by Barbara Berkeley, MD
The beginning of each year brings a new crop of diet books. Publishers aren't stupid. They know that the most common New Year's resolution is the vow to lose weight. And since none of the thousands of other books already written on this topic were strong enough to get the job done, it's time for a whole new table of tomes---purposefully displayed right at the front of the book store.
Hah, you may be thinking, she's one to talk. She's a diet book author herself!
Well, it takes one to know one and here is my no-holds-barred assessment: Most diet books are worthless. Worse, they can waste precious time by leading a reader---who is seeking answers to health problems--- down blind alleys. I sincerely hope that "Refuse to Regain" is one of the good, honest and helpful diet books. I did try hard to make it that way. But that is for others to decide. Either way, books on weight loss that fit that description are few and far between.
This year, I was disappointed in "What Are You Hungry For?" by Deepak Chopra. The subtitle of this book is: "The Chopra Solution to Permanent Weight Loss, Well-Being and Lightness of Soul". A tall order for any book....or any person....that's for sure.
Dr. Chopra is a very smart doctor, an endocrinologist, whose brother (also a physician) was a favorite preceptor to my husband and me when we were medical residents. In recent years, as anyone who has a television is aware, Deepak Chopra has become well known through writing and counseling about spirituality and the ancient Indian medical practice called Ayurveda. He has filled an important void by focusing on the vital area of our inner life, so often ignored in modern American.
But January 1st brings a glut of diet books that publishers are betting will sell lots of copies. Selling a book requires recruiting authors who are well known and who have a "platform" (millions of people who follow them already). And so Dr. Chopra has ventured into an area that is not basically his. The book does not claim that he spends a great deal of time dealing with ow/ob (overweight and obese) patients. Instead, it starts out by recounting Dr. Chopra's own experience in successfully losing 20 pounds. This raised an immediate red flag for me, because those who gain 20 pounds or so into mid-life are not the same as those who are able to easily accumulate much greater fat mass. In other words, I believe that a person who can gain 100 pounds is processing food quite differently from the person who, in the same environment, stays stable or gains just a little. Thus, generalizing from the experience of someone who had to get rid of 20 pounds is unlikely to help someone who is much larger. Many of the things that Dr. Chopra says in his book appear to be conclusions drawn from his own weight loss. Other are conclusions he reaches more because of his worldview than from observing or treating ow/ob people.
My major disappointment with "What are you Hungry For?" is that it is built on the premise that we are fat because we overeat, and we overeat to fill a spiritual or emotional hole, not because we are motivated by true hunger. He also believes that we can somehow gauge "true hunger" if we only pay attention. This is the belief system of those who promote "intuitive eating", a technique which I believe to be weak at best and possibly destructive to real weight loss efforts. (For those who haven't read my take on intuitive eating, you can find it here. And--before you write in---I do recognize that there are some readers who will have found intuitive eating helpful. Nothing is completely black and white.)
The belief that we eat because we are emotionally flawed is not new. In fact it's one of the oldest concepts out there. Personally, I feel that this is an outdated belief that does a disservice to our current understanding of weight gain, and more importantly, to those people who struggle with overweight. I understand, of course, that eating is tied to emotion. I also understand that there are a subset of people who eat strictly to solve problems, hide under a layer of fat, or act out self-destructively. But in the many years I've been treating ow/ob patients, I've discovered a fascinating thing. Almost everyone believes that they are overweight because of an emotional failing. When we give them real skills to battle their problem, they find out that they actually had more of a physical and neurochemical problem. It just felt as if it was their fault.
I think that the knee-jerk reaction that ties an empty, meaningless life to being too fat is the basis for the guilt we feel when we gain. We must be weak. Worse, we are obviously lacking in some kind of happiness, balance, humanity. Because we believe these things about ourselves, others are free to view us in just this light. And believe me, they do.
"What Are You Hungry For" begins with a fundamental contradiction. If weight gain is based on a lack of fulfillment, why would Dr. Chopra, among the most balanced and enlightened men on the planet, gain weight? And if Dr. Chopra was unbalanced, how could those of us with far less skill and training hope to gain an enlightenment greater than his?
Dr. Chopra actually does not describe any hole in his life. Instead, he describes a situation in which he stopped paying attention to what he was eating due to being stressed and busy. To lose his own 20 pounds, Dr. Chopra did not look for the lack of fulfillment in his being. Instead, he started paying attention to what he was eating (he prefers to use the word "mindfulness") and went on a diet.
Chopra does not like the word diet. Many authors of weight loss books don't like that word, even while writing about their chosen diet for 300 or so pages. "Diets don't work!", they all proclaim. But that's only because these authors use the word diet to describe some faddish form of starvation. In fact, a diet is simply a prescribed and definite way of eating. Following a diet that you believe in, that works for you and that YOU control is one of the most important keys to healthful life. Diet not only works, it is supreme.
Thus, I reiterate, Chopra went on a diet. His choice?
No processed foods at all
No alcohol, no cheese
No white sugar
Drastic cut back on salt
No red meat. Smaller amounts chicken and fish.
Pure water
Greater focus on vegetables and fruits.
Adequate sleep
I would submit that the reason that Chopra lost weight and felt better was that he cut out carbs and salt. If he wanted to lose more, he could have also cut out grains. Making these types of changes, particularly if you are a man with some muscle mass and a decent metabolism, is often enough to cause a weight loss of 20 pounds or more. Getting processed foods and many carbs out of the diet lowers appetite and makes long term weight loss possible. Preventing the re-entry of the foods engineered to addict the brain, releases the eater from the shackles of the SAD.
But while Dr. Chopra does devote a good deal of the book to eating a cleaned up diet, he spends equal time telling the reader that the reason he or she got into this fix was a life lacking meaning. "Fill yourself with other kinds of satisfaction" he says," (and) food will no longer be a problem". Here is where Chopra loses me. Although sustaining balance is very helpful when one is trying to change the way one lives, it is not, in my view, emotional balance that staves off poor food choice. It is the long term practice of cutting out addictive foods that accomplishes that.
For those of you who might have any interest, here's the difference between Chopra's beliefs and mine.
Chopra: "Why does normal eating slide into overeating?" The simple answer: lack of fulfillment."
Berkeley: Why does normal eating slide into overeating? The simple answer: a toxic environment filled with addictive, cheap,pleasurable foods to which pretty much no one is immune. When a cheap, legal drug is right there in front of us, we will use it.
Chopra: "In its natural state, the brain controls hunger automatically." But, he contends, emotion overrides this natural control. "If you stop focusing so hard on diet and calories, you can see that the story of overweight in America is the story of missed fulfillment."
Berkeley says: "In its natural state, the brain controls hunger. But eating in America makes it impossible to be in the natural state, particularly when we are rushed, stressed, controlled by advertising messages and exhorted to eat by friends and family. In order to return to a natural state, we must return to natural food patterns (just as Chopra did, quite successfully). This is a defensive effort. If you stop focusing on diet as Chopra suggests---and I mean diet in the larger sense--- you are utterly bound for failure. The story of overweight in America is the story of the monster we've created via a powerful, unregulated food industry. To remain healthy, protect yourself. Don't blame yourself or fall prey to the belief that this is all your fault.
Chopra: This is what naturally thin people say: "My body tells me what I want. I feel uncomfortable if I gain 2 pounds. I exercise because it feels so good." Chopra attributes this golden state to a mind-body connection that is working properly (in other words, thin people are balanced, healthy and perfect. Where does that leave the overweight?)
Berkeley: This is the true story of a naturally thin person....me! I was naturally thin until I was 40 years old. During those years I ate whole pizzas, ring dings and boxes of Mallomars without giving a thought to the calories. I never exercised and never gained a pound. I was continually hungry. No one would have described me as having any greater emotional balance than anyone else. I just didn't gain weight! Thin people simply have a sturdier metabolic balance than overweight people, but it breaks down under the onslaught of the SAD eventually for almost everyone. Now I'm just like the patients I counsel. Without, by the way, any change in the meaning or fulfillment of my life.
The second half of "What Are You Hungry For?" delves much more into Dr. Chopra's area of expertise. I recommend meditation and other relaxation techniques to my patients....not because they are imbalanced but because these methods help them to do the hard work of changing life habits. There are many pages of helpful techniques in Dr. Chopra's book for those who are looking for such methods.
What are YOU hungry for? For most of the people I've worked with over the better part of two decades, the answer is: good ole' sweet, fatty, addictive, cheap, salty, mass-produced American food. The only way to break the habit is to decide you want to do it and to get very, very serious about it. This is a tough addiction to disable and one that will keep challenging you for a lifetime. But it can be done. And you will be happier and more whole as a result of the effort---not because you started out with a fatal flaw.