12. Behind the Scenes at the Rentea Metabolic Clinic

My good friend Amanda Sabicer recently quizzed me about what’s going on behind the scenes at the Rentea Metabolic Clinic and my journey to starting my own clinic.

Amanda is a nonprofit executive and life and business coach for women who want to do big things and, in my case, revolutionize obesity medical care. 

We talked about my goals to scale a more patient-centric treatment to serve the obese community in a holistic way, rather than contributing to a system that continues to enable more bias and provide patchwork solutions. 

Why did I decide to get into medicine?

There was never any other thought in my mind of what I would do. I grew up in a two-physician family household, so I have been surrounded by medical things my whole life, as well as aspects of running a clinic and of patient care. I could never imagine doing anything else. I always loved science and eventually got into medical school. Initially I wanted to be an endocrinologist, which was why I picked a university setting for my training.

I then realized that I actually liked the primary care setting and the continuity. When I got into primary care, I loved the patients. But again and again, there was never enough time to get into what the metabolic problems were. My schedule was so full that you’d only have a very small amount of time to see someone and then the next visit would be booked in after around four to six months. So it felt like we were never getting down to the root issues, like insulin resistance and some of the things that could actually make the biggest impact for all of their health.

Why did I start my own clinic?

I remember the exact moment when I had a female patient of mine, who was sitting in front of me, crying about not being able to lose weight. She was trying everything and had tears streaming down her eyes. I felt completely helpless, knowing I had just 15 minutes every six months with her. I realized it doesn't matter how many podcasts I recommend, how many programs I refer her to, or if I tell her to see the dietician. It felt so fragmented. 

And so I had a moment of feeling that I would never be able to have an impact on even one person when I'm inside this system. It took a long time for me to sit down and figure out what I wanted it to look like, especially as the way I’m doing it is very unique. I had to have a lot of faith that people who want this help in a different way would come to that solution. Despite it taking years for me to build up enough confidence for that move, I knew my medical knowledge was sound and that I could help people in a different way. 

What are the challenges in our medical system when it comes to obesity as a disease state?

Firstly, what I find most scary, is that everything is blamed on weight. A lot of the time life-saving diagnoses are missed. If you’re overweight, it can often be the case that this is blamed for many different symptoms when actually, there could be something completely different going on. 

A lot of this bias comes from medical school, where our training teaches us that if somebody’s overweight, then there will be a lot of negative health consequences. This then stops doctors from really looking when there might be another issue. 

Secondly, because of this bias occurring so often, people with chronic obesity stop engaging with the healthcare system. People who are overweight expect to be told that is the reason for their ill health, even if it’s a sore throat, so they simply stop going. Some patients prefer telehealth appointments because it means they don't need to come into an office and get put on a scale and have a comment made.

These challenges lead to patients not getting the treatment that they need and they don't realize that there are effective tools to help them.

What is different about my clinic?

One of the things that I wanted to start to create was an environment where people have much more access to me. This means not only longer visits, but also when you want to communicate with me, it would come directly to me. 

In previous clinics I worked in, messages would get triaged, meaning it could be up to three days until it’s looked at. That message isn't top priority, but if patients are suffering with issues that are affecting their life, they need to be dealt with straight away. 

I also wanted access in the sense of not having to wait a ridiculously long time to get to me (once you are a patient). When you are my patient, I want you to be able to book a week or two out, and have availability for you at a time that works. We've got room and we can accommodate things. That was what I dreamt of. You can get access to me, I'm giving you really good care, I can look things up for you, and the attention to detail is significantly increased.

I also feel my coordination is much better than most. For example, if a patient is on blood pressure medications, a lot of the time when you start to lose weight, you're likely not going to  need as much blood pressure medicine. So we'll slowly start to titrate that down, or remove it altogether. A lot of patients might have a cardiologist and I always make sure to involve all parts of their team. My communication is really easy to understand and I will get on the phone if I need to. These were things I could never do before.

Additionally, I wanted there to be price transparency. I didn’t want patients to receive surprise bills for things they didn’t know about or thought was covered. So I decided to look at the lowest I could make this available, where patients can receive all the information, meet with the dietician, have a video course, etc. This is why for the behavioral side, I do a group call where you can ask me questions, and it’s really condensed so you don’t waste hours looking online for information.

What is the role of coaching and mind management in addressing the dynamic of what the body instinctively wants to do to protect itself?

The body really is designed to protect itself. It has a very elaborate protection system and typically when you “solve” one area, something else in the body will flare up as an attempt to protect you from losing weight. This metabolic adaptation can make the process extremely challenging for people.

Therefore, there is a large amount of mind management that needs to go with it too, which can't be done separately. We need to have a comprehensive approach because the body is trying to preserve itself. 

If we look at obesity medicine, there are four main pillars: nutrition, exercise, behavioral, and medications/surgery. And then possibly medications or surgery. 

When we look at this, physicians are great at the medication side of things, and for the nutrition aspect, there are great dieticians, but when it comes to the mindset part, I always saw patients being tripped up in the clinic. It's all the self sabotage. So you can be doing well for a few weeks, a month or two, and then something happens in life and you just abort it altogether.

So we need to look at increasing your chance of making it to the next step and working on your mindset, or cognitive behavioral tools. If there's something that's related to a really big trauma event, I'm always going to make sure that a therapist is involved.

But a lot of the time, the reason I love using coaching in my practice is that people just need to be empowered. Moving forward in a really energetic way is what people have never been taught before. Ultimately, the diagnosis of obesity comes with a big mental load because for so long we've been oppressed with this. And so I work on that aspect so that long term you feel like a different person. The weight going down never changes how you feel about yourself. If you don't do the internal work, you still end up feeling unhappy.

What is the experience for a patient signing up with me?

Right now I'm doing a meet and greet because this clinic will not be the right fit for everyone.

It's a really quick call where I see what's going on for you and if we could work together. Sometimes people want to be handed a specific meal plan to follow perfectly and if that is the case, my clinic won’t be right for you. My aim is to work on empowering you so that you can start to learn to do this on your own. 

If it is a good fit, we send the patient the registration. The first step with joining the clinic is always meeting with me, and then afterwards they meet with the dietician. This is all done in quick succession, and then we start to really customize what we are working on. 

One of my key values is providing really high level care to people without them having to spend all day on it. I want to set realistic goals that people can actually go away and do, such as a specific place in a video course to watch. There is usually some type of a first step that I can see for you, whether it's medication-based or nutritional. It’s a highly customized approach. 

The weekly calls are there as a place for questions to be answered and to work on mindset blocks. Sometimes I also talk about different studies or cool things that are coming out, to offer some good information without having to scroll for 10 hours questioning what’s accurate or not. There's a lot of misinformation out there and so I try to bring that together. If people can’t come to the live calls, there are replays so it is customizable and fits into your lifestyle.