Jan. 2, 2024
27 | Weight Loss Secrets: A Dietitian's Top Tips
New Year, New You! There's no doubt your patients are seeking your advice on how to lose weight in 2024, so in today's episode we'll answer 5 of the most common questions around weight loss. Joining me today is Melissa Mitri, an experienced Registered Dietitian and expert in weight loss. Discover the truth behind fad diets, the pros and cons of weight loss medications, and the real deal about late-night eating. Melissa shares valuable insights on exercise recommendations, emphasizing the importance of finding joy in your fitness routine. Plus, unravel the mystery around strength training for women – newsflash: it won't make you bulky!
As both a pediatric PA and a dietitian, I'm eager to share our strategies for compassionate patient engagement, steering clear of the BMI tunnel vision, and embracing a more comprehensive health narrative.
Here are some Key Takeaways:
- Sustainable weight loss requires long-term lifestyle changes, not fad diets.
- Understand the pros and cons of weight loss medications before recommending them.
- Embrace a balanced approach to exercise, combining cardio and strength training.
- Explore the truth about eating late at night and discover better snack options.
- Learn how to refer patients to a Registered Dietitian for personalized guidance.
Don't forget to link up with us on Instagram @examroomnutrition for more nutrition tips and community, as we strive to make our patients healthier, one exam room at a time.
Connect with Melissa:
Website: https://melissamitri.com/
Email: melissa@melissamitri.com
Instagram: @theweightloss.dietitian
Connect with Colleen:
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Disclaimer: This podcast is a collection of ideas, strategies, and opinions of the author(s). Its goal is to provide useful information on each of the topics shared within. It is not intended to provide medical, health, or professional consultation or to diagnosis-specific weight or feeding challenges. The author(s) advises the reader to always consult with appropriate health, medical, and professional consultants for support for individual children and family situations. The author(s) do not take responsibility for the personal or other risks, loss, or liability incurred as a direct or indirect consequence of the application or use of information provided. All opinions stated in this podcast are my own and do not reflect the opinions of my employer.
00:00 - Weight Loss Questions in Patients
11:12 - Weight Loss and Exercise Guide
21:46 - Bodybuilding, Weightlifting, and Eating Late
32:53 - Lifestyle Change for Long-Term Health
WEBVTT
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I barely eat anything and I exercise every day.
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Why aren't I losing weight?
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Is bread bad for me?
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Should I go on a weight loss medication?
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Is eating late bad?
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Have your patients ever asked you these questions?
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My name is Colleen, I'm a pediatric PA and registered dietitian, and this is the Exam Room Nutrition Podcast where each week, I'm giving you the nutrition training you never got in school to help you guide your patients with compassion and confidence.
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At the time of recording, it is the new year and with that come new year's resolutions, a time when people reflect on the year past and look toward improving themselves in the year ahead, and a lot of the goals people make have to do with their health and weight.
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So you're absolutely going to be presented with questions from your patients about the best way to lose weight, and I'm here to help you guide them on their journey.
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So today we're going to unpack five of the most commonly asked questions patients ask their provider when it comes to losing weight.
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So get comfy and join me in welcoming my guest, melissa Metry.
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Melissa is a registered dietitian, nutritionist, weight loss specialist and expert health writer with over 16 years of experience in the health and wellness industry.
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She owns a virtual private practice that specializes in helping women achieve sustainable weight loss.
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You can follow her on Instagram, at theweightlossdietician, or online at melissimetrycom.
00:01:22.927 --> 00:01:25.688
Melissa, I am so excited to have you on here.
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This is such an appropriate topic for this time of year.
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Thank you so much for the gift of your time.
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Welcome to the show.
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Thank you so much, colleen.
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I'm so excited to have this conversation with you today.
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I love what you're doing with your podcasts and your messages on social media.
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I think it's so important and awesome that you're a dietitian and a PA, because I'm sure you have really unique experiences from that.
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This is why I made this podcast, because as clinicians, we get trained in the medical model and we know how to diagnose and how to treat, but really a lot of it comes down to health and nutrition, and so bringing dietitians onto my podcast has been so awesome and I really hope that the listeners gain a lot of practical information that they can relate to their patients, because, yes, there's tons of dietitians out there, but you guys aren't always the ones that are on the front line speaking to patients.
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So I'm really excited to get into this topic because I know a lot of the primary care practitioners have to kind of navigate these difficult questions.
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So we're going to give you guys answers to five of the most common questions that your patients are probably coming to ask you about.
00:02:28.867 --> 00:02:44.930
But before we dive into those common questions, I really think it's important to discuss how clinicians even bring up the weight conversation, because sometimes it's not appropriate, sometimes it can be mentioned in a harmful or judgmental way.
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So provide the clinicians listening with some practical strategies that they can actually bring up the weight conversation in a more gentle way.
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So first of all, I think it's really important to not assume a patient wants to talk about their weight or even has a concern about it.
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So I think that's the first and foremost kind of thinking it from the patient's perspective.
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And so the first step during your appointments with your patients is to address their chief complaint first, like why are they coming to your office in the first place?
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What is their main health concern bringing them in there, and then allow them to drive the conversation with their own questions or concerns first.
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And then, once those issues are discussed, it may be appropriate to bring up the weight conversation in a few key scenarios.
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So one if they have a medical or physical condition that can be caused or worsened by being overweight or obese, so such as diabetes, heart disease, high blood pressure, et cetera.
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Or they have a physical ailment such as knee or hip pain, which is very common in someone who's overweight.
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So if you see those issues, it may be appropriate to bring it up and I'll kind of discuss a little bit more how to do that.
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And then the second scenario is they themselves have brought up their weight in some way during the conversation.
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So whether it's really more direct, such as them saying I know I need to lose weight, or just bring it up themselves or sort of in a more indirect way, which can sometimes happen so, such as your nurse is weighing the patient and then they say, oh, please don't tell me my weight, I'd rather not know.
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There's some indications that maybe they have concerns, but they may not be directly bringing it up.
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So it's either of these situations are present or you really generally feel like it should be brought up in the best interest of the patient.
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You can start by just saying something like how do you feel about your weight at this time?
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Especially, this is easier to do if they sort of casually bring it up themselves.
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Or you can say can we talk about your weight today and kind of ask for their permission and then let the patient drive the conversation and sort of hear them out first before you add anything more to that, which can be a nice way of sort of gently bringing up the conversation without sharing too much or being too direct with it.
00:05:05.579 --> 00:05:25.050
Just as sort of an aside, if you do bring up the conversation, a lot of research really shows that most patients prefer certain terms to be brought up in the conversation, so such as weight or BMI, rather than using the word fat or obese, it can be kind of taken a little bit more negatively from the patient perspective.
00:05:25.050 --> 00:05:28.129
So just important to keep in mind in your conversations.
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I've also getting a lot of questions, and many of you practitioners may also have, that they ask about BMI.
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Is that still an important measure or something that is a useful marker of health?
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And I always tell them that it's just one tool to measure health, but it's not the only tool, so there's other ways of measuring, such as waist and hips circumference, that muscle mass or other health risk factors that they may have.
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Yeah.
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So, looking at it in the big picture, I think that's really important too, and I love that you pointed out that verbiage matters and the words that we use matter to the patient.
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If someone wants to sit there on the receiving end and be told, oh hey, you're too fat, that's really harsh and can be really detrimental to somebody who already probably knows that there's a weight issue going on, and now to be slapped with that really shameful term can be very, very harmful.
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So I also love that you suggested that we ask permission first, because you're right, some people really don't want to know and they might be too nervous or they might not know that they can say, hey, I don't want to know what my weight is today, or can we do a blind weight, and they might not know that that's even an option.
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So I think giving patients a little bit more autonomy when discussing their weight is so important.
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Those are some really good tools, for how do we even get that conversation started?
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So I'd like to move now into those common questions.
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Now that maybe you've got a patient in front of you who is actively looking for some suggestions and advice on how to lose weight, let's jump into those five common questions that healthcare practitioners are probably being asked.
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So number one patient might say oh, I'm sorry, I barely eat anything and I exercise every day.
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Why aren't I losing weight?
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How do we answer that question?
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Yeah, that's really, really a great question to ask.
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So a lot of times patients may feel like they're coming to you and then saying something like that like I'm trying everything, I'm doing all the right things, why aren't I losing weight?
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So it's important to address the fact that if they're saying they barely eat anything or they're being really restrictive, that they're probably in too low of a calorie deficit so that actually may hinder their weight loss, and so letting them know that it's actually just the fact that if they're trying to lose weight, that doesn't mean that the less they eat the better, because it needs to be a balance and explaining to them that when you are too restrictive usually backfires because your body thinks that you're in this starvation sort of mode and it goes into like a fight or flight response and what happens is your body usually holds on to what it has and it makes it actually a lot harder to lose weight.
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So it's kind of similar to like the caveman era, when people were either in a feast or famine state, and so your body tries to hold on to what it has.
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So I would advise them, if they're struggling and they feel like they're being restrictive, not seeing results, just to consult with a dietician so that they know what their calorie intake should actually be to promote weight loss.
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So what I usually recommend is what I call a modest or moderate calorie deficit, where it's just a few hundred calories below what their sort of maintenance needs are and that they're getting enough to fuel their workouts and to feel satisfied, because that's going to lead to sustainable weight loss.
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Yeah, those are great points.
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And you know it's kind of counterintuitive for the patient to be like, oh, you need to eat more if you want to lose weight, and they're probably like what that doesn't make any sense.
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But metabolically and biologically it does make sense.
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And so also, too, what can happen is if they're in such a calorie deficit.
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You know, I've seen patients say, oh I'm, you know, I try to stay to 800 calories a day or 1000 calories a day and they're exercising, and so what's happening is they're just losing all their lean body mass.
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So it's kind of like the opposite of that goal that they're trying to achieve.
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So definitely contact a dietitian to help at least establish what their maintenance calories are, to help them, if they are counting calories, to get on the right track with that.
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But if your patient comes to you and says I barely eat, I'm not losing weight, you might suggest that they eat a little bit more of the healthful things like fruits and vegetables, like protein items.
00:09:30.120 --> 00:09:34.783
So really good point, really common question that I know a lot of clinicians do get.
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Let's move into some specifics and let's move on to question number two, and this is what a lot of I think mostly women may be here because it's probably like a lie or a social media fad that they're hearing that bread and carbs are bad for you.
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So how do we address this question when someone asks us are bread or carbs bad and can I have them?
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still so in terms of this question, I would just let them know right off to that it's not true.
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Bread and carbs are not the devil.
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I think many people, like as you said, fear bread or carbs a lot because of social media, because of a lot of the low carb diets that are out there and people seeing weight loss with them.
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That it gives us facade that carbs are kind of like the reason why work anyway, but the reality is, what you want to tell them is that you want to focus on the right carbs and so really focusing on the portion and the type of carb that you're eating.
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So more about choosing the more nutritious carbs that are whole grains so, for example, brown rice, starchy vegetables like potatoes, and whole grains like oatmeal or quinoa.
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So choosing those types of carbs more often and limiting the more processed ones like donuts, pastries, cookies, white bread, those types of carbs that we associate with inflammation and diabetes and a lot of the health conditions that we have, and really just kind of steering them towards the healthier options.
00:11:02.875 --> 00:11:07.654
Good point, and I hate when people demonize carbs because they are not the enemy.
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They are our number one source of fuel, so they're so needed and so important.
00:11:11.563 --> 00:11:14.260
Now I'm going to throw a random question at you.
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So if a patient is kind of along those lines, talking about low carb dieting and saying, hey, well, it's worked for me in the past, I lost, you know, 20 pounds on the Atkins diet or on a keto diet or on intermittent fasting, any of these kind of fad diets if we could group them into that, of course they're going to lose weight, right, but why are they losing weight on these diets?
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Can you maybe help the clinician explain?
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Okay, this is why you lost weight and why it might not be sustainable for the future weight loss.
00:11:41.738 --> 00:11:46.113
Yeah, so a big bulk of the weight loss on low carb diets is related to fluid.
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So when you reduce your carb intake significantly, you tend to lose fluid because carbs tend to hold onto it.
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So it doesn't mean that carbs make you retain water, necessarily, but a big reason why you see a lot of patients losing weight quickly in the beginning of a low carb diet is a lot because of that fluid loss and not actual fat loss.
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So that's really important to keep in mind.
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And then the second part to that is depending on what they were doing before.
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Like if that person was eating a lot of high calorie processed carbs that cause more cravings and overeating and then they make a drastic change and stop eating those foods, then of course it's going to cut their calories the amount of calories they've been eating significantly, just like any other type of low calorie diet.
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It's really no different and it's no more effective.
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It's really, if they're reducing their calories to where they need to be, then it's going to cause them to lose weight.
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But what often happens is it's not sustainable because, as you said, we need carbs for our brain health, for our fuel, for exercise.
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You know, actually the majority of our diet should be comprised of carbs more than fat and protein for most of us, and so when you restrict that you tend to not feel satisfied.
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Over time you tend to miss those foods when you kind of demonize them more and then it eventually leads you to kind of just bounce back and start eating those foods again over time and sort of crave them, at times more with the inventions than you did before.
00:13:12.850 --> 00:13:18.591
I'm so glad you touched on that that you know any of the diets are gonna make you eat a little bit more healthy, Right?
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I don't really know of any bad diets or any diets out there that are like oh yeah, you can have as many donuts and bagels and pop tarts and french fries as you want and you'll lose weight.
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You know what I mean.
00:13:27.932 --> 00:13:31.259
Why, like that would be amazing if that was sure way, but obviously that's not.
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Yeah right.
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All of the diets are gonna generally push you towards more healthful eating, but the problem is that they're overly restrictive to where, like, you can absolutely never have any pasta ever again.
00:13:43.970 --> 00:13:54.773
And that's why there's not long lasting, sustainable weight loss that these patients are seeing, because, yeah, most of them, you're eating more fruits, more vegetables, more nuts and less of the processed foods, so that's why they're losing weight.
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And I think a lot of patients kind of are drawn toward the sexiness of a diet, because really the general health guidelines they're not that, you know, drastic and they're not that fun or beautiful or sexy, you know.
00:14:10.090 --> 00:14:16.624
So I think it is more you're more drawn to the fad diets, but really and truly you don't have to be that restrictive.
00:14:17.150 --> 00:14:18.052
Quite exactly.
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It's only exciting for a short period of time and then usually that excitement wears off.
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Right, and then you go back to eating your pop tarts and your donuts and your pizza right exactly.
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All right, let's move on to question number three and with the craze of some newly approved weight loss medications, we probably are having some patients come into the clinic asking about weight loss medications.
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So how do we answer this question if a patient says, hey, I heard about XYZ medication.
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Is it appropriate for me and should I go on that medicine?
00:14:46.692 --> 00:14:47.716
Yeah, great question.
00:14:47.716 --> 00:14:50.871
So this is something that you're probably many of you are being asked it's.
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I know many of my clients are asking me about these medications, like we're goby and is mpik and etc.
00:14:55.743 --> 00:15:01.529
And the answer would be it really depends on the person and their history.
00:15:01.529 --> 00:15:10.509
So if somebody asks you about them, it's really important to kind of evaluate their own personal Situation to see if it's going to be something you'd want to recommend to them.
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So a few things to kind of consider when you're asked this question.
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So I would weigh out the pros and cons.
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These medications are typically best for someone who has tried many different Attempts to lose weight.
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So they really exhaust a lot of their options with just diet and exercise alone and they're not getting past a certain point.
00:15:27.929 --> 00:15:39.509
So if you know someone has tried many attempts and then they just can't get past a certain point and they hit a plateau and maybe something to consider if they don't have any risk factors or contraindications.
00:15:39.509 --> 00:15:47.649
So I would always advise patients that still more research needs to be done into kind of the long-term effectiveness of these medications.
00:15:47.649 --> 00:15:55.289
I think a lot of what we're seeing is the short term and then how they do help them lose weight, but do they have to stay on them forever in order to maintain that weight loss?
00:15:55.289 --> 00:15:57.157
There's a lot of unanswered questions.
00:15:57.157 --> 00:16:07.250
So I think letting the patients know, be be aware of that, so they're making a informed decision, and then a few situations where may be contraindicated for patients to keep in mind.
00:16:07.450 --> 00:16:13.716
So in the case with someone that has a history of an eating disorder or an active eating disorder, it would not be appropriate.
00:16:14.150 --> 00:16:24.250
Somebody who drinks alcohol pretty regularly, or someone just at risk for pancreatitis Because there's a heightened risk with some of these medications, or someone with a history of thyroid conditions.
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There's been several studies, mostly animal studies, but I've shown there's a link between increased risk of thyroid cancer with some of these medications and so the general consensus is to stay away from it in those cases.
00:16:35.870 --> 00:16:47.485
And then also such something to keep in mind is you know the patient, if they're sort of like a chronic stress eater, emotional eater, this may cause them to only have temporary results from the medication, because what happens?
00:16:47.485 --> 00:16:51.094
The medication makes them feel full, it's just a big driver for the weight loss.
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But if they're eating typically for other reasons, not because they're actually hungry, then they may not be successful with this medication and so making sure the patient is aware of that and that they still have to make healthy behavior changes and manage the stress eating In order to see success with them.
00:17:09.330 --> 00:17:13.338
Yeah, and you know the medication sometimes can be thought of it's a band-aid.
00:17:13.338 --> 00:17:18.800
If they are emotional eating or stress eating, the medicine isn't Solving that problem, it's just kind of covering it up.
00:17:18.800 --> 00:17:28.950
So you know, when we talk about weight loss, it's not always about the number on the scale or their BMI, it's the big picture, and so sometimes medicine doesn't address all the other issues that are tagging along when it comes to weight loss.
00:17:28.950 --> 00:17:36.317
I think another one too that's important to at least Discuss with the patient is any of the side effects that might come along with it.
00:17:36.317 --> 00:17:41.022
Right, like some of these medications that are Approved are more used off-label.
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Right, if it's approved for diabetes, but a side effect is is weight loss, and now you're just using it for weight loss.
00:17:45.980 --> 00:17:51.383
You have to look at the pros and cons for that because, as with any medication, there's going to be some side effects.
00:17:51.383 --> 00:17:57.363
So I think it's really important that the patients know what those side effects are upfront before putting them on those medicines.
00:17:57.970 --> 00:17:58.393
Absolutely.
00:17:58.393 --> 00:17:59.156
I completely agree.
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All right, let's move on to question number four, and I know this comes up a lot in clinic and even for me in my PA school training.
00:18:06.823 --> 00:18:13.573
We didn't talk about exercise recommendations at all, so I'm really excited to hear how you would answer this question.
00:18:13.573 --> 00:18:19.664
So common question number four would be what type of exercise is best to help me lose weight?
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So, first things first, both cardio and strength training are equally as important.
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But the most important thing that I would recommend what I tell my patients as well is that you have to do something that you like.
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So, regardless if it's cardio or strength or both, it has to be something that you enjoy, because then you'll actually stick to it.
00:18:38.791 --> 00:18:46.673
If you're exercising very sporadically, you're not going to get as many of the weight loss benefits and many other of the health benefits that you get from it.
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A lot of people think that cardio is like they have to do more cardio to burn more calories and lose weight.
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But strength training helps in that aspect as well.
00:18:55.204 --> 00:19:00.109
So cardio is essential for burning sat cardiovascular health.
00:19:00.109 --> 00:19:04.932
But strength training helps build muscle and it also supports a healthy metabolism.
00:19:04.932 --> 00:19:20.529
So when you build muscle from the strength training, you are supporting a faster metabolism, because when you have more muscle, it helps you burn more fats, it makes your body more metabolically active, and so the cardio and strength training work sort of hand in hand.
00:19:20.529 --> 00:19:27.290
So I would just tell patients that doing both is equally as important, but finding ways that you have things that you enjoy.
00:19:27.290 --> 00:19:42.689
If you have a patient that's new to exercising, it's important to recommend that for them to start slow, so maybe starting with a walking routine or maybe some light weights for strength training and then gradually move up to more, higher intensity as tolerated.
00:19:42.689 --> 00:19:50.490
Maybe they work with a personal trainer if they need more guidance and encouraging patients just to do something to stay active most days of the week.
00:19:51.244 --> 00:19:55.833
I think where you started with that is so important and that it does have to be something that you enjoy.
00:19:55.833 --> 00:20:01.335
And I think that is he is asking them like what would you not absolutely hate to do?
00:20:01.335 --> 00:20:06.709
And obviously for people who've never exercised or this is new to them, right, they're gonna say, oh, I don't wanna do anything, I hate all the things.
00:20:06.709 --> 00:20:16.912
But starting small is really important and finding something that they like and, I think, thinking outside the box too, for people who really have either never worked out or just don't really like the idea of it at all.
00:20:16.912 --> 00:20:25.829
You know, zumba was a huge craze that came into the scene a couple of years ago and so many women who you always know I hate exercising, love it because it's dancing.
00:20:26.144 --> 00:20:28.112
Doesn't feel like exercise, and that's great yeah.
00:20:28.785 --> 00:20:33.549
And you made such a great point that says like, hey, it doesn't have to be your traditional, go to the gym, lift weights.
00:20:33.549 --> 00:20:36.634
You know moving your body is exercise.
00:20:36.634 --> 00:20:39.769
It's gonna be beneficial to your health and your weight overall.
00:20:39.769 --> 00:20:42.890
So I think those are some really crucial points to point out to patients.
00:20:42.890 --> 00:20:51.612
I wanted to linger here a little bit because we've talked a little bit about strength training and I want you to clear up a common misconception among women specifically with weight training.
00:20:51.612 --> 00:21:00.951
I hear it all the time and women are kind of more timid or less likely to grab some weights because they say well, I don't want to get bulky.
00:21:00.951 --> 00:21:04.112
How does the clinician answer that question?
00:21:04.573 --> 00:21:04.854
Yeah.
00:21:04.854 --> 00:21:16.393
So it's really not true that strength training needs to bulkiness if you're doing it right and even a common myth is that, like if you lift heavier that you're going to get bulky, it's more about the technique that you're doing.
00:21:16.393 --> 00:21:23.894
So if you don't want to get bulky, it's more about doing like more reps, not necessarily training to like exhaustion.
00:21:23.894 --> 00:21:34.713
And also the reason why a lot of people get bulky is if they're eating like a ton of protein or they're on supplements like creatine or other supplements that may potentially support more muscle gain.
00:21:34.713 --> 00:21:37.969
So I definitely would not fear it, I would embrace it.
00:21:38.170 --> 00:21:45.834
Yeah, I'm so glad you cleared that up because I don't know how and why it still is kind of a thought among women that they're gonna get bulky if they lift weights.
00:21:45.834 --> 00:21:47.491
But really it is a full-time job.
00:21:47.491 --> 00:21:49.550
I mean bodybuilders and crossfitters.
00:21:49.550 --> 00:21:53.972
To get that much muscle mass on a woman's body is a full-time job.
00:21:53.972 --> 00:21:58.669
They are supplementing, they're eating an excessive amount of calories overall and protein.
00:21:58.669 --> 00:22:02.289
They're lifting probably two or three times a day, exercising every single day of the week.
00:22:02.289 --> 00:22:10.849
So for the general woman who's exercising, we don't have those hormones naturally in our body to get that big, so you don't need to worry about it.
00:22:11.005 --> 00:22:14.510
I am a big supporter of weightlifting for women because I think it's super empowering.
00:22:14.510 --> 00:22:16.711
You feel strong, you feel beautiful.
00:22:16.711 --> 00:22:19.634
So for those ladies out there listening, go lift some weights.
00:22:19.634 --> 00:22:20.950
I think it's gonna help you a lot.
00:22:20.950 --> 00:22:25.751
All right, let's move on to the last and final question, and I think a really, really big one.
00:22:25.751 --> 00:22:26.868
And again, it's a myth.
00:22:26.868 --> 00:22:27.952
That's kind of out there.
00:22:27.952 --> 00:22:32.231
So I'm excited to hear what the science is behind our timing of eating.
00:22:32.231 --> 00:22:37.892
Specifically, question number five is is eating late bad?
00:22:38.173 --> 00:22:38.433
Yeah.
00:22:38.433 --> 00:22:47.109
So eating late at night, I would tell patients it's not bad or something to feel guilty about, because I think a lot of people have this fear or feel guilty about doing it.
00:22:47.109 --> 00:22:57.373
But it's not necessarily ideal for a few reasons and when thinking late at night I really think more about like shortly before you're going to sleep, depending on your sleep schedule.
00:22:57.373 --> 00:23:07.712
So a few reasons why it could be potentially not ideal is you're eating too late before you go to sleep, like too close in proximity, so one it can interrupt your sleep.
00:23:07.712 --> 00:23:26.250
It can cause bloatedness, gas reflux or indigestion because your body is working hard to digest your food when you're probably not as active during that time and then your metabolism slows down at night and again, since you're less active, your body will probably not utilize the calories you eat as efficiently.
00:23:26.250 --> 00:23:28.792
So that is another potential negative.
00:23:28.792 --> 00:23:32.154
So it can increase your risk of weight gain.
00:23:32.285 --> 00:23:39.648
If you're eating late at night regularly, if you're doing it once in a while, it's really not a concern and I think there's a few key scenarios where it may actually be helpful.
00:23:40.204 --> 00:23:52.171
If you need to eat late once in a while or you actually feel hungry before bed, I would recommend just some healthier options if patients ask you as far as what they should eat, because there's definitely better options.
00:23:52.384 --> 00:24:10.074
So choosing something that's a little bit lower in calories so it's not too heavy on the stomach, such as a small bowl of cereal with milk, an apple with peanut butter, or even like a few whole grain crackers with cheese, kind of like a small meal or a snack versus a big, you know full meal late at night.
00:24:10.074 --> 00:24:16.152
A lot of these foods that I mentioned are also rich in magnesium, which can promote a more restful sleep.
00:24:16.152 --> 00:24:23.553
So if you're going to have something later at night, these are some better options to have so they actually can support your sleep, not hinder it.
00:24:23.553 --> 00:24:30.029
So really, overall, the recommendation would be to try to limit eating late at night, not do it all the time.
00:24:30.029 --> 00:24:46.452
But if the patient is finding that they feel hungry a lot late at night, then again referring them to a dietitian to really look at their day and what they're eating, like maybe they're not eating enough for dinner, maybe they're not eating enough to match their activity level and they need a nighttime snack.
00:24:46.452 --> 00:24:48.853
But it's more about you know what they're eating.
00:24:48.853 --> 00:24:50.455
That is most important.
00:24:51.761 --> 00:24:53.965
Yeah, and it's, you know, like anything with nutrition.
00:24:53.965 --> 00:24:56.972
It's not going to be a one-size-fits-all black and white.
00:24:56.972 --> 00:25:00.670
This is the only way to do it for every single patient that walks into your clinic.
00:25:00.670 --> 00:25:05.089
But I think some general guidelines in clearing up some of those myths out there is so important.
00:25:05.089 --> 00:25:16.310
So I want to just like really drill this home, because I almost every day have teenager patients tell me oh, I shouldn't eat after seven o'clock or I shouldn't eat after eight o'clock, right?
00:25:16.310 --> 00:25:23.512
So answer that question Is there a magic time that patients should just stop eating altogether?
00:25:24.382 --> 00:25:25.626
Yeah, no, there's definitely.
00:25:25.626 --> 00:25:31.412
There's no research based on like timing, the exact timing like that, like no eating after seven or eight.
00:25:31.412 --> 00:25:43.603
And I think that it can get confusing now that a lot of people are in men, fasting too, in terms of, like you know, stopping after a certain time and maybe they feel better from doing that, but there's no magic time that you have to stop eating.
00:25:43.603 --> 00:25:54.627
It's more about what I usually recommend is to try to limit any heavy eating or meals within a couple hours of going to sleep Because, again, just better for your digestion, better for your quality of sleep.
00:25:54.627 --> 00:26:04.209
But if you're, you know, if you're not going to bed until 11 o'clock, then there's no reason why you have to say like I can't eat after seven if you're hungry, especially.
00:26:05.561 --> 00:26:08.229
Yeah and I think you also made a really good point is finding out.
00:26:08.229 --> 00:26:09.760
Well, why are you eating late?
00:26:09.760 --> 00:26:14.211
You know, if it's because you have a later evening job, like I do, I work late.
00:26:14.211 --> 00:26:18.982
I work until 11 o'clock at night, so I do have, you know, a dinner, kind of before I go in at four.
00:26:18.982 --> 00:26:24.244
So for someone to tell me, hey, you can't have anything after eight o'clock, I would be starving by the time I get home.
00:26:24.325 --> 00:26:30.057
So I think number one looking at a patient's work schedule and their day to day schedule is really, really important.
00:26:30.057 --> 00:26:38.743
But also number two is finding out why are they eating late, because oftentimes it's not a work related, you know schedule necessity.
00:26:38.743 --> 00:26:51.707
It is because they're emotional eating or they're binge eating Because, like you said, they might have been under fueling throughout the day or we've got some, you know, depression, anxiety, some other mental health component to it that's causing them to cope with food.
00:26:51.707 --> 00:27:03.740
So, looking at their schedule, looking at the why behind it, and then absolutely finding out what foods are you eating late, because if it's a cheese and cracker or something healthy, like you had suggested, I also too don't see any problem with it.
00:27:03.740 --> 00:27:07.951
But if it's a bowl of ice cream or a bag of Skittles or something like that.
00:27:07.951 --> 00:27:09.262
That's a different story.
00:27:09.262 --> 00:27:14.525
You're not really providing your body with fuel to actually help facilitate lean muscle mass.
00:27:14.525 --> 00:27:19.006
You're just adding to possibly the propensity towards blood sugar spikes and lows.
00:27:19.607 --> 00:27:25.888
So I think those are super important to discuss and it's not just a one size fits all eating late is bad or not bad?
00:27:25.888 --> 00:27:28.541
You really need to get into those couple of details.
00:27:28.541 --> 00:27:39.051
In closing, I almost probably every episode say that we need to be referring to your registered dietitian, and the dietitian who's on always says refer to a registered dietitian.
00:27:39.051 --> 00:27:46.064
And I can't stress how important it is to get a dietitian on board and on your team that you can routinely just refer to.
00:27:46.064 --> 00:27:58.814
But I've never really given instruction on how to do that Because you know we know how to refer to other specialists but sometimes dietitians aren't on insurance and you know, not everybody's listed in our EMR.
00:27:58.814 --> 00:28:07.113
So give us a little education on how do we do that and what if the patient's insurance doesn't cover nutrition education.
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