#166 Obesity and GLP1 Medications with Dominique Williams, MD

Hey, this is Melissa Parsons, and you are listening to the Your Favorite You Podcast. I'm a certified life coach with an advanced certification in deep dive coaching. The purpose of this podcast is to help brilliant women like you with beautiful brains create the life you've been dreaming of with intentions. My goal is to help you find your favorite version of you by teaching you how to treat yourself as your own best friend.

If this sounds incredible to you and you want practical tips on changing up how you treat yourself, then you're in the right place. Just so you know, I'm a huge fan of using all of the words available to me in the English language, so please proceed with caution if young ears are around.

Melissa Parsons

Hello everyone and welcome back to Your Favorite You. You are in for a treat this week because we are speaking with one of my beloved friends from residency way back in the way back. Her name is Dominique Barkley Williams. That's how I will always call her and she is someone who after our pediatric residency went on to specialize in obesity medicine and I wanted to have her on the podcast. I asked her and she graciously said yes after I did the podcast about my relationship with my body and telling you all about my biases that I had against myself and against taking medication to help me with my medical diagnosis of obesity. So Dominique, welcome to the show. I'm so glad you're here.

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Dominique Williams

I’m so glad to be here. So thank you for having me.

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Melissa Parsons

I just want you to briefly, you don't have to go too far in, but start by introducing yourself and telling us kind of what drew you into being interested in obesity medicine.

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Dominique Williams

Sure. So, I am Dominique Williams, DPW to Melissa Parsons, but my undergraduate degree is actually in nutrition, because I felt even then at that, quote unquote, young age that nutrition is probably going to play a role in my medical career. Like I knew I was pre-med, but I wanted to major in nutrition. And then to your point, after I did my initial residency, just learning more about the systems of food and how we feed ourselves and feed each other, then I pursued my second degree in nutrition. So I have an MPH to nutrition, just to understand what are the external factors at play that influence the food that you eat or the access to the food that you eat. Still feeling like this, we can't oversimplify this to like, you make a good choice, you make a bad choice. Because in my mind, the good choice is you ate, the bad choice is you went hungry, and you were actually hungry. And so you didn't nourish your body. So after all that, that continued to propel my interest in nutrition. But how I was drawn to obesity was just observing. I don't, I'm not the hero. It's just, I was compelled to listen. And as I listened, I was compelled to learn more. And with learning more, I felt it was my responsibility to be better trained. And so pursued my board certification in obesity medicine. And that was years ago, you know, before it was in style, quote unquote, it was a while ago, just a few months ago, you know, in the way back, way back, but and so from there, I think leading with like good intentions and being curious, I think it was a great reciprocal relationship with my patients that they just provided me the privilege to care for them, and that I was able to listen and learn from them and deliver care, you know, for all that time. So by the time I transitioned from my clinical career to my now career in industry, I was caring for children, adolescents, and young adults and adults. So pretty much going the spectrum for the care of obesity and just have learned an immense amount and understanding there are a few other disease states or chronic conditions that we feel like we need a social narrative, a peanut gallery, opinion, and a bunch of other stuff to go with the diagnosis, like, we just don't see that as much with other chronic conditions. And so I think that's what kept me as an advocate and a clinician in the space is just to know that it was my heart's intention, like my desire to deliver good care, because people deserve good care. And if that was needed in that space, then I was prepared to do that. So, you know, that's my story, little more than 30 seconds of my elevator pitch, but that's my story.

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Melissa Parsons

I love it. And, you know, people don't need to know this, but I'm going to tell them anyway, because that's how I roll. But we had some shared patients who absolutely loved the care that they received from you. And it was just always such an honor to refer people to you, because I knew that they would be given the utmost care and guidance and get all the DB love that, you know, that they possibly could get. And so I just want to acknowledge that I loved having you as somebody to send my people to.

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Dominique Williams

Do you make people cry on your podcast? Is that how I get like, hello everyone, welcome back. And yeah, I mean, I think it's mutual love and, and respect. Obviously, you know, that you are one of my ride or dies and that's also, that's an added responsibility, right? When you give me the privilege to care for your patient, I take that very seriously, but I am glad that they felt the same way and that they felt well cared for because that's half the battle, right? To feeling like you can get better from whatever it is, is just to believe that the person that's caring for you believes in you and believes that you can get better. So, so yeah, we, you and I back in the day, in the way back.

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Melissa Parsons

And yes, of course I make people cry on the podcast all the time.

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Dominique Williams

I'm just like, what's happening here? I feel it's a little bit in my chest. It might come out of my eyes at any moment.

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Melissa Parsons

Okay, so for those who might not be familiar or who maybe have just heard about you know these types of medications on the news, can you explain what GLP1 and their sisters and brothers, what these medications are, and how they actually work in the body?

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Dominique Williams

Yeah. So I think the most important thing to remember is that we make GLP one in our bodies. It's not that the medicines were created and then introduced something new. The GLP one is included in that concept of like, like an illegal break, like a breaking system to help signify, you know, that you've had enough to eat that you are, you can go an interval of time without eating after you've had something to eat. And since, you know, my personality, you know, that I have a tendency to nerd out on some things and fall into a rabbit hole on others. I do have to give a nod in a historical context to the bariatric surgeons, because it's through the process of doing gastric bypass and ruin wise, that they started to appreciate that we, the medical community really started to appreciate the importance of GLP one as part of that story of how you can achieve diabetes remission after bariatric surgery, that it wasn't just the impact of the weight that some of the hypothesis was that are there some other things happening at the cellular level that are helping people to achieve better health. So again, that is such a predate to what our current social narrative is about GLP ones. And even how we use the term that, you know, depending on what generation of a clinician you're talking to, they could go down memory lane in that way. But it's, it's great to level set to know that there are things that are within you that the tincture of time and the process of medical and scientific innovation, it just takes time to get to a place where there's something that disrupts our understanding of how we care for people. So to your original question of like, okay, explain the medication, it still requires us to like go back, because the medications, the class of medicines, the GLP ones, you know, however technical you want to be, they have been around for at least a decade with glycemic control, and glycemic management and people with diabetes and learning that for all the mechanisms of action, right, so it can help with delayed gastric emptying helps with that sense of early satiety, but it also helps with activating insulin. So that's going to bring down your blood sugar. So it had usefulness in a blood sugar management space. We knew that decades ago, it came in different forms. That was a while ago, and you might have observed that there was some weight reduction with that. And so fast forward into our current awareness. And that's where innovation and learning more has refined the formulations. And now we're learning, okay, if you use this medication at this dose for this length of time, you not only achieve better glycemic management, but you are achieving, in some instances, the level of weight reduction that rivals bariatric surgery.

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Dominique Williams

So it's a disruptor in our perception of how we care for people living with these conditions. But in my opinion, to have a non surgical intervention, achieve this level of weight reduction just unleashed some hidden things that and how we talk about bodies and shapes and weight and, and health and aesthetics and belief in obesity as a chronic disease, as, you know, you should be able to manage your health privately, like all of that really goes into the history of trying to understand why are the medicines being discussed and pursued and utilize prescribe like what is it about it, it's just a convergence of many things that this is where we are in 2025.

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Melissa Parsons

Okay, so interesting. Okay, so you've kind of already alluded to this, but I think that obesity may not be the only one, but it really is the only medical diagnosis that I can think of where we would expect someone to be able to willpower their way out of having the diagnosis. Can you speak to that? I mean, I know you can, so will you please speak to that?

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Dominique Williams

I think here's the thing, if I understand your question correctly, so, you know, if you have a certain condition, it's not always visible to people who you may encounter, right? And the way that things have been portrayed, historically, you, you would think if you consume certain types of media, oh, the person with extra weight is the one who's lonely is the one who's funny, who is the one who might not try the best is the one who might not be as smart, right? Like, this is where we all have to like, take this moment and say, I've been influenced by that I have, I have internalized that I've externalized that I've had those thoughts like this, this is the moment because if we say at a cellular level, at a scientific level, the process of obesity as a disease is so much more complicated than someone saying, I'm going to make a good choice. It also requires us to acknowledge that some of our ideas about it may have been incorrect over simplistic or just outright bias. And acknowledging obesity as a chronic disease doesn't mean that there's some levels of like chronic disease management that still puts responsibility to the person that's trying to manage it, right? Like calling it a chronic disease doesn't mean you relinquish everything to the disease and you say, Oh, I can't do it. I'm sorry. I know I'm not going to move my body today. You know, obesity is a chronic disease and I have a chronic disease, you know, you know, so it's it's not it's not in that way, but to but to imply that someone just has to buckle down and be disciplined to me, it's illogical because then if you just go and say, well, think about your friends and family that have obesity and that you think they have brilliant minds. So if you follow that logic, then why would you think that person with a brilliant mind can't apply willpower, right? Because then that becomes illogical. It's just like, you know, that's a good point. And if that person has a brilliant mind and they're concerned about their health, why would they not do everything that they could do to be a healthier person? Right. Like it just seems illogical. So it just takes a moment for us to challenge that way of thinking. But even as hard as we try, the bottom line is up until the emergence of GLP ones as a form of treatment for obesity, probably one of the most studied aspects of obesity care was like lifestyle interventions and behavior modification. And especially, you know, in younger patients, the emphasis is on what can you do at home to change? Like, what can you change about yourself in order to change the severity or the impact of the disease? And my comments don't mean to say, like, just relinquish control and say, like, I have no control over it. It's just, I just feel like there's moments where we just if we took an extra moment to think about the logic of it, maybe we would challenge it a bit more and consider whether that is the right way of thinking.

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Dominique Williams

So, you know, willpower in my clinical experience, and there is some data to that willpower in a technical term, when you think about eating like that could be called dietary restraint. Dietary restraint is a setup for disordered eating. So the more that you go somewhere and you feel like you're, I'm going to be good today. I'm not going to eat this thing. I'm not going to drink this thing. But you've already assigned value. I'm going to be good. I'm going to try not to be bad. That's dietary restraint, because what if you're hungry and you have limited choices and among those choices, they're all quote unquote, bad, but you're, you know, restraining yourself from that, that not to mention that internalized bias, you may have to urge yourself like, I am bad because I clearly have made bad choices because my my body weight is bad, because that's what has been told to me, like all those things like add into a cycle could add to a cycle of a disordered relationship with food. But again, you know, I'm not asking the rest of the world to fall into the rabbit hole with me. It's just that moment of pause to think about challenging what you think you know about obesity, about weight, to know that it's far more complicated than willpower and what could be the risk and benefits of applying such a narrative to someone about their discipline in their, and their willpower. So I'm not going to fall in the rabbit hole. I'm right there. I'm looking down in it, but you know, willpower to me is just, I'm not, I'm not buying it for a host of things because you could easily apply it to diabetes management. Why did you eat that thing? If you knew it was going to drive your blood sugar, why did you eat that thing? If you thought, why didn't you move your body? Like, don't you have the willpower to know there's better choices to make, you know, it's just over simplistic and it's not, not a holistic approach to the whole person that's sitting in front of you or next to you or, or that you love or engage with. I would just say that I would challenge willpower narratives with just be a little bit more curious and creative.

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Melissa Parsons

Even the simplicity of calories in versus calories out, I mean, that too, I think is way over simplistic. Right.

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Dominique Williams

Because what happens is that it just makes it harder to be able to interact with that piece of information in a meaningful way. Because energy balance is still important, right? You still want to be cognizant of how you balance your plate, how you balance the amount of energy that you take in and the amount of energy that you burn. But if the math isn't math-ing, and so you've done all this math to get to this 500-calorie deficit, and you do it consistently to minutiae bordering on, yet again, a risk of disordered eating, and you feel as though, and the objective data from this scale is, there's no outward manifestation, no physical manifestation that I'm doing the math, and that everyone questions like, really, are you sure? Sometimes there's hidden calories in places that we just don't think, I mean, do you write down what you eat? So again, I just feel like there are a few chronic conditions where we want to have such a level of skepticism to things without having a level of curiosity. So if the math isn't math-ing, and there's a whole person in front of you, then that's where you ask more questions, because clearly it's more than energy balance. It's not that it isn't energy balance, it's that it's energy balance and, and it's behavior modification and, but it's not, this is it, I know what you need to do, let me tell you what you need to do, because this is how you're going to fix this thing, this is how you're going to keep the weight off. Like, you know, it's more of an and than an or, but that's not a convenient narrative and it requires extra thinking. And sometimes we just don't have it in us to do it, we would just much rather go to someone and say, you know, you should eat more salad, you should drink more water.

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Melissa Parsons

So beyond weight loss, I mean, I'm excited about some of the things that I'm hearing that these medications will do for my overall metabolic health, my cardiovascular health, my neurological health, that type of thing. You know, what other benefits are we seeing with these medicines?

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Dominique Williams

So again, if we go back to like, okay, if we make GLP one in our body, then we're the receptors in our body. And so to your point of like, cardiovascular metabolic things, so we have receptors, like head to toe and in between, like they're kind of sprinkled and peppered throughout our body. And the initial mechanisms that I shared with you that kind of were more GI mediated, so like the gastric emptying, the sense of satiety, the impact on the pancreas, you know, insulin, all of that. That's one proposed set of mechanisms, but there's also mechanisms where what's the impact of GLP one on like the immune system and inflammatory processes so that when we think about the other label indications or where the research may be going, is it really all about well, the benefits come because the weight comes or are there other drug effects or mechanisms of action beyond what we associate with weight? And that's, it's not the great unknown. That's just the part that has to happen as a tincture of time and medical innovation. You have to have the time to look into these things, evaluate them, you know, assess the risk and benefits and then say, you know, this, this might, might be an option. So to your point about like neurocognitive health, brain health, things like that, I mean, right now the sky's the limit on what else we could learn to the benefits of the medication, but we have to do our due diligence to do the research and ask the tough questions and look at the data, look at the outcomes and still ask tough questions if we didn't get the outcomes that we expected based on what we know about the receptors. And then again, we're still dealing with like old people. So it's still also looking at when you think about the drug trials and the populations that were included in the drug trials, there's inclusion and exclusion criteria, right? But aside from choosing your friends and choosing your extended family, like when else do you get to apply inclusion and exclusion criteria? Because when you're a whole person walking the street, are you thinking of yourself of inclusion and exclusion criteria? Because the other thing to consider about the potential for the medications is it's the real world application as a potential for the medications because the drug trial, the initial approval trial process, that has to be like a fine tuned process with a little bit of heterogeneity, but not too much because that could affect how your study is executed and whether it muddies the data and the results. And when you get down to it and you live your real life, will you be a responder to this medication? Will it be as impactful to you? It's not a panacea. It's not for everyone. And so those are like the nuanced things to think about is like now that things are out and they are approved and there's label indications, it's still a level of discernment to see, okay, but based on your whole person, your whole history, is this a good fit for you?

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Dominique Williams

Even if the rest of the world says like, of course it's a good fit for you. Look what it did for Susie, Nancy, Karen, Becky, whoever, okay, but I'm here. It's me. Here's my, my history here in my bag of rocks, all of this. Is this still the best fit for me? And maybe it's not the best fit for you for weight reduction, right? I mean, maybe it could be a better fit for you for reduction of your cardiovascular risk because there are GLP one receptors that could affect your cardiovascular health and you might not get the weight loss that you wanted, but you got some other thing to mitigate this cardiovascular health. Maybe it's none of those things and you have some neurocognitive disorder or maybe you have an addiction disorder, there's, let me be clear. What I'm saying currently is off label. I'm just suggesting future thinking. If we take discernment and curiosity to the application of these medications, it's to think beyond weight reduction. It's to be more curious and creative than look at all that it can do for your weight because that's its only usefulness. That's what the research and hopefully the data and the evidence base over time will reveal is that you have GLP one in your body for a reason. You have receptors in multiple places for a reason, and it's just going to take time to fully elucidate the mechanisms of action that help to explain the full benefit of the medicine and why it seems like it's everywhere for everything.

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Melissa Parsons

Mm-hmm. Interesting. Okay. So what I'm hearing from you is, and please correct me always if I'm wrong, the long-term safety and the efficacy of these medications. Well, first, it's already been out for 10 years, or they have already been in the industry for 10 years. And we already produce this peptide in our body as it is. So it's basically giving us something that we already produce on a regular basis, some more than others, obviously.

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Dominique Williams

It's ramping up the receptors, right? So it's making you more sensitive to what is there, so the receptor agonist.

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Melissa Parsons

Okay. So, you know, one of my biases that I had to kind of think through was, you know, it hasn't been on the market that long, quote unquote, right? Like we don't know the long-term effects and that type of thing. And my doctor did a great job of explaining to me, you know, why I didn't necessarily, you know, have to be worried so much about that. So I'm hearing that from you too. Is that correct?

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Dominique Williams

Yeah, I mean, so like I said, they've been around a while in different uses in different chronic conditions. The thing that we have to remember is when research is published, or when trials are ongoing, the research study has a beginning and an end. So that's the part where we have to remember, like when it's published, and it says these things happen, it happened within this window of time for that designed protocol. And as we learn more either anecdotally, experientially, or as people apply real world evidence, and then publish that, that's where you can start to have an understanding to your point of like, what's the long term of it, but the concept of long term, you're not going to get that in a drug trial, there's 68 to 72 weeks. Yeah, long term comes when people report things that happen, people being like the prescriber or the person that's using it. And then if there's extra surveys after the original trial that you know, you follow up with the participants, you know, you may have that post surveillance. But you know, it's like everything else that we release, we need the tincture of time to see what's going on. But for that interval of time, for those outcomes, this is how the medicines have been demonstrated to be helpful. And when you're working with a clinician, like you're actually working with someone who knows you, your history, and there's more of a collaboration, not as transactional, then the concept of long-term and efficacy can be defined by you and your prescriber. Because what is efficacy? Like, how are we defining efficacy? Is it efficacy in weight reduction? Is it efficacy in food-seeking behaviors? Is it efficacy in mitigating risk of cardiovascular disease? Is it efficacy related to my metabolic, here's the mouthful metabolic dysfunction associated steatohepatitis mash like because that's that's another indication. Is it your sleep apnea? Like, what is it, right? That requires a clinician with the expertise, fund of knowledge, and the therapeutic relationship between that whole person and their clinician, their prescriber, to start to define what does efficacy, success, what does it look like, and what does long-term look like for you relative to what your endpoints for success might be.

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Melissa Parsons

Interestingly, I think that when my doc and I were having the discussion, I wasn't even thinking about the long-term effects of obesity and what those would be on my body. To be completely honest and frank, I wasn't thinking. Those obviously are not long-term effects that I necessarily want for my health and my body.

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Dominique Williams

But, you know, it's also your perspective and your lens, right, because you're not thinking I'm consuming obesity and you're not thinking I'm injecting obesity or I'm taking a daily dose of it. So I can see how the concern or the concept of long-term, it varies depending on your perspective. It's not that you don't care about your long-term health, right? Because that probably was the driver for some of your questions about the long-term effects of the medication. But it sounds like you had someone who was prepared to listen to you and to understand where you're coming from before trying to make you understand where they're coming from. And, you know, that's half the battle. Like when I was in clinical practice, and I just always felt like it doesn't do me any good to think that the people that I care for are going to show up and not care. Right. It's just a matter of like, can we figure out what, where we can align on what we care about? Like, you know, everyone has their reasons. Sometimes the responsibility or the burden to figure out those reasons feels a little bit heavier as the prescriber, whereas, you know, as the person coming in, sometimes you feel like, I have to make the case for this. I have to help them understand. Like, I really am trying hard. I really wanna, so, you know, your feelings are your feelings, right? It's not my place to talk you out of them. It's to try to listen and figure out, okay, well, where do we go from here?

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Melissa Parsons

Do you want to talk about the idea of, I guess it for lack of better terms, like taking the medication is quote unquote taking the easy way out. Oh, if you guys could have seen, if you guys could have seen the eye roll that I just got from DV Williams.

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Dominique Williams

Yeah, I mean, here's a thought that I have that I think could be perceived as a bias and that is I am not, I'm not a hero and people with obesity are not victims. And so what causes the change in my body language is like, then I feel like really compelled to like over talk, over advocate for why it just bothers me immensely to think in that way and how that's a barrier to care. Like I just go in between this emotional brain and this, this logical, almost like robotic brain of data of like, why like, do we say that when someone breaks a bone and they go and they said the orthopedic surgeon and it's set and do we say to them, well, player, you took the easy way. You could have just applied pressure and put an ace bandage on that and kept him moving. Like why, why did you need to go to the surgeon like, like, like, do we say that? And it's not to like, belittle the person who has a broken bone, but like, why do we, why is it okay to say that if someone's not breathing because they have bronchospasm, do we say you really just need to re center yourself and try to take a deeper breath and think more about like, why are you breathing heavy? Because the easy thing to do right now would be to get that inhaler to help you. Yeah. To give you some epinephrine right now. I mean, but somehow we think that that's easy. Like, it's easy to go to the doctor and it's easy to just get into the doctor's office. And I'm not talking like by body habits. I just feel like if everyone has a narrative about your body, your weight, or, or people like you with similar body habitus, similar weight, like how easy is it really to go somewhere and ask for help? And should we be surprised that in a care model where access to a provider and to the medication seems a lot, quote unquote, easier, right? Because it's telehealth or virtual, like, should we be surprised about the reception to that? Like why that seems appealing if when you go into the medical office, like, and this is like in weight bias data, like the furniture isn't suited for a larger body. You don't feel loving vibes from the front staff. Now it could be because you're not giving loving vibes, or it could be that the people with whom you interact have, have weight bias. And then when you go to the scale, someone makes a comment compared to your last way, like, Oh, looks like you put on a couple pounds. And then so like, is it easy to go through all of that? And then when you go to the clinic visit, and then it feels like then someone's gatekeeping it from you like, well, your insurance says that you need to show that you've tried to do something for at least six months. But if we all just aligned and said that obesity is a chronic condition, if we can align and say, the longer you were affected by obesity as a child or an adolescent, the more likely it is that you may be affected by it.

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Dominique Williams

As an adult, like if we go with that logic, is it like really easy? And then you ask your insurance company as your clinician, hey, can I have access to this medicine? Well, you need to show me that you've tried for six months to do what and by what measures, or my favorite is you have to have failed lifestyle intervention, because that's the way to make people feel seen. And it's like, show me your failure. So you know, it's the same discussion that could be had about bariatric surgery. Is it easy to undergo general anesthesia? Is it really like, again, it's that moment of like, just, but I understand that my personality, my tendency is to go into this kind of like hero advocate mode for a group of people that I just feel like this is ridiculousness. So for the people that I know and love that have been affected by it, it's not easy. And for the people that I cared for, it certainly was not. easy and I just think it's unfortunate and I still think at the end of the day to have to traverse that type of commentary it just creates a level of shame and can be a barrier to seeking care or thinking that you're worthy of care. If you feel as though when I finally decide to do it everybody thinks I'm just taking the easy way out when really there's nothing easy about any of it. Yeah.

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Melissa Parsons

I love it. Thank you for saying all of that Dr. Williams.

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Dominique Williams

Did I fall in? Did I go into the rabbit hole or am I good? My hands were moving. I was starting to like shift in my chair.

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Melissa Parsons

This is the energy I wanted for this podcast. So we're right on track, sister. Okay. So another one of the biases that I had was that I didn't want to have to quote unquote be on a medication for the rest of my life. But then I remembered that I had successfully advocated for myself to be on estrogen likely for the rest of my life and testosterone and progesterone for the rest of my life. And I was also on the path of needing to be on my hypertension medicine for the rest of my life. So I guess maybe I should ask you, is there a subset of people that may not need to take the medicine for the rest of their life? Or are most people who are signing up to take it probably going to need to be on some form of this medicine for the rest of their life that they want to not be under the chronic diagnosis of obesity.

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Dominique Williams

Yeah, so I think the concept of the rest of your life is still relative to what are the endpoints for treatment, like where are you trying to get to? So if you say, I have obesity, your doctor's like, yes, you have obesity, and I'm concerned about your health, and we need to change your weight by X in order to address this other health condition. So that would be one like, okay, I'm going to use this medicine to achieve this so that I can mitigate the risk of this, right? But part of what you're asking is that as we enter into this decision to take the medication, it's just to make sure that everybody's on the same page. What is it that we're trying to do? Because if it's that I want to non surgically have weight reduction, 20%, right? Like that's such a clinical sterile way of saying it, because I don't know what that number is for someone, but they say, well, I want to lose this much weight, because I'm worried about this or that in my family history. And if that's it, that's it. Because we've asked all of our other questions about mood, quality of life, social interactions, disorder, eating, like, we've gone all the way down. And really, it's just like, if the weight changes by this, and I can see this other thing, then I'm good. Then do you need medicine for the rest of your life? You may not need that medicine for the rest of your life. Will you need treatment, monitoring, support, whatever, for the rest of your life? There's a chance that you will need something. Yeah, for the rest of your life. But will it be medicine? You know, I don't know. So I think part of the question lends itself to you have to begin with the end in mind. So if you're beginning the medicine, begin it with the end in mind, the end being, where am I trying to get to? So you rattled off like estrogen, progesterone, testosterone, like, but the reasons that you're taking it, you have a very clear idea of like, I am taking these medicines for this reason. And if my dose changes, or if I discontinue it, it will be relative to these key reasons why I went to my provider in the first place and asked to be put on it. And that's where I feel like that part of the narrative around the medications needs to I don't, I don't want to say it like it needs to, this is the part of the narrative around the medication that's troubling to me, I'll put it back on me and say because we're taking something so private as someone's health, and making it out of our, our, our social and comedic and it's a part of everything. But really, it's like, it's none of your business. Because what if I want to change my weight, because I, I want to improve my chances at fertility, when I meet that person, like there's like this, it could be a long, long list, but I should not have to tell you one bit of those things public peanut gallery, but I should be able to relate that to my provider so that together we can say, and when I get to this milestone, this is what I'm looking for. And when I get to this milestone, this is what I'm looking for. Because part of beginning with the end in mind is to say, at what point do we deprescribe, de-escalate, transition to something else to help us maintain what we have achieved.

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Dominique Williams

And that's like a part of that's a boring conversation. Like who wants to put that on social media, because then that to me is like the best part of the practice of obesity medicine like to be trained and to know not that not like oh I know it all but it's like to have the training in the historical context. Because that's when you know in the toolkit of obesity medications and other things. The history, Melissa, it goes back to like the 1950s like we're talking Barbies on the scene, the twilight zone hit TV like Hawaii is now part of you know the 50 that's how far back obesity medicine goes, right. Then when you say like well do I have to be on the rest of my life? Well chances are if you are you're gonna pay a lot of money the rest of your life because right now it's not covered that's not the model. But if you are working with someone that has the clinical expertise the clinical experience and has the historical context and I begin with the end in mind, I've mitigated your risk of chronic diseases, maybe we have some abnormal food seeking, perhaps I want to preserve your fertility, or I want to lessen your perimenopausal menopausal type symptoms. Like whatever it is, but if I have that overall awareness then I know like you know what once you get here I've got this other thing in my kit, it's an oldie but a goodie it goes back to the 1950s, it's so generic and cheap. Listen you could spend more money at Starbucks than you could to transition to this medication. It has a different side effect profile and now we know how we're going to leverage it right and we could say once we get to this this destination of a weight decided by the person in their prescriber, if the weight goes up by x we activate this, if the weight goes down by y we activate this, if it stays this way then this is what we what we'll do. And all that math and all that mental gymnastics you know it's a lot to say, which means it's a lot to do. And I don't know that we always have the privilege to do that when we're in a visit with our providers. But if you start with the end in mind that is where you need to lay it out like right then and there. Like in my clinical experience, I had people who wanted to achieve weight loss they had a number in mind. What we did not account for is what that number would look like on them, and then with that number how their cultural and social environments would react to them at that number in that body habitus. That I can think, this was early in my career I can think of at least one person who came to me and said I'm done with the medicine because when I went to visit my family I was so isolated and felt so separate from them that it wasn't worth it to me and if I can just keep my weight in this range to keep the high blood pressure away I'm good, but I cannot lose... even though in their minds they wanted to get to this like there was total alignment, but it was kind of in a silo because once they got back to a place in their life that they valued far more than that number. They were like thanks, thanks but no thanks. I would take it in little increments right the rest of my life you mean the next six months, the next 12 months, the next- because it's going to change very likely and of course the innovation is going to change but you know your needs will change. What I needed medically at 35 is so different than what I need at 51 and my food seeking behavior at 51 my goodness is so vastly different than 31 when I was still in residency at 31. I just slept so let's go back let's say 51 compared to like 27 where my sleep cycle was different, my stress was different, like just a host of things, right? So I wouldn't be so future thinking to border on the catastrophic notion of like, oh my god the rest of my life. It's more like what what's my life like now that this is going into my choice for asking for the medicine, because what would be the endpoints for success that would then lead me to reconsider this concept of the rest of my life because whatever it is that is your business it is not my business unless I'm taking care of you. There’s so much that we could be focused on instead of other people's business. And, and here's, here's the other thing that we haven't talked about, but I'm just throwing it in the chat.

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Melissa Parsons

Oh, yeah. That was my next thing. Like what else do we need to talk about?

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Dominique Williams

Because if we think about how we socially digest this concept of personal health and pursuing treatment for obesity or choosing to use a medication, when someone's body habitus changes, like a famous person has a change in their weight, right? And then you stick the microphone in their face and you're like, are you using JLP once? Like reflexively, whatever the question is, you're gonna be like, what? Oh, no, right? Because then the headline is, allegedly, Melissa's using, allegedly, we use that language when we're talking about crimes. Right, right. Like, why is it a crime for me? Or Melissa tried to play down accusations that accusations, like, are you mad? Like, what is happening? Because then it goes right back into all the questions that you asked, including this concept of the rest of my life.Because if I had to deal with all of that for the rest of my life, that would also play into my concept of like, well, how long am I going to be on this medicine? Because I cannot tolerate all these people in my business the rest of my life. And I don't know that I have it in me to say like, Oh, just brush it off. Oh, just ignore it. Like, no. And so I give like a famous person example just to be like totally drama. And like, you get the point, right? We can all think of the famous people who might have had that heading. Because then if you just think about the normal everyday person, it's it's far more penetrating and hurtful because it's your circle saying things to you or that you're in the midst of your friends that have a feeling or a thought about it. And you've not disclosed to others that you're taking it. So how do you feel when you're sitting and you're out with your girlfriends and you're like, Did you hear about such and such taking that? Like, who does that? Like, that's so easy. Like, why can't you just because then you know, human nature is like, you know, I'm not talking about you, girl. No, you good girl, right? Like, you know, and it's like, Okay, but I've been taking it for like six months. And that's why I didn't tell you, you expletives, because this is what you were gonna say to me, right? Like, those are too many rocks to carry, right? Like, and those rocks get, they get heavy. And then, and again, it goes back, that's a barrier to care, you're gonna stop it, you're gonna discontinue it, you're gonna talk yourself out of it.Even if you had access to it and your insurance pay for it, and it's not a matter of money, you have to deal with that all the time, like the cognitive burden to try to like, keep up with those conversations, so that you can protect yourself and maintain social relationships. Yeah, because otherwise, you just don't want to talk to anybody, you just like, get out of my face with that. Like, I just want to get better. I don't need all this. That right there, that'll set me off for like a whole other hour is just get out of here with that.

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Melissa Parsons

Well, to my friend's credit, everyone has been very supportive of my journey and it might be because you're threatening them.

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Dominique Williams

But the shortest person in the pack is like, talk shit, really try it. But let me hear you say one thing. No, no, I think the privilege of our lives, my dearest Melissa Parsons, is that we found each other and that that's been our greatest gift is that see, this is when I'll cry. This is our greatest gift is like we all had no idea what we would become when we first met each other. So that's the privilege of being friends for so long is that friends who say just about anything in front of each other, let's put that in the middle of that is that the port looks different depending on our stage of life and our milestones, right? Like we've all gone through different things together, but we all were aligned with we will support each other. So that, but that's a privilege and that's, that's a gift and, and we all know well enough to, yeah, exactly. And, and we, we all know that people can't call a friend like we are to each other and say, help me navigate this conversation or help me not hurt somebody today, like you don't, you don't always have that, which I, I think even in the thought process of should I, or should I not pursue this form of treatment, like, you know, we've had such deep conversations relative to like menopause treatment. So like, but that's just the nature of our friend group. I think that that's great. And that's why as a clinician, it wasn't my job to be friends to the people that I cared for, but it was my job to be the place where they felt that they could bring their questions or concerns. Um, that in the absence of those things, and in light of, of me being like that in their health, um, history, their health journey, that they knew there was at least one place they could go and say, or speak or inquire or ask about that aspect. And that I would try my best to stay curious and to listen.

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Melissa Parsons

Mm-hmm. Well, this makes me have to say something about the hospital that shall not be named, like what they lost when you left.

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Dominique Williams

Yeah, it's what I gained when I left, though, I certainly wouldn't be on your show.

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Melissa Parsons

Yeah, my advice to everyone listening is get yourself some smart friends. And really, honestly, like get yourself a circle of people where you can be your favorite you and where that is sometimes fucking messy.

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Dominique Williams

Yeah. Yeah. And we'll let you be messy. And we might not always clean up your mess either. We just might look at you and say, let us know when you're done with that. I mean, we'll be here, but, and then sometimes we just don't have answers for each other, you know, either way. I really think like at the end of the day, I can acknowledge how the medication has been such a disruptor. And I can acknowledge how it feels easy. If there's an outward manifestation that then seems like, oh, now I believe that you're working hard. Whereas before it was always questioning, right? Like I can see both sides of the coin on like, where the conversation goes. And it's why I kind of tiptoe around the soap boxes and the, and the rabbit holes. But, you know, at the, at the end of the day, it's a personal decision at, at the end of the same day, the number of people who meet criteria for the medicine, that number of people compared to who is actually using it, it's such discordance between the two. So it's still a woefully limited access, underutilized treatment, just as much as the surgical intervention of bariatric surgery, but that we still have to come to the table with the assumption that people are, are seeking better health, whatever that concept is, you know, independent of, of body habitus or the diagnosis of obesity, like most people are looking to have better health. So, why should we have such a social opinion of people wanting that, if that's a shared decision that they've made with their prescribers? So, you know, I have lots of opinions and things I could say, but in the end, it's still, it's still just that it doesn't speak to what that listener or what that other friend or who else out there has a different experience. This is still their business.

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Melissa Parsons

Thank you so much for coming on. I so appreciate you.

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Dominique Williams

My pleasure. This was good, and I appreciate you.

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Melissa Parsons

I appreciate you, too. Listeners, come back next week for more shenanigans.

Hey - It’s still me. Since you are listening to this podcast, you very likely have followed all the rules and ticked off all the boxes but you still feel like something's missing! If you're ready to learn the skills and gain the tools you need to tiptoe into putting yourself first and treating yourself as you would your own best friend, I'm here to support you. As a general life coach for women, I provide a safe space, compassionate guidance, and practical tools to help you navigate life's challenges as you start to get to know and embrace your authentic self.

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