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If you’ve ever had a patient training for a marathon (or you are that patient) this episode will change how you think about fueling, injury risk, and longevity in running.  In this episode, you’ll learn: Why runners over 35 are uniquely vulnerable to injury, even when they "eat healthy"Why so many runners under-consume carbohydrates (and how to explain carbs without triggering fear)How inadequate fat intake may increase injury riskHigh-yield screening questions clinicians can ask runners in a short visitWhat RED-S (Relative Energy Deficiency in Sport) really is and why it’s often missed in older athletesWhen sugar and ultra-processed foods actually make sense for endurance athletesConnect with Erin  Ultra Appetites  Resources Mentioned: Australian Institute of Sport International Olympic Committee – RED-S Consensus Statement (2023)    RED-S Clinical Assessment Tool American College of Sports Medicine Joint Position Statement Any Questions? Send Me a Message Support the show Connect with Colleen: Instagram LinkedIn Sign up for my FREE Newsletter - Nutrition hot-topics delivered to your inbox each week. Disclaimer: This podcast is a collection of ideas, strategies, and opinions of the author(s). Its goal is to provide useful information on each of the topics shared within. It is not intended to provide medical, health, or professional consultation or to diagnosis-specific weight or feeding challenges. The author(s) advises the reader to always consult with appropriate health, medical, and professional consultants for support for individual children and family situations. The author(s) do not take responsibility for the personal or other risks, loss, or liability incurred as a direct or indirect consequence of the application or use of information provided. All opinions stated in this podcast are my own and do not reflect the opinions of my employer.

Patient-Centered Weight Management | Dr. Robert Kushner on the Six-Factor Questionnaire, GLP-1s, and Lifestyle Counseling  “Eat less, move more” might be the fastest way to lose your patient’s trust, according my my guest Dr. Robert Kushner, a passionate doctor, educator, and researcher who has spent more than four decades improving care for people living with overweight and obesity. Dr. Kushner shares the framework from his new book, Patient-Centered Weight Management: The Six-Factor Professional Program and Toolkit, including his 27-item Six-Factor Questionnaire designed to quickly identify what’s really driving a patient’s struggles (food environment, time, mindset, movement, self-talk and more). You’ll also hear how lifestyle counseling fits alongside today’s anti-obesity medications, including GLP-1 receptor agonists. If you counsel patients on weight, obesity, nutrition, or behavior change, and you want a time-efficient system you can use in real clinic visits, you'll love this framework. Resources: Buy the book! Patient-Centered Weight Management Connect with Dr Kushner Any Questions? Send Me a Message Support the show Connect with Colleen: Instagram LinkedIn Sign up for my FREE Newsletter - Nutrition hot-topics delivered to your inbox each week. Disclaimer: This podcast is a collection of ideas, strategies, and opinions of the author(s). Its goal is to provide useful information on each of the topics shared within. It is not intended to provide medical, health, or professional consultation or to diagnosis-specific weight or feeding challenges. The author(s) advises the reader to always consult with appropriate health, medical, and professional consultants for support for individual children and family situations. The author(s) do not take responsibility for the personal or other risks, loss, or liability incurred as a direct or indirect consequence of the application or use of information provided. All opinions stated in this podcast are my own and do not reflect the opinions of my employer.

What’s missing in obesity care? It’s not another diet plan or more willpower.  In this episode Colleen  is joined by Dr. Robyn Pashby, clinical health psychologist and co-author of The New Food Fight, to unpack the mental and emotional side of obesity care (the part most clinicians were never trained to address) Together, they break down why shame, stigma, and oversimplified “just eat less and move more” messaging continue to derail patient progress, even in the era of GLP-1 medications. Dr. Pashby introduces the powerful concept of food noise vs. shame noise, explains why some patients feel safer seeking care from pop-up prescribing clinics, and shares practical, trauma-informed strategies clinicians can use, even in short visits.  In this episode, you’ll learn: Why willpower is the wrong framework for behavior change and weight managementHow to talk about weight without triggering shame or damaging trustThe difference between food noise and shame noise and why medications don’t fix bothLanguage clinicians should avoid (and what to say instead) in weight conversationsHow to support patients on GLP-1 and anti-obesity medications beyond the prescriptionWhat Health at Every Size gets right and how to practice health at many sizes Red flags for disordered eating in patients of all body sizesIf you want patients to stay engaged in care, feel safe coming back, and make sustainable progress, this conversation will give you a new lens Resources: Obesity Medicine Nutrition Course - use code POD15 for 15% off! Connect with Dr Pashby Any Questions? Send Me a Message Support the show Connect with Colleen: Instagram LinkedIn Sign up for my FREE Newsletter - Nutrition hot-topics delivered to your inbox each week. Disclaimer: This podcast is a collection of ideas, strategies, and opinions of the author(s). Its goal is to provide useful information on each of the topics shared within. It is not intended to provide medical, health, or professional consultation or to diagnosis-specific weight or feeding challenges. The author(s) advises the reader to always consult with appropriate health, medical, and professional consultants for support for individual children and family situations. The author(s) do not take responsibility for the personal or other risks, loss, or liability incurred as a direct or indirect consequence of the application or use of information provided. All opinions stated in this podcast are my own and do not reflect the opinions of my employer.

The 2026 Dietary Guidelines for Americans just dropped and the new upside-down food pyramid caused quite the chatter online this week.  In this special Nutrition Newsroom roundtable, Colleen Sloan, PA, RDN, brings together nine nutrition experts to break down what the new guidelines actually are (and what they’re not), what stayed the same, what changed, and what’s missing.  You’ll hear respectful disagreement, real-world clinical concerns, and practical talking points you can use the next time a patient says, “So… butter is healthy now?” Here’s what we discuss:  What the Dietary Guidelines are designed to do and how they’re created. Plus what was different about the 2026 processWhy the new pyramid graphic is creating mixed messages for clinicians and consumersThe most controversial updates: saturated fat, full-fat dairy, added sugar guidance for kids, new protein targets, and alcohol recommendationsHow to translate all of this into patient-friendly counseling without fearmongering or food shamingWhat experts say the guidelines missed: fiber, cultural diversity, access/affordability, and community surrounding mealsWhat are your thoughts on the new guideline? Resources: Dietary Guideline Advisory Committee Process Scientific Foundation for the New Guidelines New Dietary Guidelines Connect with the experts: Jennifer Van Zant Christina Link Crystal Duque Barbara Ruhs Tony Castillo Marina Chaparro Krystal Zuniga Gisela Bouvier Dustin Moore Any Questions? Send Me a Message Support the show Connect with Colleen: Instagram LinkedIn Sign up for my FREE Newsletter - Nutrition hot-topics delivered to your inbox each week. Disclaimer: This podcast is a collection of ideas, strategies, and opinions of the author(s). Its goal is to provide useful information on each of the topics shared within. It is not intended to provide medical, health, or professional consultation or to diagnosis-specific weight or feeding challenges. The author(s) advises the reader to always consult with appropriate health, medical, and professional consultants for support for individual children and family situations. The author(s) do not take responsibility for the personal or other risks, loss, or liability incurred as a direct or indirect consequence of the application or use of information provided. All opinions stated in this podcast are my own and do not reflect the opinions of my employer.

Today’s episode is a mashup of my favorite moments, quotes, and “clinic gems” from the year. These are the tools that made conversations easier, built more trust, and helped patients actually follow through… and I’m bringing all eight of them with me into 2026. Inside this episode, you’ll learn: The simple mindset shift that instantly reduces clinician burnoutThe question that uncovers barriers faster than any advice ever willHow to start tough conversations about weight without creating defensivenessThe one identity-based exercise that helps patients move beyond the scaleThe exact line I use to avoid feeling cornered by those last-minute “oh by the way…” questionsResources Mentioned: Obesity Medicine Nutrition Course - use code POD15 for 15% off! 132 | It’s Not Your Job to Make Patients Change with Staci Belcher 67 | Is Your Patient Noncompliant or Just Struggling? with Laura Koller 68 | The Right Way to Talk Weight with Nina Crowley 134 | Weight Doesn’t Equal Worth, But It Still Impacts Health with Dr Doron Sneak Peek Week Mini-Series (Goal-Weight Exercise with Jeannie Boyer)   Any Questions? Send Me a Message Support the show Connect with Colleen: Instagram LinkedIn Sign up for my FREE Newsletter - Nutrition hot-topics delivered to your inbox each week. Disclaimer: This podcast is a collection of ideas, strategies, and opinions of the author(s). Its goal is to provide useful information on each of the topics shared within. It is not intended to provide medical, health, or professional consultation or to diagnosis-specific weight or feeding challenges. The author(s) advises the reader to always consult with appropriate health, medical, and professional consultants for support for individual children and family situations. The author(s) do not take responsibility for the personal or other risks, loss, or liability incurred as a direct or indirect consequence of the application or use of information provided. All opinions stated in this podcast are my own and do not reflect the opinions of my employer.

"What’s good for the heart is good for the brain."  Can better cholesterol management in midlife actually lower your patient’s risk of Alzheimer’s disease?  In this episode, I’m joined by returning guest Josh Wageman, PhD, PA-C, a clinical lipid specialist who studied cholesterol disturbances in Alzheimer’s disease.  Together, we unpack how cholesterol, APOB, APOE4, insulin resistance, and statins intersect with Alzheimer’s disease and cognitive decline, and what clinicians can do now to protect brain health long before symptoms appear.  Plus, a peek at emerging therapies (including GLP-1 receptor agonists and lipid-centric approaches) and how a metabolic lens is reshaping future Alzheimer’s treatment. Resources Mentioned: Josh's New Book 117 | What’s the Best Diet to Lower Cholesterol? 111 | HDL = Good, LDL = Bad? It’s Not That Simple. 80 | The MIND Diet: What To Eat For Brain Health Any Questions? Send Me a Message Support the show Connect with Colleen: Instagram LinkedIn Sign up for my FREE Newsletter - Nutrition hot-topics delivered to your inbox each week. Disclaimer: This podcast is a collection of ideas, strategies, and opinions of the author(s). Its goal is to provide useful information on each of the topics shared within. It is not intended to provide medical, health, or professional consultation or to diagnosis-specific weight or feeding challenges. The author(s) advises the reader to always consult with appropriate health, medical, and professional consultants for support for individual children and family situations. The author(s) do not take responsibility for the personal or other risks, loss, or liability incurred as a direct or indirect consequence of the application or use of information provided. All opinions stated in this podcast are my own and do not reflect the opinions of my employer.

GLP-1 medications are changing the game in obesity care. Patients are losing weight, feeling full faster… and often eating less overall. But less food can also mean less muscle, unless we guide them toward the right nutrition.   In today’s episode, we unpack how clinicians can better counsel patients using anti-obesity meds, and how nutrient-dense, affordable options like pork can support satiety, muscle maintenance, and sustainable weight loss.  In this episode, we cover:  How GLP-1 medications affect hunger, fullness, and food preference What makes a protein “high quality” — and why that matters for preserving lean mass How pork compares to other proteins like chicken, tofu, and beef when it comes to: Nutrients like vitamin B12, selenium, iron, and thiamin Satiety and fullness Affordability and accessibility How to assess whether a patient is meeting protein needs — even with a reduced appetite The “Pork + Plants” strategy and why pairing protein with fiber supports GLP-1 success This episode is brought to you by the National Pork Board’s Pork & Partners healthcare professional community, helping clinicians reframe the role of lean pork in a healthy diet. You can join here!   Resources Mentioned:  Episode 109: Is Pork More Nutritious Than You Think  Lean Pork Guide Pork Comparison Guide Role of Pork for Patient’s Using GLP-1s Any Questions? Send Me a Message Support the show Connect with Colleen: Instagram LinkedIn Sign up for my FREE Newsletter - Nutrition hot-topics delivered to your inbox each week. Disclaimer: This podcast is a collection of ideas, strategies, and opinions of the author(s). Its goal is to provide useful information on each of the topics shared within. It is not intended to provide medical, health, or professional consultation or to diagnosis-specific weight or feeding challenges. The author(s) advises the reader to always consult with appropriate health, medical, and professional consultants for support for individual children and family situations. The author(s) do not take responsibility for the personal or other risks, loss, or liability incurred as a direct or indirect consequence of the application or use of information provided. All opinions stated in this podcast are my own and do not reflect the opinions of my employer.

Menopause nutrition and weight management aren’t as simple as “eat less, move more.”  In this episode, menopause expert and RD Dr. Su-Nui Escobar breaks down what’s really driving midlife weight changes and what clinicians should focus on instead.  What You’ll Learn: How fluctuating estrogen affects fat distribution, metabolism, inflammation, and cardiometabolic riskWhy traditional weight-loss advice fails during perimenopauseHigh-impact nutrition strategies: protein targets, fiber, anti-inflammatory foods, realistic portionsIntermittent fasting in midlifeKey nutrient priorities for women on GLP-1sResources Mentioned: Connect with Sui-Nui  122 | How to Support Patients on Obesity Medications Any Questions? Send Me a Message Support the show Connect with Colleen: Instagram LinkedIn Sign up for my FREE Newsletter - Nutrition hot-topics delivered to your inbox each week. Disclaimer: This podcast is a collection of ideas, strategies, and opinions of the author(s). Its goal is to provide useful information on each of the topics shared within. It is not intended to provide medical, health, or professional consultation or to diagnosis-specific weight or feeding challenges. The author(s) advises the reader to always consult with appropriate health, medical, and professional consultants for support for individual children and family situations. The author(s) do not take responsibility for the personal or other risks, loss, or liability incurred as a direct or indirect consequence of the application or use of information provided. All opinions stated in this podcast are my own and do not reflect the opinions of my employer.

How To Address Weight In A Body Positive Culture In this episode, I sit down with Dr. Tzvi Doron, a board-certified Family and Obesity Medicine physician and lipidology expert, to unpack the middle ground between body neutrality and evidence-based obesity care. We talk about how to approach weight without shame, how weight loss impacts lipids and cardiometabolic risk, and why protecting lean mass should be your new top priority in weight management. Key Takeaways Weight ≠ worth. But it still influences health, and that’s okay to address.Ask permission first. “Is it okay if we talk about how your weight may be impacting your health?” opens the door without judgment.Protect lean mass. Resistance training + adequate protein are non-negotiable for long-term health.Obesity is a brain disease. Effective care focuses on underlying drivers, not just pounds lost.Success looks different. Better labs, more energy, improved function, and confidence count as wins.Resources Mentioned Episode 111 | HDL Good, LDL Bad — It’s Not That SimpleObesity Medicine Nutrition Course: Earn 10.5 CE credits and learn how to help patients change (use code POD15 for 15% off)Connect with Dr DoronAny Questions? Send Me a Message Support the show Connect with Colleen: Instagram LinkedIn Sign up for my FREE Newsletter - Nutrition hot-topics delivered to your inbox each week. Disclaimer: This podcast is a collection of ideas, strategies, and opinions of the author(s). Its goal is to provide useful information on each of the topics shared within. It is not intended to provide medical, health, or professional consultation or to diagnosis-specific weight or feeding challenges. The author(s) advises the reader to always consult with appropriate health, medical, and professional consultants for support for individual children and family situations. The author(s) do not take responsibility for the personal or other risks, loss, or liability incurred as a direct or indirect consequence of the application or use of information provided. All opinions stated in this podcast are my own and do not reflect the opinions of my employer.

Creatine isn’t just for athletes. In this episode, Dr. Scott Forbes joins Colleen Sloan, PA-C, RDN, to unpack the latest research on creatine safety, dosing, timing, and real-world use. Plus who should (and shouldn’t) take it.  This one supplement can support muscle, bone, and brain health and has over 600 clinical trials backing its safety. Too good to be true? Nope. That’s creatine. Dr. Forbes shares the latest research, safety data, and practical recommendations for using creatine across the lifespan. You’ll walk away knowing exactly what to recommend, how to dose it, and how to talk to your patients about it. In this episode, we cover: What creatine actually is and how it works in the bodyDietary vs. supplemental sources and why it’s tough to get enough from food aloneMonohydrate vs. HCl vs. gummies: which forms are the bestCreatine + coffee: is combining them effective? Ideal timing, dosing, and how long it takes to see resultsClinical populations who may benefit mostWhat to do if creatinine is elevated on labsCommon myths about bloating, bulkiness, and safety in women and teensWhich brands to trust and how to spot third-party tested supplementsResources: Creapure Creatine supplements Connect with Dr Forbes Episode 72: Popular Diets and Supplement Science: Build Muscle, Lose Fat, and Stay Fit Any Questions? Send Me a Message Support the show Connect with Colleen: Instagram LinkedIn Sign up for my FREE Newsletter - Nutrition hot-topics delivered to your inbox each week. Disclaimer: This podcast is a collection of ideas, strategies, and opinions of the author(s). Its goal is to provide useful information on each of the topics shared within. It is not intended to provide medical, health, or professional consultation or to diagnosis-specific weight or feeding challenges. The author(s) advises the reader to always consult with appropriate health, medical, and professional consultants for support for individual children and family situations. The author(s) do not take responsibility for the personal or other risks, loss, or liability incurred as a direct or indirect consequence of the application or use of information provided. All opinions stated in this podcast are my own and do not reflect the opinions of my employer.

It’s not your job to make patients change. Your job is to create the environment where change feels possible.  In this conversation, I sit down with Staci Belcher, RDN, an Internal Family Systems–informed dietitian, to unpack how to use curiosity, compassion, and counseling techniques to unlock motivation. You’ll learn practical ways to apply behavior change psychology and motivational interviewing principles in real exam-room conversations.  Staci shares how resistance often hides wisdom, why fear-based motivation backfires, and how to use curiosity and compassion to help patients reconnect with their own inner drive to change. Grab the Cheat Sheet here: examroomnutrition.com/saythis Key Takeaways: How to respond when a patient says, “I know what to do — I just can’t do it.”What to do when resistance shows up (and what it really means).Small phrases that lower defenses and open the door to change.The emotions your patients bring into the exam room — and how to spot them.How to protect your own emotional energy between visits.If you’ve ever felt stuck in that ping-pong match of “I can’t” vs “You should,” this episode will completely reframe how you approach behavior change. Connect with Staci Any Questions? Send Me a Message Support the show Connect with Colleen: Instagram LinkedIn Sign up for my FREE Newsletter - Nutrition hot-topics delivered to your inbox each week. Disclaimer: This podcast is a collection of ideas, strategies, and opinions of the author(s). Its goal is to provide useful information on each of the topics shared within. It is not intended to provide medical, health, or professional consultation or to diagnosis-specific weight or feeding challenges. The author(s) advises the reader to always consult with appropriate health, medical, and professional consultants for support for individual children and family situations. The author(s) do not take responsibility for the personal or other risks, loss, or liability incurred as a direct or indirect consequence of the application or use of information provided. All opinions stated in this podcast are my own and do not reflect the opinions of my employer.

AI is everywhere. Is it coming for our jobs… or just taking mundane tasks off your plate? If you’ve felt equal parts curious and cautious, this conversation will calm the noise and show you some brilliant ways AI makes your life easier, both professionally and personally. In today’s episode, I’m joined by Raul Palacios, Registered Dietitian, educator, and AI-in-healthcare tinkerer who’s my go-to AI guru.  Key Takeaways: AI terminology. A plain-English way to explain predictive analytics vs. generative AI vs. LLMs and finally understand things like hallucinations, prompt and Chat Bot. Evidence at your fingertips. A smarter way to query clinical literature (e.g., set year ranges, human-only data, age group, comorbidities) so you don’t waste time sifting. Easing your workflow. How recurring AI tasks can auto-pull new research to your phone (then file to Notion/Docs) and how agents can take on tedious admin (think scheduling calls and prior auth steps) with guardrails. Resources Connect with Raul on LinkedIn DM me on Instagram @examroomnutrition if you want a follow-up episode focused on AI for educators (lesson builds, simulations, Gamma, and more). Any Questions? Send Me a Message Support the show Connect with Colleen: Instagram LinkedIn Sign up for my FREE Newsletter - Nutrition hot-topics delivered to your inbox each week. Disclaimer: This podcast is a collection of ideas, strategies, and opinions of the author(s). Its goal is to provide useful information on each of the topics shared within. It is not intended to provide medical, health, or professional consultation or to diagnosis-specific weight or feeding challenges. The author(s) advises the reader to always consult with appropriate health, medical, and professional consultants for support for individual children and family situations. The author(s) do not take responsibility for the personal or other risks, loss, or liability incurred as a direct or indirect consequence of the application or use of information provided. All opinions stated in this podcast are my own and do not reflect the opinions of my employer.

What happens when a dietitian and a PA sit down to talk about heart disease—from both sides of the exam room? In this episode, Colleen brings together two heart health experts: Michelle Routhenstein, MS, RD, CDCES, a cardiovascular dietitian known for her evidence-based prevention strategies, and Josh Wageman, PA-C, PhD, a clinical lipid specialist who’s spent his career studying cholesterol disturbances and Alzheimer’s. Together, they tackle one of medicine’s most common (and confusing) topics—heart health. You’ll hear how each expert thinks, what they prioritize, and how they talk with patients who are juggling elevated LDL, inflammation, insulin resistance, or menopause-related changes.  By the end, you’ll see how bridging nutrition and medicine leads to smarter, more patient-centered care—because this is how the healthcare team should work anyway.  Resources: Episode 38 | Love Your Heart with Michelle Episode 111 | HDL Good, LDL Bad with Josh Episode 117 | The Best Diet to Lower Cholesterol with Josh Connect with Michelle Buy Josh's Book Any Questions? Send Me a Message Support the show Connect with Colleen: Instagram LinkedIn Sign up for my FREE Newsletter - Nutrition hot-topics delivered to your inbox each week. Disclaimer: This podcast is a collection of ideas, strategies, and opinions of the author(s). Its goal is to provide useful information on each of the topics shared within. It is not intended to provide medical, health, or professional consultation or to diagnosis-specific weight or feeding challenges. The author(s) advises the reader to always consult with appropriate health, medical, and professional consultants for support for individual children and family situations. The author(s) do not take responsibility for the personal or other risks, loss, or liability incurred as a direct or indirect consequence of the application or use of information provided. All opinions stated in this podcast are my own and do not reflect the opinions of my employer.

What happens when a woman in menopause, a man considering bariatric surgery, and a young adult on a GLP-1 all walk into clinic? In this episode, I’m joined by Dr. Leslie Golden, a dual board-certified physician in Obesity Medicine and Family Medicine and founder of Weight in Gold Wellness.  She brings both clinical expertise and lived experience to her work—helping patients heal their relationship with food while addressing the complex biology of weight. Together, we walk through how she approaches three very different obesity cases, what she prioritizes first, and the exact language she uses to keep patients motivated and supported. Join the Obesity Medicine Nutrition Course here and use code POD15 for 15% off at checkout.  Connect with Dr Golden Episode 5 | Bariatric Nutrition Basics Any Questions? Send Me a Message Support the show Connect with Colleen: Instagram LinkedIn Sign up for my FREE Newsletter - Nutrition hot-topics delivered to your inbox each week. Disclaimer: This podcast is a collection of ideas, strategies, and opinions of the author(s). Its goal is to provide useful information on each of the topics shared within. It is not intended to provide medical, health, or professional consultation or to diagnosis-specific weight or feeding challenges. The author(s) advises the reader to always consult with appropriate health, medical, and professional consultants for support for individual children and family situations. The author(s) do not take responsibility for the personal or other risks, loss, or liability incurred as a direct or indirect consequence of the application or use of information provided. All opinions stated in this podcast are my own and do not reflect the opinions of my employer.

In this episode, I sit down with Julie Duffy Dillon, RDN, therapist, and author of Find Your Food Voice, to help clinicians replace diet-culture with practical, patient-centered coaching. We dig into what a “food voice” is, why so many people get disconnected from it, and how you can guide patients back to hunger/fullness cues without meal plans, shame, or quick fixes. You’ll leave with language you can use tomorrow in clinic—plus simple interventions (like CHiPs check-ins and “letters to food”) that help patients quiet the noise, honor body diversity, and focus on behaviors that truly move health forward. Resources Mentioned: The Obesity Medicine Nutrition Course (this has a fantastic module on Intuitive Eating and use code POD15 for 15% off) Episode 104 Body Diversity Find Your Food Voice book Connect with Julie Any Questions? Send Me a Message Support the show Connect with Colleen: Instagram LinkedIn Sign up for my FREE Newsletter - Nutrition hot-topics delivered to your inbox each week. Disclaimer: This podcast is a collection of ideas, strategies, and opinions of the author(s). Its goal is to provide useful information on each of the topics shared within. It is not intended to provide medical, health, or professional consultation or to diagnosis-specific weight or feeding challenges. The author(s) advises the reader to always consult with appropriate health, medical, and professional consultants for support for individual children and family situations. The author(s) do not take responsibility for the personal or other risks, loss, or liability incurred as a direct or indirect consequence of the application or use of information provided. All opinions stated in this podcast are my own and do not reflect the opinions of my employer.