Latest / Clearly Hormonal / Why We Withdrew From the ADA Webinar, and Why Peer & Lived Experience Must Be Central to Obesity Care

Transcript

Why We Withdrew From the ADA Webinar, and Why Peer & Lived Experience Must Be Central to Obesity Care · Clearly Hormonal

• 0:00
  Komal Patil-Sisodia: Welcome back, though this episode is a little different.
• 0:03
  Komal Patil-Sisodia: It's running today on Clearly Hormonal, The Obesity Guide and Weight and Measure at the same time, because this is a conversation the three of us needed to have together.
• 0:11
  Komal Patil-Sisodia: Today, September 16th, was supposed to be a live webinar.
• 0:15
  Komal Patil-Sisodia: Dr.
• 0:15
  Komal Patil-Sisodia: Matthea Rentea and I were presenting, Mike Donnelly-Boylen was moderating, and it was supposed to be hosted by the Obesity Association, a division of the ADA.
• 0:23
  Komal Patil-Sisodia: The topic was integrating peer and lived experience into obesity care, but here we are.
• 0:29
  Komal Patil-Sisodia: We're not doing that webinar.
• 0:30
  Komal Patil-Sisodia: A few days ago, the three of us made a decision to withdraw in support of the broader boycott of the ADA programming.
• 0:37
  Komal Patil-Sisodia: Before we get into the actual content of what we would have presented, because we still think it matters and we still want you to have it, we want to explain why we're not doing this in the way that it was planned.
• 0:47
  Komal Patil-Sisodia: Quick context, if you haven't been following this closely at all, the ADA's scientific sessions back in June gave MAHA representatives a keynote speaking slot, and scientists and physicians who peacefully protested that decision were removed from the conference.
• 1:03
  Komal Patil-Sisodia: The ADA commissioned an independent review after that.
• 1:06
  Komal Patil-Sisodia: Leadership acknowledged parts of the situation could have been handled better, but when we saw the organization's public explanation, it didn't resolve things for us.
• 1:15
  Komal Patil-Sisodia: The response focused on narrow technical questions and didn't really address the bigger ones about how a scientific organization treats disagreement and dissent from its own members.
• 1:27
  Komal Patil-Sisodia: There's something particular about the timing here, too.
• 1:29
  Komal Patil-Sisodia: This webinar is about trust, about listening to lived experience, about building spaces where people feel heard.
• 1:38
  Komal Patil-Sisodia: Presenting that under an ADA banner right now felt inconsistent with the values we'd be asking clinicians to bring to their own patients.
• 1:45
  Komal Patil-Sisodia: So here's what we're doing instead.
• 1:47
  Komal Patil-Sisodia: We're going to walk you through why we made this call, then we're gonna actually give you the content of the webinar, because the science and the patient stories in it are real, and we don't want the obesity care community to lose that just because we pulled out of the room it was supposed to happen in.
• 2:03
  Komal Patil-Sisodia: And if you're a patient in this space, we still want you listening to this because it's important for you to know what discussions are happening in rooms that you're not traditionally a part of.
• 2:13
  Komal Patil-Sisodia: So let's get into it.
• 2:15
  Komal Patil-Sisodia: Welcome to the podcast today.
• 2:17
  Komal Patil-Sisodia: I am Dr.
• 2:18
  Komal Patil-Sisodia: Komal Patil-Sisodia.
• 2:19
  Komal Patil-Sisodia: I'm an endocrinologist by background.
• 2:21
  Komal Patil-Sisodia: I am also an obesity medicine specialist and a women's health expert.
• 2:25
  Komal Patil-Sisodia: I am joined today by Mike Donnelly-Boylen and Dr.
• 2:28
  Komal Patil-Sisodia: Matthea Rentea.
• 2:29
  Komal Patil-Sisodia: I'm gonna let them introduce themselves.
• 2:31
  Michael Donnelly-Boylen: Everyone, I'm Michael Donnelly Boylan.
• 2:32
  Michael Donnelly-Boylen: I am an obesity care advocate.
• 2:34
  Michael Donnelly-Boylen: I am with the Obesity Action Coalition, and I'm an inactive member at the moment of the Obesity Association's Obesity Care and Weight Management Advisory Board at the ADA.
• 2:46
  Matthea Rentea: Amazing.
• 2:46
  Matthea Rentea: I am Dr.
• 2:47
  Matthea Rentea: Matthea Rentea.
• 2:47
  Matthea Rentea: I'm internal medicine and obesity medicine board-certified, and I myself not only deliver a lot of obesity care, but also myself have, as a patient, had to struggle with this, so I'm really passionate about this topic in general.
• 3:01
  Komal Patil-Sisodia: All right.
• 3:02
  Komal Patil-Sisodia: We have all of us in the room, and I think before we start, we kinda have to address the elephant in the room about- I think we
• 3:09
  Michael Donnelly-Boylen: have to.
• 3:10
  Komal Patil-Sisodia: Yeah.
• 3:11
  Komal Patil-Sisodia: About why, and I'm happy to let you all kick it off and get started with that,
• 3:17
  Michael Donnelly-Boylen: I know, Dr.
• 3:18
  Michael Donnelly-Boylen: Patil-Sisodia, you were in New Orleans and were actually in the session.
• 3:21
  Michael Donnelly-Boylen: Can you tell us a little bit about sort of your reaction to what you heard?
• 3:25
  Komal Patil-Sisodia: Yeah.
• 3:26
  Komal Patil-Sisodia: I went to the keynote, and there were whisperings at the conference that, oh, it's a MAHA representative that has the keynote, right?
• 3:34
  Komal Patil-Sisodia: And right now, when science is so polarized or believing in science feels like it's becoming optional, I thought that was a really interesting choice.
• 3:42
  Komal Patil-Sisodia: But I was trying to go in with an open mind and see what this talk was about.
• 3:47
  Komal Patil-Sisodia: I sat through the talk, and they were framing how the MAHA agenda aligns with the ADA's goals, and we should all work together, which, in theory, sounds great, right?
• 3:58
  Komal Patil-Sisodia: And we're going through the conversation, and it was just interesting how certain things were put forward that were not necessarily related to diabetes care.
• 4:10
  Komal Patil-Sisodia: We deviated into vaccines.
• 4:12
  Komal Patil-Sisodia: We deviated into fluoride in the drinking water.
• 4:14
  Komal Patil-Sisodia: We had slides that were assuming in their intent that currently our scientists and researchers are not appropriately addressing or researching conditions, and that somehow this administration and their new principles and alignment could help us do that better.
• 4:33
  Komal Patil-Sisodia: And it was odd.
• 4:35
  Komal Patil-Sisodia: It was offensive to all of the researchers in the room.
• 4:39
  Komal Patil-Sisodia: And I think everybody just sat there in shocked silence when we...
• 4:43
  Komal Patil-Sisodia: I was looking around the room and talking to the people next to me, just thinking,"Are, is this for real?
• 4:48
  Komal Patil-Sisodia: Is this actually happening?" And then Dr.
• 4:50
  Komal Patil-Sisodia: Kalyani, who is, I think, the chief scientific officer for the ADA, she came in, and they had a fireside chat, right?
• 4:56
  Komal Patil-Sisodia: We were not allowed to ask questions as the audience, and so I found that a little odd.
• 5:02
  Komal Patil-Sisodia: They only had the fireside chat where she was asking curated questions.
• 5:06
  Komal Patil-Sisodia: But to her credit, she actually did a good job of trying to hold him accountable with some of those claims, and then also brought up the fact that they are changing the structure around how research is being funded in this country, right?
• 5:19
  Komal Patil-Sisodia: And the current changes to NIH funding are actually cutting the funding of about 70 to 80% of studies, which is really unfortunate.
• 5:30
  Komal Patil-Sisodia: For example, and I'm gonna make the numbers simple to understand.
• 5:32
  Komal Patil-Sisodia: If you have$20, or$40 and say it costs you a dollar to fund the first year of each study you can fund 40 studies But now what they're saying is you have to fund five years up front, right?
• 5:47
  Komal Patil-Sisodia: So that 40 divided by five is eight studies.
• 5:50
  Komal Patil-Sisodia: So instead of funding 40 studies, you're only funding eight, and we're cutting the ability to do research in this country, right?
• 5:58
  Komal Patil-Sisodia: So she did a great job holding him accountable for that.
• 6:00
  Komal Patil-Sisodia: Dr.
• 6:01
  Komal Patil-Sisodia: Steve Kahn and the other editors of Diabetes Care had written a really great op-ed article about this particular situation.
• 6:09
  Komal Patil-Sisodia: And so they felt, in protest to having somebody from the administration giving this talk, they could peacefully hand out articles, copies of that article in the lobby, right?
• 6:19
  Komal Patil-Sisodia: And I was very disturbed by the talk, and I didn't know if I was gonna come back to the conference, so I left.
• 6:25
  Komal Patil-Sisodia: I saw them with the stacks of articles, handing them out, and then I went back to my hotel room, which is probably when everything went down with security getting called and them being escorted out and having their lanyards taken away.
• 6:38
  Komal Patil-Sisodia: And then I didn't actually come back until the next day because I was so upset.
• 6:41
  Komal Patil-Sisodia: So you were there immediately in the aftermath, so I'd love to hear from you because- I was i'm so curious.
• 6:47
  Michael Donnelly-Boylen: I was there.
• 6:48
  Michael Donnelly-Boylen: So I was there probably, I think, about a half an hour after it all went down.
• 6:52
  Michael Donnelly-Boylen: And many of you saw this on TikTok or Reels because it went viral.
• 6:57
  Michael Donnelly-Boylen: It was in The New York Times.
• 6:59
  Michael Donnelly-Boylen: These scientists had been removed from the conference for civil discourse.
• 7:03
  Michael Donnelly-Boylen: And while, politically, we can all come from different viewpoints, and we can all arrive in these places, and our audiences aren't gonna all have the same politics, and I'm not asking you to, but what I am asking you to consider is civil discourse and peaceful protest of accurate, information period.
• 7:19
  Michael Donnelly-Boylen: We all are talking these days about the First Amendment and whether, what rights we have to have opposing opinions.
• 7:24
  Michael Donnelly-Boylen: These scientists at least had opposing opinions and then were removed by police and that's what, for me, took it too far.
• 7:33
  Komal Patil-Sisodia: Yeah.
• 7:34
  Komal Patil-Sisodia: I would agree, right?
• 7:34
  Komal Patil-Sisodia: And then I think the rest of the tone of the conference Mike, you and I can agree, was just pretty somber, actually.
• 7:42
  Michael Donnelly-Boylen: It was very somber.
• 7:43
  Michael Donnelly-Boylen: It was very somber.
• 7:43
  Michael Donnelly-Boylen: And I'd not been to ADA before.
• 7:45
  Michael Donnelly-Boylen: As a patient, I was, like, literally one of two patients that I found at the entire conference, and it was just eerie, the conversations that were happening, just getting coffee with people.
• 7:54
  Michael Donnelly-Boylen: It was like everyone, everyone felt it.
• 7:57
  Michael Donnelly-Boylen: It felt like science was under attack.
• 8:00
  Komal Patil-Sisodia: Yeah.
• 8:00
  Komal Patil-Sisodia: And it's a very disheartening feeling when you are coming together to try and improve the health of a community that so desperately needs that help, right?
• 8:12
  Komal Patil-Sisodia: And we've, the ADA historically has been able to do pretty great work around advocating for these patients.
• 8:18
  Komal Patil-Sisodia: I think for a lot of us to see it just see it tainted by this was really hard.
• 8:26
  Komal Patil-Sisodia: And I, like you, Mike, I had not been to this conference before.
• 8:29
  Komal Patil-Sisodia: I think maybe as a fellow, like 20 years ago.
• 8:32
  Komal Patil-Sisodia: But I hadn't been since I'd started practicing, and so I was actually excited to be there.
• 8:36
  Komal Patil-Sisodia: One of my friends was speaking.
• 8:38
  Komal Patil-Sisodia: I was going to connect with all these people, which I did end up doing, and that part was great.
• 8:43
  Komal Patil-Sisodia: But even still, like in my friend's panel discussion, there was still somebody there speaking and representing the MAHA viewpoint of, something within pediatric endocrinology.
• 8:55
  Komal Patil-Sisodia: And I just thought, why does it have to be called out that way when we're all in support of science," right?
• 9:00
  Komal Patil-Sisodia: It just felt like it was seeded throughout.
• 9:02
  Komal Patil-Sisodia: So I thought, let's see what happens." The ADA put their apology out, which I'm sure you and I both saw after- from the CEO.
• 9:11
  Komal Patil-Sisodia: And I thought, I made two decisions that weekend.
• 9:13
  Komal Patil-Sisodia: One was to go back to the conference because I thought, all these scientists and researchers who've put in all this time and effort to have their work there deserve my attention, and my patients back home deserve me going and learning new things that I can bring back to my care.
• 9:29
  Komal Patil-Sisodia: And then secondly, it was around Giving people a second chance, right?
• 9:34
  Komal Patil-Sisodia: Because I am a firm believer that if we don't allow people the space to evolve their viewpoint or to work their way through a misstep, then we are no worse than people who give absolutely no grace or are very staunch in their viewpoint.
• 9:50
  Komal Patil-Sisodia: So that was where I was at.
• 9:52
  Michael Donnelly-Boylen: Yeah, very much it, we all deserve to have the opportunity to do a redo.
• 9:57
  Michael Donnelly-Boylen: I just think it's taken a long time to get that redo.
• 10:00
  Komal Patil-Sisodia: Yeah, absolutely.
• 10:01
  Komal Patil-Sisodia: And so you know Matthea, I know you and I chatted about it after the fact and you were not there, and I think a lot of people were surprised to initially see me posting about it on social media and I got a lot of inquiries from colleagues, like,"What actually happened, what is going on?" And so that's why I decided to release a podcast episode around what happened for that.
• 10:23
  Komal Patil-Sisodia: And now fast-forward, here we are and I didn't...
• 10:27
  Komal Patil-Sisodia: I was the last in the chain of the three of us to find this out.
• 10:30
  Komal Patil-Sisodia: So Mike, I'll let you tell that part of the story.
• 10:33
  Michael Donnelly-Boylen: After the latest statement there was a boycott called on the ADA from what is called the New Orleans Five the five folks that were removed by the police.
• 10:42
  Michael Donnelly-Boylen: And I really reflected on it, I'll be honest with you, because I'm a patient.
• 10:47
  Michael Donnelly-Boylen: I was one of literally the only patients at a conference of well over 10,000 people.
• 10:51
  Michael Donnelly-Boylen: And I take that responsibility of being the first really seriously.
• 10:55
  Michael Donnelly-Boylen: But I really just felt in the end like I needed to speak as well for the patient community, which many of them who saw it on social media reacted very strongly to me being at the conference.
• 11:05
  Michael Donnelly-Boylen: So anyways, long story short, I reached out to Dr.
• 11:08
  Michael Donnelly-Boylen: Rentea and I said,"Hey, what are you thinking?" And this sort of led to what's happening today that we're doing it here instead of doing it with the American Diabetes Association.
• 11:18
  Komal Patil-Sisodia: I think all of us feel very strongly that the patients and the clinicians need to be supported, and that this topic is extremely valuable because one of the biggest barriers to patients coming in for this type of care is trust, right?
• 11:33
  Komal Patil-Sisodia: So how do we bridge that gap?
• 11:35
  Komal Patil-Sisodia: How do we create a space where we can welcome patients in, where we can teach clinicians how to be that welcoming force, and then also integrate patients' lived experiences into the process.
• 11:48
  Komal Patil-Sisodia: Because I honestly, like I feel my patients learn better when they know that there's something, somebody else that's going through the same thing as them, or they find community.
• 11:57
  Komal Patil-Sisodia: And community is really everything.
• 12:00
  Michael Donnelly-Boylen: So how would we define our topic for today?
• 12:02
  Michael Donnelly-Boylen: What would we say our topic is today?
• 12:04
  Komal Patil-Sisodia: The topic of our webinar was integrating lived peer experiences into obesity care.
• 12:11
  Komal Patil-Sisodia: And I think really there's lots of different pieces to it.
• 12:15
  Komal Patil-Sisodia: There's the trust gap.
• 12:17
  Komal Patil-Sisodia: There's trying to communicate lived experience as a communication tool.
• 12:21
  Komal Patil-Sisodia: There's ways to build trust and engagement, and then where the evidence around that stands.
• 12:27
  Komal Patil-Sisodia: And I think we can kinda go through each of those and talk about it.
• 12:30
  Komal Patil-Sisodia: And I think the one benefit of doing it this way is that previously Dr.
• 12:35
  Komal Patil-Sisodia: Rentta and I were just going to be talking, and you were going to be moderating.
• 12:39
  Komal Patil-Sisodia: This actually gives us the opportunity to have your experience and your insight into this, Mike, in a way that I think we probably wouldn't have been able to do during the webinar.
• 12:49
  Komal Patil-Sisodia: Here's my hope that it's even better than what we had planned for.
• 12:53
  Michael Donnelly-Boylen: Thank you both for having me.
• 12:55
  Komal Patil-Sisodia: Of course.
• 12:55
  Michael Donnelly-Boylen: I'm just excited to be on the same podcast as Dr.
• 12:58
  Michael Donnelly-Boylen: Rentta.
• 12:58
  Michael Donnelly-Boylen: I've been fanboying since the day I got on Mounjaro,
• 13:02
  Komal Patil-Sisodia: I
• 13:02
  Matthea Rentea: was gonna say, I'm sorry the situation that surrounded this, but I love both of you guys.
• 13:06
  Matthea Rentea: You both have podcasts.
• 13:08
  Matthea Rentea: I've known both of you for a long time, so I'm like,"Listen, this is still gonna be a great time."
• 13:12
  Komal Patil-Sisodia: It's a meeting of friends and colleagues, right?
• 13:14
  Komal Patil-Sisodia: And I got to meet Mike for the first time.
• 13:16
  Komal Patil-Sisodia: I think I heard about him from you, Mattea, and I was listening to the podcast prior.
• 13:21
  Komal Patil-Sisodia: And so it's been nice to meet you in real life.
• 13:23
  Komal Patil-Sisodia: We'll call it in real life since virtual counts for that these days.
• 13:28
  Komal Patil-Sisodia: But I just think it'll be a great discussion and all of us bringing very different viewpoints.
• 13:33
  Komal Patil-Sisodia: I work in a hospital system where I've had the privilege of working alongside partners who've built a nationally recognized obesity medicine and bariatric surgery program.
• 13:42
  Komal Patil-Sisodia: Mattea has a very different concept around, or her practice.
• 13:47
  Komal Patil-Sisodia: So our first topic, we'll say, was the trust gap in obesity care.
• 13:51
  Komal Patil-Sisodia: So Mattea, I'm gonna hand that over to you because I know you see this firsthand, and you've also experienced it as a patient and I think this is a really important-
• 14:01
  Matthea Rentea: Definitely.
• 14:01
  Matthea Rentea: This is not only a big topic, but it has big clinical ramifications for patients.
• 14:06
  Matthea Rentea: So weight stigma in clinical encounters, it drives patients away from care.
• 14:12
  Matthea Rentea: And individuals report that they feel dismissed, they feel blamed, things are oversimplified, right?
• 14:18
  Matthea Rentea: It's this classic eat less, move more.
• 14:21
  Matthea Rentea: And traditional patient education alone, it hasn't closed this gap, because we've been saying for years now that it's more complicated and nothing's happening with that.
• 14:30
  Matthea Rentea: And so even the oversimplification is a form of bias, right?
• 14:33
  Matthea Rentea: Even it's almost, it's belittling- Yeah who's in front of you.
• 14:36
  Matthea Rentea: And I wanted to give one example with this.
• 14:38
  Matthea Rentea: I had on the podcast previously Dr.
• 14:40
  Matthea Rentea: Lindsay Ogle, and she gave a really good example how she had a patient that had...
• 14:45
  Matthea Rentea: i'm just rough strokes telling this story, but the patient- had, let's say, bariatric surgery the year prior.
• 14:50
  Matthea Rentea: Before getting bariatric surgery, a patient is supposed to be fully worked up mammogra- age-appropriate preventive screenings, whether it be mammogram, pap, things like that.
• 14:58
  Matthea Rentea: And this patient had not been fully worked up, and despite having surgery, and now after, had uterine cancer.
• 15:05
  Matthea Rentea: And this is something that could have been detected if someone had fully been looking at this patient, fully going through things, this could have been caught.
• 15:13
  Matthea Rentea: And a lot of the times, again I'm bringing this example up because sometimes clinicians might not want to do a pap based on someone's size because it might technically be more difficult.
• 15:23
  Matthea Rentea: And so this is- just one example where of course you as a patient even have shame about that, and then on top of that, the clinician's turning away from it, and now the patient is suffering in the end.
• 15:35
  Komal Patil-Sisodia: Yeah.
• 15:35
  Michael Donnelly-Boylen: Can I just say, that hits hard on me.
• 15:37
  Michael Donnelly-Boylen: I actually had a really hard time, in fact never really got my colonoscopy because they couldn't find a bed for me that was large enough and when I was at my largest in Boston, in a major medical city.
• 15:49
  Michael Donnelly-Boylen: So yes, it really does happen where doctors look at us based on our size and decide something's just too difficult.
• 15:56
  Michael Donnelly-Boylen: The number of phone calls I made was insane, and it never came about.
• 15:59
  Matthea Rentea: Yeah.
• 16:00
  Komal Patil-Sisodia: That's heartbreaking.
• 16:02
  Komal Patil-Sisodia: And I'm sorry that you had to face that.
• 16:04
  Komal Patil-Sisodia: I think that is so much more a common story than we realize.
• 16:07
  Komal Patil-Sisodia: It's so common, coming from a women's health perspective, when you shared that study about the delayed uterine cancer screening.
• 16:14
  Komal Patil-Sisodia: We are quick to say that overweight and obesity increase the risk of dysfunctional uterine bleeding, but nobody thinks to take the next step.
• 16:23
  Komal Patil-Sisodia: Or for you, Mike, you may have had a misdiagnosis just because your care was so delayed because of lack of infrastructure and lack of resources around that.
• 16:34
  Komal Patil-Sisodia: One of the other things that I see in hospital systems, especially for referrals that are coming into our clinic, are gonna be ortho patients, right?
• 16:43
  Komal Patil-Sisodia: Patients who need a joint replacement, they're having a lot of pain, and all they're really being offered is injections and being told,"Okay, go lose 40 pounds and then we can do your surgery," right?
• 16:54
  Komal Patil-Sisodia: And that's all good and fine, except how?
• 16:58
  Komal Patil-Sisodia: With what tools?
• 16:59
  Komal Patil-Sisodia: With what resources?
• 17:00
  Komal Patil-Sisodia: With what help?
• 17:01
  Komal Patil-Sisodia: Because as somebody who has struggled with overweight and obesity myself- Unless you have a lot of different resources or you have a doctor who's really engaged in knowing how to do that, you feel kinda left out and hung out to dry, right?
• 17:17
  Komal Patil-Sisodia: In full disclosure, like I have PMOS and I didn't get a diagnosis until much later just because people were not aware of that.
• 17:25
  Komal Patil-Sisodia: But that has an increased association with overweight and obesity and insulin resistance and all of these things.
• 17:30
  Komal Patil-Sisodia: And if nobody is teaching you how to address those issues or you yourself don't know how to get that help, we're not creating a safe space for patients to be able to do that, right?
• 17:41
  Komal Patil-Sisodia: So one of the nice things about having built a bariatric surgery program and a weight management program within this hospital system is that we were able to work with our in-house orthopedic surgeons to say, please don't do that with patients.
• 17:56
  Komal Patil-Sisodia: Send them to us.
• 17:57
  Komal Patil-Sisodia: We can bring them in.
• 17:59
  Komal Patil-Sisodia: We can give them the foundational lifestyle hacks like nutrition and moving their bodies and what they need to be doing for overall wellness.
• 18:08
  Komal Patil-Sisodia: We can pair them with a physician to get them on the right medication.
• 18:11
  Komal Patil-Sisodia: If they need bariatric surgery before you can safely do the joint replacement, we can work towards that goal." But the whole point is we can't leave patients out there without support, right?
• 18:21
  Komal Patil-Sisodia: It is our responsibility as clinicians in this space to figure out what the resources are in our community and pull that together to be able to support these patients.
• 18:31
  Komal Patil-Sisodia: I feel very strongly about that, so I'm gonna toss that back to either of you.
• 18:37
  Matthea Rentea: And I think something this leads us to the next point of what we were gonna talk about is...
• 18:42
  Matthea Rentea: So let's take, for example, the colonoscopy- Yeah example because when I did primary care, we had an outpatient colonoscopy center within the building that we were in, and they would risk stratify based on the weight set point, whether they would do it there or not.
• 18:55
  Matthea Rentea: And the thing that patients would come to me, it's not that they had to go to the hospital, in case something happened, that there'd be more resources.
• 19:02
  Matthea Rentea: It was the language with which it was transmitted, right?
• 19:05
  Matthea Rentea: That they were very shamed for that.
• 19:07
  Matthea Rentea: And so this brings a point that patient narratives, your peers, how they are describing things, that shared language is gonna reduce shame, and it can increase validation.
• 19:18
  Matthea Rentea: So clinicians cannot just rely on factual information.
• 19:23
  Matthea Rentea: Knowing the language that peers are speaking with is gonna help to communicate better.
• 19:30
  Matthea Rentea: And even if clinicians themselves, they don't have an experience with this, everyone doesn't need to have suffered with this disease to be a- Right good advocate.
• 19:37
  Matthea Rentea: I think it's really listening to, being willing to sit there and hear what is actually, how are people speaking about this, and then how could I bring some of that, the, humanize it and really bring it into the way in which I communicate with patients?
• 19:53
  Matthea Rentea: Or even...
• 19:53
  Matthea Rentea: Oh, go ahead, Mike
• 19:53
  Michael Donnelly-Boylen: the doctors who I've had the best experience with are curious.
• 19:57
  Matthea Rentea: Yes.
• 19:57
  Michael Donnelly-Boylen: They're curious about my experience.
• 19:59
  Michael Donnelly-Boylen: They sit with me.
• 20:00
  Michael Donnelly-Boylen: They ask questions.
• 20:01
  Michael Donnelly-Boylen: They don't make assumptions, and they use person first language, right?
• 20:04
  Michael Donnelly-Boylen: It's not that I'm obese, that I'm a person with obesity, that I live in a larger body.
• 20:08
  Michael Donnelly-Boylen: And knowing that language is so validating as a patient.
• 20:11
  Michael Donnelly-Boylen: It's incredibly validating, and there's just not enough folks out there outside of our spaces that do that.
• 20:17
  Matthea Rentea: Yeah.
• 20:18
  Komal Patil-Sisodia: I would agree with that.
• 20:19
  Komal Patil-Sisodia: I was taking a look through, Google Photos and I had something pop up that looked like a snippet from a patient note, and I was looking at it and thinking,"Good God, why did I take a picture of this?" And there was no patient information in there, and then I remembered it was from a colleague in the hospital who had sent a referral to the endocrinology clinic, and the line said,"Patient will see endocrinology for their pain and misery." That was the referral, and I was like,"This is in the patient record.
• 20:49
  Komal Patil-Sisodia: What what is this communication," right?
• 20:52
  Matthea Rentea: I thought I've heard it all.
• 20:53
  Matthea Rentea: I have not.
• 20:55
  Komal Patil-Sisodia: It was a reminder we have to be careful with not just how we communicate to patients, but also to our colleagues.
• 21:01
  Komal Patil-Sisodia: We're sending somebody in to get a consult for something.
• 21:04
  Komal Patil-Sisodia: If we are using negative language around that the person receiving the consult is going to think negatively.
• 21:13
  Komal Patil-Sisodia: How we speak to people and about people is so important, right?
• 21:17
  Komal Patil-Sisodia: And being empathetic to what somebody is going through maybe this person thought they were being empathetic and getting across that this person was really suffering.
• 21:25
  Komal Patil-Sisodia: But it didn't land in the way that it was intended.
• 21:28
  Matthea Rentea: yeah, and the way in which we're gonna talk, it's gonna create safety or not, and that is gonna dictate if there's actually gonna be a relationship there or not, where you can move towards something.
• 21:37
  Michael Donnelly-Boylen: Absolutely.
• 21:37
  Michael Donnelly-Boylen: And in this day of electronic records, where so many of us go into them and can see what's said, I've gone back into some of my older records and I'm just- Yeah it's horrifying sometimes to read about yourself and the language that's being used in the record.
• 21:49
  Michael Donnelly-Boylen: Oh, yeah.
• 21:49
  Michael Donnelly-Boylen: That's just changed.
• 21:50
  Michael Donnelly-Boylen: That's a very different world that we live in now.
• 21:53
  Komal Patil-Sisodia: Yeah.
• 21:53
  Komal Patil-Sisodia: It really has, and I will say, one of the cooler applications of AI for me has been the AI scribe in the room.
• 22:01
  Komal Patil-Sisodia: They capture so much detail and so much nuance with what the conversation actually is.
• 22:07
  Komal Patil-Sisodia: I actually think my notes are better than they have been.
• 22:10
  Komal Patil-Sisodia: Initially when I was using it, it was confabulating and it spent a three-week period writing my notes in British English that I called its Bridgerton era.
• 22:17
  Komal Patil-Sisodia: But Once we got past Bridgerton, it's been excellent.
• 22:21
  Komal Patil-Sisodia: So trying to find, tools that help you articulate what the conversation was with the patient in a way that's non-threatening.
• 22:29
  Komal Patil-Sisodia: Some of these tools out there actually do a really great job.
• 22:31
  Komal Patil-Sisodia: So for our clinicians that are listening, you can use that if you can't quite find the right words to say what you're trying to say.
• 22:39
  Matthea Rentea: 'Cause I was talking to a friend here recently- and I can't remember the exact example, but I had been so offended by how someone had talked about weight, and they couldn't- understand why I was offended.
• 22:50
  Matthea Rentea: And I think I was picking up on a lot of bias and innuend- it- I was just hearing a lot because, you know- Yeah coming from my lens of my experiences, and they couldn't understand it.
• 22:59
  Matthea Rentea: And so I had to sit there and really break it down to them.
• 23:02
  Matthea Rentea: So sometimes we don't even realize what we're saying.
• 23:05
  Michael Donnelly-Boylen: And I'll just say that patients deal with their own internalized bias and stigma.
• 23:09
  Michael Donnelly-Boylen: And so the words we may be using in the office may be stigmatizing and shouldn't be mimicked back to us, right?
• 23:16
  Michael Donnelly-Boylen: They should be modeling for us how we should be talking to ourselves.
• 23:20
  Matthea Rentea: That's brilliant.
• 23:21
  Komal Patil-Sisodia: I really like the way- that you said that.
• 23:23
  Komal Patil-Sisodia: This is where we have tried to create some support groups within our obesity medicine programs and make sure that we have a support group for people who are going through bariatric surgery, who are going through just the weight management arm of our program, where they're doing medication instead of surgery, and really trying to create an environment where people can share their experiences and learn from each other and feel safe in that.
• 23:49
  Komal Patil-Sisodia: A lot of times when you're going through something, a health crisis, and you don't have that community, you feel very alone, right?
• 23:56
  Komal Patil-Sisodia: And especially for conditions like overweight or obesity or even my patients who have diabetes, it can be a very hard thing to navigate when you feel like you're alone in it.
• 24:06
  Komal Patil-Sisodia: And I think these groups offer some of that.
• 24:08
  Komal Patil-Sisodia: And they look different in traditional healthcare systems versus what Matthea has done a phenomenal job of building outside of a traditional healthcare model.
• 24:19
  Komal Patil-Sisodia: And so I'd love to, hear from both of you if you've had experiences with groups like that, what programs have worked for you.
• 24:26
  Komal Patil-Sisodia: And Matthea, I'd love for you to chat about what your program is like.
• 24:31
  Matthea Rentea: Yeah, I'll say even before I talk about my program- It being part of peer groups was the thing that helped me to get better health.
• 24:38
  Matthea Rentea: So years- ago, I joined, it was actually a group for female physicians, and I'm still friends with all those doctors to this day, but the point is the fact that everybody could speak on calls, you didn't have to explain yourself, you could just fully get- the help that you needed it was invaluable.
• 24:54
  Matthea Rentea: That was the first time I realized, oh, when you feel safe in a space and you can say what you need to say and you get the help that you need, it can be massively transformational, like healing in a way that cannot occur just with information.
• 25:09
  Michael Donnelly-Boylen: Yeah.
• 25:09
  Michael Donnelly-Boylen: I'll say for me I started off with Weight Watchers when I was, like, 13, and while I don't love the Weight Watchers experience, what I loved was the support group back in the day in the room.
• 25:19
  Michael Donnelly-Boylen: That for me was everything.
• 25:20
  Michael Donnelly-Boylen: And my doctor, my primary care doctor gave me the medication and gave me very little information.
• 25:25
  Michael Donnelly-Boylen: And my students had told me that at that point in time in 2024, if you have a question, you ask that question of TikTok.
• 25:32
  Michael Donnelly-Boylen: And so I asked the question of TikTok, and the doctor who ended up being my cardiologist is who popped up and said,"This is the information I need you to know," which was amazing.
• 25:40
  Michael Donnelly-Boylen: But what I did find on TikTok was the peer support community that I needed.
• 25:45
  Michael Donnelly-Boylen: I wish it was regulated.
• 25:46
  Michael Donnelly-Boylen: I wish I was getting into a more organized program where it was being overseen by a physician and not patient to patient, which makes me very nervous.
• 25:52
  Michael Donnelly-Boylen: But at least I had that.
• 25:54
  Michael Donnelly-Boylen: And I needed that for success.
• 25:56
  Matthea Rentea: Yeah.
• 25:56
  Matthea Rentea: And, Mike, that's the reason.
• 25:58
  Matthea Rentea: So I have my clinic, but then I also run a program, and it's called 3030.
• 26:02
  Matthea Rentea: We can call it group coaching, but the point is everybody is in the same peer space with working on their metabolic health, plus or minus medications, things like that.
• 26:09
  Matthea Rentea: And the reason I did it is because of what you're talking about, where people need to be able to share their lived experience and get support and ideas and all the things, but every so often, something will pop up where it is medically incorrect or someone needs to kinda make sure that the space is maintained as safe, right?
• 26:26
  Matthea Rentea: And that just didn't exist out there.
• 26:28
  Matthea Rentea: And so There is a utility to making sure that someone is still there that understands what's going on.
• 26:35
  Michael Donnelly-Boylen: 100%.
• 26:36
  Komal Patil-Sisodia: Yeah.
• 26:37
  Komal Patil-Sisodia: I would agree with that.
• 26:38
  Komal Patil-Sisodia: And honestly I never really thought about social media until I met Matthea, and Matthea's the one who encouraged me to start my podcast and then told me that I needed to be on social media, and I was like,"Oh, no."
• 26:50
  Michael Donnelly-Boylen: I think she was in my first 10 follows, actually.
• 26:52
  Michael Donnelly-Boylen: Oh, really?
• 26:53
  Michael Donnelly-Boylen: Yes, for real.
• 26:55
  Matthea Rentea: Oh, I love that.
• 26:55
  Matthea Rentea: I remember your first video.
• 26:56
  Matthea Rentea: Yeah.
• 26:56
  Michael Donnelly-Boylen: Cause I went looking for doctors.
• 26:57
  Michael Donnelly-Boylen: I went looking for doctors'cause my doctor wasn't giving me the information I needed.
• 27:01
  Matthea Rentea: Yeah.
• 27:02
  Michael Donnelly-Boylen: But I- And thank God you were there.
• 27:03
  Michael Donnelly-Boylen: Thank God.
• 27:04
  Komal Patil-Sisodia: And she's been an inspiration to so many clinicians who are getting out on social media and trying to put out good quality information to patients.
• 27:12
  Komal Patil-Sisodia: But I have to say, I respect what you both have built in that space, both from a clinician and a patient perspective.
• 27:19
  Matthea Rentea: I don't think I've ever told this story publicly, but one of the reasons that I started social and...
• 27:23
  Matthea Rentea: 'Cause there was, like, I think a year and a half that I was doing social.
• 27:26
  Matthea Rentea: I had no clinic, right?
• 27:27
  Matthea Rentea: I was working at another organization and another clinic, and in that organization, I was doing the obesity clinic, okay?
• 27:35
  Matthea Rentea: So everyone, it was the obesity clinic.
• 27:37
  Matthea Rentea: The way in which the registered dieticians and members of that team would speak about the patients, I was so offended.
• 27:45
  Matthea Rentea: Me and the other doctor that ran it were almost fighting with them on calls.
• 27:49
  Matthea Rentea: "Look, do you understand how you're saying this?
• 27:51
  Matthea Rentea: Look at this.
• 27:51
  Matthea Rentea: Look at that." They had the old paradigm of you have to prove yourself before you can get medication.
• 27:56
  Matthea Rentea: It was just really old-school thinking, not realizing what was happening, and that was one of the big reasons that I kept making videos.
• 28:04
  Matthea Rentea: And what was funny is those videos that me and other doctors, they were taking off.
• 28:08
  Matthea Rentea: People were getting the help that they needed, and that pharmacist sat there and said,"Oh, these TikTok trends where, you know, people-- now the medications are going into shortage." And I thought, no, for the first time, people are getting some good information where they can go and get help.
• 28:21
  Komal Patil-Sisodia: This is where creating that good information for patients, we see the needle start moving on people getting the care that they need.
• 28:30
  Matthea Rentea: And, the thing is, the way in which this support looks is gonna be different based on where you are.
• 28:36
  Matthea Rentea: So if, when I have an independent clinic, it can look very different- than when you're at a big organization.
• 28:43
  Matthea Rentea: So Komal, you said that you guys had built a program that was very- comprehensive.
• 28:48
  Matthea Rentea: How did you guys do that and incorporate that support there?
• 28:51
  Komal Patil-Sisodia: It's interesting.
• 28:52
  Komal Patil-Sisodia: It started as the Wild West where I'm at.
• 28:55
  Komal Patil-Sisodia: It was that the hospital system that I work at has had a bariatric surgery center of excellence for over a decade, right?
• 29:03
  Komal Patil-Sisodia: But it was all external surgeons who were bringing some of their cases to the hospital, and we thought,"Gosh, we really need to probably have some structure around this," especially since we were starting to get word that, obesity medications were starting to be released, right?
• 29:19
  Komal Patil-Sisodia: We were noticing that the GLP-1s were going to become a big part of this, and we needed a structured program.
• 29:25
  Komal Patil-Sisodia: We were also running into issues where, surgeries weren't getting reimbursed because people hadn't gone through whatever the proper hoops were for that.
• 29:32
  Komal Patil-Sisodia: So we really wanted to bring a quality lens to it.
• 29:35
  Komal Patil-Sisodia: It was, how do we make care in the community better?
• 29:38
  Komal Patil-Sisodia: And our CEO at the time came to me and said,"Hey, do you have an interest in building this?" And I was like,"I am not the right person to build it, but I will help hire the people that need to be in this so that we can build it in the right way," Initially, we brought on our obesity medicine doc who is also an endocrinologist by background, Dr.
• 29:57
  Komal Patil-Sisodia: Sonia Hans.
• 29:57
  Komal Patil-Sisodia: She's amazing.
• 29:58
  Komal Patil-Sisodia: She's my partner at work, and I just love everything she does.
• 30:02
  Komal Patil-Sisodia: She had, we met, and she had enough- exposure to obesity medicine care in her endocrinology fellowship because she trained in Shreveport, Louisiana.
• 30:13
  Komal Patil-Sisodia: They had a big swath of the country that really struggles with overweight and obesity coming through the program.
• 30:19
  Komal Patil-Sisodia: So she was board eligible right away, and she said, but if I'm gonna do this, I'm gonna need a partner who knows what to do, cover me and help take care of these patients." So I decided to go along that journey with her.
• 30:32
  Komal Patil-Sisodia: But she came in with such a great idea of, it can't just be medications.
• 30:37
  Komal Patil-Sisodia: It can't just be surgery.
• 30:38
  Komal Patil-Sisodia: It can't just be diet, right?
• 30:40
  Komal Patil-Sisodia: And we need to meet people where they're at.
• 30:43
  Komal Patil-Sisodia: So she built a three-arm program where it was, for people who don't have much nutrition background or don't know how to move their bodies or don't really understand body composition, like a lifestyle foundational 12-week program.
• 30:58
  Komal Patil-Sisodia: Where that is really what you need to focus on so that we can get good habits into place before we put you on medications.
• 31:05
  Komal Patil-Sisodia: Because if we put you on medications and you don't have good habits in place, it becomes really hard for those meds to work.
• 31:12
  Komal Patil-Sisodia: And then when your appetite's suppressed, it's harder to actually go follow the nutrition advice.
• 31:16
  Komal Patil-Sisodia: But then, it was, like, people who went to that initial consult who are like I've been, doing CrossFit.
• 31:21
  Komal Patil-Sisodia: I work out five times a week.
• 31:23
  Komal Patil-Sisodia: This is what my food logs are." It didn't make sense for them to have to sit in a 12-week program.
• 31:28
  Komal Patil-Sisodia: So these people could be escalated then to the pathway where they work with a physician and look at what medications are good options for them.
• 31:36
  Komal Patil-Sisodia: Based on whether there's insulin resistance or disordered eating and, She had really worked out a great way to pick different medications depending on what somebody was going through and what their background was.
• 31:47
  Komal Patil-Sisodia: And then we had our bariatric surgery COE that was there, and we hired a bariatric surgeon to come in and be the medical director over that.
• 31:56
  Komal Patil-Sisodia: We found an amazing person who is also obesity medicine board-certified on top of being a bariatric surgeon, which I think has been really great.
• 32:05
  Komal Patil-Sisodia: And so we have patients who if they're not doing well on medication, and we have a screening process for if they're over a certain BMI or they have a set number of comorbidities, we actually schedule them with him for an obesity medicine consult.
• 32:19
  Komal Patil-Sisodia: And he talks to them about, this is what the plan is.
• 32:22
  Komal Patil-Sisodia: If after, this percent of time we're not seeing an improvement, then we can go down the path of bariatric surgery.
• 32:29
  Komal Patil-Sisodia: So we're trying to do it so that it is across a spectrum because no one-- no two people are at the same starting point.
• 32:36
  Komal Patil-Sisodia: And then we also have it built in where, they have their post-bariatric surgery care with us, and then they can come back in say they're having weight regain after.
• 32:44
  Komal Patil-Sisodia: They can see one of the obesity medicine physicians and then potentially also be on weight management medications after.
• 32:51
  Komal Patil-Sisodia: So really trying to create that broad spectrum of care in a system, and we were lucky that we had a system that really wanted to address this issue for our community and pour resources into it.
• 33:02
  Matthea Rentea: Yeah, it's incredible.
• 33:03
  Matthea Rentea: I think about, I worked at the VA for a period, and there they had- I don't know if they still have this, but where it's called the MOVE program.
• 33:09
  Matthea Rentea: It's kind of- what you're talking about, where it's like- think however many weeks so you had to go through that before the medications could unlock.
• 33:15
  Matthea Rentea: Again, things might be different now, but it's what you're talking about if you had someone in front of you where that wasn't appropriate.
• 33:20
  Matthea Rentea: They were maybe a triathlete, right?
• 33:22
  Matthea Rentea: It would make no sense.
• 33:23
  Matthea Rentea: Yeah.
• 33:23
  Matthea Rentea: And so yeah, what you're talking about, that's so nice to really find out where they are.
• 33:28
  Komal Patil-Sisodia: Yeah.
• 33:28
  Komal Patil-Sisodia: It's just trying to pivot and meet people where they're at and create.
• 33:32
  Komal Patil-Sisodia: And the other nice thing is we had our diabetes education and nutrition group that was supporting the endocrinologists and all of the patients struggling with type 1 or type 2 diabetes, and they were so excited to be a part of this.
• 33:45
  Komal Patil-Sisodia: So within that group, we have dieticians who only do care for our obesity clinic.
• 33:50
  Komal Patil-Sisodia: They have really created a great system within the nutritionists.
• 33:54
  Komal Patil-Sisodia: Everybody was wanting to go to conferences and get educated on the right type of language to use with patients, and creating it in a way that it was delivered in a sensitive manner.
• 34:05
  Komal Patil-Sisodia: One of our patients is a donor at the hospital, and he noticed that our door to get into our clinic was not wide enough for a bariatric wheelchair.
• 34:14
  Komal Patil-Sisodia: And he, was like,"I'm gonna donate money for this.
• 34:17
  Komal Patil-Sisodia: It's only for this.
• 34:18
  Komal Patil-Sisodia: We're gonna fix the door so people can get in and out of the clinic." Like there, these are small things that you don't think about sometimes where it just escapes your notice.
• 34:26
  Komal Patil-Sisodia: Our rooms were up to code, our bathrooms were up to code.
• 34:28
  Komal Patil-Sisodia: Nobody thought to look at the front door.
• 34:31
  Matthea Rentea: You know what this makes me think of?
• 34:32
  Matthea Rentea: During the pandemic, it became a time where you could- actually go to someone's car and see could they get out of it or not.
• 34:37
  Matthea Rentea: Yeah we started to get a look into people's homes with telehealth visits, right?
• 34:40
  Matthea Rentea: Yeah.
• 34:41
  Matthea Rentea: And a lot of the time we have no understanding of what the day-to-day life looks like, all the abilities, things like that.
• 34:47
  Michael Donnelly-Boylen: It's funny.
• 34:48
  Michael Donnelly-Boylen: I experimented with the idea of going into a clinical trial not too long ago.
• 34:51
  Michael Donnelly-Boylen: And I walked into this office that's mainly being done for endocrinology, and there weren't seats for larger bodies.
• 34:58
  Michael Donnelly-Boylen: And it struck me that this is a space where many people who are coming in for experimental GLP-1 NOOSH type medications.
• 35:06
  Michael Donnelly-Boylen: And it was just really striking to be in that particular space, and to think that no one had noticed it probably but me.
• 35:12
  Michael Donnelly-Boylen: And this is why- trust me, when you've lived in a larger body, you notice.
• 35:15
  Matthea Rentea: Yeah.
• 35:15
  Komal Patil-Sisodia: Yeah.
• 35:15
  Komal Patil-Sisodia: I believe that.
• 35:16
  Komal Patil-Sisodia: And, this is why the patient voices are so important, right?
• 35:20
  Komal Patil-Sisodia: This is why having patients sitting down with clinicians when we are designing care models or ways to engage with the community, it's so important.
• 35:29
  Komal Patil-Sisodia: Because while I might know all the science part of whatever, my attention to detail is not there.
• 35:35
  Komal Patil-Sisodia: My husband is the one who decorated our home.
• 35:38
  Komal Patil-Sisodia: I'm not the one paying attention to that stuff.
• 35:41
  Komal Patil-Sisodia: So everybody's a little different in how they're perceiving what the work that needs to be done.
• 35:46
  Komal Patil-Sisodia: But I'm forever grateful to that patient who came to us and said,"No, this is not gonna work."
• 35:53
  Matthea Rentea: Definitely.
• 35:54
  Matthea Rentea: And I think so we can know all these areas, right?
• 35:56
  Matthea Rentea: That, okay- Yeah we want to change care, but what are some practical places where this could come in for a clinician?
• 36:03
  Matthea Rentea: So I think when we thought this through, there's three different areas.
• 36:05
  Matthea Rentea: Number one, in a clinical sense, meaning when you're doing the intake with a patient, instead of having it be this factual experience, actually having it be more storytelling.
• 36:15
  Matthea Rentea: Tell me what your experience has been like.
• 36:17
  Matthea Rentea: When did this become a challenge for you?
• 36:19
  Matthea Rentea: Really eliciting the story so you can understand what they're going through.
• 36:23
  Matthea Rentea: I think a second area would be educational things like continuing medical education.
• 36:28
  Matthea Rentea: So the fact that, Mike, it makes me think of when you're saying,"Hey, we should be modeling how a patient could help themselves with thinking differently." We would need to learn that ourselves to begin with.
• 36:39
  Matthea Rentea: Yeah understanding, just giving one example in each of these, and then the community setting, again, the peer support groups that we've been talking about.
• 36:46
  Matthea Rentea: And there are many other ways in which you can do that.
• 36:48
  Matthea Rentea: But the thing I wanna stress here, if you're listening as a clinician, you don't, you can't do all the things at once.
• 36:53
  Matthea Rentea: Oftentimes like the organization, they don't have the money to change the blood pressure cuffs or, it's so rudimentary sometimes at some level, but you always have agency with one thing.
• 37:03
  Matthea Rentea: Like how you're asking a history, you can do that.
• 37:05
  Matthea Rentea: Even if they're requiring you to stick the BMI in the chart, you can still give trust and respect at that session with asking consent to talk about weight and how you're asking about it, and I think that's the important thing here is, are you helping move this forward so that your patient gets better care?
• 37:22
  Michael Donnelly-Boylen: Can I just say acknowledging when you don't have it and- Yeah I don't wanna say apologizing, but acknowledging it so that we don't think we're crazy.
• 37:29
  Michael Donnelly-Boylen: It's such little things like that.
• 37:31
  Michael Donnelly-Boylen: Ask, I will know when you're treating me like a human being and when you're being curious about my experience.
• 37:37
  Michael Donnelly-Boylen: Yeah.
• 37:37
  Michael Donnelly-Boylen: Those little acknowledgments make a huge difference to me hearing you, trusting you, and knowing that you understand obesity as the disease that I'm, I have- Yeah as opposed to who I am.
• 37:48
  Matthea Rentea: Yeah.
• 37:48
  Komal Patil-Sisodia: Yeah, and I learned that the hard way, and Matthea knows what story I'm gonna share, not with a patient who was struggling with overweight or obesity, but somebody who had come in to see me for diabetes.
• 38:00
  Komal Patil-Sisodia: Blood sugars in the 3 to 400s.
• 38:02
  Komal Patil-Sisodia: And the biggest lesson I learned from this is I can know exactly what to do, but if I can't present it in a way or hear my patient in a way that it's gonna land with them, I'm gonna fail, and that's exactly what happened with this patient.
• 38:16
  Komal Patil-Sisodia: So I had this patient come in and see me, and their blood sugars were in the 3 to 400s, and I went through and I did my diet history, and I'm asking them to do their 24-hour diet recall, and this person was drinking four two-liter bottles of Mountain Dew A day, right?
• 38:33
  Komal Patil-Sisodia: That's eight liters of fluid.
• 38:34
  Komal Patil-Sisodia: I can barely get in 64 ounces of water.
• 38:36
  Komal Patil-Sisodia: I don't know how that's possible, but that is what this person's crutch was.
• 38:41
  Komal Patil-Sisodia: So I thought,"Okay, cool.
• 38:42
  Komal Patil-Sisodia: I know what I'm gonna do.
• 38:43
  Komal Patil-Sisodia: I'm gonna wean you off the Mountain Dew." And I made this Mountain Dew titration schedule, like literally cutting it by four to eight ounces every three to four days until they were off, and I think the whole thing took four months.
• 38:56
  Komal Patil-Sisodia: And the person came in with labs, and the A1C was perfect, and I was like,"I cured your diabetes.
• 39:02
  Komal Patil-Sisodia: We fixed it." And this person came in and looked at me and said,"I hate this.
• 39:08
  Komal Patil-Sisodia: I hate you.
• 39:09
  Komal Patil-Sisodia: I'm going back to my Mountain Dew, and I'm never coming back to see you again." And I just sat there shell-shocked because in my mind, I had just fixed it, right?
• 39:19
  Komal Patil-Sisodia: And this is when I was a baby endocrinologist, like right after I'd gotten out of fellowship, so I didn't know any better at this point.
• 39:25
  Komal Patil-Sisodia: And I sat there and I was like,"I don't even know what to do." And at first I was, like, offended and sad and,"What do you mean?
• 39:33
  Komal Patil-Sisodia: I helped you.
• 39:33
  Komal Patil-Sisodia: I fixed all of this." But this person was not ready to hear what I was presenting.
• 39:39
  Komal Patil-Sisodia: They were not in a position where they were able to, for whatever circumstances in their life, give up the crutch of Mountain Dew, and I hadn't done a good enough job of investigating why the Mountain Dew was a crutch for this person.
• 39:55
  Komal Patil-Sisodia: And I had, in my effort to get them to a cure really quickly, not really done my due diligence, and it was an extremely humbling lesson for me early on in my career that even if I am saying the right things and checking off the things, you can still come across in a way that is extremely disingenuous to patients and actually does them more harm than help.
• 40:19
  Komal Patil-Sisodia: Had I taken a different approach, this person might still be my patient and maybe we would've weaned off the Mountain Dew in two years and not four months, but then they would've stayed with their care.
• 40:30
  Komal Patil-Sisodia: And so I regret that.
• 40:31
  Komal Patil-Sisodia: I regret that encounter.
• 40:33
  Matthea Rentea: Like we have no idea what brings people the most amount of joy in their day or what- matters or doesn't to them.
• 40:38
  Matthea Rentea: And so having to assess that is always imperative.
• 40:43
  Michael Donnelly-Boylen: I love it when a doctor asks me what my goals actually are, right?
• 40:47
  Michael Donnelly-Boylen: Is it really the scale?
• 40:48
  Michael Donnelly-Boylen: Is it my A1C?
• 40:50
  Michael Donnelly-Boylen: Is it the ability to get up the stairs?
• 40:51
  Michael Donnelly-Boylen: Which what it was for me, to be able to walk two blocks and not be in excruciating pain.
• 40:56
  Michael Donnelly-Boylen: Assumptions about goals and what brings us joy in life is such a really important note that I wanna underline as a patient.
• 41:04
  Komal Patil-Sisodia: Yeah.
• 41:05
  Komal Patil-Sisodia: And I think, in learning that motivational interviewing, it only goes so far if you're not curious.
• 41:12
  Komal Patil-Sisodia: And I think both of you have brought up the curiosity word a few times in our conversation.
• 41:17
  Komal Patil-Sisodia: So for our clinicians, we need to stay curious so that we can have people be able to trust us with what their thoughts and goals and feelings are around what they're going through.
• 41:30
  Michael Donnelly-Boylen: Can I add one side note to that?
• 41:31
  Komal Patil-Sisodia: Yeah.
• 41:32
  Michael Donnelly-Boylen: You may be the most wonderful physician out there, but what I want you to know is that we may have ongoing medical trauma, never mind past trauma.
• 41:41
  Michael Donnelly-Boylen: We might be seeing a specialist- right now who's- actively doing that.
• 41:45
  Michael Donnelly-Boylen: So when you're doing everything right, sometimes we may still react a little crazy, and the reason we're reacting crazy has nothing to do with you.
• 41:53
  Michael Donnelly-Boylen: Keep doing what you're doing.
• 41:55
  Michael Donnelly-Boylen: It may be that urologist next door who's just put us through our paces and made us feel really small about the fact that we're on a GLP-1 or something like that.
• 42:05
  Michael Donnelly-Boylen: Ongoing medical trauma is real.
• 42:07
  Michael Donnelly-Boylen: All we ask is that there try to be somebody that can be our safe space and understand that sometimes we may not react well to that safe space, but my God, do we appreciate it.
• 42:17
  Komal Patil-Sisodia: That's a really great way of saying that, because I think a lot of us don't think about what's happening outside of our four walls,
• 42:24
  Matthea Rentea: yeah.
• 42:25
  Komal Patil-Sisodia: And then in terms of, patient peer support groups, I know we've gotten good feedback on our peer support groups, and I know Matthea, you have your 3030 program that is really more of a support group as opposed to a medical program.
• 42:39
  Komal Patil-Sisodia: I'd love to hear more about that.
• 42:41
  Komal Patil-Sisodia: I think that is a valuable model that we don't always consider.
• 42:45
  Matthea Rentea: Yeah.
• 42:46
  Matthea Rentea: I think one of the biggest things with when I started that program and when I've been running it, is that I had the belief that people don't need one more piece of information.
• 42:55
  Matthea Rentea: Yes, I can be there and make sure that medically things are not off the wall, but people need to hear stories from other people.
• 43:01
  Matthea Rentea: They need to get ideas.
• 43:03
  Matthea Rentea: They need to get inspired, and through being able to meet weekly, biweekly, whatever it is, they get that opportunity to help each other, and it's just a really powerful experience.
• 43:16
  Komal Patil-Sisodia: Mike, have you had experiences with peer support groups in your healthcare journey?
• 43:21
  Michael Donnelly-Boylen: I really struggled for a long time to find an obesity medicine physician who I felt truly supported by.
• 43:28
  Komal Patil-Sisodia: Oh my
• 43:28
  Michael Donnelly-Boylen: god.
• 43:28
  Michael Donnelly-Boylen: And I have that now.
• 43:29
  Michael Donnelly-Boylen: But the piece, the hole for me has always been filled through social media.
• 43:33
  Michael Donnelly-Boylen: TikTok has some really great live communities, and I've had a lot of support through that.
• 43:38
  Michael Donnelly-Boylen: I go and I travel the country to meetups with people and things like that, and that's how I've filled that gap.
• 43:43
  Michael Donnelly-Boylen: Do I wish that two and a half years ago that I had that?
• 43:47
  Michael Donnelly-Boylen: I do.
• 43:48
  Michael Donnelly-Boylen: Do I regret that I have the community that I have now, and that somehow at 53 years old I've become an influencer?
• 43:55
  Michael Donnelly-Boylen: No.
• 43:56
  Michael Donnelly-Boylen: I don't know, maybe some days, but usually not, it's just what it is.
• 43:59
  Michael Donnelly-Boylen: But I've watched what Dr.
• 44:00
  Michael Donnelly-Boylen: Rentea does with 3030 for a long time, and it looks it absolutely looks amazing.
• 44:05
  Michael Donnelly-Boylen: And the fact that you can get the kind of services patients can get from you, Komal, in an organized healthcare system is just, it's amazing, and I wish that for everyone.
• 44:15
  Michael Donnelly-Boylen: Although, again, I'm happy with- my experience.
• 44:19
  Komal Patil-Sisodia: Yeah.
• 44:20
  Komal Patil-Sisodia: And I'll say even within our healthcare systems, there are so many constraints with insurance and who will cover what.
• 44:27
  Komal Patil-Sisodia: We have a person who just runs insurance for all the referrals that come in, and some of the things we see are wild.
• 44:34
  Komal Patil-Sisodia: It's like you're covered for the nutrition consult and the bariatric consult, but not for the surgery or the medication.
• 44:43
  Komal Patil-Sisodia: It's like nothing adds up, right?
• 44:45
  Komal Patil-Sisodia: So I think we have a lot of advocacy work that we need to do as a community as well in terms of making sure...
• 44:52
  Komal Patil-Sisodia: I think we've made progress, right?
• 44:53
  Komal Patil-Sisodia: Probably five, six years ago it was one in four insurances that had any sort of weight management coverage.
• 44:59
  Komal Patil-Sisodia: I know when we were building our program at our hospital system, one of the, the first things we pointed out was, our health insurance plan doesn't actually have coverage for any of these things, so we need to change our benefits so they align with the program we're building.
• 45:14
  Komal Patil-Sisodia: Again there is advocacy that we can do on a insurance company level in terms of, what is available to different patients.
• 45:21
  Komal Patil-Sisodia: What hoops are they having to jump through?
• 45:23
  Komal Patil-Sisodia: I know that, the Medicare Bridge Program has been a great example of being able to help impact that community.
• 45:30
  Komal Patil-Sisodia: Currently-- I sit on a county medical board where I live, and this year's docket, was about Medicaid coverage for GLP-1s, right?
• 45:39
  Komal Patil-Sisodia: So there's ongoing ways to get involved in a community, sometimes in ways that you didn't, you may not think about it in a traditional sense,
• 45:48
  Michael Donnelly-Boylen: I do think that over 65 group that's come on board right now desperately needs these kinds of peer support communities.
• 45:55
  Michael Donnelly-Boylen: I've unofficially set one up.
• 45:57
  Michael Donnelly-Boylen: Both of my parents are on GLP-1s right now- down at their retirement community in Florida, where I put out handouts, and my parents hand them all out, and they all talk about their GLP-1 experience
• 46:05
  Komal Patil-Sisodia: love that
• 46:06
  Michael Donnelly-Boylen: for people of a certain era, I think that's a real opportunity right now.
• 46:09
  Matthea Rentea: Yeah.
• 46:10
  Matthea Rentea: It's funny, when you would think about with my group, we have a lot that are retired or even in their 70s or 80s.
• 46:15
  Matthea Rentea: You wouldn't assume that, right?
• 46:16
  Matthea Rentea: It's so diverse who needs the help.
• 46:19
  Michael Donnelly-Boylen: And they have the exact same concerns.
• 46:20
  Michael Donnelly-Boylen: My mother looked at me at the pool and said"Why don't you have more loose skin like I do?" And I'm like,"Jesus, Mom."
• 46:27
  Matthea Rentea: I think that one almost last thing here to highlight is that this is a chronic medical condition where patients are very susceptible to this multi-billion dollar wellness industry.
• 46:39
  Matthea Rentea: And so I think it, because they're wanting so desperately to have help that a lot of things that get present- they're vulnerable to it.
• 46:46
  Matthea Rentea: I think that it's important when we talk about a transferable model, if you're in a system that doesn't have a lot of supports, what can you do?
• 46:54
  Matthea Rentea: We mentioned you can say,"Hey, here's a good podcast.
• 46:57
  Matthea Rentea: Here's a good social channel." Maybe you find a YouTube channel.
• 47:01
  Matthea Rentea: Half of what I do in the clinic is making sure to have good resources for people and that you're helping them because you're like,"Hey, I trust this," which is hard to say nowadays, but that is a way that you can help people.
• 47:13
  Michael Donnelly-Boylen: Because online people see so many people who have MD after their name or DO who are selling a supplement or- selling some sort of wellness thing or maybe didn't do their residency at all and are just out there pitching products.
• 47:26
  Michael Donnelly-Boylen: And I hate to say it, but most of us see physicians as godlike figures, and the moment a, a physician says it, we say this physician said it.
• 47:34
  Michael Donnelly-Boylen: This doctor said it to me." And so the wellness community is something that can be really scary in the online space.
• 47:41
  Michael Donnelly-Boylen: The only way to combat bad information is with more good information.
• 47:44
  Michael Donnelly-Boylen: That's the most important thing in the First Amendment.
• 47:46
  Komal Patil-Sisodia: Exactly.
• 47:46
  Michael Donnelly-Boylen: And we do pass good information among ourselves.
• 47:48
  Michael Donnelly-Boylen: I can't tell you how many people I've sent to Dr.
• 47:50
  Michael Donnelly-Boylen: Rentea online to be like,"You absolutely have to-" it's a must follow on your first week.
• 47:54
  Michael Donnelly-Boylen: You have to.
• 47:55
  Matthea Rentea: Thank you.
• 47:55
  Komal Patil-Sisodia: I think the other part of it is if you are in a healthcare system or if you're in a community, how do you build these resources?
• 48:03
  Komal Patil-Sisodia: How do you find these resources, right?
• 48:05
  Komal Patil-Sisodia: And I think we touched on a few different areas that can happen, and sometimes it could just be starting a support group or something like that, right?
• 48:12
  Komal Patil-Sisodia: And really trying to figure out what that's going to look like for your patients.
• 48:16
  Komal Patil-Sisodia: I think there is something to be said about making sure that whatever you're setting up, you're setting the rules of engagement and the container around that for creating a safe space for patients.
• 48:29
  Komal Patil-Sisodia: My big thing in healthcare has always been that is if we put the patient at the center of it, and we build around what patients need, it will organically grow into what is a very high quality program because we're trying to do it with patient- comfort and treatment and all of those things in mind, right?
• 48:45
  Komal Patil-Sisodia: So if you're building a support group who are the people that you're going to bring into that space?
• 48:50
  Komal Patil-Sisodia: Are they allies for the community?
• 48:52
  Komal Patil-Sisodia: Are they people who are going to use patient first language?
• 48:55
  Komal Patil-Sisodia: What does that look like?
• 48:57
  Komal Patil-Sisodia: Is there a clinician in your community, if you're not a clinician yourself, who is very passionate about this that you can bring in to help moderate or support that support group?
• 49:07
  Komal Patil-Sisodia: I think one of the things that I've seen, I've never run a Facebook group that's super large, but when Facebook groups, grow past a certain amount, they need moderators and people paid to moderate and things like that.
• 49:18
  Komal Patil-Sisodia: And I think just really understanding what your goals are around that, and then also making sure whoever is coming to that is representative of the population at large.
• 49:26
  Komal Patil-Sisodia: It's very hard when it's just one type, one set of people.
• 49:32
  Komal Patil-Sisodia: We saw this in the diabetes program that we built.
• 49:35
  Komal Patil-Sisodia: I grew up in the community that I'm practicing in, and when I went to high school, I had three other Indian kids in my class, two of whom were twins, so I really only counted two'cause I was like,"Two of you came from the same womb," so not as diverse, but by the time my sister graduated, she had 15 Indian kids in her class.
• 49:53
  Komal Patil-Sisodia: And so it grew exponentially, but then the demographic of health changed in the community.
• 49:58
  Komal Patil-Sisodia: And what you were doing in terms of outreach to the community in the'90s is different than in the 2000s, is different in the 2010s, is different in the 2020s, right?
• 50:08
  Komal Patil-Sisodia: So you have to adjust and evolve with your community and see who's out there, who needs the help, and how their needs are different.
• 50:16
  Komal Patil-Sisodia: For anybody who is looking to set up programs like this or even just create a support structure, these are gonna be major things to consider
• 50:23
  Michael Donnelly-Boylen: yeah, our population's not a monolith, right?
• 50:25
  Michael Donnelly-Boylen: We have so many intersectionalities of race- and sexual orientation and gender and age, and you need to be considering all of that for what your patient population looks like.
• 50:36
  Michael Donnelly-Boylen: Yeah I went to a gay men's health center, and that's where I was failed because there wasn't, and I don't know that there is anymore, still anything geared towards the obesity community within that space.
• 50:45
  Michael Donnelly-Boylen: And it, th- that is isolating when you can't find a space that you feel comfortable in.
• 50:49
  Michael Donnelly-Boylen: Yeah.
• 50:50
  Michael Donnelly-Boylen: So I resonate with what you said.
• 50:52
  Komal Patil-Sisodia: Thank you.
• 50:53
  Komal Patil-Sisodia: that pretty much wraps up what we were going to be talking about.
• 50:58
  Komal Patil-Sisodia: This conversation about making sure that we are creating a great peer community and we're integrating these lived experiences is important.
• 51:07
  Komal Patil-Sisodia: And that concludes our episode for today.
• 51:10
  Komal Patil-Sisodia: I hope you all found it helpful.
• 51:11
  Komal Patil-Sisodia: We are really trying to bring this topic to the forefront.
• 51:16
  Komal Patil-Sisodia: Like I said, you can reach out to any one of us.
• 51:18
  Komal Patil-Sisodia: I'm Dr.
• 51:19
  Komal Patil-Sisodia: Komal Patil-Sisodia.
• 51:20
  Komal Patil-Sisodia: You can find me on Instagram or TikTok at drpatilsisodia are my social handles.
• 51:26
  Komal Patil-Sisodia: My podcast is called Clearly Hormonal, and this episode will be there.
• 51:30
  Komal Patil-Sisodia: If you don't follow Mike and Dr.
• 51:32
  Komal Patil-Sisodia: Rentea, highly recommend that you do, and I'm gonna let them tell you where to find them.
• 51:37
  Matthea Rentea: Okay.
• 51:38
  Matthea Rentea: I'm, so I am Dr.
• 51:39
  Matthea Rentea: Rentea, and you can find me, Matthea Rentea, on all socials, Instagram, TikTok, YouTube.
• 51:45
  Matthea Rentea: And the best way long-term to stay connected with me is my podcast, The Obesity Guide with Matthea Rentea, MD.
• 51:52
  Matthea Rentea: And really to be able to find all that, it's Renteaclinic.com, and you just click on podcast and there's a roadmap and you can look through it and really find specifically the areas that you're interested in
• 52:03
  Michael Donnelly-Boylen: And I'm Michael Donnelly Boyle, and I'm known as Mike On A Mission on both TikTok and Instagram, where you can find me.
• 52:09
  Michael Donnelly-Boylen: Or you can follow my podcast, which is called Weight and Measure with Mike and Zach.
• 52:14
  Michael Donnelly-Boylen: If you're a clinician and you're gonna be at Obesity Week, come find Zach and I.
• 52:17
  Michael Donnelly-Boylen: We will be there.
• 52:18
  Michael Donnelly-Boylen: We're gonna have a booth.
• 52:19
  Michael Donnelly-Boylen: It'll be a lot of fun.
• 52:20
  Michael Donnelly-Boylen: Or you can just easily find the podcast on any platform at www.weightandmeasurepod.com.