Obesity Conversation: Dr. Prologo
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Guest: Dr. Prologo
Release Date: 8/8/2022
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Steve Washuta: Welcome to Trulyfit. Welcome to the TrulyFit Podcast where we interview experts in fitness and health to expand our wisdom and wealth. I am your host Steve Washuta, co-founder of Trulyfit and author of Fitness Business 101. In today’s episode, I discussed obesity with Dr. David PROLOGO.
Dr. PROLOGO is uniquely double board certified in interventional radiology and obesity medicine. He has spent his entire career working from the perspective of the patient to develop compassionate and out-of-the-box solutions for those who suffer from complicated pain syndromes, and or struggle to lose weight. Dr. Pro logos book The catching point is the meat of our conversation. That’s what most of my questions are about in this interview.
If I were to give a quick thesis of this book, is looking at obese patients, let’s call it experience from both the physiological and the psychological. But really, to push the notion that most people in the health and fitness and just general population would think that the major issue with obesity is a willpower issue is a psychological issue, where Dr. PROLOGO really wants you to understand there are physiological barriers and hindrances that are hurting people who have obesity and stopping them from getting to their goals.
And if we don’t understand the physiological side of what’s going on, then ultimately, their progress is going to be slowed down or maybe they never even make progress. So again, in the book, he marries both the psychological and the physiological sides of the obesity issue. And he has a unique perspective, because of what he does, he’s able to do things like bariatric embolism, and procedures on obese patients.
And he’s able to have an understanding of what obesity patients are going through from the physiological and the psychological side because he’s an obesity medicine specialist. It’s a great conversation, I really enjoy his perspective, especially the fact that he believes these procedures are not the finish of the journey. They’re the start of the journey.
With no further ado, here’s Dr. David PROLOGO. Dr. PROLOGO, thanks so much for joining the Trulyfit podcast, why don’t you give my audience and the listeners a little background on you what you do in the medical field, and a little bit about your book and the impetus to write your book?
Dr. Prologo: Sure, Steve, thank you for having me. First of all, my name is Dave PROLOGO. And I’m I have dual board certification, in obesity medicine, and what’s called interventional radiology. It’s a little bit of a unique space in the world and has evolved to essentially be the use of needle procedures in X-ray or CT, to manage obesity.
Dr. Prologo: It’s something that was birthed out of what we call advanced interventional pain management, where we were targeting nerves to quiet pain signals, and evolved to what procedures can we do that can decrease hunger, and, so those things sort of came together. And what I learned during this time, and during my care of patients and research was very much that the attrition rate, the very high-efficiency rate, for those folks who try to lose weight is clearly in the body. And so then I became sort of almost obsessed.
Dr. Prologo: But it’s been my passion to show this and to get this message out to those people who have struggled. And so again, that’s why I appreciate very much that you would have me on to talk about this. And that’s the impetus behind the book is that this sort of mind over matter, this historical, mind over matter thinking and all the bad things that have come out of that, like fat shaming, for example, and condescension. It’s all debunked.
Dr. Prologo: And so the impetus behind the book, the answer to your question is, I wanted that message out there. I have a busy job already. And so it wasn’t so much to sort of make money or get famous, it really was to write in this book, this message to people that what you feel and what you’re trying to describe to us about how you follow this diet and that diet, but that can’t seem to lose weight or can’t seem to get to the end.
Dr. Prologo: There’s a reason for all of that, and, and the rights that your body is fighting you. And we realize now that you have a difficult time explaining that, but your feelings are real. They’re rooted in real biological processes. And I want people to know that and to be vindicated.
Steve Washuta: We’re gonna get into your book and sort of your methodologies and your ideology behind the book and your messaging but first I have to ask, you know, interventional radiology. I’ve never heard of it. My wife is a she’s a pediatric sports medicine doctor. Even when I asked her, could it, I mean, she was putting the pieces together, but she never heard of it as far as anyone who went into that specific study.
So tell me why exactly, I guess a radiology radiologist I should say, is suited to do the procedures that an inch radial like that you do meaning like could that be another subset that does that? Or is it because specifically, you’re doing these procedures during the imaging process?
Dr. Prologo: Right. So it’s, it’s a little bit of all of that. And we have this joke at our graduation dinners to We congratulate the trainees, you’ve now become certified in a field that no one has ever heard of. And so I know, I know what you mean. Essentially, what it is, is you spend your time in medical school and you spend your postgraduate training, learning radiology, which is a five-year process of how to interpret these images.
Dr. Prologo: And then you do a subspecialty year, whereby you use these, you’re now an expert in imaging modalities, like CT, MRI. And now what you do in that final year, is you learn to use those imaging modalities to guide needles into the body, to reach places nobody can reach, right. And so we’re uniquely suited to get a needle into any place from the skull base all the way to your toes.
Dr. Prologo: And I know our day job, we do things like biopsies, or sometimes if people are bleeding to death, we can we can get to those vests and block those vessels. So we do all of that through it a pinhole through a needle hole. We are able to do that, because we do it all under live imaging, you’re in the CT scanner, we step on a pedo CT images, show us where the needle is. And so we’re all busy enough doing that, right, we’re using that job to treat cancer, diagnose cancer treat Trauma Center, our center.
Dr. Prologo: And so that’s busy enough as it is, what happened to me was that I sort of branched out and started to use that same skill set to manage pain. And so what happened then was oh, my gosh, we can we can use this. So if this was a needle, we can use this CT scanner could guide this needle to a pain generator that otherwise can’t be reached, right, like a nerve in the pelvis or a nerve deep in the abdomen or in the skull base. And now all of a sudden, we have this, we can solve all these problems that couldn’t be solved before.
Dr. Prologo: Because you can’t have surgery to get to your skull base, or your pelvis. And so, so that became targeting nurse, I’m trying to keep this not too dry here, Steve. That the idea, then, here’s how I can I can make this a little more interesting. So the idea then became well, if we can guide these needles, without surgery, just through a pinhole anywhere we want, and we can shut down nerves to help people with their pain. What if we could shut down nerves that do other things. And an original study that we did. Now, this was kind of painful to hear about.
Dr. Prologo: But we did this study for men who had a sexual disorder called premature ejaculation. Because the sense the sensory nerves, the nerves of a king sensation from that area, we thought, Well, Jesus, that’s the problem, we can probably target those nerves, shut them down, and get these people feeling better. So we did that that was a big deal. It helped those people. But more importantly, it showed that, hey, we can we can shut down nerves, for any reason.
Dr. Prologo: And so then because I was training in obesity medicine at the same time, the question became, well, can we guide this needle, and block the nerve that carries hunger from an empty stomach. Because when people try to die, one of the things that stops them is hunger, right? They get to day two, day three, and the nerve from an empty stomach is just firing uncontrollably sending you on food seeking missions.
Dr. Prologo: And if you can overcome that any more than you can overcome, then you can stay underwater and overcome your body’s signals to get air right, you just can’t overcome that. And that’s a separate topic that we can talk about. But for this discussion, we were able to do exactly the same thing. We just guided that needle to that nerve that carries the hunger signal, we froze it and shut it off.
Dr. Prologo: And so then when people went on diets, they didn’t feel hungry. And that’s what was stopping them before, right? So we were able to keep people on their diets. And they could lose weight because they didn’t feel hungry. And so that’s kind of how it all it all came together.
Steve Washuta: That makes sense. And they still need to be doing the work on there and afterward. So for example, if you just relate this to sports medicine, if someone gets a patella femoral nerve blocked, but they still have compensations and synergistic dominant somewhere in their quad or something right.
So they still need to build up that musculature because there’s still a problem there. That’s the reason they had the pain. Right. So they started to work on those things. So one would say that doing this, the people who are dieting still need to diet right. This is not this is not stopping the the or the process. It’s not a finality, it’s the beginning of the process.
Dr. Prologo: Yeah, so So God bless you for saying that actually. So it’s the it’s it’s like Nicorette, right. When you stop smoking. You have real signals in your body that cause you to crave right it’s not like a psychological thing. I’m sure you We realize that this is a real response that the body has. So this is, it’s the opposite of we do something and you lose weight.
Dr. Prologo: What this is, is what greasing the wheels, we’re making it easier, we’re we are conceding that this hunger feeling that you get when you restrict your calories is not something that you can overcome. So we take it away. And what you do with the absence of hunger, like you said, is absolutely up to you. But what we see is that when you take that obstacle away from people, they are off to the races, because they’re so excited that they’re not hamstrung by hunger anymore.
Dr. Prologo: That it’s easier. That’s what we want to do want to make it easier, we wanted to take this seemingly impossible task of of losing weight and make it easier for people. Because to me, you have the CDC reports how many people were on a diet, like 150 million people fail to diet in a given year? That’s a lot of people 150 million.
Dr. Prologo: So there’s got to be this must really be hard, right? Or the or the flip side is that all these people are lazy and worthless people right? That can’t be right. So it’s really is hard. And so what we wanted to do is make it easy. So yes, you do have to follow some sort of calorie restriction. But it’s no longer a drag in difficult and impossible.
Steve Washuta: Well, let’s work backwards here and talk a little bit about obesity. So in your book, you talk about how people try to almost for lack of a better term fat shame and blame willpower as a reason people are not sticking to diets, when you discuss physiological reasons why being obese is different. Can you discuss some of those with us?
Dr. Prologo: I would love to, it’s really, that what you’re asking me now is really what gets me up in the morning now, for my job. And it’s the fact that the majority of the negative commentary that you hear, which, by the way, is unbelievable. I’ve posted internet articles, to have people reply with just the nastiest, unbelievable comments.
Dr. Prologo: And so the first thing I would say is that most of that sentiment comes from people who have never actually gone through this, right, the people who are saying that, Oh, they should just shut their mouths and you know, stop beating their fat, you know, this, and that the people who say that, almost inevitably have never been overweight, and transitioned to lean, which is what these people are trying to do.
Dr. Prologo: So the first thing is, there’s this huge disconnect, because the people who say these negative things have never actually been through it. So it’s no different than saying, all you know what, these folks that grew up in low resource countries or low-income neighborhoods, they should really just buck up and, and study and read like I did, you know, in my upper middle class, White House, you know, it’s not the same, it’s not the same, the conditions are different. So that’s number one.
Dr. Prologo: And number two, is that the things that stop people from being successful, are not theoretical, they are real thing, one, the hunger, nerve signal, right? That’s the thing, one, because the body is wired to survive. So you decrease my calories, my body thinks I’m entering into famine or starvation, and drop everything and eat because the body wants to survive. But it’s not just the hunger nerve, right? The stomach dumps, the empty stomach dumps hunger hormone, into your bloodstream, which I’m sure you’re familiar with ghrelin. And so that gralen is measurable.
Dr. Prologo: And that signal in that nerve is measurable. So these are real things. So hunger is number one, number two, your metabolism will slow down. And again, it’s the same thing, the body says, Look, if all of a sudden food is scarce, which is what it seems like to me when you die it, then I better slow down my burn rates. So we don’t die. And that slowdown in metabolism offsets what you do by cutting your calories.
Dr. Prologo: That’s why people will cut their calories and then show up in your office and say, Look, I did what you told me to do. But I’m just not losing weight. And so So my point is that, number two, these things that black people are real. And when we hear oh, you really just need to white knuckle through and suck it up. Most of the time that sentiment is coming from someone who’s never actually been through it.
Steve Washuta: Yeah, that’s a great point. The book talks a lot about how we’re all coming from different variables and different obstacles. You can’t assume you not having been through it that, that your journey is the same as theirs. It’s not again, just from a psychological perspective. There are actual physiological reasons why they are struggling.
And another one that you talked about is when people first start to work out people like me, personal trainers who have made never even taken two weeks off in our entire lives from working out. don’t really remember or understand that if you haven’t worked out, let’s say in two or three years, and your first jump back into it. You were sort of set back by your body fighting against you. Can you talk a little bit about the physiological things that happened to your body when you first start working out?
Dr. Prologo: Absolutely. Things are the best questions I’ve ever been asked. Because you’re really highlighting what it creates that disconnect. Right? You who will not know personally, of course, who someone who has been working out for what I call the always lean population, that experience is not the same.
Dr. Prologo: The experience of running and eating clean is not only usually not difficult, people will describe it as pleasurable people will come right out and say I can’t live without working out. And my run in the morning, right? That experience is totally different than the experience of someone who’s starting at say 250 pounds and a decondition. State, when they start to exercise and decrease their calories. The experience is one of complete misery, right?
Dr. Prologo: And this is where I wish that I could make some sort of science fiction switch and take one of the always lean people and put them in there. And then they will say, Oh, I didn’t know that. I didn’t know that it felt like this, you know, nobody’s going to overcome this. And, and then that’s what we see, nobody does overcome it right. Every once in a while something like the biggest loser will happen where you will see a concentrated group of people in an isolated circumstance, and maybe they’ll get it done.
Dr. Prologo: But the facts of regular America and even the world is that less than 5% of people can ever get it done. So it is a totally different experience. And so instead of if we want to change the outcomes would, you know, assuming that’s what we want to do, we can’t just tell people to keep trying the same thing. That doesn’t make any sense. So what we need to do is make it easier, we’ve got to make it easier.
Dr. Prologo: One example I like to give is, if you came to me, God forbid, with cancer, and I gave you therapy, but that therapy made you nauseated, you just couldn’t keep it down every time you tried to throw it out, right? You just couldn’t tolerate the therapy. When you came back to me and said, I can’t tolerate the therapy you gave me, I would never look at you and say,
Dr. Prologo: Well, I guess you just don’t really want to be rid of your cancer, right, I would find another therapy for you, or I would make it tolerable for you. So the current therapy that we have now diet and exercise doesn’t work for 9.95 out of 10 people. So we need to change that and make it easier for people.
Steve Washuta: Is it a little bit though this was my push back question here. That it’s it’s people’s decisions in their lifestyle to not go ahead and make those changes on their own? Or do you think the impetus really is on medical professionals and personal trainers and registered dieticians to say, Hey, listen, guys, we don’t need to be perfectionists, we don’t need to have all of these strict rules and regulations on what foods you can and can’t eat?
This has to be a long journey. And we have to think about this as like finances like compounding, right? You look at your 401 K every day, you’re not going to be doing great, but if you look at your 401 K, you know, every three or four years, by the time you’re looking at it 10 years from now, you’re gonna be very happy, it’s this, this is what we need to do as professionals.
Dr. Prologo: So in my opinion, that’s very close. And that is exactly what the book is about. It, you know, looking at your 401k now is a little bit of a different comparison, because there’s no discomfort for you there. Right, You’re it’s not you don’t have to endure any discomfort to get to that point 10 years down the road. And, and so what, what the education that people need, and this is what my book is about, the education that people need is that there is probably the most important thing I’m going to say today.
Dr. Prologo: And I know that you know this, there is a point at which this journey becomes fun. There is a point where somebody who’s experiencing misery with this diet and exercise and this non-sustainable non-endurable program, there is a point beyond which you won’t feel like that anymore. And that’s the point you need to get to the book called The catching point, we’ve defined the catching point with exercise capacity and all sorts of different ways. But the point of the chronic diet killer is there is a point beyond which this will not be miserable.
Dr. Prologo: But here’s the thing, here’s the catch that time between now and when you get to that point, you’re not going to lose weight. And so the comparison that I like to make is, if you Steve want to do surgery, cardiac surgeon, right? I’m sure that you could. But if you approach it like we approach weight loss, that means you’re going to start Monday, because that’s what we do. We hang up the program we say, I’m gonna start off start following this program on Monday.
Dr. Prologo: So if I give you the steps to cardiac surgery and you hang it up on your refrigerator and you start Monday, you’re gonna fail miserably right? But that doesn’t mean you can’t do it. It just means that you need some training ahead of time.
Dr. Prologo: And during that training during your medical school, you’re not going to be doing surgery. So you’ve got to be willing to put in that time ahead of the critical points during which you will seemingly be making no measurable progress. And after that, you can do surgery.
Dr. Prologo: So if I can convince all the people who have failed diets in the past, the critical point beyond which everything will change for you, you will no longer have to endure this, you will turn into one of these people who wakes up in the morning and can’t live without it, you will be able to join the always lean group and you will be able to feel like they feel but you have to pass through this point first. And to pass through this point is going to require six to eight months of not losing weight. Right. And that doesn’t sell the so that’s why that is hard. A hard message to get to people.
Steve Washuta: Yeah, people want short-term fixes. It doesn’t matter whether it’s my industry, or your industry, like I said, my wife, is a pediatrician. Every day people come to her and say, hey, my kid has ADHD and give them medication. Well, she said to slow down, we have counseling, getting a psychiatrist, we have other options that people want.
People want the quickest fix that they can get. But again, it is the medical professionals in her case. And in my case fitness and health and nutrition professionals make sure that our clients slow down and understand that the quick fix doesn’t work. We have all of your stats that you’ve presented in the book, and that you just said, it doesn’t work. Everyone’s failing, because they want the quick fix.
And part of that is I think, some of the terminology you use or you don’t use, it’s interesting because it in this whole conversation, I don’t think you use the word failure. And the part of the reason why it’s in your book, you talk about how you shouldn’t consider it a failure along your journey. You’re just you’re not stopping. You’re continuing that journey the whole time. There are ebbs and flows, but there’s never a failure. Can you elaborate on that?
Dr. Prologo: Yeah. So what you’re talking about is what we call in the book, The no restart principle. And the no restart principle is, is it we try to bring this attempt to do something into real life? So you’ll treat it like you’ve treated other things. If you embark on a journey to say get a college degree, or you embark on a journey to get promoted to a new management position, right, you will start doing these things, but you’re gonna have a bad day.
Dr. Prologo: And you’re gonna have a day where you don’t feel like studying or you don’t feel like working. And so you’ll be off. And when that happens in real, what I call real life, I guess is you don’t give up on that day and start over. Right. So if we’re stuck with the college example, if you have a hard day and you’re tired, and you don’t feel like studying, and you have a hard course and you take a couple of days, you know, you go on spring break where you don’t come back, quit college, and then start over, you know, two weeks on Monday, you hold on to the progress that you all met already made.
Dr. Prologo: But historically, when it comes to weight loss, it’s almost we treat it like a video game or something that we think has to go perfectly from day one. Nothing that anybody ever accomplishes goes like that. It always is this sort of up-and-down long-term pursuit to get anything to accomplish anything in our lives. But when it comes to weight loss, we get to say Thursday, and we go to the opposite party and have a cheeseburger.
Dr. Prologo: We should come back Friday and pick up where we left off. But no one does that everyone wakes up Friday and says, Well, I’m off my diet, and they just the whole thing and start over, you know, two months down the road. So the no rolling no restart principle tries to turn this thing into a long-term, a long-term endeavor, just like anything else worthwhile.
Steve Washuta: Yeah. And I think it’s sort of a self-punishment that people do, right? They fall off the wagon for lack of a better term. And they go, You know what, I need to punish myself now. So even if they stay back on that diet, that you said, the cheeseburger on Thursday at the work party, and then Friday, they feel like, okay, I have to restrict myself even more, which isn’t good, right? That’s not a good habit.
You don’t want to punish yourself and have to go through further restrictions. You just have to let it go. It’s its life, right? There are going to be ebbs and flows. It’s you have to have amnesia of sorts and say, whatever happened, it’s a new day.
Dr. Prologo: Right. And if you can tolerate one more sort of analogy, I, if you were a coin collector, or you decided you wanted to collect this, this collection of coins of rare coins, whatever it might be. And so you started on Monday, and you got a coin from this shop, and then you went on vacation one time and you got a few coins there and you really were building up towards this collection that you wanted.
Dr. Prologo: And then you had stress at work, and you couldn’t think about your coins at all for like a week. You wouldn’t you wouldn’t then at the end of that week, come home and throw all your coins out and start over. Nobody would do that with any other things. So why it is that we’re still engrained that if it doesn’t go perfectly, which, again, nothing does, then we have to throw it out and start over? So one of the principles in the book to help you get to the caching point and make this easier for you is that we’re not going to restart.
Dr. Prologo: And so it’s better than to get if you we had a 90 day workout plan, for example, it’s better to and they gave you say, 45 things to do in that 90 days 45 workouts, it’s better to get 20 of those done, over 90 days, which is isn’t even half, then to do five quit and start over five, quit and start over five quit and start over. Because when you start to get to number 6789 10, you start to internalize some of these changes, and now it’s kinetic, and it starts to get easier.
Dr. Prologo: But no one ever gets to that point where it starts to get easier. So they’re, they’re unaware that that even happens, many of my patients are unaware that this can even be easy. So, therefore, what we’re asking them to do in their minds is to feel like this starving, depressed, sore, fatigued, anxious, and feel like this forever. That’s what they think we’re asking them to do.
Dr. Prologo: So that’s why I wrote this book to tell you, that’s not what I want you to do, I just need you to get to this one point where it becomes fun and easier. And after that, and I’m sure you’ve seen this, after that you don’t even need me anymore, you’re on your own. After that, you’re taking selfies. And you don’t even need help after that point.
Steve Washuta: What is so addictive and attractive about the new trends and the new diet? So that’s really what gets people. So you’ll see these people jump from diet to diet to diet, say, Oh, this one’s different. I read about it, my friend Nancy lost 30 pounds on the Steven Washuta diet, you have to try this diet.
We know that people succeed on all diets, and people fail on all diets because it’s not really come down to the food choices necessarily, as opposed to the I guess you would say the habits that you’re building long term around those diets. But why are people so attracted to these fats?
Dr. Prologo: Yeah, so two things I would say about that the stats that you’re talking about are no different than get-rich schemes. And I think that most people realize that when you see an email that says, Make $2 million, by next Tuesday, or in 90 days make $2 million. Most people realize that this is a scam, and they will buy into it, right? But if I tell you, you’re going to lose 90 pounds in 90 days, you just snap that right up.
Dr. Prologo: So I don’t know, I don’t know why it is I guess it’s just so attractive. That it overcomes our logic. Because I do believe that deep down, people realize that that plan is undoable, and B if you’re the one in 1000, who does it you’re not probably going to be able to sustain it anyway. And then the second thing I would say is what you’re describing in the medical literature is adherence. So there are these famous studies out there in a journal American Medical Association, where they compared Atkins, the Zone Diet, Ornish Diet, and a few others.
Dr. Prologo: And the only thing they found that correlated with success was adherence, which seems like it seems like common sense, right? If you stick to it, you’ll succeed. It doesn’t matter what diet it is. And so again, that’s what the book is about. The variable that needs to change is your ability to stick with the diet, not the diet itself. And we lose when we try to say that, because the so-called fad diets or get-rich schemes, they’re not necessarily trying to help you.
Dr. Prologo: They’re trying to sell you something. Yeah. So when I’m watching the news, and I see a commercial for, you know, X, Y, or Z, it is clear to me that X, Y or Z is they’re trying to sell me something not necessary. As long as I buy it, they’re happy mission accomplished. They’re not necessarily trying to help me and get me where I need to go.
Steve Washuta: Yeah, and I think the maybe I don’t know, if you want to say like the reverse of the aha moment for some people is that they might have tried a diet, let’s go ahead and say keto, and it worked for them for a short period of time, and then they failed. And then they go, Well, it did work, I just need to go back on it. But what they’re not understanding is the adherence to that is too restrictive.
And they’re, they’re never gonna have that aha moment in this particular case, right? That is not going to come up. And you have to force them out of that so that they can have the real aha moment, which is, this is a long-term game where we’re not married to a particular food, options, and choices, but we just have to make good healthy habits overall.
Dr. Prologo: Right? And when, when that becomes fun, so for me when I’m unfortunately or fortunately, I’ve lived on both sides of that catching point and so on. On the wrong side, you’re looking for something that you can do, but when you’re on the other side of the catching point, the right side of the catching point, you do it because you want to do it. This is something that you wake up thinking about and you don’t have to follow a given program.
Dr. Prologo: And because you, you know, every time you make a choice, you, you want to make a good choice. So I use this quote over and over again, from Harvard Professor Lee Kaplan, a famous quote, where he said that exercise changes our food preferences toward healthy choices. So basically, what he’s trying to tell us is, after a certain exercise capacity, you’ll make the right choice on your own because you want to now take the struggle out of it.
Steve Washuta: So this isn’t necessarily in your book. And this is sort of a global problem and macro problem here and feel free to respond any way you want. But what are your thoughts on how we should be teaching nutrition from let’s say, the ground up? Should we have nutrition classes in, in young youth school?
Is it that is there an issue with people let’s say personal trainers who don’t have the education, giving out nutrition advice? Should there be more gatekeepers in giving nutrition advice? How do we It’s a wild wild west out there, what do we do to wrangle the sound?
Dr. Prologo: So what I would say is that the education, it falls on the patient, right? And what I mean by that is it so let me try this. I would imagine that before you started this podcast, you weren’t educated on how to do podcasts, right? I don’t think you were born with the knowledge of how to how accomplish and edit and disseminate a podcast, right? But it was something that you wanted to do, it was a goal that you set for yourself.
Dr. Prologo: So you found the way you educated yourself, you grew as you went along. Now you’re full of this knowledge and experience and evolution in how to do a podcast, because you crossed a point in your life where you decided that you wanted to do this, right? That’s what I want to focus on for caregivers is if we can get these patients to the point where they want to do it, then they will be on their own. I’ve seen it over and over again, they will come to you in the beginning, and ask you specific questions about nutrition and so on.
Dr. Prologo: But what will happen after they’re through that point is they’re off on their own, I mean, I can’t even reach them anymore, unless I follow them on Instagram and see these selfies that they take so so I would, I would take that education piece. And I would leave it out there. Because if I can convert people into those who wake up and want to be educated are interested in this, then they’ll do it on their own.
Steve Washuta: Let’s go into a little bit of the science here in chapter 12 of the book you talk a little bit about and I know you’re not a bariatric surgeon, but you talk a little bit about the different interventions, surgical and procedural that one could go under to help through obesity.
Can you talk a little bit about those? When is the right time for a patient to do that? And then maybe from our standpoint, from a personal trainer standpoint, how we help our clients handle that coming out of those types of surgeries? Great, great
Dr. Prologo: question. And, and I want to answer that, but I want to say first, that the value for me, in the bariatric surgeries has been proof of concept, right? So for me, it’s the overwhelming message that I want people to receive is that the obstacles and difficulties and things that block you from being successful are inside your body, not your mind.
Dr. Prologo: And so the bariatric surgeries, serve to support that, for me, they serve as a huge body of work that proves exactly that because nobody went in and did an A willpower implantation surgery, they didn’t do that they made changes to the body, they took out that part of the stomach that spills the hunger hormone. And when they make changes to the body, then in a retrograde fashion, people’s minds started to change, and their weight was lost.
Dr. Prologo: And then they did better. And they crossed through that point. So that’s the real value for the interventions. But to answer your question, the folks who have BMI greater than 40 can almost certainly benefit from you know, minor exceptions from bariatric interventions. And I encourage most people whose BMI to come to see me is greater than 40 I at least educate them and let them know, look, this is out there. This is real, this is a change we can make to our bodies that will result in weight loss and a retrograde change in our minds. So that’s how I select them after 40 Now or above 40.
Dr. Prologo: Now on the way out, that’s probably the most critical point that we can make about personal trainers and how to manage these folks because they, I know I’m going to now I’m going to talk out of both sides of my mouth there. They do need to be educated. Because now all of a sudden they’re not as hungry as and they don’t want to eat as much they have this extra tool at their disposal. And so that is where I know I just said they will do it on their own. But that is where the guidance comes in, comes in helpful. And I can provide an example of this.
Dr. Prologo: We did a procedure once on a patient who was trying to lose weight, we took away that hunger signal, we talked to them months down the road, they said, it’s unbelievable. I’m not hungry anymore. Some days I forget to eat. Then we started to ask, well, well, when you do eat, what do you eat? This person was having like cheeseburgers for breakfast, even though they weren’t hungry. So I was like, Why are you eating that? You know, and it didn’t even occur to this person that that was a bad choice. Yeah. So. So I guess I know, I just I just said that people will figure it out on their own. But you’ve pointed out a very useful place where where guidance and education can help. Is there
Steve Washuta: anything that patients do on the front end, and I’ll sort of put this into our perspective. So when we have clients who are going in for, let’s say, like, a hip replacement, bilateral hip replacement, or a knee replacement, they need to strengthen their quads prior to going in so that the surgery sort of takes better.
But I also think that the physicians tell them that they need to do this, because they know that if they start getting them working on it, they’ll be more sort of in tune and likely to continue to work on it post-op, which means that it’s going to take better, is there something that’s similar to that in your line of work?
Dr. Prologo: Yeah, so the the term we use for that is just run in. There’s always a run into bariatric surgery, which is two to three months of whatever calorie restriction plan, you intend to be on post surgery. We do, we do do that. I’m not sure that I love it. I mean, putting people through this, this very difficult phase of calorie restriction, only to kind of pull something away and make it easier for them.
Dr. Prologo: I’m just, I’m just not sure we do it. Part of it is a reimbursement mechanism that’s in place. And I’m not sure if it’s the same in orthopedics. But you have to kind of sort of jump through these hoops to have the procedure itself covered. So we have it, but I don’t love it.
Steve Washuta: Okay, good to know. And I don’t know from the scientific side, if it’s great, but I do think maybe from a mental side, maybe not the caloric restriction that you’re talking about, because I don’t know exactly what it is, but just putting something in front of someone to say, Hey, you’re gonna, you’re you’re starting this process. I’m in the middle of this process.
And then you’re finishing this process, so that they feel that they’re on the hook in the front and the back end, and you’re just doing a small portion in the middle, if that makes sense. i does i like it the way you put it that way. Yeah. So talk a little bit about the slow moving cliffs that you write about in the book and how people can understand that
Dr. Prologo: better. Oh, yes, thank you for asking about that. This is another principle. The no restart. Basically, the catching point is, that the book itself is about getting people to that critical point. They can have a fun time and an easy time with dieting and not a miserable time. Right. And so then people the inevitable next question is, well, how do I do that? How do I get to this catching point. And so we outlined these principles.
Dr. Prologo: The first one was the no restart principle, which we talked about earlier. Another one of those principles is called the slowly moving clip, which is essentially the other side of things. What it means is that people can overdo this, right. This is an equal contributor to failure in the absence of the catching point mentality. What slowly moving clip is. If you’re deconditioned, and you’re 250, say, and you embark on this exercise, and, and diet restriction calorie restriction plan, your body is not ready to contribute to weight loss through exercise. It’s just not. And you may disagree, boy, and if you do, we can talk about it, but it’s just not right.
Dr. Prologo: Because if your job was to empty a pool, and all I gave you as a Dixie Cup, which is essentially what your exercise capacity is, at the beginning of this example, you’re not gonna be able to empty that pool with a Dixie cup, you’re going to start and try and then you’re going to give up right and so the slowly moving cliff is a measure of what your body is telling you and how much exercise you can do. Because ultimately, what the catching point is, is an exercise capacity.
Dr. Prologo: Well we defined it as 220 minutes so what that means is, when you’re able to do that much exercise, then things including food choices and exercise will be easier for you, but it is super easy to overdo it and either get hurt or accentuate all these overtraining signals that make you feel even more fatigued, more sore, more tired, like you can’t go on. And so we want to teach you in the caching point to listen to your body.
Dr. Prologo: You because each and every person is an individual, and I know you know this each and every person is an individual, and one person can embark on X number of exercises in a given week, recover from that their body changes, and now they’re in a better place. And then there’s another person who needs a different amount of recovery. And the only way you can tell that is if you’re listening to your body signals.
Dr. Prologo: And so what the slowly moving clip is meant to illustrate is that if you go too fast, too soon, you’re going to run right off the cliff. But if you pace yourself and listen to your body, and don’t follow a static schedule, but instead, follow the signals that your body is going to give you along the way, you are much more likely to stick to the program much more likely to adhere and be on this thing for much longer than you otherwise would be.
Steve Washuta: Yeah, I mean, you don’t want to throw all of these variables in when you’re starting this journey, because you can’t pinpoint which one is working. And then in your, in your case, in your example, which one is not working, what is wearing at me, right. So if I, if I decide to go from zero to 60, I’ve never, I haven’t run in five years, and I’m going to start running five miles a day.
But in addition to that, I’m going to do push ups and sit ups and back squats, and then I’m going to cut my calories, 2000 calories, and I’m not going to eat any carbohydrates, and then you’re not sleeping well. And everything else sports is control. Obviously, you’re going to fail in that. But you also can’t pinpoint what exactly was working and what’s not. But I do think that people have the tendency to want to do that.
And I think that’s the hardest part for personal trainers, registered dieticians anybody who’s working with someone is that there’s this, I don’t know, the natural inclination, this sort of intuitive nature where people say I have to sacrifice on the front end, I needed to make a large front end sacrifice in order to be successful. But we have to find a way to coach people out of that. And that’s essentially what a lot of your book does.
Dr. Prologo: And I appreciate you saying that, and it’s a relatively complicated issue, right. It’s something that higher level athletes understand and pay very close attention to how their body’s responding, and whether or not they’re getting worn down, or if they’re responding appropriately to their exercise, which brings up another point, and maybe we’re going to ask about this down the road.
Dr. Prologo: But another one of these principles that people have to understand is recovery, right? If you and the analogy I use in the book for this is if you buy a flower at the store, that’s not you know, there’s still under the dirts in the pot, and you water that flower, if you wanted that flower, again, it’s five o’clock. And again, it’s seven o’clock, and again at 11 o’clock, and you just overdo it, it’s never gonna bloom, right.
Dr. Prologo: And so many people who have very limited exercise capacity, we’ll start off with what exactly you just said, I’m gonna run on Monday, I’m gonna do Pilates on Tuesday, I’m gonna do this you are by note, you are drowning, because your body is not ready for that. But if you would, instead, give a little water to that flower and then leave it sit for a while that sitting period is the recovery period that most people are in are unaware of.
Dr. Prologo: That’s the time when you’re sitting in the sun, that the flower is changing, that your body is changing into the kind of person that you want to be, you want to be on the other side of that catching point where all of this is easy, but that’s a different body. And in order to get to that different body, you have to induce the change with exercise, and then stand by while your body adjusts, and turns you into that other person.
Steve Washuta: Yeah, that 24 year old elite athlete who’s super lean, who can do all of the things that you just named, who can run five miles and then do pilates and then do you know, chest presses all day long. You’re not him or her yet. And their exercise and diet prescription doesn’t work for you. Because you’re not there yet you haven’t crossed the caveman. That’s why you have to wait.
And I think a really big part of this, too, that we haven’t mentioned yet, I just did briefly. But age is such a huge component to this. Because, again, a 24 year old and a 65 year old. We’re not dealing with the same exercise prescription or nutrition prescription. Because you’re gonna be in different stages of your life doing different things. Injury Prevention is something that’s big with me. I’ve, you know, I’ve worked with some of the same clients for eight to 10 to 12 years.
So I’ve watched people go, let’s say, from 50 to 62. And in that time, doesn’t matter how much they’re taking care of their bodies. You know, there’s just it’s Mother Nature is taking over here and you see how people progress or don’t. And I always tell personal trainers, you have to train people for old age. Meaning if you’re working with someone who’s in their 20s and 30s.
As long as they’re not training for something specifically, right. If they’re training to go to the Olympics or something that’s a different story. But if they’re training for overall health and wellness. You have to think about them in their 40s and 50s and 60s, that’s why I relate this to finance a lot.
Give a financial advisor, he’s going to be less risky on the front end with your money, right. Or she has been more risky on the front end with your mone. But as you grow older, you’re going to move that from stocks to bonds because because we have to worry about that and that’s the same thing in fitness. You have to take the load off. Take the weights off And then focus more on mobility and moving and more recovery more rest as we move into older age.
Dr. Prologo: Right? Oh, it’s just such a pleasure to talk with you that. And I agree with all of that. And probably the most striking example that I’ve seen. You remember Ronnie Coleman, who was a big bodybuilder I read?
Steve Washuta: Sorry, he’s a disaster now.
Dr. Prologo: Yes, yes, I recently saw a documentary. And that’s exactly my point. I mean, just blew me away. I mean, it was, you know, at the time, I was just enthralled with Ronnie Coleman and his ability to move heavy weight. And, and he’s probably the best illustration of the point you just made, I mean, the guy’s nightmare. And now he’s done walking sticks, and you know, all kinds of things.
Dr. Prologo: So right, keep the keep the long term in mind. But I would piggyback on that just to stress the point. That when we say exercise prescription, it’s every person is such an individual. And then on top of that, we have individual stressors. So I have some ability to recover, which is maybe different than yours, probably different than yours. And then, on top of that, I have individual stressors in my life. I had to deal with somebody trying to get in college, one of my kids, and my job is stressful, now for some reason.
Dr. Prologo: And so all these things create a real individuality, that has to be fluid, you have to, you have to react to external circumstances plus the individual’s ability to recover. So that means listening to feedback. Understanding that, hey, next week, I have to work nights, so I can’t stay on this. So that’s another one of the principles not that I’m trying to get to every one. But another one of the principles in a book. Is to ditch the static schedule, these static schedules are such contributors to quitting.
Dr. Prologo: And to what I mean for your listeners is that a static schedule is the schedule that you get on your calendar that says, Do this on Monday, this on Wednesday, this on Friday, then next Tuesday, next Thursday, you try to follow this. And then like we said earlier. When you can’t follow it, because you have to work nights next week, you just quit and go back to the beginning, but can’t do that with our book, because there’s no restart.
Dr. Prologo: But in this particular case, just ditch that static schedule completely. And implement these workouts when you can according to your own ability to recover. According to your own life, and whatever stressors and responsibilities you have in your life. And that’s why in the past, successful diets, life exercise programs are impossible to publish on a piece of paper. Yeah, because they don’t move. And they have to move in order for the person to be successful. Yeah,
Steve Washuta: Just again, to piggyback off of your piggyback here. The there’s a cost to everything you do in fitness, there’s a positive cost, if I go run six miles, there’s a metabolic cost. So I burned a certain number of calories. But then there’s also a negative structural cost. What did I do as far as the pounding of my joints and ligaments and knees and hips and ankles? And I think people have to understand that we have to look at both of those costs. Factor in recovery at all times.
Then from a static schedule perspective, as a personal trainer. I wrote about this in my book fitness business one on one. Is that you need an update phase with your client before you start any exercise routine. Meaning if Dr. Proloquo comes to me, and he goes, see Hi, Steve, I’m ready for the workout today. The first thing I say is, how are you feeling? What did you do yesterday, what did you do this week, what did you eat today? And then I based that workout? Purely off of that. because if David comes in and says, Hey, I you know, outside before, as I was walking in here, I kind of rolled my ankle on the curb a little bit.
And if I didn’t ask him that, and I didn’t know that. Or if you said you know what, my wife is running a 10k. And I wanted to train with her. So last night, I ran, you know, six miles with her. And I didn’t know that and I had a whole leg day ready for him to be able to think on the fly and now we have to do something different and that’s the same thing for your audience, good to walk into the gym, but I say is do a dynamic warmup. So dynamic warmup just means moving all directions, right.
Ball and socket, shoulder hips, move your hips in a circular fashion, touch your toes, do some walking movements, maybe go on the treadmill walk for five or six minutes get warmed up and then see how you feel. Because some days you’re not ready for a tough workout. Some days you just need something light and then some days you’re gonna want your revved up you’re ready to go and you say you know what, this is my day I’m going to do the exercises I don’t like or that are more difficult for me but you have to sort of feel that out.
Dr. Prologo: You have to go with that you have to listen to your body right now. You might it might be a Monday and you feel great. Like you just said do the do the squats or whatever it is that are hard for you on that day. Might wake up on Tuesday and still feel great. But it but that’s your that’s a scheduled update. You know if you stick to that schedule, if that static schedule.
Dr. Prologo: Now I would really like to take this moment though, to point out that what you and I are talking about and for most of your audience, this is people understand what we’re saying. Right and this is great. education for people who are high level trainers like you are. But it’s complicated. So if you just take the last five minutes of our discussion, and then ask yourself What chance does the deconditioned 280 pound person off the street have of entering this?
Dr. Prologo: Well, we all this nuances that we were just talking about entering this on Monday on their own and being successful, their chances are near zero. And that’s exactly what we see, almost nobody succeeds. And so, hopefully, we can simplify that for them. Get them get them to make a shorter journey and get them in chunks to a different spot.
Steve Washuta: Part of that, from my perspective, why they fail. Is because they believe. Even if we let’s take the static schedule out of it, there’s also a static exercise choice. And what I mean by that is, let’s say they don’t have a static schedule. They still think they need to go into the gym and lift weights. Or they need to follow this particular regimen where I mentioned I squat and deadlift and do these things. You don’t have to do that at all exercise is good exercise.
If you like to play badminton, go play badminton. If you’d like to play ultimate frisbee outside, go play ultimate frisbee, it doesn’t always have to be lifting weights. And I think that’s that’s really where it comes into it. Because people have a bad relationship. Sometimes with the weight room, maybe they’re nervous to go in there. They don’t know what they’re doing. Like we just talked about, if you’re brand new to fitness, or you know, the injury prevention, I think sometimes starting your exercise journey.
If you can just do anything that gets your body moving. You don’t necessarily have to pick up weights all the time. And I think people think they’re relegated to only lifting weights, because maybe it’s a vanity thing. It’s just sort of a cultural thing.
Dr. Prologo: Right, right. Right. Right. Amen. Amen. And so this, sort of is a segue into something else I know, we’re going to talk about. Which is the comparison between this approach that I’m talking about. And a right, you’re kind of describing that right now. Which is, you know, we if we think about Alcoholics Anonymous. How it works, it’s, it’s this it’s this huge worldwide institution. With no real leadership and no real structure. All of it’s the most successful thing we have for recovering from an alcohol addiction.
Dr. Prologo: But it’s it’s kind of an enigma like, how does it work? Right? How does something like that? Get results? And it does it in the way that you’re saying? Well, you just said, All exercise is good, right? Essentially, what what people will tell you in AAA, at the end of every meeting is just keep coming back. Right. The people who show up there the first day. Or the just like the people who show up the first day on their own trying to lose weight. Were ahead of them, they have this seemingly insurmountable journey, and they want to know, what is that fix? What is the answer? Tell me now tell me today, what do I need? What is this, what a will tell you is just keep coming back.
Dr. Prologo: As long as you keep showing up here, the details are almost irrelevant. And so what the details become, in my opinion. Are just products for sale. That’s all the details becomes any any person who packages a diet up and puts it on TV for sale, it’s just a product for sale, it’s not really intended to teach you how to get to the, to the end of this and be successful. Because actually, if you did get to the end. You weren’t successful, you would no longer be showing up the byproducts. Right?
Steve Washuta: Yeah. You know, it’s really interesting, because when I read that, initially. In your book, I thought, I had, you know, a really high. Sort of recidivism rate and sort of failure rate. But it’s just, it’s just perspective, it’s how you look at it. From their perspective. No, no, we don’t people keep coming back. Eventually they get it and that that is our marker of success. oNt people who slip up once and like you said, that’s the same thing you can think of in fitness.
Yeah, maybe you go to the gym, maybe you have a bad day. Or maybe you had that cheeseburger on Thursday. But ultimately, this is this is a long journey here. We’re not measuring it in a day to day basis we’re not measuring on on just your quote unquote failures even though we don’t want to use that term. We’re measuring it on if you stay the course and that’s that’s the ethical
Dr. Prologo: thing of course adherence is the ultimate goal and adherence is terrible on on its own people don’t adhere and so why they don’t adhere and how to improve adherence has been all of my professional work that’s been my focus forever and it started with my own mom who who I knew was a was a very strong person had a an iron will of steel raised three boys went to night school all this stuff.
Dr. Prologo: I knew she was a strong person because I lived there and I thought, but she would fail diet after diet and and I would be right there to talk to her because at that time, I was a member of the always lean population. So I just couldn’t understand like, why can’t you just go run around the block. Or restrict your calories, but to hear it from her, made it clear to me. That there’s something blocking her. It doesn’t have to do with with how bad she wants it. Or how much willpower she has, there’s something going on in her body.
Dr. Prologo: And so and so adherence is the key and how to change adherence. You don’t change adherence by fat shaming someone you change adherence by educating them about what’s blocking them. Teaching them how to address that teaching them about recovery, teaching them about the no restart principle, teaching them about overtraining, teaching them about fluidity and all the things that we talked about.
Dr. Prologo: And once people learn all of that, then they become independent people who enjoy it, they kind of what I call the crossover, right? Right now they live in a certain population where all of this is miserable, terrible undoable. But if we can get them to add here by explaining to them what’s actually going on, and how to get around it. And once they get past that catching point, now they’ve joined the new population, they don’t feel miserable anymore. And you have people who spend the rest of their life feeling good and weighing less.
Steve Washuta: Tell my audience where they can find everything about your book. As well as you and any other services that you provide.
Dr. Prologo: Thank you for that. I have a website. It’s Dr. PROLOGO. So Dr. P R. O elogio.com. And that’s a pillow.com has the book and some description of these principles and links to all of the other things that we’re doing to try and help human beings.
Steve Washuta: My guest today has been Dr. David PROLOGO. Thanks for joining me.
Dr. Prologo: Thank you so much for having me.
Steve Washuta: Thanks for joining us on the Trulyfit podcast. Please subscribe, rate, and review on your listening platform. Feel free to email us as we’d love to hear from you.
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