Showing posts with label losing weight. Show all posts
Showing posts with label losing weight. Show all posts

Sunday, October 14, 2012

Why You Stay Fat...Part One

In my previous blog "Why You Get Fat...," I explained that there are five factors that contribute to weight gain (medical, diet, physical activity, sleep and stress). Of course, to lose weight you must address these factors. But once you have gained weight, to shed the unhealthy excess pounds becomes more complicated than just confronting the factors that caused you to get fat in the first place. That's because your body actually doesn't want to give up it's fat stores. It sees fat as energy storage and is invested in the rainy day theorem that you can never have enough fat for difficult times.

(In fact, according to a recent study dealing with diabetes, as the disease progresses, the human body begins to waste away. Therefore, the study showed that those with more body fat actually fare better because they survive longer. Diabetics take note: Just because extra fat can sometimes have perverse benefits, please don't let your disease get to that wasting away stage because there are ways to prevent such progression.  Nevertheless, for most people excess weight actually causes problems like the metabolic syndrome with elevated blood sugar, cholesterol, triglycerides, and blood pressure.)

So, why you stay fat has a lot to do with why and how you try to lose the weight.

The most simplistic, albeit meaningless, answer as to why must people stay fat is because as Albert Einstein once gave as the definition of insanity, they do the same thing over and over again and expect a different outcome. They bounce from one diet plan to another. Or they look to miracle cures, magic pills and quick fixes, offered by the likes of Dr. Oz and thousands of other pill-pushers. They know such approaches never offer permanent solutions, but they are so desperate, they will  try anything. (I make this point in the hope that by sheer dint of repetition it will eventually sink in.)

They try diets that include cookies, low-carb and high fat, hCG injections, appetite suppressants, calorie restrictions, gluten free, vegan, etc. and still inevitably end up around the same weight or worse.

The real problem is that most people never truly understand why they got fat other than thinking they simply ate too much. In response, they spend their time and money floundering around in search of ways to control their appetites, chasing the latest and greatest fad.

Everyone knows and many have tried diet programs with names like Atkins, The Zone, South Beach, Weight Watchers, Medi-fast, etc. and yet.... if it was only that simple. Diet programs fail for most people.

I think, based on now treating hundreds of patients with weight problems, that there's a much more profound reason why people keep their excess weight. Please read on to learn what I hope will be a new, life-changing perspective.

Patients who come to me for treatment of a weight problem often ask me during our first encounter if I am a psychologist or a physician. (I am the latter.) The reason is that our first meeting often begins with a discussion about their motivation.  When someone has gained a lot of weight, even reaching a point where they are defined as obese, the road back can be difficult and challenging.  In order to succeed, one has to have the right attitude and be optimistic, if not confident that if he or she does the right things, success will follow. Most importantly, they must be motivated to do so.

In order to gauge such motivation, I often ask a simple question, "Why are you here?" If they answer "to lose weight," I counter with "Why do you want to lose weight?" Some look at me puzzlingly when asked such a question as if the answer is obvious. Others chip right in with answers that range from the aesthetic, "because I want to look better" to the practical "I want to feel better." Some proceed to elaborate how they are sick and tired of feeling sick and tired.

But virtually all patients pause to answer my next question which is a variation of "Why do you want to look or feel better?" They puzzlingly ponder how I could ask such a question, so much so that I often have to repeat it to get an answer.

After a few more iterations of my probing deeper into their answers, we eventually settle on that aspect of their life which is what they label as their number one priority. We identify that aspect of their life for which they are motivated to make sacrifices to succeed. While I encounter a wide variety of ultimate answers, with most often including reference to grandchildren and spouses, we also sometimes settle on what appear to be mundane core statements such as "I truly enjoy life and just want to keep going" or "I have a fear of death and want to delay it as long as possible." These actually reveal a far deeper motivation as they strike to the essence of one's perspective.

With a candid answer finally in hand, my questions turn to how much do they want to succeed on a scale of 0 to 100.  Any answer that is less than 100 is met with further probing questions about why they are not 100% motivated to succeed. There is no right answer and 100 may simply never be in the cards for some, but it is very important for both the patient and I to know exactly what their motivation is to lose weight and how motivated they truly are to succeed. (The spouse sitting next to them and prodding them usually doesn't work.)

Take a moment and ask your self the same questions. Challenge yourself to find YOUR truth. Keep asking yourself the question until you reach past the easy, cheap answers. Dig deeper until you are absolutely certain you fully understand your motivation(s) and how deep they run.

Everyone's reasons are different. One poignant example illustrates this point.  A patient once shared that although she was married, she loved another man. Although she longed to be with this other person, she was committed to her husband and was steadfast in her fidelity. However, she believed that if she outlived her husband (of course, dying from natural causes and not foul play), then she may eventually have the opportunity to spend some time with her true love.  Her commitment to increase her health and lose weight was based on this single desire. It is difficult as a physician to hear about a patient's torment, but I was delighted to help the woman articulate her ikigai (Japanese for purpose in life) that would lead her to make positive life-altering changes to her health.

(By the way, it is never my place to judge, but it is always to help. I respect the diversity in people and recognize the very different lives they have lived. No one can, or should ever presume why someone does what he or she does. Studies show that some people gain weight because it offers a protective shield around them from the cruel world in which they suffered childhood adverse events.  Some studies have shown a direct linear correlation between the number of vices, such as binge eating and alcoholism, and the number of adverse childhood events, like the loss of a parent, living with an alcoholic parent, or experiencing some form of abuse before the age of 10.  In such cases, identifying such traumas and dealing with them is vital to changing eating habits. So the next time you see a heavy weight person, please hold back judgment. You certainly have no idea what led to his or her weight gain.)

End of Part One. See next blog for Part Two.


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Monday, July 9, 2012

Busting Myths: Does Dr. Oz Have A Monopoly?

Yesterday, I wrote about Dr. Oz's suggestion to snack with up to 200 calories two hours before eating your dinner in order to lose weight. There seemed to be no good logic to doing so. Imagine my surprise when today I get an email from RealAge.com, which is at least partially owned by Dr. Oz (see http://www.realage.com/press-release-sharecare) with the headline, "3 New Weight Loss Myths Busted."

Here is my favorite myth the article clams to bust.

"Myth 1: Eat five mini meals throughout the day.
The initial idea was to eat small, healthy amounts of food every couple of hours to keep blood sugar levels steady and energy high. The trouble is, many people end up eating what amounts to five full meals. "I find that people do much better when they sit down and have three balanced meals a day with two small snacks in between," says nutrition counselor Katherine Tallmadge, MA, RD. "Real meals stave off hunger. If you eat tiny bits throughout the day, you're hungry all the time."

This is diametrically opposed and mutually exclusive to Dr. Oz's concept of eating a small meal, which he calls a 200 calorie snack, two hours before dinner. Which is it? He probably doesn't even know, but busting myths seems to be one of his favorite concepts on his show. It's as if he has a monopoly on doing so. However, I never thought that in the span of one week, I would see him connected to both creating and busting a myth.

Here is another myth supposedly debunked by the article.

Myth 2: Eat less by using small plates. Studies have shown that large plates lead to more eating because they make portions look smaller, but the small-plates idea only works if there's a limited amount of food to put on the plate. In a recent diet study at Texas Christian University in Fort Worth, Texas, 10 overweight and 10 normal-weight women were randomly assigned a large or small plate for eating lunch on two different days, then allowed to serve themselves. The result? The ladies ate until they were full, regardless of plate size. "Make what you need, or measure the amount before putting it on a plate, then put things away," recommends Tallmadge, who was not involved in the study. "It's having easy access to food that keeps you eating more."

Contrary to what RealAge would have you believe, there is actually science that confirms the small plate approach to weight loss. See http://smallplatemovement.org/doc/big_portions.pdf for a review of the science. Brain Wainsink of Cornell University is one of the leading food investigators in the U.S. After reading his book, Mindless Eating, I am more inclined to trust his studies over the new study. I also know it works because it worked for me. I switched from a larger to a smaller bowl for my breakfast and never missed a beat on my way to a 20+ pound weight loss. Either way, with the conflicting study results, I hope you agree that this does not fall into the myth-busting category; however, it should fall into the sensationalistic headline one.

Here's a quote from Dr. Oz's website under the title "5 Diet Myths Making You Gain Weight" about the small plate issue:

"Dieters have been advised to eat from smaller plates in order to limit the amount they eat. Why? Because smaller plates make regular portions look larger. However, new research published in the Journal of Human Nutrition and Dietetics found that plate size had no impact on the calorie consumption of either normal weight or obese individuals. Despite these findings, Dr. Oz still recommends using small plates to help guide you in terms of how much you eat. But use them the right way – a small plate is not an excuse to pile on food vertically or go back for seconds."

So what are we expected to trust? The Dr. Oz Show or a website Dr. Oz has ownership in?


The third myth the article purports to bust is "it doesn't matter what meal plan you're on because you'll lose weight as long as you stick to it." Really, any food you eat as long as you stick to it will help you lose weight? The study the article referenced used 5 specific plans. There is definitely more than one way to lose weight, but the meal plan (and total number of calories) will always matter.

It is because of articles such as this one and the Dr. Oz Show that there is so much confusion out there that allows anyone to claim he or she is busting a myth. Besides, I caution trusting anyone that constantly claims they are a myth-buster. Wouldn't it be better if shows and websites just presented the science in layperson's terms and let intelligent people make the decision on their own. I think so. Do you agree?