“No, You Do Not Need To Lose Weight!”
Tuesday, October 8, 2013
Recently I saw Betty* in my clinic. She is 44 years old and never had a “weight problem” till her 8 year-old only son met with a fatal road accident.
That was 12 years ago. Since then she has steadily gained almost 10 pounds a year, which is why she is now 120 pounds heavier than she was at 32.
“I desperately need to lose weight“, she told me between sobs.
“No“, I disagreed with her, “You don’t“.
“What you need to do first“, I added, “is to stop gaining weight!”
This is a conversation I have had with hundreds of patients, who come to me seeking weight loss. Many of them are gaining even more weight than Betty every year – all of them want to dive straight into losing weight. They are desperate, ready to embark on the next diet or exercise program – even bariatric surgery – whatever it takes!
I understand their desperation – not seldom do they come to see me because their doctor has suggested they come to our clinic for weight loss.
But here is the problem. Betty is out of control. Steadily gaining 10 pounds a year means she is eating 1000s of extra calories a day – the more weight she gains, the more excess calories she eats (here is why). No diet, no exercise, not even bariatric surgery will address her need to eat.
Before even remotely contemplating weight loss, Betty should be working on gaining less weight next year than she did last year.
Indeed, if Betty could manage to just put on 5 instead of 10 pounds in the next 12 months, she would have spectacularly succeeded in cutting her weight gain in half – quite the achievement!
Perhaps, with a professional help and empathic support she can even manage to make it through the next 12 months with no weight gain at all – imagine the success – for the first time in 12 years, Betty will not have gained a single pound in a whole year!
Imagine if Betty had only received the help she needed 12 years ago – she may well have avoided a 120 pound weight gain! Had she even just cut her annual weight gain in half, she would be 60 pounds lighter than she is now.
But, why not simply jump into the next diet or exercise program – or book the next surgeon?
Because, I do not think that doing so would address the underlying problem – as a quick visit with the psychologist reveals, Betty is overwhelmed by chronic grief, guilt, shame and remorse – even thoughts of ending it all. She eats for comfort – to feed the gaping hole – to ease the pain.
I can hardly imagine, that taking away her food – the only thing that keeps her going – is the right approach.
Fortunately, there is hope for Betty. An experienced grief counsellor should have little problem guiding Betty along a path to forgiveness, acceptance and control. As she regains control of her emotions, she will regain control of her life and her food.
When she does, do I expect to see her lose weight? Of course not, but I do expect her to stop gaining. After all, why would she continue overeating, now that she is back in control?
That, perhaps, will be when she can begin thinking about losing some of that weight. But, as Betty has no severe or acute health problems (her severe depression is now well controlled), there is no urgency.
Just making it through the next few years with no further weight gain may well be enough to allow Betty to restore balance in her life.
I see hundreds of Bettys in my clinic – not all have lost a son. But many have experienced trauma – emotional, physical or sexual abuse. They have lost jobs, spouses, parents, friends, moved to a new town, province or country. They are overwhelmed by life events over which they have little control, if any. They are burned out, exhausted, abandoned, helpless. They have depression, anxiety, cannot sleep, cannot focus, cannot find comfort, have long lost hope.
No diet or exercise program will “fix” them – surgery, most certainly, will not.
As for Betty, now that she is back in control, anything is possible.
She may well decide to eventually lose some of those pounds by restricting her calories and exercising and perhaps she will be one of the few who succeed in keeping them off (her chances for this are definitely better now than they were while she was still gaining). Perhaps she will opt for surgery; now that she is in control, she can follow the strict diet and exercise plans that she will need to make her surgery work for her.
Sometimes, the best thing you can tell a large patient is that you really don’t think they need to lose weight – you may be surprised at the response.
@DrSharma
Edmonton, AB
*The name was changed to protect the innocent.
Tuesday, October 8, 2013
Dr. Sharma,
I just recently began following you after listening to you on the CBC’s White Coat, Black Art with Dr. Brian Goldman and I couldn’t agree with you more. The idea that we can be successful at meeting our weight loss, SMART or not so, goals, what I call “performance goals” while leading a life lacking fulfillment due to the death of a child is at least misguided.
Keep up the great work and creating awareness for others!
Rob
Tuesday, October 8, 2013
Hi Rob, Great to have you on board – appreciate your comments!
Tuesday, October 8, 2013
Thank you Dr. Sharma for posting this. I have SUCCESSFULLY remained at my current weight of 270 lbs (+/- 5 to 10 lbs. My highest weight 290 lbs) for the past 18 years. I had two points in my adult life where by my weight reached this high. I participated in a program called, “Life It Up” in the mid-1990s, which promoted living and a healthy lifestyle and not dieting. I believe my participation in this program and the awareness it gave me set me on the right track to not gaining further weight.
Since then I participated in one of early ‘lives’ of the Weight Wise Clinic where we met and you diagnosed me with Binge Eating Disorder, which, finally, helped me to understand what was going with me (the first book I read was ‘Binge No More’). My journey since then has been many hours of psychotherapy to understand the WHYs I have the relationship with food that I do. As many will understand, it has nothing to do with food — it is what is going in my head, my heart and my soul.
I have journeyed a second time through the Weight Wise Clinic and I’m currently awaiting a surgical referral (something I wouldn’t even consider the first time). The WHYs of my relationship with food continue, but my understanding of this relationship is more thorough, my coping mechanisms are moving into place, but it doesn’t mean Bariatric Surgery is going to FIX me. I see it as a treatment. The rest is still up to me. I will still need to be vigilant regarding my relationship with food (like an alcoholic with alcohol and an addict with drugs). My psychiatrist framed it this way: I’m switching one set of issues for another set of issues. Therefore, the work, determination to change and keeping my goals in sight will always need to be front and center.
I’m off my soap box now. 🙂
Donna
Tuesday, October 8, 2013
Bravo! So true. When I finally started to get a hold on things, I was nudging 295 pounds. I got some vitamin levels straight where they were deficient and ate a lot less gluten and tried to eat a reasonable amount of calories/control bingeing and compulsive overeating and managed to lose 20 pounds or so and greatly improve my bloodwork. I have stayed about right there since which has been 3 years now (I gained the weight back durign pregnancy but have quickly lost most of it again). Now I have been addressing the depression I have had on and off for years that drives me to eat/soothe emotions with food and postpartum depression now after my second child. I totally agree with you about Betty and others like me. I was so happy just to stop gaining weight all the time!
Tuesday, October 8, 2013
You list many reasons why people are traumatized and eat for comfort. What about when obesity itself has become traumatic. Not even counting the social disapproval, being obese is miserable. Can’t do things. Physically disabled. Obesity is another trauma added to all the other problems. Sometimes the worst thing you can tell a patient is that they probably will never escape from the fat. Whatever metaphorical weight is on their shoulders and in their hearts, it will have to be dealt with while the poor person is also struggling to carry the literal physical burden of fat. I’t physically traumatic to carry fat around; it’s phychologically traumatic to realize you’ve travelled down a one way road and now you’re stuck with that fat forever.
Tuesday, October 8, 2013
Dr Sharma,
In my opinion, here is the low-carb diet you should be showing “Betty”: (scroll down) http://www.australianparadox.com/pdf/why-we-get-fat.pdf
The priority is avoiding foods and drinks with added sugar. That seems to be a critical change that within weeks restores appetite control for many.
Readers, modern rates of sugar consumption – especially via sugary drinks – are a key driver of global obesity and type 2 diabetes, together the greatest public-health challenge of our times: http://care.diabetesjournals.org/content/33/11/2477.full.pdf
Importantly, outsized rates of sugar consumption – alongside alcohol and tobacco – are a major driver of the unacceptable “gap” in life expectancy between Indigenous and non-Indigenous Australians: see the bottom row of Box/Table 2 in https://www.mja.com.au/journal/2013/198/7/characteristics-community-level-diet-aboriginal-people-remote-northern-australia
In an effort to counter these disturbing trends – especially amongst young people and Indigenous peoples – I am calling for a ban on all sugary drinks in all schools in all nations: http://www.australianparadox.com/pdf/Sugary-Drinks-Ban.pdf
Readers, if after assessing the facts you think this proposal has merit, please forward it to parents, students, teachers, principals and heads of schools, nurses, doctors, dentists and others involved in public health and education.
Tuesday, October 8, 2013
Sorry Rory, I would not be showing Betty a low-carb or any other diet till she deals with her emotional problems. All of the research on this shows that any ‘restrictive’ diet to uncontrolled eating will only precipitate more uncontrolled eating. We really have to stop making obesity a “diet” problem – it simply is not and never will be.
Tuesday, October 8, 2013
This one made me cry. Thank you for “getting it”.
Tuesday, October 8, 2013
“All of the research”? I’m taking a wild guess that Betty’s “emotional problems” would decline substantially – and her morale would soar, as did mine – if someone showed her a way to downsize her body significantly while eating all meats, eggs, cheese, green veges to satiation – whenever she is hungry.
I’m shocked, Dr Sharma, that you think overweight/obesity for most people is not principally a function of diet composition. I’m not a scientist, but I’m pretty sure it is a well-established fact that (excess) carbohydrate drives (excess) insulin drives (excess) fat storage. The solution to that problem seems straightforward, if I’m right in taking a wild guess that Betty is eating heaps of yummy refined carbs, not limiting herself to meat and green veges at mealtime.
What am I missing?
Tuesday, October 8, 2013
Sorry, the “carb-insulin” hypothesis is just that, a hypothesis, albeit one that sells books. In fact this story is the perfect chicken-or-egg dilemma – what comes first – the weight or the insulin. And how do you explain obesity in the people who are even more insulin sensitive than most of us? The diet centric focus of obesity treats the symptoms not the cause. Betty’s emotional problems are not due to her weight – they are due to significant unresolved grief – you do not fix grief with a diet.
Tuesday, October 8, 2013
Out of curiosity, Dr Sharma, what is “Betty” eating each day? I would be surprised if the same calories in a different diet would not be hugely beneficial in terms of stabilising/reversing trends to obesity and type 2 diabetes.
For starters, sugar is highly addictive for some: http://www.youtube.com/watch?v=kVPmfMDFS9A
And added to (most) processed foods, sugar/HFCS promotes excess consumption, regardless of emotional state. Just removing sweet/sugary items probably would pay huge dividends for most people in terms of appetite control, assisting the desired stabilisation/reversal of trends to obesity and type 2 diabetes.
Tuesday, October 8, 2013
I want to thank you for this blog… I have struggled with my weight my entire life.. it has been in control of me.. and I’ve allowed it to be.. I recently sought WLS and had the sleeve done back in June… I’m 61 years old. I told myself it was now or never… I have lost 40 plus pounds.. and I am pleased… but I can honestly tell you I would have given anything to have had someone like you in my corner… All I’ve EVER heard from professionals is you need to lose weight.. like I didn’t know this .. I would ask how and their silence so often was deafening… I was not at all “psychologically” prepared for this surgery and I had no warning of its challenges. … as a result I find myself pushing its limits.. to prove it wont work… twisted mentality huh… thank you for connecting some dots for me as I and many other struggle with this issue…
Tuesday, October 8, 2013
Rory, good for you losing the weight. You see, I have tried just about every diet under the sun. Never did I consider the emotional aspects of my eating. Now that I am, I now have an ability to work at understanding why the things that triggers my overeating combine that with the knowledge of good nutrition and activity, I am losing weight at a reasonable rate.
Rory, remember people are emotional, they have lived good and bad times, learned habits, gained good and bad knowledge. This why weightwise is such an essential program. I am in the program and it is valuable because the program deals with the whole person utilizing doctors, RN Case managers, dieticians, psychologists, psychiatrists, and excel isle specialists. A diet on its own can’t support you or provide you a framework as you start to lose weight and you begin to get frustrated or think you have arrived and start to gain weight back. The resultant weight gain, depression and loss of confidence requires MORE THAN a diet based on hypothesis – it requires the best interdisciplinary team. As an Albertans, I am so happy with this program because this is and should be loudly hailed by Alberta Health Services as a marvellous success. I would suggest a model for other medical programs.
Tuesday, October 8, 2013
That would be exercise specialists! My auto correct lulls be int a false sense of safety! LOL!
Tuesday, October 8, 2013
Simply, thank you for writing one of the few truly compassionate posts I have ever seen about weight.
Wednesday, October 9, 2013
Prior to me joining the group, a doctor gave a presentation to our weight loss group and said the same main point: For many people, maintaining weight will be a success. This was retold to me several times since. It helped many people in my group feel positive about weighing themselves and addressing their emotional and eating issues. Thanks for raising this valuable point.
Wednesday, October 9, 2013
Interesting article, but can you clarify this point – “Steadily gaining 10 pounds a year means she is eating 1000s of extra calories a day”? When I do the math, I get:
10 pounds / yr * 3500 kcal / lb x 1 yr / 365 days = 96 extra calories a day (not ‘1000s’).
Wednesday, October 9, 2013
That math is wrong – the 3500 calorie rule is not how weight gain (or loss works). It not only takes 1000s of extra calories per week to gain weight, it actually takes an ever increasing amount of excess caloreis to keep gaining. Why, is explained here and here.
Thursday, October 10, 2013
Preach it, Dr S!!!!
Saturday, October 12, 2013
I loved this post. I must admit, I’m kind of agape at the commenters who completely missed your point, but I’m so glad you’re the one dealing with people, not them.
Saturday, October 12, 2013
Dr. Sharma, your article is priceless. I am someone who has been overweight her entire adult life and has gained steadily every year up until a few years ago. I’ve also tried every diet out there, and had momentary success with some, only to regain and add pounds when I couldn’t sustain the rigid plans. I find it totally unhelpful (and actually detrimental) when a doctor or other person tells me (as if I didn’t already know!) that I just “need to lose weight.” What finally worked for me was a lifestyle driven by ethical veganism – I stopped gaining weight and actually lost about 26 lbs. Having been at a plateau for about three years now, I’m now exploring the CAUSE of my overeating, which is, I’m convinced, due to the food itself, and the fatty, sugary and salty, concentrated flavors created by the food industry and now expected by us every time we sit down to eat. We eat to titillate our tongues, not to nourish our bodies, and the food is killing us. I urge everyone to read “Salt Sugar Fat” by Michael Moss, to understand how the food industry has manipulated food and thus our appetites, and “The Pleasure Trap” by Alan Goldheimer and Douglas Lisle, to understand how these foods affect our bodies, and provides a plan for releasing ourselves from the lure of sugar, salt and fat.
Saturday, October 12, 2013
Thank you for this. I appreciate that you “get it”, and Rory needs to understand that what might work for “some” is not what will work for “everyone”. For those of us who have had emotional eating issues all of our lives, it is refreshing to hear and to know that SOMEONE understands.
Saturday, October 12, 2013
Readers,
In my defence, I do “get” what some of you are saying. Something that I found motivating – and ultimately overwhelmed the emotional issues that had me eating way too much of the wrong foods – was coming to understand that being overweight/obese is dangerous, in that it is a large step towards type-2 diabetes, heart disease and cancer. In the end, I was thrilled – and my life changed profoundly – when someone showed me a simple way out of the hole into which i had fallen. The centuries-old obesity- and diabetes-reversing diet to which I refer is in my first post above.
Here’s the sort of information that convinced me to avoid the yummy, comforting food that was making me fat and sick: http://www.youtube.com/watch?v=xDaYa0AB8TQ&feature=youtu.be
Rebecca, your excellent Michael Moss comes in at about the 15-minute mark. And between minutes 26 and 28 in the link above, prominent US cancer researcher Louis Cantley says added sugar – what most of us and our kids are getting from softdrinks, energy drinks, ice-cream, chocolates, popular breakfast cereals and yoghurts, etc – causes cancer.
I was comfortable enough being fat. But once I got reliable information on what I was doing to myself, wasn’t prepared to keep committing slow-moving suicide.
Friday, October 18, 2013
This is an excellent post. yeah, we don’t realize that the pounds accumulate, year by year. Even if it is only a pound per year, it ads up overtime. That is why most of us don’t fit into our wedding dresses (lol). Seriously though, in Betty’s case it is emotional eating and as she gets counseling her weight goes down ot at least it won’t go up. A lot people are emotional eaters and that needs to be dealt with before one even starts dieting.
Friday, November 1, 2013
I’m with Rory on this.
Further, I’d like to see the evidence for this ’emotional eating’ hypothesis.
I really feel for people like Betty who are told they are emotionally broken, or lazy, or weak willed when maybe all they need is good advice on what to eat. Reduce carbohydrates. Embrace fat. Eat until you are full. That’s all.
Thursday, December 19, 2013
I’m with Matt on this one – some people are damaged when they are told they’re damaged – and they weren’t before. This advice can really destroy someone’s confidence in themselves and we need to be very careful.