Weight is the first vital sign most patients hand over, usually in a hallway, usually before anyone asks why they came in. Dr. Michelle May, MD spent 16 years in family medicine watching what that does to a visit. Then she left practice to build something different.
In this episode:
– Where weight stigma actually shows up in a clinic, from the waiting room chair to the too-small BP cuff
– What the research says about weight cycling, and why restriction drives the cravings patients blame themselves for
– How to reframe lifestyle conversations around behavior and follow-up labs instead of the scale
– A physician’s honest read on GLP-1s: what they finally proved, and what they still leave unanswered
Michelle May, M.D., CSP is a former family physician, Associate Professor at Arizona State University, and founder of Am I Hungry?® Mindful Eating Programs and Training, which has trained more than 800 healthcare professionals.
Resources: amihungry.com | Free chapter 1: amihungry.com/chapter1
Explore physician jobs → pacificcompanies.com
Subscribe wherever you listen.
Views expressed are Dr. May’s own and are not medical advice.
#WeightInclusiveCare #WeightStigma #MindfulEating #PhysicianPodcast #PrimaryCare #DocLoungePodcast #PacificCompanies #DoctorLife
Full transcript:
Stacey Doyle (00:01.388)
Welcome back to the Doc Lounge Podcast. I’m your host, Stacey Doyle, Senior Director of Marketing at Pacific Companies. And today I’m joined by Dr. Michelle May, a former family physician associate professor at Arizona State University and the founder of Am I Hungry Mindful Eating Programs and Training? Dr. May brings both clinical expertise and deeply personal experience to today’s conversation. From middle school through medical school, she struggled privately with disordered eating, body image, and repeated dieting.
During her medical career, she discovered that many of her patients were experiencing the same difficult relationship with food in their bodies. She went on to create Am I Hungry? which has trained more than 800 healthcare professionals to offer mindful eating programs. She is also the author of Eat What You Love, Love What You Eat book series, and has taught a mindful eating masterclass for the CalMapp. Dr. May is also the co-author of a scientific review examining the consequences of weight-centered healthcare and presenting a framework.
Framework for more weight-inclusive patient care. Today we’re discussing how our diet and weight-obsessed culture affects patients, the harms, the harm weight stigma can cause in healthcare, and how clinicians can shift the conversation away from body sides and towards sustainable health and well-being. So, Dr. May, I’m really excited to have you on. Welcome to the DocLems Podcast.
Michelle May MD (01:20.746)
Thanks for having me, Stacey. I’m glad to be here.
Stacey Doyle (01:24.032)
Such an important topic and one that I don’t feel like is discussed enough. So really excited to bring this to our audience of fellow physicians and and clinicians. So tell us a little bit. I know you described, you know, earlier on you had kind of this struggle with food and and body image, and then how that kind of shaped your personal experience as you became a physician.
Michelle May MD (01:49.471)
Yeah, you know, I think it’s very common. It was common even way back then, and it I think it’s become increasingly common, especially for women, but men as well, to have body image struggles. And that often will start a pattern of restrictive dieting, whatever that looks like for the individual, and of course that’s something that has changed many, many times over in in the last number of decades, but that pattern of restrictive.
Dieting often leads to other issues that will eventually cause a person to go into overeating cycles as well. In fact, I call it the eat, repent, repeat cycle. We also call it yo yo dieting, weight cycling, and we see this a lot in our practices. But personally, I had struggled with exactly that same challenge since I was 13. It didn’t really have anything to do with why I went into medical.
I probably went into medicine, you know, wanting to help people, sincerely wanting to help people, and at the time didn’t realize that my own personal struggles would be the way, the pathway for me to help many, many people who weren’t getting the help they needed in other places.
Stacey Doyle (03:07.95)
Well, that is inspirational. Obviously, you knew that you wanted to help people. That’s why you became a provider and then really said, okay, this is something that I know I know about and I can use obviously all the skills that I learned in medical school to to help with my patients. tell us, I mean, how would you describe healthcare, you know, as operating within kind of this very weight centric paradigm? It’s typically BMIs, you know, your weight, that type of thing.
Michelle May MD (03:36.063)
Yeah, that’s that has really been something that many of of my patients and people that I’ve worked with since then have struggled with. Because of course, the the minute you walk in, weight is the very first vital sign that’s collected, oftentimes in a very public place. and I think a lot of people experience a lot of shame and concern about that in their in their medical encounter, which is unfortunate because it puts
The physician and the patient in from the very beginning in a difficult situation. The other thing that really happens with this is because the clinicians are really presented with this weight-centric approach to health, they will often address most problems in a larger bodied patient as though weight loss will solve all issues. That’s not true.
Course, many people have problems that thin people get as well. Thin people get diabetes and hypertension and arthritis and other kinds of issues. And so we wouldn’t recommend that they lose weight. We would do the appropriate testing or studies. We would refer them to physical therapy, write the appropriate prescription, hopefully have some conversations about how lifestyle might improve their condition. But when it comes
to weight, we’re s the culture is so weight centric that oftentimes that’s the first thing and too often the only thing that gets addressed.
Stacey Doyle (05:17.986)
That makes a lot of sense now that you’re saying it. Obviously it’s, you know, when you first get into, you know, and you’re going to see your provider, that’s the very first thing that they do. And then it seems like it’s obviously they’re they’re really weighing kind of everything based off of of that. so tell me I mean Yeah. Yeah. So tell me, I mean, how w what do you think some of the stigma can look like in healthcare settings? You know, it may be more subtle or maybe more overt, but what tell us about that? Obviously you have experience.
Michelle May MD (05:32.916)
Not intended, right?
Michelle May MD (05:47.201)
Well, it happens the minute somebody walks in the door. You know, a person in a large body may not have a seat that appears comfortable and safe for them right when they walk into the waiting room. They may end up in the exam room getting a blood pressure check when the cuff is too small and misreads their blood pressure, or where the medical assistant says, hang on, this cuff is too small for you. Let me go get a bigger one.
And leaves the room, you know, creating this sense of embarrassment and shame. Then you hand them a paper gown that doesn’t cover their body and makes them feel exposed and embarrassed, and ask them to step on an exam table that may not be stable for a larger body. So, in many ways, there is this bias that is created in the system, and it and it causes people to not want to go to the doctor.
at all. In fact, there have been some really good studies that have shown that, for example, gynecological cancers are diagnosed later in people in larger bodies. And so the assumption might be, well yeah, people in larger bodies get, you know, gynecological cancers. Maybe, maybe they’re not going in to see their clinician because they’re afraid of the encounter. They’re concerned about how how they’ll be treated.
There. And then a lot of physicians have their own internal bias, their own implicit bias. They don’t even realize that they aren’t recommending the same studies or treatments for their larger patients. And maybe creating some of the things that we blame on weight might actually be from withholding appropriate blood pressure medications, for example, until some
Somebody loses weight, which we already know based on studies that weight loss, particularly behavioral weight loss interventions, don’t aren’t very effective and they aren’t very sustainable. Same with medical therapies as well.
Michelle May MD (08:16.89)
And the patient feels like there’s something wrong, but nobody’s really putting their finger on what the problem is.
Stacey Doyle (08:26.03)
Well that is very insightful and very, you know, I think again, something that haven’t heard before. So tell us a little bit. Obviously many patients spend years losing and regaining weight. What does the research tell us about weight cycling and its potential physical and emotional consequences?
Michelle May MD (08:46.89)
Well, for one thing, the fact is that that restrictive eating, restrictive dieting doesn’t work well because our bodies are uniquely designed to prevent us from starving to death. You know, we evolved over centuries of food scarcity. And so when the body perceives food scarcity, even if it’s intentional, that will have negative metabolic effects. People certainly lose weight, but they lose.
Muscle which is metabolically active and it ramps down their metabolism, and similarly, it creates a whole series of psychological changes. So the hedonic properties of food, the properties of food that make it taste good and smell good become heightened because the body is trying to tell you to eat more. So it is not your imagination that when you go on a diet, it seems like the food you’re trying to avoid.
Appears everywhere and seems very hard to resist. So we set up this way of losing weight that is not sustainable for the vast majority of people. So they will lose weight initially. When they regain weight, which most do, we know this happens over and over clinically, we’ve all seen it time and time again. The tendency is to blame the patient. They’re not adhering to the diet, they haven’t found the right
Diet, they’re not being good, but the truth of the matter is their body has set them up to regain that weight. And when they do, they regain mostly the fat that they lost, not the muscle mass that they lost, and so their metabolism may be permanently lower. And this may be partial, this may partially explain why over time many people seem to gain more and more weight as they go. So all that to
Say that you know it’s easy to focus on weight and it’s easy to focus on weight loss as the solution, but actually the research is very much based on correlation, not causation. So we can assume that diseases are caused by weight excess, but in fact, they’re correlated. There have been some studies that have shown that weight cycling may be part of what makes people.
Michelle May MD (11:16.54)
More prone to certain diseases. Weight stigma and weight bias, as I talked about before, can affect the way a person shows up in medical settings, maybe prolonged, you know, waiting to go in for symptoms, or their clinician. And there’s some pretty horrific stories about this that they went in with a specific complaint, and instead of addressing that complaint, they were advised to lose weight. And by the time they were finally diagnosed with stage four cancer, it was.
was too late. And that, you know, hopefully that doesn’t happen very often, but it’s it happens enough that all of us need to be much more aware of our own explicit and implicit bias when we’re seeing our patients in larger bodies.
Stacey Doyle (12:05.09)
That is a perfect leeway because I wanted to ask you how can clinicians address some of these concerns that they may have that may that may or may or not be associated with weight without making their patients feel, you know, judged or blamed?
Michelle May MD (12:21.246)
W without a doubt, many of these conditions at least partially respond to lifestyle changes. So if we can talk about behavioral changes without making the intention weight loss, for example, somebody with let’s say hypertension or early, maybe you know, early hypertension, we might talk about beginning an exercise program, we might talk about
Modifying the diet, we can have those conversations without saying you need to lose weight. Because ultimately, if the person doesn’t lose weight or loses weight and then regains it, they have failed. Whereas if you talk to them about starting a gradual exercise program, that might be something that they can sustain long term without focusing on whether it results in a change in their weight and follow up their blood pressure and
instead of the number on the scale, as one example.
Stacey Doyle (13:25.678)
That’s a great that’s a great example. ‘Cause that and that that leads ’cause I was gonna ask you, so what in your opinion, what does weight inclusive care look like in practice? Is it, you know, is it simply avoiding some of these conversations or is it is it bringing it, you know, in a different light? Yeah.
Michelle May MD (13:43.389)
we’re not trying to avoid it. And the truth of the matter is your patients are bringing it up as often as you are, if not more. You know, people we all live in a very weight-centric environment. And so your patients are coming in asking for weight loss. That’s what they’ve been taught and told that they should, you know, do and they expect to have
Stacey Doyle (13:49.026)
Yeah, right.
Michelle May MD (14:06.012)
Miraculous results with that. So it’s it’s not about being afraid of it, it’s about not centering every conversation around somebody’s body size and really having conversations with our thin patients just as we would our larger patients. Because this works both ways. I’ve had clients of mine who are in smaller bodies who tell me that they have an eating disorder and they were
Never asked about their eating behaviors. I’ve had clients who used exercise in a punitive, punishing, restrictive way, and they were applauded for it. And so I think if we can think about asking all of our patients about their lifestyle behaviors and then work with them on maybe beginning with one of the simplest ones right up front, how can we, how are you willing to?
Work on I’ll say your soda intake. It sounds like you’re concerned about how much soda you drink. Is that something that you have wanted to address? And if they reply affirmatively, okay, so what are you thinking about doing? What would be a realistic way of beginning to modify that particular choice you’re making? So you see, I’ve I’m there’s a lot of language I’m using that I want to just point out. One is I’m not using
Language like obese and overweight, because those, first of all, the word obese implies that this is automatically a medical condition that has to be addressed. It’s a you know a medical diagnosis. Overweight implies that you are over some specific weight that you should be, when in fact, research shows that people, the healthiest people are in the BMI, which we that’s a whole other discussion we could have, are
In a BMI range of 35, 25 to 30. Those are the ones who live the longest. And so again, those are core, that’s correlation, but I think rather than using terms that people have come to feel ashamed about, I think we can talk about medical conditions without always turning it back to BMI or weight. The other thing that I was showing as I was talking about.
Michelle May MD (16:35.522)
Perhaps these lifestyle changes is not being the expert in the room.
But being somewhat of a coach, you know, really guiding people to make decisions for themselves. Now, you, you know, you are the expert and you are the one who’s going to you know, there, you’re there. Obviously, you don’t have a tremendous amount of time with each one of your patients, but having a conversation that opens the door and trusting that over the course of your relationship with that client, that patient, you’ll get to build on a
You can tell I was a family doc before I before I turned full-time to mindful eating.
Stacey Doyle (17:20.878)
Well, I love it. Now tell us about mindful eatings. Tell tell us about this concept. I know you’ve obviously done a ton of work and and helped design this so tell us about it and help us understand what it can do for us.
Michelle May MD (17:34.335)
Yeah, sure. Well, so I had I went into family medicine. I practiced family medicine for about 16 years altogether. but as you said in my introduction, I did struggle with with my own eating and body image problems. And when I went into my practice, I kept hearing the same thing from a lot of my patients. And at first I was sending them to Weight Watchers, because that’s what I’d done forever. And you know, Weight Watchers is a perfectly good diet, but they weren’t.
Really having any better long-term success than I had. And that really got me thinking that maybe the whole paradigm was flawed and what we were asking people to do really doesn’t work. Because, gosh, if you can get through medical school, you should be able to stick to a diet permanently if it’s possible. And it wasn’t possible for me. So the process that I developed, and I worked with a dietitian, an exercise physiologist, and a psychologist initially to develop this.
approach, but it’s really based around the idea that restrictive dieting creates more obsession with food, more cravings, willpower runs out, and then we end up in that eat, repent, repeat cycle.
So we used a non-diet approach, meaning we’re not telling people what they can or can’t eat, but instead, we’re using mindfulness skills to help them become more aware of their own natural internal cues of hunger and satiety, which is something that most of us get completely divorced from. You know, as children, we’re made to clean our plate, or in medical school, we’re rushing through a meal, or we go on a diet.
And we’re told we’re not allowed to eat unless you know we’ve there’s been four hours between meals, even if you’re hungry, or conversely, that you have to eat every three hours and you know, don’t let your metabolism go down. So there’s a lot of fear-based messaging around eating, when in fact we were all born with the instinctive ability to know when our body needed fuel and to know when we’d had enough fuel, and we’ve unlearned that.
Michelle May MD (19:50.983)
So we use mindfulness skills to help people re-engage with their signals of hunger and satiety, and similarly to also recognize when they’re wanting to use food for other reasons: environmental cues, social cues, emotional eating, and so forth. These other cues that cause people to eat when they aren’t hungry or to continue to eat past the point of satiety.
Stacey Doyle (20:20.258)
That’s fascinating. And I know you’ve worked this into your your book. So tell us about you know, your book that’s available and what, you know, anyone reading that can can expect to learn.
Michelle May MD (20:33.696)
So the book, it’s actually a series of books. The first one was called Eat What You Love, Love What You Eat. And we had so much success, so many people telling us how transformational it was. We adapted it for others as well. So we have Eat What You Love, Love What You Eat for Diabetes, Eat What You Love, Love What You Eat for Students. I teach this class at Arizona State University. And we have a workbook for people who’ve had bariatric surgery and a
Eat what you love, love what you eat for binge eating. So these are all based on the same process, which is a model called the mindful eating cycle, where you and your patients can learn how to make mindful decisions that don’t involve willpower and guilt to control yourself. In fact, I say it’s not about control at all, it’s about learning how to be in charge, meaning that you’re aware of what’s happening in that present moment. You’re not
Not judging yourself or thinking you’re bad if you want to eat the cook the cookies, there’s no problem. Lots of people eat cookies, and when you can do that without guilt, you don’t have to eat the whole package because you can have them again whenever you want them again. There’s no impetus to finish it off and go back on your diet the next day. So that mindful eating cycle is a really simple but elegant way to understand the
decisions we make around eating and begin to change that decision making process.
Stacey Doyle (22:10.946)
This sounds like really, really important, you know, just a different approach to to eating and to being, you know, and thinking about weight loss. And I mean, right now all we hear about are GLPs and and all these things like that. What do you think how is that impacting your work and how people are viewing eating and weight loss in general? And and where do you kind of see things going? Obviously, because knowing
Some of those you have to stay on them for that for that effect to continue.
Michelle May MD (22:43.496)
Yeah, yeah, so I’m not in clinical practice anymore, so I’m not in a position to prescribe these to my patients or clients. I will say that they finally I’ve been saying I’ve been doing this work since 1999, and I have been saying for literally two and a half decades diets don’t work. Diets don’t work, diets don’t work. Finally, all of a sudden these come out and everyone’s like, Well, you know, diets
Stacey Doyle (22:48.898)
Yeah.
Michelle May MD (23:13.5)
Don’t work. And I’m like, right, I’ve been telling you this forever. But until they had something else that that had an effect, there was no admission that what we had been forcing down people’s throats really was not effective. So that has been a positive change. The negative part about it is that it, like many other past cures or solutions, I won’t even name them all. they’re
is always a period of time when everyone’s like, this is it, this is the miracle, this is gonna solve the problem.
But you’ve already addressed one of the issues, which is apparently now we don’t have the studies for people on it for the rest of their lives. So we don’t really know what happens to people when they’re on it for 40 or 50 years, which presumably is what they’re suggesting. And so my concern is that it doesn’t really address why people are eating in the first place. And so we may not
ever get to a place where we are doing anything more than waiting until people get to a point that they need to start a medication and then putting them on it forever.
That’s a bit problematic for me. And I and I feel that although I don’t have an easy, easy way to address this, I think that we’re gonna have to think more deeply about what it is that we’re actually recommending because I don’t think it’s going to be affordable or accessible, and we certainly don’t know safety or even effectiveness when people are on this for many, many decades. And most people don’t. I mean, you know, there are studies showing.
Stacey Doyle (24:58.382)
Mm-hmm.
Michelle May MD (25:00.802)
showing that well over half the people are off by year two. So you know I think I think we’ve got another solution, solution that may not actually get us where we need to go.
Stacey Doyle (25:16.898)
Very fascinating and I appreciate that because I know that’s, you know, top of mind for for a lot of clinicians out there that are obviously, yeah, dealing with this day in, day out. I wanna just give you an opportunity to let, you know, fellow clinicians or any patients that just want to learn more how they can get, you know, best a hold of your books and any other information about working directly with you. I know you also have
a master class in the com apps. That’s really cool.
Michelle May MD (25:48.053)
Yeah, well, we do so. Am I hungry is my website, ammihungry.com. And there are loads of free articles and blog posts and things for you and your patients on that site. So you can learn more about mindful eating and explore this idea more. A very simple way to check out the book is to download the first chapter. and the reason that I do that is that it explains the mindful eating cycle and it very quickly
Will give you and your patient a way to say, is this for me? Does this make sense to me? So it’s it’s ammihungry.com/slash chapter ones, chapter spelled out, and the number one. And I’ll send that to you so you can include it in the notes. But you can download it for free and see whether it makes sense to you in terms of whether this might be a new way of looking at these eating decisions that you’re making.
We do train clinicians as well to offer programs and coaching and therapy and and other things. So you’ll find that on the website too.
Stacey Doyle (26:47.756)
Band.
Stacey Doyle (26:57.932)
Fantastic. Sounds like valuable resources. And this has been a very, very enlightening conversation about something that I don’t think is talked about enough. So I wanna thank you, Dr. May, for coming on, bringing awareness to this issue and having a great, you know, practical resource that everybody can utilize to help them with with the way that they’re thinking about eating. So thank you so much.
Michelle May MD (27:20.628)
You’re welcome. And I forgot to mention, I do have a the clinical paper that you mentioned at the beginning. I’ll be happy to send that abstract to you. And we produced a one-page document to how clinicians in a clinical setting can reduce weight bias and a weight-centric approach. And so I’ll send that to you as well in case people are interested in learning how to do this in their practices.
Stacey Doyle (27:48.418)
That’s fabulous. We will share that with our audience and and post that as well. So thank you so much, Dr. May. Really appreciate it.
Michelle May MD (27:55.371)
Thank you.
