Jennifer Schriever, MD - Sanford Health News

Four pillars of weight management, defined

Cassie Alvine (announcer):

This is the “Health and Wellness” podcast brought to you by Sanford Health. Our conversation today is about weight management options, including discussion on recent medications for weight loss. Our guest today is Dr. Jennifer Schriever with the Sanford Weight Management Center. Our host is Alan Helgeson with Sanford Health News.

Alan Helgeson (host):

We’re talking with Dr. Jennifer Schriever on the “Health and Wellness” podcast. Are there any statistics or things that you can share regarding BMI as we maybe start our podcast today?

Dr. Jennifer Schriever (guest):

Well, the history of BMI is, it’s a really old measurement based out of men in Belgium. So it’s not a perfect measurement, but it’s what the current standard is. So to come to our clinic, we generally require a BMI of 30 and above, or if you have a BMI with weight associated diseases, then we will consider those as well.

We are now starting to accept pediatric patients 12 and above, and they have different ways to qualify their BMI. It’s greater than or equal to the 95th percentile for pediatric or obesity or if overweight and have medical co-morbidities related to weight. Then their BMI is at the 95th, 85th to the 95th percentile for age.

Alan Helgeson (host):

Dr. Schriever, we’re hearing things like weight management versus weight loss management. Are those the same thing?

Dr. Jennifer Schriever:

They are different. Certainly, the goal of most of our patients as they come in is weight loss, but then we want to make sure it’s done in a healthy fashion and appropriately because we want to make sure you’re able to keep your weight off for the long term. And it’s not just about weight, it’s about how is your body composition? And if you have extra skeletal muscle, that’s going to play a factor in how much you weigh. So we want to make sure that you keep that skeletal muscle on board and have the appropriate body composition. So that is more weight management than weight loss.

Alan Helgeson (host):

You know, we hear so much about diets. I mean, we’re just programmed to talk about diets. We see commercials, the ads. Regardless of where you look at it, it’s all about diets. Body image. Do diets work?

Dr. Jennifer Schriever:

No, really because a diet tends to be something short term, and really that you’re not going to be successful unless you find something that can be long-term for you. Short-term weight loss doesn’t necessarily add up to long-term weight loss if you resume old habits. So, and a lot of diets are something that people don’t find sustainable and weight loss may not be in a healthy fashion.

To me it needs to be a lifestyle change that you can develop and continue and adapt to so that you have new habits and understanding that of how you lead your life leads to improved health versus just a short-term program where you can lose weight fairly quickly but then it doesn’t stay off because of maybe your metabolism changed. Or once you resume more routine diets that you’ve done previously, then you can easily gain the weight back.

Alan Helgeson (host):

So if I’ve done a diet in the past, I’ve lost this 20 pounds, you know, a fairly quick fashion, but then I’ll go back to my old ways and it sneaks back on. But not only that 20 pounds but it’s 25 pounds or maybe it’s 30 pounds. Why does that happen?

Dr. Jennifer Schriever:

Yeah. Often what is happening with rapid weight loss or large weight amounts of weight loss fairly quickly is we’re also losing skeletal muscle, and that holds the majority of our metabolism. So if we lose weight through dieting and aren’t aware and understand about how is the best way I can keep my skeletal muscle, then we lose skeletal muscle. Thus our metabolism declines.

And then as we resume old ways, or it can be just become more difficult to maintain that weight loss and easier to gain again because your metabolism has declined.

Alan Helgeson (host):

Dr. Schriever, let’s talk about specifically what weight management options does Sanford offer.

Dr. Jennifer Schriever:

A variety of weight management options. You can start with your primary physician and they can help refer you to a dietician or their health coach in the office to help you with some information on healthy eating and maybe meal planning for your family. Some primary physicians and other specialists are comfortable with weight loss medicines and providing some lifestyle guidance.

Obviously we have the Sanford Weight Management Center and then we have a nice comprehensive team with a dietician and we have connections to behavioral health that can help you with depression and anxiety and binge eating disorder or anything that affects how you feel about eating and the stress related to that or even body dysmorphia. We’ll prescribe medications according to what is safe for you and your health conditions as well as your medication list and physical activity guidance. And as I alluded to earlier, we can help monitor your body composition.

Another option is bariatric surgery. The guidelines are a little bit different than weight management. They now recommend surgery if you want to at a BMI of 35 and above, or above 30 with weight associated medical conditions. And maybe even surgery should be considered lower than that if someone has really made some significant efforts at weight loss.

The first steps: checking on what you should do or consider, you can certainly talk to your primary physician or one of your specialist physicians for recommendations and also check with your insurance and see what is covered. If you are interested in our program, certainly call or have your physician refer you. We will give you some guidance on how to check with your insurance, but you can also be self-referred or have your physician refer you bariatric surgery. You can have your physician refer you to a bariatric surgeon’s office here at Sanford.

You have two surgery options, I believe the sleeve gastrectomy and then gastric bypass. Often they will know, that office will know if your insurance covers it so that they can help save you the time if your insurance doesn’t cover bariatric surgery. And they also often have informational meetings that you can come and get informed in what that process is like.

Alan Helgeson (host):

What are some signs that a person may need weight management care?

Dr. Jennifer Schriever:

First of all, just if they want that in a comprehensive program. Think if you have multiple medical problems, then you might want someone more specialized and focused in with a training to help people with their weight management.

If you feel like you’ve worked on your weight and lifestyle without improvement in your health and are really frustrated and need a new plan, then we can help with that.

If you appreciate and would like ongoing, regular and frequent contact and support, then we’re a good program for you because that’s what we’re here for the duration, for life if you need it or if you’re just confused and not well informed about nutrition and what’s so important in lifestyle because that has been a difficult topic to learn over time. And there hasn’t always been great nutrition information out there. So, and that just keeps getting better. And our group is pretty dedicated to stay up with the latest and greatest.

Alan Helgeson:

I want to go back to something you mentioned when we first talked about this question. One of the things you mentioned is if you have multiple medical problems, could you maybe go into that? It seems like so many things we hear about, one of the things we hear is weight related of just about everything. Weight is tied into so many things. Could you maybe expand a little bit on that Dr. Schriever?

Dr. Jennifer Schriever:

Sure. Sometimes it’s even hard to think of something that is not weight related. You know, certainly diabetes and heart disease are weight related. A variety of cancers are related to weight. So we can reduce risk of cancer by improving one’s health. Mental health is tied to the disease of obesity. So depression or anxiety or eating disorders. High blood pressure, high cholesterol, if you have arthritis and problems with your knees or hips for example or even chronic back pain, it’s going to be related to the disease of obesity.

Alan Helgeson (host):

We were getting ready for the program today and you had mentioned there’s some calculation that losing a certain amount of weight and, and I can’t remember what that number is, but that if you lost such, it equates to another number of taking pressure off your knee.

Dr. Jennifer Schriever:

Yes. So for every pound of weight you lose, it takes four pounds off your knees. So you can see more rapid improvement in your knee pain just with even smaller amounts of weight loss because of the effect of gravity in addition to the weight.

Alan Helgeson (host):

Everybody has knee pain, right?

Dr. Jennifer Schriever:

A lot of people certainly. Or back pain.

Alan Helgeson (host):

Or back pain too. So everything is tied to, I mean so many things are tied to weight related issues. OK. We talked about maybe how to go about getting some help and maybe some of those signs. What does a person need to know about weight management?

Dr. Jennifer Schriever:

So the goal of weight management is to create a lifestyle that leads to improved health and body composition so that you reach a point that you’re comfortable with where you are. Those chronic diseases can improve with just as little as even five to 10% of weight loss. Cancer reduction risk I think is closer to 20% of weight loss. We use a body composition scale to help guide you too so that you understand and appreciate what is going on rather than just trying to watch the scale budge.

Alan Helgeson (host):

Can we talk a little bit about watching that scale? If it’s only about a number, how can you get people off that piece, Dr. Schriever?

Dr. Jennifer Schriever:

I think in our clinic it becomes easier because we do have a scale that helps to measure body composition. So we go over that each visit. It includes obviously the total weight but also what does your lean tissue weigh such as a total number for your bones, muscles and organs. It also has the dry lean mass. So that’s looking at what do your muscles and maybe bones weigh without any water content. So that reflects your muscle health and balance as well as just a number that reflects your skeletal muscle weight.

So we can help you monitor that because as you lose weight, we really only want you to lose less than 20% of your skeletal muscle compared to your total weight loss. There’s also a percent body fat, and we watch visceral fat – that’s the fatty tissue inside our trunk, around all the organs. So that’s different than subcutaneous, which is underneath our skin. The visceral fat causes inflammation and puts us at risk for all the diseases that can occur from organs in our belly like diabetes and heart disease. And then reducing that reduces all of our risk factors or reduces risk for the cancers that occur in those organs.

Alan Helgeson (host):

So we’re talking about what are some of the keys to healthy weight management. Let’s talk about what are some of the do’s and don’ts of weight management?

Dr. Jennifer Schriever:

Find a plan that is sustainable and stick to it. Don’t look at those fad diets or advertisements for supplements that just seem to be amazing because they probably aren’t. And I hate to see patients spend money on something that isn’t well studied for our program. It is most effective or if you follow our guidance then if you feel like you’re stuck and what we’re telling you isn’t working to come back and tell us what you’re doing and give us some details so we can help figure out how we need to adjust that.

Encourage patients never to be embarrassed to come back because life happens and interrupts everything and makes following your plan difficult. And we also strive for consistency, not perfection. So that’s important because we want to participate in different things in life. That might mean we’re eating something that we don’t consider as healthy as others, but that doesn’t mean you can’t enjoy it once in a while.

We focus a lot on tracking nutrition at some point. We don’t want that to be stressful, which it certainly can be for some people, but you’ll find the most success over time tracking to some extent or doing a check-in with yourself. And we at least start with having patients know the right amount of protein to get and working towards getting to that. And then as comfort level improves or understanding of nutrition improves, we can look at other ways to track nutrition.

Exercise is also very important. We do strive to help our patients find a way to do that that is comfortable for them because it can be very uncomfortable at first or they have joint problems that make exercise or knowing how to exercise difficult to understand. So we try to collect as many resources as possible to make that work for them.

And then just don’t give up. We’ll help you figure it out.

Alan Helgeson (host):

Let’s talk about some of those keys that are really core to healthy weight management. Could you cover some of those please?

Dr. Jennifer Schriever:

Sure. So there are, through the Obesity Medicine Association, four pillars that are integral and important to improving lifestyle and they all need to be included.

1. So one of course is nutrition, and the main focus here is getting adequate protein and then creating a calorie deficit for what you need. But we’ll help you adjust to that and figure that out over time.
2. The second pillar, highly important – actually they’re all important – is physical activity. So I always point out it says physical activity, not just exercise. So how much are you moving every day? And for heart health you need at least, or it’s recommended to get 5,000 steps a day or more and sit less than six hours. So that’s really important and that’s called neat non-exercise activity thermogenesis or some people will say time. So how much are you moving every day? And little bit by little bit even extra steps here and there are super helpful in managing your weight.
3. The third pillar is behavior. We often have stress eating or emotional eating or binge eating that we find as we get new patients. I also often talk about how do you get through a social event and feel comfortable about it, go out to eat, go on vacation, and we can help you with some thoughts on how to do those things if you want to keep your health in mind. Now sometimes you might say, this is my time, I’m going to enjoy myself and that’s totally fine, but often it’s as simple as get some protein first, whether it’s there or on your way and then that’ll help fill you up so you don’t feel so hungry there.
4. The final pillar after, so the first three were nutrition, then physical activity and behavior. Then the final pillar is medication. So all of those pillars are important to develop a lifestyle that works for you and medication should be included as long as you need them, as long as they aren’t causing any harm. And even in when you get to a maintenance phase or where you’re comfortable, they’re part of what we’re working on. And so as long as there’s no adverse effects then we continue with those to support you as long as you feel like you need them.

Alan Helgeson (host):

Do you talk to your patients about using the wearable technology and some different apps? Are those important within your clinic?

Dr. Jennifer Schriever:

I think they’re definitely valuable to the right person because it gives you an idea of where you’re at and if you can consider improvement. You know for some patients they don’t or aren’t able to move a lot. So then I say well then can you add an extra 50 to a hundred steps a day, depending on their capability? Or do we look at, can you increase by 250 to 500 steps on average? To make small goals that seem more obtainable. Then we all tend to think that 10,000 steps a day is what we need and if we think we need that, that doesn’t seem reachable. So I do encourage them, if they’re able to get one of those or to at least maybe carry your phone more often for a day. Because it does count your steps and then you at least know where you tend to be at.

Alan Helgeson (host):

Let’s switch topics here because this is really dominating so much of the category of weight management and weight loss. It’s the medications. Could you talk a little bit Dr. Shriver about these medications and how they work and why they’re getting so much attention?

Dr. Jennifer Schriever:

The generic name for Ozempic and Wegovy is semaglutide. And so Ozempic is the brand name used for diabetes and then Wegovy is the brand name used for weight management and the dosing is slightly different. Those are both a GLP-1 it’s called, which is a hormone that your small intestine makes and distributes once you have eaten.

So it triggers some insulin and blocks glucagon secretion, which means that your blood sugar level doesn’t peak as much and you get better blood sugar control. It also slows down your stomach from emptying so you feel full sooner and faster and also sends a signal to your brain to tell you you’re full and satisfied. So it can take away some of those cravings and food noise that people talk about.

Then Mounjaro, it is a GLP-1 medicine but it also has GIP in it and that’s another GI or gut hormone that can increase satiety. So it can help with full feeling but mainly acts by affecting a portion of the brain that makes you feel satisfied, that helps to decrease then your calorie intake. It also is affecting the insulin and the glucagon after you eat and is released into that response. It also can help kind of your fat distribution, encouraging fat deposition into your fatty tissue rather than your organs, which is where you really don’t want it.

Alan Helgeson (host):

Who is a candidate for these medications?

Dr. Jennifer Schriever:

The criteria for medications is the same as the criteria for our program. So anyone with a BMI of 30 and above or the BMI of 27 and higher with a weight associated condition.

Alan Helgeson (host):

But what is an ideal patient journey for these types of medications?

Dr. Jennifer Schriever:

Yeah, it’s kind of funny how a drug gets named. So the drug company goes to the FDA and says we’ve studied this medicine, here’s our evidence and this is a condition we studied and then they pick a brand name.

And then they go back after they’ve studied it and clarified that it can be used for weight management and then they rename it and then it’s called Wegovy and then that’s how the patents are created. But that’s also how insurance determines what they cover those medications for through that process. Which is why your insurance won’t cover Ozempic for weight loss.

So certainly we want to make sure as we screen patients that they qualify based on their BMI and health conditions or and also that they don’t have a contraindication – which sometimes the contraindications are listed but maybe not necessarily an absolute. But generally we don’t start patients on these medicines if they have a history of pancreatitis that we don’t necessarily know why. Although I think some studies show that that’s maybe not as concerning as we initially thought.

There’s a family history of a specific type of thyroid cancer that we wouldn’t recommend those medications for and that’s medullary thyroid cancer, which is not very common. I would also hesitate if a patient has known gastroparesis, which means their stomach already doesn’t empty very quickly and if the patient still wanted to, we’d have a significant discussion about how that’s going to go.

Alan Helgeson (host):

So we talked about the insurance thing. If someone’s insurance doesn’t cover this and they still wanted to pay for it out of pocket, could they do that?

Dr. Jennifer Schriever:

They certainly could. Generally mainly the ones that are FDA approved for obesity but it’s fairly expensive for a while. Maybe you could get it for $500 but I think lately it’s more like $800 a month and we’re still dealing with drug shortages so can be pretty hard to find at the moment.

Alan Helgeson (host):

At what point can we start identifying as something for long-term success with them?

Dr. Jennifer Schriever:

Well by the time a medicine like this has come to market, it’s been well studied and some of the evidence out there is as long as five years. The Ozempic has been out since 2016, not necessarily used and dose adjusted for weight management, for more for just diabetes. So then Saxenda, which is the daily injection liraglutide is also Victoza and that’s been out since 2012 I believe. So then we have some more longer term data in the general population but they’re studied well beyond that for several years prior to coming to market. Probably more like 10 to 20.

Alan Helgeson (host):

So it’s been out there a while.

Dr. Jennifer Schriever:

It has. So far we don’t know of any definite long-term risks of these medicines. I mean certainly there are rare complications which maybe we want to get into.

Alan Helgeson (host):

Yeah, let’s talk about some of those. That’s a good lead into those.

Dr. Jennifer Schriever:

Yeah, so some of the concerns initially and especially based on study is significant or can be significant nausea and constipation. I actually supply the patient with a prescription for something for nausea and caution them to definitely eat slower and drink slower because these are slowing your stomach from emptying and the effect of that can be fairly immediate or it can take several weeks into the dosing.

The latest on that gastric emptying or the stomach emptying slowing, seems to be out there where there are cases reported where they talk about their stomach being paralyzed. That was never necessarily found in the studies as the drug companies did prior to bring it to market. Certainly that condition can happen randomly, so I don’t know if that is a true association and, but it does slow your stomach from emptying. So that is a risk.

And if I have a patient at risk with diabetes for example, which they are at risk, I might ask them a lot of questions about how they feel around eating and if they have any symptoms that make me suspicious. So I have checked a few patients for that prior to prescribing it.

There’s a list of diabetic retinopathy, which is an eye complication that can lead to blindness for patients with diabetes. If their blood sugar is pretty stable, it’s not really a risk if you know these medicines can help their diabetes improve so then that can change their blood sugar levels quickly. But I don’t think that risk is as significant as worried but it certainly doesn’t hurt to contact their eye doctor about what they would recommend as far as maybe dose adjustment or what their blood sugars are doing or what is the status of their diabetic retinopathy.

The medications, you know, can cause pancreatitis. So we might hesitate depending on the cause of the pancreatitis. If it’s due to your gallbladder or some other concern, then the medications are still fine. If we aren’t really sure then we will have extra precaution about continuing those. It can raise heart rate typically only a few points and not an ongoing problem, or can make it feel be significant. But generally that often isn’t a reason that we have to stop it.

They’re the common, just like any medication, since these are injections, you can have a rash at your site or an allergic reaction. Low blood sugars are possible but not very common. Another common one, like in the media or social media is about kidney problems. Often if you’re going to have severe GI problems like nausea or vomiting or sometimes you end up with diarrhea and you aren’t able to stay hydrated, then you know that is a risk for having some stress on your kidneys.

So certainly on these medications especially you don’t think this is just a side effect that I can try to deal with at home, seek care sooner than later.

And then one thing, I don’t know if it’s still such a big deal out there, is that Ozempic face? Ozempic face. Yeah. Really anyone who has weight loss, you know they’re going to lose weight or fatty tissue in particular in a variety of places. So some people will lose more in their face and maybe look a little gaunt or quite a bit different than they used to. So I think that’s what that’s referring to. But that can happen with any weight loss method.

Alan Helgeson (host):

If you are taking these medications, are you on them for a long time or just till you maybe get to a point where you don’t need them anymore?

Dr. Jennifer Schriever:

I think that’s going to vary on the individual. Certainly it’s very important to incorporate all the lifestyle and the pillars that I talked about earlier.

So we have to focus on the nutrition and that certainly helps with satiety feeling. It’s important to focus on the exercise and strength training because we need to maintain that skeletal muscle health, which we also need the protein for.

Have we learned how to address our behaviors or know some techniques or improved with counseling around mental health concerns or binge eating. And how stressful has weight management been for you most of your life?

So for some patients they really do well with those lifestyle changes or a lot of them do, but it depends on, I think, their life experiences and the fear of that hunger returning, how long these medications are needed. Some have done very well having to suddenly stop them based on insurance changes, job changes, et cetera, that they’ve done well and at least maintained stability before they’ve come back to see me. And some certainly have a lot of anxiety of what’s going to happen when they go off. So it really should be a long-term medication that the patient and the doctor can work on a plan if they’re ever ready to go off. But it’s not that way for everyone.

Alan Helgeson (host):

In a quick summary here, a lot of things you would hear the media and some places would say this is the quick miracle drug of the moment. It’s getting its 15 minutes of fame. OK great, whatever, what isn’t this medication?

Dr. Jennifer Schriever:

Yeah, I think the unfortunate part about how it’s advertised, and maybe it’s just what we really hear from that message is how successful these medications are in the studies to help someone with weight loss. But it’s so imperative to do everything together because by themselves they may work to some extent but they’re not going to work for the long term if you aren’t keeping aware of what does my nutrition need to be and how do I support my muscle health and how do I exercise to keep my metabolism?

Because for some it is such a relief to not be hungry anymore and historically they might have lost weight just by eating a lot less or not eating, but that’s not going to work in the long run based on your metabolism and all sorts of things that change internally. So it’s still a comprehensive plan, but that’s a major tool to include. But it doesn’t mean it’s the only thing.

Alan Helgeson (host):

On social media, they’re talking about how these medications may have an unknown added effect that is spilling over into some other addictions. How it is maybe working to curb some other addictions?

Dr. Jennifer Schriever:

Yeah, so the details certainly aren’t fully known yet, but we do know that part of their effectiveness is how they not only send a message to the stomach from the GLP-1 standpoint, but both the GLP-1 and GIP effects are going up to your brain to tell you you’re full and satisfied. That seems to be triggering a portion of the brain that does help with addiction and compulsive behaviors by just taking away that desire to continue to do those sort of things.

And it seems to be having an effect on the dopamine pathway. And our dopamine chemistry is behind a lot of our addiction and cravings behaviors. So people, I even have patients who aren’t necessarily have an alcohol addiction but they just don’t crave that alcohol anymore or it’s helping them quit smoking and then, you know, certainly people do feel addicted to food sometimes and so it helps taking those cravings away. So that’s just such a benefit. Because as you think about those thoughts, they’re very stressful. Because you don’t want those thoughts, you might not want that food or to drink more alcohol, but yet that craving is there.

Alan Helgeson (host):

If you watch the various news reports, they’re making the miracle thing of the moment, but it’s just a thin slice of one of the many options. And there’s so many things that Sanford offers in helping somebody in a journey to finding a healthier way to live. And it’s a lifestyle thing, right?

Dr. Jennifer Schriever:

Certainly. And there are other medication options. Patients are often so disappointed to know that their insurance might not cover these medicines, and they’re so expensive to consider out-of-pocket.

But some of the cheaper medications we have patients very successful on that and they’re also incorporating of course, nutrition and lifestyle changes like exercise and the physical activity as well as any behavior things that need to be addressed. And so they do very good on medications and if weight management isn’t covered by insurance and you don’t have a contraindication to take some of the pills, patients are spending $25 a month out of pocket.

Alan Helgeson (host):

It’s nice to know that there are so many options available and that Sanford Health has really, really gotten behind helping people get healthy in so many ways. And the big takeaway, if you could give people one takeaway from this, what do you want them to do or want them to know?

Dr. Jennifer Schriever:

Wow. Big question. But I think what I really want people to know is that there is a healthy and sustainable way to help you with your weight loss. And it’s now available at Sanford and we do our best to meet everyone’s needs and it make an individual plan that works for them. And it is very frightening to come into a clinic and discuss your weight and just know that we are going to treat you kindly and without any bias and really aren’t going to judge because everybody has a different life journey.

Alan Helgeson (host):

Before we go, I want to mention that many of the services and care options mentioned during the conversation with Dr. Schriever are available at the Sanford Weight Management Center in Sioux Falls. If you’d like information on what options are available near you, call your provider, your clinic, or visit sanfordhealth.org.

Cassie Alvine (announcer):

This episode is part of the “Health and Wellness” series by Sanford Health. For additional podcast series by Sanford Health, find us on Apple, Spotify and news.sanfordhealth.org.

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TikTok nutrition trends: What’s safe versus a scam

Alan Helgeson (host):

Hello and welcome. You’re listening to the “Health and Wellness” podcast, brought to you by Sanford Health. I’m your host, Alan Helgeson, with Sanford Health News.

Our conversation today is about the TikTok and internet nutrition and wellness trends. Are they facts or are they fiction? Our guest today is Dr. Jennifer Schriever with Sanford Weight Management Center. Dr. Schriever, thanks for being with us today.

Dr. Jennifer Schriever (guest):

Oh, thanks for inviting me.

Alan Helgeson (host):

We wanted to go right to the expert and to talk to you today to maybe answer some of those questions, debunk some of that stuff. I’m wondering is there a danger in jumping into some of these nutrition trends online?

Dr. Jennifer Schriever:

Certainly. Because some of them can be harmful, especially if you have some health conditions or on some medications that could affect those treatments. They also tend to not be very well studied. So then how do you know the true safety, and are the ingredients what they say they are? A lot of the supplements and created products like that aren’t well regulated. And so even pill to pill or jar to jar, you don’t know if you’re getting the same ingredients.

Alan Helgeson (host):

Another question we have here too, Dr. Schriever, is how do we identify a fraud or verify if something’s safe for us?

Dr. Jennifer Schriever:

Certainly look for who is giving you that information. Do they have good credentials? So if they’re a dietician, are they a registered dietitian or a licensed dietitian? Do they have a master’s degree in dietetics, nutrition, public health or other related sciences Or are they a doctor, an M.D., a D.O. or a Ph.D.?

And then also look for multiple sources of information. Don’t just trust the first one. Look for other organizations that might support it. Do they have an organization behind them supporting that? Be alarmed or concerned if it is a famous person selling that and telling you it’s great. Is it just an online testimonial that this worked great for me and my friend? Is there any studies behind it and are there multiple studies and can they be reproduced? Those studies, those are things to look for.

And if you aren’t sure, then look for another health system and look at it there to see if they’ve put any information out to confirm is it safe or not.

Alan Helgeson (host):

These are some of the top ones that are showing up and people are wondering about: powdered greens.

Dr. Jennifer Schriever:

Those tend to be supplements that are made from basically ground up and dried fruit and vegetables. So nutritionally they might have a lot of vitamins and things that are helpful. But really you’re best off still eating the fruit and vegetables because you’ve lost out on the fiber content through that processing. And also keep in mind there might be bad ingredients.

So I look for a third party reviewer. If it’s a good company, they’re going to ask an outlying company to review their product for safety and make sure there isn’t any extra contaminants like lead or something else or heavy metals.

The other thing to keep in mind again is if you have any kidney disease or if you are on some medicines such as blood thinners or a blood pressure medicine that might affect your electrolytes, adding some powdered grains could certainly affect levels of certain medications. And so you want to let your pharmacist know or your doctor know.

Alan Helgeson (host):

Here’s a unique one we’re seeing a lot about is tongue scraping.

Dr. Jennifer Schriever:

Yeah, so that’s interesting. As far as weight management, probably not adding much to your health. If you have, in general, good care of your teeth and oral tissues, do you need to add tongue scraping? Not necessarily.

But if we have poor dental health, then we have extra bacteria in our mouth which can cause inflammation. Inflammation can lead to heart disease or stroke. In pregnancy it can cause pregnancy difficulties such as preterm birth and other complications like infection and pneumonias. You’d be at higher risk for pneumonia if you don’t have good dental hygiene. But do you need to add tongue scraping to your typical routine? No.

Alan Helgeson (host):

I know a lot of people like to look at recipes on Pinterest. I like to do that and we’re seeing a common theme here. One of those things that people talk a lot about these days, Dr. Schriever, is drinking bone broth.

Dr. Jennifer Schriever:

You can certainly use it if you want to be sure it’s safe if you’ve made it yourself. You need to be aware of the risk of bacterial and contamination. And make sure you use it up by the expiration date. It’s, I think, touted as a protein source but there’s only nine grams of protein in a cup. Liquid also tends to be very filling. So if you’re using it to help feel full, that’s a good way to do it. So you can certainly use it as a tool to help with fullness and for protein content.

But we look at least needing at least 30 grams at a time to support your muscle health and regrowth. So that’s only nine grams. So you’d need to be aware of what else is in your meal to help balance that out.

Alan Helgeson (host):

What can you tell us about dry scooping?

Dr. Jennifer Schriever:

Gosh, don’t do that. (Laugh). So dry scooping is referring to using pre-workouts I think mainly. And instead of mixing it in water, just throwing it in your mouth and swallowing it, you’re going to certainly place yourself at risk for choking and aspirating, which is not good for your lung health, could lead to infections. And we all know where choking could go, but also consider those tend to have a lot of caffeine in them and if you’re going to swallow it that quickly, you’re going to absorb all that caffeine so quickly it can elevate your heart rate, could certainly cause some heart damage if you’re going to do anything like that to a significant extent. Or frequently you could have chest pain, numbness, tingling, nervous system effects, dizziness, all sorts of just really not feeling well. So as you look at pre-workouts and if you’re going to use them correctly mixed with water and things, try to keep it under 200 milligrams of protein a scoop or a serving.

Alan Helgeson (host):

Dr. Schriever, as you were talking about the dry scooping stuff here and you mentioned pre-workout, well, let’s talk about pre-workout.

Dr. Jennifer Schriever:

A lot of people that work out like to use pre-workouts. They have caffeine as a stimulant and some other herbal things that can be stimulants as well. So try to be really aware of what is in that supplement and if at all possible, be aware of how much caffeine they’re putting in there. Sometimes it can be very difficult to determine and if it’s difficult to determine I choose another product or you can reliably know how much you’re getting.

People find more energy so that they feel like they can do a more intense workout. It might help reduce – depending on the ingredients of your pre-workout – muscle soreness. You might have more energy after. Some of them have B vitamins so then you can improve your energy that way. Some might have nitrous oxide to increase your blood flow for weightlifting or sprinting but you could also just drink some coffee before your workout, and some have a lean protein prior, and get similar benefits.

Alan Helgeson (host):

Alright, let’s talk about internal shower drinks.

Dr. Jennifer Schriever:

(Laugh) Interesting thoughts of what is out there. So that can be using a lot of chia seeds and water to maybe do a colon cleanse or clean you out. Apparently this is actually a replica of a traditional Mexican drink called agua de chia. But if you use chia in moderation and when a tablespoon or two at a time, that can certainly help with regularity of your bowels because it has a lot of fiber in it. But those little seeds absorb a lot of water. So if you’re going to take a lot of chia seeds at once, they’re going to absorb a lot of water and you could actually end up with a bowel obstruction because they absorb so much water and kind of get glue and sticky-like. So, not a great plan.

Alan Helgeson (host):

(Laugh) It doesn’t sound like a lot of fun and I’m running out of room here on my post-it note Dr. Schriever. And the last one I have here is liquid chlorophyll.

Dr. Jennifer Schriever:

From what I could tell, there’s no proven benefit. You could increase your risk of sunburn. Can they truly get enough chlorophyll in that liquid dropper to make a difference? Probably not. There’s no evidence that it’ll improve your health.

You’re better off eating spinach, kale, green beans and peas if you’re interested in getting more chlorophyll naturally. And those have the added benefit of fiber and vitamins.

There are a few other thoughts I had that might be out there online, too, or on the media to bring out one. And a patient did just bring this up the other day, “Well, I heard magnesium could help me lose weight.” There are some studies showing a little bit of benefit but only in certain populations and not significant benefit. So if you do have a magnesium deficiency, if you have insulin resistance, so that means like pre-diabetes or those sort of conditions or obesity, you might lose weight supplementing magnesium, but it’s only at 0.21 of a BMI.

So I’m 5’4”, that would be two pounds. So not a significant benefit to taking magnesium. There are other benefits for magnesium. It can help with bowel regularity. For some it helps with sleep so you can use it for that, but I wouldn’t rely on it to help with your weight a lot.

There’s also off and on a lot of concern about artificial sweeteners. “Are they safe?” “I should drink regular Coke instead,” and I would disagree with that entirely. Certainly we want to eliminate as much sugar from our diet as we can and really most of the studies that I can find and have evaluated against artificial sweeteners such as cancer causing or other long-term risk really aren’t very valid. So I’d rather see you using an artificial sweetener to meet a sweet craving over picking a sugary beverage that is going to have a lot of calories.

So you can certainly flavor your water if you want to, if that helps you drink more water. There is that benefit. Now for people who kind of feel addicted to sugar, if you can gradually over time use less sweetener, that can help you adjust your taste buds so you don’t want so much or desire so many sugary things.

I think that’s one of the things online as well called WaterTok. A fad of drinking a gallon of water a day and flavoring it in all sorts of ways and (laugh) a large variety of recipes. So certainly that’s a great idea if it does help you drink more water. But as long as you’re keeping a balanced diet, you know, if you drink too much water and you’re using that to stay full and you’re not eating, so that’s your diet plan, that’s not a healthy way to lose weight.

And I think some of that comes across in the social media that people desire that to look thinner. So they’re drinking these drinks that taste good and help them stay full and maybe distract them from their hunger. But really if you’re doing that not eating enough, you could throw your electrolytes off by drinking too much water. It can be difficult to do in the short term because you have to override your kidneys, and adult healthy kidneys are going to be able to metabolize your electrolytes and water just fine. But if you have any kidney disease or are on any medications that affect that, and if you do that for too long, you are going to gradually deplete your electrolytes and that can be very harmful.

Let’s also touch a little bit on CBD. As far as weight management, there isn’t great human studies on how helpful that could be. There is some evidence that initially it can maybe contribute to weight gain but then can contribute to weight loss. But there’s nothing reliable to show any proven benefit. Some people do use CBD for other health conditions and if that’s such as chronic pain, that’s a very stressful condition. Stress interrupts your weight management. So that could indirectly maybe benefit you as far as your weight management journey, helping you adjust your lifestyle to improve, but nothing to support actual benefits for weight loss currently based on studies.

Alan Helgeson (host):

Dr. Schriever, those were some great tips about some of these things and there’s just so many it would take days to get through them all. Let’s jump in on something you touched a little bit on: cleanses and detoxes. Do these things work?

Dr. Jennifer Schriever:

There’s really no benefit to doing a cleanse or a detox. And again it goes back to are you on medications? Do you have health problems that could make that risky and you throw your potassium off based on a medication you’re on? Certainly in the short term, if you’re going to clean out you might lose a few pounds, but in the long term you’re just going to start eating again and gain it back. If you are struggling with your bowels, then I would certainly talk to a doctor about how to correct that and help you through that rather than risk going through one of these cleanses.

And some of them you also aren’t going to know what are the ingredients and why are they working? Could you cause a colon issue or hemorrhoids or heart disease or something else? If you have diabetes, are you going to throw your blood sugar or weight off or get severe diarrhea and make yourself really dehydrated? Just doesn’t sound very fun or pleasant to do anyway.

Alan Helgeson (host):

Not at all. Dr. Schriever, as you meet with patients on a regular basis, sometimes you have to kind of boil things down to what are those golden rules or what are some of those two or three or four or five, sometimes more, things that you want to share or leave people with or questions to ask. So I’m going to kind of throw that out to you. Do you have any golden rules or maybe questions to take away to ask when seeing a new fad or trend?

Dr. Jennifer Schriever:

Sure. Well certainly is it too good to be true? Does it promise short-term weight loss, or is it even sustainable? Is it something you can do long-term? Typically any, most things you do in the short term, and you return to your typical habits, the weight’s going to just likely come right back. So are they claiming it’s the best kept secret or just one person is claiming it worked for them? You know, someone famous is saying it. So it’s back to going, is it legitimate? You know, if it’s on a website, is it a dot-edu or dot-org? Is that the organization presenting it? Because those are more reliable than dot-com or dot-net.

Alan Helgeson (host):

Yeah. And talk a little bit about how this approach is different.

Dr. Jennifer Schriever:

So we have studied the science behind helping people manage their weight, and we take a full health history throughout life. We know we ask you your weight history and what’s contributed so that we can guide you to a lifestyle change that is sustainable to lose weight, feel good, and help you reach your goals.

We use all the tools – they’re called pillars of obesity medicine. So that includes nutrition guidance, physical activity, behavioral – that might be emotional or stress eating – and then medications if needed to help you. Obesity was re-diagnosed as a chronic disease or finally recognized as such in 2012 or so. So you know, we recognized that it isn’t your fault or the patient’s fault that they have got to that point and we’re ready to help you through the ups and downs and through the difficult times and to help you improve your weight in the right way and maintain it.

Alan Helgeson (host):

Why does this approach work?

Dr. Jennifer Schriever:

We do use the most up-to-date information, and we’re constantly adjusting and all of us are listening to what is new, even in nutrition exercise, and of course the medications. We do use a body composition scale and I think that’s helpful for us, but also very helpful for the patient. Because it shows your muscle health, body fat content, water content, and we can explain progress through that. Your muscle mass is very important to your metabolism. So we help patients understand on the inside what is going on so that they can progress through their healthy lifestyle and understand the importance of protein intake and strength training and other just general movement.

We also provide a lot of support. So there are physicians and nurse practitioners to help guide you. We have dietitians, we have a health coach and we have a counselor to help you through all the angles of weight management. We are also helping to guide you through good exercise options that fit your lifestyle, your comfort level, and also finances. But so, and we’re also looking at adding in support from Sanford Wellness and how can we include that to help our patients as well.

Alan Helgeson (host):

Could you share a little bit about your clinical background in treating overweight patients?

Dr. Jennifer Schriever:

I’ve cared about my own health and nutrition for a really long time and certainly had a passion to try and help patients. But until I did the obesity medicine certification, I really didn’t know very well how to educate patients as well. So during COVID, found the online continuing education I could do to get board certified in obesity medicine. So I did that and so did a couple of my partners and really learned a lot that was very helpful in learning how to talk to patients, how to educate them, what is the science behind helping people lose weight and the science behind obesity to understand that, how it happened in the first place so that we can explain what happens physiologically and metabolically to patients. So did that training in 2021.

Sanford was very helpful and let me start a pilot clinic with my two partners. By half a day a week we expanded then to a full-time nurse, a practitioner, and now have two nurse practitioners as well, as well as three of us physicians working here, two of us part-time and I’m full-time.

Alan Helgeson (host):

How can patients be seen within your clinic? Do they need a physician referral? Do they call just to get in? What, what is the right pathway in?

Dr. Jennifer Schriever:

You can certainly have your physician send a referral. You can also call the number yourself and make a self-referral. We will evaluate your weight and height to make sure you qualify. We have certain guidelines that we take, but generally, we understand patients really want to come here, so we’ll work really hard to make sure you’re accepted if you’re within our BMI guidelines. And currently we take ages 16 and above.

(Adults who qualify for services at the clinic must have a BMI of 30 or above, or BMI of 27 to 29.9 with obesity-associated conditions. The BMI definition for children is based on percentiles.)

Alan Helgeson (host):

You’re doing some great things in your clinic, Dr. Schriever, and I probably should have asked this earlier. But in this technology world, we’re never more than a few arms’ lengths away from our phone and having that in our hands. I’m guessing there are probably some apps that you might even recommend for people, depending on where they’re at in their journey. But are there a few apps that you might share that people could trust as they’re looking into their weight journey?

Dr. Jennifer Schriever:

It can be very helpful if you’re ready and willing to do so to do some food tracking. So we will suggest various apps. You can use MyFitnessPal, Lifesum, Lose It!, MyNetDiary’s kind of nice because it grades your food. Bitesnap, you can actually take photos of your food. And then that’ll help you suggest portions. We will guide you though on your calorie goal and your protein goal, so don’t rely on the app for those things.

But otherwise those are great resources to journal your food if you’d like to. Studies will show that people that do some monitoring of their own intake do better, but it doesn’t have to be a hundred percent of the time. Some people benefit from journal apps or self-care apps. A couple of those are Finch and Habit Tracker. You can also benefit sometimes from meditation apps like Insight Timer, Calm, or Headspace are other ideas I collected from our staff too.

Alan Helgeson (host):

Dr. Schreiver, I feel like you know where I’m going and what I’m thinking, which is awesome because the next question I wanted to ask is, for so many people that with a weight loss journey or have experienced being overweight, that there’s so much of a mental piece to it. How can we move through that journey and better our health and fitness without maybe feeling bad about ourself? And I know that’s probably a whole different discussion for another episode, but maybe just a few things or just a few high level thoughts from you.

Dr. Jennifer Schriever:

And I do love the opportunity to talk about that. I think patients have a very difficult time coming to their first appointment here, and that’s pretty evident sometimes. They’ll say so or be in tears because they feel shamed or fear or embarrassment.

And a lot of patients have experienced weight stigma throughout their life or bias. Did people make comments to them about how much they ate or their weight while growing up or even in life? And even in health care, family, friends, health care providers can say the wrong thing that makes them feel bad about themselves. And once you hear something like that, you internalize it. So even though someone might not be saying something to you about your weight, you’re thinking you don’t deserve better or that you’re down on yourself for these things.

So what we need people to know, first of all, just coming here, we’re not going to judge you. We know obesity is a chronic disease. There are a lot of things that have changed on the inside over time that make it very difficult to lose weight and it’s out of your control. So unless you have good guidance, it can be very challenging. And you can’t lose weight based on willpower alone or diet and exercise typically only gets you a small percentage of weight loss. And willpower only lasts so long. So also, if obesity is a chronic disease, it’s relapsing and remitting. So certainly we’re all going to be successful for weight loss for a timeframe depending on what we choose. But then our body is going to start to think we’re starving and it might make us more hungry and then make it more challenging to continue the program we’ve selected to work on our weight loss.

Alan Helgeson (host):

Such great information. Dr. Schriever, any final thoughts to share on our episode today?

Dr. Jennifer Schriever:

I think people are surprised about how good they feel as we adjust them through their nutrition and exercise and those sort of things. Certainly the joint pain improves fairly quickly. For every pound you lose, it’s like taking four pounds off your joints, particularly your knees. People have more energy, they’re less tired. Just by altering nutrition in the right direction, also adding more protein helps them feel full. So at least as you adjust those sorts of feedback occur fairly quickly. So it is also a challenge. We don’t anticipate patients to absorb all our information the first time.

Alan Helgeson (host):

Well, Dr. Schriever, I want to say thank you for taking time to talk to us today. This episode is part of the “Health and Wellness” series by Sanford Health. For additional podcast series by Sanford Health, find us on Apple, Spotify, and news.sanfordhealth.org. I’m Alan Helgeson, and thank you for listening.

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