055. How to Stop Midlife Weight from Sneaking-up On You with Dr. Heather Awad

00:05 Dr. Ann Tsung Are you struggling to advance your career and sacrificing time with your loved ones because of endless to-dos, low energy, and just not enough time in the day? If so, then this podcast is for you. I am your host Dr. Ann Tsung, an ER critical care and space doctor, a peak performance coach, a real estate investor, and a mother of a toddler. I’m here to guide you on mastering your mind and give you the essential skills to achieve peak performance. Welcome to Productivity MD, where you can learn to master your time and achieve the five freedoms in life.

00:52 Hello. Welcome to Productivity MD Podcast, and I am your host Dr. Ann Tsung. Today I have here Dr. Heather Awad. She’s a family medicine boarded physician. And currently, she does 50% weight loss coaching for professional, midlife woman and beyond, and also 50% long-term real estate investment. And she also is a mother of four as well. She just does so much. And the reason why I wanted to bring her on is, number one, how does she handle everything with four kids and able to transition from clinical medicine to where she’s at now? And number two, vitality is a huge thing in productivity and peak performance. And it’s super important to have peak energy so that it can help you in the rest, all of the other areas of your life. That’s the reason why I wanted to bring Heather on. So thank you so much for coming onto the show. I really appreciate the time. Can you tell the audience a little bit? Expand a version of what I just said about your backstory. And really, why do you do what you do now?

01:59 Dr. Heather Awad Sure. Sure. Thanks for having me on. I find your podcast fascinating. I love hearing about how other people managed to live these busy, up-leveled, fun lives. So why I do what I do is, I had done pretty well with my weight most of my life. And then all of a sudden, by mid-40s, not even knowing that I was in perimenopause yet, the first thing I actually noticed was that I started to just gain weight without changing anything I was doing. I was an exerciser. I ate pretty healthy. Then all of a sudden, the weight just kept going up and up. So I tried all the things that have worked for me before, and I was very surprised that they just didn’t work at all. And so my weight actually got to a point where I knew this is an unhealthy range. And I got worried about disease and thinking, am I stuck with this? So I did some of the diet things. I thought, well, these will be fun to try — keto and paleo. I mean, those made me feel terrible, so I quit those. I did one of those app-based diets. And I worked really hard for six months and got my weight down. Then, you know, you’re back even higher. So it was terrible. I just thought there’s something wrong with me, you know. What is this?

03:14 But I then thought, well, the conventional things didn’t work. Let me do some research. Because I’m a doctor, I’m going to research this. And what I found was that the body changes at midlife make what you did before not work anymore, and a lot of the traditional things not work anymore. I think that really the magic of weight loss at midlife is understanding that we have a bump in insulin resistance with that big drop in estrogen that comes there. And paying attention to that can make weight loss much, much simpler. Now, I would like to say that just understanding that went on from there. But I had some issues with being a caregiver. A lot of us who are doctors are caregivers. We have our families, and we’re pretty stretched. I went to do some coaching, where I was getting coached with some other women physicians. Then kind of that world opened up to me where I found, oh, I could put myself first and still be a good mom. I could take care of myself and still be a good doctor. I can have my own back. No one else is coming to take care of me. I need to have my own back. Those ideas, all of a sudden, weight loss got really easy. Because I was eating a lot of the frustration or resentment around just being stretched too thin, and working too hard, taking care of all the people and all the things.

04:36 So I decided that I really love this aspect of kind of freeing our minds around taking care of ourselves at midlife, along with noticing that not a lot of people teach this biology that’s really pretty basic for midlife but different. You get a new body at that time, and so weight loss is very different at that time. And so I thought, you know, I’m on the other side of this. It can be really simple. I want to bring this to other people. And that’s how I ended up starting this business. I was rounding in nursing homes during the alpha wave of the pandemic. And I thought, you know, when you feel like you’ve had your life threatened, you think, when you get on the other side of that, you think, well, what do I really want to do? This really is my only one life. What’s inspiring? That all came together, and so I started this business of coaching. And I really, really enjoy it.

05:34 Dr. Ann Tsung That’s awesome. And it sounds like there was real estate. Just to clarify, was it real estate before that, or after that, or at the same time?

05:41 Dr. Heather Awad Yeah, so we always had a couple of houses, rental houses. My husband is also a physician, and our parents had done some real estate. So we, along the way, acquired a couple of rental houses. And so I kind of manage those as a side thing. Then we have one kid left at home. As your schedule really lightens up as your kids leave, I thought, you know, we could really uplevel this and have more passive income with some real estate investing. My husband and I are both really into that and were actually — it’s funny. Some things that you think, well, you work together well with your spouse on things, and some things you don’t so much. But real estate is a really complimentary space for us. So it’s been a great business for us as well.

06:25 Dr. Ann Tsung Okay. Got it. So, yeah, it’s a combination of you starting the coaching business. You already have real estate. But now you have a little more time with the kids leaving, so now you’re ramping up as a team essentially.

06:36 Dr. Heather Awad Yes, exactly.

06:38 Dr. Ann Tsung And in terms of the why, in terms of why women should care about this, I’m curious if you can touch on not just weight loss, but what about other things that come with being able to lose that weight midlife? Maybe the mental portion, maybe the energy portion, or any other benefits? Why should women care about what you say now?

07:01 Dr. Heather Awad Well, most of the women that I worked with, they lose the weight. And pretty quickly though, they say, “Oh, my goodness, I feel so much better now.” They start prioritizing some things like sleep, which is really important, and that helps them feel better. But looking at eating in a different way, they definitely find new ways that make them feel better. I get a lot of women who come to me with joint pain, which they think is menopause pain, or they think is arthritis. Then when they start eating in a way that’s more anti-inflammatory, when they’re not eating all day long which is our culture, when they’re not eating sugar at every event and in the break room, then that pain in their joints goes away. They’re like, “I have a new life. I walked down the stairs, and my knees don’t hurt anymore.” So it’s very motivating, too. They’re losing the weight, and they’re like, “I don’t want to stop this style of eating because I feel so good.”

08:00 Dr. Ann Tsung Yeah, it’s more like they’ve started a small commitment. And as they saw incremental gains, then they are scared to go back to the way they were.

08:09 Dr. Heather Awad Yes, in fact, I tell people, you know, have pie at the holiday or whatever. Have pumpkin pie on Thanksgiving. They’re like, “Maybe. I’m not sure I want it. Because then I know my knees are going to hurt the next day. And so I don’t know. I’ll think about it.”

08:26 Dr. Ann Tsung I can totally relate to that. It was the same thing for me when I quit caffeine. Back in critical care fellowship, I was taking caffeine pills right when I wake up, because the Keurig just takes too long to take effect. So 200 milligram, pop it. Then I make my Keurig for the way.

08:44 Dr. Heather Awad Sure, yeah.

08:45 Dr. Ann Tsung It was so bad. Four shots and espresso. And I wonder why I end flipping nights and days, 12 hours, 13 hours in the ICU. I wonder why I could never wake up rested. So when I was doing this test to check my natural energy throughout the day from, I think, The One Thing book or Deep Work book. I can’t remember. Maybe it was the Deep Work book. You want to check the natural productivity, max productivity, so I had to quit caffeine. I just felt so good sleeping. I actually felt like I rested that I was so scared to touch coffee again.

09:22 Dr. Heather Awad I’ll leave it after all that time of logging yourself with caffeine.

09:26 Dr. Ann Tsung Yes, so I completely get — you get to a point where the reward has become so great. And putting alcohol, too. I used to have to take ibuprofen after alcohol because of the muscle soreness and joint pain. So I totally get it. It sounds like if you just start down this path, not only you will get your energy back. The pain that you thought that would be long term for you will not be there. And actually, your mental energy, your mental space is freed up. And you could probably be more present with whatever you’re doing professionally and personally, actually have more successes that way.

10:08 Dr. Heather Awad Right. Because a lot of people at midlife are leading teams, or they have their own business. And they noticed that they can really do more and be a more effective leader and move their business forward with new projects all from feeling more energized with better food.

10:23 Dr. Ann Tsung Yeah. Okay. Well, I’m going to ask you what results can they see? I know timing may be different for everybody. But I’m curious. If you can give a rough timing of when they can achieve some sort of progress typically if they are disciplined enough to do what you say?

10:45 Dr. Heather Awad Sure. The people that come to work with me really come to get the accountability. The people that come to all their accountability meetings tend to lose 15 to 20 pounds in three months. That’s pretty typical, and then they kind of go on from there. So that’s a pretty typical weight loss for my group. There are people who sign up and then do not come to those meetings, and they do not lose as much weight. There are some outliers as well. There’s people that go really fast, which I kind of work on them not going so fast. Because I think it’s not healthy to go to lose weight too fast. But also, there are some people who will find that they have something else going on that slows them down. Like, we had a woman that I said there’s stuff going on with your sleep from what she was describing. It turned out she had really bad sleep apnea. So that slowed her down in the beginning. Then it kind of took off again once she got that sorted out.

11:36 Dr. Ann Tsung Okay. Yeah, that’s huge in terms of like, you said, almost close to 15 pounds in three months. That’s like five a month typically.

11:42 Dr. Heather Awad Yeah.

11:46 Dr. Ann Tsung This is like going to the how a little bit, but I’m just curious. Is it a once-every-two-weeks accountability, group accountability, or how does that work?

11:53 Dr. Heather Awad Actually, right now, people meet one-on-one with me every week.

11:56 Dr. Ann Tsung Oh, wow. That’s intense.

11:57 Dr. Heather Awad Yeah, it’s a half-hour meeting, so it’s not too long. But it gives us time to kind of dig in on accountability and goals, and then the special things that come up for professional women. They’re traveling for work, or they’re traveling with their family, or they’ve got an event. There’s going to be a buffet there and all those kinds of social situations that come up. Okay. What’s happening this week? They’ll say, okay, I got this thing I’m worried about. Then we talk it through and make a plan.

12:26 Dr. Ann Tsung Okay. We’ll dig into that a little bit more, on the plan portion. Now in terms of your own vision, in terms of where you want to take this ideally, let’s say, 5 to 10 years, where do you see yourself in terms of the coaching and real estate, with you professionally and maybe some of the goals with your family, the vision with your family?

12:48 Dr. Heather Awad Sure. Professionally, I think this coaching program is going to grow. Right now, it’s mostly one-on-one. We’re going to add a group coaching program this year. I’d like to grow it and then eventually get a partner so that it lives on. I think the science behind it is great. The coaching part behind it just comes together so well that it really helps a lot of women. I like it to help inform how we talk about how we eat in our country. Because we eat in a way that increases insulin resistance, and it’s not good for any of us, really. But it’s especially important for women in midlife. The real estate, my husband and I are going to continue to grow this. Where each time that we buy something, we’re buying something larger and working with more partners in new ways. Sometimes I think, well, how do I have time to grow both of these? But we’re also working on building our team so that we’ll have more people working on things that are in their zone of genius. We just hired a bookkeeper. We’re getting close to hiring an admin person who’s going to help us get things done. We do have property managers. So kind of just building that team is going to help us grow all of that.

14:04 Dr. Ann Tsung Yeah, I always love to hear like how people are outsourcing or how they’re able to maintain the productivity and scale and do more things. You do have an assistant of your own, too.

14:14 Dr. Heather Awad I do.

14:16 Dr. Ann Tsung And what would you say, after having the kids and now scaling the coaching and the real estate, what would you say was the one thing that you did that really allowed you guys to scale?

14:29 Dr. Heather Awad I would say it’s sort of the same all the way through, but what served us going forward is having some help with the home stuff. My husband loves his ophthalmology career, so he works a lot of hours there. I have juggled, working less hours when the kids needed more time and more hours now. But really, when our kids were little, we hired a nanny because we couldn’t make that daycare and time. Because with two physicians, there was no way that we could be there, promise to be there at six o’clock every day. So we hired a nanny, and soon realized this person is helping us run our life. They’re taking care of the kid, but they’re also folding clothes. They can meal prep or make dinner or those kinds of things. And getting more and more help around those things has been really great. I like to cook, but I don’t want to do it seven days a week. But I want us to eat healthy food, and we like eating at home. So we were able to work that out with our nannies. We only have a 17-year-old. Sorry. She just turned 18. We only have an 18-year-old at home now, so I don’t have a nanny. But I did just hire someone to come do some of those additional house things like folding laundry and some of just little things that would take me a couple hours here and there and distract from what I’m trying to do with my business. And I’m just not interested in it. I started ordering groceries. And so I still cook two or three times during the week for dinner, and I enjoy that. I enjoy trying new recipes, but I don’t do it all the time.

16:08 Dr. Ann Tsung Yeah, I love, love our house manager. And I agree with you. It was when I have my first baby. When the baby was like two months old, I was not making any progress in my work at all. Like, do I just stop on this side of my life or what? Then that’s what forced me to get an assistant, a house manager, a nanny, all that stuff. So I agree. I think that is really the first step. If you want to be able to spend quality time with your family, do the things you want to do when you want it, not took all the time because you have to, then really, outsourcing is really the best way.

16:48 Dr. Heather Awad And I’ll say too that those people have enriched our family. My husband and I are both in the science-related fields, and so we hired nannies that were artistic and did those kinds of things with our kids. So they were a part of the family and brought their own thing that was different than what my husband and I bring. And so I felt like it was nice for them. We have lived in towns that we weren’t close to extended family. And so this was another adult that was important in their lives that had a lot to offer.

17:19 Dr. Ann Tsung Yeah, because you guys are all STEM, right?

17:22 Dr. Heather Awad Yeah.

17:23 Dr. Ann Tsung You’re like left-brained, and then you want somebody who’s more right-brained and creative. Right?

17:27 Dr. Heather Awad Yeah, that’s great.

17:28 Dr. Ann Tsung I get it. Then I’m curious. Do you have a system software or planning, goal setting type tactic or strategy that you use to plan your day, your year? Any project management software that you use?

17:44 Dr. Heather Awad You know, not really. We both use Google Calendar. My husband I are mid-50s. We’re old enough that we use paper for planning. We have tried switching and have found that we use different parts of our brain when we write and when we use software. And both of us really like writing it out. So we don’t.

18:08 Dr. Ann Tsung When you write it out, you tend to actually do more. Because, I mean, I have some of my goals. I mean, it’s not this one, but it’s basically same thing. I have post-its, writing the top three priorities down.

18:18 Dr. Heather Awad Yeah, I do use Trello with my team, though. I do appreciate that productivity software for my team.

18:25 Dr. Ann Tsung Okay. I use the same one as well. I usually ask this because the next question is about, how do you communicate with your spouse? Making sure when you’re working with your spouse, especially on real estate — I’m curious how everybody does it — how do you split up personal versus business? Do you guys have dedicated time for a business meeting and then date night or a date week or something like that?

18:52 Dr. Heather Awad Yeah, we do keep a date night. Well, we have a Thursday night where we go do something together. Then we also bought — over the years, we bought subscriptions to things. Like right now, we have the local Broadway Across America traveling thing. Because that reminds us to also go out sometimes. But otherwise, he and I both like to work, so that’s a little bit of maybe a downside. I don’t know. Because if it’s Tuesday night and we’re sitting there, we’ll be like, well, why don’t we pull out the stuff and take a look at those spreadsheets or the cash on cash calculator for the apartment building? We think that’s fun when Martha Stewart started saying that she thought work was fun, and she liked working a lot. I thought, oh, good. I’m not the only one. So we do like that. So we do try to carve out some time. And on weeknights, I have kind of a hard stop time from work. Because you know how being an entrepreneur, you can just go, go, go. Then if my kid isn’t around or whatever, I might do a little more work later. But I also really, like Saturdays, I don’t work at all. Anytime I’m tempted to, I stop myself because I know that I need recovery time, and my brain needs to not be constantly thinking about things. I think when you work seven days a week, then nothing inspirational bubbles up. You need some time where you’re not thinking about your business that you love.

20:12 Dr. Ann Tsung You need a white space, basically, right? White space for that aha moment to actually connect one idea from an idea that seems to be far away.

20:22 Dr. Heather Awad Yes, definitely.

20:24 Dr. Ann Tsung And how do you set your non-negotiable time with your leftover, like one last child in the house? They’re going to go off to college soon, and so the time is very precious. How do you set that time with her?

20:36 Dr. Heather Awad I mean, we still like to do family dinner but she’s not always available. But when she is, and she sends a text, “Hey, I was thinking about doing this,” then we’re like, “No, we got dinner at home. We want to eat with you or all of us together.” It’s funny because teenagers, in some ways, they want to push you away. But some ways, I think she also likes, like, “Hey, my parents are requiring me to be home because they want to spend time with me.” I think there’s a bit of that too, which is nice. She appreciates that we do want to spend time with her. And I have really — you and I were just talking beforehand that you went to a conference I did not go to because my kid had finals. So I’m looking a lot at her schedule this year, both to kind of finish strong as a parent, to really be here in that way, but also selfishly, to not miss any of the special things this year. Because she’ll be gone, and kids don’t always come home after.

21:32 Dr. Ann Tsung Yeah, four months left, right? Four months left.

21:35 Dr. Heather Awad Yeah.

21:37 Dr. Ann Tsung Yeah, it will be like bittersweet, probably. But I’m just thinking. Yeah, I guess, for me, it’s like 17 years, 16 years. But it already feels like really fast already, the past 19 months.

21:51 Dr. Heather Awad Yeah.

21:55 Dr. Ann Tsung I know we talked a lot about how you do things, how you maintain everything. Now I do want to dig in also, to scratch my own itch, in terms of the weight loss portion. I’ve read Dr. Fung, the nephrologist.

22:09 Dr. Heather Awad Yeah, I love him.

22:11 Dr. Ann Tsung Everything is a hormone theory. Basically, it’s hormones. Weight loss is hormonal. And from what I gathered, it is insulin and cortisol. Sleep plays a big, big role. Would you say that is basically the foundation that you teach?

22:25 Dr. Heather Awad Yes, and the thing is that this is the thing that goes haywire for women at midlife. That’s why they have to pay attention to this, and not count calories, and do cardio and all the things. They really have to pay attention to this part. Some of that is normalizing an eating schedule. It’s a little countercultural. It’s eating meals instead of grazing, even healthy stuff you don’t want to graze on. You need some time where your hormones and your digestive system get quiet, right? Nighttime eating, which is also very a norm in our culture, is really hard on midlife women. Because then, you shorten the time overnight where insulin drops and goes down. Because we need some time when insulin is hanging around all the time. So if you graze all day long, your insulin goes up all day long, your body will never naturally pull fat for energy. And if you can get yourself into a state where your body sometimes pulls fat for energy, you can lose weight and still eat and not be hungry. You don’t have to restrict yourself, but you have to have some time where you’re not eating.

23:30 Dr. Ann Tsung And it’s because, from what I understand, insulin is basically a fat-storing hormone. So if you’re insulin is up all the time, you’re just storing fat and not pulling fat.

23:40 Dr. Heather Awad Right. Then with estrogen going down, you have a bump in insulin resistance. So it’s a little harder and takes some intentional choices to behaviorally get this insulin to drop. So that’s there. Then your cortisol goes kind of haywire, and you have sleep problems. That works against weight loss as well. So you have a midlife woman who’s not sleeping well. She’s anxious because her cortisol got really high, because it’s going a little haywire with the change in estrogen. Then what she does is, she restricts calories because she has gained weight. Then the body says there is some emergency going on. The cortisol is high. There isn’t enough food. No matter what, do not let go of anything. And so people are like, “I’m not eating, and I’m not losing weight.” No, because your body thinks there’s some emergency. So we need to look at sleep and get sleep back in order. Do some active distressing things to help cortisol get better as much as we can, and then eat nourishing foods. The body’s like, oh, everything’s fine. We’re going to use this food. Then when we’re not eating, we’re going to just pull some fat for energy. So, again, hormonal, very important at midlife and beyond.

24:59 Dr. Ann Tsung And I’m going to get into a little bit on the numbers and the tactics a little bit, more time-restricted eating window. How many hours do you recommend or maybe a range of hours that you technically recommend your clients?

25:11 Dr. Heather Awad I do recommend a range. I have some clients who are very happy eating three meals, and so we just do that. I do think that we don’t have a lot of science on the exact number of hours. But I think starting with something like 12 hours of no eating can be a big step for people and then having time in between meals. A lot of my clients will do a lunch-dinner type of eating style because they’re not hungry in the morning. I think we have studies that show that eating breakfast is better for normal weight. But we also have studies show that intermittent fasting is better for normal weight. So I would say that people can choose what works for them. That’s what I find in my clients. It’s that this does work. And everyday doesn’t have to be the same. So I’ll have clients who eat lunch and dinner every day, except for the day that they have a morning thing where maybe they have a tennis game in the morning that day. They eat a little breakfast because they feel better. You can really do this kind of planning. I have radiologists who are like seven days on and seven days off. They have the seven days on meal plan. They have the seven days off meal plan. And so you can really customize this.

26:23 Dr. Ann Tsung Have you recommended or prescribed continuous glucose monitoring for your patients, I wonder? Because I’ve done it for a few years, and I love it that you keep the glucose variability or the peaks and troughs down. So I’m curious if you’ve done that for your patients as well.

26:40 Dr. Heather Awad I have talked to people about it. Some of them have done it, and some have not. Because most people are paying out of pocket, they’re trying to decide if they want to bother with that. I have also done this and really enjoyed it. But we just behaviorally do these things. So we’re looking at, when I did it, I was very surprised. I wanted to just do some experimenting when you first get one. So I went and got to a coffee shop and got a fall syrup, vanilla latte, and watched my blood sugar go into an abnormal range. But then, a few weeks or a week later, I had a normal breakfast and I had a sandwich with lunch. Those two pieces of bread sent my blood sugar to the same level as that vanilla latte, which surprised me. But flour and bread is very inflammatory — the flour that we get in the US, if you eat regular bread. And so that was an eye-opener for me. And so now bread is a sometimes thing that I eat not first thing in my meal. It can be a helpful and very interesting way to look at your blood sugar curves.

27:42 Dr. Ann Tsung Yeah, I think I tested it on pizza. Oh my god. I was like four hours long of glucose in the 220s down to the 180s. They took like four hours for it to even start coming down. It was crazy. And even some places I went to, they said, oh, it’s this keto pizza. I got keto pizza, but it’s still — I think it elevated to like 150, 160s, which something was in the flour. Do you do European flour or something with no glyphosate? I’m curious. Or, do you just do it like every now and then US, that’s fine for you?

28:16 Dr. Heather Awad I just do it now and then. Every now and then, I have it. I do have some clients who do that. I have a client who I worked with before that was from France, and so she used European flour. Some of my clients have tried some of the ancient grains breads or sprouted breads and really liked those. They just switched over. Some things aren’t worth replacing. It’s just worth pivoting to something a little different. I don’t really miss having sandwiches anymore, even though I used to be a sandwich-everyday person. I usually have leftovers from a homemade dinner that I really like, or I’ll mix something up as a bowl with extra vegetables that would be a sandwich. That pivot has been no trouble.

29:00 Dr. Ann Tsung Yeah, I agree. I think I did the same thing when I was in residency from my coach at the time. I was losing about 1% body fat by caliper each month. But when he took a look at my food diary, I was like, oh, because I’m Asian, so I have rice. I have dumplings. I have noodles. So he took those out. I don’t eat bread. But it’s those things, the brown rice. Even brown rice, rice noodles that you cook, noodle soup, he took those out. Then the following month, it was 6% loss. It was so fast. So I totally agree what you’re saying. This does not have to apply to midlife. This is like all life, really.

29:41 Dr. Heather Awad Yeah, and I do get people who come and say, “I want to eat my cultural food.” Doctors who are like, “I come home, and my mother-in-law has made this wonderful Indian meal. And if I don’t eat that, then I have to make my own dinner.” And so we talk about things like, have a small scoop of rice and then put all the rest of it on top. That’s the main part of the meal. And people do well with that kind of thing, if they aren’t going for a goal like body fat percentages.

30:07 Dr. Ann Tsung I’m curious then. From what you’ve seen in your clients, have you seen any limiting beliefs that they have that unless they break through that, that will be very hard for them to lose weight?

30:20 Dr. Heather Awad Yeah, a couple of them that come to mind are, one, honestly, is that they have to believe that they can lose weight. Because some of them don’t. Often, I have a whole group of people who are clients of mine who say, “I didn’t believe I could lose weight, but I saw this friend of mine who worked with you. And so I thought if she can do it, I can do it too.” Because I think their body is broken at midlife, and it’s just a little different. So this is a workable problem.

30:46 The other one that I think is difficult is, people think that if they turn down food from someone else, that they’re not a nice person. And that is a difficult limiting belief too. We tried to do some experiments with that. Like, what if you just said no to your mom when she offered the cinnamon roll? Sometimes people say, oh, my goodness. She just said, okay, do you want an egg instead? And it was fine. Or, they’ve noticed that some of these people that have been kind of pushing food on them, they decided they don’t actually care what those people say. I was talking to someone last night who said this person at work pushes these weird soups on me and is really offended if I don’t eat them. And I asked, well, you know, do you care about offending this person? She says no, this person is kind of generally annoying at work. She does this about a lot of things. I said, you know, what if you were just okay with offending her and saying no, thank you, I don’t want any soup? I said, does that sound like a mean thing to say no, thank you, I don’t want any soup? So people find ways of very nicely not eating the thing that someone else wants them to eat and also finding a different way to — I guess I would say the other thing that people worry about is that food is connection in our culture. There are still ways to connect while not over eating or eating something that you don’t want to eat. You can eat a meal with family and just not overeat. If someone is pushing food on you, you can take it home with you. And you have accepted that love. Like, thank you so much. It’s so lovely. Can I take it home? Because I don’t want to eat any more now. Then you don’t even have to eat it later. You already accepted the love by taking the package.

32:31 Dr. Ann Tsung Yeah, I agree with you regarding the culture thing. You know, I used to be a lot stricter in terms of what I would eat. And like you, I went through like no fat, high protein, keto. Now it’s just like not strict keto but like 50% fat, lots of healthy fat, 25% carbs, 25% protein but very restricted in terms of inflammatory flour, dairy. And it’s so funny. I’ve let myself try things now when I go out to eat with friends. Then they would make the comment, wow, Ann. You’re fun now. It’s the same thing when I quit drinking too. Like, there was such a big — I used to be the person who pushed people to drink. It’s like, drink this. And I would get them drunk. But all of a sudden, when I stop that, they feel like there’s like a loss of connection. If I don’t want to try the food they order, that’s a loss of connection. What do you do? Or, another thing. If you’re eating like healthy kale chips or something like that, people look at you like, ugh, it’s green. So how do you deal with that? Then the flip side is when you start on this journey. Maybe you feel actually alone and siloed.

33:43 Dr. Heather Awad Yeah, I mean, at some of it, you have to be willing to eat what nourishes you and what makes you feel good. You have to feel really centered in that intention. I’ve noticed now what works for my body and what makes me feel good. And most people don’t want to go back when they feel that good. So that part of you just have to get good with. And then if people make fun of your kale chips, you know that part’s okay. There are different ways to connect with food. And I think this kind of also for people who have food allergies and cannot eat the thing, or just thanking people, talking about how beautiful it is the thing that they made but not eating it. And one thing with kids, too. I had a client who went to Italy, and her daughter wanted to eat gelato every afternoon. She said: that’s awesome but I do not want to eat gelato every afternoon. It doesn’t sound good to me, and it’s not going to serve me because I’ve just lost weight. And I want to maintain my weight. And so she came up with the idea to connect through pictures. So the one or two times she did have gelato, she took the pictures when her daughter had it. She took pictures of her near all the the cute things in Italy, so her daughter could put these up on social media. They could still do selfies even though my client was not eating the gelato. And it was just her daughter was eating it. So there was just a way to kind of enjoy the whole event of the gelato without her having to put it in her mouth.

35:13 Dr. Ann Tsung Yeah, like pivoting to create other experiences not around food. In Asian culture, it’s always like when families get together, it’s always around food, every time with my mom. And trying to go out to more parks maybe for connection instead of surrounded by 10-course meals or whatever like Asian weddings.

35:33 Dr. Heather Awad Yeah, and I have another client who was like they always met for dessert. It was summertime, and she asked her friends that always got together. She said, hey, why don’t we walk around the lake today for our meetup? And they loved that idea. There wasn’t even talk about the food, and she felt super great about that.

35:51 Dr. Ann Tsung Yeah, take a walk in nature instead. And I am curious what your thoughts are. What if there’s a client who definitely know it’s bad? He has a sweet tooth. It’s bad. It’s all over the hospital. I wonder if you have clients like that. In the hospital and the clinics, everybody is always bringing doughnuts in the morning. Candies everywhere, pizza. And you’re stressed at work. Because it’s the clinic, or the ER, or the hospital. How do you systemize it or have the discipline? Because when you’re stressed, you don’t have the discipline anymore, really. So how will people even — because I do have clients like that, too.

36:29 Dr. Heather Awad Some of it is thinking what is there, and how often do I want to have it? Like doughnuts or cake in the break room, do I want to have that every day? If you ask your client that question, they might say, “Well, no, I don’t want to eat a doughnut every day. That doesn’t sound like it’s good for me.” Well, how often do you want to have a doughnut? Well, once a week, or twice a month, or you just pick something. Then it gets a lot easier. Because when you’re stressed, you’re like, well, but I already had my doughnut this week. So I can walk away because I already had my doughnut this week. I haven’t restricted myself. I had made a plan. It’s a little easier. If you’re just sitting there with the stress, you’re like, oh, I don’t want to eat a doughnut. You’re like fighting that. That part, it feels terrible. So when you’re feeling stressed and you’re like, oh, the day that you haven’t had a doughnut that week and you’re stressed, you’re like, oh, it’s my doughnut day. Yay, I’m going to have it. You just enjoy it because you plan to have one doughnut a week. Then two days later when you’re stressed, you’re like, oh, I already had my doughnut this week. I’m going to move on to the next floor. So that kind of thing.

37:32 Then some things too, like looking at the candy on the floor. How good is this candy? Is this like primo chocolate that is really important to you? If you’re trying to lose weight or be healthier, you can kind of look at things and think maybe that’s not for me. I usually try to have people find a mantra that feels very peaceful and helps them feel more calm. When you see the candy, that’s not for me. That’s not for me. That’s not for me. Or, you find something else. That can be a mantra for you if there’s something that you’re trying to avoid. But you also do need to think of something else that helps with that stressed feeling, whether there’s something that you can do that is an active de-stressor. Like, I had a friend that went outside. She was a hospitalist. She took a picture of herself outside on the lawn. And I was like, can you go outside when you’re a hospitalist. But she just would go outside once during her shift, and that made her feel better. Or, when you’ve had that urgent feeling of the candy, just stopping and noticing how bad it feels. Oh my gosh, this feels terrible. I want the candy. Then thinking, oh, I can feel this. I wonder if it’s going to go away. I’m not dying. My brain is telling me we might die if we don’t eat the candy, but I don’t think I’m going to die. You’re just kind of noticing that this is an experience. And often times, it’ll just fade. So we can just be uncomfortable, watch it fade, and then move on. So maybe that’s too many ideas. But—

39:01 Dr. Ann Tsung No, I mean, this is good because everyone’s situation is different. And I wonder, do you have any common replacement? Because I have talked about replacing with nuts, replacing with avocado, high-fat, the high-satiating items. Or, maybe instead of crappy, processed desserts, you get high-quality Lindt chocolate that has very minimal ingredients or something like that. Do you have any recommendations to replace my ideas or like athletic greens or something like that?

39:32 Dr. Heather Awad What I would say is, sometimes we want to replace something and sometimes we want to just not eat something. And notice how people feel about that. Like if there’s junk around, are you actually hungry? If you’re trying to lose weight and you’re not hungry, then the answer is not putting something in your mouth. So that’s something to think about. If you want to do a swap, that can be good as well. Actually, I’m not a fan of nuts as a swap because people over eat nuts. If they’re trying to lose weight, I got a whole group of women who just lose weight because they quit over eating nuts.

40:06 Dr. Ann Tsung That’s true. Because it’s supposed to be like an ounce, really. An ounce is like this much.

40:11 Dr. Heather Awad Yeah, and then they have that three times because there were three times they were upset at work. And sometimes it’s a little bit more, and the crunch is so nice. It is a healthy food, but it’s really easy to overeat. So if you’re trying to lose weight, then that’s not my favorite swap. But there are other things people will keep around, something like a raw vegetable that they like and hummus. When you think, okay, I’m going to replace that and you go, well, raw vegetables like carrots and hummus, I don’t really want that, then you didn’t need food, right? You can move on. I have my backup plan. And if you were actually hungry, you’d eat the carrots and hummus because you like carrots and hummus. But if you’re not hungry, you might be like, well, I actually don’t want that either. So move on.

40:52 Dr. Ann Tsung Move on. Get yourself out of that situation, essentially. And this is like my own, scratching my own itch. And I’m curious what your thoughts are on it in terms of what you’ve read in your research in terms of postpartum weight loss? Is it similar when you have high estrogen? Well, you have high estrogen. Then you have a low dip in estrogen postpartum before it comes back again. Is that why some women don’t lose their way to postpartum until way later? I’m just curious about your thoughts. When I had my first baby, I just lost 10 pounds. They’re just like there. Same diet but just like there.

41:32 Dr. Heather Awad Yeah, I apologize. I don’t know a lot about postpartum weight loss. And most of the thing I’ve counseled people is to be kind to themselves. I think there’s some emotional eating postpartum that happens too because there’s a lot of — finding emotional support, working to try to get some sleep, I think, is helpful with your partner or whoever can support you. I get that, especially in some families, one person, whether it’s the mom because she’s breastfeeding or whatever, one person is the person getting up all the time and maybe need to be some nights where the other person is the one getting up. And if you’re the one who is postpartum, and you get a full night of sleep sometimes. So you have some of those things.

42:14 Dr. Ann Tsung Yeah, I know. That’s actually definitely true. My husband and I alternated, so we could each every other night get six or seven hours. And you’re right. It’s the same thing for anybody, really, when you don’t get enough sleep. When sleep is not prioritized, cortisol goes up. And I don’t think we talk specifically what the connection, to the audience for who’s not medical. But from what I understand, cortisol goes up. That stimulates the insulin to go up as well, which is a fat storage hormone. So that’s why it’s hard to lose it. But in terms of the correlation with estrogen, you said that when estrogen goes down, insulin sensitivity goes up. So there was a period.

42:50 Dr. Heather Awad And I’m not sure how much that happens at postpartum time. I just don’t know. Because it’s very important. Because, in general, women at menopause with this insulin resistance get a higher risk of other diseases as well. We start worrying more about heart disease and diabetes in women postmenopause. So I don’t know what that dip if it’s the same or not. But it would be interesting to see some studies on that and also be interesting to see if people did some things like looking at having time in between meals. I wouldn’t say that intermittent fasting would be a good idea postpartum, but maybe making sure you have maybe an eight-hour window for sure that you’re not eating or 10 hour if it makes weight loss easier. I’d be really curious about that. But I don’t know.

43:34 Dr. Ann Tsung Yeah, I mean, I did all of my progesterone, estrogen, testosterone. They were like all low postpartum. So I know for sure, objectively, I definitely had low estrogen. But I wonder about the insulin resistance part. Because, yeah, that’s interesting. And I know we’re almost at time here, so I wanted to — maybe one last question. Have you found anything that has been very useful for clients to really decrease their stress, decrease their cortisol? Sleep is one. I’m curious. Is there some other recovery tactic? Or, really, if you don’t prioritize your sleep, then forget about everything else.

44:11 Dr. Heather Awad Well, I mean, I think we’re finding out that sleep is one of the most important things we all need to prioritize. The other things that I recommend for women in midlife are some of the active things like meditation and yoga are nice for decreasing cortisol. Women at midlife, without jumping deep into exercise, need to do strength training to keep their muscles going and keep their metabolism up and to keep strong. But for the cardio part, I really recommend people do something that they enjoy, at a level that they enjoy. So if they’re going to walk, walk at a pace that feels joyful and fun. Talk to someone. Take a dance class if that sounds fun for you. I like playing sports, so that’s fun for me. Other people would feel like that was like, oh gosh, now I got to go do that thing and playing that sport. You want to do something that feels like it’s stress relieving. So something that sounds fun. Maybe pick something up that you did as a kid again, or try something new. But definitely, something that spiritually, mentally feels like, oh, I just felt better when I do this because it’s fun. Going to the elliptical at the gym and pounding out usually doesn’t feel that great for a lot of people. We measured that people get higher cortisol from that. In fact, I was reading something recently where they looked at blood sugar curves again. One of the things that’s recommended is a five-minute walk after a meal, if you need to lower your blood sugar curve. They looked at that versus people doing cardio after a meal, and their blood sugar was better when they just went for the walk.

45:53 Dr. Ann Tsung Okay. Interesting. Because the cortisol was less, so less insulin secretion. Basically, I can see that happening. Okay. Yeah, I’m probably like in my second pregnancy now, I had to, because of a pregnancy complication, I had to stop lifting after lifting for 10 plus years. For the past two, three months, I have not been able to lift. And I’ll tell you. I think my cortisol is probably half. And not even walk. Like less little gravity as possible is what my OB said.

46:27 Dr. Heather Awad Yeah, that’s a tough deal. That’s really a tough deal to think about what could be fun.

46:32 Dr. Ann Tsung I love your idea. You just do what’s fun for you. Pick an aerobic activity that’s fun for you. Don’t do it just because other people are doing it or because they’re telling you to. Strength training is important to keep up your bones too and your muscles. And if you have muscles, then when insulin is secreted, the muscles can actually pull in those glucose and actually use it to grow. Okay. Awesome. And if you were to leave one action item or takeaway for the audience, what do you think it would be?

47:04 Dr. Heather Awad I would say that weight gain that comes on at menopause is kind of its own problem and is very solvable. And if you want to try just one thing, I would say try eating three meals and not having snacks and not over eating at those meals, and see what happens. And in between, if you’re hungry, like you can feel your stomach is growling and you have that gnawing feeling, then eat some nourishing food.

47:34 Dr. Ann Tsung It’s simple, right?

47:36 Dr. Heather Awad It sounds simple. People are like, well, that can’t be it. But then it is.

47:40 Dr. Ann Tsung Yeah, eat the colors, essentially. Eat whole foods.

47:44 Dr. Heather Awad Yes, and it’s important to have protein and fiber and healthy fats at every meal. So some protein, some vegetables, berries, fruit, and a little bit of fat in there which you’ll get if you have meat. Or, you can cook with olive oil or whatever you need.

47:59 Dr. Ann Tsung Okay. Awesome. Can you tell us how people can find you, or if they want to work with you as their coach in this, how can people find you? And like a very, very brief, I guess we talked about your structure already, if you already have like concrete details about your cohort coming up, please share that as well.

48:17 Dr. Heather Awad Sure. I would say just go to my website heatherawadmd.com or vibrant-md.com will get you there. There is a free mini course for professional women at midlife to talk about why you don’t need to count calories and macros, and why you don’t need willpower and kind of what the magic is for weight loss at midlife.

48:38 Dr. Ann Tsung And also a podcast.

48:39 Dr. Heather Awad Yes, the Vibrant-MD podcast is available on all the platforms. I talk about weight loss, women’s health and food there.

48:48 Dr. Ann Tsung Awesome. And do you have a date of your cohort at all, or it’s not playing here?

48:52 Dr. Heather Awad We’re evergreen right now. Anyone can join at any time. When you go to the website, there actually is a spot where you can book a call with me. And I’ll give you some real results. You’ll tell me your weight loss story, and I’ll give you your two next best steps. And through that conversation, if you feel like, gosh, I want to work with her and get some accountability, then we sign you up at that time. And if not, then you’ve got your two next best steps. And you can just go on from there.

49:17 Dr. Ann Tsung All right. So anybody who is in your midlife, professional woman who wants to either learn how to eat, free up more time, more energy, please reach out to Heather. And that’s A-W-A-D. Listen to her podcast. Book the call now. I think just book a 30-minute call, right? That’s typically how long it is, yeah. If somebody is offering you some tips through her wealth of experience, there’s no risk at all. Just book a call, and then see what your next two steps are. And that’s all it takes. And if you can just take one takeaway from it, one micro action, do it right after this or make a commitment to yourself to eat three meals a day or, say, one doughnut a week or whatever it is. Just make one commitment after this.

50:03 Thank you so much. Thank you, Heather, again for — I went over time because that was just so, I wanted to pick your brain for my own benefit. So I really appreciate your time. And the show notes again will be at productivitymd.com. And just remember that everything that we need is already within us now. Thank you, Heather.

50:29 Dr. Heather Awad Thanks so much for having me.

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