The Obesity Doctor Podcast

In this episode, I’m joined by Dr. Ariel Dalfen, a psychiatrist and women’s mental health specialist, to explore the intersection of reproductive hormones, mental health, body image, eating disorders, and metabolic health.

We talk about why reproductive transitions—from the menstrual cycle to pregnancy, postpartum, perimenopause and menopause—can be particularly vulnerable times for mental health, and how clinicians can distinguish expected changes from symptoms that warrant treatment.

We also discuss:
- PMDD: what it is, how it differs from PMS, and why tracking symptoms across the menstrual cycle can be so helpful

- Mental health during perimenopause and menopause, including anxiety, depression, sleep disruption and emotional dysregulation

- How a history of PMDD, postpartum mental health concerns, or other psychiatric illness may influence risk during the menopause transition

- When menopause hormone therapy, psychiatric medication, or a combination may be appropriate

- How we should consider weight gain and metabolic health when choosing psychiatric medications

-The significant impact of menopause on body image and the risk of eating disorder relapse

- The growing pressure around food, exercise, protein, and body composition—and when healthy behaviours can become obsessive

- What we know, and what we still don't know, about the relationship between GLP-1 medications and mental health

- Why individualized, multidisciplinary care matters so much in women's mental health

Most importantly, we talk about the importance of listening to women, taking their symptoms seriously, and looking at the whole person rather than reducing complex experiences to either "just hormones" or a psychiatric diagnosis.

Dr. Dalfen is the CEO and co-founder of BRIA, a virtual women's mental health and hormone clinic. She is also an Assistant Professor of Psychiatry at the University of Toronto and previously led the perinatal mental health program at Mount Sinai Hospital in Toronto.

Learn more about BRIA at betterbria.com and BRIA Academy at briaacademy.com.

Follow BRIA on instagram: @bria.health

Why does staying on track with weight loss often feel so much easier during the week, only to become more challenging once Friday afternoon rolls around?

In this episode, Tedi Glik, RD will break down what the “weekend effect” is, and how the way we approach food from Friday through Sunday can influence overall weight-loss progress. With more social events, meals out, brunches, alcohol, and time with family and friends, the weekend naturally looks different—but that doesn’t mean it needs to become a completely different eating pattern.

We will talk about planning for indulgences rather than thinking in terms of “cheat meals.” The goal isn’t to eliminate the foods you enjoy, but to be more intentional about which foods and experiences are actually worth it to you. Whether that’s a favorite dessert, a croissant, or a glass of wine with friends, there’s a way to incorporate enjoyable foods while still building meals that are satisfying and supportive of your goals.

We will also explore some of the thoughts that can drive weekend eating, including “I’ve been good all week, so I deserve to enjoy myself,” “I don’t want to think about food on the weekend,” and “I’ll just start again on Monday.” Sometimes the biggest shift isn’t changing what we eat, but changing the way we think about the weekend. Planning doesn’t have to mean restriction—it can actually create more freedom by reducing the number of food decisions you have to make.

Ultimately, you don’t need to choose between losing weight and enjoying your life. The goal is to learn how to do both, and make your weekend part of the plan!

MEDICAL PROGRAM FOR OBESITY

O​​ntario-Wide Virtual Obesity Management Clinic
https://www.highmetabolicclinic.com

Join my Health & Consistency Coaching Program for women, Best Weight https://www.sashahighmd.com/bestweight

Recover Strong for Binge Eating
https://www.sashahighmd.com/bed

Taking the first step toward weight loss can feel overwhelming — but you don’t have to do it alone. I’ve created a curated list of my podcast episodes to gently guide you as you begin your journey. https://www.sashahighmd.com/podcast-guide

FOLLOW SASHA
Instagram
https://www.instagram.com/sashahighmd/

What happens after you’ve lost the weight you wanted to lose?

In this episode, I’m looking at what we actually know about maintaining weight loss with GLP-1–based medications. The evidence so far suggests that for most people, continuing treatment at the dose that produced their weight loss provides the best chance of maintaining that weight loss and its associated health benefits.

But what if staying on the same dose isn’t possible because of side effects, cost, access, or personal preference?

I break down what we’re learning from SURMOUNT-MAINTAIN and ATTAIN-MAINTAIN, including evidence that reducing tirzepatide to a lower dose or switching from injectable semaglutide or tirzepatide to oral orforglipron can preserve substantially more of the weight loss achieved than stopping treatment altogether.

We still have important questions about tapering, extending dosing intervals, and whether some people can eventually come off treatment successfully. But for now, the evidence suggests that if we need to reduce treatment intensity, maintaining some active treatment may be a much better strategy than simply stopping and waiting to see what happens.

Ultimately, maintenance is about finding the level of treatment that allows an individual to maintain the health benefits they’ve achieved—while recognizing that for many people with chronic obesity, ongoing treatment at their effective dose will be necessary.

MEDICAL PROGRAM FOR OBESITY

O​​ntario-Wide Virtual Obesity Management Clinic
https://www.highmetabolicclinic.com

Join my Health & Consistency Coaching Program for women, Best Weight https://www.sashahighmd.com/bestweight

Recover Strong for Binge Eating
https://www.sashahighmd.com/bed

Taking the first step toward weight loss can feel overwhelming — but you don’t have to do it alone. I’ve created a curated list of my podcast episodes to gently guide you as you begin your journey.
https://www.sashahighmd.com/podcast-guide

FOLLOW SASHA
Instagram - https://www.instagram.com/sashahighmd/

In this episode, I sit down with Dr. Tasneem Sajwani, Medical Director of the Edmonton Weight Management Centre, for a behind-the-scenes look at the world of obesity medicine. We discuss how she found her passion for this field, the challenges and rewards of building a successful obesity medicine clinic, and the key elements that drive long-term patient success.

We also explore the critical role of allied health professionals, lessons learned from years in practice, and practical clinical pearls that patients can apply to their own health journeys. Whether you're a healthcare professional or someone interested in understanding obesity treatment more deeply, this conversation offers valuable insights into the science, systems, and support that make effective obesity care possible.

Find Dr. Tasneem Sajwani’s practice in Edmonton, Alberta, here: https://www.ewmc.info/

Find Dr. Sasha High’s practice in Ontario here: www.highmetabolicclinic.com

Significant weight loss can be life-changing for your health—but it can also lead to changes in facial volume, skin laxity, and the way we see ourselves in the mirror.

In this episode, I’m joined by dermatologist Dr. Kucy Pon to unpack what happens to the face after significant weight loss, including weight loss associated with GLP-1 medications. We discuss why these changes are a result of weight loss itself—not a toxicity of the medication—and why age, genetics, skin quality, and the speed and amount of weight loss can all play a role.

We also explore what can be done to support skin quality and facial volume, including skincare, nutrition and resistance training, as well as aesthetic options such as hyaluronic acid fillers and biostimulators like Sculptra® and Restylane®.

As part of today’s episode, we also discuss Sculpt and Lift by Sculptra® and Restylane®, and how these treatments may be used as complementary approaches to address different aspects of facial volume loss and skin quality.

Most importantly, we talk about the importance of individualized assessment, realistic expectations, choosing an experienced, medically trained injector, and remembering that aesthetic treatment is entirely optional.

My biggest takeaway: improving your health and wanting to feel good about how you look are not competing priorities. We pursue obesity treatment for health and longevity, but it’s completely okay to want your outward appearance to reflect how vibrant and healthy you feel inside.

Please speak with your trusted injector to discuss Sculptra and Restylane’s safety profiles.

Learn more at galdermaaesthetics.com/ca or @aestheticsbygalderma.ca

Sculptra® Canadian Instructions for Use July 2022.

Restylane® LyftTM Canadian Instructions for Use February 2024

Thank you to Galderma for sponsoring this episode.