Chapter 1
Why diets frequently don’t work

If it sounds too good to be true, it probably is.
Your parents

Fad Diets

          All of us recognize that fad diets don’t work and yet everyone flocks to them. Why? What is it that makes us want to go on the current fad diet? What is it that prevents us from seeing reality?
          The Surgeon General reports that 60% of adult Americans are overweight—an alarming trend that continues its dramatic upward climb. You are not alone in your quest for weight control. Many others have the same goals, but they just don’t know how to get there. They know the problem; it’s just that they don’t have a map, or their map may be the wrong one. Or worse yet, they don’t know how to follow the map.
          Most Americans have been taught that there is a magic pill that will cure all your ills. We all know that we don’t live in Utopia, and that our streets are not paved with gold. It’s just that we don’t always want to accept reality. It would be so much better if we could only believe in Utopia, Santa Claus, and the Easter Bunny.
          The American Dream was founded on the premise that people could work hard and pull themselves up by their bootstraps. It is the concept that this nation was founded on: that with hard work, people could become whom they chose to become. They could choose where they would live, how they would dress, and what they would eat. They were in control of their destiny.
          They also acknowledged that they had to live by the rules of society or pay the consequences. They still had control; they could choose not to follow the rules that society had in place, but they knew that to do so ----would be harmful for society and for them.
          So what does that have to do with Fad Diets? Many people look to fad diets to find the control that they are seeking for their weight problem. They have not been able to find it in the way they have been living, so they figure it must be out there somewhere and maybe it will be in the next new diet. Most start the diet only to have it fail. It did not fail because the diet was inherently bad, but because the underlying problem was not addressed. Most diets will work if losing weight is your goal. The question that you have to ask yourself is “what is your goal?”
          Is this just about losing a few pounds? Is it about self-control? Is it about changing your life for either medical or psychological reasons? Have you really thought about why you want to be on a diet and what you hope to gain from it? I hope that you will take a few minutes or hours and just think about what your reasons might be, then write them down on a piece of paper and keep that at hand to motivate yourself and to stay focused. If you are going to lose weight for someone else, then it won’t happen. If this is all about you, then it probably will happen.
          It is only when you take responsibility for your life that things will change. Just as our ancestors had visions and dreams and took the steps to bring their dreams to fruition, so will you when you take responsibility for your life. You are the most important person in your life. If not, then you you need to be. You need to value yourself. You need to remember that God created you for a purpose, and your job is to figure out what it is that you were sent here to do. You are just as important as the President of the United States. It is true that you may not have as many responsibilities as he/she does, but nonetheless you are as important. Most people don’t think of themselves that way; they see themselves as less important or even insignificant. You are not. You have the ability to influence the world in a positive way--perhaps not to the same extent as someone else, but you have the ability.
          Let’s say that you have chosen to lose weight because you feel empowered to take better care of yourself. You have decided that it is time to do what you need to do for you. This is all about you. How do you avoid the pitfalls? And there will be pitfalls. Because we are all human, we will occasionally have some setbacks. But just because you have a setback does not mean that you have failed. No one is perfect, we all have to try our best, but we have to admit that we may backslide occasionally. That does not mean that we are worthless; it only means that we are human. You must remember that this is about you and changing your life; this is not about failure, it is about growth. It is about whom you are and what you are here to do.
          Let’s say you decide to lose weight because your spouse wants you to. You are not as attractive as you once were; the beer gut is not becoming in your new clothes. Perhaps you want to lose weight so that you will fit into the new swimsuit that you bought. In short, you are going to lose weight for someone or something else. So what’s wrong with this idea? The problem is that it is being done for the wrong reason and the motivation that will be needed to follow through with your plan will not be there. As a result, you will probably fail. If you do get the weight down for the clothes that you want to wear, it will most likely be a temporary thing and it won’t be long before the motivation that you had vanishes.
          Weight control is not a one-week or one-month undertaking: it is a life-long journey. It is something that you will deal with for the rest of your life. If you only focus on what is going to happen with your next swimsuit, then you will not make the commitment to the long-term process that you need to make your goals come true. It is only when you decide that you are important and that you are going to do this for you that you will have the commitment necessary to follow through with the plan. You will be successful if you look at it from that perspective.
          When babies start to walk and they fall down, do we laugh at them and make fun of them? No, we may laugh so that they think it is funny and they won’t cry, but we encourage them to walk. With time they figure it out and then they can walk. Every time they fell, were they worthless? No, they simply were developing the skill needed to be successful. With time it paid off. They then not only walked but ran. So when you have a lapse on your diet, do not criticize yourself. You must stop beating up on yourself and realize that you are on a learning curve, and that you are still mastering the skills that you need to help you succeed in this endeavor. Many people berate themselves mercilessly when they stumble in their diet. But this is ultimately counterproductive.
          You have to understand that you will falter, you will stumble, and you will fall. You have to forgive yourself when you stumble, be gentle with yourself, and respect yourself. Do we expect a young person to know how to drive a car without lessons, and do it perfectly the first time? Of course not. Like the child learning a new skill, we try, we fail, we try again. That’s life.
          As I said earlier, I believe that almost any diet other then the “see food” diet (you see it, you eat it diet), will work. There seem to be dozens of diet books out there, so why do we have this crisis of obesity in America? The problem is not in the information; the problem, I believe, is that the goals, the commitment, the desire is not there because the goals are not solid. People want to lose the weight not for them but for someone or something else. When that happens the commitment is not there and the positive results do not occur. Without the commitment, people cheat on the diet and the next thing you know they are completely off the diet. It seems that the first time you cheat you have a little guilt, but after you begin cheating on a regular basis the guilt is gone and so is the diet. They fall off the wagon, so to speak.
          Why does the diet work for some people, but not for you? Again, it could, but only if you had the same motivation that they had. Perhaps you have heard the joke about the person who was asked how much weight he had lost; he replied: “About 2000 pounds.” That is because for many people, the weight problem is an up-and-down process that they will continue to deal with for the rest of their lives. They lose weight and then they gain it back—over and over again. For some, when they fall off the wagon they constantly beat themselves up. Then as they feel worse and worse about themselves, they resort to the one thing that makes them feel good—a full tummy--so they eat. Indeed, many people believe that when they go off a diet, they gain more weight than they had previously lost.
          How can we break this cycle? First you have to accept the problem as yours. You have to admit that you and you alone are responsible for your weight problem. Until you do this you cannot deal with the problem.
          Many people would love to blame the problem on someone else. “It’s not my fault,” they say. Instead, they are quick to blame someone else, such as their ancestors. I’ve heard many patients tell me, “Look, my great-grandfather and my grandfather were both obese and so am I. It’s all inherited.” Using this rationale, they absolve themselves of any responsibility. But be careful: if you argue for your weakness, then it will become your weakness, via a self-fulfilling prophecy. I am not denying that there are genetic tendencies that exist, and that your metabolism may be slower then someone else’s. However, if that is the case then you are fortunate in that you will not have to eat as much as someone else in order to maintain the same weight. Therefore, you have the ability to save a lot of money at the grocery store. You need to view this as a positive, rather than a negative.
          Others may want to blame the weight problem on their upbringing. “My parents fed me too much when I was 2 years old. It is their fault that I have this problem,” some of my patients tell me. It may be true that obesity as a child predisposes some people to obesity as an adult; however, you don’t have to buy that lie either if you don’t want to. That is simply another excuse to avoid taking responsibility for the problem. Again, if you argue for the weakness then it will be yours. Again you will have a self-fulfilling prophecy and will be able to say, “See! I told you so.”
          The third common excuse that people use for explaining their obesity is to blame the environment. Watching the commercials on television featuring popcorn, pizza, and hamburgers did it to them. That is why they went to the fast-food chains for their meals. They would not have done it but they saw it on TV and had to do it. It was also their environment that kept them from going for a walk or to the gym. They were so tired when they got home that all they wanted to do was to sit in the recliner, watch some TV and rest. [It might be interesting to include some data here about the correlation between excessive TV watching and obesity. I think the Centers for Disease Control have done a study about this]. They had such a stressful day that they felt they only had the energy to go home and put their feet up. It is sad but true that more people rust out then wear out.
          So it seems that most people don’t want to take responsibility for their problems. Is that new? No, in our country all we have to do is look around and we will find examples of people abdicating their responsibility for all sorts of issues. For instance, there are lawsuits in which people claim they didn’t know that the coffee was hot, and then burned themselves when they spilled it, sued McDonald’s Corporation and won a huge sum of money. Another person was driving his mobil home and put it on cruise control got up from the drives seat and went back to make a cup of coffee. The veichel crashed and he sued the motor home company because he crashed. I guess he thought cruise control and auto pilot that airplains use were the same.
          By not taking responsibility, we don’t have to deal with our own issues. We are like the 4-year-old who claims, “Johnny did it, Mommy! It wasn’t me.” When in fact it was. I guess the fear is that if we take responsibility for the issue then we have to deal with it; we have to address our own imperfections. If we are less then perfect can we live with that?
          In contrast, when people admit that they have a problem and they know it, then it becomes manageable. The alcoholic has to take the first step of admitting his alcoholism. Until he takes responsibility for the issues, until he owns it, he cannot work on it. Until you own your own problems--whatever they may be --you will not resolve them.
          So what happens when you accept the problem as your own? First, you acknowledge that you chose to eat what you have eaten. You acknowledge that your obesity is a product of your actions. However, just as it was a product of your actions so can the process be to solve the problem. You can choose to be obese or you can choose not to be. The choice is yours. I know that there are many out there who claim that it is not their choice. Again, if you argue for your weaknesses then they will be yours.
          The question that has to be asked is: Do you want to be re-scripted to believe another way or not? If you have written a play and the last act doesn’t seem quite right, you can re-write it. After you have re-written it, it now has a new ending. The old ending is gone. The story is different now. In the same way, you can rewrite the story of your life by achieving a normal weight and the health that goes along with that.
          There are many problems that we have when it comes to losing weight. One of the most important is that most of us do not know the caloric content of the food that we eat. Nor do we know how many calories we burn a day. If we did, then we might make different choices. Another problem is the lack of awareness that you are even putting food in your mouth. I have seen cases where the person just finishes a large meal, has left food on the plate and is presumably full—but then sticks a piece of candy in his mouth. In cases like this, people are not eating because they are hungry; they are simply eating out of habit, like a reflex.
          Many people are not willing to deny themselves anything and therefore, they will not lose weight. I have heard people say, “There’s no way I am going to give up ice cream” or whatever is their weakness. They don’t realize that they do not have to deny themselves their weakness; they only have to limit it. You do not have to give something up forever; you only have to limit its quantity and frequency. If I want ice cream or chocolate I can still have it; I just use moderation. I don’t think that you should ever totally eliminate something from your diet if you like it; you just have to learn how to eat it in moderation. I will try to give you ideas in this book on how to do just that.
          There are many who feel that losing weight is drudgery, and it may not be the most fun you have ever had in your life, but it will make you feel better and then you can have more fun with the life that you have. Work is not necessarily fun all the time either, but we do it so that we can have the money that we need to pay the bills and go to the beach or the mountains. As you lose weight you will be amazed at how your life will become more fun, rewarding, fulfilling, and pleasurable. Most people don’t believe this until they loose the weight. Then they come back and tell me “you know, you were right” “I feel ten years younger, have more energy, and am enjoying life more then I have in years”. I simply smile, I am glad that they found the truth out for themselves. You can tell people truths, but it means so much more to them when they experience them for themselves.

My reasons for weight loss

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If it sounds too good to be true, it probably is. This is true for diets, too.

Carelessness and over-confidence are usually more dangerous than deliberately accepted risk.
- Wilbur Wright 1901

Why diets frequently don’t work

           There are hundreds of diets out there, and some of you have tried almost all of them. They range from peanut butter diets, to grapefruit diets, to social programs like Weight Watchers. So with all these options, why do people have trouble with diets? One problem is that no matter what diet you are on, the bottom line is this: the total calories you eat must be less than the total calories you burn up. We all know this is true. If we have to go and see the veterinarian and they tell us that our pet is 20 pounds overweight and that we need to cut back on what he is eating or he will die soon, we do it. We follow the diet to the letter; we know that for our pet to lose weight, we must put the animal on a diet and decrease the amount of food he eats. This only makes good sense. Yet when it comes to ourselves, we try very hard to find convenient excuses for why we can’t lose weight, such as “I have big bones” or “My metabolism is slow.”
           We don’t want to believe that we eat too much. We don’t want to believe that we can control this behavior. We don’t want to believe that we choose what we eat, as well as the amount. We want to find another answer. It cannot be that simple; it has to be complex; there must be someone or something that we can blame and not have to look at ourselves. The problem is that it is that simple and we do need to look in the mirror when we deal with the issue of overeating.
           To be honest, there are some bad diets. They are not healthy, and I don’t think I need to list them; you can use common sense and figure most of them out. The old adage “If it sounds too good to be true, it probably is” will help guide you. If the diet says that you can eat all that you want of everything and have the fat melt away, be wary of that one. If it says you don’t have to exercise or that eating their food in its special format will make your dreams come true, look out. As I tell patients, if it is a diet that makes sense with what you know about nutrition, then it is probably a good diet. Most of us know about the food pyramid; we know that we should eat certain things every day. Some of the in-vogue diets would like to discredit the food pyramid and perhaps it is not perfect but it is a good guide for the majority of people. If you use one of the diets that does not believe in the concept, than that is okay as long as the diet is working for you. If the diet stops working, then you may want to revisit the issue. So what is the food pyramid? It suggests that there are some foods that you should include in your diet in larger quantities. In my approach to weight loss, I do not believe in deleting anything from the diet but instead advocate moderation. If you choose a diet that totally eliminates certain foods that is fine; one diet does not fit all needs. It is more important that people are able to drop the 20% to 40% of their weight that they need to drop and keep it off, than which diet they follow.
           We should eat fruits, vegetables, protein, fat, and fiber. It is not as critical what form the food comes in. It does not matter to the body which fruits you eat: only that you eat fruits. Nor does it matter what vegetables you ingest; only that you include them in your diet. It may matter what fats you eat if you are on a heart diet, or if you tend to have elevated cholesterol. For the most part, the human body can deal with lots of different food types. You can be a meat eater or a vegetarian; it does not matter to the body. You are lucky that you have such a good machine that you can feed it “regular” gas or “high test,” and it will work well on both. Some cars don’t, but your body does.
           Why doesn’t the grapefruit diet work? The answer is fairly simple. If you have to eat a lot of one thing—whether it be grapefruit, apples, pickles, or peanut butter--the diet will fail because it will be hard to maintain. If, on the other hand, you have a diet with a lot of variety then you will probably have an easier time sticking with it. This may not always be true, if on the other hand the diet requires you to eat a certain amount of fat, carbohydrates, and protein at each meal, and some diets do. It may simply prove too cumbersome to follow.
           So what are we to do? I think it is important that you use a diet with a lot of flexibility, yet one that is not too difficult to stick with. You need a diet that you believe in. You need a diet that you can work with, especially with your lifestyle. If you are vegetarian, then you probably don’t want to use the Dr. Atkins diet. So as you begin to look at different diets, try to take these things into account. Look at your lifestyle and your beliefs about meat. When you read about diets look at them critically. Do they make sense with what you already know about the human body? If you don’t know a lot about the human body, maybe you need to learn something about it [Include some recommended reading on this subject at the end of this chapter] before you jump into a new type of “revolutionary” diet. It is also important to remember that if a diet claims to be “a rapid way to lose weight,” “easy” and a “no-fail” system, then it is probably bogus. You have to remember the old saying: “If it sounds too good to be true, then it probably is.”
           To be honest, I believe that almost any diet would work for people unless it is a diet that furnishes you with more calories then you are burning up. If you start a diet and it has 5000 calories a day, and you are only using 1500 calories a day then you will gain weight. All diets that limit your intake will work; they may not be enjoyable, but they will work.
           So why don’t they work? The main reason they do not work is that people come off the diet. The phrase used is that they “cheat” on the diet. Most of the time they don’t want to admit it, but they know the truth. They cheated. Some diets are very hard to live with, and you can see why that would happen. Many times they don’t think that the snack that they ate was important; it did not matter. The truth of the matter is that it does make a difference. People don’t look at a small deviation in their diet as a problem, but the small deviations become the large deviations over time. They know that donuts will make you fat but they tell themselves: “This donut will not make me fat.”
           So what can we do about it? First it is important that you find a diet that seems to make sense and that you can follow. It is important that you not only have a program that controls intake but also caloric expenditure. There are many formal diets that do this or you can do it on your own. I will talk more about doing it on your own later.
           One major misconception that people have is that weight control is a short-term battle. Far from it: Weight control is a life-long battle. Most of us love food; we love the taste of it, the smell, the texture, and the feeling that we have after eating. So with all those good feelings about food, it can be difficult to limit your intake. Many people eat in a very short time frame. They may get their supper and gobble it down in 30 minutes. They eat but they don’t dine. What is dining, you ask? That consists of taking a meal at your leisure, lingering over it for 2 hours or more. It takes time for the stomach to register that you have just eaten. It takes time for it to send the signal to the brain that yes, food is there and you are feeling better. The hunger that you were experiencing is vanishing. When you eat quickly, by the time the brain has registered that you just ate, it is also getting the impulse that you over-ate. You are now bloated, feel miserable, have some heartburn, feel tired, want to just lay down and rest until the bad feeling goes away--and that may last up to 4 hours. At this point, you are usually asking yourself: “Why did I eat so much? Why did I not use a little more self-control?” You just feel bad.
           In general people, want a quick fix; they do not want to deal with delayed gratification. They want the gratification of the food, yet they want to lose weight. They generally want some kind of pill that will allow them to eat what they want to eat and not gain weight or a pill that will take away the feeling of hunger. They do not want to have to deal with the feeling of hunger. It is not a good feeling and they know that. If you suggest that patients occasionally go to bed without supper they will think you are crazy. The idea of a fast occasionally and skipping supper is not in their thought process. That is something that has never been seriously entertained. They will tell you that they will not be able to go to sleep. They will be awake all night because they are hungry. Little do they know that yes, it might happen on the first night but very quickly their body would learn that it better just forget it because you are not getting up and getting some food. You are going to sleep. The body learns quickly. What do I do if I am going to skip a supper or “fast” for a meal? I will drink water. At bedtime, I will drink two large 10-ounce glasses of water just as I am getting ready to climb into bed. Yes, I know that I will have to get up 3 hours later and go to the bathroom, but it allows me to drift off to sleep. Then, when I get up I may get another glass of water if I need one. It works.
           If you want to find out what it is like to really deal with being hungry, really hungry, without going through the ordeal yourself then you need to read the book “The Child Called It.” This is the story about a child that was abused by his mother. His mother denied him food; he learned to steal food out of the garbage after everyone had eaten and to eat hot dogs out of the freezer still frozen until his mother started using the garbage disposal and put a lock on the freezer. He would dream of food and have to sit on the stairs while his mother, father and siblings ate supper every night. This will allow you to understand what people can tolerate if they have to. This will let you know what thousands of children go through on a regular basis in this country and the world. With the degree of hunger that is present, we as adults surely can miss an occasional supper. We will not die because we missed one supper. Yet we believe that we have to have the food or surely, we will perish. It is amazing the stories that we tell ourselves.
           So when a diet does not work, it is because the person chooses to eat things that are not on his or her diet. They choose to come off the diet, and eat extra food. People do not like the idea that they choose to be fat. That, however, is the reality. They choose everything about what they consume and do. The problem with assigning the responsibility to people who choose to overeat, is that then you also assign them the responsibility for the effects. If they choose to overeat, then they also by definition choose the consequences of the act. They also have chosen to be fat.
           People do not want to take responsibility for being overweight. They will blame it on anything they can but not their actions. They will blame it on their parents, their large bones, their social situation, their psychological conditions; in short, they will blame it on anything they can but they will generally not blame it on themselves. It is only when people realize that they in fact are responsible, and that the problem is theirs and theirs alone, when they own the problem, will they begin to deal with it. They have to take ownership before they can resolve the issue.
           People also get frustrated when they don’t lose the weight that they want to lose. If they don’t lose it as fast as they want, they get upset. They know that the weight did not come on quickly and they know that it won’t come off quickly but they want it to. They don’t want to wait for delayed gratification. They want instant gratification. They want the weight off now, and they mean now. Not tomorrow, next week, or next year. People also underestimate how much food is needed to maintain their weight. People will say: “I don’t eat much,” and they honestly believe that. They don’t know how they can possibly not lose weight when they eat as little as they do. If people honestly believe that they are not eating much and someone tells them that they have to eat less, they don’t know how they can do it and not die. They feel that if they eat any less then they won’t be eating anything at all. The reality is that they do not know how much they are currently eating. So when they try to lose weight and it does not come off as quickly as they want it to, they get frustrated. They probably do not even recognize the fact that they are cheating on the diet either. Many will drink milk shakes and supplements because it is not solid but in a liquid form; they think it does not count. Yet all the calories count.
           Because the weight comes off slowly, they quit and say it was not worth it. Again, frustration comes into play and they give up. The reality was that they were cheating on their diet. Because they did not lose weight on the diet, they claim the diet was in error, not them. The mind does a great job in protecting your ego, or self-esteem. It blames the diet, or all the other things that you can think of, but usually it does not blame itself. When people are on the diet and they cheat, they may realize that they have cheated and then their ego may beat them up. Their ego may tell them that they are not good enough or are unworthy. The ego can be cruel at times. People will be harder on themselves then they are on others. They will beat up on themselves for the donut--even crucify themselves for one donut--but they would never do that to someone else. So for those who do beat themselves up, what can we do?
           First of all, be gentle with yourself. Forgive yourself if you deviate from the diet. Tell yourself that you are not worthless; sure you messed up the diet a little but that is OK; you can get back on the diet again. You would not be so cruel to your friend, so why do it to yourself? We are not flawless; we will make errors, but those errors can be corrected. The errors are not so terrible that we are condemned. So don’t condemn yourself. Forgive yourself.
           You say: “How can I forgive myself? Just look at me: I am not perfect. I am overweight. I am fat. I am not good enough.” This is a theme that many people have internalized. How can we get people to change their thought process? How can we get them to understand that they are good enough? To be honest we can’t. They have to do it themselves. They have to want to. Can it be done? Yes it can. How can they do it? One way is to get help by seeing a psychologist or a social worker who helps with counseling. The problem is that there are good ones and bad ones, so how do you know whom to see? Ask a friend, or your physician for a recommendation. If you don’t hit it off with that person, change to someone else. You can also deal with the issues through reading. There are many valuable self-help books out there that can be very helpful. Go to the book store or library and see if any of the books seem to jump out at you; see if any of them seem to be saying to you “Read me.” If you see such a book, check it out. It may not be the book you need, but it might be. Give it a try. There is an old saying that when the student is ready, the teacher appears. The teacher may be a book, or an audio tape; it does not have to be a person.
           In large studies of people on diets, often 50% or more of the people drop out of the study. If you drop out, accept that you chose to stop the diet, but realize that you may choose to restart the diet whenever you want to. When you are on a diet, make sure that your weaknesses—whether it be donuts, soft drinks, potato chips or ice cream--are not in the house. Get rid of them. It is much easier to follow a plan when your weakness are not there to tempt you. You are human too. Help yourself; protect yourself; don’t set yourself up to cheat.
           If your diet dies not work, you can always rethink your goals and how you want to reach them. You can re-evaluate your methods, and analyze why it did not work. You can redouble your efforts next time. You can redo and re-script the story so that you get the ending you want. This is a life journey, not a short battle, but a trip that will teach you a lot about yourself, It will allow you to respect yourself, to learn to take care of yourself, and to learn how important you are.

Suggested reading:
Encyclopedia of the Human Body, Richard Walker (ed)
The Human Body: An illustrated Guide to its structure, function and Disorders, Charles Clayman (ed).

 

Skipping Meals and Fasting

           Many people skip meals and think they are doing a great thing, as it pertains to losing weight. So it is an important concept. Should you skip meals and if so, what meal should you skip? Is one better than another?
           The general opinion in the medical community is that it is better if you do not skip meals on a regular basis. Skipping meals, generally speaking, will not help you lose weight. But you may say, “Since I did not eat, think of all those calories that I missed: Surely that has helped me lose a pound or so.” Others may wonder, after skipping breakfast for a week, why they have not lost weight? In fact, they may have even gained weight. Why?
           The answer comes in many parts. The first part has to do with the calories that you eat at breakfast. If you were to have ½ cup of cereal with 6 ounces of juice and ¼ cup of milk or yogurt with your cereal, then you would have taken in perhaps 300 calories. That is not a lot of calories; that is just 1/11 of a pound when you look at the calories in a pound of fat. So you missed breakfast all week and at most you missed 2400 calories from the food. Well, I have said that calories count and they do. So why did these calories not count? They do count. There are other factors that you need to consider
           When you skip breakfast, you have already gone for 8 to 10 hours without food. Now you are skipping breakfast and it may be another 3 hours before you get anything in your stomach. You may go 12 hours before eating anything. Your body needs food supplied in a regular fashion for the body to work well. The brain, for example, is an obligatory user of glucose. It cannot function on fat or protein. When you skip breakfast, then the body has to destroy fat and muscle tissue and glycogen stores to make the fuel for the body to work. We all know studies have shown that children who eat breakfast before they go to school do much better in class then children who do not eat breakfast. This is the same issue as the one we’ve been discussing. The children need the fuel to help the brain function. Without the fuel they are not able to learn as well; they do not have the attention span and therefore, do not do as well in school.
           Skipping breakfast is probably the most commonly skipped meal and—as we’ve just discussed--the worst one to do without. Some people think that because they did not eat 3 eggs, 4 slices of bacon, two strips of sausage, cereal, juice, coffee, toast, butter and jam that they skipped breakfast. Breakfast can be simple—but just a glass of water or a cup of coffee is not breakfast. It does not have to take long to fix or eat. Cereal, with a glass of juice, is an example of an easy breakfast. This is not heavy on the stomach, is easily digested, and will provide the fuel that the brain needs to function well. Some people claim they just don’t like breakfast. Well, there is nothing to like or dislike about breakfast; it is a time to get some fuel into the body so that it will function properly. Try a bagel with cream cheese, toast with butter or jam. It does not have to be extensive--only 200 to 300 calories will give you what you need to keep going full speed.
           Some people skip both breakfast and lunch and only eat one meal a day. Is this bad? What frequently happens in this setting is that the person is either drinking his calories during the day or he is snacking on foods and does not even realize what he is doing. Many people do not consider soft drinks to be food, and rightfully so. They are not food; they are only empty calories. The empty calories, though, still add up. The problem with drinking sugar during the day is that you get a little bit of a sugar high, but you do not get any nutritional value from what you have just eaten or drunk. Your body would do much better if you had taken the calories in the form of food rather then empty calories. Most people who skip two meals are not even aware of the things that they put in their mouth on a daily basis. They will tell you that they don’t eat anything, but if they kept a diary of food consumed, they would find that in fact they do put a lot of calories in their mouth on a daily basis. I frequently will ask patients what they have eaten and they will say “Nothing, honest, I have not had anything to eat all day”. Then when you get into what they have had to drink they say “OH yeah” and the light goes on. They have had a lot of calories, but they just did not think about them as calories.
           If you do skip breakfast and lunch, or simply skip lunch, then when it gets time for supper your blood sugar will be on the low side and you will be famished. You will tend to overeat. That is exactly what happens to a lot of people. They get home from work and then they eat until they go to bed. They spend the next 4 to 5 hours with food in front of them and they continue to graze until bedtime. As a result, they end up taking in a lot more calories then they would have if they had eaten breakfast, lunch and a normal supper. They would not have been famished and felt like they needed to constantly eat.
           Rather then skipping meals, it makes more sense from the body’s point of view to eat several smaller meals than to eat one huge meal. Many people recommend that a small breakfast is good, a piece of fruit at 10 a.m. then a moderate lunch, followed by a piece of fruit at 3 p.m. and supper when you get home. The advantage of fruit in the middle of the day is that it provides you with natural sugars; it gives you fiber or volume in your stomach so that you are not as hungry. That way, on the drive home you are not tempted to stop at the local sticky bun dealer or whatever your weakness is and get a snack. You are able to drive home and not feel hungry. Then when you get home you do not start a feeding frenzy.
           So it won’t actually hurt you to skip a meal, but it may cause you to not function at your best. You will not be able to be as productive at work; you will not be as innovative. If you are going to skip a meal, then the one to skip is supper. Yes, I can hear the moaning, but it is true that if you want to skip a meal that is the one to skip as long as you don’t continue to graze for the rest of the night. You also know this to be true as well. As long as you eat breakfast, then skipping supper will not affect your performance at work or school. So if you are going to skip a meal make it supper. Get into the habit of eating breakfast, a piece of fruit at 10 a.m., a moderate lunch, and an apple at three, so you will not be as hungry when supper comes around. Occasionally you may even want to simply eat fruit for supper. That would be good for you and will help you lose weight. At least if you skip supper, you are not putting a lot of food in your stomach right before going to bed.
           What about fasting? Some people will fast for a day at a time, frequently for religious reasons. Fasting for an entire day can be harmful if you are a diabetic, and skipping meals can be very dangerous for diabetics. For most people fasting for a day is not harmful. Wait a minute, you may ask, if skipping a meal is bad why is it okay to fast? It’s because fasting is something done occasionally, usually for religious reasons, and the rest of the time those who engage in it are eating well. It is still true that they may not have the sugars that will allow them to function at their peak if they fast for a day. However, the benefits that they receive from a religious perspective may outweigh the medical losses. They are connecting with their spiritual roots and that can be a very positive force. The body does not need to fast to make it work correctly or work more efficiently. The body is very good at dealing with the nutrition that it is given and missing food for a day is not a problem in the long run. People who fast still need to take in enough water so that they do not get dehydrated. If they did not eat or drink and it was hot, then they would be at risk for dehydration. The body is also very efficient at conserving fluids when they are in limited supply.
           So fasting will not hurt you. Most people do not like to do it. Fasting as a weight-loss plan generally will not work. People will tend to make up for the food they missed over the next few days. If you choose to fast for a day, you could use up 2000 calories in activities and 2000 calories from food you did not eat--so in theory you could lose 1 pound a day if you ate nothing. Occasionally we see patients who lose 5 pounds a week from starvation. This is not good because they lose fat, but also a lot of muscle and can get very weak.
           The point that I only touched on earlier is that if you skip breakfast and lunch, when you get home from work or school you are very hungry. The problem is that your blood sugar is low. When your blood sugar is low the brain tells the body that it needs fuel and so you eat. When you start eating you may eat as if there were no tomorrow; you have just gotten the signals from the brain to start fueling up and so you do it. This effect is something that we use in medicine, when we have a patient who needs to gain weight we will have them drink a glass of wine or a beer approximately 30 minutes before meal time. Alcohol will also lower the blood sugar and increase the desire for food. So if you have had a hard day at work and decide that when you get home that you are also going to have a glass of something with alcohol in it, then you can really drop your sugar more and have a tremendous appetite. This is also why when you go to a bar you will find finger foods to nibble on; they know that the alcohol will drop you sugar, and they are ready for it.
           I have suggested that if you are going to skip a meal that it be supper. Most of you will say “I can’t do that”. Again I don’t recommend skipping supper, but if you are going to skip one that is the one to skip. You must have a positive attitude and that does not include the word can’t. If “I can’t” is in your vocabulary then that is one phrase that you need to get rid of now. Can’t, can’t do anything. It is very important that you have a positive thought process and use the phrase “I can”.

 

Food Addiction

Obsessing over food.

           We all enjoy eating. However, there are some people who are addicted to food or obsess over it. This is a small group of people. All they do is think about food. They have trouble focusing on other things. They may be talking with you when they may change the topic abruptly and say, “I want to have pizza for supper.” It may make you wonder if they heard a thing that you said. They obviously had their mind on something else, and it was food. Most people may think of food before meal time, at snack time, and maybe when they are discussing dinner plans. However, they do not focus their life around food and it is not the center of their thought process. People who obsess over food all the time have a food addiction. Some people focus at lot of energy around food; for example, when they are going to go somewhere for vacation they make sure that they have the restaurant reservations made well in advance for every meal. Food is important in life but it should not be all you focus on; the latter does not represent an addiction but rather a situation where food is a main focus of life.
           Food addiction interferes with their ability to do normal work and have a social life. People may want to go to the opera, but unless it involves food in some way they may not want to go. Work goes well as long as they can eat at their desk, and they will have food in the desk drawers, just in case the machines ran out of food. They are planning their snacks and their next meal before the last meal is over.
           So what can you do about the problem? If you suspect that you suffer from this condition, then get help. This can be sought from a professional counselor or from a group such as Overeaters Anonymous (www.oa.org) (write World Service Office, PO Box 44020, Rio Rancho, NM, 27174-4020 and tel # 505-891-2664). If you think that you have any kind of addiction, there are anonymous groups that use the 12-step programs that may help you. The key is recognizing that the problem exists. Like most people who are addicted, the person with the addiction is usually the last to admit there is a problem. Until the person is willing to own his or her problem, there can be no progress. Just like the alcoholic, the individual has to be willing to admit that he or she has a problem. You may not find out that anyone thinks you have a problem unless someone else mentions that a problem exists. You will probably have to think about the problem for a while before you will be ready to admit it to yourself. Once you own the problem, then you can begin to address it. As long as you do not own it, you can’t work on it.
           When do you need professional help? When the eating is interfering with your work or social life, then you need to get help. If any problem is interfering with your life you need to consider help. One problem is that it may be difficult to find someone who has dealt with this kind of issue on a regular basis. Any professional that deals with addiction and addicted personalities should be able to help. Many people do not seek help until their addiction has destroyed their life. Either they have lost their family, job, or health. People with food addiction may lose their jobs or health but generally do not lose their family. Many times the family acts as enablers to allow the problem to continue.
           One patient I cared for serves as a prime example. Eileen was a lady who weighed over 500 pounds and was bedridden. What I could not figure out was how she could weigh that much, given that she was unable to walk to the refrigerator. Eileen was not mobile, and had already had one leg amputated due to a complication from obesity. Her husband, Bob, however, was normal size: 5 feet 8 inches tall and about 170 pounds. We discussed his wife’s problem during the year that I helped care for her. I talked with her husband at length about what we needed to do if we were going to keep her healthy. He was the sole caregiver; he took care of Eileen 24 hours a day, seven days a week. I eventually realized that he was a co-dependent person, and his job was to enable his wife to overeat. He was the one who went to the refrigerator, did the cooking, and brought the food to her on the couch so that she was able to eat all that she could.
           So I began to wonder what the relationship was that allowed this to continue. Did Bob want to get rid of Eileen, and was that his motivating force? We talked about that issue, as well. He knew that the food was going to kill her, and it did. I realized with time that he was not after her life insurance policy, or a new mate, but that in fact he did love her. To me it was incongruous that he knew what was going on, yet continued to do it. That was my first experience with an enabler, other than with alcoholics. Bob was enabling Eileen to maintain her unhealthy lifestyle. He had as many psychological problems as she did. He continued his practice until she died.
           Families may be more tolerant of food addiction, but jobs and health may not be. It is much better to deal with a problem while you still have your job and good health then after you have been fired, or have had a massive heart attack or stroke.
           When you suffer from food addiction, you may find that you crave food immediately after you eat. You only left the table 30 minutes to an hour ago and you are already “hungry” and want something else to eat. It takes 20 minutes to register in the brain that you have eaten food, so by the time these signals have arrived, you are beginning to look for more to eat. People with food addiction may also obsess not only over food but diets, just as alcoholics who are sober may be obsessed with sobriety when they fall off the wagon. And, just as the alcoholic can’t remember what, when or how much he drank, food addicts often do not remember what they ate or whether it was enjoyable.
           One approach to treating addiction that some have used is to replace one addiction with another. You might think that is foolish, but in a way that is what the 12-step program does. It replaces the addiction to the abused substance—whether it be drugs, food or alcohol--to the addiction to the 12-step program. You can substitute any addiction that you would like, but it is best if you substitute a healthy addiction such as walking or exercise. If you can find a healthy addiction to replace the unhealthy one, you will have gone a long way towards improving your health. That may not deal with whatever the issues were that led you down the path to addiction, but at least you will be healthy. At least you will have time to begin to address the issues that tend to lead you down the addiction path. One patient of mine wanted to quit smoking; he smoked 1-2 packs a day and enjoyed smoking. He had asked me to let him smoke if he ever had to be admitted to the hospital. I told him that I would, even though it would be unhealthy. I was going to let him be the captain of his ship. We talked about his quitting smoking and then one day he began to wonder why he had to smoke; what was out there that he needed to learn about. He knew that as long as he was smoking, he would not learn the lesson that was waiting for him. In order to quit he elected to replace the smoking with walking. It worked very well for him; at times he would walk 10 to 12 miles a day. He would go for a walk in the mornings and go for a couple hours. He enjoyed it. He was able to get off cigarettes. He replaced an unhealthy addiction with a healthy addiction.

 

Surgery: Why or why not have it?

           For many people, the idea of having surgery to fix a problem seems like the ideal solution. They believe that it is all very simple: the doctors wheel you into the operating room; you go to sleep for a couple hours; then you wake up and are normal. Almost like a fairy tale. It fact it is a fairy tale. You have to remember the old adage that if it sounds too good to be true, it probably is. This is the case here, as well. There is no free lunch. There is a price to pay, and you have to decide if the price is right or if it is too high. How could there possibly be any problems, you may ask; it is a simple process, so what could go wrong? Well, to be honest a lot can go wrong and if you choose this path to travel, then you must also accept the problems that go with it. If you want a surgeon to solve all your weight problems, then you are not being realistic about what is going on. The surgeon cannot control what you choose to eat. Only you can. After surgery you will have the same desires and cravings that you had before, so what are you going to do about them? Unless you have a lifestyle change, you probably will still have trouble with your weight. You probably need to check out the web site at the end of this section if you are contemplating surgery.
           What are your options? One approach is gastric bypass surgery. This is a procedure which causes food to bypass the stomach. Surgeons can opt to make the stomach smaller and hook it into the small intestines, so the food does not spend a lot of time in the stomach (or they may leave the stomach the original size). The food is then routed from the remnant of the stomach into the small bowel, which is 33 feet long. A lot of digestion of food occurs in the stomach, and if food is not in the stomach very long then it does not have time to get digested and ends up not being absorbed. Some of you may be saying: “That is exactly what I want. I want to get rid of undigested food, so it does not get absorbed and turn into fat.” But consider this: The human body that you were so blessed to receive has a lot of functions. One part of the stomach helps with absorbing vitamin B12 and the first part of the small bowel helps with absorbing iron. So when you bypass some portions of the bowel, you may be altering what your body normally does and in a way that it was not initially designed to do. When you alter the temple that you were given, you may see some consequences that you had not expected including the metabolism of fat and the absorption of certain vitamins and minerals.
           Another surgical technique involves gastric stapling or banding, in which you staple the stomach so the pouch for the food is a lot smaller. This keeps the intestines intact so that you don’t have some of the problems associated with bypassing the stomach. Because the stomach is now a lot smaller, theoretically you would have trouble eating as much as you did in the past and then you would lose weight. This procedure is designed to make your stomach smaller, thereby forcing you to eat less. In fact, the goal is that you should only be able to eat ½ to 1 cup of food before becoming full. If you continue to eat, then you would develop pain and possibly vomit. Of course, if you are ingenious enough you could find ways around the problem. All you have to do is drink a lot of your meals in the form of milkshakes or the like and get the food down past the narrowing quickly so that it doesn’t count. When you eat solid food, the bulk of it sits in the new stomach pouch and waits to be digested by the enzymes in the stomach. When it is liquid enough then it moves on down the system and is digested. Some of our foods are already in a liquid format or close enough not to count. For example, ice cream turns to liquid at body temperature, in fact at room temperature; nutrition supplements are already liquid. So if you are intent on getting in the calories you can still do it, even with a gastric stapling.
           Well, you might ask, why not have an intestinal bypass? Then, even if I overeat, the food will not spend enough time in the intestines where all the nutrients are absorbed and I will lose weight because my intestines are shorter. That is true; the surgeons make your intestines short so that the food will not be around long enough to get absorbed and it passes out undigested in the stool. But here again, the same problems occur: You do not absorb a number of the nutrients that you need and you compromise your health. All the doctors are trying to do with this procedure is to find a way to get some of the food that you are eating out in the stool before it has a chance to be absorbed.
           Okay, then, what about liposuction? Let the surgeon get in there and just suck the fat out. “I know that I have too much and I won’t miss it,” you may say. Sounds good, doesn’t it? Eat what you want and every year or two go and get it sucked out. What could possibly be the problem with this approach? What you will notice if you look at some of your friends who have had liposuction is that when they gain weight, they gain it in other parts of their body. If they had their stomach and legs treated, then they may put the weight on in their back. It may not be in the same areas as before and so the surgeon may not be able to go back year after year and re-suction the fat out. You will be limited as to how many times you will be able to have it done. If you are very overweight, the surgeon may not want to do it because it will have little overall effect on your health. He may not be able to suction 30 or 50 pounds off. You may have to go for much smaller amounts and that may not be beneficial.
           These types of procedures also cause side effects in many people—and the risks are not trivial. Neither are the risks of remaining overweight. So you must weigh the risks of the procedure—both short and long-term--against its benefits. Patients who are more then 100 pounds overweight are at an increased risk from being anesthetized for surgery, as well as from having the surgery itself. There are risks of blood clots that travel to the lungs or that stay in the legs, as well as risks of infections because of obesity. In addition, there are risks of infections from wounds, pneumonias, heart attacks, and poor wound healing. If you are fortunate and all goes well, then there are problems with poor absorption of food. Some people will suffer profound diarrhea when they eat; others will develop volatile blood sugar; and still others will be afflicted by liver failure, kidney stones or gallstones. For some, the risks are worth the benefits because they know they are unwilling to control how much they eat. They may be binge eaters and when they start a binge they know they will not be able to control it. For them it may be worth the risk. Of my patients who have surgery for their obesity, most have lost some weight but still continue to be overweight. They may be down to 225 or 250 pounds from 350 or 400 before surgery and that is a significant improvement, but they still have a problem. There is no free ride; there are trade-offs, and you must be willing to accept the trade-offs if you choose this route.
           If you don’t want to take on these risks, then what do you do? You still have options. As you read and learn, you will find that you have many options open to you: the only question is which will you choose? Life is about choices and so far the choices that you have made may not have been the best that you could have chosen and perhaps if you knew then what you know today you would have chosen differently. As one older person quipped, “If I had only known I was going to live this long, I would have taken better care of myself.” Edward Matchett commented: “ We must not weep for what we might have been. There is still time.” You still have the option to change your life. The decision is yours. You may have tried everything that you know and you are at your wit’s end, ready to have surgery. If that is the case, then surgery may be the best option for you. If not, then read on and perhaps you will find some clues and tips in this book that will give you the chance to get it back together again. One thing that is important when it comes to life and weight control as well, is don’t quit trying. When you do, you are dead. As Aristotle put it so well, “What lies in our power to do, it lies in our power not to do.”

* * *

Web sites to visit if you are considering surgery:
www.niddk.nih.gov - Click on “health information,” then “weight control” and then “gastric surgery for obesity.”

 

Diet Pills: Do They Work or Not?

           What kind of diet medicine exists on the market today? As you are well aware, there have been a number of pills out there that people have used in the past in hopes of keeping their weight under control.
           I have given some of my patients these pills, with the rationale that obesity is like hypertension--a chronic disease that will need to be treated for a long time. It will require maintenance therapy with some medicine taken forever, similar to diabetes. However, some of the diet medicines have been taken off the market due to cardiac toxicities and some new ones have replaced them. I have been very reluctant to use the new medicines because of the toxicities associated with the old diet pills. Like many in the medical profession, I fear we may do more harm than good and that the benefits may not outweigh the adverse effects of the new medicines. Some of the medicines available over the counter are harmful and have been associated with heart attacks and strokes; clearly, the benefits do not outweigh the downside of these pills. You have to be very careful, since some of the medicines are made from herbs and many people feel that herbs are fine. This may, in fact, be far from the truth. Herbs represent medicines that have not been tested in humans. They can claim success and glowing results that would not be possible for a drug monitored by the Federal Drug Administration (FDA). This is because herbal medicines do not have to pass the stringent tests that the FDA requires; no one in our country regulates herbs. Some herbs can also cause strokes and heart attacks. So you must decide if the benefits outweigh the negatives of these drugs. The problem is figuring out whether you have the information you need to make that decision. My guess is that you do not.
           How do the drugs that are available work? Some of the drugs in the herbs act as stimulants. The companies that sell the agents generally have kept the toxicities hidden, but the government has intervened, so that now some of the side effects of the ephedrine-like agents are becoming more well-known and people are starting to avoid them. In the past, some people have used these drugs in hopes of losing a few pounds only to end up with a major health problem. If you decide to use them, you must ask yourself, “Is it worth it? Is it worth it to drop 5 or 10 pounds and end up with a major health problem like a heart attack or a stroke?” I think most of us would agree that the answer is no, it is not worth that toxicity. Most of us are not willing to sacrifice our health for 5 or 10 pounds.
           Some of the new drugs that are available by prescription cause a different problem. They prevent you from absorbing the fat in your diet. So you eat fat and do not absorb it; instead, your body discharges it in the stool. That results in diarrhea, and a stool that floats in the commode because it has so much fat that it won’t sink. So what, you might ask? What’s the big deal? Well, the problem is that not only do you lose fat in the diet; you also lose fat-soluble vitamins. There are a lot of fat-soluble vitamins such as A, D, E, and K and if you become deficient in them, other problems arise such as night blindness, increased bruising and bleeding, as well as muscle weakness and wasting. The fatty diarrhea that you get can results in malabsorption that can lead to greasy malodorous stools that are difficult to flush. Oil seeping form the rectum diffuse abdominal pain, milk intolerance, increased bleeding and bruisability, amenorrhea or loss of menses, sore tongue and mouth and excessive flatus or gas.
           The fat that is not absorbed does not become excess poundage on your body. Only if you absorb the food and it gets into your blood stream will you add the additional calories to your weight. The stimulants in the herbs may work—although this is not well known; what we do know, however, is that they cause toxicity. Again you must ask whether it is better to consume the calories in the first place, or to leave them on the shelf at the grocery store?
           The problem that many of us in the medical profession see with diet pills is that because they are new and their long-term effects unknown, we are afraid that by prescribing them, we will find out in a few years that we have inadvertently hurt our patients. So again it comes down to the issue of the risks and rewards of these medicines. Are they helpful or will they hurt you? Do we really have enough data to tell us? I think that the majority of us do not believe we have enough data, so many of us do not use them at all.
           From my vantage point, I would not recommend them because I think their risks far outweigh any benefits that they might confer. Ultimately, though, this is a decision that you have to make for yourself. You have to look at your own situation and try to make the best decision that you can with the information at hand. If you decide that you can accept the known toxicities in light of the potential benefits, then you might want to use certain diet pills. Other people make that kind of decision every day with drugs like cocaine and heroine for recreational use. They decide that the benefits outweigh the burdens and they are willing to use them. They eventually get hooked, and then their decision making process may be impaired, but at some point they made the decision. Likewise people make the same decision with alcohol and tobacco, perhaps with slightly less toxic side effects. You nonetheless make decisions on a daily basis about all sorts of things and then act on them and live with the consequences. For example, if you drive through the light that was bright yellow knowing that it was going to turn red before you got through, you did so after making a decision based on the risks and rewards that you perceived at that moment. And you must live with the consequences of that decision.
           To sum up, we simply don’t know all the risks associated with the diet medicines out there. What we do know, however, is that a number of people have had significant problems with both over-the-counter and herbal preparations. As for the prescription drugs, here again, we do not know the long-term side effects. We only know the short- term effects. In a few more years, we will know if the new medicines are safe or if they cause serious health problems. From my perspective, I think the best approach is to use a method that is safe and effective. Don’t rely on pills, even though our society urges immediate gratification, and everyone wants a pill to cure everything that ails us. That is simply not reality. Some things we do not have simple pills for; instead, we must use knowledge, ingenuity, our own cleverness and our desire to take care of ourselves as the force to keep us healthy. In the chapters to come, we will see how to achieve that.

Recommended Reading:

The Mind of the Soul: Responsible Choices, and The Seat of the Soul, by Gary Zukav and Linda Francis. Website: www.zukav.com

Chapter 2 >