Today on the podcast Melissa interviews Dr. Maggie Landes – board-certified physician, public health nutritionist, and anti-diet wellness expert who specializes in educating health professionals and their patients about the Health at Every Size model of care. Through her Pro2Pro services, Maggie supports other health professionals to participate in, and promote, a weight-inclusive approach to their clinical practice.
Which is why she was the *perfect* person to ask: what would it take for doctors to stop focusing on weight?
- Maggie’s “a-ha” moment that moved her toward the Health at Every Size practice
- What doctors are learn (and don’t learn) about nutrition and weight during their medical training
- The harms of medical weight stigma, and how to protect yourself as a patient
- How grassroots and top-down efforts can work to change access to weight inclusive health care
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Follow Dr. Maggie Landes on Instagram, Facebook, and LinkedIn: @maggielandesmd
Melissa’s free guide: How to talk to your doctor about Health at Every Size
Join the Break the Diet Cycle Podcast Community in Instagram: @break.the.diet.pod
Connect with Melissa on Instagram: @no.more.guilt
This episode was sponsored by No More Guilt with Melissa Landry. Reminder that though we are dietitians, we’re not *YOUR* dietitian. Podcasts don’t constitute treatment. If you have concerns about your dieting behaviors, seek out guidance from a medical or mental health professional. And if you’re looking for the process, support, and focus you need to live life without food guilt apply for a coaching program from today’s sponsor. No More Guilt with Melissa Landry is currently enrolling clients into 1:1 programs, group programs, and, recently added a do-it-yourself learning format: the Ex-Dieter’s Guide to No More Guilt.
what would it take for doctors to stop focusing on weight? transcript
Melissa Landry 0:02 Hi there, I'm Melissa, a registered dietitian specialize in intuitive eating for on again off again, chronic dieters, and I'm here to help you take the guilt and stress out of eating so you can be the first in your family to break the diet cycle. I'm interested in helping you unlearn generational diet trauma, so you can be who you are without food guilt. Be sure to follow on Instagram at no more guilt for more support between these episodes. Are you ready? Let's jump in. Before we dive in on this episode, I want to tell you some great news it made me so happy to see the waitlist for the gentle nutrition intensive grow these past week. My podcast community is very special. You guys are with me every week doing the hard work trying to understand your generational diet responses and how to make the most of them. And so to offer you this very special, small group to this community, it means the world to me. And we are actually going to open the doors to this program this week, on Wednesday, November 16 2022. If you are on the waitlist, you are going to get an email from me inviting you to join this exclusive offer. I'm going to keep it open until Black Friday, which is the 25th of November. So you'll have a little over a week to take a look at this intensive six week small group program that we're going to be starting in the new year. And because you are my most very special community, I'm throwing in two bonuses with the general nutrition intensive. One of them is the full access to my course the Ex-dieters guide to no more guilt. So alongside your group meetings with me and other members, you're going to have a chance to learn deep dive skills from the intuitive eating frameworks Health at Every Size and other tricks I've learned along the way to help heal your relationship with food bonus number two is going to be three months of access to the no more guilt community. That means while you're in your group calls, and after the fact, you're going to have my support through monthly office hours, monthly community meetups and a message board where you can ask questions of me and other members 24/7. This offer is one of my favorites to open up when I can alongside my typical one to one work. So if you've been following along and you are interested in learning more about this offer while it is here, click the link in the show notes. Put your name on the waitlist and watch out for an email on Wednesday. I can't wait to invite you and hopefully see you in our small group in January. Here's Dr. Maggie Landes is talking about why it is that our doctors can't seem to get on board with Health at Every Size. Hey, Maggie, how you doing today? Maggie 2:59 I'm good. Thank you for having me. Melissa Landry 3:01 Before we met for this recording, I told you you are one of the only medical doctors I see in the space, speaking out about Health at Every Size and really approaching your medical care and your self care from that lens. I'm really looking forward to your perspective today. Maggie 3:17 Well, thank you. I wish there wasn't I wish I wasn't in such a minority. But it still is. And that's that's part of my mission is to really help healthcare providers, specifically doctors to understand that they can change how they've maybe practiced forever up till this point. Melissa Landry 3:31 But why are their medical doctors missing from this conversation? I don't think that's a taboo thing. I think there are a lot of forces at play that make it difficult for providers to choose this work. So how do you feel about diving in on that conversation to that, Maggie 3:44 let's get to it. That's what I love talking about. Melissa Landry 3:46 He's like metaphorically rolling her sleeves, right Maggie 3:48 and rolling the sleeves up, Melissa Landry 3:50 let's get to know you a little bit better. Tell us a little bit about your background as a medical doctor and what ultimately led you to Health at Every Size, then we can talk more about big picture stuff. Maggie 4:00 Right? Well, so as many medical doctors or dieticians or other professionals that work in this space, we didn't start here that goes without saying that most of us have had to transition at some point in our careers because this this inclusive weight inclusive practice is not the model that we are taught. So I was just like everybody else. I've been a physician for 20 years, 15 years, I practiced in a weight centered, very diet, culture influenced way of practice because that's what I was taught. That's what I believed personally, that's what I just like you don't ever stop to question to be honest, when everybody is telling you this is what you do. You don't even stop to like think twice. I mean, there's just simply not the bandwidth and the time to scrutinize every single thing you're being told. So the professor with the white hair in the bow ties in the front of the lecture hall in medical school, and he says if you're overweight, you're gonna get diabetes, you just sort of like say okay, and you write it in your notebook and you keep going because there's not the luxury of like questioning everything and particularly if the information you're learning is consistent with what you already know. Like, quote, no, because you know, everybody knows. If it's consistent with your own personal belief system, you don't question it, you just keep going, going going. So here's where I transitioned. And this is probably the worst and best thing that happened to me. But I got cancer two months after my 40th birthday, which was at this point, almost six years ago, and I decided almost being dead was bad. And I needed to, in my recovery, find, quote, the perfect human diet so that I don't die. Because I was just like, obsessed with like, I'm not going to have anything that I could have prevented happened to me. And this is you have to remember this from my like, diet culture brain right now, I've already I mean, I'm 40. Like, I was 40. I'm not 40 anymore, but I had tried every diet that was has been in public between 1988 and current time. So it's not as if I really thought I was going to discover something different. But I decided I was going to do like a kind of like a more deep dive into the actual literature, instead of just reading the headlines and reading whatever pop information, I was like, Okay, I'm pulling articles, like, I'm actually gonna read about the science of weight loss, and the science of diet and all this sort of stuff. And I realized, actually, really quickly, there's nothing this doesn't hold any water. You're like, wait a second, this study that was supposed to be this landmark study truncates, its data collection at six months, and you're just like, whoa, wait a second, the whole infrastructure of what I believe just fell apart. And then I started I don't even know how I who the first kind of point of contact was, but I started realizing, wow, there's actually a whole world of this weight inclusive weight neutral practice, intuitive eating Health at Every Size, all these terms and people that advocate for that and teach on that. And the science. That's, I mean, I was sold on the science because I'm like, I'm just sort of a cynic. Like, you have to kind of prove it to me, right. But there's good science to support this. This is not just like, oh, well, we like feel bad for fat people. So we need to be nicer. It's not that at all. I mean, yes, we should be nicer. But that's that's true, too. But that's not that's not what sells me on the practice of medicine in this way. So so I just totally changed. I mean, just totally changed. I personally quit dieting. That was the last time I ever did. Actually, I just said I'm done. This is crazy. And now when you're in this space, I'm sure you feel the same way you can't unsee everything around you it is once you're aware, then you realize, oh wow, this is infiltrating every aspect of our culture, including the practice of medicine, it's okay to change. I mean, that's if there's anybody listening to this who's a doctor or you know, healthcare professional, it's okay to change our understanding of things, both personally and as a collective group evolves over time. I mean, the stuff that you learn in training as you go 10,20, 30, 50 years into your career, we had no like, you wouldn't go have surgery and some guys like I've got this great piece of surgical equipment from 1960 Yeah, you wouldn't like consent to that right? For some reason nutrition science, we have this mental blockage thinking that it can never change that some guy wrote a paper in 1950 that says, if you eat cholesterol, you'll have a heart attack and die like and then we just hang on to this with this like sort of biblical truth kind of conviction and but everything else is okay we understand new drugs come out new surgical procedures come out new antibiotics come out new we discover new viruses like that isn't the health models have evolved? Yeah, and see, that doesn't throw anybody off. We all kind of accept that, like, we need to update our practice in all these other ways. But then when it comes to food and eating and weight, we are hanging our hat on these totally antiquated ideas. There's a lot of reasons it's a problem. But that's that's how I came to this space. So I am like, you know, five to six years like into this work with a very long history of diet culture, practice personal, you know, disordered eating and dieting. I fortunately escaped the grips of a full on eating disorder. But I could have easily because I was all in the diet bus. You know, we left the station in 19, probably 88. Melissa Landry 9:04 And up, she went off, Maggie 9:06 she went into the yonder. Yes. Melissa Landry 9:10 It's so interesting to think about your personal experience. And it sounds like that time of the cancer diagnosis was a real catalyst. Maggie 9:17 Well, yeah. Because let me tell you, what if I wouldn't have had that, sort of like, forced break in things, I probably would have never even considered twice what I was doing either personally or professionally and I probably to this day would still be somewhere handing up food pyramid and buying keto strips and who knows what other crazy stuff I would be doing because I just there wasn't, there wouldn't have been any kind of impetus to change. So I would like to have people understand that it's okay to change. It's safe to learn new things. And in fact, it may end up actually being better personally and professionally. If you can figure that out without having to go through the experience of cancer then that's like a you know, When even better, even better, a little more and more It's becoming creeping into the mainstream this conversation about eating disorders and disordered behavior with this and body image and inclusion and diversity and determinants of health. It's certainly not the mainstream conversation, but it's at least a conversation happening. The problem is, once you start hearing about this, now you're accountable as like a physician, you know, you can't, even if you're not the one who's diving in first, like, once you see it, you can't pretend like you didn't see it or ignore it, then that, to me, is really negligent practice. And I use the word negligent, not casually, if you know, you're harming people, or it potentially could harm people and you're doing it anyway, that's not good practice. You really have to be held to a higher standard, because let me tell you, what the layperson, the non medical person who's your patient, they don't have a clue. Okay, they don't have that. And they cannot be held to the standard of knowing what's good science. And what if this is, you know, statistically significant trials is a clinically meaningful outcome. They're not really there seriously, they're getting their health information from Instagram and headline news, you know, like, we have to be the link between a person making a decision, standing in a grocery store with a shopping cart, we're responsible for that connection. That's, to me, that's like one of the major parts of practicing medicine is vetting the scientific information and handing it over to the patient in a way that they can consume. And then they get to make decisions, they still have autonomy over their decisions, but you're the one that allows them to make a well informed decision because they may not be able to parse through all that information on their own. I know you asked what's trapping doctors in this weight centered way of practice, the training teaches a model of weight management and weight being a primary modifiable risk factor. I don't think it's modifiable or particularly risk factor for most things that we're talking about. But that's just what you're taught. And then the system is really broken. If you get in with or even for a physical like, annual physical with the primary care physician, if you have 15 minutes with the direct contact with the provider, that's a that's a, you're pretty lucky. Most people don't even have that much. I mean, heck, we've talked longer than that already on this recording. So it's the point of like it in that time, they have to talk about all the things not just nutrition and weight, or whatever they're talking about the path of least resistance is to go with the flow. Melissa Landry 12:42 You know, they, I think out of training and protocol, they say, Do you have any questions about your care, and I get to always see a provider's face change. I'm like, actually, and they're like, Oh, God, is this a thing? Like, please, like, please do. I remember, someone had prescribed me an oral antibiotic? And I was like, Can I just we just talk about the pros and cons. And just like, for Christ's sake, please, like, I totally want to see like, just take the freakin pill. You know, she eventually talked to me, and we made a decision together about it. But it was, it was interesting to see that and feel that tension in her that she had to go, Maggie 13:12 it's, it's very labor intensive to because your patients are coming in with a weight centered way of thinking to Okay, most of them in practice, you would have to transition yourself and then do the work of trying to transform the patient's belief systems. And that is not happening in seven and a half minutes. All right. This is such a mess. I came totally unglued last week when the FDA said they're going to put more labels on foods and put them on the front of the package instead of the back of the package. The reason that people are confused, and apathetic and inactive in terms of health management is not because of lack of information. Okay, that is not the primary problem. There is not a problem that people saying like, Oh, I've never heard of diabetes. Oh, I had no idea that fast food had fat in it. I mean, nobody's saying that. No, there. It's not because we don't know it is because we have people that aren't making a living wage. We have lots of determinants of health, we have inaccessible health care, we have all I mean, there's 1000s of problems contributing to these health outcomes. And weight stigma is on that list, by the way, too, and changing the label on the box of Oreos from the back to the front. That's not the problem, folks, that's not the problem. Melissa Landry 14:31 Health has historically used guilt and fear as a tactic to, quote manage the obesity epidemic, which again in a whole other podcast, how that reopening. And ultimately you're right, that is adding more guilt and fear. It's this big level of guilt and fear that's trickling down in these doctor's appointments. The doctors are using those techniques with their patients and the patients are using these techniques on themselves and it's you The culture is ultimately flawed and how we talk about health. Maggie 15:03 Okay, well, let's take a humongous step back because I want to make this point because I do get some doctors that kind of say like, Well, what about this? Well, what about that, you know, and they really, really, really believe weight loss helps health outcomes. Okay, for just a moment, let's play that side of the coin. Okay, let's say there was a health benefit to intentional weight loss. Okay, I don't personally believe there is. But let's just say because that's why all these doctors are saying, guess what, in the last 40 years that you have been telling people to lose weight, they're not even losing weight, your methodology of telling them to lose weight, assuming that that leads to good health outcomes, whether or not that last part is true is actually irrelevant, because, in fact, the more we tell people to lose weight, they're losing less weight, the mean BMI of the American population, it's just going up in this like super tiny ramp. And then 1977, when the first dietary guidelines came out, and that was the first time in history that the American government basically said, this is the correct, correct way to eat, and all Americans should eat this way, within the next five to 10 years, that slope of that curve, skyrocketed. Telling people to lose weight, in fact, makes them gain weight. And there's nothing wrong with gaining weight. But what I'm saying is that if we're recommending to do something that's causing the direct opposite relationship, that's like saying, Hey, you have high blood pressure, I'm going to give you this medicine to lower your blood pressure, and then I give you the medicine and it makes your blood pressure go up. And then I keep you on the medicine and prescribe you refills. That last little bitty link whether or not because it is it is a lot to make a doctor a believer that really maybe weight is not even impacting these health outcomes very much at all or at all. We can even lay that to the side, because the more proximal conversation is telling people to lose weight doesn't even make them lose weight, even if that's what you think they should be doing. It's not working, because it's not supposed to work. Because that's not how biology works. That's not how the human body works. And brains. Yeah, and we're kind of like pouring a lot of resources, you know, time resources, manpower, resources, brainpower, resources, like money into a model of care, that actually doesn't benefit. Anybody. It doesn't benefit, the patient doesn't benefit, the provider doesn't benefit the community at large doesn't. So could we just do something else? Like that's just like the most simple basic question, but there's a lot of resistance to change, because we have, quote, always done this other way. And, quote, everybody knows, well, no, I'm sorry, we need to stop basing our standard of care practices on something that quote, everybody knows when there's actually no science to show that, who's everybody and what do they know, stop telling people to that weight loss will fix every problem that they have in their entire lives. Melissa Landry 18:11 For right now, there is a lot of grassroots work that has to happen at the visit level, patient self advocacy, sometimes you can get providers who can support you and advocate for you finding a provider that is Hayes aligned, those are some steps you can take are within your power, but you can't always control the outcome of that conversation or right how it's going to be perceived. And so that's a helpful tip for anyone who's, you know, maybe has a doctor, they can't find another doctor, that happens for a lot of my clients, where they maybe are in between medical providers, it has been helpful for them to focus more on the conversation of this has not worked historically for me. And there's evidence to show it may there is that that backs up, but it's backed up by the evidence, and how can we move forward knowing that information instead of trying to get them to understand the larger philosophical? No, it's not. Maggie 19:02 It's a big job to know. And it's especially if you're in a large body and experiencing weight stigma in your care. It's not your responsibility to retrain the health professionals but you have to be prepared personally, to navigate this environment, the chance of you like going online and finding a HAES aligned medical doctor that's in your area that's taking new patients that takes insurance that you can see that like if you can find all that you don't even need to listen to this podcast, you're done. Right. But the the the luxury of that is is going to be a very limited group of people that can experience that most people don't have that level of flexibility and who they see and when where they are and stuff like that. I see my advocacy work as twofold. One is I want to help doctors and other health professionals understand how to change and why this benefits their practice. While that's happening, I want people to go to the doctor tomorrow, next week and have some some tools to stay in healthcare. Because let me tell you what the worst thing is to go and have such a awful experience with a doctor that not only do you not go back to that doctor, you don't go back to any doctor at all. And you just leave the system and that's a surefire way for something small to just run off the rails and become terrible. No healthcare is worse than basically almost any healthcare. There is not a single disease condition in human medicine that only fat people get. Not one, not one, not diabetes, not sleep apnea, not arthritis, not PCOS, not heart attacks, whatever you want to name, but it gets pinned on your size. There are people in thin bodies, there are young people, there are white people, there are whatever all sorts of people that have every single one of those conditions. If a thin person goes to the doctor and has diabetes, the doctor does not just stand there and stare at them didn't say, shoot, I have no idea. I have no idea what to do. I'm the only thing I know about diabetes is for fat people. And I have no idea and you're thin and I don't know. Yeah, no, like exactly. There is treatments and interventions besides weight loss, discounting whether you even think weight loss helps those things. That's not the only thing for any patient. So when the doctors tell me like, well, if I don't tell my diabetics to lose weight, what am I supposed to tell them? And I said, literally, is that the only thing you're telling them? Like there's no other instrument? And they're like, Well, no, I told them that they should move their body and they should drink water, and they should sleep and manage their stress. And they should do this and that, okay, okay, then all those things on that list are fair to discuss except for the weight loss, just like basically, if you had like a list and you're writing it on a paper, you just like strike that top one out. That's it, there's plenty to discuss. Melissa Landry 21:56 And the reality of weight loss is this again, let's take that hat for a second. We do this on the podcast sometimes, like let's pretend we believe it, that weight loss will cure the thing or improve the thing. The gold standard research says safe weight loss is happening at a super super, super slow rate, right? It would take you sometimes weeks to months to accomplish what it is that they're asking you to do. And we don't see the weight loss continuing past five or 10% that is in the most successful averages kind of a thing. So even if you were to pursue it, many doctors would not be satisfied with that outcome from the perspective of like, quote, losing weight because your BMI maybe stayed within the quote obese range through that experience. Even if that were true, you deserve health care today, you don't need to wait for that weight loss to occur to get the health care. And it does not last and it does not treat the problem. Okay, let's play this out. I pursue the weight loss that my months before I get treatment for this thing that's happening right now. And that doesn't make any sense either to me, Maggie 23:01 yeah, no, it doesn't. And then the only fallacies that the phrase that like just burns me up is this when the weight weight is a modifiable risk factor. I don't think it's directly a risk factor. And I don't think it's directly modifiable. It's not an activity. It's not a thing you do you don't do air quotes. Your weight. It's a noun. It's not a verb. I say that often. So now it's not a verb. And I people that Oh, yes, you do. I lost all my weight. Okay, how did you do that? Did you just sit here and say I'm going to lose weight? Well, no, I started doing this and I quit going to restaurants and Okay, okay. Okay. Now those things you just said those are actual action verbs, if you can incorporate more vegetables into your, you know, regular eating plan, and you have access to them, and you know how to cook them, and you have a way to refrigerate them and you like them, and your family will eat them and you can afford them. That's probably not a bad thing to do. You know, but it doesn't mean that it's going to even change your weight. There's lots lots of good science, about blood sugar regulation and diabetes, that movement helps insulin sensitivity, Melissa Landry 24:08 We can name biological reason why that's the thing that's sometimes interesting about these behavior based things, we have a biological theory for how that is happening. Maggie 24:17 The doctors are linking the behavior to weight loss to the outcome. So they say you need to start walking more, okay, let's say you have diabetes, you have diabetes, you need to start moving your body more so you'll lose weight, so your blood sugar is maintained. The problem is that's not the right order of events. So what happens the patient says, okay, yes, yes, sir. Doctor, okay. Then they go, they start exercising, they do not lose weight. And they say, Well, I can't do this. But actually, the movement helps your blood sugar regulation, even if your body does not change one ounce of weight. And so the problem is when we have told them that the outcome his weight loss. And that is not achievable, they don't think any of the benefit is going to be present because there's no weight loss. But that's actually not true. So then they get frustrated and they beat themselves up and I can't do this and I'm such a failure, then they do nothing, then they say, Well forget it, I'm not going to get up early and go walk. And when they had an opportunity to do a health promoting behavior, but they were told the wrong outcome, it's damaging to link weight loss to these, quote, good outcomes that we want. Because it doesn't matter if you lose weight, gain weight stay the same way that's kind of like just has no relevance at that point. Melissa Landry 25:38 In a weight stigmatizing environment to like clients, this is a thing, we want to go back to our doctor and have them say, I'm really pleased with the work you did. I'm really pleased to see you making an effort here, I see you working toward this outcome that we came together. And that gets lost also, when weight loss is on the table where even if doctors and I have a client who's like, Well, my doctor is not rude about it. I'm like, right. But there, there is an absence, absence of positive affirmation on your behaviors, that is missing in this relationship. And that can be really hard on people too. When you know, the when the metrics the weight and the wait doesn't move, even if they say, well, at least you got some movement. It's a weird pat on the back to people where they Yeah, it's so weird, recorded and seen. Because it is really hard to wake up that early morning and take the walk like our lives are freaking complicated. And we're getting old and creaky and tired. And taking a walk is a big heart ordeal. Maggie 26:30 Yeah, yeah, the thing is that and your client, goes back to the doctor and sort of just like deals with the fact that the doctor is not exactly supportive. But a lot of people, that's enough for them to be like, totally turned off like, well, forget it, whatever I'm not, if I can't, you know, they told me to lose however many pounds and I'm supposed to see him in six months. And then five months goes by you're making your appointment, you haven't lost the weight that they told you. And so you just kind of either don't go at all or you like kick the can down the road a little bit and like, Okay, well, we'll wait a few more months, maybe I'll finally quote get in shape or whatever, then you're not getting health care, then you're not getting your agency check. You're not getting your blood pressure check. You're not I mean, like, like I said before, no health care is the worst form of health care. So we've we, as the doctors are the drivers of if patients come back or not to us or to any other of our colleagues, we're doing a big disservice to the delivery of our health care. Melissa Landry 27:29 We've talked about training as one opportunity that could improve skills of of doctors, what do you think, would support a more weight inclusive experience for patients, let's say at the PCP level, we can kind of hone in right there. What would help the PCP environment feel more weight inclusive? Maggie 27:50 We don't ask the right questions. I mean, that's another this would be a simple thing to do. Like we're talking zero cost zero training, you should not tell a person to restrict their diet, if you haven't even asked what their diet is. Okay, because I've heard that a million times people say, you need to cut carbs. And you're talking directly to somebody who's got an eating disorder that you don't even you don't even asked about and you are giving them you're telling them to cut back or telling somebody that you obviously need to exercise more and it because maybe they're in a large body. What if they already are over exercising and they've lost their menstrual period? And they're like, if you don't ask, what is the current state, it is unfair to give advice. No matter what the advice is. That's easy. It's not being done. My own daughter she's in high school. She had to go get a school physical for her. She does competitive dance. Okay, so we're talking a teenage white, middle class girl in competitive dance in high school, 14 years old. They did not ask one question at this physical which the physical was for the purpose of dance, okay, I didn't take her in for a sore throat. I took her in for a physical for dance. Not one question about body image. Not one question about eating disorders, not one question about dieting, purging over exercising laxatives nothing, not one question. So how are we going? If we're not even asking the individual who is like the textbook, red flag waving, pre eating disorder risk patient? We're certainly not asking the middle age, fat man or whatever. Melissa Landry 29:28 We're not going to non-stereotypical presentations, which we know exactly. Eating disorders are not bound to the Maggie 29:34 you know, and that's the majority. The majority of patients with eating disorders are not in thin white teenage girl bodies, most of them are not. The fix is to ask the fix is to ask good questions. Honestly, that's a good practice of medicine anyway, is you don't need a bunch of excess tests and things if you just asked good questions. We've got to start there. We've got to start there. And then the other One thing that will help this is if, as a culture, all of us health professionals and non professionals, most of them are dieting, restricting, exercising, Melissa Landry 30:11 following data to tell you what they're doing. How many clients have told me they're just like, Oh, my doctor told me they were on keto. And now they're proportioned promoting this as Yeah, so do Maggie 30:21 belief, our personal beliefs influenced the way we practice medicine, our personal life experience colors, the way we practice, we try to be objective and try to not let that creep in. But it just we're humans. We're influenced by the same stuff. We're doctors. Yes, we're doctors. But guess what we shop at the same grocery stores you we have to go buy the same clothes, we watch the same internet, we do the same. Like we're hearing all the same stuff. We have the same issues with our own food and body and eating and particularly right now, these people that are sort of like I would say mid career to late career physicians, these are the people that grew up in the 70s and 80s. That were like the, you know, got the head start on the biggest surge of diet culture influence that America has ever endured, like starting in probably the 70s with the dietary guidelines. That has been our life. Okay, that has been our whole life. We all lived through the 80s and did drink the SlimFast and did the ThighMaster and the Jazzercise not we like so we're trying to unpack a lot of stuff. And we also have to keep in mind like, okay, so what if the doctor does keto and has normal blood pressure and whatever? Guess what that doctor also has certainly a lot of other factors in their life that influence the outcome of their own health. Okay, if you're practicing medicine, you are already in a privileged group of people, okay, you have an education, you have an income, like, regardless of all the other things like N equals one, like something happened for one person doesn't mean that like Melissa Landry 31:58 testimony, it's not science, that is no one case study. Maggie 32:03 Yeah, that no, we don't believe that stuff. I mean, you can associate anything, you can be like, I ate a banana yesterday. And then today, I have a migraine. So bananas must cause migraines. Melissa Landry 32:13 Zodiac zodiac, people don't come for me, my husband, I believe I'm a Leo through and through my husband Read me a horoscope of like, a Sagittarius. And I'm like, Oh, my God, yes, that is me. He's like, it's Sagittarius. I'm like, don't do that. But it's like we can we can make connections anywhere where Maggie 32:27 you can. Yeah. And if you want to believe that about yourself, that's fine. But we all have body autonomy, including doctors and you are allowed to diet or eat keto or whatever. When you're wearing a white coat and telling other people about it, you are held to a different standard 100%. And that's, that's where we come derailed pretty quick. Melissa Landry 32:51 Who do you believe are the people that could have the most impact on this? You know, I think folks like ourselves. And there are other people in our community, private practitioners who do that advocacy work and make effort. But it's also difficult. I'll say for myself, like I run a private practice. I see clients all day, you don't always have the clout to knock on someone's door and say, Hello, can I teach you about something you don't want to write? Who do you see that as the agents of change? Maybe not immediately, but over time? Is it the American Medical Association? Is it more local than that? What would be some of those agency or groups you think that could actually start to? Maggie 33:27 Well, you know, I think it's going to come from both ends, I think it's going to be the tippy top Department of Health and Human Services, the FDA, the top policymakers, when they set standards of practice, that stuff trickles down. And that immediately becomes how third party payers request practice to be in medical records to be that's how we treat people in the military that haven't there's just like, the tippy, tippy top, a lot, a lot of that rolls downstream. You know, so I think people at the big huge policy level understanding some of these basic things would help. Also, we need to work from the bottom up and start with the trainees and the students, the medical students, the medical trainees, the dietitian to be people the physical therapy I mean, this doesn't Melissa Landry 34:14 die out. I'm yeah, like who can I precept who can I teach? I would love to get into a university and teach Maggie like, hell yes. Is there something Maggie 34:23 that because those are the people that are going to practice for the next 50 years? Now? Does a first year medical student have the clout to really like shake the tree today? No. But if we those are sometimes easier places to insert ourselves and these are people that still have a you know, elastic type of belief system about the practice of medicine, we can change the culture from the ground up, and then it will get easier as those people come into positions of authority and become leaders and stuff like that. Yeah, it's it's really hard. For example, for a cardiologist in practice Who is a, you know, paying member of the cardiology society, whatever, and the American Heart Association and the this that and they go to all these meetings and this is like who tells publishes the journals and stuff, telling them, your patients need to lose weight your patient who's like patient lose weight, and then, you know, they listen to you and me and read a few things and listen to podcast, like for them to change their practice is extremely hard. Okay. It doesn't mean that it's not right. I, there are many hard decisions that are the right thing to do. But sometimes the hard involved in that is just too much to overcome. Melissa Landry 35:39 And honestly, was it easy for us? I will tell you, this is hard. It was hard to leave the community of practitioners that I used to have the immediate recognition I got for working in those institutions. You know, I worked in major hospitals that people write how it's hard to go on your own the the lack of insurance coverage, there's all this stuff, right? Hard. So yeah, I empathize with that as well. And Maggie 36:04 I have essentially left clinical practice to pursue this education piece, because it takes it's a full time job to be talking about these things. Most clinicians that are working, you know, 70-80 hours a week, face to face patient time, they're not doing this kind of work, because they can't I mean, they just can't like the bottom line is they just can't and and you want them. Yeah, you want them to keep seeing patients because trust me, we've got a provider shortage and it's getting worse. And so we you know, I'm not discouraging anybody to leave the practice of medicine. But it's, I just want to make clear that there's like a lot of things at play. This is just not a bunch of like Jackalope doctors who have absolutely no sensitivity or cultural awareness of being a cat out to like damage the world, you know, and I'm not excusing anything, but it's just people have to understand like, this is how this is how your doctor came to be practicing like this. And it's not right. And it's not fair. And it's not scientifically supported. And it's, in my opinion, not the most ethical way to practice medicine in the year 2022. But this is how it is. And so let's collaborate and try to get what everybody needs out of this interaction best that we can. Melissa Landry 37:15 It's understanding you and your doctor on our team. And as best as you can choose someone who's respectful and aligned. Yes. Do that. And to the jury, you can't The question becomes how do we become on the same team for me? Not the dogma of weight loss or what the insurance companies say how do I get myself good with my philosophies and my understanding so that I can be on Team with this doctor, and takes care of me because you are the outcome you This is there's all these influences on that visit and on that interaction, but you are what matters most. It's an empowering message that you give that that's possible for people to learn and that there are things that we can all do little by little over time to hopefully see a future that I believe will be different. It has changed. Maggie 38:05 It's changed now even year over year, I see little bit of changes, like there's things that like wouldn't have ever ever, ever even happened. In fact, I saw this is just a side note. I do not watch Dr. Phil McGraw show. I do not like Dr. Phil, I do not. Melissa Landry 38:21 I didn't even know his last name. Maggie 38:25 Yes, well, he I did not watch the show. But I saw that he recently broadcast a show where he brought on a body liberation fat activist. And basically, and if you have any context with Dr. Phil, he's like Oprah's BFF, and has been prescribing weight loss. And he's personally he's lost weight. And he had all these diet plans back in the 90s. And all this sort of self help stuff. Anyway, but and now I will say the review I read of the show, actually, he did a terrible job and was extremely berating to fat people that it was not a positive experience for any fat person watching the show. But the fact that he invited a guest on, like, what the point of me saying that is that, like we're tapping into the spaces where it would have never ever ever been even a little tiny morsel of conversation. Did that help? Was it handled the right way? According to this review, probably not. It probably was terrible. So he's still probably not somebody who's going to support weight neutrality, but But it's things are happening in places where they never ever did before. You know, like, Melissa Landry 39:25 They're having the conversation there. They're realizing they can't ignore the conversation because there's a collective now particularly with social media, and the popularity of intuitive eating and body acceptance. They might be having the wrong types of conversations, but they're forced to have them now because they're asking for it. They're saying what does that mean? What does that mean when they're saying that and they right sponsor, right. Maggie 39:52 So it'll, it's it's uncomfortable. I mean, the process of getting from A to B is very uncomfortable for everybody, but I I see it happening and hopefully We can you know, the practice of medicine can really change in our career spans. I hope so. Melissa Landry 40:06 Well, you are such a positive influence on that. I'm just so I'm proud of you as a colleague, it makes me really excited and happy to see a medical doctor supporting people. I know that probably wasn't an easy transition for you to make. Maggie 40:20 Yeah, well, it wasn't. But in the same token, it's, it's not that hard. Because once you see this science and the information, it's actually it's, like, basically do everything that you're doing, like you've been trained to do except prescribe weight loss. Like you're just only removing one little tiny piece of information, everything else is but you can still say and do everything else that you know to do. It's not discrediting your whole, you know, bank of knowledge, but you have to be able to, like, admit that, I, I should change I should I want to change and to, like, you may even have to, like verbally say that to patients like say, hey, you've been my patient for 15 years and I know I've always told you that, you know, really we should work on your weight in this but I've learned some more here's some information I found and I think that we have another way to go I mean, that's a little bit like saying it's like apologizing to your spouse or something like there's like a little bit of like, kind of Sir pair. Melissa Landry 41:13 That's a really no kinship. Yeah, yeah, but it's Maggie 41:17 but it's possible. So I would encourage you to do it and I would encourage the patients that are listening to just find whatever resources you need to support you so that you stay in health care and see somebody to get health care. Melissa Landry 41:30 main takeaway, where can we find your resources? Maggie, tell us a little bit about how to support you and follow your work ongoing. Yes, well, Maggie 41:37 Yes, well, it's easy to find me Maggie Landis, MD and I'm sure you can put the link in the show notes or whatever but that's my website Maggie Landis md.com Maggie Landis, MD is my handle on Facebook, Instagram, and I have a podcast too called Health can't wait i rebranded it recently it used to be called the influencer but it is now called the Health can't wait, wait spell weight. Like that. You see the pun? You see that in that funny? So you can find that everybody listen to podcasts. And I've got lots of I have some solo episodes, some guest episodes that are all about these topics specifically about weight stigma in the practice of medicine. Melissa Landry 42:12 Excellent. Well, thank you for your perspective, your time, most importantly, your role modeling of what it looks like to transition your care and then help other people do the same. Maggie, it was so fun talking to you today. Thanks for Maggie 42:23 Well, thank you for having me, Melissa, Melissa Landry 42:25 you're welcome. Bye bye. It makes me really mad. When my clients who work so hard to heal their relationship with food with me and my programs go back out into the world. And the real world isn't quite caught up to speed. My belief is that you getting clear on your values, how to advocate how to navigate is the best thing we can do doing for now. But I can't help but ask bigger questions like what would it take to actually make a difference. So if you're listening to this, and you belong to any kind of organization, where you can make a difference for folks in larger bodies, I hope these episodes inspire you to think of ways you can do that beyond your personal work. So often when we're doing this, you know, and I guess you're listening to podcasts, it's like self help, right? Like you right now are listening to a podcast to get ideas and how to make your experience better. And that's a really important start. But as you do and particularly after you feel strong and healed, I really hope that this podcast inspires you to look around your world and say what is something small, I can just do to dismantle weight stigma and fat phobia in the world around me. It would make such a difference. You know, I had a client once, who I love, I love when I get nurses and doctors as clients. She was a nurse. And she went through my program and we work together. And one day she came to the session, she said, you know the way that we are about weighing, it's not working for me. And I don't think it's working for my clients. So she actually spoke to her manager at the doctor's office. And they came up with a new flow for weighing patients. So that was one person who had the bravery to notice what might be made better in her environment. And she made a small change. It's not everything, but it starts to shift the culture, breaking the diet cycle at a bigger level than just healing ourselves. I don't know that's really exciting to me. It gives me more meaning and purpose in this work and I hope it does that for you too. Okay, you get the point you're adequately inspired. I want to tell you what I'm up to tonight. At the time of this recording. It is Friday. And my friend and I you know how it is with your friends. When you get older. You make a plan six months from now because that's when y'all are both free. My friend knows that I love Gloria Estefan, you might have seen me tell this story before on Instagram when I was a little kid. I love to go Maria Estefan so much that I named every single one of my teddy bears Gloria, all of them were named Gloria. Since that time, I have continued to love Gloria conga is my karaoke song. I have seen Get on your feet, the Gloria Estefan musical, and no surprise to any of us when she released a movie this year. Father of the Bride, which is an we're gonna have to wait and see. We're watching it tonight. That's the headline, a remake from a childhood. I am very, I was very excited to watch this. So my friend texts me and she's like, we're gonna watch this movie together. So it took some time to finally get the plan in place. But it is going down tonight. That is the exciting social life of your favorite dietitian, we are going to order some pizza. We're going to keep the pizza Friday tradition going. And we're going to watch father of the bride. I'm gonna see my girl Gloria Estefan. All of this is giving me a little kid vibes, right? You're having your friend come over, you're watching a movie, you're eating pizza, my favorite star, it's just gonna. And I'm sharing this with you because we have to get practice with that side of ourselves that just loves ourselves and has fun for the sake of it. You need to practice with that because as you heal your relationship with food, there's going to be more space. And sometimes that feels really scary. But sometimes it really is super fun. So alongside all of this work we're doing to like, be with these uncomfortable feelings and do the hard work. What if we started making space for some quirky fun, simple, inexpensive, authentic ways and having fun? That's what I'm doing tonight. So if you've seen the movie, do message me after. Well, yeah, by the time this airs, I'll have seen it so message me if you watched it and we can discuss what we thought of Gloria's return to the screen. What an amazing woman. We'll be back next week. Maybe talk about getting ready for Thanksgiving. And as I mentioned, if the gentle nutrition intensive is something that you're going to want to be a part of put your name on that waitlist we will make sure to get you all the information you need to set yourself up with a small group in the new year maybe this is the one we don't do a diet again and we don't feel guilty about it. Otherwise, you can apply for a one to one program anytime you'd like at Melissa Landry nutrition.com or message me at no dot more dot guilt and I'll give you all the details to help you decide if the program would be a fit for you. Until next time, be good to your good body. Transcribed by https://otter.ai