Jaime Lewis (Host): Menopause is hot in more ways than one, and the world of weight management has completely transformed due to GLP-1s, such as Zepbound, Ozempic, Mounjaro, and Wegovy. So how do you as an OBGYN, navigate patient asks and expectations around these topics and how can nutrition and lifestyle guidance help with both? Enter our guest Registered Dietician, Katie Linville.

Katie is here today to discuss her expertise in lifestyle care and her work with Gennev and the Unified Virtual Clinic. This is the Women's Health Perspective podcast. I'm Jaime Lewis and Katie thank you for being here.

Katie Linville, MS, RDN, CSO: Thank you, Jaime. Glad to be here.

Host: Well, in your experience, I'm going to pick your brain a little bit. As a woman in midlife myself, this is wonderful perks of the job is I get expertise from people like you. So I'm wondering, in your personal experience, what are the main concerns you hear from patients who are going through the menopause transition?

Katie Linville, MS, RDN, CSO: Yeah, and you know, I've been working in this particular menopause space for about five years now, so I've worked with many women and some of the top topics I hear include obviously weight challenges, right? There's a lot to navigate as the body changes in perimenopause with hormone changes, and so we do talk a lot about what is the best approach for nutrition and exercise as hormones are changing, right? It may look different than it used to. So that's a big topic. And disrupted sleep, I will say. I hear that one a lot as well. And as we know, sleep is foundational. So when sleep is off in any kind of way, it makes it really hard to navigate exercise and eating well, consistently planning ahead.

So, that's another one that will frequently come up. And then the mental health side of things. Some women as hormones are changing, they're experiencing anxiety for the first time in their life perhaps, brain fog can come up. There's so many different symptoms as they're also navigating all the changes happening and trying to identify, who am I now? What does this look like for me? So there's just a lot to work through there, and so there's a lot we can do to support people as, they're having that experience.

Host: That's fantastic and obviously very needed. Something that we haven't ever had before, in our culture. And when you talk about the who am I question, that is a very real question. It's like puberty all over again and moving us into different directions than we expected. But as you mentioned, nutrition and lifestyle support.

I'm wondering why you think that's a key compliment, to the OBGYN care, rigorous care that you give, especially for women in menopause.

Katie Linville, MS, RDN, CSO: Yes. Well, as women are meeting with their doctor and sharing their experiences, I'm having this low energy, I'm having these symptoms, the doctor has the ability to refer to our dietician team and we're able to really establish a solid working relationship with our patients. We'll meet with them a couple times a month. We recommend two times a month for at least three months, so we can dive in and hear their experience, create a personalized plan to help them feel better, manage symptoms and discuss if referral is needed for medication options, in-person exams and things like that. So it's really a holistic approach to their care as they're also meeting with their doctor in-person.

Host: Are you willing to pull the veil back a little bit and tell us some of the most supportive strategies for women experiencing those kinds of symptoms?

Katie Linville, MS, RDN, CSO: Yeah, I would say that we talk about on the nutrition front, of course it's individualized, but protein needs are higher than they've ever been, right, in the past. And so really after age 40, I mean we're losing muscle mass. And in the perimenopause transition that speeds things up a little bit as far as muscle mass loss.

And we really need to identify what are some ways to realistically increase protein intake, but also find balance with fiber rich carbohydrates, healthy fats and vegetables. Eating every three to four hours. But again, this plan will look different for each person. We also consider their medical history, so there's so much there.

But we do find when people are able to discover that right fit on the nutrition side of things, they really start to notice feeling better in one way or the other. But we also talk about exercise, stress management. All of these things tie in.

Host: Well, the elephant in the room, of course is the effect of GLP-1 medications like Zepbound, Wegovy, Mounjaro and the like. I want to know, what do providers like you, what are you understanding about the changes that are transforming this field?

Katie Linville, MS, RDN, CSO: GLP-1s have hit the market. Right. And I would say especially the past year, but really even the past couple of years, we've started to hear about them more and to me, I think they can be helpful tools. There's still been a lot that we are learning as we go about these medications. And there are challenges, insurance coverage for one, and the costs that can come with them having to pay out of pocket.

But for some patients they can be a great fit as they're also working on nutrition, exercise, the lifestyle side of things, and seeking the medical care they need. And so I'm working with several patients in that realm, some who are taking a GLP-1 and some who are not for various reasons. And so I'm seeing on both ends people are able to work toward their goals and many times the GLP-1 can really help them get there and then they can work to maintain and build further toward their health focus and goals.

Host: Well, let's talk a little bit about the virtual clinic. So how is its weight management pathway unique compared to maybe other approaches?

Katie Linville, MS, RDN, CSO: Yeah, so our weight management pathway, it's a holistic approach. So they're meeting with not just a doctor to be prescribed medication, but ongoing appointments with one of our dieticians on the team to really bring it all together. And so actually before meeting with the doctor, they're initially meeting with the dietician because we're going to discuss their lifestyle plan and that will include then having them get scheduled with the doctor, having the doctor order medications that they need to be able to review for prescribing. And we're able to work closely with our doctors on the team and the referring provider, to share what the patient is working on with us. And so it's a big picture view as we all work to support the patient, with this ongoing care.

Host: Well, after a physician makes a referral to the virtual clinic, what's the process for coordinating a patient's care with their physician?

Katie Linville, MS, RDN, CSO: Yes. So when the physician puts the referral in in Athena, we have a whole team, on the virtual clinic that is the patient care team, and they are actively working to support our patients. They're reaching out through call and text once that referral has been placed, to reach the patient and let them know how they can sign up and schedule an appointment with the dietician.

And so they'll do that initial reach out, text and call. If they haven't heard back, they'll reach out one more time. And then after seven days, if they haven't heard from the patient, we'll fax the note back to the doctor just to let them know, Hey, we reached out. Now the patient, often later will get in touch and still schedule with us.

So once the patient creates an account in the virtual clinic, they can verify their insurance, schedule an appointment, and then they meet with us, and then we help assist in follow-up appointments or they can reschedule or schedule online. And we go from there and we help them get scheduled with the doctor as well as indicated.

Host: Awesome. Okay. Well, before we wrap up, I just want to ask a question about you, I mean, everybody chooses their profession for a specific reason. And I'm curious, what do you know now about nutrition that you wish you'd known earlier?

Katie Linville, MS, RDN, CSO: I think learning to be in tune with my body on what does it need nutritionally and just in general has made a huge impact in my experience, my day-to-day life, how I'm feeling physically. I'm able to identify, oh, okay, I'm hungry. Let me think about grabbing that snack before I get to that hangry point, too hungry.

Let me check in with what I need now and that I think my quality of life is just feeling in a much better place and I appreciate that. Right. Having that knowledge and ability to support myself in that way.

Host: Yeah, it's like a superpower.

Katie Linville, MS, RDN, CSO: Yeah.

Host: Well, is there anything left that you want to leave with our listening audience?

Katie Linville, MS, RDN, CSO: Well, I think in general as we're thinking about supporting our patients, just some goals that I find work for most people in general, or some focus points I often work with clients on are finding a system to plan ahead with, right. I think that planning ahead can really be key to our success in one way or the other.

And I'm thinking on the health perspective. And so oftentimes if we take that extra time to plan ahead for our meals for the week, maybe we're not talking four hours chopping in the kitchen every Sunday afternoon, but some type of planning system. Maybe it's using your phone calendar and talking with your family.

What do we want to do for dinner this night? Let's enter it in the calendar. Let's set an alert, a reminder. Can I add in a URL link if I have a recipe? Just thinking on what system works best for you. Some people that's pen and paper. But planning ahead is oftentimes key to success. Same for exercise, right?

So I think that's so key. And one thing that comes up very often and then a couple of other things, really focusing on hydration for energy, for digestion, for just overall, feeling full and satisfied. That is a challenge during our busy lives, our busy schedules. So what type of system will hold you accountable there?

Can you set alarms, reminders? These days we have these large, 40 ounce, containers we can carry around and keep the water cold all day. So it's sometimes finding those small strategies to build up to help you meet your goals long-term. And it can feel slow at first, but then you look back and it's those small gradual changes that make that long-term difference. So those were a couple additional thoughts I had that came to mind.

Host: Perfect. Well, thank you for all of your expertise, your insight, and for talking with me today.

Katie Linville, MS, RDN, CSO: Thank you, Jaime.

Jaime Lewis (Host): That was Katie Linville, a Registered Dietician specializing in women's health from Gennev and the Unified Virtual Clinic. To learn more or to refer patients, visit unifiedvirtual clinic.com/clinicians/clinicians-overview.