What Makes Us Healthy? With Dr. Mary Dagen, MD

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Episode 25. This week I talk to Dr. Mary Dagen. Dr. Dagen is a board-certified family medicine physician and has been practicing as a medical Bariatrician for the past two years. Dr. Dagen became a certified culinary medicine specialist in 2018 and is currently serving a 3-year term as a board member for Ottawa Food, whose mission is to ensure affordable access to nutritious food. Away from the office, she enjoys running, gardening, and wildlife photography. Her favorite time is spent with her husband, two kitties, and their bunny.

Want to get some background on what this podcast is ALL about? Check out the Foundational Episodes of the Motivation Made Podcast here!

Introduction: What is this podcast all about?
Episode 1: Want to Get & Stay Motivated? A Crash Course on Motivation, Weight Loss, and Health
Episode 2: How Dieting Steals Our Motivation
Episode 3: How To Get Motivated To Improve Your Health (Motivation 101)
Episode 4: How to Transform Health Fears Into Forward Progress

What to Expect from this Interview:

Discussion of the pros and cons of considering obesity a disease
Some of the barriers physicians face with regards to measurement of weight and health markers
Ways to understand your health beyond just the number on the scale
The importance of working with a health care professional who seeks additional training in something like lifestyle medicine and not believing everything you learn on the internet
Why you should never worry about eating fruit again!
The importance of taking a wholistic view of health, all from the physician’s perspective
A physician’s take on her introduction to the Health at Every Size movement

Beyond Body Mass Index (BMI)

There are many ways to measure your health besides the body mass index. Dr. Dagen and I discuss why the BMI is problematic and some of the other ways she tries to measure health. She states:

“I’m pretty honest with patients. I put it [BMI] on the chart because I have to put it on the chart, but it really doesn’t define anything so we’re working to improve other health conditions that they are coming to see me for.”
Dr. Mary Dagen, MD

Culinary Medicine: Using Food to Prevent or Reverse Disease

Dr. Dagen talks about her certification in Culinary Medicine and how she learned in that program about using food to prevent or reverse disease.

The culinary medicine classes typically involve a chef, a physician, and a dietitian. As someone who has taken these classes, we reflect on how these classes are typically the opposite of diet mentality, and instead teach people to enjoy cooking, build mastery, while also creating a sense of community.

The hope and the plan is to build in this type of education on a larger scale over time, given how effective this would be over counting your calories for the millionth time in a row.

The culinary medicine specialty falls under a bigger umbrella of Lifestyle Medicine.

What is Lifestyle Medicine?

We talked about the field of Lifestyle Medicine and how it incorporates many aspects of health beyond just what we eat. This field talks about the importance of:

Sleep
Stress
Emotional well-being
Movement

Dr. Dagen talks about how even though she already had specialty training in obesity medicine and culinary medicine she has learned an immense amount within the process of studying for Lifestyle Medicine board certification.

We discuss the fact that most physicians don’t get any of this training unless they specifically seek it out, and even when they do there is a LOT to learn in this field, given how complex it is. Dr. Dagen talks about the fact that even though she is board certified in family medicine, she did not get any of this training at all. Though the training in medicine in this area is shifting, it’s a very slow and gradual process.

That said, if you are seeking out a different way to look at weight loss and dieting, you are very likely to come across physicians who have views that are uninformed and/or unhelpful, and you may need to be an advocate for yourself.

Consume Information Online With Extreme Caution

We talked about the fact that although it’s good that more professionals are sharing evidence-based information online, it’s incredibly hard for people even with training to decipher what’s real and what isn’t.

Therefore it’s always important to consult with a professional who knows your history.

Thoughts from a physician regarding the Health at Every Size movement

Dr. Dagen admitted that she does not know a lot about the Health at Every Size movement, and that she did some learning about it by listening to the Health at Every Size podcast interview I did with Annyck Besso, MS, RD, and doing some reading online since she and I talked a few weeks ago.

She stated that she really appreciates that she really likes the emphasis on de-stigmatizing weight and reducing judgment on individuals.

She stated that her main concern as a physician was making sure that we aren’t normalizing poor health and not taking disease risk factors seriously until it’s much harder to reverse.

She talked about some of her experiences as a primary care physician and seeing families with kids with very high weights whose parents didn’t seem concerned about it due to it being socially normative.

“I Don’t Want Things To Be Missed”

Dr. Dagen talked about the fact that we know that the food industry is contributing in a very negative way to our health and the importance of not missing this point or glossing over it.

She stated that she hopes we can continue to have conversations about reducing weight bias and stigma AND improving food quality and nutrition knowledge.

I find that this view is really common among medical professionals and Dr. Dagen and I talked about how we don’t really know exactly if and how this movement contributes at all to this lack of concern, or if other factors are at play here.

The main take home message (at least for me) is that most professionals agree with the idea of de-centering weight as the sole measure of health and continuing to look at health and all the things that go into it as a larger picture than just weight or what we put in our bodies (e.g., not forgetting about sleep, stress, social relationships, social determinants of health, etc).

Don’t Stress About Fruit

Dr. Dagen answers one of the most common question she gets regarding plant-based diets and managing blood sugar, particularly in people with diabetes.

She states:

“I find that somebody at some point, whether it’s their PCP or endocrinologist or someone managing their diabetes has told them that fruit will make their sugar be high and make their A1c worse and will make them gain weight and the reality is that none of that is true. There is zero evidence to support that.”
– Dr. Mary Dagen, MD

She goes on to talk to us about how plant-based diets get confused with a more whole foods plant-based diet, and like anything we can get distracted from true healthful eating when we rely too heavily on processed foods like the Impossible Burger and things like Triscuits that promote the “plant-based” label on the side to boost sales.

She talks about the importance of eating foods as close to their natural form as possible and reminds us that:

“Carbs are not our enemy.”

And of course, Impossible Burgers, or any food for that matter are not “bad” they just aren’t the epitome of health just because they don’t have animal product in them.

Body Intuition Rules All

Dr. Dagen shares how she was diagnosed with juvenile rheumatoid arthritis and how she was told not to run, but she did so anyways and she believes that this is something that her body needed. To her doctor’s surprise, she ended up going into remission from the disease and remains in remission today, suggesting that her intuition to follow what she felt was best for her body, was very much the correct one.

She talked about her decision to stop running competitively in college due to no longer enjoying it, and returning to running for herself and how important that was in maintaining intrinsic motivation to do so.

She stated that as soon as she pulled out of that final competition, even though she had to have a tough conversation with her parents who had driven 10 hours to see her race, it was the right move. She started doing it for herself again, and started enjoying it again. To this day, running when she is able and not limited by health concerns, remains something that makes her feel empowered and in control, and incredibly grateful.

Moving from Should to Choose To

We talked about things that feel like a should for her, and how she has moved them to more of a “choose to.”

Strength Training and Walking. She stated that she does not naturally love strength training or walking, but stated that “I need to love it for my overall health.” She talks about gradually learning to embrace walking when she isn’t able to run (as she is not currently able to due to recovering from a health condition) and trying to really enjoy this. She also talks about trying yoga and strength training and how taking time and space for herself can be challenging, but is consistent with her values of self-care.

Sleep. She states, “I know I should get enough sleep.” Dr. Dagen talks about setting some boundaries with when she should sleep and the impact that this has on her physically and emotionally.

Taking Self Care Time. She talked about the struggle she has had in the past with taking time for herself. She has been actively working on this in the last few years and tried to fiercely protect her self-care time and how this is intimately related to her overall health.

Main Takeaways

Your health is way more than your weight. It’s incredibly important to realize that there is no perfect BMI or weight for every person and that it’s essential to work with a health professional who will get this and support you with looking at your health in a broader way.
Nourishing our bodies can be fun. Culinary medicine classes offer and opportunity to learn fun new cooking skills and enjoy the process and is just one example of how we can actually learn helpful nutrition in an enjoyable way.
Lifestyle medicine is a field working on expanding our view of health. Lifestyle medicine encompasses culinary medicine and is working to broaden how we think of health, including nutrition, activity, social relationships, stress, sleep, etc.
The Health at Every Size movement is not mainstream, but that doesn’t mean it isn’t legit. The reality is, this movement isn’t really talked about or fully understood in medicine. The phrase “health at every size” gives certain messages, but as we talk about in our previous episode on the topic, there are a lot of myths and misconceptions about it.
Physicians support de-centering weight. I can’t speak for all physicians, but Dr. Dagen and many of the medical professionals I’ve interacted with very much support a reduced focus on the number on the scale. Sometimes a concern about this arises that somehow more acceptance of body diversity could lead to poorer health, but I think most people can agree that we don’t really have clear evidence that this would occur. It can be something to keep an eye on, but the more I talk to medical professionals, the more I realize that most of us actually do agree that a great degree of reduced focus on weight, and increased focus on other things that matter (e.g., nutrition, cooking habits, community, exercise, social relationships) will do us all a world of good.
Stop worrying about eating fruit! The concern about it raising your hemoglobin A1C (marker of blood sugar control over time) is not evidence based. “Fruits are amazing” says Dr. Dagen. So go mow down on that fruit salad and while you are at it, really savor it.
You don’t have to be perfect. Dr. Dagen reminds us that “In this journey of figuring out what health means, there’s no 100%.” She talks about the importance of patting ourselves on the back when we have done something good. She also reminds us that, we need to be our own biggest champion and cheerleader. Sounds pretty healthy to me.
Your journey is yours alone. It’s incredibly tempting to compare, but Dr. Dagen reminds us that someone else’s journey is not your journey. This can be challenging, but you also don’t have to go it alone. You can find others to relate to, even if their path is different. You can also find medical, nutritional, or behavioral health professionals who support you where you are now, and help you reach your health goals, and otherwise.

Let’s Focus on Changing Something We Actually Can Control

You probably already know that the vast majority of weight loss plans fail within 1-5 years. Like 2-20%, depending on how you measure it (Wing & Phelan, 2005). Even the really great evidence-based ones typically lead to weight regain, and often further weight gain beyond that. Yep, it’s true. Frustrating right?

What if I told you that there was a measure that predicted exercise behavior 3 years down the road AND weight loss maintenance among women. Would you be interested to know?

Autonomous motivation for exercise (or any behavior, really) is predictive of long-term change. For women studied, it predicted weight loss maintenance and exercise adherence 3 years later. That type of long-term data is RARE, so when we find it, we gotta pay attention (Silva et al., 2011).

So I bet you are like, cool Shawn HOW do I get this type of motivation for exercise? Well I created a free resource just for you.

You see, to gain autonomous motivation, you first need to take the pressure off, shake things up, have fun with exercise. I created this free 10 minute guided audio to help you do just that. It has uplifting fun music and my voice, guiding you through a new way to consider your body and movement in a way that creates joy and empowered, not shoulds.

Grab it for free today, and pop your ears buds in and shift towards the motivation that will serve you well beyond today. Give yourself that gift for me, will ya?

Disclaimer: This blog and podcast is for informational and educational purposes only. It is not a substitute for individual professional advice or treatment, including medical or mental health advice. It does not constitute a provider patient relationship.