#33 How to ask your doctor for healthcare instead of weight-care with Dr. Maggie Landes MD

Even if you're not on an anti-diet journey, you're going to want to listen to this episode with Dr. Maggie Landes MD. We talk about her cancer diagnosis and how her journey convinced her to break up with the BMI, why most clinical encounters don't require your weight (and how to talk to your doctor about it), and why telling someone to "lose weight" is not only bad medicine but unethical. 

Maggie Landes is a board-certified physician, public health nutritionist, and anti-diet wellness expert. Her dual-mission is focused on not just helping women in midlife escape the grips of diet culture and recover from their lifelong turbulent relationship with food, but Maggie, in her Pro2Pro services, supports other health professionals to participate in, and promote, a weight-neutral approach to practice.

She is also the creator and host of “The Eatfluencer Podcast” where she and her guests unpack all the issues related to constructing a healthy, complete, and high-quality life unlimited by the oppression of diet culture.

All of her personal coaching and programs support the Health at Every Size philosophy (HAES®), the framework of Intuitive Eating, and a weight-inclusive, body-neutral approach to health and wellness. 

Learn more at https://www.maggielandesmd.com and grab her “Client to Clinic” Health Pro Resource Bundle here https://www.maggielandesmd.com/pro2pro

Click here to hang out with me on YouTube!

Looking for more about midlife, menopause nutrition, and intuitive eating? Click here to grab one of my free guides and learn what I've got "on the menu" including my 1:1 and group programs. https://www.menopausenutritionist.ca/links

Transcript

Jenn Salib Huber  0:02  
Hi and welcome to the midlife feast the podcast for women who are hungry for more in this season of life. I'm your host, Dr. Jenn Celine Huber. Come to my table, listen and learn from me. Trusted guests, experts in women's health and interviews with women just like you. Each episode brings to the table juicy conversations designed to help you feast on midlife. Hi there. My guest today is Dr. Maggie Landis. And Maggie is not only a board certified physician, she's also a public health nutritionist and an anti diet advocate. And she has been having conversations around the importance of providing weight neutral care, and breaking up with the BMI. And she's been one of my favorite people to connect with on social media, just just to getting the message out that we need to be changing the conversation about health and weight and nutrition, not just with ourselves, but also with our healthcare practitioners. So my conversation today with Maggie is all about why we need to be changing that conversation and how we as individuals can maybe feel a bit more empowered going into these health care conversations and advocating for weight neutral neutral care. So have a listen. And I know that you'll be as inspired by Dr. Mackey as I am. And I'd love to hear if you have any questions about this episode. Hi, Maggie, welcome to the midlife feast.

Dr. Maggie Landes  1:30  
Well, thank you, Jen for having me. I'm thrilled.

Jenn Salib Huber  1:34  
So I've been really excited about this conversation, because I was recently on your podcast, and we had a really great conversation. So I feel like this is like part two of what was you know, a fun conversation that was talking about everything to do with weight neutral care in mid life. But weight neutral care is something that you're pretty passionate about. We'll get into that in a minute. But I think it's it for for people who are working on this new relationship with their bodies and trying to move forward in a world where they're not always trying to change their body and make it smaller. The health care conversations are often the hardest, and most emotional. So I definitely want to dive into that with you.

Dr. Maggie Landes  2:18  
Oh, well, that's that's what I deal with all the time. Because it is a major problem. I mean, really, the the health care system is fraught with weight stigma, and it's extremely confrontational, especially if you're in a large body. And it's, you know, my whole platform is that it's we're not helping our patients that way. And frankly, we may even be doing harm. So yeah, I'm glad you want to talk about this, because this is okay. Well, before

Jenn Salib Huber  2:47  
we get into all that, because I feel like that's gonna be an awesome conversation. But tell us how did you as a medical doctor and a public health nutritionist, I'm not sure what came first. But how did you get into the business of anti diet and advocating for weight neutral care?

Dr. Maggie Landes  3:06  
Right? Well, I will make this as succinct as possible. But I am 40 am I 45? I'm 45 years old, I had to calculate whether I was 45 or 46. I can't remember. And so I say that because I grew up in like the 80s and 90s. And dieted myself never particularly had a quote, you know, weight problem, but just dieted. Because that's what you do. Because that's what it's like normative. So I grew up thinking that managing my size was just a part of, like, that's just how you That's life, right? Always wanted to be a doctor went to medical school. It the, you know, of course, we're going to talk about this, but like the training doctors get is very weight centered. The, you know, a lot of the literature we use is weight bias. There's just so much in there, but you don't realize it because you just, you know, I mean, you're in medical school, you have to have so much to learn that if some professor tells you, hey, you know, fat makes you have heart attacks and die, then you just say okay, and then you tuck that in your brain and you keep going because you don't have time to like, scrutinize everything. Well, so fast forward. Five years ago, I was diagnosed with lymphoma, and I'm recovered and everything but that's not the point. The point is, I decided when I was like kind of faced with my own mortality. I'm gonna figure this out. There is a perfect human diet out there. And I'm gonna find it. I am smart enough. I'm capable. And now I have six months off work on getting chemotherapy. So let's do it. And lo and behold, long story short, there is no singular, perfect human diet, no matter how smart and how much time you have to research it. So then I thought, Okay, how are we like supposed to eat right? So hey, wait, this is what I did. I went back to grad school at that time, because I was like, I'll just get a master's degree in nutrition because they'll Tell me how to eat. That's so dumb. This isn't but this is my diet culture brain thinking this right? So I go back to grad school and shocker, the entire education there is diet culture focused as well. And I thought, oh, no, this is just this can't be right. I mean, there's no way that this is the best information we have. So I did a lot of, you know, honestly, sort of independent education. I read books I did. And I mean, like read like studies and stuff, not just like scrolled Instagram all day, and tried to figure this out with expert there's gonna be a lot of different Well, I there is a there's a lot of armchair Instagramming these days. But that's how I sort of came to find this whole. I don't want to say underworld, but there's so much information, robust information about the anti diet or non diet approach to health. And once you see that, you can't, like unsee it. So that's when I said, Okay, I need to not only figure this out for myself as an individual person, this needs to really be how we approach patients and clients. And so then I just that I got crazy and started doing all this. But it was only but I'll tell you what, I'll be the first to admit, had I not had that like sort of forced cancer, sabbatical, whatever you want to call it. I think I would probably still be peddling diet culture and going on and off and on and off diets myself. I just what yeah. And then the interesting part in relation to what you do is I, you know, basically went into chemical menopause, like, instantly, like I went through menopause in like two weeks because of my chemotherapy. And so now I'm dealing with all that sort of ish personal health issues at a probably a decade earlier than I would have otherwise. So it's sort of interesting to compound that with everything else. But you know, it, we just believe dieting is the only way because it's the only way we've ever been told or taught or seen represented. Yeah, yeah.

Jenn Salib Huber  7:10  
Yeah, I hear so much of that, you know, in my training as a dietitian, and my training as a naturopathic doctor, it was assumed like it was the given that everything was better if people could fit into this size, range body shape.

Dr. Maggie Landes  7:28  
And then we don't even question it. Right.

Jenn Salib Huber  7:32  
Yeah, shunning. And we never really discussed the, what are the side effects of what people have to do to get there? What are the side effects of doing that over and over and over again? What are the side effects of teaching people not to listen and trust to their their bodies? There was absolutely never any question about that. In any part of my training, it was just well, if they're not at a healthy and I'm using air quotes, healthy weight and size, that's where you start. Yeah, no. And so not only was it like the end goal, but it was the starting point. And it was often the only thing that I you know, people would come to me and it's what they wanted. And it was often you know, the obvious, again, air quotes, choice when it came to giving people what we thought was health advice. So yeah, I really, I echo that so much of this experience, and you realize that like the house of cards was crumbling. Right. And, and then what because I remember, my thought was, oh, shit, what do I do now? Like, this is all I've known personally and professionally, how do I go about being a dietitian and a naturopath? If I'm not teaching people how to lose weight? Like it was really like, what have I learned? And I have to unlearn it all. And I have to start all over again, like, what did you do with all that

Dr. Maggie Landes  8:58  
information? Well, you know, and that's exactly right. It and to be totally transparent, I have all but essentially left my clinical practice now. I've been a physician for 20 years, but it is really hard to make these changes like to try to change the culture from the inside while you're doing it. Because there's just there's no space. I mean, the and I'm not here to throw doctors and dietitians and people under the bus we are, you know, the practice environments really a disservice to us because we have so little time with patients we have so like this real, like, very limited interaction, and we've got a million things we've got to do and the amount of documentation that's required. It's just like, I don't know, I felt like I guess I probably could make change from the inside out, but I knew it would take 20 times longer, maybe 100 times longer. So I basically decided to pursue this business or you know, sort of educational platform to try to change the culture in healthcare, because I, outside of practicing have space to do that.

Jenn Salib Huber  10:08  
Yeah, yeah. Oh my goodness, is it ever needed. So let's talk a little bit about health care interactions. Because, you know, we all need primary care providers, whether that's a family doctor, a nurse practitioner, a naturopathic doctor, whoever it is in your circle of care. You we know we need those people as part of our team. But if those health care providers aren't kind of, you know, in tune or tuned into what a weight neutral approach is, many have never heard of it have no idea what Health at Every Size is have no idea what Intuitive Eating is, it can be really intimidating as a patient to go in and say, I am pursuing this weight neutral approach I'm learning, you know, to eat again, I'm learning a new relationship with food, and I want your support, I need your support. And so one of the first interactions that a lot of people have is being weighed at the doctor's office, either by the doctor or the nurse or whoever. And how, I mean, that's intimidating to go in and say, I don't want that. But what language or what tools can, you know, people have to maybe just, you know, neutralize some of those conversations before they get started so that they don't feel like they're going in to an argument or antagonistically.

Dr. Maggie Landes  11:30  
Right? Well, and I don't recommend that because, you know, being like, aggressive with the staff and kind of disrespectful patient is not going to get you very far. So I don't ever advise that. But I want to say first, that people may not realize the people listening to this right now may not realize there's actually a very limited number of clinical conditions that require your weight, like at every touch point, very limited. And it's it's like kind of the exception to the rule. I mean, if you're on dialysis, you're getting chemotherapy, you're having general anesthesia, like stuff like that. But the typical visit for a physical for acne, for Joint Pain for stomach problems for anxiety, whatever the general problem is, you don't actually in adults need to be weighed, there's this belief that if they're going to write a prescription they need it. But that's actually not true. In adults, that's only true in children, you give the same medication for whatever, two adults no matter what size they are, it's usually based is usually there's a standard dose for everybody, or it's based on a metric, like you get a different amount of blood pressure medicine, depending on how high your blood pressure is. But it has nothing to do with whether you're big or little or whatever. So no, just have that in your back pocket, knowing that when you go in like you if they are want to weigh you, there needs to be a reason I'm just a believer of not like, getting information for no reason. I mean, that drove me nuts when I was in the hospital, like, you know, I was in the hospital quite a bit when I was sick. And they draw labs every day, every single day. And I'm like, Are you going to do something with this result? Like today? Like, do you really think my sodium from yesterday to today has changed that much, because I'm already anemic. And here you are just drawing blood because you just have like a standing lab order, you know, just that as an example. I just don't like that kind of stuff. I feel like every time you're collecting information, it as a provider, and you know, this Genda you have to have, like, what are you going to do with it? Yeah, if it's high, what you can do with it? If it's low, what are you gonna do with it? If the answer is nothing, then who cares, then you don't need to mess with it. So that's my point is the weight is one of those sorts of it doesn't matter. Because, okay, if you weigh this, or you weigh this, or you weigh this, it makes no difference on the impact today. You know,

Jenn Salib Huber  13:48  
it's not a proxy for health. Like, that's the thing. Oh, my gosh, not at all. Yeah. How many times have people told me stories of going in, getting weighed in the reason that they went into the office or to see their health care provider was for you know, let's just say it's acne or something, you know, and then the person that they're seeing let's look at their chart talks a bit about the acne and then comments on their weight, like it's relevant to the concern. You know,

Dr. Maggie Landis  14:16  
they come out of the visit with a referral to like, a bariatric surgery. I mean, it's crazy how far they take it when that wasn't even, like the chief complaint or the concern, you know, yeah, that

Jenn Salib Huber  14:29  
I was just about to say that, I would say this is a good point to actually talk about how, you know, that weight bias is at play, but also how, you know, people will feel the stigma from that and will not seek care when they really need it, for fear of that weight bias and stigma showing up in their relationship with their health care provider. Right. Yeah. So important thing?

Dr. Maggie Landes  14:53  
Well, it's and then it's a cycle that kind of begets itself because what happens You know, this is the public health part of me talking, which is not exactly the answer to your question. But on a bigger scale, like a population scale, what happens is these patients come in get weighed stigmatized, because they come in with a sinus infection, they come out with a referral to bariatric surgery, and they don't want to go back, they are crying in their cars on the way home, they're like, forget it, I'm not going to the doctor unless I'm literally at death's doorstep. So they don't go, they don't get mammograms, they don't get pap smears, they don't get their blood pressure check. They don't get any sort of preventative health care. And then what happens is, let's say 10 years later, 20 years, like I don't know how many years later, then they do have a problem, then they show up with let's say, diabetes. And then we the medical community says, Look, all the fat people got diabetes, we told you, and then we publish a study that says fat people get diabetes. And don't account for the fact that maybe because we drove them out of the health care system altogether. They did, they got no support, and no preventative care to prevent the problem. Then we publish a paper and we use that to like, beat the head of all the new patients coming in for sinus infections and say, Look, I know he came for science fiction, but if you don't lose all this weight, you're gonna get diabetes, because we published a paper that says fat people get diabetes, like, and I'm being exaggerating, but but that's really what happens. And then the cycle just keeps going and going and going. So yeah, and I hate that patients have to advocate like this hard for themselves. You know, I wish I didn't have to give, you know, my clients and these patients like scripts for what to say, because but I you know, you kind of do at this point, the culture is still your if you find a Health at Every Size, align Doctor, do whatever you can to stay with them, because that is a diamond in the rough. Yeah, but yeah, approach the whole thing with like, I'm, I would like, well, first of all, you can talk to the doctor, before you get weighed or the provider, like you don't need to be weighed in the hallway between the waiting room and the exam room, which is typically how it's done, at least in the United States, that's how it's done. That person who's doing that is usually an MA, or somebody who has no clinical sort of knowledge set, they're just doing a task, they're told to take the patients, put them on the scale, put them in the room, you can have a more sophisticated conversation with the provider and decide, you know, essentially, it falls under informed consent, the whole thing. I mean, if I had to summarize this, like, everything that happens to you in a clinical setting requires your consent, period. And that includes getting on the scale. And you know, people say stuff to me, they're like, but my doctor forces me on the scales, it forces you or bullies you on the scale, because forces you as they like physically pick you up and put you on the scale, which I doubt is what is happening. But they may be shaming you and saying stuff to you, that makes you feel so bad that then you you get on the scale, that's different, that we handle those things differently, okay. Because you deserve to have a sort of risk benefit. Everything we do is like this really, really super quick risk benefit. Check in our brains, like everything has a risk, everything has some sort of benefit. Like we're just kind of measuring those and deciding whether we proceed. And with little tiny things, we do it so fast, we don't even realize that we're making that decision. But that's the decision you're essentially making on the scale. So, you know, to kind of slow that thought process down. If you're going into the doctor for a sinus infection, and you have a history of an eating disorder, I would say the risk of getting on the scale outweighs the benefit. All right. Now, there may be other situations where there is more of a benefit. And then you can start employing some of the other techniques like standing backwards on the scale, asking them to cross it out on your discharge papers, because usually it's like printed at the top of the discharge papers. I mean, if it legitimately needs to happen, it may need to happen. And there are I'm not saying no patient ever needs to be weighed. I don't want you to buddy to misunderstand that. But it doesn't have to be the focus of every clinical encounter. Because I just it is such a distraction. And, you know, I'm just going to repeat this because I think it's important. I'm not blaming even necessarily the doctors or the providers, we are trained to do this. This is what we believe to be the best thing to do. And we're doing it because we think somehow in this warped education that it's protecting our patients and managing their health. And that's just like a big misunderstanding. Yeah, exactly. You know,

Jenn Salib Huber  19:49  
so what about those situations where it really is clinically relevant? You know, situations that come to mind would be like medication dosages for things like you know chemotherapy or dialysis or surgery. And in those situations, you know, oftentimes, I think the patients still don't want to see the number because again, if they have an eating have a history of an eating disorder, or whether or not they're just trying to move out of that weight centric kind of thought process and their own mind. Can they ask not to see that number? Can they still ask for some participation in you know, trying not to make that the focus of their care?

Dr. Maggie Landes  20:32  
Right? Well, sure, you certainly can. And if you have kind of a good reason for that, because you are, like, have a history of an eating disorder or this disordered of thoughts about your body image or whatever, that's really a problem for you. I think that's, I mean, they, if they're listening to you, they should know that. Now, I will say there's a couple of situations like, okay, so, for example, when I was in the hospital, you know, there's this big like board on the wall that has like the patient, patient's name, room number, nurse, whatever, and your weight is big on that wall. Because in case of an emergency, and all these people come into your room, everybody needs to know, your wait immediately to dose the medications for a resuscitation. Okay? But now, and let me tell you when I was getting my chemo, and I was like, on, like, diet brain, I didn't care that it was on the wall, because I figured that was fine. And plus, I was the skinniest I've ever been because I had cancer. I mean, sure, why not show it off. But the, you know, what I could have done like thinking back, like, had I been in this anti diet framework and had to go through that experience? I think I would ask, could they like, take a piece of paper or put like a post it note over that, that says patient's weight? And then like, Okay, if it's an emergency, and I'm unconscious, they can pull the post it note down, everybody in the room can see it, and I'm unconscious, and I won't, I'll be fine. You know, if they're working on saving my life, you know, and the same thing that happens in operating rooms, too. Yeah. And that happens in operating rooms, too. Is that what you're about to ask? No, yeah. But yeah, it's the same. I think the same thing could happen. Like in surgery, it is important that the way it is known, and that's a legitimate thing for the anesthesiologist, and for people giving blood products and stuff, but like, it doesn't have to be you don't need to know it. I mean, the patient isn't the one doing those things. So I think just asking them, like, could could you just make it not visible? Could you put it behind my head? So I can't see it? Could you put a sticky note over it until it's needed? I mean, like, you know, and just asking that, it's really problematic for you to know that. And then in your, your regular clinic visits, just tell them you want to stand on the scale backwards, and you don't want to see it. And then if they could block it out on the after visit summary. That's usually sufficient, you know. And I'm just

Jenn Salib Huber  22:50  
remembering someone had told me about a situation where they were going into a procedure, and the pre op nurse wanted to weigh them. And they actually thought on the spot, which I thought was really clever to say, you know, the last time that I was wage should be on my chart, and my body hasn't substantially changed since then. Could you use that, you know, reference, and they were able to do that? So, you know, I think that's another way that, you know, if your body hasn't changed much since your last recorded weight that, you know, that should be sufficient, because for most, you know, adults, they would have a good sense of that, I think, right? Yeah.

Dr. Maggie Landes  23:26  
And if it, especially if it's recent in time, I mean, theoretically, if you have a pre op appointment, it's because within the last probably two or three weeks, you saw our provider for the decision to have surgery. So, you know, now if it's like two years ago, I think you probably do need to

Jenn Salib Huber  23:42  
depends where you live. I think some of our listeners in Canada might relate more to the two years than two to three weeks.

Dr. Maggie Landes  23:49  
Yeah, well, yeah, that's true. That's true. So yeah, I mean, that's very reasonable. That's very reasonable. And, in fact, you could even like if you know, you can even do that. I'm thinking about that. You could even do that at a regular clinic visit, like let's just say, the, you go in for your sinus infection, and they're like, We need your weight. Well, you don't really need my weight, I have trouble seeing this. And I don't think it's going to be necessary. I'd like to talk to the doctor first. And if this confrontation continues, and you're comfortable with it, you could just like, give them a number. Like your like you said your last known weight and if it's off by however many dozens of pounds, who cares? Like, like, it doesn't matter. I'm telling you, it doesn't matter if you had a sinus infection, so just to appease them. Um, but yeah, it really I just wish that the more providers understood how much harm was being done. Like it's not like I said, it's not and here's the, the other flip side of this coin is now clearly the worst is it people in larger bodies, they have to contend with more weight stigma more judgement more, more. have adverse problems. However, the number of people I have talked to personally who had eating disorders, went to a doctor got weighed further, stupid sinus infection, or whatever. And were congratulated on losing weight or having a shrinking body or equal, you know, small body or whatever. And they literally had an eating disorder. And nobody asked them, why they were losing weight, how they were losing weight, if they what they felt about their weight, they just got like this high five, like a way to go, since last time you were in here, you've lost below how many pounds? You know, and you're like that, you know, that's a problem, too, if we aren't even properly screening people on the other side of that, you know, and I don't, I don't want to make it equal because that they don't have the social stigma that people in large bodies do. But in a clinical environment, if we're going to separate weight and health, which is the crux of Health at Every Size, absolutely. Like that is the singular, like bottom line message is weight and health are not the same thing, then we as the providers need to make a decision, are we delivering weight care or health care? Okay, if our goal is to have our patients shrink, and to promote weight, loss of weight loss products and stuff, then you are allowed to do that. But then you need to be transparent that you are awake care provider, and not a health care provider. It's different, it's a different business. You know, the

Jenn Salib Huber  26:40  
gentleman Yeah, I'm talking about like the practical pieces of weighing. But at the end of the day, what we're really advocating for here is health care that is not primarily or largely based on weight being the driver, or the metric, or the most important piece of health. And, you know, like we were talking about the beginning with most medical nutrition training, it really does, it's the first place that you start so so one of the things that you do is that you try and re educate healthcare providers so that maybe the patients don't have to advocate as much so that maybe they can more easily find a provider who is aligned with these weight neutral goals. But that's a big task, because like we talked about is what everyone knows, so, so tell, so tell us what you're doing with that? How do you leave it? Where do you even start, like I don't even know where I would start? Well, you know, I,

Dr. Maggie Landes  27:38  
you start with the very first thing and I what I want to do is create the education that I personally wished I would have had five or six years ago, so that I didn't have to like, piecemeal all these little bits together. Because the only reason I was able to do that, frankly, is because I wasn't actually working full time. I mean, just to be honest, if like I said, if I was working 7580 hours a week, I would not have had the interest or the bandwidth to piece all the little bits together. And I would probably still be in a clinic somewhere today handing out the food pyramid from 1970. Truth so so I want to make it accessible even to working busy health professionals that are still actively practicing. And I think there's a couple of pieces. So it has to be accessible. So essentially, I have a course that it starts with. And then there's a community kind of that forms after you've participated in the course. But the other thing to recognize is this is not just doctors, all right, just because I'm a doctor, I'm happy to educate other doctors and I love working with doctors, but doctors alone are not the problem. And doctors alone are not going to be the solution. So being open minded to every person who views themselves as a health professional as a colleague, is like super important. So I work with you know, functional nutrition. What do they call it practitioners and chiropractors and dietitians and physical therapists and clinical social workers and people that you kind of would be more considered like peripheral health care providers, I guess. But we're all colleagues we if every touchpoint it all it has to do with the client or the patient, believing that they're getting health care, okay, it doesn't matter if they are taking this information as health advice, whether that's coming from a licensed professional or a coach or whoever, like then that's important that we have that information right. So yeah, so you got to just get it in the right hands and make it accessible and palatable to people that are willing to change and easy like all we want everybody wants everything to be easy. Isn't that like ease is like a goal of everybody's as like a, like a core value of like every human. So yeah. And I just think that that's how it starts it starts with one person even changing their mind. And you know what the interesting part is that even the patients and the client's you telling them that you don't want to be weighed for your sinus infection. And they say, Okay, fine, you know what you think it's just like good for you. But you have planted that little seed like that may be the first time they've ever heard a patient, like approach that, that may motivate that one nurse that one doctor, that one dietitian to listen to a podcast, or pick up an article, or, you know, Google Health and every size or whatever, like it just you could be part of everybody's part of the solution. And it's going to take time. Yeah, it's gonna take time. I mean, this is not under no guys. But if if we get to a point where everybody is practicing health centered and not weight centered health care, and I go out of business, then fantastic, I there'll be plenty of jobs for me to go get, I'll go get another job. But, you know, I hope we live in a world like that, where this is like a historic her diet cultures, like a footnote of history would not be amazing. That'd be cool. Well, yeah,

Jenn Salib Huber  31:19  
it's interesting, because I think that for a lot of I think it is a buzzword. I think that more and more health care practitioners and allied health care practitioners, you know, have heard of intuitive eating or anti diet or, you know, dieting isn't cool anymore, whatever. They've heard that, but they still believe that it is the proxy for health. And so I think it's so important to be able to really undercut them. Well, yeah. And beliefs so that they actually feel confident in supporting someone who wants to pursue this. Well, sure. No, it's not just writing. Yeah. And they also,

Dr. Maggie Landes  31:58  
they, most of them, realize, and I will tell you, I did too, I was, you know, promoting diet culture in clinical practice, while all the while knowing that my, in my own personal life, I have been dieting for 20 years, and it hasn't gotten me to any of the great health achievements that I thought it was going to. So you know, the, the scientific evidence is there, that dieting doesn't work. But honestly, every single person has their own anecdotal evidence that basically died doesn't work either. So when you are able to recognize like, okay, maybe it's not just me, you know, maybe it's not just them, the other person in the exam room, like, maybe there's something to this, that's the motivation to like, sort of study that on a bigger scale. Like, why this is such a problem.

Jenn Salib Huber  32:49  
That's so interesting, because I mean, you know, prior in the before times, which is what I call everything before, you know, COVID, if I was a, you know, a party or an event, or kind of anything, where I might encounter someone in primary care, and they learned what I would do, the first thing would be like, Why are you telling your patients for weight loss? My patients really struggle with it. And, you know, as I kind of got further along into this, and I'd be like, well, it's that we're prescribing weight loss, that's the problem. But there's gotta be something that works, right? No, not permanently. That's why they keep coming back. It's why it never works permanently, like it's part of a problem. And you know, and it would just like, I could just see some people like eyes glaze over check out, like, they're like, Oh, this is a crazy person. I'm not talking to this person. They don't know what they're talking about. But, you know, I think it really speaks to how ingrained The belief is that you have to be a certain size or shape in order to be healthy. Oh, absolutely. Yeah. They have evidence in their own practice that diets don't work. They know that.

Dr. Maggie Landes  33:54  
Yeah. But somehow it you know, if there was one answer, we'd be done talking about this by now we'll be over like we wouldn't this whole thing wouldn't. There wouldn't be a conversation happening because it would be over. You know, but see, that's interesting. The interest that when you mentioned that what just flashed through my mind, when I was like, deep into diet culture, as a, as a practicing physician, the first time I ever heard even the term Health at Every Size, I think I saw something on social media. Okay, before I ever did any sort of scientific investigation, and my gut reaction to it the first time I saw it, I'll be honest, this is Oh, this is it very transparent to say this, I thought, this is just a bunch of fat, angry people who don't want to do the work that I'm telling them to do. Yeah, like that was my thought. And now I think, Maggie, that is horrible. Like, but that was a that is what I thought. It's like, no, there is no Health at Every Size. There is no possibility of these very large people being healthy. You're just mad because you're not willing to do to work and get healthy like I'm telling you if you know that Have I thought, and then I just sort of ignored it for a long time. And then, you know, you know the rest of the story. But I think there are, there may be somebody listening this podcast right this minute who's like,

Jenn Salib Huber  35:08  
that's what I think, no guarantee, I can guarantee that there are like people, not even providers who are listening to this podcast who feel that way. Because it is often what, like when people get to the point where they're, you know, ready to join one of my programs or work with me, they have often, like they come to the table still with that belief, like and you know, but they also see that that belief isn't working for them anymore, that they need to move past that. But I think with a healthcare perspective, because the system is supporting it, the system is encouraging it the system is telling people that and providers like this is something that you need to manage as part of providing health care. They don't see a way out of it. They don't see how it can exist without it.

Dr. Maggie Landes  35:55  
Yeah. And you know, what, I think it's, frankly, is malpractice. I mean, I think it very it is toeing the line of malpractice. And I think it would not take much for a very savvy, smart attorney to basically prove in court that this model of care is doing harm to people. Yeah, I really do. I think if people ask me all the time, they're like, Well, if I change the way I practice and start doing this are not going to get in trouble. I'm doing air quotes with, with the Academy of dietetics, with the Academy of Family Medicine or whatever, whoever they're they perceived to be their higher authority. It's like, aren't I gonna get in trouble? And I said, Well, you know, frankly, I think we were at pharma risk of getting in trouble if we knowingly go into every encounter, giving advice that harms patients, you know, and I think that may happen, mark my words, if you're a smart attorney, listening to this podcast right now, call in the next five minutes.

Jenn Salib Huber  36:50  
And I say all the time it was I can't remember the exact year I want to say it was like 2016, or 17. But that I closed my practice to weight loss because I felt like it was no longer ethical to support people in any way where weight loss was the goal. And I mean, I say this, I feel like all the time, and it feels like it needs to be said that intuitive eating is not anti weight loss. It's just it's the pursuit of intentional weight loss, where we get caught, where everyone gets caught when we make that the goal when we make that what everyone is focusing on. Everything else gets lost all of the other really important conversations around health, like your relationship with food and movement and actual health care and being able to access that health care, you know, gets lost. So yeah, I'm with you. I'm with you. So you have this. What sounds like an amazing course for healthcare practitioners who are wanting to learn how to do things differently, right? My favorite saying Don't try harder. Try differently. So if you know if you're a healthcare provider, and you feel like this is something that your patients want, or that you want to do, how did they learn about this amazing program? Because I think I don't want to join it just for fun. Yeah,

Dr. Maggie Landes  38:05  
well, the first step, I have a free workshop, which is like the first step in anybody, I'll give you the link. So you can put it in the show notes. But it is the first step is breaking up with the BMI, essentially, because that you have this like BMI centric thinking. And we have to like uncouple, that and break up with that idea. Before we can sort of engage any other Health at Every Size, structure, or whatever. So that's the starting point. And I'm happy to talk to you I have a podcast where I talk about this stuff all the time, too, I just, I can't say it enough that I want to, I want to like shake the tree and change the culture. And this is my I am so super on fire about these issues. Because I want it to be different. I want it to feel different when I go to the doctor or the dietitian or the physical therapist or wherever I go. Like, I just want people to feel welcome in health care, no matter what their body looks like, or what their size is, and that they can feel very certain they're getting health care when they go.

Jenn Salib Huber  39:10  
You know, that's what it's all about. That's That's it. So yeah. Well, I would love I would love to, yeah, talk to anybody who's interested. But that's the first break about the BMI. I mean, just break up. Yeah. And your podcast is such a great resource and for everyone, not just kind of health, her healthcare professionals, but I think anybody who is interested in the health conversations that you know, are going beyond, you know, what we talked about with weight stigma and you know, weight bias, but just really talking about like, how do we pursue weight neutral care, and how do we, what does that look like? So yeah, yeah, so thank you so much. I always ask my guests at the end of the podcast. What do you think is the ingredients in midlife? Oh, shoot.

Dr. Maggie Landes  39:59  
You didn't prep me for this when the missing ingredient?

Jenn Salib Huber  40:03  
Do I have to have found it by now or what? Man just you know what something that was missing from the midlife experience?

Dr. Maggie Landes  40:13  
You know what, I think we need to have a heck of a lot more self compassion for how we got this far. Okay. I mean by this time in our life whether you're you know, I don't know what midlife What does midlife 4050? What do you consider midlife? Yeah, okay, I'm just in my head. It's like in your 40s and 50s, sort of, maybe 60s Even I don't know, depends on how long you plan on living. But, you know, we have we beat ourselves up about the things we're not doing. And a lot of times we forget to look back and like, look at all that we have done. Like, we have created families and businesses and homes and communities and all these things, that we're always just like, looking forward, like, what's the next thing I need to do? And I think that it's very useful to stop and pause and be like, you know, what, look what I've done so far. I mean, heck this is because it has the really the truth is if you end up with an experience, like I had, where your mortality is sort of like right in your face, you're not going to be worried about what you haven't done yet. You're going to be worried about the people and communities and and, you know, things that are surrounding you now. So yeah, a little compassion. It's, it's gratitude. But it's more than that. I think for women, it's like not being critical of ourselves and just, oh, yeah, no, that's so that's, that's my ingredient.

Jenn Salib Huber  41:35  
I hope that I love it. Thank you so much. For anybody who's looking for links, they will be in the show notes. And thank you so much for this conversation, Maggie. Well,

Dr. Maggie Landes  41:45  
thank you for inviting me, Jen.

Jenn Salib Huber  41:48  
Hey there. Thanks so much for tuning in to this episode of the midlife feast. You can find a link to my group program beyond the scale and anything else that I've got on the go in the show notes. You can also find a link to download my free menopause nutrition for underwriters Guide, which includes some of my favorite recipes to help you implement gentle nutrition. And as always, come hang out with me on Instagram at menopause dot nutritionist. It's where I love to connect with people who are in this stage of life and are looking to try different instead of harder