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.
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I barely eat anything and I exercise every day. Why aren't I losing weight? Is bread bad for me? Should I go on a weight loss medication? Is eating late bad? Have your patients ever asked you these questions? 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. 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. 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. So today we're going to unpack five of the most commonly asked questions patients ask their provider when it comes to losing weight. So get comfy and join me in welcoming my guest, melissa Metry. 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. She owns a virtual private practice that specializes in helping women achieve sustainable weight loss. You can follow her on Instagram, at theweightlossdietician, or online at melissimetrycom. Melissa, I am so excited to have you on here. This is such an appropriate topic for this time of year. Thank you so much for the gift of your time. Welcome to the show.Melissa:
Thank you so much, colleen. I'm so excited to have this conversation with you today. I love what you're doing with your podcasts and your messages on social media. 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.Colleen:
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. 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. 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. 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. So provide the clinicians listening with some practical strategies that they can actually bring up the weight conversation in a more gentle way.Melissa:
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. So I think that's the first and foremost kind of thinking it from the patient's perspective. 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? 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. And then, once those issues are discussed, it may be appropriate to bring up the weight conversation in a few key scenarios. 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. Or they have a physical ailment such as knee or hip pain, which is very common in someone who's overweight. 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. And then the second scenario is they themselves have brought up their weight in some way during the conversation. 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. There's some indications that maybe they have concerns, but they may not be directly bringing it up. 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. You can start by just saying something like how do you feel about your weight at this time? Especially, this is easier to do if they sort of casually bring it up themselves. 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. 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. So just important to keep in mind in your conversations. I've also getting a lot of questions, and many of you practitioners may also have, that they ask about BMI. Is that still an important measure or something that is a useful marker of health? 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.Colleen:
Yeah. 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. 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. 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. So I think giving patients a little bit more autonomy when discussing their weight is so important. Those are some really good tools, for how do we even get that conversation started? So I'd like to move now into those common questions. 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. So number one patient might say oh, I'm sorry, I barely eat anything and I exercise every day. Why aren't I losing weight? How do we answer that question?Melissa:
Yeah, that's really, really a great question to ask. 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? 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. 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. 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. 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.Colleen:
Yeah, those are great points. 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. But metabolically and biologically it does make sense. And so also, too, what can happen is if they're in such a calorie deficit. 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. So it's kind of like the opposite of that goal that they're trying to achieve. 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. 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. So really good point, really common question that I know a lot of clinicians do get. 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. So how do we address this question when someone asks us are bread or carbs bad and can I have them?Melissa:
still so in terms of this question, I would just let them know right off to that it's not true. Bread and carbs are not the devil. 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. 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. 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. 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.Colleen:
Good point, and I hate when people demonize carbs because they are not the enemy. They are our number one source of fuel, so they're so needed and so important. Now I'm going to throw a random question at you. 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? Can you maybe help the clinician explain? Okay, this is why you lost weight and why it might not be sustainable for the future weight loss.Melissa:
Yeah, so a big bulk of the weight loss on low carb diets is related to fluid. So when you reduce your carb intake significantly, you tend to lose fluid because carbs tend to hold onto it. 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. So that's really important to keep in mind. And then the second part to that is depending on what they were doing before. 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. It's really no different and it's no more effective. 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. 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. 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. 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.Colleen:
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? 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. You know what I mean.Melissa:
Why, like that would be amazing if that was sure way, but obviously that's not. Yeah right.Colleen:
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. 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. 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. 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.Melissa:
Quite exactly. It's only exciting for a short period of time and then usually that excitement wears off.Colleen:
Right, and then you go back to eating your pop tarts and your donuts and your pizza right exactly. 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. So how do we answer this question if a patient says, hey, I heard about XYZ medication. Is it appropriate for me and should I go on that medicine?Melissa:
Yeah, great question. So this is something that you're probably many of you are being asked it's. I know many of my clients are asking me about these medications, like we're goby and is mpik and etc. And the answer would be it really depends on the person and their history. 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. So a few things to kind of consider when you're asked this question. So I would weigh out the pros and cons. These medications are typically best for someone who has tried many different Attempts to lose weight. So they really exhaust a lot of their options with just diet and exercise alone and they're not getting past a certain point. 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. So I would always advise patients that still more research needs to be done into kind of the long-term effectiveness of these medications. 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? There's a lot of unanswered questions. 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. So in the case with someone that has a history of an eating disorder or an active eating disorder, it would not be appropriate. 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. 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. 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? The medication makes them feel full, it's just a big driver for the weight loss. 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.Colleen:
Yeah, and you know the medication sometimes can be thought of it's a band-aid. If they are emotional eating or stress eating, the medicine isn't Solving that problem, it's just kind of covering it up. 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. 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. Right, like some of these medications that are Approved are more used off-label. 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. You have to look at the pros and cons for that because, as with any medication, there's going to be some side effects. So I think it's really important that the patients know what those side effects are upfront before putting them on those medicines.Melissa:
Absolutely. I completely agree.Colleen:
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. We didn't talk about exercise recommendations at all, so I'm really excited to hear how you would answer this question. So common question number four would be what type of exercise is best to help me lose weight?Melissa:
So, first things first, both cardio and strength training are equally as important. 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. 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. 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. A lot of people think that cardio is like they have to do more cardio to burn more calories and lose weight. But strength training helps in that aspect as well. So cardio is essential for burning sat cardiovascular health. But strength training helps build muscle and it also supports a healthy metabolism. 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. So I would just tell patients that doing both is equally as important, but finding ways that you have things that you enjoy. 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. 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.Colleen:
I think where you started with that is so important and that it does have to be something that you enjoy. And I think that is he is asking them like what would you not absolutely hate to do? 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. 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. 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.Melissa:
Doesn't feel like exercise, and that's great yeah.Colleen:
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. You know moving your body is exercise. It's gonna be beneficial to your health and your weight overall. So I think those are some really crucial points to point out to patients. 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. 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. How does the clinician answer that question?Melissa:
Yeah. 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. So if you don't want to get bulky, it's more about doing like more reps, not necessarily training to like exhaustion. 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. So I definitely would not fear it, I would embrace it.Colleen:
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. But really it is a full-time job. I mean bodybuilders and crossfitters. To get that much muscle mass on a woman's body is a full-time job. They are supplementing, they're eating an excessive amount of calories overall and protein. They're lifting probably two or three times a day, exercising every single day of the week. 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. I am a big supporter of weightlifting for women because I think it's super empowering. You feel strong, you feel beautiful. So for those ladies out there listening, go lift some weights. I think it's gonna help you a lot. All right, let's move on to the last and final question, and I think a really, really big one. And again, it's a myth. That's kind of out there. So I'm excited to hear what the science is behind our timing of eating. Specifically, question number five is is eating late bad?Melissa:
Yeah. 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. 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. 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. 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. So that is another potential negative. So it can increase your risk of weight gain. 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. 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. 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. A lot of these foods that I mentioned are also rich in magnesium, which can promote a more restful sleep. 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. So really, overall, the recommendation would be to try to limit eating late at night, not do it all the time. 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. But it's more about you know what they're eating. That is most important.Colleen:
Yeah, and it's, you know, like anything with nutrition. It's not going to be a one-size-fits-all black and white. This is the only way to do it for every single patient that walks into your clinic. But I think some general guidelines in clearing up some of those myths out there is so important. 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? So answer that question Is there a magic time that patients should just stop eating altogether?Melissa:
Yeah, no, there's definitely. There's no research based on like timing, the exact timing like that, like no eating after seven or eight. 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. 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. 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.Colleen:
Yeah and I think you also made a really good point is finding out. Well, why are you eating late? You know, if it's because you have a later evening job, like I do, I work late. I work until 11 o'clock at night, so I do have, you know, a dinner, kind of before I go in at four. 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. So I think number one looking at a patient's work schedule and their day to day schedule is really, really important. But also number two is finding out why are they eating late, because oftentimes it's not a work related, you know schedule necessity. 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. 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. But if it's a bowl of ice cream or a bag of Skittles or something like that. That's a different story. You're not really providing your body with fuel to actually help facilitate lean muscle mass. You're just adding to possibly the propensity towards blood sugar spikes and lows. 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? You really need to get into those couple of details. 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. 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. 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. So give us a little education on how do we do that and what if the patient's insurance doesn't cover nutrition education.Melissa:
Yeah. So there's a few different options here on what you can do. So first, you want to, in the best interest of the patient, you want to refer to a registered dietitian, ideally that specializes in the patient's primary problem. So, for example, if the patient wants to lose weight, it's important to refer them to a dietitian. Experience and weight loss. Or if they have got you know, gi issues, gi dietitian, et cetera. In terms of insurance coverage and plans, so a lot of insurance plans cover nutrition counseling. It really depends on the plan and the state that they reside in. So there are a few different variables but in general the coverage is actually pretty good. And if their insurance doesn't cover then there are a few other options to make patients aware of. So, for example, there are some insurance plans that patient has like an HSA or FSA account, so like basically pre-tax dollars from their employer plan, and many people have this on their plan and may not even be aware that they have it as a benefit. I know I've had like several patients that I let them know like, hey, I accept HSA or FSA payments and they're like what is that? Or like they need they checked with their insurance and they're like, oh yeah, I do have that. And then so they can set aside funds to cover that are pre-taxed, and so that's another option, sort of as like a backup if their insurance plan doesn't cover. And then the last sort of option or situation if they want to see an RD that doesn't accept insurance at all, then the RD can submit what's called a super bill. So it's sort of just like a receipt that outlines what the patient's nutrition appointment entailed. So the patient takes that receipt, submits it to their insurance company and many times they receive either partial or full reimbursement. So they're paying the dietitian out of pocket in this scenario, but then they're getting potentially some of that money back from their insurance company as sort of like an out of network benefit. So there's a few different options. I know that there's. It's probably a little bit confusing, but just to know as a provider, that there are many options.Colleen:
Super helpful, and I think that shouldn't be a barrier to why clinicians are not referring to registered dietitians, because obviously, like you just spelled out, there are so many different options to help get the services paid for. And this has been a goal of mine with this podcast not only to provide you guys with nutrition verbiage and nutrition solutions that you can provide to your patients, but also to expose you to registered dietitians who specialize in all these different areas. So I hope that in all of these episodes, you're starting to follow some of these dietitians and at least keep them in the back of your mind when you do have patients, like today, if you've got patients who are interested in losing weight, that you can remember Melissa Mietri. She has a virtual private practice so you can connect with her on Instagram at the weight loss dietitian. Melissa, thank you so much for your time. I am so grateful that you came on and had this conversation with us. We'd love to have you on again. Thank you so much, kelly. Take care. All right, guys. Now it's time for my nutrition notes. In this segment, I will leave you with a nutrition tip, an encouraging quote or an interesting case that I think might add value to your day Today. I wanna leave you with an encouraging quote, and it comes from Arthur Ashe. Arthur Ashe was the first African-American to win the men's singles title at Wimbledon and the US Open and the first African-American man to be ranked number one in the world for tennis. And he said start where you are, use what you have and do what you can. And I think this is such an encouraging quote, not only for you as a healthcare practitioner, but for you to relate to your patients, especially for those who are on a weight loss journey or who are just starting. And those three components, I think, are so important and so helpful. Number one start where you are. If your patient has never exercised before, like Melissa was saying, you don't need to tell them that they need to get an expensive gym membership with fancy shoes and fancy clothing and workout six days a week. That would be impossible for them. They would never do it. But if you can start where they are, hey, do you have a sidewalk that you can walk around for 10 minutes every day? Or if it's hot outside, hey, can you throw on a YouTube video of a 10 minute at home workout video and just follow along to that, maybe three times a week. But starting where the patient is is really really important. And then you can build on that. Number two use what you have. Hey, if they don't have the funds for gym membership or even any gym equipment, there are a ton of resources, of body weight exercises that they can just do at home. So encouraging them, hey, use what you have. We don't need to be spending a lot of money on gym memberships if you don't have those funds right now. And then, number three do what you can. Remember. We're looking for lifestyle change. We're not looking for a quick fix. Our goal is to help our patients be healthy for the entirety of their life, and so doing what they can right now, I think, is really, really key and important. If your patient is in a season of mothering three small children at home and all she has time for is five minutes to stretch great, you know what in this season, I think that is sufficient. Or maybe you're in a season where you're working a little bit less. You know you've got a little bit more free time. Let's see how we can allocate those extra minutes to maybe being more active, to walking, to getting up and maybe doing an at-home workout, but doing what you can with what you have and starting where you are, I think, is a really, really helpful principle that you can provide and suggest to your patients. Well, thank you so much for joining me today, guys. I really hope you found value in today's conversation. If you'd like to connect with me, you can find me on Instagram at Examry Nutrition. I would love if you could share this podcast with your colleagues, just so more people can find this useful content. And that's it for today, guys. So, as always, let's continue to make our patients healthier, one exam room at a time. I'll see you next time.