onto weight and not lose it, and how hard it is to keep it off alone. And so, I think it's just important for patients to understand that we're here to help and it's okay to need help.

Yeah, the other thing I hear often is, once I get the weight off, it'll be easy to keep it off. And again, going back to what we've talked about already with metabolic adaptation, it's unfortunately not the case. I wish it was. But that's really not how our bodies are wired. And so, it's okay to ask for help. That's what we're here for. It's no different than seeing your provider because you need help with management of your blood sugar or your blood pressure, right? This is a chronic disease that warrants a holistic approach as well.

Host: So as we start to wrap up here, I'm kind of interested in how you went down this field of medicine, weight and weight management, wellness? How did you choose this?

Rhonda Mough, MD: Yeah. So, I actually did primary care medicine. I took care of patients in a primary care setting for many years. And, you know, I saw a lot of chronic diseases. Many of which were, in some way or another, related to weight. And so, I quickly recognized that overweight and obesity can contribute to a lot of the health problems that we see commonly in the clinic. And I really just wanted to be able to focus my energy on that root cause or root contributor to many of those problems. And so, that's why I chose to do some additional certification in Lifestyle Medicine and Obesity Medicine so that I could really provide that personalized and holistic approach to weight management.

And I really find it very rewarding. It's wonderful to see people need fewer blood pressure medications or maybe not need treatment for sleep apnea anymore, or see improvements in their diabetes control, not to mention the positive impacts on their energy level and their mental health. It's just very rewarding for me to see those types of changes in my patients as they're losing weight and going along this journey.

Host: I love it. That's fantastic. Any last words for the listening audience? Any last golden nuggets you'd like to share?

Rhonda Mough, MD: I think I would just say, you don't have to walk this journey alone. That's what we're here for. We have a whole team assembled that is just ready to help if you would like to set some goals and work on improving your health. So, please reach out to us.

Host: This has been fantastic. Thanks for coming on today.

Rhonda Mough, MD: Thank you so much.

Host: That was Dr. Rhonda Mough. For more information about weight loss services, you can visit novanthealth.org. Now, don't forget, if you enjoyed this podcast, please share it on your social channels and explore the entire podcast library for topics that interest you. This has been Meaningful Medicine. I'm Dr. Mike. Thanks for listening.