Core Bariatrics

Episode 24: Q&A

• Dr. Maria Iliakova & Tammie Lakose

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Have you ever struggled with the balance between savoring life's journey and maintaining your health on the road? That's the tightrope we walk in our latest episode, where we share tales from our medical conference adventure in Cleveland, and the attendant challenges of eating post-bariatric surgery. Our conversation takes flight with the introduction of Bari Buddy, the AI assistant that's revolutionizing post-op life with reliable, guideline-based advice, a creation honed through over a hundred hours of meticulous programming. Tammie dishes out her wisdom on navigating airports and staying true to dietary needs without sacrificing the joy of travel.

When the road takes a turn towards the procedural, we've got you covered with the nitty-gritty of colonoscopy prep for the bariatric patient. It’s a must-listen for anyone facing the daunting prospect of a colonoscopy, offering practical tips on a liquid diet and debunking the 'pouch reset' myth with an emphasis on a holistic approach to weight regain. Through Tammie’s lens, each patient's journey is underscored as unique and deserving of tailored care, sidestepping the notion that additional surgery is the go-to solution for complex issues related to weight.

Closing out, our discussion pivots to challenge the healthcare industry's fixation on BMI and weight. We advocate for a focus on overall wellness and metabolic health, pondering the conundrum faced by patients and doctors alike when cultural standards and medical requirements clash. From the diversity in athletic physiques to the comparative recovery paths of different bariatric surgeries, we shed light on the multifaceted world of weight management. This episode is an exploration of the many layers of obesity and body standards, offering insights and empathy to anyone affected by these pervasive issues. Join us for a heart-to-heart on the transformative potential of bariatric surgery, set against the intricate tapestry of societal, genetic, and psychological factors that shape our health and self-image.

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Speaker 1:

Welcome to Core Bariatrics Podcast, hosted by bariatric surgeon Dr Maria Iliakova and Tami LaCose, bariatric coordinator and a patient herself. Our goal is building and elevating our community. The Core Bariatrics Podcast does not offer medical advice, diagnosis or treatment. On this podcast, we aim to share stories, support and insight into the world beyond the clinic. Let's get into it. Maria, you've been like MIA for a solid three months. It is so hard to get time with you. I'm so happy to see your face.

Speaker 2:

We just spent the whole weekend together pretty much in Cleveland, which was fantastic. We were there for a conference and learned a ton about this kind of surgery reflux surgery, all kinds of things. It was a blast.

Speaker 1:

Yeah, it was, so I should say yes, I have seen you, just not on here, so it's like brand new all over again. That's right.

Speaker 2:

And we've been working on a podcast. We also created a chat GPT for our people called Berry Buddy, which is like an AI assistant for people who have gone through bariatric surgery, and we've trialed it and tested it and initially did not work, but now it's working a little better.

Speaker 1:

So, berrybuddy, try that out. Yes, berrybuddy, chat GPT, yes, and it is nice. I have gone on Facebook groups for bariatric surgery and inputted questions off that Facebook page into there and it comes up with great answers. So, instead of people using those Facebook groups as a quote, unquote doctor, can I have an avocado one month post-op? Everybody's going to have a different answer where this chat GPT will give you a good, solid answer that probably all providers will agree with.

Speaker 2:

Yeah, and we try to make it pretty generalized. But it all comes from guidelines and really good research papers and our own program materials and I spent probably over a hundred hours total training this thing and making sure it worked right and making sure it's not giving people crazy answers. That's not to say it's not perfect or that it is perfect. It is not perfect. However, it's probably a very good general use tool so we can create a, put a link up for that. But if people want to give that a shot, definitely go for it. It is free-ish Technically. It's behind the paywall for chat GPT. I can't change that at the moment.

Speaker 1:

But as soon as I can, I promise you I will. It's worth the $20 in my opinion, but that's just me.

Speaker 2:

Yeah, that's true, and then money does not come to us, it goes directly to OpenAI, so we don't make a single penny from that at the moment.

Speaker 1:

All right Throughout the past three months. I keep coming up with questions that I want to ask you, and I feel like our last question, or Q&A, went really well and it was really informative.

Speaker 2:

Yeah, where do you want to start? And you can Q&A me too.

Speaker 1:

whatever you want, oh yeah.

Speaker 2:

Oh, 100% that's going to happen. So actually let's go Q&A you first. So you've been traveling some for conferences. We've gone to two so far this year and there's more coming up. How do you deal with a change in your routine and stay on track when you're traveling?

Speaker 1:

Do the best I possibly can, I will say that airports do have good, pretty good options. You can almost always find some kind of grilled chicken. Honestly, we found sushi, which was so good. Yeah so good, there's water everywhere, as long as you can afford a $7 bottle of water, but they have the water fountains. So really just being in the mindset of eating healthy, keeping your fluids up, Because if you go sometimes this past time I was flying I flew almost a half a day. It was so bad.

Speaker 1:

It was like eight hours and so if I went that whole eight hours without drinking anything, I would come home and feel like I'm hungover. So really being mindful and being strict with yourself of I need to eat and I need to drink, but that's not to say you need to be perfect. I wasn't perfect, by any means, and I had a bag of combos because, honestly, I needed a carb and I couldn't really find any great carbs right in that moment. So I had some combos. Did I eat the whole bag? No, but what?

Speaker 2:

kind of quantity of combos did you have again?

Speaker 1:

honestly, I would say a cup no, a bag you're done, I'm sorry, I can't.

Speaker 2:

We're both like we both and people from northern iowa or parts of iowa just sound like minnesotans and you're from wisconsin, technically did I say it, did I say beg? Of course you said big.

Speaker 1:

Yes, you said big anyway, so I beg you to continue no, but just making sure that you are eating and just because you may not have the greatest options, to not eat, because that's going to put you in a whole different world of hurt.

Speaker 2:

That's very true. Yeah, that's very true. I love that because you basically said be strict with yourself, but strict where it counts, if that makes sense, because when you're traveling your routine is going to be off anyway. I get super dehydrated when I travel too, because you're just more active.

Speaker 2:

Because you don't drink. I also don't drink water, so, no, you got to drink. But also be permissive with yourself. If what? If all the food around you is not healthy, that doesn't mean you don't eat, or that doesn't mean you don't you don't take some diets and take some things. But yeah, you're right, I've been impressed, actually, over the past year. I feel like a lot of options even in hotels have gotten better. They usually have some options downstairs that you can grab, and even options in coffee shops have gotten better where you can grab like a fruit bar or nuts or something like that. So it really is getting better.

Speaker 1:

But that doesn't mean that you just have to be a saint and not partake when you yeah, especially when you travel, because you have introduced me to so many foods that might not be right in our bariatric book of what I should eat, but I'm going to eat it because I don't have it all the time.

Speaker 2:

Right and you're right, and we don't really talk about how many things you can eat, and honestly, especially from other cultures, because a lot of other cultures have totally different carbs and proteins and fats that they eat and in different combinations, and sometimes it's healthier than the standard American diet. A lot of times it is.

Speaker 1:

So getting creative and thinking outside the box with what you're trying, that's super, that's true, absolutely Okay. So I have a question for you, and I've had it come up when during our program, but I've also actually seen it on their Facebook pages, and it's something that I think we can talk almost more about later. But a little quick how do you do a colonoscopy prep when?

Speaker 2:

you have bariatric surgery, cause you got to drink all that in a short amount of time.

Speaker 1:

They're normal prep. How do?

Speaker 2:

you do that? It's a great question. Actually, I didn't. We didn't have a standard way of teaching patients how to do this, and so we didn't have any materials in our program. So when you brought this up a couple of months ago for our chat GPT for Berry Buddy I actually looked and I surveyed some other surgeons that do this and actually a lot of people basically said no changes, which I don't necessarily agree with that, because I don't think that you can especially if you're doing like a go lightly which is really a go strongly but go lightly prep like two gallons of liquid that you're supposed to do, and even if you're doing in a split fashion, where you're doing like part of it one time, another part of another time, you still probably shouldn't be drinking more than about eight ounces an hour, no matter what, as a bariatric patient.

Speaker 1:

That just sounds painful Exactly.

Speaker 2:

Think of when you were post-op and when you were doing one ounce every 15 minutes. You can probably do more than an ounce every 15 minutes, but I really wouldn't do more than three or four ounces every 15 minutes, because the other thing is all of that. There it's more important to get the liquid in than how fast you get it in. In coming up with a combined, I looked at a lot of resources for this and the consensus seems to be start earlier and do the best you can and do the best you can.

Speaker 2:

Yeah, so over the two days before your colonoscopy is when I would recommend switching to liquids, as opposed to staying on solids for the two days prior and then just being on liquids the day before. So I would do two days of liquids and then start your prep, whatever it may be. Some places do Miralax, gatorade, some places still do Golightly or Suprep or other things. Just space it out over a day as opposed to over 12 hours, and then really take those restrictions of liquids clear liquids especially seriously, because your body's going to have a little bit longer of a time processing things and a little bit longer getting through, and it's wiser for you to start earlier.

Speaker 1:

But this has me thinking of shouldn't there almost be a separate type of prep, because we don't eat as much as most people do, so we don't have as much to get through our systems, right?

Speaker 2:

I wouldn't say that's the case because a lot of why a lot of people actually have slower transit times after surgery. So some people definitely because of the malabsorption, especially if you have a dutial switch or bypass. Sometimes your transit times are faster, but sometimes they're not. So actually constipation is the bigger issue for people after bariatric surgery, oftentimes again because you're still struggling with getting enough fiber and getting enough liquids in. So transit times all in all are about the same as they are before surgery, just for different reasons. So my main takeaway here is please start at least a day earlier than you normally would with your prep. That's going to make sure that your chances of having to do it all over again are less and that everything's cleaned out, which means that you get a real, really good colonoscopy.

Speaker 2:

And I do not recommend Cologuard, which is the test that you do without the colonoscopy instead of the right and like you can. If you really just are completely grossed out by the idea of a colonoscopy or just it's. If the choice is no, no colonoscopy at all or Cologuard, then do Cologuard. But even for my own family I have recommended against Cologuard because it just does not detect as much early stage colon cancer or pre-colon cancer risk by any means as a real colonoscopy does. So I personally am not a huge fan of Cologuard. For that reason, just throwing my two cents in there.

Speaker 1:

Absolutely. Now, what do you think about a pouch? Quote unquote. I am quote unquote, quoting here a pouch reset. I hear this all the time of patients like I'm doing poorly, I'm gaining weight, and people are like, do a pouch reset, go back to liquids and work your way through the purees. Yeah, what are? Your thoughts on that.

Speaker 2:

Yeah, so technically, yeah, technically we actually had a whole panel on this at this SAGES, the conference that we went to over the weekend, and I was actually one of the speakers on how to use your team to combat weight regain after surgery. So this is a topic really near and dear to me. But the idea is there's no such thing as a pouch reset per se. Technically, if you've had a sleeve some people do sleeve resizing surgeries and if you have had a gastric bypass which does have a stomach pouch to it, there is a chance that the pouch was made too big or that the opening between the stomach and the small intestine has become bigger over time. That does happen. We don't have a lot of evidence that sleeves stretch out. So if you started with a big sleeve, if the surgery was done in a way that it left a lot of tissue there, then you're going to have a big sleeve and it's probably not going to work as well as a smaller sleeve. And it's the same thing with a pouch. If the pouch was big to begin with, you're going to not have as much malabsorption and as much metabolic change. So your chances of weight regain down the road are higher and your chances of not really losing the weight or having that much change to your metabolism to begin with are higher too. There are some surgeries that can be done to revise these things. That's typically not the first step, though they're starting to be right.

Speaker 2:

So, again, it's always a good idea to reassess your lifestyle in general. Think that you're overeating. If you think you're overeating certain things, if you think you're not drinking enough, if you're thinking you're not getting enough exercise you probably aren't it's a good idea to take a look at the things that you can address and fix in your lifestyle. I will always say it's a good idea to also think about your mental health and make sure that you're not overstressed, that you're in a good place, whether that means engaging with family, friends or a professional or all of the above. Those are good things to do. Same thing with a dietician. It's oftentimes helpful to have a third party take a look at things, and not just your friends and family or yourself when it comes to reality as to what we're eating myself included sometimes. So that's a good idea. Chatting with your bariatric program is a good idea if you're having issues with weight regain, especially Some weight regain is insignificant and it does mean something and some doesn't.

Speaker 2:

So, we don't really treat all of it the same way and it's not like it's a straight shoot to surgery for anyone, so that's a meandering answer, but that's because it's a meandering issue.

Speaker 1:

Now you said reevaluate what you're eating. So this kind of has a question for me how come I can only eat six ounces of chicken breast? But I could, if I wanted to and if I really felt like it, I could almost eat a whole, half a pizza. I even told you the other day when we were eating sushi I'm like wow, that little amount of seaweed and California roll or whatever we ate, filled me up so much and it was such a little amount of food. But I technically, if I really wanted to, could eat a whole lot more in size of pizza.

Speaker 2:

Oh, yeah, absolutely so. There was actually one of the speakers also at this conference, when we were talking about weight regain, put up a couple of charts that showed all of the different hormones and all of the different molecules that are interacting in the body between the stomach and the intestine and the brain and other body parts, and there's like hundreds of them. So I absolutely will not try to recreate this complex drawing for anyone on a podcast. That would be pretty ridiculous. But the idea is that different kinds of foods are processed differently by our bodies, even by the stomach as they hit the stomach, even how our hunger and how our desire for food, our satiety when we feel full, is affected by the food we eat and if there's protein in it, if there's fiber in it, typically, or even fat. Actually, fat also typically triggers the feeling of fullness faster than carbohydrates do.

Speaker 2:

And there's certain kinds of carbohydrates that trigger faster than others, which is why liquid calories typically, you don't really feel full from liquid calories, but you do feel full from solid food, yeah, and so some of its physical, some of its truly okay chicken kind of stays put more than like soda or juice or something, or a protein drink even, but if you actually have certain proteins, and it's specifically some proteins more than others, and some kinds of fats more than others, and insoluble fiber more than soluble fiber, anyway, so we can get into very specific things in another episode, which you probably should, but it absolutely does matter what you're eating, because you will feel fuller faster if you're eating things that have protein and have fiber in them. That does not mean, however, you should just be eating like chopped chicken or something for the rest of your life, and that being the only thing, but that is one reason why, when we talk about eating snacks and food in general, it's a good idea to eat combinations of food rather than just one thing at a time.

Speaker 1:

What if I came into your office and I said I don't want to know what I weigh?

Speaker 1:

Yeah, I tell you all the time that I'm honestly really not on the scale a whole lot because and actually one of your panels was talking about this and actually debating this BMI target we should be at and one of them was like I don't care about a BMI target If my patient is a BMI of 38, let's say 40, it feels fantastic. I'm not going to choose that BMI. What if I came into your office and, maria, I don't want to know what I weigh?

Speaker 2:

Yeah, absolutely. We've actually had that First of all. We've had that scenario. So I can tell you 100% what I have done is said okay, no problem, because I agree.

Speaker 2:

I think we have this obsession with BMI and weight in this industry because it's the one thing we can measure easily and it's a vital technically, it's a vital sign and, technically, like we can measure it even at home with your weight, with your scale and stuff, so pretty easy to measure. That doesn't mean, it means anything and I think that's exactly what it was. Actually Dr Teresa Lemasters, who's the recent president of ASMBS, one of our big organizations and also just an incredible powerhouse here in Iowa, in Des Moines, who was specifically talking about how, while BMI is an easy indicator and it's something that we cling on to, it's not that useful and probably in the next 10 years or so, there's even now a really big push to move away from BMI and talk much more about function, talk much more about what are our goals, what are our metabolic issues that are going on here. Does this patient have diabetes? Did their diabetes come back? How bad is their diabetes? What about their blood pressure? What about other issues like fertility? So I agree 100% that weight here.

Speaker 2:

We oftentimes, and the problem is is, because it is a number and because it is a, like, an easy thing to measure, we not just providers, not just surgeons and coordinators and stuff get get hung up on this sometimes, but it's used to punish people. I think sometimes to in the sense that with you, yeah, and I think when we're talking again, like morality just doesn't have any role in this field, or really any healthcare field. I think so when we're trying to provide people care that supports their goals and makes people healthier, we should be finding ways to enable that, not to make people feel bad about it, and especially like you as a provider, especially after surgery, especially after that like one three month follow up.

Speaker 1:

You only see six months and then you see a year. Look, you don't know if, okay, I was 175 the last time but now I'm 190. But that might look different. I might be way more in fit than now because muscle does weigh more than fat. So how would you handle? Because, as a provider, documenting, I think you do need a weight. And I think as a. To be able to help your patient, you do need a weight. How would you just ask them nicely to get on the scale but turn around or like how?

Speaker 2:

No, it depends. It depends if actually we do need that weight. So different insurance policies need different things before surgery, After surgery. I don't really know of any insurance policy that requires weight measurement because nothing really depends on that, so I don't. The only consideration there is what is required by insurance.

Speaker 2:

And again, we use BMI and we use weight because it's easy to bill for, it's easy to submit, requesting a prior authorization or a billing code or something like that. Not because it's necessarily the best measure of health. Definitely it's not. And it's not the best measure of success or goal achieving or anything like that. And I know personally I fluctuate about 20, 30 pounds in my life as an adult, and sometimes at my higher weight is when I'm the most fit and at my lower weights is when I'm the least fit. And that extends massively to everyone else on the planet too and some of the some Olympic level athletes. Actually there are quite a few Olympic level athletes whose BMIs are over 35.

Speaker 2:

So while they would qualify for bariatric surgery, that would absolutely not be the appropriate choice for them, Nor would any medical intervention be appropriate for their weight if they're achieving so much functionally. Yeah, I'm glad that there's a reassessment of BMI and weight. I don't think that's going to happen overnight, so it depends on what it's needed for. If it's really needed documentation and we need to use it to get to surgery, then that's a discussion, a one-on-one discussion with a person and to say, hey, we need this for documentation and how important is it for you to get to surgery? Because we have to have it for getting there. But if it's not required and the person doesn't want to do it and it's not making a difference to their function, then I agree.

Speaker 1:

Yeah, absolutely. So we talked about this one time because we went and saw one of our patients that just had a bypass and I'm like she looks like nothing even happened to her and I'm like I was over there dying. And you actually said bypasses are easier to heal from than speeds.

Speaker 2:

Yeah, okay. So this is, I would say, immediate post-op. It's not necessarily long-term, yeah, and it still depends on how you do it. But the thing is, when you're making a sleeve, what you're doing is you're turning a big reservoir, think a dam, like before that wow, I'm really not an engineer, am I?

Speaker 2:

You're turning a lake, let's say, into a stream, and so the effect of that is immediately once you start drinking and eating afterwards you really feel the difference because you still have a muscle right after your stomach called the pylorus, that prevents things from emptying or dumping into the small intestine and moving on.

Speaker 2:

That is not there anymore after a bypass. That pylorus is bypassed part of the deep, the area that's not part of the what's seeing food or drink anymore. So immediately afterwards you actually don't feel that kind of resistance and that kind of fullness and bloating that a lot of people do feel after a sleeve. That's not to say that nobody feels that after a bypass, right, certainly some people do, for the the most part, but fewer, and it's somewhat anecdotal, but actually there is some literature on this too, that it's actually easier to discharge patients the day of surgery after a bypass, from a symptom standpoint, or the next day after a surgery that's a bypass than it is after a sleeve, because about something like 80% of people who have a sleeve still will have some nausea into post-op day one whereas the bypass is less than half.

Speaker 2:

So there's a big difference. Yeah, based on that feeling of oh, we've gone from a big space to a little space that still has some back pressure, versus in a bypass, you're going from a big space to a little space, but you don't have the back pressure anymore, because things are immediately emptying from the stomach into the small intestine.

Speaker 1:

That makes sense. Now, if you were, if you struggled with weight or if someone very close to you struggled with weight, being a bariatric surgeon, would you have bariatric surgery or would you recommend it to your family?

Speaker 2:

Oh heck, yes, yeah, and I maybe have drunk this Kool-Aid, but I've now seen so much data on this and I have seen so much of the patients and so many of the people practicing this. We do not use bariatric surgery as a tool early enough or as much as we should, and I know that there's a dip right now happening because of Ozempic and all the other GLP-1 media and stuff, in terms of how we use bariatric surgery, because people are like, oh, I can just lose weight with a pill and not have surgery. We are not the same, and I wish they were, because that'd be cool, that'd be fun For sure. If you could do this with a pill, that would be amazing. But we can't, and that's the kicker is that you have to take pills forever.

Speaker 2:

Pills have side effects more than surgery and they're expensive and they're not covered by a lot of insurance at the moment. So if you want to be beholden to those things for the rest of your life with a medication, that's an option, and for some people who can't qualify for surgery or surgery is not safe or whatever, that is an option, but for the majority of people who have extra weight and it's really difficult for them to get it off, especially if they have issues like diabetes or high blood pressure or infertility, or their sexual function is impacted or other problems like arthritis. Surgery should be considered sooner, and if it were me, I would In fact, when you're talking about family members, I'm not really at liberty to say, but that is a consideration, and I have sent some of my closest friends and people I respect the most in my life for bariatric evaluations.

Speaker 1:

Yeah, and I ask that because usually when you are at the heart of things like that, what can go wrong, what the complications or like long-term whatever effects? Just like a respiratory therapist, I feel like a lot of us are like do not intubate me, because I know what that looks like.

Speaker 1:

So I just wanted to ask that I knew what your answer would be, or I thought I knew, but I just wanted to put that out there, because there are a lot of people out there that think, oh, you just do this and you recommend this because that's your job, that's your career and you make money off of it. So that's why I asked that.

Speaker 2:

Yeah, and to be honest with you, there's a lot of ways to make money as a surgeon.

Speaker 2:

There's a lot of subspecialties, there's a lot of things, and if you don't like this one you can go to another one, and I am like trained in other ones as well that I think are really cool. But this one, I think, is the one that makes such a big impact. And the thing is, I think people think latch on sometimes to oh, it's surgery, it's extreme, it has risks, you could be hurt not doing something about it, and a lot of people's cases can hurt. I have seen a lot of people lose toes to diabetes or lose function, lose the ability to feel comfortable, walking through problems or not be able to bear a child, or have really crappy sex lives or just not like how they look and not feel comfortable to interact with the world the way they want to. I think those things are way more devastating than the less than 1% of people who have any kind of surgical complication. So for me it is a total no-brainer. If this is an issue for me or a family member, it is getting a surgery evaluation.

Speaker 1:

And I'm watching the time here. So just like salute to me when you like are done. This one, I know, can go down a rabbit hole, so I want you to give the least amount of time. Oh sure, is obesity 100% preventable if you do all things and you are all eating a thousand calories or whatever? Um, exercising 30 minutes, 60 minutes a day, doing all the things right, taking all your vitamins, doing all the right things, is it a hundred percent preventable?

Speaker 2:

No, no. And let me explain why. So it's preventable, in the same way that, like, aging is preventable or pregnancy, I guess pregnancy is preventable, but having a pregnancy and not having any impact on your body is completely impossible. Yeah, so no it. Pregnancy is preventable, but having a pregnancy and not having any impact on your body is completely impossible. Yeah, so no, it is not preventable.

Speaker 2:

First of all, there definitely are factors of this that run in families.

Speaker 2:

There are hereditary things that basically travel from a person in their family line to them, in their genes and above the gene level too.

Speaker 2:

It's also humongously part of our society If we were to change all of the infrastructure of our society, like how we eat and how we get that food and what that food costs, and our work lives and our school lives and overall, just like education and access. We're completely different in our society than maybe fewer people, but definitely not everybody. And then there's other things that we don't even think about sometimes, which is like prior attempts to lose weight. So people who are at healthy weight and then diet, that wrecks your metabolism long term for pretty much everybody that does it. So even if you were at a healthy weight but you try to lose weight, to become skinnier at some point, or to lose weight for an event or something like that can have a lasting impact on you and make it a lot harder for you to either stay at a healthy weight or lose to a healthy weight in the future, and the more times you do it, the more damaging it is.

Speaker 1:

So that's what Dr Jessica Smith said is that how many diets are women on by the time they're 30?

Speaker 1:

Chances are it's probably a dozen, where men they're like I maybe stopped eating bread for a week or something and I feel like in my head that's why it's easier for men to lose weight, because they haven't done all of those diets usually and haven't wrecked those metabolisms like us women have. It's just, I feel like I started dieting when I was before my even teen years and at that age most men aren't even thinking about their weight. They're barely thinking about yeah.

Speaker 2:

About that. I will say one. There is a whole nother topic, I think, with men and weight and men's bariatrics, because I actually do think there's a lot of disordered eating in men that we don't call it that and dieting my husband eats once a day, usually Exactly, and maybe that's by work, because of work or other reasons.

Speaker 2:

But there's actually quite a bit of disordered eating in men too, and we definitely do need to talk about that. And men do also have body standards that are unrealistic that they're held to. But here's the thing I think for men at least, those body standards are not.

Speaker 2:

You have to be the skinniest you can possibly be and a stick in order to be attractive, or just some unreasonable like stick plus boobs that we expect people to be, which is, again, like, essentially nobody is that without surgery, essentially, unless you're extremely lucky in some genetic lottery, which fewer than 1% of people are. And then what was it? Where was it going with this? Yes, so the society standards of especially women having to be the skinniest they can possibly be. There's actually a lot of data that shows that women are at their most fertile, at their most healthy, at their best bone density, all kinds of things at a BMI of 25 to 30. So, and that's from a young age on, through, especially, menopause and after menopause. So if we could convince women that the healthiest weight, which is, you know, a BMI of 25 to 30, is also the weight at which they're the most beautiful, or they're the most, they're going to be the best perceived by society, or they're going to be the most loved, or they're going to be the best perceived by society, or they're going to be the most loved, or they're going to be the most respected, or they're going to be on billboards or whatever it is, then maybe we would prevent more people from dieting, and especially dieting over and over again to avoid getting out of that BMI of 25 to 30.

Speaker 2:

Because I do think a lot of women do diet at a lower BMI than men do or try to lose weight. You see what I'm saying. It's like men do it too, but they might do it at a slightly different range, and, for women, we're doing damage to our bodies when we're in a healthy weight range. That's the real kicker and, believe me, like I have had, like I have binge eating disorder, I have struggled, as myself, I'm at a BMI that is considered healthy, but in my life I have probably been on a diet more than I haven't been, and so it's 100% something that I relate to and I really wish that we were better at talking about and better at supporting women and indicating to women that you are healthy and beautiful as a result of that healthiness and what your body can do.

Speaker 1:

That's why I love you. You always hype me up so much. I'm always like, and you're like, you're beautiful, you're a babe, and I'm like you are a babe.

Speaker 2:

Oh my God, I saw your TikTok today. I was like dang girl, you're looking great, looking very fine.

Speaker 1:

Don't fight me about bariatric surgery being the easy way out.

Speaker 2:

All right.

Speaker 1:

Before we go, do you have anything else to add? Or question, or?

Speaker 2:

Yeah, Again you're busy. No, but I do want to ask you so in feeling, do you feel that pressure now about your body size or about your weight, and how do you deal with it if it does come up?

Speaker 1:

I think my body size right now so I'm about 5'5 and 190 pounds, I'm not afraid to whatever it's and there's a lot of loose skin, unfortunately. I think where I'm at right now is perfect for me. I think it honestly is perfect for a lot of women, Like that's usually. This is probably about I was probably 20 pounds less in high school, but this is about where I was at high school. Now it just doesn't look as perky and stuff. So I feel like I am not Join the club, Tammy. I'm not ashamed of my size or anything. I'm more ashamed of how I carry it now and that is just my own mental barrier that I'm really trying to figure out how to battle, because I guess I don't even have that much loose skin. I don't have.

Speaker 1:

I still have decent size breasts, but they just but this is just me, this is not. This is me wanting to look at myself in the mirror and being like, yes, girl, I would tell anybody else. Yeah, you always tell me. Would you say that to anybody else?

Speaker 2:

No, that's why I'm like Tammy you are very beautiful, you're really hot, you're also just really like warm and engaging, and I do think that part of our society being so superficial about our looks that is especially damaging to women is that we cannot be accepted for being having an internal beauty and internal ability, engagement with the world that goes beyond our looks and I really think that has impact on our health. That has impact on our not just mental health but our physical health a lot.

Speaker 1:

It takes up mind way too much. So that is something I'm working on of. So I do feel good about where I'm at. People could probably say I'm skinnier or could be skinnier, but I am so happy where I'm at, I'm comfortable, I can outrun my children. I do struggle looking at myself in the mirror, but that's probably what has been drilled into my head growing up is skinny, big boobs, perky boobs, big butt.

Speaker 2:

Yep, well, meh, yep, yeah. On that lovely note, we obviously have some mental health and other things to talk about in future episodes, but I'm really grateful to talk with you today and it was wonderful to see you in Cleveland. We should do more of that.

Speaker 1:

Yes, absolutely All right, I'll see you next time. Thanks everybody. Big hug, my love. Goodbye, all right, we'll see you next time. Thanks everybody.