Eva Sheie (00:03):
The purpose of this podcast is simple. We want you to get to know your doctor before meeting them in person because you're making a life-changing decision and time is scarce. The more you can learn about who your doctor is before you meet them, the better that first meeting will be. There is no substitute for an in-person appointment, but we hope this comes close. I'm your host, Eva Sheie, and you're listening to Meet the Doctor. Welcome back to Meet the Doctor. I'm so excited about my guest today. Her name is Rose Huber. She's a clinical psychologist in Miami, Florida, and her counterpart in the practice she works in was on the podcast a few months ago, Dr. Keshavarzi. And so we learned about her from him and thought that we needed to hear her story too. So thank you for joining me today.

Dr. Huber (00:54):
Thank you so much for having me. I appreciate that.

Eva Sheie (00:57):
Okay, so in the context of your work with Dr. Keshavarzi, who's a bariatric surgeon, how are you helping patients there? Let's kind of start there.

Dr. Huber (01:07):
Yeah, no problem. So I work with Dr. Keshavarzi and his patients, and I do all of the pre-surgical clearances for him. So anybody who's going to do any kind of bariatric procedure, they speak to me. We go over any mental health issues, I set them up for some information, getting them prepared from a mental aspect because that is very important to this process for the long-term success. So we just make sure that there are no major mental health issues and then just kind of prepare them for the process and also set them up with getting to know me and any future kind of contact that they need in order to again, maintain some success with their procedure.

Eva Sheie (01:53):
I don't know that we hear often that there's a psychologist or someone there to help with the mental aspect of bariatric surgery. Is that unusual for your practice? Are you guys special in that way?

Dr. Huber (02:05):
I think that's what sets us apart is that we want to approach the whole process. So not just the physical process because weight loss is, and health is a lot of it is mental and trying to change behaviors, relationship with food. So for a long-term success, I think you really need to address that and it definitely sets us apart from others because what we see in a lot of other practices is just they do a procedure or they just do medication and then they send you on your way. We really want our patients to be successful, so we really try to set them up for success in that way.

Eva Sheie (02:45):
What kinds of struggles, aside from weight, are the patients that you see having?

Dr. Huber (02:51):
Well, every day kinds of life stressors. We see a lot of people kind of going through relationship issues, divorce, family kinds of things going on, anxiety, depression. So there are a lot of different things that are involved with kind of your everyday life or people's mental health that we have seen through this process, so.

Eva Sheie (03:16):
Are these, a lot of times these stressors or these life situations, the reason why somebody is overweight and needs to have surgery in the first place, those don't go away just because you have surgery, right?

Dr. Huber (03:27):
Oh, absolutely. And I tell people that all the time you will have stressors, it's life, things will happen. And so what we're trying to do is figure out where you are right now, how to help you currently. But in the future when things happen, you don't go back to let's say poor coping mechanisms. And a lot of people have used food as a coping mechanism to deal with stress. I hear that time and time again as I'm emotional eater or I get stressed and not just stress, but you could be excited or a celebration or something really good happening and then someone will find themselves in front of the refrigerator and wondering, why am I here? But just that excitement or that change in emotions can lead people to overeating or grazing or eating poorly.

Eva Sheie (04:17):
I think, why am I here? The answer is usually because I'm always here. So what do we do instead? That's the bigger question.

Dr. Huber (04:26):
Yeah, exactly. So I work on trying to figure out what have people used for their coping mechanisms besides food, when do they find pleasure in other things? We develop coping strategies so that they don't use the food anymore, or at least they try first to use some other coping skills and see if that helps to derail that path in the brain. So some things that people have come up with. I love bubble baths. I like talking to this friend because they're really supportive. I like going outside for some fresh air journaling, meditation. There are so many different things out there, but we like to figure out what specifically for that person has worked in the past and or could potentially work that fits within their lifestyle and their personality.

Eva Sheie (05:13):
So a lot of times I would expect that you are replacing a behavior and trying not to replace it with another addictive behavior. For instance, I used to hear all the time I quit smoking and now I eat ice cream instead. Which that backfires too in a different way. Ice cream probably won't kill you as fast as cigarettes.

Dr. Huber (05:35):
But it's still a negative coping mechanism. Right?

Eva Sheie (05:38):
Yeah. Do you find that people give you a lot of pushback on what the replacement is? All of your suggestions sound incredibly boring to me Dr. Huber. Writing in my journal is not going to scratch the itch that I have.

Dr. Huber (05:52):
Yeah, I mean, sometimes I get some pushback and sometimes then I say, okay, well then figure out something else because we can't keep using food as the coping mechanism. And yeah, you're right, you can substitute with another negative coping mechanism. So I do mention that we have to be cautious going into the procedure that we don't do that. Some examples would be drinking or shopping to access or even sex. There could be other things that could be potentially problematic if they replace it in that way.

Eva Sheie (06:26):
Why do we like the things that are bad for us so much more than the things that are good for us?

Dr. Huber (06:31):
There's excitement in it, there's, it's easy, it's fun. It releases endorphins, so it's a pretty strong connection in the brain. And so we have to change that connection completely. So I have a client that would tell me the other day, you'll be so proud of me, instead of snacking on some chips, I went for some carrots. And I'll say, that's great. It's healthier option. However, you're still connecting, I'm stressed, therefore I need to eat or I need to munch. And I would rather you do something else because eventually you're going to get tired of the carrots or you're going to run out of the carrots and you're going to go back to the chips because that connection is still very strong in the brain.

Eva Sheie (07:20):
For many people, millions, I would say many millions of people, this is overwhelming, extremely overwhelming. And so we can't talk about bariatric surgery without talking about GLP one medications. And where I want to go with this is really what you're describing here to me is food noise. So I replaced the noise of I want cookies with, I want carrots. The noise is still the noise. How have you seen the medications actually change behaviors for people who have struggled like this for so long?

Dr. Huber (07:57):
Yeah, I do hear a lot that the medication does help kind of calm the noise and that it frees them to do other things or enjoy other things and to not have to have that noise so loud. And so I think that it can be very helpful. I only worry that if they stop using it or they run out of it, what then happens have they developed those coping mechanisms that are positive that they're able to maintain? So it's really trying to strengthen more of the positive coping mechanisms and dealing with their stressors on an everyday basis and not letting things build up.

Eva Sheie (08:35):
Are the medications part of the practice that you're in? Are they just a tool in the toolbox?

Dr. Huber (08:42):
It's one of the tools that we have that we offer. And again, we talk about the pros and the cons to it and just making sure that they understand fully what they're getting themselves into when they start with this. If you stay on it, I think that it does tend to keep working, but you really do have to make those behavior changes. You have to make those positive coping skills in your repertoire of things to use.

Eva Sheie (09:09):
If you sort of zoom out from all the people that you see. Is there a profile of someone who's set up to be successful? What does that look like?

Dr. Huber (09:20):
So we have found, actually a lot of research that we've done, and I usually mention this in our initial meeting with people, is that what we see is that people who have a lot of information, a lot of knowledge, they've really done the research, they've started to kind of gear up towards this mental change, this lifestyle change versus just like a diet or a fad, then they are going to be more successful if they have support. That's also another huge indicator for long-term success. If they've already started on their weight loss journey or they've been successful in the past, that's also another indicator for long-term success. It's the people that they just come in and they're looking for that quick fix and they think it's a magic wand and everything will be great, and they don't have to make those changes or put the effort or energy into it. They tend to not be so successful in it.

Eva Sheie (10:13):
Have you ever seen this phenomenon where you get married and then all of a sudden over a period of years you end up wearing the same, the husband and the wife are basically the same size because you eat the same food all the time?

Dr. Huber (10:27):
Well, and the same lifestyle, the same interests.

Eva Sheie (10:31):
Yeah.

Dr. Huber (10:31):
Exactly. And so something that you're talking about is something I talk about with our clients too, is that relationships can change and do often change. And so the best thing to do is to bring their partner with them and get them on board because where they used to bond over going out to a restaurant or trying some food together, it's going to be different. And so if you can go for a walk together, go to the park together, go to the gym together, then that makes for a more successful long-term result with the relationship. But also for the weight loss too.

Eva Sheie (11:08):
You have to find activities, you both, and when you have kids and you have a busy kid life and finding time for activities together, it's a lot of work. This is a big change.

Dr. Huber (11:19):
It is. You've got to figure out how to set yourself up for success as much as you can. So you're going to take the kids to their practice, see if maybe your partner can come with you and you can walk around the field while they're practicing or go to the gym during that time or find ways to set yourself up for success. But it is difficult. Absolutely.

Eva Sheie (11:41):
So in your capacity in the practice, you see people to clear them for surgery, do you also see people long-term on regular schedules every week or every other week?

Dr. Huber (11:51):
I do. I do. And actually they tend to be more successful as well, the ones that really keep up.

Eva Sheie (11:56):
I bet.

Dr. Huber (11:57):
And they know that they need to put the effort into the emotional and behavioral changes. So absolutely, I see them. And not everybody has the time or the desire, so it's really at their discretion of what they can do. But yes, I highly recommend it because I see just better long-term results with it.

Eva Sheie (12:19):
How did you end up here with, it's clear you have a heart for people who are going through this. How did you get here?

Dr. Huber (12:27):
Yeah, that's a great question. So I originally was interested in forensic psychology, and I went to grad school in Texas, in San Antonio, and I had the option to take a intro to behavioral health psychology course, and I thought that sounded interesting, and I've always been into health and those things. And I took that course and I remember learning about BMI, and so I said, well, let me check out my BMI. And so I did, and I found that I was considered obese, and I remember just being like, me obese? And so I decided to make some major changes, and I actually lost quite substantial weight, diet and exercise and was just really on it. So I loved that aspect of health. I ended up doing an internship with the VA in their MOVE program, which is all about helping veterans with weight loss and maintaining weight loss, and then started doing surgical evaluations. And again, I at first was not a believer in it until I saw the after effects and then go, okay, this is pretty amazing. And so I just continued and we continued to do this and then met Dr. Keshavarzi and just had this great synergy to create this program together that really addressed both the physical aspect as well as the mental aspect.

Eva Sheie (13:54):
Are you there or do you see patients anywhere else?

Dr. Huber (13:58):
Yeah, so I have my own practice, and so I see actually I do pre-surgical evaluations for a lot of different surgeons in Florida as well as Texas. And I have my own clients too who don't necessarily have the weight issues. There are other issues that they're working through. So it's called SoMi psychology, but I do predominantly work with all of Dr. Keshavarzi's clients.

Eva Sheie (14:23):
It's important work. Do you live in both Texas and Florida, or do you go back and forth, or are you just mostly in Florida now?

Dr. Huber (14:30):
No, I'm Miami, Florida, but I do a lot of telehealth, actually, predominantly, I think maybe 99% of my work is telehealth. So I meet just like this over the camera and we talk, and I have clients in Texas and I have clients in Florida, and I just happened to have my license from Texas because that's where I did my training and kind of started out.

Eva Sheie (14:52):
I hope you have a standing desk.

Dr. Huber (14:55):
I have actually a desk over my treadmill at home. So when I do work from home, I do sometimes get on the treadmill.

Eva Sheie (15:02):
A treadmill desk.

Dr. Huber (15:02):
Yep. And sometimes when I'm talking to my clients, I'm walking and I try to kind of be as efficient I can and trying to move while also talking to people.

Eva Sheie (15:14):
I have a story about realizing when you have that moment of reflection and say to yourself, how did I get here to this place where I need to lose all this weight? And calculated that I started working from home in 2007, which is when I basically started sitting all day. And if you gained a pound a month from 2007 to 2024.

Dr. Huber (15:37):
It adds up.

Eva Sheie (15:38):
It does. It creeps. It could just be a couple extra a hundred or a couple extra thousand calories a month. But over time, if you don't go in the other direction, there you are. And especially if you don't see other people every day and you don't have to get dressed in nice clothes every day, all of these little things were like frogs and pots of water that is boiling.

Dr. Huber (16:03):
Yes, exactly. So I have a little alarm on my computer that goes off every hour, and all it says is it tells me the time. It says it's 11 o'clock, it's 12 o'clock. That is my mental reminder, get up, walk around. You need to move. Don't keep sitting. And I tell clients that all the time. Set a timer, 45 minutes, an hour. You shouldn't sit more than that because you need to be moving, even if it's just a little bit of movement.

Eva Sheie (16:31):
Where do you think that we're headed? Obviously the last year, I mean, for anyone who's paying attention to the weight loss industry and the overall picture, if you don't know about weight loss medication at this point, you probably don't have a television or a phone. So can you kind of give us your take on what's happening and where we're headed?

Dr. Huber (16:53):
I think it's important to talk to your doctor and stay in touch with them and see where we are going with things and what's going on so that you have the best tools. Like we're talking about that knowledge, that information is key. And so staying on top of that while you're also, again, working on yourself and your coping mechanisms and your behavior changes and things like that, I think that that's going to be really important is knowledge and information as well as the continued process.

Eva Sheie (17:24):
I think what's surprising, it's probably not a secret here that I am coming from personal experience on some of these questions, that when your primary focus in life isn't I got to lose weight, it shifts to something else. And figuring out what something else is kind of a hard thing to do, and having the support of someone like you would be really valuable in sorting through all these, like, I'm not a different person, but I'm completely, the whole context around me is different. Still the same in my head, mostly I think, I hope. Actually I'm nicer.

Dr. Huber (18:00):
I think it's finding, well, that's good, that's good. It's finding joy and other things and life and figuring out what is it that makes you happy and what feels like fun for you. And doing more of those, starting somewhere with it and doing more. Going back to a time where you did feel happy and in a good place, and what were you doing at that time? What were other people seeing and noticing about you that made you think that that's a time that you were happy and joyful? And again, just trying to start there. So I think that it's important to reflect and to have somebody to talk to, have a sounding board or to kind of think through things differently.

Eva Sheie (18:43):
When somebody comes to see you for the first time, what does that appointment look like?

Dr. Huber (18:48):
At first, I pretty much try to help them feel at ease. I promise I don't bite. Just talk to me as if I'm just a person that you're talking to, you shouldn't hold things back from me. This should be a place where you can feel really free to just be you. So I have some people who apologize for cursing or for saying something that they feel like is inappropriate, and I tell them, no, no, no. This is the place you need to feel like completely yourself. I want you to just let it out because that helps me to help you to really kind of get your inner dialogue. And so it's more about just getting to know them. Tell me a little bit about yourself. Tell me how you got to this place and where we are and the process, and then we go from there.

Eva Sheie (19:38):
Is there anything you've noticed that most people have in common in that storytelling about themselves

Dr. Huber (19:46):
When it comes to weight issues? Absolutely. I have an intake that I ask for people's strengths and their weaknesses. I want to know what they feel strong about and what they feel like as a weakness. And I started to notice after a while that the weakness was consistently people telling me that they can't say no, that they take on the responsibilities of their entire family, that they can't say no to their boss, to their family, that they just have a hard time saying yes to themselves, but they can't say no. And that was consistently across all the uptakes.

Eva Sheie (20:29):
Wow. What an interesting discovery. What do you do with it?

Dr. Huber (20:35):
Well, I talked to them about my hierarchy of where I really feel like taking care of others. You first really need to take care of yourself, so you have to first take care of yourself, then your relationship, then your children. A lot of moms have a hard time with that one, and then their extended family and then their community at large, because if they are not in the best place for themselves, then their relationship suffers. If their relationship's not in a good place, then their children around them suffer, and then it just trickles down. So if you take care of yourself, if you really take that time out, you are going to be so much better of a partner, of a mom, of an extended family member, a sister, a brother, a child of community, a volunteer, maybes doing something else for others. So you really do have to focus on making sure you take care of yourself first.

Eva Sheie (21:30):
And I don't think any of us would want to set our kids up to fail. And so when they're young, especially showing them is way more important than telling them. And if they grow up seeing you take care of yourself, then they know that that's normal when they get there.

Dr. Huber (21:47):
Yes, exactly. Exactly. You are their biggest role model, and kids soak up everything, so when they see you do things, even say things, they will take that on. They plant that and then they use it later on in life. And so you want that inner voice. You want the seeds to be positive.

Eva Sheie (22:07):
Yep. That's very wise. What do you do outside of work?

Dr. Huber (22:13):
Oh, so I try to take care of myself as much as I can. And a lot of my time is involved with my practice as well as my husband and I have a son who is an avid baseball player, and so we do a lot of baseball stuff, including throwing the ball and going to the parks and the games and all of those things. So travel, I love traveling, going to Colorado, Texas, California. I ski a little bit. And yeah, that's pretty much it.

Eva Sheie (22:48):
It's been a pleasure getting to know you. I am sure that I'm going to have you back at some point. I just don't know when or where yet.

Dr. Huber (22:54):
Please do.

Eva Sheie (22:55):
But we'd love to hear more from you, especially on such an important topic that we all over here, care about this subject very much so. It's nice to hear from an expert.

Dr. Huber (23:06):
Thank you. Appreciate that. Yeah, I do think that it's really important, especially when it comes to weight, to put the mental health aspect in it. I actually kind of have a percentage of it. I feel like 30% is the medical aspect, like either the surgery or the medications. It's 30% of your weight loss journey and 70% is up here is behavioral changes, the emotional connection with food, the things you need to change in order to continue the weight loss, because the medical aspect will give you some weight loss, whatever it is that you do. But if you don't change the mindset and your approach, then it's not going to be, again, long-term or as much as you would like it to be.

Eva Sheie (23:50):
Nobody wants to gain it back.

Dr. Huber (23:52):
No, no.

Eva Sheie (23:54):
If someone's listening today and they want to reach out to schedule with you or just find out more, where should they look?

Dr. Huber (24:01):
SoMi psychology.com is my website, or they could call Dr Keshavarzi's office, miami VIP surgery.com. So either one.

Eva Sheie (24:11):
We'll put those in the show notes. Thank you so much, Dr. Huber.

Dr. Huber (24:15):
Thank you. Thank you. I appreciate it. Thanks for having me on.

Eva Sheie (24:21):
If you are considering making an appointment or are on your way to meet this doctor, be sure to let them know you heard them on the Meet the Doctor podcast. Check the show notes for links including the doctor's website and Instagram to learn more. Are you a doctor or do you know a doctor who'd like to be on the Meet the Doctor podcast? Book your free recording session at Meet the Doctor podcast.com. Meet the Doctor is made with love in Austin, Texas and is a production of The Axis, T-H-E-A-X-I-S. io.