Learn The Sleep-Weight Connection For Healthier Living

Carolynn Francavilla Brown, MD

Thank you so much for having me be a part of this.

Audrey Wells, MD

Yes, it’s great. I wonder if you can elaborate on what you do, because I’m also bordered on obesity medicine, and I find that people don’t know that this is a medical subspecialty and that they can get care from someone who has this expertise. What is your experience?

Carolynn Francavilla Brown, MD

We can all start with a different specialty, and then we can move on and add obesity medicine or focus on that. My original specialty is family medicine, so primary care is for all ages. I was immediately interested in helping people lose weight to treat and prevent medical problems because I saw the impact it could have on so many medical conditions. So when I discovered the field of obesity medicine, I was very excited to learn the skills that would help my patients. So for the last ten years, I have incorporated obesity medicine, or weight loss into my family medicine practice. That looks like treating obesity comprehensively. I always look for underlying causes. Why does someone struggle with their weight? Is there an explanation, a reason, or something that we can fix? Of course, nutrition is important. Exercise is important for everyone’s health, especially for maintaining weight. Once we’ve lost weight or prevented weight gain, our behavior changes, like logging and changing our mindset around food in our body. then, of course, medications, which people are starting to learn more and more about, and we have more and more exciting options there. I utilize a combination of all of those tools when treating my patients, but my goal is always to help improve their health with that. I don’t believe in weight loss for the sake of weight loss trying to treat an underlying medical problem or preventing medical problems that are likely to occur in the future.

Audrey Wells, MD

That’s amazing. What I’m hearing from your answer is this degree of personalization for medical care, which is so important because we have metrics of weight or body fat. But how does somebody know if they need to lose weight? That’s the first step. Right?

Carolynn Francavilla Brown, MD

That is such a key question. That is something I always try to start and address with my patients at the beginning: do you need to lose weight, and if so, how much? So some of the questions you might ask are above and beyond the scale. Everyone has the lowest weight they’ve been in their life, a weight they feel the best at, or where their clothes fit. But that doesn’t necessarily mean that BMI is the healthiest or the weight you need to be at, as we’re starting to have discussions around a flawed tool. BMI is just a ratio of height to weight. It was just created quite a long time ago for scientific articles, to have a standard number, but there’s no real magic to that BMI. I’ve seen a lot of patients who come in and look at that BMI chart, and they think, I’m not normal, and here I need to do something. That’s not always the case. Patients and physicians need to recognize that the BMI is a screening tool. It gives you an idea of whether someone should maybe have a conversation around weight, but just because you are higher on that BMI chart does not automatically mean you need to lose weight. Some of the questions that are more important to ask are: What does your health look like? Bloodwork can tell us a lot. Does your cholesterol make your lipids look good? Does your blood sugar look good? Do we have signs of pre-diabetes or diabetes? How do you feel? Do you have good energy? What’s your exercise tolerance? Are you able to walk up a flight of stairs without getting short of breath? Can you walk a mile or run a mile? Are you hiking for hours on the weekend or riding your bike with your kids for an hour? If you feel healthy in your body, your bloodwork looks good, and you have no medical problems that we think are going to improve from weight loss, you might not need to lose weight. That doesn’t mean you’re not allowed to. You can. But a lot of people put themselves under a lot of stress by obsessing about their weight. A lot of people do things that are maybe not ultimately great for their health, like crash diets or aggressive things that they can’t sustain long-term and, in the end, are not helping their health. I always like to take it from this big point of view of how losing weight would improve your health, and then how much you need to lose becomes the next question. You probably do not need to get to a normal weight on a chart to improve your health.

Audrey Wells, MD

That’s valuable information and something that people can digest as they consider: What do I need to accomplish with my health? One of the reasons that I got into obesity medicine as a way to improve my understanding of the problem is because there’s a lot of overlap between sleep apnea and insomnia, and superimposed on that is an issue with weight, such that a lot of people who have sleep apnea are under the impression that it’s because they’re overweight or in the obesity range. But that’s not necessarily the case. It’s one example of obesity bias. I wonder if you can talk about obesity bias as a whole.

Carolynn Francavilla Brown, MD

There are so many conditions, and you alluded to this in the beginning, where it’s a chicken and an egg situation. Extra weight can make sleep apnea worse, and sleep apnea can certainly cause weight gain. It can often be this chicken and egg situation. We see that for other conditions like diabetes or pre-diabetes, once you have those high blood sugars, it gets harder to lose weight. When you start to lose weight, your blood sugars can get out of control. Most of the things we see with weight go in both directions. But what I have seen many of my patients experience is that their condition, whether it is sleep apnea, back pain, knee pain, or fatigue, whatever they’re going to complain about, if they have a BMI that is not normal on that chart, the problem gets blamed on their weight without further workup. Of course, many of the things that you might do to improve your weight, like moving and exercising more, and eating a healthy diet, are going to give you health benefits. But what happens is that a lot of times patients get dismissed; they get ignored with their health complaints because of their weight. Patients need to advocate for themselves a little bit and ask a couple more questions. One patient that always comes to mind is a patient who had a knee injury, and she kept saying she’d go to the ER; she’d go to urgent care. She would go to different doctors, even sports medicine. They just kept telling her to lose weight. So she told me the story with her knee. I was like, It sounds like you have a torn meniscus, and we got an MRI. 

Sure enough, she had a torn meniscus. Is weight helping her knee pain? Probably not. But she had a torn meniscus. That is unrelated to her weight. By continuing to blame things on her weight, the underlying issue wasn’t solved. then, of course, she couldn’t move as well. It was hard for her to exercise and do some of the things she needed to get healthier. We need to be mindful of that and help patients advocate for themselves. Ask a few more questions.  Well, okay. You’re telling me that my weight is impacting my sleep apnea. Can you explain that a little bit more?  Or how much weight do you think I would need to lose? Or, in many cases, I don’t know if you see this. Someone has already lost weight. They’re like, Oh, well, someone already suggested I lose weight. I did Weight Watchers, I did Optavia, I cleaned up my diet, I cut out soda, and I lost 20 pounds, and I still have sleep apnea. Can we look into what else is going on? Because often, your doctor won’t ask you if you’ve ever lost weight before.  They will see that number on the chart, and they’ll say, Your BMI is 32; you have obesity. But they don’t know that your BMI used to be 37.  You have already lost 40 pounds. You’re exercising every day. If we look at just the number, we’re missing out on the whole person.

Audrey Wells, MD

That perspective is so great. Yes, I do see that when people lose weight and then, because they haven’t internalized the idea that their sleep apnea is because of their overweight or obesity, they stop getting treated for sleep apnea without getting retested. It’s such a shame because weight is a significant risk factor for obstructive sleep apnea, but it’s not the only one by far. I talk about nine causes of obstructive sleep apnea. Weight is just one. So I feel sad when somebody stops sleeping on me. If they have a residual problem with sleep apnea, that’s a reason to gain weight back. You have to raise that back. It’s such a drag. I want to ask something that I feel like my patients always have under the surface. Some ask me and some don’t, and I’m just excited to bring it to you today. Which is why it is so damn hard to lose weight?

Carolynn Francavilla Brown, MD

Thank you for asking that. That is probably one of my favorite questions to answer, and I always start by answering that for my patients. There are many reasons why people struggle with their weight, but the universal reason that it is hard to lose weight and keep it off is that our body is programmed to gain weight. If we look at studies for both people and some animal studies, we see that most of us are programmed to slowly gain weight throughout our lifetime. So we have to actively fight that. What happens when we actively fight that? When we change our nutrition plan, we go on a diet, we watch what we’re eating, we exercise, and we try to make changes. Two major things happen to the body. The first is that your metabolic rate will slow down, and it slows down more than we would expect. Based on your change in size, smaller people burn fewer calories, but you burn way fewer calories as you’re losing weight. Your body’s trying to conserve that energy. It doesn’t want you to lose weight. The second thing that happens is that your hunger signals change. So you are hungrier when you’re losing weight, and you’re less full. If you’ve ever tried to do some diet or lifestyle plan and you get to a point where your weight is not changing, whether you’ve lost five pounds in your plateau or you’ve lost 50 pounds in your plateau, that is your metabolic rate changing. If you get this in your head and you think this is hard to keep doing, what’s wrong with me? Why is it so hard? That is because your body truly is making you hungrier, and it’s making you less full when you eat. so that is where you may need additional support. You may need medications; you may need mini-bariatric surgery because, biologically, your body is trying to fight that weight loss. I always like to tell people it’s not your fault; it’s biology. We blame people a lot. Some people will start a nutrition plan, they will exercise, they will do all the things they’re supposed to do, and they will have good results. But for many people, they will do those things, and they will find that it gets hard and that they’re not seeing results, and it’s not their fault. It is biology.

Audrey Wells, MD

That’s so true. That feeds into the idea of obesity bias, too. Some people, just feel so defeated when they’re characterized as not having enough willpower, being lazy, or not being able to stick with something.

Carolynn Francavilla Brown, MD

Yes. Understanding weight from a biological and a physiologic perspective is so powerful for patients as well as for us as physicians to think about this as something biologically that’s hard. This is something that I’m sure I have some bias toward. When I was first learning about this. Then I quickly learned as I worked with patients, Oh, no, these are very smart people. These are very hard-working people. These are people who knew a lot about nutrition at the beginning; some of them knew more than me because they’d been on so many different diets and nutrition plans for decades. So I was like, This is not a knowledge gap. This is not a work ethic or motivation issue. There is something biological going on. So as I learned the science, it was so powerful to have an explanation, even for my patients, of why it is so hard. It’s not them.

Audrey Wells, MD

This is one reason why medications are helpful, and something that has been in the news lately is the new medication for weight loss. But the truth is, we’ve had medications available for weight loss for many years. Yes. Can you give us some perspective on when a person needs medication and maybe a glimpse into why choosing the medication is important?

Carolynn Francavilla Brown, MD

The first question goes back to what we talked about before.  Do you need to lose weight? Is there a pressing medical reason? Some people will want to try not to use medication first. That’s reasonable. If you have never tried making nutrition or exercise changes without medication, see how they work for you. But if you’re that person who has tried that many times or a few times and you have that happen where your weight plateaus and then you find it hard to continue because of all that biology that’s going on there, that’s where considering a medication or sometimes metabolic and bariatric surgery, depending on your weight and what you would like to do, are options. What the medications do is disrupt those hunger and fullness signals. We have some older medications that are pills, like Phentermine and Contrave. Those medications work more on hunger, so it’s much easier for people to stick to their nutrition plan because they’re just not as hungry. We have newer medications that are injectable right now. Wegovy is the one that’s in the news. That’s a medication called semaglutide. We’re accepting one called Tirzepatide. We don’t know what its name for weight loss is going to be, but it is going to be available very soon. Those medications do help with hunger, but they also make people feel much more full metabolically. So that is very helpful because people will eat a small amount of food, the amount that they should eat, or even a smaller amount. They feel full, satisfied, and done. So what my patients describe the medications, all of them, when we find the one that works for them, is that they’re finally able to do what they wanted to do, what they had been told to do, what they knew they should do, and what they had been trying to do. But now they have a tool that lets them eat that smaller portion that makes them feel full and satisfied with a salad. It turns off the brain part that’s telling them to snack on some pretzels or have that handful of M&Ms. It’s a powerful tool to let people who struggle with sticking to a plan be able to follow it.

Audrey Wells, MD

That, all by itself, is such a relief to people who have had decades of struggle. that the medications are approached with caution, which is appropriate for any medication. But these weight-loss medications work effectively. A question that comes up a lot is: How long do I need to take these?

Carolynn Francavilla Brown, MD

Just like most medications that are for something chronic, they are something we would expect you’re going to take long-term. If you have a urinary tract infection, once you take the antibiotic and your urinary tract infection is done, you’re done with the medication. But if you have a medical condition that you’ve had for a long time and that you don’t expect to go away from, like high blood pressure, diabetes, or sometimes depression, then you’re probably going to need to be on that medicine for many years. The same thing is the case with these anti-obesity or weight-loss medications. If they work for you, what we expect from most people is that you’re going to have to stay with them. Now, that may mean switching between medications based on what you can afford, based on side effects. It doesn’t. We have to stick with that medicine forever. The worst thing that happens if you stop the medicine is that you regain weight. A good mindset for anything someone is doing to lose weight is that whatever you do to lose weight, you have to keep doing it. That’s pretty universally true. Whether that’s a specific way of eating or not, maybe you’ve decided to do an aggressive plan like Keto or Whole30. Well, if you can’t stick with that way of eating, you’re likely to regain weight. Same thing with exercise: if you exercise three hours a day and that’s how you’re losing or maintaining weight, you have to be able to keep exercising at that volume, or when you go down to 20 minutes a day, you’re likely to regain weight, and the medications are the same. If the medicine is what was very helpful for you to lose weight, you’re probably going to need to stay on some medication for a long time, maybe forever.

Audrey Wells, MD

That’s a new idea to some people—that the medication helps your weight go down, and then to keep that at that level, you would need to sustain the medication. Always, of course, with the support of nutrition, exercise, and behavioral changes.

Carolynn Francavilla Brown, MD

Yes. All the medications are FDA-approved to be used with nutrition and movement, or diet and exercise. the fact that they all work better together. When we see how people who exercise an hour a day plus take the medicine do, do they do better?  These things add up. But what most of my patients find about the medicines is that they let them stick to the plan. Now they can do those things. But this is why medicines should be used when someone has a compelling medical reason for weight loss. If you want to lose five pounds to look better in your swimsuit, that is not what these medicines are for. All medications have risks, and you’re likely to regain those pounds as soon as you stop the medicine and your beach trip is over.  That’s not what these are for. These are for someone who has struggled with their weight and is not having success with all the common-sense things that they’ve been told to do.

Audrey Wells, MD

I’ve heard people say, Just tell me what to eat. That’s all I want to know. What is the best diet? Just give me that.

Carolynn Francavilla Brown, MD

The longer I do this, the more simple my nutrition advice gets. We can find a good scientific article that tells you whether any food is good or bad for you. It’s hard to analyze that for populations of people because we’re so complex with what we eat. Eating foods that make you feel full and satisfied is helpful, and whole foods are better at that. The more processed a food is and the more that food scientists have gotten involved to make it tasty, the easier it is to overeat. It’s pretty hard to overeat vegetables, for example. They’re going to stretch out your stomach; you’re going to feel full; and then they have lots of healthy things in them. If you eat a little too many of them, then you’ve gotten some extra good stuff for your body without too many calories. It’s easy to overeat processed foods like chips, crackers, and frozen foods. Those are things that are in sweets, gummy bears, or things like that. Those are easy to overeat. Instead of treating foods as good or bad, try to fill up on foods that are healthy for you: vegetables, fruits, and whole grains. 

I do recommend that most people eat meat. I’m not someone who recommends plant-based diets but fills up on plants first and then gets protein. However, you get that, whether that is plant-based or animal-based, and then met in a mine is the amount of processed food in your diet because that is the stuff that is so much easier to overeat. That’s like the simplest nutrition advice, but there is no best diet out there. When we look at the data on what people do with, say, a ketogenic diet that involves no carbohydrates, there is often a lot of animal protein, a lot of red meat, and a lot of cheese. People who do a plant-based diet like the Ornish diet, which is completely animal-product-free, can lose the same amount of weight and have the same health improvement. But what makes the difference is how well they stuck to the plan. The more you can stick to your nutrition plan, the better results you’re going to get. Picking something that you can sustain long-term is the most powerful thing for most people. For most people, that’s going to mean working on a pattern of eating that’s more balanced, getting plenty of vegetables, fiber, and whole grains, and getting protein in with each meal. Moderation on processed food is the quick nutrition advice I tend to give.

Audrey Wells, MD

I agree with everything you say, and the processed food question is a big issue. Food companies are not our friends when it comes to food.

Carolynn Francavilla Brown, MD

Anything that has a label on it is probably something that we need to eat less of. It doesn’t mean don’t eat. I don’t eat processed food at all. For example, protein bars are a processed food. Those are things that help me meet my nutrition goals. So that’s a processed food that I choose to eat. But I will overeat crackers or chips like most people. So that is something I’m intentional about with portion sizes, and I generally try to keep them out of my house because if they’re there, I’ll eat too much of them. But if I have carrots instead, I’ll probably eat the carrots. Some of it’s also setting ourselves up for success by providing ourselves with lots of healthy food.

Audrey Wells, MD

One thing I talk about with people is the impact that sleep loss has on their cravings and their decisions around food. For me, I’ll just share that the cilantro lime chips made by Tostitos are like my kryptonite. That is something I just can’t keep in the house. If I’m sleep-deprived or had a bad night, chips are my go-to comfort food, I guess. But sleep loss from any sleep disorder or even just purposely restricting your sleep has an impact on food cravings and food decisions. What kinds of things do you see?

Carolynn Francavilla Brown, MD

Yes, . We know from good science that the stress hormones that are released from poor sleep impact people’s cravings and desires for food. So most people will end up craving things that are saltier, sweeter, and more nutrient-dense and have more calories in them when they are under that state of stress from not getting enough sleep. I like to think of sleep deprivation as being in a state of stress, and the interesting data from some of the sleep studies is that even small amounts of sleep disruption can impact appetite. This isn’t like, Oh, I got five hours of sleep, and now I am starving. This is, I got 30 minutes less than I should, and that’s affecting my appetite. Optimized sleep does make a big impact on appetite and hunger. Some people are going to be a lot more sensitive to that than other people. The other big challenge with that is people who work shifts.  And so, I would say nobody makes a salad at 10 p.m.  You’re not watching TV. You’re up late working and making yourself a chicken Caesar salad. Like, that’s just not a very common thing you’re going to do. So if we’re staying up too late, whether that’s for fun or whether that’s for work, we may have to be very intentional about what we’re eating because it is so much more likely that we are going to eat something unhealthy.  Again, no one’s eating a salad at 10 p.m. That’s an uncommon thing.

Audrey Wells, MD

Part of it is because the decision-making part of your brain is not fully online when you’re sleep-deprived. When those decisions become more challenging, you are more susceptible to giving in to cravings or just seeking a reward from food. I want to ask about something else that I’ve seen come up in conversations about food. It’s certainly part of my practice because I’m always thinking about timing. Every cell in our body has an internal clock. So when I look at a person’s sleep issue, I’m also looking at all their wake issues. I want to talk about time-restricted feeding, also known as intermittent fasting. Tell me your thoughts.

Carolynn Francavilla Brown, MD

I am not the biggest fan of fasting for most people. There are some patients who it can be a good fit for, and it tends to be my older patients who have a much more flexible schedule, and their caloric needs have gone down as they’re 65 or 75 years old. But most of the people who come to see me because they’re struggling with weight already have a pattern of eating where they do not eat breakfast or they don’t eat a very nutritious breakfast. They might just have coffee, and then they don’t eat that much throughout the day, and then they tend to overeat later in the day. If someone can fast where they have a healthy, balanced breakfast, a healthy lunch, and maybe a small snack in the afternoon, that can work well for people. But the vast majority of people that I see, when they try to intermittent fast, cut out breakfast, or just do black coffee or black tea, end up overeating later in the day. so that pattern tends to cause more problems than good. I will always say I’m team breakfast. There’s pretty good data showing that people who eat breakfast have a healthier metabolism and a more stable weight. In one of the longest-standing studies we have of people who have lost weight and kept it off, the National Weight Control Registry, one of the most consistent, healthy habits people who’ve lost weight and kept it off without medication or surgery have is eating breakfast. If intermittent fasting is something someone wants to experiment with, what I tend to recommend is cutting that out later in the day and eating again at that time of day when no one’s eating a salad at 10 p.m. and seeing how that works. But for a lot of people, restricting that just triggers overeating. At other times, you have to evaluate how it works for you. For some people, it can be a great solution, but it’s certainly not a magic wand for everyone.

Audrey Wells, MD

I agree, and the data in the sleep literature is also robust in showing that putting most of your calorie consumption toward the beginning of the day has better effects on weight management and sleep. I always recommend to people that they’re not consuming any calories within three hours of bedtime for a big reason. One is that you, your digestive hormones, and your metabolism have a circadian rhythm. Those calories are metabolized differently than earlier in the day, but you also run into problems with acid reflux or indigestion that can disrupt sleep. When you’re sleep-deprived because your diet is off, that becomes a feedforward mechanism as well. There’s a pun in there with these forward mechanisms. One of the things that people will think about when they engage in a weight-loss program is the role of exercise. I’d like to hear from you what role exercise has when you’re trying to lose weight and also when you’re trying to maintain weight loss.

Carolynn Francavilla Brown, MD

Most studies show that people do not lose weight from exercise. I’m sure we’ve all met someone who has. I have certainly met those people. They tend to be younger, and they tend to be doing a lot of exercise. But most people will not lose significant weight from exercise. It’s hard to get in the volume of exercise needed, and most of the time our body is smart, so metabolically, it will just make you hungrier if you’re exercising a lot. I 100% know that’s me. If I do a lot of high-intensity exercise, I’m hungrier. So, even though I exercise quite a bit because I enjoy it, I certainly don’t lose weight from it because my body just tells me to eat more to make up for it. For most people, exercise is not how to lose weight. Exercise becomes essential to maintaining weight. It’s often not the first thing I’ll start with for patients. But after we’ve worked together for six to 12 months, I’m expecting that they are moving in some way 30 to 60 minutes a day. I’m in Denver, and people are super active, so people here tend to think that they need to do intense exercise, but that is not necessary. Walking, for example, is fantastic exercise. Going back to the data we have from the National Weight Control Registry, which is people who’ve lost at least 30 pounds and kept it off for a year, 90% of those people who’ve had sustained weight loss are exercising an hour a day, and most of them are walking. It’s like 94% of them are moving more than they were before they lost weight. Exercise is truly essential to weight maintenance, and then, separate from weight, exercise is essential for all of us. All of us will live longer and better. We have fewer heart attacks and strokes, and we have fewer certain cancers. Most of us sleep better. We will have better lives when we move more and separate from weight. Because not everyone listens to this when trying to lose weight. Exercise is one of the most powerful things any of us can do for our health. So when someone has lost weight, I like to think of it as a bonus. It’s just that it’s helping you keep off. But we all should be doing at least 30 minutes a day of some movement. We should all be doing sorry. We should all be doing strength training at least twice a week. Those are the guidelines for all of us. But if you’ve lost weight and you’re trying to keep it off or you’re working to maintain your weight, you’re probably going to need to be closer to an hour a day of movement.

Audrey Wells, MD

Just that parameter is helpful to know. So I thank you for that. Nutrition is better at the beginning when you’re trying to lose weight, and then exercise is better for maintenance.

Carolynn Francavilla Brown, MD

Yes. If you’re trying to start somewhere, that may be the place to start if you’re trying to see a difference on the scale. But if you’re just trying to improve your health and how you feel, increasing your movement is always good, and don’t get intimidated by that one hour. You can break it up into chunks. If right now you’re doing zero movement, doing 10 minutes a day is going to have a huge improvement on your weight and your metabolism beyond doing nothing. Probably the most important thing is for all of us to just try to move a little more, no matter where we’re at right now.

Audrey Wells, MD

Exercise can be a challenge if you’re not preparing your mind to take advantage of every opportunity you have. But starting small is significant.

Carolynn Francavilla Brown, MD

Yes, I have patience, if you don’t mind me sharing a story. When I first saw her, she was getting out of breath, walking to the mailbox, and we were going to have to start doing a big workup for why she was having such a hard time breathing. I convinced her to start just walking one minute a day on her treadmill, and she started with one minute and increased it to two. Over like four months, she got up to move an hour a day on her treadmill, and it transformed her life and her health. that power of starting small, if you can only do a minute, like start with a minute.

Audrey Wells, MD

I agree. I had a parallel experience. I was very weak in my leg muscles. I started doing ten squats a day. Now I’m up to 100, and I feel so much better. It’s something that applies to everyone. It’s good for your brain’s health. It’s good for your cardiovascular system. Know that there’s very little downside to exercising.

Carolynn Francavilla Brown, MD

I’m a CrossFit fan, so we’re big squat fans in the CrossFit world, and squats are such an important movement because you’re going to do that movement for the rest of your life. If you need to get on and off a toilet, what do you have to do? You have to squat down. Do you want to pick something off the ground, like you might be squatting to do that? Yes, those small things have such a huge impact on our health.

Audrey Wells, MD

It’s very empowering. I just realized the power of keeping up with that program. So I have my sister to thank for that. I want to talk a little bit as we wrap up here about your program for clinicians who are interested in helping their patients. Your website is called helpyourpatientsloseweight.com. Any time somebody is teaching, that underscores the depth of their expertise. Please, what do you do for people who want to pass this on to their patient panel?

Carolynn Francavilla Brown, MD

Yes. I have what is currently a 13-hour course. That’s a very comprehensive way for clinicians, physicians, and nurse practitioners to learn all the essentials about treating obesity from start to finish, including maintenance, eating disorders, and all the comorbid conditions. It also includes all the handouts that I use for my patients so that they can seamlessly utilize those in their clinic or adapt them to how it works for their clinic. It’s designed to be an all-in-one solution. then I have a mini course that has just been available live so far, but that is available very soon, and that is going to be about three and a half to four-hour course, for just the essentials, for someone who wants to feel up to date or maybe wants to do a little bit of weight loss in their practice but isn’t ready to be full-time obesity medicine. Because if you want to have this conversation correctly around sleep or diabetes, getting a little more education is powerful. Those are the two main things. Then I also help people start their practices. If they’re wanting to do this full-time, then that’s a resource you can find there as well.

Audrey Wells, MD

That’s fantastic. You’re educating these hubs of clinical providers who can spread the message about how to better treat the condition of obesity.

Carolynn Francavilla Brown, MD

Yes, we’re just not taught this in standard medical education. Even students nowadays get very minimal information about how to treat weight comprehensively.

Audrey Wells, MD

On that note, I want to review what we’ve discussed today and make sure that we covered all of the highlights. We first talked about the idea that somebody needs to establish whether they need to lose weight or not, and then how much the second point was that obesity is a disease. It’s a medical condition. It’s a biological condition in which we are programmed to defend our reading, so to speak. For this reason, it’s worthwhile to seek out medical care if you have trouble with the disease of obesity. Medication is one option, certainly in the context of good behavioral patterns to support healthy physical activity. But the way that medication is different is that it’s blunting those hunger cues and improving the satiety or fullness cues. We touched on what foods to eat, which are the foods that you can eat for a lifetime. There’s a fair amount of common sense in choosing foods that are living, they’re unprocessed, and whole foods have fiber in them. All of these underscore the fact that what you eat matters. The more you can look for foods without food labels, the better off you’re going to be. We said a little bit about intermittent fasting or the timing of food. Again, this is my bias when looking at everything on the spectrum of a 24-hour cycle. try to stop eating the three hours before you go to sleep and then exercise. If we exercise for health overall, but for weight loss in and of itself, it turns out it’s not that effective. It is much more valuable for weight maintenance. Have we left out anything that you want to make sure of and let all of the registrants know?

Carolynn Francavilla Brown, MD

Well, if people want more information about all of these things regarding health and weight, I have a podcast called Dr. Francavilla Show. That is a great tool for everyone. That is not just for clinicians; that is for the public. You can learn about different medical conditions that affect weight. You can learn about behavior, improving your relationship with your body, nutrition, and other information. Everything I talk about with my patients and my colleagues goes into this podcast. It’s great, and it’s just called the Dr. Francavilla Show.

Audrey Wells, MD

I love it. People can get and experience a dose of Dr. Francavilla if they go to your podcast. It’s been such a pleasure to speak to you today. I certainly will take all the notes here and apply them not only to my own life but to that of my patients as well. It’s a pleasure to see you.