You did it: you found the right diet, exercise routine, surgery or medication to help you lose weight. Now what?
On this episode of On Nutrition, we talk with nurse practitioner Julia Jurgensen about why keeping weight off is so difficult, what’s worked for people who’ve maintained weight loss long-term, and the tools and teams available to help you along the way.
Powered by RedCircle
Listen to Keeping the weight off
Read the Transcript:
Tara Schmidt: This is “On Nutrition,” a podcast from Mayo Clinic where we dig into the latest nutrition trends and research to help you understand what’s health and what’s hype. I’m Tara Schmidt, a registered dietician with Mayo Clinic in Rochester, Minnesota. In this episode, Weight Loss Maintenance. But first we have a listener question about the episode on sugar.
Listener Intro: My name is Barry, I just listened to the podcast on sugar. Stevia was mentioned. Monk fruit was not, and I’m not sure if Stevia is the same as monk fruit, but I’d like to know the answer to that if possible, because I’ve bought monk fruit to add to my baking, and I need to know whether that’s something I have to calculate as the number of grams of “sugar” I’m taking into my body.
Tara Schmidt: Hi, Barry. You probably know that added sugar in your food is a health concern, but are natural or artificial sweeteners any better? Both monk fruit and Stevia are sugar alternatives or what we call non-nutritive sweeteners. They’re up to 100 times or even 300 times sweeter than white sugar.
When you use them in place of calorie-containing sweeteners like honey, non-nutritive sweeteners can decrease the total number of carbs and calories found in your foods and beverages which may help with weight management and blood sugar control. But the verdict is still out on their long-term effects. It may be best to work towards decreasing your intake of all added sweeteners, whether they have calories or not. I’m glad you asked about baking, because I love to bake as well.
I recommend starting with replacing about a quarter of the sugar and gradually increasing it to 100 percent as you become more familiar with the taste and texture of the product. Remember, monk fruit is much sweeter, so you may be able to replace sugar with monk fruit, but be aware that the conversion ratio may not be one-to-one.
Thanks for your question — Now on to the show. Intentionally losing weight is a huge accomplishment, but it’s only the beginning of a lifelong and life-changing journey because as much as we wish we could just will ourselves to stay a certain size, our bodies are always changing. According to some estimates, 80 to 85 percent of people who lose a large amount of weight will regain it. It might feel like the odds or your body are against you, but you’re not alone.
There are all kinds of strategies, resources, and people here to help, including my colleague Julia Jergenson. Julia is a nurse practitioner in family medicine and bariatric surgery who works with patients every day to help them lose weight and keep it off. Thanks for being here today.
Julia Jurgensen, DNP: I’m so excited to be here and share all this fun stuff with you.
Tara Schmidt: You and I know that there are many, many, many ways to lose weight. We’ve got this whole heap of dieting and exercising, now prescription anti-obesity or weight loss medications are available. We’ve got bariatric procedures and we’ve got bariatric surgeries, gastric sleeves, and bypasses.
We’ve got balloons that we’re putting in people’s stomachs now. It’s all very exciting. You and I are never here to shame or praise any one particular method, because everyone’s needs are different. We look at patients as individuals, we look at their health histories individually. Why do some approaches work for some and not others?
Julia Jurgensen, DNP: Everyone’s different. Whether it comes to diabetes or blood pressure, each disease is unique. Obesity is no different. What works for patient A isn’t going to necessarily work for patient B. What works today may not work five or 10 years from now for the same patient.
We have to really be always thinking about what we need at this moment for our patient and what we need to be thinking about today, tomorrow, five years down the road and how we need to adjust for that person.
Tara Schmidt: We have even been in meetings or care conferences together where I’m talking about the patient’s eating habits today. The surgeon is talking about their health needs today. You are talking about their likelihood of success in three years. It’s actually okay that we all have these different opinions because they’re all valid, but it’s really complicated.
Julia Jurgensen, DNP: It is complicated and we need all the disciplines together to be able to successfully help our patients.
Tara Schmidt: Let’s talk about some of the different reasons behind, “Why is this hard for me?” Let’s talk about some of the different ways people lose weight and what kind of outcomes you’ve seen. We call them pathways in the clinic. It could be a lifestyle pathway, diet and exercise, a medication pathway: surgical or procedural. Do you have some stats or insight into how these usually turn out?
Julia Jurgensen, DNP: I’ll give you some general statistics, certainly there’s outliers to all of these. But in general, that lifestyle piece, if we see five to ten percent of body weight loss, that’s phenomenal. I celebrate that with patients.
Tara Schmidt: No one ever believes us that that’s great news.
Julia Jurgensen, DNP: Phenomenal. Weight loss medications again, 5 percent up to like 25 percent with these new injectables. We’re seeing some phenomenal results with those injectables. But again, they really vary depending on the weight loss medication. Then surgery.
We are anywhere from 25 to 45 percent. It depends on our surgical type and the patient. There’s a lot of variation within there. But it depends on the patient. It depends on the pathway. But there is a huge variation between 5 percent and 45 percent.
Tara Schmidt: This is changing, especially with these medications. But what we used to say or what we used to draw in the office is this pyramid where on the bottom is lifestyle. We’re saying, okay, this is the foundation, everyone. I don’t care if you’re getting surgery, you have to do the foundation, which is dieting and exercising and behavioral change.
Then we moved up the pyramid into medication and then into procedures and to surgeries. Used to say the higher on this pyramid you go, highest being surgery, the more weight you are likely to lose because of the intervention. But as you go up that pyramid, you’re also increasing the risk. Surgery is a risk. It’s a much different risk than, “Hey, I’m going to go count my calories on an app.”
Sometimes that’s how we have to kind of weigh the pros and cons. Then like we were talking about, look at that patient and their medical history and their lifestyle as a whole.
Julia Jurgensen, DNP: Exactly.
Tara Schmidt: Let’s talk about that first year after someone has actually been successful in reaching their goal weight or an improved weight, whatever that may be. Sometimes I call it the honeymoon phase.
Julia Jurgensen, DNP: Absolutely. That first year after surgery, or weight loss medication, whatever it may be. We got to our goal. Things are really good. We’ve got a new set of clothes, a new set of patterns in our day. Confidence. We have lots of people telling us how amazing we look. We’re driven by feedback. We’re getting that feedback.
Tara Schmidt: Kind of like an external validation.
Julia Jurgensen, DNP: That’s a really awesome place to be. That reinvigorates. Let me keep going. Those people that say, “Oh, wow, you look so fabulous.” That eventually changes. Those people have already seen you. They’re used to the new way you look. That external validation ends eventually. That honeymoon phase is no longer going to remain long term. Then it turns into “What am I doing as an individual? Am I continuing my habits?
Am I continuing to do the things I need to do to maintain the success I’ve had with my weight loss, however I got there, because I’m not going to always have those external reminders.” That’s often the hardest phase. It’s when the rubber hits the road. It’s that long term maintenance phase that is honestly the hardest part about weight loss.
Tara Schmidt: It’s sometimes less exciting not only because you’re getting less external validation, but because you’re not seeing as many changes. The first pound you lose, you say, “Yes, this is working!” Then the first new pair of jeans you get, you say, “Yes, look at these!” But you cannot continue to lose weight and continue and continue until you are zero pounds. Not possible. Eventually you will hit some kind of plateau and you will no longer get the validation from the scale and you will no longer get, like you said, maybe from other people.
Are your doctors already impressed with you and they’re happy with you, but you can’t continue to get off medications if you’re not on any medications anymore. Do you feel like the biggest challenge is continuing to do the work?
Julia Jurgensen, DNP: Continuing to do the work, but also continuing to maintain those habits in the environment we live in. We live in this obesogenic society. We live in this world where you walk or drive down the road and you are bombarded by food.
You turn on your TV, you’re bombarded by food. That constant reminder of all these foods, all these things, and that desire to go back to old habits has to be that right. How do you continue to remind yourself, “I have new habits and I’m not going to choose my old habits.” It’s hard because we live in a society that is very different from what many people need in order to succeed in maintaining weight loss.
Tara Schmidt: Let’s just say there are no billboards for salad, and there are no commercials for fruits. Okay, maybe avocados. They have a commercial on there. But what we see as these triggers and reminders in the ease of getting food, we’re not talking about nutrient dense, low calorie foods.
We’re talking about ultra-processed, very calorie dense, likely low nutritionally valuable foods. It’s the opposite of what would benefit our population. You and I don’t love this fact, but we do know that the majority of people who lose a large amount of weight will gain at least some of it back. We can talk about habits. We can talk about motivation. Are there also biological factors at play?
Julia Jurgensen, DNP: There’s kind of this new theory out there, the set point theory that our body over time, is like fighting us. Set point is what each individual person’s body determines as their comfort zone. Like your body is happy at this weight and everyone’s body is happier at a different weight.
That doesn’t mean exactly one pound. It’s a little bit of a range and we can move that range. But the body likes to be at a specific range. It says, “Hey, now you’ve reduced calories on me and it is literally sending signals like hunger pains and constantly sending it to us. It’s literally slowing down our metabolism to bring us back to our set point.
Tara Schmidt: Why are we losing weight? It’s not natural.
Julia Jurgensen, DNP: Let’s go back. Why are you doing this to me? Basically it’s fighting against our efforts that we are choosing.
Tara Schmidt: How I describe it is this is where my body kind of naturally goes towards kind of regardless of what I’m doing sometimes, which is a pain in the butt if you don’t want your weight where your set point weight is.
Julia Jurgensen, DNP: That doesn’t mean we don’t get a win or give up. We can choose what we feed our body. We can choose how we exercise and the sleep that we get and the stress management and the medications. We can choose all those things. But our body is going to use certain mechanisms and fight back against us somewhat.
Tara Schmidt: We saw this in ”The Biggest Loser” study. We are not just talking about the show and you can have positive or negative feelings about that show. That’s fine with me. But what we care a lot about is the information that we got afterwards and like years afterwards of these contestants.
We know they have lost a large amount of weight. We know they lost it very quickly, and we know that their health improved and that was positive. But then we found that they had significantly slower metabolisms, which you can guess with a lower body weight, but also were struggling with increased hunger. It’s harder to keep the weight off.
I always say that there’s this confounding factor of they’re no longer living on the set of “The Biggest Loser.” Can you explain some of those more physiological aspects of why the body makes it difficult to maintain weight loss.
Julia Jurgensen, DNP: We have some hormones in our body. The ghrelin hormone, it’s like our hunger hormone. Then we have leptin, which is like our full hormone.
Their hunger hormone is like revving up and their leptin hormone is like I’m just going to kind of wean off. They’re trying to say, “Oh, I want my ghrelin to go down and my leptin to go up” and then their bodies are like, “Oh we’re just going to do almost the opposite.”
Again that kind of goes back to that set point theory of their bodies slowing their metabolism down and fighting against all the efforts that they did in that rapid weight loss that they experienced during the actual show.
Tara Schmidt: Now they’re back in their own kitchens.
Julia Jurgensen, DNP: With all their own environments.
Tara Schmidt: Yeah. Let’s talk about bariatric surgery because when someone undergoes weight loss or bariatric surgery, some of the things that you were talking about change. Sometimes ghrelin and leptin are impacted. Often we also have a change in the size of someone’s stomach or sometimes their plumbing, as I say — how their intestines are routed when someone regains weight after bariatric surgery, for example. Is this a result of the surgery itself, a complication or a failure? Are these lifestyle habits? What’s going on here?
Julia Jurgensen, DNP: Big question. Sometimes patients that gain weight after bariatric surgery can have surgical complications such as an outlet dilation where literally the plumbing should be a certain size and it’s actually bigger.
Or they have an extra hole where they shouldn’t have a hole. Well, obviously, then we can have extra food going through and they’re going to be hungry. In that case, that is a surgical complication that we in the surgical world can help correct, and that procedure can then lead to weight loss.
On the other hand, there can also be a lot of personal behavioral changes that happen after surgery that can lead to weight. It’s not even necessarily really rapid weight gain or something that patients even realize that they do. It could be really gradual. It could be something as simple as starting to eat throughout the day. People typically call it grazing.
I don’t love that term. But kind of a continuum of eating. When we continue to eat in a small stomach, it kind of breaks the purpose of the surgery, and allows you to eat all day long. You can also binge through surgery sometimes. Patients have maladaptive eating through these surgeries. Patients can tell us that they have a loss of control, with their eating.
They just continue to eat despite feeling very, very full. That can actually lead to those outlets being dilated, or enlarged. We also have to think about whether it may not be the calories just going in, but what’s going out. Or is the lifestyle just sedentary? Are you sitting all day at work? Are you not exercising? What is that factor too? What does liquid calories look like?
I call that the sneaky calorie or the low hanging fruit. It’s always the first thing that I try to go after when thinking about people’s habits and what can we change when we’re starting to think about weight gain after surgery?
Tara Schmidt: You’re talking a little bit about behavioral drift. In the first year, maybe even two years after my weight loss intervention, I am diligent. I am following the rules. I should say guidelines. I am doing what I was told. I’m measuring, whatever it may be. That gets old.
I’ll tell people and my patients this is not necessarily fun. No one loves to count calories or measure their food. It’s necessary in a lot of cases, and in this case, I’m trying to prevent your outlet from being dilated.
I’m trying to keep your weight loss successful, or I’m trying to keep you at a healthier weight. But year after year after year, our habits can kind of drift back into old habits.
It’s not this automatic regain and I’m back to my baseline weight. It’s a pound here and a pound there and two pounds. It can be very, very gradual. But over the course of 10 years, 15 years, it can be pretty dramatic.
Julia Jurgensen, DNP: Absolutely. It’s hard doing something like measuring all your food and it gets so boring and repetitive.
Tara Schmidt: A pain in the butt.
Julia Jurgensen, DNP: We don’t even want to do every single thing. We understand that. It’s learning how to do what you need to do in order to not drift completely away and recognizing when you need to tighten up and when you can loosen the reins. That’s really, truly the value of having patients coming back and seeing their team. Because that’s when they recognize, “Oh, I’m drifting.”
Tara Schmidt: Let’s talk a little bit about weight loss medications. There are weight loss medications that have been around for a very long time. We know that, but the public has always known that or been as familiar, but let’s talk about what happens when someone stops taking weight loss medication.
A lot of times we were talking about Wacovi and these GLP ones, and people don’t necessarily want to be on them forever. Right now, as of today’s date, they are expensive. Sometimes they cause side effects, which you can argue is the mechanism of action or part of it or not. But there’s a fear now of, “okay, but if I go off this medication, what’s going to happen?”
Julia Jurgensen, DNP: Unfortunately, most people regain a substantial amount of the weight they lost when they go off of the injectable GLP 1 medication. The Ozepics, the Wagobis, all of those injectable medications, and that’s the tricky part. These are medications that are designed for significant weight loss but meant for long term, lifelong use.
Tara Schmidt: That’s really challenging to share with someone, but I kind of will explain to someone, if I’m giving you a tool that is impacting your hunger, I’m decreasing the hunger signals and sometimes the craving that’s coming from your brain. I’m also decreasing your gastric emptying.
I’m helping you to stay fuller longer. That’s what’s working. If I take those tools away, you’re going to go back to baseline. Your hunger is going to return. Your normal gastric emptying is going to return. It’s kind of an expectation that you would have regained and that’s not the blame of the person.
It’s just, okay, you were on a blood pressure medication and now you’re off of it. Your blood pressure is going to go up. It’s really hard to maintain that lower body weight without that tool, because we actually know that your metabolism is lower now.
Julia Jurgensen, DNP: Exactly.
Tara Schmidt: No matter how you lose weight, diet and exercise, medications or surgery, maintaining weight loss is a real challenge. Once the newness and compliments fade, it’s not easy to keep up that vital, but also very boring work. There’s a couple of reasons. Weight tends to come back.
For one, our bodies like to stay in a general weight range called our set point range. Anytime we move away from that, our hormones and metabolism adjust to try to bring us back to that baseline. Another reason people tend to regain weight is behavioral drift. They gradually slide back into old habits over time. Weight gain can also happen due to surgical complications.
Long story short, we’ve got our work cut out for us. Let’s get strategic and talk about some do’s and don’ts for weight loss maintenance. Let’s talk about the rate of weight loss. I think most people would agree with me that if we lost like five pounds in five days or thirty pounds in thirty days, we’d be quite thrilled. But does slow and steady typically win the race?
Julia Jurgensen, DNP: I would say, in most equations, yes. Slow and steady wins the race. I say the only time that this is not the norm is in the surgical world. First of all, it tends to be a more sustainable weight loss. We tend to not affect our metabolism. We’re not affected by muscle loss, because when we have dramatic weight loss, we tend to lose fat and muscle. Slow and steady tends to be more of a true fat loss. Then we’re not just doing something crazy like going on a liquid diet or eating grapefruits for a week.
Tara Schmidt: It’s like cabbage soup or whatever people do. I often tell patients that your percent adherence to whatever plan we’re talking about, whatever changes we’re talking about, is likely more important than the plan that you’re selecting. Can you do it? Can you do it well? Can you do it for a long time?
Julia Jurgensen, DNP: Absolutely. Because if I tell you, Tara, to go eat, fish, and broccoli…
Tara Schmidt: And brown rice.
Julia Jurgensen, DNP: And you hate all those things, then I’ve done you no good. Versus, if we come up with a plan that you leave my office saying, “Oh my gosh, I can actually do this,” what a much more successful plan you’re going to have. Food is also enjoyment; it’s not just our fuel. It is enjoyable and we want our patients to enjoy their food, even if we’re losing weight.
Tara Schmidt: Once people are at a lower weight, what do you think are some of the most important behaviors that they can avoid? Let’s start with a “don’t do this” list first.
Julia Jurgensen, DNP: The things that I like to say, let’s not add back in things like unintentional snacking. You’re sitting at your desk and all of a sudden the chip bag is open and you have no idea how you got through half the bag. Lack of movement, just sitting all day and not recognizing that you haven’t moved from your desk.
Tara Schmidt: When you mentioned unintentional snacking, that also made me think of liquid calories. It’s so easy to start drinking something sugary and next thing you know it’s all gone and you don’t even feel full. What are some examples of liquid calories that you’ve come across? I feel like this could be quite a long list.
Julia Jurgensen, DNP: Soda, in the South, sweet tea is a big thing. Alcohol…
Tara Schmidt: Juice. Sports drinks.
Julia Jurgensen, DNP: Energy drinks. Milk. I’m good with milk. But the flavored milks are where it gets tricky.
Tara Schmidt: Or milk in excess.
Julia Jurgensen, DNP: Sugar-based coffees are everywhere. I believe Duncan has a drink out there right now that has the equivalent of like 14 donuts. Basically what I’m saying is you could eat like 13 of them and you’d still have less sugar than the one coffee drink. Or what you could do is just have black coffee and one donut. And you’d probably be more satisfied.
Tara Schmidt: When you look at it mathematically, and from a satiety standpoint, you can probably actually just enjoy that donut, and you’re coming out better, shockingly, than having the special drink.
Julia Jurgensen, DNP: I’ve been known to literally rewrite patients’ coffee orders.
Tara Schmidt: It’s fun. I say, do you know that you can ask for two pumps instead of four?
Julia Jurgensen, DNP: Then they say, “I don’t want to be that kind of person.” I’m like, “Why? You’re paying seven dollars.”
Tara Schmidt: I’ll sometimes have a conversation with patients in an absolutely neutral way, not blaming, not shaming, but saying, “What do you feel like were some of the contributors habit-wise to your weight gain?” Most people know and can list ten for me right now. Then those, for that person specifically, are the ones that we need to avoid like the plague, because those were triggering for some people.
Some people do drink liquid calories and some people don’t. If I lecture someone about soda who’s never drank soda in their life, what a waste of your time and my time. Sometimes I’ll look at what their habits were when they had a higher body weight or when they had less healthy habits and say we need to really be mindful of these because it sounds like they could be your personal triggers to excess calorie intake.
Julia Jurgensen, DNP: I love that.
Tara Schmidt: Let’s talk about exercise because I tend to emphasize exercise more in the weight loss maintenance phase than I do in the weight loss phase.
Julia Jurgensen, DNP: I do too. Exercise is how we actually rev up that metabolism, and especially weight training. Our muscles burn more calories than our fat cells. They also take up less space in our clothes. We need to figure out, number one, what kind of exercise do you like? If you despise Zumba as much as I do, do not do Zumba.
Tara Schmidt: You can’t do some jazz squares to Pitbull, Julia? Come on.
Julia Jurgensen, DNP: No. But if you love weight training and you want to do it by yourself at home, do it yourself at home with a video. If you need to go to the gym and you need to be involved in a class, go to a gym and be involved in a class that we have to have strength training involved in it and it needs to be at least 150 minutes per week to help us with that weight loss maintenance.
Tara Schmidt: For decades, we have watched research that’s come out of the National Weight Control Registry. This registry is kind of like an ongoing study that has been tracking over 10,000 people who have lost and kept off at least thirty pounds. They did not specify how you had to do it.
Some of these people did lifestyle or commercial diets, etcetera. The coolest thing about this group is that they’ve collected a bit of a list as to common attributes. A few of them are waking up early, watching less than ten hours of TV per week, exercising at least one hour per day, and weighing themselves weekly.
Ninety-eight percent of them changed their eating habits to a lower calorie diet. Why are some of these, what we could consider small changes, so effective?
Julia Jurgensen, DNP: They may seem really minor, but when you look at it, it’s like waking up early. That helps us prepare for the day. I know there’s research out there that those who tend to get up earlier tend to eat healthier.
Tara Schmidt: They tend to exercise more too. I should say, people who exercise in the morning tend to be more consistent than people who do not. Because guess what? It’s already done. You don’t have any excuses.
Julia Jurgensen, DNP: I mean, the first thing I do when I get out of bed is put on my workout clothes and go downstairs and work out because by the time I figure out that I’m working out, I’m already halfway done. That’s some of it. Ten hours a week of tv, gosh, less sedentary time.
They weigh themselves weekly. I talk to patients about this often. Cause they’ll ask if it’s better to do it daily, weekly, not at all? I always say, what helps you? It’s good to have a check-in of some sort, as long as it’s not harmful to you to have that check-in. I have some patients that have to put the scale away and just do it once a week, and then put it back, having that check to make sure they’re not way off base.
Tara Schmidt: I should say that these are not small habits. They don’t seem extreme when we look at the world of dieting, but exercising an hour a day. That’s great. These people are working their butts off.
The reason that they’re successful with weight loss maintenance is because they’re doing what needs to be done. They are maintaining their lower calorie diet. They’re burning and ideally maintaining or building muscle mass to keep that metabolism fight going.
Thanks to people who have been successful at keeping weight off. We know a thing or two about what works. First, keep a lower calorie diet and try to avoid mindless snacking and liquid calories like alcohol, soda, juice, or sugary coffees. Next, try to be active. Find a type of exercise you actually like, whether it’s taking a dance class or doing workout videos. You’ll also wanna incorporate some form of strength training to keep up your metabolism.
Last, but certainly not least, consistency is key. Pick your new habits and stick to them. If you know certain things might trigger your old habits, try to be proactive about avoiding them. Those are great places to start and keep going. Now let’s talk about resources to help you along the way.
We have a lot of people, especially in America, and I’m just going to say, especially females who find themselves, myself included, in yo-yo dieting, weight cycling. I could call this getting trapped into fad diets or what’s popular this week on the internet. How can we help people get out of that pattern or cycle?
Julia Jurgensen, DNP: The first thing you need is to find a medical provider, whether it be a dietician, primary care provider, endocrinologist, someone who can help you to break that pattern, and figure out how can I move forward in a way that I’m not going to continue this cycle that’s harming my body, but that’s going to help my body to live a healthy lifestyle. Having that partner from a medical perspective it’s going to be critical for that person.
Tara Schmidt: And accountability.
Julia Jurgensen, DNP: Yes.
Tara Schmidt: Hopefully to share with them the big picture. Because sometimes patients won’t believe me that I’m taking all of their diet rules away. They say okay, I do low carb and I do this, and I do this, and I do this, but they also tell me that it’s not sustainable for them. We say alright, let’s wipe the slate clean and start to talk about what has worked, what is reasonable, and what you can see yourself doing for a long period of time.
Those might be super minor things. Like I’m going to exercise in the morning, I’m going to eat breakfast, and they say, “Wait, this is what you’re prescribing me? Like this seems like it’s not going to make a difference at all.” But my hope is that those small changes make an impact on their total calorie intake.
They do start to see some weight loss with time. Then they just continue, and so we have a really boring, slow reduction in weight.
Julia Jurgensen, DNP: But boring over time, slow, is so much healthier.
Tara Schmidt: We actually know that when people choose a variety of diets, good, bad, and otherwise, by the end of one year, whether you lose it super fast or super slow, most people end up at the same weight anyway, so it really doesn’t matter what your graph looks like. You might as well do it slow and steady because you’re gonna still get the same race time in the end as someone else.
Julia Jurgensen, DNP: Absolutely.
Tara Schmidt: Weight loss, weight regain, all of everything that we’re talking about is really frustrating. I think it’s really psychologically difficult. How do we help people practice patience, self compassion and self care through all this?
Julia Jurgensen, DNP: Giving ourselves grace is one of the hardest things that we have to do through weight loss. This is a process and it’s a journey and a lot led up to this weight. We didn’t get here overnight. We’re not going to lose overnight. We need to work on how I am going to do self-care during this time?
How can I reward myself without food? How can I teach others around me to care for me without food? How can I speak to myself about my body lovingly? Because so often we beat ourselves up more about our bodies than anyone else around us and the things that we say about our bodies, we would never say about someone else’s body.
Tara Schmidt: I don’t want my child to hear me say it about myself. I say it in my head, of course, don’t say it in your head either.
Julia Jurgensen, DNP: A lot of weight loss is also learning to have patience through the process and being satisfied with the moment right where you are. What can my body do today that it couldn’t do yesterday?
Tara Schmidt: Yes. How does walking up a flight of stairs feel? How does pushing your kid on the playground feel or chasing a grandkid down the street? How do your clothes fit? How’s your blood pressure? There’s just a million things that I could list.
Julia Jurgensen, DNP: I ask patients all the time. “Did you write that down? Because on the day that you are having a rough day, you’re going to need that reminder of why you did this.”
Tara Schmidt: Even if someone has been successful after bariatric surgery specifically, how often should they be checking in?
Julia Jurgensen, DNP: In that first year after surgery, we recommend coming in essentially like every three months to check in with the bariatric team. Then after that, we recommend it on a yearly basis, essentially forever. Because your bariatric surgery team knows your bariatric surgery better than anyone else in your healthcare team.
What does that weight trend look like? What are the GI side effects? What’s that diet look like? Are there any of those things like, “Oh, I didn’t realize that I was drifting away from doing what I was supposed to? Am I taking my vitamins? What do my vitamin labs look like?”
Unfortunately, attrition or lack of follow up is significant after bariatric surgery, often because of patients feeling like they’re doing well, or because patients are like, I’m not doing what I’m supposed to, so I don’t want to come in.
As a provider, I want to see all the patients. We want to help patients wherever they’re at, but we can’t if we can’t get them in the office.
Tara Schmidt: I would always say, if you’re doing great a year from now, that’s awesome. I want you to come in. I will give you a high five. Julia will look at your labs and your blood work and your urine and will say, that’s great. Then we will let you leave.
If you’re not doing well, I want you to come in and I want us to have a conversation, let’s say about the five pounds that you’ve gained in the last year before that five pounds becomes thirty pounds. I have seen that before when someone comes in ten years later and I say “I haven’t seen you in nine years.” They’re like, “Yeah, I wasn’t doing great. Then I’m like, “You know, I wasn’t going to yell at you. I was there to help you.”
Julia Jurgensen, DNP: It’s hard to come in and ask for help. As humans we want to just figure it out ourselves.
Tara Schmidt: What are some resources if people want support outside of their clinical team? We’re wonderful, of course, but what if they want more peer support or online or they want to be a little bit more anonymous?
Julia Jurgensen, DNP: Of course, there’s a lot on social media. It can be a little scary. Be careful out there. Mayo Clinic does have Mayo Connect. It actually has a phenomenal support group for bariatric surgery. Those patients are really interactive there. If there’s questions, they’ll actually reach out to the team. I highly recommend that one.
There’s actually a blog on there as well. They are actively posting from our team. There’s recipes that are on there. There’s frequent questions that we get on all sorts of topics.
Tara Schmidt: That’s Connect.mayoclinic.org. It acts as a support website for a ton of different diagnoses. People who are going through the same thing that you or a family member is, whether or not you’re a Mayo Clinic patient, actually.
Julia Jurgensen, DNP: Outside of Mayo, of course, there’s plenty of other resources, but the thing that you want to be careful with is just recognizing, is it a reputable site.
Tara Schmidt: Absolutely. Do you have a story about a patient and their weight loss journey that you wouldn’t mind sharing with us?
Julia Jurgensen, DNP: I do. I have a phenomenal story actually. I have a gal who I have followed for many, many years. When I first met her she weighed over four-hundred pounds. She came to us and wanted to do surgery. We told her that before surgery, she really needed to lose a little bit of weight.
What I remember the most about her pre-bariatric surgery experience is that when she started with us, she could barely walk around her kitchen table. But she committed to start walking. She would walk laps around her kitchen table and that was her exercise. She built up over time.
Six months in, she walked to my appointment for the first time. She said, “Did you see that there was no wheelchair out there for me today. I walked here.” You have to understand Mayo Clinic is huge. To get from the parking garage to my office is like a very long way. That was huge for us.
Then she had surgery. She was an incredibly diligent patient about coming to see me. She’s lost over two-hundred and fifty pounds. The best part of her story is not her weight loss journey, but it’s where she walks. She and her husband now go to the Mall of America and they walk five days a week around the third floor for an hour and a half. She changed her life.
Tara Schmidt: I absolutely have goosebumps right now.
Julia Jurgensen, DNP: I adore her and her husband. She is why I do my job every single day.
Tara Schmidt: Julia, thank you so much for spending time with me today and sharing all of your wisdom.
Julia Jurgensen, DNP: Absolutely, Tara. It was so fun to be with you today.
Tara Schmidt: If you’re feeling stuck on your weight loss or maintenance journey, your care team can be an amazing resource. They can help you find a path forward that works for you, as well as provide accountability and encouragement. If you’ve had bariatric surgery, check in with your team once a year. No matter how you’re doing, we’re happy to give you a high five or some helpful tips for how to readjust your habits.
Mayo Clinic Connect is also a great resource to find other people who are going through the same things. It’s a forum that’s moderated by healthcare professionals, and there’s other helpful content like blog posts and recipes from the Mayo team.
That’s all for this episode. If you’ve got a question or topic suggestion, you can leave us a voicemail at (507) 538-6272 — we might even feature your voice on the show!
For more on nutrition episodes and resources, check us out online at mayoclinic.org/onnutrition, and if you found the show helpful, please subscribe and make sure to rate and review us on your podcast app. It really helps others find our show. Thanks for listening, and until next time, eat well and be well.
Relevant reading
The Mayo Clinic Diabetes Diet, 3rd Edition
This adaptation of the #1 New York Times bestselling book, The Mayo Clinic Diet, provides those living with type 2 diabetes a simple and straightforward guide to losing weight and keeping it off.
You did it: you found the right diet, exercise routine, surgery or medication to help you lose weight. Now what? On this episode of On…
