By Lance David Levy B.Sc., M.B., Ch.B., M.Sc., FRCP(C)Director of the Nutritional Disorders Clinic in Toronto, Ontario, Canada and author of Conquering Obesity. For more information, visit www.drlancelevy.com
Most days I see several new patients who were referred to me for the management of obesity. As obesity has become public health problem number one, everyone working in this field is trying to figure out why we have an ever increasing number of kids and adults who are overweight or obese, and as a consequence are facing serious health risks. Almost without exception, these individuals have tried all sorts of diets over the years and have not managed to lose weight and keep it off.
For many years it was felt that failure at weight loss was due to a lack of knowledge about diet, exercise and general lifestyle change. Often, seriously obese people were thought to be lazy or unmotivated. A research project I managed in 1985 showed that almost everyone with chronic obesity knew what they ought to do to lose weight; the problem was they could not sustain any method over a long enough time to be successful.
We also discovered that after failing at numerous diets, almost all with chronic weight problems felt defeated, and deep inside had no “drive for thinness” left in them. In other words they were highly sceptical they could lose weight and did not have the desire to devote more time to a “ project” that was doomed to failure. In short, they were turned off and angry if the word diet was raised in conversation. Well, we had to find a way around that scepticism, because it exerted such a negative influence and prevented a person from devoting both time and energy to a weight loss plan. The obvious way to determine why everyone felt so defeated was to discover why weight loss plans failed. It seemed clear that if roughly 98 % of people failed to maintain weight loss over a year, the problem was with the methods used and not with the people themselves.
After a number of experiments we determined that all diets end more or less the same way. Typically events occurred that were not planned for, and the effort and energy spent coping with, for example, an extra work load at ones’ job, financial worries, illness and so forth, meant that taking time to be mindful of what was being eaten, shopping adequately, and sleeping enough to be alert was not possible. Under the influence of unplanned energy and time sapping events, diet plans just fell by the wayside with predictable weight regain! Surely an individual could manage a diet and lifestyle change with a bit of planning and so stay on track.
Unfortunately our naive optimism was not borne out in fact. The fact is that people do well when they can, and if they can’t it is because they cannot, and not because they are lazy or uneducated. To find a reason for why keeping plans on track was so hard, we tried a variety of experiments on our patients. We found that as the degree of excess weight increased (higher BMI) the number of people with mood problems, daytime fatigue, chronic pain, digestive problems, and problems with impulse control increased in an exponential fashion.
In 1998, one patients’ story of weight loss failure was mystifying and caught my attention. I discussed him with Dr. John Fleming, a clinical psychologist I have collaborated closely with for 20 years. The patient in question was a man in his thirties. He was obese, with a BMI of 45, and ran a trucking business. He was brilliant at juggling all the truck routes and time schedules, affable, and good at dealing with emergencies, but terrible at self care. He simply could not follow the diet and lifestyle correcting plans I worked on with him; getting to bed on time, eating at regular intervals, grocery shopping, and taking a walk each day were totally beyond him. Convinced of his sincerity in trying to be compliant, we realized we were missing something. What we asked him to do was not “rocket science” yet it was impossible. In my next blog I will tell you what we found out and how it helped this man succeed in weight loss and in other ways as well.