My approach to weight management and health
Why did you start this blog?
I have been interested in healthy lifestyles since medical school in the 1960s when we had courses in human ecology and nutrition. I have always equated the practice of medicine with improving health outcomes, and it turns out that few medical interventions are as effective in the long run as behavior modification. The blog idea came after I wrote Weight Management for Your Life as a way for me to reach an audience and to continue learning and discussing the issues presented in the book.
The specific stimulus for writing the book came from a dinner conversation with friends where I took the position that one’s behavior has a huge influence on one’s weight and health in general. My friend, also a psychiatrist, took the position that we have little control over our weight and health – that most of it is genetic or biologically determined. We began emailing about this topic and each of us read books and articles and used them to bolster our arguments. Eventually, we came to a middle ground, and I continued to read and study the issue until I had the material for the book.
Who is the audience for your book?
Primarily it is a self-help book for people concerned about weight and health. I have long been interested in consumer empowerment and education, and have made this a focus of my psychiatric practice and writing. However, I also believe many health care practitioners can use this kind of concise yet comprehensive research-based information in their work with clients, and I hope many of them will read the book and then use it to help others. Training the trainers has always been a powerful multiplier of useful health-related information.
There are so many diet and lifestyle books on the market; what is different about your book?
Most of what is out there, and it is an amazing amount, falls into two categories: either it is research-based but narrowly focused and selective in order to promote a specific point of view; or it is completely opinion-based and hyping some fad or promoting a product (which may be the book itself). Very little is comprehensive and unbiased, which is what I am trying to be. Of course, we all have our biases, and mine are that we DO have some control over our thoughts, feelings and behavior, and that health decisions must be based on attention to biological, psychological, and social (interpersonal) factors. I do think I am very clear in the book about where I stand on these issues and I directly address the issue of bias (to see for yourself, look up “bias” in the book’s index). Too few authors, in my opinion, honestly discuss the issue of bias.
Has your approach to weight management had results?
Yes and no. My approach has not really been tested experimentally – it is too comprehensive to lend itself to clinical research, which must focus on specific research questions. But the various bio-psycho-social components have been tested, and I cite the studies that indicate how they have been tested. My medical/psychiatric practice has never been weight-focused; people came to me for treatment of psychiatric disorders, usually severe ones, and being overweight is not a psychiatric disorder. But many of my patients struggled with weight issues and much of my work with them involved helping them become healthier. I also treated patients with substance abuse and dependency, and a lot of that practice focused on lifestyle change. I would love to see whether this book, as a self-help tool, really does help people. I believe it will and sincerely hope so.
Have you personally had a weight problem?
I have worked hard throughout my life to be healthy and stay within a reasonable weight range. As a teenager I was horrified by having acne, and the conventional wisdom of the day was that carbonated drinks, greasy food, and chocolate caused acne. So, I gave up most soft drinks, potato chips and chocolate (I still ate lots of burgers and fries, though). I got in the habit of avoiding those kinds of foods for a long time, and that really helped me develop healthy eating habits (even if for the wrong reason initially). When I hit middle age, though, I slacked off and gained weight and became soft and out of shape. It hit me hard when I injured my lower back doing some yard work, and, when the orthopedic surgeon asked me to do a sit-up, I could not do a single one! I was completely ashamed of myself. At about the same time I discovered my cholesterol was well over 200, and I began to think about my sedentary lifestyle and poor eating habits. I began to read about diet and exercise, and (as I had as a teenager) made a conscious choice to eat better and get more exercise. I lost the ten extra pounds I had put on and, more importantly, began to feel much better. My cholesterol came down to normal levels and my back became stronger.
The other thing I have personally experienced is how pleasurable eating can be, and how much control we can have over our food choices and preferences. My father had an extremely limited diet – only meat and potatoes and almost nothing else. My mother, though, loved food and introduced me as a child to delicacies like lobster and salad. I have always been adventurous about food, and love to find wonderful, new things to eat. I have never gone on a “diet” because the concept seems ridiculous to me. Why in the world would one plan to deprive oneself? The simple and logical approach, to me, is to teach yourself to like foods which happen to be good for you, or at least not too bad. I don’t eat much red meat, hardly any fried food, no soft drinks, and don’t like food that is too rich, too sweet, or too salty. These are choices I have made and yet I enjoy a wider range of delicious food than almost anyone I know.
Can we really change our food likes and dislikes?
To some extent, we can. In general, our minds are more powerful than many people assume. How we think about something, the choice of words we use in our silent self-talk, has a major effect on what we feel and do and how others respond. Food preferences are one example of this power of thinking. For example, if I decide that whole milk is too fatty and want to switch to skim milk, at first it will taste funny and “watery.” If I reassure myself by thinking “I will get used to this new taste and learn to like it,” soon I will prefer skim milk and when I drink whole milk again will think it tastes too creamy. Similarly, and I have done this recently, if I decide to cut way back on the amount of salt in my diet, I will soon get used to it and not feel at all deprived of salt. Again, a critical step is catching yourself before you talk yourself out of something that is good for you. But you can, if you wish, talk yourself out of something that is bad for you. If you want to give up an addiction to candy, for example, you can tell yourself “Yuck! This is too sweet!” Obviously, not all food preferences are easy to change; I will probably never like beets, for example.
How do you eat and exercise?
People who know me are amazed at how much I eat and yet never seem to gain weight (I weigh about 170 pounds, at 5 feet, 11 inches). No one enjoys food more than I do, but as I said in the previous question, I avoid rich (creamy, buttery, sweet) food and don’t eat much red meat. I don’t like soft drinks or junk food, and almost never eat “fast food.” I love fruits and vegetables and whole grains, and also love seafood of all types. I do not snack. I very much look forward to three meals a day, and when I am done eating a meal I am through until the next one. If I overeat at a meal, I will eat less for the next few meals. I never skip breakfast (typical breakfast: unsalted “raw” almonds, orange juice, whole grain cereal with fruit and skim milk, and tea). I shop local, seasonal, and organic when I can, and love to eat foods from other countries (Japan, China, Viet Nam, Mexico, Greece, the Mid East, Italy, France, Africa). I am a moderate alcohol drinker (not daily and not too much; mostly wine, beer and martinis). I take a “Senior” multivitamin (without iron) 3 days per week.
Regarding exercise, I have never been an athlete and do not play any sports (when younger, I liked to swim and water ski). I don’t jog or go to gyms. What I do is walk a lot, use the stairs, move a lot, and use free weights and bands twice a week for resistance (strength) training. I also stretch at least once a day. Recently, I have done some cycling (no more than an hour a day, not every day), and have added an elliptical machine. I am a strong believer in “spontaneous exercise” and NEAT (non-exercise activity thermogenesis; this is discussed in the book). I like to walk and cycle with friends; they are great social activities.