Weight Neutral Medical Care and Advocacy Against Weight Stigma with Dr. Michelle Tubman

If you’ve ever been told you have to lose weight for health reasons, or if your medical problems always get blamed on your weight, or you fear going to the doctor because they might comment on your weight - this is the episode for you!

Our guest today is Dr. Michelle Tubman a Canadian physician who operates from a health at every size approach.

In our conversation Michelle set the record straight on what really contributes to poor health outcomes, and spoiler alert - it’s not the number on the scale.  She shared her opinion on the theory that “obesity” is a disease and discussed the very real health risks of repeated weight loss attempts.

You’ll leave this interview with a very clear plan on how to handle the conversation and advocate for yourself if you’re told that your weight is to blame for your health problems and are told that losing weight is the answer

About Our Guest

Beautiful, healthy, fabulously fulfilled, you don't need to change your weight to have it all. You just have to change your mind. Body acceptance advocate Dr. Michelle Tubman is the founder of Wayza Health and the host of the popular podcast, Thrive Beyond Size. Her coaching programs are designed to liberate women from the dangerous diet culture that's dominated their lives since they were old enough to understand a world in which their weight determined their worth. A now-reformed chronic dieter who struggled with shame and low-self-esteem, Michelle set out to find the answers. She is certified in eating psychology, binge eating treatment, intuitive eating and life coaching. As a physician, she is triple board certified in obesity, lifestyle, and emergency medicine. 

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Health at Every Size Resources

About the Host

Kim Hagle (she/her)  is a Body Image Coach, Certified Personal Trainer, Registered Holistic Nutritionist, and founder of Radiant Vitality Wellness. 

Through mindset and movement coaching she helps women develop a kinder relationship with their body so they can consistently fuel and move it in a way that supports their health without restricting food, doing tortuous exercise or constantly worrying about the number on the scale

New Here? Join our exclusive email community: Embrace Your Radiance is our weekly email series that helps women overcome feeling limited by their body. Each week you'll receive exclusive coaching tips to help you feel healthy, happy and confident no matter what the scale says. As a subscriber, you'll be notified when new podcast episodes drop and will also be the first to hear about all of my free and paid offers. Emails come out every Sunday at 7 pm.  

Want to feel good in your body at any size?  Register for our FREE mini course. Learn simple, sustainable habits and mindset shifts so you can feel healthy, energetic and confident without rules, deprivation or willpower

Ready to take the next step?  Book a free consultation call to discuss how coaching can help you reach your goals.

Let’s stay in touch! Kim is on Instagram and Facebook @radiantvitalitywellness 

Disclaimer.  The information contained in this podcast is for informational purposes only and is not a substitute for medical advice.  Always consult a health care professional about your unique needs

Transcript

MacBook Air Microphone: 0:47

Hello, and welcome back to another episode of the Power in Motion podcast, the show for women who want to feel great in and about their body, regardless of size, so they can live their fullest life. Now, if you have ever been told that you have to lose weight for health reasons, or if your medical problems always get blamed on your weight, or you fear going to the doctor because they might comment on your weight. This is the episode for you. I'm your host, Kim Hagle, certified body image coach, size inclusive personal trainer, and non diet nutritionist on a mission to help women just like you develop a kinder relationship with your body so you can consistently fuel and move it in a health supporting way without restricting food, doing torturous exercise, or constantly worrying about the number on the scale. I have A great interview planned for you today. Our guest on the show is Dr. Michelle Tubman, a Canadian physician who operates from a health at every size perspective. In our conversation today, Michelle set the record straight on what really contributes to poor health outcomes. And spoiler alert, it's not the number on the scale. She shared her opinion on the statement that obesity is a disease and discussed the very real risks associated with repeated weight loss attempts. So you're going to leave this interview with a very clear plan on how to handle the conversation and advocate for yourself if you're told that your weight is to blame for your health problems or you're told that weight loss is the answer to your health problems. So let me tell you a little bit about Dr. Michelle. Body acceptance advocate Dr. Michelle Tubman is the founder of Wayza Health and the host of the popular podcast Thrive Beyond Size. Her coaching programs are designed to liberate women from the dangerous diet culture that's dominated their lives since they were old enough to understand a world in which their weight determined their worth. A now reformed chronic dieter who struggled with shame and low self esteem, Michelle set out to find the answers. She is certified in eating psychology, Binge eating treatment, intuitive eating, and life coaching. As a physician, she is triple board certified in obesity, lifestyle, and emergency medicine. Now all of Michelle's links that we mentioned in the show are in the show notes, and if you want to check out her podcast or her programs. I've also linked to some of the resources that we mentioned in this podcast, particularly the HAES, Health at Every Size, fact sheets and letters that you can share with your health professionals to advocate for yourself in the doctor's office. Now one more thing before we jump into this interview, I want to remind you of the upcoming workshop I'm hosting on April 18th, 2024 at 7 p. m. Eastern Time called What the Health? It's a workshop that's going to help you identify your own health goals and create a unique, individualized action plan to achieve them. During our 90 minute workshop, I'm going to help you to create a definition of health that makes sense for you and feels simple to attain so you can stop wasting your time with things that don't matter. I'm going to help you identify your top four health goals. and how you'll measure your progress so you'll know if your efforts are working. I'm going to teach you my revolutionary method for setting goals that actually stick so you don't get overwhelmed and give up on yourself. And then I'm going to support you to create your own action plan so you would know exactly what you need to do and the steps you need to take to move forward and start feeling your very best. It's going to be very hands on and practical. No school slideshow or script or me dictating what you should do. I'm going to be using my coaching process to help you create your own goals and game plan. And there's going to be lots of time for discussions, questions and individualized coaching too. So you can go get registered for that at the link in my show notes or on my website, radiantvitality. ca slash health. Okay. So let's jump into this interview with Dr. Michelle Tubman. I hope you enjoy it as much as I did.

Kim: 5:04

Dr. Michelle, welcome to the Power in Motion podcast. I am thrilled to have you here and for the conversation that we're going to have about weight and health and weight stigma in health and then how we can advocate for ourselves in health care. Welcome and thank you so much for sharing your time with us today.

Dr. Michelle: 5:26

Oh, thank you, Kim. I'm very excited to be here. And I think this is such an important topic for us to discuss. So I can't wait to dig in.

Kim: 5:34

Me too. Me too. I am so excited. Okay, so before we get into the really good meat and potatoes of all of this, can you just tell us a little bit about yourself and the work that you're doing today?

Dr. Michelle: 5:45

Sure. So my name is Michelle Tubman and I am a physician. I'm actually triple board certified in emergency medicine, obesity medicine, and lifestyle medicine. And the reason why I have all of these additional certifications is because I have struggled with weight my entire adult and adolescent life. It has something that's. Defined who I thought I was as a woman forever was an overweight woman and then an overweight physician and during the pandemic as an emergency physician at the beginning of the pandemic, the messaging was don't come to the E. R. Unless you're. You are super, super sick and need to be there. And what that meant was we were not as busy as usual. And I had some time and with that extra time, I decided I was going to become a coach. Cause that felt like a very positive thing for me to do to counteract all of the, you know, the struggles and the challenges in the early stages of that pandemic. And I decided I was going to be a weight loss coach initially, because that's what I had been struggling with. the most. And for the first year of my career as a coach, it didn't feel right. And I couldn't really understand why, like, I felt like I was doing harm to clients by coaching them through weight loss. And it didn't make sense to my mind, because I grew up as a woman inside diet culture, and I trained as a physician. Physician inside diet culture, and what I believe to be true at the time was that weight loss was the way to better health. Weight loss was the way to more happiness. Weight loss was just the solution to all of our problems as, as women. And I thought that the reason why it didn't feel right for me. for me was because I didn't know enough about it. And that's why I went and did training in obesity, medicine and lifestyle medicine. And all that training did was increase the confusion because I would learn about the science and I would learn how. diets cause harm. I would learn how yo yo dieting is really responsible for a lot of the chronic diseases that we associate with being overweight. And I learned that over the long term diets just don't work. And then at the end of the lecture, after acknowledging all of this, The, the, the, the lecturer would say, but still we have to encourage people to lose weight. And so thank goodness we have surgery and medications. And so none of that ever really, you know, felt, felt right for me. And so I took it upon myself to start reading the science on my own, not inside an academic you know, container. And that is where I learned about the health at every size movement and intuitive eating. And so now I am a health at every size provider as a physician and now I coach intuitive eating and health at every size and my coaching program. Are really all about helping women feel at home in their bodies again, be comfortable in their bodies again and heal their relationship with food and start to challenge diet culture and the stigma that we often face as women living in bigger bodies.

Kim: 9:05

Oh, I love that. And I am. I'm so thrilled that you took it upon yourself to, like, dig into that discomfort that you were feeling and the harm you felt you were causing and, like, take it upon yourself to educate yourself about the truth and then change your practice like that. I feel like that's a bold move in today's society and it takes a lot of work.

Dr. Michelle: 9:30

It's certainly a counterculture move. Right. And I like to tell my story that I started off as a weight loss coach because I think this is where we all start because we get the message from literally everybody, our family, our friends, our mothers, our doctors, the media, social media, everything tells us that if we're not thin, then we better lose weight. And if, if, you know, if we haven't lost the weight, then, then we at least better be trying. And then there's some redemption there for us, right? And so, you know, I think, I think the, the baseline for most of us is to truly believe that thinness and weight loss is, is the answer. And so it actually, it actually takes some courage and a little bit of, you know, reflection and some, some deep work to really start to challenge all of that around us. And so it was a huge process for me. I went and got. two freaking board certifications trying to trying to figure it all out. Right. And so it's, I like to tell that story cause I, I think we all have to do that work to, to really step back and take a look at how our current culture is affecting us as women.

Kim: 10:43

Yeah. And I think that your story is not unique. Amongst the Health at Every Size community and professionals, like, so many of us have all the education that we have because we were trying to figure out the way to lose weight, like, as if all the things that are out there don't work. Like, well, I'm just going to study more. I'm going to learn more. Like, that's what happened for me, right? I became a personal trainer. I went on to become a nutritionist, like, give me all the education so I can finally figure out what the magic thing is that I'm missing. And then, you know, by the time you educate yourself enough, you realize like, oh, there actually isn't. And this is all a very flawed, flawed system.

Dr. Michelle: 11:23

So true. So true.

Kim: 11:25

So let's talk specifically about some of the harms that you felt or that you were seeing as you were practicing under the weight centric approach. And what do you continue to see as the harms that come out of the weight centric health paradigm?

Dr. Michelle: 11:39

Oh gosh, that's, that, that, that's a big question. I think I think before I answer that question, I want to, but I want to be clear about what we mean when we talk about the health or the, the weight centric paradigm, because I think, I think a lot of women are beginning to question dieting and, and are starting to understand that over the longterm, it just doesn't work because we all have these personal stories of decades of trying and over the decades our weights, you know, just, just keep, keep getting higher despite, you know, trying every, every diet out there. And I think what has been happening is we're starting to use different language to talk about the same thing. So we're now. Starting to see lifestyle changes and you know, healthy habits and, you know, other, other languaging that suggests we're not actually doing weight loss. We're doing a lifestyle change. We're doing, we're doing this, but then the goal is still weight loss. Loss. Okay. So I, I like to clarify that because often when I start having conversations about this, people will say, but this isn't a diet. This is a lifestyle change. So I want to be clear if you're doing anything to try to shrink your body, no matter what you call it, it's, it's still a diet. Okay. So when we, when we look at the harms of, of dieting or intentional weight loss, there's, there, there's so many. And I think. We can talk about the physical effects for sure. And I will, but I think one of the bigger problems and what really made me feel uncomfortable was every time I told a woman that she had to lose weight or I offered support for her weight loss, I was telling her that she wasn't enough as she is. And that hurt my soul. And the message that I was telling myself is, well, then clearly I'm not enough either. If I'm still living, living in a bigger body, And this is how the diet industry and diet culture gets us and how it causes us to spend, you know, 71 billion a year is because it sends this message that you're just not enough as you are right now. And we all are enough as we are exactly right now in, in, in the bodies that we have. And so I think as long as we're thinking that we're not measuring up because we're not thin or we're not deserving of. The job, the love, the life, whatever, whatever you want for yourself, because you live, live in a bigger body. I think that's, that's the hugest harm and sending this message that, you know, it's, it's not okay to take up as much space as you take up as a woman in a bigger body is, is what does the. the biggest damage. But in addition to that, there's also physical harm that we cause when we are trying intentional weight loss. So any sort of calorie restriction or restricting certain food groups causes harm to the body. And so the body is biologically designed to hold on to its weight, right? So back, back in our evolutionary history, as a Early humans, food was not as easily available as it is now. Right. And so there were periods of time where food was available to us and longer periods of time where we had famine and food wasn't available to us. And so our bodies were designed to hold on to all of that energy so that we could survive those famines. When you go on a diet, your body doesn't know that you're doing this intentionally. Those same biological mechanisms that allowed us to survive. Famines as early humans kick in for us today, and it really causes us to hold on to, to all of the weight, okay? And so this is why diets just don't work. So you can, you know, restrict yourself in the short term and lose weight on almost any diet out there, but after about six months to a year, the weight starts, starts to climb back on. And, and the science is pretty good. pretty clear that after about two years, 95 percent of people will have gained the weight back and two thirds of those will have gained even more weight back. And that's just, you know, biology and the problem with repeated. Attempts at weight loss or yo-yo dieting that we like to call it is, it's that fluctuation in weight that is really associated with the development of heart disease and diabetes and some of the other chronic metabolic diseases that we associate with being at a higher weight. And so we actually cause harm physically. With repeated attempts at weight loss.

Kim: 16:20

So I just want to reiterate that point because I think this is a really good one to hammer home is not the BMI itself. That is the risk factor. It is the fluctuations of weight that contributes to those so called obesity related diseases. Am I hearing you right?

Dr. Michelle: 16:37

You're, you're, you're absolutely correct. And the BMI is bullshit, complete nonsense. I like to call it the bullshit meter index actually, because it truly is completely, completely meaningless. You know, Tom Cruise is the best example of this, right? Like by BMI because he is a short guy. He's actually classified in like the obese category, which is, is that right? No. Yes. Yes. It's absolutely ridiculous. So it. Like that, that example just drives home the fact that, you know, BMI is really, truly meaningless and not all doctors know that doctors will still record your BMI when, when you go, when you go to see them. And, and, you know, this is just one of the reasons why we have to educate ourselves so that we can we can have these conversations with people who think otherwise. Yeah. Yeah, so with so

Kim: 17:25

much evidence to the contrary, and, and it, like, you're not the first person I've, I've had on the show or, like, that has said, It's not the weight itself. It's the fluctuations of weight or the lifestyle factors. There's that involved.

Dr. Michelle: 17:39

Sure. Sure. Here's another, another thing that they'll often not talk about, but the science is also very, very clear that if you look at your fitness level you know, and, and With weight, it totally takes away any effect that being at a higher weight has on developing these, these chronic diseases. So if, if you are living in a bigger body, but still getting exercise, a lot of that risk, you know, goes, goes away. But we don't, we don't, we don't talk about that. We gloss over that part.

Kim: 18:12

Yeah. Yeah. And so why do you think that is? Why do you think with all of the evidence that it's not about BMI, it's not about weight, why do so many health professionals still. Operate from that perspective,

Dr. Michelle: 18:25

because the dominant cultural paradigm right now is that thin is ideal, okay, and it's very much industry, industry driven, right? If you think of it's 71 billion per year, that the weight loss industry, industry drives. And so if, if you think about it, You know, and you can read about the history of this, right? Because if you think back 100 years ago, bigger bodies were actually considered beautiful and healthy, right? And there were actually programs and diets to help you gain weight. And then, you know, it's at some point and you can read about the whole history of this, all of that changed. And once culture sends this message that this is the accepted body, this is the healthy body. body. It just becomes something we don't question anymore. And when you also look at a lot of the studies that are done when it comes to, you know, weight science and metabolism, a very large proportion of it is actually funded by By by the weight loss industry. So there's lots of people out there, you know, that's that stand to make a lot of money from us thinking that we, that we need to lose weight. And that's not true for doctors. Doctors don't get paid, you know, for, for helping their patients lose weight, but we, but we are all growing up and trained in this. culture that just tells us thin is in. And so people don't question that because it just feels, feels so true. Feels so true.

Kim: 20:01

And now that there are medications and, and though the doctors are not getting kickbacks and they're not paying to prescribe these drugs, it's, it's very much in their face that there is this new solution.

Dr. Michelle: 20:13

It's very much in their face. And, and you know, as a physician, and I mean, I practice emergency medicine, so I don't, I don't, You don't necessarily have a lot of conversations about weight with patients, but when you look at, you know, family physicians, and when I have conversations with my friends who are family physicians, what they say frustrates them the most is patients who come to them with weight loss because nothing ever works. And so they feel helpless. And so now they're very excited that there's now these drugs on the market. That, you know, on the surface of it looks like they're, they're quite effective. Of course, you know, they're not over the long term, just like everything else. And we can have a whole other, other conversation about that. But, but, but they're just as excited to finally see results in their patients, as Patients are, you know, to see results in, in, in themselves. And so I think, I think this is a bit of a challenging time because of these new, new drugs on the market, but we we've actually been through this before with so called miracle weight loss drugs in the past. And I, I'm sure the same story is going to kind of unfold over the coming years as well. And so I think the work really is to have conversations like this, you know, Kim, it, and to really start. Educating people to ask questions and to push back when, you know, their doctors are really pushing for for weight loss, because there's a good chance that they also just aren't aware of, of what the science actually says about all of this.

Kim: 21:39

And I want to talk about those questions that we can ask of our health professionals. But there's one other thing that just popped into my mind that I want to ask you first. I'm hearing a lot lately in the media, especially with, we're recording this just after Oprah had her big special on TV. And the big theme of that was that obesity is a disease. And I'm using obesity in air quotes and disease and air quotes and At least in the special, there was a lot of talk about it's a disease, it's not your fault, like likening it to like being an alcoholic, that some people just have this tendency. And it didn't, it doesn't sit well with me, but I'd like to hear your opinion about obesity as a disease.

Dr. Michelle: 22:21

Yeah, so this is such an excellent question. And when I first started my training in obesity medicine, I liked this idea. of calling obesity a disease because it does take away some of the personal responsibility about it. Right. And so initially I thought, Oh, I like thinking about it this way. As I learned more and sat with this, It became the same experience you had this. None of it really, none of it really felt right. And the reason is because when we call something a disease, we pathologize it, right? We're saying that, you know, it's wrong. It's unhealthy. It's something that we need to treat or fix. And this is where the health at every size paradigm comes from. Because when we say obesity is a disease, We're automatically saying everybody who lives in a bigger body is unhealthy and needs to be fixed and that's just not the case. I love to use myself as an example. I live in a bigger body and I have perfect blood pressure and my fasting glucose and my hemoglobin A1c are perfect. My cholesterol levels are much better than normal. Then average my family doctors always asking how why I'm an active girl. I move every day. Like there's I have no pain. Why am I unhealthy? Why am I healthy? Just because I live in a bigger body. And the other problem with that is. this is that it goes the other way as well. So we have become so used to thinking that it's people in bigger bodies who are at risk for heart disease and diabetes and all of the other things. And so when you go to your doctor and you're in a bigger body, they're automatically going to do this blood work, you know, to screen for you. If you're in a thinner body, they're going to have this assumption you're healthy and you don't have these. Things. Mm-Hmm. And they don't do the screening as often. And so I have seen numerous patients in the emergency department who are presenting with diabetes because nobody screened them because they were in a thinner body. And so by pathologizing obesity and calling it a disease, we're labeling everybody who lives in a bigger body, which is often subjective. Be because the BMI is, is, is. is not, not reliable as, as we've mentioned before. And so we're, we're making assumptions about people on all ends of the weight weight spectrum about their health based, based on size. And then, you know, as, as we also, you know, said earlier, even if you are in a bigger body, if you're getting movement in that takes away, you know, a lot of the rest. And so it's so much more complicated than, than just weight. And so I, I don't agree with calling obesity a disease and, you know, I certainly don't agree that there's an epidemic of obesity either and, you know, that's a whole other conversation we could have also.

Kim: 25:20

Yeah. Yeah. I'm so glad I asked you that question because that was a beautiful explanation and exactly what I needed to hear to like reconcile this dis ease I felt about that statement.

Dr. Michelle: 25:30

Yeah. Awesome.

Kim: 25:32

Okay. So I want to talk about How we can advocate for ourselves as patients when we're, when we're told that our problem is related to weight and the solution is losing weight, that's the reason I'm asking is because this recently happened to me. Like you, I'm a, I'm a very healthy person. I, I do have a high BMI, but I'm overall very healthy. I recently found out that I have fibromyalgia, and along with that came an elevated A1c. And that was the thing that flagged my doctor that, well, it's because of your weight, and I was recommended Ozempic. I specifically asked my doctor, is there anything else that could be contributing to this because I have a very healthy lifestyle? And he specifically said, no, it's your weight, you're insulin resistant, you must lose weight. So I, I told him I needed some time. I refused the Ozempic and I'm happy to report three months later that it has completely resolved. I have like completely normal A1C now without losing weight. So I know it wasn't about my weight and I can't wait to have that conversation. You know, it was still really, at the time, it was really triggering, and I was like, oh my gosh, am I like, am I misinformed? Like, am I being irresponsible in my work here? And, and I have tools, I have knowledge, and I went and sought out information, but So many of us, we just take what we're told, right? And we don't think to Christian. So what can we say? What can we ask when we're told you must lose weight? Your problems are completely related to your weight and you have to lose it.

Dr. Michelle: 27:03

So these are not easy conversations to have. I'm going to start off. You know, saying that because doctors are, are still stuck in this weight centric paradigm. And I also just want to clear the air right away and say that weight does not cause insulin resistance. Insulin resistance causes weight gain. It's the other. around. All right. So it's, it's, it's not. And then the second thing is ozempic is not a treatment for prediabetes either. So they're just want to put that, put that out there. But when you are having these conversations with your doctor, there's a few things to always keep in mind. And so what I like to always counsel patients to do is have a goal in mind when you go to see your doctor. Okay. So you know, what's, what's an example if I'm going to my doctor because of knee pain, my goal might be to have a strategy for addressing my knee pain and to make sure that that Is a strategy that feels right for me when I leave. So if I go to the doctor and the doctor simply says, Well, if you lose weight, then your knee is going to feel better. And, you know, then you might question, Okay, well, it might take lots of time to lose weight, Or I don't want to lose weight, or, you know, whatnot. And it's okay, well, but what can I do right now in the meantime to help? to help with, with the pain in my knee. If you are brave enough, one question I love to ask is, you know, if I were a thinner person coming in with this knee pain, what would you advise me to do? And that, that can actually be a quite powerful question that, that will cause doctors to stop and, and think for a second. It's an excellent question to ask whenever somebody is just. Suggesting weight loss as well. Okay. But if you know, someone in a thinner body was coming with, with these problems, you know, what, what would you advise them to do? And, you know, in, in the instance of fibromyalgia and suggesting weight loss, you know, you could also just ask you know, doctor have, you know, do you have any, you know, thinner patients that also have fibromyalgia, right? Cause then it just, it just gets them. To think so. I think that's that that's the number one thing. Second thing is sometimes it helps to send a letter in advance of your appointments. So if you send a letter to your doctor saying that I am not interested in having a conversation with you about my weight. I don't wish to be weighed in the clinic. I am however, interested in learning ways that I can help prevent diabetes aside from weight loss. And just, you know, be very clear in, in the letter. And then that saves some time when you, when you go in for your appointment as well. There's actually, if you go to the. The health at every size website, there's actually letters there that you can print off and either take with you or send to your doctor ahead of time. And then I think there's two things that are so important when it comes to making decisions about what you want to do with your doctor. And one of those is informed consent. And the other is what we call shared decision making. Okay, so you and your doctor work together as a team. Okay. The doctor isn't the boss, right? Doctor is somebody who works for you and you make decisions together. And so you know, using Ozempic might be a great example of, of how, how this would work, right? So the informed consent piece means that your doctor has to tell you all the Potential. benefits of taking those MPIC. They also have to tell you all of the potential harms and all of the potential downsides and give you the full, the full picture. Okay, so that's what informed consent means. Is that you have to understand The risks and the benefits of either taking or not taking whatever medication or intervention they're they're offering for you. Okay. And so you, it's okay for you to ask questions of, okay, well, what are the downsides? What are the risks? What are the side effects? What might happen if I don't take it like and, and have, have the conversation and get all of that information from the doctor. And then when it comes to the shared decision making piece, it's, you know, our, our relationship between patient and doctor is not meant to be perspective. It's meant to be a conversation. And so you get to decide if you want to move forward with their recommendations or not. And that's a conversation that you have together and the doctor should respect, you know, the decision that you make. And if they're not, then, you know, that might be. be a signal that it's time to find a different a different health care provider who, whose values are more in line with yours.

Kim: 32:01

Which is hard to do in Canada, I have to say. Like, it's a different model than over in the USA where you can, you can doctor shop and switch any time you want. That's tricky, but it can be done. Right. And maybe it's,

Dr. Michelle: 32:15

you know, it can be done and, and it's also I think lots of people feel a little bit intimidated when they go to the doctor and, and I do understand that, but it is also okay to advocate for yourself. So, you know, if, if you even can just say, you know, I don't feel ready to make a decision right now. I book another appointment in, you know, a couple of weeks. So I have some time to think about it and to read about it. Right. And you know, most doctors should be okay with, with that. And if they're not, I mean, I, I'm Canadian too, and I understand how very difficult it is to find a family doctor, but you know, there, there are doctors out there who you know. Who will have these conversations with you.

Kim: 33:03

And for the sake of argument, because I know our listeners, I gotta hear it at least weekly that people come to me and say, I have to lose weight though for health reasons. How many times is that statement actually true? Where you must, like on a percentage scale, how many times is it true that you have to lose weight to improve your health?

Dr. Michelle: 33:23

Oh, geez, to give you a percentage. That might be hard for me to do, but it's rare. It's, it's, it's rare. There are numerous studies, for example, one that came out within the last year that show that people in bigger bodies actually have better surgical outcomes for, I think this study was knee replacements. It might have been hip replacements, but I, but I think it was knee replacements that people in bigger bodies. Yeah. actually have better outcomes. And yet almost everybody is going to get The advice to lose weight before you're considered for hip or knee replacement surgery, right? And, and so in, in this instance, we, we know that there actually isn't any, any, any additional risk, right? And you know, as we talked about earlier in this episode, there are risks associated with weight loss as well, right? And so we actually do a little, a lot of harm when we counsel patients to, to lose weight. Almost all of the chronic diseases that we typically associate with overweight can be managed with changes to how we move our body and changes to how we eat, how we sleep, how we manage stress and, and other things. And so, you know, I, I can't, I'm trying to think of. of an answer where, you know, weight loss might be the solution. And I'm like, I'm drawing a blank. So

Kim: 34:48

I just, I really wanted to ask that because I wanted people to hear that when you, when you hear that you have to lose weight, there's probably there, there is another solution. To

Dr. Michelle: 34:57

well, there always is. And this is the thing. And I get so angry because people will often make the assumption that People in bigger bodies can't exercise or move their bodies, right? And that is not the way, you know, to approach this is, you know, there are so many ways like chair yoga and like, there are so many different opportunities. And if we actually take the time to figure out, you know, what is actually going to work for your body, how can we, How can we get you moving? How can we get your heart pumping a little bit rather than just making the assumption of, well, you're in a bigger body, it's impossible for you. Right. And, and I think that's what the weight centric paradigm does is just make all sorts of assumptions about what we can and can't do. And so then the default becomes, well, lose weight. And then I can tell you.

Kim: 35:50

Yeah, but yeah, but really when we're prescribing weight loss, we're actually Prescribing weight gain long term like

Dr. Michelle: 35:56

that is sort of it. That is 100 percent what, yes. And, you know, here's something that I love to describe to really drive this point home. So if you look at the eating behaviors that we use to categorize people as having disordered eating or an eating disorder, these are the very same things that we counsel big, you know, people in bigger bodies to do. Like, just, just let that sink in for a minute. Right? And so we are truly judging people based on the size of their bodies. And, and it's, it's so harmful and wrong.

Kim: 36:32

Mm hmm. Yeah, it's true. If a person were in a small body to begin with, and we're eating only 800 calories a day, we would probably hospitalize them, but it's totally acceptable. And To prescribe that to a person in a larger body. It's the same behavior. It's just as risky.

Dr. Michelle: 36:49

And not, not only would we prescribe it, but if patients come in and say, this is what they're doing, we celebrate it. Right. It's, it's, it's insanity. Yeah. Yeah.

Kim: 37:01

You have really shed a lot of light on this conversation and explained these things in such a tangible way. I know that this is going to be so valuable and helpful to those listening. Is there anything else that you feel is relevant to add to this conversation before we sign off on this, Michelle?

Dr. Michelle: 37:18

Yeah, I think it's, this is a process. I think, I think it's a process. And when you're starting this work, I think you just have to make the decision that I am going to stop attempting weight loss for now. And I'm going to experiment with looking at how I can start making myself feel better. Without weight loss, you know, being being the goal and to look for a team of professionals that can help you do that Right, and so that the health at every size website is a great place to go to get printouts that you can take to to your family doctor Yeah Absolutely do that I am working on, it's not anywhere near ready to go live, but for Canadians in the audience, I am working on creating a nationwide directory of health at every size providers, not just physicians, but also, you know, physiotherapists, nutritionists, trainers, you know, people who who get this that you can, you know, Go to if you if you need a health practitioner, that's that's going to be on on your side and to just understand that you will come up against, you know, resistance and lots of questions when, when you start to advocate for yourself in this way, just because it is counterculture right now, where we're asking you to, to put aside that weight centric. Paradigm. And instead look at this, you know, how can I, how can I work towards being healthy if that's what I want for myself, right. Without weight loss being the means the means to get there

Kim: 39:05

and the measurement of it, right? Like that's the other part of it.

Dr. Michelle: 39:08

Yeah. Yeah, yeah, yeah, absolutely. And I feel like if I can do it after like literally 40 years of, of being stuck in this weight centric paradigm oh my gosh, it's so beautiful on the other side. So it's never felt better. I've never felt healthier. Like this, this is. This is a beautiful place to be. Do I not have my moments where every once in a while, I think, God, wouldn't it just be better if I could, I could lose weight. Of course it is because, you know, I, I, I have to, you know, I just came back from this amazing, you know, trip to Africa. Right. And, you know, I had to contend with uncomfortable airplane seats and all of the things. And, and so I still have to live in this very weight centric weight world. And so I'm not perfect and I have my moments. But, you know, for the most part, Oh my gosh, so much better on this side.

Kim: 40:03

Yeah. You wouldn't trade the peace and the freedom for all of the obsession and insanity that goes along with trying to control your body. And I wholeheartedly agree. Much nicer place to live for sure. Well, I am, I am so glad. So thankful for you coming on and, and sharing this knowledge with us and our listeners. Before we leave, can you just tell us about your offers and services and where our listeners can keep in touch with you?

Dr. Michelle: 40:30

Sure. So I'm on Instagram at Waza Health. That's W-A-Y-Z-A Health. I also host a podcast called Thrive Beyond Size, and you can find that on, you know, Spotify, iTunes, or www dot. ThriveBeyondSize. com. In April, I will be launching a new course that really talks about all of what we've explored here today in, in greater depth and also introduces how we can use intuitive eating to help with all of this. That course will be called Nourish Yourself, Body and Mind. And it comes along with six month coaching as well. So that'll be coming out in April and you can find out more about that on my Instagram account or on my website, which is ways of health. com.

Kim: 41:18

Fantastic. I highly recommend following Dr. Michelle on Instagram and listening to her podcast. It is so good. And that's like, that's how I found you and why I wanted to invite you on this podcast. So much. Thank you so very much for sharing your wisdom today. It's just been such a valuable conversation.

Dr. Michelle: 41:36

Oh, thank you, Kim. I had so much fun and thanks so much for having me here today.