Jim Hill:

Welcome to Weight Loss And, where we delve into the world of weight loss. I'm Jim Hill.

Holly Wyatt:

And I'm Holly Wyatt. We're both dedicated to helping you lose weight, keep it off, and live your best life while you're doing it.

Jim Hill:

Indeed, we now realize successful weight loss combines the science and art of medicine, knowing what to do and why you will do it.

Holly Wyatt:

Yes, the “And” allows us to talk about all the other stuff that makes your journey so much bigger, better, and exciting.

Jim Hill:

Ready for the “And” factor?

Holly Wyatt:

Let's dive in.

Jim Hill:

Here we go.

Jim Hill:

Holly, people love it when we talk about these new weight loss medications. So today we're going beyond just what to eat and talk about how these GLP-1-based medications may change your entire relationship with food. These medications don't just reduce appetite, they alter how you feel about eating altogether. Foods you used to love may now seem unappealing. Mealtimes can feel like a chore instead of a comfort. And yet, getting the right nutrition is more important than ever.

Holly Wyatt:

Yes, this is a really hot topic. We're hearing this all the time. I'm not hungry now, but I know I should eat something. So what do I do? And it's not just about calories and weight loss. We got to consider energy levels and maintaining muscle mass and nutrients and really the quality of your life. And there's an emotional side to this too. So this is a big topic.

Jim Hill:

It is a big topic. And we have exactly the right person today with us to help navigate all this. We brought in someone who makes nutrition science accessible, practical, and believe it or not, actually fun.

Holly Wyatt:

And that's what we love, fun. That's what it's got to be.

Jim Hill:

Joan Salge-Blake is a registered dietitian. She's an author. She's a professor. She's a media expert. She's a Clinical Professor of Nutrition at Boston University Sargent's College of Health and Rehabilitation Sciences, where she's educated and inspired thousands of future health professionals. Holly, she's also the host of a very popular podcast called Spot On, and I've had the privilege of joining her on that podcast a couple of times, and it really is fun. Joan is a nationally recognized communicator. I love these people who know the science and are able to communicate. So many people that are actually good at developing the science aren't very good at communicating. Joan's good at both. She has written multiple books and appeared on countless media platforms. She's really famous, particularly in the dietitian community. Yeah, they all think she's fabulous. Joan has dedicated her career to helping people understand how food can empower them. She's built a reputation for cutting through the noise to bring people real, useful advice. Joan, we're so excited to have you with us today. Why don't we start by hearing a little bit about your journey? How did you get where you are and what fuels your passion these days?

Joan Salge-Blake:

Well, first of all, Jim, thank you. I want to thank you again for reading the introduction that my mother sent. So, I mean, that was just spot on. I got into this field going in to be a registered dietitian. Actually, it was my second career. Yeah, this is interesting. I worked for the Pillsbury Company.

Jim Hill:

I did not know that.

Joan Salge-Blake:

Oh, no. Here we go, the little dough boy and girl. How cute. Well, what happened, Jim? After a while of sitting at a desk all day long, I started to look like the dough boy and girl. So I said to myself, Sel, I think we need to do something about this. So I went off and put myself on a stupid, silly diet. And I lost weight, but I was so intrigued by it that I took a nutrition course. And I realized afterwards what I did was not healthy way to lose weight. So I went back and here I am, a registered dietitian. I have a doctorate. And there we go. And my whole focus really was to try to help people lose weight sensibly for long-term success.

Jim Hill:

What a story. I didn't know that about your background. And it sounds like you're really having fun with what you do.

Joan Salge-Blake:

Oh, my goodness gracious. I love what I do. I teach and I used to have a private practice specializing in weight management. Now I teach at Boston University. And let me tell you, they keep you sharp. I'm telling you. Holly, you should see these kids.

Holly Wyatt:

I know. I now teach an undergraduate class at University of Alabama, Birmingham. My first undergraduate class. Love it. But you are absolutely right. They keep you on your toes.

Joan Salge-Blake:

Holly, the only thing, and transparency, I've said this to the dean before, the only thing I dislike about this job of teaching at Boston University, every year, they're the same age. I'm the only one getting older. I find it very annoying, Holly, okay?

Holly Wyatt:

They keep you young.

Joan Salge-Blake:

Yeah, they do.

Jim Hill:

All right. Let's turn to the topic at hand here. I'm going to start, Joan, with a big picture question. You know, these GLP-1 medications have revolutionized obesity treatment in many, many ways. No question about it. I get 20 news reports a day about the medication and right and left and new ones are coming on. As a nutrition expert, how do you view these medications in the overall picture of weight management?

Joan Salge-Blake:

They're game changer. I mean, they really, really are for a lot of people who've had problems getting the weight off and keeping it off. Let's face it, we do not live in an environment that allows people to easily eat healthily, affordably, have access to it, exercise. We don't. We have an environment that we live in. That it makes us sedentary, makes us a less than healthy food choice is the quickest option. So it's really stacked against a lot of people, especially if you're genetically predisposed to being overweight. Really, it encourages weight mass or body fat increase. It's really, really challenging. So these can help so much for those people who struggle with this.

Holly Wyatt:

Yeah. So these are definitely game changers. I think we think of them the same way. They're changing the field. I think what we're noticing is a lot of people are interested, a lot of people are getting on the drugs, but we're also starting to see that a lot of people don't stay on them long term. I say we're having this discontinuation of the medications. What do you think about that? What's driving that? And how is that going to play into this new world for people trying to lose weight?

Joan Salge-Blake:

They're expensive. I read it from the Boston Globe, so I don't know if this is nationwide, but Blue Cross Blue Shield is questioning whether they're going to be paying for the weight loss. They'll pay for the version that appeals for those who have diabetes, but they may no longer be paying for weight loss. That's going to make this really, really a big change because it's expensive. It is really, really expensive. So stay tuned for that. I'm looking forward, I hope, for the price to come down. Hello, drug companies, do you hear me? And also, I'm also looking forward to this oral potential, because I think a lot of people don't like these shots. So I think there's a lot going on here that may change in the future, but clearly cost is one of them. And I think that there's a problem where you visit that vacation spot, Holly. You know this. It's called the weight loss plateau. It's a vacation spot where you don't want to go visit and take a vacation there, and your weight stabilizes. And if they're continuing to stabilize and they're not seeing any more weight loss, then they might say, why am I poking myself? I think a lot of things are going on.

Jim Hill:

Oh, wow. I have so many follow-up questions on that. But, Joan, one of the questions I know you and I get asked a lot from people is, how long do I need to stay on these drugs? If you think about it, the drugs work great, but they only work when you take them. And when you stop taking them, we are getting more and more evidence that most people who stop taking them gain the weight back. So from an insurance company, I can see that if I pay a lot of money, people get a lot of weight off, they improve their health, they go off the medications, they gain the weight back. I don't get the long-term benefits of that. So I do think solving this problem of long-term weight maintenance, either on or off the drugs, is very important.

Joan Salge-Blake:

I totally agree, Jim. And I tell you, I think the secret weapon that could help this is that every time the physician wrote a script for this, prescription for this, they also, on the second prescription, wrote a prescription to go visit a registered dietitian nutritionist from the get-go.

Jim Hill:

Are you saying that physicians don't understand nutrition enough to advise patients?

Joan Salge-Blake:

All I'm saying is they only give out one prescription. They need to be giving out two prescriptions. That's all I'm saying, okay?

Holly Wyatt:

She's not saying that, Jim. You're making that up.

Jim Hill:

No, I love it totally. I think you're exactly right. I think what happens, there are some obesity experts out there who do know that. But for most of the primary care physicians who would be prescribing these, they don't have the expertise in nutrition to really help the people.

Joan Salge-Blake:

Nor the time to do it.

Jim Hill:

Nor the time.

Track 3:

Right.

Jim Hill:

Before we get into that, I had one more question I want to ask here. Sometimes Holly and I are hearing from people saying, oh, these drugs, I don't like them. They're the easy way out. It's not fair. You shouldn't do that. You have to work hard and pay the price. The drugs are just bad because they're just making it too easy. How do you counter that?

Joan Salge-Blake:

This is like Barbra Streisand. I have to suffer. I have to suffer. I mean, you don't really need to suffer. I mean, if you have this problem, a genetic problem, and it runs in your family, for goodness gracious, get some help, and this can help you. If you have type 2 diabetes and have to go on medication or hypertension, so these medications can really, really help you. And what you can do is really go into it and say, okay, I'm going to be on these, but I'm also going to make these lifestyle changes that are going to help me improve diet quality and hopefully help you have a better chance of maintaining the weight loss. So I think you can go into this saying, okay, let me try this, but let me also try this with some expert nutrition counseling so I can maybe make some changes in my lifestyle that really have wonderful benefits.

Holly Wyatt:

I think we're definitely seeing that, hearing that. But also, and I want to see if you've heard this, there's some people who their appetite's completely gone. They really don't enjoy food anymore. The things that they used to do with their friends and family they can't do at all. And even they're not getting enough nutrients. They really have to work at getting enough vitamins and just nutrients. And that's a new problem, really. I mean, we saw it a little bit in bariatric surgery, but not to this extent sometimes. So that's another reason why I think people may be stopping the medications or we got to deal with at least.

Joan Salge-Blake:

Right. You want to be working with a registered dietitian so that person can assess like, wait a minute, you're having this side effect or maybe you're constipated or whatever. Let me help you do that. Or, you know, something, maybe your appetite is not so good in the morning. Let's go with little meals in the morning. So this way we can get the nutrition in so that you stay nourished. Because the whole idea of this, for many people, what got them into this issue where they have excess body fat is maybe their diet choices and their lifestyle have fed into this, okay? So let's look at these diet choices and the lifestyle. What the role of the registered dietitian nutritionist is to take their nutrition expertise and fit it into your lifestyle. So depending on what kind of life you have, your work, your family, whatever, they're going to say, okay, let's do this. You got to be on the road by 6 a.m. Let's do this for breakfast and really make it individualized and personalized, which is going to be key for long-term.

Jim Hill:

In a way, Joan, the meds are so powerful. They're doing the heavy lifting on the weight loss. It's not nutrition to produce weight loss. It's nutrition that supplements the meds, help you manage side effects, right? So that's a little bit different way of thinking about nutrition interventions.

Joan Salge-Blake:

Right. Where were these medications 20 years ago when I was helping people lose weight? Because you're right, Jim, what this does is the drugs will take care of the initial weight loss. That's fine. Now I have a person losing weight so they're happy.

And then when they're happy, they're ready to make more lifestyle changes. To me, it's like, wow, this is fabulous. It's a perfect, but you got to start from the get-go once you start this medication to work with that registered dietitian nutritionist to help if there should be any side effects. But more importantly, look at your lifestyle that made it more challenging to maintain a healthier weight when you were an adult.

Holly Wyatt:

Yeah. So I know some people, I don't want to just talk about this, but I do want to get your input on what should people be eating? What do they tend to miss if they're on the GLP-1s? You know, I get that question a lot. What should I pay attention to when my appetite is not very high?

Joan Salge-Blake:

Okay. So let me tell you some sad information here, okay? So we have something called a healthy eating index. And a healthy eating index is a measure of how your diet adheres to the dietary guidelines for Americans. The dietary guidelines for Americans will tell you we need to have more fruits and vegetables on our plate, leaner sources of protein, make some of them whole grains, and lean dairy and healthy oils. All right, now if you're following the dietary guidelines for Americans, you're getting your score for your healthy eating index will be 100. Just guess what the average American's score for the healthy eating index is. 100 being the highest.

Holly Wyatt:

Well, I know it's really low. We did a show on this and then we knew the percent of people that were doing it was really, really low. I don't know if I know the score. I'm going to guess 20.

Joan Salge-Blake:

Well, not that bad, Holly, but you're down there.

Jim Hill:

40.

Joan Salge-Blake:

It's 59.

Holly Wyatt:

[15:10] 59? That's better than I thought.

Joan Salge-Blake:

Now, Holly, at Boston University, if you get a 59 on the final, you, honey, have flunked the final. Okay? You flunked.

Holly Wyatt:

I knew we were flunking. Yeah.

Joan Salge-Blake:

What I say that for is oftentimes the average Joe and Josephine on the street will come into this having unhealthy diet. So we have to make sure that we change that around to make it healthier, especially now on the medication when the appetite is so much lower. So we have to make every bite count. So we want to go in there and say, okay, so let's, How can we make this more nutritionally adequate and nutritionally dense? Nutrition for every bite? And let's get into that habit, which, by the way, even help you to have maybe better success on the medications. If your diet beforehand was full of jelly beans versus green beans, and you're just eating a diet with less jelly beans, we still have an unhealthy diet.

Jim Hill:

So this is important. And I think it really emphasizes what you said of the need to get some professional guidance here. A lot of people felt like, well, if people lose weight, they're just going to naturally want to improve their diet and they're going to exercise more. I don't think that's what we're seeing. I think a lot of people are very happy to continue their poor lifestyle and then let the meds do the weight. And this is why I think we need some help in guiding people. Now that you've lost the weight, let's do some other things that help your quality of life and adherence and overall health.

Joan Salge-Blake:

And also, Jim, I'm very frugal. So if I can change your diet to be more healthy, healthier, more fruits and vegetables and whole grains and less of the added sugars in our diet and unhealthy fats, I not only can help your waistline, but I can help your heart.

Joan Salge-Blake:

I can help your high blood pressure. I can help your bones. So I'm getting a lot of bonuses from my bucks here. And so why not? You may get the weight off, but if have a unhealthy diet and even it's less calories, that's not good for your heart. So why don't we do some house cleaning here and change the diet so a lot of the body parts, everything can get an improved health.

Jim Hill:

You and I have talked about this before, but I think we both see this as an opportunity for people interested in lifestyle, not competition, not something to worry about. Holly and I have been doing weight loss for years and years and years. And the difficulty is getting the weight off. And we're saying, holy cow, these are tools that help. Absolutely. Now we can take it from there. And I think the same thing for registered dietitians. This is a wonderful tool. They should embrace it, not fear it.

Joan Salge-Blake:

Yes. And we've been doing nutrition counseling for weight loss and lowering cholesterol and getting high fat for a hundred years. Yeah, I mean, like this is nothing. We already know how to do this. But what we just have to get out to the medical community is to make sure that they promote also visiting with a registered dietitian nutritionist. Here also, depending upon your medical history, if you already have high blood pressure, maybe you're pre-diabetic, which is a lot of pre-diabetes, which a lot of Americans, unfortunately, high cholesterol, you may be, based upon your insurance, the counseling with the registered dietitian nutritionist may be covered. So you could be a co-pay away from getting this. So check that out. Don't assume that this is going to be something that's made an added financial, because maybe it's really covered by an insurance company and you should really check it out.

Holly Wyatt:

Yeah. You said something earlier that I want to bring back up because I think it is the key. We've been doing this for a long time. But now that people lose a certain amount of weight, they're happier.

Joan Salge-Blake:

Yes.

Holly Wyatt:

And this happiness opens the door to them saying, what other changes could I make? And more willingness, I think, to think about changing their diet. More willingness to think about moving a little bit more. Willingness to talk about, well, what other ways can I relieve stress other than emotional eating? All of that stuff. And I think it's because they've been successful, they're happier, they're happy with this weight loss. We've never gotten the amount of weight where people could be happy before.

Joan Salge-Blake:

Absolutely, Holly. That is so spot on because when you're happy, it's easier for you to make positive changes because you're happy. I mean, when I was counseling my patients got stress in their life. Like, hello, who doesn't have stress in their life? Unfortunately for a lot of them, they, you know, when they got stressed, they called their two best friends. That was Ben and Jerry. And you know what I mean? So, that's a habit and you're the darn Ben and Jerry, they're good friends and they work and you feel good right after you have that Cherry Garcia. But then afterwards we have two problems. the original stress than what the Cherry Garcia. So now when they're happy, they're like, okay, I'll do this. I can try that. Okay, I'll get hummus in the house. Okay.

Holly Wyatt:

Yeah. And what I tell people now is let's take advantage of this. There's always some risk in being on a medication. There's always benefit and risk. That's what we're constantly going back and forth with, making that decision. And if you're going to be at some risk, then take the full benefit of these drugs and use it to change other aspects of your lifestyle. It's the perfect time to do it. I want to switch just one over a little bit because this is another question that I know is so hot and I want your opinion. This idea that we may be on the medications losing a little bit more muscle mass. I don't think we know that for sure. We all lose some muscle when we lose weight. Question is, are we losing a little bit more or is there a certain population maybe that is losing a little bit more on these medications? We don't know that. Is there any thing you tell people in terms of what to eat, protein, et cetera, that you think could be helpful for that?

Joan Salge-Blake:

Right. So, this is a big an issue. And actually, it was an issue for older people like you, Jim, because when you're losing muscle mass, quicker speed than Holly and I. Hello.

Holly Wyatt:

Yeah.

Joan Salge-Blake:

So, yeah. So, anyway, what we want to make sure we want to do is make sure that we have adequate protein. But, Holly, you know what we do oftentimes? We don't have much protein in the morning, a little bit at lunch, and then we bank it all for dinner time. And we know now that that's not good. And what we want to do is take that protein and distribute it throughout the day. So we're talking at least 60 grams of protein, at least 20 at each meal, right out throughout the day. So we know that that can help with maintaining or triggering muscle synthesis throughout the day. So that's important. That's another situation where you get with a dietician and they'll say, protein, I don't want chicken at breakfast. Well, you don't have to have chicken at breakfast. Let me help you figure out to get some more protein at each meal. And, Holly, you know this, that we know that protein is a powerhouse nutrient because it increases satiety. So that's a good habit to get into once you get off the drugs or you taper or microdose or whatever to make sure that you keep that protein distributed throughout the day.

Jim Hill:

Joan, I want to jump in here because I was just at a, I was on a Zoom symposium yesterday about protein. And there was a wonderful talk from a researcher at University of Toronto, basically saying high protein is good when you combine it with a stimulus exercise. In other words, if you're going to affect muscle metabolism, high protein alone may have a little bit. But if you really want to increase muscle synthesis, you've got to combine the protein with the exercise. And so I think if you're worried about body composition, that's a great pairing. And so my question is, we've talked before about registered dietitians, and they're trained in nutrition, but a lot of them understand the physical activity part too, right?

Joan Salge-Blake:

Right. It's a three-pronged approach to long-term weight loss and maintenance. And that is diet, what you're eating, physical activity, and behavior modification, changing that behaviors. So we know that all three have to be working together. And physical activity is a huge component of that. And not only in helping to, you know, synthesize that muscle mass, great stress release, great stress release. So instead of calling Ben and Jerry, you call your sneakers and put them on and do something to release it.

Jim Hill:

Joan, what about fiber? What's the role of fiber here?

Joan Salge-Blake:

Here's another sad story, that Americans are not getting enough fiber in their diet — way, way too low. So we need more fiber in their diet. Now, this is interesting, because if you start eating a more healthier diet, which is vegetables and whole fruits and more whole grains, your fiber is going to increase and go up. And we need to be getting it up to anywhere between 20 to 35 grams a day. We're coming in around like 15. It's like, you know, you wonder why we're constipated and cranky. We want to make sure that we're getting enough. And these changes in the diet that could help you with better weight management is actually going to be good for or getting the high fiber in your diet, that with a lot more fluids, we can help keep things regular, keep things moving. And we also know that certain types of fiber may help better control blood glucose levels and lower blood cholesterol levels.

Holly Wyatt:

Yeah, and the gut microbiome, that's hot too, and fiber is really playing a role there. But some people, when they talk about they eat something with a lot of fiber, it increases the side effects of the GLP-1s. They have nausea, you know, that delayed gastric emptying. The drug is already doing that. Now you put some fiber and some water in there, and you even have that more intensity of that. How do you handle that?

Joan Salge-Blake:

These side effects don't typically, they lessen up as time goes on here. But that's where you're working with a registered dietitian. They say, okay, that breakfast is too much. That's too big. Okay, we tried it. It didn't work. Let's divide it up. Let's have some of that 6 a.m. and then have a little bit more when you get to the office. So this way you don't have that overload, large breakfast or large any meal, and the way you may feel more uncomfortable and it leads to more nausea. Again, it's all about taking the nutrition and putting it into your lifestyle because you have to commute two hours a day or whatever and you have to get up at the crack of dawn.

Joan Salge-Blake:

Again, you're looking at your lifestyle and how to make it fit for you so that it works.

Holly Wyatt:

Yeah, and the side effects that you have. Not everybody has the same side effects. These drugs affect you differently. So I love this individualized approach and having someone that can help you, give you the knowledge, give you ideas. You try it, you come back, you make a change again. That's really how it has to happen, I think.

Joan Salge-Blake:

Absolutely.

Jim Hill:

All right, I want to go back to happiness. I tell Holly all the time, what people are really after here is to increase their happiness. Now, what they think, and we see this all the time, people think if I get the weight off, that's going to do it. And I think getting the weight off, don't get me wrong, it's important, but that alone isn't going to make you happy. And I think one of the things these meds can do is to help us reevaluate what success looks like. Yes, this number on the scale is important, but at the end of the day, that's not what really motivates people. I think they're looking for happiness. So how can registered dietitians go beyond just telling people what to eat to deal with other aspects of their life so they get the weight off and they're a new person? We oftentimes hear people say, “Oh, my gosh, I'm a different person after I've lost weight.” And I think they're open to some other changes that impact happiness. How can dieticians help there?

Joan Salge-Blake:

Right. So going back many, many ways, first of all, you're right. Because they lose the weight and they can walk. They can pick up the grandchild. They can pick up the laundry basket. I mean, they can do things. So life is easier and they can walk and they're not out of breath. This is like unbelievable. But also, when we get back to the stress if you're releasing your stress at the kitchen table rather than on the walking path, once you do that, afterwards, you're not happy. You're really not happy. You wish you hadn't done that, and then you have that whole problem and you're ruminating over that. So, again, it's these changing the behaviors while you're on it make you happy. And you're like, “I'm stressed. I had a bad day today with my boss. I'm going for a walk before I go into the house.” Go for a walk, release it before you get into this house. And then they release it, they walk into the house and they say, “No, I am not going to go to the cookie bin or whatever. I feel better now.” So they've learned that. So they're releasing it. You have to have a mechanism to release the stress but it doesn't have to be in the kitchen.

Holly Wyatt:

Yeah. I think though, there's some people that experience that, But sometimes they think their weight has caused all their problems. It's going to losing weight is going to fix a relationship or their job or the fact that they're not doing what they have passion. They're not living a life or something like that. Their identity is not really who they are. And so there, I think, is where people will lose the weight but still not be really in their best life.

Joan Salge-Blake:

Right. And I think at that point, you have to look and say to yourself, maybe it wasn't the weight. Maybe it was something else that's going in my life. And that's where you talk about a team here, an interdisciplinary approach. That's where you might say, “Maybe I need a counselor. Because I said, I thought it was the weight. If I only lost 20 pounds, I'd be happy. I guess what? I lost 25 pounds and I'm not happy.”

Holly Wyatt:

Yeah, or it's an and. It's both. It's both.

Joan Salge-Blake:

Right. So let's, maybe what else is really, really going on here? And again, when you're happy or because you lost the weight, you maybe are open to getting advice by a counselor to help you with the other parts of your life that may not be making you happy.

Jim Hill:

Holly and I often talk about a three-pronged approach. Food is medicine, physical activity is medicine, and the mind is medicine. And I think the more we look at long-term weight loss maintenance, the more important we see the mind in how you approach it. And this is one where, I make several mistakes a day, but one that I make that Holly always calls me out on, I kept saying, this is hard. And Holly said, that's the wrong way to look at it. Look at it as a journey. Look at it as self-exploration. I think if we're selling success as, oh, my God, this is something you got to do, and it's going to be hard, but you got to get in there and do it — people are going to fail. I think we help people reach a lifestyle. It isn't hard. It's easy when they get in the right routines. And when we study people in the National Weight Control Registry that have done this, they say their life is better. It's not as if “Oh, my God, my life's awful. I'm constantly battling this.” They say, 98% say my quality of life is way better.

Joan Salge-Blake:

Right. Because they have made those lifestyle changes that really make them unhappy.

Jim Hill:

Exactly.

Joan Salge-Blake:

They change those so they realize, you know something? I'm happy now that I don't do blank.

Jim Hill:

I think we got to start selling a healthy lifestyle as a happy lifestyle. It's not deprivation day in and day out. And part of it is most of our behavior is automatic. We have routines and rituals and everything. And when you get the healthy ones, it's just as easy in the long run as doing the unhealthy ones. Holly, did I get that right?

Holly Wyatt:

You did so well, Jim. I liked it. I think we're taught, and I was taught this from medical school and residency, you know, just grit your teeth and do it. Just get through it. Just struggle that kind of Victor mind state about it. And it works. But I don't think it has to be that way. I think you can change that and it doesn't have to be a struggle. And especially because now we're talking about a lifestyle. It's going to be forever. Do you want to feel like you're struggling forever? No. And you don't have to. You can still be successful and it not be holding on for dear life.

Joan Salge-Blake:

People will say, I remember a client or patient, you know, I don't like any vegetables or anything. And really what it came down to is he didn't like preparing any vegetables. So I said, you know, let's do frozen vegetables. Really? I thought they weren't as good as fresh. I'm like, oh, no, no, no, no, no. I don't know who told you that story. Okay, they're frozen. In fact, they're better for you. Here comes with the lifestyle, Holly, because guess what? They're clean, chopped, and ready to go. It's like having Rachel Ray in your freezer. And so that you don't have to do any of the prep. And then after he started doing like, wow, these mixed vegetables are really good. I said, no kidding. And so they just think that the story before them of eating wilted broccoli was so disgusting. But now they realize, gee, this is really easy and I really like them. And so again, going back to this journey is healthy and it can actually be delicious.

Holly Wyatt:

Yes.

Jim Hill:

Holly, I want to turn to one other topic. This time is flying by and I have so many more questions still. But Joan, for whatever reason, the data suggests that at least half the people that go on these meds don't stay on them long term.

Jim Hill:

And if they go off the meds without a plan, they regain the weight. What's the role here for dieticians and people? There are lots of good reasons to go off the meds, costs, side effects, etc. We always say if it works for you, stay on them fine, but if you go off them, we need to help you not gain the weight back. What's the role of the registered dietitian here?

Joan Salge-Blake:

This is what I said, Jim, earlier, from the get-go, the first time you take that medication, you should be with a dietician so that you're making these long-term changes. So when you decide, maybe a year later, “I think, you know, I've lost some weight and I'm feeling really better. I think I'm going to taper down or maybe go off it.” And then you see, with that help and guidance, you can see that you have a better chance of maintaining the weight loss. And then maybe, I don't know, I don't have a crystal ball. Maybe, Holly, you can address this. But maybe, okay, you go off it for six, eight months. And all of a sudden the weight is not so good. Stop seeing the dietician and stop them in the kitchen. So maybe you say, “Okay, let me start back with the dietician. And let me call the doctor. Maybe I need a little bit more.” And you kind of make an adjustment based upon your lifestyle and what's going on. So I don't know, Holly, what do you think about that?

Holly Wyatt:

I love that. It's redefining success. Success, you may come off the drug with a plan. I like it, with a strategic plan, with help, with support. See what you can do. Something may happen in your life. You regain, start regaining some of the weight. No big deal. Doesn't mean you failed. Doesn't mean you're not successful. Get that out. Okay, I call my doc. I might get back on the meds for a little bit. Or I might intensify my support with the dietician or whatever. And lose a little bit more. Maybe lose a little bit that I've regained. And continue on. That's what success is going to look like. People think it's going to be, I'm going to lose all my weight and then I'm just going to maintain it perfectly. No. That would be wonderful. And if you can do that, yay. But success doesn't have to look like that. And that's, I think, what you're saying. So right what I agree with.

Joan Salge-Blake:

Right. So let's write it out. Let's make adjustments for the rest of your life based upon this and just see where it goes. If you had high blood pressure and you made some dietary changes and you maybe gained some weight and then your blood pressure goes back up, well, the doctor's going to give you blood pressure medication. But let's go back and try to maybe clean up our diet a little bit, get more exercise, and maybe go off the drug. So it's on and off and on and off. But basically what we want to do is maintain a healthy body and ask for support. So, you're not going to lower your blood pressure by yourself, okay? You need a physician to maybe give you some medication and some diet advice and activity advice. You're not doing this by yourself. You need some help here. So take it, a little bit of help, and see where you're going.

Jim Hill:

And also, we need to get people to understand this is a long-term sort of process. So Holly and I have started asking people who go on these meds, what's your long-term plan for keeping weight off? You know what the number one answer is? I don't have one. I haven't thought of that. I haven't thought beyond losing the weight.

Holly Wyatt:

I'll deal with that later.

Jim Hill:

I think for both physicians and dieticians, bringing this up at the beginning, “I'm going to help you get the weight off. But we need to be thinking about finding a permanent way for you to live your life with or without the medications.”

Joan Salge-Blake:

So true. So, you know, what is your goal? Is your goal to be happier and be healthier? Let's do that. And then we can see long term, maybe you can go off the medication. Maybe not. Maybe taper down. I don't know. Let's go see what happens.

Holly Wyatt:

Yeah. All right. You know what I want to do, Jim?

Jim Hill:

You want to go to listener questions.

Holly Wyatt:

I do. And I'm going to do them rapid fire. She can do this. Some of our guests can't handle this, but I know she can.

Jim Hill:

Pressure's on.

Holly Wyatt:

I'm excited about this. All right. You ready? Rapid fire listener question. Number one, are protein shakes a good idea on the GLP-1s or should I try to eat more whole foods?

Joan Salge-Blake:

Whole foods first. I'm always food first. Because I want to get you into the habit of having a diet that is based on foods. Because when I have the whole foods, I get the fiber, I get the phytochemicals, I get a lot of nutrients. But if you're on these medications and your appetite is so low that you're not meeting your protein needs, then the dietician will say, let's say a little shake here.

Holly Wyatt:

All right. Jim, do you want to do the second one?

Jim Hill:

Okay, I can't eat big meals anymore. What are some nutrient-dense snacks I can rely on?

Joan Salge-Blake:

Right. So what we want to do with that is we want to look at the fall short food groups of Americans, and that is fruits, vegetables, and whole grains. But what you want to do is add protein to them. So what I want to do is have a little bit of protein. So you may have like, say, cottage cheese. Let's put fruit on top so I get the fiber. So I got a little bit of protein, plus I get the fiber. And these are great high protein, high fiber snacks that you can have throughout the day.

Holly Wyatt:

All right. Next question, should I stop intermittent fasting while on these medications? Some people do the intermittent fasting or the timed eating. Do you think that's a good combination or should we stop doing that?

Joan Salge-Blake:

I'll tell you what I like. I like this stopping this late night eating. You know what I mean? Eating from the time dinner's over until the end of Jimmy Kimball. I would like to stop that type of eating and just end at the dinner. And there is actually research that suggests that if by eating more of your calories earlier in the day, when you're more active and less later on in the day, is better for reducing body fat.

Jim Hill:

Okay, I can't eat nearly as much as I used to. Should I be taking a multivitamin or protein supplement?

Joan Salge-Blake:

Okay, this is where definitely you need to be a registered dietitian. Remember I told you when we started this that the healthy eating index was the big 59 flunked. So your diet wasn't healthy. So odds are you weren't making your nutrient needs. So this is where you're probably going to need a supplement. However, with that said, you may be on certain medications that you got to worry about interactions. And that's where a dietitian can help you to say, “Okay, let's make these changes, but we also have to watch. We'll get a supplement.” I'm going to give you a great story. Even though this is rapid fire, I'll do a rapid fire. So if you're on Coumadin for a blood thinner, all right? So what you want to do is you want to keep your vitamin K stable. You don't want to go up, you don't want to go out because it interferes with the Coumadin and your blood clotting. And let's face it, when you fall down, go boom, you bleed, you want to clot. So if you go on these weight loss medications and you start having more cellulites in your diet and you're on Coumadin, it's like, let's call the person, the MD that diagnosed and gave you this Coumadin because we cannot tell him that we're going to eat more healthier so the medication can be just appropriately. He or she's going to want more green vegetables in your diet, but not the expense of interaction with the drug.

Holly Wyatt:

That's a great point. All right. I love this next question. I can't wait to see what you say. I used to love salads, but now raw veggies make me gag. Now that they're on the GLP ones, what should I do?

Joan Salge-Blake:

Okay. This is where you have soup. I love soup. Okay. So soup is so absolutely wonderful. And this is how you make homemade soup, Holly. Okay. This is what you do. You take two cans of vegetable soup. You put them in a pot. You go to the freezer, you open up the frozen mixed vegetables, you put it in there, you stir, you have homemade soup. Okay, that's what it is. And so easy. And if you need fiber, you add a can of drained beans in there. Now we have soup, which is a wonderful snack, high fiber, and a way to get the vegetable and the fiber.

Jim Hill:

Wow, I love it.

Holly Wyatt:

Oh, my gosh. I'm so doing that. This is I am so doing that. I love that. That's I always say if you see a recipe for me posted, it has less than five ingredients. I love anything like you can just do quickly like that.

Jim Hill:

Last question. Is it dangerous to eat too little on GLP-1s?

Track 3:

Yes, it is. It is because we want to make sure you stay nourished. We also want to make sure, and this is where it's a team approach, if something goes on that we have a little bit of a disordered eating going on where we're purposely not eating a lot and weight is coming off too rapidly. And so that's where we go for that. You know, we need a counselor to help us and figure this out. So you want to do this in a healthful manner, changing lifestyles. That's going to make you happy.

Jim Hill:

Okay, Holly, let's ask her one vulnerability question. You choose one.

Holly Wyatt:

Oh, goodness. All right. What's one myth about nutrition or weight loss that you believed for way too long? What's something you kind of got wrong and then you changed your mind?

Joan Salge-Blake:

Only eat in the periphery of the supermarket. Only eat, the food is in the periphery. Well, heck, you know something? The bakery and the wine is in the periphery of the supermarket.

Holly Wyatt:

I love this. Yes.

Jim Hill:

Oh, my gosh. Oh, Joan. This has been amazing. I'm supposed to give us takeaways here. And I guess the number one takeaway I would say is these GLP-1 medications are awesome. They're game changers. But if you really want to maximize the effects, weight loss, health, happiness, work with a professional and a registered dietitian. They are affordable and they can look at your lifestyle and help you adhere to the meds to have fewer side effects. And if you decide to go off or go down on the meds, they can help you with that. So, Joan, last question. How do people find a registered dietitian to work with?

Joan Salge-Blake:

Oh, I'm so glad you asked me that. So you can find one in your area. Go to [eatright.org](http://eatright.org/). And up on the screen, this is the Academy of Nutrition and Dietetics. This is their website. And that's the academy that the dietitians are members of. And up in the corner, it's going to say find an RDN. And then you click on it and you go down at drop down box and you'd see your state, where you live, and then we can find one. So definitely, that's the easiest way to find one.

Jim Hill:

Joan, this has been fantastic. Thank you, and thanks to all of our listeners. We would love to hear from you. If you're on the GLP-1 medications, what are your challenges? What are some of the solutions you've found? Write to us. Send us your questions. We want to hear from you, and we'll talk to you next time on Weight Loss And...

Holly Wyatt:

Bye, everybody.

Jim Hill:

And that's a wrap for today's episode of Weight Loss And. We hope you enjoy diving into the world of weight loss with us.

Holly Wyatt:

If you want to stay connected and continue exploring the “Ands” of weight loss, be sure to follow our podcast on your favorite platform.

Jim Hill:

We'd also love to hear from you. Share your thoughts, questions, or topic suggestions by reaching out at [weightlossand.com](http://weightlossand.com/). Your feedback helps us tailor future episodes to your needs.

Holly Wyatt:

And remember, the journey doesn't end here. Keep applying the knowledge and strategies you've learned and embrace the power of the “And” in your own weight loss journey.