So many diet doctors are frauds. I am not, haven’t been, and never will be a diet doctor — but I was a fraud, too. As I wrote in our first post, I honestly thought that I was giving useful medical “advice” about weight loss by espousing the usual platitudes of eating less and moving more. But what good does it do to tell someone that calories-in/calories-out is a simple equation? What good does it to do tell someone that they should exercise? How do those words help someone to become motivated to change and to develop strategies to help sustain the success? Here's the answer: they don’t.
It never occurred to me that not only was I not encouraging my patients in a helpful way, but I was also just adding to the discouragement they felt in their struggles with weight. It took my own experience with becoming overweight and then finding my own path to losing weight to have a better appreciation of my patients’ challenges and then to be able to help them in a meaningful way. Let me tell you how it happened.
I didn’t really have a weight problem until I was 40, after the birth of my second baby. But that doesn’t mean that I didn’t have food issues before that. I had always had a “sweet tooth,” and I ate large portions, but I could get away with that when I was young. My mother was a fabulous baker, and Friday was her baking day. I’d come home from school every Friday, and there would be two pies on the counter: one for the family and one just for me. My pie was smaller — but not by a whole lot. I ate the whole thing right then and there. And I remained slim.
I never enjoyed exercise either. Years ago, when I was a teenager, girls didn’t have to participate in gym if they had their periods. Somehow, my gym teachers never seemed to notice (or perhaps just pretended not to notice, since I was so pathetic at sports) that I seemed to have my period just about every week. Later, when I was in my 20’s and 30’s, I was grateful that I was slim and didn’t “need” to be physically active.
Somehow, I got away with these habits. Until I didn’t. Eventually, my age and my changing metabolism caught up with me. I had no idea what to do. Don’t get me wrong — I knew full well what I “should” eat. I was a doctor, after all — an expert! I would try one diet or another, and each one did work for a while. Until it didn’t. There was always something that would derail my efforts. I was frustrated and furious with myself for not having more “willpower.”
One day, in 2013, after years of this pattern, I found myself on a stepladder in my kitchen, trying to reach into the back of the cabinet over the refrigerator. I was foraging for some old Halloween candy or any other chocolate I could lay my hands on. I knew that it was going to be uncomfortable coming down off the ladder because my knees hurt. I knew that my knees hurt in part because I had gained weight — a lot of weight — and now weighed exactly what I had weighed when I was nine months’ pregnant. Just baby fat, right? Except that the baby was now 23 years old. I also knew that in four months from this time, I was going on a trip to Switzerland with my two daughters, and I had been hoping to go hiking with them.
It was at this moment that something clicked for me: it was the realization that being disgusted with myself was not going to motivate me to change in a sustainable way, but that wanting to take good care of myself might be just the thing. I decided to shift my thinking. I would think about being more active with my daughters and with my future (please, God) grandchildren. I would think about being able to live an independent and vigorous life as an old lady. I would make more space in my brain by not playing the continuous loop in my head about what I wanted to eat but shouldn’t eat or shouldn’t have eaten and now felt ashamed and undisciplined and hopeless — that undermining voice of the "Evil Twin.” It dawned on me — finally — that I would never lose weight by hating myself or feeling ashamed of myself. Never. Then I climbed down, uncomfortably, from the stepladder and wrote down some lists:
List 1: what are the reasons that I want to lose weight?
List 2: how do I go about this in a self-compassionate way?
Once I reframed wanting to lose weight into a new paradigm of wanting to take care of myself, the day-to-day strategies fell into place. I gave myself constant, gushy positive feedback. I got rid of all the chocolate in the house. I started every meal with vegetables. I planned ahead for what I was going to eat at the next snack and at the next meal. I created short-term goals that were achievable and sustainable. It had to be a positive experience! Goal-setting was a strategy that Jay and I have talked about before, and I will share these strategies with you in greater detail in future posts.
Three months later, I had lost 15 pounds and gotten myself into better shape — and then I hiked the Alps with my daughters! After six months, I had lost a total of 30 pounds, which I have not regained (except for a brief “Trump Ten” relapse, but I reversed that, too). Since that time, in working with my patients, I have come to believe even more strongly in the importance of kindness and compassion toward oneself as key to losing weight in a sustainable way.
More than I have helped my patients, though, my patients have helped me to deepen my understanding of the connection between food and shame. This came as a result of starting a group for students at the University of Pennsylvania, where I work, to address issues around healthy eating and weight loss. I talked a little about this in our introductory post,. The big issue wasn’t weight, and it wasn’t food. It was shame.
I no longer discuss with my patients what they “should” weigh. I talk about eating and moving in a physically and emotionally healthy way. I talk about strategies to reinforce positivity and to negate shame. Here are a just few examples:
- Every time you notice that you’re thinking negatively about yourself, reframe the thought into something positive. You ate a second piece of cake after dinner and now you're a failure? Uh-uh. You ate a second piece of cake, that’s all. You don’t like how that feels, and so for now, you’ll make your kitchen a no-cake zone and have cake on special occasions when you’re at a restaurant.
- Every single time you make a healthy decision — fruit instead of cookies, going to the gym instead of to the mall — thank yourself and congratulate yourself.
- Don’t eat anything unless you’ve decided ahead of time — even if it’s five seconds — that you want to eat it.
These are the kind of strategies continue to work for me and for my patients. That’s the reason this blog exists, as well as why Jay and I are writing our book. There’s no place any more for shame.