Refuse To Regain

The Menopause Myth: Why It Can Be EASIER to Lose Weight Later

by Barbara Berkeley, MD

It's always healthy to be skeptical, particularly where dietary pronouncements are concerned.  

In the past year, I've been asked dozens of times about HCG.  Everyone is talking. It's all over the media. Does it work?   The answer should be obvious to anyone.  If HCG was any kind of obesity cure, 3 out of 4 people you know would be taking it already.  The first pill or treatment that comes along and can really zap obesity will burn through America with such rapidity that we won't know what hit us!  Lesson?  Just because someone or some newspaper article says it's so, doesn't make it so.  Skepticism is healthy in the diet world.

What many years of obesity practice have taught me is that we should also be skeptical of what passes for conventional diet wisdom.  Alot of it is just plain wrong.  And because we accept it as fact, we lose out on many opportunities to change our lives.

One of my least favorite "wisdoms" is that weight gain is inevitable after menopause.   I wrote about this a couple of years ago in my post on weight loss after fifty.  As time goes on and I work with more and more peri and post menopausal women, I am more and more certain that lower weights can be maintained without difficulty despite age and hormonal status.  Further, I think it's often easier for women to get healthy when they are past 45. 

The key to weight loss and maintenance at any age is the same:  a complete overhaul of the foods you eat.  This seems so simple and obvious, but practically no one who goes on a diet does it.  The vast majority simply returns to a modified version of their original diet.  Because modern foods are addictive, this modified version becomes the full-blown version in very short order.

The key to weight control after menopause is the strict limitation of starches and sugars, and that includes grains, whole grains and the flour-based products made from them (pasta, breads, and so on).  As I explained in my earlier post, this is because we tend to be more insulin resistant as we age.  This causes us to make more insulin in response to these foods, which in turn causes easier fat storage and an inability for stored fat to be released.  If you can make the change to fruits and vegetables rather than grains, potatoes, breads and cereals (and you can learn how to do it in books like Refuse to Regain or others on Paleo or Primal diet) you will lose weight and your age will be immaterial.

But there are also reasons why weight loss and maintenance is actually easier for those who are post-menopausal.  

One of the major reasons is the empty nest.  Feeding growing children and ravenous teen-agers makes it extremely hard to adhere to personal dietary rules.  If you have kids but they are now out of the house, you will find it hugely easier to make your own plans and stick to them.  Most of my patients report (and this has been my own experience) that husbands are usually willing to be flexible about eating.  They will often follow along even if they've eaten differently at an earlier stage in life. 

A second reason that it's easier to make change is that social pressures begin to modulate.  A couple of years ago, Don and I took a trip to Las Vegas.  While sitting at one of the enormous breakfast buffets at the Mirage, I had to laugh.  All of the people under 45 were tucking into huge portions of bacon, eggs, danish, muffins and potatoes.  Those who looked to be over 50 were eating egg whites, little bowls of granola with skim milk, and prunes!  Getting further along in life puts you in mind of the final third of the journey.  You and your friends will start to be more conscious of health and longevity.  Sayng that you no longer eat foods that make you fat and that you want to reach 95 in good health will no longer elicit eye-rolls.  You'll be admired, not scorned.

Another factor that I mentioned in my earlier post is the greater ability to be yourself that comes at mid-life.  The opinions that others have of you matter alot less now, and your tendency to speak your mind and live life by your own rules increases.  Use this new freedom by declaring yourself and your rules for eating.  You've earned the right to make your own way.

If you no longer are feeding a family at home, it's a simpler task to clean your kitchen and vow never to allow fat-promoting starches, sugars and junk foods to enter.  The need to entertain and cook is often lessened.  You've probably had that role for many years and perhaps younger generations will take on all or part of it now.  Minimizing baking and complicated entertaining can be very helpful when you are trying to make permanent healthful changes.  Keep things simple for a while and see how much easier it is to control the food environment. 

Exercise is a vital component of health from mid life on.  You can get away with being sedentary when you're young, but it's for sure catching up with you by the time you pass 50.  The good news is that it's also a myth that exercise ability lessens with age.  While no one wants to get injured, many of us take to our couch at the first hint of soreness.  We are not as fragile as we think.  Unless you have a very real reason not to exercise, get out there and do activities that get you excited.  If this guy can run the marathon at 100, you can train to walk a 5K, shake your booty in a zumba class or conquer the downward dog.  

Finally, changing your life and eating habits requires belief in your ability to get things done.  That's not something many people have in their 20s and 30s.  But after you've built your career, your family, your life, you clearly know how to get things accomplished.  Make the same kinds of plans you did to get other important things done in your life and take on your goal with a passion.  This is an advantage for  mid and later lifers.  Use it.

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Habit and Reward: Good for Target, Good for Maintainers

By Barbara Berkeley, MD

Here's an article everyone should read.  In yesterday's New York Times magazine section, there was a long and eye-opening piece on the science of consumer behavior.  It seems that we buy things because it becomes our habit to do so.  Marketers rely on this habit and try to create it.  There are times in our lives when we are more susceptible to changing habits.  Target has found that pregnancy is one of those times, and it has gone to great lengths to identify pregnant women and to market to them.

Research with rats gives us insight into our own behavior.  It turns out that habits have three components:  a trigger, a behavior, and a reward.  The brain is actively engaged only during parts one and three.  What makes the habit a habit is that the behavior component, no matter how complex, is run automatically.  In other words, once the habit is triggered, it’s on autopilot. 

I’m sure that many of you will be horrified, as I was, by the extent of mind-control and manipulation that goes into modern marketing.  But if we leave that aside, the information on habit formation gives us some powerful tools for changing things we may want to alter in our own lives.  Changing habits is arguably the most vital task for maintainers.

So, I see two avenues to explore.

First:  Since habits are so automatic and ingrained, and since powerful rewards like the pleasure of eating junk and sweets have carved habits deep into our neuro-pathways, we must consciously avoid putting ourselves in situations that pull the trigger.  We’ve discussed this many times here, most recently in the last post.  As much as we’d all love to eat controlled amounts of the modern foods that everyone else is downing, we’ve mostly learned that we can’t.  We’ve also observed that when we do indulge, we are punished by a return of cravings.  This is addressed in the Times article:

Habits aren’t destiny — they can be ignored, changed or replaced. But it’s also true that once the loop is established and a habit emerges, your brain stops fully participating in decision-making. So unless you deliberately fight a habit — unless you find new cues and rewards — the old pattern will unfold automatically.

“We’ve done experiments where we trained rats to run down a maze until it was a habit, and then we extinguished the habit by changing the placement of the reward,” Graybiel told me. “Then one day, we’ll put the reward in the old place and put in the rat and, by golly, the old habit will re-emerge right away. Habits never really disappear.”

 Habits never really disappear.  Words to live by.

Second:  Since habits are created all the time and since we know their components, why not create our own?  Rather than let someone else manipulate us with their chosen reward, how about deciding to reward ourselves? When I think about my own maintenance, I realize that I’ve set up many of these loops and that they are what keep me going.  Weighing myself every day is a reward in maintenance.  When I have to lose some weight because I’ve edged up a little, the scale is both my trigger to lose and my later reward.  I’ve learned to get pleasure out of the feeling of being hungry on days when I have to bring my weight down. How have I done that?  I associate that feeling with a pleasant day I’ve set up. I follow a pre-set reversal plan that I enjoy---usually to have a non-fat, skim mocha for both breakfast and lunch, a nutrition bar at 3 and to try to do some shopping if I can, which is fun and which distracts me. Then I have a huge salad and some protein for dinner.  I look forward to these days rather than dreading them.  The scale on the next morning’s weigh-in is a further reward.

I find that my Primarian eating style has become a reward in itself.  After forcing myself to stay away from starches and sugars for many years, I now truly enjoy eating chicken, fish, nuts, veggies and fruit with some low fat dairy mixed in.  I look forward to these meals and they have become their own reward.  Each day, the pleasure that comes from eating this simple good food ingrains the habit more deeply.  I have no doubt that if I started eating Mallomars again, I would immediately re-activate my chocolate cookie circuits.  Why do that?  I simply don’t want to.  

One of the toughest jobs I have is to convince non-exercising patients that fitness has rewards that are as strong as bread, chocolate cake and pasta.  I never used a muscle until I discovered aerobics in my late 30s.  Within a month or so, the music and the energy took over from the pain of using those veal-like structures for the first time.  Now, years later, I’ve found that I can create the same high from running to Michael Jackson’s “Jam” on a sunny day or playing a great set of doubles in tennis.  Nothing beats a high-energy, dance-y aerobics class though.  For me, the pinnacle is exercising when I am in the Bahamas: a place where dance, party and exercise all exist in one class at one time.  When setting up your new reward circuits, don’t forget to search for the bliss that is found in physical challenge.

The Times article makes the point that rewards can be subtle.  You are rewarded for backing out of your driveway successfully simply by the fact that you achieved that tricky maneuver.  A reward doesn’t always have to be a treat.  It can be a sense of balance, completion or satisfaction.  The trick with food is to eliminate the over the top rewards of drug-like sugars and starches.  It’s hard to compete with the hit of a drug to the pleasure centers, and these foods come way too close to that experience.  Don’t put them in competition with other rewards because lesser rewards will lose out.

In essence, the Times article leads to conclusions that are just the opposite of those in my last post (Tied to the Mast).  The two go well together because they demonstrate the two opposite faces of maintenance.  The first:  studious, focused avoidance of things that others find pleasurable.  The second:  the creation of a brand new world of habit and reward, based on one’s own rules…not those of the culture at large. Part Two completes Part One.

After all, there is no point in getting past the Sirens if you land in a grim place that no one would want to inhabit.  Make it beautiful and you will want to stay. 

Creativity is the basis of all art, even the art of maintenance.  

 

Tied to the Mast

by Barbara Berkeley, MD

 Odysseus, the wandering protagonist of Homer’s Odyssey, had a healthy fear of temptation.  In Greek mythology, sailors were regularly lured to their deaths by Sirens, creatures who sang a beautiful and irresistible song.  Entranced by the song, these sailors steered toward the call and were dashed to pieces on the rocks.  

 In order to avoid this fate, Odysseus ordered his crew to plug their ears with beeswax and to tie him firmly to the ship's mast.  On hearing the Sirens' song, Odysseus himself could not resist and begged to be untied, but since he had instructed his crew to ignore him, they refused his pleas.  Thus, the ship was able to sail safely past danger; but only because Odysseus was smart enough not to underestimate the power of temptation.

The Odysseus story is mentioned in a recent article that detailed the effectiveness of offering restaurant-goers the choice of smaller servings.  I loved the analogy. 

Negotiating the modern food world so often seems like sailing through Siren filled waters.  The call of the brownie is so sweet, the bowl of M & Ms looks so jolly, the Ben and Jerry’s packaging is so alluring…and that  fresh baked bread?  It’s the staff of life, isn't it?

Until we crash into the rocks. 

As our doctor reveals that our fasting blood sugar is now above 100 and pulls out the prescription pad to treat our rising blood pressure and refill our Lipitor, we may suddenly realize that we’ve been had.  Lured like bugs on sweet sticky-paper, devoured by the fragrance of the Venus fly-trap…

The work of maintenance, the life work of maintaining, is to learn to navigate these waters and, to some degree, to discover how to bind ourselves to the mast.  Temptation will always surround us and we need to find a way to deafen ourselves to the call.  But how?  Perhaps you will add your own perspectives, but these are some of the ways I have found to be effective:

1. Temptations lose potency when they are not reinforced.  For this reason, I advise most people to practice avoidance of trigger foods and to do this as completely as possible.  Don’t make exceptions for birthdays, retirement dinners and cruises.  The more you exclude triggers, the less power they will have over you. 
2. Reduce exposure to the Sirens by avoiding the places where they live.  Don’t detour unneccessarily into the cookie aisle or start a long conversation with a friend in front of the bakery window.  Avoid restaurants where the main thrust of the menu is food you can’t eat. 
3. Ban the Sirens from your presence.  Do this by not inviting them into your home, by asking that they be taken off desks that adjoin yours at work or removed from plain sight in break rooms.   
4. Finally, tell your crew not to listen to your pleas.  Make it clear to friends and relatives that you simply don’t eat certain foods.  They will be embarrassed to serve them to you and you will be embarrassed to ask for them in their presence.  Enlist those who are close to you in supporting your goals.  If you plead for cake, make sure that your allies remind you that you'd really rather not.

How do you avoid being dashed on the rocks?  Send me your strategies.

 

 

 

 

 

 

Life on the Island

by Barbara Berkeley, MD

No man is an island entire of itself; every man is a piece of the continent, a part of the main….. John Donne, 1572-1631

As John Donne famously observed, each of us is connected to the other and to the larger world.  In free societies, our belief in personal liberty often obscures this point.  We are free to choose, or so we believe. But our freedoms are enormously affected by the influence of the culture in which we are immersed, by the very connections that make us human.  Are we choosing or are we being led?  At no time is this question more pertinent than in an election year.  Our political choices are based on the information we learn from PACs, Super PACs, newspapers, TV pundits, the opinions of friends, and finally...our own observation.  How free is our choice?  Pure freedom of choice depends on the degree to which we want to unearth and establish the unvarnished, un-spun truth.  This kind of fact-finding requires a serious amount of focus, time, and commitment. 

And so it is with our dietary choices.  We may feel that we have the freedom to choose how we eat.  We are certainly told that we do.  If we choose to eat badly, it’s our own fault isn’t it?   But I observe a quite different reality.  In fact, our freedom is severely tested and influenced by the enormous weight of a food culture that condones, encourages, and normalizes a quite different message.  Eating is a sport, a right, an ultimate enjoyment to which we are all entitled.  Further, modern food is not bad... it’s GOOD.  It is only our choice that is poor.  Swimming away from that cultural current can be like opposing the force of the ocean.   The water looks calm, but we are actually caught in a rip tide.

This is the reason that making an analogy between successful maintenance and life on an island so appeals to me.  In order to avoid the influence of the food culture, we have to absent ourselves from it.  We have to live, to some degree, outside of it.

How is this done?  Some do it by becoming fierce proponents of diets that don't look anything like the modern American plate: vegan, vegetarian, paleo.  Others become immersed in the world of nutrition and fitness.  They blog, take courses, become trainers, write books, become experts.  But for the vast majority of maintainers, it's a matter of applying a set of mental blinders.  They doggedly focus on the road ahead, follow their plan, and try not to be overwhelmed by the flood of food messaging.

Maintainers can feel both proud and lonely.  They sit on an island while the rest of the world swims in a sea of food all around them.  Often, it’s hard to avoid jumping back in the water.  It looks like so much fun that it’s easy to forget what it took to get up on dry land.  It's hard to remember that we once felt like we were drowning. 

Since we are social beings, connected to one another whether we want to be or not, it’s easier to stay on our island if we know that we are not alone.  Those who belong to a diet subculture (like the vegans, vegetarians and primalists referenced above) have websites, books, and mentors to follow.  But for all maintainers, a vital task is finding other people who live on the island.

As you know, I run a monthly group for maintainers in the Cleveland area.   After a couple of years of meetings, those of us who participate have discovered that we never run out of things to say.  For many in the group, the maintenance of a significant weight loss is the defining challenge of their lives.  They never tire of discussing the process.  They also enjoy sharing their observations of what’s going on off-island. Viewed through the eye of the group, the behavior of the rest of the world seems nonsensical at times, almost incredible.

Month after month we repeat the truth to one another.  It’s the truth of our island culture, not the truth of the world according to the Food Network.  We congratulate each other, support each other when we venture a bit to close to the water’s edge.  It is an enterprise that I highly recommend to those of you who are maintaining out there on your own.  I offer my support if you would like to try starting a group in your area.  Email me and I'll help as much as I can. 

Form a group.  Define your culture.  Meet your neighbors.  An island can be a pretty beautiful place to live, as long as you are not alone.

 

The Paula Deen Flap: Sugar, Lies, and the Bitter Truth.

by Barbara Berkeley, MD

I think I generally try to be non-judgemental, but I'm afraid I'm about to depart from that behavior temporarily.  The reason?  Paula Deen, her diabetes, and her response.

Here's a nauseating little morsel:  CBS News report on Deen's big reveal.  

Turns out, Deen has been diabetic for three years during which time she has continued to encourage Americans to eat some of the worst food on the planet.  Of course, she intended her viewers to eat this food "in moderation" (these two words make me see red dear readers)....as SHE herself does!

OK, so Deen may have been among the misguided.  Perhaps she really didn't realize that eating a crispy creme burger would contribute to obesity and it's deadly handmaidens. Maybe she really believed that her message was a moderate one:  just have a little.  (A little fried stuffing on a stick, anyone???)

But that explanation is, shall we say, a bit hard to swallow.

I am perfectly content for individuals to decide what they want to eat, as long as they understand what's at risk if they develop conditions like diabetes, hypertension, high cholesterol, and heart disease. If they understand fully, this remains their right and their choice.  But most people don't understand, and I feel badly for those who think that a glass of water and a handful of lipitor, diuretics and metformin will reverse the damage caused by eating without thinking.

 Deen's choices are a different story.  She is not an individual.  She's a public spokesman for food.  Now that her food choices have made her ill, she should be honest about the cause.  I'm particularly angered by Deen's new role as "Diabetes Ambassador".   She has made a deal with a diabetes drug manufacturer and is already speaking for diabetes as if she knew something about it.  Let's see.  What would a drug company want a desginated celebrity to say about diabetes?  Oh...I know!  "Don't you worry.  Our drugs can take care of everything.  Just make sure to buy the particular drug we make, and make sure you order often."

Here's Deen on diabetes:

“I’m here today to let the world know that it is not a death sentence,” said the Food Network star, who is now being paid as a spokesperson for Novo Nordisk, the pharmaceutical company that supplies her diabetes medication. Coinciding with her announcement, Deen and her family are appearing in a new ad campaign for the company this month.

The announcement that diabetes is not a death sentence would be news to the families of the tens of thousands of people who have died as a result of this disease.  It would also be news to the Centers for Disease Control, whose diabetes web page describes diabetes as follows:

Diabetes Is Common, Disabling, and Deadly

• 25.8 million people in the United States (8.3% of the population) have diabetes. Of these, 7.0 million have undiagnosed diabetes.

• In 2010, about 1.9 million new cases of diabetes were diagnosed in people aged 20 years or older.

• If current trends continue, 1 of 3 U.S. adults will have diabetes by 2050.

• Among adults, diabetes is the leading cause of new cases of blindness, kidney failure, and amputations of feet and legs not related to accidents or injury.

• Diabetes was the seventh leading cause of death listed on U.S. death certificates in 2007.

• A person with diabetes has a shorter life expectancy and about twice the risk of dying on any given day as a person of similar age without diabetes.

Does Ms. Deen know that type two diabetics frequently progress to needing insulin?  Does she know that studies have unequivocally shown the importance of dietary change and life habits in controlling this disease?  Is she appropriately concerned about her own health and, perhaps more importantly, the health of the vast audience she commands?  If not, does she have any business offering herself as a spokesperson? Time will tell, but right now, things don't look good.

According to the Today Show, on which she made her announcement:

When asked about whether she will make a change in how she cooks on her show, “Paula’s Best Dishes,” Deen didn't give a direct answer, instead encouraging viewers to practice moderation.

“Here’s the thing, you know, I’ve always encouraged moderation,” she said. “On my show, you know, I share with you all these yummy, fattening recipes, but I tell people 'in moderation... You can have that little piece of pie ...'"

This does not give me much hope for Ms. Deen as an advocate for the real behaviors and tough lifestyle changes that can truly change the life of a diabetic.  But someone will benefit.  She'll probably make alot of money for the sponsoring drug company who will be more than happy to perpetuate the lie that pills and shots conquer all, even a deadly and toxic diet.

 

 

 

Is Your Irisin A'Risin?

by Barbara Berkeley, MD

The latest chemical substance to get scientists into raptures is irisin, a hormone that is produced in muscle cells but exerts its effect on fat.  We've all figured out that exercise and weight are somehow tied together and that this means that muscle and fat must communicate. Unfortunately, we've showed a woeful lack of imagination in tryng to come up with the mechanism. For decades, we've persisted in trying to jam the same puzzle piece into a space that doesn't fit.  We are determined to prove that the connection is calories.  It seems so logical.  If we burn calories through working out we must lose weight, right?  And yet the evidence that this is so remains annoyingly equivocal.  

While readers will occasionally write to me about great weight loss successes from becoming physically active, it is rare to observe this in clinical practice. The more common experience is to see people who have added exercise, but have not achieved anything more than a minor result.  As I've mentioned in the past, I have taken care of many very athletic people, even marathoners, who were clinically obese.  Could they have just been eating enormous amounts of food?  Of course it's possible.  But most of them were trying to lose weight by modulating their diet.  One would think that these prodigious amounts of exercise would force weight loss, but in their cases it did not.

On the other hand, it is observationally obvious that maintainers who exercise have a higher rate of success at keeping weight off.  This observation has been confirmed by data from the National Weight Control Registry, a large study which monitors those in maintenance.  While the NWCR subject pool is limited to maintainers who volunteered themselves (and thus are probably highly motivated), the data shows that successful study maintainers are exercising a lot (on average, about 1 hour daily). 

Irisin is a hormone that is produced from the breakdown of a protein that is produced when muscles are exercised.  In rodents, it's injection appears to turn white fat into the more metabolically active brown type.  Humans do not have very much brown fat, so it is difficult to speculate whether this finding is meaningful for us.  Even rats who made more brown fat did not lose weight when injected with irisin.  So why the flurry of interest?  Because high levels of irisin appear to improve the way the body metabolizes food, making it less insulin resistant and more weight stable.  The following is from a recent NY Times article on irisin:

But while irisin appears to have a critical impact on metabolism, it does not appear to play any discernible role in the effects that exercise has on the heart or the brain. And various issues remain unresolved. Why, for instance, if exercise increases levels of irisin and irisin increases the body’s stores of energy-burning brown fat, does exercise so rarely produce significant weight loss? The mice injected with irisin lost little weight. On the other hand, Dr. Spiegelman notes, they resisted weight gain, even on a high-fat diet, and their blood sugar levels remained stable. So it would seem that exercise, through the actions of irisin, can render you healthy, if not svelte.

As I have repeatedly said in this blog, research results only become important when they are repeatedly reproduced.  The irisin story is obviously in its very earliest chapters.  But the existence of such a hormone may well help to explain why exercise is so important during maintenance, and relatively ineffectual during weight loss.  For those who are currently losing weight, I don't discourage exercise, but I ask you not to rely on it.  Weight loss is about forcing the body to burn itself (which it would prefer not to do) through caloric restriction.  Think of your exercise as a way of rebuilding and retuning your muscles for later use.  Once you reach maintenance, these irisin producing factories will be fired up and ready to go--giving you a much improved shot at maintaining the body you've earned. 

Sir: I Detect an Excess of Avoirdupois

by Barbara Berkeley, MD

A few days ago, I wrote about the excessively blunt language and targeting of obese kids in an anti-fat campaign in Georgia.  On the other end of the spectrum, doctors are being cautioned about using straightforward words like "obesity" when counseling patients about weight loss.  

A survey from the University of Pennsylvania asked overweight people to rate words that described their condition and to assign them negative, neutral or positive values.  Words like "obese" and "fat" were given low marks, while words like "weight" were considered acceptable.  Based on these responses, doctors in Canada are being cautioned about turning off patients with words that offend them. But in reality, it's not the words themselves that are the problem.  It's the sentences that surround the words and their perceived subtext. Changing individual words is silly in my opinion.  Often attempts at political correctness lead us even further astray from our objective, as our beliefs remain the same while the words that describe those belefs simple become euphemisms.

Some time ago, I wrote about the lack of effective words in English to describe exercise.  Prior to becoming a doc, I was an aspiring writer and English major (gee, can you tell?) and someone who respected the power of words to create reality.  Here's an example:  if we had lots of better words for types of exercise, these descriptive words might entice many more people to try it.  The single word that we DO have--exercise-- is so devoid of depth and so connected to negative perceptions that it limits our ability to motivate.

Similarly, we have very few words to describe the state of having too much fat.  Here are the main choices:  "overweight", "fat", "heavy" and "obese".  If we start eliminating these, we get into some pretty labor-intensive options:  "scale-istically challenged"?, ""metabolically weight-accumulative"?, "lipidophilic"? Or we might move even further into safe territory by developing acronyms like "PAL" (prone to accumulating lipids) or "FAD" (fat accumulation disorder).  Feel free to make some up, perhaps one of yours will enter the lexicon.

As many as 78% of physicians currrently give no counsel to overweight patients about losing weight.  In some odd jump of logic, the U of P survey leads some to conclude that asking doctors to limit their ability to level with patients will make it easier for them to provide this guidance.  I would submit that the reason that doctors don't counsel patients is exactly because they don't want to risk riling them up or offending them.  Will politically correct language solve this problem?

I have a novel idea.  Suppose we learn how to sympathize with obese patients and speak to them in a way that shows that we not only support them, but understand them and aim to help?  Here's the approach that I take:

"Mrs. Jones, according to our BMI charts you are considered medically obese.  That's a term that doctor's use and it just means that you are more than about 30 pounds overweight.  So I want to tell you a couple of things.  First of all, if you're strugging with weight loss, I don't think that's your fault.  What I believe is that most people haven't gotten good guidance about how to lose weight and keep it off.  What you think you may know about eating healthy may actually not be correct for you, so I hope you will listen to what I propose and consider it.  Second, It's very, very worthwhile to lose weight.  Extra fat is simply not good for you.  With every pound you lose, you'll take a strain off your heart and your joints.  You'll also correct your diabetes, high blood pressure, reflux and cholesterol to a large degree.  You'll be amazed that once you start eating a diet that is harmonious with your body instead of oppositional to it, that you'll also feel much more energetic and less anxious.  You'll probably be interested in doing some physical activity for the first time in a very long while. I've done this with lots of people and I'll be here to help you the whole way.  But here's the most important part:  many people can't make these changes on their first try.  Getting closer to eating well can be a life's work.  Lots of people who've done it permanently have had missed attempts.  So don't blame yourself if it doesn't "take" right away.  Just keep tryng. So, here's the plan.  If you agree, let's get to work and give this a try."

No fancy words, no acronyms.  On the other hand, a doctor might say this:

"Mrs Jones, your BMI shows that you are obese.  (subtext:  that's your fault).  You really need to lose about 50 pounds (subtext:  I don't know how to tell you to do it, that's your problem).  This is important, you're going to have lots of problems down the road unless you take care of this.  (Subtext: I'll be annoyed if you haven't lost anything by the next time you come in)."  

It's not about the single words, is it?

 

 

 

 

 

On Dietary Purism and Pragmatism

by Barbara Berkeley, MD

Human beings are curious characters who seem to enjoy nothing more than dividing into factions, the better to denigrate those on the other side.  Sometimes this unavoidable tendency turns life into a series of tiresome tug-of-wars.  Are Cleveland Cavs fans really so different than Celtics fans?  Clearly not, and yet even sports rivalries can engender strong beliefs that one side is physically, geographically, perhaps even morally, superior.  

When we divide into groups, we seem often to inflate the "truthiness" of our cause.  Part of the action is to believe that we have found the one true path.  So it is with religion, politics, and nationalism.  Yet we can't all be right and there are an awful lot of factions claiming to have the one right answer to an awful lot of problems.   If this line of thinking sounds familiar, it's because I've blogged in the past about our need to form dietary factions that look alot like the other tug-of-wars described above.(Dietary Tribalism: Factionalism Goeth Before the Fall).  

In my post on dietary tribes, I wrote this:

....At least as I see it,  the truth about optimal diet remains the furthest thing from being settled.  It is as complex and elusive as a shadow that recedes into our endless human past. Does any group, whether it be the vegans, the vegetarians, the Primalists, the Mediterranean Diet followers...ad infinitum.... truly have the hubris to believe that they have completely solved the equation?   There is no diet on earth that does not eventually lead to death.  And if there is ever to be one it will have to come with the assist of modern science, since no living species has yet negotiated immortality.

I believe it unlikely that there is one, true diet. ( See: Previous post on The Perfect Diet). However, I do believe that there are diets that work exceedingly well for individuals. It's interesting and important work for each of us to find the one that best fits ourself. Based on clinical observation, I feel strongly that a mostly Primal diet with elimination of the bulk of sugars and starches is an excellent diet to choose.  But there are people who may do very nicely as vegetarians, Ornish followers, Mediterranean devotees, etc.. 

 I remain a dietary pragmatist. I don't like to criticize the dietary choices of others (unless they are making no choice other than to default to the SAD).  I also realize that purism within dietary philosophies is not necessarily practical.  For example,  I often receive questions from readers about perceived contradictions in my book and blog.  How can I suggest that maintainers use artificial sweeteners, use Lean Cuisine occasionally, or buy meal replacement shakes?  I make these suggestions because they work, are practical, and don't seem to cause harm.  I do not expect people to be perfect in the adoption of any new way of eating.  Imperfection is the reality for the vast majority of us.  So my goal is to try to give readers practical ways to maintain lower weights, that allow them to remain "primarily Primarian".   Luckily, the body--particularly when at good weight and in good physical shape--is a wonderfully flexible instrument.  A continued commitment to eating well is required, but utter perfection is not.

So I'd like to start the New Year with a confession and an observation.  My confession?  I don't have the answer about perfect diet.  My observation:  No one else does either.  When you look for guidance from the gurus who are out there on the internet and whose words seem so much weightier because they appear in books, remember that YOU are the most important part of any dietary experiment.  Here is the list of guidelines I've posted in the past for deciding if your diet is a good one:

1. Your diet  is good if it is helping you achieve normal blood sugar, decent cholesterol readings, low triglycerides and a good blood pressure.  If you already have some of these problems, your diet is a good one if it is lessening these markers or allowing you to decrease your medications.

2. Your diet is good if it is allowing you to stay a a good weight.  That weight doesn't have to correspond to a perfect BMI, but it should be as low as you can comfortably maintain and should stay relatively stable.

3. Your diet is good if your energy is good.  If you are sluggish or have no energy to get out and move around, look at making a dietary change.

4. Your diet is good if it exposes you to the fewest carcinogens.  We get enough exposure to cancer causing chemicals in our air, plastics, x-rays, and modern products.  Avoidance of processing and additives is the basis for every healthy diet whether it be Primarian, Pritikin, Vegetarian or an Atkins variant.

5. Your diet is good if you can believe in it and stick to it.  If you are simply eating reflexively, without any specific thought, it's unlikely that your diet is healthy.  The reason is simple: we are presented with few good choices.  In order to eat well, we have to eat mindfully.  

6. Your diet is good if you wake up without guilt. 

7.  Your diet is good if eating it makes you not only healthy...but happy.

Feel free to let me know about the dietary discoveries you have made as you've proceeded on your own journey.

 

 

 

 

 

 

 

 

 

Big Kids on Billboards

by Barbara Berkeley, MD

Just a quick post about a recent article on the anti-obesity campaign that is running in the state of Georgia.  The bottom line is that someone has decided that a tough way to tackle childhood obesity is to put up posters that feature fat kids and harsh rhetoric (example: "Big bones didn't make me this way.  Big meals did.") 

I believe I can predict your response to this, although some may say that we need more blunt and honest approaches to the problem.  Speaking for myself, I have always been particularly infuriated by those who blame parents for the obesity epidemic.  It is increasingly difficult to control the lives of children when an entire society opposes the message you give at home.  And for many parents, especially in low income areas, the options for eating well may be few.  We can't ask parents to do this on their own and we certainly shouldn't be giving the greater society more ammunition for shunning those who are obese.

Here's my posted response to the article above:

It makes us feel good to blame the problem on someone (in this case, the parents). We think that the fix is an easy one: simply cut out the chips, turn off the TV, and take a walk. It simply isn't so.

There is no fair shot for kids until the fight against obesity permeates our national consciousness. Schools MUST teach children about their bodies and the real consequences of bad eating. We can't shrink from the graphic understanding of how a clogged artery kills the heart or what diabetes does to destroy kidneys, eyes and limbs. Second, we need a public campaign to demand that food manufacturers be prevented from marketing junk foods to kids. Third, public outrage must demand better food from food makers. Fourth, we must reward good health and healthy behaviors with incentives in our insurance premiums and at work. Fifth, we must work in our own communities to bring in healthier food and to tamp down the proliferation of fast food and chain restaurants. I'd personally love to see supermarkets divide their stores into processed and minimally processed sections so that anything bought in one area would contain no more than one to three ingredients, none of which was an additive. 

The list could go on endlessly. Parents are a vital part of the equation, but will be unable to control the problem without much broader public strategies. The problem is in the larger culture, of which each home is simply a greater or lesser reflection.

 

Care to weigh in on this one?

 

Got Eudaimonia? Beyond Diet and Lifestyle Change

by Barbara Berkeley, MD

" The ancient Greeks called it eudaimonia, and positive psychologists have adopted the term to refer to the kind of profound satisfaction and meaning one derives from raising children, training for an Olympic event, completing a college degree or helping your neighbors rebuild after a disaster. " ( NY Times, "Get A MidLife", 1/8/12)

 

It's a gift from the ancients!  Today's New York Times introduced me to a word I've needed and searched for; a word to take the place of the weak and poorly descriptive phrase:  "lifestyle change".  One of my early blogs on this site complained about the fact that dieters dutifully repeat a rote phrase when asked why many diets ultimately fail, "It can't just be a diet," they say, "it has to be a lifestyle change."  

Whatever that means.

 While every successful maintainer I've every met has definitely altered his/her lifestyle, the phrase "lifestyle change" is not sufficient to describe the accomplishment, nor does it provide any specifics about what that change included. Some time ago, I asked readers to come up with words that better described the experience of maintenance and that included the profound sense of transformation and accomplishment that seems to go with it.  But no words seemed strong or specific enough.

Today's NY Times has an article about modern middle age, it's drawbacks and it's benefits.  Among the good things middle-agers experience is more frequent EUDAMONIA: a sense of having accomplished something truly profound.   Bingo!  I believe that eudamonia is what separates those who just diet from those who become different people at the end.

Look at the Silly  Season ads that currently fill our airwaves and magazines.  What's the message?  That diet is about fitting into smaller clothes.  That dieting is painless and can be accomplished by eating the very same foods that the SAD equates with pleasure. (Nutrisystem: Features "butternut squash ravioli", "double chocolate almond cookie").  Who are the spokepeople?  Often, they are celebrities who have long histories of gaining and losing weight.  Chances are you wouldn't believe that Oprah or Kirstie Alley had found the secret to weight loss unless they had managed to stay at lower weights for a very significant amount of time.  What are the attractions?  Women in tiny jeans and lots of makeup.  It's pretty superficial when compared to the significant tasks that anchor weight maintenance. 

What creates eudaimonia?  Achieving something big, meaningful, and real.  To do this, we need to go several steps past the usual suggestions.  Here's an example:  a weight loss tip from US magazine: "When baking, replace oil with applesauce".  The same tip for those in pursuit of eudaimonia:  "Stop baking.  Guess what? You'll live."

You can find the comments of eudaimonic maintainers scattered throughout the responses to most online articles on diet.  They generally will describe how they lost the weight and their long term regimen for keeping it off.  There is always a simplicity to it and a pride.  They worked it out!  This has created a deep satisfaction.  

As I always like to say,  losing weight is no more nor less than throwing out the trash at home.  It's great to get rid of it, but it's not a cause for intense, deeply-felt pride.  But if you can turn that nice, clean home into a showplace, a thing of beauty, a place that anchors the neighborhood...now you've got eudaimonia.