Beyond ADHD A Physicians Perspective: Dr. Leslie Golden

Dr. Leslie Golden

I just got to a point where I felt like I kept just prescribing and adjusting meds and adjusting meds and higher meds. Not really getting to the core of, what was going on with people, that whole comprehensive health, that whole person. When I started diving a little deeper and trying to help people.

Maybe not increase her insulin. I kind of unlocked Pandora's box.

Hello. Hello. Welcome to beyond ADHD. A physician's perspective. I am Dr. Deanna mage. I'm a family medicine physician practicing in rural Texas. To be hindered by my ADHD, but I now see it as a gift that helps me show up as the person. I was always meant to be both in my work and in my personal life.

In the past two years, I've come to realize that unlearning some of my beliefs and some of my habits were just as important as learning the new set of skills.

Well, hello. Hello everybody. I am so excited today. I have my dear friend, Dr. Leslie golden. She's a physician and she also has a master's of public health degree, and she's not only a board certified in family medicine. She's also board certified in obesity medicine. So, so exciting to have her here today so she can share her, expertise.

And she's going to explain to us how, behavior can, can really manage, the patient's long term disease states. And so obesity obviously can be prevented sometimes, but sometimes it's genetic and sometimes it's. You know, just the easy thing to do when we're so tired at the end of the day to go through the drive through and stuff, but you have the real deal here today.

She, is gonna share all her expertise with us. And so we're so excited to have her, and she's gonna explain why, sometimes metabolic syndrome, can be something that, It's not so obvious just on labs. So please, please, please, tell us how you decided to go into family medicine and how you decided to do obesity medicine.

Sure. Well, thank you for having me so glad to be here. When I went through, med school, I was one of those people that I went into med school and I was pretty sure I wanted to be a radiologist. not entirely sure why. , and then went through and got in my first clinical rotation was family medicine up in Queens.

 It was this single practitioner owned his own practice. Everyone knew him. He knew everybody. And I was like, this is a great experience. This is fun. But I'm gonna be a radiologist. Right. And so went through my clinical rotations and as I went through, I just couldn't let go of that experience.

That feeling that really knowing people, a child would come in and he'd say, His mom had this and the grandmother, I took care of her too and had this. And, um, and then I think the truth really came out when I got to my electives and did my radiology rotation. And I was like star for interaction.

When people would walk by in the hallway, I'd be like, come hi, come talk to me. Went into family medicine, for that relationship, that connection., as I practiced family medicine, loved it, but it's so broad, you know, everything and which is fun. But I just got to a point where I felt like I kept just prescribing and adjusting meds and adjusting meds and higher meds.

And. Not really getting to the core of, of what was going on with people, this, that whole comprehensive health, that whole person. Um, and when I started look diving a little deeper and trying to help people. Maybe not increase their insulin. I, it, I kind of unlocked Pandora's box of, um, just diving into like their nutrition, their physical activity, their stress, their sleep, their behaviors, their relationship with themselves and others.

And, um, found a home in obesity medicine, because it's such a complex disease that you have to look at all of it in order to help someone. Yes,

that's so good that you PO you found those con connections because the way that medicine right now is unfortunately, like if you're working with insurances, they kind of dictate some how much time we spend some time with their patients and they kind of say quickly, come in, come out.

Right. Mm-hmm . Sometimes it feels like bandaids instead of like getting to the root cost of why is it that they have obesity or why is it that they're depressed? Or why is it that they're doing X, Y, and Z. And so it's so good that you found a way to be able to start to make connections and, and using those relationships to help you to do that.

Um, have you noticed any links with people who have ADHD and obesity or have you noticed any pattern.

Definitely, you know, I think what's interesting to me about obesity and ADHD is in, in so many ways I can see similarities, right. Because very behavior based, but not completely behavior based. Right. Just a lot of, you know, the, the neuro the brain chemistry changes and, um, that in.

Conditions that there's stigma about. Right. I, I think there's still people, even the medical community that still don't believe ADHD is, is a legitimate thing, right? They, they, oh, it's because of inadequate parenting or, or, or you should grow out of it. And all these misunderstandings and obesity is so much the same.

Um, so many people think it's, it's a choice and, and it very, it very much isn't that way, ADHD in the behavior. That often people with ADHD struggle with can, can be a lot of the behaviors that we work with with patients that struggle with obesity, but at a whole nother level. Right? So, so much about obesity.

We work with patients on, um, structure planning, um, sleep, you know, impulse control, processing, their thoughts, and then you take. And take the ADHD brain and put those together and, and it it's, it just adds more complexity to it. And it's just another great example of just you can't treat obesity in a vacuum.

Right? Um, it it's, it's just so many layers there. And I think it was back in, I wanna say 2015, the American journal of psychiat. Did a meta-analysis and found that, um, patients, the, the prevalence of obesity was 70%, uh, increased by 70% in patients with ADHD, um, in adult patients. And I believe like 40% in, in children with ADHD.

And I think it has a lot to do with. You know that prefrontal area, uh, where we, where we see those struggles with the planning, the organization, the attention, um, emotional reaction and memory, and, and also the neurochemical changes, uh, with dopamine being low GABA being low, you you're gonna see.

Physiologic drive in someone with ADHD to naturally seek a dopamine increase from the external sources, which comes in food. And sure. We're not aware that that's what we're doing. But Austin, that's what we're doing. Yes, that's

exactly like, I didn't realize why, like around two or three, like I wanted to go get that cookie or wanted to go get that chocolate because I was trying to get through the end of the day.

And I was trying to give myself a little bit of dopamine boost. Right? Mm-hmm or why it is that sometimes even though you are quote unquote, trying to lose weight, you go and grab the stuff. Give you the quickest, like energy boost and you're not. And it almost feels like impulsively. You don't have a choice mm-hmm but like you said, when you approach it from the point of view, like, oh, let's set up a plan, let's try to plan for what's gonna happen.

If you do say slip or whatever, like how can you get yourself back on track so that it doesn't become. Except, you know, a one time slip doesn't become like a week or a month or a year slip. Right. Mm-hmm because then our brain can usually be like, ah, what's the point? Right. And so understanding that, you know, you have a way to change if you want to, to help yourself, um, in your weight and in the way you.

Take in information and process information. It it's so helpful to have a physician who can walk you through those, through those things. Um, yeah. So have you seen any specific eating disorders? I know sometimes binge eating can be part of like, uh, they don't realize that, but it, it, again, because of the impulse problem, sometimes it, or you forget, like you're so hyperfocused on what you're doing, you forget to eat.

And then all of a sudden. Binging or, or then you feel guilty about it, or what have you noticed, have you noticed any

patterns? I definitely would say that there's a strong link there between binge eating disorder specifically and, and that, um, that ADHD tendency with that impulse control that, that the emotional reaction control and external sensory seeking.

And, um, that, that just encouraging that, that rapid pace and, you know, You're consuming at the rate. Um, based off impulses before the executive part of the brain really has a chance to like, process and be like, oh, that's right. I had these more significant goals that I was working on. I was trying not to engage in this.

Yeah, that's so good. Um, and I know that we're not the, the patients like, you know, doctors per se, so we can't really give them a specific medication treatment plan or anything like that. But what I have seen is that sometimes some of my patients do really well with like a medication, like by. Plus, like you said, uh, maybe a, an exercise plan or a personal trainer or a nutritionist, like kind of like in a group approach.

Yeah, definitely. Cause in, in both obesity and ADHD, you know, there, there are several tools out there. To treat it right. So I often feel like the behavioral approach working on your thoughts, realizing that your, your thoughts don't control you, that you can increase your awareness and, and take control back over.

It's a big part of it, but the medications are a huge part of our toolbox as well too. And it, when we're talking about obesity and ADHD, we're talking. Diseases. Right? So the, the abnormal physiology is there. The BR the brain chemistry shifts are there, and we do have medications that, that can help. And, and in that study, they did show that when, when patients with ADHD were on medical treatment, They were less likely to have obesity, just really showing the benefit of that control and Vivs is very helpful in, in binge eating disorder.

It's FDA approved for that. There are some other medications that are, um, used off label that can be very effective too. Um, And on the obesity side of things, a lot of our FDA, FDA approved medications, you know, like Leggo, um, are very good at reducing that, that brain interest in food, those, those physiologic drivers within the hypothalamus that are encouraging, that, that seeking out of.

I really, before what Gabi came into the picture, you know, some of my, my patients who were, uh, prediabetic or had a metabolic syndrome, like I was starting them on SIS because it was, I just understood how it worked. And especially my ADHD patients who had obesity, like when I saw like, when I did RSIs plus like their ADHD me.

Oh my God. Like some of them lost, like. 2040 a hundred pounds. And it was just such a life changing thing for them that mm-hmm, all of a sudden they could have one more tool to allow them to self, uh, regulate something that they didn't think they could ever do. And so it's so good to be just really like, see the person as a whole, right?

Because there, like you said, there's so many components that can come together and can make a big differe. Um, so tell us a little bit about your practice. You know, you help patients with obesity. Are, are you also doing family medicine or are you mainly obesity? A little bit of both. Can you share a little bit with

us?

Sure. I, I still do a small amount of family medicine, mainly because of patients I've taken care of for, for a while. But I'd say it's been about three to four years now that I've been practicing obesity medicine and it is just kind. Taken over my practice, you know, and, and, and I enjoy it. I love it. It's been wonderful.

So, um, it it's been a welcome change because it's happy medicine, you know, it, it giving people hope and really having such a change in their lives, um, helping them make such a change in their lives. It, it really is fulfilling and in you're you're right. You give them that sense of self worth back. You, you see their confidence growing and then you see the way it impacts every other area of their life.

That. A switch has flipped, you know, in their head and they have this power over, over their relationship with food again or over their behaviors again, in the, in this, in the case of ADHD. So most of my practice now is primarily weight, health related, um, or even patients who have obesity, but don't necessarily wanna treat the obesity directly, but they want a physician that's going to.

Treat them in respect them, um, and not make every complaint that they have. About oh, it's your weight? Um, so kind of a, a little bit of, of all.

Yeah. That's so good. Um, so where can people find you if they wanna be like, oh my God, I can't wait to talk to Dr. Golden. She's speaking my, my choir , you know, where can they

find you?

Right. Right. So I, I practice, um, at Watertown family practice in Watertown, Wisconsin, and. It's uh, between Madison and Milwaukee. And, uh, I'm able to provide virtual care to patients across the whole state of Wisconsin. And I have, um, Instagram and, uh, Facebook pages, weight and gold wellness, as in worth your weight and gold.

That's

amazing weight, gold weight in gold. That's amazing. So, uh, where do you see yourself in the next, like three to five years? Oh,

in the next three to five years, you know, I. Huge advocate, um, for equal access to care for obesity. I, um, work with the obesity medicine association, um, on their national advocacy team.

And I, I would love in the next three to five years to. Have a little bit more of, of a national platform and, and be sharing and, and helping more people understand obesity as a disease and help reduce the stigma around the disease. And what

about

for fun? What do you see yourself doing in the next three to five

years?

Oh, lots of bicycling in, uh, vacations with family. So. You know, a few years ago, um, in a period of stress and challenged myself and wanted to take something else more. I had not ridden a bicycle since I was a child. Um, and decided I would take on rag. Bri. I don't know if you're familiar with that. um, but it's a bicycle right across the state of Iowa.

So I'm actually leaving tomorrow to, to head to rag Bri. Um, and I will be riding my bicycle with my husband and 25,000 other, uh, wonderful friends, um, across the state. That's

amazing. Yes. You know, we, we often forget that fun can be really what fuels us and what really can, uh, replace what sometimes food gives us

Right. Sure. So we gotta find what gives us the meaning to our things. So, um, it's been so wonderful. So the last part that I usually. Is that let's say that people just started listening to us, you know, because we have wondering attention, what would be the little nugget that you would want them to take?

I, I would just want people to, um, take home that everything can change.

You have the ability to still change your behavior, find ways, um, to take back control of your thoughts and. Change your health. And there are more and more people that are open to helping in, in areas of weight, obesity, mental health, more and more than probably ever, ever, that we've seen before. So reach out for help.

If you don't find the right person willing. Keep searching. That's beautiful.

Yes. Keep searching. You're definitely worth the investment. You're definitely worth, uh, realizing that, you know, a second or third opinion sometimes is needed because, um, different people have different personalities and sometimes, you know, we don't.

Explain ourselves as well. Uh, when we're saying something, but you need to keep advocating for yourself so that you can get the help that you need. And, and you're right. There's so many resources nowadays. So it's, it's worth definitely exploring, but thank you so much for coming to be in my guest today.

It's been one.

Thank you.

Thank you for spending your time with me. I really believe that time is your most valuable asset. Please subscribe to the podcast, share with your colleagues, and don't forget to check out my website@adhd-livecoach.com, where you can find out about my upcoming coaching. Classes as well as free master classes and other exciting events that are happening.