Transcription:

Scott Webb (Host):  Fad diets may come and go but lifestyle changes can often be more effective when it comes to living at a healthier weight. And joining me today to discuss weightloss and the value of dieting and lifestyle changes, is Dr. Drue Webb. She’s a Family Medicine doctor at Pullman Family Medicine. So, Dr. Webb, thanks so much for being on. We’re talking about diets today and why people might struggle with dieting and how to help them be successful. When should people even consider dieting? What’s the threshold to begin a diet?

Drue Webb, MD (Guest):  So, at least from the physician perspective, when we look at patients, we’re looking oftentimes at their body mass index and that’s just looking at weight versus height. And so, in general, if somebody is over a BMI of 25, they’re considered overweight. And then especially once you get above 30 to 35, then you are getting into the obese category where people start to have more health issues that come from being overweight and that’s when we really start getting concerned about people’s weight and when we start recommending that they look at dieting and exercise, those kinds of things.

The recommendations that I make to my patients are that if we’re starting to see high blood pressure, diabetes, or prediabetes, then we absolutely need to start having that conversation.

Host:  So, let’s assume that people are dieting, and we were talking off the air, maybe everybody is on a diet in some way, shape or form. But if people are on a diet, and they’re not losing weight, when they know that others have gone on the same diet. How do we explain that to them? What’s going on there?

Dr. Webb:  Yeah and a lot of that comes with a conversation with the patient. A lot of it has to do with the diet that they’ve chosen. Some people are better at being consistent with certain diets than others. And so, usually when they’ve seen some people have success with a certain diet and they are not; it’s because it’s not the right diet for them. They’re really struggling to be consistent with it. they are not necessarily doing it as a lifestyle change. It’s something that they are doing to get success quickly. And that’s the other problem. People expect results in a really rapid fashion and that’s usually not the way weightloss happens with diets and so, in general, when people tell me that I’m doing this diet, I’m not seeing weightloss, what’s wrong. I usually strip it down, talk with them and find that it’s because they’re not really being consistent. Maybe they’re over cutting carbs or protein or fat. That can be a problem too. Those are the biggest things with that.

Host:  Let’s assume that somebody feels like they’ve tried everything, and they simply can’t lose weight. Is it possible, I’m sorry if this seems pedestrian, but is it possible that some people just simply cannot lose weight without some surgical or medical intervention?

Dr. Webb:  So, there are studies out there that show that there are some genetic links to people who have more difficulty losing weight. In general, we can always find a way for a patient to lose weight. Sometimes it involves helping with medications and surgeries. But a lot of times, when patients tell me I’ve tried everything and I can’t lose weight; when I talk to them about it, again, there’s always ways that I can find of okay we definitely tried a lot of diets that are fad diets and some exercise, but usually when I drill it down, there’s other things that we can try to add into it to make some success. But yes, there are just some people who are just genetically predisposed to having a little bit more difficulty losing weight than others.

Host:  And you mentioned fad diets, and so let’s talk about diets in general or fad diets if you like. Is one diet better than another or is it about marrying the diet with the patient?

Dr. Webb:  It’s more about marrying the diet with the patient. And you get a lot of questions, especially right now, keto diet, is really popular as well like intermittent fasting. And I don’t have any problem with those diets. I just again, I always reiterate that the word diet I hate the word diet. It’s all about a lifestyle change because in general, people think they eat like this for a little while, I lose the weight and I’ll go back to what I was doing before, and it will be fine and that’s not the case. People need to pick something that they are going to be able to stay with for the rest of their lives because this is how they maintain that weightloss once they achieve it. And so, there’s really not one that’s better over the other. It’s about what you can maintain for the rest of your life. And what will keep you fulfilled because if you are feeling like you’re not getting satisfied with what you’re eating; you’re more likely to fall off that diet and start doing the things you used to do before.

Host:  That’s such a great point. I know that we – many people, I don’t want to say everybody, but a lot of people, if we’re going on vacation and we know that we’re going to be wearing a bathing suit, we go on these sort of crash diets to lose weight quickly and it makes us feel good while we’re on vacation for those few days or that week; but then we come back to real life and as you say, it’s really about a lifestyle change and something that we can maintain.

Dr. Webb:  Absolutely. Absolutely.

Host:  If you were putting a list together for a patient that comes in, who has reached the BMI threshold; what are some ways that you help them to be successful? Like what’s that sort of to do list for weightloss patients?

Dr. Webb:  There’s about four recommendations that I make and there’s some things that can go in those as like subcategories. But the biggest one is that I don’t really recommend that they pick a diet. I recommend that they start by making small sustainable changes at a time and moving forward from there. The data has very solidly shown that people who make small changes at a time and make sure that those changes are something that they can be consistent with, that they do the best in maintaining those changes as they progress. And so, I talk to them about baby steps of you don’t just cut from 2500 calories to 1200 calories. You really have to look at okay, I eat cereal for breakfast every morning. What could I eat for breakfast instead. And so just doing small goals like that.

Another one that I do is to let patients know that not all calories are created equal. If they say well, I’m going to cut back to 1800 calories, but they are still eating quite a bit of junk food that brings them to that 1800 calories; they’re still not going to see the success that they want to see because those calories aren’t the same as you get with fruits, vegetables, lean meats, fresh foods. So, I really try to let them know that the goal is to stick with the outside of the grocery store as opposed to the inner aisles where everything is produced and packaged.

And then, the third one is having goals that are not just a number on a scale. So, a lot of times, we focus on that number on the scale and that can be motivating to some but others it can also be a source of a sense of failure so, if we’re not meeting that goal; then we start to feel like oh, we’re not doing what we want to be doing and we’re more likely to give up or get off that diet or those lifestyle changes. And so, I really recommend that people find another goal other than just I want to weigh 120 pounds or a pant size. If they have a goal of I want to be healthier, I want to be able to get out with my kids and play with them without feeling tired or those kinds of things tend to be a little bit more motivating over the long term and keep people more successful over the long term.

And lastly, I just recommend be kind to yourself. I think that’s the biggest pitfall that we all run into is that we get very frustrated that we’re not making progress that we want, that we’re not doing as well as we want, and we sort of punish ourselves and that becomes a negative feedback loop when we’re doing these things. And that doesn’t tend to be motivating at all. It actually tends to make us give up, fall off the wagon and that leads to yo-yoing with our weight. And the more we yo-yo, the harder we have losing weight over the long term. So, biggest thing anybody can do is just be kind and say if I have a bad day and I eat different than I was planning on eating, just say tomorrow is a new day. I’m going to start over and try and focus on more positive things to tell yourself as you are going through this process. Because it can be tough for everybody. Everybody struggles with this.

Host:  Yeah, no doubt and we have a scale that talks to us and I swear, I hear her laughing. She’s not laughing, but I can just faintly hear when I go to weigh myself, I can hear that little snicker in her voice. And of course, we need to be good to ourselves. We need to be kind to ourselves and know that everybody has a bad day, or we fall off the wagon or whatever the expression is. As you say, tomorrow is a new day, and we can get back at it tomorrow.

Dr. Webb:  Absolutely. And just knowing that everybody has those moments where they feel like the scale is snickering at them. And a lot of times, there’s groups out there you can join where you can talk to people about the issues that they’ve had with weightloss. And a lot of times, people find that helpful too because then they feel like they’re not alone and they’re not the only one struggling to lose the weight.

Host:  Yeah and who among us wouldn’t like to lose a few pounds. We’re all in this together of course and especially during COVID-19, people have been treating themselves to a lot of comfort foods and wandering around the house and snacking and we’re all in this same boat together and of course there are groups out there where you can talk to people in a similar situation. So, when we talk about exercise, are there any downsides to exercise and in general, what’s the weekly recommendation for adults?

Dr. Webb:  Yeah, so exercise obviously you want to do it safely and make sure that you’re not going to hurt yourself doing it. I think one of the downsides is that sometimes people think that it’s the only way that you can lose weight. And that’s not actually true. The biggest issue with losing weight is what we eat. The exercise is more about your heart health, your cardiovascular health and the recommendations for that is that you exercise three days a week for at least 30 minutes at a moderate activity and that’s a hard definition to fill. But in general, I tell patients if they are able to get their heart rate up and their breathing up but still have a conversation; that’s considered moderate activity. And so, the goal for just cardiovascular health is three days a week for 30 minutes at that. Cholesterol, you have to do a little bit more vigorous exercise for three days a week. It’s about 45 minutes and really vigorous exercise where you are not able to have a conversation to get your cholesterol down. So, those are the recommendations by the American Heart Association in terms of cardiovascular health and cholesterol.

But in terms of dieting and weightloss, I try to not stress that for patients because a lot of times, patients will have issues with that. They have chronic pain or knee pain or back pain that maybe limits how much they can do with exercise and then they feel like well if I can’t exercise, I can’t lose weight. And so, I try to let them know that look exercise is a way to help you feel better, but it shouldn’t be your main driver of losing weight.

Host:  And Dr. Webb, as we wrap up here today, anything else – I know you don’t like the word diet necessarily but anything else we can tell people about lifestyle changes that can help them and really how to successfully lose weight.

Dr. Webb:  Yeah, I think that when you’re looking at making lifestyle changes, not just looking at the food you are eating but just things that can make you more active, more happy, more healthy; those are all changes that are going to help eventually in your diet or in your weightloss because that’s overall going to make you a happier person and help you make healthier decisions and help with so many other things beside your weightloss as well. So, in general, I just try and help patients make decisions throughout their whole spectrum of their lifestyle that can make them happier, healthier.

Host:  Yeah, definitely. What a great way to end. We want people to be active, and happy and healthy and mentally and physically well and it sounds like you’re doing a great job helping people get there. So, Dr. Webb, thanks so much for being on today and you stay well.

Dr. Webb:  Yeah, thank you. You too.

Host:  That’s Dr. Drue Webb. For more information visit www.pullmanregional.org. And if you found this podcast helpful, please share it on your social channels and check out the entire podcast library for additional topics of interest to you. This is the Health Podcast from Pullman Regional Hospital. I’m Scott Webb. Stay well.