For this DrTalks I have a guest. Sarah Stombaugh. He is a family physician and diplomat of the American Board of Obesity Medicine, as well as a life coach.

And we are going to be talking about mindset with weight loss and why that's important, and how you can change some mindset things to help with your success.

Thank you for joining us. Yes. Thank you so much for having me today. I'm really excited because I find that so many patients come into my practice and say, Dr. Stombaugh, I know what to do and I'm not doing it.

And so this mindset piece I think is so valuable. So what do you think people mean when they say that? When they say, I know what to do, but I'm not doing it?

What does that mean when you hear it? Yeah. You know, I think a lot of people have been through the diet culture for, you know, many years, decades of their lives even.

And feel like they have a really good grasp of whether it's the nutrition piece, whether it's the exercise piece. And I sort of had this idea of sort of what is perfect or what is the ideal, and then they feel like they don't match up to that.

And a lot of times there's this all or nothing thinking that comes in, and they have to be sort of all in this diet plan or this weight loss program, or I'm just not doing it properly.

And so a lot of times it's that relearning and understanding what, you know, what this can look like. I think that's really powerful. So what are some of the reasons that people do struggle to stick with their goals?

You know, I think there's so many programs that are designed to support weight loss. We've seen in the weight loss industry over the last many decades.

There's all sorts of programs, from big ones to small ones, people who do it, you know, the keto diet or the Mediterranean diet or people who are vegan.

And you see that people have success on different ones, and people feel very strongly they're the best advocate for their own program. And a lot of times we get told, okay, go do these, you know, dozen things.

And a lot of times people don't necessarily identify with those being important to them. So maybe they're doing a program that incorporates a bunch of food that they don't even like, but they sort of choke it down because they know that it'll help with their goals.

And I think that it will help with their goals. They haven't really defined what their goals are. You know, sometimes they have these really broad goals, like, I want to lose weight, but they haven't stopped and thought about what would that mean?

What are my actual goals? What what would be achievable for me? What would I do in order to support this? And why is it important? Why do I actually even want to try to do this in my life?

And so it's in defining some of these things that a lot of times we have these kind of nebulous ideas of, I want to lose weight, I'm going to do this random program, and it never really becomes part.

It's ever important. It doesn't really become part of our identity. That's really powerful. Yeah, we just sign up sometimes for things that may not be the right fit or may not fit with our with our identity.

One of the things, that we sometimes talk about is connecting with our body and what do we do when people don't feel connected with their body? You know, it's really interesting, especially when we think about hunger and fullness, but really just in general, a lot of times we don't stop and pay attention to what it is that our body is asking for, whether that's food, whether that's movement, whether that's sleep, whether it's just a pause in a really stressful day.

A lot of times we have become so disconnected from our bodies. And so I like to think about my children. I am the mom of young children, and I think about how I'm supporting them and how their body is sort of naturally no to do some of these things, they need guidance towards them.

But we think about the way that my children eat, for example, and there's days where my children eat wild amounts of food and like, how does this, you know, 30 pounds, a little being consumed, so much food, and another day where they eat very little and they are just totally connected with what their body needs.

And then over time, though, it's really interesting how we learn to eat for all of these reasons. Beyond hunger, we learn to eat because we're bored. We learn to eat because we didn't make the sports team.

We learned to eat because our boyfriend broke up with us. All of these societal and cultural pressures make a situation where all of a sudden we haven't paid attention to what is our hunger, what is our fullness.

And so a lot of times, learning to reconnect with that has to be this very sort of intentional, real learning that happens, almost bringing us back to what would it be like to be a child?

What is my tummy saying right now? You know, that's the language I use with my children. But even when I talk to my adult patients, it's like, what is your body asking for?

Are you hungry? Are you full? And let's start paying attention because sometimes we don't even know. Yeah, that sort of concept of mindful eating right off, of paying attention to what we're eating.

What are some of the tools that you will use around mindful eating for your patients? Yeah. You know, I think it's interesting because we hear things like mindfulness.

And when I would first hear about this and like I have this idea that food should be some sort of like meditative experience and that we needed to carve out a space where we're just sitting at a table and focusing only on our food.

And while that may be ideal, but there are also ways that we can bring mindfulness in that are completely practical. And so paying attention to, for one, are we multitasking while we're eating?

Are we able to sit down, eat our food, pay attention to the food that we're eating, and be focused on that and not a work project or a call or a TV show or something like that.

And so are we focused on that eating? Because I'm sure you, as many people have had that experience of I eat a food and like, oh, I don't even really remember eating it.

Like it kind of, yes, just happens to my body. And I'm like, oh, I wish I could go back and read it because I didn't really enjoy eating it. And so stopping eating by itself.

But paying attention to to what is the flavor of the food? What is the texture of the food? What does it taste like? And actually asking yourself, do I enjoy this?

You know, sometimes I've eaten food in the past so quickly that I haven't realized actually, that donut wasn't actually that good. You know, if I'm going to have something, am I choosing one that's high quality is going to really satisfy my taste buds?

I mean, I feel really, you know, enjoy, have this really enjoyable experience rather than sort of eating something quickly and not paying attention to it.

So this mindfulness while eating can be the act of while you're actually eating, paying attention to it, and then also writing down sometimes what it is that we're doing some type of food log.

There are people who do it in a notebook. There's people who do it in different apps. But really this intentionality of am I eating at times throughout the day?

That makes sense for me when I'm actually hungry? Am I eating for a reason beyond hunger? Like an emotional response? For example? And so bringing this awareness to what is actually happening throughout the day is a really important way to increase mindfulness.

Are you eating at the work you know, work breakroom? Did you walk by and see a cookie and you had a quarter of a cookie? Were you even hungry at that time?

So there's just awareness of what is my body asking for? Am I hungry right now? And then what is actually going into my mouth? I think that's really powerful.

When I talk with my patients about it. We start with that first step of being trying to not eat distracted, meaning not multitasking like you said. So a lot of us might be eating in the car, right?

We're running around. We know we need to eat something. Maybe we've gotten fast food and we're eating that while driving and not really enjoying it. Not really paying attention to it, not really knowing if we're full from what we've eaten because we're we're busy driving, maybe listening to the radio, talking to our kids like there's a lot going on.

We were just eating it until it's done as opposed to, you know, did I enjoy it? Am I finished? Did I, you know, when am I done? Or while working. You know, people don't take real lunch breaks.

And so they're like, working away and, you know, eating, while they're working, don't really enjoy it. Don't really pay attention to their natural cues of when they're done.

They're just done when the plate is empty. That's exactly right. And so right. Am I full or am I eating for a different reason. Beyond just what am I eating for a different reason.

Yeah. And then the other big time I'll see it for my patients as well as myself. Is that nighttime eating while you're maybe watching TV. And again you're kind of focused on the TV show.

And so you're not paying attention to when you're done with the food. And so that's especially problematic if you're eating like out of a bag of chips or, a bag of candy or something.

Because if you're not really paying attention to it, you can easily eat several servings or the whole container before you realize what what has happened.

Yeah. Well, and honestly, even with healthy foods, you know, I found people may overeat carrots, you know, they may find that like, oh, I'm going to have this healthy snack, but then 50 carrots later that has gone from a healthy snack to a snack that really is not serving their network.

Or I don't eat with like, nuts. Right. Because I think nuts are tremendous for people's health and, can be really satisfying food, but also they're really calorie dense.

So if you're not paying attention to how many you're eating really easy to eat, a lot of calories worth of nuts, even though they're a healthy food, you can easily eat too.

Too many of them. Yeah. Oh, I agree 100% though. I also talk about like portioning things out a little bit and then checking in to like, see if you're full.

Instead of just automatically eating, eating what's left on the plate, kind of having to check in with yourself a little bit along the way. Yeah. You know, I think that's a great point.

And one of the things that's come up with a handful of my patients is this idea will ask them to pour a portion into a bowl, into a cup, into a plate, whatever.

And then you can always come back, right? You can get seconds, you can check in and say, am I hungry? Am I full? Have I had enough? And there's nothing wrong with going back for a second.

But it's been interesting to me. A lot of my patients have had some shame and going back for seconds, whether that's at a family event or some type of event where people the idea of going back for seconds is way more shameful than just filling up too much on your plate at the beginning.

So pay attention to some of these belief systems that we have that are a lot of times completely at our subconscious. We haven't even stopped to realize that, for example, going back for a second would be problematic.

And why is that an issue? So starting to bring this curiosity to is the belief like that actually serving me and my weight loss goals? That's super powerful.

Like, you may not even recognize you had that belief. Right? And so asking yourself, why does that bug me? Oh, well, one time when I was a teenager, someone you know made fun of me for eating too much and I always felt like, oh, I shouldn't get seconds or like, where is that coming from?

And is it a true story? Right? Like, we tell ourselves these stories. Is that a true story? Is it a hopeful story? Yeah. When I find those behaviors, you know, I think back to my childhood and things that my parents shared with me, beliefs that really made sense, like, don't waste food.

You know, I think of my grandparents who grew up during the Great Depression and wasting food was a terrible sin. And it's really interesting how in 2024, a belief system like that did not serve most of us, and we can still have a desire to not waste food.

And that might mean that we have a list when we go to the grocery store that we're really intentional about eating the food that's in our refrigerator, that we save and eat leftovers at a later occasion doesn't mean you have to throw everything in the trash can.

But one of the things that I found most interesting is that, like a belief system like that, if you don't need the extra calories, you're wasting the food.

Whether you put it into your body or whether you put it into the trash that. Doesn't need the time. It also it was out of my mouth, literally. Exactly what I say. Yeah. Oh, I love that.

But it's true. Like, you know, it's just as wasteful to put it in the trash can is to put it in your body. Like, why are you treating your body like the trash can?

Yeah, 100%. That's so powerful to, like, question why we do some of these things. And that's what we're talking about with mindset, right? Is like, why am I doing these?

And how do I need to change that? So you, you know, one thing we talked about is that some of these foods we, we overeat and we talked about, you know, carrots versus nuts versus fast food.

But I think it might be worth pointing out that there are certain foods that are easier to overeat as well. So you kind of talked about kids and how we watch them.

And they're kind of naturally intuitive about what their body needs. But I think one of the challenges for us in the modern world is there's a lot of foods that disrupt our, normal like body chemistry, like really ultra processed foods that are designed to be really, really, really tasty, designed so that we eat like a fair amount of them at a time.

And it can be more challenging to listen to our bodies because honestly, the foods were designed to make our bodies want to eat more of them. So how do you help your patients navigate some of that?

Yeah. So I agree completely. And it's it's a conversation we have frequently, as you can imagine, because a lot of our food, I would also describe it like food, like substance.

A lot of the foods that we eat are not really the food. They are truly created in the lab. I actually went to college in Omaha, Nebraska, and ConAgra.

It's now based in a different city, but it was based in Omaha at the time. And so a lot of people from our chemistry department would go and work in food science and literally work in laboratories wearing, you know, the big white protective suits and face and all of that to create these.

Quote foods. Right. And they're not they're these highly processed food like substances. So a lot of times it's interesting bringing a light to it, shining a light about understanding why a calorie is not a calorie.

You know, we think about these ultra processed foods and how our body is able to absorb them for energy. Very well, right? Our body can absorb every last bit of those calories, which, you know, it's great that there is an efficiency of calories there.

But when we have this surplus of food available to us all the time, and then you add on these things like the way that texture is in our mouth, saltiness with the sweet balance and maybe the crunch and all of these things that make these foods such that they're designed to be addictive, right?

That is, people's full time jobs is to make these foods addictive. And so, like you were saying, with intuitive eating, intuitive eating really only works when we're eating real foods, when we're eating some of these really highly processed foods, it really hijacks our brains, hijacks our bodies such that we are not able to listen to our signals in the same way, because they just don't come up in the same way.

So let a times that educational piece is really important. And thinking about then when we're choosing the foods that we're eating, how are we choosing foods that help us to be more in line with intuitive eating, to help us to recognize those satiety signals?

And a lot of times when we can limit those ultra processed foods, that's really one of the best things we can do. You just summed up so well what I have.

I don't know that I've ever been able to just put it into one sentence like you just did that for eating to work, it has to be real foods. And but I think that's true, right.

Because there's always been this mismatch for me of absolutely believing in principles of intuitive eating and mindful eating, but also seeing it not work for people because they're eating these very triggering foods that really are not designed to be eaten intuitively.

So like, wow, way to just like summarize that there. Like, you know, it works if it's with real food. So that's super powerful. Yeah I agree that it makes a huge difference.

Right. And so yeah I love that. Like it's possible to overeat carrots as you mentioned. But it's. It's. Harder. Like I've I've seen people do that. But as often as I've seen people over eat chips or crackers.

Right. Like it's much less common to eat excessive amounts of, of carrots. Yeah. When you've got fiber, when you've got protein, when you've got some healthy fats, those create a very different situation for your body.

So part of the mindset that you've touched on is, you know, am I hungry. Why am I eating. And so when we're talking about the difference between like physical hunger, true hunger, need to eat versus emotional hunger or eating for other reasons.

How do you help people differentiate between those two things? Well I think it's really hard right. Sometimes when we have been so far removed from it we don't know.

Right. I have patients all the time who they rely on signals like just like being hangry or being nauseated or being like just feeling totally bled before they're eating and not necessarily relying on, or they're looking at the clock to eat.

They're not necessarily relying on any sort of internal cue or sort of a stable internal hunger cue. And so when we first start paying attention to it, a lot of times it may even be bringing questions and this awareness to, okay, am I hungry right now?

And you might have to use some logic here, like, okay, when was the last time that I ate? How many hours ago was that? What did I eat at that time? Does it make sense that my body would be hungry right now?

And so if you realize, oh, it's been four hours since I eat and I eat, you know, whatever food at that time, these rumblings four hours later are probably hunger, and it may make sense to start paying attention in that way.

The other thing is to ask yourself if the hunger came on really suddenly, it makes thing any big emotion. Right now, so many of us have this emotional relationship with eating, and some people identify it very clearly where they say, oh my gosh, I'm an emotional eater.

I eat when I'm stressed and eat when I'm anxious. But a lot of people don't realize that there's a lot of emotions besides just stress or anxiety that lead to eating it.

Maybe boredom, right? That is an emotion as well, which is boredom. And so are you scared? Are you angry? It's very common that people have maybe a handful of different emotions that are more likely to trigger their eating behaviors, because they have these sort of well-worn pathways of every time I feel boredom, food is a solution to that boredom, or every time I feel overwhelmed.

Food is a solution to that. And so when you have this hunger coming up, especially if you check in and you're like, oh, it's only been an hour since I ate.

Kind of surprised I'm hungry right now. Was there a really big emotional trigger that happened? Was there a pause in your day trying to identify? Is there some sort of emotion that's coming up may help you to identify it as well?

I also use a numerical scale with my patients to help them think about their hunger, or think about their satiety, and to assign a number on that. Sometimes at the beginning, it feels like guessing.

People are not always sure when they assign themselves like, that's fine. Just sort of guess we'll see. It'll calibrate over time. But that can be a really good way to to take this thing that's really pretty qualitative inside of us, but try to just give it a little bit of analysis and bring that intentionality.

Yeah. So just trying to become more aware of it in different ways. And I think your description of some people with the hunger, like it's like ten out of ten hunger before they eat.

Right, that, that hungry, they're starving. And I find for myself and my patients, it's so much harder to, eat intentionally in that setting. You're so hungry that it's easy to eat too much.

It's easy, to eat. Maybe the less nutritious foods, the things that are more immediate, right? When you're really hungry and there's chips right on your counter, then it's a lot easier to eat those than to eat the salad that maybe you had intended to eat, right?

Oh, exactly. One of the other mindset things that is pretty frequent when people are losing weight is an anything mindset wise, to be honest, is when we have a setback, when we're not reaching our goal or we maybe slip up.

This happens a lot with nutrition, right? Because people maybe have that plan that they're trying to stick to, and then they have a vacation, or they go to a party, or they just decide they want to eat something.

And then they, you know, maybe regain weight or, struggle with their mindset. How do you help people when they are struggling once they've had a setback?

Yeah. You know, I think it's interesting you mentioned a plan because the interesting thing is a lot of times we don't have a plan, right. We have this sort of vague, you know, my goal is to lose weight.

And that may not be like when that's the entirety of the plan. It's very easy for us to stray from that, because it wasn't really a good plan to start with.

And so I do encourage people to have a plan, whether it's from the beginning or whether it is for the sake of a reset. What is it that I could do if I'm going on vacation?

What would be the ideal vacation in terms of what would be a plan that allows me to eat the foods that I'm really excited about, allow myself to enjoy them, but also come back from the trip and feel like, okay, I didn't totally, you know, mess up.

I've been in line with my goals. They've made decisions that I'm excited about, and so we'll maybe can create a plan. That's really one of the best things that we can do.

And so in a reset, a lot of times it's giving yourself grace and there's a sort of fine line between you want to bring an awareness to it, you want to bring a curiosity and you want to make a plan for next time, because we can sort of forgive ourselves and move on.

And while I think it's important to give yourself grace and to forgive yourself, I also you don't want to move on too quickly because there's probably a really good learning opportunity in that setback.

And the other thing is that sometimes we, you know, just beat ourselves up. And from that place of beating ourselves up, we're not able to actually have any good opportunities to stop and learn.

So there's this kind of sweet spot where you can be curious, where you can be sort of thoughtful or have a plan of, okay, let's say I could do that again.

How would I have done it again? If I find myself in a similar situation, what would I like to do differently? What would help me to be in line with that and to recognize that it doesn't have to mean, you know, you have this one setback.

You know, lot of times we're like, oh, I'll start again tomorrow morning. I'll start again Monday morning. You can start again right now. You know, just because you quote messed up one meal or a couple of meals, you can start over whenever you want to.

But making this plan and having this intentionality, and then giving yourself grace and allowing yourself to recognize that you're just human and most people are not 100% in when they're losing weight.

When we find this balance of what allows us to eat the foods that we enjoy in a way that also meets our health goals, that is totally possible. And you mentioned earlier that concept of like black and white mentality, and that is one of the struggles I see so common for my patients.

They either feel like they're doing it all right or they're not doing it at all. And that's just not a realistic way for really any of us to live our lives.

Right. We're going to go on vacation. We're going to have hard days, and we have to figure out a plan that is going to work for us, but also when we go off the plan, whether it's our exercise plan or our nutrition plan, like have that resiliency and have that mindset that we can restart what our intention was, you know, the next minute, right, like just because you had a bite of the donut, if you take a bite and you're like, I don't even really like this, it's okay to stop eating it and and move back to what your initial plan was.

Right, exactly. And a lot of times I talk about this sort of 90-10 principle where if we're 90% in line with our goals, that is usually a number that helps us to be very successful.

And then that 10% can be very intentionally planned. You know, like I'm going to eat birthday cake on my birthday. Maybe my husband's birthday. But what I don't need to do is eat birthday cake.

You know, my kids are five, three and one, so especially my five and three year old. They get invited to birthday parties with their classmates all the time.

And so every weekend we're at a birthday party and there's cupcakes and it's like, I can really enjoy a birthday cake at my birthday or my husband's birthday, my kid's birthday.

But it doesn't mean I need to enjoy it. Every single child's birthday of every kid, and most. Of the time they're like, not that. Good of. Cupcakes, right?

At those parties. Creative thinking. It's like a cheap cupcake. I'm like, no, I'm going to hold out for the really good cake. Right? Exactly. Yeah. I'm not going to have the store bought cupcake with the terrible sugar frosting and sometimes.

Would all, recommend in that situation because I think some of us, like we fight ourselves, right, is to give yourself permission and be like, can I have I can have that cupcake.

I'm totally allowed to have cupcake. I'm an adult. One cupcake isn't going to kill me. Two cupcakes isn't going to kill me. But I really want. Right? Like, how am I going to feel afterwards?

Am I going to feel a little sluggish? Am I going to feel bloated? And then I feel tired? Is it going to mess up? The workout I'm planning to do later, like, you know, do I really want it?

Like I'm allowed to have it? But do I want it? And I find that not giving yourself permission works well for some people to. Yeah. Oh, absolutely. Because there's definitely this human psychology when we restrict ourselves that all of a sudden we really want something, right?

I that person I know, I'm that person. Totally. I you know, I was joking with someone the other day. I went to an Airbnb and there was a sign on the door that said, do not open this door.

And it was just a random closet. I would have never tried to open the door anyway, but as soon as there was a sign on the door that said don't open the door, I was like, oh my gosh, what is in that door?

I have to know, right? Right. You've been. Locked. You would have been like, oh, it's like an owner's closet, or there's cleaning equipment in there, but like the sign, like the forbidding it, like the rain couldn't stop thinking about it.

So I think let's go ahead. Yeah. I, you know, when we think about the foods and we think about, okay, if I'm going to put something on my absolutely cannot have list, your brain gets really fixated on that.

And so instead the intentionality and like you said, give yourself the permission if that's valuable to you, to have that food when you choose to have it and be really excited about it and actually enjoy it, if you're going to have it, you know, if you're going to use that energy, really allow yourself to have the enjoyment in, you know, be free from the guilt rather than beat yourself up.

If it was an intentional decision to have it. I think you gave so much good, food for thought here. But if someone, you know, and we gave lots of tips of what people could maybe do on their own, but if someone, is having a hard time seeing these patterns themselves, what sort of people might they work with to to help find these, these mindset blocks that they're having?

You know, I think a lot of times it can be really challenging to look at this type of thing on your own. It's really helpful to have a partner in that to ask maybe some critical questions, give you some feedback, show you where your brain is jumping to conclusions that are not serving you, where you're beating yourself up unnecessarily, maybe.

And so I think it can be really valuable to work with someone, whether that's someone like you and I who's a certified obesity medicine physician, whether that is a health coach or a health psychologist.

There are a lot of people who can absolutely be really supportive in this. There's even some really great books that can be helpful in mindset. But I think having a accountability partner is a really excellent thing to do.

Oh great idea. Accountability partner can also be great. Well, thank you so much. Where can people find you if they want to connect? Yes, absolutely. So I have a private practice in Charlottesville, Virginia.

I see patients throughout the state of Virginia and Illinois. You can also find me at Conquer Your Way. I have a podcast. I'm on social media trying to spread some good information.

So Sarah Stombaugh MD conquer your weight. I would love to share my information with anyone who's interested. Awesome. Well, thank you so much for joining us.

Thank you so much.

Sarah Stombaugh

Reconnect: Building A Healthy Mindset For Weight Loss