Don’t let the holidays sabotage your weight loss goals [PODCAST]

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“The holiday season is rapidly approaching, and it is not uncommon for us to gain up to 10 pounds between Thanksgiving and Valentine’s Day. But what if we do not want to put on some insulation? What can we do? I specialize in medical weight loss, and my first recommendation would simply be to be aware of the food around us and recognize that seeing food in itself can be a trigger to eat.”

Angelice Alexander-Martin is a family physician.

She shares her story and discusses her KevinMD article, “Don’t let the holidays sabotage your weight loss goals.”

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Hosted by Kevin Pho, MD, The Podcast by KevinMD shares the stories of the many who intersect with our health care system but are rarely heard from.

Transcript

Kevin Pho: Hi, welcome to the show, where we share the stories of the many who intersect with our health care system but are rarely heard from. My name is Kevin Pho, founder and editor of KevinMD. Today on the show we have Angelice Alexander-Martin. She is a family physician, and she wrote the KevinMD article “Don’t let the holidays sabotage your weight loss goals.” Angelice, welcome to the show.

Angelice Alexander-Martin: First, thank you so much for allowing me to be here. I’m really excited, and thank you for receiving my article.

Kevin Pho: So we’ll get into that article in a little bit, but first off, can you share your story and journey to where you are today?

Angelice Alexander-Martin: Yeah, so I’m a family physician by trade. I went to family medicine residency, and as I opened my own business back in 2009, I started to expand what I do. Now I focus more on medical weight loss, addiction medicine, hormone balancing, and body sculpting. I tell patients all the time that the majority of what I do, I did not learn in medical school, and I didn’t learn in residency, so it’s things that I learned on my own. When you talk to different physicians, a lot of the other physicians are probably in the same boat that I was in, in that we’re just not exposed to everything in medical school and residency. So there are a lot of knowledge gaps, and I found that these are very important areas that a lot of people need treatment for. I’ve just gotten very passionate about it, and we’re having a lot of fun with what we do.

Kevin Pho: So tell me your approach to obesity and weight loss that isn’t necessarily taught.

Angelice Alexander-Martin: I mean, we talk about the definition of obesity, and maybe we talk about some medications. But often as a family physician, I would have a patient who would come in for, I don’t know, diabetes or strep throat, and as you’re reaching for the door, “Oh, by the way, could you give me something to help my weight?” I knew that there was more to it than just medication, but I really didn’t know what else. I wasn’t trained; I didn’t know. I also knew, especially in Ohio, that there are a lot of restrictions about medication, so I typically wouldn’t prescribe something, because I didn’t want to set somebody up for failure. I just knew that there was more to it than meets the eye. So now, as I look back, I wish I had that knowledge, but I didn’t. But that’s what I say: What was I taught in medical school? With obesity medicine, in addition to anti-obesity medications, there’s nutritional education, behavior modification, and physical activity, and I just did not have the knowledge or the counseling skills or motivational interviewing skills to talk to patients and help them address these areas.

Kevin Pho: So give us some sample patients that you’ll see in a typical day, and walk us through what you would do with them.

Angelice Alexander-Martin: So when patients come to see us, one of the fun things we get to do is a body composition analysis. We don’t just weigh the patient; we actually put them on a device that tells us how much fat they have, how much water and muscle, and what their metabolism is. When they initially come in, it allows us to predict how much weight they could lose in just six weeks, and that’s often exciting, because, “Well, I could do that.” Then we talk about different treatment options. You know, how aggressive do you want to be? How slow do you want to be? Are medications a good fit for you? Which medicine would be a good fit? What’s your medical history? We’re just trying to figure out the best way to help them reach their goals.

Through the patients I’ve seen, I’ve gotten patients off their blood pressure medicine, I’ve gotten them off their diabetes medicine, and I had a lady who I got off of her opiate pain pill, because her pain was better, because she was able to lose weight. So in classic medicine, it seems like we’re always adding a medication to treat the condition, and in obesity medicine, my goal is, can I reduce your medication by helping you lose weight, and can I improve your quality of life? Because now maybe you can go exercise, or you feel better, you can play with the grandkids. It’s improving their quality of life, and that’s really my heart and my passion.

Kevin Pho: So when you talk about the various options, ranging from conservative to more aggressive, give us some examples along that spectrum.

Angelice Alexander-Martin: Yeah. So my most aggressive program is what we call our quick start program, and basically I put patients on meal replacements for a period of time that’s up to them. Nothing is set in stone. I’ve had several patients drop 100 pounds using exclusively meal replacements, and that’s very, very exciting. When they come in for follow-up, again, we don’t just weigh them; we do the body comp, so we can see what has changed. We want to make sure that they’re losing mainly fat and that they’re not losing as much muscle or as much water, because if so, that’s not healthy weight loss. And then with that, we do counseling at each of the visits as well, again trying to modify the behavior and help them understand what they’re doing, because I want them to change their behavior, so five years down the road they’re not doing what they’re doing now. Because if they are, that’s kind of what put the weight on to begin with. So we’re trying to make a big impact there.

So there’s the quick start program, and then we have some patients who want to have some meal replacements and a regular meal, and that’s our modified program. There was a study recently that said how critical those meal replacements really are for long-term success, that they just make things easier; they help control the calories. I myself am on a modified program, where I have three meal replacements a day and a regular meal, and there can be some good weight loss with that.

And then our last program is the ease-in program, where there are really no meal replacements. It’s all regular food. We put patients on a balanced deficit diet and talk about how many calories for them to aim for, which food has how many calories per serving, and measuring, monitoring, and logging what you get. So all three are very structured, and then there could be some overlap. I have some patients who do all meal replacements during the week, and then they may have a meal with the family on the weekend, or they may start on all meal replacements and say, “Hey, you know what? Let me add one here or there.” So we can blend things as well to meet a patient’s needs. It’s, you know, what is their goal, and how can we help them get to their goal in a safe and effective way?

Kevin Pho: And what do you mean by meal replacements?

Angelice Alexander-Martin: So for instance, we have protein shakes. You know, we have medical-grade meal replacements. They typically have about 15-16 grams of protein, maybe as low as 100 calories, and lower carbohydrates, so a very different quality product than at the grocery store, and we can prescribe these for patients. It can help them lose weight quickly. It’s wonderful-tasting, I mean, really good-tasting stuff, but that allows them to lose their weight quickly. From there, we would transition them to more regular food, and then as they introduce food again, we counsel on how you can prepare this and how many calories to aim for, because we’re trying to educate along the way. But if they lose that weight quickly and safely, that’s going to encourage them all the more, because, “Wow, I really have been able to do this.”

And then, you know, we also use anti-obesity medications. There’s a variety of medicines out there. In Ohio, things are a little bit stickier than in some other states as far as regulations we have to follow, but we do use medications when appropriate, and they have been a great adjunct as well.

Kevin Pho: All right, let’s talk about the KevinMD article that you wrote. It’s titled “Don’t let the holidays sabotage your weight loss goals.” Now, for those who didn’t get a chance to read your article, can you just walk my audience through it and share the story of why you decided to write it?

Angelice Alexander-Martin: Yeah. So one of the things that I counsel my patients on is that typically between Thanksgiving and Valentine’s Day, we can gain up to 10 pounds, and most people don’t realize that. It’s the holidays; you know, we’re in hibernation, and they don’t really think, but that may not be the best, especially if you’re trying to stay healthy and have a healthy weight. So we talk about things to be aware of. How can you reduce the likelihood of that happening? I had a patient I just saw last week who actually lost a pound and a half over the last two weeks, including Thanksgiving, and that’s perfect, because she was able to lose despite that.

We talk about being aware of the visual trigger of food. You see food, and there’s this subconscious desire to do something about it, to put it in your mouth. So sometimes we just have to get it out of sight; you know, out of sight, out of mind. I had a company recently come in to talk with me, and they brought in a canister of cookies, and the cookies were in the kitchen, and I found myself gravitating to the cookies. I said, “No, no, I don’t need these. Someone else take them.” But I recognized that in myself, and so I’m trying to help other people be aware of that, because if I do that, you may do that. If you understand it, now you can plan accordingly and say, “Well, you know what? Maybe I’ll pass on that.”

One of my patients told me that as she walks at work, there was a cookie or candy canister on someone’s desk, and she kept coming by and getting it. And we said, “Maybe you should take a different path.” You know, it’s a visual trigger, just seeing the food. Or if you’re preparing goodies for someone else, cookies and things, and you see them, don’t sample them. You know, let your youngsters sample them. You’re trying to make them for someone else, but just recognize that you see it, and you want to sample it.

Thanksgiving is a big time where there’s typically an abundance of food, and sometimes people go into it with the idea of almost overindulging deliberately, and that’s not very good for your weight if you’re really trying to lose weight. So we said, well, maybe if you really think you want to sample everything, maybe take just a tablespoon of everything. That way you can sample it, but you’re not really getting a full serving of anything, to help reduce your calories. Or if you are limiting what you get, maybe have a full serving of fewer things, and don’t get seconds. But again, have a strategy, so that it doesn’t throw you off. Or don’t go in on an empty stomach. If you arrive and there’s food and you’re already hungry, you’re probably going to overdo it, just because you’re hungry to begin with. So if you have a snack or something beforehand, you’re more likely to be in control.

And then, of course, there’s the effect of alcohol. I talk to my patients all the time about how alcohol has a lot of calories. You know, there are seven calories in just one gram of alcohol. That’s more than carbs, more than protein; the only more calorie-dense macronutrient is fat. And alcohol tends to make people want to eat more. So it’s not that you can’t consume alcohol, but just understand the cause and effect. I’ve had many patients tell me the same thing, like, “Yeah, you know, I have that glass of wine, and I find myself eating more.” And, OK, well, as long as you understand what you’re doing and why you’re doing it, then you may or may not make that decision to still have that glass of wine, because you know the alcohol is going to have calories, and if you eat more, that’s not going to help you lose weight. So those are the kinds of things that I just like to counsel patients on, to help them prepare and to plan wisely, so that hopefully, come Valentine’s Day, they haven’t put 10 pounds on.

Kevin Pho: Now, during the pandemic, over the last almost two years, I’ve seen a lot of patients in my clinic gain significant amounts of weight because of, you know, lockdown, whatever, and they’re stuck inside, sometimes unable to exercise. So I’m sure you’re seeing this as well. What kind of advice do you have for these patients?

Angelice Alexander-Martin: Looking for opportunities. You know, yes, you may be on lockdown, but how can you still be physically active? Are you able to walk where you are? Are you able to go outside the house and walk around the block? Are you able to do upper-body exercises? Are you able to still stretch? And even on lockdown, you still have control over what you’re eating. You know, you’re still preparing food, so are you preparing food in a healthy way? Are you frying everything, or are you removing the visible fats? Are you having fruits and vegetables? Are you having a lot of processed foods? So again, it’s just that awareness. And yes, there was that lockdown. We talked about people gaining the “COVID-19 pounds,” so to speak, and it’s very, very real. But understand what led to that, and then what changes can you make to try to reverse that?

It’s also fun for people to partner with someone. You know, exercise with a buddy. I told families, “Hey, go walk around the block as a family afterwards,” because as the parents, you’re setting the example for your children and trying to help them learn healthy habits as well.

Kevin Pho: At what point should patients consider seeing a weight loss or obesity medicine specialist like yourself?

Angelice Alexander-Martin: You know, that’s a great question. Obesity by itself is defined as when someone has a BMI of 30 or greater, but there’s also the stage before. And I should say, BMI is a calculation where you look at your height and your weight and you compare the two. But before you get obese, there’s pre-obesity, which is really a BMI between 25 and 30. That also depends on certain populations, because for the Asian population, for instance, how we define pre-obesity and obesity actually drops a little bit lower.

But if you’re going in for your regular physical, hopefully your weight is being measured, though. True story: I had a patient who saw their doctor for 16 years, and their weight was never measured. So that was really kind of sad, and she said, “Something’s wrong,” and we came and did something about the weight. But hopefully that’s being discussed then: “Hey, you know what? You’re pre-obese,” or, “You’re obese.” Or if you have complications that could be related to obesity, like high blood pressure, type 2 diabetes, or high cholesterol. You know, we call diabetes “diabesity,” because the vast majority of people with type 2 diabetes are obese. There are exceptions, but they almost go hand in hand. So for anyone who’s got type 2 diabetes, I would say, “Hey, go see a weight loss specialist.” Again, I’ve been able to get people off the medication, and that’s really fun. So I guess that would be a good threshold. If you have those complications, or if your BMI has hit 25, that’s a good point to at least start having a conversation, so things don’t get worse.

Kevin Pho: We’re talking to Angelice Alexander-Martin. She is a family physician and obesity specialist, and she wrote the KevinMD article “Don’t let the holidays sabotage your weight loss goals.” Angelice, in the exam room, as you can imagine, in primary care we have very limited time with patients, and a majority of my patients fall into that category of obesity. Now, given that limited time, what are some really quick, actionable, effective tips that most primary care clinicians can give that patient in a 15-minute office visit?

Angelice Alexander-Martin: Yeah, so as I said earlier, often obesity comes up in the “Oh, by the way, can I have a prescription for XYZ?” What I would try to do during that visit is say, “Hey, you know what? I would love to help you. There’s more to obesity than just a pill. Please, let’s schedule a time to really focus on it.” Because as I said, there’s nutrition education, behavior modification, physical activity, and anti-obesity medicine. All of that goes into effectively taking care of a patient with obesity. So, you know, just as if someone came in and said, “Oh, by the way, I have this wart I want frozen,” or something, I may say, “I would love to help you with that. I want to give it the time and attention it deserves. Could you please schedule a follow-up appointment, and we will focus on that, because it is very important, and I appreciate your interest in it, and I want to help you.” But I would really encourage them to set up a separate time to focus on that.

And if that’s something that you’re not comfortable with, I mean, again, I wasn’t trained, I didn’t know that. I would try to partner with someone else who is familiar with obesity medicine to help that individual. Because again, I remember people wanting me to prescribe an X medication, and I just didn’t want to set them up for failure, and especially in Ohio, there are certain rules we have to follow in prescribing it. And I don’t want to give you something, and I’ll give you the tools to be successful with it, because it’s a package of things that really need to go together for successful weight loss.

Kevin Pho: And my final question: What are some of your take-home messages that you want to leave?

Angelice Alexander-Martin: Obesity is a medical condition, and it should be treated as such. It’s not cosmetic; it’s actually a medical condition. So we want to take it seriously, and there are so many complications that go along with it. Just by helping someone lose weight, you can greatly improve their quality of life: feeling better, having more energy, being able to play with the kids, running, jumping. And I talk about looking in the mirror and just smiling a little bit more, because you like what you see. So just take it seriously, and know that you can have such an impact on someone’s quality of life if you can help them lose weight. And again, if you are limited in some of those skills, then partner with someone who does have them, and I think your patient will thank you when, you know, you can maybe reverse some things and just improve that quality of life.

Kevin Pho: Angelice, thank you so much for sharing your time and insight, and thanks again for being on the show.

Angelice Alexander-Martin: Thanks for having me.

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