To Overcome Obesity, the Brain Has to Do Some Heavy Lifting

weightLoss

THERE HOPE FOR LOSING WEIGHT AND KEEPING IT OFF LIES IN SMALL, DOABLE STEPS.

Television reality shows about extreme weight loss (there are several now) leave the impression that it’s all about diet and exercise. Some shows, but not all, also touch on the psychology of being “deconditioned,” the industry term for obesity and poor general health. But most deal with mental barriers such as motivation and self-control.

Whether the cause is simple (eat less, exercise more) or complex (emotional eating), losing significant amounts of weight is a herculean task. But it makes sense there would be different paths for achieving the goal. Identifying which path works for you is the Holy Grail of weight management.

Hard work works (except when it doesn’t)

For example, Muata Kamdibe is a California college English instructor who erased 120 pounds from his 320-pound frame. He’d struggled with yo-yo gains and losses since college, tried supplements and the Atkins diet and made attempts at exercise. But he still ended up at his peak weight around the time he hit age 30.

Kamdibe’s approach is a study in discipline and good fitness sense. His blog traces his trials and travails with faddish and imbalanced approaches but concludes it is about the work: eating right, exercising smartly — all with vigor and dedication, the way things should work. He bravely posts before-and-after photos of his shirtless torso to prove his point. Today Kamdibe is a fit fitness fanatic and very happy to share what he knows with fans of his Mr. Low Body Fat’s Blog.

But a plethora of books, Web sites and therapists argue that weight management is often rooted in something far less concrete yet equally powerful: emotions and psychology. From “Big Medicine,” on Discovery Health/TLC, television psychotherapist Mary Jo Rapini, whose day job is in a bariatric unit at Methodist Hospital in Houston, says, “I have conducted research and have evidence that obesity is largely due to an addiction of ‘trigger foods’ for many patients.”

Rapini further explains that bariatric patients may lose significant amounts of weight and be able to go off diabetic medications, but “the one problem that the surgery will not take away is an underlying food addiction.” The psychotherapist says she has seen patients resort to installing locks on food pantry doors and refrigerators, while others in treatment facilities would sneak outside to steal food from the garbage. Typically, she sees patients a year after surgery who “have lost their best friend. They feel empty; their comfort is gone.”

Rapini says that food addiction is lifelong and needs to be approached with a 12-step program, similar to those used to treat alcoholism and drug addiction.

“Shame-blame doesn’t work”

I spoke with Michelle May, M.D., and author of Eat What You Love, Love What You Eat: How to Break Your Eat-Repent-Repeat Cycle. She conducts workshops for very overweight individuals and with health professionals who work in weight management. An important focus is to identify nonhunger reasons for eating, she says. This is in response to triggers that can include the time of day, very appetizing foods, boredom and stress. Her approach separates the function of hunger, as driven by the biological need for fuel, from nonessential things such as appetite, cravings and just wanting to eat.

“I’ve worked with many intelligent, self-sufficient, accomplished people, ” Dr. May told me. “Unfortunately, they have developed habits that are self-reinforcing. The shame-blame paradigm doesn’t work at helping them to change their habits and lose weight.”

It’s a complex area, to be sure, but May works off a basic behavior modification rule: For change to occur, the pain of staying with the status quo is greater than the pain of making a change. In other words, the individual has to perceive that lifestyle changes — food and increased physical activity — are easier to accomplish than simply remaining overweight with no hope of improvement. She instructs workshop participants to ask this question, “What is the least amount of exercise you can do most days of the week, joyfully and consistently?” One patient, an engineer in his mid-40s who needed to go on hypertension medication, responded to that question by saying he began taking a flight of stairs at work in place of an elevator. Soon that flight became two, then three, then ultimately eleven stories, and he added working out on an exercise bike — such that he was able to reduce his use of medication because his weight dropped.

“By giving him permission to start small, he was able to make that progress,” May notes. “Small steps create the journey.”

May also recommends a focus on the “why?” of eating. “You need to be in charge, to make decisions mindfully. You can allow yourself to eat that second piece of cake, or you could decide that doing so might get in the way of enjoying your grandchildren.”

Men and women: There are differences

It cannot escape notice that Muata Kamdibe’s approach fits the typical male approach to weight loss: (1) work out, perhaps as you once did while playing high school sports and (2) develop a disciplined approach to diet. Because men overall have an easier time of losing weight than do women (greater proportions of natural lean body tissue enables a higher metabolism), this may be the reason his blog is written specifically for “average Joe couch potato.”

Dr. May notes that women who are taking a serious approach to diet and exercise are much more likely than their male counterparts to weigh and measure foods. For men, using a car analogy sometimes helps (“Why would you pull off a highway to get gas if your fuel gauge says you have plenty in the tank?”). But she also cautions that these are generalizations.

May also differs from what Rapini reports. May says the cause of overeating frequently is from habitual patterns, less so from deep, dark psychological problems. Recent study findings showing that social groups and families tend to be obese together lend some support to the theory that it’s about patterns for most people.

Which takes us back to considering how obesity is a widespread problem, experienced in varying proportions up and down all socioeconomic strata. The ill effects may be the same, but the causes can be quite different.

The good news is that for the person whose weight and general conditioning are pretty far gone, there may be a different approach that is worth trying.