This is a transcript of a discussion Dr. Rohn Rigby had on the Daily Diagnosis; Ogden Clinic’s podcast. Dr. Rigby asserts that there are many more factors at play when managing our weight than just diet and exercise. These are his seven pillars.
Intro: About Dr. Rigby’s Medical Weight Loss Practice
April: Hey guys, this is April from Ogden Clinic's marketing team.
Parker: And this is Parker from Ogden Clinic’s marketing team.
Rohn: Hi, I'm Dr. Rohn Rigby.
April: So, Dr. Rohn Rigby founded our medical weight loss program and this program started out in one clinic, Davis Family Physicians. It has since exploded in the last couple of years. He's now in four locations. Dr. Rigby, can you tell us a little bit more about your practice?
Rohn : Yes, obviously doing medical weight loss like April said. We're in four different clinics from Mountain View up in the North Ogden area, also at McKay Dee Hospital and Davis Family Physicians, which is in Layton. We’re also now in Bountiful with Bountiful Dermatology near the Renaissance building.
April: That’s amazing. And you’ve got staff members under you too, right?
Rohn: Yes, I have two nurse practitioners, one is Sheryl Bingham PA-C who is at McKay Dee two days a week and at Davis Family Physicians. Then Jonathan Wilson, FNP-C who is up at Mountain View (Pleasant View or North Ogden area). Then myself, I go down to Bountiful right now.
The Seven Pillars That Affect Weight Loss
April: Medical weight loss is one of our biggest specialties here at Ogden clinic and I'm sure if you follow us on social or if you've seen a lot of what we put out; we talk a lot about this medical weight loss practice. We generally hear that weight loss is tied to diet and exercise—those are the two big ones, but in today's episode what we want to talk about are some of the other factors that maybe we don't discuss enough that also affect our weight.
Dr. Rigby, can you talk to us more about some of the main factors that are affecting weight loss besides diet and exercise?
Rohn : Well I usually look at it as seven different pillars or key factors that affect weight loss; starting with the eating habits.
Second is exercise which we won’t focus on as much today. Also, your stress, your sleep, your gut microbiome or your gut health, your social environment, and one that we don’t mention enough is the medication you’re on that could be making things worse.
How Stress Affects Your Weight
April: Awesome, so let's break apart those pillars as much as we can. Of these seven pillars, which one do you want to start with?
Rohn: Let's start with stress. We live in a world of stress; we always make stress out to this horrible thing. I always tell people you have to focus on these stressful events in one of two ways.
Either what we call distress: I don't like my work, I am having some relationship issues, my teenager is driving me nuts, my financial situation is stressful. All of these are distress.
Then there’s “you stress”: I like going to work. I love my coworkers. I've got all these big projects that I'm working on, I don't want to go home early because I'm excited about my progress. It's growing; I'm developing. I'm in a brand-new relationship, everything's going great. It's almost going too fast but it's going in the right direction. My envornment is busy but it’s good; I enjoy what I'm doing. I call that “you stress”.
Parker: So, “you stress” is like good stress?
Rohn : Right, that's good stress. So, we want to look at these stressful situations and ask “What can I do to avoid distressful things and turn it into “you stress”. Maybe I need to change my approach; maybe I need to change my relationships with coworkers to put us in a better enviRohn ment where I’m excited.
Maybe it's my perspective I need to change. Perhaps I need to exercise more so that I can now deal with my stress effectively. These are all ways to transform distress into “you stress.”
April: That’s interesting.
Stress and Cortisol Production
Parker: Since stress does make you gain weight, is stress similar to a defense mechanism? Like: I'm going into hibernation mode because there's too much going on. What's the deal behind it?
Rohn: There are lots of different theories behind stress and weight gain. One of them is stress bumps up your cortisol level, which is a stress hormone. It's that acute stress: the fight-or-flight type that raises cotrisol.
I've sometimes used the analogy that if we're up walking in the mountains, they're nice and quiet. All of a sudden, you hear this crash behind you and you turn it's a big black bear, what happens? Your cortisol goes through the roof. Why? To either help yourself fight your way out of that situation or get your butt out of there.
That’s part of the reason why it’s so hard on our bodies to sit still all the time without a threat. We are still producing that fight-or-flight cortisol in stressful situations. Coritsol goes up, and what does it do to our bodies?
It dumps sugar into your bloodstream that your body can’t do anything with. Therefore, it has to bump up your insulin to now actually get into the cell. Now we traditionally have two options: We can either fight our way out or get your butt out of there. That’s why sugar bumps up our insulin.
But if we're not doing anything with that stressful situation physically, we're now pushing that sugar into the bloodstream because we're not using it as much, which leads to the weight gain.
Acute VS Chronic Stress
Parker: So, in situations like public speaking: You have that sugar in your blood but you're not exercising or doing anything to burn it off. So, that leads to weight kind of accumulating?
Rohn: It can, but again acute stress and chRohn ic stress or two different things. Acute stress (that excitement about it or scared about doing that public speaking or being on a podcast) can be a good thing. It gets you hyped up. It gets you more energy. It gives you the excitement to do what you need to do. But if we're getting into a more of a chRohn ic stress—an ongoing type of stress—that's now causing this ongoing response that can make it more difficult to deal with things where you're not seeing an end to the situation.
Chronic stress can look like: I don't like my job, I’m stuck here for another 20 years. Or another mundane situation; saying I'll just get over it, doesn't work. That's what we need to look at altering, trying to figure out what's going on with the situation. It’s where I recommend working with a therapist or someone else who can help combat the chRohn ic distress.
April: And weight loss is a benefit.
Parker: So, do you prescribe ever a vacation?
Rohn: Haha, I'm willing to write for it. I just don't know who’s going to pay for it.
April: Does insurance cover that?
Sleep’s Effect on Your Weight
April: So, let's talk about the next pillar: Sleep. I feel like we're hearing about the importance of getting enough sleep so much more now.
Rohn : Right. With sleep, it’s not just quantity, but it's quality. We always say “You should be in bed for 7 or 8 hours.” But it's not just being in bed, it's getting good REM sleep and being rested when you get up.
Unfortunately, our society puts a big emphasis in getting up. “I have to be to work, my routine is I have to be up at 6. Therefore, I'll try to go to bed. Well, the kids are up, or I need to finish my TV show, or gotta listen to this podcast.” Now we’re getting to bed later and later. We are not making sleep a priority.
Creating an Environment for Quality Sleep
Rohn : We also should look at the environment. Sometimes, especially if you share a room with somebody, they might like it warm and you like it cold. They like it with noise, you like it quiet. So, try to find that environment that really helps you get that best rest. It’s called sleep hygiene.
Find a temperature that helps you sleep better. Think about sounds, do you sleep better with a white noise machine? Try to have ample darkness when you sleep.
April: Interesting. So how does better sleep improve our weight loss efforts?
Rohn: Studies have shown that if you're actually rested in the morning, you’re less likely to reach for that sugary treat at 10 am or need a handful of M&Ms after your meeting. A lack of sleep actually spikes hunger hormones, especially for carb-rich and convenience foods.
Parker: I felt like you were describing my life.
April: Sounds like you need some better sleep.
Sleep Apnea and Difficulty Sleeping
Rohn : There are 3 people in this room, we all might need different amounts of sleep. So, try to figure out what works best for you as far as adequate sleep and environment.
If that's not still not working, then talk to a doctor. Maybe we need to do a sleep study, especially with if you’re overweight. It’s possible you may have sleep apnea. That’ where your airways are being blocked off and you’re not sleeping well. We have a great sleep department here at Ogden Clinic that performs sleep apnea testing and treatment.
Pillar 3: Your Gut Microbiome and Your Weight
Rohn: There’s a lot of research coming out about the gut and gut health. The lining of your large and small intestine has bacteria which help your body break and absorb nutrients. A healthy gut microbiome is one that absorbs nutrients in the food and breaks down effectively, but a lot of factors play into gut health.
There have actually been tests where you can take some of the gut bacteria in an overweight mouse and put it into a skinny mouse—that will cause the skinny mouse to begin gaining weight.
April: That's crazy.
Rohn: Research about the gut microbiome is still in it’s infancy, but we do know that it plays a very big role in our cravings, nutrient absorption, and weight.
Pre- and Probiotics
Rohn : I will encourage people to take a probiotic, as well as eat pre-biotic foods to work on getting the right type of bacteria in the intestine.
Parker: Okay so a probiotic, like in yogurt?
Rohn : Exactly, a live culture food. Now the thing you have to be careful with yogurt is that most yogurt is more of a dessert with the added sugar. So you can try plain Greek yogurt and pair it up with a probiotic supplement.
April: What are some prebiotics?
Rohn: Prebiotic type foods would be sauerkraut, kombucha, kimchi, and my favorite, pickles. Any type of fermented type vegetables can definitely be a good option.
April: Interesting.
Parker: I like me some pickles.
Rohn: Gotta have kimchi, come on.
Pillar 4: Social Environment
Rohn: We want to have people in our lives who understand what our goals are and support us in them. That’s why I joke that it’s easier to work with women than men on weight loss. Let’s say a woman is married or in a relationship; playing the odds of society the probably does some of the cooking.
When she starts eating cleaner, she’s not going to cook two different meals. She has a lot of influence on the people around her to eat healthy since that’s what’s for dinner. I think having that discussion about eating better food and getting everyone on board is an excellent support system.
Parker: And countless times in social situations, you may not communicate that you’re trying to eat better then you feel pressured to eat junk food or eat it as a reward/ celebration.
Rohn: Unfortunately, in our society food is a reward. You showed up to work: here’s a treat. Scored a goal: here’s a treat. Passed a test: here’ s a treat. And there’s nothing wRohn g with a reward system, but it doesn’t always need to be food.
Pillar 5: Medication
Rohn: First off, your doctor is not intentionally trying to derail you, but the fact is a side effect of some medication is weight gain. That's something to think about if you're if you're on multiple medications. Medications that cause weight gain are considered “weight positive.” It’s another risk factor if you’re trying to lose weight.
April: So, can patients on weight positive medication visit you or visit one of your nurse practitioners so to have a look?
Rohn: I'm always willing to talk to anybody, but I also encourage them to talk to their primary health provider. Tell them your concerns and see if adjustments can be made. If you’d prefer to see my staff, we are in four clinics now like I mentioned.
7 Pillars Summary
Rohn: So, in summary, those six things that we talked about is your eating habits, your exercise, your sleep, your stress, your gut microbiome, the gut health, your social enviRohn ment but that last one to consider is the medications you're on.
April: It sounds like it's a lot more than just exercise. So, thank you for sharing those other factors with us. If you want to learn more about Dr. Rohn Rigby, he has his own website, utahmedicalweightloss.com and then you can also visit us at ogdenclinic.com.
