The Main Reason You Can't Lose Weight is EXACTLY What You Think!

Most businesses hope for repeat customers; weight loss businesses bank on it. Following New Year's, every single year, thousands of resolutions to lose weight are made and broken. If you have dieted once, chances are you have done it many times. You've tried the programs, read the books, watched the shows, took the pills, had the injections, and maybe even spoke to your doctor about your desire to lose weight.

Perhaps, you've even enjoyed some success, only to find yourself slipping again. But despite your best efforts, every time you look in the mirror or get out of a chair, you know you are carrying around more weight than is good for you. You are probably ready to throw your hands up in disgust and give up. Or maybe you will keep watching Dr. Oz hoping that one of his far flung schemes or pill of the day may actually work for you. Don't! The problem of losing weight and keeping it off is clearly a challenging one and difficult predicaments need good solutions. So what's a person to do?

From the inception of MDPrevent, I have believed that psycho-social issues are at the forefront of most people's inability to lose weight and keep it off. Some eat too much or choose the wrong foods because of stress, poor sleep, anxiety, depression, comfort, loneliness, etc. There are many reasons, and sometimes they even combine. Either way, if you don't deal with them, they keep plaguing you.

That's why one of the first professionals I added to my team was a health psychologist. Patients who want to lose weight once and for all find seeing a psychologist trained in such matters to be a godsend. Why? The answer comes from the psychologists themselves.

A new survey of psychologists confirms that dieters should pay attention to the role emotions play in weight gain and loss if they hope to succeed.

According to the American Psychological Association, the survey, conducted by the Consumer Reports National Research Center, queried over 1,300 licensed psychologists about how they dealt with clients’ weight and the challenges of losing weight. The strategies psychologists cited as essential to losing weight and keeping it off, was "understanding and managing the behaviors and emotions related to weight management." The doctors believed this was essential to forty-four percent (44%) of their clients who wanted weight loss. "Survey respondents also cited “emotional eating” (43 percent) as a barrier to weight loss, and included "maintaining a regular exercise schedule" (43 percent) and "making proper food choices in general" (28 percent) as keys to shedding pounds.

In general, gaining self-control over behaviors and emotions related to eating were both key, indicating that the two go together."

Among the 306 respondents who provide weight loss treatment, 92% reported helping a client “address underlying emotional issues related to weight gain.” More than 70 percent identified cognitive therapy, problem-solving and mindfulness as "excellent" or "good" weight loss strategies. In addition, motivational strategies, keeping behavioral records and goal-setting were also important in helping clients to lose weight and keep it off, according to survey results. Cognitive therapy, one of the clinical approaches often used by psychologists, helps people identify and address negative thoughts and emotions that can lead to unhealthy behaviors. "Mindfulness allows thoughts and emotions to come and go without judging them, and instead concentrate on being aware of the moment."

The full survey results are reported in the February 2013 issue of Consumer Reports Magazine.^®

Now clearly, psychologists telling the surveyors that their efforts to ensure their clients keep losing weight is somewhat self-serving, and I would be a ‘doubting Thomas’ myself if I didn't see the difference a psychologist can make. By the way, it’s not just the psychologists with whom I work that make a difference.  I recently sat with a friend from out of state who has enjoyed over a one-hundred pound weight loss. When we sat down to discuss his formula, the secret sauce is that he has been working with a psychologist.  My only concern in listening to him was that some of the foods he was eating to lose weight are not the healthiest.  Also, he would have been better off to consult with a nutritionist or registered dietitian to make sure that he was both losing weight and eating health promoting foods. Not all weight loss is healthy and ultimately what's the point of losing weight only to get sick?

Therefore, I recommend that if you can afford to see both a registered dietitian and a psychologist to lose weight, there is no better combination. If you have Medicare, nutritional consultations for weight loss are 100% covered under a program called Intensive Behavioral Therapy for Obesity if your body mass index (BMI) is above 30.

Last year, MDPrevent was the largest provider of such services in the State of Florida. If you can get to our office in Delray Beach, I welcome you do so (561-807-2561).  If not, consult with your local primary care physician or cardiologist to identify who is offering this service near your home.  Even if you don’t have Medicare, you can still give us a call so we can let you know what your insurance company will cover.

It turns out that the key to losing weight may really be in your head and we can help you use that knowledge to unlock a healthier, higher energy, and more enjoyable life.     

So stop wasting your time and money on programs whose results usually don't last and address once and for all the real problem: your emotional health.

It's Never One Thing

It would be an understatement to state that I have become fascinated with all aspects of longevity and disease prevention. Over twenty thousand studies and a dozen books later, my search for the quintessential answer to a long and healthy life goes on.  The body of knowledge is so vast and the hours are so short that I suspect that I shall never fully grasp all the intricacies of what allows any single person to optimize his or her longevity and minimize susceptibility to disease. While scrutinizing certain cultures that appear more successful at longevity may offer some clues, even among their members you will find those that die far younger than others despite similar lifestyles.

However, one thing has become abundantly clear to me: a long and disease free life is never dependent on just one thing.

This statement is made with the caveat that obvious detriments to health, such as consuming lethal poison or jumping off a perilous cliff, offer certain consequences.  Nevertheless, when one removes from the list such immediate threats to continued living, it becomes crystal clear that a host of factors contribute to the life we live and the day we die.

Foremost, but often not close to the most important factor, is the role that genetics plays. This is the influence least under our control as we obviously have no role in choosing our parents. But numerous studies, and in particular, the Swedish Twin Studies (that began in the 1870's, involving tens of thousands of identical twins who happened to grow up separately with varying lifestyles who developed different diseases and died at vastly different ages),  have demonstrated that genetics plays no more than a 15 to 30% role in our overall longevity and disease development. Of course, those born with Down's syndrome, hemophilia and other genetic disorders would argue otherwise and they would be right. But for most people, genetics at most represents a predisposition for diseases whose ultimate manifestations are under our control.

So what does matter? For one, but not alone, it is environmental factors. Which? That's the $64,000 question. Is it processed foods, gluten, pesticides, household chemicals, pollution, contamination, etc., or could it be some mix and match of all of them?

Anyone who tells you they know with certainty is either delusional or just flubbing.

The reason no one can tell you the absolute answer is that it is often different for different people. For example, there are smokers who live to 100 and others that die far earlier. Some obese individuals have heart attacks in his or her 30's while others survive into their 90's.

More importantly, no one can do better than hypothesize because the scientific method can never be applied to such a multivariate question. The gold standard of scientific inquiry into a population's health would require a double-blind, randomized controlled study where all confounding variables are controlled. Unless we could snugly place people in a bubble, we could never firmly establish a definitive working conclusion.

Nevertheless, scientists slog on trying to make sense of what they can. They can show a strong correlation between smoking and lung cancer, alcoholism and cirrhosis of the liver, obesity and heart disease, etc. What they can't do is tell you if you simply avoid or consume one particular food then your longevity is guaranteed to be positively or negatively impacted, respectively.

For example, I think there is a strong basis in science to call sugar a human poison, albeit a slow acting one. My patients are cautioned to avoid it and to go to great lengths to minimize their exposure to it. Nevertheless, I don't believe that avoiding sugar alone guarantees a long life.

I often tell my audiences that if they eat plenty of fruits and vegetables, nuts and beans and seeds, whole grains and wild fish--they are going to die.  I suspect they expect a different conclusion than the one proffered, but it's the truth.  Long before processed foods even existed, people died and some at relatively young ages from a myriad of other factors--infections foremost among them.  Food allows you to live by providing essential nutrition, but it doesn't guarantee health. Healthy eating doesn't offer protection against many simple infections like chickenpox and viruses or more esoteric infections like tuberculosis and tetanus.  These sometimes life-threatening ailments often depend on passing exposure to these pathogens.

So what else matters? The mind.

Many an otherwise healthy person has been befallen by stress, anxiety, depression or any other number of mental health issues. Such factors may have a genetic or familial disposition. Some may be purely situational. Sometimes it's both. The connection between the mind and body is well established. It facilitates innocuous placebos to work and allows real, measurable systemic diseases to develop in the absence of any other factors.

I have witnessed this first hand. Learning about my family member's cancer brought back my heartburn which I thought I had banished forever. No diagnostic medical test, and I've had plenty of them searching for a clinical reason, has shown any other identifiable cause for this phenomenon. I know it is because of stress.  Despite eating, sleeping, and living well, I have struggled to control my own guttural reaction to difficult news. I know that I must learn to manage my reaction to difficult news and I strive everyday to naturally manage my stress to relieve my symptoms.

This is why I know that the complex human body forged over 150,000 years to it's current form, and millions of years earlier in prior forms, is at once and always will be a very vulnerable and fragile system, highly complicated and efficient-- a veritable miracle of nature subject to forces sometimes beyond our control.

Although many would have you believe by the titles of their books such as "Why We Get Fat" or "Wheat Belly" that your health depends on one thing, I will tell you that it's simply not true.  No pill, prescription or supplement, no food described as super or otherwise, no exercise routine, done in the gym or in nature, will guarantee health.  Alternatively, certain vices like smoking and excess alcohol, consumption of certain processed foods, a sedentary lifestyle, poor sleep, great stress, etc. while expected to have a detrimental effect on your health, don't always factor in your death.

Your health depends on a combination of factors that affect both your body and mind.  Ignoring any of these factors shifts the odds against you for a long and healthy life.

But please take note, it's never one thing.

I Will Never Tell You To Relax

When I was in medical school some 30 years ago, I was taught never to tell a patient to relax. Nothing seems to make someone less relaxed than being told to do so. The alternative advice was to tell them to clench their toes and then slowly let go and feel the sense of relaxation sweep up your legs into the rest of your body. Showing them how to relax proves much more effective than telling them. That actually seems to work and I've tried it on myself numerous times.

I share this anecdote because it is a good prelude to today's topic. How do you tell someone about the dangers of stress without stressing them out?  That would seem to defeat the purpose of alerting them. I'll come back to this paradox later.

It's been an acceptable axiom for some time now that stress wreaks physiological damage on our bodies, even perhaps on the chromosomal level. I've seen references to a study that revealed that the telomeres which are the end of our chromosomes, shorten secondary to stress. Scientists generally believe that when a telomere shortens to a certain length, typically a cell undergoes apoptosis or cell death.

Along comes a meta-analysis study by Tom Russ, MRCPsych, of the National Health Service Scotland, and colleagues that reviewed 10 British cohort studies that showed that the risk of all-cause mortality or reasons for death in adults with the lowest level of psychological distress -- termed subclinically symptomatic -- was significantly higher than that of asymptomatic adults at an age- and sex-adjusted hazard ratio of 1.20 (95% CI 1.13 to 1.27). In other words, stress increases your likelihood to die from any number of reasons.

To quote medpagetoday.com, "The study measured the association of psychological distress with death by any cause, cardiovascular death, cancer death, and deaths from external causes using data from the Health Survey for England. The survey included data from 1994 to 2004 on 68,222 adults ages 35 or older, mean age 60 years, who were free of cardiovascular disease and cancer, and who lived in a private household in England at baseline."

As an observational study, in which results are observed as opposed to created, the study has its limitations. For example, we don't know the cause and effect relationship. Did people who became unhealthy develop more stress and therefore die at higher rates or did people who became more stressed thereby became unhealthy, which led to their death? There is no good way to do a high quality study of this kind because you can't have a group that you stress out to see if the stress will kill them. So, we are left with correlative studies such as this one as our best science. Notwithstanding, I think we can all agree that stress is not a good thing.

I know that whenever I hear about the dangers of stress to my health it raises my stress. It's like someone telling you not to think about something and you start thinking about it incessantly. The mind is a wonderful machine that still escapes our full understanding. Still, we have to work with what we know and that is it is better to be somewhat relaxed than somewhat stressed. In the book, The Longevity Project, by Doctors Friedman and Martin, we learn that a little bit of neuroticism is a good thing. I wrote about this some time ago. It's healthy to be aware of your surrounding and potential dangers. It's normal to worry about finances and relationships. It becomes unhealthy when you are consumed by such thoughts.

So how do we find a healthy balance between legitimate worries and irrational thoughts? I think the answer is focus. Ask yourself what is the focus of your life? Is it on potential and possibilities or what has gone wrong? Is it on tomorrow or yesterday? Is it on things you have to be grateful for or things that bother you? For some people making these choices is easy. If you are one of them and your focus is on the positive, I suspect that you enjoy life more than most. If you are hampered by a continuous stream of consciousness that accentuates the negative, you need to address this proactively. You can't ignore it; you need a plan. Speak to your clergyman, a doctor, or anyone you think may help.

I share these concerns about stress because despite the fact that it may raise you stress in the short-term, you will be better off in the long term by developing effective ways to lessen its toll on you.

As the studies suggest, living with stress means dying early from stress. Don't let yourself become a statistic.

We All Can Use A Little Help Sometimes...

I have always been a fan of psychologists. When I was in college, I was very distraught over a family situation. In a mere fifteen minute session, a college-based psychologist gave me advice that served me profoundly well. Sometimes, we get so lost in our heads that we need someone, trained and professional, to help us get some clarity. I did that day and it made me a believer.


Psychologists, particularly those with a PhD, spent as much as ten years, including postdoctoral internships and fellowships, getting the full range of their intensive education, and they can make a huge difference in your life.

That is why, before MDPrevent had it first patient, I hired a full time health psychologist for our team. Her name is Dr. Jessica Kordansky and patients rave about her. She offers the full range of health psychology services and also leads our Mindfulness Meditation classes each week.

What is a health psychology? It is a field of psychology concerned with understanding how biological, psychological, environmental, and cultural factors are involved in your physical health and illness. In other words, it takes all aspects of your life into consideration to help you maintain the best possible emotional and mental health. It helps you develop strong coping mechanisms to deal with the inevitable stress and anxiety that seems to accompany most people as they age.

New Study

Why do these matter? A recent population-based study showed that individuals scoring higher on a measure of general mental health had an increased risk of stroke mortality. Psychological distress predicted a significant 66% elevated risk of death from cerebrovascular disease, according to Mark Hamer, PhD, of the University College London. It's really simple. Stress kills.


"These [new] data suggest that the cardiovascular effects of psychological distress are not limited to coronary artery disease," Hamer's group wrote.

Scientists know one of the mechanisms by which stress kills is by shortening your telomeres, which are the tails of your chromosomes. Each time your cell divides, your telomere shortens and eventually when it reaches a certain length, the cell dies. Stress accelerates this process. Another mechanism by which stress induces great harm is by its affect on your blood pressure. Increased blood pressure damages both your heart and vascular systems thereby increasing your risk for stroke and heart attack.


I think that the overwhelming majority of patients would benefit from one-on-one time with a health psychologist.   It seems that as we live our lives, we accumulate a lot of mental baggage and it gets really crowded in our heads making and keeping sense of it all. A health psychologist can help you sort out the things that you should stop thinking about because they are not meaningful, the things that you need a plan to address, such as your finances, and the things that you can't stop thinking about, such as your children, that you can't change, but need a effective and useful way to cope with it.

I often quip that smart people always take advantage of psychological counseling because I learned in medical school from a family friend who worked in a local mental health center that many of my fellow medical students were taking advantage of the service available to us. I also once heard that Newton, Massachusetts, where I lived for ten years, has the highest per capita rate of counseling anywhere in the U.S. It's not surprising because it is also home to some of the smartest people in the country who are professors and doctors at local universities such as Harvard, MIT, Tufts, Boston University, Boston College, Wellesley, Brandeis, etc.


The best part of health psychology is that it is covered by Medicare and most other insurances.  So if you find yourself believing that your "thoughts are facts," which they are usually not, and would like to get some stress reduction, better sleep, less anxiety, and an overall better handle on life, maybe it's time you spoke to a health psychologist? At a minimum, it may help you avoid a stroke.

There are many excellent health psychologists. I am impartial and think I have one of the best, who by the way trained at Emory University. If you are interested in speaking with Dr. Kordansky, you may reach her at (561) 807-2561.

Either way, if stress, anxiety, difficulty sleeping, strained relationships, loneliness, depression, or anything else is affecting your health or your life, consider speaking to someone. It doesn't really matter why, but if you you think you would benefit from such support, you should do so because we can all use a little help sometimes...