Tara Schmidt, M.Ed., RDN, LD is the lead dietitian for the Mayo Clinic Diet, host of the Mayo Clinic On Nutrition podcast, and Medical Editor of the Nutrition & Fitness channel.
Today she joins me for a holistic, evidence-based conversation about GLP-1s, where we cut through the misinformation around these drugs and offer information you can really trust.
If you’re already taking Ozempic or Wegovy, you want to start so you can lose weight, or maybe your doctor’s recommending it — this episode is for you.
I hope you enjoy it, and if you do, RSVP for my FREE Workshop on September 3rd, Untangle Your Food Triggers: Catch Yourself Before You Fall Off Track.
We discuss:
- What GLP-1s are and how they work
- The place of medication and are these long term drugs?
- Micro-dosing and low-dosing GLP-1s
- Which doctors should be prescribing metabolic drugs
- Regenerative healing from GLP-1s
- The causes of food noise
- Hunger vs appetite
- The triggers for emotional eating
- Why eating for comfort makes sense
- Reclaiming your agency so you want to change (rather than feeling like you “should”)
More about our guest:
Tara Schmidt, M.Ed., RDN, LD is a registered dietitian and an instructor of nutrition at Mayo Clinic in Rochester, Minnesota. As the lead dietitian for the Mayo Clinic Diet, she provides guidance rooted in evidence-based principles, helping individuals develop sustainable and realistic strategies for long-term health. She also hosts Mayo Clinic On Nutrition, a podcast that dives into current nutrition research and practical weight management tips, and she lends her expertise as the Medical Editor of the Nutrition & Fitness channel. In addition, Tara co-authored The Mayo Clinic Diet: Weight Loss Medications Edition, highlighting her commitment to thoroughly researched and medically sound advice.
Beyond her professional endeavors, Tara is devoted to reducing weight bias and ensuring that everyone, regardless of size or background, has access to accurate, empathetic dietary information. She balances her busy career with family life, staying active with her husband, two children, and a golden retriever who—just like the rest of the family—enjoys a healthy serving of vegetables.
Connect with Tara and Mayo Clinic:
Mentioned in this episode:
- Insatiable Episode 280: What’s Missing From the “Emotional Eating” Conversation with Dr. Deborah MacNamara
- Insatiable Episode 271: Over 40 Metabolism Myths with Liz Wolfe, NTP and Certified Personal Trainer
Connect with Ali & Insatiable:
Transcript
Ali Shapiro [00:00:00]:
Welcome to Insatiable, the podcast where we discuss the intersection of food, psychology and culture.
Tara Schmidt [00:00:09]:
There are 10,000 different ways that you can exercise and move your body. There are actually like 15 technically different ways that you can diet that have been proven in research to be healthy and realistic for weight loss. And now we have medications and there’s going to be more of them. And we’ve had medications for a while. Actually. There was just this like gigantic boom. And with GLP1s, I think, because they’re more successful in terms of weight loss percentages than a lot of medications we had earlier in the 2000s.
Ali Shapiro [00:00:42]:
I’m your host, Ali Shapiro, an integrated health coach, 32 year and counting cancer survivor, and have radically healed my relationship with food and my body. And for the past 17 years, I’ve been working with clients individually in group programs and in company settings to do the same.
Tara Schmidt [00:01:02]:
Welcome.
Ali Shapiro [00:01:04]:
The information in this podcast should not be considered personal, individual or medical advice. So you know them by the names Ozempic, Wegovy, Zeppbound, Manjaro. These are the brand names for GLP1 peptides. And unless you’ve been on a deserted island, you probably have heard about these. There was a huge mainstream media frenzy about them. I think a couple of years ago I did a whole podcast episode on Ozembic, Oprah and our outrage. Right. That was more kind of like a cultural look at these.
Ali Shapiro [00:01:40]:
But I wanted to bring on Tara Schmidt, who is one of the lead dietitians at the Mayo Clinic, and she’s actually a lead dietitian for the Mayo Clinic diet. She’s really into evidence based principles, helping people develop sustainable and realistic strategies for long term health. And she knows a lot about these GLP1s. So I wanted to have someone on who could bring a really nuanced look at them because I have several clients who I’ve worked with one on one who wanted to use these, but they also did not want to do a quick fix, a fad. They wanted sustainable results. They felt a little conflicted about them. And I also have more and more people coming to my programs, my Truce with Food programs, who are on these. And I wanted to understand more about them because I have helped some clients and I talk about this in the episode today, really as a thought partner, use these in a more sustainable way than I think they’re being talked about in the mainstream media.
Ali Shapiro [00:02:46]:
And I knew Tara could offer some real evidence based guidance and thoughts around these drugs and how to use them really as not a magic bullet, but a supplement. And she had so many wise words. She’s also very empathetic. She’s dedicated to eliminating weight bias. So I just wanted to have someone on who could hold all of that. And it did not disappoint. Okay. We got into really some of the nitty gritties around these, how to consider if you do want to use them.
Ali Shapiro [00:03:17]:
I shared some of the client successes I’ve seen happen with the people that I’ve, I’ve guided or you know, served as a thought partner. And so I think you’re really going to have a different perspective around these peptides drugs once you listen to today’s conversation. So enjoy. And Tara and I got into a little bit about the psychological. I mean it’s actually the second half of the episode the about the psychological approaches that we have towards food. And we have the same and different approaches. But if my approach resonated, I want to invite you to a free workshop on Wednesday, September 3rd. It’s Catch Yourself before you fall off track workshop.
Ali Shapiro [00:04:01]:
And if the triggers that I mentioned and, and you want to learn more about those resonated, that’s what we’re going to talk about in this workshop. I’m going to take you through a coaching exercise so that you can identify really the roots of your falling off track with food and what is your specific trigger. And having an accurate diagnosis is so important. And so I hope you will join me at that workshop. There’s gonna, I’m gonna take you through a coaching exercise. There’s gonna be lots of Q and A coaching and you’re gonna learn more about that. So if you’ve got on your back to school list, back to school vibes are starting here that you really want to focus on improving your health habits, your eating habits. This workshop is really for people who have tried all the things and are really ready to explore the emotional reasons that they turn to food.
Ali Shapiro [00:04:51]:
Okay. And realize that food is about so much more than calories, macros and restriction. It’s actually a portal to your deeper hungers. So the first step, come to the workshop. Check it out. This is also a free sneak preview of my fall program, why am I eating this now Live with which opens for registration September 3rd through the 10th and we get started on the 17th. And this is my research based client proven framework to help you really get to the roots of falling off track so that you can get the results that you want without more rules, more restriction, just more results. All right, onto today’s show.
Ali Shapiro [00:05:28]:
Enjoy. Tara, thank you so much for being here today. I have More and more people coming into my programs who are on GLP1s, and I’m so happy they are because my work is more about like the emotional roots of food. I mean, I work on blood sugar and stuff, but this is such still a hot topic. Even though I feel like the mainstream media has kind of moved on, but people are still kind of grappling with how to use these and what are they and all the things. So thank you for, for coming on today to, to chat with us.
Tara Schmidt [00:06:01]:
Well, thank you for having me. I don’t think they’re going away, that’s for sure. Right. So even though they’re not necessarily taking over the headlines of social media like they they once were, I think they’re here to stay. And I think that we’ll even see more of them or different versions of them or different ways that we’ll be using them, even, you know, from injection to pill form. So they’re going to be around for a while, to my knowledge.
Ali Shapiro [00:06:24]:
Yeah. And I’m so glad you said that because some of my questions are around like, are there potential healing benefits and certain, like, I want we’ll get to there, but I just see the like, well, we’ll get there, but let’s first for people, because I have found I first want to define what GLP1s are and how they work, because I find sometimes people either think they’re doing something magical or people don’t know how they’re working, so they don’t know how to really match. Match a treatment plan with what’s actually happening. So I kind of tell people like, hey, they help with satiety, but can you explain a lot more what, what’s actually happening with them?
Tara Schmidt [00:07:05]:
Glucagon, like peptide 1 is what we’re talking about and receptor agonist if we really want to get lengthy. So what this is is it’s a hormone in the body. We all already have GLP1 in the body. We all naturally have this hormone. Now what the drug version is doing is essentially increasing the amount, so it’s kind of replicating what we already have in our body. Now why these started as diabetes medications is because they act to help things like lower the rise in blood sugar after a meal, help the insulin to bring down the blood sugar. And they’re acting not only in like the liver and the pancreas in that diabetes family, but they’re also acting in the brain and in the stomach, which is really helping with obesity. So what I tell people is the main mechanisms of action are GLP1s are going to decrease the rate of gastric emptying.
Tara Schmidt [00:08:04]:
So they’re gonna slow food down from emptying from your stomach into your small intestine. So you’re going to feel fuller, longer, because food’s going to stay in there longer. Right. We have the stretching mechanism. I always do this with my hands where when the stomach is stretched, that stretching mechanism sends a hormone signal to the brain and saying, like, hey, we’re, we’re filling up here. Which is why you should eat slowly, which is why you should eat mindfully. There’s my, like, little pitch for everyone. She’ll be one or not.
Tara Schmidt [00:08:32]:
But now, when food is going to stay in the stomach longer because of delayed gastric emptying, you’re going to have that same signal, active longer. That’s happening in the stomach now also in the brain. It’s acting on our satiety signal. So we’re going to stay again, like, have less hunger, stay fuller, longer. And it’s also acting in some parts of the brain that control things like cravings or what we like to call food noise. Like, oh, my God, I just ate. When is my next meal? Like, thinking about that snack. I know I’m not really hungry, but I’m like these, like, constant thoughts of food that I think some people have.
Tara Schmidt [00:09:08]:
And if you don’t know what food noise is, I have a feeling. Feeling you’ve never had it before. But if I mention it and I kind of describe it to some people, they’re like, oh, yeah, yeah, yeah, like, I’ve got that. Like, that’s me.
Ali Shapiro [00:09:19]:
Yeah. I think there’s like two root causes of food noise. One is the lack of satiety and blood sugar control and then like, emotional de. Attachment.
Tara Schmidt [00:09:27]:
Environmental. Yes, yes.
Ali Shapiro [00:09:30]:
But I think what you brought up to people is just really explaining to them how they feel satisfied from feeling food. Because one of the women I was chatting with about questions, she was. She’s on them and she’s, I think, like the 5 milligrams. And I don’t know what else she’s doing, but she’s like, it’s amazing. I don’t feel restricted or deprived on them. And it was like this kind of like, interesting thought to me, because if, you know, I am not about diet culture at all, but part of the kind of conventional thinking is, oh, we only binge or overeat when we restrict. Right. But it’s like, there’s more nuance to that because this woman is sharing this, like, oh, I’m.
Ali Shapiro [00:10:12]:
I’m still Restricting now, but I don’t feel deprived or restricted because I actually feel satiated. So I think that’s just like an interesting thing for people to realize. It’s not necessarily restriction or deprivation. Like it’s not automatic. When you cut back, it’s like, are you still balancing your blood sugar? Are you still feeling satisfied from eating slowly, mindful. It just kind of, it kind of turns some of that, like conventional. Well, all binging is from restriction on its head, I think.
Tara Schmidt [00:10:41]:
Yeah. And you know, the thing that we have to be careful of with GLP1s is people actually undereating or not eating healthily or in nutrient dense or getting enough protein in. Because some people really don’t feel hunger or even thirst after these medications. And you can think in terms of weight loss, like, oh, that sounds great, but. But like, no, no, I. I still need you to eat. I still need you to get nutrition in. So it’s this really fine balance of like, yeah, you might feel so much more at peace or at ease, like just not having constant hunger, like not really having an appetite, feeling more satisfied.
Tara Schmidt [00:11:17]:
You kind of have more. We would call glucose homeostasis with the GLP1 because of how they’re acting, like they’re stimulating insulin secretion and release from the pancreas. We’re suppressing glucose glucagon secretion. And that’s all good. Right? However, not having an appetite or not eating in hello. Diet culture does not equal good news in all cases. So we gotta also make sure that there’s this like, nutrition, please all.
Ali Shapiro [00:11:49]:
Well, I’m glad that you bring this up. Cause how do you think about GLP1s? Because I want to, I want to hear how you think about them. And I love that you said, you know, in one interview, you’re like, I work at the Mayo Clinic. Like we. We’re rule followers to a T. Well, and exactly like to me, that’s part of why the Mayo Clinic is so revered. Right. Like you follow the evidence and the research and yet.
Ali Shapiro [00:12:10]:
And holding the. And we also know that a lot of these clinical studies are done on a specific kind of population that is, I would say, more of an emergency state than sometimes some of the people who are in the middle. It doesn’t mean they’re not creeping up that way. But how do you think of these GLP1s? How do you use them in your toolbox?
Tara Schmidt [00:12:31]:
You just took the word out of my mouth. I literally say, these are another tool now that we have in weight management or in obesity management. Again, Thinking of that as a clinical diagnosis, which we would in the clinic or the hospital. Because I also work with people who are doing it via lifestyle. I work with the Mayo Clinic diet. And for many years of my career, career, I was specializing in patients who were undergoing bariatric surgery or procedures. So I like to say that to manage excess weight to improve your health, not to get a new jean size, because who cares about what jean size you wear? Lord knows. We have lifestyle, we have medications, we have procedures and we have surgery.
Tara Schmidt [00:13:13]:
And there’s going to be different risks associated with those. Right? Like going under the knife per se. Like is risky. Like surgery is a risk. There’s also a risk to dieting. And we know that there’s some pretty bad risks to things like weight cycling. But there’s always an appropriate pathway based on your health history, based on how much weight you, quote, need to lose to improve whatever health conditions we’re talking about. If you even want to lose weight, if you want to trial a medication.
Tara Schmidt [00:13:43]:
But it’s also not a, like you pick something and that’s, that’s the end of the road. We’re using some medications with, with surgery or we, I think we’re going to see a little dip in surgery, which we have with GLP1s. But also like the cost of them over the long term compared to the cost of surgery is up for debate. So it’s an option, right? Like there are 10,000 different ways that you can exercise and move your body. There are actually like 15 technically different ways that you can diet that have been proven in research to be healthy and realistic for weight loss. And now we have medications and there’s gonna be more of them. And we’ve had medications for a while. Actually.
Tara Schmidt [00:14:23]:
There was just this like gigantic boom with GLP1s, I think. Cause they’re more successful in terms of weight loss percentages than a lot of medications we had earlier in the 2000s.
Ali Shapiro [00:14:35]:
So what I hear you saying is that it’s a tool. Like I always tell clients who are interested in it, it is the supplement. Like you still have to do the foundations to sustain it. And the reason that I asked that is because I wanted to ask you about dosing. And that’s why I was kind of like, you know, oh, we follow the rules. And coming back to the studies, the type of people they were done on, because I love evidence based research. And I also think science is a continuing quest for knowledge. Right.
Tara Schmidt [00:15:03]:
It’s always changing.
Ali Shapiro [00:15:04]:
Yes, it’s always changing. So you have to hold both But I’ll give you two client examples of. I feel like these trials were done in a way to kind of have the pharmaceutical companies prove that they work right. So it’s like, we kind of have to show this. This shift, which is, of course, you want to see that. But it doesn’t seem like they were looking at sustainability to me unless the solution is to stay on them. So, for example, I want to give you these two client examples of people I was working with. One client, she’s never been officially diagnosed with pcos, but it’s.
Ali Shapiro [00:15:39]:
She’s always had some insulin challenges. So for listeners, that means satiety is really hard when you have insulin blood sugar challenges. And she wanted to get pregnant and was having trouble with pregnancy. And she came to me and she’s like, I’m, you know, I’m thinking of using these. And I was like. And she was doing everything else right, because we had worked together. And it’s now kind of in the. Now it’s in the mainstream.
Ali Shapiro [00:16:03]:
This was two years ago of like, micro dosing or low dosing. And I don’t think there’s evidence on that yet. But she was like. I was like, well, in general, it just seems like you would always want the least amount of dosage and maximum results. And she did wait. She told me, and I’m allowed. Everyone gave me permission to talk about this. She started with.06 and ended up at the full dose and over a year had lost, like £60 and got pregnant.
Ali Shapiro [00:16:28]:
That’s why she eventually went off of, like, she got off them and then got pregnant right away. And so that’s an example of someone who’s like, also considering her metabolic health and preserving muscle and all these things that you would need to do, but didn’t use the full dose. And then I had another client who was in her 40s, did not want to get pregnant, but her doctor had said, you know, you. You should lose weight. And so she came to me and we had. We had worked together in the past and she’d gone through a lot of stress with the pandemic, having a baby perimenopause. And I said, sure. I said, well, you know, keep lifting, keep, you know, let.
Ali Shapiro [00:17:02]:
Let’s keep things. And we worked a little bit on the emotional eating for her, but she was. She started at 2.5 milligrams, which is like the standard starting dose for. Oh, God, I forget. I think. I forget which one. I think she was on Zepbound. I think that.
Ali Shapiro [00:17:16]:
Yeah. And her insurance covered it. And so then she was starting to lose weight and then within a month, you know, after the month you’re supposed to go up to five. And her doctor was like, okay, it’s time to go up to five. And I said to her, I said but you’re still losing at like a pound a week and we want to preserve your muscle. Because she was finding that she was actually, actually gaining strength, she was able to do more pushups on these lower doses. Cuz again we had made sure she was eating right and all this stuff. So fast forward and then she had some insurance changes.
Ali Shapiro [00:17:47]:
So she was like, what do I do? And I said, and again, I’m not prescribing, I’m just kind of like a thought partner with my clients around this stuff. And I was like, well why don’t you cycle off for a little bit and like get back up to some of the the calories to maintain while you figure out your insurance. So she did that for like three months, maintain and then wanted to lose more and went back on 2.5 again and is still losing. And she has lost about. We’ve done it over a year. I mean she’s done it, but I’ve guided her over a year and she’s lost like £50, has kept it off and has preserved her muscle, has done it slow and steady. And she also told me that her periods are now more regular, her hot flashes are gone. So people are kind of going on these and like told you have to stay on them forever.
Ali Shapiro [00:18:34]:
But isn’t there another way to make these actually a tool and a supplement instead of the magic bullet?
Tara Schmidt [00:18:41]:
That’s the question. Right, So I love that you said that these are a tool or a supplement in addition. Right. Because what I’ve hated is this notion that this is all you have to do. Like you just get to take this and it’s magical. And in all honesty, they are kind of magical. Like they work, right? And we want medications to work. Like if we, we’re going to have prescription medications out there for disease states, like let’s have them work, let’s cure cancer.
Tara Schmidt [00:19:07]:
Woohoo. However, with this one, I think it is forgotten that in the trials and in like the published evidence, the people in these trials were also given nutrition counseling, they were also given exercise programs, they were given dietitians, they were given a calorie deficit. Like it’s important even for these pharmacological companies who are trying to prove the efficacy of them to like also give them all the right things. Now will they work without all the right things, honestly, yeah. But if we’re talking long term, I have a concern about your muscle mass, I have a concern about body composition, I have concerns about your bones. Right. And your metabolism even. So I do always want them used in conjunction with all of the right things.
Tara Schmidt [00:19:59]:
But when it comes to long term usage, that some, those are some questions we don’t yet have answers to. Because what we know thus far is that after one year after drug cessation, so after stopping the drug, people have typically regained about half to two thirds of the weight that they had lost. So they are kind of meant to be taken long term because we know long term usage is going to essentially promote long term success. Right. And I always give this really silly example, I’ve said this thousand times of like, if you have chronic high blood pressure or chronic high cholesterol and you needed to go on a beta blocker or you needed to go on a statin, and you still did all the right things, right? Like you did the diet thing, you did the no smoking thing, you did the exercise thing, but then all of a sudden we took you off your prescription. That would probably go back up, right? Like if you have chronically high blood pressure, you have chronically high blood pressure, even though you’re doing the right thing, maybe we can be on a lower dose. Maybe your statin you can take a few times a week instead of every day. So I’m hoping that whoever your provider is is always going to get you on the least amount of medication.
Tara Schmidt [00:21:14]:
But there is a place for medication when we’re talking about chronic diseases, because they are chronic. Like that’s the word. So it’s an unknown, right?
Ali Shapiro [00:21:27]:
I, well, I think what I’m struck by is like, what works and how we’re defining that because I think often it’s just, I want to see what works in the, in the short term. I mean, we are not winning at weight loss.
Tara Schmidt [00:21:38]:
We’re not going in the right direction even with these drugs. Like, these drugs are going to be, I think, life changing, life saving for a lot of people. But like, we are not yet curing the obesity epidemic, which it is an epidemic.
Ali Shapiro [00:21:51]:
You know, when I see my clients having these type of results, I’m like, this could actually, like, what they’re doing is working not only in the short term, but long term. And it just feels like when you understand metabolic health, you wouldn’t be dosing. And again, everyone’s different. So you have to match the dose with the patient. But it seems like jacking People up when they’re. Some people are essentially on a starvation diet. And One of my one client who lost the 50 pounds, her doctor was like, she was like educating her doctor on metabolic health. I was like, well why don’t you suggest this to her? Like we were kind of like chatting about like and she’s like.
Ali Shapiro [00:22:25]:
And the doctor was like upset about how she did not learn this from the pharmaceutical rep. And like she’s like, you’re my only patient who’s maintaining the weight loss and doing things the right way. And when I think about like what works like you brought brought up about you know, cost. What about like when your body stops responding to these, these drugs? Like so I just feel like there needs to be a much broader conversation around, around like the dosing and you can see it online. Like it’s, I mean this is microdosing has taken off now. I don’t get these ads yet. Maybe after us talking I will.
Tara Schmidt [00:22:58]:
They’re listening, they’re list.
Ali Shapiro [00:23:02]:
But I, there’s a couple practitioners who have talked about like you know, matching the dose with the patient and using the least amount so that you preserve muscle mass. You don’t put people on a crash diet. And I like looked in the comments because I love, because again I think research, we often find what works in real people from like their experiences. And I think that’s important evidence. And it was amazing to me to see how many people were like low dosing or microdosing and they were getting huge success. And some people, I don’t, I’ve never seen these pens so I don’t know. But one woman was like my insurance will cover the pen the way like the pre filled pen, she does something to take part of it out.
Tara Schmidt [00:23:42]:
La la la.
Ali Shapiro [00:23:44]:
Oh, you can’t hear it.
Tara Schmidt [00:23:46]:
Okay.
Ali Shapiro [00:23:46]:
I was like what is she doing? Like, but I mean my, when I read that I was like, wow, she’s going to a herculean effort to be able to microdose. I don’t even know. So I was like this is really fascinating. These are real people who are trying to figure it out on their own. And there’s a lot of proof that like they’re losing weight at like a healthy rate, you know, half a pound to a pound. They’re preserving muscle. They’re like I’m sleeping better. Carpal tunnels going away.
Ali Shapiro [00:24:12]:
So I just like are you guys.
Tara Schmidt [00:24:14]:
At all curious about that? Oh for sure.
Ali Shapiro [00:24:16]:
Where do you think like the people listening to Insatiable tend to like have high levels of education on this stuff? Looking for more nuance in depth. So I’m just curious.
Tara Schmidt [00:24:25]:
They’re engineering their pens to microdose.
Ali Shapiro [00:24:27]:
Okay.
Tara Schmidt [00:24:28]:
There’s a few things going on here. And again, I’m not a physician, so I’m not prescribing these. But here’s where, like, the medical industry is coming from. Here’s where your prescribing provider is coming from. The FDA approved medications are the ones that come in the pens, right? They’re only manufactured by a few big guys in the market because those are the ones that were studied and those are the ones that are FDA approved. We have my own clinic only do FDA approved things, right? Unless you have an allergy and yada yada, then we’ll get you compounded, whatever. So what’s happening out there with, quote, microdosing is you can’t microdose with an FDA approved medication unless you’re Jimmy Reagan your pen, which again, like, I can’t. I just can’t endorse it, you guys.
Tara Schmidt [00:25:15]:
Okay? I can’t because it’s not FDA approved. So at Mayo, we’re not microdosing because we’re not prescribing compounded medications. You can only microdose from a compounded medication because those are going to come in a vial, which you use your syringe and you decide your dose, right? Like, you literally, like pull up the medication to however many units you need and then you inject yourself. The people who are doing it with a pen is kind of impressive to me. Please don’t do that.
Ali Shapiro [00:25:43]:
But that way to think outside the box, like, or outside the syringe.
Tara Schmidt [00:25:47]:
So those are the two companies of like, you’re not getting the FDA approved medication if you’re microdosing. You’re only getting the FDA approved medication. If you’re on some. If you’re getting it from a company and it’s in a pen or a syringe for you, like preloaded. So that’s the information out there. Compounding is meant to be going away. I don’t know how to say that eloquently. There’s a lot of lawsuits out there currently against compounding.
Tara Schmidt [00:26:13]:
So I’m not sure how long that’s going to happen. But because there was a shortage at one point in time which allowed it, that shortage is no longer present. So now Big Pharma, let’s call them, is going after the compounding. Now, I absolutely agree with you that we are not escalating people just to escalate them. That’s the, that’s the Progression, like, so that’s essentially like, what the directions say to do. Like, after four weeks you do X, and after eight weeks you do Y. But I don’t know any physicians that are, like, pushing people to be on the highest dose. If anything, people are asking about microdosing or, you know, like, going off long term.
Tara Schmidt [00:26:56]:
And the answer to me has always been, we probably are not going to take you off, but we’ll get you on the lowest dose possible so that you can, like, keep that, like, therapeutic, helpful dose so that you keep getting the effects and you don’t have this 66% weight regain effect.
Ali Shapiro [00:27:13]:
Yeah, yeah, because I. When I was asking questions, you know, to give questions to bring to you, one person was like, you know, I’m. She’s like, I feel so conflicted because she’s like a feminist and, you know, like, trying to. But she’s like, but I need to lose weight. And I was like, no, that’s fine.
Tara Schmidt [00:27:28]:
Those two things can be true.
Ali Shapiro [00:27:31]:
Yeah, exactly. Exactly. And she’s like, I’m on five, but we’re debating whether to go to 7.5 milligrams, and I’m not having any side effects. And I was like, I don’t think the question is, like, if you’re having side effects, it’s like, are you still feeling really great and reaching your goals on the current dose? I said, but I will ask. Tara, for you.
Tara Schmidt [00:27:50]:
There’s always this balance of, is it working? One, like, are you getting the results that you need to get or the results that are expected? Because if you’re not getting results, then, like, let’s not be on an extra medication. Like, let’s change it up or let’s, you know, switch it up, do something different. So, one, we need to be getting results because otherwise we’re putting something in your body that’s not working for you and not helpful, clearly. And then two, there’s also side effects. So we. We might bump someone down not because they don’t need that much, but because they’re puking or, like, they’re miserable or they’re nauseated all day long. So the good thing about these medications is that there are multiple dosage of all of them in. In most cases, especially if it’s an injectable.
Tara Schmidt [00:28:35]:
So we can go up, we can go down, we can go off and maybe put you back on. Like, there’s. There’s options, and. And those are conversations that I want people to feel empowered to have with their prescribing provider of, like, ask questions like, you Are the patient. Why don’t you ask? Like, hey, can I just stay on 5? Like, do I. Do I have to go to 7.5? Or, like, is it safe for me to. To go up, you know, after this? Or I’m. I’m really having symptoms.
Tara Schmidt [00:29:02]:
Is it okay if. If we drop it down? I don’t know any physician who wouldn’t want you to ask those questions. Like, they’re gonna follow the rules because that’s what they’re meant to do, and that’s what they’re legally obligated to do, and they’re gonna do what the pharmacology companies told them to do because they’re. They’re following what’s been researched and what they spent years doing with subjects. But you still get to have a say in if it’s safe. Why wouldn’t they let you do something like that? Especially take less medication? I’ve had plenty of people come in and be like, hi, I know I have high cholesterol, and I would really love to avoid a statin. And the cardiologists I work with, if it’s safe, will say, you got three months. Go hang out with Tara and come back in three months.
Tara Schmidt [00:29:49]:
Or, hey, I’d really love to avoid this. All right, Go hang out with Tara, come back in six months, and we’ll see if it is safe. And I’m going to say that a thousand times, right, because we. We need to keep you safe. At the end of the day, we’ve got to do our job and then all that. Hippocratic oath, et cetera. But of course. Of course, you get to control a lot of things, and maybe people just need to feel empowered to say, like, hey, I got some questions for you.
Tara Schmidt [00:30:16]:
This is what I Googled. Like, but I’d like your clinical opinion. I’m like, all right, let’s go.
Ali Shapiro [00:30:23]:
Yeah, well, that’s what I. I’m glad that you said that, because I. Part of the developmental process that I take people in, my Truce with food model is to realize that there. There are experts, but there’s no, like, absolute authority of, like, what is right in everyone’s body. You have, like, you come into any treatment plan with a unique health history, a unique, you know, place that with your health. And so I want people to. To know that through this episode that. That, like, okay, this.
Ali Shapiro [00:30:52]:
These may be the rules, right? But there’s also. There’s also things not being studied that I personally would love to have being studied, and that this is, like, based on a certain set of clinical trials. And that there doesn’t mean there’s flexi. There’s not flexibility within that. Because I think a lot of times when people have had shame and struggle with weight, right, there’s this perfectionism that comes in. It’s like, if I do things perfectly, it’s going to work. I can’t tolerate any risk of going outside the plan. And it’s like.
Ali Shapiro [00:31:23]:
But the plan isn’t always, like, totally tailored for you. So I’m glad that you said that because I want people to work with their prescribers. I’m just finding that some of the prescribers don’t even understand how metabolic health works, which is, like, mind blowing to me. And it’s like. And just for listeners, metabolic health, we’ve done some past episodes, but that’s kind of preserving your muscle mass, getting your heart health in check, like getting insulin under control. And that is the. That is the goal to keeping weight off. Right? Wouldn’t you say that, Tara?
Tara Schmidt [00:31:51]:
Well, in. When you talk about metabolic health, I’m thinking like, of course they know about metabolic health, but I’ve heard, I work at a very highly specialized clinic where, like, we have, we have a women’s health department and we have an endocrinology department and we have a surgery department and we have a GI department. And like, they’re everyone’s, like, in their little houses. I also know of someone who got a GLP1 from their podiatrist. What?
Ali Shapiro [00:32:14]:
What?
Tara Schmidt [00:32:15]:
If you can prescribe, you can prescribe, right? Which I can’t do, so I’m, I’m not giving it to you. But when you talk about, like, people not knowing about metabolic health, that’s going to be my opportunity to say, go to someone who does know. Like, I would love you to go to a physician who’s comfortable and knowledgeable about prescribing these. That’s in our department, endocrinology. And there are family physicians and there are internal medicine physicians who are absolutely comfortable and they’ll do it. But I also was in an appointment one time asking some questions. My provider’s like, you know what, Tara? Like, I just think I want to send you over to Women’s Health for that question. I was like, thank you for, like, your honesty and, like, being a little bit vulnerable, even though you’re a brilliant physician at Mayo Clinic.
Tara Schmidt [00:33:04]:
But for saying, like, you can I send you down the hall? Like, that’s just really not my thing. And I said like, oh, my gosh, I would love that. Thank you so much. So know that you can be an authority. I love how you were saying like there are experts out there, but you are, you are one of the experts. Cuz it’s your body. And there are diet experts and there are exercise experts and there’s psychology and there’s metabolic or endocrinologists. There’s lots of wonderful people out there with all different kinds of specialties.
Tara Schmidt [00:33:29]:
But it would be important to me in this conversation that we’re having would be to go have that conversation with someone who is an expert in these medications or at least in obesity management, in endocrinology. I don’t really care. But I’m hoping you have a physician who if they don’t know about metabolic health, they’re not prescribing in all honesty. Right. Like I hope they’re like, hey, can you go down the hall and talk to my colleague? Because that’s I think what the responsible thing would be. But like I’m not anyone’s mom other than my small children. So that’s just my little soapbox there.
Ali Shapiro [00:34:03]:
Yeah, yeah. And I’m, I’m grateful that you said that because I want people to be in good hands. Right. Like if you’re going to undertake something, you need the right support. And I just, you know, and again, things are changing, but we’re in this very specific moment in time where a lot of things are broken and doctors are just starting to learn nutrition in medical school. Right. Like it’s so it’s. And again, this isn’t like western medicine also was designed at a time where it was like, you know, if you’re in a car crash.
Ali Shapiro [00:34:33]:
Right. It wasn’t designed with chronic disease in mind. So it’s, it’s, it’s nobody’s fault or anything.
Tara Schmidt [00:34:38]:
It’s just, it’s slow moving.
Ali Shapiro [00:34:42]:
Yes, exactly. So one more question on kind of like the physical aspects of this. Do you think that there is some sort of healing happening with insulin resistance or anything? And because when again, when I read some of these comments, it’s amazing. People saying hamstrings getting better. My client, her carpal tunnel got better and I’m like, okay, is that inflammation from the weight loss? Maybe a little bit of both. But even I have a family member who’s struggling with Parkinson’s and I found clinical data that liraglutide, which was kind of like the first version of these, has been clinic like in clinical trials shown to help certain Parkinson patients. And I was like, what is like, I’m just curious about, do you think there’s some regenerative medicine happening within these.
Tara Schmidt [00:35:31]:
I think there’s a lot going on and kind you kind of said this like will we ever know if it’s like I don’t know if chicken or the egg is the right model to use here. But like is it the weight loss, is it the like beta cell function that’s improving things? Is it lipids? Right. So we are going to continue to see, which is great, more and more research about other uses for these drugs. So again, started out as diabetes and that was great. Went into obesity, that’s great too. Now we’re looking at like the cardio protective effects of it. And is it going to be approved? Right. For, for heart health.
Tara Schmidt [00:36:05]:
So there’s this like giant list of okay, if we have lower energy intake, we have lower appetite, we’ll have a lower weight, increased insulin, increased beta cell function, decreased glucagon and like we can like talk about again, that’s all the stuff we talked about before. But we’re also finding they improve lipid disorders like fat in the blood, blood pressure. Fatty liver is a huge problem in the United States, even with kids, which is really kind of scary and sad. So these are improving fatty liver, reduced risk of heart disease, reduced risk of kidney disease, delays the progression of diabetes related neuropathy, renal benefits. I don’t know if I said the kidney already. Cardio protective, increased lifespan, all cause mortality. Studying it for Alzheimer’s, alcohol use disorders in terms of like the addiction. So I don’t have answers, I don’t think I have the answer to your question.
Tara Schmidt [00:37:03]:
But like there are things happening that are positive, hugely positive obviously. And we also know in the more negative realm that like having excess weight negatively impacts all of those things. So I think maybe both things can be true. Right? Like when we have improved function of all these things, like that’s good, clearly. And when we reduce our excess weight and okay, now I have a third thing that I thought of. And are we reducing our, in our intake of ultra processed foods? Okay, that’s, that’s, it’s like honestly a whole nother bucket, right? Not only are we losing weight, not only do we have like improved organ function, but because we have lower appetite, because we have less cravings now, are we eating less. Can I say crap? Crap, that’s not a bad thing either. So maybe it’s all the above.
Tara Schmidt [00:37:56]:
We need like a chicken and an egg and something else.
Ali Shapiro [00:37:59]:
In my truth with food models rooted in developmental psychology and what you what I’m trying to always get clients to realize is that what you’re trying to do is move them up. It’s called complexity fitness. Being able to hold nothing is one thing.
Tara Schmidt [00:38:13]:
Oh, my gosh, yes.
Ali Shapiro [00:38:14]:
Right? So what you’re saying is, like, okay, maybe it’s the weight loss, maybe it’s the inflammation, maybe it’s the beta. But the cool thing is, is, like, when you address the roots of something, you don’t have to address each thing individually. Like, all the systems get better. Right?
Tara Schmidt [00:38:27]:
So I wish everyone knew that about nutrition, because I’m asked so many questions, mostly from the media, about, like, specific foods, specific ingredients, and I’m like, it’s more complex than that. Like, we don’t just, like, live in a room and, like, eat bananas. Like, okay, bananas. Good or bad? Like, well, you locked me in a room and all you gave me was bananas. Like, there’s a problem there. Like, that’s one. Not how anyone lives.
Ali Shapiro [00:38:51]:
Is there anyone gonna let me out? I’m claustrophobe.
Tara Schmidt [00:38:54]:
Like, bananas are great. So let’s not study that bananas are bad because you locked me in a room and all you gave me was bananas. So I. I love that you mentioned complexity because food is complex. Like, eating is complex.
Ali Shapiro [00:39:08]:
Oh, my God. I tell my clients, I’m like, those continuous glucose monitors. The banana example, like, did you eat the banana in a rush because you were late to drop off your kid and you have a big work? Like, that stress is gonna.
Tara Schmidt [00:39:18]:
Did you only eat the banana, or was there some peanut butter and toast with.
Ali Shapiro [00:39:22]:
Well, this is. I mean, this is not what clients come to me for. But they leave valuing discernment. And I’m like, you need to understand the media is targeting a developmental level.
Tara Schmidt [00:39:32]:
Of good or bad, of headlines. Like, bananas are bad. Like, but super simple butter is back. Like, literally three words, right? Like, don’t drink coffee. Wait, wait.
Ali Shapiro [00:39:45]:
The answer is always. It depends. But that is not going to sell magazines.
Tara Schmidt [00:39:49]:
People hate when I say that. Yes. Oh, my gosh.
Ali Shapiro [00:39:51]:
I know, I know, I know, I know. Well, fortunately, like, you get tired of that eventually, and you’re like, okay, I have. I have to add some more complexity. So. So speaking of complexity. So a lot of my clients kind of come to me when they. I don’t know if they can articulate this yet, but they know that what they were doing is no longer working. And so I basically help them see that health, weight, food is more than food and exercise, that it’s also actually in my work about attachment and belonging.
Ali Shapiro [00:40:18]:
And we turn to that when we don’t we don’t feel like we have that because it, nature, when we turn to food, it stimulates attachment chemicals, but it doesn’t give us the deeper caregiving. Yes. Dopamine, oxytocin. I mean, dopamine is sometimes right, like super, super stimulating, whereas oxytocin is more like your, your warm fall soup instead of your ultra processed foods. Yeah, we could. That’s a whole other podcast. I’ll have you back on about our addiction to intensity, but when we think of food noise. So we talked about the first one being about around satiety.
Ali Shapiro [00:40:51]:
Okay. And then I see the second is kind of the emotional reasons people turn to food. And I heard you say in an interview that, and I love this, that you, you discern between hunger and appetite. So can you talk a little bit about that?
Tara Schmidt [00:41:07]:
And I don’t know if, if I made this up or where I’m supposed to be giving credit, but personally, this is just how I, I kind of define things when I’m talking to, to my patients and my members is that I think that there is hunger that comes from your stomach where, like, your stomach is growling. You could eat a freaking horse. You have not eaten in multiple hours. Like, physiological hunger, like, your, your body is like, hello, like, we’re hungry here. Like, it’s giving you all the right signals. Hunger’s a good thing. Loss of hunger, especially if you’re talking about, like, end of life, like, is. Is not honestly a good sign.
Tara Schmidt [00:41:45]:
Then there’s appetite, which I think is more coming from the brain of, like, I feel like getting myself a latte at Target today. Or like, I feel like having a glass of wine. Like, my stomach did not tell me that I wanted a latte. My brain told me that I should treat myself because I’m a target without my kids. And that sounds really delicious. And I think I’ve got a gift card in my purse somewhere. And so I, I, I differentiate it between, like, your stomach and your brain. And it’s, it’s more complex.
Tara Schmidt [00:42:18]:
Like, these are not just like two little, like, signals sitting here. I think a lot more things can play into appetite in, like, what you’re seeking. Are you seeking comfort? Are you seeking a blood sugar rise? Are you seeking pleasure? Are you seeking a reward? And, like, going down like that, like, path versus, like, oh, my gosh, I’ve been, you know, like, working for the last five hours and haven’t had any lunch. My stomach is, like, tiny, tiny and screaming at me.
Ali Shapiro [00:42:49]:
Well, and I love that distinction for people because even your language Because I’m super into language and the story it tells. Like, I feel like. And my work, again, I kind of showed you. Told you briefly, briefly. But it’s really. And this is kind of building. I mean, my work is. Is research based.
Ali Shapiro [00:43:06]:
The Mayo Clinic would like it. But also it builds on Dr. Deborah McNamara’s childhood development work about, you know, how food. Basically, nature designed food belonging to be served with the side of food. Right. And so when you talk about comfort, right, I think sometimes we. We think of that in a shaming way. Like, I’m looking for comfort.
Tara Schmidt [00:43:25]:
That’s not a bad thing.
Ali Shapiro [00:43:26]:
Yeah, yeah. No, I’m not saying you were. But I think people in the media, it’s like, stop turning to food for comfort or pleasure or a reward. But she talks about food really being this place of rest, right, where we have a caretaker who. There is comfort in their presence. There is a reward of being able to kind of lay down your troubles, right? In a way of getting support. And so that’s kind of the angle that I take of, like, why does this make sense, that you need comfort? Why does this make sense? But how do you approach the psychology of food? The more appetite. I feel like this rather than I’m actually hungry.
Tara Schmidt [00:44:01]:
Well, and do you go all the way? While you were talking, I was, like, having this, like, these thoughts about breastfeeding, because breastfeeding can be absolute nutrition. Like, your baby screams their head off, and they’re like, okay, are you hungry? Are you wet? Like, what’s going on here? But I think that babies can also nurse for comfort. Like, have you ever had a baby? Like, it, like, has, like, a few little sucks and then it falls asleep. You’re like, oh, you weren’t hungry. Like, you just wanted, like, to smell your mom and to, like, get comfort. Like, nursing can be comfort, too. So it’s really complex. And sometimes I’d even talk to my patients about how we lose our sense of listening to our physical signals of fullness pretty soon.
Tara Schmidt [00:44:46]:
Like, I don’t know, into childhood. Because babies, when they are breastfeeding or bottle feeding, that doesn’t matter when they’re full, like, they’ll turn their head away. Like, they’ll be like, get that. Like, get that thing away from me. Not. This is not the comfort scenario. This is the hunger scenario, right? Of, like, I have an unlimited supply of food in this bottle or in this breast. But, like, my brain told me because my stomach filled up with milk and then, like, stretched, and then this hormone signal went to my brain, and now I’m like, no, thanks, mom or caregiver.
Tara Schmidt [00:45:17]:
Like, I don’t want any more of that. Like, I need to burp and go to bed now. We lose listening to those signals very early on because, one, we have more mature brains and more like functioning humans eventually. But we have environmental cues, right? Of like, ooh, that looks good. Right? Like, I saw the Starbucks. Or we have emotional cues of like, oh, I’m really feeling like this. I’m going to use food to provide me with that. So I do a little bit.
Tara Schmidt [00:45:49]:
Especially because I’m in groups. A lot of the basic, like, okay, what was your trigger? What was the response to the trigger, and what was the reward at the end of the day? And, like, helping people find how they’re rewarding themselves. And just the question of not, can you do something else always, but can you adapt your response? So, like, not that you’re not gonna have a cookie because you want a cookie. And guess what? Cookies are not, like, evil things or, quote, bad. I hate when people call foods good or bad. Like, they’re. They don’t have values associated with them. Like, it’s just.
Tara Schmidt [00:46:26]:
Just a cookie material. So I would do more. So, like, okay, I understand you’re seeking this reward. How can we improve your response? Like, maybe it’s one or two. Maybe it’s saved for Fridays. Maybe it is, no cookies leave the house. Like, you actually just needed some sunlight. You needed to go for a walk.
Tara Schmidt [00:46:44]:
But I look more at the. Yes. What reward are you seeking? And how can we adapt either your trigger in the first place or your response to it.
Ali Shapiro [00:46:57]:
Yeah. Yeah. Well, I love that you brought up breastfeeding and. Because I think sometimes when there’s advice around, like when I read in the magazines, right, it’s like, oh, it’s for comfort or pleasure. But what you’re. You’re describing is that we know, but don’t remember that food and safety are intertwined. Right. Because.
Ali Shapiro [00:47:16]:
And this is what actually, Dr. Deborah McNamara, I had her on my podcast. Well, we’ll link it in the show notes, episode 2 80. But she talked about what Maslow got wrong. Like, you know. Yeah, Maslow and its hierarchy of needs. And she said Maslow did not have the benefit of neuroscience. So he.
Ali Shapiro [00:47:32]:
We now know that belonging or that caretaking is actually more important to the brain because that’s how you secure all the other basic needs. Right? So like, you talked about, sometimes the baby’s just like, needs a couple, a little bit of milk for comfort and. But it’s the comfort of Knowing someone’s there and the food happens to be there as well. So we know but don’t remember. So when we’re going for that comfort, it’s this, like, automatic pilot, this drive that has been with us, and that nature actually designed it for that way. And then the other thing she talks about is that Maslow actually didn’t have strong attachment with his parents, so there’s no way that he would know as a theorist. Oh, wow. Right.
Ali Shapiro [00:48:11]:
And that caretaking is so important. And I would get into how, like, even the pyramid. And that’s kind of western mentality of linear ality.
Tara Schmidt [00:48:19]:
Oh, I love this.
Ali Shapiro [00:48:20]:
Yeah, yeah. But what you were even talking about the latte at Target. Right. It’s interesting that the foods people tend to go to are dairy and sugar, which are the sweetness of breast milk or formula. Right. And these more mothering foods. I mean, even if. If we put on a different framework of traditional Chinese medicine, sugar, wine, dairy, all has very yin or mothering qualities.
Ali Shapiro [00:48:42]:
Right.
Tara Schmidt [00:48:43]:
I’m literally, like, drinking, like, my version of breast milk at Target.
Ali Shapiro [00:48:46]:
Yeah. The adult version. That’s acceptable, but, like, it makes sense. Right. Like, and so my clients start to realize, like, when they’re turning to this stuff, it’s like, oh, and again, this. I hate to use the word mothering, because this is not about mothers or parent. You know, It. It.
Ali Shapiro [00:49:05]:
It. It’s not that, but it is that energy of, here is a place to rest. Here is a place to, like. Right. Because people talk about being. Being stressed. They stress eat, or they want a comfort. And it’s like, I think what they’re most deeply looking for is that sense of exhale, that sense of, I can lay.
Ali Shapiro [00:49:24]:
I’m. We’re laying down my troubles. But it’s. It’s. But what people tend to do is isolate when they’re stressed, which further then makes them want to turn to food. Because food is the closest thing to the attachment. Because again, back to the attachment chemicals. And Dr.
Ali Shapiro [00:49:38]:
Deborah McNamara talks about, like, there’s nothing as addictive as something that almost works. And so it’s like, oh, food almost gives me that sense that I’m not all alone in this and it’s legal.
Tara Schmidt [00:49:49]:
And it’s super accessible. And I do think it gives you dopamine, like, and all the good, happy little thing. Like, no one eats. No one’s eating carrots at this point in time. Like, if you stress eat carrots, like, you go, girl. Like, good for you. I don’t need to see you in my office. But that’s not what’s happening.
Tara Schmidt [00:50:05]:
Like, we’re. We’re seeking the things. And I’ll even have patients experiment. And I’m sure you do too, with your clients. Like, okay, is this like a time transition habit? Like, I come home from work and I go right to the kitchen to, like, have my glass of wine and cheese and crackers. Okay, I get that you absolutely deserve a time transition, but when you get home from work, I want you to, like, pour yourself a cup of your very, very favorite tea and sit on the porch. And I think you’re gonna hopefully get the same benefit. And if you don’t, then my experiment failed, and we’re going to go back to the drawing board and think of something you do.
Tara Schmidt [00:50:43]:
Like, because you’re like, ewater, I hate teas and I hate mosquitoes. Like, okay, then you give me something else. But we, like, continually experiment until you get that same feeling, if that’s appropriate. And if we just need to be like, okay, less wine, or let’s eliminate alcohol. Okay, like cheese and crackers. We’re going to add some apples and some nuts to that charcuterie board and just cut down on the other things.
Ali Shapiro [00:51:06]:
And it.
Tara Schmidt [00:51:06]:
It’s all possible. It doesn’t have to be this, like, eating for comfort is bad. Like that. That’s not bad. It’s. It’s okay. But how often? How much. What are you going for? Like, we have room.
Tara Schmidt [00:51:20]:
It doesn’t need to be black and white.
Ali Shapiro [00:51:23]:
Yeah, well, and that’s part of the developmental process people have to go through is like, not being all or nothing good, bad. But I love that you talked about basically the way that I heard it is like, when is this just a habit that your brain has picked up? And the neuropathway is like, you know, that’s comfortable because it’s like, there’s no resistance. And I love that you said this, because this comes up when people are further along in the process, when they really understand what’s going on. They’re like, how. How do I know this just isn’t a habit that I need to unlearn versus feeling like this is actually about safety and belonging and just to kind of back up. I take a similar approach to you, but I think we might deviate a little bit. Is that I. There’s four main triggers that I help people identify.
Ali Shapiro [00:52:05]:
It’s like tired, but it’s not just about a nap. It’s. It’s not being. Not like, doing things that you like in your life. It’s overriding your body’s. Need for rest. Right. Anxiousness, which is like when uncertainty is coming from the outside.
Ali Shapiro [00:52:18]:
So I’m sure you saw during COVID right, Like, weight went up, alcohol use went up. Like, we are. We in America. Even. Even though we’re going through, you know, the past several decades more transition. Like, we are. We’re a relatively stable country. Like, you know, so it’s like, uncertainty can be.
Ali Shapiro [00:52:35]:
Can be hard, and then inadequacy, which is like, I’m not feeling enough. I’m feeling too much. And initially, people think that’s just about their weight, but it’s all. It’s like, oh, and, you know, I’m feeling inadequate in other ways, which is like, you know, oh, my God, I messed up at work. Or I feel like an imposter. I’m going to go get something to eat while I decide what to do. And then loneliness is where you just feel, like, really separate in whatever you’re struggling with. Not only food and weight, but other things.
Ali Shapiro [00:53:02]:
And so what I’ve mapped in my research is that there’s different needs that each trigger needs satiated by. So I say to my clients, I’m like, you know, so example, the. The tire trigger needs rest, but there’s other ways to get rest than just taking a nap, right? There’s walking. There’s kind of what you were talking about. Like, let’s try some different things. But what I say to clients is like, okay, if you cannot make the change through logic alone, it’s probably not, like, habitual, right? Like, if you. If you’re getting a. Like a logic plan.
Ali Shapiro [00:53:33]:
Right? Like, and transitions are. Transitions are such. I love that you brought that up. Hard times for people. Because feeling our feelings is a luxury, right? Like, the body’s prioritizing, like, what. What’s. What’s the. I can only do what’s efficient, right? Like, and so to feel our feelings, we actually need a safe space for them to come up.
Ali Shapiro [00:53:53]:
So for a lot of people, you know, I’m like, is it really about the transition? Or all those feelings that you kind of just push through during the day are now coming up? So. And it’s like, oh, when they.
Tara Schmidt [00:54:04]:
I love.
Ali Shapiro [00:54:05]:
My clients are like, I’ve been through so much therapy, even trauma therapy, and it’s like, then you asked me this, what tail trigger is it? I’m like, I had no idea so much was happening inside me. And I’m like, yeah, because we’re. We’re kind of like most people. Most of my clients feel like bobbleheads, right? Like, I’m just kind of cut off from the. The neck down. But it’s about identifying the needs and that. So it’s like, well, if during a transition, just like, you know, not, you know, altering your routine when you get home, having cheese and crackers in the house, not having it in the house, because different people feel differently. I don’t know if you found that, but like, some people feel really unsafe, especially if they’ve developed.
Ali Shapiro [00:54:40]:
If they’ve experienced food insecurity as kids.
Tara Schmidt [00:54:42]:
Or there’s other people in your home who are, quote, allowed to have cheese and crackers. Like, yeah, yeah, yeah.
Ali Shapiro [00:54:48]:
So it brings up. There’s so many, like, emotional complexities in each of this, but I’m like, if you try the thing that’s kind of logical and it’s not working, then this belonging radar, which is. I’m getting really geeky, but I feel like you like geeky. It’s called an emotional immune system that is really trying to preserve our ideas of looking good. If that feels alarmed, no amount of logic is going to kind of help you, help you change those food habits. So that’s how I see the difference between, between the two. Because it’s a more primal emotional alarm that can only be satiated with needs rather than changing habits. Is that clear?
Tara Schmidt [00:55:24]:
Yeah. Because the example I thought of is when I am very anxious about something, like I’m. It’s not logical. Like, I know that, but if. If my husband, for example, I’m gonna throw him under the bus is like, well, you don’t have to worry about that. I’m like, thanks.
Ali Shapiro [00:55:41]:
Captain Obvious, you get the award.
Tara Schmidt [00:55:43]:
I didn’t need your logic. I know I’m not logical right now, but my brain is on fire. And I actually had a therapist tell me, a psychologist tell me that like, the fire alarm is going off. Like, beep beep. Like that super, super annoying fire alarm is going off. And so my brain is like, oh. Like my house is on fire. Like, I have the right to be stressed out right now.
Tara Schmidt [00:56:08]:
My house could be on fire. However, in some cases, like, oh, I just burned toast and like the smoke from the toast made my fire alarm go off. And that’s really annoying. So like, not logical that I’m freaking out because there’s toast in the toaster and like, oh, like, okay, no big deal, Tara. Like, haha, move on. But I’m not logical when that alarm is going off. So that’s what I was thinking. Sometimes you don’t have the space to be like, oh, that’s just toast.
Tara Schmidt [00:56:34]:
Like, no, no, there’s beeping and I don’t know what it is.
Ali Shapiro [00:56:39]:
Yeah, well, and I love that you brought up that example. Cause that’s a great example. Our emotional immune system is made up of stories of things that really happened in the past that, that smoke in this case was associated with maybe bad things happening or hard things happening. I mean, this. I just went through a breast. I had cancer as a teenager and I got my first mammogram. And they were like, we see something abnormal. We don’t know if it’s just your body.
Ali Shapiro [00:57:01]:
Let’s do a diagnostic mammogram. And I was like, oh, okay, fine. And then they were like, the doctor’s like, look, I don’t think you have cancer, but with your history, I want you to do a breast biopsy. And I was like, what? And it was like, I knew all the logical stuff, right? Like, I know this is probably nothing. They’re being really. They don’t want to get sued. They’re being. They also care like all this stuff, but like, I could not sleep.
Tara Schmidt [00:57:22]:
Of course not.
Ali Shapiro [00:57:24]:
Yeah. And. And it was, it was like my body has actually been through some real things that this is. You know, when I was 13, they told me 25 chance, nothing. You know, it was. Or 75 chance it was nothing. But that is like where we have to have compassion for ourselves. But then we.
Ali Shapiro [00:57:40]:
But people try to give us advice and it’s just like, okay, I know that I. This is a different situation. But like, yeah, so we have to figure out how to resource ourselves. There. That’s the need with, with uncertainty is like, how do I resource myself so that I can tolerate all of this that that is happening. But what we tend to do is restrict ourselves from the support we need. Right. Like, we don’t just try to restrict food.
Ali Shapiro [00:58:01]:
It’s like an overall strategy. So. So one other question kind of on the emotional stuff, because I’ve seen it reported that I mean, there’s a lot of reasons that people don’t stay on these. On these drugs. Right. Maybe it is cost. It could be, you know, hard to access. But one of the things I found really kind of like, oh, yeah, that makes so much sense is a lot of people struggling with anxiety and depression because the reasons they turn to food, which in my, in my opinion are these safety belonging issues haven’t been resolved.
Ali Shapiro [00:58:30]:
Have you seen that in your clinic of people really a lot more anxiety, depression because they’re. They don’t have food to cope anymore? Or is that Is that not always true? I mean, it’s never always true, but have you seen that?
Tara Schmidt [00:58:43]:
I, I personally have not seen it, but I also like to talk about these medications, like, giving us the room to do what we’ve always needed to do. So like, if, if you’ve dieted, welcome to the club, right? Since you were 13. And we’ve like tried to do all like the quote, right Things of like, okay, I’m, I’m only. I’m going to eat three meals a day and I’m going to limit ultra processed foods and I’m going to limit my added sugar. Like all of the, like, reasonably healthy things, not in an overly restrictive manner. But like, if you’ve ever tried to lose weight or if you’ve tried to improve your eating or your exercise at some point in time, it’s like this, it’s exhausting. Like, I’m hungry, I’m crabby. Like, this is not working.
Tara Schmidt [00:59:29]:
Which is why people, yo, yo and cycle. Can these drugs, this is a question, right, that we would love them to be used in this way. Like, can these drugs, because they’re taking a little bit of the, the hunger away, because they’re helping you feel fuller, longer, right? Because they’re allowing you reach a healthier weight. Cause you should only be on them if you’re an unhealthy weight, right? Can these drugs be the opportunity, give us the opportunity to take the space to do the things that we were meant to do, right? And so from a food standpoint, I’m like, oh, hey, let’s not just take the drug and have it be your magic pill. Let’s take the drug if it’s appropriate and like, be on the best diet possible because you’re not bothered by food noise anymore, because you’re not craving these foods anymore. Like, let’s have a fabulous diet and we’re taking the medication because it’s helping you improve your health. So when you mentioned that, I was thinking, like, okay, if we’re not struggling with the food noise and the craving, can this be the time where we really figure out, like, hey, it actually wasn’t, or it was turning to food, but it’s not food that was giving me what I needed. So, like, letting us have like a little bit more of a gap between like, this is what I was struggling with and food was my answer.
Tara Schmidt [01:00:45]:
But now I’m recognizing that it doesn’t have to be. So I’m spinning that positively. And I didn’t mean to do that, but that’s where I went And I.
Ali Shapiro [01:00:54]:
Think that’s why I see more people coming to my programs on these, because it’s especially my. The emotional component.
Tara Schmidt [01:00:59]:
Yeah. Like, they have the space.
Ali Shapiro [01:01:00]:
Yeah, they have the space. And it’s like. And again, I know that you wouldn’t maybe not say this, but they don’t want to be on them forever, the drugs forever.
Tara Schmidt [01:01:08]:
It’s a scary concept. Like, you’re going to be on this medication for the rest of your life. Like, whether or not that’s true, like, that’s, I think is. Is overwhelming to hear. And any kind of medication.
Ali Shapiro [01:01:17]:
I know, I know. Especially if. If the cost. Yeah. I mean, you deal with insurance a lot. I. I don’t know what the. With the deals with insurance and stuff, but.
Ali Shapiro [01:01:26]:
But yeah, I see so many more people and I’m like, this is great. Like, you now have some. I love that you said the space. I think of the stability to, like, really focus on, like, what were these reasons that. That maybe when my blood sugar was deregulated and all these other. I just. I just couldn’t do so. Okay, one more question.
Ali Shapiro [01:01:45]:
Is, what have you seen be the most successful with your patients with the psychological aspect of food? Is it those experiments? Is there something that sort of universal themes that. That people could start to be thinking about with themselves?
Tara Schmidt [01:02:02]:
There’s a few, I think the biggest conversations that I have and like, why there’s a box of Kleenex in my office that gets, like, heavily used is the conversation around, like, you don’t have to lose weight, you don’t have to do anything that you’re not ready to do. We don’t have to address food until we address sleep. Like that. The assumption is that changes to food and. Or changes to weight is the answer. And it’s always going to be the answer. And it’s always this, like, emergent. Like, I’m bombarded all day every day about being, quote, skinnier, and I hate that word, but it’s all over my Instagram, of course.
Tara Schmidt [01:02:52]:
And I’ll sometimes ask my patients, like, is, do you want to do this? Like, do you have a capacity to do this? Do you have the time to focus on this? Do you want to work on your stress first? Do you want to work on your sleep first? And I’m not always sure that whoever it is, like the Internet or their medical provider, like, has given them that option, because we do. Like, we can be honest and know that there are health consequences to excess weight. Like, I’m not going to pretend like, there are not potential consequences. There are also consequences to having normal weight obesity or having poor metabolic health, even if you’re a normal weight. So again, like, weight does not equal health. Like low weight does not equal good health and high weight does not equal bad health. We can be on all sorts of the spectrum and we can get into that if we want. But I have seen more than I care to count, like relief on my patients faces when I’ve said, like, you don’t have to do this.
Tara Schmidt [01:03:55]:
Like, I know that you got sent to the dietitian or that you were told that maybe you should go on a medication or that you were encouraged to have bariatric surgery. But like, we don’t. You don’t have to, like, you didn’t do it yesterday or you did it a thousand times before. That didn’t work. Like, do you want to just work on getting more sleep? Like, do you want to work on finding a therapist that you actually like? It doesn’t have to be this like urgent need, doesn’t have to be a need at all this year or this Monday or this January. But it’s so, it’s everywhere and I feel like we can’t get away from it. And that’s our next episode on obesity bias because it’s everywhere. It’s everywhere and I’m quite passionate about that.
Tara Schmidt [01:04:40]:
So maybe we’ll talk again.
Ali Shapiro [01:04:42]:
Yeah, no, that’s so beautiful because so my graduate work is in like how adults change. And when you take our autonomy away, we almost rebel against the other side, right? It’s like, so for you to give them agency, right? Like you’re giving them choice. Like all of this stuff is going to have to be addressed, like, and then you’re starting them on developmental process of like, let’s listen to your life and your body and where you are, what feels like the next step for you, right? And I think that is, I don’t think most people get that in a practitioner. So I, I can see why you’re so respected and popular. That’s. I feel like I’m saying you’re like a high school popular girl, but you.
Tara Schmidt [01:05:24]:
Know what I mean?
Ali Shapiro [01:05:24]:
Like, I just think that’s so important. And again, I think this kind of circles back to earlier in our conversation of like, I know, I know in coaching, I know in therapy it’s like 50% of the effectiveness is just if you feel like you have a good connection with the person. And I think you’re, you’re setting people up for success when you approach it that way, which I don’t you think is the exception that you do it that way.
Tara Schmidt [01:05:46]:
And I know fabulous, fabulous people who, who practice the same as me. And I was taught by the best. But I was gonna say like, I have some crazy goals that I’ve written down with patients. Like, you know, ideally patients leave my, my room. We practice medical nutrition therapy. So, you know, you’re coming to see me for this condition and nutrition, it’s an aspect of that. And so I hope to, to help be a part of your, your treatment plan in terms of your doctor and whoever else you need to see. But I’ve had patients leave my office be like, Ally’s going to go to bed at ten o’ clock five days a week.
Tara Schmidt [01:06:18]:
And they’re like, who are you? I thought you were the dietitian. But our whole concept, our whole conversation was about how you don’t get enough sleep and how that can impact your eating habits and that can impact your weight. Or like Allie is going to find a new therapist because she hates so much. Yes. And I really think you need cognitive therapy or something. Psychotherapy or. I don’t know, I’ve just. You can.
Tara Schmidt [01:06:41]:
I’ve, I wrote down once, like, I, I’m going to drink six cokes per day. Never in my education did anyone say like, hey Terry, you should prescribe six Cokes a day for people. I prescribed six cokes a day for that person because they were drinking 12 and they agreed to six for me. And then the next time I saw them, we worked towards two. Right? Like, or the mini cans or X number of beers. I had a, someone who wrote down like, I’m only going to buy beer in six packs the next time that go to the liquor store. Because that was their trigger from coming home from their very, very stressful job. If they bought 20 beers, they drank 20 beers, but if they just bought a six pack, they only drank six.
Tara Schmidt [01:07:20]:
So I had very non nutrition goals millions of times in the clinic because I heard from my patients that those things were more important than like, please eat 80 grams of protein and 1400 calories. And some people got that and that’s what they wanted and needed and I gave that to them. But a lot of times I was like, I’m not sure that food or calories is what we’re talking about here or what we need to talk about.
Ali Shapiro [01:07:48]:
A lot of what I work on with the root of people is that all or nothing. It’s, it’s. They’re in. They don’t have the flexibility of their mindset and it’s like, you are helping them realize that, like, you can meet yourself where you are and it doesn’t have to be all or nothing. And having that experience that it quote works, right? And that, like, there’s something about, like, I got here slowly. I’m not going to lose it overnight either. That allows people to rest in the results and actually do better versus the all or nothing perfectionism, instant success or no success. Like, success failure binary that a lot of people, you know are operating under.
Ali Shapiro [01:08:23]:
And again, complete compassion. I struggled with my weight for 18 years. All of this stuff, I’ve been there. I get it. And it’s so scary to go slow and steady, even though it’s. It’s easier.
Tara Schmidt [01:08:34]:
Well, and we’re marketed that, right? Like, I hate, like, bouncing back after baby. Like, oh, I grew this baby for nine months, so your bounce back program better be at least nine months. But now I’ve got an infant, so I hope you give me some grace and give me more time. Or like, wedding things. Like, the people who are coming to your wedding know exactly what you look like because they’re important people in your life. Like, do you. Do you need to look different for your wedding? And again, I get it. Like, we all have desires and needs and wants and all of those things are okay.
Tara Schmidt [01:09:03]:
Like, I wanted to look good on my wedding day, but we have these, like, messages that, like, you need to be different. And they’re like, I’m not sure that that’s true.
Ali Shapiro [01:09:13]:
You nailed it. And Right. And it’s like, there’s already so much shame around food and weight. And then if we’re coming through that lens, we hear you’re different and we hear you’re wrong rather than, hey, you’re right where you are. Makes sense. And let’s just start from there and we can go from there. And then it. To me, it’s like I found with my clients because I go slow instead.
Ali Shapiro [01:09:34]:
I mean, I don’t tell them what to do, but the process is slow and steady. It’s like, okay, if you’re drinking. I mean, a lot of my clients are sober, but if we take the six, if we go from the like, 12. Well, now I’m switching to Coke. 12 Cokes to six Cokes. There’s going to be some withdrawal. I imagine there’s Mike going to be. If they’re drinking caffeinated.
Ali Shapiro [01:09:53]:
I don’t. Is Coke has caffeine in it, doesn’t it?
Tara Schmidt [01:09:55]:
Yeah, like, you’re going to have a headache.
Ali Shapiro [01:09:56]:
You’re going to have a headache. It’s like, okay, okay. But then pretty soon, you know, I mean, this is. I cycle in and out of coffee. Oh, that’s been a long time since I’ve been off it. But I was like, oh, I thought I was tired because I wasn’t drinking coffee. But it was like I learned, oh, no, coffee makes you tired because of the withdrawal of caffeine. Like, you’re not really tired.
Ali Shapiro [01:10:15]:
And it was like, oh. So like you learn these things on the way that are like, make it easier to keep with the changes or. I don’t know, it’s just. I always use the metaphor of clients with like, if you’re eating a lot of ultra processed foods, you’re not taking care of yourself. Like internally, it kind of feels like a polluted lake, right? Like dark dirt, dirty water. But like as. But like when you see the Mediterranean, you’re like, oh my God, it’s gorgeous and blue, right? So as you start to like untox if we’re going to use like, I don’t. I mean, I know our body detoxes, but as you start to remove that load, next time you go to drink seven cokes or you know, you’re gonna be like, oh my God, I feel this so much more than when I felt it because now my water’s clear and I Can I see the slug now.
Tara Schmidt [01:11:00]:
You jumped into a dirty lake. Yeah, yeah, yeah.
Ali Shapiro [01:11:04]:
And so it becomes again to circle back to. Adults need to have autonomy and they need to feel like this is their choice. It becomes, I want to want to do that. Not that Tara or Ali told me to do that, but that’s where again, this integrative thinking of where I want people prescribing G O P1s to understand metabolic health. I want more healthcare providers to understand how adults actually change. But that’s part of the new world we have to build. Right, Tara? So thank you. So one more question.
Ali Shapiro [01:11:36]:
I know this is kind of like a. It feels like a little not so as integrated as the rest of our conversation, but someone was interested in access and they said like med spas and all these things. And I know that you obviously said like, go to your provider, but I’ve also heard from people that like some people are selling these GLP ones, like in a multi level marketing part of. I was like, oh, I didn’t know that. But med spas, like, what is your opinion on those?
Tara Schmidt [01:12:07]:
I would like you to get a medication, no matter what it’s for, from someone who specializes in. In that.
Ali Shapiro [01:12:16]:
End of story.
Tara Schmidt [01:12:18]:
Not from your podiatrist, please.
Ali Shapiro [01:12:22]:
So, Tara, thank you so much for your time here. Is there anything else you wanted to add that I haven’t, that I haven’t asked, or that you think people should know? When they’re taking this more holistic look.
Tara Schmidt [01:12:32]:
At GLP1s, I want to remind them that it’s okay that it is a tool, but also to use the tool with every other tool in their toolbox. I just said tool a hundred times. But use what you need to use for stress management. Use strength training to decrease your loss of lean mass. Get enough protein, get enough hydration, get enough nutrients. And again, like, use the GLP1 as the opportunity to practice what you haven’t been able to practice before.
Ali Shapiro [01:13:10]:
I think that’s beautiful. Thank you so much. Where can people find more about you?
Tara Schmidt [01:13:16]:
So I write for Mayo Clinic Press, which is more of a consumer facing website for Mayo Clinic. I am the lead dietitian for the Mayo Clinic Diet and and my favorite part of my job is Mayo Clinic on nutrition, which is a podcast that I’ll have you on. Allie. We can talk all about. I love what you are doing with the psychology and the belonging and the needs. Coming up future episode everyone.
Ali Shapiro [01:13:42]:
Well, thank you and we will link to all of that in the show notes. Thank you so much for your time, expertise and compassion.
Tara Schmidt [01:13:49]:
Tara, it was really great to spend time with you. Ali, thank you for having me on.
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