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Episode 271:
Show Notes
The episode features Dr Lucy Burns speaking with Dr Jeremy Lim, a lifestyle medicine physician with interests in metabolic health and obesity management. Dr Jeremy shares his journey from traditional rehabilitation medicine toward lifestyle medicine, emphasising prevention and proactive health choices. The discussion highlights the six pillars of lifestyle medicine and their role in reducing morbidity—the burden and suffering from illness prior to death—by improving overall metabolic health and preventing chronic disease.
About Our Guest
Dr Jeremy Lim is a medical doctor and lifestyle medicine physician with a passion for metabolic health, men’s health, and preventative care. He helps people make sustainable, evidence-based changes through supportive, judgement-free care. Dr Jeremy consults via Real Life Medicine Telehealth and in-person at the National Institute of Integrative Medicine Clinic.
Lifestyle Medicine Overview: The discussion highlights the six pillars of lifestyle medicine:
- Quality Sleep: Emphasises the importance of adequate, restorative sleep for health.
- High-Quality Diet: Mentions evidence-based diets like keto and Mediterranean for chronic disease prevention.
- Regular Exercise: Stresses the value of both cardiovascular and resistance training.
- Social Support: Recognises the role of community and relationships in maintaining health.
- Stress Management: Discusses techniques for managing life stressors.
- Mindset and Mentality: Focuses on adopting positive attitudes and mental frameworks toward health.
Morbidity Defined: Dr Lucy clarifies that morbidity refers to the suffering or ill effects experienced due to disease before death, not just mortality.
These points collectively advocate for a holistic, lifestyle-based approach to health, emphasising prevention, well-being, and the integration of physical, mental, and social factors.
🔗 Book an appointment with Dr Jeremy Lim here: 👉 www.rlmtelehealth.com/metabolic
Episode 271:
Transcript
Dr Mary Barson (0:04) Hello, my lovely friends. I am Dr Mary Barson.
Dr Lucy Burns (0:09) And I'm Dr Lucy Burns. We are doctors and weight management and metabolic health experts.
Both (0:16) And this is the Real Health and Weight Loss podcast!
Dr Lucy Burns (0:21) Good morning, lovely friends. How are you this week? Dr Lucy here. I am without the fabulous Dr Mary but have replaced her with the fabulous Dr Jeremy. Jeremy, welcome to the podcast.
Dr Jeremy Lim (00:34) Oh, thank you, Dr Lucy. I'm very happy to be here.
Dr Lucy Burns (00:38) Excellent. Good. Well, I'm happy to have you. I thought you would bring a really g eat perspective for some of our listeners because, like me, you're a lifestyle medicine doctor, and you're also interested in metabolic health and obesity management. So tell us a little bit about you and how you came to work in this space.
Dr Jeremy Lim (00:59) Yeah, you know, I graduated med school in 2018. I did a bit of training in rehab medicine, where you learn the classical routes of prescribing medications for medical issues. But then I stumbled upon the Society of Lifestyle Medicine, which really focuses on the power of proactive health choices and preventative health. When I found the Society, I really found my passion in helping people stay healthy, rather than fighting their way back to health after developing chronic diseases. And yeah, I never looked back. I gained an interest in cardiometabolic health as well, which I think makes up a big part of the morbidity and mortality in Australians.
Dr Lucy Burns (01:59) Oh, absolutely. And I think that the morbidity part is really interesting. For our listeners, morbidity means it’s the suffering, if you like—the effect of the illness before you die. People don’t realise that cardiovascular morbidity steals your glory years—the last third of your life, which is often when we’re meant to be retired and gallivanting around the world and doing all of those sorts of things. For lots of people, that doesn’t come to fruition.
Dr Jeremy Lim (02:24) Yes, yes. I always tell people that most adults, because of the rising cost of living, are very focused on their finances and their work so they can have a comfortable retirement. But just as well, it’s very important to emphasise investing in your own health so you can enjoy your retirement years with independence and with your family around you. I guess that’s what everybody really wants.
Dr Lucy Burns (02:51) Yeah, absolutely. And I think you're right. I love that concept of investing in your health, and investing in your health, you know, sometimes requires some money, but it also requires perhaps time. So I’m wondering, with your approach to helping people invest in their health, what sort of things do you do?
Dr Jeremy Lim (03:11) I guess a good place to start would be the six pillars of lifestyle medicine, which are high quality, adequate sleep, high quality diet—and very popular diets these days are the keto or the Mediterranean diets, which have very strong evidence for preventing chronic disease. Obviously, a good amount of exercise in terms of cardiovascular and resistance training is very important for health. And then the secondary layer of things, like getting social support, managing your stress, as well as adopting the right mindsets and mentality, which you talk about a lot as well.
Dr Lucy Burns (03:47) Oh, absolutely. So we like to call it the “6’s for success.” So, sustenance. And again, for us, sustenance means your nutrition. But number one is real food. And, you know, for people who are insulin resistant, then low carb real food is helpful. And everybody should be prioritising their protein. So that’s kind of our little sustenance bit. Then we do sleep, stress management, strength training, social connection, and a bit of sunshine.
Dr Jeremy Lim (04:21) Oh, I like that.
Dr Lucy Burns (04:23) Yeah, yeah, it works really well. The one we miss that is in the lifestyle medicine pillars, though, is toxins. So I guess things like smoking and excessive alcohol. And I can’t think of an S for them just yet. But maybe I’ll call them substances, I guess.
Dr Jeremy Lim (04:39) Substances is a good one. Tobacco and alcohol minimisation. Yes. Very important.
Dr Lucy Burns (04:44) Yes. In fact, I’d put in there tobacco, alcohol, and ultra processed food.
Dr Jeremy Lim (04:48) Yeah, I very much agree with that. I do think with the way ultra processed food has been designed, it can very easily cause addiction to these foods. And I guess that’s one of the reasons we’re seeing rising obesity rates, rising high cholesterol, and hypertension rates with the current food environment that we have.
Dr Lucy Burns (05:08) Yeah, absolutely. Absolutely. So you help people with the six or seven pillars we’ve just talked about, which is wonderful. I guess one of the things that, you know, Dr Mary and I see a lot of women. And yes, we see blokes as well. But I know for you, you see a lot of blokes. And yes, you see women as well. So what have you noticed that is sort of particular for men, and barriers, I guess, for men seeking help with their health?
Dr Jeremy Lim (05:37) Yeah, that’s a good question. I feel like, and obviously these are generalisations, but men culturally tend to be more avoidant with their health issues. Sometimes they prefer to sweep it under the rug and hope it’ll be okay. As you know, they tend to be more stoic and self-reliant as well. And so I guess they don’t really go to doctors for multiple reasons. Number one, their work commitments can often mean that visiting a doctor after hours becomes a bit tricky. And then the second thing, culturally, you know, it’s not normal for them to regularly stay on top of their health issues, perhaps compared to female counterparts. Obviously these are generalisations, but a reality that you and I are seeing in our clinics very often.
Dr Lucy Burns (06:27) Yeah, absolutely. I think you’re right. I mean, women start off seeking health care, particularly around, you know, reproductive health, when they’re even young, you know, access to the pill or whatever it might be, and then pregnancy and follow up with children. And again, as you mentioned, these are traditional—not every woman. But yeah, they’re more used to going to the doctor, whereas blokes perhaps are not used to it. But also, you know, put it down the priority list. And I think one of the biggest barriers—and this is really a big barrier I see for all people now, particularly even women who are working, like working people—the barrier is that traditional general practice is difficult with time management. So you book an appointment. And, you know, I think GPs are squeezed so tightly now that they’re often double booked or squeezing extra people in. And so it becomes a really—you know, your 10 o’clock appointment might not actually happen at 10 o’clock. It might actually happen at 11 o’clock, or 10:45. And so suddenly, something that, you know, in your mind you’re going, I’ve got a 15-minute appointment, it takes half a day. And so that becomes tricky as well.
Dr Jeremy Lim (07:43) Yes, I think increasing waiting room times does lead to even more frustration when going to see the doctor. And I guess one way of removing those pain points, becoming more popularised these days, is the telehealth services that are available for patient accessibility. They can certainly add to more convenience for the patient in terms of waiting in their own home and speaking to the doctor on their phone or on their computer. I think this development, it’s really become popularised since COVID. But I do think that despite some of the concerns around telehealth, the increased accessibility and the increased convenience have empowered more patients to access medical care with doctors that they trust as well.
Dr Lucy Burns (08:31) Absolutely. And a disclaimer to all our listeners—clearly, you know, we now run a telehealth platform, and Dr Jeremy is one of our metabolic health doctors. But I guess what I would love to add to that is that not all telehealth is created equally. And I think there are plenty of platforms out there that are really just designed for rapid throughput. Rather than being part of the solution, they just cleave off a little area. And it can be anything from medical certificates or something like that. But our telehealth platform, RLM Telehealth, the tagline, if you like, is collaborative care. So I think it’s really important that the GP is still kept in the loop—that they’re still front and centre in coordinating the patient’s care. They’re told about medication changes or medication suggestions, and they’re kept informed. Like honestly, I think that so many of these companies aren’t doing that. They’re just sneaking off, doing their own thing. And meanwhile, the patient doesn’t even necessarily tell their doctor, and it can be really problematic.
Dr Jeremy Lim (09:44) Yes, I think everyone truly, truly needs a specialist general practitioner that they rely upon to keep their medical records and documentation, and to coordinate care between their specialists. And in the future, if someone needs to go to hospital, all of these documents and history are kept with the GP. And ultimately, your trusted GP is the one that advises you on most health issues and medications. The other thing that you mentioned as well, that I think is missed in these quick prescribing clinics, is whether or not informed consent is done. Oftentimes, patients access these clinics to potentially talk about some of their pain points or maybe to even get help with weight loss. Often, they end up with three-minute consults where they’re prescribed something, but they barely understand the side effects or the contraindications for. I think ultimately, each individual is unique—that’s clear in medicine. And a doctor taking the time to understand the patient’s background, what other issues they have, and whether the medication at hand is appropriate.
Dr Lucy Burns (10:59) I think you're absolutely right. I mean, there are really two types of telehealth platforms. One, I guess, you know—and again, one like ours—where we look to behave, if you like, like proper doctors. Where you take a history, where you talk with the patient, where you ask them about themselves, what they're looking for, what their barriers are, you know, and combine that concept of lifestyle medicine with plus or minus medications. And then you come up together with a plan that is then implemented. Or you can go to a telehealth clinic, and basically, it's like going to a vending machine—you just kind of order what you want, which, I know, I get it. There are some people out there that that's what they want. But that's not actually necessarily in your best interests. And I think sometimes people—like I've seen in Facebook groups—are put on medications they can't afford, because these are expensive medications. So they're scraping together money to afford them. And the idea is, sometimes these medications are meant to be for long-term use. And people think, you know, they've been told, "Oh well, you can just have it for a couple of months, and then we'll see how you go." But there is no "see how you go." There's no follow-up. There's nothing. They're just left abandoned.
Dr Jeremy Lim (12:18) Yeah, I'd almost see it the same way as getting a service from an accountant or getting a service from a plumber. If they're spending three minutes with you, it's questionable—the service they're providing.
Dr Lucy Burns (12:30) Yeah, yeah, yeah. Well, I was thinking of it also like—you can go to your artisan, traditional pizza, you know, Italian pizza restaurant, or you can go to Domino's.
Dr Jeremy Lim (12:42) That's true.
Dr Lucy Burns (12:42) They, you know, technically deliver the same product, but the quality is vastly different. Yeah, yeah. So thinking then again around metabolic health and obesity management, which is your special interest—maybe explain to our friends out there, why do people find it so hard? Like, what's going on there? You know, you hear other people tell people, "Oh, they just need to eat less, they just need to cut the calories, they just need to choose low calorie options." But the problem is that people don't know about low calorie—like honestly, really. And so if I show them enough low calorie recipes, then they'll be fine.
Dr Jeremy Lim (13:21) I think you bring up a very interesting problem in this paradigm of health behaviour. It's not just knowledge alone, is it, for patients to change these behaviours? I like to think of it with the three E's, I suppose. The first one is knowledge, as you mentioned—to educate someone so that they learn different pieces of information. So things like, why are my cholesterol levels important? What are the exact health risks with smoking, with drinking alcohol? And that, you know, comes with education. A patient probably understands that it's not great for them, but giving them a bit more scientific background of the actual numbers and the risks that are there can also contribute towards health behaviour. And I think the second E that I use is Engage. People won't really change their behaviour unless they think it will lead to the outcome that they're hoping for and engagement can look like motivating someone towards their specific goals, which may be to move more freely, to move without pain, to have a higher exercise tolerance so that they can play with their grandkids. Many of these things are not as obvious when we're talking about health, but they should ultimately be the goals that we aim towards when we take proactive health choices. And I think finally, and also very importantly, is to encircle the individual with support. So if someone tries to take on health behaviour change by themselves, oftentimes you see people make these herculean efforts. They're like, "Okay, we're going to do a full haul of our diet in the first five days." But then after a while, willpower starts to wear down. And without the support of people understanding the journey that they're going through, it's very difficult to keep motivated and to stay consistent, because ultimately we're looking at a timeframe of months to years before these health habits slowly embed themselves in a person. And that support very importantly comes from the people around them—whether their loved ones are there understanding their journey and supporting them, but also, once again, from a health practitioner that they can trust.
Dr Lucy Burns (15:40) Absolutely. I love that—the three E's. So we've got education. What was the next one?
Dr Jeremy Lim (15:45) Engagement.
Dr Lucy Burns (15:47) Engagement and encircling. They're great. They're great. I love those. And I think when you talk about that engagement, it's a bit like finding the why. Why do you want to do this? So people will sometimes go, "Oh, well, I just want to lose a few kilos," or, "I want to lose some weight," or, "I want to lose 20 kilos." And you go, "Yeah, but why?" Because until they really get into their very deep why's, often, as you said, the motivation can wax and wane and come and go. And our very sneaky brain can justify anything if we're not really clear on why we want to keep going.
Dr Jeremy Lim (16:25) Yeah. The why.
Dr Lucy Burns (16:26) Excellent. I love that. I love that. And that approach is fantastic. And I think it also, I guess, just emphasises the importance of having somebody—an expert, an expert in health—which, you know, is often us, a doctor. Might not necessarily be, but it often is, to keep you focused, I guess, when you wobble. So one of the things I've found over the years is that people love coming to see me when they're going well. And it's a bit like they want me to be able to say, "Yay, well done, good, pat on the back." And I'm very, very happy to do that—always happy to be a cheer squad for people. And then what happens is they might have a little wobble, or things aren't going so well, or they've stopped, and they don't want to come. They don't want to come and tell me that. They're worried. So what are your thoughts around that? What can people do when they feel like they're not doing well?
Dr Jeremy Lim (17:21) I think you're right. Oftentimes, when someone's health habits and potentially their symptomology are getting worse—so they're feeling like they have lower energy levels, they're unmotivated, they're potentially continuing to put on weight despite doing everything correctly—that's when someone should really go and, well, not necessarily, but that's when most commonly people go and seek help from the health professional. It's at that stage, normally, that potentially advanced diagnostics—specific blood tests—can be done to identify imbalances in the human hormone system, or specifically what's going on with the health that's causing them to have this outcome. I think there are situations as well where a person's stress can often lead to negative outcomes. As you know, the HPA axis—using a bit of jargon—as you know, stress really impacts the appetite as well as food choices. And so if a person is seeing that they're continuing to make the wrong choices, or their health is going in the wrong direction, that's a really good time actually to do a tally-up with their doctor, just to see what areas can be focused on and how to troubleshoot their issues.
Dr Lucy Burns (18:48) Yeah, absolutely. I think it's interesting. People often don't want to seek help. So if they've sort of—maybe they've already come, they've started the process, and then they're not following through—they often don't come back because they feel a bit embarrassed or a bit ashamed, or think they should be sorting it out, or even worse, that we're going to be cross with them. And I always say to people, I will never, ever be cross, but the time that I really want you to book the appointment, get online, make the call, is when you feel that you're not doing well. So yes, I'm happy to see you when you're doing well, because yeah, I'm always a cheer squad. But honestly, because that's all around motivation and behaviour change. So when you're not doing the things that you kind of think you should be, or could be, that's behaviour change. And, you know, behaviour change is tricky, our brains are tricky, and you need somebody to help—I guess somebody who's objective—to help troubleshoot why you're not implementing your knowledge.
Dr Jeremy Lim (19:49) Absolutely. And I think that's where lifestyle medicine physicians shine, where they take more time to get to know the person, to explore the whys, to explore potentially what's going on in their life that has caused them to, you know, uptake certain eating habits. Whether, I guess, you and I, even in our clinical practice, are seeing a rise in patients who identify with symptomology of ADHD. And we know that these symptoms—emotional dysregulation and executive function—can very easily result in leaning towards dietary choices that have a higher proportion of hyper-processed foods, mainly because these foods sort of hit a bliss point and offer a dopaminergic response, allowing a short period of comfort. But obviously, in the long term, it can be detrimental to people's health. So it's exploring these small issues like stress, emotions, sleep, whether or not they have energy to do the physical activity that they plan. These things do take time to explore and to talk about. And like you said, when people are really struggling and they've gone for weeks or months in the wrong direction with their health habits, that's when they'll start to get these symptoms. And that's potentially where people can get the most value or the biggest bang for their buck—when they seek input from a clinician who will listen to them and work with them.
Dr Lucy Burns (21:18) Absolutely, absolutely. I totally agree. So there's, you know, and again, you mentioned there's obviously a rise in people being diagnosed with ADHD. There's also a rise in, you know, the weight loss medication that we've now got available. What's your approach with, you know, where weight loss medications fit in?
Dr Jeremy Lim (21:38) I do think weight loss medications, especially the GLP-1 medications that have risen in popularity, do have their place. Well, obviously, they do have an evidence-based role in managing diabetes. But with those trials finding that they can contribute to obesity management and weight loss by means of regulating hormones and controlling appetite, we’ve found that these medications can be very useful for helping with weight management in patients who have genetic predispositions, or environmental and lifestyle predispositions, to having elevated BMIs. And as we know, elevated BMIs ultimately contribute quite significantly to cardiometabolic outcomes. We’re talking increased rates of heart disease, stroke, Alzheimer’s, and vascular dementia. And all of these things are what people are trying to avoid towards the later years of their life. And so I do think these medications are quite potent tools when used with the right oversight, and when used in appropriate patients with informed consent. So I’m all for them to be used in the right context, I suppose.
Dr Lucy Burns (22:59) Yeah, absolutely. And I think, you know, the thing I love—and I think this is your approach as well—is that when you’ve got lifestyle medicine combined with pharmaceutical medicine, it allows you to prescribe lower doses. You know, we spend a lot of time deprescribing. Once people are able to optimise their lifestyle, we can often get rid of medications—reduce blood pressure medications, eliminate blood pressure medications, or diabetes medications. And so when we’ve got the lifestyle component sorted, then the thing is that this allows us to use really quite low doses often of these medications, which is in stark contrast to what the drug companies would like us to do. And they would, in all of their trials, they’re all done with people on the maximum tolerated dose. So it’s almost the opposite. We do the lowest effective dose, which is better for the patient, cheaper for the patient, not so good for drug company profits—whereas they want people to be on the highest tolerated dose, which I think is fraught. So yeah, I agree with you. I think they have a place, but they need to be wrapped around. And I love this concept. There is a concept called wraparound care. So it’s wrapped around with essentially the lifestyle medicine pillars.
Dr Jeremy Lim (24:19) Yeah. Important thing to note as well is that behaviours can be synergistic and antagonistic toward the medication. So, you know, if you’re eating whole foods, satiety levels tend to be better. And when used in conjunction with these GLP, GIP medications, they can serve to regulate satiety a lot better. On the other hand, if a person is not managing their stress well, their sleep regularity is all over the place, they’re drinking a bit of alcohol—as we know, which increases your propensity to eat snack foods and desserts as well—those things antagonise the medication’s ability to regulate appetite. And so when people do get on the medication, it’s very important, as you say, to get the foundation of lifestyle and use it as a wraparound treatment, rather than to sort of rely on the medication so that they can neglect their lifestyle factors.
Dr Lucy Burns (25:20) Yeah, absolutely, absolutely. So I guess, in summary, what would you put as your top tips for people who are wanting to improve their metabolic health, you know, perhaps reduce their BMI if it needs that, and, you know, live their glory years to the fullest?
Dr Jeremy Lim (25:40) I'd start maybe by emphasising stress management and optimising sleep. I think these two are often undervalued for what they can bring to a person's cardiometabolic health. When a person’s overstressed, their appetite regulation becomes a lot more tricky, and their cravings for certain foods that they find comforting can go up. So I think really getting your sleep to a regular period—so falling asleep at the same time every day, sort of two to three hours after the sun sets, and sort of waking up together with the sun, preferably at the same time seven days a week—is really good for the circadian rhythm. And the circadian rhythm also regulates a lot of your metabolic health and metabolic efficiency. So that's what I want to highlight. The second thing I think that easily is a really good tip is: don't buy it from the grocery store if you don't want to eat it. I help a lot of people quit cigarette smoking as well, and one of the ways to sort of cruise through the cravings is to have the premeditation that when they go past these tobacconist stores, or when they go past the grocery stores, just to avoid the areas where cigarettes are sold. And in the same way, avoid the sections of the grocery food store perhaps where you don't want to go and buy those Tim Tams or those Oreos, because if you don't buy it, it won't be in your pantry and you won't have to have the willpower struggle later on. And the third one, I think, is get support. Whenever you take a journey of any sort, let alone a weight loss journey, you do want the people around you to recognise that it will be a trialling time for you. You might be shorter with your temper, you might have difficult emotions come up as you struggle with behaviour change, and so when people understand your journey and they understand the struggle that you're going through, it’s very likely that your loved ones stand in to support you during that period. As well as, as we’ve mentioned, getting support from a trusted healthcare professional—whether that's your GP, whether that's your health coach, whether you see a naturopath or a metabolic doctor at Real Life Medicine Telehealth—I think it's important to work with someone you trust who can give you that support when you need it the most.
Dr Lucy Burns (28:07) Absolutely, absolutely, I love that. I think the combo of lifestyle medicine plus or minus pharmaceutical medicine is the key. What you eat is important, but why you eat is really where the gold is. And once you understand that and make measures to develop skills around that—again, identifying the problem is one thing, but you need skills. And people think that stress management, the way to manage their stress, is an absence of stressors, whereas in fact it's a skill around developing skills to manage external stressors. And so I love that you talk about that as well in your consults. Jeremy, this has been fantastic. I know that you are now an RLM Telehealth practitioner, which I'm very excited about. I know that you have got some bookings available, and again, any listeners, if you want a booking to see Jeremy, you can. If you happen to have a husband, father, son, brother-in-law, friend who's perhaps not listening to the podcast, you can certainly forward the link, because I think that would be helpful. And yeah, and hopefully together we can help as many people as possible.
Dr Jeremy Lim (29:23) Yeah, thank you so much, Dr Lucy, for having me on the podcast. I'm a big admirer of what yourself and Dr Mary do with Real Life. And so I'm very excited to join the team and, yeah, look forward to working with patients.
Dr Lucy Burns (29:37) Indeed, indeed. All right, beautiful friend, have a fabulous week, and I, or Dr Mary, or both of us, will catch up with you next week. Bye for now.
Dr Lucy Burns (29:50) The information shared on the Real Health and Weight Loss Podcast, including show notes and links, provides general information only. It is not a substitute, nor is it intended to provide individualised medical advice, diagnosis or treatment, nor can it be construed as such. Please consult your doctor for any medical concerns.
