Ep175: F the Snapback with Endocrinologist and Obesity Medicine Specialist, Dr. Katy Brown

Dr. Nicole (00:00): Wouldn't you want to learn about postpartum weight loss from an expert in weight management? Well you are in luck, because that is exactly who we have in today's episode of the podcast, where I chat with Dr. Katy Brown. And this episode is being supported by Bamboobies. Welcome to the All About Pregnancy & Birth podcast. I'm Dr. Nicole Calloway Rankins, a board certified OB GYN who's been in practice for nearly 15 years. I've had the privilege of helping over 1000 babies into this world, and I'm here to help you be calm, confident, and empowered to have a beautiful pregnancy and birth. Quick note, this podcast is for educational purposes only, and is not a substitute for medical advice. Check out the full disclaimer at drnicolerankins.com/disclaimer. Now let's get to it.

Dr. Nicole (01:04): Hello there. Welcome to another episode of the podcast. This is episode number 175. Thank you for being here with me today. In today's episode, we have Dr. Katy Brown. She is a board certified endocrinologist and obesity medicine specialist. She's the obesity medicine director at the Weight Management Institute in Corvallis, Oregon. She is passionate about helping her patients optimize their health and wellness through evidence based medicine and lifestyle chains. And she herself is a mom, she delivered her first baby in July of 2021. Y'all when I tell you that this conversation is packed with so much good information, it is packed with so much good information. We are going to chat about why postpartum weight management is important. You're gonna learn why BMI is not a great tool. There are other tools that can be used. You will hear her advice on when you should start thinking about losing that postpartum weight.

Dr. Nicole (02:10): It may surprise you what she says. She's gonna share exactly how much weight you really lose with breastfeeding a reasonable pace for weight loss, how often you should weigh yourself. We chat about using apps, our hormones, importance supplements. We go through it all. There is so much great information in this conversation. You're gonna love it. She has a really positive approach to weight loss, and I'm just grateful that she's gonna come on and you are gonna get all this goodness today. Now, before we get into the episode, a quick word about our episode supporter Bamboobies. Bamboobies was created by a mom who was really frustrated at the lack of reusable and comfortable nursing pads. And Bamboobies combines a smart design with baby and mom friendly materials to provide worry free, effective products that support and empower every mom at every stage of her motherhood journey.

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Dr. Nicole (04:10): Thank you so much, Dr. Brown for agreeing to come onto the podcast. I'm really excited to have you here. And I know this is a topic that is going to resonate with folks.

Dr. Katy (04:20): I so appreciate you having me on, I've been waiting for this moment for a while, and it's exciting to be here with you.

Dr. Nicole (04:27): Yes. So why don't you tell us a bit about yourself and your work and your family, if you'd like?

Dr. Katy (04:31): Absolutely. My name is Katy Brown, as you already said, and I'm a board certified endocrinologist and obesity medicine specialist. And, uh, for a while I was practicing general endocrinology. So that's mostly diabetes, thyroid, osteoporosis hormones, as you know. Um, and I found that I just really loved, uh, working in the metabolic side of endocrinology and focusing on weight management and the implications of, of what excess, uh, weight can do as far as type two diabetes and high cholesterol, high blood pressure, things like that. So I solely focus on that in my practice now. Um, I am married, I have a nine month old son, and so very pertinent to our topic that we're talking about today. As I, you know, I practice weight management every day in clinic, but then at the same time, uh, having gone through it myself and being kind of right in the middle of it, actually right now, um, uh, has been especially helpful, uh, for me to, to kind of speak, uh, on my own personal experience as well. Um, I practice mostly telemedicine and, oh, interesting. So my husband, yeah, my husband and I actually live physically in Montana. Um, but I'm the obesity medicine director for a hospital in Oregon. Uh, good Samaritan. So, uh, the pandemic, uh, had kind of allowed, uh, more of that flexibility as far, far as, uh, where we live.

Dr. Nicole (05:59): Okay, awesome. Awesome. So why don't you tell us a bit about the training and certification that goes into being both an endocrinologist and an obesity medicine specialist? I like people to have a bit of a background as to what type of training experts have when they come on the show.

Dr. Katy (06:15): Absolutely. So, um, as many people are aware, uh, you need, uh, four years of undergraduate work and then about four years of medical school and then residency. So I did an internal medicine residency, which is three years long at University of Colorado. And then an endocrinology fellowship can be two to three years, depending on if you're going a clinical tract versus a research oriented tract. Um, so two years of endocrinology fellowship, and then on top of that, the obesity medicine certification it's, uh, through the American Board of Obesity Medicine. And you can get the required hours through your fellowship. Um, as long as you're of course working closely with an obesity medicine specialist in your fellowship training, or if outside of your fellowship, you don't get those hours, you can get in your hours through, uh, CME conferences, uh, things like that before you can sit for the board exam. So there's a couple of different pathways to getting that certification. Um, it's becoming more and more popular as more and more physicians are realizing that we really, uh, need to, to, to try to help, uh, folks, uh, with weight. Um, and so, uh, there's all kinds of specialties that can, uh, become more certified in obesity medicine. Um, so yeah, it's quite a bit of training, uh, just like a lot of us go through

Dr. Nicole (07:37): Yes, it is. Yes it is. Yeah. So we are going to talk all about postpartum weight management. So first off, why don't we talk a little bit about why is thinking about your weight postpartum important and does it have implications for your long term health?

Dr. Katy (07:56): Yeah, so we, we know that excessive gestational weight gain and weight retention, uh, predict a higher BMI, uh, leader, and that, that confers an increased risk of, of cardiovascular risk factors, such as high blood pressure, high cholesterol, uh, prediabetes type two diabetes, uh, all of these things. So, so we do know that that there's long term implications. Um, when we refer to postpartum weight retention and it's similar to, to, you know, women who are, who are not pregnant or are not going through, uh, pregnancies. And that, uh, we know that if we're carrying, um, excess adiposity, especially in the abdominal, uh, region, what we call the visceral adiposity around the organs, then that can really increase, uh, our long term risk of, uh, cardiovascular complications, especially. So, so we are, are hoping to, uh, help to decrease those risk factors as much as is possible.

Dr. Nicole (08:51): Gotcha. Gotcha. And, um, this is sort of a side question, but you brought up BMI and I know folks sometimes have a lot of, um, concerns about BMI and whether that's like the greatest indicator of health, should we be thinking about BMI in a different way, or is that just one piece of the puzzle? What are your thoughts about BMI and how we use that number?

Dr. Katy (09:15): Yeah, it's, it's definitely, um, not a perfect screening tool that is for sure. So, so we know that BMI, um, which, uh, for your listeners, it's a measure of your body weight in kilograms divided by your height in meters squared. Um, and so it's a ratio and as a screening tool in medicine, it's really good for, uh, the population at large to help, uh, healthcare providers and physicians kind of get an additional, an initial idea about, do we need to look into risk factors, uh, further by, by marker of BMI? Um, it's most certainly not a perfect screening tool, meaning the BMI. Um, doesn't tell us where we are storing excess adiposity, if we have excess adiposity. So kind of what I was saying a little bit earlier where we store excess adiposity is important as far as the, the visceral adiposity abdominal adiposity.

Dr. Katy (10:08): Um, and it also, you know, doesn't tell us, uh, what the muscle mass is. What the lean tissue is. So, um, we certainly can have an, a falsely elevated BMI in individuals who do not carry excess adiposity and, and just have quite a bit of muscle mass. And so it's always a clinical diagnosis too, so we don't wanna just go based off of BMI, but we also wanna go based off of what's happening clinically. Um, a lot of times, uh, and this is becoming more and more popular Dr. Rankins where, um, more and more clinics are getting, uh, body composition analysis. So, you know, we've got gold standard underwater weighing, uh, which, you know, that's, very, uh, difficult to do. And, and, and, uh, not a lot of centers have that capacity, but we,

Dr. Nicole (10:51): Well, I'm sorry you weigh people under underwater?

Dr. Katy (10:54): Yeah, you can. So there's an underwater. The gold standards used to be this underwater wing where you're, uh, looking at, um, lean tissue versus adipostis tissue. And I haven't looked at kind of exactly the, the science behind that in a long time. Um, but now we have biological impedance, which if you get a medical grade biological impedance, then that is pretty strongly correlated with, with accuracy. And then we also have Dexus scans, which tell us very accurately what's adiposity, what's lean tissue. We've got Bod pods, which is using displacement of, of air. Um, those are more expensive equipment, but most clinics now have, um, bioelectrical impedance medical grade, uh, devices in their office now. And that can give us a much better idea of really what's happening with adiposity versus lean tissue, um, much better than the BMI alone.

Dr. Nicole (11:49): Gotcha. Gotcha. Yeah, I think it's important to think about it from a big picture perspective and not just from that single number, it sounds like.

Dr. Katy (11:58): You are absolutely correct.

Dr. Nicole (11:59): Yeah. For sure. Yeah. Yeah. Okay. So getting back to postpartum weight loss. So after you have a baby, you know, you got 15,000 things going on, when do you think sh someone should start, like thinking about, Hey, I know I've gained this weight during pregnancy. When, when should they start thinking about losing the weight postpartum?

Dr. Katy (12:18): Like many things I wanna encourage women to, to really kind of individualize their there's certain situations. There's so many different scenarios that can play out here. And so it's really important to kind of say like, what, where am I at right now and what is feasible for me? With all these million things happening, just like what you said. So, um, but, but I also wanna say that from that perspective, I think it's really important to, if you're going to breastfeed, for example, to make sure that you're getting your breastfeeding established for your, for your baby, your milk supply in and getting into a really good routine without, I, I don't, um, think that focusing on strongly on weight loss is, is gonna be super beneficial prior to, to getting the breastfeeding, um, schedule, uh, up and running. I, I would say that, um, potentially after that 12 week marker, if women wanted to start a little bit more strongly about like, okay, where am I at? And, and what are my goals here? And, and start coming up with a plan at that point in time, some women are gonna be ready a lot sooner than that. Some women are not gonna be ready because of all the things happening in their life. But, but certainly we know that we've gotta take baby steps in that direction. Um, most of us need to take baby steps in that direction, um, in order to come up with a good plan to health healthfully, uh, lose some of that, uh, weight gain that we had during pregnancy.

Dr. Nicole (13:43): Yeah. I, I love that. You said like, just chill for a minute and get some other things established. And then at 12 weeks that's three months, y'all, you know, then start thinking about it. Like, don't feel, yes, it's an important thing, but don't the whole, I think about that in the whole like snapback culture where it's like, oh, you know, I'm back to my pre-pregnancy jeans three seconds after I had a baby or whatever on Instagram. Yeah. It sounds like, yeah. It sounds like you're saying just, just, you know, don't feel like you have to buy into that for sure.

Dr. Katy (14:18): Absolutely. Yep. Yep. Chill, chill for a minute. I like that.

Dr. Nicole (14:22): Now speaking of breastfeeding, does breastfeeding really help a lot with postpartum weight loss? I know it can, but what are your thoughts on that?

Dr. Katy (14:33): Yeah, it it's, we kind of think of it as, as maybe slight to moderate benefit. So, and, and I kind of experienced this firsthand. Um, I am still breastfeeding and, um, my own personal, uh, experience with it has been that, wow, it makes me really, really hungry. So my appetite just absolutely skyrocketed during breastfeeding. So I wanna kind of keep that in mind, but yes, the studies do show that there is slight benefit. So, um, there was one study in particular that I thought was interesting. Um, they noted that there was a 1.1 pound postpartum weight retention, um, benefit at three years for women exclusively, exclusively breastfeeding for six months versus 10.5 pounds for those who never exclusively breastfed. Okay. So, you know, um, 10.5 pounds, weight retention on average versus 1.1, uh, pounds weight retention at that six month marker. So, or after three years, if you did exclusive breastfeeding for six months, so, okay. I mean

Dr. Nicole (15:33): That's

Dr. Katy (15:34): Grain salt, its

Dr. Nicole (15:35): Yeah. Okay. Okay. So just add it to the list of one of the other things that can help, but don't think that because you're breastfeeding that suddenly the weight is just gonna like drop off, like exactly. It's not a, exactly a magic, a magic cure.

Dr. Katy (15:49): Exactly. And, and kind of like, again, going along with my own personal experience, I was like, wow, this, my appetite is just through the roof. When I'm breastfeeding. So I, so kind of similarly, like I think a lot of women, maybe some women's expectations are, if I'm going to breastfeed, then the weight's just gonna melt off and that's not the experience of most, most women breastfeeding,

Dr. Nicole (16:11): I would say. Yeah. Yeah. For sure. For sure. Okay. So someone has gotten to the point where they're thinking about they're ready to start focusing on, um, losing weight postpartum. What are, what are three strategies you recommend for folks?

Dr. Katy (16:25): Yes. So, um, kind of going along with giving yourself some grace and some patience in that postpartum period, it's a really, really difficult time for many reasons. And so number one, um, I would like women to focus on what they can do and not what they can't do. So practicing gratitude for what your body, uh, just did. Yep. Um, and, and realizing that, um, we are not aiming for perfection here and there's gonna be a lot of things happening in your life. So focusing on what you can do, um, is, is really number one. Um, number two is I, I would definitely wanna emphasize whole foods. So this is the same for, for people who are, are not in the postpartum period, right. But we wanna focus on whole foods that are nutritious and really trying to limiting processed foods as much as we can processed foods and sugar sweetened beverages.

Dr. Katy (17:19): Um, and that can be a little difficult. I know again, kind of, I do this for a living and, and firsthand experience, especially in that first trimester of pregnancy. I didn't necessarily crave that whole nutritious foods that I had been eating all before. And then similarly, like kind of in the postpartum period, um, you know, in the middle of the night, I remember getting up and, and uh, breastfeeding and just being so hungry and not necessarily reaching for, uh, you know, a nice whole food nutritious snack. Sometimes I was reaching for some processed foods. Um, and, and so I definitely consciously had to make that effort to say, you know, this is not the most healthiest food for me right now. It's not gonna nourish my body and, uh, my baby through breast milk in the best way. So I'm gonna try to reach for whole foods as much as possible.

Dr. Katy (18:04): So that's kind of, um, really a really simple way to approach things like, all right, I'm gonna try to, to limit my processed foods and choose really healthy, nutritious whole foods as much as possible. Yep. Um, and then number three is move your body in ways that feel good to you. So, um, a lot of my patients, I think, um, unfortunately kind of downplay the, what they're doing. So for example, they might say, oh, I only went for a 15 minute walk a couple of days per week, the last couple of months and they'll say it like that. Right. And my response is always is, oh, wow, you, you still got that done. And you still benefited from that. Everything counts. Yes. So, so move your body in ways that feel good and, and try not to minimize or downplay what you are doing because everything counts as far as moving your body and, and doing that in ways that feel good to you. And then I was also saying prioritize sleep, which woo. Real, real hard.

Dr. Nicole (19:04): Listen.

Dr. Katy (19:09): Real, real hard, but, but sleep plays a big role in weight and metabolism, energy, all these things. So, so there might be a lot of moms out there rolling their eyes because, uh, sleep can be, you know, so difficult, um, especially with an infant, but, but my, what I'm saying is do the best that you can. Right. And just realize that wherever you can, whenever you can try to sleep, um, as much as you can.

Dr. Nicole (19:38): Yeah. I think that is just I'm. I'm so glad you said that because I really don't think people understand how important rest can be for your overall health, including your weight. And that's actually, I, I don't, I don't, I don't wanna say it's a simple thing, cuz it's always not necessarily simple, but it doesn't require like, you know, you're not out running and doing different things. You just have to like be intentional about getting some more rest. So I'm really glad that you mentioned that.

Dr. Katy (20:07): Yeah. And, and it's so hard right. To, to your, maybe your baby is sleeping and you have a million things that you wanna do, but you're super tired. And, and I know that sometimes the last thing that you wanna do is maybe try to take a brief cat nap or, or go to bed early but it's so, so important for health and weight and metabolism.

Dr. Nicole (20:28): Yep. Love it. Love it, love it. So once people are starting to lose weight, what is a reasonable pace for losing weight? You know, like a couple pounds a week or a pound a week, what, what do you, what do you think is reasonable for folks,

Dr. Katy (20:42): Especially in this really sensitive postpartum period, I, I would say, say about one pound, uh, per week is reasonable. Typically even in the non postpartum period, you know, you'll hear physicians quote, uh, one to two pound, one to two pounds per week, that comes from some pretty old data actually that, that says that one pound of adiposity is roughly about 3,500 calories. I think that that data needs to be revamped and re-looked into again, but that's where it comes from to say about, if you create about a 500 calorie per day deficit, then that can lead to about one pound per week, weight loss, one to two pounds. Um, so, so I think one pound per week, um, in the postpartum period is okay, realizing too that this is not a linear process. So a lot of people might picture, okay, this is gonna be a nice, steady curve, real linear as far as, and it's not at all. It's the squiggly roller coaster line process. So, so it's not linear.

Dr. Nicole (21:44): Gotcha. Gotcha. I'm glad you said that. Cause, cause it's definitely going to be ups and downs. Yeah. And you don't wanna like get disappointed when you see things kind of have that, that squiggly line. Yep. Um, and so, and sort of related to that, how often do you even in general recommend that folks weigh themselves?

Dr. Katy (22:03): Yeah. I really try to individualize this recommendation. Um, there is definitely a, a great deal of data that shows that, um, folks that are monitoring their weight, uh, and keeping track tend to do better as far as, um, reaching their goals and keeping a, a healthier weight. That being said, it can be very detrimental to some people because we can perseverate over the scale. We can, uh, derail, we can kind of have all these negative thoughts about what's happening. It's absolutely normal to have fluctuations in the scale that are absolutely not reflective of what's happening with adiposity or lean muscle mass. It can have to do with water retention and salt and whether or not you had a bowel movement or not. Right. All kinds of things. And so if, if I have someone who's like really perseverating and, uh, kind of beating their themselves up over the scale, then that's where I say, like, let's back off here. Let's, let's weigh ourselves once a week or once every two weeks, maybe even once a month. And for someone who were, they're not necessarily perseverating over it. And it's just, it's a helpful marker tool for them. Then if you wanna weigh yourself every day, you can. But, um, once a week I think is a very nice reasonable amount of time for most people.

Dr. Nicole (23:17): Gotcha. Gotcha. And then do you recommend like in the morning or particular time of day, or just the same time of day, that kind of thing. Yeah.

Dr. Katy (23:25): I, I think it's, it's, uh, it's probably best as far as having the most continuity with how you're weighing yourself and comparing your, your numbers to do it in the morning. If you have a normal, uh, sleep wake cycle, of course. Um, but in the morning after you get up, you know, you go to the bathroom and then, and then weigh yourself. I think that's a, that's a generally a good time.

Dr. Nicole (23:46): Okay. Okay. All right. And, um, another question that just popped into my head, how do you feel about things like fitness tracker apps or fitness track or any apps or things like that to help folks with weight loss?

Dr. Katy (23:59): Yeah, so, so again, it's a bit nuanced because some people tend to do well in that it, it motivates them, they set their goals for their steps or they close their loops, uh, per se. Um, and it really helps to motivate them to, to reach certain goals. Um, for others, a again, it can be a bit of an unhealthy relationship because there could be maybe some perseveration over it in an unhealthy way. Um, the data hasn't really been robust, uh, about, uh, fitness monitors and trackers, meaning I haven't seen any super convincing data that it makes a significant difference for the majority of, of people as a whole. So again, I think it's an individualized thing. Um, for me personally, I, I like to, um, track things like my heart rate when I'm working out. Um, and, and I'm a runner, so I like to see, um, my times and certain pace and things like that.

Dr. Katy (24:59): So I find it helpful in that way. Um, but, but I would, again, kind of individualize people for some people. They maybe have never tracked their steps before, and they may not be engaging in planned intentional activity most days of the week. And, but if they have a really active job for example, and they wanna start getting an idea about how many steps they're getting in a day, I think that can be helpful, cuz there is maybe some data that shows that that 10,000 steps per day or about five miles per day of activity, um, might be kind of a nice threshold to aim for, for some people. So, um, so individualize it. Do you, do you wear, uh, any kind of trackers?

Dr. Nicole (25:35): I actually do. Yeah. I have a Fitbit. Yeah.

Dr. Katy (25:37): Do you find it helpful?

Dr. Nicole (25:38): I do. I, you know, it's like in some ways it's great because it's like, oh yeah, I do. I do like it, especially when I'm at work in the hospital. Yeah. And I'll like walk while I'm walking through and I'm like, okay, let me go take some, some more steps and I can get to 10,000 today. Yeah. Um, at home sometimes I'm like, oh, it's reminding me again that I haven't like gotten up. So yeah. Yeah. So in general I do like it and I do like that it attracts my, um, my, my heart rate and like keeps track of like Fitbit can connect to other stuff. Like I have a Peloton and connects to that and all that, that stuff. So I find it helpful.

Dr. Katy (26:16): Yeah. Exactly.

Dr. Nicole (26:16): Yeah. But, but like you said, um, individualizing isn't is, is important. And I love that because I think especially so much in weight loss, there's so much of a, like, people kinda want like a magic bullet and I understand that, but it, there is no magic bullet absolutely. Of weight loss.

Dr. Katy (26:37): Absolutely. That is so true.

Dr. Nicole (26:39): Yeah. Yeah. So, okay. So what are some common challenges that you see when people are trying to lose weight whether they're postpartum are otherwise like challenges or mistakes that people make?

Dr. Katy (26:51): Yeah. So I do, I do see just this big rush, like this gigantic hurry. We've we've touched on this a little bit already. Um, I, and so I think that's a big mistake, you know, it, I think taking some time to just appreciate what our bodies have done growing this human, um, giving birth to this human and we're, it took a long time to do that. And, and so it's not gonna happen overnight, uh, for us get to get, uh, to where we wanna be as far as, um, whatever that looks like for us. You know, some women are like, I wanna get back to my pre-pregnancy body and weight and you know, your body's a it's different after you are pregnant delivered a baby. So so again, just having that, that grace and, um, just that patience with yourself as, as you're going through this huge life transition.

Dr. Katy (27:47): Um, so realizing it takes time. Yeah. Um, I see, um, women not asking for help or support in a very timely manner. So sometimes, you know, I might have someone come to me and they've been dealing, um, with postpartum weight retention, um, for, for years, right after they've given birth. And they definitely mark like, oh, pregnancy and having a child or having multiple children, um, was, was several years ago. And now here I am many years later and, and I'm still just not quite where I, I was hoping I would be. And so they just, they took a long time to ask for help. So asking for help sooner, rather than later, if you feel like you would benefit from that support. And I think most of us really do benefit from that support. Right. And then mistake number three is buying into fad diets and really worthless supplements.

Dr. Katy (28:40): Like so many of us want that quick fix, just like what you said in there's absolutely no data to support that the supplement industry is gonna be helpful here. And, and there's a lot of concern with that too. It, I think you might have even touched based on this at some point in time, but you know, supplements are not regulated and so they have a lot of ingredients in them that are not necessarily safe, not necessarily in the, in the amounts that they say that they are in the label and they there's no evidence to support them. So they're expensive and they could be dangerous and they're not helpful. Yeah. Um, and then the fad diet, so fad diets are, you know, what's the definition of fad of a fad diet. It's a diet that is not sustainable, um, and not consistent with what the evidence shows as far as what is a healthy, you know, eating pattern. And there's no one size fits all for what a healthy eating pattern just for everybody. Like, we're not like everybody should be on this meal plan. That's not what I'm saying, but what I'm saying is that we wanna be on a meal plan that is sustainable for us. It's a, it's our lifestyle. It's not a crash and burn fad diet that gets quick results, but then is not sustainable. And so results in weight regain later.

Dr. Nicole (29:48): Yep. Yep. All all great, great pieces of advice. So when should someone, you know, you're talking about getting help, when should someone see someone like you, when should they see in obesity medicine specialist?

Dr. Katy (30:01): We certainly at, at this point in time in this juncture of our specialty, tend to see patients who have a BMI of over 30. Um, so that's in the class one obesity category. Um, I don't necessarily think that that's a great thing because I, I do think that physicians in general, especially those who specialize in this field, we need to be, uh, thinking more about preventative medicine too. Right? So I'd like to be seeing, uh, patients, uh, when there's weight gain happening, um, at, at BMIs that are, that are more, maybe the overweight category, maybe even sooner. So we want some, we wanna start doing preventative, but most of the time when patients come and see me that their BMI is 30 or greater, and most of the time they have a specific goal in mind. So, um, speaking to this particular podcast and what we are talking about, the data really is, uh, going more towards maybe outcomes from maternal and infant health are more strongly correlated with pre-pregnancy BMI versus gestational weight gain, or even postpartum weight retention.

Dr. Katy (31:07): And so in a perfect world, I would see someone like some, a, a woman who might be planning pregnancy in the future. Um, but who wants to optimize, um, her health and wellness prior to becoming pregnant, that would be the, the best time yeah. To actually come and see someone like me, if, if, if you're someone who struggles with weight. Um, and then after that, that being said, after that, you can, you can really come and see me at any time, but mostly I see patients, um, who have a BMI of over 30 and are looking, um, to optimize, um, and, and lose weight for, for health reasons or for, for other reasons.

Dr. Nicole (31:45): Gotcha. Gotcha. And then what should someone kind of expect when working with you or as someone who specializes in, in obesity, medicine and weight management?

Dr. Katy (31:54): Yeah. You can expect a pretty comprehensive evaluation because we know that weight metabolism, weight loss, it's really, really complicated. Um, I, I have never once heard somebody say weight loss is so easy. Weight loss and weight loss maintenance is so easy. You just live in a society in a culture that, which does not necessarily promote the healthiest of lifestyles. And so it's not easy. And, um, so you can expect a really comprehensive evaluation because weight and metabolism is tied to so many things. It's tied to our nutrition. It's tied to our sleep. It's tied to our physical activity. It's tied to our genetics. Um, it's tied to our mental health. Um, so we go through all of these things with a fine tooth comb and, um, you can expect to be focusing on baby steps. So James Clear is the author of Atomic Habits.

Dr. Katy (32:54): And I've been talking about, um, his book and his podcast with Brene Brown a lot, because it's really phenomenal information. Um, just how we can approach, um, goal setting and, uh, attaining habits in our lives. And, and it's no different with, with health and weight management. So we're looking for baby steps and he talks a lot about, um, instead of trying to, uh, come up with these super lofty and gigantic goals that instead we wanna be thinking about, um, baby steps in order to kind of accomplish, um, these small steps in the direction of where we wanna go that over time, add up to really big changes. Um, so you can expect baby steps. Um, you can usually expect to see one of, uh, the dieticians that I work with. Um, not all of my patients see my dieticians, but, but a lot of them do because having that one on one dietician support can be obviously super helpful for, um, getting onto a meal plan.

Dr. Katy (33:52): That's gonna work for your personal preferences, your taste, your lifestyle. Um, and then you can expect a conversation about pharmacotherapies if that's of interest to you. So, um, we, we don't use pharmacotherapies as often as we should be utilizing them in, uh, in the management of weight. This is a bit of a, uh, more tricky situation in the postpartum period because we don't wanna start a medication that's going to, um, be secreted in breast milk and be contraindicated in breastfeeding. Um, but there's definitely some women who would qualify for pharmacotherapy that can be super helpful. Sometimes we have this really, really high degree of appetite and hunger that can really respond well to a pharmacotherapy and help us to reach our goals in that way. You know, they don't work by themselves. They always need to be combined with, uh, lifestyle change. But, but if, if there is a, a consideration for pharmacotherapy, then definitely that's a part of the conversation. Um, and then last but not least, um, there's also a potentially a conversation about, about surgery, metabolic surgery. Um, if, and when, uh, someone is interested in that, um, that's one of our most effective tools, um, for weight loss and weight loss maintenance.

Dr. Nicole (35:13): Gotcha. Gotcha. And then, um, can you, can you say a word about hormones and I kind of chuckle because, I hear, we hear so much about like, oh, hormones are messed up and that, and can I get my hormones checked and balanced and this, that, and the other. And we, as gynecologists are always like, I don't know, keep talking about checking hormones, but like, so what, what, what can you say about hormones cuz there's not like a, a panel that we do or anything but that like language is out there. So what, what are your thoughts on that?

Dr. Katy (35:51): That language is absolutely out there and it's, it's not language that came from the endocrinology field. So an endocrinologist specializes in hormones. Um, this, this is, uh, this is what we do. Um, and, and that kind of language didn't come from our profession. I, I think it came maybe more from the alternative medicine type of world. So it does kind of come across as kind of like, well, you know, what do you mean by balancing hormones? So, you know, to an endocrinologist, we are going to do a thorough assessment and, um, a thorough review of systems. And then we're gonna be looking for, um, hormone problems based off of those things, family history and all that kind of stuff too. So, so when I have an evaluation and, and we're, I'm definitely thinking about hormones as an endocrinologist, um, I'm looking for, uh, things that are pretty rare actually, but, but Cushing's disease and excess of cortisol, um, acromegaly or gigantic and excess of growth hormone, um, P C O S uh, type of, uh, physiology or, or clinical presentation.

Dr. Katy (36:59): I'm looking for those things. When I have someone who is carrying excess weight and wants to lose weight thyroid, um, definitely looking for thyroid dysfunction. Um, but none of these things, uh, Dr. Rankins are, are necessarily things that I find that often in my evaluation, I'm definitely looking for them. We definitely wanna address it. If there's a hormone deficiencies or hormonal excess, they do contribute to weight. It is a part of the factor they do need to be considered. But I would say the vast majority of the time, we, we don't find a diagnosable hormonal problem that is causing weight gain, or that is preventing weight loss.

Dr. Nicole (37:38): Gotcha. Thank you. Thank you for saying that. Yeah. All right. So as we wrap up, what are some things, or, um, that you feel like you've learned personally from your own weight journey and postpartum weight journey?

Dr. Katy (37:51): Yeah. So I have learned that I need to practice what I preach.

Dr. Nicole (37:58): Uh, don't we all, yes.

Dr. Katy (38:01): Yeah. I definitely found myself at times, just getting really impatient with myself and being like, well, I thought by now I'd be at this particular, uh, juncture in my journey, you know? And, um, I thought by now I would be at this specific wait or, you know, whatever it is. And so I have many, many times had to be like, no, Katy, uh, that's, that's not how this journey is gonna go. Right. Um, um, so, so practicing what I preach, what I preach in being patient with myself has been a huge, uh, part of my journey so far. Um, I had already, uh, kind of mentioned the, the being a bit surprised by how my appetite had changed with breastfeeding. So, yeah, so I, I, I learned to have, um, some more empathy, I think for that and saying like all the changes in appetite that we experience through pregnancy in the postpartum period, um, is it's a big deal.

Dr. Katy (38:57): And it, it's definitely, uh, something to consider here, again, going along with being patient with yourself. Your, body's giving you those hunger cues for a reason you're, uh, you're making milk for your, for your baby. Um, and then things that, that, um, I think a lot of women deal with as, as far as just time management and, um, having things at home that you can do while your baby's napping, if you're not gonna take a nap to like, um, some home exercise equipment or some home videos, some gentle yoga, um, or some ways in which you can try to go for a walk, um, just things that at home that you can do that are gonna help you to move your body, uh, but not necessarily have to have some, a caretaker come and take care of your child or your baby, or, or go to the gym or something like that. I fully support all of that as far as moving your body, but having ways, especially with the COVID pandemic, having ways where you can move your body at home, um, is, is really helpful.

Dr. Nicole (40:00): Gotcha. Yeah. Cause like you said, every, every bit counts.

Dr. Katy (40:03): Yep. Exactly.

Dr. Nicole (40:04): So what's the most frustrating part of your work?

Dr. Katy (40:07): Yeah. One of the most frustrating things is, is, uh, having patients come to me who have already spent maybe quite a bit of money on the supplement yeah industry, the, the fad diet industry, it's a multimillion dollar industry. Yeah. And, and it's so tempting, it's so tempting. Um, but I, I just find that really frustrating because, you know, it's, it's not helpful agree. Um, and, and people spend a lot of money on it too. So it's just, um, hopefully, uh, things like this, uh, can help kind of get the word out that, that it's just, it's not the way to go. Yeah.

Dr. Nicole (40:42): Yeah.

Dr. Katy (40:43): And then, and then I would say, um, I do get frustrated, which is kind of the, the lack of, of general education as far as, uh, physicians go, who don't necessarily specialize in this kind of, there is some MIS misinformation out there um, or, or people, even physicians who might just be a proponent of one particular meal plan, like, um, you know, ketogenic meal plan has been popularized, uh, the last several years. And, and some people might feel like, well, the only way to go is low carb. And sometimes physicians perpetuate those kinds of myths as well. And I'm not faulting, you know, in medical school. I think we need to do a better job of, of just educating about nutrition and weight and metabolism in general. But, um, those things have been kind of a frustrating, um, in my career, but I think it's getting better. So that's the good news.

Dr. Nicole (41:36): Oh, that's good. That's good. That's good. Yeah. So on the flip side, then what's the most rewarding part of your work I can imagine, but what do you think is the most rewarding part?

Dr. Katy (41:44): Yeah, the most rewarding part is, is when, um, patients I've been seeing patients for a while and they're making progress, they're reaching their goals and they're just getting healthier. So, um, I wanna emphasize that it's not about the scale weight. It's more about what is your health and what is your wellbeing. And so, especially patients who, um, have seen a really significant improvement in things like blood sugars or blood pressure or cholesterol, or they are seeing a big improvement in how they move their body before they might have, uh, not been able to physically do the things that they wanted to do, especially with their kids. And now they're, they can, uh, physically be active as they wanna be. And, and those are just an improvement in health and wellbeing is the most rewarding part of my work.

Dr. Nicole (42:31): Yeah. I, I, I love that. I love that. I love that. So what is your favorite piece of advice that you would give to expectant moms?

Dr. Katy (42:40): Mm, I want expectant moms to, um, to be kind to themselves and to be patient and to practice gratitude. Yes. And, um, and to take baby steps. So realize that things are not gonna change quickly. It's gonna take time and just take those baby steps in the direction in which you wanna go.

Dr. Nicole (43:00): Awesome. Yep. This it's, it's like all of these things are so connected in our lives, like gratitude, patience, whether you're working on weight, whether you're trying to work on your mental health, whether you're, you know, your job, all of these things are important and connected. So it just sounds like you're, you know, this is another place to take a holistic approach to things and, and just be kind to yourself in the process.

Dr. Katy (43:26): Absolutely. Yeah. Well said, yeah.

Dr. Nicole (43:29): Yeah. So where can people find you? Do you do telehealth, like all over or where, where, who, what type of patients can you see and where can people find you?

Dr. Katy (43:38): Yeah. So I, as of right now, I am, um, doing telemedicine through good Samaritan in Oregon. So, um, patients in Oregon can, can find me at good Samaritan. Um, and I am on Instagram. My handle is Jane K J B J a N E KJB. I have not been as active on social media since I had a baby. Um, but, but yes, I am on Instagram.

Dr. Nicole (44:05): Okay. All right. All right. Awesome. And I think it's, um, it's really interesting. I wasn't expecting that you would do telehealth, but I think that that's a great option. We're, we're headed in that direction in medicine, in general. I think the pandemic has helped us see that we should definitely be expanding options. So I'm, I'm, you know, hopeful that even more folks will be able to see you from different places as, um, as we keep, keep chugging along and making sure we have like, options that are available for, for folks.

Dr. Katy (44:32): Yeah. It, it is one of the, the few things that came out of the pandemic. That was a, a benefit, I think for medicine, a lot of hospitals, as you know, had to really adapt quickly in telemedicine is one of those things that, um, that's been really beneficial. Yeah.

Dr. Nicole (44:47): Yeah. For sure. For sure. All right. Um, well thank you again so much for coming on. I, so, so appreciate your time.

Dr. Katy (44:54): I just wanna again say how awesome your podcast is. I think you're doing amazing work. I listened to a lot of your podcasts while I was pregnant. Very, very informative. I learned so much and just became a really big fan.

Dr. Nicole (45:08): Aw, thank you so much. I really appreciate that.

Dr. Nicole (45:17): Wasn't that a great conversation. So much insightful information there, and I hope, and I know actually it's gonna help you on your postpartum weight loss journey. This is information that I wish I would've known when I was going through my postpartum weight loss journey. Okay. You know, after every episode, when I have a guest on, I do something called Dr. Nicole's Notes, where I talk about my top takeaways from the conversation. And before I get into my doctor Nicole's Notes from my conversation with Dr. Katy brown, let me tell you a bit about our episode supporter, Bamboobies. Bamboobies puts moms first. It was created by a real life mom who was frustrated at the lack of reusable and comfortable nursing pads. However, nursing pads are not the only thing that they have. They also have a great yoga nursing bra, their best selling yoga bra has a stylish racer back design that offers all day comfort.

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Dr. Nicole (47:05): Okay. Let's get into Dr. Nicole's Notes from my conversation with Dr. Brown, number one F the snap back y'all don't fall for the tricks on Instagram and social media of I'm back in my size, whatever jeans, three seconds after I had a baby, Dr. Brown said 12 weeks before you even think about your weight management, you need to get breastfeeding established first, just kind of settle into being a new mother. So please don't feel like you have to go into that snap back culture, slow and steady wins the race. And when you start, make sure you use an individualized approach, a one size fits all approach is not gonna work. Make sure it's holistic takes into account your lifestyle and the things that work for you. And just remember that there's no quick fixes for this. I wish there were, we all wish there were, but you really wanna set yourself up with lifestyle changes that you can actually maintain.

Dr. Nicole (48:05): So F the snap back, slow and steady wins the race don't think about even thinking about, uh, weight loss after a baby until 12 weeks. Okay. Number two, optimize your health as best you can before you are pregnant, or even in between pregnancies, okay. Optimize your health before you're pregnant, or even in between pregnancies. I know it can be challenging, but it really is ideal. If you can be in the best health that you can, before you get pregnant, it just makes, um, things better for you and your baby. You know, I'm not saying that you have to be at a perfect weight, even losing 10% of your body weight can make a difference in your pregnancy. So you don't have to be at a perfect weight, but just getting down a bit can be helpful. And even if you don't go into one pregnancy as healthy as you want, you can certainly in between pregnancies get healthy and episode, um, 61 of the podcast, Emily shared her birth story, and that's drnicolerankins.com/episode61, where her first pregnancy was relatively unhealthy. And then in between, she really took a proactive role and like got completely healthy in between pregnancies. That's a really great, inspiring story. And you can hear the differences in her pregnancies because she got healthy the second time around again, that is episode 61 of the podcast. So do your best to optimize your health before pregnancies or even between pregnancies. Okay. Number three, don't downplay the things that you're doing. This is something that I'm guilty of a lot, where I'm like sort of minimizing things or not recognizing the wins. Even if the wins are small, don't downplay what you're doing. If you're walking more, that counts, if you're parking away from the store. So you have to walk into the store that counts. So don't downplay. The things that you're doing is little things. All of it counts.

Dr. Nicole (50:05): All of it adds up a little bit here, a little bit there a little bit here, a little bit there that makes a difference in your health. So take pride in your wins and celebrate them. Okay. And then the last one is ask for help and not help just with weight management. She mentioned that she would hopes that, you know, people would come in sooner. Don't just ask for help for weight management, ask for help with things in general, ask for help. When you have a new baby ask for help with meals, ask for help with shopping, um, ask for gift cards to DoorDash or Uber eat or whatever it is. Don't be afraid to ask for help and seek it out in areas where you, you don't have expertise. Now, one place I can help you. For sure. In addition to this podcast is with my online childbirth education class, the Birth Preparation Course, the Birth Preparation Course gets you calm, confident, and empowered to have the most beautiful hospital birth.

Dr. Nicole (51:02): You can check out all the details of the Birth Preparation Course at drnicolerankins.com/enroll. And it's not just the content in the course. It also comes with a great supportive community where you can bounce off questions. You can connect with other people through your pregnancy and the postpartum period as well. So check out all the details of the course at drnicolerankins.com/enroll. All right, so there you have it. Please share this podcast with a friend. Sharing is caring and it helps me to reach and serve more pregnant folks. That is my heart, soul and passion. Also be sure to subscribe to the podcast wherever you're listening to me right now and leave a review, in Apple Podcast. If you feel so inclined, I love what you hear. I love what you have to say about the show. I love what you hear too, right? Because I made the content. All right. Also come follow me on Instagram. I'm on Instagram at Dr. Nicole Rankins, and I am also dabbling in the TikToks these days. So I'm on TikTok at Dr. Nicole Rankins, I will say the Instagram is where I hang out the most for sure. But if you wanna catch some of my content on TikTok, you can follow me there as well. So that's it for this episode, do come on back next week and remember that you deserve a beautiful pregnancy and birth.