WHY WEREN’T WE SKINNY
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Episode 282:
Show Notes
This is Episode 282 of The Real Health and Weight Loss Podcast hosted by Dr Mary Barson and Dr Lucy Burns, two weight management and metabolic health experts who address the question "Why aren't we skinny?" in response to social media criticism about their appearances.
Genetic Predispositions and Health Challenges
Both doctors have significant genetic factors that make weight management difficult. Dr Lucy has a family history of type 2 diabetes (her father has it) and muscular dystrophy, which means she lacks metabolic muscle function and gains weight very easily. Dr Mary has both parents with type 2 diabetes, polycystic ovarian syndrome (PCOS), and a lifelong struggle with weight since childhood, including gestational diabetes during pregnancies despite doing "everything right".
Past Unhealthy Behaviors
Both doctors describe their previous dysfunctional approaches to weight management. Dr Lucy engaged in cycles of avoidance (hiding from the scales until clothes didn't fit), followed by extreme calorie counting and restriction that required canceling social events for a "clear run". She would weigh herself six times daily and swing between eating nothing and consuming two packets of Maltesers daily. Dr Mary spent hours exercising and restricting food as a medical student, yet remained heavier than peers who ate more with no effort.
Emotional Eating Recognition
A major breakthrough for both was recognising emotional eating patterns. Dr Lucy realised she was using food to soothe, numb, and manage her emotional state, describing herself as "emotionally illiterate" at the time. She had no other tools for emotional regulation beyond food.
Current Sustainable Approach
Both now manage their weight through addressing insulin resistance rather than restriction—using low-carb real food, intermittent fasting, and strength training. When they gain weight (which happens during life challenges like holidays, pregnancies, or family crises), they respond with gentle adjustments rather than punishing restriction.
Reframing Success
They've shifted focus from appearance to health. Dr Mary considers herself a "hottie" (healthy on the inside) and grateful she doesn't have the strokes, heart attacks, and dementia she treats in patients. Dr Lucy focuses on maintaining mobility despite her muscular dystrophy rather than achieving thinness.
Diet Culture Resistance
Both acknowledge ongoing struggles with diet culture messaging that says they should look like "gym bros" to be credible health professionals. They receive criticism for not having perfect physiques but choose to continue their work, refusing to use before-and-after photos and instead focusing on metabolic health markers like blood insulin levels.
The "Golden Goose" Analogy
Dr Mary uses Stephen Covey's metaphor: they are golden geese laying golden eggs (their contributions to society, relationships, and patient care), and nobody cares what the goose looks like—the focus should be on caring for yourself to keep producing value.
Practical Strategies
Current weight management includes food tracking for data (not restriction), protein prioritisation to prevent evening hunger, mindful fasting (2-3 twenty-four-hour fasts weekly for Dr Mary), and prioritising strength training despite busy schedules
Episode 282:
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) Hello, lovely friend. How are you this morning on what is a miserable Tuesday morning in Melbourne? Honestly, the weather here — I know, I bang on it all the time. It's ridiculous that I'm still banging on it five years later, but it is miserable here. So I am going to introduce my own personal ray of sunshine, Dr Mary. Hello, lovely friend. How are you today?
Dr Mary Barson (00:42): I am feeling good, my lovely luminescent Lucy. I am pretty tired. I was on call for the whole weekend at Long Hospital, saw lots of interesting things, did lots of interesting stuff. And I'm attempting to take it easy today, give myself a bit of rest and recuperation.
Dr Lucy Burns (01:00): Yes, I love that. So often we don't prioritise rest. We're very good at being busy. We're very good at achieving, very task oriented, as are many of our members, followers, cohort, women, anybody. And rest, it's so interesting. So many people think rest is a bit lazy. But as you and I know, you absolutely have to complete the stress cycle. And the way we complete it is to finish it with some rest.
Dr Mary Barson (01:27): Yeah, it's an ongoing struggle for me, but I'm being conscious of rest today. Yes.
Dr Lucy Burns (01:34): Indeed. All right, well, today we have got what I think is a great topic because, you know, it's all about us. But we're talking about why you and I aren't skinny. We've had multiple comments on social media over the years of like, why would I listen to you? You're not that thin. No, it's a good one. Yes, we're not. I guess from my point of view, I have a family history of type 2 diabetes. My dad has diabetes. So clearly there's some genetics in there with the ease of which I can become insulin resistant. And then coupled that with muscular dystrophy, I have no metabolic muscle organs, so to speak. So I gain weight like crazy, like so easily. And the olden day me used to just kind of go, oh, well, you know, gain weight, don't step on the scales, hide, hide, hide, hide, until I'd reach like some critical threshold, which usually was no clothes to wear. And then I go, oh. And then I procrastinate for days or weeks about getting on the scales because I just knew it was going to be, you know, in my own words, horrendous. Get on, and then I go, oh, now I have to do something.
Dr Mary Barson (02:52): Yeah. The pain had become so great that you're like, it pushed you into action. Yeah.But not necessarily the right action. Am I right, Lucy? Lucy of old.
Dr Lucy Burns (03:02): Correct. Yeah. The Lucy of old. Not yet. Well, it would be, you know, I would do calorie counting restriction. There'd be multiple points along the way that would have to happen before I felt like I could take action. So I would need what I used to call a clear run. So there would have to be no, no events on because, you know, how could I go to an event? That event might be just, you know, coffee with a friend. It's not a major event. You know, so I would then go, oh, and I'd cancel everything and just sort of stay home and count and track and hop on the scale six times a day. And, you know, and then feel good that I had some action going, but it was really, when I think about it now, just a really unhelpful way to manage my weight.
Dr Mary Barson (03:47): Not sustainable and not getting to the root of that insulin resistance.
Dr Lucy Burns (03:52): Yeah. Two things, I think: insulin resistance and emotional eating. So I was a very, very good, good emotional eater.I'm like so skilled. Yeah. Some good emotional eating skills. Yeah.Absolutely. What about you, Miss?
Dr Mary Barson (04:13): Ah, similar, but different. So I also have a very strong family history. So both my parents have type two diabetes. There is diabetes and obesity throughout my family. I have polycystic ovarian syndrome, which is a type of severe insulin resistance in the ovaries. And I have struggled with my weight my whole life. Ever since I was a child, I was a chubby kid. And so for me, it's been a lifelong story. And, you know, I've got the whole suite, everything, you know, I even got gestational diabetes in my pregnancies, you know, despite doing everything, inverted commas, right. So for me, I can gain weight like crazy. I can remember when I was a medical student and I lived in a hostel with a whole lot of other rural medical students. And I'd look around at these other lovely, lovely humans that I was sharing this accommodation with in my 20s and just see what they ate. And they ate more than me and they ate cakes and they ate pasta. And they were all so much thinner than me with so little effort. But I was exercising hours a day and restricting and doing all of these things to control my weight. And yet I still wasn't as slim as these other people. And it is just my phenotype, just my genetic heritage. So I find that if I stop doing what works, if I take my foot off the accelerator as such, then I can very easily gain weight, and I can very easily gain weight, you know, right now. And it's just something that I have to manage. And there have been times over the years where I have, my weight has gone up again, and then I've taken action and got it back down again. The difference, I suppose, in the last few years is that I do it in such a much more healthy and sustainable way, a way that works with my metabolism rather than against it. It's not dieting, it's not restriction. It's getting to the heart of that insulin resistance.
Dr Lucy Burns (06:07):, Yeah, absolutely. And I think same with me. So I used to, you know, people have heard me use the lane assist analogy. I would be careering down the road of life on either one side, just, you know, hoeing into everything, or on the other side, hoeing into nothing. And it would be just this, you know, out of control feeling. The only time I felt in control was really when I was sort of hoeing into nothing, except that just is not sustainable. And the story in my head used to be, I will be able to sustain it because I'm very disciplined and I will be able to do it. And I could definitely do it for reasonable amounts of time. But then what would happen is that I would start to get a bit hungry again, and I'd start eating a bit more again, again, not tons, but it would then just sort of trigger this floodgate of the all or nothing. And then I'd just go back to eating, you know, two packets of Maltesers a day. So it was a really wild ride, if you like.
Dr Mary Barson (07:09): yeah, does not sound fun. Not a fun ride.
Dr Lucy Burns (07:12): No, no, not at all. And also, the tricky bit would be that the reason I think I'd start eating, you know, two packets of Maltesers again, was that it was really my only tool to emotionally regulate. And I really had no other tools that I knew about, or even understood. I didn't really even understand what I was doing. I just sort of thought, look, I'm just giving up again. When really it was about using food as a tool to soothe, to numb, to mitigate, to manage my emotional state. And just being so emotionally illiterate that I had no idea what I was doing. And I just would say to myself, Oh my God, I can't believe you keep doing this. Whereas I think now I have got tools. Now, having said that, I am not perfect at all. And in fact, recently, I was on holidays, yay, with some beautiful friends of mine — our ours, my husband and I, we've got these, you know, just, you know, when you've just got really, really good friends. So we were away for two weeks together. And you know, it's interesting, part of me thinks I let loose. I don't think I let loose, not loose in the old way of that loose would let loose. But certainly, certainly drank more alcohol than I would normally drink. So we probably had a drink most days, and occasionally would eat more carbs than I normally do. And yeah, I gained some weight. And it's like, and I got back and on the drive home, I was thinking, my clothes feel a bit tighter. And so I knew, I knew what was going on, because I wasn't doing the things that normally keep my weight maintained. I was doing the things that don't maintain my weight. And so, you know, it's not rocket science. When I got on the scales, I had gained some weight. That was just sort of evidence of what I'd been doing. And so old me may have gone, Oh God, and sort of thrown in the towel, thinking, God, I can't even go on holidays for a couple of weeks and sort of relax without some sort of punishing consequence. And then I just sort of thought, and maybe, you know, just gone, I'll stop it. I'm not doing this anymore. It's not working. That's probably what I would have said. It's not working. Of course it's not working. I wasn't actually doing it. Yeah. So, so, so it's interesting, because on my way home, then I was formulating a little plan — we were driving, so there's plenty of time to be formulating plans. And I just decided that, right, well, what I need to do is do the thing that works, which is, you know, change the things that I was doing. So I've been home a few days now. So I've stopped having gin every night. That's been helpful. You know, when you're on holidays, you'll often have like five o'clock sunset drinks. So the drinks come with the food. And even though we were doing low carb crackers and cheese, still eating more food than I would normally eat in that environment.
Dr Mary Barson (10:21): Yes. Yep. Yep.
Dr Lucy Burns (10:23): Yeah. Yeah. And I think this is the really interesting thing. Like we talk a lot about, you know, calorie counting is not the best way to lose weight. Calorie restriction is not the best way to lose weight. But there is no doubt that if you overeat, like you eat more for a considerable period of time — again, not one day, but in my case three weeks — it goes somewhere.
Dr Mary Barson (10:48): Yeah, it does. Yeah.
Dr Lucy Burns (10:49): That's right. Even with low insulin. So I think this, I mean, we've done an episode earlier on, Can I eat as much cheese as I like?
Dr Mary Barson (11:00): Yeah. And the answer is, you know, no. Not without consequences. Yeah. Absolutely. And that's that, that non-hungry eating. Ah, so what about me? Well, I have gained some weight recently, and over the years it's just sort of come on and off and on and off over the years. And it has always been that, that little devil on my shoulder, that little inner critic wanting to scream at me and tell me that I'm hopeless and stupid whenever it has. And that there is a real pattern with me. So I mentioned that I am probably one of the most genetically primed people to be obese, have diabetes — like I just have got all the genes for it. And it is something that I have struggled with my whole life. But, you know, if I eat low carb real food, if I do my intermittent fasting, if I do my strength training, then usually, you know, things are under control. But if I just let my — if any, I let any of those go for a while, the weight does creep back on. So circumstances. So I've got a three-year-old now. When I was trying to get pregnant with him, I stopped fasting. And, you know, the weight did sort of creep on during that time. Then when I was pregnant, I did gain a bit of pregnancy weight towards the end, as you typically do.
Dr Lucy Burns (11:22): That's normal.
Dr Mary Barson (11:23): That's right. I didn't fast while I was breastfeeding. So then that was another time of some weight gain. And, you know, I gained weight with that whole adventure. And then, you know, I got it back down again. Then I got that extremely annoying CSF leak, that neurological injury, which was just so challenging. And with that, I actually had bed rest for weeks. Weeks. Yeah. I mean, if you add it all up, not all together, but actually sort of multiple months of bed rest over that whole seven-month adventure. So two things happened there. I lost a lot of strength and I really deconditioned. And also I was gaining weight. And also during that time, I just let fasting go. And I don't even really completely know why, other than the mindset I was in was just, you know, I just feel crappy. And I wasn't, you know, eating the chips and chocolate and ice cream, but I just wasn't doing the things that I need to do, which is the strength training, the fasting. I was kept on track with my food, but not the other two. But then I sort of, you know, slowly got it back down again. But then my mum got really unwell last year, and there was a lot of chaos and turbulence in my life relating to that. And just with that added stress, I stopped fasting. And then that was enough for the weight to start coming back on again. And there would be a time, old Mary would have been so pissed off about this. I just would have been like, this is not freaking fair. You know, here I am, I'm eating well, you know, I'm not out having chips and chocolates and ice cream. It's just so unfair that this happens to me. But I was — that's just not a helpful belief. And so I've reframed that belief. Instead, I think about, well, what if I wasn't doing all of these things at least most of the time? Okay. So I've gained some weight. My pants are a bit tighter, and I like it. I want to be five kilos lighter. I don't feel great about that. But if I wasn't eating low carb real food, if I wasn't managing my mindset, you know, if I wasn't doing the things that are helpful to me, I'd have diabetes by now, right now, you know, I would be in a much worse situation. Whereas as it is, I'm fairly metabolically well, I am a HOTI, healthy on the inside. And I'm so grateful that I'm a HOTI. I mean, I just did a shift at, you know, Lawn, and I, you know, I'm treating people who've had strokes and heart attacks and have got dementia and all of these consequences of insulin resistance. I just don't want that for myself. So, okay. My thighs and tummy are jigglier than I want. My pants are a bit tighter than I want, but I'm still healthy.
Dr Lucy Burns (15:04): And that is what I choose to focus on. Yeah, absolutely. And I just love that because same with me, I could have the mindset, you know, I've got muscular dystrophy. I can hardly walk. So there's no strength training in my, in my life. So my brain could go, well, you know, if you can't do any strength training, what's the point? You know, if you can't walk, what's the point? But what I try and focus on is thinking, well, I would like to be as lean as I can without damaging my muscles because then the muscle fibers that do work have got less work to do. So that it's not about being thin so that I look good. Although to be honest, that still creeps into my mind. That. Absolutely. Mine too. Yeah. You know, diet culture — that you're not good enough if you're not thin enough, that, you know, you can't be helping other women manage their weight. If, you know, you don't look like a supermodel, blah, blah, blah. It's a quiet voice, but it is still there versus the, just the actual reality, which is, well, if I was still eating, you know, bags of Maltesers a day, which I did used to do because I had no skills to manage these emotions. And, you know, we all have big emotional upheavals. You know, you've had challenges with your own health, your family's health. You've got little kids. There's, you know, a chaotic household. I've obviously got my own health challenges. Mobility — reduced mobility sucks. Degenerative neurological disease sucks. But the option that I have is do nothing and basically end up in a, you know, my Jason Recliner watching reruns of Bold and the Beautiful for the rest of my life. And yeah, I don't really want to do that.
Dr Mary Barson (16:56): Yep. I can see how that has less appeal than doing something.
Dr Lucy Burns (17:00): Yeah. So the consequence is that I certainly give less of a shit about what I look like because I don't have a body that looks or even functions like a standard human, if you like. But that's not really what's important. What's important is your contribution, I think, to society, or the relationships you have with your friends, you know, plus or minus your family. And again, I use the — the family is double-edged. I know for many, many people, families are hard and, you know, we're coming into Christmas when family relationships rear their ugly heads and cause lots and lots of trauma for people. But yeah, having meaningful connections is so important to our wellbeing. And yeah, I think just feeling purpose in life.
Dr Mary Barson (17:50): You're the golden goose, Lucy. That beautiful analogy from Steve Covey. You are the golden goose, and you can lay these beautiful golden eggs, which is your contribution to society. It is your relationships, your friends, the way you enrich my life, the way you enrich the life of your patients, you — these beautiful golden eggs that you lay, and you have to look after the goose. And it doesn't matter. It doesn't — nobody cares what the goose looks like. You lay these beautiful golden eggs, and to be able to keep laying them, you need to care for yourself.
Dr Lucy Burns (18:24): Yeah, absolutely. And I think that's the bit that we need to just keep front of mind for women. I know we have all been tarnished, if you like, by diet culture, which really plays at our own insecurities and vulnerabilities.
And none of us are immune to that. But, you know, I think about, like, your little Maxie who's three, and, you know, he loves you with all his heart and soul. And he does not give a rat's ass whether you have a thigh gap or not. Absolutely not. That's right. And, you know, if we could cultivate that feeling and that connection and, you know, somehow sell it, we would be bazillionaires because that is really at the crux of it. Same with you. You know, you love him with all your heart and soul. You don't care what he, you know, looks like, whether he's even got snot coming out his nose or whatever three-year-olds have.
Dr Mary Barson (19:26): There's a lot of snot. There's a lot of snot. Yeah. Yeah.
Dr Lucy Burns (19:28):Yeah. So if we can cultivate that same feeling for ourselves, then really we're our own self-fulfilling machine, if you like. And I think that can be really a really useful way to think about ourselves, our bodies, our, you know, who we are, what we do. Yes.
Dr Mary Barson (20:48): I had my little struggle with this recently when I found out that we had been, you know, finalists in the Lifestyle Medicine Awards for the Australasian Society of Lifestyle Medicine. And you rang me up, Lucy, and I was like, hey, we're finalists, like, there's an award ceremony in Sydney. Do you want to come? And I had to think about logistics of kids, but then I got back to you, and I did. But then, you know, there's this little bit of my brain just goes, oh, I wonder what I look like in the photos. Like this, isn't that just a horrendous little, like, diet trauma hangover that we have? That there's this moment where we get to celebrate our achievement, our contribution to lifestyle medicine in Australia, which is something you and I are both so passionate about. But a little bit of my brain was just going, oh, the photos. And I mean, I just gently, you know, gently can brush that aside. But yes, we just need to shift the focus away to health, to contribution. That's what's going to make life so much more meaningful.
Dr Lucy Burns (20:49): Yeah, absolutely. And again, it's tricky. There are still, you know, diet culture is alive and well. And because we run a health program, our Instagram feed — my Instagram feed — is full of other people. Instagram thinks I'm interested in that, which obviously I am, but it's full of people, and particularly sort of trainers. So gym bros, gym women, gym people who are still well and truly entrenched in calorie counting, who still use their physique as an example of do what I do and you look like me. And so it's easy for us to feel vulnerable in this space because we don't do that and we don't look like that. And, you know, again, personally, I think our way is the best. But I am really, really mindful that by us putting ourselves out there in this space without these gym bro bodies, we are fodder for criticism.
Dr Mary Barson (21:55): Yes. Yeah. And that is hard. That's always hard. I mean, no matter how tough you are, how tough you believe you are, it's still unpleasant. Getting criticism is still unpleasant, getting negative comments. And, you know, it's just something that does echo through your life, and it is something that we have to manage. But what's the alternative? The alternative is that we stop spreading our message and that we sort of run and hide?
Dr Lucy Burns (22:24): Yeah. I don't want to do that. No, I don't want to do it. Look, there are days. Don't get me wrong. There are days where I think, oh, my God, why am I doing this? This is, you know, horrendous. And then I just have to have a little, you know, like you, gentle chat, little kind of rally of my own inner troops and go, no, no. Well, I think what we do is important and hopefully helpful. And hopefully we provide a space for all of the people who are like us, without their gym bod, perfect bods, but, you know, genetically primed to develop obesity or type two diabetes. And we will never put up, you know, the before and after pictures, because that's also really toxic, because it's not about what you look like. You know, I'd love to be putting up, you know, here's their, here's their bloods before and after insulin results, which, which we certainly do when we do masterclasses, we will show people that this is what you can achieve. And I think that's really helpful because it doesn't add any moral value to what you look like. It's really at the guts of health.
Dr Mary Barson (23:26): That's right. We could do some before and afters with, like, ultrasounds of your liver, if it's your non-alcoholic fatty liver, and then there's your beautiful, healthy, smooth liver. Don't know if that would be such a scroll stopper on Instagram, but that's kind of what we believe in.
Dr Lucy Burns (23:42): Totally, totally. It's all about being a HOTI, healthy on the inside, healthy on the inside. So coming back from my holidays and I've gone, ooh, yep. You know, a bit of weight on the scales. Old me would have gone, I don't know. I'll wait till after Christmas because, you know, it's now November. I need to clear run. Remember, old me needed a clear run. New me has just gone, oh, look, let's just, just reign this in a little bit. Like it's not, I don't have to do a whole overhaul. So the interesting thing is I am doing an audit. I'm tracking for a couple of, maybe a week. Like I don't need to track forever, but it does two things for me. One, it makes sure that I'm eating enough protein during the day so that I'm not hungry in the evening and vulnerable then to snacking from the cupboard. But two, it also gives me a little chance to pause from mindless scoffing of nuts. So, because in my brain I go, ooh, if I eat those, I'll have to put them on the tracker. That's okay. I can put them on the tracker, but do I want to do that? No, I don't really want to do that. I think I'll just let them go. I don't need them. And so it, again, just highlights, I think, what you do mindlessly versus what you actually do.
Dr Mary Barson (24:53): Yes. Yes.
Dr Lucy Burns (24:54): So again, it's not a diet. It's just using this as data to make some adjustments without white-knuckling your way through everything.
Dr Mary Barson (25:05): Yeah. And for me, the reset that I need to coming back to is just examining my life and looking at, like, just why aren't I doing the strength training? And, for example, and for me, that's usually because I just let, I let other priorities push it on my time. That's my default: I'll do everything for everyone else and nothing for myself. So it's just that little reset that, oh no, this actually is extremely important. I need to care for this golden goose. And then also is to be mindful with my fasting again. And, like, my fasting is not that extreme. It's sort of, you know, two to three 24-hour fasts a week, but I'm flexible with it. Sometimes it'll be less, sometimes it might be more, but just tuning into my body and just making sure that I'm mindful that I can really nurture my body with short, sharp periods of not eating. And that is a good thing for me personally, and just making sure that I prioritise it. If I do both of those things, then, you know, I get back on track really quickly.
Dr Lucy Burns (26:07): Yeah, absolutely. Absolutely. Which, of course, just brings me to a little public service announcement. We do have a Keep Staying on Track Through Christmas masterclass coming up. We will drop the link in the show notes, or you can go to our website at rlmedicine.com, and it's rlmedicine.com/christmas. So it's not that hard to remember. But you, Mary, are giving a fabulous masterclass on options that you've got to stay on track because, for most of us, the default becomes, "It's all too hard," and we just give up and do nothing. And our favorite thing — well, we've got a billion favorite sayings, as you know — but one of our favorite sayings is, "All or something." So doing something is better than nothing. And you've got some great strategies. If people want to tune into that, it's November 20th, 7:30 PM Australian Eastern Daylight Savings Time, i.e., Melbourne time.
Dr Mary Barson (27:01): Melbourne time. Absolutely. Manage the stress and the food environment of Christmas whilst having fun, having fun, and staying healthy. It's totally possible. It's just those few brain-based strategies. So I'd love to see you there.
Dr Lucy Burns (27:14): Wonderful. All right, friends, we will talk to you next week. Have a fabulous week ahead.
Dr Mary Barson (27:18): Bye now.
Dr Lucy Burns (27:22) 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.
