Ep. 32 - LiveWell Talk On...Healthy Weight Loss
Host: Dr. Dustin Arnold, chief medical officer, UnityPoint Health - St. Luke's Hospital
Guest: Abbi LaBarge, CHWC, health coach, UnityPoint Clinic Healthy Living Clinic
Dr. Arnold: This is LiveWell Talk On...Healthy Weight Loss. I'm Dr. Dustin Arnold, chief medical officer at UnityPoint Health-St. Luke's Hospital. Fad diets come and go. Obesity is a problem. Sustainable weight loss is difficult. There are a lot of unhealthy ways to do that. At St. Luke's and UnityPoint Health, we have a comprehensive weight management program designed to help people achieve their long-term weight loss as well as maintain it. Throughout the program you are guided by a team of health professionals, including an endocrinologist, a dietitian, and a health coach. With me today to talk about this program is health coach Abbi LaBarge. Welcome.
Abbi LaBarge: Thank you for having me.
Dr. Arnold: What is a health coach?
Abbi LaBarge: So a health coach is basically a profession that gets thrown around a lot. A lot of people use it to describe themselves, but not as many people have the actual certification to be a health coach. So I'm a certified health and wellness coach through Wellcoaches. What that means is I've gone through all of the work to really learn how to talk to people in a way that keeps them motivated about themselves. It's not a health educator. I talk about it in ways, it's kind of like therapy for your physical health. It's a way to help you achieve your goals and do what you want to do without me pushing a lot of ideas onto you.
Dr. Arnold: So your training is then in, not only health and fitness, but also perhaps with some degree of psychology?
Abbi LaBarge: Absolutely. So I actually did my minor in psychology and human relations. And so that was really what drew me to the health coaching field, was it really was that middle ground between knowing the information and putting it into practice. We know that knowing it doesn't necessarily mean doing it. And so by using health coaching, it's helping people motivate themselves to actually see behavior change and do things a little bit differently than what they haven't done in the past.
Dr. Arnold: Yeah, I think a huge aspect of weight loss is behavior change. We'll talk a little bit about that, but give me the difference between a diet and a lifestyle change.
Abbi LaBarge: So a diet we typically look at as something we do for a period of time. So it's something, maybe it's 30 days, maybe it's three months, maybe it's until we hit our weight loss goal. But there's usually a start and an end point to that. It's very extreme. Typically there's rules associated with it. It's yes foods, no foods or exercise X amount of hours a day or whatever. But we're pretty good at following them, because there's an endpoint. We can pretty much do anything we set our minds to if we know that we don't have to do it forever. And so we see all these extreme ways of eating and they work. We lose weight, it's exciting and we talk about it to our friends and it kind of spreads like wildfire. But the point is, is that at some point it comes to an end. Whether that's the 30 days are up or maybe we have a really stressful day at work and then we just don't care that day. Whatever it is, some point it comes to an end and then we start to see the weight part start to creep back up. Sometimes it even goes more than maybe when we started. And that makes it very difficult for us to kind of live a healthy lifestyle because we're weight cycling and then we also have that mental component. So not only are we gaining weight, but now we feel guilty for gaining weight and we start that cycle as well. When we talk about lifestyle changes, we're talking about actually doing things differently forever. Much more difficult. Now we're not putting an end point on that. So now somebody is changing the way they're doing, they're behaving differently, they're thinking differently about food, they're making different food choices. You kind of have to not put a band-aid on the situation. You have to think, well, why is it on a long day after work do I gravitate towards the easy convenient foods? And we have to dig a little deeper and really learn about that before we can make the changes. And it's much more difficult. So people have a harder time with behavior change and lifestyle change because we don't have that endpoint. And we're actually putting a lot of more work into it.
Dr. Arnold: That's so true. And it's difficult to eat healthy. I mean, the amount of processed foods that are in front of us is just tremendous. Some of the fad diets of recent, can you talk to some of them and some of the dangers of them perhaps, some ones that you're hearing about or seeing?
Abbi LaBarge: Yeah, so there's a lot of them out there. Keto is kind of the biggest one we hear thrown around a lot. The key is, is when your body is not running the way it wants to run, it's going to have a hard time keeping up with it. And they're very extreme, like I said, so they're not conducive to living a healthy lifestyle. You can't go out with friends and enjoy yourself without focusing solely on the food. If you're, you know, watching everything that goes in your mouth, you're not able to have the enjoyment that comes from food too. I think that's a piece that we forget about, is that food is obviously needed to nourish our bodies, but that's not the only thing food does, That's how we come together.
Dr. Arnold: Absolutely, There's such a huge social component to food. You know, we used to live with my grandmother when I was young and we kind of lived at the kitchen table. You know, it was breakfast and then you went out and worked and then lunch and then you know, or dinner as we called it. And then you know, supper. And so, I mean the whole activity of the whole household was around the kitchen table. So you know that that is a component that you just can't overlook can you? I mean you have to be wise, wide open. I've said on other podcasts and I've said outside the podcast universe that there's three things you really don't want to talk to people about. And that's religion, politics and food because they're the strongly held beliefs that people are reluctant to let go of. They can tend to rationalize anything. You know, I think part of that's the Keto, that well then they can rationalize doing it, etc. What are some tools that you use to address those behavior issues? Other than being transparent about, okay this is a problem What are some other things that you use?
Abbi LaBarge: So typically when people are coming to us, they've kind of gotten to a place where they realize this isn't working. That they've tried a couple of diets, they've done the cycling, they realize that there's more to it. So when people are really ready for that lifestyle change, it really opens up a lot of doors. But getting there is hard. You have to realize that there is no magic fix. There is no pill you can take and magically everything's different. Another key piece is that, weight loss doesn't solve all your problems. We hear that a lot, that if I just lose the 10 pounds or the 15 or the 100, then I'll be happy. And so we know that's just not true. And so once people get to that point where they can understand that and realize that, that's what we can do a lot of the work of helping them understand, well, why is it that I emotionally eat what was going on in my past that led me to think that food was the only thing that I could control or not control. We hear about binge eating a lot. We hear all these different things and once someone's really ready to be vulnerable there and do the work, we can really make a lot of progress there. But usually it's a lot of talking through and helping them goal set and not over jumping on those goals either. We tend to be completely in or completely out and there's a lot of progress that can be made if we take one step at a time and start very small and work on the routines of things versus jumping all the way in very quickly.
Dr. Arnold: There is a degree of discipline with this, that's true. I always kind of laugh to myself when people say there'll be on a diet and then they'll grab a cookie and say well, I fell off my diet. I'm going to eat the eat the rest of the day. I'm going to fall off my diet now. He's like, well, okay, so if you dropped your cell phone, would you jump up and down on it? No, you would try not to drop it again and and protect it. So we tend to rationalize those behaviors that we are suppressing. Is there education about what foods are healthy and what are not? I mean, do you identify those? Like how to shop healthy?
Abbi LaBarge: Sure. Yeah, in our programs, we talk a lot about those kinds of things. We like to instead of saying good and bad food, because we don't want to say that food is good or bad. Food doesn't have morality. But the thing is is there's foods that we can eat a lot of and we can feel good about and they are nourishing our bodies. And then we have special occasion foods. And so we talk about those kinds of things and making sure that it's okay to still enjoy the food that maybe isn't healthy for us, but planning it and paying attention to portion control. And maybe it's not the thing we eat every single night. But we can still enjoy it. And so it's finding a way, what really balances for you. Because it's different for everybody. And I think that's what makes it so difficult is there's no one size fits all approach. You kind of have to just work with yourself and somebody who knows how to work with food and you, to be able to kind of find that real plan that's going to work for not just 30 days but really the rest of your life.
Dr. Arnold: And do you approach the diabetic patient differently than the non-diabetic patient?
Abbi LaBarge: So with us being in the Diabetes and Kidney Centers where we're housed, we work with endocrinologists and so Dr. Rao and Dr. Aluri, have a lot of patients obviously that have diabetes. And so they really manage those patients from medication perspective. We don't change much of what we do. That may influence the diet plan they go on initially, but not so much because none of our programs are really low carb. They're basically just balanced and we know a healthy balanced meal. Balanced of your macro-nutrients is what works for really every population.
Dr. Arnold: I hear that term and I'm not so sure that I understand macro-nutrient versus micro-nutrient. I mean from a medical level, I understand micro-deficiencies that occur with malabsorption, etc. But from your field of work, what is a macro-nutrient? What is a micro-nutrient?
Abbi LaBarge: Sure, so a macro-nutrient are kind of our three big things that make up every food that we eat. So we have our protein, our grain and our fat. And then our micro-nutrients are basically all of those things, then we add in things like the water and our vitamins and minerals and all that stuff. So when we're talking about food and what it's made up of, we're really talking about our macro-nutrients. So a lot of the diets that we hear about those fad diets are going to be different makeups and different percentages of your macro nutrition. So we hear high protein or high carb, low carb, high fat, low fat, those things get tossed around a lot. Basically what we know is your body needs carbs to run. Your brain only functions with carbohydrates.
Dr. Arnold: Glucose and oxygen are the two things your brain needs.
Abbi LaBarge: Exactly, you need them. So you have to have more carbs than you do anything else. And so when you go really low carb, like these fad diets, you have a hard time thinking. You can't think straight, you don't feel good. So your body needs carbohydrates. It still needs protein, but not really in the quantity that we think we do. We don't need quite as much as what the, especially in Iowa, what we tend to eat when it comes to protein sources. And then also your body needs fat. You can't go without any fat. You need some fat. But that balance there is making sure you have a little bit more carbohydrate than you do protein, a little bit more protein than you do fat, but your body needs all three to function.
Dr. Arnold: That's a great explanation of that. When do you recommend the bariatric surgery? The surgery for obesity.
Abbi LaBarge: So there are the exact BMI cutoffs and your doctor can really talk to you more about those exact cutoffs. But typically we use it as a way, if you're really struggling. So we really encourage people to try real lifestyle change first. Sometimes it can seem like a really appealing way to go because it seems easier than putting the work in and that's just not true. It takes just as much work and it's probably even harder in the long run. But sometimes it's a really good option for people. If somebody has been struggling with weight all their lives and they've really put the work in. They've tried the lifestyle changes, they've tried the meal replacement programs, they've done it all and they're just not finding success that it's really time to talk about that route and see what that looks like for you.
Dr. Arnold: You mentioned there, meal replacement program. Can you describe in more detail?
Abbi LaBarge: Yeah, so that's one of the programs that we offer at the Diabetes and Kidney Center and so that is a program that's 24 weeks long. We use a meal replacement product, it's called Health One. It's like a medically balanced and very complete meal replacement, meaning it has everything your body needs in that packet. We start people off on five to six packets a day, which is 800 to 950 calories. What's nice about that is, it's very low in calorie, but it's getting all the nutrition you need. So you know, if you tried to do that with real food it'd be almost impossible. Which is what's nice about the meal placements. Ours specifically is not just a liquid diet. That's a very common thing we hear. We're like, I can't just live on liquids for 10/11 weeks and we agree, we don't want you to. So you can actually cook with our product. So you can bake it into lots of different things we have five flavors. So we have vanilla, chocolate, strawberry, potato and pancake. Obviously you don't want a potato or a pancake shake. So that gives you opportunity to have those savory things as well and have the crunch and the warmth from food and people really like it. Especially people who have really struggled with food. A common thing I hear is, it's an addiction just like any other addiction, but you can't just not eat, you can't just stop eating like you can with other addictions.
Dr. Arnold: Right. That's a good point. It's a balance.
Abbi LaBarge: Right, meal replacements really give you the opportunity to do that. You can really go without food for a little bit and reset your palate. And people like fruits and vegetables but maybe you've never had them before because you really reset your palate by doing the meal replacements.
Dr. Arnold: What about intermittent fasting. I hear a lot about that. Some of the literature I've read is actually related to athletic performance that I remember when we used to wrestle. We'd load up on carbs the night before. I mean it's easy for a 14 or 15 year old to do that, but that might not have been the best idea. What do you know about intermittent fasting?
Abbi LaBarge: Yeah, so we do some of that in our clinic. Our other program, which is New Directions, that one is all grocery based. So we play around with a lot of different things and intermittent fasting is one of them. There's kind of two different ways to do it. And I will say I'm not a dietitian so this isn't my realm, but we do work with it in the clinic. We do it kind of two different ways where either you are focusing on the hours of day you're eating and not eating. Or you do it based on the days of the week that you eat a lower calorie amount, so maybe twice a week you go down a thousand calories and maybe the other days you're up a little bit higher. Either way it's basically cycling that. It keeps your body guessing. It keeps it a little bit different. So we do see weight loss happen. The key with all of that is just you have to do what works for you. If you try it and it's not working and you're miserable, don't do it. Figure out something else. But some people have success with it.
Dr. Arnold: Yeah. I've always told patients the first thing they need to do is like themselves and not feel guilty about this because that's horrible for the patient to go through life with this sense of guilt and failure, particularly with diets. Now with your training, your background and the exercise component, what would you recommend for exercise? Just for the non-athlete?
Abbi LaBarge: Sure. So the ACSM is kind of the gold standard. That's where we go to for those. And basically what that says is you want to get active at least five days a week. You want to get in at least three days of some cardiovascular training. So getting that heart rate going and at least two days of a full body resistance training. You don't need to be a bodybuilder. You don't need to be going crazy or doing anything that's gonna hurt you in the gym. But just to get your muscles working and get that heart rate up there is really what's recommended. We can also can't forget about stretching. That's a common thing that we just kind of throw to the side. But really stretching is going to be a key as well. And making sure we're doing that after our workouts, not before. So we can really get the most bang for our buck with our stretching.
Dr. Arnold: And you would also recommend that they're evaluated their physician prior to starting an exercise program?
Abbi LaBarge: Absolutely.
Dr. Arnold: That's kind of just straight forward. How do you get referred to the clinic? Do you get a referral from a family practice, a primary care physician?
Abbi LaBarge: So you can, any provider can refer you to us, but we don't need a referral. So it's actually, we have information sessions that are held weekly. And so by coming to an information session that gets you in the door. So anybody who comes to an information session and can see one of our endocrinologists for weight loss and that gets the ball rolling. So at that point you've known, we really educate you in all of our programs and get to the nitty gritty details of everything. And then you'd see one of our providers and they would help you make the decision on what program was going to be best for you. Then you would see myself or our dietitian, Meg, for your orientation and then we just jump into a program in both of our programs are 24 weeks long and so it's really six months commitment in this process.
Dr. Arnold: And you've seen good success?
Abbi LaBarge: Absolutely. Yeah, we have great success. We have people who lose a hundred pounds in 24 weeks. We have people who lose 30 pounds. But it's all just based on where you're at and what your comfort level is and how much you have to lose. Really what you're looking for at the end of this.
Dr. Arnold: That's really great information today. Thank you so much for taking time to talk about this. Again, that was coach Abbi LaBarge from UnityPoint Clinic Diabetes Kidney Center, healthy living clinic. For more information, visit unitypoint.org. If you have a topic you'd like to suggest for our LiveWell Talk On podcast, shoot us an email at firstname.lastname@example.org and we encourage you to tell your family, friends, neighbors about our podcast. Until next time, be well.