197. Weight Loss Plateaus: When to Worry & What to Do with Dr. Marilyn Galindo

Subscribe on Apple 

Subscribe on Spotify 

Your GLP-1 was working great… until it wasn't. 

The scale has stopped moving, the food noise is creeping back before your next shot, and now you're wondering what to do. 

Should you increase your dose? Switch medications? How long is too long for a weight loss plateau? And what if you're actually gaining weight despite doing everything right?

These are some of the most common questions we hear in obesity medicine, and the answers aren't always straightforward.

I sat down with my good friend and fellow obesity medicine physician, Dr. Marilyn Galindo, to talk through how we handle these tricky situations in our own clinics, what we look for, and the adjustments we consider.

Let's get into some of the questions we hear most often.

How Do You Know If You've Hit a Weight Loss Plateau?

When you first start a GLP-1 medication, it's exciting to see the scale consistently moving down. Then, a few months in, your weight might stay the same for weeks, and you start wondering whether the medication has stopped working.

Dr. Galindo sees this frequently, particularly around the six-month mark. Her approach is to give things some time before calling it a true plateau.

She generally waits six to eight weeks without weight loss before investigating further. Weight naturally fluctuates, and sometimes your body needs time to adjust.

When someone has been stuck for a while, she looks at what's happening beyond the scale:

• Stress: Has something difficult happened at work or in your personal life?
• Sleep: Are you getting enough rest?
• Nutrition and movement: Have your usual routines changed?
• Medication: Is your current dose still appropriate?

We also talked about how significant life events, particularly grief, can affect your body and your ability to maintain your usual habits.

One thing we both agree on is that maintaining your weight is an achievement in itself. If you've lost a significant amount of weight and you're keeping it off, that's meaningful progress, even when you'd like the number to keep dropping.

Why Does Your GLP-1 Wear Off Before Your Next Shot?

This is one of the most common frustrations we hear. You take your weekly injection, feel great for the first few days, and then by day four or five, your hunger and food noise start creeping back.

Dr. Galindo explained that this is something she regularly sees with patients taking medications like Zepbound and Mounjaro.

One of the first things she checks is whether someone is eating enough earlier in the week.

When your appetite is heavily suppressed, it's easy to eat very little for the first couple of days. Then, as the medication's effects become less noticeable, your body starts making up for that lack of nutrition.

We discussed a few ways to approach this:

• Eat consistently throughout the week. Pay attention to your protein and overall nutrition, even on days when you're less hungry.
• Consider your injection day. Depending on when hunger is most challenging, your doctor may help you choose a day that works better with your routine.
• Review your medication plan. In some situations, an obesity medicine specialist might consider other medications or adjustments to help manage breakthrough hunger.

We also talked about why automatically increasing your dose isn't always the best move. If you're still losing weight and your current dose is generally working, there may be good reasons to stay where you are.

Any changes to medication dosing or combinations should be made with your prescribing clinician.

What If You're Gaining Weight Despite Doing Everything Right?

Few things are more frustrating than seeing your weight go up when you haven't changed anything.

Unfortunately, this can happen, even when you've been consistent with your habits and medications.

Dr. Galindo's first step is to investigate what might be contributing to the gain. That could mean checking thyroid function, reviewing recent health changes, or looking at body composition to understand whether the change involves fat, fluid, or muscle.

Sometimes medication adjustments are needed. Other times, it's about understanding how your body has adapted over time.

We also discussed something that people don't always want to hear: your lowest weight may not be the weight you're able to comfortably maintain long-term.

You might regain a few pounds and find that you're able to maintain that weight while enjoying your life and keeping up with habits that actually fit your schedule.

Dr. Galindo shared her own experience of losing weight years ago through incredibly strict dieting, only to regain it when that routine became impossible to maintain.

It's a reminder that even when you're highly motivated, there's a limit to how much time and energy you can dedicate to managing your weight every single day.

How Do You Know When You've Lost Enough Weight?

This is one of the trickiest conversations we have with patients.

Someone might reach a weight where their blood pressure, cholesterol, blood sugar, and body composition have all improved significantly. They're feeling good, moving comfortably, and doing really well medically.

Yet they still want to lose another 10 or 15 pounds.

Dr. Galindo explained that it can take time for your perception of your body to catch up with the physical changes you've experienced.

When we're discussing whether someone should continue losing weight, we consider much more than the number on the scale:

• Blood sugar, cholesterol, and blood pressure
• Muscle mass and overall body composition
• Energy levels and physical function
• Eating habits and nutritional intake
• Quality of life and how sustainable the current routine feels

Sometimes this means working with patients over several appointments to help them recognize how far they've come and feel comfortable shifting their focus toward maintenance.

And maintenance itself takes work. Your medication needs may change, new challenges come up, and you may need adjustments along the way.

What Does Long-Term Success on a GLP-1 Actually Look Like?

One thing Dr. Galindo and I kept coming back to is how important it is to build a treatment plan around your actual life.

We've all seen the advice online telling people to meal prep every meal, exercise for hours, track every calorie, and follow a perfect routine.

That might sound manageable when you have endless free time, but it's a different story when you're working, raising kids, managing stress, and juggling everything else.

Dr. Galindo talked about meeting patients where they are. If someone can't manage an hour at the gym every day, perhaps 30 minutes a few times a week is realistic.

We also talked about the emotional side of weight loss, including changing relationships, comments from other people, and adjusting to life in a different body.

These are all things that deserve attention as part of ongoing obesity treatment.

What If Your GLP-1 Really Isn't Working Anymore?

Toward the end of our conversation, Dr. Galindo brought up something I loved: hope.

It's easy to feel discouraged when your progress slows, especially after years of trying different approaches to weight loss.

But obesity medicine continues to develop, and there are already different treatment options available depending on your circumstances. New medications are also being studied.

If your current treatment isn't giving you the results you need, it's worth having a conversation with a clinician who understands obesity medicine and can help you explore your options.

And don't forget to look at what you've already achieved. Maybe your weight isn't changing right now, but you're sleeping better, moving more easily, or feeling more comfortable doing things that used to be difficult.

Those changes matter.

Want to hear the full conversation? Listen to my episode with Dr. Marilyn Galindo for more on how we work through these situations with our patients.

You can follow Dr. Galindo on Instagram and TikTok, or visit leonspringsobesitymed.com to learn more about her obesity medicine practice in Texas.

TRANSCRIPT:

Disclaimer: The transcript below is provided for your convenience and may contain typos, errors, or grammatical inconsistencies, as it has not been professionally edited or proofread. Please enjoy it as-is and read at your own discretion.

Please note: The content shared in this podcast and blog post is for informational and educational purposes only and is not intended as medical advice. Always consult your healthcare provider for personalized medical guidance.   

 Welcome back to another episode of the podcast. Friends, I am so excited today. We have Dr. Marilyn Galindo. And let me just, er, let me take everybody back. So I feel like it was years ago at this point, you created an account online, right? So you're an obesity medicine physician, and I was following. I was like, "I love her content." So then we end up meeting at a conference. It was a direct care conference, so everyone that's listening, that means not dealing with insurance. We learned together, and we were talking and all the things. It was me, you, and Amanda. And then after that, we've kept in touch. And I love your perspective. I love how you approach things. So I thought it would be super fun to bring you on today, and we talk through some of those scenarios where people kind of get stuck. Like, how do you think about it? 'Cause it might be different than me, and I think people learn from all of that. Can we start with you just introducing yourself, and tell us a little bit about maybe how you got into medicine and about your clinic, just so people have a little bit of context. So hi, everybody. I'm Dr. Marilyn Galindo. I have an obesity medicine practice called Leon Springs Obesity Medicine in San Antonio, Texas. So I can see patients anywhere in Texas. I do virtual visits. It's a direct specialty care practice, so we don't take insurance. But it's actually really nice that way because it, it allows me to do a lot with my patients, my appointments are longer. I'm able to really connect and get to know my patients. So it's just a great way to practice medicine, in this current environment where, insurance is dictating everything that we do. We really have the time to, dig deep into your medical history and try to figure out how we can optimize things to improve your metabolic health. So that's what I'm doing. I'm very excited to be here with Matthea. She's been my friend for a couple years. We have very similar philosophies on how we approach weight and, obesity in general because it is a disease and it's not something that you're gonna fix with a quick diet and exercise. We know this. And we also recognize the challenges that our patients face with, the stigma and, all of that. So- Totally. And- I'm very excited to be here ... and I want to say, guys, you know it's rare when I.. If people email me and they're like, "Oh, I need a doctor in whatever state," I always send to you if they're in Texas. I'm like, "Dr. Galindo is who you need to see." Yeah. And it's so nice when there'll be people that maybe have done my programs, and then they come and see you, and they're like, "She's amazing. Thank you." So just, you're marked a safe doctor, just FYI, to anyone that's listening. So let's just start out with this. I feel like you just hear this all the time where people, they've been stuck for a few months somewhere. So they say they're plateaued, stuck, whatever weight they... whatever term they use. I am thinking, "Gosh, I'm so glad that you're maintaining," 'cause that's really hard. Mm-hmm. But when someone's like, "Look, I..." They've made a lot of meaningful progress, but the scale has stopped. How do you decide whether it's, you're gonna call it a plateau or that this is just a normal phase of treatment? When do you find that what's what, and when do you shift the goals of care? So that's a really important question because, I think when people start treatment, they're doing really well at the beginning. Those first six months especially, you're seeing that steady decline. Every time you get on the scale, you've lost one pound, two pounds, right? And then I would say around six months is usually when I start to see things kinda plateau and, then the panic sets in because you thought this was working and now it's not working. So for me, I always tell patients, like, "I'm not gonna call it a plateau until it's been almost six to eight weeks," because there are some fluctuations. Sometimes your body just needs to adjust, and then we need to investigate. What is going on in your life when this started to happen is it that you're not on enough medicine? Is it that you had a family emergency or something tragic happen in your life and you're not eating like you're supposed to, or all of a sudden you don't have time to work out? So a lot of times we have to look at it and say, "Okay, it's been two months." I actually worry more when people start to gain. Plateaus don't bother me as much because, like you said, they're maintaining. It's just your body adjusting. Let's give it some time. But if you start to gain, then I'm like, "Okay, let's look at this more closely. Do we need to check labs? Do we need to, figure out what's going on in your life?" And if when we interview the patient and we find out, hey, your mom just died or something horrible happened to you, then we gotta, really take a step back and be like, "Okay, let's give you some grace here." Things happen. Things are not perfect. Something bad happened in your life and, um, you need to grieve and, we need to... Because life happens, life is not perfect. I'm so glad that you bring that up because, unfortunately in my group a lot of people have lost, a parent- Mm-hmm ... elderly parents, and I know in our family we had a loss. And grief is a whole-body experience. It is no joke. You don't just... And it's not about... It... You can even in your mind be like, "Well, I'm moving on, and I'm, and I love them, their memory, and I'm..." You know, a- all the things you can feel are okay, but your body perceives something different happening, and I think people don't understand how significant that can be. Like, I've had patients that have grief weight loss, which is actually horrendous, right? Because it's like they're not... This is not how we wanna be going about it. But we can't control all the things mm-hmm. And then we have people where they might be gaining weight during that time, and it needs a different set of eyes compared to just, the quote-unquote routine pathway. Mm-hmm. But I don't think they realize that, that it's like, no, now you're in a different lane potentially for a period. Correct. Your body's completely disrupted because there are the four things that we need to make sure that we're accomplishing. We need to eat well, we need to make sure we're working out, that we're sleeping well, and then stress is the fourth one. Yeah. Like, so if one of those is off, your whole weight loss journey might be, on pause for a little bit. So I, a lot of times I try to reassure patients,, this is probably temporary because it usually is. Eventually- Yeah ... with some adjustments, we can get them back to losing. Another approach that I have taken, and I'm not sure if this is what... I would like to hear your perspective on this, but I usually am more of if your dose of medication is working, we're not gonna adjust until it stops working, which, you know, not a lot of people do that. I've gotten a lot of patients who go up, up, up, up, up, and then they have nowhere to go, and... Totally. I'm 100% with you, and my thought process on it is similar to yours. It's that if, things are working for you, we don't wanna get used to, "Oh, I'm so suppressed, I don't eat, and I love that I never think about food," and it's this crazy land that you're not gonna live longterm. If you get used to that in the first six months, year, things like that, then the panic is through the roof when it doesn't feel that way anymore versus if we do it nice and gentle where it's a tool, it's one leg of that table, but it's not every single one. Mm-hmm. You can still stand without it, right? It's- Mm-hmm ... they have long-term, I find it works out so much better f- for them. My people don't have panic that sets in. A little bit. They're like, "Oh, yeah, it's not working as much," but they know they're gonna be okay because they've been used to this the whole time, that it's a tool and not a shut-off valve. Exactly. So that's kind of my approach, too. It's like we're gonna take this very stepwise approach. We're not gonna rush into things and another thing I always say is, this is the rest of your life, right? Mm-hmm. It's not gonna be something... and I'm sure you set these expectations early on in your appointments, this is not something where you're gonna g- reach your maintenance goal weight and then we're done. And you and I both know, and you were touching on this earlier, once you reach maintenance, that's also very hard. Yeah. There's a lot that goes into that, the body dysmorphia, the grief of, maybe not starting sooner it's such a complicated time for a patient. Totally. I think the skill of being able to, whatever comes up, I'm strong enough to process it, I'm resilient, I can handle this, because there's always gonna be something new. People always think they're gonna arrive and everything's solved, and it's like, no, now there's just a whole nother kettle of fish. So, Mm-hmm ... it's like learning that you can handle it no matter what. But I do think it's massive what you're talking about, how even in maintenance it continues. Uh, 99% of my patients have been with me for years and years and years. Mm-hmm. Majority of them do get to maintenance, and they're where they wanna be. And the reason that they stay in the clinic, and I'm wondering your thoughts on this too- Mm-hmm ... it's because something always pops up. It doesn't matter if it's three months in, six months in, one year in, and we're always then just doing, small course corrections instead of always having to recreate it because it's been- Yeah six months, a year, and no one when it first started just had some gentle words for them or a little bit of perspective change. They're used to just such shifts that are just aggressive, honestly, for what they then need to do because you don't have to reinvent the whole wheel, usually it's just adjusting a couple things here and there, and getting... And sometimes it's even just encouraging people- Mm-hmm ... 'cause, you know, they're so discouraged because, they've been told, oh, they didn't do all the right things. It's not... Nobody's perfect. We're not always gonna count our macros, and our protein is not gonna be, where it needs to be. But overall, are we doing our best? Totally. And how can we continue to, push forward and continue so that we do reach our health goals? So. Yeah. Oh, so good. Okay, so the other scenario that I feel like we could talk the whole episode about this. Mm-hmm. It's the med dose is potentially working. Let's say their weight actually is going down month to month. Mm-hmm. But they say by day four or five, they feel like it has really worn off, and they have, that maybe one, two, three-day period where their- Mm-hmm ... increased hunger urges and cravings until they take the next shot. How do you handle those, days for people? Okay, so I'm glad we're talking about this. I've actually talked to the reps all the time, the pharmaceutical reps about the meds. Mm-hmm. Yes, it's dosed weekly, but they themselves knew that the medicine, especially the Mounjaro and Zepbound only last about... or Tirzepatide only lasts five days. So- Yeah and most of our patients will tell us on day four or five, they're starting to feel it wear off, and now they're starting to eat more, and the food noise is coming back. So this is a very common scenario. So how I battle it usually is there's a couple of things you can do. One, make sure patients are eating consistently, 'cause I sometimes will find let's say they take their shot on Monday. Monday, Tuesday, they don't really eat very much because they're so suppressed, and then the medicine starts wearing off, and they didn't really get enough calories in the beginning, so now they're having to make up for that at the end of the week. So that's the first thing I try to rule out is, did you eat enough calories those first couple days? Because if you didn't, that hunger's gonna come back Much stronger on day four or five. Well, I like to think about the nutrition we're getting. It's just like with sleep debt at some point that's gonna catch up with you, it's not like one night and everything's recovered mm-hmm. And it's the same thing with nutrition. Your body knows when it's been under-eating all that time. You might have had the signal gone to the brain that made the alarm go off, but it will eventually go off. It doesn't know there's a fire yet. People just forget how important the, the consistent macronutrients are. Exactly, because you're right. Now you're in debt, right? So you didn't eat enough the beginning of the week, so you're gonna make up for it at the end. Also I think strategically when you take the shot matters, too. Some people, tend to overeat a little bit more. They need more suppression on the weekend, for instance, so it makes more sense to take the shot on Friday. Or they overeat during the work week, so they need the suppression, so they need to take it on Monday. So that's one other strategy. I've also seen s- I ha- I don't do this very often, but I do know some other people have started to kinda split the dosing. I don't know if you're very familiar with that, but where they're trying to do twice a week versus one a week. I don't really do that very often unless it's, like, really- Making them struggle I've tried it with some patients, hon- and I'll be honest, I tried it with myself as well. Mm-hmm. But I didn't, for myself, I didn't find it was- Yeah ... as effective, and with patients I don't. And one of the things I- Yeah ... I think is that people get used to they can feel that it's more effective when they have it- Mm-hmm those first few days. Mm-hmm. And when you split the dosing, it's almost like it's never as effective, if that makes sense. Yeah. And technically it is the same amount per seven days. Mm-hmm. The only time I do split dosing or, like, funky things with it is if someone's, like, really nauseous for a few days- Mm-hmm but they then are so hungry, so it's like we can't get it right. It's not a dosing issue- Mm-hmm ... it's a timing- Mm-hmm ... of that dose. That's the only time I had someone once a day on the smallest amount of Ozempic ever because that's what they tolerated. So per week the dose was appropriate- Mm-hmm ... but they could only handle this, like, micro dose daily. It was, like, really interesting. Yeah, and that's what... So that's kinda the same scenario. Sometimes I have patients that are very sensitive, so we'll do, a very small dose, and then we can kinda do a smaller dose later. So as you know, everybody's different too, so we provide very personalized care, so we're gonna have to make adjustments based on their history and their side effects. So that's one thing. The other thing is if it's really bad and really uncomfortable for the patient, it's really hurting their progress, then you could consider adding, phentermine or something like that at the end of the week, which is another obesity medication, just for those two days to kinda help with the suppression. So that's another strategy. And then I know there's another drug called Plenity. I don't know if you use it often. I think we should- I think Plenity is off the market now. If people are listening- Yeah ... it's a think, a hydrogel, right? It's like a hydrogel- Mm-hmm ... matrix or... Think about it- Yeah as eating a lot of cucumbers all at once, 'cause it sort of, like, blows up in the stomach, and it was- Mm-hmm ... supposed to help. I did use it here and there, but only when patients had, like, allergies to other medications. Mm-hmm. And I never saw good results. Did you ever in the past when using it see good results? No, I, I've, I've rarely used it either. I just thought I'd mention it because I know that there's,, different ways you can try to combat that. But it's a hard, it's a very hard issue to have because, I guess eventually they'll come out with a drug that r- truly is seven days, but for now we have those two days where it's kinda not perfect for most people. And I always say to people too this is the definition of something chronic, that you usually don't have perfect control every single day- Mm-hmm ... long-term all the time. Because if that were the case, okay, we would've taken care of it, it's gone. But,- Mm-hmm ... what's hard about this disease is that you're almost, like, daily having to keep thinking about it and investing in it and caring because it's just not going anywhere. It's the same thing with, diabetes and stuff like that. Oh, yeah, absolutely. Like, your... Every day you're gonna think about this in some... Because we have to eat every day, so it's not like it's, gonna go away all of a sudden. And once you have that underlying metabolic dysfunction, and you've had it for years, you just can't reverse it. I speak to my patients all the time about this. I'm like, "This is chronic, and, you know, this is how we're gonna have to live with the rest of your life, so we need to make the solutions livable for you." Yes. Totally. The other thing I do with my people, I don't know if you do this as much- Mm-hmm but sometimes we get to more, it almost feels like it's back to diet culture, but more volume-based eating those days- Mm-hmm ... because they are more hungry. They do have more room. Now we do bring out the bigger salad. We do bring out, um- The veggies, yeah ... more yogurt, right? Yeah. So it's like you'll see, and this is, like, a buzzword online. I actually love these channel- channels. There'll be v- people that have lost weight and kept it off, and they do volume-based eating. And you think it's ginormous what they have in front of them. Mm-hmm. But it's really, like, a cucumber, a this, a that. I mean, and when you really look at it, there's, like, nothing happening on the plate. But people with this GLP-1 era look at it like, "Oh, my gosh is that a lot." And it's like, but no, that's actually healthy, what you're seeing there. Yeah. The challenge I see there- Mm-hmm ... is that then when they take the shot again, now you can't be high volume because then you'll get sick if there's too much food on board. It's like this hard little merry-go-round and also, like you mentioned, it's also about setting the expectation. I usually do warn patients, like, "Hey, this might happen," even before we start because "This is why the timing of your shot really matters because what day you decide to take it," because if you pick the wrong day let's say you really don't wanna eat out a lot on the weekend, but you're taking a shot on Sunday, like, that's gonna be a problem. Yeah. So I do let them know early on that this could happen. And, and most of the patients do eventually notice it, the... especially the longer they are on the medication, I think- Oh ... and their body has started to adapt. So hopefully everybody listening, you hear if you're on the medication, you're struggling with this, this is a very normal thing that happens. Mm-hmm and there are... I'm glad that you brought up phentermine and things like that, and sometimes I have to use Contrave or, you know- Mm-hmm ... other things because there, there are things that can be changed and nuances. Some of my women will do different dosing pre-period verse the other three weeks, and these are just things that if you're actually working with a physician like us that, that knows what they're doing in this area, these can be very easily adjusted and really change your quality of life because life is not hard 24/7 when you have these kind of adjustments. And I'm glad you mentioned that because there is a big difference between somebody who took the time to do an additional obesity training fellowship versus somebody who might just be seeing you in the clinic every six months. Yes, it's easy to prescribe a GLP, but it's like do you know all the side effects of the GLP? Do you know all the other medications you can use with the GLP to, enhance your results? Yeah. And I often get a lot of second opinion patients who they've already- Yeah ... started their journey somewhere else, and now they're coming to me, and there's definitely a lot more we can be doing and optimizing because we really understand all these different pathways on how our body k- holds onto weight. Absolutely. And so we're... when you're adding the Contrave and you're adding all these other medications or the phentermine, we're really working at it from different angles, so. Totally. I had someone online, people are asking me quest- they're asking you too, like questions- Mm-hmm all day long. And I think they were on Zepbound and had also been started on phentermine, and then they were like, "Well, is this a short-term thing?" "Is this just to re-kickstart things or-" Hmm ... "then do I go back?" And whenever I... My, r- 10 red flags waving is when someone says, "Is this a kickstart?" Because I'm just like, "There is no such thing. You probably will need this thing long-term." I just don't believe in, it's there for a week, and then we take it away. I think that type of language though is used by a lot of doctors that are not obesity medicine because that's kind of how they're thinking about it. And exactly. And you can even tell because I've also had patients tell me, like, "Well, I reached my goal weight," and they were about to stop my medicine, and I'm like, "Ah. What do you- what do you think is gonna happen when we do that?" Well- The weight's gonna come back, what do you do for the patients that, you know, I... Everyone's always been indoctrinated smaller is better. Mm-hmm. And so I find that people will get to where I consider them they are just in a great, healthy spot when we look at body composition, the way in which they're eating, how they're moving their body, how they feel in their life, just all the things, but they have this perception that they still want the size to be smaller. And assuming that there's not, I just wanna say this, that there's not, clinically diagnosed body dysmorphia, okay, or something like that. Mm-hmm. We're gonna remove that from the equation, but how do you talk to them when maybe your goals for them are different than what they might wanna do? So whenever people ask me, I obviously love this field, but this to me is the most challenging part of our job. Yeah. Because, it takes a while for people's brains to catch up to their new size. Oh, yeah. And so a lot of times we get these people at their goal. We know they're healthy. Their labs look great. Mm. They look great. But in their head they haven't fully captured where they are, and they wanna keep going. Yeah. So a lot of times I will say, usually finding their maintenance dose takes a little work. Maybe we keep them at the same dose because they're not really losing anymore. Maybe if they're still losing but I don't want that, we might have to go down a dose. But a lot of it is a lot of coaching and time, and just making sure that, they catch up to that point where they realize, "Okay, I am healthy. I am doing all the things." But it takes time. It's not, "Here you go." Yeah. I- everything's h- And that's where I see all the grief usually. Yeah. I... It- it's, I 100% agree with you. It takes a long time, and I might monthly just again and again and again be going over- Mm ... "Look, you're in a great spot, and here's why, and here's... Let's look through this and look through that." Here's the thing. It's not me just repeating the same things. I as a patient need to hear these things again and again. Learning can be rushed, change cannot. These things take time to settle in, like you're saying. Mm-hmm. I, in the past, there was a co- a long time ago, there was a coaching group that I was doing sessions for them. Yeah. And one of the reasons that I stopped coaching for that group is that the women in there, in my estimation, I thought it was inappropriate what they were trying to achieve. Mm-hmm. And I was like, "I don't wanna be part of this, of coaching you through something," where I'm like, "You shouldn't do it." Like, I don't wanna be part of this and part of that is, like, I- I do think that there's this subset of community where, we've just gotten back to just this inappropriately thin look that they're... It's not necessarily healthy. Right. And I'm not about looking at someone to determine whether they're healthy or not, but at some point we can clinically see when it's like you've lost the fat pads in your face. We can see at some point when it's just it's not at a great spot where you're at. No. I- I- I 100% agree with you. And you see it a lot. We can use celebrities as an example, right? Yeah. Like, you see it a lot with them where they were probably at a normal weight, very healthy. They started ta- It's very obvious when they start taking something, and then all of a sudden you're- you're starting to worry that they've gone to the, in the other direction. Yeah. And so- And my goal in my clinic is for that not to happen to you. Yeah. Because the goal is health for you to enjoy your life, but not go on the other side where now I'm having to worry that you're not eating at all or, you know- Yeah ... you- you're just, lost track of where you are because you, in your mind, you're still at a bigger size or your goal was just not realistic. Not everybody's meant to be super small. No. That's the other thing is, not everybody's gonna be a size zero. You can still be healthy at a bigger size, and that's fine- Yeah ... if your labs look good and you feel good. So I, I really... When I coach my patients at this stage, I'm always, trying to reinforce, look how far you've come. Look where you are. Like, let's look at all the positive things. And then I bring up the facts, like their labs. And there's nothing that makes me happier than when I see, maybe you had diabetes, now it's very well controlled. Or maybe you had high cholesterol, now that's gone. You used to be on blood pressure meds, now those are gone. So I try to focus on those kinds of things in my appointments- Yeah ... versus you've reached your lowest weight ever- ... kind of thing. I'm just laughing because, yeah, that's so not, not the point. Which is always- Yeah ... so funny to me when people come to us 'cause they think that that's the only thing we're gonna care about, and that is, the furthest thing from our mind. Mm-hmm. Last scenario I wanted to ask you about is i- I, I hear this all the time, "I'm doing everything right, so why am I gaining weight?" Right? Mm-hmm. So maybe they... there's a few weeks where they've been gaining weight despite they feel like they're really consistent with their habits. Mm-hmm. What's the first thing you ask them about? Like, how do you help them to make sense of it without dismissing how frustrating it feels? 'Cause I, I know that it's a really hard spot. When people start gaining weight on- Yeah ... and they've been doing good? So I have actually seen that a little bit more with... 'Cause now we've been doing this a couple years. Yeah. The meds have been out for a while. I, I do really think at some point- the medicine it's working, but it's not, your body has decided to outsmart it- Yeah ... is kinda how I feel, right? And so first of all, I try to make sure nothing has changed. Maybe it's time to do labs again because we gotta make sure your thyroid's okay or there's nothing new that happened. A physical exam is still important, did they gain water weight? We do the body composition. Where exactly are they gaining the, did they lose all of a sudden a lot of muscle it's really exploring those things. But obviously the first thing is not to make my patients feel like this is their fault, because I think that's, a lot of people do that, where these patients who've been suffering from this chronic disease for so long, they come to the office and people are like, "Well, you didn't, you're lo- you're not telling me the truth." This is a really a hard disease to treat. Yeah. And people need to realize that. And then, we talk about options once we've done the full evaluation, like do we need a different medication? Do we need to... Sometimes we have to talk about surgery if we have been throwing everything at it. But yeah, it's just about giving patients options at this point, 'cause it's, it's hard and I'm seeing this more and more now that- You know, people have been on the medicine for several years. Totally. And a lot of- I don't know if that's been your experience. That, that's definitely been my experience, and I find that, again, the results are phenomenal. Mm-hmm. And sometimes, like let's say that medication wasn't involved, there's always a regain that occurs, and people hate to hear this, but- Mm ... most people will not achieve their lowest weight and just stay there perfectly. Basically just in general, let's say before we really had some good anti-obesity medication- Mm-hmm ... people would potentially get somewhere, and then there's... It's almost like there's more metabolic adaptation. They gain a little bit of that back. Mm-hmm. And it's not because they suddenly got lax on their habits or- Mm-hmm ... all of life fell apart. And it's also oftentimes people are very excited when they're starting out, and they're able- Mm ... to do a lot of things, but if we really looked at it from a long-term perspective, like in 10 years, can you keep doing all this stuff? It's not realistic. They're putting every ounce of energy into it, which that might be needed in the beginning, okay, everybody who's listening. Mm-hmm. Yeah, you do need to learn how to meal prep. You do need to learn a lot of these things. Mm-hmm. But then there comes this point where it's like oh, but that's not realistic. And so, yeah, maybe five, 10 pounds needs to come back on, but you can stay there, and you have a normal life versus every single minute you're having to, clamp down on what's happening 'cause your body physiology actually doesn't wanna support you being there. Mm-hmm. Exactly. Your body's fighting you the whole time and I'm gonna speak a little bit from personal experience here I have definitely been on a weight loss journey my entire adult life, and I can tell you the first time I lost weight, without meds 20 years ago, I did it. I was perfect with my diet. I was perfect with my eating. There was no meds back then, but I still regained the weight because you're right, the fatigue sets in, right? You can't keep up that lifestyle. It becomes very restrictive, and that's what people don't understand, and it's kinda similar on the meds. The med is a tool. It helps you. It really helps you if you have all the habits already in place, which most of our patients actually already have because- They do. Isn't that so funny? Yeah, because they've been trying and failing and trying and failing. But it's just... I think the second time around for me, there was, like, this aha moment where I was like, "Okay, I'm not gonna control everything, and that's okay. I'm gonna do my best," because once it... you really internalize that this is a lifelong disease that, unfortunately, you have to deal with- It really changes your whole perspective. And now I'm not gonna feel bad if I have a donut here and there, you know? 'Cause I mean, as long as I'm being healthy the rest of the time or I'm getting my workout in, I just feel like you're hurting yourself if you're trying to be perfect all the time. Mm-hmm. And it's better to just kinda be, have more balance because the fatigue really sets in. And as somebody who, dealt with that a lot pre-meds, I just, I don't even have it in me to be- ... putting things into MyFitnessPal. You know what I mean? And I know a lot of our patients feel that way because they've been trying and failing, trying and... I really advocate more holistic, trying to have balance in your life when you're making these changes. Yeah. Yeah. Totally. Oh, I love that you bring this up because I think sometimes this is the good thing with us, working full time and being parents and, you know, having full lives because sometimes when I see, we're just gonna go there, the 20-year-old influencer online who has no training in anything. Mm-hmm. They're, they've not experienced anything metabolically yet just nothing has happened to them, and they're sitting there, "We all have the same 24 hours." No, we don't. No, we don't. Some of us, the kids are waking us up in the middle of the night. We're getting up at- ... 5:30, "Give me a breakfast." It's way different. Everyone does not have the same time, responsibilities, stress load. There's socioeconomic factors. I mean, it goes on and on. And- Mm-hmm ... we have to take that into account with treatment. It is so vital that that's part of it with what we're doing. Exactly, because y- you're right. Like, when I was 20 years old, I could work out for two hours, but now I have child pickup and, you know- homework that I'm working on. I don't have that time. So I always tell patients when they start telling me about their own responsibilities, like, "Okay, I want you to set aside... Sure, I'm not expecting you to work out a whole hour. How about just give me 30 minutes two or three times a week?" Yeah. That's a win in my book. Like- Oh, yeah ... i'm not expecting you... Because I realize where you are in your life, and I think that's something you and I do really well with our patients, is we meet them where they are, right? Totally. We're not trying to, like, make them be these 20-year influencers where... Because this can become a full-time job. Oh, yeah. I mean, do you remember back in the day with Biggest Loser? We're not even gonna talk about all the contestants, but basically- Mm-hmm ... the only ones that kept it off, it's where they made it their profession, they became a personal trainer. Mm-hmm. I mean, obviously we, we saw then the train wreck later that occurred- Mm-hmm ... and we learned a lot- Mm-hmm ... from it, to be honest. Mm-hmm. But, but those were the only people that maybe were able to keep some of it off. Yeah, because once they went back to the regular life with all their regular responsibilities, they didn't have time to go to the gym for six hours. You know what I mean? It's not realistic. And nobody can keep up that level of work., So I agree. A lot of this is when you truly find a doctor that's working with you, all of these things come into play, right? Like making sure that they look at your life and try to work with where you're at. Mm-hmm. Because then you are gonna be successful. I... and I... and I'm sure you see this in your clinic, but your patients maybe were working with somebody else, then they come to you, and then now they're like- It's radically different I always say, we can't have a personality transplant, and this is not about, developing motivation and discipline. Mm-hmm. It's not about that. What I mean is, if you... I'm gonna give the example with this one patient of mine. Just think it... it's, it's sort of like us, like, highly ambitious- Mm-hmm ... woman that works a lot. And then, like, a previous doctor had wanted all of that to change for her. Like, "Well, you can't work this late, and you can't do this. You can't do that," but she likes it. Who am I to sit here and to say what your life... First of all, it's very judgemental when it's like- Mm-hmm ... "Oh, well, you're overworking." Says who? Because if it's working out for that person- Mm-hmm . They can be working those hours and feel amazing, and someone else is, dying with that type of work, right? Mm-hmm. And so that we can't even lay judgment. But yeah, the, the goal with working with her was we worked it into parts of the day that made sense, so it doesn't look like the cookie cutter kind of morning or evening time. It looked different for her. Exactly. And then also I think you and I provide a lot of emotional support- Yeah ... which is needed- Yeah ... during this time because it is a big change, people might start making comments about your appearance or, you know... And there's a lot that comes with it. Grief we spoke about already. Maybe you stop socializing with friends. Friendships and relationships change. There's a lot that goes into it that... than just, oh, the scale moved. Yeah. You know? I was, like, reading an article the other day how, , there's o- ozempic divorces or something like that because, now the partner has lost weight, and then the relationship has changed. So o- our patients need a lot of support from their physicians, and I think you and I do a... We're very similar in how we practice. Yeah. Definitely. Do you think there's stuff that you hear very commonly that, that we didn't talk about today? I would say one thing that I do bring up is hope. Hmm. And, and I'm gonna, I'm gonna leave the podcast with that because even if this medicine is stopped working for you, or at least that's the perception, right? 'Cause we've- Yeah ... stopped losing. We've plateaued, or maybe we've reached that 20% weight loss- There are more drugs coming- Yeah and more medications, right? So there is more medications out there I try to give people hope that maybe this stop working, but who knows? Maybe the next medication will get them to their goal, if they're still struggling. Totally. So- And the- So that's the exciting part about this, people, is that- I l- there's more to come. I love that you bring this up because I say the exact same thing. There's always more to do. There's always- Mm-hmm ... stuff we can change, and if we can not get into a despair, like despair is not a fun hole to be in. And so- Mm-hmm ... I love what you're saying, that hope, perspective, change. Also, my gosh, they've achieved so much. Even if you stay right where you are right now compared to where you were, it's radically different. It's just we habituate. We're so used to where we are, but we forget you're a totally different person right now compared to who you started as, and they just forget that. We gotta celebrate their wins, right? Remember two years ago when you started working with me? Look where you are." Yeah, I agree with you. I love doing this work. I know for you it's also a passion because you really... There's something so special about having your patient walk into your office and be like, "Oh my gosh, complete transformation." Yeah. Yeah. In very positive ways. And it's not just, looks. No. I wanna be very clear about that. It's like, "I was able to get on the plane and not have a panic about that," or- Yeah ... "i can run with my kids now." It's just such rewarding work. I... When... I'll sometimes have patients, they'll be on vacation, like in another country- Mm-hmm and they'll be like, "I know we have a visit in two weeks, but I just wanted to tell you this just happened and it was because we've done that stuff." I literally am bawling, you know what I mean? Yeah, I know. Me too. To think that they would take the time even out of that experience to let me know what changed for them. Like, it just- Yeah ... yeah, it makes me wanna every single day do more and more in this area, 'cause I... And we know how hard it is, and I think that too is like you don't ever wanna stop helping someone when you know I myself need continuous support all the time, thank you for coming on today. Mm-hmm. I feel like there were a lot of topics that I think people are gonna get just a lot of good, perspective on, how can people find out more about you? How could they potentially follow you online, see you in the clinic, all that kind of stuff? Oh, yeah. So I have a TikTok and an Instagram account @marilyngalindoMD, so you guys can find me there and follow me. Um, you can also go to my website, leonspringsobesitymed.com, and you can find how to join my clinic. Usually it's pretty easy to join. You can either schedule a meet and greet with me so we can discuss more, or you can send an email or a text and we'll discuss the, specifics of the clinic. And then we make it pretty easy once you decide, you wanna join and you're ready for this, and then we kinda go from there. I'm so glad that you invited me. We've been friends for so long, and I love your podcast. I always recommend it to my patients, and I'm just glad that I, and honored that you had me as a guest today. Awesome. Thanks so much, and everyone who's listening, if if you didn't get a chance to write all that down, it'll be either right underneath in the show notes where you're listening, or again, you can go to RenteaClinic.com/blog and we have all of this written out. There's always really nice show notes, means that everything- Mm-hmm we talk about is written out there so you don't have to miss anything. All right,. I hope you all have a good week.