- Every January our social media feeds and conversations are filled with talk of New Year's resolutions.

And the most common resolutions usually have to do with health and fitness.

Next on "Health Matters," we talk with local experts about how we can make those health goals sustainable.

Maybe your goal this year is to get in shape, lose some weight in the process.

Maybe you just wanna be healthier and cook more meals at home.

And so often those goals get abandoned or the pressure of meeting those goals starts to have a negative impact on our mental health.

Welcome, I'm Aaron Luna.

Tonight we're talking about how to approach those resolutions in a way that leads to positive results, and how cultural conversations around these topics can actually keep us from success.

But joining us tonight, Megan Vulcan, nurse practitioner with MultiCare Health Systems, Hailey Davis, owner of Farmgirlfit, where she's also a coach.

And Katrina Knizek, a licensed mental health counselor and Pilates coach.

Thank you all for being here and sharing your expertise.

Weight loss, healthy eating and getting in shape are common New Year's goals and they're also known for having a high failure rate.

Megan, you work with patients at the Center for Weight Loss and Wellness.

What would you say is the most important thing someone should do before diving headfirst into a health and fitness overhaul?

- Thank you for having me again.

At MultiCare, we really try to approach patients as a system, and a family, and really looking at their safety, and their health first.

So I think when we're trying to deploy any kind of changes that impact health, we need to see where people are presently.

They should have a medical evaluation to ensure that any changes they're wanting to make are safe.

And that's really kind of the fundamental starting point is to assess their current health, their current habits, set goals that are reasonable, and find things that are often near goals, far goals, and to kind of prioritize those things so that we're not overwhelmed.

Quick successes are important, but also thinking about the long term, and how to sustain those things is very, very important I think for patients.

- Someone could say, "Well, medical evaluation, I'm scared of needles or I don't wanna go in and go under, you know, undue procedures."

What is a medical evaluation and how simple can it be?

- Sure.

So a medical evaluation would just be a baseline physical and history.

It could be taken by your primary care physician or a weight management program like ours at MultiCare.

Generally it would involve height-weight evaluation, listening to the heart and lungs, doing a full physical exam, blood pressure.

Usually baseline blood work is helpful just to make sure there aren't underlying health issues that are making it more difficult for that person to lose weight.

Or sometimes it shifts our priority if there's a more pressing health issue at hand.

It also can determine whether it's safe to make a dietary change or whether it's safe to go to the gym.

We don't want people to go out of the gate, and do something harmful to their body or their mind with their mental health too.

Overwhelming people is not usually our goal.

But every patient that I evaluate, and my partners in our clinic, we always say we don't know what the plan is going to be until we talk to them.

And often we will ask, "What has worked in the past?

What has made it hard for you to continue making changes?

How do we plan for those things so that you have a better outcome with whatever we decide together as a team with our shared decision making together."

- Excellent.

Thank you.

Hailey, a lot of people out there may be heading to the gym, signing up for the first time as a fitness professional.

What do you tell first-timers or maybe someone who's kind of getting back in that routine after maybe an extended hiatus?

- I think having somebody come in for the first time is probably a lot of emotions going on, and they're feeling very motivated but not to bite off more than you can chew.

And make sure you're meeting your body where it's at currently.

We're excited to have you in the gym, but what's gonna be sustainable for you to keep coming?

You know, does this fit your schedule?

Does this fit your lifestyle?

So yeah, just having those open conversations and building that relationship.

And then, of course, making sure that they have a great experience, and they're having fun, and they're enjoying what they're doing.

- How often do you have to have that conversation about realistic expectations or is that something you kind of let someone ease into?

- Working at an all-women's gym, it's a constant conversation because telling people that if they're not seeing certain progress or if we are seeing them a lot, but they're being really hard on themselves with unrealistic expectations, showing them like these mini victories that we've seen them have these wins that we've seen them have I think is super important.

And yeah, a lot of people do go into the gym with unrealistic expectations, quick fixes.

And I think the people that keep coming know that they're there for different reasons, and the longevity portion of it.

- And, of course, all this plays into our mental health.

Katrina, what are some of the mental health factors to think about while you're exploring changes to your lifestyle and some changes, you know, you want these to have an impact over years?

- Yeah, when it comes to looking at body-focused resolutions, we do have that risk factor of it is very easy for an eating disorder to take root.

And that's something as a yoga and Pilates teacher of over 13 years, I've worked with many people in the fitness realm who have those unrealistic expectations twist into really, really painful and lifelong, sometimes debilitating mental health conditions.

- And I had the opportunity this week to sit down with a woman in South Carolina who's not only on a journey to change her life, she's taking a community of thousands along with her.

(screen whooshing) A health journey on full display.

- What I eat in a day as somebody on a journey to lose 200 pounds.

I'm currently down 64.

- [Aaron] Callie Goodwin is working hard to find balance in her physical and mental health.

- I've been overweight my entire life.

It's pretty much all I've ever known.

- [Aaron] And hundreds of thousands of people are following along online.

- And I knew that if I really wanted this change to be permanent, I needed to have accountability.

So I created my social account because figured it's a little less daunting when there's strangers holding you accountable versus like the people you see day to day.

- [Aaron] With joy and an infectious smile, Callie has been sharing her wins on and off the scale, building an online community now 270,000 followers strong but her biggest influencer has been her younger brother and a kitchen conversation they had together in late 2023.

- And he said, "Hey," he cornered me in the kitchen and was like, "Hey, like I'm learning a lot in med school.

I'm very concerned about you and your health."

- [Aaron] Those words kicked her into action.

And it's not as if she hasn't tried to lose weight before.

- I've done pretty much every fad diet that is out there.

Everybody says like, "This'll work, this'll work, this'll work.

And I would try that.

- [Aaron] Diet she tried in secret, but now with people watching, she needed something different.

So she dropped the fad diets, picked up a phone, and called a registered dietician.

- And so it's been interesting trying to unlearn diet culture with her, but also relearn like proper nutrition instead of just all of the crazy like quick weight loss tips that the internet tells us.

- [Aaron] Working with a professional turned out to be a total game changer.

It wasn't just meal changes, it was a lifestyle change.

She's also taking a GLP-1 to address her type 2 diabetes.

- [Callie] The weight just started dropping and I was like, "Wait a second."

- [Aaron] Her social media handle is @theloseitlog where she focuses on sharing her journey and what worked for her.

- If you're nervous on where to start, that's okay.

That was me back in April and here's what I've learned and here's my tips.

- [Aaron] And while she's lost more than 70 pounds in the last nine months, her biggest win has nothing to do with the number on the scale.

- Just being able to participate in life.

There are some things like walking around the mall is not fully exhausting anymore.

I can easily park at the back of Target, and walk to the store versus like having to drive around, and like wait for an upfront parking spot so that I'm not out of breath when I get into the store.

Being able to go to Disney, and run around conferences and just be able to move and enjoy life.

It gets easier and easier the healthier that I get.

- [Aaron] With a growing online community, Callie's advice for those interested in their own health journey might surprise you.

- Well, my first thing is I always tell people don't listen to influencers on the internet unless they're telling you to go seek professional advice.

I was the victim of that for years, following anybody and everybody but actual professional advice.

(screen whooshing) - Callie's story really hits a lot of familiar and relatable themes.

And one that we've been hearing a lot about in the news is GLP-1s, medicines like Ozempic and Wegovy.

There's a few different ones on the market.

And Megan, can you tell us a little bit more about these drugs?

We're starting to see ads on Instagram for them.

You can order them online or even get them through programs like WeightWatchers.

Is that safe?

If someone is interested in these drugs, what do they need to know, and what do you tell them?

- I tell them to have a medical evaluation first because any medication has risks and benefits, and there are people that are very appropriate to be on GLP-1 medicines, but there are many that are not.

There's a lot of confusion with the naming of these medicines because Ozempic and Wegovy are molecularly the exact same medication.

They're just FDA approved under different brand names.

So there's a lot of confusion out there where people don't understand that if you have diabetes, you'll get one, and if you have a weight management need, you'll get another.

But they are the same medication.

These medicines have been out for more than a decade.

They're very safe, but they do have side effects that need to be monitored and mitigated.

So we don't encourage a lot of buying on the internet.

I don't think we would do that for many medications.

And there's a lack of monitoring with a lot of those programs where it's kind of the Wild West, and I think that's where a lot of the negative is being kind of put out there in the media with people having side effects, and a lot of worry that should not happen where people should be managed more appropriately with the medicine.

- Katrina and Hailey, you can weigh in on this.

Like, you know, you've seen the ads.

They're popping up everywhere.

What are people telling you, and are people talking about that in the gym as, you know, where can I get it or a supplement?

What have you seen?

- I haven't seen it as much I think in the gym because of the mindset.

I think that maybe even certain gyms foster, and the community and the focus.

But I do know people that are currently taking these medications, and I just advise them to seek other outside help like where you are able to sustain if you go off the medication or talk through emotional side effects too.

- I really loved hearing from this person that you had interviewed because it is so important to speak to actually trained professionals.

I also have many friends who've ordered these offline, and there's so many risks that can come with very rapid, and unmanaged, and unsustainable weight loss.

Cardiac complications can truly damage like your metabolism for the long run.

And so when I have had clients bring that up in the counseling space, we talk about the underlying desire.

And if the desire to lose weight is so strong that you're not willing to go to a doctor to get that help, that might not be a really healthy desire, and there might be more underlying factors that we need to look at first.

- So the thought process that surrounds the quick fix, and then everything will be fine, and I can go from there is a little bit more damaging it sounds like.

- I think absolutely.

Partially because of the work I do, working with the dark side of weight loss, and when it becomes an eating disorder, there is a lot of messaging happening culturally that's developing into what we refer to as orthorexia, which is not in the DSM, it's not a diagnosis yet, but it's the dysfunctional way that we become so fixated on health that ends up being a damaging relationship to food, to fitness, to life as a whole.

So we've got folks who are working out four or five, six hours a day, and also taking Wegovy on top of that or online ordering Ozempic.

I'm sure there are exceptions, but overwhelmingly, that is not a very healthy or sustainable way to relate to your body, to your weight or to your consumption of food.

- In our center, we reevaluate people monthly that are on these medications.

So we are checking in with them frequently, and have triage nursing that can access in MyChart that they can message if they're having a hard time.

And we do body scan evaluations where we look at body mass, skeletal muscle, fat mass, water.

So we really try to look at the long run, and think about that, that faster is not always safer.

And then remembering that weight management, people who struggle with weight loss, it is a chronic condition that is multifactorial.

So any other chronic disease, if you stop a treatment for it, it will get worse.

So the concept of GLP-1s being a temporary or quick fix is really, really misguided because these are chronic conditions, and they will deteriorate in it.

I think socially on social media, what I see is that it's sort of cast as a failure of character or effort.

If somebody has a rebound when they're off of a treatment, but any other medical condition, we wouldn't feel that way.

- Right, right.

I think that leads us into our next topic too.

And Callie talked about how information on social media and online really failed her, fad diets.

There's always new workouts we hear we should be doing or ones that were popular that are suddenly the wrong workout to be doing.

And how do we break through some of this noise, Hailey?

Let's start with you.

- I don't think there's ever a good or bad workout.

It's whatever suits you, and how your body feels when you're doing these workouts.

But again, those extremes, right?

When you are doing the kind of all or nothing, like Katrina was talking about, that's when you're gonna set yourself up for failure.

So trying different things and maybe building more of a foundation where I start is can I do these things, like gardening or just those functional fitness moves?

And then building on that.

And that's a very, very good way to see progress, and then see success.

So the fad, the yeah, quick fixes.

- I wanna add to that as well that if we think about weight as the most important definition of health, we're missing a few different layers that follow that.

If the only way to be healthy is to be fit or thin, that is going to exclude a large portion of the population who, for genetic reasons, medical reasons, anthropological reasons are not going to have a body that's deemed as correctly healthy in social media, in the public culture.

But even more than that, if the only bodies that have worth, and the only people that have worth are healthy, we are fully signing off a huge portion of our population of folks with disabilities, whether that is chronic, acute, visible or invisible.

So I find that if we focus on, "My goal is to lose weight, so then I will like myself," we get lost in the mess of can you love yourself, can you support yourself?

Can you value your worth regardless of what the body is going through, weight or health wise.

- In our program, we do psychologic evaluations to make sure we're picking up on that, and provide a support group for our patients.

So there is a support.

Whether they're actually a patient at MultiCare or not, our support group is online, and available to anybody who has questions.

The question about fad dieting, there is quite a bit of medical literature to support how we look at that, and we know the bulk of them are not sustainable long term.

Statistically, most people on a really restrictive diet are gonna have around a 10% success rate in the long run.

So promoting a really restrictive diet has a 90% failure rate, and it generally is just not something that people want to do.

So asking what do you like to eat?

How do we plan ahead?

How do we listen to our cues for hunger?

Am I really hungry when I'm eating or not?

Am I hydrated?

Is my body misunderstanding those signals?

So I think learning to pay attention to those cues and plan ahead.

Our dietician couldn't be here tonight, but I asked her, "What are your big tips?"

And one of her big mantras is failure to plan is planning to fail.

And so kind of just really thinking through how we fuel our bodies.

I think I heard you say about fueling.

So traditionally, diets that exclude a whole food group are not going to be sustainable for most people.

- And we kind of talked about breaking, you know, kind of sorting through that noise.

Do you tell people you're working with, "Get off the social media for a bit, like stop comparing yourself to everyone else who's already shaped this way or looks this way or has success this way."

Is that a conversation you have?

- Yeah, I think the comparison conversation is one, especially working with people that maybe have been working out for a long time, but your bodies evolve.

You're an evolving human, and so we get members that have, you know, "In my 20s I used to do this, before baby I used to do this."

But meet yourself where you're at, and where currently, you know, all of these different things that accumulate to how you are and your body is is so important to yeah, consider.

- Instead of holding up a picture of someone who's posing on Instagram and saying, "I wanna look like this."

- Exactly.

- That's the biggest thing.

So my bachelor's is in art history before I got into the counseling field.

And when we look at something as topical, and ever-changing as the ideal body, that comparison is killer.

And my first step with all of my clients who struggle with self-image, whether it's disordered eating, or general everyday, garden variety, having some tough stuff when you look in the mirror, we do a social media cleanse.

They say, "Unfollow everyone who makes you feel bad about your body."

That means your mom, that means your friend, that means your neighbor, people who have really good intentions, if you can't unfollow them, just like unwatch their feed for a while.

And it is mind blowing how when you change what you are taking in on a daily basis, your conceptualization of what normal bodies are, and what healthy bodies can look like, it can change by leaps and bounds.

- Unfollow those people, follow your dietician, follow your nurse practitioner.

- [Katrina] Right.

- Are there accounts out there that will give you that?

I mean, do you see dieticians out there, you know?

And we talk about the negatives of social media, but there can also be people who you might find something useful with.

Is that is something you've seen in your field?

- Definitely.

I think they tend to be a little bit quieter in general.

So I think generally just using that barometer of if it sounds quick and too good to be true, it probably is.

We have resource pages that we give our patients that have lists of kind of trusted, and evidence-based, you know, people out there but they are ever changing.

And I think people, they get burned out, and they shift onto something different.

And in our center, we have kind of the full spectrum of care.

So we try to have the mental health piece, the nutrition piece and the medical side but we try to also have people trying to fact check themselves.

That internal voice of how they speak to themselves is very important.

I will have patients stand up in the middle of the office and look in the mirror with me there, and recite what they said about themselves when I walked in the room 'cause they often don't hear themselves doing it.

And often that internal voice won't change, regardless of how much weight they lose.

So it's very important work to make sure that they're aware of that and that that internal voice is kind of the most positive and the most encouraging along the way.

- Powerful.

- Yeah.

- And if someone's looking to find a dietician, how do you recommend someone pair up that way?

What are some good questions to ask a dietician, and how can you make that match the best one possible?

- It can be challenging to find somebody in your community, partly due to coverage.

It's not well covered by health insurance.

So sometimes it's just access, and what people have access to.

So in our clinic, we have a whole variety of different types of people.

I think sometimes it's about who are you comfortable having that conversation because food is probably one of the more personal parts that people feel judged immediately if you don't ask the question the right way.

So it might be that you need someone with a certain gender background, age background where you walk into the building, if you need a virtual option.

So they don't have to live in your community to be the right provider for you.

But it should feel like someone that you can kind of just lay it all out there, and know that they're not going to slap your wrist if you ate a cookie 'cause we would encourage people to do that occasionally.

It's normal to eat foods that are kind of on the whole spectrum.

- Kinda the same goes for, you know, picking a workout program or maybe a gym culture that you would wanna go to.

You kind of wanna feel it out 'cause everyone's different.

- Yeah, I think having that support, and that accountability is awesome because it is what motivates you, right?

It's gonna get you outta bed, get you there.

And sometimes that's the most important part, that social connection instead of the workout.

So yeah.

- I definitely see that where I am because we follow patients for life.

So I've been at MultiCare for 18 years, and I have patients that I've seen for 18 years to help manage their health and their weight.

And it is funny how they'll come in with Christmas little gifts or you know, a birthday card, they know when my birthday is.

You develop this rapport because you're walking through something that's very challenging, and it'll have highs, but then they'll have lows, just like anything else.

We always say weight management and health, it has seasons, and we have to be okay with starting again and again and again.

So the message of today, I always hope for people to do that every month, not just in January, but knowing that starting again is okay, and it's normal, and we should normalize that part of our culture.

I don't think we do very well.

- And Katrina, it's kinda the same question for you as well.

How do you go about finding someone that you trust to have those vulnerable conversations with?

- Yeah, so there's a few things you can look at when you're like reading someone's website is checking their credentials.

Another big thing is looking for the verbiage that they use.

So I operate from a HAES lens, which is Health at Every Size.

And I also operate from a like non-shaming and intersectional lens.

So that means if someone comes to me, and say they're from the Native community, that's a community who's had so much history of trauma around food, and traditional foods being taken away, I am not gonna tell one of my Native disordered eating clients, "You can't have fried bread."

Not only is that like culturally not acceptable, it's very disrespectful if I have clients who are Black or from Mexican culture.

Those historic and ancestral foods are important to who you are as a person.

So if you're seeking for a provider who is going to see you as a holistic person, that kind of language should be seen top to tail through the way that they show up to the first session, the way they set up their lobby, if it's in person, to show that you have space for people.

Something like having chairs that don't have arms to be able to inhabit bigger bodies makes such a huge difference if you're coming into a space to feel welcome, and to feel like you will actually be seen as a person, and not a problem.

- That's great advice.

And what are things we can look at, let's say beyond the number on the scale?

Callie talked about how she could walk without getting winded.

What are things that aren't related to how much we weigh that can really show improvements or growth in that capacity?

Hailey, let's start with you.

- In the fitness aspect, it would be finding a goal, and maybe I want to work on my pushup, right?

And then starting at level one, and then progressing, and just keep dedicating yourself to, "I'm gonna do a pushup, I'm gonna do a perfect pushup, I'm gonna do five pushups."

So there's so many ways you can actually do, and show progress without a scale.

Yeah.

- Yeah.

- Many of the people I see, they tend to come in because they want to get off of medications or they're seeking to have an outcome at the end of the line, like a pregnancy.

If they have had trouble with pregnancy, or I had someone this morning that needs a kidney transplant, and is hitting all these obstacles along the way.

So we tend to have a lot of ways to measure in medicine.

So we track blood work, we track blood pressure, but those non-scale victories are also a big part of it too.

What matters to you?

Are you feeling like you're living the life that you want to live?

Participating.

- And Katrina, we're getting short on time, but what is something that you can kind of measure emotionally or mentally?

- Self-esteem.

If you're able to look at yourself and say, "This is a person with worth and value," that's gonna supersede any number on the scale 'cause we age, we all have changing bodies, but self-esteem is something we can keep lifelong.

- Any parting words you'd like to leave?

We have about 30 seconds left.

I think we've had a great topic.

I love how you said the perfect pushup.

(Aaron laughing) Let's not let people get away with those weak ones.

(all laughing) - I think people just need to start somewhere.

- Start somewhere.

- Yeah.

- Yeah.

That's great.

Again, I wanna thank everyone for being here tonight.

If you wanna share this episode of "Health Matters" with friends or family, you can find us online at ksps.org.

Or if you wanna follow Callie's journey, her social media handle once again is @TheLoseItLog.

We'll see you next month on "Health Matters."

I'm Aaron Luna.

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