Episode Transcript
[00:00:00] Speaker A: From Riverside Health System. This is the Healthy youy Podcast where we talk about a range of health related topics focused on improving your physical and mental health. We chat with our providers, team members, patients and caregivers to learn more about how to maintain a healthy lifestyle and improve overall physical and mental health. So let's dive in to learn more about becoming a healthier you.
I'm really excited to have with me in the Healthy youy studio today, Dr. Sheba H. Mohsen, MD, a board certified family medicine provider. And we're going to be talking about shaping healthier futures, tracking obesity.
So welcome. Glad to have you.
[00:00:45] Speaker B: Thank you for having me.
[00:00:46] Speaker A: All right, so I'm Frankie Myers and today we're going to be talking again about, about health challenges that affect nearly half of US Adults in the US Today with obesity.
So what we're going to be diving into is how do family medicine physicians manage this?
And Dr. Mohsen is with Riverside Williamsburg Family Medicine.
So let's get right into it. Tell me how you ended up in this particular specialty.
[00:01:19] Speaker B: So, family medicine, I've been practicing that since 2011. Graduated from the Riverside Family Medicine Residency and have been with them since.
So family medicine was always, or primary care was always something that I wanted to do like taking care of an individual as a whole and also families. And so that was what I wanted to do and continue doing. But got more interested in obesity medicine more recently.
[00:01:49] Speaker A: Okay.
[00:01:50] Speaker B: And got board certified with American Board of medicine in 2022.
[00:01:56] Speaker A: Okay. Okay.
And how, I'm sure, you know, being in your field, you see all types of diseases.
So obesity is that one that you're seeing more often. And because of that is something you really, really dove into.
[00:02:15] Speaker B: And yeah, that's what makes my patients, is what makes me think about that. Right. So if you look at the statistics, it's staggering. Like about 40% of adult Americans are obese or overweight.
The incidence is rising in children. So when I go in an exam room and see overweight or obesity patients with obesity, I, I do see that the impact it has on their health, overall health and emotional health. Right.
So comorbidities start with that. And things like hypertension, diabetes, high cholesterol, sleep apnea, all of that plays a great role in, if you want to make a patient healthy, you have to address the root cause. And I began to find that that's the root cause.
So that's what got me interested in it. And I started getting educated, extra certification to see what, what tools we have so I can help my patients Better.
[00:03:19] Speaker A: Thank you for your commitment and your dedication to this particular area, which is so important.
Let's start by talking about a few common myths.
One of them is obesity is rare and mostly a personal kind of failing. Is that, is that, you know, it's something that, you know, I struggled with and even within my family.
So I'm glad we're exploring this a little bit more.
According to the CDC, over 40% of United States adults now live with obesity, and nearly 1 in 10 qualify as severely obese.
Among kids and teens, the rates have climbed to 21.1%, with 7% in the severe category.
Additionally, obesity is not just about weight. It's linked to over 200 chronic conditions, as you mentioned, from heart disease and type 2 diabetes to sleep apnea and even more cancers.
Dr. Mohsen, how do these results show up in your daily work? And you alluded to some of that a few minutes ago.
[00:04:39] Speaker B: Yeah. So these are some numbers that should be eye openers.
We as healthcare providers already see that in our exam rooms. I think it should be an eye opener to the general public and health policymakers to do something about it, since we. That is how you will make your population healthy. Right. To address the cause. And the myth that you talked about, that is what I see day in, day out. And I feel like that if I can leave listeners with one thing, I would say look at obesity as, first of all, change the language. It's like not an obese person, it's a person with obesity. Because obesity is, is a chronic medical condition. It is not as simple as eat less, move more. Which is what I am guilty of, like, thinking, going through medical school and training, the more we learned about it, the more we understand that it's a complex interplay of hormones, stress, sleep.
It's a lot of things that culture.
[00:05:44] Speaker A: With your eating habits and what you eat.
[00:05:47] Speaker B: Exactly. And then those are the things that we feel like need to be addressed.
[00:05:52] Speaker A: So what?
[00:05:52] Speaker B: First of all, no, it's not as simple as eat less, move more. It is address why you're having problem with your weight. And to do that, you need to go to the doctor and open up. And the doctor should be willing to deep dive into what the cause is. So, yeah, I don't think it's as simple as that.
[00:06:12] Speaker A: No.
[00:06:13] Speaker B: Yeah.
[00:06:13] Speaker A: And I know for me raised in the south, you know, food was an expression of love. You ate everything on your plate, and we had large plates and lots of carbs.
And so that was my foundation to eating habits. And it's really hard to overcome sometimes.
[00:06:30] Speaker B: Yeah, yeah, yeah, yeah.
[00:06:32] Speaker A: So thank you. Dr. Mohsen, many people oversimplify obesity, as you mentioned.
Can you help us understand what the real picture is?
[00:06:41] Speaker B: Yeah. So in our culture especially, I would talk to you about what I see in a typical patient who's struggling. Right. It can be a man and a woman at whatever age.
We lead very stressful lives. Right. The lack of accessibility to affordable, nutritious food is real.
[00:07:03] Speaker A: It's real.
[00:07:04] Speaker B: It's so real. You go after a long day of work, you go home and what is easy for you to just pick up some fast food, pick up something that's easily prepared. Sadly, that's not what.
[00:07:15] Speaker A: Or eat a bunch of junk, just what's at hand.
[00:07:17] Speaker B: And that's our lives, right? Yes. And then obviously it's going to be easier to do that versus going to the grocery store trying to figure out what's nutrition, reading the label, making sure that because we don't have affordable. And affordable is the key too. I mean, there are places that sell nutritious food that's healthy, but they've marketed it so that it is so difficult to attain.
That needs to change. Right. So that's one thing. Meal preps and all of that. That requires time. I mean. Yeah, ideally we would be doing that. The second part is like stress and sleep.
So you know, when you're stressed, you're not sleeping. Sleep. Lack of sleep raises your stress hormone, cortisol.
That is a way you hold on to the weight because your body is stressed. It needs to comfort you, so it has to do that.
So these things have to be addressed at the cellular level before we even go further as to pharmacological intervention and all that.
I always say the basis of a healthy life and weight loss is always going to be nutrition and activity, the activity part of it. Again, in our culture, we drive everywhere. Our culture is not something that is conducive to walking, to go to the grocery store or to go to work or biking or doing things like that.
That lifestyle is also not helping us to lose weight. So those are the two things. Going to the gym is not what I think is sustainable for most people, again because of the.
The time and the money construct of that. So I feel like those two things are important. Healthy eating and healthy lifestyle comes from food and movement.
[00:09:05] Speaker A: Yes, yes. And with the movement, you have to plan for it. I know the older I get, the more sedentary I get.
[00:09:13] Speaker B: So if it's built into our lifestyle, like I have to walk to go to work, Or I have to walk to go to the library or the store. Then it becomes second nature to you. Other developed countries in the world, you, you see that?
[00:09:27] Speaker A: Yeah. They get fresh food every day. They drive their bike, they walk, they have small refrigerators.
[00:09:32] Speaker B: Yeah.
[00:09:33] Speaker A: They don't stockpile a lot of food.
[00:09:35] Speaker B: And I'm not saying make drastic changes and completely overall, no little steps, like recognizing first of all that that is something we can do, incorporate little by little in our life, then I think that would be a way to go. But making people aware of it, my patients aware. I do that every day, like make little changes and I think eventually it will become your lifestyle.
[00:09:56] Speaker A: Yes. I had to make dress. I can't buy it. It can't be in my house. I love potato chips. They can't exist there or I will eat them.
[00:10:03] Speaker B: Yeah.
[00:10:04] Speaker A: Do you know what I mean? So the first stressful thing that happens, I'm grabbing that bag.
So, Dr. Mohsen, when someone says, I've tried everything and that may be true, what do you say?
[00:10:19] Speaker B: Absolutely.
[00:10:21] Speaker A: Yeah.
[00:10:21] Speaker B: They've tried everything that they can in there within their means.
[00:10:25] Speaker A: Yes.
[00:10:26] Speaker B: And their, their understanding of why they've gaining weight, why they're gaining weight or become overweight, that. So that leads me to like the, the literacy about nutrition. Right. That is another hurdle that, that a lot of people, you know, for years we've grown up with, like what is healthy, what is not.
[00:10:46] Speaker A: Right.
[00:10:46] Speaker B: Misconceptions. Like people like, what do you eat? I don't eat anything. Just a bowl of cereal in the morning. That's sugar.
[00:10:53] Speaker A: Yes.
[00:10:54] Speaker B: That's worse. Yes. So that's something. Educating my patients on that and then saying how to count carbs versus macros like proteins, what's nutritious, what's not.
That is something that. But they have tried. It's not like they're not trying. Another thing is, I always laugh about that is like people, whenever now there is more understanding, awareness of obesity as a crisis and how people are trying to be. So obviously people will try to sell you stuff, right?
[00:11:27] Speaker A: Yes.
[00:11:27] Speaker B: So every time if I have a penny for people say, have you heard of this diet, Paleo or keto or you know, all this. So there is a lot of information out there and most of those things are based on, you know, consumerism and for profit things. Right. I'm not saying these. I say every diet works, right? Yes, they do work because you're following it and you're consistent with it. The moment you stop doing that, you're gonna gain your weight back. So what is more lasting? Changes in your lifestyle completely change. Do not give up stuff.
Eat in moderation, exercise like you should, and eventually it will become something easy that you can sustain rather than just strict diet, crash diets for two weeks and then there you are again.
So I am very skeptical about people selling you supplements that are there to lose to help you lose weight or pre prepared meals that you are going to rely on for the rest of two months that you've signed up for.
[00:12:33] Speaker A: Right.
[00:12:34] Speaker B: So I feel like those are the things that I need to talk to my patients about. So try but work with your health care provider to achieve that goal and you will get there. But yeah, they try.
[00:12:46] Speaker A: Yes, absolutely. And building that relationship and rapport with your health care provider also helps to keep you on track.
[00:12:54] Speaker B: Absolutely.
[00:12:54] Speaker A: I know I wouldn't be able to do it without them. So can you share an example of root causes that often somewhat go unnoticed?
[00:13:04] Speaker B: Yeah. So I talked about a little bit of sleep and stress.
[00:13:07] Speaker A: Right.
[00:13:07] Speaker B: That is something that we do see a lot. I'm stressed people who do shift work, right. Nurses, our nurses, our doctors who are shifting, you know, they don't have time to eat, they eat on the go, they grab whatever it is, they don't get enough sleep. So that there are two, three things going against them.
The other thing I see is menopausal and perimenopausal women that, you know, suddenly they're realizing they can't lose weight or keep it off at their at around 45 to 55 age and they get frustrated, they're trying their best, they're actually in the gym longer or doing that, but they're fighting against an uphill battle.
[00:13:45] Speaker A: Right.
[00:13:46] Speaker B: Because the hormones are acting against them. So to talk to your GYN and your primary care doctor together to achieve that, I think these are examples I see on a daily basis.
[00:13:55] Speaker A: Yes, absolutely. Because there's some myths sometimes about different things, whether it's hormones that can be cleared up to support.
[00:14:03] Speaker B: Yeah, there's a lot of like different. You have to tailor it to the patient. Not everything is every the best for every patient.
[00:14:10] Speaker A: Absolutely.
Okay, before we get into the solutions, it's important to recognize the emotional weight behind this topic. For sure. For many conversations about obesity can come with some judgments and shame.
So there's a lot of blame around weight. What role does stigma play in the conversation?
[00:14:33] Speaker B: I think it was an eye opener for me when I started studying for my boards or obesity medicine and the the numbers. 70% of the patients are scared to talk to their doctor. About it because of the stigma that they go through in a healthcare provider's office.
So that is not good. Like, if a patient is coming to a doctor, scared to talk about their weight or scared to even seek help, then where do they go from there? So that's when they go to online supplements and things like that. But they rather do that than talk to the doctor.
We tend to, like, think that everything is easy. Like, you know, why don't you just get on the treadmill or lose weight? So shame. Shame needs to be taken out of this equation completely. You know, it is, like I said, a chronic medical condition. What have you tried now? What can we do to find out the cause? So the shame is there, the blame is there. We need to make it go away so that the patients who are scared to seek help from their providers can do that and then in turn become healthier. Like, not just with the weight, but also their comorbidities. That I've seen patients who've lost weight, gotten off hypertension, diabetes, cholesterol medications, because this corrected that.
[00:15:51] Speaker A: I'm glad you mentioned that. Something that I hear often is it's family history, meaning there's nothing I can do about it, so I might as well enjoy life because I'm gonna get it anyway.
[00:16:01] Speaker B: That's not true. Yeah. I don't. I try to dispel that as much as I can. Yes. Eating. You know, eating. Yeah, You. Like you said cultural. Right?
[00:16:10] Speaker A: Right.
[00:16:11] Speaker B: So you. We're not saying, like, do not follow your cultural roots.
[00:16:16] Speaker A: It's all in moderation.
[00:16:18] Speaker B: Exactly. Everything in moderation. I often say that even water in excess is bad for. You end up being hyponatremic.
So everything in moderation should be that. Because then you don't binge. You won't binge when you get the chance. Right? Yes. And it's human nature to want to do that. If you like something, you like something, you like it.
[00:16:37] Speaker A: And what I say to them is, yes, you may have a strong family history, but you need to do everything to avoid it or prolong it. Right. Because of the negative impact on those diseases on your health. Absolutely. You mentioned a little bit about the cultural considerations, and we talked about in the community. I talked about the way I was raised and how I've had to modify that.
[00:16:59] Speaker B: Yeah. I think that is, like, if somebody is mentioning it or you notice that that's the first thing you talk about, your eating habits. Right. What, how do you eat? When do you eat, who do you eat with? What is your culture around? But also when you say you understand their culture, you tell them you see them. Right.
[00:17:18] Speaker A: Right.
[00:17:18] Speaker B: You see where they're coming from and you respect that.
And you can still be healthy following all those cultural norms and do that. Find ways to, like, incorporate that. Like, if there's a recipe that you like, you can find a healthier version of it and make it right.
[00:17:36] Speaker A: Or if you like rice, it's one meal a day, not all three meals, which I. Yes.
[00:17:41] Speaker B: So, yeah. Acknowledging that there is a component of cultural influence on our eating habits and lifestyle is a big deal. And it should be. And if somebody, especially somebody's bringing it up to you, or if you feel in their history there is a history of overeating or diabetes or something that they eat a lot.
I myself, like, always am conscious because I grew up in a Pakistani family. Everything's around food and celebration.
So we do enjoy that. But at the same time, I have a family history of cardiovascular disease, so I can't say, well, that's my family history. So you do everything you can, like you said, in your power to change it, but yet be able to enjoy your culture.
[00:18:29] Speaker A: Right, right. Great points, great information.
Do you find that patients feel more engaged when their culture is. You mentioned that. You acknowledge it and then you give them suggestions of how to incorporate it, but in moderation, as you mentioned.
[00:18:45] Speaker B: I do, I do. I tell them what, like. And I love talking to them about the different. Different cuisine. And because I myself enjoy it, I travel a lot and I like to. And then we kind of like say, oh, yeah, that's great, but, you know, there's a healthier version of it that you can eat sometimes and you can save that one for.
For a special occasion.
[00:19:05] Speaker A: Yeah. And sometimes you like highly seasoned food. Like, we're of the type. You want all the seasoning in the food so you don't have to add afterwards.
[00:19:12] Speaker B: Right.
[00:19:13] Speaker A: And to make it taste good, sometimes it takes a lot of seasoning, you know?
[00:19:16] Speaker B: Yeah, I totally. And that's cute to me when patients say. I say low salt diet for hypertensive. Oh, I don't eat any salt. And I said, do you use. What seasoning do you use? Seasonal. Mrs.
[00:19:27] Speaker A: Dash.
[00:19:29] Speaker B: And I said, that is a lot. Did you read the sodium content on Mrs. Dash?
[00:19:33] Speaker A: Yeah, but if they can't taste it, they don't want to eat it. That's another. There's beverages, there's herbs and other things you can.
[00:19:39] Speaker B: And your palate gets used to a lot of stuff. You just have to give it a go. You have to be Consistent.
[00:19:44] Speaker A: Yes, agreed, agreed.
Now let's talk about solutions. What approaches are most effective for managing obesity in the long term?
[00:19:54] Speaker B: So I did allude to that earlier a little bit. But even 10 years ago when we would talk about pharmacological management of obesity, we only had two or three medications.
They were oral medication. They are still there. Oral medications, they would be either very costly or they had contraindications for most of the people that I would want to prescribe them for. But also the results were modest, like 4 to 5% weight loss, which is most of the time you need more than that. So then came the GLP1 and GLP1 GIP1 Agonist.
These were like really revolutionary medications prescribed for diabetes.
And then we found out that they caused weight loss.
So studied for a long time, not just the weight loss part, just the diabetic part of it has been there for a while.
So we know the contraindications to that. There are only a few. We know the side effects of it and now we know what dose to give for weight loss versus diabetes. So they have been a great tool. Weight loss for anywhere from 20 to 22% from these medications, which is what we need in severe obesity with comorbidities. We don't want 4 to 5%, we want that. But you can tailor it to do it gradually. It's not a quick fix by any measure.
You do that as an additional, an adjunct to healthy life, right?
[00:21:33] Speaker A: Absolutely.
[00:21:33] Speaker B: So like I said, eating no one.
[00:21:36] Speaker A: Thing alone is going to help you.
[00:21:38] Speaker B: Right. So I always tell them this is not the, this is not the end all, be all. But this will definitely be helpful in achieving that goal that you haven't been able to achieve with just diet and lifestyle.
[00:21:49] Speaker A: Yeah, thank you. That's very helpful information.
[00:21:52] Speaker B: Very, very helpful.
[00:21:54] Speaker A: What's your advice for someone unsure about the medication or the right one for them? There are a lot of myths around the medications as well and long term side effects.
[00:22:04] Speaker B: Yes. It is actually like the people have been. It's funny to me that people have been getting it through because insurances are not quick to cover it. So people can go to compounding pharmacies or online places to help them lose weight.
I would say talk to your doctor about it. I think that's the safest way to do it. Somebody who knows your health history really well and who can monitor you closely for side effects, but also for potential complications with the weight loss. So I feel that's important.
I also think that people like quick fixes and they look at it as that, I don't think that should be the approach. I think it should be in conjunction with what we talked about earlier, but under supervision of your healthcare provider.
[00:22:59] Speaker A: Absolutely. Okay, great.
So much of what we eat and how we move is shaped by our environment. As we talked about, how can families or communities support each other in this journey?
[00:23:12] Speaker B: Oh, yeah, that's a very good question. I think that is something that, like I said, culturally, who do you eat with?
What do meals look like for you? So I think what we can do, as far as I see, is incorporate little changes and make little.
Like, for instance, with children, you can, you can involve them in meal prep, right? And, and talk to them about the nutrition of the food. Like, you know, we like this because, you know, carrots have vitamin A and this has this. And let's put some of this in our food and make it like a, like a game and like a, like, fun thing to do.
Going for like a walk after meals. Like, don't have to do it every day. You can do it two or three times a week or on the weekends. You can make that. You can go and sign up for things within the community that involve, like, the whole family to take part, which includes physical activity, games, things like that. So be more mindful of, like, if we don't do that as a family individually, it's hard to. You can do it, but it's hard to do a mom preparing meals, a meal for herself versus everybody else. So why not start with everybody? And I see that happening these days with a lot of my patients, especially when I talk about the perimenopausal women. They're like, so I have to cook differently for my family. I said, no, don't have to do that. You have to make it for everyone. So now that the kids are also understanding, there will be resistance in the beginning. Right. But I think they'll come around and do that.
[00:24:45] Speaker A: And you're teaching them measurements as well. Well, but I, you, you bring a valid point. And I always say this. We have to start with our youth, teaching them how to read labels to understand portions and serving sizes and, you know, looking at how much sugar, sodium and carb is, if you do that, they're going to go home and talk to their parents about that. They're going to role model that.
[00:25:07] Speaker B: So in school lunches and all that, I think that's important to talk about what it is. I was reading an article about different school lunches in the rest of the world, and ours have become better.
[00:25:18] Speaker A: Right.
[00:25:18] Speaker B: But compared to like, What. What it is, I feel like, yeah, that's something that we can work on. And I think Michelle Obama worked on.
[00:25:26] Speaker A: That, and I think that her work around that.
[00:25:30] Speaker B: I think that these are good little steps to change the culture over time and. And make us healthier.
[00:25:37] Speaker A: Absolutely. And so that's. How can parents help, you know, modeling those good, healthy habits. Right. We talked about that. Anything else you can think of?
[00:25:45] Speaker B: I think another thing, I see the screen time thing, like a lot of kids are glued to their screen, so maybe make it a rule, like one meal without the screen. I would say every meal without screen. But if that's a problem, then, you know, no screen. Just engaging at the dinner table, talking about daily life and things that you're doing instead of so encouraging activity in kids and adults, too. Because we are. We can do that.
[00:26:11] Speaker A: We have followed what the kids are doing. So when I was growing up, all the activities were outside. Now all the activities are inside. So things. Times have really changed. What's one small change a family can start with this week?
[00:26:25] Speaker B: So many come to mind.
Yeah. Like I said, making a meal together that's healthy. Taking classes that are healthy to how to make it, and then going for a walk with the family pet or, you know, that's all you can do a little by little by little. And eventually, things that you enjoy doing, you would want to do.
[00:26:46] Speaker A: Yes. Yes.
[00:26:47] Speaker B: And you will enjoy doing it.
[00:26:48] Speaker A: Yes.
[00:26:48] Speaker B: Increases the bond between the family, too.
[00:26:50] Speaker A: Yes. Well, I'm going to share.
Since my primary care visit a week ago, I'm down five pounds.
Congratulations. Thank you. I weigh myself daily and I log.
[00:27:02] Speaker B: That's another thing. Sorry, I didn't mention that. That's what I start with, that, you know, what do you eat? Because when they say, I've tried everything, so I say, well, here, there's so many apps. Choose one and then log everything that goes in your mouth. Because we do a lot of mindless eating.
[00:27:17] Speaker A: Absolutely.
[00:27:17] Speaker B: And we don't realize it.
[00:27:19] Speaker A: No. A handful of nuts four times a day. Nuts are good for you, but not four handfuls a day. Right.
[00:27:24] Speaker B: And even a good thing, you can do too much of it. So I would say start there. So you're logging.
[00:27:30] Speaker A: I'm going to do it. I told her, by the time I come back next, my BMI will be under. It's 33. Right now it's down to 30.
[00:27:36] Speaker B: It's gonna get there. I'm gonna get it slow and steady. Yes.
[00:27:40] Speaker A: And I know what to do, so I have no excuse.
[00:27:42] Speaker B: Yes.
[00:27:42] Speaker A: Yeah, yeah.
All right. What's your message for someone feeling defeated now? Catch me in a few weeks. Check in with me to make sure I have not entered the defeated phase in the health journey.
[00:27:55] Speaker B: I would say no. There's no, no place for feeling defeated. I think anything you set your mind to, if you're consistent with it, it's going to work. You have to not feel. You always tell yourself, like, this is just a hurdle. I'm going to come. And then work with your healthcare provider.
There is no shame, no sense of defeat. There's always a positive outlook when it comes to achieving a healthy body.
[00:28:23] Speaker A: Absolutely great stuff. How do you help patients stay motivated in those really, really, really tough times?
[00:28:34] Speaker B: I actually talk to them about it because I can sense it right. When you see them the next time and they have only lost like £2. And I was like, we will celebrate that small win.
[00:28:45] Speaker A: Yes.
[00:28:46] Speaker B: Two pounds. Good enough. This is two now. And if you're consistent, I guarantee, I say, I use these. I guarantee you that if you're just consistent on what you're doing, you will lose weight. But don't lose heart and do not another thing. They say, I had a cheat day and I.
That has to be said. No, initially, when you're trying to lose weight, there are no cheat days.
You can have cheat days when you've achieved your goal, but do celebrate little wins. So that's what I do. I motivate them by telling them that, yeah, this is a good thing. Or look at their numbers and how they've improved their cholesterol and all that.
Are they sleeping better or they're, you know, those kind of things. I do talk to them and then just give them motivational, you know, talk a little bit about how.
[00:29:30] Speaker A: Yes, yes, yes. And find a village. Yeah.
[00:29:33] Speaker B: You know, there's so many partners. Yeah, there's so many people if you're looking for that.
[00:29:38] Speaker A: Yes, yes.
This is great stuff. I've enjoyed having you and I've learned a lot myself. So, Dr. Mohsen, thank you for shedding light on this disease and the deeper conversation and offering real hope to our families and viewers in navigating these challenges.
[00:29:56] Speaker B: Thank you so much for having me.
[00:29:58] Speaker A: You're welcome to come back anytime.
[00:29:59] Speaker B: I would.
Thank you. Bye.
[00:30:03] Speaker A: Thank you for listening to this episode of Healthy Youth. We're so glad you were able to join us today and learn more about this topic. If you would like to explore more, go to riversideonline.com.
[00:30:18] Speaker B: SAM.
