It Starts With You: Dr. Sheila Carroll

Today is my exceptional pleasure to be in the studio with Dr. Sheila Carroll, who is a certified life and weight coach, and also many years, dear friend of myself and my family, and fellow Bowdoin College graduates fellow, university of Vermont Graduate College of Medicine. Thank you for being Here. Thanks for having me, So this is so exciting. I am so happy to talk to you about this coaching work that you have been doing for now officially, I guess three years and five months is what I have on your LinkedIn profile, but who's counting really? But you made such a different choice from being a pediatrician for many, many years to saying, okay, I'm going to do this different thing now. I'm going to go get certified. I'm going to learn how to do this whole different set of skills. Talk to me about that. Sure. I was a pediatrician for about 20 years in clinical practice, most of it in hospitals. And I think as I was aging through that, we talk a lot about physician burnout, but I think I really experienced a lot of that extreme fatigue being a hospitalist. I was working half day shifts, half night shifts. So for about 10 years I didn't really get very good sleep at all. And so I happened to bump into life coaching through another physician at the hospital that I worked at. She had joined a life coaching for weight loss program, and I wanting that for myself. I wasn't sleeping, I wasn't exercising very much. I just was overwhelmed and feeling stuck. And I saw just peripherally what the changes that happened to her, not just her physical changes. Yes, she lost weight, but her whole affect changed, her mood, her approach, her whole approach to life changed. And so I was very interested in that and found out about it and took the leap myself for that and went through a life coaching program and found it so transformative in my own life that I became a coach after that program and thought, this is exactly what so many of my patients, not the pediatric, not the kids, but this is what I think could help so many of the parents or so many of us, just all of us, because the coaching aspect of the program was allowed. You gave you a framework with which to think about all the things that are going on in your life and understand them in a very thoughtful way that our thoughts create our feelings and our feelings drive our actions and our actions give us the results that we're having. And the results that you're having are actually just the experiences that you're experiencing in your life. So you can use that framework to understand your experiences and more importantly, change your experiences if you want to. And so that's what was so transformative for me, and I found it so empowering and so freeing. And then I realized like, oh, I want to help other people experience this, and I can't do that in medicine. I tried in my little 15 minute visits with some parents who were open to that idea, but it just wasn't set up for, the medicine today is not set up for that for us doctors to be providing that kind of help or service to a patient. Did you reach the place? Because you have a child and a house and a whole life that you probably have to fund. When did you reach the place that you're like, okay, I'm going to put this being a doctor as a profession, not as an identity. I'm going to put this behind me and I'm going to move forward with this new identity and this new profession. What was the place where you said, okay, I'm taking a leap, but I feel good about this? I had worked for 20 years, so I had saved some money, so I had a little bit of a cushion personally, but I also said, what do I really want to spend the rest of my life doing what I was currently doing in the pediatric office? And that was a really easy answer for me. No, I didn't because honestly, it didn't honestly feel like I was helping my patients giving out prescriptions for stuff and just, I didn't fulfilling for me anymore. And so I asked myself, do I want to spend the rest of my life doing this or the rest of my work life? And the answer was no. And I also, like you've mentioned, I have, well, he's now 12, but I was missing things in his life and I said, what am I going to want when I retire? Oh, I'm going to want that time back. I'm going to wish I had spent less time at the office and more time with my son who's now grown and out on his own. So I decided, you know what? I can make this work. I'm highly intelligent. I can figure it out, and I can just create the life that I want and still help people in a way that I feel is meaningful for them. It was bold. I mean, it was bold. And I remember, I think I reached out to you probably not that long after you had started doing this. We had some pediatric hospitalist shifts at our hospital. I'm like, oh, I wonder if Sheila would liked to do this, and you were unequivocal. You're like, no, thank you. Anyway, thanks for asking. I have moved on to this next thing, and I was like, I love that. I love that you're thinking to yourself, no, I'm moving in this direction now. And what I did before was valuable, and I'm done with that now, or at least for now. Yes, exactly. Exactly. And it was a great experience. Obviously anything you do in the past gets you to where you are today. So I don't regret any of that, but I'm super excited to be moving forward in this new way, have my own business doing what I want. It's fun and it's helpful for people, and I love It. Tell me about this decision to focus on weight and food and nutrition and children. I mean, it seems like this isn't something that we're seeing a lot of yet. Seems like a really nice area for you to be putting your efforts Toward. Thank you. Yes. Well, I come at it from, with a personal history. As a former overweight child, I've kind of struggled with my weight my whole life, honestly, since I was nine or 10 years old and struggled, really emotionally struggled, not so much. I didn't have any physical problems from my weight, but it was more of an emotional toll over all the years, and I couldn't get a handle on it for a long time. And then honestly, even going to medical school and residency, I never learned how to manage my own weight because I didn't have the skills and tools to manage my thinking or my mind around the actions I was taking. So when I learned those tools through life coaching, I realized like, oh, this can help everybody because as doctors, we tell people, okay, do this, eat this, don't do that. Go get some exercise, get to sleep, and that's great advice. And then the person leaves the office and they're like, yeah, but how do I, yeah, of course I already know that were telling me, but how do I actually get myself to eat what I want to eat? Choose to eat a salad or choose to eat fish or choose to eat instead of choosing the other potentially less healthy food. So you need to go back before that, before you're taking that action of eating or not going for a walk or not going to the gym or not going to bed. And really look at, bring awareness to what are the thoughts I'm having that are creating my feeling, which is driving me to eat the salad or not eat the salad. And you can re-engineer those to help you get the outcome that you want to have. And it's, it's a different way of thinking about things that we don't teach our patients how to do that. And I didn't know how to do that until I was 50 years old. And I've always wanted to, I love kids, I love babies. I always have wanted to help kids. Today in the US we have a real crisis. We have, I think it's probably north of 30% of all kids and teens would be considered overweight or in the obese category if you're using the BMI. And what's driving that is our broken food system and these ultra processed foods, which are just heavily marketed to kids, targeted to kids, and they taste so good, they're hard to stop eating. They're designed to be over-consumed. They're designed just to make money for the company, but it's driving this health crisis in kids including mental health and yes, obesity, but also kids are now experiencing diseases that only adults used to get. Type two diabetes, non-alcoholic, fatty liver disease. There's more incidents of PCOS. There's just all of these metabolic problems being driven by our food system. And so what's the answer to that? The answer is not for me to sit down with a 10-year-old or a 12-year-old, which is what the medical system offers us. If you bring your child to the doctor and they are considered to be overweight or have a high BMI, they might say, we'll come back in six months and we'll talk about it or come back in whatever amount of time, and then the doctor's supposed to talk to the child. So that to me was almost a complete waste of time and potentially harmful to the child because the last thing you want to be, what we really want to be talking about is health, overall health, not weight. Who really cares what that number is? But weight is sometimes a marker of people's health habits really. So would've been much more effective for me to have the opportunity to just sit with the parents and talk about what's going on and what's going on with the parents who are in charge of the child's lifestyle, so to speak. And so that is what I decided to try to continue helping kids, but only by working with their parents, because the parents are the ones who have the mature cognitive ability, the prefrontal cortex development, to really understand this thinking and really understand the complexities of why they're doing what they're doing. And the parents are with their kids every day, obviously. So they're the ones who are best able to help their kids, but parents need a little bit of help being able to help their kids. Have you found it to be true that parents maybe didn't have the best say coping strategies or thought processes or whatever it was that they kind of brought to the parenting table, so to speak, and that actually is a bigger driver of where things went with the child than perhaps anything the child started doing themselves on their own? Yes. I think for all of us, the culture that we live in, we use food in ways that food wasn't originally designed to be used. If you think about us human beings as this very ancient species, and we evolved very slowly over time eating food to just sustain our physical self. We didn't use food for fun, for stress relief, for coping. That is a very recent phenomenon and even more recent with the rise of the ultra processed food industry. So our culture, our culture is really teaching kids at a very young age to use food in ways that food was never meant to be used. And then your body learns, or your brain and your body learns to use food in those ways, and especially the food that's being offered to us, I think it's something like 70% of foods in the grocery store have added sugar and are considered ultra processed foods. And we know these foods aren't good for our human body, they're not good for our microbiome, they're not good for any part of us, but they're cheap and they taste great, and they're hard to stop eating once you start eating them or get used to eating them. So parents are definitely swimming upstream because there's a lot of forces at play that are driving poor health in our society today. One is that traditionally in medicine, the way that we handled encounters was to say, hello, patient. I'm going to tell you things. Here is information. You'll then leave with the information because you didn't have the information, and now you'll change your behavior. So that's part one. We believed that it was truly a lack of information that caused people to make decisions. I'm glad we're past that now because obviously it's multifactorial. The other thing though, is approaching things the way that I think we have done traditionally in a really judgmental way and saying, you are bad because your numbers are bad. You are killing yourself. You're going to get diabetes, lose your legs, lose your eyesight. Your kidneys are going to die. You're going to die. And I just think about It's, it's horrible. It's horrible, the stigma that's been attached to health problems, that these health problems are actually created by the environment we live in, our food environment and our modern environment, which we're not really getting a lot of help to make it easy for people to do the healthy thing for themselves, and they don't do the, or when they do decide to eat whatever and potentially gain weight or worsen their metabolic status, then we blame them. You just shouldn't have eaten that, as opposed to why are these foods so cheap, so addictive, and we're making it so hard for people to do the right thing for themselves. So it's been very, very challenging to work with parents to, we don't want anyone to feel that their weight makes them a bad or that there's something wrong with them. I thought that for so long as a kid, like, oh, something's not right. My friends are thin, but I'm not. I just felt it was embarrassing. It was, yeah, I just felt ashamed. And that's the last thing we want anyone to feel. So I work with parents to really build a really true deep connection over the fact with their kid over the fact that their child is perfect the way they are a hundred percent valuable and worthy just as they are. And we're not changing anything because you need to be better or even you need to be different. We're changing things because oh, now we know a little bit more and we've learned we want to keep our bodies as healthy as possible. And so really coming at it from a health perspective, and we can just even leave the word weight completely out of it, because weight is so stigmatized. And kids, all of us have a lot of internalized weight stigma as well. But doctors are notoriously challenged in that department, meaning we're not that empathetic to people who are struggling with weight. And I think especially if you are a doctor who's never struggled with your own weight, that can be even worse. So I have a lot of empathy for people because I am right there with them. Well, it's interesting to me because obviously you and I went to college at the same time. You grew up in Portland, not that far away from here. Your dad was an oncologist that I knew, and I never had any sense because when I looked at you, I did not perceive there to be an issue. It didn't come up in conversation, obviously, but I never had a sense of the struggle. And so as you're telling me this, first of all, I thank you for being so honest and wanting to share this. I think it's so healing for people to hear that, but it's also this underlying thing, and it makes me, I am sorry if there was ever anything that I or anybody around you participated in, even unknowingly. I mean, what a terrible thing to have to have in your mind and hold onto Thank you. And there was, it's just, it's our culture, and it's been that way. I don't know how long it's been that way, but even if you look at children's books like the Harry Potter series, look at Dudley, that character, he's over, they classify him as overweight. He's mean, he's dumb, he's this, he's that. And that's just so classic, classically stigmatizing. And they've done of studies that show that even kids, I think as young as pre-K or K, they look at pictures of normal weight kids versus overweight kids and versus kids with disabilities potentially in a wheelchair. And they label the overweight child as less intelligent and meaner. And so it's part of, it's baked into our society, unfortunately. So I think just bringing awareness to that and having some empathy for the people who are struggling with their weight and that it's, and the thing is, I know for sure two people can eat the exact same food, and one person could gain weight a lot more easily than another person. And that just has to do with your body, your energy, your muscle mass, all of the things that make us an individual person. So those of us that gain weight easily. That's a phrase from this really awesome writer, Gary Tabbs. Have you ever read any of his books? He writes amazing books, and he uses this phrase, those of us that gain weight easily. And I like that. I consider myself one of those people, but we were the people who would've survived in the ancient in a long time ago. Our human bodies. We were designed to store weight because for so long, food was hard to come by, and now it's not. This is the problem. We still have this ancient physiology, but in this modern time. And so that's where we need to learn. If you are a person who tends to gain easily, or if you are a parent who has a child who tends to gain easily, this is the reconciliation that needs to happen. How do I live with my ancient body and my ancient physiology in this modern time? And it has to do with all the things, nutrition, but exercise, movement, screen use, stress management, emotional regulation, sleep, of course, all of those things, those lifestyle factors, parents can influence their kids, help their kids. And the number one thing, of course, is kind of being the role model that you want your child to see. And that's what I help parents do too, is become that person, be the parent they want to be in that regard. I love that phrase, those of us who can wait easily. Too. Because there's so many things, and I think we're hopefully getting away from this now. There's so many ways in which we have labeled people of all ages as whatever disease or lack of physical ability or whatever it is that has become their identity. And even to this day, when I'm going to medical practices in my current role, and I will overhear somebody, ask a patient, are you a smoker? And every single time I listen to that, and I think, well, no, they're not a smoker. They're a human. They're a person who uses cigarettes or something else perhaps, but they're not the thing that they're using just like someone is not a diabetic or you're not an asthma Person, anorectic, asme, whatever it is that we decided to label people as. And I think we need to just continue to say person, person who tends to gain weight easily and try to understand what the words do as we have these conversations. If we approach it one way versus another, That first person language, I think there is awareness being raised to that, especially around weight. A person who carries extra weight or a person who is struggling with their weight, or however you want to phrase it, instead of an obese person or person living with obesity, I guess. But I think that's an important way to talk about it, that we all need to just be aware of. Well, even in the way that, for example, we are reimbursed by healthcare organizations. They want a diagnosis of a person, and it is, we want somebody classified type one obesity, type two obesity. And every time there's a patient who comes in to see me and we talk about their weight and they see a diagnosis like that on their chart, I mean, it's so devastating to them in ways that I think that we don't, it feels Terrible. I can tell you. Yeah, it's embarrassing. There's something really negative about it, and it hurts down deep inside. Yes, It's very understandable. I mean, Because it's been translated to us that it's your fault You have obesity because it's your fault, as opposed to like, well, I've never had cancer, but if you saw a cancer diagnosis on your chart, I'm not sure it would hit you in the same way. Oh, I caused this. I'm blamed myself for this. Maybe that is the case. I mean, I don't know. I did have breast cancer, and I still, even though I acknowledge that it is a part of my health history, I don't necessarily love to see that on my chart because even with cancer, there is a sense. People with lung cancer, we always assume that it's because they smoked. Well, he smoked. Yeah. We know that that's actually not true. Yeah. We aren't necessarily sure. We're showing up. We're engaging with the environment. There are things that we may or may not be doing more or less that might be impacting our health, but it is not always our fault. A hundred percent. Yeah, And what you're describing, I just think is so important given the prevalence of what we're talking about now. How can this be everybody's fault? Every individual person is showing up in the United States so that two thirds of our country now carries the diagnosis of overweight or obese. Yeah, each individual, it's all their faults. Yes. I mean, it's ludicrous if you really think about it. It is clearly the environment that we're living in that we've created or that has been allowed to be created that we are all living in. It's super challenging. There is a lot of, when you start to really become aware of this, there are a lot of doctors now who are speaking up about this and really trying to push back on the ultra processed food industry and the government. Our government subsidizes corn, which gets turned into corn syrup, which goes into all of these highly processed foods, which make them so cheap. So why is it more expensive to buy water than it is to buy a Coca-Cola? Well, because Coca-Cola is this, I don't even know what kind of billions they have, but they fund some of the nutrition guidelines. They fund some of the research saying that soda is not that bad for you. They're involved in the guideline creation. So it's really a systemic problem. It's a systemic problem that's been created, but it's affecting every individual at such a deep level that it's hard to believe that we as a country aren't addressing this in a more intense, aggressive way. In my opinion, this is like if everyone's health is going down, which we know it is, people are suffering more disease, more mental health problems, the life expectancy is actually falling in the United States, fertility rates are falling in the United States and people are suffering, but we're not doing anything to help people. Well, what are we doing? We're creating these drugs potentially like ozempic or offering these band-aid solutions to people which are just making money for the drug companies. So it's a challenge. So it needs to come top down. People need to be working at the government, and lots of physicians are trying to get some policy changes made. And then where I'm at, the little person at the grassroots level, like, okay, so this is where we live, what we live in, this current where we are, what can I do? I have a 12-year-old. How can I keep him safe? And that's how my view of food, my view of social media, our world has shifted to as a safety issue. We keep our kids safe in a lot of ways, like a wear seatbelt in the car, bike helmets, safety on the water, things like that. We need to actually start looking at food as a safety issue for our kids. And these highly processed foods, ultra processed foods, they're not harmless. They're not just empty calories, they're not junk. They're actually harming us and harming our kids, harming our microbiome, harming our mitochondria. And I don't want my son to experience that. So what can I do as his mom to create some boundaries around what I'm wanting him to have? And it's obviously a work in progress as he ages, and he has his own agency and he can do his own thing. But what I'm trying to do is just instill in him the understanding of the big picture, and that ultimately he does have choices he can make and he can choose to, well do the things that we think are going to keep us healthy. I'm glad that you are not losing hope on this, because I do think that is, when we talk about the healthcare environmental factors, it can be very overwhelming. And when you talk about you being the little person, which I think kind, it's a funny way to think about, it's you against the world. I, I'm am Dr. Sheila Carroll, and I'm going to go out there. Well, you know what I mean? We're like the little, I don't make the rules. I get it. I totally get that. I Have to live in this world. But I do think there's something about that that is so important. Okay, let's not give up here. Can't, I may not be testifying in front of Congress, but how do I show up every day and remain motivated to seek a healthier way in whatever way it is that I'm operating personally or professionally? And that's what I think I'm hearing from you. Yeah. Yes. How can we show, how can I show up, help my son, help his friends, help our community? Because I don't want them to suffer. I don't want him to suffer unnecessary problems. There's enough problems that are necessary or that you're going to bump into no matter what, but these ones that are avoidable, let's avoid them. And it's not that hard. And it does take some education, and it does take effort, and it does take time, and it does take money, obviously. But I am hopeful because I know the truth is, once you lose your health, there's no other, what else is there? You can't live the life you want to live. If we're having teenagers who are having liver problems, they've lost their health and they're 15 years old, we have to help them and we can. And so let's try to prevent these kids from worsening their health and just learning how to protect their health. I think what you're describing is just incredibly important. I mean, I'm sure that I've actually given this example before in conversations I've had with other people who have come on the show that I've, in working with patients, I've seen, for example, bad teeth. So by the time they're 20 years old, all of their teeth have been pulled for the rest of their lives. All they will ever have are something artificial that is put in their mouth to help them chew. So the things that we are doing in childhood are impacting people right now and forever. We have set people down a path. So I think that's what you're describing is I think we all have to pay attention to it because we're not just talking about how it impacts children. We're talking about how it impacts people for decades, like forever and ever, and probably the next generation and the next generation after that. Well, we know through epigenetics that yes, your kids' kids are being affected by what's going on right now. And I had a very similar patient to what you're talking about. She was actually the mom of my patients. She was having a baby, and the baby was in the nicu and she had to leave the NICU one day. She was going to get all her teeth pulled out, and she was in her twenties. And I was blown away by that, and I had a long conversation. I was like, is this really something? Can you help me understand this really the last, is this the only choice you have? And she said, yes. It was the only choice she had. It is not a decision she made Willy-nilly, and she didn't want that to happen either, but she had no other option. But because she's 20 something, so that didn't just start. That's been going on for probably since she was a baby. So nobody helped her take care of her body, and now she's having to do this thing that she doesn't want to do. It's Challenging, but we can help our kids and we can help all the kids in the United States do better. Well, I guess that's where I was going to go with this. Next is obviously you and I have interfaced with people within the healthcare system. You're now interfacing with people kind of adjacent to the healthcare system. And then there are people who really aren't even accessing either the healthcare system or people who are adjacent to the healthcare system, but they're still out there in the communities and probably not getting the access to care they need impacted by social determinants of health, like inadequate, healthy nutrition. So how do we pay attention to that and how do we think about things from a population health standpoint? One way to go about at least trying to provide some really good nutrition for people once they get into the school system would be offering really healthy real food at schools. And one of the leaders in the metabolic health movement, this physician named Robert Lustig, Dr. Lustig, he's written some amazing books. He calls the United States School System, the number one fast food chain in the world. And it unfortunately is because most schools are buying things from Cisco or these big companies to they're highly processed foods because there was some legislation a few decades ago that said that school food programs had to earn their keep and even make money, I think. So cooking real food became challenging for school systems from a financial standpoint. So again, we just looked at the money and we didn't look at people's health. So there's a big movement in trying. I know I'm in touch with our school department here. I am on the PTO, and I forget what his official title is, but he's the director of all the food systems in Yarmouth Blair. He's amazing. And he is highly aware. He's doing everything he can to get healthy, nutritious, real food in front of the kids. And there's a bunch of great programs. Eat Real is a really great program that is going on in the country. They'll come into a school system and help the school system pair up with farms and pair up with other suppliers to get real food. So this brings us to the topic of, okay, well, we live in this highly processed food environment, ultra processed foods where it's reported that 67% of a or teen's calorie intake or daily energy intake is coming from these highly processed foods. The solution to that is we need to start shifting away from some of these highly processed foods to more real food. And it's hard to, if you were only eating real food, minimally processed food, we wouldn't be having these health problems that we're having today because real food has fiber, real food has healthy fat, real food has protein complex carbohydrates, and our bodies were designed to run on that. And that also, if you're choosing real food, you are allowing your body's hormones, the hunger hormones to kind of function as they were designed to. And so people eat less when they're eating real food instead of highly processed food because there's something about the ultra processing of the food that is, for lack of a better word, messing up people's hunger signals so they're hungrier, so they eat more calories and eat more food in general when they're eating ultra processed food. Anyways, that was a long rambling answer. Well, it's good. I mean, you're bringing forth solutions and Yeah, I think the solution, thank y