132- Pillars for Successful Weight Loss with Dr. Lydia C. Alexander

Bryan Carroll: [00:00:14] It's weird to be saying this as this year has been a heck of a roller coaster, but we are now. Officially entering the holiday season, which means in previous years, people's health goals get shoved under the table.

You know, the table that was full of cookies pies, another holiday treats. And while I'm not really sure what this holiday season will look like history shows us that there is one thing on everyone's minds. Once January comes around weight loss, weight loss is one of the hardest things to do, especially with temptations around every corner.

But this episode will help you with that. What's up everyone. I'm Bryan Carroll and I'm here to help people move more, eat well and be adventurous. And today I have dr. Olivia C. Alexander of the obesity medicine association. Joining me to talk about strategies to help reduce weight before where we get started.

If you enjoy the podcast, please leave us a quick rating and review on your phone podcast player, those reviews, it helped to keep the show going and gets it in front of more people. And we'll be talking about the pillars for a successful weight loss today. So let's jump into the conversation, dr. Lydia C.

Alexander practices, obesity medicine, as part of the Kaiser Permanente medical weight management group in San Francisco, California. She is passionate about the practice of obesity medicine and committed to educating primary care providers about the benefits of taking a weight centric approach when addressing chronic diseases.

Thank you for coming onto the show. Lydia. 

Dr. Lydia C. Alexander: [00:01:46] Thank you so much for having me, Bryan. 

Bryan Carroll: [00:01:48] Of course, and I'm excited to chat with you more about obesity, but before we get started with that, let's learn a little bit more about you because I know there's a lot that you're involved in down there in San Francisco.

So give us kind of a brief overview of who you are and what you do. 

Dr. Lydia C. Alexander: [00:02:03] Sure. So I am, in a well I'm I'm board certified, first of all, and internal medicines from a physician who specializes in that that's adults. And I trained at UC Davis school of medicine here nearby. And, and now I. ha in part of a subspecialty that's, that's growing by leaps and bounds called obesity medicine.

And I was board certified in that in 2015. It's a, it's a new field that I believe began certifying physicians in 2012. And this year here hit a record high, in terms of people who sat for the exam, it was over a thousand physicians and we now have it. I think the last number was 4,152, physicians, certified in this.

So it's, the numbers are growing and what probably, exceed the total number of endocrinologists in our entire country. It ended up by next year is my guess. 

Bryan Carroll: [00:02:56] Which is pretty interesting because that's also an indication that obesity is becoming more and more of a problem. Is that correct? 

Dr. Lydia C. Alexander: [00:03:03] That's right.

That's right. It's I think of it as the, probably the, the, you know, the, what is the word I'm looking for? Kind of like the, you know, the basis for many of the different chronic diseases that we routinely treat in, in internal medicine. 

Bryan Carroll: [00:03:20] And what, what's the technicalities around obesity? What defines 

Dr. Lydia C. Alexander: [00:03:24] it?

so what defines obesity from, you know, in a, in a very, I guess, In a very simplistic approach is, is having a body mass index of BMI, which is kilograms per meter squared for those, would like to know that it's above 30. And, and then we classified that into three different categories. So, there's class one, which is that very beginning point, then class two and class three and above a BMI over.

40 is now considered a severe obesity or class three obesity. and, and within all of that BMI, doesn't really tell you the full picture, because I do mention from time to time that, you know, no torts and Erica are had a BMI of 37 in his heyday when he was Mister universe. And so. No one certainly would have told him or said that he was unhealthy necessarily and had obesity.

So, so also, you know, body composition is very important and other, and other indicators, a palace, around the BMI. So it's really sort of the beginning point, but a really great metric to use unless you're. You know, I guess two standard deviations out of your, out of your comfort curve area.

certainly based on BMI, about a third or a little more, almost 40% of our country, has obesity, by those numbers. And if you include overweight, which is a BMI over 25, three quarters about 70% of the United States suffers from overweight or obesity. So it is, you know, it's, it's more than a burgeoning field.

I'm glad there are more specialists like me who are coming online because we have a lot of work to do. 

Bryan Carroll: [00:05:04] Yeah, that's a significant amount of people. So you're saying about 75% of the population in the States has, is overweight or obese. 

Dr. Lydia C. Alexander: [00:05:14] they, yeah, based on, based on the BMI numbers that I, that I've just given you and in fact, you know, not to sound, you know, not to sound dire, but those are based on Caucasian populations or European, European body types, Japanese, BMI, numbers as well as those from China and subcontinental India are actually lower.

So if we were to consider, especially in my part of the United States here in, the, the, California and the Bay area where we have a larger Asian population, BMI is for them. overweight is considered starting at a BMI of 23. so, so, that number kind of only gets bigger. And I think the last statistics I saw from CDC projections is that by, by the, by 2030, that 50% of the country would have obesity by then.

What's 

Bryan Carroll: [00:06:03] kind of a jump let's let's kinda break it down in a way that people can get more of a visual idea of what these BMI numbers would look like. So if you have like 150 pound person that's, I don't know, five foot five, what would. Where would that be on that type of scale 

Dr. Lydia C. Alexander: [00:06:22] off the top of my head, that would probably fall in the overweight category.

So if we look at men and women, they're slightly different calculations, you can do. It's, it's usually easiest for me, unless I, I take out my BMI calculator, which quite honestly I can do. Cause that's the line of work I'm in. but, but if you think of, so I'm five, five, And, and so that's a good number to start with.

And so for every one inch, if you add five pounds, then my ideal body weight should be, should be one 25 by that measure. And so, my body weight. Still falls in the normal range until I have a BMI at 20, at 25 and a, and so I could still go up to about one 50, one 60 and still be in the normal range or right at the very beginning of overweight.

And, and so that, and if I were to have obesity as a five foot five woman, I would probably need to weigh around one 70 or so. Okay. So that gives some indication of, of kind of the ranges we're talking about and a BMI think about between every seven to 10 pounds probably puts you in an additional, you know, one kilogram per meter squared, you know, depending on male, female, and where you are in those categories.

Bryan Carroll: [00:07:40] And does age get factored into this at all 

Dr. Lydia C. Alexander: [00:07:43] as well? No. So that's super interesting too, because age, age doesn't play any part in BMI and where you should be in BMI. but we do know that as we get older, our body composition changes. And so, you know, the body composition I had when I was 20 in college and an athlete is very, very different than the VMI rage I have now, you know, a couple of decades later.

So even if I'm the same weight, whether I'm in the healthy weight or the overweight or obesity, that number, the number on the scale and the body mass index, don't tell the entire, you know, don't tell the entire picture. And again, I think Arnold Schwarzenegger is know one of those great examples to show that, you know, your skeletal muscle mass and your, your, your body fat percent can really change.

And, and the number that first number is kind of like a, just kind of quick and dirty indicator of, you know, of, of kind of. You know, where you fall on, on that scale. And so this can be PR particularly, you know, important in, in older adults say over the age of 60 or 65, who, you know, maybe at a, you know, let's say a BMI of 26 and you think, wow, they're overweight, but you know, it's okay.

I, you know, Not so bad could be, you know, could be better, could be worse, but if you were to do a body composition analysis, and the most common one that we use in a, as an in obesity medicine is obesity specialists in our office are the BIA, the body, impotence, tracking. And you probably have seen those where you stand on it.

Some people have the home scale, that'll do kind of a, you know, a rudimentary. A rudimentary prediction of what your percent body fat is and all that. I've got a fancy one even tells me my heart rate through my feet, but the, which is kind of interesting. But anyway, you hold onto these, these handles and, it runs some electric current through you.

and, and then we'll tell you, what is your, you know, your intracellular and extracellular. Waterweight your percent body fat. Your skeletal muscle mass. And, and so the concern with older adults, especially if they're sedentary, which is, very easy to do these days in our, in our society. they, you know, it's not uncommon to see someone who has maybe 50 or 53% body, the fat.

So half of them literally, as, as body fat. And, and so they're actually sort of sicker than you would, in a sense sicker than you would predict based on BMI only. Wow. 

Bryan Carroll: [00:10:12] Are you using the InBody machine? Is that the one that you use? 

Dr. Lydia C. Alexander: [00:10:15] Yeah, we actually do use the embodied machine. Yeah. There are three or four on the market out there.

We've got that one. I think the gold standard is DEXA, which is the same type of machine that's used, you know, for checking, bone mass. And, and so those tend to be, you know, pretty amazing, but they're also fairly, fairly expensive and more 

Cynthia: [00:10:34] for the purposes of research at this point. 

Bryan Carroll: [00:10:36] Right. so.

I mean with 75% of the population that are, you know, overweight or obese, obviously the big question is why is this happening? Right. So. This probably also leads directly into a lot of the treatment options that you have, but what have you found to be some of these leading causes for this increase in obesity?

Dr. Lydia C. Alexander: [00:11:03] I think that when we thinking about obesity, it's really, I it's. It's almost a, I call them obesity's. So there are so many different, you know, so you can follow to develop a, you know, an unhealthy weight, body, mass index, you know, body composition. And it, you know, if we look at society, you know, a hundred years ago and we look at.

places in the world where, people tend to be healthier and healthier than we would predict given the quality of the healthcare there they are. And I'm thinking about blue zones, for instance, you know, there's, you know, Sardinia, there's a, in, in Greece and, Okinawa in Japan and a few other places like that.

what we see is that, what's changed. Dramatically on a population level is the, there's the level of activity that we have and then the quality of the food that we eat. And, and, and, and, for instance, our circadian rhythms have been, you know, have been thrown off. So, that's also another important area.

I would say that, likely stress levels have, chronic stress levels as opposed to acute stress, have changed their number of factors. I think if we were able to. Follow it over the last a hundred or 150 years between electricity, quality of the food. And, and again, just physical movements that, that have dramatically, that have dramatically changed for, for societies as a whole.

And, and for those of us who are more genetically predisposed to have that, and there are some people who do have more of a propensity to, to gain weight. And that was likely, you know, a very good thing to have 10,000 years ago that you could retain your, you know, you could retain weight even through some type of famine or a few days or weeks with, without a constant food source.

It's, it's, it's not as, as helpful any longer because food is no longer scarce. 

Bryan Carroll: [00:12:55] Let's go through. 'em all those different options that you talked about and kind of break them down a little bit more. So if someone's coming to you and they're obese, they're probably, they probably are uncomfortable with MoMA in some form, right?

They might have some aches and pains that just might not have. You know, they might be out of breath really easy. They might not be comfortable with it. So what are some different ways to help them to increase their movements? 

Dr. Lydia C. Alexander: [00:13:19] Okay. So I'm, so I love the topic of physical activity because I, cause I love physical activity.

but also because there, so I, I like to break it down into five different categories and and so, the first category that everybody knows about a lot is, you know, is cardio. And, and I think if I were to, you know, to skew and think about who likes to do Cardi more, it's probably more of the, the, the female population.

Who's, who's really into cardio. And then the second one is strength, training and strength training also super important. And, and these two are the, you know, the forms of physical activity that we're most accustomed to. Know, most accustomed to, when we think about what we should be doing, you know, using the word exercise, beyond that there's also balance and there's flexibility training and, and my favorite one is called meat.

and that's an acronym that stands for non-exercise activity. Thermogenesis. I mostly shortened the thermogenesis and just call it time. and so needs is, is probably where I would say. Start to some extent with a, with a patient of mine who may be more sedentary and, and, you know, And is having, you know, his does not have a history of having been physically active for some period of time.

And what that means is just getting extra movements throughout the day. So generally speaking, it's, you know, if you have some aches and pains and those sorts of things, if you're carrying a, you know, more weight than may be comfortable, we want to be careful about, you know, joints and ligaments and tendons and not cause, you know, any type of.

You know, fiscal stress or damage with suddenly changing our behavior overnight, but we can focus on needs. We can also focus on balance and flexibility to increase, you know, increased stability, increased movement, in a, you know, in a helpful way. And so. so those are three areas that I focus on, depending on, you know, the level of ability, either a lot of incredible chair exercises that you can do that.

you know, but even just, you know, sitting, you know, standing outside yeah. The chair and getting back in the chair and doing that a certain number of times. Times throughout the day are within a Workday can be really helpful, to, you know, to strengthen some of the muscles in terms of balance and flexibility.

And it also engages a lot of our muscles is, standing on one foot and, and, and trying to see how long you can stand there and you can make a game out of it to see, you know, can I make it five seconds, 10 seconds? How many seconds can I do? Probably want to have some type of stable, like a wall or a door or something.

That's not going to move too much, you know, for, You know, to help you get started with that. And then you can start to try to let go and see how long, how long you can last, but that can really help our proprioception and engages the muscles. And it's a great way to start with patients who have an extremely low level of physical activity.

And the nice thing about knee is that okay. If we think about 24 hours in a day, And let's say the ideal person. I know that's not, a lot of us are getting eight hours of sleep. Now we've got 16 hours in the day to work with here. And, you know, even if I were a, a, a, a very active person, I would probably, if I were I, which I'm trying to be again with go to the gym and work out maybe 60 minutes.

And if I got really good at it, maybe I would do 90 minutes and I would try to incorporate strength, training cardio and some, you know, maybe some flexibility training or whatnot. You know, every day during the week. And so that's just 90 minutes and now we're left with all these other minutes. And what can we do with that?

Maybe you can't have that level of activity for more than an hour and hour and a half. The average person would, you know, probably not be able to sustain that, but needs you can do for very long period of time. And, and I think this is the activity going back to the blue zones. Across the world is really the title of activity that is, is noted to be occurring on a reproduction all daily basis, that we were just moving your body and, you know, for, you know, for hours during the day.

And so that could really help with, you know, with maintaining. Muscle mass. and, and it can also help with, with blood sugar regulation or with blood pressure regulation with, you know, maintaining energy, decreasing stress hormones, because after all we are animals and we do like to move around and, and that feels good, increases endorphin.

So there's a lot that need can do for us, even though it just feels, like a. I don't know, maybe the math, you know, category, but I think it's a really important category. And one that I focused on a lot with my patients. 

Bryan Carroll: [00:18:01] So what an example of neat be like, I'm not parking in the very front of the parking lot, maybe parking for their back and walking a little bit further to the grocery store or taking this set of stairs instead of the elevator.

Dr. Lydia C. Alexander: [00:18:13] Exactly. That's exactly what it is. It's all those little movements. like those, it's, you know, for instance, if, you know, if I'm on the phone with my, you know, my brother and my sister, my sister in law, my brother, I might just get up and pace up and down, you know, the repeatedly up and down the hallway while I'm talking to them on the phone and I've been able to get.

You know, easily 5,000 steps from a good conversation. you know, the hallway there and, and you know, over time it really makes a difference. for one of my, you know, life hacks, I would say, trying to extend, cause I know there are a lot of. You know, sedentary jobs out there. And as a physician, I do have one of those jobs.

I need to be in front of the computer, a lot charting and answering emails. And, and now as, in, in, in my new position at the time, but tech startup, I, you know, I, I spend a lot of time in front of a computer. So my mind pack is to get neat. by not only having a standup desk, but a treadmill desk.

And so we got, one of those for our place of work and, kind of all share, you know, share, using that. 

Bryan Carroll: [00:19:20] Perfect. Yeah. So there's always a little bit tweaks here and there that you can add to your environment to try and make a neat happen a little bit more often, just like the walking treadmill.

one thing you brought up multiple times is that sleep and how, You know, not very many people are getting very adequate sleep. So do you have some really good ways to help people to try and get more sleep and more restful sleep? 

Dr. Lydia C. Alexander: [00:19:42] Yeah. So, so I would say one of them would be, it would be neat.

and I, it absolutely. And then. you know, in strength training as well, there's a lot of little strength training tricks that you can do. Yeah. These exercises and, and, you know, suggestions are for, for people who have been at baseline extremely sedentary for long periods of time and, and have obesity, but, you know, marching and.

Place doing, I call it like marching, marching sit-ups, can, can, can, you know, can activate many different muscles in our body, including our core, doing wall pushups, can be, can be really, really helpful. And so when we engage different muscles in our body that way and reuse ourselves physically, it really, because it reduces some stress hormones, especially cortisol and increases the endorphins over time.

It, it can really help modulators, you know, improve, improve sleep. I would also say that's a. You know, trying to adhere a little more to, kind of like natural circadian rhythms. I know, we know that we do have, you know, early birds and later people, you know, out there and there, you know, there's some extremes, there, but for, for many people, you know, trying to, to, to keep, you know, a reproducible sleep pattern during the week and the weekends, you know, many studies will show that.

Outside of these outlier populations, the Lark and the night owl, that many people fall kind of squarely more in the middle. And, and I think for many of us we've noticed that feeling now that there's, you know, there's lights all the time. We have our computer screens. And so we don't get those same, you know, you know, outdoor nature cues.

About when, you know, when to start getting ready, you know, to wake up or go to sleep. many of us, I don't know if this has ever happened to you, but maybe around 8:00 PM at night, if you're putting the kids to bed and you kind of feel tired and you're just like, Ugh, I'm exhausted. I, you know, I'm gonna, I'm gonna crawl in to meet with the kids.

Right. I'd like to go to bed myself right now and then somewhere around. You know, maybe an hour, an hour and a half after that you get your second wind and some of your best work done from, you know, from 10:00 PM until midnight. And if you stretch it, yeah. 1:00 AM and, you know, and you might be off too, the races there for some of us.

And, but you still have to wake up for, you know, for work most likely or for kids yet again, early in the morning. Yeah. So that signal that's happening around eight. PM is actually our body's natural rhythm where it saw the sunset. well, not today, not yesterday here because of the fires, but it saw the sunset and, and in your body, your melatonin is coming up.

And so you're getting ready for bedtime. And because we're all turning on the lights, looking at our computer screens and, and whatnot, we're able to, to kind of bypass that and start all over again. 

Bryan Carroll: [00:22:35] So, if you have a sleep deficit during the week, and then you go into the weekend, can you actually play catch up on air, sleep over two days and then go back into a deficit or does that not work?

Dr. Lydia C. Alexander: [00:22:47] So that's a very interesting question that I debated with my son just last week. So who's, who's 17 and, and wanted to know, you know, could he catch up on sleep? You heard he couldn't, he was a little disappointed about that. And so, It it it's. So I guess it's kind of a tricky answer because there have been studies out there that show you can't really.

So if I'm, if I'm sleep depriving myself for, it be for weeks at a time getting six hours of sleep, I know that I'm squarely an eight hour person. I don't, you know, I, six hours is not enough for me. can I, can I catch up on all that sleep? And the answer is no, you can't really catch up on all that sleep.

It's you know, it's gone. I, and there might be some, you know, there there's some health, you know, ramifications too that, but you, but you. On some level can catch up on, on sleep, you know, over the last few days, so to speak. So I'm see, you can refresh yourself by, you know, and, and we all notice that if, you know, if the timing is right and the house is quiet, that, you know, we will get nine or 10 hours of sleep and be passed out after a hard, hard week at work or whatnot.

So, so yeah, you, you will do that to some extent, but, but not fully. And 

Bryan Carroll: [00:24:00] now you were talking about, some knee activities will help with sleep. If you are doing something that increases heart rate right before bed, is that going to spike you up and keep you awake or is it going to help you pass out 

Dr. Lydia C. Alexander: [00:24:13] for most people at that is.

Going to probably, you know, take a little bit of time for you to, you know, to, you know, to come back down to relax and, you know, and to get into a sleep routine. There's some people certainly who can do that again. There are always outliers, but for the general population, Planning physical activity, at least two or three hours away from bedtime is, is usually a good idea.

and I, when I specifically am thinking of strength training, and certainly cardio, when it comes to needs, I, I, I think again, it's a, it's a beautiful thing because you could do it any time and it's only going to make you feel, you know, feel better, right. you know, to some extent, so, you know, that taking a stroll after dinner is not only going to lower your blood sugar and maybe give you some time to reflect, which also feels great, but is, is probably going to help, help with sleep as well.

So that one would be, I would say is okay. And 

Bryan Carroll: [00:25:08] then you also, so brought up stress as a contributor to, weight gain and obesity. How can we first off, how can we regulate stress? And then that second, how can we regulate super stressful periods that come out of the blue that we aren't prepared for? Like right now?

Dr. Lydia C. Alexander: [00:25:25] so, so, you know, like the I'm going to take the ladder first and I think in some ways, the human, you know, the human condition, you know, again, we're animals, we're mammals and I, and we have certain survival instincts. And that's what the hormone had mentioned a couple of times right now, cortisol in some ways is all about.

So when there's an acute. an acute stressor and for, you know, for us here for me here, in, in Northern California, it's, it's the, you know, in addition to coronavirus, it is now the California wildfires and the air quality and, and the stress around that, not knowing when it's going to go away and, and trying to, you know, to stay indoors and stay healthy.

So these types of acute stressors and maybe, you know, . a sudden, you know, you know, you're, I don't know that you're, you're. Something catches on fire. I hate to use that one, cause I just talked about wildfires, but you know, there's some acute stressor or you need to, you know, your child, you know, falls down and, and you're, you know, you're acutely stressed out and you run over there to make sure they're okay.

and so that fight or flight mechanism is, Has been, he has been engineered to do humans for a very, very, very long time. And that type of stress is actually very, very manageable. And they've done studies in, you know, in, in, in, you know, babies in utero that have shown that this is actually a very healthy thing to have a little bit of that stress come up, come down, come up, come down, through time.

It's really the chronic stress that we're. Saying, you know, now five or six months into Corona virus, these fires have been going on for three, three weeks. And probably they're going to go on locker. I know Australia had the huge fires in January that went on for, for many, many weeks. They sort of chronic stressors like that, are very, very different because now we're percolating in our cortisol over long periods of time.

And we're, we're really not designed to do that. And so that type of stress is the stress that we, you know, that we're trying to avoid the. Acute stressors and these peaks are, you know, are, are not what does it for us, but it's the, it's the longterm effects of, of elevated cortisol levels. And, and for, and those are really the most detrimental and, and we do spend a lot of time talking with our patients around what are some ways that you can, you know, you can moderate that throughout your day.

There are a whole bunch of, apps now on, on our iPhones and that's kind of good and kind of bad because down to your back on your iPhone or your, you know, whatever is your, you know, your, your PDA device, it's like a mini computer that can help, you know, breathe. And, fizz is great for sleep and a few other ones.

But those, you know, those can be very, very helpful. you know, different habits such as journaling can be great. And, and again, I think, you know, physical activity can also play a part. 

Bryan Carroll: [00:28:15] And then, you also talked about food. You talked about, different qualities of food, around the world, especially in those blue zones.

So we know that we have easy access to processed foods and fast foods here. And a lot of people, you know, that's kind of all they know, and in a lot of communities, especially lower income, and that's what they can afford. So how can people. Start to transition from fast food processed foods and start making a change to a little bit healthier quality of food.

Dr. Lydia C. Alexander: [00:28:46] that's, that's a super interesting and complicated question, because, you know, I, you know, in an ideal world, I would say, you know, you should learn to cook and, you know, and, and source everything organically and at the farmer's market and, you know, and have a wide variety of. You know, of all the good stuff in, you know, in, in daily life, you've got maybe a family, you have work commitments, you have limited resources and certainly limited time.

How do you do all that? and, you know, the, Part of it, I think is, is planning ahead and strategizing. And so one of the things that, we're working on here at an opera house is, is putting together, they, you know, these virtual grocery tours and, and not just any old grocery store we're, we're putting together, for instance, you know, five, you know, five foods is under $4 at seven 11.

And so what can you, you know, what could you do if you're in a pinch? and you know, and you're in your seven 11 or a convenience store, what is actually, you know, a good grab and go, or a better option? because I think if we. Are going to try to solve for perfection. that might be the enemy of good enough.

So, you know, so we're trying to meet people where they are. They are, figure it out some low hanging fruit where we can make progress and, and move forward from there. So I guess that's my first piece of advice is that it's not necessary. to be perfect. I just pick one, one goal, and, and work from that sometimes it's, it can be, you know, breakfast can be maybe the simplest, you know, place to begin and to try to make some helpful changes there.

cooking. you know, and, and male planning perhaps on a Sunday and making some, you know, incorporating some, intentional repetition throughout the week and maybe, you know, warning your family that you're going to do that I can be another, another way to. to, to get some, you know, some healthy eating and they're repurposing foods.

So, you know, you might start out with a rotisserie chicken on Sunday, and it becomes, chicken fried rice on, on Monday. And whatever's left over, ends up and, you know, in your lunchbox on Tuesday, are some, some, some good ways to go about that. 

Bryan Carroll: [00:31:02] I'm so glad that you mentioned meeting someone where they are at, because I'm sure you've seen it before where, Someone gets this diet plan and it's completely opposite of what they've ever eaten in their entire life.

And that they're really excited about it, but they can't follow it because it's just so difficult to make that, that big of a change. So the fact that you're talking about, you know, it doesn't have to be perfect right out of the gate. All you need to do is make a little tiny change and change the idea around the food that they're choosing from.

In the same places that they might be going is going to get them so much further with making those dietary changes. 

Dr. Lydia C. Alexander: [00:31:41] And that I think that's probably the, you know, some of the most important advice because, you know, we're each at each one of us is our own toughest critic and w we, you know, we're very, you know, it, we tend to be very kind of, you know, self-critical and I think I.

Most people I know in may tend to fall into that category. And, and so you can end up throwing the baby out with the bath water. When, you know, when these small changes, we're actually making a big differences. And so I'd like to look at, you know, not only the physical activity and the need I mentioned, but also, food and nutrition in, in that same and that same way.

And maybe over time, it starts to become more fun. It starts to become more interesting. The more you think about it, you. May come up with your own, you know, food hacks that are going to work super, super great for you. I have one where I, you know, tend to, you know, make a, like, a quiche, but without the I'm too lazy to try to make a pie crust or even to know which one I should be buying, but I will, you know, make some type of like a frittata type thing, but I'll, I'll put it into muffin cups and, and then I'll freeze those.

So I can just pop those out and, you know, and eat them throughout the week. grab it, grab it to go there. A bunch of, you know, great options at trader Joe's that don't involve, that don't involve a lot of meal prep, like those French lentils and a few other, you know, a few other, you know, great, great, you know, great grape, parts of meals there that you can put together and, and, and use throughout the week.

Bryan Carroll: [00:33:13] Now Lydia, is there any other, kind of pillars there? Yeah, that I masked, we covered food. We covered movement sleep and stress. Was there a fifth one or was the four. 

Dr. Lydia C. Alexander: [00:33:23] Yeah. So the, so in, in obesity medicine, the, there are four major pillars and I would say with, and that kind of like a fit off shoot and was so when we treat, you know, a patient comes to see me, for instance, as there'll be city specialists, I very much do think of physical activity.

In all those five components that I mentioned, I think about, I think about nutrition and not just in terms of the macronutrients, the, you know, the ones that we all know, the protein, fat and carbohydrates, but I think of the quality of, of the food that Eaton and, and, and try to. understand and again, meet the patient where they are, because we do, you know, ultra processed foods do cause, you know, you cause metabolic imbalance and, and then the third one would be behavioral model and time.

And if, you know, when you're changing nutrition and physical activity, in a sense you are already engaged in behavioral modification so that, you know, that's definitely a component there. And behavioral modification is almost in some ways an umbrella. Around sleep around stress around all of these different factors.

And, and so that's the third pillar. And then the fourth one yeah. Is actually, medication management and, and, and so there are, you know, we call them AOMs, in our, you know, in our lingo, but, anti obesity medications, and then also weight gain medications. So, you know, there's a lot of, you know, there are a lot of blood pressure issues out there, cholesterol, depression and so forth.

And many of these medications are also associated with weight gain. some sleep medications can also be associated with weight gain, and it's not something that is, you know, Always that obvious, to, to a non physician and especially a non obesity specialist is some of the stuff we think about all the time.

And so we'll discuss medication management and into obesity medications, and then the fifth kind of offshoot, which is, you know, is surgical. And so while this isn't something that an internist I would do, but it is kind of in my toolbox that I'm thinking, when might this be a, an appropriate referral for my patient?

Perfect. 

Bryan Carroll: [00:35:26] Well, is there any final things that you want to touch on with obesity medicine before we wrap up here? 

Dr. Lydia C. Alexander: [00:35:33] let's see what I would say that, It is. I, you know, if you're considering a, you know, a career, we are in medicine, whether as a, you know, a physician or a nurse practitioner or a physician's assistant, a registered dietician, right.

That consider this field, it's an absolutely amazing, you know, amazing. Place where we reverse, diabetes. We reverse, you know, hypertension and, and I, I liken it to being started the labor and delivery of adult medicine. And I feel really fortunate to, to be working with the obesity medicine association on a national scale.

To, you know, to be able to educate and mentor, you know, to mentor others. And, and then also, you know, I teach my patients, you know, about, about this kind of health living, because when we, I always say when he treat the roots, which are obesity then, that's a better place to be than treating the fruit.

So we're not playing whack-a-mole with blood pressure and with, blood sugar, if we're treating the in sleep apnea and all the different joint issues, when we treat, toward a healthier weight, the, the improvements we see are all of across the spectrum and that's, and that's super exciting.

Bryan Carroll: [00:36:41] In the transformations that happen both for the patient and the clinician is just absolutely amazing to see that transformation happen as 

Dr. Lydia C. Alexander: [00:36:50] well. It is. It's like the labor and delivery of adult medicine specialty that I'm in. 

Bryan Carroll: [00:36:56] well, my final question for you is what do you do each day to improve your own health?

Dr. Lydia C. Alexander: [00:37:02] Well, I, I, you know, I do, I, you know, have my, my neat that I'm always trying to get in my treadmill desk, and, and so forth. other things I, I try to do is, is, is spend time, you know, with my community. And so that's my family, you know, my, my friends. And I, and try to reach out to people that way.

One of, one of, I think the, the areas that might be, you know, under, under appreciated and, and a lot of this work toward health, and, but it was seen in the blue zones again, is that these, these friendships, these, in these connections within communities, And this, this feeling of having, having a purpose there that you're, you're giving to others.

And, and then also receiving from others, I think is really important, in terms of our, of our mental health. So on a daily basis, I, I think about that and I think about what, you know, what I can do for others and, and how I fit into a community, which, which is, you know, great for mental health.

Bryan Carroll: [00:38:01] Well, people can find more about, the work that you do at obesity, medicine.org. You also have the new startup that you're at. Do you want to talk about that a little bit? 

Dr. Lydia C. Alexander: [00:38:10] Sure I'd love to. So I, so in a true Silicon Valley, you know, approach to, you know, to all things that would seem I, I joined a medical, med tech startup a couple of months ago called the Nara health and as their chief medical officer and medical director, which has been really, really exciting because we, you know, from what we discussed just now, Bryan, we take that, you know, that four pillar approach to, to managing patients.

And we do it in a way that. We are available, you know, with a very multiple, multiple multidisciplinary approach to patient care. So there's the physician that you get. There's also a group of registered dieticians. We just brought on physical therapy, which I think is an important part. you know, of, of helping people have.

Pain-free movement, especially when you are patients with obesity. We have a, a behavioral therapist who's on board too. And so there's all, you know, all of this working together. And we have an exercise physiologist as well, who works on strength training, focuses on, you know, on, on sarcopenia and, and, and reversing that and some of our older adults.

So I feel super excited to, to be helping develop an application or an app. That, that is, that is full service like that for our patients. and so there's an asynchronous and then a synchronous, you know, a physician appointment and RD appointment and all that, portion of it as well. 

Bryan Carroll: [00:39:34] Well, it sounds like you're doing amazing work and I know you are over with them, obesity, medicine stuff, and that app sounds really cool.

is that currently alive or is it still in beta? 

Dr. Lydia C. Alexander: [00:39:44] No it is, it's live it. it's a Nara health and it's a membership. it's a membership, medical group where, you know, we give this multidisciplinary, very intensive behavioral therapy approach to, to managing, to managing our patients.

We're in three different States now, Illinois, Texas. Course California. And, and, and it's growing quickly and it's, it's super exciting, but you know, our patients will see a registered dietician every single week, then, then an exercise physiologist and, and their physician. And, and I feel in.

Many ways that we sort of cracked the code for, for not only weight loss, but weight maintenance, because one of the biggest areas here is, you know, many people can lose weight, but you're dealing with physiology and metabolic dysregulation and imbalance. And so, you know, The, the name of the game is weight, weight loss, and then maintenance.

Our patients maintain, the results, for, for years and years. And, and that is really great for me to see that we're reversing, you know, we reversing their, other chronic conditions that they've had and, and keeping them healthy for many years at a time. 

Bryan Carroll: [00:40:53] Well, Lydia, you're doing great stuff and we need a lot more people like you.

So it's awesome that you're also training other practitioners to do this type of stuff as well. So thank you so much for coming on and sharing all this. 

Dr. Lydia C. Alexander: [00:41:05] It's been my absolute pleasure. 

Bryan Carroll: [00:41:07] I hope you are able to take these pillars of weight loss and apply it to yourself. If you are trying to lose weight and people working in obesity, medicine clinics, see some phenomenal transformations occur with the patients and clients they work with.

And they've learned a lot about different triggers that can stimulate weight gain. And remember, you can always go back and relisten to this episode to hear the information again, if you didn't get it the first time next week, Cynthia Kane will be joining me. So let's go learn who she is. I am here with Cynthia Kane.

Hey Cynthia, what is one unique thing about you that most people don't know? 

Cynthia: [00:41:43] Most people don't know that I lived in Madrid for about seven years and I wrote a hiking guide book while I lived out there. 

Bryan Carroll: [00:41:50] Oh, wow. What's your favorite hike? 

Cynthia: [00:41:53] My favorite hike is, in . I mean, it's just one of the hikes that's in the park there. I mean, the area is just phenomenal and we started a guiding company too. So if you go to Madrid, you can check out hiking in the community and Madrid and they still go out every weekend. It's like a little Intercom meal. It's awesome. 

Bryan Carroll: [00:42:12] That's amazing. That sounds awesome. Or w what will we be learning about in our interview together?

Cynthia: [00:42:19] Well, we'll be learning about how to be in difficult interactions and ways that, you can navigate those a little more easily. We'll learn about, how to allow other people to speak without us interrupting and learn a little bit about, how to, you know, connect with ourselves differently in these moments too.

Bryan Carroll: [00:42:43] And what are your favorite foods or nutrients that you think everyone should get more of in their diet? Mm 

Cynthia: [00:42:48] that's a good question. I think that water, even though you might not consider that a food, I think water is 

very important. also, protein and, I, I also believe T Martin liquid, I'm more of a liquid type of person. I think. 

Bryan Carroll: [00:43:05] What's your favorite tea? 

Cynthia: [00:43:07] So I'm really loving this lavender camomile tea. It's really quite delicious. And then what are your top three health tips for anyone who wants to improve their overall wellness? meditation sleep. And, being outside, walking in nature is a huge part of everything we do.

Bryan Carroll: [00:43:30] And I've noticed how hard it is for people to have open conversations with each other. You'll definitely want to listen to that episode. So until then keep climbing to the peak of your health.