Jim Hill:

Welcome to Weight Loss And, where we delve into the world of weight loss. I'm Jim Hill.

Holly Wyatt:

And I'm Holly Wyatt. We're both dedicated to helping you lose weight, keep it off, and live your best life while you're doing it.

Jim Hill:

Indeed, we now realize successful weight loss combines the science and art of medicine, knowing what to do and why you will do it.

Holly Wyatt:

Yes, the “And” allows us to talk about all the other stuff that makes your journey so much bigger, better, and exciting.

Jim Hill:

Ready for the “And” factor?

Holly Wyatt:

Let's dive in.

Jim Hill:

Here we go. Holly, today we're shining a spotlight on a really key player in weight management. Sometimes doesn't get the recognition it deserves. We're talking about registered dietitians or registered dietitian nutritionists. We'll talk about the difference there. You and I have worked our whole career with dietitians and we know how much they can do. And what we want to do today is help our listeners understand what a difference dietitians can make in their weight management journey.

Holly Wyatt:

That's so true, Jim. We have worked with some incredible dietitians in our research studies, in our clinics over the years. And I can honestly say that their expertise has been critical in helping people make real sustainable changes, which I think most people really want. But a lot of people don't even know when or why or how to reach out to a registered dietitian or an RDN, as we'll be talking about. Instead, there's so much noise out there, they turn to popular diets, they turn to influencers, they turn to weight loss programs that don't always give the best guidance. So today, with all that conflicting information out there, I think it's easy to get overwhelmed. Today, I think we can talk about where they can get some real solid information about what they're eating and all the questions they have about nutrition.

Jim Hill:

Yeah, Holly, that's why I'm excited about today's conversation and particularly to be able to talk to our guest, Hope Warshaw. Hope is a longtime nationally recognized registered dietitian and certified diabetes care and education specialist. Over her long career, she's focused on diabetes care, weight management. She's written several award-winning books, she's appeared on national television, and contributed to several publications like Diabetic Living, Dietribe, The Washington Post, and Today's Dietitian. Hope has served in leadership roles within the Academy of Nutrition and Dietetics and the Association of Diabetes Care and Education Specialists.

She is a co-author on a recent publication that caught our eye Holly, published in the Journal of the Academy of Nutrition and Dietetics. It was titled Incretin-Based Therapies (that's the new GLP-1-based drugs) and Lifestyle Intervention, the Evolving Role of Registered Dietitian Nutritionists in Obesity Care. Hope has dedicated her career to helping people cut through the noise and get science-based nutrition advice they can actually use. So today we're talking with Hope about the role of RDNs in weight management, how they fit into the latest obesity treatments, and how we can improve the way nutrition information is communicated to the public. And I might mention that Hope and I go way back. We're old friends. We've worked together for many years. And one of the fun parts of this podcast, Holly, is that we can bring in people that we like and that we think are really good out there. And so that's an advantage of doing this.

Holly Wyatt:

Absolutely. I say we only bring in people we like, right?

Jim Hill:

Absolutely.

Holly Wyatt:

That didn't mean they have to agree with us.

Jim Hill:

Right. No, no, no.

Holly Wyatt:

Not the same thing. Yeah. So Hope, welcome to Weight Loss And. You've been such a visible voice in the national media. You've provided science-backed nutrition information to the public. Maybe we can just start by having you share a little bit about how you became such a recognized communicator in this field.

Hope Warshaw:

Right. Well, thank you, firstly, for the invitation and that introduction and setup. I've been a registered dietitian for 40-plus years now, not giving the exact number. Suffice to say, I've been around a lot of blocks and seen a lot of changes. I realized after my first 10 years in clinical practice, actually, that's really where Jim and I interfaced in diabetes and weight management that I enjoyed translating science for consumers and felt that there was a big need for good nutrition communicators. Having identified my niche early on in diabetes specifically, but also in weight management because those two things are intricately linked, I maintained my niche in these areas as a nutrition and health communicator. My first book, which was on healthy restaurant eating, was published in 1990.

I wrote several other books along the way. And as more communication was being done in blogs and on websites and other electronic mediums, I developed content for a variety of these venues. I would like to say I was a bit ahead of my time as a nutrition communicator. Today, there are many excellent RDs talking to the media, writing articles, books, engaged in social media, and more, and they're translating food and nutrition science to consumers. At the same time, and I know you both mentioned this and you talk about this on your podcast, and I know because I listen, there's so much food and nutrition misinformation and conflicting information about diets and what to eat. And I believe wholeheartedly people need science-based, reliable and practical information and that's really what I try to provide.

Jim Hill:

Oh I love it, Hope. I oftentimes say you can decide what you want to eat and you can find a book somebody's written that tells you that's exact thing to eat so the poor consumer out there and in this age of social media I mean you can go on TikTok and you can find just crazy stuff out there so I'm really excited.

Hope Warshaw:

[6:29] From a 25-year-old. Right?

Jim Hill:

[6:30] Yeah.

Holly Wyatt:

[6:30] Well, I think the problem is anybody who eats thinks they're an expert on eating.

Jim Hill:

[6:35] That's right.

Holly Wyatt:

[6:36] So if you eat, you think you can go out there and talk about what to eat. And that, I think, is the problem why.

Hope Warshaw:

[6:42] There's no science to any of this.

Holly Wyatt:

[6:44] Yeah. It was just, yeah.

Jim Hill:

[6:45] We're going to have fun today. Maybe, Hope, start with people who don't know much about registered dietitians. What is a registered dietitian? How's that different from a registered dietitian nutritionist? How are these people trained?

Hope Warshaw:

[7:00] Sure. So for terminology, an RD, registered dietitian, is the same as an RDN, a registered dietitian nutritionist. The RDN term was introduced back over a decade ago. It could be two decades because time certainly moves along. They wanted to encompass the word nutritionist. I continue, because I've been around a while, to use the term RD. Others use RDN, but most terms are acceptable and really are the same credential. So today, there are over 110,000 plus RDNs in the U.S.

Jim Hill:

Wow, that's fabulous.

Hope Warshaw:

Yeah, and our professional association is the Academy of Nutrition and Dietetics. There is a consumer-facing side to that website, and it is [eatright.org](http://eatright.org/). And to go a little deeper, as a profession, we consider ourselves the food and nutrition experts. I've mentioned I've seen a lot of change in my 40 years as an RD. One area is how this profession has evolved. Over the years, RDNs have really spread our wings as healthcare professionals and business professionals in myriad ways. And I'm sure you both have seen this. And as you mentioned, you both have been surrounded by RDNs, which of course warms my heart. And that's been true in the clinical arena as well as in the research that you do. I mean, you hear about all of these large NIH studies with Kevin Hall with ultra-processed foods, and I can go on and on and on and on. And the dieticians who are so integral to those studies and feeding people in the 24-7 clinical sites don't always get mentioned too much.

Jim Hill:

Oh, I love it. And Holly, did you know I was a dietician?

Holly Wyatt:

Yes, I did. You tell me that all the time.

Jim Hill:

[9:14] I'm an HN.

Holly Wyatt:

I know. You are.

Jim Hill:

[9:17] I'm an honorary dietitian.

Hope Warshaw:

That's right.

Holly Wyatt:

Why did y'all do that? Why did you let him in the club?

Jim Hill:

No, it actually is a great honor. I will tell you, it actually is a big deal.

Holly Wyatt:

I know, but.

Jim Hill:

[9:31] So the Academy every year picks some people who aren't really dietitians and making them honorary dietitians. And it's a great honor.

Hope Warshaw:

It is a formal nomination process. So there were likely, I don't know the history, but likely a group of weight management dietitians who have interfaced with Jim and thought he was worthy of nominating him for this lofty honor.

Holly Wyatt:

I wish I need to talk to them a little more. Wait, wait, wait. I want to focus on one thing, because I think this is critical. So it sounds like RD and RDN are the same credentials. But what about someone that calls himself a nutritionist? Because I think there's a lot of people out there who say, I'm a nutritionist. What does that mean?

Hope Warshaw:

It means, I mean, we don't want to get too deep down this road, but, I think today, roughly about 40 states across the U.S., RDNs are licensed. I currently live in North Carolina. I have to hold like an annual fee to be licensed. There are a few states, California is one, I think Virginia is another, where they have not been able to get licensure through their state legislature. But definitely look for the RD, RDN credential.

Holly Wyatt:

[11:04] That's what I meant. I think there's a lot of people that just say I'm a nutritionist and there's really nothing behind it. But if you have RD or RDN after your name, you have gone through some rigorous training. And I think that's a really important distinction.

Hope Warshaw:

Yeah, and I can just note a couple items about training, which also has evolved over time. But RDNs generally have earned an undergraduate degree from an accredited dietetics program. They've completed a clinical practice experience roughly a year, often referred to as an internship. And just last year, the requirement to have completed a master's degree in the nutrition field was added. And that you have to do that prior to taking the national examination to hold that credential. And like most health fields, we have continuing education requirements to keep our credential. And there is definitely, like this across all medical fields, a push towards career advancement and earning specialty credentials. So you may see dieticians within the obesity arena with a credential that is certified specialist for obesity and weight management.

Jim Hill:

Yeah, that's wonderful. And we train dieticians here at UAB, and these people are fantastic. And they come out of the program, and they have so much energy, and they really do want to help people.

Holly Wyatt:

And it's rigorous. I don't think people realize how rigorous it is. So that's what I wanted to really focus and say there's a lot to it.

Jim Hill:

Oh, yeah. These people are trained. They know how to interpret science. All right. Hope, I want to get into the meat of what we want to talk to you about today. In the obesity world, the weight loss meds are the big thing. Weight loss meds, right and left, producing massive amounts of weight, 20%, 25%. Holly and I often say, for the first time in our careers, we see people that are reaching their goal weights. So given the effectiveness of these medications, why the heck do we need registered dietitians? Or physicians or anybody.

Hope Warshaw:

Yeah, you just need the power of the pen, right?

Jim Hill:

Right, right.

Hope Warshaw:

I mean, you mentioned a bit earlier that I was a co-author on this article that addressed the role of RDNs in incretin-based therapies and note sort of why we thought this was important.

As you know, we're still very much in the early stages with these medications and gaining experience with them, and particularly this current generation of even more powerful GLP-1 meds, though we all know that earlier generations of these meds have been around for several decades and particularly being approved by FDA and used in people with type 2. But to date, very few studies, if any, have really been focused on nutrition and nutrition adequacy while using these meds. And to date, there's no firm guidelines or recommendations that exist. I mean, I think we sort of have been leaning on the nutrition guidelines recommendations that are published around metabolic and bariatric surgery. So this group of authors, mainly RDNs, thought it was critical to state the importance of nutrition and counseling delivered by an RDN. And almost to put a stake in the ground, if you will, about into to have this paper be in the body of literature and be part of the ongoing dialogue about best practices with the use of these meds. I mean, who better than us to sort of insert ourselves into this dialogue. And, you know, I think you all know, if we don't do it, there aren't going to be people coming and asking us to join their standards committee or guidelines committee. So we felt like it was really important. And, you know, I can go on and talk about how I think and how we detailed in this paper, the role of the RDN with these meds.

Holly Wyatt:

Before we do that, maybe back up one minute, because I think this is really important. And I agree. If we don't go out there and say, let's put some science and who can talk about this, the influencers, and we're going to get all kinds of information out there.

Jim Hill:

It's already happening out there.

Holly Wyatt:

Yeah. So I totally agree with that. But for our listener who's listening and saying, okay, I'm going to go on these meds. I'm going to eat less. Why do I really need to worry about my nutrition if this medication is going to decrease my appetite? That's my big problem, right? Is that I eat too much.

Hope Warshaw:

There are a number of key points. And I may be channeling you too, Holly, with this comment, but I know Jim better, is that weight loss maintenance.

Jim Hill:

[16:30] There we go.

Hope Warshaw:

Weight loss maintenance, I mean, gosh, we still, after all this time, have people having unrealistic expectations about how much weight they want to lose or can lose, and how just magically that weight is going to stay off once they've reached this magical goal weight on the scale. So, if someone made me king or queen, I guess, I would want every person who gets a prescription for these medications or a medication to first go and see a dietician. Even before. I mean, you know, we talked about in this publication about how pairing counseling from an RDN can accomplish a lot. For starters, I think people go on these medications, they don't know what to, what they do, how they work, you know. Why are they causing nausea, vomiting, and constipation because they're decreasing motility of your GI tract from top to bottom.

Jim Hill:

Also, I think they go into it without a thought about weight loss maintenance. We've asked several people, as you start in the drugs, what are you thinking long-term? They are not thinking beyond just getting the weight off.

Hope Warshaw:

Right. I mean, God, I wish we could but really help people focus on that. If you really want this to be your last time working through getting some pounds off, and we have these very effective medications at this point, but what we know is if you are going to be successful at keeping these pounds off, you'll either need to continue on these medications, and it's not an and or, do some major changing to your food choices, eating habits, and your exercise patterns.

Jim Hill:

I agree with you. Here's the way I think of it. The weight loss meds are wonderful tools for weight loss. And Holly and I over and over have said we welcome them. They're only tools. They're not the solution. So to me, you've got three options. If you lose weight on the meds, there are a lot of people that discontinue them. But let's say you reach your goal weight. One option is you continue on these long term. And the data we have suggests you're going to be effective.

Hope Warshaw:

And maybe you don't need the highest dose.

Jim Hill:

Well, I'm going to come to that. But for one solution is stay on the drugs lifetime. We do that with other drugs. But still, is the goal just weight or is increasing your fitness and increasing your diet? To me, there are so many roles for registered dietitians in those people who continue the meds. All right. The second one, and one Holly and I are very interested in, is people that lose weight on the meds, but for whatever reason, they can't or they don't want to continue on the meds. We need to give them a runway that gives them the best chance of keeping the meds off. This, in my mind, Hope, is a wonderful opportunity for lifestyle change and for dietitians. And then the third one is some combination. So it doesn't mean if you go off the drugs, it doesn't mean you can't come on them episodically or when you need them. So some combination, but on all three of those, there's a role for registered dietitian. And you talked about exercises being important. And even the other thing that comes up is you can have nutritional deficiencies on the drugs because people eat so little oftentimes.

Hope Warshaw:

That's right. You just covered a number of roles of RDNs from the get-go. We've talked about side effects, and that's, I think, one of the biggest things that's known. Nausea, vomiting, I think, is better known than constipation.

Jim Hill:

Yep.

Hope Warshaw:

What I understand, that is a big issue. I would like to see, and we used in this paper, the term prevention. Prevent and manage. If someone is in front of an RD and talking about you're going to go on this medication, stop eating the second that you feel any level of fullness.

Jim Hill:

That's a great point is you're preventing the negative side effects.

Hope Warshaw:

Right. Get as much fiber as you can. And you may need to even start a fiber supplement. So giving people the education that they need, that these medications are going to tremendously impact your appetite and your hunger, and you may not have any. But it's critically important that you eat nutrition-dense food choices, that protein is very important, etc.

Holly Wyatt:

So, you know, we, we do a lot of times require, but a lot of times in bariatric surgery, we, you know, registered dietitians are involved from the very beginning for exactly the reasons you're saying, what should you eat even before you start? So you don't get into trouble. And then what should you prioritize eating? So you get the nutrients you need and we require that. And we're seeing not quite as much weight loss as we see in bariatric surgery, but we're getting up there in terms of the amount of weight loss and how fast we lose the weight, etc. So it would make sense then we would also use registered dietitians to help with these medications.

Hope Warshaw:

Right. But herein lies a big rub, Holly, and you guys know this, is... Referral, and coverage. And in metabolic bariatric surgery, which is way less frequently done than the handing out of these prescriptions. I mean, we have guidelines, we have standards, we have RDNs incorporated in these sort of obesity centers of excellence, and they're there. And they're part of the care. I've been talking about this area of GLP meds now for over a year and a half. I know, Jim, you know that as with the academy, I was very much part of developing a series of webinars that have been highly watched. And I also know, you know, Linda Gigliotti, she and I have been like partnered coast to coast for a year plus. And we have often been trying to use that analogy to what has evolved over the course of time related to RDNs in the area of metabolic and bariatric surgery. One can only dream, I suppose, that the same would be true. And I think we would have a heck of a lot better outcomes.

Jim Hill:

So this whole idea of insurance coverage is a big one, because the insurance companies are even struggling with providing the meds, much less providing some expertise to help. But in the long run, being able to get reimbursed for seeing experts like registered dietitians would be a way to make all this more effective. There's no question.

Hope Warshaw:

We would like to think, Jim, if an insurance company says, sort of show me the money or where's the research... I don't know that we yet have it.

Jim Hill:

We don't, but we desperately need that, I think.

Hope Warshaw:

I know. Let's do an RCT.

Holly Wyatt:

Yeah, but we can't wait. This is the other thing.

Jim Hill:

This horse is out of the barn.

Holly Wyatt:

I get it. I think we need to be collecting the data.

Hope Warshaw:

Oh, God, yes.

Holly Wyatt:

We need to get it. I'm not saying that we need guidelines. I'm not against that at all. But right now, we've got people giving people information, and we can't wait for randomized controlled trials to be published and look at and all that. We've got to get some good information out there now.

Hope Warshaw:

Right. And the truth be told, also, when you look at the studies that have been done for FDA approval of these meds, there are components of lifestyle education.

Jim Hill:

Right.

Holly Wyatt:

Always.

Hope Warshaw:

And RD utilization, behavioral coaching.

Holly Wyatt:

All the studies had some aspect of that. Every single one.

Hope Warshaw:

That's right. That's why FDA is allowing the study to go forward. But we don't do a good job replicating that.

Jim Hill:

So that's the way we wish the world is. Let's talk about the way the world is, Hope. If somebody now, our listeners, are thinking about going on one of the obesity medications, how can they find a dietitian? What would be your advice for them connecting with the registered dietitian?

Hope Warshaw:

I think it's very different depending on where you are sort of getting this prescription. Let's sort of track that. If you are getting a prescription from a prescriber in an obesity medicine center, I would imagine that there's much greater access and referral to an RDN. If you're seeing your primary care provider, and I have nothing against primary care providers, they are overwhelmed and overloaded. And if someone walks in and says, can I get a script for, you know, Ozempic, because that's the name they know from commercials.

Jim Hill:

Right.

Hope Warshaw:

You think they're going to get referred to an RDN? I mean, no, it's not happening. So I think getting this message out to consumers to say to their primary care, “I've heard that even before going on this medication, it would be excellent for me to start to develop a coaching relationship, an ongoing coaching relationship with a registered dietitian nutritionist. Do you have any you refer to?”

Jim Hill:

Oh, I love that. I love that. So put it back on your primary care physician.

Holly Wyatt:

Yeah, I like that. then bringing them in and they're prescribing that medication. So it makes sense, right?

Hope Warshaw:

That's right. I wonder when we brought up in this publication about an RDN, even observing your injection technique, these are injectable.

Jim Hill:

[27:31] Ah, I love it.

Hope Warshaw:

How many people that are one that not that they're difficult, but you know, we just make the function that people are going to know how to do this and take it and hold that in.

Jim Hill:

Oh yeah. That's a great comment. And also, Hope, I think a registered dietitian could help people think through that long-term strategy. What is your strategy? Are you going to keep taking these? If not, what's your backup plan? Because what we know right now is if you stop the meds without a plan, you're going to regain the weight.

Holly Wyatt:

Yeah.

Jim Hill:

Wow, Holly.

Holly Wyatt:

Yeah, I think asking your physician, I like that. I think that's the first place to start. And I also say if your physician doesn't give you the answer you need, keep looking. There's usually other people in the practice or maybe somebody who has a specialty in obesity or weight management.

You can always talk about it that way. I want to shift just a little bit. So much noise out there. We talked about the influencers. We talked about everybody thinking they're a nutrition expert. How do you approach this? How do you get people to distinguish Hope Warshaw, trained, nutrition expert, you know there's going to be science behind what you're talking about, from Tammy with no training, who's doing a TikTok in her bedroom with a dance or whatever. I'm exaggerating a little bit, but you know what I'm saying.

Hope Warshaw:

First of all, I love that you guys use that phrase about whoever eats and we all eat thinks they're a nutrition expert because I use that. And I would tell you, I think it's a more challenging time today than it was 30, 40 years ago to be an RDN and to say, I'm the food and nutrition expert. But I like to help people see the big picture regarding healthy eating and disease prevention and to really focus on what we know. We know without a shadow of a doubt from many research studies and guidelines: eat plenty of fruits and vegetables. I mean, I don't think there's any doubt about that - fresh, frozen cans, don't really care, just not sauced with lots of butter and cheese. Choose whole grain and high fiber starches and cereals. Eat more beans and peas and legumes - great, very overlooked and under-consumed food. Eat more nuts and enjoy protein sources that are lean and low-fat and treat them as a side dish, not your main course. I mean, those are really some of the generalities.

Jim Hill:

But Hope, the other thing that dieticians can do is put that into practice, that can put that into, okay, here's what you buy at the grocery store. Here are recipes you might want to look at. So taking the general advice and making it work for you, given your preferences and your lifestyle.

Hope Warshaw:

That's right. Yeah. Based on sort of a deep assessment.

Jim Hill:

Yes.

Holly Wyatt:

[30:50] Jim and I call that putting the pie in the plate. You know, you got the pie in the sky. It sounds good. But then it's like, how do I put this in something my family will eat on a Wednesday night when I work till 7 p.m.

Jim Hill:

[31:03] That's what dietitians can do. That's where they can really help you.

Hope Warshaw:

I think of all this noise tend to make this task more difficult than it needs to be in reality. I mean, you hear all this noise around, “Oh, it's really expensive to eat healthfully.”

Holly Wyatt:

Well, that's excuses. Also, this is why I think I don't do it. But in reality, you can solve that problem. And they still don't eat vegetables, you know.

Jim Hill:

And again, back to a registered dietitian, whatever your budget, they can help you find foods that work.

Hope Warshaw:

That's right.

Jim Hill:

Holly, I want to get into some listener questions. But before we do have one more for you, Hope. If I'm trying to find a registered dietitian, can I just get on the internet and find a registered dietitian near me?

Hope Warshaw:

You can. I'm fairly sure if someone uses that website that I mentioned before, the Academy of Nutrition and Dietetics, consumer-facing side, [eatright.org](http://eatright.org/), you can find an RD. Now, I will add one caveat, and that is, yes, there are over 110,000 registered dietitian nutritionists, but we work in a huge breadth of areas. I mean, there are people in oncology, there are people in sports nutrition, there are people who work for food companies, for restaurants, for etc. So I don't want people to think that all of this 110,000 individuals are focused on obesity care.

Holly Wyatt:

So maybe it's looking for someone who has an RD or RDN after their name and specialty in weight management, obesity, or maybe diabetes, if you have diabetes, lifestyle, looking for that. But I do think it's critical to look for those credentials now, really look for, you know, the letters after the name, because they mean something because you do have that science backed training, which I do think is important.

Jim Hill:

Holly, let's do a couple of listener questions. You want to do one?

Holly Wyatt:

You go first.

Jim Hill:

Okay. Here's a question. I know I should eat healthier, but I struggle with making it work in my busy life. How do RDNs help people create sustainable eating habits?

Hope Warshaw:

We covered that a bit, but the first thing I would say is we ask lots of questions. We assess by asking lots of questions. And I mean, really, one of my favorites, if I'm in front of someone who is contemplating maybe going on one of these medications or embarking on a weight management plan, is what is your why?

Jim Hill:

Oh my gosh, Holly.

Holly Wyatt:

That's my language, Jim.

Jim Hill:

She is hitting all of her buttons.

Holly Wyatt:

Yeah, definitely. We start with that. I start with that.

Hope Warshaw:

If your why is to get into a wedding dress in three months or your mother of the whatever dress or being a bikini, no, no. It's really got to be focused on long-term health.

Jim Hill:

Cool.

Holly Wyatt:

Yeah. I'll take any why, Hope, though.

Hope Warshaw:

Okay.

Holly Wyatt:

I'll take that wedding dress, but we'll dig deeper. We'll dig about what you really want. What's the reason you want to get into that wedding dress? Let's dig a little deeper, see if we can broaden it out, really get to what you want to experience and feel. But I'll start with anything. But I love the idea of starting with why instead of what. People tell me what to eat. I'm like, nope, we're not going to start with what to eat. We're going to start with why you want to do this so I'm 100% on board.

Hope Warshaw:

What to eat depends on who you are, your food likes, what's your family situation, and budget.

Jim Hill:

See, that's so different than one size advice fits all. You go out on TikTok and everybody should be eating quinoa or whatever. You make it personal to the person. I love it. Holly, you want to do one more?

Holly Wyatt:

Yeah, this is a big one. You're just going to be able to hit the top, but we could do a whole podcast on this one. But this one is a question we get a lot. I've lost weight before, but I always gain it back. What strategies do RDNs use to help with long-term weight maintenance?

Hope Warshaw:

Well, firstly, I think you really have to have an ongoing coaching relationship with an RDN or it could be a Weight Watchers group. It needs to be within the realm of what someone can afford. And this is all about helping people make long-term lifestyle changes. And Jim, I know I've heard you talk about who you associate with.

Jim Hill:

Yeah.

Hope Warshaw:

I mean, there's research on that.

Jim Hill:

Absolutely.

Hope Warshaw:

I mean, I've long restaurant eating and healthier restaurant eating has been sort of one of my beats for a long time. I mean, if you were doing that three, four, five days a week, you just can't continue doing that. I mean, can you go out to restaurants and enjoy restaurant meals? Absolutely. Let's talk about how you can do that. I would also say exercise, exercise, exercise. I mean, it is critically important. And I know neither one of you agree with it.

Holly Wyatt:

Well, and in weight loss maintenance, I love it. We're talking about weight loss maintenance. So you got to talk about the exercise. I totally agree.

Hope Warshaw:

[36:48] And also, as I'm experiencing, I mean, the older you get.

Jim Hill:

Yeah. Tell me about it. It's harder.

Hope Warshaw:

It don't get any easier. Yeah.

Jim Hill:

All right. This is the part where we ask a couple of vulnerability questions, Hope, and I'll go first. You've had a really long and successful professional career. If you could go back and give yourself advice when you were just starting out, what would that advice be?

Hope Warshaw:

So, I am pleased that early on I did sort of find these niches of diabetes and weight management. I think I would have enjoyed perhaps being involved in doing some clinical research and or, because I think you can do both in that realm of being in academia and an RDN who is training the next generation of my colleagues.

Holly Wyatt:

Wow. So you can still do that though, right?

Jim Hill:

People are living longer, Hope, you know?

Hope Warshaw:

One can dream. Yeah.

Holly Wyatt:

All right. I've got, I got another one. This is one I always ask, but I really like this. You're obviously an expert. You give a lot of the science-based nutrition advice, but I always say even the experts, and this is a question I have to talk about myself all the time, struggle with their own habits. So how does your personal lifestyle look when it comes to eating and movement? Where do you struggle? You know, you may say one thing, but you may struggle. And I also use the example of, I'm always in the grocery store. And I have my cart filled and I see one of my patients or one of my and they're like, we're like looking at each other's carts and you know.

Hope Warshaw:

Cart assessment.

Holly Wyatt:

Cart assessment. Yes.

Hope Warshaw:

So you're asking sort of what I personally do to manage my weight?

Holly Wyatt:

Or where you struggle maybe. It's one thing to say eat these vegetables but is that where you struggle or maybe a different area where do you struggle personally.

Hope Warshaw:

Think I struggle in the limiting what we would consider those unhealthy but yummy foods. And I'm not a preacher of avoiding, particularly with food. Yeah, you can avoid cigarettes, you can avoid alcohol, but with food, it's really...

Jim Hill:

You got to eat.

Hope Warshaw:

Yeah. And you got to make choices. So I think for me, if there were a bag of chips around...

Jim Hill:

Oh, chips, Holly, that's your thing too.

Holly Wyatt:

That's mine. See, look, we channel each other. Chips are my thing. I cannot go down the chip aisle in the grocery store. I just don't go down it. ‘Cause if I go down it.

Hope Warshaw:

You can't have them in your house.

Holly Wyatt:

No, can't have them in my house. I get a single serving somewhere. It's not that I never have them, but I can't have in my house and I can't go down the chip aisle.

Hope Warshaw:

Right. And I mean, I think the other is sweets, for me. It's like I want to have, and it can be a small amount of something really delectable. Like don't waste my time on crappy yellow cake from the groceries.

Jim Hill:

Give me the good stuff. Alright. Hope, this has been an incredibly useful conversation. I think the take-home message here is you have to understand there are health professionals out there, registered dietitians, registered dietitian nutritionists. These people are trained. They're trained rigorously. They can absolutely help you whether you decide to lose weight on the medications, on your own, or you want to just change your lifestyle. These are incredibly useful people and take advantage of them.

Holly Wyatt:

Yeah. So as we close, we like one piece of pie in the plate, right? Like I say, pie in the sky to pie in the plate. So could you give our listeners just one small change that they could make today that aligns with maybe how an RDN would guide them toward better health? Just something they could do today.

Hope Warshaw:

I'm very much a fan of to thine own self be true and by that I mean take an honest assessment of your current eating habits and food choices be honest and you've got to know that because before you can set some goals and know what is reasonable to change you got to know what you're currently doing. Oh, through that little self-assessment, I realized I don't even eat a piece of fruit a day. Make your goal. Eat at least one piece of fruit per day. I mean, that sounds so simple, but when we talk about changing eating habits, which we hold very close to our heart, and it's tied into a lot of stuff, it's hard to make those changes and make them stick.

Holly Wyatt:

I like that. Awareness.

Jim Hill:

Great advice.

Holly Wyatt:

Start one little thing. Be aware. Love it.

Jim Hill:

Well, Hope, thank you so much. It's been a wonderful conversation and we so appreciate your time.

Hope Warshaw:

Well, it's been a delight.

Jim Hill:

And we will talk to you next time on Weight Loss And. Bye.

Holly Wyatt:

Bye, everybody.

Jim Hill:

And that's a wrap for today's episode of Weight Loss And. We hope you enjoy diving into the world of weight loss with us.

Holly Wyatt:

If you want to stay connected and continue exploring the “Ands” of weight loss, be sure to follow our podcast on your favorite platform.

Jim Hill:

We'd also love to hear from you. Share your thoughts, questions, or topic suggestions by reaching out at [weightlossand.com](http://weightlossand.com/). Your feedback helps us tailor future episodes to your needs.

Holly Wyatt:

And remember, the journey doesn't end here. Keep applying the knowledge and strategies you've learned and embrace the power of the “And” in your own weight loss journey.