Holistic Weight Loss with Dr. Leslie Sanchez-Goettler

In this episode, I talk to Dr. Leslie Sanchez-Goettler, the medical director of Radiance MD and an obesity medicine specialist, about her comprehensive approach to weight loss. Dr. Sanchez-Goettler emphasizes a holistic methodology, integrating the 'five pillars' of nutrition, physical activity, sleep, emotional and spiritual wellness, and appropriate medications. 

She shares her personalized strategies, including hiking and weightlifting sessions, with her patients, highlighting the importance of psychological support and bio-composition tracking. She also discusses the challenges and benefits of weight loss medications, the significance of avoiding compounded drugs, and her dedication to building a compassionate, patient-centered practice.

00:00 Introduction to Dr. Leslie Sanchez-Goettler

00:52 Holistic Approach to Weight Loss

01:56 Peer Support and Exercise

06:38 Personalized Nutrition Plans

08:15 Emotional and Spiritual Wellness

10:44 Medications and Hormone Replacement

13:16 Challenges and Solutions in Weight Loss

20:29 Insurance and Accessibility

22:29 Conclusion and Contact Information

Transcript

 I'm here today with Dr. Leslie Sanchez-Goettler , who is the medical director of Radiance MD, who is an obesity medicine specialist. And I wanted to talk to her about weight loss and how she helps her patients move forward on their weight loss journey. So, um, thank you so much for being here today.  You're welcome.

I'm glad to join. So when I see patients in the clinic and, and I think that losing weight would help them. I mean, I'm a urogynecologist. And so a lot of times I'm seeing patients with incontinence and weight loss frequently will help with incontinence. I will tell them to lose weight, but I'm not really offering them a lot of help, right?

I'll suggest new or weight watchers or refer them back to their PCP and that doesn't seem to be enough for most people. What do you think is missing there?  Well, I think the main thing is really taking the holistic approach and I know that it was traditional medicine right now. You don't have the time because there's usually a productivity that you have to kind of see a certain amount of people in a certain amount of time.

And that's one of the reasons why I left, you know, being part of a big system is that I wanted to spend time with people, but you know, and then within that, it's taking that holistic approach where we're working on nutrition. I talk about the five pillars, which are nutrition, physical activity, sleep, emotional, spiritual wellness, and medications.

And so I kind of spend an hour per patient per month,  and I actually even lift weights with all of my patients. I was, I've been a personal trainer since I was 16, so I actually personal train them, lift weights with them, um, and go on hikes. So it's really, I'm able to do that because I have time, and that's just something that, that, uh,  People who are in more of the traditional practice can't do right now. 

Do you think that lifting weights with your patients, do you think that that's kind of peer support, right? Where you're almost challenging them to do it too? I mean, I can't imagine seeing, going back and seeing a provider and saying, Oh, I didn't do it, but I know you, you did it. I've seen you do it.  Yeah. I think it makes it seem less daunting for them.

So,  A lot of people, first of all, feel intimidated by lifting weights. So they think they're going to be a massively muscular or they don't know what to do, um, or they just even are intimidated to go to the gym because they don't feel like they will look good. Just being there in the trenches with them.

makes them feel safe and that they can do it. And then also, yeah, that I've, I think they see that it's not easy for me as well. And that I, I just do it,  you know, I think just having that, you know, the peer support and then knowing that I'm there with them helps a lot. Do you do your own exercise classes as, as part of your program or are you mostly helping people get started and, and helping them feel more comfortable?

Actually, I go on a hike with all my patients every week. So, uh, we go into the forest and actually we could do like four mile hike. Some people can only do a mile, so they'll just do a mile there and back, but then whoever can, I do four miles with. I don't do any group classes currently. Eventually I want to do group retreats and group classes, but currently I don't do that.

I just do one on one so they feel more safe. And then I also have a personal trainer, two personal trainers that work with me, and so they train them every, well, there's different packages, and so some of them are trained every week, or it can be twice a month, or three times a month, and one of the trainers trains people virtually, and one trains in person, because I work out of a physical therapy office.

And so it's really wonderful because they have the access to all the equipment there. Or we do. Yeah, that's pretty amazing. So your patients could pick to exercise with you or, you know, or with your staff, or maybe even just, you know, get an introduction. So they know, feel more comfortable or have a routine that they could do on their own at their own gym.

Yeah, exactly. And, and so each month they see, they see me every month for six months.  And so in each time they do meet with me, we do this 3d optical imaging, which is called a sticu, and it's, uh, 98 percent correlated with a Dexa. And so we do, we check their lean body mass, their body composition, because as we, we both know, it's not about just the number on the scale.

It's much more about your body composition. Also, one of the concerns that a lot of people have about the weight loss medications is that they're going to lose lean body mass. And I can tell you, with all of my patients, that has not been an issue. In fact, they're gaining lean body mass.  Even though they're losing some of them, one of them just hit 200 pounds that he lost last week.

So, so amazing. That must make you feel so great to be able to help people on that, on that journey.  I absolutely love it. I feel like I've come alive again. Feel it, you know, in, in medicine, I was just kind of getting to a point where I was just so burned out and feel like I was a factory worker. And so I feel that I'm coming alive and, you know, you can get people off.

All of their medications. Many of them have been able to get off their diabetes medications or their blood pressure medications. Um, and they, I always ask every patient, what's something you want to do that you've never, either never been able to do, or that you want to do that you used to be able to do, and that kind of motivates them.

And so one of them last week said, you know, they wanted to, for the first time, not have a seatbelt extender when they went on a plane. So he met his goal or, you know, I want to get on a jet ski or I want to Go hike with my cousins or do things that they could never do before. And that it really is rewarding to be able to see people to reach those goals and, and not just add more and more medication, but to take away the medication.

Yeah. I think those personal goals are so important, right. And, and do really help to motivate people and, you know, something like a seatbelt extender,  that's, you know, Got to feel so there must be so much shame and embarrassment there, right? When you have to ask for that and use that and you know, the seats are so small and you know, the people next to you aren't particularly happy if you're a little bit bigger, you know, there's just so much that goes into it.

Can you talk a little bit about each pillar? I mean, we talked about physical, what about nutrition? Yeah. So for me, what I do is I give them three options. Okay. One is that I set their macros in an app like MyFitnessPal or CarbManager. And so we'll do, set their percent  protein, fat, carbohydrates, and calories.

And then I'll set that for them in the app and then I'll teach them how to track. So you can actually just scan foods if it has a barcode  or you can enter it manually. It just helps them to kind of track along what goals they're supposed to meet each month. And then I can review that when I see them.

And if they have questions, they can email me or whatever as well. Or another option is for some people, we do meal replacements. So I have, um, I have, um, some partnerships with pre made meals where we can, they can kind of get a discount for pre made meals, um, or they can do even sometimes for a period of time doing some shakes might be beneficial, but long term, I like to have people eating regular food and learning how to cook.

I actually eventually want to do cooking classes as well. I love to cook. You know, so they have those three options as far as nutrition.  Um, as far as sleep, you can put in a referral to sleep medicine if they need to do a sleep study, but a lot of my patients do have sleep apnea. And one of my patients actually this week, who's down 160 pounds, was able to took a repeat sleep study and was, does not need her CPAP anymore.

So that was really exciting for her. Gift, right? Cause sleeping with one of the CPAP devices is so hard for most people. And then, so the. Emotional, spiritual wellness. I, I also, so my undergrad was psychology and then I went to seminary as well. So I have a master's in philosophy and a master's in theology.

So kind of this holistic approach is important because,  you know, there's so just, you, you had the right word. You said a little while ago, it's the shame that not only about the, the seed Valley center, but just so many patients have been condemned by their doctors or by other people or themselves. And there's so much shame that's involved.

And there's also a lot of trauma, you know, sexual trauma, childhood sexual trauma is very common in my patient population. And so that's something that we need to overcome together because that's one reason why they'll keep the weight on, is kind of as a protective mechanism. So there's a lot of things that we need to work through together to, so they feel safe in losing the weight and they don't self sabotage.

So we talk through that together. Um, like I said, I think just having, knowing that I, Accept them where they are.  I don't know if you noticed like the image, the messaging on my website is really about teaching people that they're beautiful as they are. And one of the things I like to teach people is that it's okay to love who you are and where you're going at the same time. 

So it's not just about, you know, you're going to be good enough when you get to your goal. It's, That you're beautiful now  and that you, you know, but it's okay to keep working on yourself too. Yeah. When I was taking notes on your website, I wrote down being enough, right? That was kind of the message that I took away from it, right?

That you're enough at this point in time. Can you do all of that counseling at the, at the same time in that one hour appointment?  I do. Yeah. Cause I'm kind of multitasking. I'm lifting weights together. I have, and we're just talking, you know, we're just. I think they just feel really safe with me, because I'm down there doing sit ups with them, like, and it's just, you know, we're really lift, literally lifting weights together, hiking together, and patients know that I don't judge them.

Yeah. And I think that, that they really get that. I, I think of my job as bringing hope to the hopeless. Yeah, that's so many people have tried everything they feel like they've  not been listened to that they've been condemned or the doctors will say to them, you just need to eat less and exercise more.

And it's you're doing something wrong. Obviously, one thing that we've been able to see over these last. You know, 10 years is that how much physiology is involved in weight loss that, you know, one of the big reasons why this medication, the GLP 1 agonists are so effective is that as women get to perimenopausal and menopausal stages, the GLP 1 goes down.

And so that hormone is something that causes you to feel full and to delay gastric emptying. And so I don't think of the medications as a crutch. I think of them as hormone replacement.  Uh, they were getting you back to homeostasis, back to balance. What percent of your patients are on medications?  Oh, that's a good question.

I would say probably 70%. Do a lot of people start off without the medications? And, and try to do that. So, so I think these medications are, you know, likely to be, you know, a complete paradigm shift for us, right. As we move forward. But I see a lot of patients who, uh, you know, have a little bit of shame about the medications too, right.

And, and feel like it's a crutch and they should be able to do it on their own.  Yeah. I think that that's kind of something that we, what we really need to educate them about that. You know that it, and I think Oprah is actually helping a lot with this right now, because, you know, she, if anybody could have done it, it would be Oprah.

You know what I mean? She's got all the books and the trainers and the money in the world and access to anything, and she couldn't do it on her own. Um, but now with these medications, she has been able to, so it's, it's really teaching people that, that it is. Physiology that, that for some people it is a disease and that  we don't, and also educating physicians that it's not something that we condemn people for.

We don't condemn people for cancer, you know, and, and that for some people, obesity is a disease that it's really multifactorial that, um, you know, some people it is, they just, you know, eat too much or exercise too little. But there are, for some, some people that I have many patients who have really exercising six days a week.

And they're, you know, eating a thousand calories and why are they not losing weight? That's why we're, you know, we're seeing the hormones that are related or the medications that, or the cortisol levels, or they're not sleeping well. So we have to kind of get to the root. And that's what takes time. You can't just, you know,  You know, start them on a medication and send them out when you need to really work through that with them.

So you've mentioned a couple of times that you have patients who've lost a lot of weight, right? Over a hundred pounds. Are you just addressing people that have more than a hundred pounds to lose or are you helping people that have bothersome weight but smaller amounts?  Yeah, actually a lot of, a lot of my patients are menopausal, perimenopausal women, menopausal women.

But anybody who has a, wants to lose more than five pounds, because for some people it's just even working with the trainer, because my trainer is a state champion bodybuilder. They're both phenomenal. And so they just lifting weights,  having that health coaching, having that accountability. Makes a really big difference.

So they can even, they don't necessarily even have to work with me. They could just work even with my trainers. I'm happy to work with anybody who has extra weight to lose because.  It can affect your health in so many different ways, you know, with all the comorbidities that are related to weight gain.

And once we address the one issue, we can address all the issues. Do you prescribe a lot of hormones, too, for those perimenopausal and menopausal women?  I don't personally. That's something I'm interested in learning more about. Actually, I just went to a talk about that. So it's something I'm certainly considering doing.

I don't currently do that. I just, just the, I mean, like I said, I consider the GLP 1 agonist hormone replacement therapy, but I don't do the estrogen progesterone at this point. Yeah. Yeah. It's, it's interesting, right? Cause I think menopause and, and perimenopause in your body changes and frequently it feels like somebody else's body.

Right. And figuring out  how to get yourself back in, in line can be really difficult. Yeah, that's a really big, I just set up a talk, uh, last week with, uh, about perimenopause and weight gain, actually in menopause, menopause and weight gain. And I had about 12 positions that came to that. And we just had a kind of a round table discussion, but it is, and so as somebody going through menopause,  I get it. 

Yeah.  It's really a challenging thing, but like I said, I can tell you that with these holistic approach. I'm seeing this increase in lean body mass, and that's the weight that people have not been able to get off. They've been able to get off. Yeah. I love the idea of checking body composition regularly, right?

Because then I think you're really reinforcing the right habits. And we do get so focused on the scale and that number. And sometimes the higher weight is better, right? If you have more muscle mass.  Exactly.  But that's a, that's a hard thing to teach people if they're just looking at the scale.  I get a lot of job offers to just sit there and we're just sit there every 15 minutes and prescribe GLP 1 agonists.

And I said, you know, that's just not what I want to do. If they're not lifting weights or taking this holistic approach, they could gain it all white right back. Yeah, you know, they're just, they're losing the lean body mass. You kind of beat me to it because that was going to be my next question because I feel like a lot of people get those medications without the additional services that you're providing.

You know, I've seen them advertised at plastic surgeons offices, um, you know, through the mail med spas, right? But I, I think that kind of misses the point.  Exactly. And, and, you know, another important point is that you want to do the FDA approved ones and not the compounded ones. Because, at this point, there's not, there's no regulation over these compounded ones, and we're seeing, you know, a lot of adverse reactions, you know, it's compounded with high levels of magnesium or high levels of B12, there's nobody regulating those at all.

So, even though they may seem cheap,  I do not recommend that. Do you have trouble getting the medications?  I don't, you know, one of the things that I will do if people don't have coverage for is to prescribe it to Canada, which is actually, which is. Okay, to do is legal to do and we said there's some pharmacies in Canada and they'll mail them to patients because I'm because I'm really determined to only do the FDA approved medications.

And so we can actually get it down to where it's about 200 a month. They, um, by doing that, but you're not having a supply chain issues with it.  No, not, not for the would go be.  Currently, uh, Zet bound is a little bit harder to get, but, you know, I had just patients got a call around a little bit, but they're usually able to get it.

And they're billing. I mean, it's, there's so much demand that they've put three factories. I know for the Novo Nordisk has opened up three factories just to make it.  So there, there's going to be a lot more and, and it's getting more, um, indications. So now it's indicated for, you know, what go V for our, so cardiovascular risk reduction.

And I think chronic kidney disease now, um, and then non alcoholic fatty liver. So there's a lot of other indications for, again, because the fixing the one thing helps all the others. Obesity does, um, you know, impact us in so many different ways. So I think I know how you're going to answer this question, but I'm going to ask you anyway, which one of the five colors do you think is the most important? 

Well, I think. I'd say between nutrition and the mind,  both of those two. Yeah. Is that what you thought I'd say? No, I thought you would say it depended on the patient, but then I, I think, you know, that mind body component is just so interesting to me, right? The things that we resist doing and we don't really realize that we're resisting it.

If your mind is not on board, then you're just going to keep self sabotaging. Um, you know, with the high, if it's high stress and the cortisol levels, if you're not,  if you're worrying all night and you're not sleeping, then that can cause you to resist losing the weight. If you're, you know, covered in shame and guilt and condemnation, then you're going to, again, self sabotage.

So even if you make success, if your mind isn't,  uh, at peace, then you're You'll just gain it right back, but then nutrition, I would say that's kind of the big issue for every  majority of patients is eating a lot of carbs that can, and I'm not, you know, I do find the right mix of macros for each person, but, but if you're eating a high level of sugar and carbs are processed foods.

Then that's going to cause your insulin to spike and then it's caused you to store calories. And so there's physiology there as well. So I'm going to digress a little bit, but I was once watching a reality TV show and it was about the Dallas cheerleaders, the Dallas Cowboys cheerleaders, and they were talking about nutrition and the advice that they gave everybody was don't eat anything that comes out of a bag.

Yes. And, you know, while this is probably not where I should be getting, uh, my medical information,  you know, I thought that was really, I mean, it kind of summarized it all, right? If you're not eating something that comes out of a bag, then it's much less likely to be processed, right? You're eating fruits and vegetables.

And I thought that was a, that was a good summary. Tell me a little bit, do you take insurance?  I don't  has, I wouldn't cover the time that I'm spending with patients. So I, but I have all the different packages where I can, you know,  where you're seeing a lot of personal training or just seeing me and it's, I'll just say I've never turned anybody away. 

I'll put it that way. I make it work for people. Cause I'd much rather them bring me eggs than I would, you know, be having to rush people through. And, you know, it's just, I don't want to spend my life fighting insurance claims and they don't, Oftentimes, insurance companies have not gotten on board about covering weight loss or obesity, and yeah, I just don't want to spend my life fighting them.

I just want to see patients and give good care. That's all I want to do. It's an interesting time in medicine, isn't it? Because it feels like we need to redesign so many things, and we're Not emphasizing the physician patient relationship enough or preventative care or quality of life. Right. And that's what a lot of this comes down to.

I mean, you want to treat the weight loss before you have major problems.  Yes. Yeah. And so, you know, so I don't do HSA FSA and I give them a super bill that they can submit to their own insurance. And again, because I can get also, I can do samples. So that can kind of help too, just.  With the coverage, so, you know, to make it more affordable for people.

So I don't, I don't turn people away, but I'm with you. It's, we've got to redefine things. So yeah, both patients, both positions are not burned out. And. Then that patients feel like they're being seen. Yeah, I mean, I, I think you said it so well, right? I mean, you want to enjoy your day and enjoy the care that you're giving and, and be proud of it at the end of the day.

And then I think when you do that, people really feel it and they get a lot better too. So if someone is interested in working with you, where can they find you?  So my website is www dot radiance md do org.  So that's where they can, uh, schedule a free discovery call on there. And then let's see all the phone number.

It's seven one four three two six two three two  so they can  call. And I'm happy to, to do a free discovery call just to kind of get to know,  get to know you, and just see if we'd be a good fit.  Okay. Well, thank you so much for your time. I really appreciate everything that you do for patients and best of luck. 

Well, thank you. I appreciate you having me.