Latest / Resiliency Radio with Dr. Jill Carnahan, MD / 328: Resiliency Radio with Dr. Jill - The New Science of Weight loss, Longevity and Behavioral Change with Dr. John Oberg

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328: Resiliency Radio with Dr. Jill - The New Science of Weight loss, Longevity and Behavioral Change with Dr. John Oberg · Resiliency Radio with Dr. Jill Carnahan, MD

• 0:00
  Dr. Jill Carnahan, MD: Welcome to Resiliency Radio, your go to podcast for the most cutting edge insights integrative and functional medicine.
• 0:08
  Dr. Jill Carnahan, MD: I'm your host Dr. Jill and with each episode we dive into the heart of healing and personal transformation.
• 0:14
  Dr. Jill Carnahan, MD: Join me as I interview world leaders, medical experts, innovators of all types and people to help you on that journey to find optimal healing and human performance.
• 0:23
  Dr. Jill Carnahan, MD: Today's no different.
• 0:24
  Dr. Jill Carnahan, MD: We have a human performance and behavioral expert who's led behavioral change in the clinic and you're going to learn today about all things behavioral related longevity and weight loss.
• 0:35
  Dr. Jill Carnahan, MD: We're going to dive into some of the most popular topics so stay tuned as I introduce him in just a moment.
• 0:41
  Dr. Jill Carnahan, MD: Before I do, I want to remind you that we at Flat Iron Functional Medicine are accepting new patients.
• 0:46
  Dr. Jill Carnahan, MD: If you're looking for a provider to help you with any sort of complex chronic illness, Lyme related illness, mold disease, environmental toxicity, autoimmunity, new onset symptoms that you just don't know what is causing, that's our specialty is mysterious illnesses.
• 1:03
  Dr. Jill Carnahan, MD: Give us a call at 303-993-7910 or just email info@Flatiron Functional Medicine.com to schedule or get more information.
• 1:13
  Dr. Jill Carnahan, MD: We'd love to hear about how we can help you out.
• 1:16
  Dr. Jill Carnahan, MD: And again, that's Flatiron Functional Medicine in Boulder, Colorado.
• 1:21
  Dr. Jill Carnahan, MD: Also, I think most of you know who listen to our show.
• 1:23
  Dr. Jill Carnahan, MD: We have products and services specially curated for you.
• 1:28
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• 1:35
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• 1:42
  Dr. Jill Carnahan, MD: And one of my Favorites is the Dr. Jill Beauty product called Vita CE Serum.
• 1:48
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• 1:50
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• 1:52
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• 1:53
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• 1:54
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• 2:03
  Dr. Jill Carnahan, MD: It's called the Vita CE serum, so check that out at Dr. Jill health.com okay, let me introduce our guest.
• 2:10
  Dr. Jill Carnahan, MD: Dr. John Oberg is an entrepreneur, healthcare innovator, executive advisor, professional, has spent more than three decades helping organizations and leaders navigate growth, conflict and change.
• 2:19
  Dr. Jill Carnahan, MD: He's the founder of pioneering healthcare companies including Sededra, Prina Health and advises executives and healthcare organizations on building high performance cultures rooted in authentic human connection.
• 2:31
  Dr. Jill Carnahan, MD: You're going to love this interview.
• 2:32
  Dr. Jill Carnahan, MD: He's a doctorate from the University of Southern California and mba, University of New Mexico and he brings a unique blend of behavioral science, leadership and business strategy to his work.
• 2:43
  Dr. Jill Carnahan, MD: His mission is to help people and organizations thrive by strengthening the intersection of people, performance and purpose.
• 2:50
  Dr. Jill Carnahan, MD: Let's welcome Dr. John, Dr. John Oberg.
• 2:54
  Dr. Jill Carnahan, MD: I am delighted to have you on today on Resiliency Radio.
• 2:58
  Dr. Jill Carnahan, MD: And we always talk about all things related to longevity, optimal performance, how do we show up better in the world.
• 3:04
  Dr. Jill Carnahan, MD: And you are an expert in all of these areas.
• 3:06
  Dr. Jill Carnahan, MD: So as we kind of talked about before coming on here, we could go in many different directions.
• 3:11
  Dr. Jill Carnahan, MD: Our topic is kind of like the new science of weight loss and longevity because there's been so much talk about that.
• 3:16
  Dr. Jill Carnahan, MD: So we will, if you're listening, we're going to head into some really exciting things on these topics.
• 3:21
  Dr. Jill Carnahan, MD: Old news, news, new science, old science, how it all fits together.
• 3:25
  Dr. Jill Carnahan, MD: But before we do, I want to know who is Dr. John?
• 3:28
  Dr. Jill Carnahan, MD: How did you get to where you're at now and how, what's your journey to get to the science of where you're at right now?
• 3:34
  Dr. John Oberg: I think kind of accidental.
• 3:36
  Dr. John Oberg: Like I certainly didn't see myself here.
• 3:37
  Dr. John Oberg: I think unlike most doctors on your show, I'm a doctor of social work, not a doctor of medicine.
• 3:42
  Dr. John Oberg: And so I got here, I started working in the business world.
• 3:46
  Dr. John Oberg: I started getting involved in organizational change management, which requires the change of human behavior.
• 3:52
  Dr. John Oberg: So I became very interested in the psychology of human behavior very early on in my career.
• 3:57
  Dr. John Oberg: I had a lot of people that were working with me and for me early in my career.
• 4:01
  Dr. John Oberg: Then I went back and I got a master's degree where I did some really cool stuff at the University of New Mexico, working with one of my professors as a consultant inside the nuclear laboratories and learning about commercializing technology.
• 4:13
  Dr. John Oberg: And, and then I started starting companies and so that was really fun.
• 4:17
  Dr. John Oberg: I, I founded a company and I co wrote the patents for credit card processing on a mobile device back before there was an iPhone and raised a whole bunch of money and then flew the company into the ground and it was a spectacular disaster.
• 4:32
  Dr. John Oberg: And, and then I went out and worked in a couple other turnaround situations and then as a consultant for a while.
• 4:38
  Dr. John Oberg: But all the thread through all of it was a couple of them.
• 4:41
  Dr. John Oberg: One, I was really interested in human behavior and how that drove performance in the business world primarily at that time.
• 4:48
  Dr. John Oberg: And then secondly, I wanted to work with fun people.
• 4:50
  Dr. John Oberg: Like I wanted to work with neat people.
• 4:51
  Dr. John Oberg: And so that really drove me.
• 4:53
  Dr. John Oberg: And then I got into healthcare and doing a lot more with healthcare.
• 4:55
  Dr. John Oberg: My family was from healthcare.
• 4:57
  Dr. John Oberg: I joked that I Started in healthcare at age 8 when I was filing paper charts for my mom one day when I had to go to work with her.
• 5:03
  Dr. John Oberg: And then as I got older, I was like, you know, developing X rays.
• 5:06
  Dr. John Oberg: I was probably 12 at that point and there was no OSHA, no HIPAA and but I could read X rays.
• 5:11
  Dr. John Oberg: It was kind of fun.
• 5:12
  Dr. John Oberg: Not really read them, but it was fun to do and yeah.
• 5:15
  Dr. John Oberg: And so then I ended up in 2019, my mother in law got sick.
• 5:18
  Dr. John Oberg: She ended up in the hospital.
• 5:19
  Dr. John Oberg: DKA, she has type 2 diabetes.
• 5:22
  Dr. John Oberg: And I got really frustrated about the whole process.
• 5:24
  Dr. John Oberg: And she has a great doctor, I really liked her doctor, but the process wasn't, it just didn't go well.
• 5:28
  Dr. John Oberg: And so I called my friends at USC where I had done some undergraduate work before I went to New Mexico.
• 5:32
  Dr. John Oberg: I said, hey, I want to come back and get a doctorate and I want to solve this problem.
• 5:37
  Dr. John Oberg: And they were like, yeah, that's pretty cute.
• 5:38
  Dr. John Oberg: Like, we've been working on solving the problem of type 2 diabetes for decades, but we'll take your money and we'll see how it goes.
• 5:43
  Dr. John Oberg: And we did a pilot study where we took 49 patients out of 50 and all 50 had diabetes or average A1C.
• 5:50
  Dr. John Oberg: I'm not sure what kind of listener you have.
• 5:51
  Dr. John Oberg: It was 9.6 and in 12 weeks we got them down to 6.4.
• 5:55
  Dr. John Oberg: 49 Out of 50 patients were controlled.
• 5:57
  Dr. John Oberg: We kept them controlled for two years.
• 5:58
  Dr. John Oberg: I went back to my committee and I was like, what do you think?
• 6:01
  Dr. John Oberg: And their jaws hit the ground.
• 6:02
  Dr. John Oberg: They're like, what did you do?
• 6:04
  Dr. John Oberg: And so we told them, it's like we took all the things we could learn about them from a medical perspective.
• 6:09
  Dr. John Oberg: We learned everything we could about their behavioral health.
• 6:11
  Dr. John Oberg: We took all of the clinical administrative things and tried to kind of wring out all of the hard parts.
• 6:17
  Dr. John Oberg: Then we took all the non clinical stuff that people don't pay attention to.
• 6:20
  Dr. John Oberg: And then we talked to the patient, we did crazy stuff, we read their chart, we found out what things they were interested in changing and we made tiny little changes one at a time.
• 6:30
  Dr. John Oberg: And, and so we created this, you know, systemic therapeutic alignment and rapid titration model is what we call it start.
• 6:37
  Dr. John Oberg: And so we start people in the right direction and they do really well.
• 6:40
  Dr. John Oberg: And we take really sick people and get them really healthy really fast.
• 6:43
  Dr. John Oberg: And we keep them healthy for a really long time.
• 6:45
  Dr. John Oberg: And we do it.
• 6:47
  Dr. John Oberg: Whether someone's high income, low income doesn't really matter.
• 6:50
  Dr. John Oberg: It doesn't matter if they're rural or Suburban or urban.
• 6:52
  Dr. John Oberg: It's like we have this thing that works for people by and large by taking all the things that we knew, but putting them together in a way that was actually something people could do.
• 7:02
  Dr. John Oberg: And it's so cool because we have a medical practice now and our caregivers, whether it's a doctor, nurse, practitioner, nurses, they're like the cool stories we used to tell once every six months in our clinics.
• 7:17
  Dr. John Oberg: Now we tell them like multiple times a day because there's so many things happening.
• 7:21
  Dr. John Oberg: They're so amazing.
• 7:22
  Dr. John Oberg: We've done a second study I can tell you about.
• 7:24
  Dr. John Oberg: And anyway, we're geeked out on how patients get healthy and stay healthy for a long period of time.
• 7:30
  Dr. Jill Carnahan, MD: Okay, my jaw is dropped.
• 7:32
  Dr. Jill Carnahan, MD: I love this because what you did is you actually talked about the human instead of the medicine.
• 7:37
  Dr. Jill Carnahan, MD: And what I see is, right, people think healthcare is medicine, but the truth is, you're arguing that it's fundamentally about people and behavior, which makes so much sense.
• 7:46
  Dr. Jill Carnahan, MD: Even in functional medicine, where I'm at, it's like I'm one one with that patient and there's no protocol.
• 7:51
  Dr. Jill Carnahan, MD: People all the time, like, what's your protocol?
• 7:52
  Dr. Jill Carnahan, MD: I don't have one.
• 7:53
  Dr. Jill Carnahan, MD: I sit with that person and say, what do you need?
• 7:56
  Dr. Jill Carnahan, MD: What's your goals?
• 7:56
  Dr. Jill Carnahan, MD: What's your dreams?
• 7:57
  Dr. Jill Carnahan, MD: What's your desires?
• 7:58
  Dr. Jill Carnahan, MD: How can I be a travel guide and help you get there?
• 8:01
  Dr. Jill Carnahan, MD: Right?
• 8:01
  Dr. Jill Carnahan, MD: And then I try to formulate a plan, individual for that person to take them on that journey that they want to go on.
• 8:06
  Dr. Jill Carnahan, MD: Which is exactly what you did in a really cool thing, because you didn't just.
• 8:09
  Dr. Jill Carnahan, MD: I mean, you did it one one, but you also created a model and a study to back it up.
• 8:14
  Dr. Jill Carnahan, MD: And now, so tell me, you mentioned the clinic.
• 8:16
  Dr. Jill Carnahan, MD: And so this was like a pilot initially, and it was so successful.
• 8:20
  Dr. Jill Carnahan, MD: Then what happened?
• 8:20
  Dr. Jill Carnahan, MD: How did you get to the clinical part?
• 8:22
  Dr. Jill Carnahan, MD: And did you create a medical clinic that you hired?
• 8:24
  Dr. Jill Carnahan, MD: Or how did that happen?
• 8:26
  Dr. John Oberg: Yeah, so my partner is a medical doctor, Dustin Williams.
• 8:29
  Dr. John Oberg: He's written medical school curriculum for, I can't tell you how many dozens of medical schools across the world.
• 8:34
  Dr. John Oberg: And so we partnered up.
• 8:35
  Dr. John Oberg: He's the one that actually designed all of the medical protocols.
• 8:38
  Dr. John Oberg: Like, he's the.
• 8:39
  Dr. John Oberg: He is a medical genius.
• 8:40
  Dr. John Oberg: Like, there's no two ways about it.
• 8:42
  Dr. John Oberg: He is a medical genius.
• 8:43
  Dr. John Oberg: I was on the behavioral health side.
• 8:45
  Dr. John Oberg: And we've got this really cool relationship where we can talk to each other about each other's world and help each other understand it.
• 8:50
  Dr. John Oberg: And so it's super fun because now you know, our clinicians get trained pretty regularly by us about, you know, whatever, like either the medicine from him or the behavioral health from me.
• 9:01
  Dr. John Oberg: And really help us to meet patients right where they are.
• 9:05
  Dr. John Oberg: And that's the cool part is we meet.
• 9:07
  Dr. John Oberg: And that's our protocol.
• 9:08
  Dr. John Oberg: Our protocol is about meeting where they are with the medicine, meeting where they are with the, you know, behavioral health and really understanding readiness for change, which is a, you know, it's a concept in the world of psychology and social work where you can really understand what can change.
• 9:24
  Dr. John Oberg: And then we just take it down to the smallest possible change so that we talk to patients, we joke, we do crazy things, we read patients charts before they come in.
• 9:31
  Dr. John Oberg: Like crazy stuff, you know?
• 9:34
  Dr. Jill Carnahan, MD: Right, exactly.
• 9:35
  Dr. John Oberg: And.
• 9:35
  Dr. John Oberg: And so we take time with people.
• 9:37
  Dr. John Oberg: And so it's been really successful.
• 9:39
  Dr. John Oberg: You're going to love this.
• 9:40
  Dr. John Oberg: Our second study, we took patients.
• 9:42
  Dr. John Oberg: The only patients that could get in was if their A1C was above nine.
• 9:46
  Dr. John Oberg: So we wouldn't take any patients below nine.
• 9:48
  Dr. John Oberg: The average A1C was 11 point something.
• 9:51
  Dr. John Oberg: Oh, something.
• 9:52
  Dr. John Oberg: And we dropped them to 7.2 in six months.
• 9:54
  Dr. John Oberg: And 30% of the patients using insulin at six months were off insulin permanently.
• 9:59
  Dr. Jill Carnahan, MD: Wow.
• 10:00
  Dr. Jill Carnahan, MD: Wow.
• 10:00
  Dr. Jill Carnahan, MD: And it just goes to show you, what we're taught in medical school is patients won't change their diet, patients won't change.
• 10:06
  Dr. Jill Carnahan, MD: And we're literally, I see colleagues that are enmeshed in that conventional system that won't even mention that you need to move your body and choose healthy foods.
• 10:15
  Dr. Jill Carnahan, MD: And because they're not willing to take the time to talk about a grocery store, where do you shop and how do you get the healthy foods and these kind of basic things that are behavioral.
• 10:23
  Dr. Jill Carnahan, MD: From your perspective as a social scientist, I love this because you're looking at how do we change behaviors, how do we keep those changes, how do we keep motivated?
• 10:32
  Dr. Jill Carnahan, MD: Give us a little outline.
• 10:33
  Dr. Jill Carnahan, MD: Like say, I'm your patient, Mr.
• 10:35
  Dr. Jill Carnahan, MD: Patient, Mrs.
• 10:35
  Dr. Jill Carnahan, MD: Patient, you're talking.
• 10:36
  Dr. Jill Carnahan, MD: Where do you start?
• 10:37
  Dr. Jill Carnahan, MD: How do you engage them?
• 10:38
  Dr. Jill Carnahan, MD: Like, give us like a little role modeling of how you'd start with someone on the road and like, what kind of questions.
• 10:44
  Dr. John Oberg: Yeah, well, so we start before the.
• 10:46
  Dr. John Oberg: Before the visit.
• 10:47
  Dr. John Oberg: Like, what we'd start with is like, getting all of the medical charts we can possibly get before they come in.
• 10:52
  Dr. John Oberg: It could be hundreds of pages or thousands of pages of things.
• 10:55
  Dr. John Oberg: And then we have a process by which we go through all of that and find out what's most important so that Dustin is ready to talk to them when they come in.
• 11:01
  Dr. John Oberg: And he knows what he's asking about,.
• 11:04
  Dr. Jill Carnahan, MD: Screen some of this.
• 11:05
  Dr. Jill Carnahan, MD: So it's not just the doctor.
• 11:06
  Dr. Jill Carnahan, MD: You have a team that actually looks at that and says, here's like, if you're preparing for a podcast, right?
• 11:11
  Dr. Jill Carnahan, MD: Like, here's the bio on this patient.
• 11:13
  Dr. John Oberg: That's right.
• 11:14
  Dr. John Oberg: And we know, and we know what things are going on and what questions we're going to have and where there might be gaps we have to fill in.
• 11:19
  Dr. John Oberg: And so.
• 11:19
  Dr. John Oberg: And we use technology to make that lighter lifting, obviously, but we have people that are getting ready for the appointment, and then Dustin comes in and, you know, and when they meet Dr. Williams, it's like it's just Dustin to them.
• 11:30
  Dr. John Oberg: And so.
• 11:31
  Dr. John Oberg: And there's lots of time set aside so that they don't feel rushed.
• 11:34
  Dr. John Oberg: It's not a quick, you know, because you're talking about complex chronic disease.
• 11:38
  Dr. John Oberg: And many of them, in many cases.
• 11:40
  Dr. John Oberg: And then we talk about, you know, the medicine usually first.
• 11:44
  Dr. John Oberg: And then we try to understand, generally speaking, we do some screening for depression, anxiety and stress.
• 11:51
  Dr. John Oberg: And so there's different models you can use, but we generally start with, like, two question surveys to figure out if we have to go deeper or not.
• 11:57
  Dr. John Oberg: Then there's longer surveys, then there's clinical intervention by clinical therapists if necessary.
• 12:01
  Dr. John Oberg: We have all that ready to go, if necessary.
• 12:04
  Dr. John Oberg: And then we, you know, to the.
• 12:06
  Dr. John Oberg: Over the next 30 days, we have a series of conversations with that patient, some in the office, some over the phone and.
• 12:12
  Dr. John Oberg: Or video call, and we get this whole picture of them over 30 days.
• 12:16
  Dr. John Oberg: Right?
• 12:17
  Dr. John Oberg: And so when I gave my TED talk, I was thinking, like, how do we explain to somebody?
• 12:20
  Dr. John Oberg: And really it's what is the patient willing to do?
• 12:23
  Dr. John Oberg: What does the expert know?
• 12:24
  Dr. John Oberg: So that you don't just have a plan, but you have an expert plan.
• 12:28
  Dr. John Oberg: Right.
• 12:29
  Dr. John Oberg: And how do you put all that stuff together so that everyone's clear about the next one step?
• 12:32
  Dr. John Oberg: And then how do you give someone that.
• 12:34
  Dr. John Oberg: That quick support?
• 12:35
  Dr. John Oberg: So we have some patients that want to talk to us every day.
• 12:38
  Dr. John Oberg: We've had a couple of patients who want to talk to us multiple times a day.
• 12:40
  Dr. John Oberg: You know, it's like, how do I inject this drug for the first time?
• 12:43
  Dr. John Oberg: Like, can you get on and can you help me get comfortable?
• 12:45
  Dr. John Oberg: And that's all fine.
• 12:46
  Dr. John Oberg: And then other people, you know, it's like, I'll talk to you every two or three days.
• 12:50
  Dr. John Oberg: In some cases, we're actually changing the medicine doses every two or three days with enough data to help get them into kind of clinical control.
• 12:58
  Dr. John Oberg: And so every patient has A little bit of a different plan that's part behavioral, part medical and.
• 13:03
  Dr. John Oberg: But we help them by getting really granular with them.
• 13:06
  Dr. John Oberg: So like one patient, like the medicine kind of worked and it was doing fine, but we just changed their coffee creamer because they were getting so much sugar in their coffee creamer.
• 13:16
  Dr. John Oberg: We just changed a different flavor.
• 13:18
  Dr. Jill Carnahan, MD: Unbelievable.
• 13:19
  Dr. Jill Carnahan, MD: And it's that kind of attention to detail that makes the difference because that patient would have never.
• 13:23
  Dr. Jill Carnahan, MD: It's like a needle in the haystack.
• 13:25
  Dr. Jill Carnahan, MD: Right.
• 13:25
  Dr. Jill Carnahan, MD: But you're kind of screening, looking, asking the right questions.
• 13:28
  Dr. Jill Carnahan, MD: Is it mostly through forms or actual interview?
• 13:30
  Dr. Jill Carnahan, MD: Because it sounds like before they ever come in, you have a really good idea of this is the shape of the life and the pain points and those kinds of things.
• 13:38
  Dr. Jill Carnahan, MD: Right.
• 13:39
  Dr. John Oberg: Well, I think that, you know, when you, you're the medical doctor, so you would know better than I would that like each, you know, chronic disease like has a set of protocols.
• 13:46
  Dr. John Oberg: Right.
• 13:46
  Dr. John Oberg: And so if you have type 2 diabetes, that's how we handle, you know, there's a certain set of medicines and medical interventions and if you have, you know, high blood pressure, it's a different set of medicines.
• 13:55
  Dr. John Oberg: But there's some similarities and titration and how you deal with things.
• 13:58
  Dr. John Oberg: But then food and exercise, you know, we say move to the right, so on the left hand side you have processed food, on the right hand side you have whole food plant based.
• 14:06
  Dr. John Oberg: And then there's a spectrum.
• 14:07
  Dr. Jill Carnahan, MD: Yeah.
• 14:08
  Dr. John Oberg: And so we just want to understand where somebody is and how willing they are to move one tiny little bit to the right.
• 14:13
  Dr. John Oberg: And so I joke with people, like if someone's eating Captain Crunch for breakfast, you don't tell them to have kale and carrots.
• 14:19
  Dr. John Oberg: Like you're not going to get them there.
• 14:20
  Dr. John Oberg: You go from Captain Crunch to Frosted Flakes to Honey Nut Cheerios to Cheerios.
• 14:25
  Dr. John Oberg: Like you have to move them along a spectrum.
• 14:28
  Dr. John Oberg: And no one's ever gone down that exact spectrum.
• 14:30
  Dr. John Oberg: Right.
• 14:30
  Dr. John Oberg: But the idea is a little bit less.
• 14:33
  Dr. John Oberg: You know, it's like I had one patient who's like, I want to go walk a mile.
• 14:37
  Dr. John Oberg: It's like, man, get to the mailbox and give me a call and tell me how you're feeling.
• 14:41
  Dr. John Oberg: They got to the mailbox.
• 14:42
  Dr. John Oberg: Like, my knee hurts.
• 14:42
  Dr. John Oberg: It's like, well, let's talk about that.
• 14:44
  Dr. John Oberg: And so the next day they got to the mailbox twice.
• 14:47
  Dr. John Oberg: Like that was great.
• 14:47
  Dr. John Oberg: But had they tried to go out for that mile, they would have overdone it.
• 14:50
  Dr. John Oberg: They wouldn't have wanted to call back.
• 14:51
  Dr. John Oberg: And so it's like, what's that easy win that you can get first?
• 14:54
  Dr. John Oberg: Like get an easy win first.
• 14:56
  Dr. John Oberg: And once you get that first easy win, then what?
• 14:59
  Dr. John Oberg: Then what's the next easy win you can go get next, but get an easy win.
• 15:03
  Dr. Jill Carnahan, MD: Yes.
• 15:04
  Dr. Jill Carnahan, MD: Oh, this makes so much sense because often I'll talk about like, and again, I love your expertise because you're clearly expert at this habit formation, but it's really the foundation of healthy principles is getting those things enmeshed.
• 15:14
  Dr. Jill Carnahan, MD: So I'll say, okay, what do you do first thing in the morning?
• 15:16
  Dr. Jill Carnahan, MD: Brush your teeth.
• 15:17
  Dr. Jill Carnahan, MD: Put this by your toothbrush and let's add it in.
• 15:19
  Dr. Jill Carnahan, MD: Or it might be habit stacking.
• 15:21
  Dr. Jill Carnahan, MD: Right?
• 15:21
  Dr. Jill Carnahan, MD: Habit stacking.
• 15:22
  Dr. Jill Carnahan, MD: All these tips.
• 15:22
  Dr. John Oberg: Yeah, yeah.
• 15:23
  Dr. Jill Carnahan, MD: BJ Fog and Atomic Habits by James Clear.
• 15:26
  Dr. Jill Carnahan, MD: And I've read all of that.
• 15:27
  Dr. Jill Carnahan, MD: I think it's so profound.
• 15:28
  Dr. Jill Carnahan, MD: And you're clearly using that.
• 15:29
  Dr. Jill Carnahan, MD: And sometimes I'll be like, okay, you want to do 10 push ups a day, do one push up with your tooth.
• 15:33
  Dr. Jill Carnahan, MD: You know, brush your teeth, do one push up.
• 15:35
  Dr. Jill Carnahan, MD: And then the one is so easy they can't not do it.
• 15:36
  Dr. Jill Carnahan, MD: And then all of a sudden they're doing three or four, so they're stacking.
• 15:40
  Dr. Jill Carnahan, MD: I love that.
• 15:42
  Dr. Jill Carnahan, MD: What do you find are the biggest blocks for people with behavioral change?
• 15:46
  Dr. Jill Carnahan, MD: Is it fear?
• 15:46
  Dr. Jill Carnahan, MD: Is it shame?
• 15:47
  Dr. Jill Carnahan, MD: Is it, is it feeling like they can't do it?
• 15:50
  Dr. Jill Carnahan, MD: Is it unsupport?
• 15:50
  Dr. Jill Carnahan, MD: What would you give?
• 15:52
  Dr. Jill Carnahan, MD: Like the general.
• 15:53
  Dr. John Oberg: We go the other way.
• 15:54
  Dr. John Oberg: We try to find someone's compelling reason to do something.
• 15:57
  Dr. John Oberg: It's almost always emotional.
• 15:58
  Dr. John Oberg: And if you can tie it back to their why.
• 16:00
  Dr. John Oberg: I tell my, I tell my staff all the time.
• 16:02
  Dr. John Oberg: It's like, hey, like, everyone does things for exactly the same reason in this world.
• 16:06
  Dr. John Oberg: It's because they have a reason.
• 16:08
  Dr. John Oberg: And your job is to go figure out what that thing is.
• 16:10
  Dr. John Oberg: But, but everyone's is the same in that it's theirs and it's different in his.
• 16:15
  Dr. John Oberg: And sometimes you can talk to one patient seven days later and something's changed.
• 16:19
  Dr. John Oberg: So you can't assume that because you talked to them a week ago that it's the same emotional reason today.
• 16:25
  Dr. John Oberg: And so I was talking to one patient in our clinic who was, you know, retired, was not showing signs of clinical depression, but showed signs of subclinical depression.
• 16:36
  Dr. John Oberg: And we got into like, what was going on with them.
• 16:38
  Dr. John Oberg: And she had retired from being a sheriff and she didn't have kind of the thing to wake up for in the morning.
• 16:44
  Dr. John Oberg: And what she really wanted to do was she wanted to teach underprivileged kids how to read and didn't know how to go about doing that.
• 16:51
  Dr. John Oberg: And so I got her on a three way call with her librarian.
• 16:53
  Dr. John Oberg: With her permission, we talked to her librarian to get them connected about how she could go volunteer at her local library.
• 16:58
  Dr. John Oberg: And all of a sudden she was excited.
• 17:00
  Dr. Jill Carnahan, MD: Hey guys.
• 17:00
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• 17:12
  Dr. Jill Carnahan, MD: Especially check out the Dr. Jill Beauty line.
• 17:15
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• 17:22
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• 17:25
  Dr. Jill Carnahan, MD: If you haven't yet checked it out, you can find that@doctor Jill health.com okay, let's get back to our show.
• 17:31
  Dr. Jill Carnahan, MD: And it's not that hard.
• 17:32
  Dr. Jill Carnahan, MD: It just takes the time.
• 17:33
  Dr. Jill Carnahan, MD: One of the things I heard you say that I think is so critical and missing, unfortunately in most modern offices is that authentic human connection.
• 17:41
  Dr. Jill Carnahan, MD: Like really, I always say if the patient feels like they're seen and heard, it makes all the difference.
• 17:47
  Dr. Jill Carnahan, MD: And that's this esoteric thing.
• 17:49
  Dr. Jill Carnahan, MD: We kind of know intuitively how to do it.
• 17:50
  Dr. Jill Carnahan, MD: But how do you teach your staff, how do you teach your clinic to actually be present with the patient?
• 17:56
  Dr. Jill Carnahan, MD: What are like some of the practical tips for that?
• 17:59
  Dr. John Oberg: Someone not in my staff, but somebody once asked me like, hey, how do I get someone to like think I care about them?
• 18:05
  Dr. John Oberg: It's really, it's really easy.
• 18:07
  Dr. John Oberg: You actually care about them.
• 18:08
  Dr. John Oberg: Right.
• 18:09
  Dr. John Oberg: And so I now I will say that by and large in healthcare, I don't find that's the problem.
• 18:14
  Dr. John Oberg: I think most people get into healthcare because they do care.
• 18:16
  Dr. John Oberg: And so I don't find that to be a problem, broadly speaking.
• 18:19
  Dr. John Oberg: And there's obviously the exception to that rule.
• 18:21
  Dr. John Oberg: That's pretty rare.
• 18:22
  Dr. John Oberg: And so with us it's like, hey, you have to remember that wherever you are as a clinician, you've been doing this for a year or five or 10 or 15 or 20 years.
• 18:31
  Dr. John Oberg: And you've done this five or 10 or 15 or 20 times today.
• 18:34
  Dr. John Oberg: But this is their first time today and they may be scared or worried or anxious or whatever.
• 18:42
  Dr. John Oberg: And so, and so our job is to meet them right there in that moment and to try to bring them on that one next step for that next easy win.
• 18:49
  Dr. John Oberg: Like what's that one thing they have to do?
• 18:52
  Dr. John Oberg: And so that means we have to go meet them where they are.
• 18:55
  Dr. John Oberg: And that means patience in every sense of the word, right?
• 18:58
  Dr. John Oberg: So you've got to be patient with your patients and meet them where they are and help them on that one.
• 19:02
  Dr. John Oberg: Next thing, the cool thing is the momentum happens, right?
• 19:05
  Dr. John Oberg: So people start moving and then they gain inertia.
• 19:08
  Dr. John Oberg: And it's really cool to watch that happen.
• 19:09
  Dr. John Oberg: So, and then we role play.
• 19:12
  Dr. John Oberg: We practice a lot with our team and we've exposed AI to them, where they can go practice with an AI if they want to role play without their manager listening or without me listening or whatever.
• 19:21
  Dr. John Oberg: And so they can practice tirelessly if they want to.
• 19:23
  Dr. John Oberg: They don't do a lot of it, but they could.
• 19:25
  Dr. John Oberg: And so we give them these opportunities to practice all the time.
• 19:28
  Dr. John Oberg: And I'm never beyond practicing.
• 19:30
  Dr. John Oberg: So someone calls me like, hey, John, I want to role play.
• 19:32
  Dr. John Oberg: It's like, hey, great, what's the situation?
• 19:34
  Dr. John Oberg: I'll do the hard part.
• 19:35
  Dr. John Oberg: What's the hard part?
• 19:36
  Dr. Jill Carnahan, MD: Yeah, well, and even just interviewing you are a fun, easy, great person to talk to.
• 19:40
  Dr. Jill Carnahan, MD: So I can see how you just by showing up as you make your staff and the patients you interact with very comfortable, you have that nature and obviously it's because you do care.
• 19:52
  Dr. Jill Carnahan, MD: It's, it's easy to see that our healthc care system, which I am deep in, right, I'm kind of on the fringe because I do things differently, like your clinics.
• 20:02
  Dr. Jill Carnahan, MD: But there's every day I see things happening that are shocking and how people are cared for, how patients go to the ER and aren't even physically touched anymore.
• 20:11
  Dr. Jill Carnahan, MD: And I could name 101 things.
• 20:13
  Dr. Jill Carnahan, MD: If you had to rebuild our system, our current American healthcare system, from scratch, what three things would you say these things have to change immediately?
• 20:23
  Dr. John Oberg: It's a great question.
• 20:26
  Dr. John Oberg: I'll give you answer a little bit off center on that one.
• 20:29
  Dr. John Oberg: Because we talk to patients all the time about the healthcare system.
• 20:32
  Dr. John Oberg: Everyone agrees, they want to better.
• 20:34
  Dr. John Oberg: And you could talk to 100 people and get 100 answers about how it could better.
• 20:38
  Dr. John Oberg: And the truth is it does need to better, but it's not going to better by three o'clock tomorrow.
• 20:44
  Dr. John Oberg: What we can do is help patients understand that even in a broken system, there's things they can do right now, even in the most difficult of circumstances, there's something that can be done as an individual to make their healthcare a little bit better today, even inside of a broken system.
• 20:58
  Dr. John Oberg: So for anybody listening who's like, yeah, the system's broken, I don't disagree.
• 21:02
  Dr. John Oberg: And right now Patients can take control of the thing they can control even inside of a system that's less than optimal and still do something about it for themselves.
• 21:10
  Dr. John Oberg: And I encourage all the patients to do that.
• 21:12
  Dr. John Oberg: So that's kind of step one is let's get all the patients to be advocates for themselves.
• 21:17
  Dr. John Oberg: Just like they consume other things in the world, consume healthcare with the same vigor and the same understanding and the same care.
• 21:24
  Dr. John Oberg: And that way at least we get the benefit as patients right inside of a system.
• 21:29
  Dr. John Oberg: And then I think, you know, we've got to look at the incentives, I think we've got to look at where the incentives are inside the system and just follow the incentives.
• 21:36
  Dr. John Oberg: You know, I'm concerned about that and I'm actually working with people in the world of policy to understand more about how the policy world works so that I can help answer those questions more definitively.
• 21:47
  Dr. John Oberg: But I'm, you know, as much as I know about individual human behavior, that's how little I know about policy today.
• 21:52
  Dr. John Oberg: And so I'm very hard to make those connections so I can start talking to people about like, hey, you know, how does policy get impacted and how do we change behavior at the policy level?
• 22:02
  Dr. John Oberg: Because it clearly works at the individual level.
• 22:04
  Dr. John Oberg: I've got all the data to show us that.
• 22:06
  Dr. John Oberg: So let's go do it at the community level, let's go do it at the policy level.
• 22:09
  Dr. John Oberg: And so I don't have like the best answer today other than fix the individual experience as an individual even though the system's working against you in some cases.
• 22:19
  Dr. John Oberg: And I get that it is and that sucks.
• 22:20
  Dr. John Oberg: But find people who are going to help, you know, walk the walk with you through it.
• 22:24
  Dr. Jill Carnahan, MD: Okay, so for that patient listening, for that person who's been struggling with their doctor, you're saying really go deep, find out what you need, ask for what you need.
• 22:32
  Dr. Jill Carnahan, MD: Maybe get an advocate to come with you, maybe get a friend or family member to listen with you and just go there and become more empowered.
• 22:40
  Dr. Jill Carnahan, MD: I couldn't agree more because nowadays you really, I think the more in fact I love patients that come with research with the come with because I find I tell my, I have mid levels in my office and I'm always telling them if you listen to the patient, you're going to learn more from your encounters than any sort of, I mean as much as any reading outside of the clinic, you're going to learn from your open minded.
• 22:58
  Dr. Jill Carnahan, MD: So love that now you alluded to something I think is important.
• 23:01
  Dr. Jill Carnahan, MD: And guys, if you're listening.
• 23:02
  Dr. Jill Carnahan, MD: I promise we're going to shift in a minute here to longevity and weight loss.
• 23:05
  Dr. Jill Carnahan, MD: But I think this is so critical and we agree, John, we're just going to let this go where it flows.
• 23:10
  Dr. Jill Carnahan, MD: So I think that what we've talked about is so critical as a foundation.
• 23:13
  Dr. Jill Carnahan, MD: But what I want to shift to before we go to the long dipting weight loss is the physician, the provider.
• 23:19
  Dr. Jill Carnahan, MD: Nowadays mid levels providers, nurses, any sort of medical professional in the clinical realm.
• 23:24
  Dr. Jill Carnahan, MD: So many of my colleagues are burned out and they're overwhelmed and they're stressed.
• 23:28
  Dr. Jill Carnahan, MD: And I think like you said, the policy level of how our system is working is part of the problem because of the bureaucracy of documentation and EMRs and all the things that take away time from what we love to do, which is be with the patient and actually connect with the patient and be a healer.
• 23:44
  Dr. Jill Carnahan, MD: Right.
• 23:45
  Dr. Jill Carnahan, MD: To the physician listening.
• 23:46
  Dr. Jill Carnahan, MD: We have a lot of physicians in our audience.
• 23:48
  Dr. Jill Carnahan, MD: What would you say as far as reigniting purpose?
• 23:52
  Dr. Jill Carnahan, MD: If they're from anything from a hospital system to a clinic that's owned by a hospital to their own private clinic anywhere on the spectrum, what tips could you give that provider to reignite and re engage and become the best healer that they could?
• 24:06
  Dr. John Oberg: Yeah, I think I have a lot of faith in technology and you know, I think that we're going to see that a lot of the things the government wants are going to be able to be done with much more automation in the very near future and probably done a lot better than they've been done in the past and with better cross cutting so that things don't get missed that are easy to miss today the way the system is built.
• 24:29
  Dr. John Oberg: But I think technology is going to let us do a much better job for patients in that way and there'll be less pajama time, you know, less charting while you're at home watching tv.
• 24:38
  Dr. John Oberg: And we're already doing that in our clinic.
• 24:40
  Dr. John Oberg: So we have ambient scribes.
• 24:42
  Dr. John Oberg: A lot of people have ambient scribes.
• 24:43
  Dr. John Oberg: We have ambient scribes that do a whole lot of work for us.
• 24:45
  Dr. John Oberg: But they actually let the doctor be the doctor.
• 24:48
  Dr. John Oberg: Right.
• 24:48
  Dr. John Oberg: And so, and they let the, you know, for us it's nurse practitioners and physicians, associates, both we use and they can do that work.
• 24:56
  Dr. John Oberg: And so here's the world that I want to live in.
• 24:59
  Dr. John Oberg: So on the mental health side, I think we can get to a place where you can get into, you know, where there's sub clinical topics that can be talked about by peer counselors, you can have a consensual AI listening in.
• 25:14
  Dr. John Oberg: And then when there's a therapeutic topic, the AI can alert somebody with everyone's permission and say, hey, this is for the professional.
• 25:21
  Dr. John Oberg: So everyone can be working at the top of their license.
• 25:23
  Dr. John Oberg: I think that can be happening with mid levels too.
• 25:25
  Dr. John Oberg: Like, I think that right now ratios that are followed for a really good reason.
• 25:29
  Dr. John Oberg: But I think we can extend a lot of that so that people have more autonomy in their profession and less need for documentation and a lot of guardrails being built in.
• 25:39
  Dr. John Oberg: I think we're early.
• 25:40
  Dr. John Oberg: I think we're not there yet.
• 25:41
  Dr. John Oberg: I think that there's still have a lot of governance issues that need to be sorted out.
• 25:46
  Dr. John Oberg: But I'm really hopeful the technology is going to strip away the administration so that we have more time for that relationship.
• 25:53
  Dr. John Oberg: And I don't think we should automate it to the point we take the relationship away.
• 25:56
  Dr. John Oberg: I don't think the AI should be the caregiver.
• 25:59
  Dr. John Oberg: I think that relationship needs to be the central point of the entire system.
• 26:04
  Dr. John Oberg: So that's my takeaway.
• 26:06
  Dr. Jill Carnahan, MD: Makes so much sense.
• 26:07
  Dr. Jill Carnahan, MD: And I'm seeing that in my clinic too.
• 26:08
  Dr. Jill Carnahan, MD: There's these pieces that used to be incredibly burdensome that are being assisted, but it doesn't take away the doctor patient relationship or the ultimate authority of the doctor or the mid level to decide next steps.
• 26:18
  Dr. Jill Carnahan, MD: And so I could not agree more.
• 26:20
  Dr. Jill Carnahan, MD: And I think we'll hopefully see that really taking some of the burden off the administrative part of the physician.
• 26:26
  Dr. Jill Carnahan, MD: So weight loss and longevity, two of my favorite topics.
• 26:28
  Dr. Jill Carnahan, MD: I think weight loss is a really good prototype for behavioral change because for so long it's been seen as this behavioral disorder when it really is far more complex.
• 26:38
  Dr. Jill Carnahan, MD: What is the state of the union on weight loss?
• 26:40
  Dr. Jill Carnahan, MD: We obviously cannot go without talking about GLP1s and how they've influenced the market.
• 26:44
  Dr. Jill Carnahan, MD: But from a behavioral scientist perspective, give us the landscape of that and then let's talk specifically about weight loss and new or old findings.
• 26:53
  Dr. John Oberg: Yeah, you know, I love GLP1s.
• 26:55
  Dr. John Oberg: We use them in our practice all the time.
• 26:56
  Dr. John Oberg: I think the place where I probably differ than some people is I don't think that once a GLP1 for the rest of your life.
• 27:02
  Dr. John Oberg: I just don't think that has to be the case.
• 27:04
  Dr. John Oberg: I think they can be deprescribed over time given a certain set of circumstances that are not studied that we haven't.
• 27:09
  Dr. John Oberg: We don't know yet.
• 27:10
  Dr. John Oberg: But it would follow from kind of what we know about science that over time, if a GLP1 is used and somebody changes some of their eating habits and their exercise habits appropriately, which we're very clear, like if you're using GLP1s, you need to be doing resistance training so that you're continuing to, you know, keep that muscle tissue going.
• 27:28
  Dr. John Oberg: And you've got to make sure that you're eating well so that you're, you know, your system is actually adapting the right way.
• 27:34
  Dr. John Oberg: If your stomach shrinks and if your taste buds change, then it would make sense to me over time that you could deprescribe GLP1s.
• 27:41
  Dr. John Oberg: And I think that doesn't take 90 days.
• 27:43
  Dr. John Oberg: Right.
• 27:43
  Dr. John Oberg: That takes, it may take a couple of years for people to kind of to stabilize there.
• 27:47
  Dr. John Oberg: But I think we can see deprescribing and then re prescribing when necessary if somebody gets off track.
• 27:54
  Dr. John Oberg: But if we use it as a kind of a magic silver bullet to eat whatever you want and continue bad behavior.
• 28:00
  Dr. John Oberg: I don't think that people are going to get the full benefit of what this class of drugs in particular can offer.
• 28:06
  Dr. Jill Carnahan, MD: Yeah, I couldn't agree more with what we see in clinical practice.
• 28:09
  Dr. Jill Carnahan, MD: And I'm actually majority of my patients are on very tiny doses because it just gives them that little edge with very little side effect.
• 28:15
  Dr. Jill Carnahan, MD: And then they have the.
• 28:16
  Dr. Jill Carnahan, MD: Because what you're doing in clinical practice is creating this incredible foundation for behavioral change, which is really what we all want, obviously that having that GLP1 is a boost that we never had before.
• 28:26
  Dr. Jill Carnahan, MD: That's really powerful.
• 28:28
  Dr. Jill Carnahan, MD: What percentage would you say is the GLP one?
• 28:30
  Dr. Jill Carnahan, MD: And what percentage is your clinicians actually looking at the patient's behavior and giving them those tools so that they can interface both?
• 28:37
  Dr. John Oberg: You asked me to kill.
• 28:38
  Dr. John Oberg: So I'm a scientist and you asked me a percentage I haven't measured.
• 28:41
  Dr. John Oberg: I gotta tell you, I haven't measured it.
• 28:43
  Dr. John Oberg: But you know, but sometimes like, you know, you take one away and things start working.
• 28:47
  Dr. John Oberg: You take the other one away, it stops.
• 28:49
  Dr. John Oberg: And the GLP1 has definitely been a catalyst to help people get on a track they want to be on.
• 28:54
  Dr. John Oberg: And so I think it's fantastic.
• 28:56
  Dr. John Oberg: I think that.
• 28:57
  Dr. John Oberg: But people have to be open to the fact that they have to actually do move and they have to do, have to, they do have to exercise and understanding what healthy resistance training.
• 29:05
  Dr. John Oberg: I just had a conversation earlier today about resistance training and they're like, well, what do I do?
• 29:09
  Dr. John Oberg: It's like, well, you've got to find someone who can help you if You've never done resistance training before, whether it's trainer in a gym or a friend who works out that knows what they're talking about.
• 29:16
  Dr. John Oberg: But the key here is don't overdo it.
• 29:20
  Dr. John Oberg: So we talk to people about the first thing you want to do is start moving for 10 minutes at a time.
• 29:24
  Dr. John Oberg: Even if you don't break a swim sweat, then you want to get to 150 minutes a week.
• 29:28
  Dr. John Oberg: So 10 minutes at a time, whether it's 30 minutes at a time or three times, but you don't even have to break a sweat.
• 29:33
  Dr. John Oberg: Just get moving.
• 29:34
  Dr. John Oberg: And then once you're at the glp, then you want to start actually resistance training, doing some things with weight.
• 29:40
  Dr. John Oberg: But we had one patient who had a number of MSK surgeries, and it was like, hey, I can't tell you what to do.
• 29:46
  Dr. John Oberg: You've got to go talk to your orthopedic surgeon and figure out what's appropriate for you in your given state.
• 29:51
  Dr. John Oberg: So I think whoever the experts are that are around you, right, you've got to work with those experts in their field and just know that there's definitely going to be a movement component, there's going to be a food component, and there might be a medical component to it.
• 30:05
  Dr. John Oberg: And if you're talking about a habit change, you're not talking about 21 days to change.
• 30:09
  Dr. John Oberg: You're talking about 90 to 365 days to change.
• 30:12
  Dr. Jill Carnahan, MD: Right.
• 30:12
  Dr. John Oberg: Like, that's the whole 21 days to change thing came from a study that we don't all have to deal with, where it was dealing with people who are amputees, not people.
• 30:20
  Dr. John Oberg: Well, yeah, so.
• 30:21
  Dr. John Oberg: So this study that you probably heard 21 days to have it change.
• 30:25
  Dr. John Oberg: Not.
• 30:25
  Dr. John Oberg: I mean, that is a thing if you're an amputee.
• 30:28
  Dr. John Oberg: Fortunately, most of our, you know, patients are not.
• 30:31
  Dr. John Oberg: And so behavior change comes a little more slowly than that.
• 30:34
  Dr. John Oberg: That's okay.
• 30:36
  Dr. Jill Carnahan, MD: So I love that you're talking about the protein, making sure adequate intake of actual calories with this change, because it's easy for patients, especially on the higher doses, to not eat enough.
• 30:45
  Dr. Jill Carnahan, MD: And then the resistance.
• 30:46
  Dr. Jill Carnahan, MD: Absolutely essential.
• 30:47
  Dr. Jill Carnahan, MD: Couldn't agree more.
• 30:48
  Dr. Jill Carnahan, MD: What other things do you find pre GLP1 or currently with GLP1 that are the saboteurs of weight loss for most patients?
• 30:58
  Dr. John Oberg: I think, you know, the things we really focus on are making sure they have the right medicines across their entire medical.
• 31:02
  Dr. John Oberg: You know, we had a woman who came in who was.
• 31:05
  Dr. John Oberg: Had $1,000 a month of supplements that she was taking, and it was Making her feel horrible.
• 31:10
  Dr. John Oberg: And so when we got her down to the right things, it was much less expensive in terms of time, energy, money, and stress.
• 31:16
  Dr. John Oberg: So all of it kind of.
• 31:17
  Dr. John Oberg: But getting onto the right things and recognizing those can change over time.
• 31:20
  Dr. John Oberg: So I think that's a.
• 31:21
  Dr. John Oberg: So medicine is one of kind of things.
• 31:23
  Dr. John Oberg: We check for what conditions they have, whether it's wellness or sickness or whatever they are, but they need to be in the right medicines.
• 31:29
  Dr. John Oberg: Then.
• 31:29
  Dr. John Oberg: Then when it comes to, like, food, wherever they are, we just want to take that one next step like we talked about earlier.
• 31:36
  Dr. John Oberg: And then movement.
• 31:37
  Dr. John Oberg: Movement's the same way.
• 31:38
  Dr. John Oberg: Like, just start with 10 minutes, then 20 minutes, then 30 minutes twice a day, like, and eventually 150 minutes a week.
• 31:46
  Dr. John Oberg: The saboteurs are the.
• 31:47
  Dr. John Oberg: Are the things you know about.
• 31:48
  Dr. John Oberg: It's the added sugar that's hidden in places.
• 31:52
  Dr. John Oberg: It's thinking you're doing something healthy and taking the fiber out of a fruit and then thinking that's the same thing as having the fruit.
• 31:58
  Dr. John Oberg: It's just really not.
• 31:59
  Dr. John Oberg: And then the other things that shock people, snacking, like, grazing is not good for the system.
• 32:05
  Dr. John Oberg: Like, we talk a lot about just grazing can really not be good for you.
• 32:09
  Dr. John Oberg: And so getting people into healthy patterns of eating through habit stacking and some of the other things we do, that's also really important.
• 32:16
  Dr. Jill Carnahan, MD: And are you, in most cases, obviously, you get to know the patient.
• 32:19
  Dr. Jill Carnahan, MD: We've established that.
• 32:20
  Dr. Jill Carnahan, MD: Are they seeing a nutritionist?
• 32:22
  Dr. Jill Carnahan, MD: Are your middle levels providing the education?
• 32:24
  Dr. Jill Carnahan, MD: Who in your clinic actually provides the dietary education?
• 32:28
  Dr. John Oberg: It depends.
• 32:29
  Dr. John Oberg: Like, we just see a lot of patients in Medicaid and Medicare and they don't have the resources for nutritionist.
• 32:34
  Dr. John Oberg: So we actually have an AI helper that helps us create meal plans for people if necessary.
• 32:39
  Dr. John Oberg: And so it will take, like, pictures of what's in their pantry, pictures of their pots and pans, talk about what cooking skill they have or want to have it will talk about how many times they want to have leftovers, how they're going to store it, you know, how big the refrigerator is.
• 32:52
  Dr. John Oberg: Like, we'll take all the variables if somebody wants us to, and.
• 32:55
  Dr. John Oberg: And we'll create, like, here are the recipes, here's the shopping list.
• 32:57
  Dr. John Oberg: Here's how you cook it.
• 32:59
  Dr. John Oberg: You know, here's how you store it.
• 33:00
  Dr. John Oberg: Like, as much detail as they want us to get in so that it makes it really simple for them.
• 33:05
  Dr. Jill Carnahan, MD: Oh, that sounds phenomenal.
• 33:07
  Dr. Jill Carnahan, MD: That makes so much.
• 33:08
  Dr. Jill Carnahan, MD: Then again, it's their house, their pantry, their foods, the things they like, and then maybe get Rid of this, add this, and you know, we're about to.
• 33:14
  Dr. John Oberg: Expose it through a portal.
• 33:15
  Dr. John Oberg: We haven't done this yet, but we want to expose this through our patient portal.
• 33:18
  Dr. John Oberg: So they can do it on their own or they can just do it with their provider.
• 33:21
  Dr. John Oberg: And the provider's happy to do it because it takes so little time to plug it in.
• 33:24
  Dr. John Oberg: Once you know everything, it's just used to take 90 minutes to do that.
• 33:27
  Dr. John Oberg: Now it takes 90 seconds.
• 33:29
  Dr. Jill Carnahan, MD: Yeah, yeah.
• 33:30
  Dr. Jill Carnahan, MD: This is what's amazing about the pieces of AI that are actually really helping us do our job.
• 33:34
  Dr. Jill Carnahan, MD: I want to talk about longevity.
• 33:35
  Dr. Jill Carnahan, MD: This is a big topic.
• 33:37
  Dr. Jill Carnahan, MD: I was just in Switzerland earlier this year talking about immune system as longevity.
• 33:41
  Dr. Jill Carnahan, MD: And there's so many more things like that.
• 33:43
  Dr. Jill Carnahan, MD: But how would you define longevity?
• 33:44
  Dr. Jill Carnahan, MD: How are you incorporating into patients thinking about it?
• 33:48
  Dr. Jill Carnahan, MD: Because I think as people hear that word, of course everybody's like, well, I want that.
• 33:51
  Dr. Jill Carnahan, MD: Right?
• 33:52
  Dr. John Oberg: Yeah, boy.
• 33:53
  Dr. John Oberg: I feel like I'm talking to the expert and the expert's asking me, here's what I would say is health span is as important as lifespan.
• 33:59
  Dr. John Oberg: So those are words that are not ours, but having that health span.
• 34:02
  Dr. John Oberg: So for us it's about finding the why on the behavioral side.
• 34:05
  Dr. Jill Carnahan, MD: Right.
• 34:05
  Dr. John Oberg: There's the medical side that your listeners hear about all the time.
• 34:08
  Dr. John Oberg: But when you find someone's why, I think why have a health span is really amazing.
• 34:13
  Dr. John Oberg: And so, you know, one of the things that I do and I share with my team, if they want to see it, and we're happy to share with our patients, but you know, you can look at a life plan that has these 10 year visions and that's amazing if you've been doing that for decades, which I have been.
• 34:27
  Dr. John Oberg: But if not that, then why this week?
• 34:31
  Dr. John Oberg: Right.
• 34:33
  Dr. John Oberg: And so it's the same thing.
• 34:34
  Dr. John Oberg: It's like, why today by tomorrow?
• 34:36
  Dr. John Oberg: You know, but so I think for, you know, when I talk to my family about like what I hope to be doing in 10 years, my kids in particular, sometimes like dad, I don't even know tomorrow, it's like, well, yeah, you're right, I shouldn't be talking about my ten year plan.
• 34:49
  Dr. John Oberg: Your ten minute plan.
• 34:50
  Dr. Jill Carnahan, MD: Yeah.
• 34:51
  Dr. John Oberg: You know, and so I think the same concepts apply.
• 34:53
  Dr. John Oberg: So I think, but finding someone's why and what they're excited to.
• 34:56
  Dr. John Oberg: And here's what I tell people who have no idea.
• 34:58
  Dr. John Oberg: It's like, just take a piece of and write down everything you think you might want your why to be.
• 35:03
  Dr. John Oberg: And you can write down things you want to own.
• 35:05
  Dr. John Oberg: You can write down experiences you want to have.
• 35:07
  Dr. John Oberg: You can write down goals you think you might want, but just write everything down.
• 35:11
  Dr. John Oberg: Even if it's a silly idea, write it down.
• 35:12
  Dr. John Oberg: Like write everything down.
• 35:14
  Dr. John Oberg: And you might write down five pages of things and once you do, just put it down and come back tomorrow and just write down why next to some of them.
• 35:20
  Dr. John Oberg: Yeah, and then some of you will decide, yeah, that's not that important to me.
• 35:23
  Dr. John Oberg: And some of you are like, ooh, that's really important to me.
• 35:26
  Dr. John Oberg: And then just like, have fun with it.
• 35:27
  Dr. John Oberg: But like, no judgment, like just put everything on there and then decide if you want to scratch something off, scratch it off.
• 35:33
  Dr. John Oberg: If you want to add it again to the bottom.
• 35:35
  Dr. John Oberg: There's no right or wrong answer.
• 35:36
  Dr. John Oberg: It's your why.
• 35:37
  Dr. Jill Carnahan, MD: But figure out why that is such good advice for all of us, practitioner to patient.
• 35:43
  Dr. Jill Carnahan, MD: Right?
• 35:43
  Dr. Jill Carnahan, MD: And I really love that you're green lighting being just put it all out there.
• 35:47
  Dr. Jill Carnahan, MD: Because so often our judge, the frontal cortex is like, you know, wait a second, that's not okay.
• 35:52
  Dr. Jill Carnahan, MD: Your parent wouldn't be approving of that or what, Even if we're 45 years old, our parents wouldn't approve.
• 35:57
  Dr. Jill Carnahan, MD: You know, like we have these old programs that affect those wise.
• 36:00
  Dr. Jill Carnahan, MD: I've heard someone say before too, that go back to your five or eight year old self.
• 36:03
  Dr. Jill Carnahan, MD: What did you love to do?
• 36:05
  Dr. Jill Carnahan, MD: You know, dirt bikes and the, you know, country, whatever it is.
• 36:08
  Dr. Jill Carnahan, MD: But then you can almost always take a piece of that joy you had as a little child and find, like I jokingly tell people I would have been a librarian if I wasn't a physician because I loved books so much.
• 36:18
  Dr. Jill Carnahan, MD: And granted, I'm glad I'm where I'm at, but I love learning.
• 36:22
  Dr. Jill Carnahan, MD: And so that little five year old wanted to be a librarian.
• 36:24
  Dr. Jill Carnahan, MD: And the why there is, I want to always learn, I want to always be.
• 36:28
  Dr. Jill Carnahan, MD: So that's a really good advice.
• 36:31
  Dr. Jill Carnahan, MD: As we wrap up, we've covered a lot of topics.
• 36:33
  Dr. Jill Carnahan, MD: I mean, this has been so fun.
• 36:35
  Dr. Jill Carnahan, MD: But one thing that comes to mind that we haven't talked about, that we've alluded to, but I think we addressed it directly because I think this is the epidemic that's above all epidemics and that's lack of connection and loneliness.
• 36:45
  Dr. Jill Carnahan, MD: Now you alluded to a lot of this because your foundation clinic is built on connection.
• 36:50
  Dr. Jill Carnahan, MD: But the science shows that loneliness, isolation, these are bigger morbidity, mortality indicators for heart disease and cancer and stroke and almost anything else out there.
• 37:01
  Dr. Jill Carnahan, MD: Talk to us again as A social scientist talk to us about that.
• 37:04
  Dr. Jill Carnahan, MD: And in this age of AI, in the age of electronics and devices, how do we reconnect and get rid of that loneliness?
• 37:13
  Dr. John Oberg: Yeah, I mean, you, me and the Surgeon General.
• 37:16
  Dr. John Oberg: Right.
• 37:16
  Dr. John Oberg: So, I mean, the former Surgeon General has said a number of times, this is the epidemic of our time.
• 37:20
  Dr. John Oberg: And so I think, you know, one of the dangers I see is people treating AI as if it's the relationship.
• 37:26
  Dr. John Oberg: And so, like I said, I tell my family, you got to be careful that you don't have a conversation with your AI that you would have had with me, because it's faster, easier, and it's an echo chamber.
• 37:38
  Dr. John Oberg: So you need to still have those real connections, but use AI to get things off of your plate so that you have the time and the space for those connections.
• 37:46
  Dr. John Oberg: And I think there's a couple cool things about AI and relationships.
• 37:49
  Dr. John Oberg: If you put a bad question into AI, you're going to get a bad answer and that forces you to ask better questions.
• 37:54
  Dr. John Oberg: What does that tell you about the questions you can ask the people that you're actually talking about to.
• 37:58
  Dr. John Oberg: Yeah, right, like how do you actually learn to be a better communicator?
• 38:02
  Dr. John Oberg: And we talk about, you know, in my house and in our, in my workplace, we talk about relationship skills being vulnerability, acceptance, trustworthiness, and seeing people in their best light.
• 38:14
  Dr. John Oberg: And so if you can work on those four skills relationally, you're going to deepen relationships in meaningful ways.
• 38:20
  Dr. John Oberg: And so that when I say vulnerability, I mean appropriate vulnerability, not vomiting emotions.
• 38:25
  Dr. John Oberg: Right.
• 38:25
  Dr. John Oberg: When I say acceptance, I mean just recognizing that sometimes you don't understand where someone's coming from, but you can still accept that they have a point of view different than your own.
• 38:34
  Dr. John Oberg: Right.
• 38:34
  Dr. John Oberg: Trustworthiness is holding people's secrets in the way that clinically we're taught to do.
• 38:38
  Dr. John Oberg: Obviously, if you're, you know, in a healthcare environment and then seeing people in their best light is just choosing to see someone in their best light and giving them the benefit of the doubt, you know, until they shouldn't be given that benefit of the doubt if someone breaks trust.
• 38:50
  Dr. John Oberg: But starting with that benefit of the doubt makes things so much better for people.
• 38:54
  Dr. John Oberg: And so those are four relationship skills that kind of stand on top of responsibility and accountability that make for great long term relationships.
• 39:02
  Dr. John Oberg: And so I think, you know, people who want to practice those skills can dive right in.
• 39:07
  Dr. John Oberg: Just start today.
• 39:09
  Dr. Jill Carnahan, MD: Oh, love that.
• 39:10
  Dr. Jill Carnahan, MD: I want to be sure.
• 39:11
  Dr. Jill Carnahan, MD: And we're gonna have that in the notes, guys.
• 39:12
  Dr. Jill Carnahan, MD: If you didn't take Notes because I think that right there was one of those pearls that is going to be a takeaway that I know I'm going to remember really love that I've always heard.
• 39:22
  Dr. Jill Carnahan, MD: And again in social scientists I think you teach this positive unconditional regard right as a physician, a patient or a social worker or a psychologist, we have this duty to the patient to non judgmental enclosure holding them in a space where they know that everything is safe that we speak about.
• 39:39
  Dr. Jill Carnahan, MD: And you're just, you know, taking that to the next level with these four things I want to ask where people can find you, learn more about you.
• 39:47
  Dr. Jill Carnahan, MD: But before we do, just for you personally, what do you consider a lot life worth living?
• 39:52
  Dr. Jill Carnahan, MD: Like what for you is your why?
• 39:54
  Dr. John Oberg: I mean, yeah, so this is a big one.
• 39:57
  Dr. John Oberg: So for me I feel like it's put on my heart a long time ago that I have to help a billion people have a little bit better life indirectly or directly.
• 40:04
  Dr. John Oberg: And so it's like if I can help everyone just have a little bit better life through the indirect transactions or relationships we have, then I've done what I'm supposed to do while I'm here on this earth.
• 40:15
  Dr. John Oberg: And so for your listeners, my hope is that you know, listeners will have some one thing they can take away and make their life just a little bit better as a result of listening today.
• 40:23
  Dr. John Oberg: And yeah, but I think, you know, I, I try to keep up with that.
• 40:27
  Dr. John Oberg: Like what am I doing today to make someone's life better and it's not me.
• 40:31
  Dr. Jill Carnahan, MD: Yeah, brilliant way to end.
• 40:34
  Dr. Jill Carnahan, MD: If people want to find out more about your organization, your clinic, where can they find out more about you?
• 40:39
  Dr. John Oberg: Come check out our clinic@prina.com p r e c I n a.com we do a podcast on the stories of hope at tales of abundance.com and then I'm personally@jonoberg.com I'm super easy to find.
• 40:51
  Dr. John Oberg: I joke with people.
• 40:52
  Dr. John Oberg: I'll give out my cell phone number and nobody ever me so you know, I'll, I'll put it in your show notes.
• 40:58
  Dr. John Oberg: I'll give it to you can put it in your show.
• 40:59
  Dr. John Oberg: No one will call.
• 41:00
  Dr. John Oberg: I mean but I'll give it to them and they can call me directly.
• 41:02
  Dr. John Oberg: But I try to be really easy to get a hold of and I'm happy to talk to people and like it's just, you know, one person at a time.
• 41:10
  Dr. John Oberg: It's like how do you make the world a little better place.
• 41:12
  Dr. John Oberg: Clean up, clean up the side of the street and keep moving on down the road.
• 41:15
  Dr. Jill Carnahan, MD: And yeah, well, it is clear in your energy and your info and your wisdom that you have done that and you have brought a great, great podcast here.
• 41:24
  Dr. Jill Carnahan, MD: Thank you, Dr. Oberg, for coming on the podcast today.
• 41:26
  Dr. John Oberg: Thanks for having me.
• 41:27
  Dr. Jill Carnahan, MD: Hey guys, hope you enjoyed that episode with Dr. Oberg on longevity and weight loss and everything in between.
• 41:33
  Dr. Jill Carnahan, MD: We covered a lot of topics today.
• 41:35
  Dr. Jill Carnahan, MD: If you haven't yet hit the like or subscribe button, please do so.
• 41:38
  Dr. Jill Carnahan, MD: Hit the bell if you want to be notified of future episodes.
• 41:41
  Dr. Jill Carnahan, MD: I know many of you listen every week and we're so grateful.
• 41:44
  Dr. Jill Carnahan, MD: And if you haven't yet subscribed or left a review on the audio version, Spotify, itunes or wherever you listen to podcast, we would so appreciate if you would do that.
• 41:54
  Dr. Jill Carnahan, MD: As you know, we have a new episode out every single week and I will see you again next week for a new episode of Resiliency Radio.