Becoming comfortable with discomfort: Why nutrition in obesity care needs to feel different with Jennifer Brown

– Welcome back to “Scale Up Your Practice.” I’m Dr. Roshan Abraham, a family physician and associate professor at the University of Alberta.

– And I’m Michelle McMillan, a lived experience expert. Over time, living with obesity, I’ve realized how important it is to have a team of healthcare professionals working with you, especially when it comes to nutrition. That environment can really make a difference in how I feel supported and managing my health.

– And I can definitely agree that in my role as a family doctor, nutrition plays a massive role, not just in the care of obesity, but in all chronic disease, and honestly, in every aspect of my practice. It’s really essential that we take a deeper dive into it whenever we have an opportunity. And I’m really excited about today’s episode because we are taking that deeper dive into the broader team-based approach to obesity care.

– We’re gonna take the deep dive into nutrition. And I guess I have to add, it’s not just about the food, it’s about feeling supported in a way that makes you feel like your team is taking all of you and the whole picture into account.

– And I think when we work together as a team, we’re actually able to better tailor that care to someone’s needs, and more importantly, their goals, so it’s not just something that fits a checklist. So today’s episode might challenge the way that you think. We’re talking about discomfort, not just the physical kind, but the emotional and even systemic discomfort that comes with changing the way that we approach obesity care.

– That’s right. We’re diving into this idea through the lens of a registered dietitian who’s been challenging some of the traditional norms of nutrition counseling.

– And so we are really excited today to have us join us on the podcast, Jennifer Brown, a registered dietitian and certified bariatric educator. If you’ve read the Canadian Adult Obesity Clinical Practice Guidelines, you’ve seen her work. She was the lead author of the Medical Nutrition Therapy chapter.

– She’s also a member of Obesity Canada’s Scientific Advisory Committee, and has spent her career advocating for weight inclusion, evidence-based care. Jennifer, welcome to the podcast.

– Oh, thank you so much.

– We’re actually really excited to have you here. You’re someone that we’ve worked with or been involved with through the work that we’ve done in Obesity Canada. So let’s dive right in. One of the terms that often comes up in our discussions, especially within clinical practice, is medical nutrition therapy. We had the lovely opportunity of presenting together at a conference not too long ago, and that was the theme of one of the talks. But for some listeners, especially those outside of healthcare, that might not be a familiar phrase. Can you start by helping us understand what exactly medical nutrition therapy is and why it’s such a vital pillar in managing obesity?

– Yeah. Thanks so much, Roshan. Medical Nutrition Therapy, or something we like to call like MNT, it’s a evidence-based or like a science-based approach to using nutrition to help manage a whole variety of different conditions. Oftentimes, it would be, you know, things like diabetes, obesity, cardiovascular disease, but it can also just be basic, you know, budget, you know, eating on a budget, or anything that involves someone’s nutrition and how it affects their health socially and emotionally and medically and emotionally. So, yeah, it involves, you know, a nutrition assessment. There’s usually a nutrition diagnosis that a dietitian makes, provided, you know, looking at different nutrition interventions that help to support that person, and nutrition counseling. So, yeah, nutrition, or MNT, is nutrition therapy, it’s typically delivered by registered dietitians, and oftentimes, it’s alongside other healthcare professionals, like yourself, like a doctor. So it’s a vital piece of any part of someone’s health. But when we’re talking about obesity, it’s one of the more fundamental pieces, ’cause we all eat. The piece that I think a lot of us maybe don’t recognize is the individualized care that nutrition can play depending on the pillars of treatment that are being used. So if we’re, you know, looking at the obesity treatments, we’ve got, you know, the psychological approaches, pharmacological approaches, and surgical approaches, well, nutrition can be tailored, and there’s different nutrition interventions and ways that can actually help support individuals from each of those different pillars. So it’s pretty broad-based, but at the same time can be narrowed down depending on the evidence and what works for the person.

– Wow. I like that in the fact that, you know, it’s not just, “Oh, good, I’m going to go to someone, and I’m going to go to Jennifer, and she’s going to tell me what to eat or what to not to eat. And, you know, that’s the solution,” right? You know, I think you and I have met each other, and we’ve had a bit of a running joke with clients who come into your office and be like, “Okay, just give me like the food plan, and I’m good,” right?

– Yeah. “Tell me what to eat, and I’ll do it.”

– Absolutely.

– Yeah.

– You know, it’s such an essential process, you know, making it more than just a food plan. But I’m going to kind of lead this a little bit. I’m going to tell a little side story here as we lead into this. So the first time that I met you, I was introduced to you by someone who was also a lived experience expert, and she introduced you as a dietitian. And I think I might have done a little of, I might have slight PTSD a little bit from some experiences with some dietitian. And the person just said, “No, Michelle, Jennifer is one of the good ones.” And there are lots of good ones, and you are definitely one of the good ones. So I’d be interested to know, you know, when you meet clients, how do you start that really hard conversation, which isn’t just, “Here’s the meal plan, carry on.”

– Oh my gosh. Well, thank you, Michelle, first off. You know, I have to say, I always was really taken back when I would hear some of the horrific stories that a lot of my clients and patients have told me over the years of their experiences with dietitians. And, you know, it was one of those things that made me cringe as well. And I then remember, and I think it was at an Obesity Canada summit. And I had an opportunity to chat with people with lived experience. And I remember saying like, “Obviously, as a dietitian, I’m very biased and skewed around it, but like what has your experience been?” And the word trauma came up a lot. And that really, really resonated with me. So I actually start off all of my conversations with anybody who walks in my door, just to say that, you know, “You may have experienced some horrible experiences in the past with health providers, especially dietitians. And for that, I am utterly horrified. And I apologize on behalf of our profession.” You know, we, hopefully, with more training and more empathy, and just understanding and listening more, people can do better. But I definitely want to make a safe place for people. And I usually start by saying like, “I am not ever going to tell you what you can or can’t eat. You are the expert of nutrition for you and your family. I’m just here to help support and make sure that that nutrition matches your values, your goals.” You know, obviously, I’m still looking at things from a biomedical and a psychosocial and a whole holistic lens. So if anything, I just want to be kind of that conduit between the science and the practice of it, and really support people in whatever way they need. But yeah, it’s disheartening when I hear that there are bad ones out there. But I think like any profession and any human, there’s good ones and bad ones. And hopefully, over time, the bad ones learn and are more self-aware, and become better.

– I think this is actually a great topic of conversation for the podcast, even as the series, but I mean, we haven’t had a chance to really dive too deeply into trauma, and I know that it’s a challenging concept to do in clinical practice, let alone a podcast. But I think I do appreciate that, the good versus the bad. I find that as an educator, someone who’s actually seeing the students right when they start, and then seeing them, in many cases, when they graduate from like a family medicine residency program, because I see both ends of the spectrum, I do find that it is the system in many ways that conditions a lot of healthcare providers. There’s definitely some bias that you kind of select for in our professions, and we definitely see that when we start. But a lot of that is reinforced then, and the effort to really approach trauma and address trauma is totally left by the wayside. And nutrition and food and your relationship with food is something that is challenging for so many people and has deeply rooted trauma that’s attached to it for many people. So being able to be open and honest with our patients, that this is something that we struggle with as a profession, I think is really important. And I’m hoping we can sort of make that big change with our education systems, so that our future colleagues are better with dealing with trauma, especially around chronic disease and around food and nutrition. And I think it is something that hopefully we can start spreading the word about it as much as possible. And really, it’s getting comfortable with the uncomfortable. And I wanted to actually dive deeper into that, is that, how do you actually do that? What else, I mean, that shows up in your work and practice when supporting people living with obesity, how do you actually get comfortable with the uncomfortable, because that’s ultimately what we’re talking about.

– Yeah. You know, that’s something that I’ve been, I think, thinking about for quite some time, around that uncomfortable feeling, because everything that we talk about when it comes to food and nutrition is an incredibly personal story that we’re asking people to share. And as a dietitian, we’re trained, you know, to, we want to try to better understand someone’s, eating preferences and their values and, what a day looks like for them, what works for them, what doesn’t work for them. But we also recognize there’s so many barriers and factors in our world that are also influencing it, whether it’s the past trauma, whether it’s lived experiences that, again, could be, quote, unquote, “good or bad.” But there’s also the worry, I feel, that people sitting across from me are feeling like they’re judged, or-

– Right.

– Feeling like they should be telling us what we want to hear. And I think that it’s uncomfortable, I think it’s uncomfortable for our clients and patients to have to sit there and talk about their food and nutrition. So as a provider, I think just calling that out like a lot of times.

– Yeah.

– I just say like, “Sometimes, we’re going to have some uncomfortable conversations. And I want you and I to have a really great relationship where you can tell me, ‘You know what? I don’t want to go there,’ or, ‘You know, Jen, this is what I do want to talk about today.’” And sometimes it’s, it’s something we just evolve and we discuss over time. But I think just making space, making space for that uncomfortableness, and recognizing that there’s so many puzzle pieces to it, and sometimes it’s completely out of scope for a dietitian, which we can still listen there’s lots of pieces that become very uncomfortable. But just being human and offering a place to listen, and then offering what else could be there to support someone, if and when they’re ready, is a place to make it less uncomfortable.

– I mean, as you were saying that, I was just thinking, it just occurred to me that the profession that you’re in is unique in the fact that we talk about something physical, food, right? But food is more than that. Like, I know some people, you know, as I say, God bless them, who can absolutely live by food as fuel, and that’s all it is to them. But I think the vast majority of us, you know, food is celebration.

– Yeah.

– Food can be stress relief. Food can be the way that I show you that I love you, right?

– Yeah.

– For children or parents. You know, so it’s really complex, and I can see sometimes I’m starting to think maybe you need a degree in like nutrition/psychology to monitor these sessions, so I can just imagine.

– Yes.

– And also layering in, I come from a very privileged place. I didn’t grow up, like when I grew up, I could open the fridge, and there was always food in the fridge, but not everyone came from that place, right? And it’s so challenging coming from that really challenging thought, what do you think, and Roshan talked about new nutritionists or doctors, what kind of would be your advice on where’s the starting place to start unraveling this very complex discussion that you need to have with your clients?

– Oh, that’s a, no pun, it’s a loaded question, because it’s such a complex topic. I think, just for everybody, we all live in the same world and society, and we’re all bombarded with a lot of the same messages, a lot of it is probably debunking some of the myths and, the nuances around nutrition. So, for example, and I know every dietitian is going to have a different point of view, but I personally have a hard time with the words healthy and unhealthy or good and bad because it really precipitates the stigma of food and whether it’s health or our weight or our body size or, our overall well-being. And like you said, Michelle, like coming from a place of privilege is, and coming from a place where you may not have had access to food, you may have had times of your life, especially during childhood, where you were hungry or deprived foods, or food was used as a punishment, or it was, you weren’t allowed to have certain foods. I think that’s a piece that I feel that there needs to be more of that conversation. And as a dietitian, we do, luckily, we do get a lot of training in psychology and sociology. And yes, we get all the biomedical piece and the physiology and the metabolic part of things. But, a lot of it is we have to do extra training. And not every dietitian is going to be a specialist in a certain topic, but I do feel, when we talk about food and we talk about nutrition, there’s just, there’s so much within our society that it makes it very confusing. So as a dietitian, I think it’s really important for us to be able to translate that science to folks, but letting them know that it’s okay. There is no right and wrong food. There is no good or bad food. There might be foods that you don’t feel good when you eat certain foods, that doesn’t mean you can’t have them, and vice versa. There might be other foods where you actually feel like you do want to have them. And like you said, Michelle, it really depends on how we’re… We eat foods for all kinds of reasons. I have found, though, that through my career, and I’ve really had to go back and do a lot of education in this, was understanding the science of food and the brain and the gut, and all of those factors.

– Yeah.

– And I feel like when I started actually, teaching that to people, like when I started talking about it, and, “Hey, did you know,” or, “Hey, I just learned this. You know, did you know this?” I found that when we started to explore that together, all of a sudden, it was like light-bulb moments for people, where it was, for the first time, they were recognizing that, “Oh my gosh, I’ve been doing things right my whole life. I just put food on a pedestal and made me think that, I could never have that because it made me, gain weight, or it made me, you know, or I have to eat this way because it’s the only way I can lose weight.” And I feel like that’s a big piece as a dietitian, is that we’re really shifting that narrative and recognizing the importance of food and nutrition, and not around deprivation or restricting anything.

– That’s honestly incredible. In previous episodes, we’ve talked about the grand apology and, I mean, talking about being up to date with current research and education, and really being okay to admit as healthcare providers that we’ve come a long way, right? I think, like I completely agree with that. And I think the amount of connection you can make with patients to really extend the hand and say, “Hey, we’ve made mistakes in the past in our approaches.” It’s something I constantly am doing, not just around obesity management, but chronic disease management in general. I think it’s crucial for us, as healthcare providers, to say the science has come a long way. How we’re communicating it now needs to be even better. And we really need to be listening to the stories and to the people behind those stories. So I can’t thank you enough for bringing that up because I do think there really is that light-bulb moment for a lot of patients when you do actually make those connections,

– I often feel like we’re kind of turning a corner. I don’t know whether, I hope that, in general, the whole medical community is turning a corner, and, you know, having people like Jennifer and yourself, Roshan, like, just like Roshan. It’s so important to not only for you to lead, but also to teach the next generation. And so I’m hopeful, I feel like we’re turning a corner, but I’d be curious for myself and also for our listeners, do you have one small thing where you can kind of feel like, “Oh, this shift is happening. We’re changing the dialogue with our current colleagues and the next generation.” Maybe I’ll start with you, Jennifer. And then, Roshan, I’ll let you join in.

– Yeah, absolutely. I mean, I’m incredibly excited about the next generation of dietitians coming up through their training because they are getting opportunities to understand and learn a lot more about that trauma-informed care that we kind of talked about earlier. And they’re also being exposed to a lot more counseling, which I don’t believe us older dietitians had as much, we had to kind of do a lot of that on our own. And to be honest, it doesn’t matter if we are trained in it, it’s a lifelong skill that we constantly have to learn. But I really find that a lot of the students that I’ve had the privilege to work with over my career have, they’re so open to change, and they’re very open to kind of unlearning and relearning things. I think it depends on the person. And there’s a lot of pieces that we still have a lot of work to do in this area. But I am definitely excited to see more dietitians recognizing the social complexity and the insecurity that a lot of people have when it comes to food. And so I feel like that piece is becoming more upfront, whereas the older, and I’ll say my generation. Although as a side note, I do find it weird to say that I’m now an older dietitian, because I don’t think like that, but I am. I’ve been doing this now 18 years, and a lot has changed. So it’s nice to that there’s things changing. The one thing that I will call out my dietetic community for is that I think there needs to be a lot more openness to listening to different viewpoints. We talked earlier about that feeling like being comfortable with being uncomfortable. This is something I’ve had a lot of discussions with my colleagues about and with students as well. Because right now, there is a shift. We are seeing a change in how dietitians talk about food, talk about weight, but almost, in our profession, what I see is a little bit, there tends to be some polarization. And as a community, it’s important for us to respect and understand the science from both ends, like both sides and all viewpoints. And really, the front of it is, it’s our clients, our patients, it’s our, people that we’re caring for is what matters. It’s not our opinions, it’s not our own lived experience. It’s the person in front of us, that we really need to make sure that we’re putting them first. So, yes, I’m hopeful. Yes, I still want to see change. I don’t know about you, Roshan, but, I know that the new generation I’ve seen of med students and doctors, they’re starting to have better conversations and understanding, especially nutrition. I think they’re recognizing the importance of nutrition. But I’m interested in your thoughts.

– I’m an optimist. But in this area, because of I think how much I’ve seen over the years, the shift isn’t as monumental as I would like. In fact, I was trying to remember the book that I’d read. I don’t know if any of you have read the book by Victor, Dr. Victor Montori, about the patient revolution. And so, for our listeners, I’m sure a lot of you know, if you’re not aware, he is an endocrinologist out of the Mayo Clinic, and has written many pieces, done a lot of research around chronic disease management and the patients’ lived experience as well as a patient-centered care. And after reading that book, it really resonated with me as an educator how much that shift actually comes from patients. So when you think about the moment in my career, I mean, it’s with the GLP-1 medications that have come through, really seeing, almost opening up, sort of peeling away these layers of stigma and bias that have just sort of peeled away after years and years of a hardened shell, if you will. And these medications have, in essence, allowed us, again, in combination with excellent nutrition therapy with physical activity, which many of them were doing, part or all, in the past. It’s just being able to optimize those things. It’s not that it completely wilts away, but you can actually start having conversations because people’s own internalized weight bias seem to sort of shift away and seem to be like, “Oh, wow, this is something that I can do with the help of a team around me. I feel empowered. I feel like it’s not been my fault this entire time.” And so the spark that I’ve seen from patients, and again, I don’t have an obesity-focused practice. I’m a family doctor that sees obesity all the time because it’s a chronic disease in our practice that we see all the time. I think the patients are really the ones that are going to lead in this way, I feel, and really by exemplifying how strength really manifests in people. I think students need to see that. It’s one thing for them to hear me get up on stage in front of a lecture hall and tell them in the most cool way possible about, wow, you know, weight bias and stigma is different and how it applies to this patient case. And I do lots of innovative stuff around podcasts and all these things. The moment it hits for them is when they’re sitting in front of somebody, and that patient actually tells them, “Hey, you know what? The last visit where we talked about this, it really changed the way I looked at myself. It really changed the way I approached my chronic disease.” And I think that’s the moment that we actually see that shift. And so being able to be a part of that and be an educator to see that’s actually the impetus for change that we need is something that’s been the shift in my career probably over the last few years. So this is even after I’ve been more involved with Obesity Canada. It’s actually been the medications that have really prompted that shift. And it’s allowed us to have more of an open conversation with patients to really learn about who they are because you’re actually getting rid of some of that internalized bias. And I think that’s been a huge shift for me. And trying to bring the learners into those conversations is what I try to do. So my residents, more so than the medical students, because we’re mostly a residency site for clinical teaching, that’s what I try and do. I try to bring them in on all of the follow-ups that I do if they’re there, or the initial consultations when it comes to obesity management.

– You know, you said something there, Roshan, that it reminded me of one of the little things that I’m hopeful that we’re seeing a bit more of a shift in this, but one of the little pet peeves that I know any dietitian listeners out there right now will be like, “Yes, yes, Jen, say that again.” One of our biggest pet peeves was always, is still always, referrals from doctors for, quote, unquote, “weight management,” because it just, it emphasizes more of the stigma that, “Oh, you just need to eat healthier. Oh, you just need to”-

– Yeah.

– “You know, reduce your portions,” or you don’t even have to say anything about food. As soon as you say to someone, “Go and see the dietitian,” there’s just an automatic assumption. And then back to the point we talked earlier about, you know, when, Michelle, what you shared too around the trauma, that experience of having perhaps a bad, appointment with a dietitian at some point in your life, it just, again, perpetuates more bias and stigma around food and nutrition. Whereas now, with the medications and even surgery to an extent, we recognize like the importance biology piece of it.

– Yeah.

– And how no, you’re not going to see the dietitian for weight management. You’re going to see the dietitian to help enhance your nutrition.

– Exactly.

– So that it helps to support your treatment for obesity.

– Exactly.

– And I think that’s a-

– Exactly.

– Big shift where I think all of us, all healthcare professionals and clients and patients and the public, where we need to do a little bit more advocating or… And it’s starting, like we’re starting to see breakdowns in the diet industry. But I think that’s a big, you know, that’s a big piece, that we really need to have some honest conversations around nutrition and how when we talk about food or we’re looking at, quote, unquote, “treatments,” there’s a risk of that turning into some form of disordered eating. And I think, as dietitians, we’re very sensitive to that because we see it so much, and because the past treatments around nutrition for obesity was always, you know, cut your calories and restriction, and don’t eat this. And a low-fat, low-carb, all of these different terms that we would hear and still use sometimes, it can be problematic. So I think that that shift and really understanding the importance of enhancing nutrition for medical health, for emotional health, for functional health is incredibly important as we move forward in this.

– So let’s take a moment for our bias break, where we reflect on weight bias and its impact on care. Jennifer, did you have a particular story or experience that you quickly wanted to share with us? It could be something that happened within the last few days, week, maybe even month or year, that would be meaningful for our listeners.

– Really great question, Roshan, a bias or something I’ve experienced. Well, I mean, I can share a personal experience I’ve had as a health professional, as a dietitian. I have actually been bullied on social media within our, within my profession for working in metabolic and bariatric surgery. There’s been things I’ve shared or asked, in closed social media-type of support groups, where it led to some pretty polarizing and argumentative type of discussions amongst a whole variety of dietitians. I still remember the day I opened up my, my social media platform, and there was over 200 comments on something. And I had never experienced something like that before. I was like trying to process it and understand all the different points of views. And what I found interesting was, anybody who was trying to back up my, what I was trying, what I was sharing or asking, they too were getting bullied. And so it was very interesting. In fact, it was one of the first times in my career where I really saw that polarizing experience that our profession has. But at the same time, it really led me down a field of curiosity because it opened up my eyes to recognize that, there are things that we don’t all agree on. And I’ve definitely learned so much more over the years having had that experience and understanding their point of view. And I don’t want to say their point of view because there’s, I think all dietitians, we all have our own opinions. We also have to recognize that opinions aren’t facts. And that’s a big piece that I try to bring forward, is the fact that you can have, you know, you have the right to your opinion, but you don’t have the right to facts. And so that’s a real big important piece that I want to make sure that always comes forward. So, yeah, it was definitely a, you know, just seeing interdisciplinary bias just working in the field. So if there are any listeners out there who are feeling like they don’t feel comfortable talking about obesity, they don’t like saying the word obesity, they don’t want to talk about bariatric or, metabolic bariatric surgery, or they feel like they’re gonna be shamed because they talk about medications, I think that it’s important to… You know, you’re not alone. I think there’s a lot of people out there that are afraid to say certain things, and that’s why organizations like Obesity Canada, and there are lots of other groups out there that I feel are making a safe place for people to talk about their experiences. But yeah, that would be, I think, right up top of my personal bias and stigma that I ever, I experienced.

– Wow. Thank you so much, Jen, for sharing that and for being so vulnerable around what we, many of us, are going to see and sometimes experience in the workplace, especially as a healthcare provider. So thank you for that.

– And on behalf of patients, I mean, it’s like thank you, thank you for being our voice in the room, because, clearly, as per your discussion, you know, there isn’t consensus, and there are, I hate to use the word, but there might be a few bullies out there who have some very old-fashioned ideas about why people live with the excess weight, which may not be based on the current research. And I’m so proud and happy that there are people like you in the field that are like, “No, this is what the science says,” and you’re willing to deal with those 200 messages in your inbox in the morning, because that’s a tough ask for any profession.

– That’s a tough ask.

– Yeah.

– That’s a tough ask.

– Yeah.

– Yeah.

– But you know what? I will say, so if anybody knows me, I’m very, I’ve got thick skin, so it’s not like I, how do I word it? I can handle it, okay? But it was the fact that I just was blown away with, I had no idea that these other perspectives existed.

– Yeah.

– And to be honest, and I’m gonna play a little devil’s advocate at this because to a certain degree, some of the comments were, like, that they’re needed. Like, there is a shift. Like, and I often talk about this as a pendulum, right? Like, we kind of have gone from like one extreme to another. And so I’m going to use the dietetic profession right now to really showcase the fact that I think, as dietitians, especially in Canada, there are some amazing leaders in the space that, sure, the conversations might be controversial. Sure, it may come across as bias or stigmatizing. But in their lens and the evidence that they’re looking at is very much aligned with social injustice and the fact that the historical view of obesity has always looked at a body size, or has looked at body fat as a problem. And I think what we’re understanding now with the newest evidence is that it’s not about the weight, it’s not about the body size, it’s about having an organ that happens to be-

– Yeah.

– Adipose tissue or body fat. But it’s having an organ just like a heart, a liver, kidneys, pancreas, and we all have those organs, but sometimes those organs can become dysfunctional, and for whatever reason. And I think that’s a piece, that there has to be room for an open discussion, that we can hold space for both point of views without getting angry and without having polarizing viewpoints. But I will say, it is a pendulum swing. And without some of those experiences, like without some of that bias and stigma that I got called out for, you know, I wouldn’t have changed as a professional, I wouldn’t have had this more open viewpoint. So I think it has a place. I just wish we did it in a more collegial, respectful, human way.

– And speaking to this as not just as an educator, but someone who isn’t around these tables and conversations with individuals who don’t necessarily realize the bias is there. And it’s not just around weight bias.

– Yeah.

– There’s bias in everything that we do. I think having those open and honest conversations ends up being so critical to moving things forward. So I actually agree. I don’t think that’s controversial to say at all. I think it’s the way that we, as humans, have evolved in many ways to progress. We do need to hear-

– Yeah.

– About the way that other people are viewing the same problem or through potentially a different lens. And oftentimes, we do need that challenge to sort of say, “Hey, how do we reach across here? How do we communicate this? Maybe there’s a way that we’re communicating this, maybe we’re missing something in how we’re communicating this,” right?

– Absolutely.

– We have to, because it’s not that we’re going to be able to get everybody on board immediately, suddenly like, “Oh, this is what the evidence says.” No, this is deeply entrenched values and biases that have been held for insanely long periods of time. You do need to open the space up to have these conversations, you do, and actually be open and honest to have these conversations. Otherwise, you’re not going to be able to, and not even change minds, but just even engage in conversation, right? So as someone who deals with a lot of the newer medical students who are entering the profession, I do think it’s important for us to have these open spaces. Otherwise, they just feel like, “Oh, this is the bias. You have it, address it,” without actually challenging it themselves and actually about their own values and how they came to it. So I think it’s beautiful that you put it that way. We could talk forever, I feel. but for clinicians listening, we haven’t forgotten about you, no. But what would you say is that, in closing, what’s that one small step that, for our listeners, that they can take today to sit with discomfort in a meaningful way? We’ve talked a lot about discomfort today. What do you think is maybe one small step that they can take today to do that?

– Ooh, like you said, we could talk about this forever. Okay, one small thing that people can take away from this. I mean, as simple as the sounds, it’s harder to do. I would say the number one thing is we have to listen more.

– Okay.

– We have to listen to our clients and our patients, their caregivers. We need to listen to our colleagues. We need to listen to people we disagree with. And yeah, so listen, I think, is a big take-home. And I hate to bring it back to what we said earlier, but the grand apology is real. And I can’t emphasize enough how impactful that has been, in my own practice, just apologizing for past experiences, apologizing for how getting things wrong, and recognizing that we can do better, but we have to do it together. And that then goes back to the listening, so that, the person sitting across from us is feeling heard and feeling that this is a safe place. So, yeah.

– Well, Jennifer, I can’t thank you enough for being so generous with your time and your thoughts and your advocacy within the obesity community, both those of us living with it and the medical professionals who will be listening to this podcast. Thank you. And thank you for letting us all get maybe just a little bit more comfortable with being uncomfortable.

– And to our listeners, thanks for joining us. If you found value in today’s episode, please share it, rate us, and subscribe.

– And until next time, remember to listen to our podcast to scale up your practice.

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