Refuse To Regain

Habit and Reward: Good for Target, Good for Maintainers

By Barbara Berkeley, MD

Here's an article everyone should read.  In yesterday's New York Times magazine section, there was a long and eye-opening piece on the science of consumer behavior.  It seems that we buy things because it becomes our habit to do so.  Marketers rely on this habit and try to create it.  There are times in our lives when we are more susceptible to changing habits.  Target has found that pregnancy is one of those times, and it has gone to great lengths to identify pregnant women and to market to them.

Research with rats gives us insight into our own behavior.  It turns out that habits have three components:  a trigger, a behavior, and a reward.  The brain is actively engaged only during parts one and three.  What makes the habit a habit is that the behavior component, no matter how complex, is run automatically.  In other words, once the habit is triggered, it’s on autopilot. 

I’m sure that many of you will be horrified, as I was, by the extent of mind-control and manipulation that goes into modern marketing.  But if we leave that aside, the information on habit formation gives us some powerful tools for changing things we may want to alter in our own lives.  Changing habits is arguably the most vital task for maintainers.

So, I see two avenues to explore.

First:  Since habits are so automatic and ingrained, and since powerful rewards like the pleasure of eating junk and sweets have carved habits deep into our neuro-pathways, we must consciously avoid putting ourselves in situations that pull the trigger.  We’ve discussed this many times here, most recently in the last post.  As much as we’d all love to eat controlled amounts of the modern foods that everyone else is downing, we’ve mostly learned that we can’t.  We’ve also observed that when we do indulge, we are punished by a return of cravings.  This is addressed in the Times article:

Habits aren’t destiny — they can be ignored, changed or replaced. But it’s also true that once the loop is established and a habit emerges, your brain stops fully participating in decision-making. So unless you deliberately fight a habit — unless you find new cues and rewards — the old pattern will unfold automatically.

“We’ve done experiments where we trained rats to run down a maze until it was a habit, and then we extinguished the habit by changing the placement of the reward,” Graybiel told me. “Then one day, we’ll put the reward in the old place and put in the rat and, by golly, the old habit will re-emerge right away. Habits never really disappear.”

 Habits never really disappear.  Words to live by.

Second:  Since habits are created all the time and since we know their components, why not create our own?  Rather than let someone else manipulate us with their chosen reward, how about deciding to reward ourselves? When I think about my own maintenance, I realize that I’ve set up many of these loops and that they are what keep me going.  Weighing myself every day is a reward in maintenance.  When I have to lose some weight because I’ve edged up a little, the scale is both my trigger to lose and my later reward.  I’ve learned to get pleasure out of the feeling of being hungry on days when I have to bring my weight down. How have I done that?  I associate that feeling with a pleasant day I’ve set up. I follow a pre-set reversal plan that I enjoy---usually to have a non-fat, skim mocha for both breakfast and lunch, a nutrition bar at 3 and to try to do some shopping if I can, which is fun and which distracts me. Then I have a huge salad and some protein for dinner.  I look forward to these days rather than dreading them.  The scale on the next morning’s weigh-in is a further reward.

I find that my Primarian eating style has become a reward in itself.  After forcing myself to stay away from starches and sugars for many years, I now truly enjoy eating chicken, fish, nuts, veggies and fruit with some low fat dairy mixed in.  I look forward to these meals and they have become their own reward.  Each day, the pleasure that comes from eating this simple good food ingrains the habit more deeply.  I have no doubt that if I started eating Mallomars again, I would immediately re-activate my chocolate cookie circuits.  Why do that?  I simply don’t want to.  

One of the toughest jobs I have is to convince non-exercising patients that fitness has rewards that are as strong as bread, chocolate cake and pasta.  I never used a muscle until I discovered aerobics in my late 30s.  Within a month or so, the music and the energy took over from the pain of using those veal-like structures for the first time.  Now, years later, I’ve found that I can create the same high from running to Michael Jackson’s “Jam” on a sunny day or playing a great set of doubles in tennis.  Nothing beats a high-energy, dance-y aerobics class though.  For me, the pinnacle is exercising when I am in the Bahamas: a place where dance, party and exercise all exist in one class at one time.  When setting up your new reward circuits, don’t forget to search for the bliss that is found in physical challenge.

The Times article makes the point that rewards can be subtle.  You are rewarded for backing out of your driveway successfully simply by the fact that you achieved that tricky maneuver.  A reward doesn’t always have to be a treat.  It can be a sense of balance, completion or satisfaction.  The trick with food is to eliminate the over the top rewards of drug-like sugars and starches.  It’s hard to compete with the hit of a drug to the pleasure centers, and these foods come way too close to that experience.  Don’t put them in competition with other rewards because lesser rewards will lose out.

In essence, the Times article leads to conclusions that are just the opposite of those in my last post (Tied to the Mast).  The two go well together because they demonstrate the two opposite faces of maintenance.  The first:  studious, focused avoidance of things that others find pleasurable.  The second:  the creation of a brand new world of habit and reward, based on one’s own rules…not those of the culture at large. Part Two completes Part One.

After all, there is no point in getting past the Sirens if you land in a grim place that no one would want to inhabit.  Make it beautiful and you will want to stay. 

Creativity is the basis of all art, even the art of maintenance.  

 

Tied to the Mast

by Barbara Berkeley, MD

 Odysseus, the wandering protagonist of Homer’s Odyssey, had a healthy fear of temptation.  In Greek mythology, sailors were regularly lured to their deaths by Sirens, creatures who sang a beautiful and irresistible song.  Entranced by the song, these sailors steered toward the call and were dashed to pieces on the rocks.  

 In order to avoid this fate, Odysseus ordered his crew to plug their ears with beeswax and to tie him firmly to the ship's mast.  On hearing the Sirens' song, Odysseus himself could not resist and begged to be untied, but since he had instructed his crew to ignore him, they refused his pleas.  Thus, the ship was able to sail safely past danger; but only because Odysseus was smart enough not to underestimate the power of temptation.

The Odysseus story is mentioned in a recent article that detailed the effectiveness of offering restaurant-goers the choice of smaller servings.  I loved the analogy. 

Negotiating the modern food world so often seems like sailing through Siren filled waters.  The call of the brownie is so sweet, the bowl of M & Ms looks so jolly, the Ben and Jerry’s packaging is so alluring…and that  fresh baked bread?  It’s the staff of life, isn't it?

Until we crash into the rocks. 

As our doctor reveals that our fasting blood sugar is now above 100 and pulls out the prescription pad to treat our rising blood pressure and refill our Lipitor, we may suddenly realize that we’ve been had.  Lured like bugs on sweet sticky-paper, devoured by the fragrance of the Venus fly-trap…

The work of maintenance, the life work of maintaining, is to learn to navigate these waters and, to some degree, to discover how to bind ourselves to the mast.  Temptation will always surround us and we need to find a way to deafen ourselves to the call.  But how?  Perhaps you will add your own perspectives, but these are some of the ways I have found to be effective:

1. Temptations lose potency when they are not reinforced.  For this reason, I advise most people to practice avoidance of trigger foods and to do this as completely as possible.  Don’t make exceptions for birthdays, retirement dinners and cruises.  The more you exclude triggers, the less power they will have over you. 
2. Reduce exposure to the Sirens by avoiding the places where they live.  Don’t detour unneccessarily into the cookie aisle or start a long conversation with a friend in front of the bakery window.  Avoid restaurants where the main thrust of the menu is food you can’t eat. 
3. Ban the Sirens from your presence.  Do this by not inviting them into your home, by asking that they be taken off desks that adjoin yours at work or removed from plain sight in break rooms.   
4. Finally, tell your crew not to listen to your pleas.  Make it clear to friends and relatives that you simply don’t eat certain foods.  They will be embarrassed to serve them to you and you will be embarrassed to ask for them in their presence.  Enlist those who are close to you in supporting your goals.  If you plead for cake, make sure that your allies remind you that you'd really rather not.

How do you avoid being dashed on the rocks?  Send me your strategies.

 

 

 

 

 

 

Life on the Island

by Barbara Berkeley, MD

No man is an island entire of itself; every man is a piece of the continent, a part of the main….. John Donne, 1572-1631

As John Donne famously observed, each of us is connected to the other and to the larger world.  In free societies, our belief in personal liberty often obscures this point.  We are free to choose, or so we believe. But our freedoms are enormously affected by the influence of the culture in which we are immersed, by the very connections that make us human.  Are we choosing or are we being led?  At no time is this question more pertinent than in an election year.  Our political choices are based on the information we learn from PACs, Super PACs, newspapers, TV pundits, the opinions of friends, and finally...our own observation.  How free is our choice?  Pure freedom of choice depends on the degree to which we want to unearth and establish the unvarnished, un-spun truth.  This kind of fact-finding requires a serious amount of focus, time, and commitment. 

And so it is with our dietary choices.  We may feel that we have the freedom to choose how we eat.  We are certainly told that we do.  If we choose to eat badly, it’s our own fault isn’t it?   But I observe a quite different reality.  In fact, our freedom is severely tested and influenced by the enormous weight of a food culture that condones, encourages, and normalizes a quite different message.  Eating is a sport, a right, an ultimate enjoyment to which we are all entitled.  Further, modern food is not bad... it’s GOOD.  It is only our choice that is poor.  Swimming away from that cultural current can be like opposing the force of the ocean.   The water looks calm, but we are actually caught in a rip tide.

This is the reason that making an analogy between successful maintenance and life on an island so appeals to me.  In order to avoid the influence of the food culture, we have to absent ourselves from it.  We have to live, to some degree, outside of it.

How is this done?  Some do it by becoming fierce proponents of diets that don't look anything like the modern American plate: vegan, vegetarian, paleo.  Others become immersed in the world of nutrition and fitness.  They blog, take courses, become trainers, write books, become experts.  But for the vast majority of maintainers, it's a matter of applying a set of mental blinders.  They doggedly focus on the road ahead, follow their plan, and try not to be overwhelmed by the flood of food messaging.

Maintainers can feel both proud and lonely.  They sit on an island while the rest of the world swims in a sea of food all around them.  Often, it’s hard to avoid jumping back in the water.  It looks like so much fun that it’s easy to forget what it took to get up on dry land.  It's hard to remember that we once felt like we were drowning. 

Since we are social beings, connected to one another whether we want to be or not, it’s easier to stay on our island if we know that we are not alone.  Those who belong to a diet subculture (like the vegans, vegetarians and primalists referenced above) have websites, books, and mentors to follow.  But for all maintainers, a vital task is finding other people who live on the island.

As you know, I run a monthly group for maintainers in the Cleveland area.   After a couple of years of meetings, those of us who participate have discovered that we never run out of things to say.  For many in the group, the maintenance of a significant weight loss is the defining challenge of their lives.  They never tire of discussing the process.  They also enjoy sharing their observations of what’s going on off-island. Viewed through the eye of the group, the behavior of the rest of the world seems nonsensical at times, almost incredible.

Month after month we repeat the truth to one another.  It’s the truth of our island culture, not the truth of the world according to the Food Network.  We congratulate each other, support each other when we venture a bit to close to the water’s edge.  It is an enterprise that I highly recommend to those of you who are maintaining out there on your own.  I offer my support if you would like to try starting a group in your area.  Email me and I'll help as much as I can. 

Form a group.  Define your culture.  Meet your neighbors.  An island can be a pretty beautiful place to live, as long as you are not alone.

 

The Paula Deen Flap: Sugar, Lies, and the Bitter Truth.

by Barbara Berkeley, MD

I think I generally try to be non-judgemental, but I'm afraid I'm about to depart from that behavior temporarily.  The reason?  Paula Deen, her diabetes, and her response.

Here's a nauseating little morsel:  CBS News report on Deen's big reveal.  

Turns out, Deen has been diabetic for three years during which time she has continued to encourage Americans to eat some of the worst food on the planet.  Of course, she intended her viewers to eat this food "in moderation" (these two words make me see red dear readers)....as SHE herself does!

OK, so Deen may have been among the misguided.  Perhaps she really didn't realize that eating a crispy creme burger would contribute to obesity and it's deadly handmaidens. Maybe she really believed that her message was a moderate one:  just have a little.  (A little fried stuffing on a stick, anyone???)

But that explanation is, shall we say, a bit hard to swallow.

I am perfectly content for individuals to decide what they want to eat, as long as they understand what's at risk if they develop conditions like diabetes, hypertension, high cholesterol, and heart disease. If they understand fully, this remains their right and their choice.  But most people don't understand, and I feel badly for those who think that a glass of water and a handful of lipitor, diuretics and metformin will reverse the damage caused by eating without thinking.

 Deen's choices are a different story.  She is not an individual.  She's a public spokesman for food.  Now that her food choices have made her ill, she should be honest about the cause.  I'm particularly angered by Deen's new role as "Diabetes Ambassador".   She has made a deal with a diabetes drug manufacturer and is already speaking for diabetes as if she knew something about it.  Let's see.  What would a drug company want a desginated celebrity to say about diabetes?  Oh...I know!  "Don't you worry.  Our drugs can take care of everything.  Just make sure to buy the particular drug we make, and make sure you order often."

Here's Deen on diabetes:

“I’m here today to let the world know that it is not a death sentence,” said the Food Network star, who is now being paid as a spokesperson for Novo Nordisk, the pharmaceutical company that supplies her diabetes medication. Coinciding with her announcement, Deen and her family are appearing in a new ad campaign for the company this month.

The announcement that diabetes is not a death sentence would be news to the families of the tens of thousands of people who have died as a result of this disease.  It would also be news to the Centers for Disease Control, whose diabetes web page describes diabetes as follows:

Diabetes Is Common, Disabling, and Deadly

• 25.8 million people in the United States (8.3% of the population) have diabetes. Of these, 7.0 million have undiagnosed diabetes.

• In 2010, about 1.9 million new cases of diabetes were diagnosed in people aged 20 years or older.

• If current trends continue, 1 of 3 U.S. adults will have diabetes by 2050.

• Among adults, diabetes is the leading cause of new cases of blindness, kidney failure, and amputations of feet and legs not related to accidents or injury.

• Diabetes was the seventh leading cause of death listed on U.S. death certificates in 2007.

• A person with diabetes has a shorter life expectancy and about twice the risk of dying on any given day as a person of similar age without diabetes.

Does Ms. Deen know that type two diabetics frequently progress to needing insulin?  Does she know that studies have unequivocally shown the importance of dietary change and life habits in controlling this disease?  Is she appropriately concerned about her own health and, perhaps more importantly, the health of the vast audience she commands?  If not, does she have any business offering herself as a spokesperson? Time will tell, but right now, things don't look good.

According to the Today Show, on which she made her announcement:

When asked about whether she will make a change in how she cooks on her show, “Paula’s Best Dishes,” Deen didn't give a direct answer, instead encouraging viewers to practice moderation.

“Here’s the thing, you know, I’ve always encouraged moderation,” she said. “On my show, you know, I share with you all these yummy, fattening recipes, but I tell people 'in moderation... You can have that little piece of pie ...'"

This does not give me much hope for Ms. Deen as an advocate for the real behaviors and tough lifestyle changes that can truly change the life of a diabetic.  But someone will benefit.  She'll probably make alot of money for the sponsoring drug company who will be more than happy to perpetuate the lie that pills and shots conquer all, even a deadly and toxic diet.

 

 

 

Silly Season

by Barbara Berkeley, MD

In January, the attention of Americans turns to weight loss.  Retailers exploit this interest, displaying towers of shiny new diet books.  The media pumps out stories, offers tips and guidance (the same tips as every other year) and earnestly discusses the ways to make our New Year's resolutions work.  Gyms fill will newbies.  Thankfully, it will all be over in a couple of weeks and those with the serious intent of changing their lives will be able to go back to work undistracted. 

January is an odd time for self renewal.  Yes, the calendar turns a page and we move into a new year.  The business cycle starts anew.  But for a good part of the United States, January is a cold, unfriendly month.  It's hot soup and mashed potato time, the very month when a little extra fat feels good.  In Cleveland, the prospect of heading out for a run through slushy streets covered by slate gray skies is a tough sell even for career exercisers.  

Of course January is weight loss month because it is preceded by the season called, "I Have to Eat It, It's the Holidays".  We have developed an unfortunate cycle of gorging and disgorging on a yearly basis.  This mirrors the shorter cycle we run more frequently throughout the year:  eat things we know we shouldn't, gain weight, then diet to get them off.   The problem, as we are all well aware, is that we eventually reach a point when we can't get the weight off anymore.  We burn out, allow the higher weight to become our new reality and start adding extra pounds to that new base.

I know that I am preaching to the choir, but the reason that weight resolutions and periodic diets don't work is that they have nothing to do with the real work of making oneself healthy.  That little chore requires commiting oneself to a new way of viewing food and to new personal and permanent rules about how to eat.  These rules include guidelines for such things as exceptions.  Over the holidays, some maintainers may allow themselves a certain amount of indulgence for example, where others may stick strictly to their daily plan. But it's programmed.  Flying by the seat of one's pants is a rarity among maintainers, who are well aware that the food winds blow with gale force.  Crashing is likely unless someone has a close eye on the rudder.

January, then, is the silly season for weight loss.   This month's People leads with the popular "Half Their Size" feature.  Here are the amazing before and after photos, the airbrushed picutres of beautiful women in their skinny jeans, and the tantalizing promise that anyone can lose a mere 100 pounds or so.  The guidance for wannabes?  One woman hung a bikini in her garage and looked at it while she worked out on the elliptical.  Another ate a lot of spinach; she suggests you take weight loss 5 pounds at a time. To People's credit, they do provide a section that features subjects of the Half Their Size issue in years past. These successful maintainers look inspiring, but the amount of useful information that accompanies their stories is miniscule.  How are they doing it and what made them able to do what they couldn't before?  That's the information that might help a curious reader, but it's not included.  These features are strictly about the photos.  There's no room for content.  

Us Weekly has a cover that touts "Diets that Work" and suggests that each of us can have legs like JLo and Rihanna's abs.  The diet guidance below each photo of skinny women in shorts and bathing suits is mostly useless. One woman did 2 1/2 hurs a day of karate and boxing while training for a movie (try that after getting home from a day at the office!), another does sessions that "shorten the muscle fibers", a third practices "portion control".  In addition to sparse information, the women in these photos are mostly in their mid 20s, a time when dieting tends to work. What does any of this mean for the 50 year old empty nester who has been struggling with slow and steady weight gain for ten years?  Here's my favorite quote from Us Weekly. It comes from Mariah Carey, who has been up and down the scale more frequently than Kirstie Alley.  Once again she is at a  smaller size and is now a spokesperson for Jenny Craig. Carey says of herself, "I'm extremely disciplined."  Hmmmm.  

Silly season tips abound.  The sillier the better.  Here are a couple of great ones:  Eat with large forks.  Spice soup with pepper.  Put coconut oil in your coffee to "increase metabolism".  Oh my.

If silly season has your head spinning, here's what I suggest:

1. Cover your ears and close your eyes.  There's too much information out there, most of which is ineffectual or just plain wrong.

2. Make a resolution, but not a weight loss resolution.  Instead, resolve to begin the process of making yourself an all around healthier person, someone who will feel good and live well over an extended lifespan.

3. Pick a time of year when you will begin.  It doesn't have to be tomorrow.  It does have to be a time when you won't have immediate challenges from food....challenges like weddings, cruises, or birthdays.  Give yourself a month when you aren't forced into situations when food is likely to win.  Start with some breathing room in front of you.

4. Resolve to try eating a diet of real food, pretty much as it comes from the earth or its animals.  Unless the food in a can or package is original and not adulterated with "stuff", don't eat it.  If you are looking for weight loss as a part of this renewal, stop eating sugars, potatoes, and starchy foods like grains and the things made from grains (cereal, bread, pasta, flour based baked goods).  

5.  Read books, articles and blogs that further your knowledge of eating style.

6. Start looking around for a kind of sustained physical activity that you think you would enjoy once you mastered it.  Start doing that thing at a beginner level and without significant challenge.  Work up.  If you do it for three months and don't like it, start over with something else.  

7.  Observe yourself and take note (either mentally or in written form) of your progress along the way.  Does your skin look better?  Do you feel happier?  Do you have more energy?  Are you less anxious?  These are all results that have been observed after changes in the way people eat and live.  

Silly season can be fun if you don't take it too seriously.  Within a week or two, most of America will be back to its predictable cycle of weight gain and periodic dieting.  Be bold, and head off in a different direction.  Happy New Year!

 

 

 

 

 

The Fat Trap: My Response

By Barbara Berkeley, MD

Once a month, in a small room off the lobby of Lake West Hospital in Willoughby, Ohio, a special group convenes.  For someone observing the group and unaware of its purpose, it might appear to be a simple mix of everyday people….young, old, racially diverse.  The members would seem to be old friends but with a particular seriousness of purpose, perhaps a community group attending a lecture or learning some new skill together.  What a casual observer would not guess is that each of these people was once obese, some having weighed over 100 pounds more than they do today. 

Our Refuse to Regain group is an experiment, a safe haven for maintainers who have lost weight in many different ways and now face the reality of reconstructing their lives.  We’ve had people from Weight Watchers, people who’ve undergone bariatric surgery, people I’ve treated in my  practice and others who simply did it on their own.  A weight loss diet is no different than emptying the trash.  It doesn’t matter which technique you use to toss out the garbage.   But learning how to avoid the reaccumulation of unwanted junk is a completely different skill.  There are many basics in this process that will be the same for everyone.  There are also many specifics that will vary from person to person and which must be individually discovered.  

Here’s some of what we’ve learned so far:

1. Weight maintenance is possible.  There is nothing in our group experience (or in my personal clinical experience) to suggest that the body “forces” one to regain.
2. Weight maintenance requires a separation from the world of “normal” American eating…which is not normal at all.
3. Some people are heavy simply because they are susceptible to the modern diet , no more no less.  Others are heavy because they use food for soothing or sedation.  Most people are a mix of both.   If psychological issues are a major part of weight gain—significantly beyond the common enjoyment of food for pleasure, they need to be addressed during the maintenance phase.
4. Weight maintainers are special people who live on a kind of food island.  It’s really nice to know that the island is inhabited, often with fascinating, determined people just like you.   Rarely do maintainers get to meet and talk with one another.

This week, I gave my group a reading assignment.  That was a first.  I asked everyone to read Tara Parker Pope’s article on weight maintenance called The Fat Trap.   This article is currently online and will appear in Sunday’s New York Times Magazine.   Our group will be discussing it at our January meeting, but I’ll give you a preview of my reaction here.  Many of you may be reading our blog because you read The Fat Trap and discovered Lynn Haraldson, my blogging partner on this site.  The fact that you got here likely means that you are interested in knowing whether we are bound to regain the weight we lose, so please, read on…leave comments and join the discussion.

For those of you who are new to this blog, you should know that I am a physician who has specialized in weight management since the late 1980s.  This is the only thing I do and that’s unusual.  Why?  Because most doctors are not particularly interested in obesity, and certainly weren’t back in the 80s.   Over the past twenty years, a continuing source of frustration for me has been the willingness of doctors and the general public to accept “truths” about weight loss that are the beliefs of everyone except those who actually work with overweight people.   

Scientific research needs to square with what we see in clinical practice.  If it doesn’t, we should question its validity.   “The Fat Trap” is an article that starts with a single, small research study and builds around it.   Its point?  That there are inevitable biological imperatives that cause people to regain all the weight they lose.

I don’t buy it.

Here is the opening paragraph of Ms. Parker Pope’s article:

For 15 years, Joseph Proietto has been helping people lose weight. When these obese patients arrive at his weight-loss clinic in Australia, they are determined to slim down. And most of the time, he says, they do just that, sticking to the clinic’s program and dropping excess pounds. But then, almost without exception, the weight begins to creep back. In a matter of months or years, the entire effort has come undone, and the patient is fat again.

At one time, this was my experience too.  But things have changed.  After years of focusing my practice much more on weight maintenance, writing a book about it, and trying to figure out how to teach and encourage it, I no longer see patients with an “entire effort come undone”.   Instead, I see more and more people learning how to become successfully anchored at their new weight. And these POWs (previous overweight people) are not from my practice alone.  They are people like Lynn Haraldson and her friends “The Maintaining Divas”.  They are the long term POWs who write to me via this blog, on Facebook and on Twitter.  They are the people I hear about with increasing frequency every day. 

I admire Ms. Parker Pope for acknowledging her own struggles with weight, but as someone who has not yet solved the maintenance problem I would submit that she is not the best person to rationally evaluate evidence that says that regain is inevitable.  After talking to a number of scientists who believe that the body fights weight loss, her concluding paragraph says:

For me, understanding the science of weight loss has helped make sense of my own struggles to lose weight, as well as my mother’s endless cycle of dieting, weight gain and despair. I wish she were still here so I could persuade her to finally forgive herself for her dieting failures. While I do, ultimately, blame myself for allowing my weight to get out of control, it has been somewhat liberating to learn that there are factors other than my character at work when it comes to gaining and losing weight.

Those of us who come from families which struggle with obesity can believe one of two things.  We can believe that biological and metabolic factors doom us to fatness or we can believe that we come from families who are very sensitive to the current food environment and perhaps need to live in a new and more creative way.  It has been my experience that all successful maintainers have learned how to live a life that exists outside the current food norms.   For some, this is a daily and difficult challenge and for others it becomes a simple and treasured way of life, but either way, it is not about some inevitable biological destiny.  Rather, these maintainers have come to terms with the fact that they are ancient bodies and souls living in a modern environment and that our food culture is capable of killing them.  Controlling that environment is their choice and their challenge. 

Where I do agree with “The Fat Trap” is in its assertion that obesity is much more difficult to deal with once it is established.  We would do well to focus intense and constant attention on healthful nutrition during pregnancy and in childhood.  I believe that we can do this much more easily than we believe, if we would only adopt the idea that we should eat more like we did originally as hunter-gatherers.  It has been my clinical experience that elimination (or major curtailment) of starches and sugars (including whole grains and the things that come from them, by the way) simply works.  And this clinical observation makes sense, since the ancestors whose genes we carry were not exposed to the large amounts of starch and sugar we now eat.  Along with consumption of real food…not things in boxes, cans, or packages.... this easy concept can change lives.  We could make things so much easier by teaching this lesson  to kids rather than endlessly focusing them on per cents of fat, protein and carbs and on counting calories.

But such approaches to weight maintenance are not easily sold.  Its far simpler to believe that weight must be regained.  I’m fond of using this example for patients:  If you were to tell your friends that you are becoming vegetarian and that you will no longer touch a drop of red meat, fish, or poultry, no one would blink an eye.  You’d probably be encouraged and congratulated.  If, on the other hand, you announced that you were giving up sugar and grain, the same friends would be horrified.  “You mean you’re never going to have another piece of bread???”

I believe that the resistance to finding the maintenance solution comes from the addictive nature of starch and sugar foods.  I also believe that most of America and other SAD (standard American diet) countries are operating “under the influence” of addictive carbs.  Life without them, or even with LESS of them, is too awful to contemplate. 

But I digress.  To return to my original point, I want to forcefully say that we must stop finding reasons we can’t maintain and start getting much, much better at teaching people how to do it.  Support networks, communication between maintainers, and many more books, advocates, and techniques that focus on maintenance are key.  

I believe I may scream if I see yet another book with a catchy title that touts yet another weight loss approach without ever talking about what happens in the after-diet world.   January is the month for those glossy little productions. 

Time to get serious.  Maintenance can be done, and if you want to meet the people who are doing it, hang around this blog. 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Getting Past the R Word

by Barbara Berkeley, MD

While I don't take as much of a beating on the internet as some diet writers do (thank you for that, readers!), most of the negative comments I get are directed at the fact that my diet recommendations are too restrictive.

Restrictive is the R word.

I think that we often confuse structure with lack of freedom.  As our society increases its amount of available choice, we tend to bridle at the idea that any of these options might be taken away.  And we particularly hate the idea of any authority regulating choice...most especially the government.  But until recently, we never lived in a world with such abundant choice.  Life might have been less interesting, but it was certainly easier to negotiate. 

I've written in the past about decision fatigue, a state that seems to occur when we are forced to make too many selections.  It appears we may only have so much organizational ability and will power.  Our constant exposure to choice (mocha or latte?  grande or venti? whip or no whip? skim or soy? ...and that's just Starbucks) wears us down and makes us anxious.  Certainly this is no more evident than in our exposure to an ever-expanding food menu.  Our only defense is to have our own rules and our own plan.  We can then approach the market, the restaurant, and the vending machine using those guidelines.  

Interestingly, there is little R word push back regarding vegetarian or even vegan diets.  By R word standards, these are extremely restrictive.  But they are accepted in our society because they've been around for awhile.  In addition, most people remain unthreatened by vegetarianism.  It has the feeling of an eating style that is chosen by a select few...and vegetarians tend not to be very militant about pushing their diet on others.  Lastly, vegans and vegetarians can still eat sugar and starch (grains and other starchy carbs). For most of us, these are the toughest foods to give up.  It's more radical to suggest cutting out rice, pasta, corn and potatoes than it is to advocate giving up fish, meat and turkey.   And those who do suggest such a change may be subject to R word criticism. 

Just as we negotiate buying choice by adhering to a budget, just as we decide which moral choices to make by adhering to religious guidelines, just as we choose from the endless careers available to us by figuring out where we fit...so too should we view how we eat.  Prior to the last 30 years, eating was less easy to do and foods with the potential to hurt us far less available.  Since the advent of instant eating opportunity throughout the day, we need to apply the same sorts of guidelines to food choice.

People who write about me being too restrictive have not read me very well I think.  I have made it clear that I believe in whatever works for YOU.  The diet that I propose is one with which I have many years of personal and professional experience.  Take that for what it's worth.  Explore other possiblities too.  Choose, based on who you are and what works best.  As long as you are maintaining your weight loss and keeping hypertension, hyperlipidemia and high sugars at bay you are doing a fine job.  

Occasionally I am asked to restate what I believe is the most effective diet.  With trepidation, I'll do it again here.  But please don't view it through the lens of the R word.   Eating this way is a choice based on my own guidelines.  I have no desire to legislate, push or otherwise force this way of eating on anyone.

I prefer-- and see excellent results from--- a diet that is composed of lean animal proteins, vegetables and smaller amounts of fruits and low fat dairy.  I try to stay away from legumes like soy and starchy beans although I personally don't completely exclude them.  While dairy is not a part of most paleo style diets, I include it because I have found that it doesn't affect weight in most of my patients and it gives them greater choice.  Watch dairy products to make sure that they are low in sugar.  Sugar and grains are the two major things I like to keep out of the diet.  One other thing that people complain about with my diet is that it's inconsistent with "true" ancient eating.  I'm not really about being a purist.  I'm about getting the job of weight maintenance done.  If this means using sugar substitutes and low fat dairy, I'm ok with it, because in my world keeping weight low is the primary goal.  Health follows from that.  For those who are uncomfortable with that compromise, there are endless ways to vary such a diet plan.  

As you all know, I call this plan a Primarian diet.  You can find more detailed information in my book, Refuse to Regain and in the archives of this blog.  The degree to which you need to be completely Primarian varies from person to person.  I recommend that you use it as your default diet...meaning most of the time.  We all "go off' here and there, but it works better if deviation is rare.  That's because I remain impressed with the ability of grains, starches and sugars to take over in the brain (or gut).  Those who regain their weight have almost always been co-opted by these kind of carbs.  I believe them to be a strong drug and one that promotes insulin production and fat storage.

If other variations of eating work for you in maintenance, that's excellent.  Please share.  Each of us is a different entity and contrary to what some some have written, I don't believe in a one-approach-fits-all.  What I do believe, however, is that having rules and plans for eating is vital for healthy survival in our current environment.  None of these plans is about Restriction.  Each is about creating a way to eat that allows us negotiate the hazards of endlessly offered food choice. 

 

 

 

 

 

Halloween to New Year's Day: Joy, Anxiety and Overeating

by Barbara Berkeley, MD

Why do we eat?

In the America of 2011, we eat for the same reasons we buy new TVs, redo our kitchens or replace our perfectly functional cars.  We eat not because we need to, but because we can.  Eating is cheap, pleasurable and soothing.  It's kind of an adult "blankie". 

With that in mind, let's look at when we need a blankie most.  We want to be soothed when we are stressed, when we are reminded of unhappy memories, when the skies are dark, when winter descends, when we feel tired and overwrought.  

In the America of 2011, a supermarket is like a wonder-world of shiny new toys, each one affordable and promising a thrill.  The packages say "Fun! Fun!Fun!" while the labels say, "Heart Healthy" and "Cholesterol Free".  It's ok to be seduced, it's ok to give in.  Heck, it's even virtuous.

Combine these two stimulants to eating and you have the dangerous food period between Halloween and January 1st.   As the skies darken (at least in Ohio) and the leaves fall from the trees leaving depressing skeletons, the food intensity ratchets up.  Seasonal foods make their appearance.  Starbucks puts peppermint back on the menu, along with gingerbread.  Cooking magazines, newspapers and food channels exhort us to bake, bake, bake...as if this will somehow stave off our anxiety.  As we get older, the holidays remind us more and more about our own mortality.  They are still a wonderful time, but we remember how many of these holidays there have been and how many of those we loved are now gone.  Our kids may have grown up and live far away.  They return for the holidays, but no matter what we do, we can't return to the time when they ran down the front steps dressed as ghosts and princesses. We compare today's holidays to those past and to the celebrations of others.  Anything that reminds us of the passage of time tends to make us introspective and unsettled.  

So...let's eat!  Let's drink! 

How do we successfully negotiate such a difficult period and not regain?  The answer lies in creative thinking.  Maintaining a new, healthier body requires a new, refreshed look at life. Instead, most of us tend to repeat the same patterns.  Left unexamined and unchallenged,  life tends to break people down.  But it doesn't have to.  If you as an individual keep creating, keep innovating and keep expanding, the things life removes will have a lesser impact.  You will be more expansive.

Here are some questions for those who want to maintain from now until 2012:

Do you REALLY need to bake this year?  If baking gets you out of control, are you willing to take the daring step of experimenting and letting someone else make the cookies, cakes and pies?  What would happen?

Suppose you didn't have a single piece of Halloween candy this year?  Would your life be different?  Or would it be the candy manufacturers who suffered most?

Imagine that you designed a completely Primarian plan for Thanksgiving and decided that you would fill you plate with turkey, salad, veggies and maybe a dab of cranberry sauce.  Suppose you vowed not to have dessert this year, except for coffee and fruit.  Would your enjoyment of Thanksgiving be less?  

Suppose that you decided to do something really radical this year and ban non-Primarian foods from your home over the holidays.  Suppose that you decided to give yourself a much bigger gift than that new IPhone you've been eyeing?  Imagine that you daringly and creatively decided to stick with a primal eating plan with extremely minimal starches and sugars.  Would you have lost an entire year of holiday joy?

I can answer these questions because these are changes that I made personally almost 10 years ago.  Here are the answers.

The holidays are just the same.  It's still great to see everyone and it's still sad to miss Uncle Monroe, Uncle Aaron and Aunt Ellie.  It's still great fun to smell the peppermint and have an occasional gingerbread latte (with Splenda).  It's still a thrill to see the holiday decorations go up and to enjoy the lights, the music and the sentiments.  It's still wonderful to eat dinners with friends and family, and not a soul cares that I don't have the brownies or the stuffing.

And here's what's different.  For the past ten years I have not had to worry about my weight, my blood pressure, my blood sugar or my cholesterol.  My weight and health have allowed me to live so much more creatively...running, spinning, tennis.  Sometimes I'm just so grateful that I can easily squat down and pick up something I dropped.  Alot of people my age can no longer do something so simple.  Being lean and eating the right foods means that you are quicker and more efficient in every way.  My brain works better without the S Foods, which means that I can take up Chess, learn how to use Twitter and blog to the point where you are probably sick of me.

These are the greatest gifts.

So as you approach the holiday season, think bold.  Uphold your chosen eating plan..whatever that may be. Consider the possibility that our holiday eating may be motivated less by happiness and tradition than by habit and anxiety.  Enjoy and celebrate by continuing on your journey of self-creation.  To life!

 

 

 

Where's the Beef? Here's Mine.

by Barbara Berkeley, MD

For those of you who are old enough to have lived in the pre-modern era, Wendy's "Where's the Beef?" ad campaign likely remains a sweet, if dated memory.   Produced in the 1980s, before the obesity epidemic began in earnest, these commercials (see one here) featured Clara Peller, a feisty octogenarian who gave voice to the tagline.  They were hugely popular, and like the development of the Pillsbury Doughboy, Speedy Alka-Seltzer, and Betty Crocker, gave a specific face to the Wendy's brand.

Yesterday's New York Times published an article that announced Wendy's intention to revive the "Where's the Beef?" campaign.  But times have changed.  Dave Thomas, self-proclaimed hamburger lover and founder of Wendy's, underwent quadruple coronary bypass surgery in 1996.  His well-known form, as seen in many of the company's commercials, was unapologetically overweight and featured the pronounced pot belly that often presages health disaster.  (Thomas died of liver cancer in 2002 at age 66).  

Thomas, who had been adopted shortly after birth, was an advocate for adoption rights and reforms.  He did much good.  But we know a great deal more about fast food today than we did in the 80s and one has to wonder what Dave would really think of his company's decision to intensify the marketing of the very foods that make obesity and coronary bypass more likely for those kids he sought to protect.

The Times article contains many statements that are written without irony but seem oddly out of touch, to say the least. It also contains a link to the current "Where's the Beef" commercial featuring Little Wendy, Dave Thomas's daughter, now 50 years old. I will let you take a look  and come to your own conclusions about the use of the Little Wendy name.   

Does Wendy's believe it is doing good by promoting double and triple cheeseburgers with a budget that is "probably twice what we would normally do in a launch of a new product", in the words of their senior vice president?   The Times says that "the bleak economy is the chief reason for the intensification of the burger wars, which pit Wendy's against chains like Burger King, Carl's Jr., Checkers, Five Guys, Hardee's, In-N-Out and, of course the mighty McDonald's."  The article goes on to say, "Consumers who are struggling financially are turning to fast-food chains to save money on meals."  But oh, the irony!  The self-same NY Times featured an article by it's food writer Mark Bittman just last week that fully debunked the claim that fast food is cheaper than plain old healthy home cooking.  (Read Bittman's article here).  

In another ironic twist, Wendy's has chosen to name it's new, juicier burgers "Dave's Hot and Juicy" line, after it's founder.   His daughter "beams", "These would've made Dad say, "Here's the beef!'".  

When I was 15 years old, I was sitting at lunch with my Dad while he ate a big, juicy hamburger.  Half-way through his meal he developed chest pain, started sweating and had a heart attack.   He later had a sextuple vessel coronary bypass and was dogged with health issues related to the habits of his younger years, smoking, eating lots of fatty and fried foods, and being sedentary.   Unlike Dave Thomas, he survived it all and was able to change the way he lived and ate.  It is to that experience at the lunch table that I attribute my desire to help people lose weight and make a food conversion.  

Is it the job of business to help their customers make healthy choices?  No.  Do their over-the-top advertising campaigns and endless reach allow them to do good should they decide to?  Yes.  

Wendy's has the beef, but my beef is that they--and other large corporations-- don't have the conscience to use their brand to make a real change in American health. 

Foods That Control: Mile Markers on the Road to Our Tech Future?

by Barbara Berkeley, MD

Are you an optimist or a pessimist about the future of mankind?  There's a question to start your day.

In May, the Gallup Poll announced that optimism for the future of American youth had reached an all time low.  When asked whether they thought that young people in the US would have a better life than their parents, 55% of those polled answered no.  Pollsters commented: 

The large majority of Americans expressed optimism about the future for U.S. youth when Gallup first asked this question in January 2008, as the recession began to take hold. They continued to do so even as the economic crisis unfolded and unemployment ballooned. Hopes for U.S. youth declined to the 50% level in October 2010, however, before dropping to a new low in the April 20-23, 2011, USA Today/Gallup poll.

Of course, this pessimism reflects doubts about our economic future.  But what about the larger future of our species?  Is there a connection between the helplessness many of us feel politically and the general trends happening in our world?

On my recent trip to southeast Asia, I had approximately 60 hours of enforced down time (travel and layovers).  It was a great opportunity to read, catch up on missed movies, and watch The Godfather, (Parts I and II for the hundredth time ...still fabulous!).  One of the movies I watched was a documentary called Transcendent Man.  This is a film about futurist Ray Kurzweil, a brilliant, eccentric scientist who has predicted something called "The Singularity".  The Singularity refers to the point at which humans and technology will effectively merge, changing the course of human evolution.

 As Kurzweil points out in this film and in his written work, the pace of human techological advancement is moving so quickly that we will soon have artificial implants that will enable us to access the internet and other sources of the world's knowledge. Our bodies may soon be enhanced by injectable mini-computers and chips, making us into the bionic man. Essentially, we will eventually cease to be competely human, at least as we define that state today.  While this could lead to wonderful improvements in health and longevity, the asymptotic growth of technology has more sobering, and ultimately more frightening, aspects.  These relate to the seemingly inevitable development of artificial intelligence.  In the not too distant futures, computer intelligence will multiply itself to the point where it exceeds out own. Once computers become smarter than man, the future looks nothing like any we might have envisioned and the place of man in the universe becomes uncertain.  While many scientists believe that Kurzweil is incorrect in the timing of his predictions, no scientist who is quoted in the film doubts that we are headed in this direction.  

When we imagine a world of endlessly expanding intelligence, we realize how limited we humans are and how vulnerable these limitations make us. If we look at our behavior, our literature, our art, we are fixated on a few basic themes: tribalism (war), love, and the search for spiritual meaning are the most obvious.  Similarly, we are highly motivated by one very simple thing: our brain's system of rewards.  Endorphins, endocannabanoids, and other brain chemicals are what keep us coming back for more.  And more. Whether it's the pleasure created by food, the colors and noise of a gambling casino, the smell and feel of a cigarette, the rush of alcohol, sex or drugs, we are led around by these ancient responses, often to the point of our own destruction.  Advances in technology have already shown how vulnerable we are.

Modern science has made it easier to deliver hits to our pleasure centers.  Whether these come from the bright colors of video games, the instant access to pornography, or destructive foods masquerading as wonderful fun, we are easy to lure.  It is not hard to imagine a future in which many of us will opt to live in a virtual world, full of colors and sensations that cannot be obtained on good old Earth.   This tendency to give in to the enjoyable without regard to consequence is what gives me grounds for pessimism.  Just today, for example, I saw a new patient who had been uttterly destroyed by food.  He weighs over 300 pounds, is riddled with pain, is losing function in his eyes and kidneys, has had several heart attacks, is injecting insulin multiple times a day and yet he describes an utter passion for junk food, fast food, and sweets. Perhaps it is judgemental to say that this is a tragedy.  We all have the freedom to pick the way we want to live.  But my worry stems from a suspicion that we aren't choosing so much as being manipulated by ever-heightened pleasure experiences.  The modern production of food may be one of the best examples of this unfortunate phenomenon. 

Our inability to see that our country is being weakened by tehnologically enhanced food and our sheer willingness to embrace these products as harmless fun makes me worry for our greater future. If we are willing to be killed by food, how easy will it be to offer us other kinds of pleasurable "enhancements"?  How simple we will be to control.  Unless we start looking at our changing world critically, it will take no more than a sweeter, brighter, more colorful drug to destroy us completely.   Now that's pessimism.