Supporting Patients in the Era of GLP-1 Medications Monique Class, MS, APRN-BC

- As rates of obesity and overweight continue to climb in the US, the class of pharmaceuticals known as GLP-1 agonists have grabbed the spotlight for their efficacy in causing significant weight loss in many people. And it is estimated that 12% of Americans have been on one of these drugs. But these medications are expensive, do not work for everyone, and must be taken in perpetuity in order to remain effective. How can we help those patients who do not have access to these medications? What about those who may be transitioning away from them? - So, what GLP-1s do that I think is important to understand is weight loss is the most uninteresting part of these medications. They lower global inflammation, they increase lipolysis, fat-burning in the visceral area. If you do that, you're lowering global inflammation naturally and decreasing every single complex chronic disease that I could think of. - I am IFM Director of Medical Education, Dr. Kelechi Uduhiri, and on this episode of Pathways to Well-Being, we welcome IFM Educator and AIC 2026 Presenter, Monique Class, to discuss the challenges of obesity and metabolic health in America, the strengths and limitations of GLP-1 medications, and the ways we can help patients with sustainable behavior change. We'll talk about how to know which patients may benefit from full versus smaller doses of GLP-1s and how to help these patients transition off these medicines sustainably. Without any further ado, we welcome to the show, Monique. Welcome, welcome. - Welcome. I'm delighted to be here. This is one of my favorite topics to talk about, the interplay between behavior change, botanicals, pharmaceuticals, and how we can really move the dial on metabolic health in a global way that makes it affordable and accessible to the general public. - Oh my goodness, absolutely. And it's so great to see you. - Great to see you. - Thank you for joining us today to the podcast. Let's begin by talking a bit about bit your background. How did you get involved in functional medicine and your experience in the area of addressing sustainable lifestyle change? - Well, you know, I got started many, many years ago in functional medicine. I was blessed to be around the early adopters of this and learn from them. And at the same time, you know, I started really with the basics, the foundationals, with working with a bioimpedance machine with patients with metabolic syndrome and diabetes, and trying to move the dial on behavior change before coaching was even a thing, you know? Because we realized that in our practice, and I was practicing with Dr. Joel Evans, so, he really introduced me to functional medicine and then I quickly fell in love with it. What we realized in our practice is that just handing out metformin, just working with all of the medications we had at the time, even just throwing a bunch of botanicals at people, wasn't moving the dial, that they needed more touches to make the change and they needed to change the conversation from your weight is your worth to different metrics. So, when you look at bioimpedance analysis, it's completely different metrics. You're measuring percent body fat. You're looking at muscle mass. You're looking at visceral adipose tissue. So, you can move the conversation away and then have meaningful tracking. And also simultaneously, you can take the data and convert it to meaningful dialogue for behavior change. And believe me, I prescribed metformin in the day quite often for people that really needed it. And I worked with all of the botanicals I worked with, you know, with fish oils, and we worked with berberine and chromium and all of those things. But the crux of what we did was ask the patients what they could do, what could they afford, what was available to them, both economically speaking and emotionally speaking, and how could we get them on the path for change. And that change was listening to the story, marrying it to the labs, the bioimpedance analysis, seeing what needed to be done, and having them decide what they could do first. Like, cultivating self-efficacy, right? So, this is where we need to go. We need to change eating behavior, we need to get you moving to move the dial and enhance metabolic flexibility. So, you know, I started that program in our office and Joel would see the patients and then he would send them to me and I would see them every two weeks, having these conversations, tracking the data, and changing things on the fly. Like, what do we need to do here to move the dial on change? And so it's hard to change eating behaviors. It's hard to get people that have never exercised to start moving the body. So, reasonable, small plans that were based in conversation where they determined their first tiny, small step seemed to be the magic formula, you know? So, that's what we went with. So this has always been my love because this has been the big problem in America is metabolic inflexibility, diabetes, MetSyn and the trajectory of that curve. - Wow. You've covered so much in that one question. But I'm really gonna break it down and tease it out, right? - Tease it out. - You know, I love your journey into functional medicine. I love how you were embraced into the field. And I see, I hear your passion, and I see that you really had to take it step by step. You really had to come at it from a holistic perspective. And you really brought a lot into that question. So what I'm gonna do is let's break it down a little bit more for our audience. - Excellent. Yeah, let's do it. - Let's talk about, the GLP-1 drugs. We'll start there. That we know are being used by millions of Americans to help with weight loss. I mean, 40%, the last I checked, of adults in the United States are now classified with obesity, right? And as a primary care physician myself, I see this as a huge problem. What has been your experience with your patients and the GLP-1s? - Well, first, let say I'm not against the medications. I mean, they should win the Nobel Prize. They're groundbreaking in ways that you cannot even predict. I'm not against them. But what I am clear about is the dose makes the poison here, that we are prescribing these things without conversation, jacking up the dose without conversation. And we're swapping obesity for sarcopenia. And it's not a good trade. Right? So, these drugs done right can do amazing things. But not everybody can afford them. Not everybody can tolerate them. Not everybody needs to be on them. So the gain is, and what I noticed, you know, I was resistant. I did not wanna prescribe these things. I was like, people should just be able to do lifestyle and botanicals and all that kind of stuff. And my arm got twisted by a couple of my patients that were doing everything right and nothing was changing. Everything right. And then I started playing with tiny doses. And very quickly what I realized is that it dialed down the food noise. You're not looking to turn off the food noise. That's a bad concept to have no appetite. But it dialed down the food noise and they could get some traction on losing weight. And that momentum allowed them to change patterns of behavior. Because they actually saw these little wins. So, what GLP-1s do that I think is important to understand is weight loss is the most uninteresting part of these medications. The lower global inflammation, the increased lipolysis, fat burning in the visceral area. If you do that, you're lowering global inflammation naturally and decreasing every single complex chronic disease that I could think of has a basis in inflammation and oxidative stress. So it was small doses were lowering inflammation and things I did not anticipate. Their joint pain would go away, their anxiety would get less, their desire for alcohol would be transformed. I was like, this has addiction potential, it's got inflammatory potential, especially for women in menopause where a big ticket item, all that crops up as estrogen dips. I mean, it was game changing. But unless they were a diabetic, they couldn't afford it. And even the diabetics, even, you know, if you're doing it through pharmacies, through insurance, it's still incredibly expensive if you don't qualify and meet all of these criteria. And if you're doing it with the injectables through CVS or Walgreens or whatever, you're stuck in their doses. And many people need personalized doses. Right? What are we about in functional medicine? Like, how do I match the dose to the individual? What dose does this person need? So, in most people, Kelechi, not everybody, in most people, tiny doses, suboptimal doses will lower the inflammation, get the system moving, slightly dial down the food noise, so that there's a hesitation moment to make a different choice. And you can get momentum for changing behaviors. Understanding the physiology, and I know I may be jumping to another question. - That's okay. - But it's important to understand that we make our own GLP-1. It's made from the L cells of the gut when provoked properly. And when you eat a meal, you'll make it, it goes up and it comes down. When you give these medications, it's staying chronically elevated. So, the L cells get deconditioned. That's why if you take people off of these things rapidly, they're gonna gain their weight back and they're gonna be voracious with their appetite. It's not really a long-term strategy. It's a bridge. And we have to position it as such in people that need it. If someone's looking to lose five pounds, that is not the wise use of a GLP-1, right? But most people, it's 20 pounds, it's 30 pounds, it's 70 pounds. And that's real. That's hard to move. People are frustrated, they just give up. So there's a place for it, but not everybody should be on it. And the dose is dependent on the situation. And the dose should change as the situation changes. And you've got to work on lifestyle. So, how do you stimulate your own GLP-1? Fiber, protein, fermented foods, right? There are ways to provoke your own satiety pathway. And there are botanicals that there's real human trials on now, a hops derivative, that stimulate your GLP-1 in a meaningful way, like, sixfold above baseline, done in clinical trials with human beings. So, I'm all about follow the research, look at the person, work on their lifestyle. What do they need? What can they afford? What can we actually do in this moment? And then you've got to adjust and adjust and adjust. I mean, that's what functional medicine teaches us. That's the game. - I love it. Yes. And now you've touched on quite a bit there, too, and I'm gonna tease it a little bit as well. - Tease it out. Yeah, I'm a talker. - I heard health equity, I heard cost, I heard, you know, the dosing. I heard we've still gotta get back to behavioral changes. So, and I heard side effects. I'm gonna start there because you gave me, you're covering all the themes today. And I'm so excited that you're here, Monique. Amongst all the themes you shared with us just now, I'm gonna start with the area of side effects. Okay? We're gonna get through all these themes. So, we know that GLP-1s have some side effects. And you mentioned sarcopenia, including sarcopenia as one of them. What issues with side effects have you seen? - Yeah, sarcopenia is real, right? So sarcopenia, for those of you, most of you know it, but I just wanna clarify, it's the loss of muscle mass. And muscle mass is medicine. It's metabolically active tissue. It's healthy tissue. We're not looking to lose that. So if you put high doses and turn off somebody's appetite completely and they're not eating, they're gonna lose weight, but they're gonna lose a ton of muscle. Because there's a bunch of metabolic adaptations that happen as you lose muscle and hardly eat any calories that's hard to recover from. And then you're stuck in the wheel of the drug. So if you do smaller doses, get it to the point where you're moving the metrics and lowering the food noise, but not knocking it out, and getting people to do tiny bits of resistance training, that's the win. So, from a health perspective, every time you contract a muscle, you're increasing those little Pac-men inside the cells, the GLUT4s, they come to the surface, they open up the cell, and they increase glucose disposal. So, little bits of movement throughout the day move the dial in a large way and prevent the sarcopenia. But you have to counsel people with, it can be, you don't have to go to CrossFit and Orange Theory, even though I like those things. You can just get them moving in little meaningful ways. Yeah, and so sarcopenia is a big side effect. We don't want to swap obesity for sarcopenia. And constipation, right? Like, that's a big problem. So you're slowing transit time and you have to understand your slowing transit time. So managing somebody's constipation and reorganizing the gut before you throw these things in is wise medicine. It's functional medicine. You've gotta be thinking that way. So how can I clean up the gut, make sure that they have optimal transit time before I throw in something that's gonna slow their transit time. Like, you're weighing all of these factors before you make the call to launch in. - And I think that's the power of functional medicine, right? You know, you're looking at the whole person. You're not just looking at their obesity or their chronic health conditions, but you know, you are already anticipating those side effects like sarcopenia. You are already anticipating, you know, the slowing of the gut motility. And you are getting ahead of it by prescribing basically movement as medicine. I love that you, as a functional medicine clinician, you are taking that holistic lens to address the potential side effects that are real. And so, something else that you mentioned earlier was about food noise, right? So we know that GLP-1s can, besides the the weight loss we see, they no longer experience the food noise or those constant, insistent thoughts about food and eating. What does that tell us that so many people seem to be experiencing this food noise in the first place? - Yeah, I mean, I think that's a great question. And I'm also gonna say something you said that I think is incredibly important. The anticipatory medicine. Like, you have to be able to anticipate what could potentially happen before you throw something in. And the systems biology approach of thinking in functional medicine has taught me, if I do this, what are the potential ways that this could influence the patient? So, that's from my training with functional medicine, that anticipatory thinking. So you asked me just restate the most important. - Sure, so, you know, people say, I take this medicine because I no longer experience that food noise. Or that constant barrage, insisting thoughts about food. What does it tell us about our society, about our environment, about our choices, that so many people seem to be experiencing so much food noise in the first place? - Yeah. And you've got a couple of buckets here to understand the range. So, and this is based on talking to people, there's some people that have incredible food noise because they're so metabolically inflexible where their insulin, they're eating the wrong things, right? Or the wrong macronutrient distribution where they're carb-heavy, even good carbs, and they're spiking their insulin and then they're crashing and they're craving more food. So, it has to do with the food that they're eating, going up and down, making this rebound hypoglycemia that makes them want to eat to manage the low blood sugar. And they're going to be looking for something that's a quick sugar fix. So, you've got people that it's about, you know, they have a history, a genetic lean towards diabetes or metabolic syndrome, and they've been under a ton of stress and they've been eating wrong for many years and not moving. And now they're in this yo-yo with their blood sugar and they're craving, right? So, there's food noise from the physiology. Then you've got people that are not that much overweight and they're eating incredibly well. And the food noise has nothing to do with hunger. It's emotional food noise that is their drug of choice, right? It's where they've put, they're not using cigarettes, they're not using alcohol, but they're using food because it's acceptable, it's always available, you know. So, they're binge eating on food as their medicine to anesthetize whatever emotion it is to stuff it down that they don't want to deal with or that's too overwhelming for them to look at. They anesthetize themself with food. But both situations are a level of imbalance, but they're different issues. One is you straighten out the physiology, you're good. The other's actually harder because there are emotions behind it that are very, very troubling that, it just gives them a way not to look at it. So, that is a little bit more nuanced as a clinician and delicate to work with. - I love that, you know? It is so important that it's not just calories in, calories out, right? - It's not. - I love how you are, again, anticipating the need of your patient. You're thinking, is this food noise secondary to physiology? Is this food noise second to emotional, you know, the stress, and who's not exposed to that these days, right? So, and knowing that, you can really, you're really in a position to help your clients be more successful on this journey. So, thank you for bringing that aspect in. And then there was something else that you mentioned earlier that I want to touch on, you know? Let's get back to that weight loss and the behavior piece. So, we know that GLP-1s can lead to 15 to 20%, correct me if I'm wrong, weight loss in some people. But of course, GLP-1s don't really deal with the underlying problems that may be leading to the obesity and the overweight in the first place. So, how can we as clinicians help patients with behavior change that gets to the root of the issue? And this is your unique power, Monique. So, talk to me about this. - Yeah, this has always been my favorite thing to do. So, what the GLP-1s do as bridges is they level the playing field and they give people momentum. And so the key thing to do is don't put the power in the drug. Put the power in the patient. So, I say to them, we're using this as a bridge. It's not the answer, it's a bridge. It will give us the moment we need to change eating behaviors and transform movement, which is so crucial if we're gonna reverse your metabolic health. So, and you've gotta name it upfront what the game is. You don't just hand them, this drug will solve your problem, is the wrong conversation. This drug will lower the inflammation, will give you a hesitation moment, so that we can do all these things you've always wanted to. It's not like people don't wanna do these things. It's that change is hard. It's hard to change, it's hard to get it off the ground. So, all of a sudden you're at a moment of time where they're not craving sugar, they're not craving alcohol, they're feeling better. So, I go with what they can do first. The eating is easy on small doses of these things. So, I clean up their eating really fast. I say, you're not gonna be hungry. So we're gonna lean into protein and produce first, you know, protein and veggies, we're gonna organize that. And then whatever you have left, make carbs as a condiment. Like, I don't get overly prescriptive. So, they start losing weight, they start doing that. They're not snacking before bed. So I change the binge eating at night, which is usually, not always, usually where it's at. And then you get a little bit of leverage there. And I get them moving in, if they're already exercising, we're good. And then we can just tweak it, right? If they're not exercising, I get them moving. And this is based on research, that moving two minutes every hour will increase glucose disposal by 26%, contract the muscle, glucose goes in. So, it's a conversation like, can you move, just get up and walk around every hour? Or the other way to do it is, can you walk 10 minutes after a meal to leverage the momentum of getting the glucose inside the cell? So, we're looking to reawaken really good habits. And then on the backend we have to reawaken satiety, right? And that's where some of the botanicals come in because once you get people off, you have to think about, well, now they're gonna start to get hungry again. What can we put in instead that's not a med, that they're not stuck on the med, or what can you use and never go on the medications that has some real science behind it. What can we do? - Right, and I think, oh my gosh, what I'm hearing is so amazing, and I know our listeners are getting this, you know, it's putting the power in the person, putting the power in the client and not just in the drug. I think that is so powerful that you are leveraging what you're already doing that's working. That is so beautiful. - That's it. That's it. I mean, you nailed it. It's creating self-efficacy and strength-spotting what they're already doing right. They come to practitioners and we give them a whole list of everything they're doing wrong. That doesn't work. What are they doing right? How could we encourage it? How can we leverage it, leverage that technology, and then give them momentum to keep it going? Because once they get momentum, they're so excited. They start doing other things. Like, you can get other things done. - Yeah. Thank you. And there's a word that you mentioned earlier that we don't hear a lot in just our general vernacular, and that's satiety. Let's do a deeper dive from that. How can we awaken or reawaken natural satiety pathways, right, because we have them, that are impaired due to poor diet? Can you do a deeper dive on that for us? - Sure. So, there's two ways to do it. So, food first, and like what I said in the beginning, it's, you know, reawakening it is sorting out the microbiome in these various ways through fiber, fermented foods, protein, produce, you know, better quality if possible. I love a little bit of fermented food every day. Like a forkful, get people moving to change it foundationally so they're not stuck on probiotics, right? Get the fiber game up. So, fiber will create short-chain fatty acids that make the L cells differentiate and you make your own GLP-1. So there's strategies to do it. And then there's botanicals. Like the New Zealand government had a completely different take on the obesity epidemic, they threw $30 million to find a botanical that could reach biologic activity so that it could turn on GLP-1, CCK ,and PYY, reawaken satiety pathways through plants, right? So plants, especially bitter plants, have regulated our appetite for centuries. So when we eat bitter, it tells us to stop eating, like bitter taste buds, at least on the tongue, tell us, this could be toxic, I will stop. And sweet tells us to lean in. Right? So, you know, Ed Walker, who's just a brilliant scientist, was able to map the fact that there's bitter receptors throughout the whole GI tract. If we can awaken them through food, through hops derivatives, and you can have meaningful rises in these satiety pathways. Again, does everybody need the botanical? No. But the botanical is another bridge to get the satiety pathways reawakened without knocking them out. It mimics the circadian rhythm of our own GLP-1. We eat, GLP-1 goes up, and then it should come down. You take the drug, GLP-1 is like way over the top, 24 hours a day for seven days. Kind of deconditioning our own food responses. You take the botanical an hour before you eat, it stimulates sixfold above baseline, which is three folds above baseline what we would do, but nowhere near what a GLP-1 would do. It stimulates it for four hours beyond so that people don't want to snack four hours later. They don't eat quite as much. They eat 18% less actually. So, it's converted into meaningful behavior change. So we've got options, but these options should be based on a conversation. Do you want a botanical? Do you want a small dose? Or if they need it, some people need to start with moving them up to larger doses. Do you want to do lifestyle alone? Like, we've got options, but we understand the technology now. I mean, this is a moment in time, because of all the research on GLP-1s, we understand how it works. And now it's just, for this person sitting in front of you, what do they want to do? What's the right first chess move knowing you can adjust at any time and go back and forth between these things? It's not a set game, it's a dynamic conversation. Yeah. But it's about momentum. You cannot change this metabolic problem without behavior change. You can't do it. - Absolutely. Absolutely. Because you know, again, it's about getting to the root cause, right? I love that we do have options to stimulate, reawaken our satiety pathways. That it's not a, you know, GLP-1 or nothing, right? People do have options. And I love that you also, again, anticipating what they will need and how they can be successful. That is really so powerful in your approach to this type of obesity medicine, which is very unique. Let's go back to that patient. You know, we know that weight loss can lead to, can be very difficult for some patients, you know? So, let's say a patient wants to use GLP-1s to sort of jumpstart their weight loss, and then gets to a place where they feel they want to transition from them, instead, of taking it for the rest of their lives. You mentioned bridging. You mentioned several ways. Tell us a little bit more. How do we help them do just that? Are there things that we can leverage from their experience on a GLP-1 to help them, you know, move forward? You know, what can the behavior change field tell us about how to help these patients keep the weight off? - Yeah, I love it. Because that's the game, sustainable change, right? - Yes. We've gotta keep coming back to that, you know? - If it's not sustainable, where are we? So, yeah, that's the right question. So first of all, what you need to do is realize, for those practitioners out there, it's like lowering someone on a PPI. If you just take away a proton pump inhibitor, they're gonna have a rebound reflux and GERD, right? So, you have to titrate it down. So the company itself, or you can compound it, Eli Lilly has GLP-1s in vials so that you can play with the amount. So again, Kelechi, it's cultivating the self-efficacy in the patient. So I say to them, we're gonna titrate down, but I have no idea what you need. So this is the back and forth. We're gonna lower it by a little. So, if we were on, making this up, if we were on five milligrams, we're gonna lower it to four, then to three, then to two. And with each lowering, what we're looking for is that there's no rebound hunger, or no rebound weight gain, nothing that they can't control. So, say, let me take a step back. The thinking is you don't start taking them off until you feel you have reset mindset and physiology. They're at the right, I'm not even gonna call it weight, they're at their right body composition. Because I don't care what the weight is on the scale. But do they have the right body comp for them at this point? Weight is an insufficient metric. So, once they have that and their mindset, they've got their habits dialed in and they feel confident, like they know what their body needs, they know how to get the protein in, they know how to move at this point. They've figured out a movement strategy that works and eating strategies that works. That they've got their set, then we lower, not before then, but wait till those things are set. And then you titrate down and you have them say, listen, you put the power back in them, you've got the needle at home, you've got the vial at home. Where do you wanna start with the titration? Because they're terrified. They're reading the research, they're terrified to get off because I'm going to gain all my weight back, all this hard work. No, you won't. No, we're gonna do it with wisdom. So, I say you're in control. You titrate down, you make sure you're not overly hungry, you're not getting into bad habits. And then we make the next move. I don't care if it takes you six months to get off it, as long as you do it at a pace where you feel comfortable, you're not afraid that you're going to and you're not actually gaining your weight back, and then I make moves based on that. So, if they're not necessarily gaining weight but they notice their appetite's coming back, that's where I'll put in the hops derivative and say, okay, we're gonna work on satiety pathways as we get off, right? Then I'm using another tool as a bridge, right? I'm putting in, you know, 250 one hour before their binge time to level the playing field with satiety. And then I'm still lowering the drug, getting them off the drug. You know, it's not like some people don't stay on baby doses, but I'm not looking for that if I don't have to because I want the body to do what the body's designed to do. So, again, conversation, nuance. Some people, you know, I mean there are some people that the can was kicked so far down the line with diabetes and beta cell dysfunction that they do need to stay on it to manage their blood sugar, which can be more devastating. So you know, they're nuanced conversations, but it doesn't mean you ever take away the habits. Habits stay, the drug may or may not. It really depends on so many factors. - Yes, that is so true. The habits stay, the drugs may or may not. And that really brings me to the question of health equity. You know, I just had a call from a patient other day who, you know, medication went from, maybe it was like maybe $40 to $80 and now it's $800. So on a larger scale, we know that, from a health equity standpoint at least, many people will never have access to GLP-1 medications and many more may not wish to take them. So, what are some ways that we can help people make better food choices? - Well, that's the question. The health equity around this really bothers me. It really bothers me. We need, as a society, to be able to help everybody with this because this can be an amazing tool. So, that's a problem for me. That being said, it's the same technology. It's understanding what they can afford, what they can actually do. And starting with micro-habits, understanding the basics here, you've got to get them to move the body. They don't have to go to a gym, they just have to move. I don't care if they do a plank for two minutes, if they walk around, but they've got to move and contract the muscles. You know, even if it's 10 minutes after each meal. They've gotta understand that carbohydrates, if they're in that bucket of metabolic inflexibility, carbohydrates, they're not the enemy, but they have to make them a condiment. Just give them a visual, right? Like, it's a condiment. Eat your protein and produce first as much as you want. Make the carbs a condiment and work on late night snacking. Because if you're eating all these carbs in food, even if it's good food, late at night, you're gonna dysregulate your glucose and insulin. So it's timing of food. So, this is where the research has really helped us. GLP-1 is the highest in the morning, Kelechi, highest in the morning, lowest at night. You have a bagel and cream cheese in the morning, you're gonna metabolize it far better than if you have it at eight o'clock at night. So, just switch where they put their biggest meal and their carbs. So, sometimes I'll say, "You don't even have to take it out. Let's just put it at breakfast and then take a 10 minute walk." So, it's understanding some basic principles of macro-distribution. Not should you be vegetarian, not how much protein. I don't even talking about that conversation. I'm talking about just the, you know, look at the visual on your plate. Protein, vegetables should be the most, carbs should be a condiment. Just give them basics. And carbs in the morning. Lean and green at night. Try not to do a snack if you can get away with it. Now, that being said, sometimes people's blood sugar is so crazy that they drop after dinner, they need a snack, they can't sleep. In that case, you put in a protein, you put in something like an apple and almond butter, like something not carb-heavy but complex that has some meaning to it. Apples are great for the microbiome. Give them a little protein and good fats with almond butter. So these are strategies, knowing that they're microstrategies. If you make someone reach too far, they'll stop everything. So, the name of the game is where do you wanna start? What can you afford? What's available to you? What's available to you, physiologically and emotionally? And I always tell them, any change is a good change. Like, I don't care if you start with just two minutes every hour walking around. If that's your starting point, I'm good. And dropping one snack, I'm good. Or dropping your diet soda, which sends the whole wheel of crazy going with craving food. So wherever they want to start. And that's the key question. It can't be where you want them to start. Give them the data. Tell them where you want the puck to head and cultivate self-efficacy so they are making the choice and you're support. I'm like, brilliant. That's what we'll do. They'll do what they decide to do. They won't do what we tell them to do most of the time. - Right. Absolutely. - That mode of interacting with patients just does not work. - Does not, we know that for sure. - For sure. We know from the data. Look at where we are today, you know, with health outcomes that we're seeing in our patients, right? So, that is so powerful, you know? You look, again, you take a whole person approach. You are bringing in your functional medicine lens. You're understanding that not all your patients may be able to afford this. And then you work with them to see what can they do? You know, based on where they are, what can they do? You meet them where they are, but you don't leave them there, you know? - That's exactly it. And then you're assessing, you know, in functional medicine, it's the tracking and tweaking, right? That's part of it, it's like, functional medicine, listen to their story deeply. Understand what they have the capacity to change in this moment. Get a viable plan and then constantly adjust. Constantly going back to their why, what's happening with them, what is the meaningful change that they could make in this moment? And just, you know, again, I'm really big about moving this conversation far away from your weight is your worth, that's not a good conversation, it's not a productive conversation, to talking, helping them understand about metabolic flexibility, what that means. Talking about change in body comp, which is different. What size do you want to be in your clothes? Not what's the weight on the scale. Move away from that conversation. Have them understand some of these basics, I think, is the winning formula. But this is our training. This is how we were taught to think. That's why I've loved functional medicine. It's not about a lab test, it's not about a particular supplement, although we know how to use those. It's about a way to think through a problem, a complex problem in a way that can bring the patient, because it is in the center. Who's in the center of our matrix? It's the patient and their belief system. Mind, body, spirit. - Absolutely. Absolutely. And I would be remiss if we did not bring in some mind, body, spirit as you're an expert in that as well. Share with our audience a little bit about how you bring in that mind, body, spirit into this space that often seems so scientific. But how do you bring in that experience to addressing the clients struggling with their weight? - Well, one of the questions I always ask is almost a timeline question. The way I bring it in is, when is the last time you felt good about your body? Because you've got to understand, it's loaded for people. And even people that we look at that are visually thin, they have a problem with their weight in their head. So, I need to understand how long this problem's been going on. If it's from childhood, like you're timelining this thing, you ask them when was the last time they were feeling good about the way they looked, their body composition. I try to use body composition and not weight. They'll name a time. And then you dig in to, well, when did the wheels go off the bus, right? This is our training. What was the trigger? We're thinking what was the trigger that made this happen? Was it stress? Was it a toxin? Was it not sleeping because you were in residency? Like, you know, you're not sleeping, you're eating bad food, you're under stress, you went through a divorce, never been well, never been at the right body comp since X, Y, and Z. And then you put the pieces together emotionally for them where they can look at what factors influenced it. Like, there's genetics, but these genetics are turned on more often than not by stress and things in their life that derail them from habits that they used to have. And then it's pointing out, strength-spotting. Like, if you could give up cigarettes overnight, which they'll tell you these stories of these incredible things they were able to accomplish. Go back and get an MBA with two kids and work in a job. Like, if you can do that, like, you can do this. Like you point out that they have the capacity to change and your strength-spot where in their timeline they did these amazing things. - Oh, wow. - Give them the confidence that they can change. And that's mind-body. It's understanding what's blocking them emotionally. What limiting belief that somebody told them that made them think they couldn't do this or what derailed them. And once they verbalize that and they see it, and then it's just loving them through it. It's like taking away the shame. It's like, I don't care if no pounds come off. I want you back in my office and tell me what was the block. Because then I know we need to adjust our plan. That's mind-body medicine. - I love that. - It's not having them meditate till they're levitating off the table. What is going on in their emotional sphere with their deep belief systems that's blocking them from being who they wanna be? And how can we love them through that to get them on the path to become who they want to become, not who I want them to become. Where do you want to go? I have no idea where they want to go. I mean, I hear amazing things like, why do you wanna get better? I wanna walk the Camino with my girls from sorority, my sorority sisters from college. I wanna be this way for my son's wedding. So, what is it that they want to accomplish and what's their why? And you're putting that all together in a meaningful way. So, you're taking the data, putting it into dialogue that provokes meaningful behavior change. - Wow. That is so powerful. I can't imagine that not being an integral part of this journey. Because you mentioned one of those buckets earlier was that emotional piece to the eating, right? - Yeah. It's huge. - Or the stress. Or all the things that are happening in all our lives that are causing us to do or not take care of ourselves, not loving ourselves. And I think that's a piece that's often missing, right? In how as a society we address this problem. We just look at it as just calories in, calories out, the science, but there's so much more. - It's about eating behavior. And there's many reasons why people eat bad and it has nothing to do with they don't know what's good food and bad. That's a non, they know. They know what's good food and bad. Why they're choosing the other choice has nothing to do with information. It does not. - Yeah, absolutely. - So, the other thing I just have to call out because it's a big problem and it's bringing me back to the '80s when I was in college is now with these GLP-1s, people that never needed to use them are using them to be skinnier than ever. And we're creating this new stereotype where everybody needs to be painfully thin. So, that's another problem that's happening out there is it's changing now all these young girls that don't have a problem are coming to me. I wanna be put on a GLP-1. You don't need it. I'm not putting a 16-year-old to lose seven pounds at her. You know, so there's all of this new stuff coming at women and men about, you know, what they should look like, image. And so I think that's a conversation for another day. - Absolutely. That's a whole different podcast, Monique. - A different podcast. - We've gotta do it. - But I'm keeping my eye on that story and I don't like it. It's bringing us backwards as a society. Like anything, it's using medications and botanicals with wisdom, with behavior change, and understanding what people's why is and what their limiting beliefs and blocks are. That's the winning formula is everything has its place. It's not an either or. It's an and, and a deeper understanding. That's what my functional medicine training has allowed me to put it together this way. - I love that. - I didn't put it together this way on my own. I was taught to think this way. - It's definitely a training. It's definitely a mindset. It's definitely changing, you know, how we do medicine, and the medicine that we do, right? - Bingo. Say no more. - Have you seen this variance in your practice that some groups do better on these drugs? - Yes. A hundred percent. - Genders, you know, men versus women. What are you seeing in your practice as it pertains to this research? - Well, listen, I think that's an excellent question. And it's super fun that they're getting some of this research so that, again, we can anticipate who could potentially have a problem. So, what I'm seeing is there's this subset of women and they're Caucasian women. And what I'm seeing is not so much the nausea, this is a whole other thing, where they actually, I put them on it and they get depressed on very small doses. So, I think there's more to this story. It's not just about nausea, it's about, you know, it's about it also impacts, it's a neurotransmitter in these ways. It's impacting the brain and mood. So, it's super weird. This is a strange pattern, but these are women who were happy, like overly happy and overt and doing well and small doses made them depressed and withdraw. So, it's acting like a neuropeptide. Then, who's gonna get nauseous? I think this is really cool. I've not tracked it like I should, so I'm gonna be honest about that. But I'm seeing less nauseousness if I start with like one milligram, you know, just for the audience that may or may not know this, most people in the general public that are going to a GP, they're getting up to 10 milligrams, 12 milligrams, 15 milligrams. So, one milligram is considered a microdose, suboptimal. They used to say won't even move the dial. Why are you wasting your time? Start with 2.5 and every month go up. That's the recommendations from Lilly. But because I'm starting so low, it's my litmus test. If they're nauseous on the low, what I do is even go lower and hold. And the body adjusts, and this is personal experience, I don't have research on this, but the body adjusts, and then the nausea goes away and I can play, jazz with it. But there's an adjustment period. So, I don't understand, like I'm tracking it. But I think it's super important for us to identify the genes, be able to predict, and also to be able to understand that just because we know the gene, someone can have the gene and you can do it and they can have no nausea. It's more complex than one gene. It's good data. It can predict in various ways, but you don't know until you throw it in. I mean, like anything in life, what do they do when you put it in and then you make a move from there? It's great that they're doing this. - Yes, it's so much multifactorial, right? You know, we have genes that do all kinds of things, but it doesn't mean that we have to be our genes. We're not our genes. It's the environment that triggers the expression of the gene, correct? - A hundred percent. So I mean the bigger question, Kelechi, I guess we're going down another rabbit hole, is if they have that gene, is that gene expressed? Does the nauseousness express more when they're under stress? And is it offset by the fact that it's lowering inflammation? I mean, I have a lot of questions about this, like, how it actually plays in the wild here with our, what I mean by the wild, like in a clinical setting, and not just in a test tube. - And what I love about how you are also approaching it is that this is not a one size fits all approach. - A hundred percent. Never is. - To body composition. You have to look at multiple factors. You know, there are multiple, there's behavior for sure. There's bridging. So, and you are thinking ahead and you are thinking of how can I help the person in front of me, man or woman, be more successful on this journey to experiencing optimal wellness? - Absolutely. To feel more like themselves. I mean, that's the whole game. - That's the game. - How can they feel more like who they are and who they were or who they want to be. I mean, that's a conversation. - That's awesome. Yeah, we've covered so many topics, so many things today. You and I can be on this call for a while, but suffice it to say that I mentioned earlier in the opening that you are gonna be a presenter at the upcoming Institute for Functional Medicine Annual International Conference in San Diego. And I know that you'll be presenting. Can you give us a little snippet, a little peek into what your attendees, your audience, will learn from you at the conference? - Well, everything we were just covering. I'm going to go into it in a little bit more organized way. And then I wanna leave a lot of time for questions because I want to know what the audience wants to know, not what I want to tell. So I wanna go back and forth with them to help them out in their clinic. So, I plan on covering this. They'll have the slides, they'll have the science, they'll have my, you know, it's not just my thought process. It's a thought process of IFM of how to think through this. And then I want lots of time for them to bring cases and ask me some questions so we can help them. - I love it. I cannot wait. I cannot wait. So, as we bring this episode to a close, Monique, what is the one big takeaway that you would like functional medicine clinicians to get from this episode today? - That it's complex, but we are trained in functional medicine to take complex problems, clarify them, simplify them, and work on the foundations. It's precision. Figure out, it's not no medicine, or everybody medicine, not no herbs or everybody herbs. Figure out what that client needs for sustainable change, for optimal wellness. And that's what we're trained to do. So, I'm not for or against anything. I'm for sustainable change that supports the patient's journey. That's what we're trained to do at functional medicine. That's why we're here. - I love it. I love it. Amen. And I really just love your approach. I love how you are embracing the whole patient. You are really identifying where they are. But you don't leave them there. You walk with them on this journey. - That's it. - So, it's about changing how we do medicine and the medicine we do. So, Monique, thank you so much. - You're welcome. Thank you. - And I cannot wait to see you again. - I can't wait to see you in person. Yeah. Big hugs from afar. - Thanks for being here. - See you in San Diego. - All righty. Take care, bye-bye. Thank you for listening to Pathways to Wellbeing. Discover the latest research and clinical insights at IFM's Annual International Conference. Learn more at ifm.org/aic. The future is functional.