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Obesity Myths

Welcome. I am Dr. Tess Garcia, a Family Physician specializing in Weight Management. And I know right now that every single person out there is thinking “Why the heck should we listen to her talk about weight management. She’s obese herself!” But that is why I think you should listen to me. Because I understand. Many of you know me but may have forgotten that in 2005 when I had my knees replaced, I weighed 35 pounds less than I do now. And most of you may not know that up till March of this year, I weighed 25 pounds more than I do now. Presently, I am working on that extra 35 pounds and have every hope that I shall achieve it before the end of this year. And I think that those of you who have joined weight loss programs run by some slim, svelte person who never had a weight problem will relate better to me because I’ve been where you are, and may I repeat: I understand.

Over the past 50 years as the weight of the US population has gone up and up, the main advice given to patients by US doctors has remained the same: Eat Less and Move More. And the weight of the population continues to rise. This leads the doctors who are giving that advice to assume that nobody is following it. We have a nationwide epidemic of medical noncompliance and everybody is sitting around not exercising and chowing down on everything in sight. We are a country of lazy gluttons.

But, as all of us trying to lose weight know, that’s not what’s happening. Overweight people are trying their hardest to cut their calories and those successful in doing so see the same effect. Their weight starts dropping till about 6 months, then it plateaus and then starts sneaking back up . . . even while they’re maintaining the low-calorie diet. Some will cut their calories even more and start dropping weight again – until they reach the next plateau. Most eventually give up and return to their original weight (or sometimes more than their original weight) until the next time they try to eat low-cal . . . and get the same results.

What is going on here?!?

It’s called the Basal Metabolic Rate.

The BMR is the number of calories your body uses to keep you alive and your systems running when you are sitting still. As a reference point, it’s around 2,000 calories, more for men than women, and varies based on how much you weigh and many other variables. Actually, the BMR varies a lot from day to day. For years, overweight people have been blaming their weight on having a “slow metabolism.” In fact, overweight people have a higher or “faster” metabolism. We believe, mistakenly, that the BMR is stable, and the only thing that changes it is exercise. Movement beyond sitting still, we believe, is the only thing that increases the amount of energy expended. The incorrect belief is that if you decrease the calories going in, the BMR will stay at its same level, you will be at a negative caloric balance, and voila! Your weight drops. Same idea about exercise: you burn more calories so you will be at a negative caloric balance, and hey presto! You lose weight. If you do both at the same time, the negative caloric balance should be even greater and you should lose more weight.

But your body is too smart to let this go on for long. It KNOWs it’s getting less energy in and putting more out, and it doesn’t like that. Your body resists a negative caloric balance. Say that you put yourself on a 1500-calorie diet. The body knows that burning more than you take in will eventually lead to starvation, so as your weight goes down, the BMR starts self-adjusting downward too, using less energy to match the decreased amount of food coming in. Further, your body tries to get you to increase your energy intake – food — by releasing ghrelin, the hormone that stimulates hunger. It’s not your imagination that you’re hungry when you are on a low-calorie diet. You feel cold too because your body temperature decreases to conserve energy. Over the long term, your heart slows down and doesn’t beat as hard, your blood pressure drops, and your brain starts obsessing about food because your body wants you to eat.

Somewhere around six months into your weight loss, the BMR has decreased till it’s only using the calories you are putting in. As described above, your weight loss reaches a plateau, then starts going back up, even though you’re maintaining that low-calorie diet. And instead of feeling healthy because of your lost weight, you feel hungry, tired, and cold. Bodyweight has a set point, like a thermostat, and it resists change.

The mystery of the bodyweight set point works in the other direction too. It doesn’t want you to GAIN weight either. You can deliberately overfeed yourself and the BMR will increase, trying to burn up all those extra calories. The body does its best to get you to stop eating. It releases satiety hormones – cholecystokinin and Peptide YY – plus activates stretch receptors in your stomach that tell you that you’re full; you can’t eat anymore. It’s really HARD to gain weight rapidly and even harder to keep it on. When you return to your normal diet, you immediately drop the extra weight and get back to your set point.

So how do you lose weight? Can we reset the setpoint? Obesity medicine specialists disagree as to whether that can be done, at least resetting it to a lower weight. We have proof that it can reset to a higher weight, as all those people on low-calorie diets who gain more weight than they lost to find out. In my experience, I have found that it can be set lower.

Let’s switch directions and talk about calories now. Where did the concept of the calorie come from and what does it have to do with weight loss?

The calorie is a concept from physics. It is the amount of heat necessary to raise one gram of water one degree Centigrade. To further complicate the issue, what we refer to as a calorie is actually a kilocalorie: one thousand calories. How do they determine the caloric content of different foods? They take the food, burn it up, and measure the amount of heat produced in the burning. The amount of heat generated is the caloric content.

The focus on calorie content as a driver of weight loss or gain is actually something that’s only been around for about 50 years: basically, medicine started thinking about it once obesity started increasing. Physiology (a word that encompasses all the processes and reactions that describe how our bodies work) doesn’t work on calories. When you look at the metabolism of carbohydrates, proteins, and fats, which we all had to learn in pre-med, calories don’t appear. The unit of energy generated by the metabolism of macronutrients is ATP, adenosine triphosphate. It is STORED energy. It generates energy by losing a phosphate (called hydrolysis) and turning it into ADP, adenosine diphosphate.

So how much ATP equals one calorie (or Kcal)? I looked it up online and couldn’t get a straight answer. I couldn’t even find out how many molecules are in one gram of glucose. But I did find that one gram of glucose produces 4.1 kilocalories of stored energy. But when one molecule of ATP hydrolyzes into ADP, it releases 7.3 kilocalories of energy.

Now we know that one molecule of glucose is metabolized into 38 molecules of ATP so we can guess that hydrolyzing the 38 molecules would release 277.4 kilocalories. Which is close to what I expend in an hour on the treadmill. So, one hour on the treadmill will not burn up the teaspoon of sugar you put in your coffee this morning. Heck, even two hours won’t do it.

Fat metabolism is even more complex: one molecule of fat breaks into one molecule of glycerol and three free fatty acids. Metabolism of the glycerol molecule gives you only 19 ATP, but then each of the three fatty acids yields 441 molecules of ATP. So, when all of those molecules of ATP hydrolyze into ADP, if my source is correct, you release over 9,000 kilocalories. Which doesn’t make sense because that’s more than four times a person’s Basal Metabolic Rate.

If you didn’t completely understand that don’t worry. Just understand that calorie is a physics concept that we have imposed onto physiology. As I just demonstrated, it doesn’t fit.

So why did I confuse half of my audience with the details? It’s because a major obesity myth is that a calorie is a calorie. We say a calorie of donuts is the same as a calorie of steak which is the same as a calorie of butter. It doesn’t matter what you eat as long as you keep the number of calories steady. You go on a 1500-calorie diet and it doesn’t matter if you eat nothing but donuts as long as you keep to 1500 calories. This is a very prevalent myth. Even diabetes specialists are telling their patients that it’s OK to eat sugar.

So, if the endocrinologists believe it, why do I say it is a myth? Let’s start with the donuts. Donuts are carbohydrates, and carbohydrates break down into sugar. Even worse: donuts are made of refined carbohydrates so they break down into sugar very easily, so easily that the breakdown begins with the saliva in your mouth, well before the donut reaches your stomach. Further breakdown happens in the stomach, then it is even more easily (and rapidly) absorbed into your bloodstream in your small intestine. The rapid absorption makes your blood sugar (or glucose) level spike, followed by the release of insulin and a blood glucose drop which means that you are hungry long before it’s time for your next meal.

Proteins and fats are more complex structures and are not absorbed as rapidly or easily. They raise your blood glucose too but it takes longer AND they cause the release of those satiety hormones I mentioned earlier. So, you get full more easily and it takes longer to get hungry. The donuts do not trigger satiety hormones; you can just go on eating them and eating them. If you’re really sticking to that 1500-calorie diet, you won’t do that. But you will be hungry sooner, and you will crave carbohydrates.

Another example: let’s compare eating a calorie of sugar to a calorie of olive oil and its, effects on insulin secretion. While both the sugar and the olive oil will increase the blood glucose level, the sugar will make the insulin level spike. The olive oil will . . . not. The bottom line is: a calorie does NOT equal a calorie.

Another physics concept applied to weight loss is the First Law of Thermodynamics: energy within a system cannot be created or destroyed or more simply: energy in equals energy out. In weight loss, it has been assumed that Calories In minus Calories Out equals Body Fat. To prevent that body fat, we have to decrease the Calories In and increase the Calories Out. But we’ve already proved that decreasing intake and increasing output doesn’t result in sustainable weight loss because of the self-adjusting Basal Metabolic Rate.

Another reason the Calories In/Calories out equation doesn’t work is because it looks at the body as one system within which energy must balance. But the body is made up of multiple systems: the heart has its own system, the liver has its own, the kidneys have their own, the brain, the muscles, the peripheral nerves, the adrenal glands, the thyroid, and so on and so on. Some of the systems work together, like the kidneys and the adrenal glands work together to control blood pressure, but the point is they are all separate systems in which ATP is produced and used. So, the Calories In and Out don’t have much effect on what’s going on in the individual systems.

What makes our focus on calories in/calories out so ridiculous is that we’ve known for years that it doesn’t work. It was demonstrated by the Minnesota Starvation Experiment in 1944 and 1945. They didn’t have ethics committees back then to ensure the care of the subjects. The subjects experienced profound physiologic and psychologic effects, but the effect that most concerns this talk is that the subjects were expected to lose an average of 78 pounds but only lost 37 pounds. And the experimenters had to keep lowering the caloric intake to get them to lose that much. All body functions that require energy experienced a 30 to 40 percent reduction. And when the subjects were allowed to eat again, they gained MORE than they lost.

If you want more information on this study, you can read “The Obesity Code,” by Dr. Jason Fung.

Now let’s leave physics and go on to another myth. Eating multiple small meals a day helps you lose weight. Snacking is good for you.

This is a recent concept. Back in the 1960s and the beginning of the 1970s, we ate three meals a day: breakfast, lunch, and supper. You ate until you were full and if you asked for a snack in the afternoon, your mom said, “You should have eaten more at lunch.” If you asked for a bedtime snack, “you should have eaten more at supper.” We didn’t have snacks back then. The food companies weren’t making them. And we had about a 12-hour period of eating nothing between supper and breakfast – which got its name because we were breaking our overnight fast. Nowadays, however, we have been convinced that if we don’t have that snack, our blood sugar is going to drop and we’re going to die. And the food companies have responded by making snacks easily available. In fact, they’ve gone overboard making snack foods available to us, and most of them are carbohydrates. More on this subject later.

The result is we are eating all the time. This means our blood glucose is always elevated – not kept at a normal level in response to our snacking, but elevated. In response to the blood glucose elevation, the pancreas is secreting insulin so that the blood glucose will fall because insulin will tell our cells to open up and let the glucose in so it can be metabolized into ATP to provide energy for the cell to do whatever the particular type of cell is supposed to do.

Insulin has other effects, however: it takes any extra glucose and first turns it into glycogen, and if there’s more leftover after its glycogen storage tank is full, insulin neatly converts it into fat and stores it where it can be used for energy if ever we stop eating long enough for the body to burn fat. The glycogen and fat stores make it possible to go from supper to breakfast without dying in our sleep from hypoglycemia. Actually, enough glycogen is made for us to go 24 to 36 hours without needing to even touch those fat stores.

But we don’t go two hours without eating something because we’ve been told it’s “healthy.” And the truth is snacking is NOT good for you. It means that insulin is always elevated, and since we never let our blood sugar drop to normal, insulin is making fat all the time. But even worse: that constant exposure to insulin creates insulin resistance. This means that the cell does NOT take in the blood glucose when the insulin binds to its receptor. The glucose stays in the bloodstream, so the pancreas puts out more insulin until our insulin level is ALWAYS elevated. And it’s ALWAYS making fat.

So, what is the cause of obesity? Insulin causes obesity. Every doctor who’s ever started a diabetic patient on insulin KNOWS the patient is going to gain weight which means that the blood glucose remains elevated so the doctor increases the insulin dose which makes the patient gain more weight which means that blood glucose remains elevated so the dose of insulin is increased or the doctor prescribes anti-hypoglycemic medication that either makes the body secrete more insulin on their own or increases the body’s response to insulin which makes the patient gain more weight . . . So, the next myth is that Type 2 diabetes is a chronic, progressive disease that you can’t cure.

Why do I say diabetes can be cured? Because it’s been proven by patients who have had successful gastric bypass surgery. They drop a lot of weight and they are no longer diabetic. The secret is they are eating less so they aren’t needing all the insulin. My premise is you don’t have to have a gastric bypass to “cure” diabetes. You just need to lose weight.

Please realize that I’m only talking about Type 2 diabetes. Type 1 diabetics don’t make their own insulin or don’t make enough so they HAVE to take insulin. Type 1 diabetes was fatal before medicine figured out how to make insulin and how to deliver it. Basically, before injecting insulin, people with Type 1 diabetes starved to death. It didn’t matter how much you fed them. Without insulin, the glucose channels in the cells don’t open so glucose can’t get in so they just wasted away. They lost weight because metabolism can’t work if the glucose can’t get into the cell and because the blood glucose was high, they peed all the time. The word “diabetes” refers to the constant flow of urine. Mellitus meant the urine tasted sweet.

So that are five major myths about obesity that I hope I have sufficiently proven to you to be false. Now here is a fact about obesity that most people don’t realize: OBESITY IS A DISEASE, not a character defect. But that’s how society views obesity.

Well, isn’t it the fault of the obese that they became that way? Aren’t they the ones who sat around eating all the food and not exercising? And can’t they just fix it by eating less and moving more?

Well, we have already proved that Eat Less/Move More doesn’t work. Yet every obese person has been given this advice by their doctors. And when they don’t lose weight, their doctors assume that they are just ignoring their advice.

The sad thing is: the rest of society agrees that the obese have themselves to blame. Even the obese feel that they have done something wrong. The standard medical approach is shaming the patient about their weight, and then forgetting about them. Statistically, it has been proven that doctors spend less time with obese patients than with non-obese. Obese people are discriminated against in hiring and in a promotion. They are discriminated against in churches where they are judged as being guilty of two of the Seven Deadly Sins: gluttony and sloth. Obesity is a disease untreated by compassion and understanding.

Even worse, obesity is a disease associated with multiple co-morbidities. That means the condition of being obese is associated with a lot of other diseases. I’ve already referred to Insulin Resistance and Type 2 Diabetes Mellitus. But there’s also hypertension (high blood pressure), coronary artery disease (blocked arteries of the heart), congestive heart failure, Non-Alcoholic Fatty Liver disease, Chronic Kidney disease, Polycystic Ovary Syndrome (which leads to infertility), peripheral neuropathy, and even some cancers. Just to name a few. And sadder: many of the medications given to these patients by their doctors to treat these co-morbidities either increase the weight or make it harder to lose weight. And then ask the question I was asked by my former primary care physician: “So when are you going to do something about your weight?” YOU, not WE. It’s YOUR responsibility to lose weight.

The hallmark of primary care is chronic disease management, with the patient and doctor as a team; in Family Medicine, it’s the patient, the doctor, and the family. But with obesity, the doctor resigns from the team and the family can be part of the problem

Medicine is finally beginning to revamp its attitude toward the obese, with the creation of Obesity Medicine as a specialty. But that’s only a few doctors. The field of Medicine has to stop blaming the victim. Society has to stop blaming the victim. The VICTIM needs to stop blaming the victim.

Obesity is a disease and, like other diseases MUST be treated by a physician.

So, what can the physician do to treat obesity? If Eat Less and Move More doesn’t work, what does? There are plenty of diet options out there to choose from. We’ve got the Atkins Diet, the South Beach Diet, the Keto Diet, SlimFast, plus Oprah’s making a mint off of Weight Watchers, and there are many different companies that sell meal replacement bars and shakes. Then there are all the fat burners you can try at GNC. And the different prescription diet drugs. But which is better? Do any of them work? Do ALL of them work?

That’s why I started GFM Weight Management. Here’s my approach. First, the patient must realize that successfully losing weight and keeping it off requires a total lifestyle change. This is not a case of starving yourself for six months so you can get into that bridesmaid’s dress at your cousin’s wedding. We already know that once the wedding is over, the weight comes back. Hence, the lifestyle change.

Medical evidence has shown that successful weight loss requires multiple sessions of intensive counseling. This means more than your doctor tells you that you’re overweight and need to lose some pounds. The optimum number of sessions in the studies ranged from 12 to 20. Most physicians can’t do this within the parameters of a regular office visit, even seeing the patient monthly. We are hearing that the length of time most people actually see the doctor is around five minutes. A doctor who spends 15 minutes with the patient is a rarity, and he or she will get significant blowback from his or her partners who are seeing more patients or employers who demand greater productivity. But even 15 minutes is not enough time for the required intensive counseling, nor are monthly visits sufficient. My basic program is 16 visits over 8 months, each visit lasting at least 30 minutes.

What is covered during these counseling sessions? First, we analyze your present eating pattern. I urge patients NOT to eat a diet different from what their family is eating. So, a change to how the entire family eats is imperative because the whole family is probably eating just as unhealthily as is the patient. Further, if you are eating something different from what the rest of the family is eating, it feels punitive. And if you cheat and eat some of what they’re eating, you feel guilty and, therefore, punish yourself emotionally.

Next, we look at what you’re eating. The focus is not on how much you eat but rather what you eat and when you eat it. The first hurdle is the When: changing to three meals a day and stopping the constant snacking. This is the first step and maybe the hardest. The goal is to have time for your insulin level to go back to normal from one meal before sending it back up with the next one. The 12-hour overnight fast is imperative. Your blood sugar will not crash if you don’t have your bedtime snack.

The reason I say this step is the hardest is that often we are snacking not just because we’ve been told it’s healthy but because we’re eating in response to some trigger. Stress is a big trigger, anger at someone at work or home, guilt because you slipped up and ate so the heck with it, let’s eat more. A major part of the program is identifying the different triggers that may accompany or activate dysfunctional eating. Trauma, especially childhood trauma, is closely linked to eating disorders, and the goal is to understand the triggers and learn different coping strategies. This is why a 5- to the 15-minute session is not sufficient and why frequent appointments are necessary.

What can be summed up in four words: Low Carbohydrate, Healthy Fat. That’s how this differs from the Keto diet which is Low Carbohydrate, High Fat. Healthy fats like avocados, olive oil, coconut oil, nuts, eggs, oily fish like salmon, and cheese are examples. And you can don’t have to take the skin off the chicken, plus you can have red meat.

But what about chocolate??

To my dismay, you can only have dark chocolate (but ask me for my recipe for a cocoa-peanut butter-coconut oil-pecan fat bomb to use when you really feel you just have to have dessert).

And what about alcohol (the fourth macronutrient)??? On the Keto diet, which demands a 20-g limit on carbs, they approve of a glass of red wine a few times a week. A dry red has about 3 to 4 grams of carbohydrate. Although you can find beers with only 5 grams of carbohydrates, they have more calories than the wine, and who stops at one beer? What about the hard stuff? Would you believe that they have no carbs? But they have lots of calories, and anyway, you can’t have the hard stuff at Episcopal church functions. What about cocktails? No cocktails because they usually have lots of sugar (sucrose: arguably the most destructive carbohydrate of all.

So why is the low carbohydrate component so important? What is so bad about carbohydrates and why has Dr. Tess declared war on them. That takes a bit of national history to understand. For fifty years there has been one mantra spoken to us by most doctors: “Eat a diet low in fat, and replace it with carbohydrates.” Not to publicize my age, but I come from a generation BEFORE the U.S. Government decided fat was bad for us. When I asked my mom how to lose weight, she said “Eat less starchy and sugary food.” And it worked. I could switch to protein and drop five pounds in a week.

When I say the Government decided fat was bad, I’m not referring to some deep state, Anti-Trump conspiracy. It was all done out in the open and it happened this way: In the 1950s and 1960s, we noticed that the rate of heart disease post-World War II was going up. Saturated fat was proposed as the culprit but the medical evidence was not conclusive (the Seven Countries Study which allegedly made the connection originally included data from 22 countries. The author “cherry-picked” the data, leaving out the 15 countries whose data didn’t match his hypothesis). Actually, the study wasn’t officially published until 1978. In January 1977, however, George McGovern and the Senate Select Committee on Nutrition and Human Needs making the decision that fat was the cause and all America needed to go on a low-fat diet to avoid heart attacks, strokes, high blood pressure, diabetes, obesity, and cancer. Fat was BAD for you. This led to the famous USDA food pyramid that had as its base grains and bread and cereals and rice and pasta. We were told to eat at least 6 to 11 servings of carbs a day, plus more servings of starchy vegetables. And we were to avoid saturated fat like the plague.

But that diet is what precipitated upon the country the present epidemic of obesity. The U.S. food companies gravitated towards refined, “low-fat” foods. But when you take out the fat, there goes the flavor. So, food processing companies began loading up those “low-fat” foods with sugars, corn syrup, partially hydrogenated vegetable oils (we got peanut oil, canola oil, cottonseed oil, corn oil, palm oil, all kinds of oils), and chemicals you can’t pronounce to put the taste back in. When margarine was first developed, it contained artificial trans-fats which were banned by the FDA in 2018. Now our margarine has monounsaturated fats (MUFAs) and polyunsaturated fats (PUFAs). And now we are learning that PUFAs are not good for us, although we were originally told they were. I tell my patients to use butter. Saturated fat is actually safer.

Why do we buy this stuff? Because it’s cheap, quick, and easy to prepare. It’s available in meal size and snack size. Forget eggs and bacon for breakfast and grab a “Protein Bar” and run out the door. You don’t even have to sit down long enough to eat a bowl of cereal. How many kids get sent out the door with the cereal bar to consume on the way to school? How many of them have Jell-O cups (lots of sugar; no fiber) or fruit cups (in heavy syrup) in their lunchboxes?

Until recently most doctors have worshipped at the altar of low saturated fat. And the reason no one is losing weight is explained away as chronic, country-wide nonadherence to the recommended diet. But we DID follow the diet. We ate low-fat, high carb and that’s what got us where we are now. I remember telling my diabetic patients to “limit” their carbs to 45 grams per meal and 15 grams per snack. That adds up to 135 grams of carbohydrate a day JUST AT MEALS. With the snacks, it’s 180 grams. To put that into perspective, compare it to the Keto diet which limits you to 50 grams a day.

The Enemy is in plain sight. It’s the carbohydrates, folks. Breads and grains and cereals (even before you add the sugar) and pastries and cake and pasta and rice and flour . . . . They’re all carbohydrates, and even worse, they are REFINED carbohydrates. They don’t even have the original fiber in them, that’s all been refined out. Yup, all those foods to which you have become addicted. Why are they so fattening? Why do they make obesity levels soar? It’s because they have a simple molecular structure. Most of them are long strings of saccharides (sugar moieties) attached to a carbon backbone. Carbohydrates are so easy to break down into sugar that your saliva starts breaking them down before they even get to your stomach. It’s not just the donuts; you can taste sweet with just a bite of bread.

So, your blood sugar goes up which causes the insulin level to go up. Actually, it goes up before you take the first bite. That’s called the cephalic phase of insulin secretion; your brain is expecting sweetness, so your pancreas makes sure your insulin levels are ready for it. And as we learned earlier, insulin spends its time packing excess glucose into fat cells and storing them where they should not be. It’s called visceral fat and results in the fatty liver which can cause hepatitis, fatty pancreas so the insulin can’t get out into the bloodstream, and fat around your intestines. It is more likely to cause a heart attack than subcutaneous fat (which gives you the cellulite on your legs and buttocks). There comes a point in Type II diabetes when, according to the endocrinologists, the pancreas “burns out” and you can’t supply your own insulin. But the pancreas has not burned out; it’s just socked in with visceral fat. Lose enough weight and your pancreas will reanimate.

The other problem with carbohydrates is that it’s easy to eat a LOT of them. Everyone knows one person can sit down with a family-sized bag of potato chips and eat the whole thing while watching a made-for-TV movie. You never get full of carbohydrates, especially refined carbs. They don’t trigger your satiety hormones, so you keep on eating. This is why people say that they are addicted to various foods. They start eating those foods and have a hard time stopping. Those foods are usually carbohydrates. They’re the ones that we call “comfort foods.” But you never hear someone saying, “I’m addicted to pork chops” or “I’m addicted to salmon” or I’m addicted to eggs.” That’s because proteins and fats trigger the release of satiety hormones. And when you’re full, there’s no room for another pork chop. But amazingly, when you’re offered dessert, somehow you have room for it. Because it’s probably carbs.

Now have I just given away the farm by my rant about carbohydrates? After listening to this lecture, do you really need the GFM Program? Haven’t I already told you what and why to avoid eating and what and when to eat?

Well, you really do need the program. I’m asking you to change pretty much everything about what and when you eat. This is a total lifestyle change. You will need to change a lot of behaviors. That’s why multiple, intensive counseling sessions are the recommended weight management treatment. You may need therapy when you confront your eating triggers, and I provide that. If you’re the one who does the food shopping and preparation for your family, it makes it a little easier to switch to low-carb/healthy fat but expect some blowback from your family members, especially the kids. The younger they are, the easier it will be. If you have teenagers, it will be rougher and it will take some doing to get them on your side. You may simply have to refuse to buy the Doritos and let them know that if they want it, they need to buy it themselves. As a Family Physician, I take the team approach: the patient, the physician, and the family, and you will need support to take on the family. Family sessions may be needed. As I said earlier, the family may be part of the problem.

Another reason counseling is important is that carbs put up a fight when you try to reduce their presence in your diet. One thing I’ve run into is carbohydrate craving, especially if carbs have been a major part of your diet for a long time. Further, if you choose a carbohydrate-loaded meal, you will be hungry after an hour and you will crave more carbs. So, part of the program is the availability of “panic calls.”

Finally, I practice cognitive-behavioral therapy, which is different from behavioral therapy and, I believe, a lot more effective. What is the difference? Behavioral therapy identifies the behavior (when I go out to eat, I always eat too much), analyzes it (I eat too much because the portions served are so large and I still have leftovers to take home), determines how to prevent the behavior by developing a different behavior (cut the portion in half and put it in the take-home container BEFORE starting to eat), and identifies positive reinforcement (now I have tomorrow’s lunch already prepared and I KNOW how good it’s going to taste).

Cognitive-behavioral therapy looks more deeply into the “why” of the behavior. Take the problem above: when I go out to eat, I always eat too much (behavior identified). I realize that eating as much as I want feels gratifying and limiting my portions feels punitive (motivation for behavior is identified). Then I remember that I was overweight as a child and my mother always served me portions that were visibly smaller than those served to my brother, who was also overweight (childhood trauma recognized). But I feel uncomfortably full and sometimes sick after eating so much (negative consequences of short-term gratification acknowledged). Through talk therapy, I acknowledge that I am now an adult and can choose to eat smaller portions because I will feel better physically if I do (cognitive adjustment of feelings about portion control). This type of therapy if freeing because I can see that by overeating, I am still under my mother’s influence (determination of a new, more positive way of coping with trauma). So, when I go out to eat, I cut the portion in half before starting to eat (develop a new behavior). I congratulate myself on freeing myself from the effects of the trauma (provide positive reinforcement of new behavior).

So, are you in need of a lifestyle change? Or do you know someone else who might benefit from the GFM Program? Remember the 25 pounds I’ve lost? I’ve tried it out on myself and know that it works. Not only have I been where you’re at but, with 35 pounds still to go, I am still where you’re at. And may I repeat: I understand.

Dr. Tess Garcia

Dr. Garcia and her team provide a level of personal care that maximizes patients’ health and well-being. We treat the whole patient: spirit, body, and soul.

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Garcia Family Medicine Does Not Take Insurance, We Are A Monthly Based System That Gives You Personalized And Direct Access To Your Physician.