Obesity Care in Men: Sustainable Strategies Beyond “Eat Less, Move More”

In this Nutrition411 podcast episode, host Lisa Jones, MA, RDN, LDN, FAND, leads a clinician-focused discussion on how dietitians and other health care professionals can improve obesity care for men by moving beyond common misconceptions and toward individualized, sustainable treatment strategies. Guests Wayne T. Ho, MD, and Vance L. Albaugh, MD, discuss why obesity should be approached as a chronic, relapsing disease; how metabolic adaptation, weight bias, and unrealistic expectations can affect patient outcomes; and why success should be measured by more than the number on the scale. The conversation also highlights practical counseling strategies, including SMART goals, nutrition quality, self-monitoring, accountability, and attention to nutritional status in patients using GLP-1–based therapies.

Transcript

Lisa Jones, MA, RDN, LDN, FAND: Hello, and welcome to Nutrition411, the podcast where we communicate the information that you need to know now about the science, psychology, and strategies behind the practice of dietetics.

In recognition of Men's Health Month, today's episode focuses on obesity in men, specifically, what we're getting wrong, and what works when it comes to nutrition care and long-term outcomes. Because despite everything we know, outdated advice still shows up in clinical practice. and it's not serving our patients. So today, we're separating fact from fiction and bringing you practical, evidence-based strategies you can use right away. Joining us today are two experts in obesity medicine and metabolic health.

First, I want to introduce Dr. Wayne Ho, who is an internal medicine and obesity specialist, clinical investigator in diabetes and obesity, and professor at the Keck School of Medicine. His work focuses on improving access to high-quality obesity care and advancing public health approaches to treatment.

And my second guest will be Dr. Vance Albaugh, who is a spokesperson for the Obesity Society and a board-certified expert in obesity medicine and metabolic and bariatric surgery with focus on advancing evidence-based care for patients with obesity. Thank you both for being here. I'm so excited to jump right in.

And I kind of want to start because a lot of times we hear so many things about myths, right? And I'm sure you're combating myths and misinformation on a daily basis with what you're doing. But the first one, and one of the biggest ones I see so much is myth number one is just eat less, move more. I mean, how often are we seeing that? It's one of the most persistent messages that we hear. And frankly, conditions still use it. is that weight management comes down to this, eat less and move more. So, Dr. Ho, I'll start with you. Why does this message continue to stick? And what does it miss from a clinical standpoint?

Wayne T. Ho, MD: I think it still comes from the lack of understanding that obesity is a truly chronic relapsing disease with multiple factors. And I think what's so frustrating for me is when we as clinicians say things like that, We are assuming patients aren't already doing that. And patients are put on the defensive and will say, you know, I know you don't believe me, but I do eat right. I walk several miles a day. I get in 25,000 steps a day. And they already feel like you are judging them. And it's weight bias. And it's something that we all must keep in check.

Lisa Jones: Yeah, so true, weight bias. I agree with that. And how about you, Dr. Albaugh

Vance L. Albaugh, MD: Yeah, I mean, I think that message, it makes sense. I mean, from a fundamental, I mean, what most people think controls their weight is how much food they're putting in and how much physical and conscious energy expenditure that they're putting out. And there's this idea, and it's just basically, I think, an oversimplification, but it makes sense. And like many other things that seem to make a lot of sense, it seems to hang around for a long, it has hung around for a long period of time. And even within the medical field, I think there are a lot of, physicians that may not really appreciate the complexity of obesity because they trained decades ago when most people said, yeah, just eat less and exercise more and you'll be fine. But I think in the real world, we understand now, especially over the last 10 to 20 years, like Wayne said, I mean, obesity is a complex kind of neurohormonal disease, and the body is fighting that. And so it's not just eat less, exercise more. It's a heck of a lot more complicated than that. And most people don't realize that.

Lisa Jones: Yeah, they don't. I mean, and you're so right. Like, it's every day. Like, oh, what do I need to do? I just need to eat less and exercise more. It's like, no, there's so much more than that. So let's talk a little bit about what do you think are some key biological or metabolic factors that this oversimplification of it ignores? Vance, I'll let you go.

Dr Albaugh: I was going to say, Wade, go ahead. But I think, you know, Lisa, I think one of the things that really most people don't appreciate. some of the normal things that happen when you start to lose weight. And actually that those things happen very, very early on. So, you know, there was a lot of really good scientific studies, you know, that date decades now that, you know, once people start to lose a few pounds, you know, even within that first few pounds of weight loss, the body makes adjustments in energy expenditure and how much food people are kind of subconsciously going to eat, even if they don't feel like they're eating more. And so I think, you know, that's one of the biggest things is that and as you lose more weight, the body compensates more. And there are different hormonal changes within the body that, you know, people are completely oblivious about. But it's on a way on one level, it's almost like a subconscious, you know, the body is trying to prevent any more weight loss because it doesn't want you to waste away. But on the flip side, you know, people generally trying to lose weight are trying to lose weight because they're trying to be healthier. So it's really this push and pull, you know, consciously and unconsciously, you know, fighting your own body, fighting essentially Mother Nature. And, you know, usually when you're fighting Mother Nature, Mother Nature wins. So, yeah, so I think that's one of the big things that people don't really appreciate. And those things happen even within the first four or five, six pounds of weight loss. And so if you take somebody in my clinic very frequently, I'm looking at, you know, I see patients, they may be 30, 40, 50, 100 pounds overweight. And so when we're talking about, you know, getting a significant amount of weight down, I mean, you're talking about a significant biological force that's trying to prevent you from doing that.

Lisa Jones: Yes. I mean, that must be really tough for a lot of the patients. And we'll talk about that. But I want to let Dr. Ho weigh in first.

Dr Ho: Yeah, I just wanted to add on to what Vince just clearly. stated was that there's a metabolic adaptation that happens when you lose weight. And unfortunately, it is biologic. And patients take it the wrong way. Other people judge them the wrong way. They say, oh, you were doing so great. And then what happened? Oh, I fell off the wagon. Or you just stopped trying. And people get very frustrated. And I think this concept of metabolic adaptation and a fat mass set point where at some point in your life, and we are still learning so much about obesity, we know that at some point your body resets how much fat it wants on its body and is so protective of it. And any type of weight loss is perceived as starvation. So exactly what Vince was saying was it's... these hormones are meant to preserve that fat mass. And, again, I think we all just need to have a better understanding of what obesity truly is and that in order to treat obesity is much more than move more, eat less.

Lisa Jones: Yes. So true. And the other thing, too, as you were both talking about that is seeing a lot of patients as a dietician. One of the things we hear a lot is, oh, I've only lost a pound this week. And people are beating themselves up about only a pound, although that's good. But they can't, like, they're like, well, why wasn't it more? Like, that's a lot of, like, in addition to the eat less, move more, I hear I've only lost one pound a week. And they're upset about that when they should be congratulating themselves. So with that in mind, I do want to ask from both your perspectives, especially... You, Dr. Albaugh, working in obesity medicine and surgery, how does this mindset approach impact patient care and outcomes?

Dr Albaugh: Yeah, I think most people, you know, the patients that I see in clinic, many of them, like you said, they get very frustrated because they, you know, we want something that's going to happen, right? okay, I need to lose 10 pounds and I'm going to lose it by, you know, two weeks from now. That's just not, you know, that just doesn't happen in general. And so I think the expectations that patients have or the people have when they're thinking about their own weight loss, you know, if, and again, if your body's fighting you, you know, you're fighting the body and the things that you can't really under, they're kind of oblivious to you. But I mean, you know, realizing that, you know, even the most strict diets and the most vigorous exercise programs. you know, there may only be five pounds at a max in terms of weight loss. I mean, and that's, you know, that may be the high end of what really aggressive diet and lifestyle can do for you. And then if you reset, you know, and think about if somebody's already 100 pounds overweight, I mean, that's, you know, you're just making that even more difficult to kind of lose. So I think expectations for folks is very, when I see patients in clinic, I'll kind of help them kind of recalibrate and say, okay, Do you know how much how much extra weight you're carrying roughly? And we use BMI. It's not a great body mass index. It's not a great marker of it doesn't give you muscle mass. It's kind of a very generic number, but it gives you a kind of a reasonable set or starting point to have that discussion. And so I frequently do that. And I help I think people kind of I think they. kind of realize that, yeah, I wanted to lose 10 pounds, but maybe I'm really 30 or 40 pounds overweight. And I'm basing that on the other people in my community or my family. And maybe we're all, I think in general across the country, everybody's probably a little bit heavier than they realize. And I think kind of resetting those expectations is very, very important.

Lisa Jones: Wayne, what do you think? Do you see that in your practice as well?

Dr Albaugh: Not at all. Okay. I mean, you make such a great point, which is having that discussion really upfront about what are your expectations in terms of weight management and understanding if that's realistic from our standpoint, from a clinician standpoint, or whether or not it's completely reasonable. For example, I had this patient come in and I asked the same question, what are your expectations for weight loss? And she said, you know, All I want to do is be able to get on a plane and not ask for a seatbelt extender. And for me, that is very, very meaningful. Very meaningful, as opposed to saying, I want to lose 50 pounds and get into a size 2 dress before the end of the year for someone's wedding. I think that I try to shift that mentality to, listen, we have, this is not a race. This is a marathon, and this is a marathon you will never finish. because it is a lifelong effort. And to understand that and also give them our perspective, which is, my goal is to improve your health. Whatever number that is, it doesn't matter as much to me. I know it's completely valid to you, and it should be. We are all human. We all want to look a certain way. And to validate that, I think it's really important. But to understand that as a clinician, I am worried about your health. I am trying to improve your health. And that is my goal for you.

Lisa Jones: Yes. I love what you said, which it's, this is a marathon you will never finish. That is, I need to write that down and put it behind me. That puts it into perspective. That's a great way to say it. I've never heard that before. So thank you for bringing that to us. But it does sound like we're dealing with much more complex chronic disease process. It's not just a simple equation. I think that sums it up nicely. And it's also not about willpower, right? It's about understanding physiology and our environment and long-term management. So thank you for breaking down myth one. Let's move to myth number two, which is if you eat high protein, you're good. So another move to another common belief that's especially popular right now with what they just did with the dietary guidelines, right? There's such a strong focus on protein, particularly among our male patients. Where do you see this? How does this protein fit into effective obesity treatment, and where do you see it being overemphasized? So, Vance, Wayne, who wants to?

Dr Ho: All right. I'll start off with saying I fully admit I am a Costco lover. I go to Costco all the time, and I am shocked at what now has protein. Everything has protein. I feel like my toothpaste has protein at this point. It's incredible the amount of emphasis we have on it. And a funny story, I had a patient tell me, we were talking about nutrition, and they said, oh, we don't need to talk about this. My trainer has told me all about how much protein I need. Oh, how much is that? Oh, it's two grams of protein per pound per day. Oh, that's close. It may be not that high, and it should be in kilograms, not in pounds, which makes a huge difference. I think there are so many myths out there. We haven't touched on medications and GLP-1s, but I think even particularly in this age of GLP-1s where people are tending to eat less when they're on these medications, getting the correct amount of protein is super important. I think there's just an emphasis of protein everywhere and not understanding what is our target goal based off of your activity, based off of your condition.

Lisa Jones: Oh, wow. Well, yeah, so you're right there on the spot. You're probably seeing that a lot of times more. Or even I've heard my... my family member looked it up online and they calculated how much protein I should have. And I was like, okay, let me, and then I would double check it and it was same, same situation. So that was such a great example. And how about, how about you, Dr. Albaugh?

Dr Albaugh: Yeah, Lisa, I think that, you know, I agree with what Wayne's saying, but the, I think most people, you know, if you back up 10 or 20 years, you know, was low fat solves everything, right? And then before that, it was low carb solves everything. So it's like we have this like cyclical or cyclical kind of, you know, where we think if we just focus on one macronutrient, fat, protein or carbs, we're going to fix everything. I agree. Protein seems like it's in everything right now. But I think one of the things that people don't realize, I think they get very fixated on, I need a certain amount of protein, but then. There's not like protein that you're eating in isolation of everything else in terms of macronutrients, right? So it's like, what else is in that protein? And in general, I think what people, if they don't realize it, if they start thinking about that, a lot of times if you're eating a high protein, sometimes there's a lot of fat and cholesterol that accompanies that, depending on the source of the protein. That's not always the case. But I think being aware of the other macronutrients and kind of thinking about everything, you know, not focusing on one nutrient, because I think, you know, you could do that. And it has been done historically. And we continue to have kind of weight issues over the last 40, 50 years in this country. So it's not like if we focus on one macronutrient, it's going to fix everything. But again, it's nothing is an isolation. And so, again, it's a bit more complex than it sounds. which is a recurring theme kind of in the obesity world scientifically and clinically.

Lisa Jones: I know. And thank you for making me think about snack wells again. Like I totally forgot they existed and you brought them back. So what do you think we are missing when we focus too narrowly on protein? You kind of already touched on that already. after all the...

Dr Albaugh: I think it's diet. I think the more important thing, I'm curious to hear Wayne's thoughts on this too, but I think, just from talking to a lot of people, I think it's the diet quality. And specifically things like processed food versus unprocessed food. Not that I want to make it all about staying away from processed foods, but I think there are, when people get fixated on a particular macronutrient, it doesn't really matter. about anything else you know and and the i think the diet quality isn't necessarily great so you know there's a lot of data on fresh fruits and vegetables and fiber and things like that and there are different sources of all those things but there's a lot of good science that that shows us that a low processed type diet with a lot of like fresh fruits and vegetable fresh fruits and vegetables not processed or canned probably is better for us in the long run Wayne, what do you think about that? I think diet quality is a big thing that gets really overlooked. What do you think?

Dr Ho: I completely agree with you. It's frustrating when we talk about a well-balanced diet, right? What does that mean? It's sort of a, it's such a vague term, but I think it's part of the conversation now, as you said, Vance, is quality of food. not only quality of food, but diversity of food. I think those are the two things that we really need to emphasize. And it's really difficult for me sometimes to explain what is processed food, ultra processed food. And someone gave me a great tip of saying, if it looks like what it was when it was alive. then that's probably a whole food. If it's changed a little bit, then maybe it's slightly processed. But if it looks nothing like that out in the wild, like a hamburger out in the wild, you don't see that. So that's probably ultra processed food. So I think understanding quality of food and then that diversity of food is really key. Some people say, well, tell me exactly what to eat. I will eat... I will boil broccoli and boil chicken and eat it every day. Like, that's great. One, you're going to get bored out of your mind. And you're missing so many other nutrients that are important. And so giving people that, just that ability to say, you know what? I don't have to eat that all the time. I know salad and boiled chicken's healthy. But maybe I can mix it in with the whole grain or eat something different. And so giving people that leeway because these fad diets tend to isolate certain foods. And I think that does us a disservice.

Lisa Jones: Yeah, definitely. That's so true. And you talked a little bit about in that answer that you just gave in guiding patients towards like a more balanced, sustainable approach to nutrition. Any other comments that you want to add to that, Dr. Albaugh?

Dr Albaugh: I was just saying, I like the way you explain it, Wayne, about if it looks like what it looked like in real life, you know, when it was alive. I had that discussion with my mother-in-law. Mary is her name. And we were talking about ultra processed food. And I said, Mary, if you picture what's in the grocery store and then, you know, you leave for six months and everything sits on the shelves and you come back six months later, if you could still eat it, it's probably pretty processed. So as we're sitting there, you know, you know, having drinks and eating our, I'll say, unnamed brand of snack crackers that are clearly very processed. But, you know, it's so I think it's, you know, people are kind of oblivious to that. But you've got to kind of think about these things in terms of, you know, yeah, quality diet processing, things like that. It's very important. Yeah. Yeah.

Lisa Jones: Yeah, for sure. And I think that the whole nutrition quality piece, the energy balance and the sustainability really do all matter. Because protein is just one piece, as you were saying, of a much bigger picture. So thank you for that and for throwing out myth number two for us. So let's move on to myth number three, right? And myth number three is weight loss alone equals health. Another major misconception here, and that is the number on the scale is the ultimate measure of success. And I want to start with Dr. Ho here for this one, is when you're working with patients, what outcomes matter beyond weight loss?

Dr Ho: That's a great question. For me, it is assessing nutritional status, functional capacity, as well as body composition. I'm diverging slightly. I live in Hollywood, so I have to talk about the Oscars. And just watching the Oscars and... at certain actors and looking at the degree of weight loss that I see, that is an extreme example of what is not healthy, weight loss, because people look malnourished. I'll give you another example of a patient who was referred to me by a dermatologist who started a patient on a medication, a weight loss medication. in order to help with their autoimmune disease, which is completely legitimate. And this person looked great. It's someone I had seen before, but she felt fantastic. But when I actually did an assessment of her caloric intake and her macronutrient intake, it was not enough. Although physically she looked quite healthy, she was weaker than she was before and definitely nutritionally deficient. So I think that that all comes into play. It's just not the number on the scale.

Lisa Jones: Yes. Yeah, so true. And that I think just the Hollywood aspect that you bring up can be so misleading to, I guess I'll use the word regular people that aren't in Hollywood, that aren't stars. And they think, oh, I should look like that. And then you're looking up to like, why don't I look like that? How can I look like that? So you make a really good point there with, okay, it's not healthy, they're malnourished. Thank you for bringing attention to that. And how about you, Dr. Albaugh?

Dr Albaugh: Yeah, I agree with Wayne's comments. I mean, you know, we have this idea that somehow thin is equal to healthy. And, you know, clinically we see a lot of really thin people who are very, very unhealthy. I think when people get fixated on the scale and the number that's on the scale, it doesn't really matter about anything else. And so people will have, you know, they may be losing some fat mass, but they're also losing their lean muscle mass, which contributes to metabolic health. And so, you know, we really need to be thinking about kind of some of the other things, like Wayne had mentioned, a patient not needing a seatbelt extender on the plane. That's a great indicator of moving in the right direction, playing with your kids, being active, you know, cardiovascular fitness. You know, we have all these wearable devices now that can really help you track and monitor those types of things over time. And, you know, following up with your primary care doctor and looking at all the other things that we look at, you know, besides the scale, things like cholesterol and, you know, different lab markers, insulin resistance, things like that. I mean, those are all probably a heck of a lot better than just that static number on the scale that you're trying to budge that could be affected by some things that are not really great. And even though that number is going down, may not necessarily be associated with improved health. It might actually be sicker, so to speak.

Lisa Jones: Yeah, you mentioned so much. That's really helpful for us, for the listeners, too. So how do you define success in obesity treatment, especially in the long term?

Dr Albaugh: I think it's a lot of those kind of those wins, you know, when patients, you know, come in to see their doctor, to see me or Dr. Ho, and, you know, and they're saying, you know, I want to. i want to do more with my kids i want to be active i want to be able to walk you know three miles. I mean, that's the, that is the success. And I think getting the weight down is an important part of reaching that. And then allowing someone to be, to have a more active lifestyle, to have a better quality of life. I think that's really where the focus should be. I think we need to get it away from the scale, but that, that to me, I think is success.

Lisa Jones: Yes. So function, quality of life, composition, metabolic markers, we talked about just, just sustainability in general, right? For long-term health. And then Dr. Ho, any other comments about that?

Dr Ho: Yeah, Van said that really well. I think really it's, for me, it's about the intention, the motivation, and the sustained attention to health and the desire to continue to improve, whatever that means. And again, like I had mentioned before, this will never end. This is an effort that must be put out for the rest of your life. And my job is to help assist you keep that intentional, sustained desire or motivation to improve your health. And that can look different for everybody. For some people, it's walking up one flight of stairs. For others, it's being able to complete the marathon they always wanted to complete. So I think the goals are so different. But when I see people... that light bulb lights up and says, I want to do more. And I want to do it for myself. That's when I know there's been success.

Lisa Jones: Yes. Yeah, that's really impactful too. That's a fantastic way to put it. And just to be clear, you're not talking about the weight loss marathon. You're talking about their own like running marathon. Okay. All right. So I think really the takeaway here for that myth is the scale is one data point. not the full picture. So again, thank you for breaking all three of those myths. And let's dive a little bit into what actually works. Like what are the clinical strategies? Let's shift from what we're getting wrong to what actually works in practice. So what would you say is one approach that consistently works when counseling male patients? And we'll start with you, Dr. Ho.

Dr Ho: I am a coach, so I am a little bit biased. I do a lot of SMART goals with SMART being an acronym for specific, measurable, attainable, relevant, and time-bound. I use them a lot. And I always tell patients, and after we create one together, I always tell them, listen, if I come back and see you and you haven't met your goal, we didn't create the right goal for you. So it's not a failure. It just means that we did not create something. that was correct for you at this time. And so everyone wants to feel successful. No one wants to feel like they're continuing to fail or they have had success and now you're telling them, oh, you didn't meet your goal. So I think coaching people through creating their own sustainable goals and then really keeping people accountable. Say, hey, listen, that... We're almost there, but let's see what we can tweak. Again, it's all about sustained, continued motivation to improve your health.

Lisa Jones: Yes. Yes. Yeah, that's definitely true. And how about you, Dr. Albaugh? What do you think about?

Dr Albaugh: And I think the accountability is key. And I think especially men or women, really, if you've got other people who are in the same scenario or a similar situation. you know, frequently in our clinic, we have a support group. And I'm a surgeon clinically, we have a post-surgery group. And so because there are several, there's issues that those patients, you know, will have with their weight loss and such. And it's good to have other people to talk to and realize that other people are going through these same, you know, challenges. And I think, you know, whether that's... You know, whether you do that, you know, with a treatment specific intervention or whether it's just having a group of, you know, neighborhood guys that like to get together and work out together and make and do that on a regular basis and make that part of the normal routine. Not something I'm going to do a one off here, but hey, you know, three times a week, we're all going to get together at the gym and we're going to have a good workout and kind of holding holding other folks to that as part of accountability. I think it's a huge sort of thing. I think for guys more than. uh than the gals i think you know guys and this is probably my bias as a man but i think a lot guys want to go and when they work out they want to work out hard they want to get sweaty they want to get tired right you know my wife goes and does bar it's like a ballet bar flexibility like i've done those workouts and i just don't feel like that's really a great workout at least in the in the moment there uh the next morning is a totally different story but uh I think, you know, I think finding finding like minded, you know, other guys to kind of, you know, say we've we've all could lose some weight here and we're all struggling. We're all human. We've all got the same types of genetics and biological issues we're trying to fight here. And, you know, being, you know, being cognizant of that and having folks to kind of, you know, motivate you when you're when you're slipping, when you're feeling like you can't do it, having someone else to bring you up, I think is something that that clearly seems to be working. It works. other sorts of things besides weight loss. But I think it's one of the things that, you know, for weight loss, we don't use that enough, I think.

Lisa Jones: Yeah, the accountability. I think that really helps. And then I do have a question about adherence. So what do you think improves adherence in real life, not just in theory?

Dr Albaugh: Oh, I think the, you know, adherence, you know, logging it, writing down what you're eating, getting on the scale, taking that blood pressure, like... Making yourself see the numbers, making yourself see what did I eat yesterday, realizing that so you don't kind of lose track of the details kind of in the moment. You know, there are a number of studies that have been done showing that people who have a food log lose more weight than people who don't have a food log or people who, you know, all these little just little behaviors, little kind of small shifts can lead to a big change, you know, over a long period of time. I think that's probably one of the biggest lessons there.

Lisa Jones: Yes. Yeah, thank you for that. And Dr. Ho, anything to add to that one?

Dr Ho: Yeah, that's a great point. What I would add is also giving yourself grace. And I mean that by, for example, I have patients who travel quite a bit, and they will tell me when I'm at home, I'm great. I have my meal prep, I exercise, but I travel so much for work, and I travel to places that don't have a lot of healthy choices. They say, well, I'll get back to it when I get home. And I say, give yourself grace. If you say you're going to exercise 15 minutes every other day, walk around your hotel. Walk up and down the stairs. And do not count that as less than. That is completely valid. If you're eating something that's not as healthy, you picked the better choice out of the options that are there. So giving yourself that grace and making yourself still feel successful and motivated to continue on, I think is really important.

Lisa Jones: Yeah, grace. That's such a great thing to incorporate because I think a lot of times, and you probably both see this in your practices, you see people that aren't doing that. I was talking earlier about like they're beating themselves up for only losing a pound. Like they're not giving themselves grace at all, obviously. So I think that's a really add that into the plan too of their smart goals, right, Dr. Ho? Like it's a smart goal to give yourself grace. So that's great. So what's one thing that dieticians, if you had to give advice to dieticians, what should we start doing when working with?

Dr Ho: Ooh, Vance, that's a good one. I'm going to let you step with it.

Dr Albaugh: I would say, I would try to, I would start it with men. I would tell them, because what guys are seeing on social media and everything is this idea like protein, like we've kind of talked about. I would say, you know, talk to men and say, listen, protein's not going to solve your problems. You can't focus. It's complicated. But I think talking about kind of diet quality and balance and whole foods and those sorts of things in general, a general discussion of that I think is definitely against what they're hearing on social media and seeing in the media, but is one of the things that can actually lead to big changes over time. And so I think from a dietician's perspective, that's what I would focus on is that kind of quality and balance and things like that.

Lisa Jones: Yes, and push the needle a little bit with that. So, yeah. Do you want to handle, Dr. Ho, do you want to handle what's one thing we should stop doing?

Dr Ho: There's some things that, you know, like dietitians should stop doing. I think this is going to be, this is my own thing. It may be controversial, but I hope people stop complimenting people on their weight loss. People will come in and say, I lost 10 pounds. Oh, my gosh, that's so fantastic. And then the next time they come in, they lose maybe a pound or maybe they gain. And they're so disappointed that I didn't even want to come in because you would be disappointed. And I think we really need to stop that. And really, I always start off by asking people, how do you feel about your weight loss? How do you feel about your weight gain? Understanding what their perspective is and then trying to reframe it if it's more of a negative framework in which they're working with.

Lisa Jones: I have a follow-up. That's great. I have a follow-up question to that, though. So say, for example, they lost weight and they're all excited. So how would you handle that? Like you're not going to say congratulations on your weight loss. You're going to say... Your first thing is how do you feel about your 8-pound, I'm just making up numbers, how do you feel about your 8-pound weight loss? And let them talk.

Dr Ho: Yeah, my next question is how did you do that? What changes did you make? And if they tell me, oh, I decided to go on a gummy bear diet and just eat gummy bears so I can have a more than 500-calorie diet, that is not good. But if they said, you know, I started doing a mixture of cardio. and resistance training that I hadn't done before, that's great. That's fantastic. How can we make this a sustainable change?

Lisa Jones: Yes, I love that. It's so helpful. And I got to ask you, Dr. Albaugh, like anything that you want to add to the stop doing, because I think this is helpful for myself as a dietitian, as well as all the other dietitians that are listening.

Dr Albaugh: I think just focusing on the complexity. I think it's part of your nature as a dietitian, you know, focus on these sorts of things. Sometimes it can give people unrealistic expectations like, oh, I've got 12 dietician visits this year that my insurance is going to cover. And at the end of the year, I'm going to be 50 pounds lighter. Like that's probably not going to happen. But eating a healthy diet and kind of balancing those macronutrients and eating those, you know, the advice is good and it's leading to health. But the mismatch and the expectations, I think, like Wayne has mentioned, you know, people will, you get very frustrated and they'll say, well, heck with this now. I can't do that. I might as well just go back to do what I was doing before. You know, and then you're and then you've lost ground. Right. So it's it's celebrating the small wins and kind of focusing on the complexity and and everybody's different and everybody's endpoints or goals are going to be slightly different. And that's OK.

Lisa Jones: Yes, that's so true. And I do think that we see we often see better engagement when recommendations are practical. They're specific that Dr. Ho was talking about. And they're aligned with the patient's daily routine and they're not overly or. restrictive or complex. Cause I think that's when we lose them. Like they're like, wait, was I supposed to do again? Like sometimes it's easier just to focus on one thing. So thank you both for everything you contributed in this podcast. It's been fantastic. And I want to end with just kind of a rapid fire, quick round questions with short answers. Any, the first thing that comes to your mind, and this is for both of you. So if we want to do an order, do we want to do Vince and Wayne? Does that work? So we're not, okay. Yeah. All right. Are we ready? Let's take a fun little gear. All right. Best first nutrition change for men.

Dr Albaugh: Eliminating or trying to eliminate liquid calories is what I'm going to say. And full disclosure, I'm a beer guy. I like a beer here and there. But I think in general, it's really easy to take a lot of calories and sugar in with beverages and it kind of goes right over your head. You're not even thinking about it.

Lisa Jones: I'm going to make my husband listen to this episode. Great. Thank you.

Dr Ho: That's a great one, Vance. You took that one. I would add my usual first line is add something green to each meal and eat it first.

Lisa Jones: Yes. Green. The leaning green. Okay. I like it. All right. Next. Biggest mistake clinicians make when addressing obesity.

Simplifying it. Just eat less and exercise more, right? That's the biggest mistake.

I think not asking patients what their weight goals are and just making assumptions instead.

Lisa Jones: Oh, wow. That's a good one. Yeah. All right. Most underrated strategy in obesity care?

Dr Albaugh: Logging, monitoring yourself, wearable kind of stuff, accountability, you know, being cognizant of where you are, what's normal. I think there's a lot of, most people don't realize how much your weight can. vary from day to day, just with probably fluid retention, sodium intake, things like that. And so being aware of that, I think, helps you understand that this isn't a linear journey. There may be some bumps kind of down the road.

Lisa Jones: Yeah. Yeah. That's so good because we're not just dealing, we're dealing with males. Like a lot of times it's like a kind of another myth thinking it only happens to females, but it happens to males too. So thank you for that. I'll let you, Dr. Ho.

Dr Ho: I would say start with small intentional changes that patients can implement. and sustain. I think sometimes we walk in as clinicians and we want to give and arm the patient with as much information as possible, but it's overwhelming. It's really overwhelming. So really narrowing down to small intentional changes and holding them accountable in their own way, whether it's looking at their devices or as Vance said, using or logging in everything in their own calendar or diary. Either way, just making sure that the changes are small and achievable.

Lisa Jones: Yeah, small and achievable. And thank you. And one last question. One metric clinicians should pay more attention to.

Oh, one metric. Cool. I should pay more attention to. I mean, if you have expressed your body composition, that is fantastic. Looking at that, I think it may give you more information than just a number on the scale. And there are a lot of... cheaper, less expensive bioimpedance machines that people can use. They may not be completely accurate, but they can give you a trend. So I think that would be helpful.

Yeah, I agree. That's probably a huge one. I know in a lot of obesity medicine clinics, those types of scales are present, but most primary care providers don't have those. But they're commercially available. You can buy them. It's probably a worthwhile investment, and I agree. Tracking, again, even if it's not entirely accurate. Trends over time can carry a lot of, you know, quote unquote. weight, for lack of a better term.

Lisa Jones: Yeah, so true. And thank you both for your contributions today. And as we discussed, obesity care in men is not about simple solutions or outdated advice. It requires a deeper understanding of physiology, a shift away from misconceptions, which we went through, and a focus on strategies that are sustainable in real life. And for clinicians that are listening, that means moving beyond those one-size-fits-all recommendations and toward individualized evidence-based care. And I want to just ask, is there any closing comments that you have today?

Dr Albaugh: I'll say one thing. I think, you know, it's kind of like the elephant in the room. I think there's a lot of media attention on these newer kind of medications, like GLP-1-based medications. It's something that we get a lot of questions about clinically. And I think... with those medications especially they are very good at minimize helping people to decrease how much they're taking in and i think wayne would probably agree with me that like it really makes the nutrition part that much more important because if you're eating fewer calories and you're not eating kind of the right types of calories and a balanced diet, you really, those medications, you know, can potentially, all weight loss is not equal, like we've kind of said. And so you need to really be cognizant about the nutritional quality and the things that you're eating.

Dr Ho: I completely agree. And I would add on to that by saying clinicians who are prescribing these newer medications, whether compounded or, which is not recommended or prescribed, The clinician should be very aware of how that patient's nutritional status may change over time. And without looking at that, you may miss nutritional deficits.

Lisa Jones: Yes. What a way to wrap it up because I think that takeaway right there for today is if we change how we think about obesity, we change how we treat it. So again... you, Dr. Albaugh and Dr. Ho for being here and sharing your expertise and insights with us today. And thank you for listening to Nutrition 411, the podcast.

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