Is this Normal? Weight Loss Medication Side Effects with Dr. Francavilla

Welcome back to another episode of the podcast. Today I have an amazing guest I have on Dr. Francavilla. She is a physician that is board certified in family medicine, as well as a diplomat of the American Board of Obesity Medicine. She owns and operates Green Mountain Partners for Health Colorado Weight Care, and the reason I brought her on is because she is really a nationally recognized obesity medicine expert.

She gives a lot of lectures and talks on this, and with her clinical expertise, I think that what she has to share just really. has a lot of value for everyone. And so when I brought her on today, I really wanted to pick her brain as far as what she thinks about with management, with some of the common side effects. So I think this is gonna be really applicable if you are someone that's either considering these medications or.

Whether you're on them and you need some help to kind of think through different things. Again, none of this ever replaces medical advice and we'll make sure to say that a lot in this episode, but I think it's helpful to just hear a perspective from a different physician on this. And then the other topic that we dig a lot into is pregnancy and talking about, you know, what's healthy weight gain or not, and then also postpartum.

What is sort of the period of time that it could be expected for you to get back to your pre-pregnancy weight, and we just sort of have more of a talk about that. I think you're really gonna love today's episode. The other thing is, I'm gonna link this at the end, and I have absolutely no vested interest in promoting this, but she has a really great resource where you can get CME and there's lots of videos. She has a course. That helps explain obesity medicine to medical providers.

So it provides continuing medical education and I think it's a really good starting place. If you're someone that either is helping patients with this and you kind of want a little bit more knowledge, or maybe you are considering getting into that, if you're sort of more on that medical side. Whether it's physicians or other providers that are helping patients with obesity, medicine, I think that it's really a great resource that I, myself have done it.

And again, I just say it because I thought it was great. And whenever something's good, I like to bring it up. So if you have been looking for that, I'll have the link in the show notes and I wanna encourage you. If you're listening to this podcast and you're absolutely loving it, please leave a review wherever you are listening. Some of you have been leaving the most amazing reviews, and I appreciate that so greatly. Number one, it gives me feedback, what you enjoy or not about the podcast.

And then number two, it really helps to get the word out more when there's a review there. So thank you so much and I look forward to hearing from all of you. Okay. I wanna give a big welcome and thank you. We have Dr. Francavilla on today. She is an absolute pioneer in obesity medicine. So much of my training has come from learning from her. And so can you start with just telling us a little bit about who you are and where you're located, and a little bit about yourself.

Yeah. Well thank you for those kind words. So yeah, so I'm Dr. Carolynn Francavilla. I'm a family physician and obesity specialist, and I have a practice in the Denver area called Green Mountain Partners for Health. and I called my program the Colorado Weight Care Program. And I really quickly in medical school saw that. one of the underlying things that was affecting a lot of my patients health was nutrition and weight.

And it seemed like one of the big picture things that I could do to, help treat, my patients with some of that underlying things. So I had an interest in this, this really early in my career, jumped right in during my residency training and, and have been doing this, since I started in medicine about 10 years ago. So I love doing this.

I. Helping people have a better understanding about why they struggle with weight and, you know, trying to find real actionable things that we can do to move forward. That is, it's so nice when someone found it early on. Cause I feel like I was not in that position. I didn't get that training and so I never really knew in the beginning of training how to help people. You would hear this struggle, but you wouldn't really know good tools to offer. And so that was something I think.

With time, just like you said, I would see all the metabolic problems that would happen, but I wouldn't know how to kind of get to the root of many of these things. So one of the ways, I wonder if we can kind of just start here.

So a lot of these anti-obesity, weight loss medications have been taking off recently and really I think it's that finally. We're kind of getting out there. The word that there are effective treatments that didn't exist before. And so one of the things I'm wondering if we can just start with a quick lightning round on what are some of your thoughts or what do you offer to people with some of the common side effects that we see?

So I'm wondering if I can just kind of start with picking your brain on that. Yeah. you know, it kind of depends on the medication, right? Cause they definitely have different side effect profiles, but you know, the, the most popular one right now is the Wegovy or Semaglutide. So that's where there's a lot of buzz in the media right now. Um, and you know, it's kind of interesting and you can tell me what you've seen with your patients too.

The studies really indicate that the vast, vast majority of people, We're able to tolerate the side effects, meaning most people did not quit the medication in the studies due to side effects. but there definitely are a lot of mostly GI side effects. And by GI we mean like sort of stomach and intestinal issues and it can be a little unpredictable, right? So I have. Two patients who know each other in my practice, and one of them has terrible, terrible diarrhea from taking semaglutide.

And the other one has some of the most severe constipation that I've, you know, seen from a medication. And it's interesting that one medicine can have, of opposite side effects like that. Right. So, you know, I think. Ultimately, of course, anytime you have a side effect, we wanna make sure that you are talking about it with your physician or whoever is prescribing that medication, because it's always possible that it's something else, right? Just because when you started a medication,

you suddenly got something. It could just be a coincidence, right? If all of a sudden you have terrible headaches, Well, you should see your doctor to figure out why you have headaches, right? Maybe it's something else. so I would say number one, you know, if you're having significant side effects, you should be talking to the person who perscribed the medication, right? Because, they wanna look at that complete picture.

So I know you say this in the disclaimer in your podcast, but none of this is meant to be individual, medical advice, This really is sort of broadly speaking. but at the end of the day, we treat that constipation like we would any other constipation. So that would be, of course, starting off, making sure you're getting enough to drink. Without enough water, you're gonna have constipation. And so a lot of people describe that, decreased appetite with the medication.

But a lot of people have decreased thirst too. They're not drinking as much. Yeah, Hunger drive and thirst drive can go down. And so even if they got great water intake before, you need to keep doing that when you get on this medicine because it might kind of start to back down for you. Yeah, and so if you're one of those people where you've never had to think about drinking water, you just kind of naturally drink the right amount, you may need to now be intentional and plan.

So for me personally, I do forget to drink water if I don't set a goal for myself. So I always have like my water bottle and I'm like, I need to finish this by lunchtime. If I haven't, then I drink it all sort of right at that time. And then I do another one before I leave work for the day, and then I try to get in another one before bed.

If you, again, if it's not becoming as natural to you to drink as much fluids as you're supposed to, sometimes setting some of those goals for yourself throughout the day can be a technique to make sure you're getting the water in. If your body's not giving you the right cues about it anymore. and then, a lot of the techniques that we use for constipation also work. Great.

So MiraLax is an over-the-counter, treatment that people can use a little bit or a lot more if they, they need it for loose stools. So that has been a great solution for some of my patients. and then some people need to make sure they're still getting enough fiber in.. Maybe do a fiber supplement like Metamucil or psyllium caps. So, you know, hopefully your physician can help you figure out what is the best tool for you.

But a lot of the traditional things we use for constipation still work great with the medication. It's just some people had great bowel movements before and now all of a sudden, things have slowed down and so they're not having, as much bowel movements and they are not getting some of the same level of hydration and fiber that they had before. The diarrhea side. I find a little bit harder to treat. Interestingly, fiber can also sometimes help with that.

So some people will do while bulking up with more fiber with Metamucil or psyllium husk. and some people, once your doctor has made sure there's not a different cause for your diarrhea, can use an anti-diarrheal medication over the counter like Imodium, because most of the time those diarrhea symptoms get better, but, you know, any change in bowel movements, you should always run by your doctor because there could be other things going on.

You could have an inflammatory bowel disease, you could have colon cancer. So, you know, I think it's important to always run that by whoever's prescribing the medication, make sure they don't think something else is going on. But really, most of our over-the-counter treatments that we use for constipation or diarrhea are still in our toolbox. if, if you're having bowel changes, that's a side effect from the medication. That's such good stuff. I, so I kind of wrote that down.

So it's making sure you know, the fluid, um, fiber, MiraLax, other supplements and checking in with your doctor because something we always get worried about if someone has not had the routine age appropriate cancer screening, I'm not ever gonna assume that anything is medication related, even though again, I could say I think, but we want that discretion of what your doctor's thinking. I think the other thing I add in is movement.

That's a lot of the way that our bowel moves along now a lot of the time, right? Like we're slowing down the gut because of what we're giving. But that doesn't mean that, you know, if someone's bedbound, we know that constipation kind of goes hand in hand with that. And so can we add that in if that's something that they're not routinely doing? Sometimes even like a yoga practice. I mean it can be different. Yeah. Some yoga, some walking or. Working on some core strength.

Those all literally help things move along. So yeah, and of course we want people moving with these medications as well, cuz that's gonna have additional benefits. So yeah, that's a, a great other thing to, to add in that can help some people also experiment with probiotics. Um, there's definitely gut changes in terms of our microbiome, the bacteria, in our gut that can happen with these medications. And so always reasonable to increase probiotics from food or in a supplement source.

but we don't have any best data on what's like the best probiotic to recommend to people. So I always say, you know, if you're interested in that it's worth trying. but if you're not seeing results, you know, you can stop investing your, your money in those probiotics. I don't know about you, but I have like a 30 day rule with supplements, and if you're feeling great and it's working, you stick around.

Otherwise, like after a month or two, you know, if you're just not seeing it, if we don't have the data to support it, then, why are we wasting our time with it? The one question I have for you, I know I feel like in the weight loss community, magnesium is like, oh, everyone's taking magnesium. What are your thoughts on that as far as helping with constipation? Yeah, so magnesium, depending on what type of magnesium you take, can have more of that laxative effect.

or some of it can stay in your system, so you wanna make sure you know which type of magnesium you're getting, if you're gonna use that as a supplement, because some of them, are much better at producing bowel movements than others. But, you know, always a really reasonable, safe option for most people. Some people will have, muscle cramps and they get benefits from a magnesium supplement as well. Sometimes restless legs or trouble sleeping people will also get some of those magnesium benefits.

So I think that's a really reasonable intervention for, for people to try, especially if they're having any other symptoms. Yeah, and I have a good guide on kind of their, all the different kinds of magnesium, kind of just roughly what they do. And so I'll put that in the show notes if anyone's interested. Again, you're gonna talk to your doctor first, though, so we're gonna, we're gonna keep stressing this because there are certain scenarios where magnesium is not optimal for someone.

And so again, hopefully your doctor can make sure you're not in that, in that camp. But 99% of the time it's usually a great option. So something that that I wanted to ask you about as well, I know that you do a lot with binge eating disorder. Which, number one, I think we clinically, a lot of clinicians that are not trained in this area miss this as a diagnosis.

but how do you approach this typically, if you get someone that, let's say you diagnose binge eating disorder, they suspect that they have it. Where's a good starting place for them? Yeah, so I think it is something that has traditionally been missed in a lot of weight loss programs. and it is something that I like to teach on that we should be looking for, that when someone comes, to us wanting help with weight loss.

question I like to start with, to kind discuss that with a patient and, and for people to kind of evaluate for themselves are, are there times where you feel like you eat out of control? And it's interesting to get people's answer on that because I will have some patients who will tell me, oh yeah, I'll go to a restaurant and I know I shouldn't eat the entire cheeseburger and french fries, but I do. Well, that's not a binge episode. Right?

Like, was that like your goal for your diet or for weight loss or for your health maybe. But that was like a normal portion of food in our country. Lots of people ate an entire cheeseburger and french fries today, right? Like, I've done that. I think everyone's done that. That's not binge eating, that just may not be helping you reach your nutrition goals. but then we kind of dig a little deeper and it's like, well, do you feel like a loss of control? Like you can't stop eating.

So for some people that's going back and forth for more, you know, they have their dinner and then they eat a bunch of crackers, and then maybe they're gonna eat a bunch of fruit. Then maybe they end up eating, you know, a pint of ice cream and they just kind of can't stop that grazing. and that

happens over the course of maybe one or two hours where they just really feel like there's this loss of control. for some people it's, it's a hidden or secretive behavior. And so that's always sort of a flag that that's some sort of disordered eating, right. Even if it's not. True binge eating disorder. That's probably not a good relationship with food.

If you are getting a fast food meal, eating it in your car, throwing that away, and then having dinner with your family, that's another, you know, indication that you probably don't have a good relationship with food. Um, so some of those things, and really looking for that, that loss of control and then how you feel after, have you eaten to the point where you just physically feel really, really uncomfortable? And or emotionally distressed, right? Are you beating yourself up? Are you dwelling?

Is it a really emotional response? So those are some of the things I, I like to tease out, to figure out. Is this really more, disordered eating or binge eating disorder specifically? Or is this sort of, we all have emotional eating, right? I think some of the studies say like 80% of people emotionally eat. Um, we're all gonna lose control occasionally with how much we eat. When something's really good, it's our favorite food, it's a holiday.

Some of those situations where, moderation is a lot more challenging, but when it's a repetitive thing that happens and keeps causing a lot of distress, we really should work on treating that. Before we worry about weight, right? Because if we don't, we're just gonna set you up for yo-yoing and, and feeling like a failure and more emotional upset around food. Yeah. You know, I see this with women, or, I don't know why I'm saying women, but just patients in general.

I see that they'll get this diagnosis and then they really desperately wanna lose weight. So they don't want to sit there and kind of stabilize things first. And I try to explain to them, this might actually be the quickest way you get to your goal, but just for people to hear. Sometimes taking a step back and focusing on that first is, is the quickest way to get where you want to go. I think sometimes that's Helpful for people to hear.

Yeah, I think labeling it sometimes, you know, most people have no idea that binge eating disorder is a diagnosis, so sometimes they don't realize that what they're doing really is that disordered. And so sometimes that's just a light bulb moment for people too, to be like, yeah, actually, that that's not how everyone acts. Around food and like, let's work on that. A lot of people get a, you know, a mental sense of relief from treating the binge eating disorder.

Even if they don't see that change on the scale, it can be pretty life changing to not have so much mental energy going into how you act around food. So, you know, there are benefits beyond the scale. And I don't know what you've seen, but some people, when we treat the binge eating, eating disorder and those binge episodes go down or go away will lose significant weight. But some people, you know, don't lose any, they, they stay the same.

And that's super frustrating when that happens for someone, right? That they're like, I'm no longer having this loss of control around food and the scale hasn't changed. And that's, that's really, really frustrating for. I, see that, and there's, no way for me to predict which version that it's for them. Yeah. So to me, I'm like, look, we're, we're walking on this journey together. That's why we have frequent follow up. We're gonna keep looking at things.

But at the end of the day, I think the first thing is like, we've gotta get rid of expectations. Because however it happens, we're always gonna have another tool that we can help with. But just letting go of, like, even if it's gonna stabilize weight, might not go down. And that's okay. And then we can, we can do the next steps, but we don't wanna be too restrictive, right? So there's this perfect middle ground where we can keep helping.

And I think that's what it's tough, but, but like you said, there's always the next step. So I have some people in my practice, you know, that I've seen for eight, 10 years at this point. And so some of those, people, you know, maybe their binge eating has really been well controlled for many years. We're like, well now maybe we can start to get a little more intense on nutrition. Or now maybe is the time for bariatric and metabolic surgery, right?

Maybe now that you have this good relationship with food, you actually could benefit from that surgery. if you get surgery, before you've addressed that underlying binge eating disorder, I think you're really high risk to regain weight. But if you really have been in a good place and it's treated, it's in remission, then you know, surgery may be, you know, a great step for some people. And then, of course, our newer medications, our, our GLP one s our injectables.

I'm seeing great results for people with binge eating disorder. So a lot of people, we can do the work around the relationship with food, but then we can use some of these medications as tools and really, help with both things. Yeah, it's been so beautiful seeing that come in and that people almost sometimes will say, well, this is the date when I started at August of 2022, and I haven't had a binge since.

And frankly, it's, yeah, it's, it's quite miraculous what some of these provide something that I'm thinking. And then of course, the, the medication that we have that is F D A approved for binge eating disorder is vyvanse. And again, I've seen people. Life changing on that medicine. They just go from, you know, five, six episodes of binge eating a week to, to basically zero with that medication. But we don't always know if that's gonna mean weight loss. Right.

I actually just talked to someone this morning where history of binge eating disorder had tried vyvanse in the past and it didn't help at all. And so it's like, okay, you're, you're one of the exception. But again, it's, I think this is the frustrating thing in this area. People come in with this conception that they just wanna like lose all their weight right away. They want it to be real quick. They just wanna like move on with their life.

And what if this is actually like a chronic condition and we have to learn to manage it and we need different things at different times. And so I think the quicker, at least that I see with patients that they can get on board with that the quicker that they're able long-term to kind of see the results that they want because it's gonna keep changing what they need. absolutely.

And I think that's where having, you know, a clinician, a physician expert who can guide someone through this and not sort of be like, well, here's our six week program, or here's our six month program, but say, I'm gonna be here to navigate this with you long term. Right? So if you are losing weight for six months, great, but if you regain that in at month nine, I'm still here and we're gonna troubleshoot and we're gonna support you and figure out, you know, how to move.

Definitely something that I wanted to ask you about, cuz I know that you have some really great thoughts as well about, either pregnancy, weight gain, or al also postpartum. Where I wanna start with asking you is that I hear from a lot of OBGYN doctors that if a, if a woman has come in using the weight loss medications, let's say the injectable GLP one s. And then she stops it. They worry about extreme weight gain during the pregnancy.

And so I'm wondering, do you have any tips in general for, you know, it's quite common that women will optimize their preconception time with losing weight to sort of help that pregnancy. But do you have any tips for, if we can just start with during pregnancy, to not have excessive weight gain during that time? Yeah, that's like a, a complicated, you know, there's multiple parts to that question and, it is an interest of mine.

I got to speak at one of our recent Obesity Medicine Association meetings on this topic. And I do share the concern and I think the data supports that if you lose a lot of weight or you, you lose weight, you're doing all the right things before you get pregnant. But then during pregnancy, you, you have what we call excessive gestational weight gain.

You gain more than we would recommend, or you're not able to keep up some of those healthy habits during pregnancy that you probably have not given yourself those health benefits in terms

of, you know, increasing the safety of pregnancy and you probably haven't given your, your baby those. Benefits. And so although weight loss before pregnancy can be beneficial to both mom and future babies, it's really important that we bridge that gap and that we make sure that we as doctors, if we are helping someone before pregnancy, are there for them during pregnancy and help support them with, different interventions of course, during pregnancy.

For me, my dietary choices changed a lot when I was pregnant. And of course, most of the medications we use, we would not be able to continue during a pregnancy. A lot of times when we're having this conversation sort of before pregnancy with patients, it's figuring out when they are planning to get pregnant. And so for some of my patients, it's a distant goal. They, they're like, I'd like to have children someday. You know, maybe they're thinking 5, 7, 10 years in the future.

And so that gives us plenty of time, right? To kind of stabilize things and, have the patient be at a, a new weight before they, they conceive, but some of my patients come in and they are sort of, they're ready, they would like to, get pregnant in the next six to nine months. You know, they, really, are thinking about that in the short term and.

Oftentimes for those patients, I'm a little more hesitant to start a medication because my big tenet with, treating weight is whatever we do, we have to be able to plan to keep doing. you know, things are gonna change, right? You might have a side effectual medication. Your dietary preferences might change. You might start a new medicine and they interact or whatever.

So we might have to change things in the future, but we should go into any choice we make, whether it's the nutrition plan you're picking, the exercise plan, you're picking the medication you're picking. With this thought that we could continue that plan forever.

So if I know you're gonna stop birth control and try to get pregnant in three or six months, For many patients, I would not recommend using a medication super short term because I think there is a really high risk that now we know when we stop these medications, most people are gonna regain weight that you're, you're likely to regain weight. So I would rather you have more modest weight loss, but do more in terms of lifestyle before getting pregnant.

I just had this conversation yesterday with the patient, so I feel like it's all fresh on my mind. When we look at the data about why weight or obesity affects health, a lot of it has to do with. Metabolic parameters, you know, inflammation, high blood sugar. And so there are people who are healthier at different weights, right?

Some people have a lot of that metabolic dysfunction at lower BMIs, and some people are at a higher B M I and their blood work looks great and they're hiking every weekend and they feel great. And the people who really have no other health risk factors with their weight make me a lot less concerned for. You know, pregnancy, they make me less concerned that they're gonna get cancer someday. I'm less concerned they're gonna have a heart attack someday.

And so a lot of this is having those individual conversations with, with your physician about, well, how at risk is your weight really making you? Because sometimes it is, you know, if you are on the border of having diabetes, we really should make some changes and get you healthy before a pregnancy. But if your b m I just happens to not be ideal on a chart but you otherwise are really healthy. Maybe we don't need to get super aggressive, right? Maybe we just need to optimize what's going on.

So I guess that's my 2 cents. We don't have a lot of data for, for some of those things, but I think what we see in other areas of how weight affects health is, again, there's some people whose bodies tolerate higher BMIs than others. I think it's good to hear though the focusing on what's the timeline.

I think that's so practical and that Yeah, maybe, and, and I don't know, and again, I have no data to support this statement, so you can tell me if you think it's totally wrong, but I don't know that it is necessarily the best thing to have super rapid weight loss before you go into a pregnancy. It just doesn't Yeah. Sound like. You know, the little bit of data we have doesn't show that that helps with health outcomes.

What we really see helps with health outcomes, meaning baby, you know, is born healthy, mom is healthy, during delivery and after pregnancy is what you do during pregnancy. And so, you know, and those are modest interventions in pregnancy, right? This is things like, you know, moving on a regular basis, whether that's walking or yoga.

Personally, I, you know, I like to do really intense exercise when I'm pregnant, my body is like, no. So I, I walk and do yoga when I'm pregnant cuz I, my body just very clearly did not feel comfortable doing those things. If you're one of those people who can keep doing high intensity exercise while you're pregnant, props to you, but, What we see, you know, in the datas where they, do outcome studies is modest interventions, right?

Eating lower glycemic, that doesn't mean no carbohydrates, right? But avoiding, sweets and eating complex carbohydrates and eating balanced meals. all those really small interventions in pregnancy payoff quite a bit for most people. and even, you know, I want people to hear too, that are listening. I was someone that, just to personally share a moment, I went into a pregnancy, you know, beyond 150 pounds overweight. And I had wanted to do all those changes before this was, this was years ago.

I hadn't made those changes, but the minute I was pregnant, I made the changes and yeah, it doesn't matter where you're at. I was eating, on the lower carb side for blood sugars and all those changes really matter. And it did control that there was not a lot of weight gain with the pregnancy. And so even if you're someone that's listening where you are in that position, again, there's just always a moment to capture something positive that you can do.

And I want people to hear that, that it's not all about that. You have to be a perfect weight before. That's really not what we're saying. Absolutely. Yeah. Wherever you're at, whether we're talking about pregnancy or before a surgery or just trying to, you know, live your best, healthy life, we have to look at what's the best thing we can do right now. Right? So it, the easiest thing is to never gain weight, right? if you've never gained it, you don't have to lose it, right?

But like, we have to accept the reality of where we're at, right? Like right, and, and do the best thing. Most powerful thing for our health right now. and not get too caught up in like what could have been, or, you know, what's in that ideal world. Because really all we have is what we can do right now with the body we have right now. Exactly. I heard the best line the other day. This came from some doctor, I can't remember who, but she was like, life is too short.

So we always need to keep just looking forward we just gotta keep going. That's exactly what you're saying. So let me ask you, after a woman has a baby, there's that postpartum period. Sometimes women are breastfeeding, sometimes they're not. I hear historically from women, this is a very tough time for them to lose weight, and I tend to think that maybe weight loss, right? Initially, there's a lot going on. Hormonally, your body's getting adjusted.

Again, maybe it's not the best time, you know, the first few weeks or months, but I'm wondering what are your thoughts? Do you see the recommendations be any different at that time or is it pretty much the same as always?. Yeah, there's so little information about this. So, you know, until recently there was really almost no data about what should even happen, right? What's normal, you know, going into pregnancy, I was like, what's gonna happen, right?

Like, how long does it take to lose the weight? What should I expect? And there basically was, until recently, very little information. And there's still just like, maybe one study about this, the, the data, you know, that I have seen shows. Most women should be close to their pre-pregnancy weight by about a year.

So I think that's a good timeframe to think if you are, you know, at that nine month mark and you are, you know, not feeling like you're getting close to whatever your weight was before pregnancy, that may be time to start thinking. You know, I, I'm having a harder time than average, and maybe I do need some additional support, whether that's working with someone

who can help with lifestyle stuff, because lifestyle changes a lot after you have a baby, especially if it's your first, or whether that's seen a, a obesity physician. Um, so I think that, you know, that sort of six to 12 month time period is where if you feel like, you know, you're nowhere close to your pre-pregnancy weight, maybe you start thinking about doing something. There's usually a big weight loss with pregnancy, right?

So you, you have your baby, which is, you know, like six to 10 pounds, and there's a lot of fluid that changes. So most women are, you know, going to lose 20, 20 something pounds pretty immediately, and so, You know, if you have sort of a normal weight gain in pregnancy, you gain, you know, 30, 40 pounds in pregnancy, you're not gonna have to lose all of that. Right.

And so I think that, for women who have not been pregnant yet and are a little worried about like what to expect, I think those are some expectations. You know, the, a lot of factors in this, if you're breastfeeding, a lot of women struggle to cut calories or cut carbohydrates or, or increase exercise too dramatically, and make enough breast milk. So that's something that you definitely need to navigate.

But I wouldn't let that be a reason to be afraid to make change either because lots of women are able to successfully reduce calories, and exercise more and, make enough milk. And so if you are breastfeeding, checking in with your body and, and if you are making a change in terms of what you're doing with nutrition or exercise, See if it's impacting your milk supply. You know, watch that.

And if you're one of those women who it does decrease your milk supply, then maybe be less aggressive with, with the exercise or the nutrition change. But I, I think some women get really afraid of that and you'll know really quickly. Right. You know, you'll know in a couple days if that change had that effect on your, your milk or not. And that guides you and, the older your baby gets, the less important that gets, right?

So if you're nine months postpartum, now your baby's eating food, you probably don't need to worry quite as much about how much milk, you're able to produce because it's less of an urgent thing to have the baby get is milk. Whereas, you know, when your baby's eight weeks old, they really need all the milk you're making and so. Maybe, not an ideal time to get super aggressive, in that first, 12 weeks to six.

I think it's so helpful, just coming back to how you said that by the one year mark, you should be kind of where you were pre-pregnancy because I find that I, I don't know when women come to you, but they typically come to me years after their kids will be 2, 4, 5, 6, 7, and then they're like, I just could never get back to it, and. It's interesting. I wonder if people kind of have this empowerment to know, hey, by one year, if it's not back there, maybe now we start to get on it.

We don't need to keep delaying. Cuz I often find the longer that people are overweight, the longer that we're not working on it. Actually. Absolutely Getting, keeps getting harder. Right? So the earlier we can intervene, this applies to little kids and applies to us. Like early intervention is usually key I find with majority of these things.. Yeah, absolutely.

And again, there's, there's limited data, but, you know, I think the best study that's out right now, really that's what it says is the majority of women are pretty close, you know, maybe a few pounds away from their pre-pregnancy weight around 12 months. So that's not to like put pressure on anyone, but again, if you're finding that you are really outside of that norm, that you have gotten to 12 months and you, are not close to where you beforehand, don't wait longer, right. get some help.

Whether again, that's working with someone on the nutrition side or seeing an obesity specialist. Yeah, this is all so good. Well, I just wanna say thank you for coming on today. I've learned so much. I know all our listeners are gonna absolutely love this. Can you let them all know where can they find you on social? What kind of things do you have going on? Just so people can be more connected with you.

Sure. Yeah. So my last name's Francavilla;, f r a n c a V as in Victor, i l l A. There's not a lot of Fracavilla's in the world, so if you can spell that, you can probably find me. But I'm doctor spelled out Francavilla on Instagram, and I have a podcast. Is called the Dr. Francavilla Show, where I talk about health and weight. So lots of these similar topics and, for any physicians in the audience, I have a course and toolkit to get started in the field of weight loss.

that website is helpyourpatientsloseweight.com love it. Thank you. I'm gonna make sure to put all your stuff in the show notes below this episode. I need to say I love continuing medical education. I did your course. It's absolutely amazing. So I highly recommend this to can people that are not physicians, people that are, medical, like if it's a nurse practitioner, things like that, are they able to sign up for that course as well? Yeah, absolutely. Yeah. Okay. So anyway, it's super amazing.

So thank you so much and thanks.