Weight Management Goals for 2020
Host: standing in for Mr. Justin Gomez. I am Matt Britt and I'm happy to be with you here today in Justin's absence. We've got a great guest with us, Dr. Merritt Adams with our weight management center. Dr. Adams. Nice to have you with us. Thank you Matt. Nice to be here. We're very excited to talk to you today to learn a little bit more about [00:00:30] what our weight management center does and um, some intricacies of what our patients should expect if they choose to, um, you know, come and work with us to help them get healthier. Um, but let's start off by talking a little bit more about you. Let's play it a little casual. So tell us about yourself and, uh, your background and what brought you to wake forest Baptist health.
Dr. Adams: Yeah, so, um, I will say I came to wait for her sometime ago now. Um, I originally came to wake forest actually for medical school, um, and then stayed [00:01:00] here actually for the remainder of my medical training. So I've been here through med school, residency, fellowship, and then just loved it so much that, um, joined the faculty with weight management, um, after completing the fellowship. Uh, so I guess been here a long time just to say, yeah.
Host: What drew you into the weight management side of things as opposed, I imagine at some point in your, in your schooling you were looking at every, getting hints of every little specialty and so forth. [00:01:30] What drew you to here
Dr. Adams: and, and common question, right. Um, our field is, is certainly an up and coming one fairly specialized and not many people know about it. Um, I will say that, um, before coming to medical school, my background was in nutrition. Um, and I, I've got a little bit of a psychology background too. And so ultimately coming to medical school actually was more on kind of the GI side of things until I met [00:02:00] our medical director, dr ARD as part of my training program during residency, did a rotation with weight management and found that it would just be an excellent fit for me and my background. It just, and just my personality and, and kind of everything fell in place thereafter.
Host: I can tell you, I mean in all my interactions, you know, I've interacted with a lot of the team, um, certainly a magnetic personality there and dr art and I can see how, I can see how he kind of pulled you in. [00:02:30] That's a, that, that, that's an important piece of it.
Dr. Adams: You did. I will say, you know, the stars aligned so to speak, cause the, you know, the weight management center is only been around now for, gosh, seven, eight years at this point. And um, the fellowship was fairly new or in development when I was in the training and, and I was actually the first fellow candidate here at wake forest. Um, yep. Yep. So I started the fellowship, kind of blazed the trail, so to speak. And now we've got kind of fellows here after. [00:03:00] So yeah,
Host: we, you know, we don't have to earlier about the dr art's charisma and he certainly has it. Yeah. But I really do feel like, I don't know if it's a result of him or if it's just the kind of people he brings around him, but everyone I've met is such a, a good person interact with. And I think that's important for our patients to know too. I mean the, the comfort level and that kind of a personality and ability to engage I think is important in this process.
Dr. Adams: I agree, especially with what we do. Um, I, [00:03:30] I would say we definitely have just a very personal, um, specialty. When you think about all the various doctors and, and areas of medicine, I feel like weight is one of those places where, you know, you really delve into, in to kind of someone's personal level and, and their thinking and their behaviors and, and there's a lot of subtlety that goes into that. And so it really takes a special [00:04:00] team. And a special person approach all of that.
Host: So, so you were talking a little bit about the team and, and kind of that, that, uh, social emotional intelligence approach that this team has, which I think is awesome. Um, and certainly, uh, a piece of the weight management center. But give me a little bit more about what the difference is that the weight management center, what is, what is our weight management center do here at wake forest Baptist health?
Dr. Adams: Sure. So, um, that's kind of a loaded question, right? What do we do? We do [00:04:30] lots of things. Um, so just kind of as a bird's eye view to our program, maybe for those folks that aren't familiar with the weight management center. So we are both a comprehensive medical and surgical weight loss and weight maintenance program. I always like to throw that in there. Right. Weight management is more than just losing weight. [00:05:00] Um, we focus quite a bit on the maintaining it thereafter too, which, um, can speak about later. But, um, just kinda touching on our approach. So, like I mentioned, kind of a comprehensive approach to both medical and surgical weight loss and weight maintenance. So we've got a big team, like we've already alluded to of providers. Um, [00:05:30] that includes medical providers, that includes dieticians, exercise physiologists as well as behavioral providers, so psychologists and social workers as part of our team.
Dr. Adams: And then on the surgical side of that, certainly surgical providers in addition to all those other disciplines, the dieticians, the exercise physiologists and the behaviorists, um, which really provides our patients that [00:06:00] kind of full approach, again, that comprehensive approach to not only losing weight as a number on the scale, but all the other subtleties that play into how they got to the place that they're in today. Right? You know, most people that come to us, this isn't their first attempt at weight loss, right? This has been a long history for them and, and we recognize that. Um, and so I think it takes a little more comprehensive approach to, to [00:06:30] work with these patients to say that, you know, we realize this isn't your first attempt. There are so many other things we need to tackle during this process. Um, and so we do that.
Host: You mentioned the, uh, I think that's the most important part from an overview standpoint is that multidisciplinary approach that we have. And the one to me that's most unexpected, um, obviously great professionals and great experts, but the one to me that's the most unexpected perhaps to the general public is the, uh, the behavioralist, right? Like you're coming at it from a psychological standpoint, which [00:07:00] to your point on, I hate to admit I've been the victim of it myself, but that, that weight loss and then weight gain, right? Like you, you play that game and it's all about the mental aspect. And I, I'm sure you agree that our society, our culture plays into that psychological. So, so what we're giving you at the weight management center is a way to paddle some of that.
Dr. Adams: Exactly. And I, I, I love that you bring up the behaviorist because, um, I definitely say that they're the, they're the underdog, so to speak. They're, they're definitely the most understated, [00:07:30] right, of the group of us. Um, but I think they're also one of the most important, yeah, right. People come into our clinic and they, they know that there's going to be a medical provider involved. They know that there's going to be a dietician and exercise, right. Cause you can't go through weight loss about touching on those. But it's the behavior, that behavioral piece that that gets them. I think patients are initially resistant to chatting with a behaviorist, but they ultimately realize going through the process that that provider [00:08:00] has so much to offer them and almost plays, you know, a bigger role in someone's weight loss and maintenance effort even than the other three disciplines
Host: with no offense to the three, like incredible professionals. But just th there is this, the mind is a, is a terrible thing they say. Right. So, so, so that's the piece we're playing with and trying to make sure that we're staying on track with the goals and mission set [00:08:30] forth by these other providers and other pieces of the team. Yeah, absolutely. Yeah. Okay. So, so obviously that's a piece of what's different from, um, when we talk about what's different from the kind of more commercially known programs we're going to avoid saying them today so that we don't promote them. We're focused on weight management center, but we know there are other options out there. Um, so, so what would, what would be some of the biggest differences that people should be aware of maybe besides the behavioral list with our program versus some that they may find more, [00:09:00] more easily, readily accessible when they're following an app or something like that?
Dr. Adams: Great question. I certainly wouldn't be doing my job if, if we didn't talk about those alternatives because those programs definitely have their place, right? Patients have been successful through those various programs, but there are also reasons why they come to us thereafter. And so I will definitely say that [00:09:30] the majority of our patients, as I've already mentioned, this isn't their first weight loss attempt. And oftentimes they come to us and they've already been through one of those various commercial programs. And, and so it's interesting to hear their experience cause I've never been through one of those programs myself so I can't speak to it from the patient's side. But um, one of the things that I think that we can offer or maybe that we do a little bit better, if that's fair to say, [00:10:00] is that comprehensive approach and not just that we are tackling kind of the standard diet and exercise pieces, which I think we all know play into weight loss and weight maintenance.
Dr. Adams: Definitely the medical piece I think is missing from a lot of those commercial programs. Right? People come to our program not just to achieve their, what I call scale goals, right? The weight loss number on the scale, but also those [00:10:30] non scale goals. I think that's one thing that those other programs maybe don't look at. But when folks come to us, I want them to have more than just a number in their mind. I want them to come to me and say, Dr. Adams, I want to get off my diabetes meds. Oh, I don't want to take my blood pressure pills anymore. I want my knee to stop hurting and I'm on my back. Just stylist. Sure, sure. If it's the back, right. All of [00:11:00] those things. And I don't think that's something that patients feel comfortable going to one of those other programs and you know, either cause there isn't a medical provider or there are, again, they're just focused on the scale. But um, anyway, that's certainly a big piece. And then on the flip side of that, one of the other things I care, I hear commonly as a provider from folks who have been through those other programs, is that they're pretty good at the weight loss piece. [00:11:30] I'm pretty good at helping folks lose the weight as a number on the scale. But then what happens, right, right. They get the weight off and they get to maybe their goal number and maybe they improve some of their health issues.
Speaker 4: Yeah.
Dr. Adams: But then there's no support. Right? Right. Well what, how do we keep off the 50 or a hundred pounds? So we lost. Yes. I find that far more challenging actually in what we do. The weight loss piece actually is the easier piece of the battle, right? It's the keeping it off [00:12:00] and that's where I think we're most different and beneficial.
Host: What's our, what's our typical, uh, lifespan of our relationship with, with our average patient where, to your point, you know, and I can speak from experience, let's see, I was on, I was on keto for a, I don't know, that's a brand. I think it's more of a thing, so I'm okay saying it. Um, but I was on keto for like a month and, and I've been on other apps and done other things for some period of time. [00:12:30] Um, what kind of, my sense is that our, our relationship lifespan is typically longer because we're more ingrained in kind of your behavior there. Is that, is that true?
Dr. Adams: Absolutely. And I, I would say broadly that our relationships are on the order of years, um, not just because we're looking at the active weight loss piece, but then building that longterm plan to keep the weight off thereafter, whether you're in a formal weight [00:13:00] loss and then weight maintenance program, or even if you just see us on an individual basis quarterly or every six months or whatever it is, like you would see your other subspecialists, right? We're just another piece of that puzzle in your healthcare and, and, and so I definitely think we've got those relationships longterm and I encourage folks to think of us that way. Don't, you know, most folks don't come to us and, and just say, I, I want to lose the 50 pounds and then off I go [00:13:30] out of here in a month. Yeah. No, and I think that's great. Yeah. I think folks realize that it's just that our approach is just that different. Right? Right. It's more than just that little piece of loss.
Host: I want to talk more about our program, but I feel like this is a good time. So I broke news to you before we started our conversation today. So now we're going to, we're going to breaking news on our podcast, breaking news. Some people may not have heard, but the USA network is bringing biggest loser back to TV with Bob [00:14:00] Harper hosting. And I love Bob. I mean, how can you not like Bob watching him on the biggest lizard NBC back in the day? So, so, so just for cultural reference and relevance, um, talk to us a little bit about how, how the things we were just talking about kind of align with what's happening there and, and not necessarily about the show itself, but that kind of attitude aligns with what we were just discussing.
Dr. Adams: Yeah, absolutely. And, and, and you're right, I, I didn't know that it was coming back. I don't know all the subtleties of, of the biggest loser show. [00:14:30] I've only watched it once or twice myself, but, um,
Dr. Adams: my greatest concerns, I guess about their approach to weight loss and weight management is just that it's an incredibly aggressive one. True, right there, there, I don't know, you know, all the subtleties of, of what they're focused on. But um, my understanding is that it's a very [00:15:00] rigid dietary process with a huge exercise component, which I think is what they're known for eight hours. Oh my God. Okay. Just for the, for the future patients out there, I will never ask you to work out eight hours a day. Um, please Lord, don't do that. Right. Um, but to your point, right, a very aggressive approach and, and that's not where we're getting at. Right? Right. In order for [00:15:30] folks to be successful with their weight long term, we've got to formulate a plan that is going to be sustainable, right. And going about weight loss in the way that maybe the biggest loser does is maybe only effective for the short term. Right. But there's, you know, there's no way that, that someone can can [00:16:00] sustain that long term and if they are successful with their weight loss, like let's say they lose 50 or a hundred pounds or whatever, well then what happens? Right. I've answered that question earlier. Then what happens once they stop?
Host: Yeah. The research for biggest loser. If you go back to all the winners,
Dr. Adams: wait, just tax write off
Host: comes back. Most of them add it back to some degree if not fully, maybe not always, you know, way, way back to where they were. But that happens and I think too, the, the, the, the social, the, the [00:16:30] TV aspect plays into it and kind of distracts from the Brent the, the position your mind is supposed to be in.
Dr. Adams: Right. And, and you know, without getting into the, to the weeds, so to speak, of the science behind weight loss and weight regained thereafter is that, you know, when you lose weight in such a manner and then don't maintain those habits, yes, your body just as a protective mechanism is going to put that weight [00:17:00] right back around. Right. If you go from working eight hours a day back to 30 minutes, five times a week or whatever the case may be,
Host: just the way it's going to come back. I mean, I can't expect it not to. And I think that's a, I mean I think it's a great point you're making about kind of the difference with us. And the one thing I would say about any program like that and I think you'd agree is wherever patients in our community and our, our population can find their inspiration. Yeah. Awesome. And I think what, what some shows like that can do is help inspire [00:17:30] people to want to change. But we wanted to, the reason I wanted to bring it up was just to kinda level set that expectation as people start to see that in the news or paying attention to TV and seeing those kinds of things. Know that there's a different process to do it the right way. And that's what we're doing here at wake forest Baptist health and our weight management center.
Host: So I think those are, those are great. Um, so I know we talked about a little bit about this earlier. We've kind of, we've kind of danced around it. Talk to us a little bit more about some of the, um, the different things [00:18:00] that we encounter with, um, patient's medical issues that we can help resolve. I mean, I really, you know, when you were talking about that a little bit earlier, it astounds me when I think about it that there's so many things that get better, you know, anxiety, stress, um, a long list of, uh, you know, all the pains you listed. There's certainly diabetes and more clinical kind of serious clinical medical issues that can get better, but really losing weight and maintaining a healthy weight can can affect you in so many different ways. Right?
Dr. Adams: It [00:18:30] can, and I, and I absolutely love that you bring up the topic of those behavioral pieces, right? The stress, the anxiety, the depression, all those things that people tend not to want to talk about. People tend not to want to come to clinic and say, I want to make my mood better because I'm 50 pounds from where I really would feel more comfortable being. Of course, I want patients [00:19:00] to come to me obviously is one of the medical providers at the clinic. And say, Dr. Adams, please help me with my diabetes, my high blood pressure, my high cholesterol, my joint pains. Right? We have dedicated programs even to help folks lose weight so that they can get their joy replaced if that's what they need to lose just or just make that better. Um, but I also want them to come to me with those other goals.
Dr. Adams: Yes. Right? I want to help [00:19:30] someone's mood if it's tied to the fact that they've been overweight for their entire adult life or their social anxiety because they're overweight or whatever it is. And, and we haven't quite touched on some of the other smaller program options we offer. But you know, I encourage folks who, you know, especially the ladies, maybe if they've been overweight their entire adult life, we've got options to help them lose weight, to [00:20:00] maybe conceive or to have healthy children, all of that. That's one thing that folks don't think much about. And again, one of those harder topics to maybe talk about, but, um, important things that I think we need to tackle in terms of weight.
Host: And I think from a, from a system standpoint, from being part of wake forest Baptist health, it's not going to be easy to talk to someone from a, a commercial competitor about some of those more intimate issues. But we are an academic [00:20:30] medical center. You know, I, I love to say when I talk about best health core, you know, a lot of the team has heard me say it, but we're an academic medical center and we talked about teaching the doctors of tomorrow. I also think we're teaching the patients of tomorrow, right? So let's talk about how we can teach the community and the patients of tomorrow. And I think that's what plays in there, kind of what those kinds of things that we're comfortable talking to you about that can help you be your best you to, to, to live your best health, I think is, is an incredible opportunity coming to our system as [00:21:00] opposed to using some, you know, using a potentially fine system that's not connected to, um,
Dr. Adams: the resources that we have here. I agree. 100%. Absolutely.
Host: So, so let's, um, I kind of as we, as we get close to wrapping up here, I know part of what we do is medical weight loss and that's your specialty, right? And understood, understand there, but you're representing the entire weight management center. So let's talk a little bit, uh, for the, for the public about our listeners, about [00:21:30] what kind of options we provide from a surgical standpoint and kind of how we, how we get to that point for, for our patients.
Dr. Adams: Yeah, of course. Uh, like you said, I, I'm one of the medical docs, so that's my job is, is to help on the medical side, but we work incredibly cohesively with our surgical team too. We've got a great team of surgeons at all three of our clinic locations now, um, who can help folks achieve their surgical goals if, if that's the [00:22:00] case too. And, um, I want to explain that a little bit because I think there might be a little bit of a question or misconception maybe about what the surgical side has to offer. And, and I will see what I will say. We see a broad scope of patients on the surgical side that include the folks who are interested in surgery. Right? Right. Maybe they're folks who have never had bariatric surgery before. They've tried weight loss countless times in their life. Um, [00:22:30] and maybe they want to have a conversation with a surgeon about their various surgical options.
Dr. Adams: Maybe they feel like that's the only option they have left. Fine. Great. Our team of surgeons is happy to chat with you about that. On the flip side of that, we've got actually a good number of patients who come to us and they've had surgery before. Maybe they had surgery five or 10 years ago, somewhere else, who knows and they lost some great weight. Then they put the weight back on, now [00:23:00] what? Maybe they need a little help so we can help on that side too. Um, with what happens kind of after surgery or maybe, you know, who knows.
Host: So there's absolutely cases that makes total sense. And so there's absolutely cases where some people have, have exhausted a lot of other options and come to us and are at the point where potentially they're, they're ready to consider surgical. But there's also people that come to us going, Oh, surgery, coy, but we also have this medical weight loss option for you. Maybe you're at a position where you could consider that based on X, Y, and Z factor.
Dr. Adams: [00:23:30] Yeah. And I encourage folks, um, maybe they're not sure what direction to go in. They come to us and they say, I know I met an unhelpful wait. I've tried a few times. I don't know what the right option is for me. Again, the part is we work very cohesively together and, and so there are some patients who come and maybe they think initially that surgery is their only option and they had a conversation with the surgeons and the surgeon says, well, have you tried an intensive program, [00:24:00] a comprehensive weight management program? Like our medical team offers? And they say, no, I don't know. I did X, Y, or Z commercial plan. And, and it was fine. And they say, well, give it a try for six months, just give it a go. Right. And so they send him to the medical side and we do what we do and Hey, that's successful and vice versa. You know, maybe I've got folks on the medical side who they've tried for years and years and maybe it doesn't, they just [00:24:30] can't maintain it for whatever reason. And maybe we send them to have a conversation with the surgeons for a more longterm option. Just it vice versa, you know, just depends on the patient.
Host: And that's important for the team cohesiveness and the reason we have this weight management center. So let's talk about a couple pieces. One, one word we haven't mentioned and we've alluded to it is personalized, right? Yeah. It's, it's, it really is. It's not a, it's not a one size fits all. I've heard, I went to the doctor, ours, we'll talk about this in a minute, but [00:25:00] just to remind people about the seminars that we provide. Um, we have online and in person live seminars that you can find on our website. We'll give you that address here in a minute. Um, but I've heard dr art, I went to to listen to one of his medical weight loss seminars. I need to come see one of yours one time. Um, but I heard him, uh, speak specifically, um, to the number of hours that we take in our first, in your first interaction with us. I think it's four, you know, approximately four hours of time to build your program built around you. The individual
Dr. Adams: [00:25:30] in total. Yeah, we, we've, we've danced around this question, right? Um, but I do want to give folks a sense of how we personalize our programs. So
Dr. Adams: when patients come to us, you know, whether they're interested in medical weight loss or surgical weight loss or what have you at their very first meeting with us is certainly at an informational session and we can [00:26:00] talk about that. But we ask folks to come in and just learn about our programs, learn about these, um, this team of, of providers. Cause we certainly do come as a big team these days. Um, and that's just step one. But you alluded to kind of a four hour long assessment. And in total it probably is that long, right? Um, our patients, when they come as new patients, so to speak, they have two [00:26:30] visits to kind of initial assessment visits, I'll call them. Um, the first visit being about an hour to an hour and a half long. And, and that's kind of the data gathering visit, so to speak. And that's where we look at someone's medical troubles.
Dr. Adams: We look at their lab work. If they've got, you know, high cholesterol or diabetes or what have you, we look at their body composition, right, their muscle, [00:27:00] their fat mass, their bone health, all of that. And then we take an assessment of their metabolism. So we do a metabolism test and see where their metabolism is. Right? Folks come to us all the time and they say, doc must be cause my metabolism broken. Right? So we talked about too, right? We need that data. So anyway, that visits about an hour long and then when they come to new patient clinic, that visit is two hours minimum. I mean it is a good chunk of time and I encourage patients to set that [00:27:30] time aside knowing that it's going to be two hours because in that two hour new patient clinic visit, you get a true visit, at least 30 minutes a piece with all four of the discipline providers to get that best overall view of where you are today in terms of your weight history.
Dr. Adams: And so that visit will include time with the behaviorist, whether a a psychologist or a social worker or whomever [00:28:00] to look at, your stress, your mood, your goals, your weight history, all those subtleties that play into where you are. And then you get a visit with the medical provider of whoever's working that day and they're going to look at again, your weight history, your medical history, the medications you're on, that lab work, if there's abnormalities you didn't know about before, examine, um, your body composition and your metabolism [00:28:30] test. And then of course do a physical exam of you and then putting all of that together. You have a visit with the dietician as the third part of your new patient clinic visit. And that's where you really get into developing a meal plan that fits you. Right? Again, this is not a one size fit.
Dr. Adams: All right? We all have different eating habits from day to day, different work schedules, different family lives, you know all those things. And so the, the [00:29:00] dietician sits down with you and comes up with what, what does the sample day in the life of you need to look like, right. For weight loss. And then lastly, they finish up with the exercise provider to take an assessment of how active you are at baseline. If you're inactive at baseline, where, where are the barriers, you know, is it, is it a pain issue? Is it that you hate to be active? I got so many people, they just, exercise just isn't their thing and that's okay. The nice part is the exercise team [00:29:30] is, is willing to meet you where you are. Right? It may not look like you go out for a job three times a week. That's fine. If you want exercise to be going to Zoomba or spin class or dancing in the living room with your kids, great. They'll, they'll kind of take that assessment and, and help develop that exercise plan for you. So lengthy visit, but really important pieces to the puzzle to get to know each and every person. Yeah.
Host: And I appreciate the clarification. I didn't, you know, certainly didn't mean four hours but [00:30:00] four hours in one sitting. But it is a, is a process and I want to push that point home of that personalized process that we develop in the formula that we come up for you, the individual sitting in front of us to help you be healthier. Um, so the other point I want to hit on, just real quickly for our listeners, you mentioned our different locations. Tell us, tell us where all we have locations. Cause I think, you know, sometimes I think within our growing system, as you know, it's, it's surprising to people when they find out how far reaching we are. So, um, where, [00:30:30] where can they visit us, um, to visit the weight management center?
Dr. Adams: Absolutely. So, um, the weight management center now probably has three clinic locations. Um, we initially began in the Winston Salem office are off of country club road. About two, three years ago. We opened our office in Greensboro, so that's up at our North Elm location and then just may of last year we opened our clinic and high point. Um, so they're near high point. The hospital [00:31:00] itself. I'm happy to help folks at any of the offices.
Host: Well that's, that's awesome. I really appreciate your time today. Thank you for being with us. Enjoyed the conversation. Absolutely. That's awesome. And so for more information, people can go to wake help.edu backslash weight management. Um, they can found your profile as well as all of your colleagues profiles. They're on the website as well, um, and the location. So any information you have, you can find there. You can also call us at (336) [00:31:30] 716-6099 (336) 716-6099. Thank you so much for being with us today and we'll, uh, we'll talk to you soon.
Speaker 1: Thanks for listening to this episode of the best health podcast brought to you by wake forest Baptist health. For more wellness info, check out wake help.edu and follow us on social media. Wake forest Baptist health, the gold standard of health care.