Bridge the Gap: Weight Optimization Strategies with Dr. Sarah Stombaugh

Have you been struggling with your weight along the fertility journey? 

Perhaps someone has even suggested a GLP-1, however you were worried about how this might affect your timing and potentially your future pregnancy? 

Dr. Sarah Stombaugh debunks a lot of myths in this evidence-based conversation. We discuss the following:

• GLP-1s and the different half lives / recommendations for discontinuing prior to pregnancy

• Other weight loss medications which can be used as adjuncts during the bridge to treatment

• Intuitive eating, hunger and satiety (including protein goals, fiber, hydration, and optimizing the micronutrient environment)

• Emotional eating and how to overcome this

• Mindset pearls

Guest Details: 

Dr. Sarah Stombaugh is a family medicine physician and diplomate of the American Board of Obesity Medicine. Graduating from Creighton University Medical School and completing her family medicine residency at University of Chicago, Dr. Stombaugh practiced outpatient primary care in Evanston, Illinois before moving to Charlottesville, Virginia with her family. Host of Conquer Your Weight Podcast, Dr. Stombaugh believes in empowering both individuals and the medical community in order to promote an evidence-based approach to the treatment of obesity.

Website: www.sarahstombaughmd.com

Instagram: @sarahstombaughmd

Additional Links:

Conquer Your Weight Podcast episode #74: The Impact of Weight on Fertility with Guest: Dr. Erica Bove

Love and Science Fertility Podcast episode #61: GLP1's and Infertility With Dr. Catherine H. Toomer


As always, please keep in mind that this is my perspective and nothing in this podcast is medical advice.

If you found this conversation valuable, book a consult call with me using this link:

https://calendly.com/loveandsciencefertility/discovery-call

Also, be sure to check out our website: loveandsciencefertility.com

Follow us on social media:

IG: www.instagram.com/loveandsciencefertility

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Please don’t let infertility have the final word. We are here to take the burden from you so that you can achieve your goal of building your family with confidence and compassion. I’m rooting for you always.

In Gratitude,
Dr. Erica Bove

Transcript:

Hello, my loves, and welcome back to the Love and Science podcast.

I could not be more thrilled to have my friend and colleague, Dr. Sarah Stambaugh with me.

She is an amazing human.

And I just want to say before I formally introduce her, she's actually the reason we have a podcast called Love and Science.

It's so true.

I wanted to bring this up because back in the day when I was like, had this dream of a podcast, but I had all this mind drama about technology.

She was like, don't worry.

I figured it out in a way that doesn't involve lots of staff and like, let me sit with you and explain all the things.

And so we sat down, I mean, virtually for like 45 minutes, we recorded the session.

She showed me this thing called GarageBand and Buzzsprout and like how she started her podcast because she was a little ahead of me in her timing.

And it like got me over my drama and I was able to start and publish this starting two marches ago.

And so I just wanted to honor that Sarah, because I really like, truly like you're the reason that like I was able to overcome all the things to be able to be here in general.

And so the fact that you're a guest on the podcast today just feels like very full circle.

Yeah.

Oh my gosh.

I love that.

Thank you for sharing that with me and with your audience.

And you know, it's so funny being physicians as we are sometimes tackling new things and learning new things can create a lot of mind drama.

And so yeah, I'm so glad I could come on that journey with you and be here today.

So here we are.

So let me formally introduce you.

So Dr. Sarah Stambaugh, she is an amazing human first and foremost.

She's a family medicine physician by training and a diplomat of the American Board of Obesity Medicine.

She is a graduate from Creighton University Medical School and she completed her family medicine residency at the University of Chicago.

She practiced outpatient primary care in Evanston, Illinois, before moving to Charlottesville, Virginia to take on this new venture that she does.

So basically what she does now is she has a private practice weight loss clinic where she sees patients both in person and I believe virtually, is that right?

In Charlottesville.

And she offers telemedicine for people who are struggling with weight and it's beautiful.

She's the author of the Conquer Your Weight podcast, which is, I've been, I guess there, so we'll put the link to that interview in the show notes as well.

And through her work, she's able to share valuable insights, expert opinions, and practical advice on weight management, which helps contribute to the health of us all truly.

And I think being a coach and a doctor, somebody, family medicine who sees the whole picture and also someone who has tremendous expertise in medical weight loss and speak on surgical weight loss and also the multidisciplinary care it can take to really have the best possible outcomes.

I'm just so very excited to have her with us today.

Thank you, Dr. Stoma.

Thank you for being here.

Yes.

Thank you for having me.

And I'm excited to share today with your audience because I just have such a special place in my heart for people who are struggling with fertility, going through the IBS journey.

And it's often the patient population that many physicians are unwilling to support.

And so it is a group of patients I love supporting.

And so I'm excited for us to talk about that.

Yeah.

And I will say all my patients are so motivated, you know, and it's like, just tell me what to do and I'll do it.

But I will say like, even as an REI and a special interest in, you know, weight optimization and all those things, like there are many times that I feel like, oh gosh, this is beyond the boundaries of what I feel comfortable with.

I don't know how to answer this question.

And I'm so glad to have you here because I think we all need to work together to share the information to really bring about the best possible outcomes.

So with that, I wanted to start with a request I actually got this weekend.

This is true.

Like as of the day that's recording, this came through maybe like three, four days ago.

And I was like, oh shoot, I don't know what to do.

I got to ask.

I got to phone a friend, like look at the data.

So this is somebody who, you know, may very well be very similar to you if you're listening to this podcast.

She's a 40 year old physician.

She lives in the US.

She's on an IVF journey, single parenthood by choice.

And so basically she was on Wogobi, right?

And she got her BMI down from 41 to 34.

And basically she was on the medication.

Her own PCP was concerned because, you know, quote unquote, this is the next opioid epidemic.

So I'm going to, you know, sort of limit your dose and space it out.

Then she regained 20 to 25 pounds she had lost over the course of being on it and really struggled to, you know, sort of get back on it, right?

And really wanted to, but I think there was some resistance as we see.

Then she contacted her REI and was able to do IVF and was able to get, you know, sort of three, you played embryos, which is fantastic.

And the rate limiting step in IVF is embryo generation.

But basically, you know, then she started the Wogobi and it's like, okay, well, shoot, like now that I have these embryos, I'm trying to lose weight in the effort to get back in a better place where I can start to transfer these embryos.

But like, what, like, what is actually the recommendations?

Like what are the recommendations leading up to the embryo transfer?

You know, even during pregnancy, like what data do we have?

Quote unquote, the GLPs have really been life changing, mostly because it made me feel like a normal person and it wasn't constantly thinking obsessing about food all the time, allowing me to more easily focus on my actual tasks and goals on life, which by the way, is being a physician, you know, sort of serving the people, but, you know, sort of let's sort of unpack this a little bit.

Like, how would you approach somebody like this?

How would you guide them understanding that in this context, it's not officially medical advice, but it's just us using our expertise to educate.

What do you think?

How can we sort of advise this beautiful soul?

Yes.

So I love this case study because this is such a common type of question that I get all of the time, especially for patients who will be pursuing pregnancy in any context.

There's this, you know, we know that these medications at this time are not recommended during pregnancy.

So we know that we're talking about typically a short term use of this medication, which then can have effects like weight rebound, for example.

And so there's really, really a lot to unpack here.

Realistically, we could probably use this case study to talk about some, you know, each of the different things as we're thinking about it.

So when we look at the data of the GLP medications, the reality is there is a few different medications that we're talking about.

And then as we think about those, thinking about what is our timeline for pregnancy?

What are the factors to consider?

So thinking about the different medications.

So breaking it down into medications that are some of the glutei products.

So those are Ozem, Vic, and Magovi, which this patient, of course, or this client is talking about.

Then medications that are terzepatide products.

So that's Zepbond and Monjaro.

And then even other medications like liraglutide, for example, which is Cixendo or Victosa, and actually can have a really beautiful place to use alongside the IVF journey as well.

So when we look at these medications, a lot of times understanding someone's IVF timeline is really important.

So we want to understand, are we talking about the egg retrieval component?

And there'll be considerations about pausing before egg retrieval and anesthesia implications of that.

And then are they going immediately into the IVF journey versus are they going to be taking a pause and looking at pursuing IVF at some point in the future?

So we'll come back to some of the anesthesia piece and the IVF or the egg retrieval piece.

But trying to understand what is someone's timeline for pregnancy, for implantation, and then we can start to work backwards from there.

How long would we need someone to be off of these medications specifically?

Now this data is relevant as of 2025.

As we get more and more information, we may be able to adjust these guidelines and you and I may need to have a future conversation in a couple of years.

But what we're looking at right now is talking about having medications out of the system in advance of pregnancy.

So the nice thing about IVF is that we have often very clear timelines about what that looks like.

Now a little bit of fluctuation here or there as you're looking at where are the peak points in the cycle and how are you responding to some of the medications.

But for someone like this who's already had egg retrieval, we're just, we have a pretty tight timeline as to what that will look like.

So as we're thinking about the semaglutide products, BOGOVI and OZEMBIC, the official recommendation is those should be out of the system for eight weeks before trying to conceive.

Now I will say I like to look at the half-life data as well because when we look at the half-life of these medications, with the semaglutide products, OZEMBIC, WOGOVI, we're talking about a seven-day half-life.

So realistically when you look at pharmacokinetics, you'll get how are medications being processed through the system, how long does it take for that to be eliminated.

The reality is after four to five half-lives, a medication is going to be mostly out of your system and by six half-lives, nearly undetectable.

And so for an OZEMBIC or WOGOVI medication, a seven-day half-life, we're really talking about 42 days or six weeks that these medications would take to be out of the system.

So that recommendation of eight weeks is going to give us a pretty solid buffer.

I very frequently see people recommending even longer periods of time and those are based on sometimes fear-based medicine, for example, or physicians who are trying to protect their patients, I think of their core, but sometimes inadvertently end up causing harm in this way where patients have been discontinued for really long periods of time unnecessarily.

So looking at it, certainly that eight weeks, but realistically maybe even cutting it a little bit closer than that.

Now interestingly, when we look at the trisepityte products, so that's Zepbown and Mancharo, these medications, there actually is not an official recommendation to be out of the system.

So when you look at the FDA label for these medications, they say these medications should not be used during pregnancy.

They should be discontinued upon a pregnancy being recognized.

And there are also recommendations about using contraception in order to prevent pregnancy and using backup methods because we know that oral birth control can be affected by any of these GOP medications.

So interestingly, there's no recommendation.

So most people will utilize the Ozempic and Mogovi recommendations that eight weeks and utilize that for Zepbown and Mancharo.

Now what we do know is that those medications, Zepbown and Mancharo, which is Zepbotype products have a five-day half-life.

So realistically, even if we look at six half-lives of that, we're talking about 30 days of that medication to get out of the system.

So being off of the medication solidly for a month, you're looking at that medication being out of the system.

Now one medication that I think is going to maybe regain some popularity is the Lyrglutide product, so Sixcenda and Victoza.

Interestingly, Victoza is the version for the treatment of type 2 diabetes.

Sixcenda is labeled for the treatment of obesity.

And this medication was FDA approved 11 years ago.

It's been around actually for a while.

And I think that while we, no one was talking about it.

At that time, we had Contrave, which is the appropriate naltrexone.

We had Q-stimia, which is Fentramine Topiramate.

And when you compare Sixcenda across those, it's not that much more effective.

And nobody was talking about the GLP receptors at that time, or the receptor agonist at that time.

So we had this medication that's a daily injection.

So all the other ones we're talking about are weekly injections.

So Sixcenda, the Lyrglutide products are daily injections.

And people are like, "I don't want to take a injection.

Can I just take a pill version of something?" And now as we've seen the popularity of all of these other GLPs, there has been a little bit of a resurgence in the Sixcenda and the Lyrglutide community.

And I break that up because one, Victoza, the diabetes version of this medication, went generic last summer.

So there are generic options of this medication available.

And then most importantly, especially when we're talking about the IVF journey, we're looking at a daily medication.

And so from a half-life standpoint, this medication is going to be out of your system completely within a week.

And so that gives us a little bit of flexibility of we can sometimes cut it really close that if we know the timeline, we could bring someone, even if they were on a Wagovii product, for example, we could switch them over to Sixcenda and bring them closer to the pregnancy.

So that can at least prevent some of that weight rebound that can happen in that period of time.

Yeah.

That's interesting because I think what this person who wrote in is really talking about is the bridge.

How can I, I had so much success with the GLPs, but everybody's afraid of them and I'm trying to get pregnant.

I have these embryos.

How can I bridge to my transfer in a way that I want to feel like a normal human?

That's exactly it.

So that could be a possibility in terms of getting closer.

And then when does, would somebody have to come off as a sixcenda in order to like, how do we, a week.

Okay.

So, I mean, that's really interesting.

And I think, you know, one thing I'd love to do is just normalize having the obesity specialists like you as part of the care team from the beginning, because it is too much for PCPs to take care of, you know, it's too much for OBGYNs and even REIs.

Like we try to educate ourselves as much as possible, but there's so many nuances, like you said.

So just normalizing this and, you know, I think another question I have put into her question as well is like, what goals do we really look at?

Like what is the goal, you know, in terms of like, you know, and I know it, it, this is a very individualized conversation, but I think it's important.

You know, I see a new patient in my office and say the body mass index, which I know is not perfect, but it's, it's one thing that we use to help guide our, our management is like say 50 or 55.

And so it's like, okay, well, you know, certainly for IVF, we have certain cutoffs, but like what, what can I tell her?

Like when do we just decide that enough is enough and we move forward?

You know what I mean?

Like that's something that I struggle with in my practice is that when, when do we decide to proceed?

So let's, let's talk about that a little bit in terms of like, how do you approach that conversation?

And I mean, I think that some of it is resumption of men's ease because a lot of, you know, people in this situation are an ambulatory, but I will tell you a lot of my patients and clients who come to see me have already tried a lot of things and they're really trying to get to set the stage for IVF truly.

Yeah, absolutely.

When I think of recognizing that there's going, this is going to take some time, right?

You know, a lot of times we know, even if we have an idea of what a weight loss goal may be for a person, whether we're talking about medical weight loss or whether we're talking about surgical weight loss, there is going to be some timeline there.

And so I think a lot of times that is a huge factor in deciding from a age standpoint, from a fertility standpoint.

What are the factors?

And this is a great conversation to have with one's REI of how quickly do I need to be pursuing this?

Do I have six months?

Do I have 12 months?

Do I have longer?

So something, for example, like bariatric surgery, you know, when you look at bariatric surgery, the data on success in weight loss, the ability to keep it off.

And so there's not that same risk of rebound.

I mean, certainly we see pregnancy weight gain, but there's not the effect of, oh, I've been on a weight loss medication.

I've had to stop that medication for pregnancy and seeing that rebound, which can be really challenging both physically and then emotionally to deal with.

So sometimes bariatric surgery can be a really good option to consider if someone has that timeline.

You know, when we look at bariatric surgery, realistically, we're talking about that about a two year timeline from when that person, and probably even realistically a little bit longer.

That's like if everything lines up perfectly of from when you got in to have a consultation with a bariatric surgeon to a period of medically supervised weight loss, the most insurance companies will require a person has a period of medically supervised weight loss.

Most commonly, that six months, there are some variations and that depends on one's insurance company, but there's typically about a six month period of medically supervised weight loss.

Other things that are happening in that period as well, meeting with a psychologist, meeting with dieticians, there's monthly visits during that period of time.

And then from actually having surgery to where's your body at a place stable from a weight standpoint, but then also from a nutritional standpoint, you know, there's so much, you know, in pregnancy, we really in growing another human that requires a lot of nutrition in our body to do that.

And there is certainly a risk of malnutrition during the weight loss journey or particularly bariatric surgery journey.

So making sure that patients have really stabilized both from a weight standpoint, as well as then from a micronutrient standpoint, that they're getting all their vitamins, their minerals, for example.

So it's really interesting.

Pause elephant.

Yes.

This out.

I did you hear one in the background?

Did you hear like a, like a lawn?

You did not have it all.

Okay.

I just want to make sure that's not a part of our conversation at all.

And so we are going to keep the mindset of talking about GLP ones and micronutrients and how to bridge with nutrition.

I just want to, because my headphones were not waiting for me and I'm like, did my Twitter take them?

What happened?

I want to do them to really optimize our sound.

And I think it's going to be okay because my zoom settings are super intense.

I will be right.

I just want to find them so that I can then give us the best possible sound.

Just a sec.

We're going to pause the recording.

Dr. Sara, that's such an interesting point that you just brought up about sort of the sort of optimizing the micronutrients.

And I'm so curious about this.

So when you see a person, how do you know that they're optimized, not just from a white perspective, but also from a nutritional standpoint?

Do you check labs?

Like, you know, how do you look at that a whole picture?

It can be a really challenging.

So a lot of times in our society, we're looking at nutritional deficiency.

So sometimes if a person is having symptoms that are consistent with nutritional deficiency, and this can look like skin changes or neurological changes, we will often go seek, you know, a specific, you know, we're looking at B levels or looking at vitamin C or looking at zinc, or we're looking at these very specific nutritional deficiencies that can emerge.

But we know that in general, in the weight loss journey, that there may be a risk of those in A, maybe just less food is being consumed, whether we're talking about medical weight loss or surgical weight loss.

And then in a surgical weight loss as well, there is a malabsorption that can happen.

And so for patients who are undergoing weight loss, typically I will recommend at the minimum that they're on a multivitamin.

So for most women who are in the pre IVF journey, they may already be on prenatal vitamins.

Interestingly, I actually recommend prenatal vitamins for all of my patients, even my men who sometimes look at me like I have 10 heads.

But they're just really nice from they have good iron, they have good B vitamins, and those the proportion of those is a little bit higher in a prenatal and can really align nicely with what someone needs in a medical weight loss journey.

There are also bariatric surgery vitamins, and those generally will be a little bit higher also in fat soluble vitamins.

So particularly patients who've had bariatric surgery are at a risk of vitamin deficiency in fat soluble vitamins, as well as iron as well.

So they may need additional supplementation with those and monitoring of those levels.

So typically, a regular multivitamin will do the trick, often layering on, especially B12 for someone who's maybe on metformin medication or follows a very plant based diet, for example.

And then also if there are specific things we need to consider.

That's so interesting.

So yeah, I mean, there's so much more to it than just like, is the number appropriate?

And I mean, obviously, there's anesthesia cut offs, and there's, you know, sort of different clinics, every clinic is a little different in terms of when they will say, okay, this, you know, meets our criteria, we have a certain recommendation that people meet with a high risk OB doctor, you know, over a certain BMI, which is I think is helpful.

Just, and I actually think everyone, speaking of like, everyone should have an obesity specialist working with them, everyone should have a high risk OB doctor, just that one conversation to be like, okay, you know, what is this thing called pregnancy?

And what's my individual risk?

And what can I do to mitigate those risks?

Right.

But it's so fascinating to think about like the big picture.

Is there anything nutritionally, because I think that's also like, to the person who wrote in like to her point, like, I've heard you talk about this before, like, really, I'm focusing on like protein and, you know, just bridging nutritionally to a treatment, fertility treatment.

What do you recommend and how specific can you be in terms of certain numbers and goals?

Yeah, absolutely.

So I think one of the considerations that I have in the GLP journey is making sure that patients are, you know, knowing that we're going to be stopping, I will take a titration really slowly and that plays into to what we're doing from a nutritional standpoint.

So when we look at any of these medications, there's a pretty broad range of doses available.

And particularly for someone who will anybody is going to start at a low dose, but when we think, hey, there's going to be a pause or there's going to be a complete stop for a year or two years, depending on what your timeline and, you know, what that looks like, if we can start someone low and then go slow with their titration, that often allows us to have an amount of medication that's supporting them, while then also really playing up the nutritional pieces that they can then carry forward.

So we hear a lot of this conversation and they're like, jumpstart your weight loss journey sort of broadly, not even related to the pre-IDF journey, but related to how do we use these medications as a tool alongside all of the other nutritional pieces.

And while there's some problems in that, and I could talk about it for hours, I do think the piece of how do we use this as a tool combined with then emphasizing protein, emphasizing fiber in our diet, really learning what are the foods that naturally creates the titae for us.

And we think about the way our body experiences fullness, what the GLP receptor agonist medications are doing.

I mean, certainly they affect us in a lot of ways, but one of the primary ways is an appetite regulation and this increased the titae signal.

So we feel full more easily, we feel less hungry, and we can look at certain foods to help the mimic and create that as well.

So for one, protein can be really helpful for that.

It's also really important in the weight loss journey that we're thinking about protein in order to support our muscle mass.

We know that as we're losing weight, we don't want to just lose weight, we want to preferentially lose fat mass from our body.

And when I say that, everybody agrees with me, and there are also things we need to do specifically to really ensure that that will be the case.

We want to make sure that we're emphasizing protein in the diet.

We also want to make sure we're doing things like emphasizing resistance training, which can be supportive of that as well.

From a protein standpoint, the recommendations are really broad.

I think our society right now is really protein focused.

So I hear a lot of people who are actually even overdoing their protein.

And that's, it's hard to overdo.

I mean, your body will just process it as energy.

But occasionally I talk to people who are having like 150 or 200 grams of protein per day.

And the reality is you do not need quite that much protein.

So at a minimum, you want to look at 0.8 grams of protein per kilogram of body weight.

So really entering in some simple numbers.

If you are 220 pounds, that is 100 in kilograms.

And so we're looking at a minimum of 80 grams of protein per day.

And that's for someone who's fairly sedentary.

If you are more active, you want to drive those numbers up.

And so people who are more active may aim for 1.2 grams per kilogram per day.

So that person who lives in a 220 pound body, that 100 kilograms, we're then looking at about 100 grams per day.

If we're talking about that higher end of recommendation.

So for most people falling in this range of I'll say sort of 100 plus or minus is a really good target.

Our body doesn't have great mechanisms to store protein or actually really any mechanisms to store protein for long periods of time.

So we do want it distributed throughout the day.

So particularly on the weight loss journey, if we're aiming for protein three separate times per day, that can be really helpful in fueling our body, driving satiety, but then also supporting our muscle mass during the weight loss journey.

So what I will often say is 20 to 30 grams, three times per day is a really nice goal that can be consumed in the form of whole food.

That can also be a lot of protein shakes are 20 to 30 grams.

So that can be a really nice option for someone who's maybe not particularly hungry early in the day, looking for grab and go options.

That can be a great thing.

So the protein piece, super, super important.

I think one of the other pieces that has been a little bit less talked about is fiber.

And so fiber plays such an important role in terms of our digestion, our gut microbiome, as well as then the way our body experiences satiety and fullness.

So fiber tends to be very high volume.

When we think of foods that have fiber in them, we're thinking about vegetables, we're thinking about fruits, we're thinking about brains in their whole form.

And when we eat foods like that, it helps to provide a lot of volume, as well as those are often have a little bit of protein in them as well, particularly when we're talking about whole grains.

So we combine these protein piece and this fiber piece, those two pieces are really the most important building blocks.

Then we can look at making sure someone's adequately hydrated, making sure they're hitting their micronutrients, even if that's just a multivitamin.

And those are the pieces then that can really help to bridge even when we're looking at the cravings that come up during pregnancy.

That's so like, I'm learning so much from you right now.

This is so amazing.

Thank you so much.

And I'm like, Oh gosh, like, you know, how am I doing?

Right?

I'm like doing my own assessment, which is like, I guess I had a question of like, your recommendations, did they hold like whether people are on a GLP one and losing weight, or if somebody is trying to maintain their weight, like are those the same recommendations or are there different recommendations for like a weight loss phase versus a sort of more maintenance phase?

Yeah.

So the recommendations I just gave would be honestly pretty inclusive for most humans.

Someone who is living in, you know, someone who's like a power lifter or trying to hit huge protein goals in that way, you know, children's nutrition is going to be different.

But for most adults, the recommendations that I gave are, those are pretty solid.

And so those will be good.

Whether we're talking about weight loss, whether we're talking about weight maintenance, the piece in weight loss that can be really challenging is that a lot of times the appetite is so significantly suppressed that it can feel challenging to get those things in.

And so really that intentional lens of, okay, where am I getting in the protein, paying attention to that throughout the day can be important and, you know, more challenging to get in if you're just not having the same hunger.

That's amazing.

Thank you so much for sharing that.

And now I mean, I did want to ask you about sort of intuitive eating and satiety, like, and I've heard you talk about this before in other contexts.

Can you share with us how, I mean, and again, understand that my listeners are mostly female physicians who are, have these busy schedules.

Sometimes they're surgeons, a lot of my clients are surgeons and like, how do you help people understand their bodies?

Like say you're like me and you never grew up sort of understanding hunger signals.

And like when you're full, when you're not full, like what portions are like, I mean, I learned this as an adult on my own because I had to survive, right?

Like recovering from an eating disorder actually.

But like, how do you help people learn these cues?

Tell us your framework because I think it's so useful.

Yeah, absolutely.

So it's something we're often very in touch with when we're young.

And then as we get older, we can often get out of touch with it for so many factors.

You know, our parents saying, oh, you have to eat all the food on your plate.

There's starving children elsewhere in the world or eat your dinner.

If you want to get dessert, we then talk about the transition into medical school and particularly through residency or fellowship.

There's often these very demanding schedules that you don't just get to eat exactly when you're hungry, right?

You may have to eat at times that this is the break in between surgeries.

And so this is when I'm eating or I'm not going to have an opportunity for another period of time.

And so you think it'll be really individualized, but learning what are the pieces that fuel my body.

So think of food as fuel.

And so when we think about what are the building blocks of that looking at sort of day to day, what are the needs that I have in my life?

What is my schedule going to look like?

What are the foods?

You know, you do not have to spend a lot of time preparing food.

It does not have to be anything complex.

But what are the foods, even if it means grab and go, that are going to align with my, you know, going to help me feel full, align with my health goals and support me in that way.

We think about intuitive eating.

It's such a beautiful thing and can be really challenging to do when we're looking at a lot of very processed foods.

So when I say processed foods, not all foods that come in a package, while those would technically fall into the processed food label, not all of them are bad for us.

But a lot of foods are going to be really high in sugar, really high in flour, things that sort of bypass our natural satiety pathways, because they don't have much protein, they don't have much fiber, maybe don't even have much fat in them.

And the things that drive satiety or that feeling of fullness for us are fat and protein primarily, and then fiber as well that slows down the absorption of everything.

And so we can think about what are the foods that will help signal that to me?

It could be something as simple as, you know, am I going to have a piece of whole fruit and pair that with nuts or a nut butter or a slice of cheese or a cheese stick?

You know, is it going to be something that has some fats and proteins?

So I'm going to feel satiated for long periods of time.

You know, a lot of times for people who are in busy schedules, having lots of good proteins, having some fats, that can really help them to feel pretty stable energy levels versus if you've ever had a day where you've eaten primarily simple carbohydrates, you feel this like roller coaster of energy throughout the day.

And so even paying attention to, okay, on the morning I had a blueberry muffin, two hours later, I was just ravenous, so hungry, kind of like wanted to throw up, maybe felt a little headachy, hangry, like wanted to punch someone in the face, like feeling these wild shifts in blood sugar versus the day that I had a bowl of steel cut oatmeal and there was some protein powder and some nuts and seeds and berries.

I felt satiated for hours thereafter.

And then, okay, what was that that drove it?

And a lot of times it is the protein, it is the fat, it is the fiber that are driving those factors.

So when we think about for someone who has a busy schedule, how do we plug that in?

How do we plug in?

Is it running out the door?

My favorite grab and go snack is like those little avocado packets and like a cheese stick.

And I literally use the mozzarella cheese stick as a utensil to eat avocado, which is just, I mean, you probably don't want to do that while driving, but it's like a pretty quick, you know, you could do that in a lot of settings, for example, of I'm getting some fat, I'm getting some fiber, I'm getting some protein.

And if I know I need something that's going to stick with me for a couple of hours, something like that may be a good grab and go option, for example.

So starting to look at what are the things that are available to us?

What is our schedule?

And then how do we start to honor what our body is actually asking for?

And it can take some practice.

It's often really helpful to do this with the support of a physician or with a coach who understands these things.

But plugging in playing based on my schedule, based on my preferences, based on my goals, we're often able to align them of when my body is like actually feeling satiated and how we appropriately match our hunger.

That's so beautiful.

And, you know, as I recall, like I'm on your email list, you give people this information on your email list, correct?

Like I've gotten recipes from you and like those sorts of things.

So if you're hearing this and you're like, oh, I want to know more, please do get on Dr. Stambaugh's email list because there's this information that comes.

And don't you also have a GLP guide now that I'm thinking of your resources?

And we'll at the end of this conversation, we'll say, where can people find you?

But I just wanted to mention that because I heard you talk about sort of this GLP guide that people can access that I think might help a lot of my patients who and my clients actually who really want this more detailed information to kind of assist with their journeys.

Yeah, absolutely.

And especially, you know, when we look at the prescribing of GLPs, it's become so common, which I think is wonderful.

You know, I feel really glad that primary care physicians and OB guides and cardiologists and sleep medicine physicians, and we see these prescriptions coming out from a lot of physicians, which is amazing.

And there are people who are going to need a little bit more support in their journey than what they're getting in that context.

And so I created the GLP guide as an online series of videos to address a lot of the frequently asked questions that come up so that people can reference, you know, a five or 10 minute video, get those quick answers.

A lot of the things that we're talking about today, but it's an ever evolving resource.

One of my biggest calls to action there is that if you finish or you're looking through and you're like, oh, shoot, I do not see the answer to the question I have that you can email us and we will have that video up within 48 hours to make sure that your questions are getting addressed.

That's fantastic.

Yeah.

As I was listening to what's on that series, I was just like, wow, this is just amazing.

So I think you're doing a lot of like really necessary.

Yes, it's outside the box thinking.

And it also feels like it's like sort of plugging the gaps in the holes and so much of it like all of a sudden it happens so fast.

It feels like GLP ones for everybody.

And now it's like, wait, hold up, slow up.

We need, we need a little more support.

We need a little bit more attention to detail.

So thank you for that.

So I think what you said about like this sort of goes along with the intuitive eating, satiety conversation is mindset.

And I, you know, a lot of what I do in my fertility coaching relates to mindset because it's so important.

You're also a certified coach, right?

We went to the same place, all the things I wanted to mention that because I don't think I clearly called it out in your bio.

But can you speak a little bit about how you help your patients and your clients like with this mindset piece?

Because like you said, like you stop the GLP, you see the scale go up.

You know, even, even like the fertility treatment in general, most people as they're undergoing IVF steadily gain weight because it's like, oh shoot, don't exercise now.

And people are kind of off their rhythm.

So yeah, please, if you could speak to the mindset piece about weight, the weight journey, that would be so helpful.

Yes, absolutely.

And I think this is actually where this is where the magic is because when we look at, you know, particularly your listeners, we're talking about very intelligent women who are physicians, right?

Most of my patients, even whether they're physicians or not, they could write a book on nutrition.

You know, they've been through dozens of diet plans in the past.

They know a lot about nutrition and it's not about the knowing, it's about what you're like, where does the rubber meet the road?

Like when in my day to day life, what are the challenges that get in the way?

Where am I eating for reasons like my schedule?

Where are, where am I eating where I'm not hungry?

Paying attention to are there times where emotional eating is coming up, for example, and emotional eating being eating for any reason that's not physical hunger.

And so that can be sometimes very clearly in response to a stressful situation where sometimes it's even a situation like boredom, for example, of recognizing like, oh, you know, like, oh, what's in the pantry right now?

There's a lot of pieces that come up with cravings.

And so recognizing that cravings are often very physiologically driven as well as psychologically driven.

And so approaching cravings can take this two prong approach where we're thinking about sometimes medications, whether that's GLPs or others, as well as thinking about what are, what are my patterns surrounding that, for example?

So starting to break down, even if I know what to do, what are the barriers that are getting in my way of implementing that?

And then how do I start to see where those challenges are and work through them one by one?

And the second thing about that skill set is it follows you for the rest of your life.

And so, you know, I think about my patients and I'm like, okay, we're talking about 10 years from now or 20 years from now, we're building a toolbox that you just get to have then forever.

And so that can look like someone, for example, who's eating in the evening times and they have maybe finished charting for the evening.

They finally have this opportunity.

They've had dinner, they've went down, they've maybe charted and it's like, okay, I've got this free time available to me.

That is a very common time where people may like, oh, I'll just go have a snack, for example.

So if that's happening, starting to recognize, okay, is there a piece coming up where maybe I'm feeling bad for myself or feeling like, oh, I deserve a reward after doing those charts, for example, now I deserve to feel something good.

And you do, right?

Like if you've been charting, like you deserve to take care of yourself as a human, you deserve to have goodness and wonderful things in your life and is eating at that time the best way to meet that maybe, but a lot of times typically not.

There's other things that we can do that will help to help you feel good, help you to feel relaxation that are going to be in line with your health goals.

Sometimes we're looking at pattern interrupt.

So can it be something like, okay, when I am, as soon as I finished eating dinner, for example, I go and brush my teeth.

I don't know about you, but as soon as I brush my teeth for the evening, I'm like, you know, I'm good.

I, you know, my husband the other night was like, Hey, let's have some ice cream.

I was like, I already brushed my teeth.

I'm like, I probably would have had ice cream.

I'm like, I don't want to do that again.

And so are these things that we can, they're silly, right?

And sometimes, but they can add up in these really significant ways.

We start to work through our challenges and then build in tools that help us support to align with our goals.

Oh, that is so, that is like amazing.

I just want to bottle it up.

And, you know, I think in our coaching school, I don't know if you remember that worksheet that was like the a hundred allowed urges.

You know, I mean, I admittedly have a sugar addiction and like, I find that like when I don't have sugar, I don't want it.

And then as soon as I kind of like fall off the wagon, I'm like, Oh, it's 8 PM.

I like want XYZ.

And like, it's so amazing, but you're right.

It's physiological as well.

And so, um, and I did this when I was like trying to, you know, stop afternoon coffee and those sorts of things.

Like, I think, you know, it does not kill us to allow the urge to happen.

And it's almost like it like kind of comes to a peak.

It's uncomfortable, but then it sort of dissipates.

And I, and you know, coaching is all about, um, sort of leading into the discomfort in the service of growth.

And so I think, you know, as we are really honest with ourselves and saying, okay, like what patterns are serving me, what patterns are not serving me, and maybe we need to add a little bit more into our dinners or our lunches or something like maybe it, maybe we truly are hungry, but like, we know that like, you know, sort of eating at those hours and trying to wind down, um, you know, maybe we're trying to, it's, it's counter counterproductive at that point.

So, um, I think that's brilliant to just like look at the patterns in a nonjudgmental way and say like, what are some other ways?

So what are some other ways that we could reward ourselves at like, say 9, 10 PM, we finished charting.

We really want to feel good, um, that don't involve going to the pantry.

Yeah.

So I will often give my patients this exact assignment to answer the question because I'm always so amazed by the things that people come up with because we all have our own interests and preferences.

And so I will even encourage your lifters if you were someone who struggles, whether it's mid-afternoon, whether it's evening, if there is a time where you have this coming up of your like, I, I want to feel good right now.

The food is away and it does like food gives us a dopamine hit, particularly the processed foods that give us this hip that can feel really intensely pleasurable for a period of time.

And it just doesn't have a lasting pleasure.

And a lot of times, especially if we're in a weight loss journey, there is this an effect that I'm like, gosh, like, why did I do that?

I didn't, you know, that's not in line with my goals.

I sometimes really beating ourselves up.

So I'll encourage our listeners if this is coming up, what are the things that bring pleasure in your life that then you can even keep on a list and reference at times where you're like, I feel bad.

I want to feel good, you know, sort of simply said, and then reference that list.

But this can look like a lot of different things.

This can look like being outside.

So whether it's sitting on the porch, going for a slow walk, literally smelling the flowers.

So you know, just observing nature, seeing what's around us, paying attention to the sounds, you know, birds chirping, for example, or watching the sunset, these things that can be really, you can feel really connected to the earth into the world.

There can also be things that are self care routines.

So this can look like a really decadent skincare routine, for example, this can look like unwell winding into a book, you know, particularly really any book, but like a fiction book that you just, you know, love, and it's going to be a little bit of page turner, you know, don't read a page turner the minute before you're trying to fall asleep.

But if you want that if you want to spend some time with a magazine, for example, and looking at home decor, or, you know, whatever your interests are, for example, and starting to pay attention to is there like, do I need my hands to be busy?

Like maybe I'm knitting or crocheting, for example.

Do I want to be drinking something?

You know, do I want to be like holding a warm cup of tea, for example, feeling that warmth, getting the flavors, having the experience of still consuming something, but more in line with my health goals, even that's even helping you to sleep if you're having a chamomile tea or something like that.

So it's gonna look like a lot of different things.

That's such a small snapshot, but I'm so impressed with my patients all the time will come up with things like, oh, I, you know, when my patients started throwing pottery, for example, I have a patient who does adult coloring books and all of these things that whatever your interests are, things that give you that little bit of almost even childish pleasure, you know, dancing to a song, I have a patient who will put on a favorite song and dance to it.

What are those things that bring up some joy for you?

And it can be sometimes an intense sort of bubbling up joy can also be a more subtle thing depending on maybe the time of day and what you need.

That is so fascinating.

And I mean, I would encourage anyone who's listening and I promise you I'm going to do this exercise as well, even though I've done it in other versions, but I'm going to do it specifically for that, this purpose, because as we evolve, we always come up with new things.

Do this exercise, my friends do it, see what comes up.

And this is in line with what I always tell my clients is that sometimes as physicians, we don't think we deserve this, right?

We're like, I am fighting the good fight.

I am, you know, charting at night if that's something that you do, like I am a warrior.

And we forget that we're human beings with physical needs and the mindfulness piece, like getting into our bodies, connecting with nature, even asking ourselves the question, like, what would I enjoy?

What would feel decadent?

What would feel delicious, luxurious, all those things, like probably does, you know, sort of ask that we slow down a little bit.

But I think that's good for our nervous systems too.

But it's counter to that.

We have to be productive at every single moment.

And I think that's part of why we are in this very intense, like, you know, work hard, play hard.

And if play hard is going to the pantry, that is what it is.

You know what I mean?

So I think if we can soften a little bit and just recognize that we're worthy of connection, we're worthy of joy, we're worthy of having these pleasurable things in our routine, whether it's first thing in the morning or at night as we're winding down.

You know, I think we talk about the morning routine, everyone's like, oh, you need a morning routine, because that's what productive people do.

But we don't talk enough about like a wind down routine either.

So I really I want us all to embrace this idea because I think it's going to help us with this emotional eating, you know, weight management, weight loss, whatever journey we're on.

But I also think it's going to help us become just happier human beings, which isn't that the point?

So wow, blow in my mind, Dr. Stomba, as always.

So is there anything else our listeners, you want our listeners to hear?

And I obviously want people to know where to find you.

Is there anything else that's on your mind where you're like, I just really need her people to to know this, this, this?

Yes, I'm so glad you asked because one of the things even coming back to the very beginning in the case study, the person who reached out to you with a question of coming up with a govi, is there a good bridge?

The six center or lyrical tie that daily GLP is a great option.

What's also a great option either in addition or separately from this are medications like metformin and bupropion.

And these are medications that are very frequently given during pregnancy.

You know, metformin is the medications for the treatment or medication for the treatment of type two diabetes.

So sometimes this medication is continued during pregnancy for patients who've been using it otherwise.

Bupropion is a medication typically thought of for the treatment of mood.

Originally FDA approved for the treatment of depression, but does help with some of that craving urge pathway, for example, and is sometimes given throughout pregnancy for women who've been using it from a mood standpoint.

You know, a lot of times we may continue mood medications during pregnancy.

And so I say that to say the metformin medication works on some of the underlying insulin resistant pathways in our body.

The bupropion medication works on some of that craving and urge pathway.

They're very different from one another, so they can even be given together or sort of, you know, alongside one another.

And those are medications that someone may decide, you know, yes or no, I want to continue this during pregnancy, but it is, we have really good safety data about that.

And so there's no, okay, I have to stop for egg retrieval.

I have to stop for implantation.

I have to stop for any point.

You may, of course, have this conversation with your REI, with your maternal fetal medicine physician talking about the risk and benefits of those medications.

So when we look at the effect of the GLPs, they work on the insulin resistance, they work on the cravings.

Are there other things that may be safe options that can be a good bridge?

And so I wanted to mention these things to consider as well, because they're often something I'm starting alongside even the GLP medications or using to bridge as well, and could be something even continued through the duration of the IVF and pregnancy journey.

That is so wonderful.

I think that's going to help so many people because it is that sort of jagged, not smooth path to getting to where we're trying to go.

And I think that if we can smooth out that piece of things physiologically, I think that's going to help so many people.

And thank you very much.

If you're so creative and you're so knowledgeable and this information is really going to help so many people.

So thank you for sharing that extra, that extra pearl.

Okay.

So let's let, I mean, I'm sure you've heard all the value that I just heard.

I'm going to re-listen to this episode again to make sure I can get all the juice, right?

To help my people and myself really, because this is also, I'm learning so much too.

That's going to help me personally.

Dr. Stonma, where can people find you?

Yes, absolutely.

So I have a podcast called Conquer Your Weight, as you mentioned.

That is a great resource.

Even some recommendations, looking at the mindset piece, you know, this so commonly, as we talked about, is really important.

And so one of my favorite episodes I recorded was just last week called Progress Not Perfection.

I feel like this comes up so often.

So definitely check out the podcast as a great resource.

I have episodes every week.

I also have some online resources.

I try to be everywhere on social media.

And so find me across Instagram or TikTok or Facebook.

I have a lot of content that I put out there and engage with me.

If you have questions, I'd love to answer those for any of your listeners.

I also do, as you mentioned, have a program called the GLP Guide.

This is a self-paced online series of videos addressing the most frequently asked questions for patients who are using GLP medications.

It's a really affordable resource.

It's $97 for a full year of access.

And like I said, if someone's reviewing it and they're like, oh gosh, it doesn't have the answer to the question I wanted.

This was the whole reason I bought it.

We just email our team and we would answer that for you right away.

I would answer that for you right away, get that up within a couple of days.

And so I would love to share that with anyone.

But for any of your listeners, I know you'll have my contact information.

Please always feel free to reach out.

I'd love to connect you with even a board certified obesity physician in their area.

And remind us, and so somebody might be listening to this and be like, holy cow, I want her part of my treatment team.

Where do you have licenses so that the people who are in those states can find you in that way?

Yeah.

So in person in Charlottesville, Virginia, then I see patients throughout Virginia, Illinois and Tennessee by telemedicine.

Beautiful.

That's awesome.

And I would like to maybe add on a few more because I just, the world needs you.

And thank you so much for what you do because you're helping so many people.

So thank you so much for coming on today.

And I can't wait to collaborate more and have more conversations, my friend.

Yes.

Thank you for having me.

You're welcome.