Being significantly overweight impacts one’s life in so many ways that, as a doctor, I generally haven’t cared much about the method people used for weight reduction. I just wanted to see them get it off. Most reducing diets last for a fairly brief time. During that period, an overdose of cabbage soup, a dependency on bacon rinds or a diet of internet meals is unlikely to cause a significant problem. Or so I always thought.
But lately, I’ve become increasingly concerned with the short-term nature of diets, what they say about weight loss, and specifically their lack of maintenance education. I’m coming to believe more and more that the reducing phase itself needs to be a modified version of a lifelong diet if it is to have any sticking power. This observation comes at a time when there appears to be an increasing number of radical diet fixes and more desperate people susceptible to their marketing.
Let me tell you about several situations I encountered in the past few days alone:
Situation One: Two women seeking the surgical solution
Mrs. Howard is a longstanding patient of our clinic. Etta S. is a woman I met while on the medical conference I described in a previous post. Both are compulsive over eaters who describe “addiction” to foods and binging. Both decided that surgery was the only possible fix for their problem. Mrs. Howard has already had a gastric band, however the band has not been potent enough to restrict her eating. She described eating over six pieces of pizza in one sitting some weeks after surgery. Currently, the band is being revised. Etta is considering gastric bypass and asked for my opinion. She said that she often drove to multiple fast food outlets to buy sequential meals. She was eating quarts of ice cream at a sitting and felt completely out of control of her eating. I asked her how she felt about being forced (by the threat of vomiting or dumping syndrome) to restrict the foods she currently binged on. She immediately burst into tears and confessed that she was extremely fearful of what would happen if her addictive substances were taken away. While surgery is an effective fix for some, my question is: what happens when people rely on the surgical procedure to block a problem that still remains? Many find a way around the surgery and regain weight. Others become depressed or take up other addictions.
Situation Two: My neighbor wants the beads
A couple of days ago, a neighbor called to ask about a diet program she was thinking of joining. The program consisted of weekly visits to have beads taped to pressure points on the head. Because the beads only lasted for about a week, they needed to be replaced frequently and at a cost. Along with the bead treatment, a low-calorie, low-carbohydrate diet was administered. The question was: did I think this would be effective? The answer is that a low-calorie diet that avoids modern starches and sugars will cause weight reduction as long as it is followed. Being forced to visit weekly provides built-in support and monitoring and is very similar to what we do in our own program. But there is no documented evidence that acupressure causes weight loss and believing that some outside treatment provoked the weight loss just compounds the problem later. If weight starts to return, is it because the beads are gone? In other words, if you put your faith in magic, you’ve got to have the magic to continue to be successful.
Situation Three: HCG is reborn in the West
While traveling out west on the aforementioned conference, I had the opportunity to observe a number of people who were participating in programs that used HCG (human chorionic gonadotropin) injections for weight loss. HCG has been largely discredited. Many scientific studies have shown that HCG is no better than placebo for weight reduction. In addition, there are potential dangers to hormone injection. How can you be sure what you’re getting and at what dose? What are the long-term effects of injecting a pregnancy hormone into the body? What risks might you be taking in terms of infection and local reaction? Further confounding the issue is the fact that HCG participants are put on a 500-calorie diet. Programs claim that the HCG suppresses appetite, but I have serious doubts. This degree of caloric restriction is unnecessary (we routinely get brisk weight loss with a diet of 1000-1200 calories) and a 500 calorie diet can cause potassium and other electrolyte problems. In addition, most people who are on low-carbohydrate reducing diets will soon lose their appetite. We don’t need injections to create this side effect. It is a common feature of liquid diets and the Atkins diet and has to do with lowered insulin levels and fat breakdown products which decrease appetite.
From my perspective, the problem with all of these diet fixes is that they are techniques that take the power away from YOU, the person who needs to conquer the issue. They offer solutions that “lean” on outside interventions: the band, the bypass, the beads, the shots. What most of you have found, I believe, is that you’ve maintained your weight loss by relying solely on yourselves: on your smarts, your determination and on a lifestyle you’ve created from scratch. The question is, how can we begin this process earlier and how can we pass along what we’ve come to know?
In my own practice, I believe that we are getting better results with weight maintenance since we switched to a weight-loss regimen that lets people “practice” a version of their new eating plan. We do this by asking them to drink a diet supplement (Optifast, in our case) during the day and to eat a dinner meal. This meal can be split up so that parts of it can be consumed at lunch or breakfast. What we’ve found is that this model allows our patients to learn how to eat one major meal per day and smaller things at other times. It also restricts them to Primarian foods (no modern sugars or starches) while they remain under our supervision. I am always careful to point out that the Optifast is just a liquid food and that it has no medicine or magical component. It works nicely for weight reduction mostly because it limits choice and allows us to know precisely the number of calories our patients are eating. Weight Watchers diets have the same kind of “practice” mentality. It seems to take about three to four months for dieters to become comfortable with this new way of eating, but at this point, they usually start to say that they enjoy their new food habits and don’t want to switch back. Once they have established a comfort zone, I know that they have a good chance of making it in maintenance.
So, does it matter how you lose weight? I’m sure you’ll write and tell me your views. For my own part, I am coming to believe that the method may be a crucial indicator of the likelihood of long term success. Weight management is a continuum and the diet phase is the start of a long process. The less we separate diet skills from maintenance skills, the better it would seem. Your thoughts?