by Barbara Berkeley, MD
Perhaps you are curious about what goes on when an obesity doc like me sees a patient. Or perhaps not. If not, stop reading because I'm about to tell you.
Someone from our practice (either me or one of our dietiticans) sees each of our patients weekly. This is obviously a much more intense treatment model than most weight loss programs provide. Sometimes we can see someone every week for a year or more. When patients enter maintenance, we encourage them to see us just as frequently since (as you all know) maintaining weight takes more skill than losing it. But generally, visit frequency will drop to somewhere around once monthly in the first year of so of maintenance.
Seeing the same patient so often gives rise to lots of conversations. I get to know pretty much everything about a patient's life, or as much as they want to share. The patient also gets to know alot about me.
Our practice sees about 100 patients per week and the sole goal is weight loss and weight stability. So you can imagine that over more than two decades, certain questions and topics have come up repeatedly. Since I talk about these things so frequently to those I counsel, I'm willing to bet that these are issues that you have wrestled with as well. So here are the top five things patients say to me. And my responses.
1. I'm a terrible stress eater and I think I need some kind of psychological counseling.
While it's of course possible that you might, I feel very strongly that the vast majority of ow/ob (overweight and obese) people, do NOT have a psychological problem. They generally confuse the inability to harness willpower and their tendency to use food as a calming drug with a deep seated psychological pathology. This is our general culture talking. Conventional wisdom tells us that ow/ob people are somehow flawed, lacking in control, ie: sick. But conventional wisdom is wrong on almost every count when it comes to weight. So don't buy into it!!! You have no willpower because the people who make money from food products have addicted you, fairly willfully, to their products. Then they've stood back nodding while society blames it on you. The solution is making repeated, creative, supported attempts to get off your food-drugs: permanently.
2. I don't want to take medicine or have surgery for my weight because I would feel like a failure.
Again, who are you listening to? This is society's prejudice against the ow/ob. If you can't control things through willpower, you have failed. But let me ask you, what does the rest of society do when they have high cholesterol, high blood pressure, reflux, heart disease, respiratory illnesses? These problems could almost all be controlled by lifestyle, but no one expects it. Everyone takes medicine and uses surgery if needed. The alternative is hardly ever considered. In the case of medicine and/or surgery for weight control, these treatments are useful adjuncts in a very, very difficult fight. Often, it is not possible to go it alone without some sort of external support. If you are concerned about using one of these aids, just remember that they are just that: aids. Alone they will not cause weight loss or maintenance. You will still have to do the hard work. But medicine and surgery, in some cases, can help you do it. Don't be ashamed to use the supports that are out there.
3. I don't know why I regained. It just happened overnight.
Everything in America is geared toward weight loss. But, as I've written many times, weight loss is a completely meaningless exercise. Unless you flip the switch that causes weight accumulation, you are doomed to regain. But there is an even more important point. When we create weight loss, we trigger at the same time a primal body response that wants to regain the weight. I say primal because this response must be ancient and written into our genetic program. My guess is that we are wired this way because our gene programs are probably over 100,000 years old. At that time, any weight loss was a bad thing and meant you had suffered starvation. The body doesn't appear to have any measuring device for how much fat we have, so it doesn't understand that you lost weight that was harming you. It only knows you lost, and the regain program is tripped.
Why, why, why do we persist in ignoring this fact? It takes tough, crafty body trickery and mental focus to oppose regain. Successful behaviors include daily weighing, reversal of small regains, avoiding foods that stimulate insulin and thus fat accumulation, exercising at least 300 minutes per week, and staying in a support group or environment. Don't be surprised at regain. It is the NORM and will occur, seemingly overnight, if you let the body proceed on autopilot.
4. I thought I could handle the carbs.
Oy. If I had a buck for every time someone told me this one. Remember that your body was not built as a processing machine for vast amounts of grain, flour and sugar. We've lived in such a carb morass for so long that it doesn't seem there could be any other way to live. There always was, and there still is!!! Remember that your brain reacts with an addictive spike of dopamine when you eat these foods. Remember to respect them at all times and to monitor your responses. If you are increasing carb intake despite your best intentions, go cold turkey and reset. Don't wait.
5. I don't know why I regained. I felt so GOOD when I was at that low weight. WHY did I let it happen?
Once again. Stop taking the blame. You didn't let it happen. Your body wanted it to happen. What you did, was forget that fact. Stay ever watchful to be successful. After awhile, the skills will become second nature to you.