Stop eating before you become obese

We all know that obesity is a huge and growing (no puns intended) problem in the U.S. and most other developed countries.

The proven harmful consequences of obesity to the individual and the public health, as well as to the national treasuries, are devastating. The solutions are both simple and complex.

For most adults who are of normal weight (BMI under 25), simply maintain your normal weight. If you are overweight (BMI 25 to 30), consider this a wake-up call and act now, before you become obese. Stop eating.

I did not say fast; I did not say starve. I said stop eating too much; stop eating high calorie snacks between meals, stop eating everything on your plate; stop eating such large portions; stop eating desserts; stop routinely eating bread and butter; stop eating three full meals a day when two are enough; stop eating fats and refined carbohydrates when you can eat fresh fruits and vegetables and complex carbohydrates.

And while you are at it, stop drinking alcohol and sugary drinks.

And for those of you who are already obese (BMI over 30); too bad, but not too late — to avoid becoming morbidly obese. Stop eating even more often and for longer periods than your merely overweight brothers and sisters.

Obviously, regular significant exercise is also important; and for some, a surgical gastric intervention can help.

When I did an editorial like this called “How to stop the obese from becoming ‘obeser,’” in Medscape on Dec. 17, 2004, it did not solve the problem; the problem just got worse.

And, a lot of obese people got really angry at me for hurting their feelings. But I don’t really care that much, as long as we did get some people to adjust their eating and drinking behavior.

Stop eating and drinking excessively and stay healthy.

George Lundberg is a MedPage Today Editor-at-Large and former editor of the Journal of the American Medical Association.

Originally published in MedPage Today. Visit MedPageToday.com for more obesity news.

Comments

jsmithfan
OMG, is it really that easy? I should try this compassionate counseling with my patients. I’m sure they’ll schedule that follow-up appointment right away after I’ve demoralized them and told them how stupid they are for over-eating. You’ve obviously had great success with this approach since your last editorial.

diana barrett
dangerous advice for many people who will simply try to eat less, skip more meals and find that they aren’t losing weight as their metabolism goes into starvation mode..better advice would be to eat fairly often and smaller, healthier amounts

http://www.pacificpsych.com/ pacificpsych
LOL!! If only it were so easy..
Not doing something is far harder than doing. Positive reinforcement is better than negative reinforcement, if you want to induce sustained changes in attitude and behaviour. When people are made to feel bad about themselves, they’ll often turn to food as comfort.
Increasing physical activity is one key to combating obesity, and that means greatly increasing the amount of moving around during the day, as well as exercising. Five times a week, an hour. Nothing less. The more the better. This should also lead to less overeating, as a natural side effect.
The rest is complicated. Not impossible to solve, but complicated. Cultural, environmental and emotional factors all come into play.
I get the exasperated “just stop”! But it doesn’t work…
Good editorial
For the vast majority of the US, it is a question of self-control. I agree–stop eating so much if you aren’t burning the calories. Although I would emphasize exercise; you have a lot more leeway when you get your body moving every day. That is, you can consume so many more empty calories if you are active than if you are sedentary.
http://www.pacificpsych.com/ pacificpsych
BTW, when I moved to the United States I lived in Kansas, of all places. I was shocked. I had never before seen a morbidly obese person in my life, and there I was, in Topeka, KS… People who weigh 300 pounds! Four hundred pounds! People who have to sit in carts to get around the store–to buy MORE food! I stared at them in horror, horror mixed with fascination…
But it hardly helps to march up to someone and tell them: OMG, you’re so amazingly fat! So I didn’t…
There needs to be a cultural shift to stop the epidemic. Till then, we’ll just have to keep working on it on a one to one basis, and without humiliating the other person.
Tammy Young, Ph.D.
I’m disappointed that this article is on KevinMD.com. While I don’t always agree with the content posted here, it’s typically thought provoking and thoughtful. This post is neither of those things. There’s no advice or helpful information; It’s anger, sweeping generalizations, and inaccuracies.
Telling someone to stop eating – whatever your intent – is the worst possible message to give when dealing with food-related issues. As our nation struggles to fight obesity, we’re very likely molding certainly an entire generation and possibly an entire society riddled with eating disorders. We’re leaping from one tragedy to another and you’re lining up to make the problem worse.
If you want to say, “Change the way you eat,” then say it. Give people resources to relearn how to eat. Help families and young couples find ways to make time for meals. Teach teens and young adults how to cook for themselves simply and easily.
Don’t assume that everyone understands how to eat and what they need to do. People don’t know what to do and they don’t understand how to change what’s happening in their lives. The doubt, confusion, and misinformation has bred an entire industry of parasites helping the U.S. unhealthily yo-yo diet themselves to the grave.
Dr. Lundberg, you’ve lost the meaning in your desire to harshly and unsympathetically communicate your message. Yelling at people doesn’t work as made clear by your self-referenced last editorial (which your respondents described as “scientifically inaccurate and ethically unconscionable”). If you’re not going to contribute to a solution, please don’t waste our time with your unproductive rants.
http://thehappyhospitalist.blogspot.com The Happy Hospitalist
Let’s just tell everyone to gorge themselves so no one gets their feelings hurt. The truth is not always neatly packaged in a pretty box with a bright red ribbon.
http://medjuice.blogspot.com medjuice
Can’t disagree with what you’re saying, but not always easy to do. I think we have to remember that it’s not just BMI – there was a recent article in The Archives about how waist circumference is important along with BMI – basically showing that as circumference increases, all cause mortality goes up. Have a look here.
Mark
Why is telling people to stop eating such bad advice? When a started to get a little chunky I stopped eating as much and exercised more. Weight went away pretty fast. We overcomplicate things by talking about the resources, outreach and blah blah blah people need. Eat less. Don’t get a second helping. We need to more blunt with people.
Dr I-Practice-What-I-Preach
dear all,
frankly everyone, i agree with the overall message of the article
“Stop eating and drinking excessively and stay healthy”.
no, its not simple to do but it needs to be said. might i offer some suggestions? and before i do, i will state for the record i most certainly practice what i preach. I run 4-5x/week and lift weights at the gym, box, and hike. even in my fourties, my body looks quite nice- if i can say so myself, thank-you- and i still get compliments every now and then. and its not just just the outer appearance: my BP and cholesterol are good and i never have smoked. and BMI is just under 25. im gonna live to 110 yrs old
here is a sample diet that WORKS cuz i have put MANY MANY of my patients on it (i am board certified fam med) and have seen 10-15 lbs come off many patients in my practice.
meal 1, B-Fast: bowl of oatmeal with half cup low fat milk; half cup of OJ, on alternating days you can have 2 eggs cooked any way, 1 (YES ONLY ONE) piece of toast WITH butter if you want and one piece of fruit, plus a half cup of juice.
meal 2: MID MORNING SNACK- a piece of fruit (ex an apple, a bannana, ONE handful of nuts) or a small container of yougurt, or some grab and go veggies such as celery. basically any fruit or veg you like.
meal 3, Lunch: grilled chicken breast salad (you can buy a grilled chicken breast salad at McDonalds- DONT BUY THE CRISPY STYLE AND ASK FOR THE LOW-FAT DRESSING- this is important).
meal 4, mid-afternoon snack: see midmorning snack
meal 5, dinner: 4 oz of ANY meat (chicken, fish, beef, or lamb) cooked any way plus some veggies. a HALF cup of BROWN rice (not white). 4 oz is as small as a deck of cards. put the deck next to the piece of meat- if the meat is BIGGER than the deck, cut off some of the meat and DONT EAT IT. 4 oz means 4 OZ, ok?
meal 6, later evening snack: see mid morning snack.
if you eat 6 times a day, you will ward off hunger. if you are like me, when i am hungry i will eat ANYTHING: cookies, hamburgers, cake, i love it all… so keep your hunger controlled and it will be easier to keep some self control. so DONT FORGET TO EAT THE SNACKS. they are essential. really. and yes in the mid morning and afternoon, if you are in my office you will see me take a minute to eat some fruit.
keep in mind that at the beginning of the diet, you might feel a little bit hugry but thats ok, it will get better after week 1-2. if you are doing the this diet plan and starved, ask yourself “did i forget to eat the snacks?”.
if you refuse to eat breakfast, then you have a problem. all my heavy patients skip b-fast. but if you ask thin people, they rarely do. see a trend? become like the skinny people: eat b-fast. if you arent hungry by b-fast, maybe you are gorging out late at nite?
dinner should be NO LATER than 7:00, preferably 5:00-6:30. so many of my heavy patients eat (a huge) dinner after 8:00. sorry, it doesnt work with weight loss.
AND FINALLY- if you plan to lose weight and NOT exercise, forget it and dont bother. all i am asking if you are currently doing NO exercise is walk 15 minutes out your from front door and when 15 min passes, walk the same route 15 min back. thats 30 min and plenty. if you tell me you walk alot at work, then i will say “sorry, its not enough, or you wouldnt be heavy”. if you report “im too tired to walk” then stop whining about your weight, ok? this diet & exercise plan isnt a trip to disneyland. yeah, i get tired too but you will see me running, sometimes 9:00 at nite, a three mile course because if i dont i am convinced i will get OBESE. like my sedentary, high calorie, twice-a-day family. sure, i get tired- try running a solo private fam med practice- but i refuse to get fat- so i have learned to just suck it up and go out and exercise. over time, if you do go out even when exhausted, your “will” will strengthen to exercise. believe me cause i have.
i want you to go buy a scale and weigh yourself every day. yes you read correctly, every day. i found a study several years ago that showed that those who are on a diet and weigh themselves every day did much better in achieving weight loss compared to those who weighed themselves signficantly less frequently.
if you do this, i promise you will lose 1-2 lbs per week. so in 10 weeks you should be 10 lbs lighter. you will look more beautiful than you are now.
good luck everyone.

Patrick W. Hisel MD
Dr. IPWIP, you are the bomb! I tell my patients the exact same thing (but I start with ten minutes out, ten back).
J.T. Wenting
That’s about twice the caloric intake I have, similar exercise regimen, and I don’t loose an ounce.
Case closed?
For breakfast, 2 slices of bread with low fat cheese or meat, no butter, and a glass of water.
Lunch, 3-4 slices and some milk.
Dinner, some lean meat and veggies, totalling maybe a pound, no sauce, potatoes, rice, or pasta. And more water.
90% of what I drink on top of that is water and sometimes fruit juice.
Candy and stuff? Maybe a bar of chocolate every other week (or equivalent).
Guess what, that’s enough to make me gain weight.
It’s enough to make my father gain weight.
It’s enough to make my mother not loose weight, nor my sister.
To actually loose weight at all, I have to change that to a starvation diet of 2 protein shakes a day and a gallon of water (when the package says you need 3 of them a day to get required calories to stay healthy).
So don’t go around telling me I just need to eat less to loose weight, it’s dishonest self-congratulation on your part.

9 Dr I-Practice-What-I-Preach
first i wish you the best if your health goals.
second i have to comment that i know of no diet that suggests what you wrote above as a good diet and nutrition plan. i actually wonder that by the number and type of calories you eat in your diet, you are starving yourself and therefore finding it difficult, if not impossible to lose weight. one has to actually eat food to lose weight. it sounds counter-intuitive, but if your body thinks its in starvation mode, it will NOT lose weight, but try to hold onto it as it thinks there is a famine and maintaining weight is the bodies method of survival. therefore finding the correct amount, and type of calories is paramount.
i stand by my suggestion that 3 small meals with 3 snacks every day with a foundation of exercise 5x/wk is the method to weight loss. i will stand by my creditials as a board certified family medicine and years of experience successfully treating obesity.
but believe it or not, your story is quite interesting. i would love to talk with you further.
http://fitbydesignpts.com Carrie Partna
This is interesting to me – I’m a certified personal trainer and have heard this plight over and over for eight years now. My niche is fat loss and three years ago I started assessing peoples metabolism through gas exchange (VO2, VC02 and VE) with the New Leaf metabolic assessment machine. Over the three years I’ve run over 400 assessments. I would say that from my experience, 90% of the people were not eating enough. I have a great clientele that has had great success in fat loss. I have clients that have lost anywhere from 5 to 85 pounds. When we get the results from their assessment and I review it with them, they are ALWAYS skeptical, if the information comes back telling them they need to eat more. Of course, why not – they’ve practically been starving and it’s not coming off so how in the heck would eating more solve this problem? It is so counterintuitive – I’ve had many a phone calls from clients who start on the program and call me in a panic, wondering how in the heck they were going to lose weight eating so much – they felt like they were stuffing themselves. I’d tell them to just hang in there and we’ll see what happens. Sure enough – they come in a week or two later and have lost an inch or two in the waist, the scale goes down a few lbs and their body fat% has dropped. You can read more on this here http://fitbydesignpts.com/metabolism.html
But yes – some people that come in are eating too much. Some people are unintentionally in starvation on the days they exercise and then are overeating on days they are not exercising.
I think it’s wrong to assume that everyone is overeating. I also worked with the lap band and gastric bypass support group here as well. I would say from my experience it is a vicious cycle of starvation and overeating, it’s sad really.
The best thing you can do to lose fat is to find out what your body’s needs are, through a New Leaf Metabolic assessment and keep within those boundaries. You might be pleasantly surprised and actually get to eat more! Then it becomes a battle of the mind and habits!
You can read my blog here – http://carriepartna.wordpress.com/
Good luck!

hmm
Another theme of the piece is that America should stop being so entitled and irresponsible. There seems to be an erosion of personal responsibility in this country; its not my fault that I’m obese because of my genes, etc, etc.
To the poster above: Just run 70 miles a week with weights 3 times a week and it will be extremely difficult to be obese/overweight/out of shape.
yes
Yes, it really IS that easy for the vast majority of americans. Its a question of self-control and personal responsibility. For example, I just ate 25 sugar cookies the last two days. (I don’t even like cookies and am usually a health nut, but I digress) Did anybody force me to do this? No, I did it of my own accord. I’m responsible for the results of said action, not anybody else. If I get fat, it’s my problem.
But I won’t–thank god for running 60+ miles a week and biking the same!
jsmithfan September 7, 2010 at 11:42 am
OMG, is it really that easy? I should try this compassionate counseling with my patients. I’m sure they’ll schedule that follow-up appointment right away after I’ve demoralized them and told them how stupid they are for over-eating. You’ve obviously had great success with this approach since your last editorial.
http://www.drsharma.ca/ Arya M. Sharma
This letter reflects a complete and utter lack of understanding of the complex socio-psycho-biology of ingestive behaviour. Eating less (e.g. by skipping meals) is not only the best way to promote bouts of homeostatic hyperphagia it also induces hedonic responses by virtue of the tight biologicals links between hunger and reward centres (the author may wish to consider reading recent papers in Science, Nature, PNAS, Cell and other leading publications on the actual science of energy hoemeostasis).
It is this type of uninformed nonsense that promotes weight bias and useless but persistent notions on ‘eat less – move more” (ELMM) strategies that have been proven over and over again to, if anything, make the problem worse.
Eating less and moving more for obesity is about as simple and effective as buying low and selling high to get rich.
http://paynehertz.blogspot.com Payne Hertz
I don’t think people got angry at you because their feelings were hurt. They got angry because your rant was completely devoid of scientific fact or empirical experience, and was basically a thinly disguised (no pun intended) attack on overweight people.
No one who has ever had to struggle with their weight would believe that losing weight and maintaining the weight loss in a healthy manner is as simple as “stop eating” or just “eating less and exercising more.” Let’s explore a few facts and anecdotal observations to explain why this is so.
Fact one is that it is nearly impossible to lose excess body fat without also losing lean muscle mass. This makes dieting very problematic as you want to minimize muscle loss and depending on how much you “stop eating” your muscle loss may be very profound indeed. Secondly, it is not the volume of food you consume, but the source. It would be nearly impossible to gain weight on a diet of leafy green vegetables, yet very easy on a diet of potatoes. You could literally gain weight while starving to death on a diet of nothing but potatoes, as they lack adequate protein.
Similarly, you can starve to death on an ample diet of lean meat if you do not get adequate fat or carbs. Look up the term “Rabbit Starvation.”
http://en.wikipedia.org/wiki/Rabbit_starvation
The other problem with weight loss and particularly maintaining weight loss is that your weight tends to vary on a day-to-day and weekly basis. Drink a quart of water and you gain 2lbs instantly.. It can be difficult to tell if weight loss/gain is due to changes in water balance or actual fat loss/gain. My weight varies by as much as 15 lbs over the course of days, and the only way I can tell if I am gaining or losing is from the overall downward or upward trend, which can take weeks to discern. This makes maintaining weight loss an extremely difficult challenge and often a guessing game. Guess wrong and you can be overdoing it and losing excessive muscle mass.
Adequate protein is a must if you wish to minimize muscle loss. Yet people seeking to lose weight are often given advice by doctors and nutritionists who themselves have little experience or knowledge of what’s involved in successful weight loss, or who give out generic meal plans to everyone, regardless of size or gender. Most medically-approved diets advise you to limit yourself to the USDA daily allowance for protein, despite the fact that daily requirements obviously differ for each individual based on gender, body mass, metabolism and exercise level. Following such a diet might be okay for a small woman, but devastating to the health of a large man.
If doctors and nutritionists can’t recognize even this simple and obvious deficiency of medically-approved diets, how can you expect the average person to do so and is it any wonder they so often fail?
In my opinion the main reason Americans are so fat has nothing to do with “personal responsibility” and everything to do with the fact our food is loaded with refined carbohydrates and hormones. If this stuff makes farm animals fat, it makes us fat, too.
If you try to regulate the amount of this deadly crap in our food supply, the “personal responsibility” types will be the first ones screaming to keep the ebil gummint off the hands of our noble corporations who are apparently the guardians of “freedom” in this country.
Weight loss is not as simple as following some politically-infused slogan or chanting some inane mantra. It is immensely difficult, challenging, and requires firm knowledge of the practical difficulties involved as well as continual awareness and monitoring of your bodily functions. It requires iron discipline on a daily basis, as well as over the course of a lifetime.
You need to be conscious of the source of your food and not just the quantity, as well as be mindful of the fact that your weight loss/gain may be due to water. You need to stay away from factory food, preferably starting at as early an age as possible.
Fewer than 5 percent of overweight people can lose weight and successfully keep that weight loss off for over 5 years. Those that do often suffer from anorexia and malnutrition, so the 5 percenters are not necessarily a success story. Clearly, something is wrong with this picture.
“Eat less” is completely useless advice for anyone looking to lose or maintain their weight, but works well for those looking to maintain a sense of smug superiority.

9 Dr I-Practice-What-I-Preach
dear PH
you state:
“In my opinion the main reason Americans are so fat has nothing to do with “personal responsibility”
sorry man, i gotta disagree with you. completely. for a person struggling with their obesity, first admitting they got there one bite at a time is the first step in addressing and finding the solution. once a person admits its not some other person, entity, political power, organization that put the food in his/her mouth, s/he can next move to “i did it, so i can change it for the better”. i think if a person blames anyone or anything else it makes it difficult to be able to believe he/she can therefore make the changes, cause he/she is powerless. the individual is powerful enough to become obese, and just as powerful to lose the weight and look amazing. i see it all the time in my patients. the ones who lose weight take responsibilty, adhere to a gradual and healthy diet & exercise program- AND LOSE THE WEIGHT. is a privledge to watch as a doctor. for real.
to those who are reading this and hate how they look- you CAN do it. 1-2 lbs per week. so if you are 50 lbs thats 50 weeks. ONE YEAR. just keep doing it. slowly. it will happen. you are a thin beautiful person. its just under some extra calories. go and burn them off and eat 6x/day (small meals please). it will happen.
best to all.

Weight loss
Payne Hertz:
Great post, very informative and well-thought out. A few questions.
How do you explain the fact that Americans are so much more overweight and obese than just 30 years ago? It is obviously not genes; are you proposing that the ingredients in food are the main culprit or just one factor in this problem?
I think the author was trying to point out that a lot of people just eat portion sizes that are way too big. Also, many people opt for steaks, french fries, shakes, and unhealthy food rather than fruits and vegetables. They are failing in their food selection. Yes, fruits and vegetables are much more expensive relatively in the past but if you buy on sale they are very affordable. I have the option of becoming fat. However, due to diet and exercise, it is highly unlikely that I will ever do so. All of us have a choice.
Finally, I’m not faulting people for poor results. (being fat, out of shape) However, I DO fault them for poor process; not doing what they can to obtain those good results. I’m referring to diet and exercise.
http://www.TheHealthCulture.com Jan Henderson
“[S]top eating fats and refined carbohydrates when you can eat fresh fruits and vegetables and complex carbohydrates.”
Reasonable advice for educated, comfortably middle-class adults who are currently employed. And who are the audience for this advice. But consider the following.
From a study in the International Journal of Obesity: It appears childhood obesity rates have plateaued because the rates for higher socioeconomic groups are going down, while the rates for lower socioeconomic groups are still increasing.
From a recent issue of NEJM: “[B]etween 1985 and 2000, the retail price of carbonated soft drinks rose by 20%, the prices of fats and oils by 35%, and those of sugars and sweets by 46%, as compared with a 118% increase in the retail price of fresh fruits and vegetables.”
From a study by epidemiologist Adam Drewnowski: “A calorie-dense diet cost $3.52 a day compared with $36.32 a day for a low-calorie diet.”
Obesity rates are an economic — and therefore a political — issue. When the time comes that we can fill up on fruits and vegetables as cheaply as on junk food, maybe experts will stop telling the poor that obesity is simply a matter of will power.
For links to references, see http://bit.ly/cCpCHD
Not really
Mr. Henderson, I think your figures are very misleading.
They show the normal, retail prices. In my medium priced state, meat and milk (animal products) are very cheap, sometime meat is 99 cents/pound for drumsticks. However, fruit and vegetables are pretty much always had for less than a dollar a pound. I only buy the on sale produce so my med school debt is manageable.
Yes, calorically, the healthy diet is more expensive, but I supplement the calories with a lot of grains, nuts, and cereal. Pasta here is about 80-90 cents a pound. (1,800 calories roughly) Even though I eat about twice as much the recommended daily intake, I only spend about 100-110 dollar/month on food. Its all about saving, being frugal. (buying on sale)
I don’t see how a value meal at a burger joint for 5 dollars (giving a paltry 3,000 calories or so) is more dollar efficient than 5 dollar of pasta yielding 9,000 calories) You need to consume a lot of calories if you do heavy exercise.
http://thehappyhospitalist.blogspot.com The Happy Hospitalist
The cost of food in the US as a percentage of disposable income is the lowest it’s been in the last 100 years.
http://mjperry.blogspot.com/2010/04/happy-easter-enjoy-cheap-eggs-and-food.html
And it’s much cheaper to eat in the US than it is anywhere else in the world.
http://mjperry.blogspot.com/2008/10/blog-post.html
Which probably explains why we as a country are so fat. Perhaps what we need is more expensive food. People would eat less.
Problem solved.
docguy
i used this same advice on my hypertensive patient, I said “hey lower your blood pressure, these numbers are too high on the scale”
It didn’t work there either…
http://www.TheHealthCulture.com Jan Henderson
I think Dr. Lundberg’s advice is perfect for many people and that it’s exactly what they need to hear. He didn’t even try to scare people, which might also be effective. I wouldn’t expect him to address all the complexities of the obesity “epidemic” in 300 words. (I don’t like the term “epidemic” because it suggests being overweight is contagious, which adds to the stigma).
What’s happened over the last 30 years? It was probably always possible to find cheap, unhealthy food to eat – I certainly remember Twinkies, Hostess cupcakes, and Fritos from my own youth – but there is much, much more cheap processed food available today.
Part of the problem seems to be the change in the number of women in the workforce. In 1965, a married woman who didn’t work spent over two hours a day preparing food and cleaning up afterwards. By 1995, women were spending half that time. With full time jobs, women had less time both to prepare food and to sit down with the family for an evening meal. I know many conscientious parents still do this, but it’s a documented trend.
People started eating out much more, both at fast food outlets and restaurants. A typical restaurant meal can have more than eight tablespoons of fat. That’s more than an entire stick of butter. (Source: New York Times, “The rich little secret of top chefs: fat”)
Also, people are eating more often – snacking. Data from the USDA’s Continuing Surveys of Food Intake by Individuals show that men consumed 268 more calories a day in 1994-96 than they did in 1977-78. 241 of those calories came from snacks, not meals. For women, the numbers are 143 more calories, 160 more from snacks (they ate 74 fewer calories at dinner). (Source: David Cutler et al, “Why have Americans become more obese?” — available on the web.)
These days there are financial interests that favor obesity: the weight-loss industry, fast-food industry, processed food industry, pharmaceutical industry. Even researchers renewing their grants to study the obesity “epidemic” may not (understandably) be completely objective on the subject.
It’s good to hear from people who value fruits and vegetables, see themselves as having a choice, and intend to maintain their weight through diet and exercise. We need more of that to combat obesity. What bothers me is the assumption that the poor and disadvantaged have those same choices and have no one to blame but themselves.
9 Dr I-Practice-What-I-Preach
Henderson,
“Also, people are eating more often – snacking.”
snacking is essential to weight loss but its WHAT you snack on that makes a difference. snacking of fruits and vegetables is great and healthy. i can be honest and say that sometimes im eating more than 6x/day cuz all day long i am eating small snacks such as a hand ful of raisons, a celery stick or two, an apple, a bannana, a small handful (i can close my fist around it) of nuts. and for weight loss, snacking on fruits and vegetables with help decrease hunger when you get to b-fast, lunch and dinner which will help improve self-control. greater self-control will help the person select a smaller portion meal. important. keep hunger at bay. when i am hungry i will eat ANYTHING. including ice cream, double-stuff oreo cookies, cake, hamburgers. i am human after all.
so you heard if from me- a doctor- go ahead and snack. on fruits and veggies. all day.
Just an Eye Doctor
Take a look at the sitcoms from the 1970s and 1980s and notice how the actors appeared: they were all skinny. Whenever there was a ‘fat’ character on one of those shows, he would probably be described today as ‘normal.’ Those of up who grew up in that era were eating hamburgers and hot dogs, eggs, butter, bacon and whole milk. And there were no fat people!
Fast forward to today and the ‘low-fat’ craze. Epidemic of childhood obesity, mega-morbidly obese patients, reality shows full of patients who are so large they have to be cut out of their houses.
We’ve really messed with our epigenome. Humans are omnivores and hunter-gatherers. We were not meant to graze on grasses like wheat. Since humans started cultivating, the world was introduced to chronic diseases like auto-immune disorders and diabetes. Humans and domesticated pets are the only animals that have these problems.
The last people to get fat were farmers: they ate meat and eggs and bacon, went to bed when it was dark and got up when it was light. And they were healthy. Then came electricity and supermarkets and they joined the rest of society with its chronic disease.
Unfortunately, I think the genie is out of the bottle and turning back is near impossible. It’s probably naive to think we as physicians can make a difference but this is what I tell patients:
- Don’t listen to your internist (who is fat and hypertensive himself) or the American Diabetic Association (which tells you to eat more carbs) when it comes to your diet
- Follow a Paleo or Primitive Diet – grass-fed meat, fish, nuts, vegetables and fruit – and stop eating grains
- Get some kind of exercise, even if it is walking – but diet is 80% of the battle
- Avoid the middle aisles in the supermarket – the cereals and anything with high-fructose corn syrup or hydrogenated vegetable oils
- Get a full night’s sleep in a dark, quiet room
- Dark chocolate is okay (very okay, but I digress)
Patients of mine who have followed this advice have not only lost weight, their joints have stopped aching and they have felt better than they have in years.
Dr. G
I went to Olive Garden last week. I ordered something that I thought would be reasonably healthy. I was amazed at the size of the dish. There was no way around it, this was two full servings on one plate. Add in the endless bread sticks and salad, and it could probably qualify as 3 meals.
I neatly separated the food down the middle and ate half of it. I took the other half home. I put the information from the meal into my iphone app and was shocked to see that I had consumed 1155 calories from that one meal and over 3400 mg of sodium (I have been trying to stay under 2400 mg a day). And that is only eating half of the friggin meal!!!
Fortunately, as I approach 40 years old, I am still skinny. It seems, however, our culture is designed for those wanting to lose weight to fail. Fast food, processed food, super sizing, getting “a large for a quarter more”, Olive Garden sized plates… good luck with all that. None of this will change unless the consumers demand smaller servings and healthier foods… good luck with that also.
With that being said, I can’t say I disagree with the author. As hard as it might be the way our culture has set thing up, if you want to lose weight, you need to eat less and burn more calories. It may not be politically correct, but that is the hard truth.
Going to do my P90X workout now. Abs FTW!
jack singer
No one has commented on the completely pervasive fast food industry advertising – all equating instant high calorie foods with happiness and then saying you can have it for a buck. You can equate the profits and stock prices of this industry with the degree of obesity quite nicely. It also has become one of our top export industries and epidemics of obesity follow. Physicians who are suggesting self denial and exercise instead of instant gratification might as well be speaking in Urdu
http://www.drveronica.com Dr. Veronica
The entire discourse on this topic is quite entertaining. I am sure that not one obese person was helped by this article or all the “expert” and self-congratulatory suggestions.
Obese people need to be incentivized to become un-obese. Institute a Fat Tax. Just like when gas prices were high, people drove less, rode more bikes and begun to buy more fuel efficient cars. People will regulate themselves if it is just too costly to be fat.
Now having said that, we need to put programs in place which help people lose weight. Wouldn’t it be more cost effective to have insurance cover health club memberships, personal trainers and wight loss programs of people’s choice? How about taxing food gotten from Drive-Thru”s (Obesity surcharge) but not tax when people actually get out of their car and go in to the restaurant?
Also it should be noted that many people who are obese have emotional and psychological issues which require counselling. Obesity should be seen as an addiction problem same as alcoholism and drug abuse. This in no way is suggesting that people should not take personal responsibility. It is saying that obesisty is a complex issue in which in order for these people to “Stop Eating” they need daily and weekly minitoring ans assistance and teaching. Eating just fruits and vegetable is rather boring to most epecially when the American cuisine has few if any ways to prepare interesting and tasty dishes so one dowsn’t feel like they get to eat only grass.
Those who have learned to eat well and exercise a lot usually are those who exercise discipline in practically all areas of their life. That is why they are generally at the top of the society. Now we need a plan that will work for the average person that slowly teaches them how to eat less, eat foods that keep their body well and a healthy weight and move enough to also enhance their well-being.
People who are in the know also need to lobby the government to make sure that healhful and safe foods are available to all at reasonable prices. For those who are financially limited, the cost of the cholesterol, hypertension and diabetes medictions is markedly less than the cost of fresh food without antibiotics and chemicals. In other words, its cheaper to be fat and sick.
So let’s stop blaming the obese and lecturing to them and offer everything available to them that we can. That way then only Oprah could afford to stay fat.
http://RebelWithaFork.com Rebel With a Fork
Wow, what an interesting discussion. Dr.-I-Practice_What-I-Preach has it right. You have to eat all day to keep your nutrition levels even and you metabolism humming. Most people will starve themselves all day, then gorge at night because, “I haven’t eating anything all day!”
But Payne and Just an Eye Doctor bring up a very valid point – one I’ve been making for years – it wasn’t like this 30 years ago.
Now with the availability of all this fake food, not many people eat real food anymore. Most don’t even know how to make real food. Thats what I teach.
The funny thing is, in the time it takes to make Hamburger Helper, you could have made a great meal.
And the cost issue? Like Mr. Henderson suggests, I teach planning your menus around whats on sale. As a single mom, I have to make ends meet – yet I know the real costs add up in sick days, doctor bills, and drugs.
If you need a resource for your patients to learn how to make healthier great tasting food, fast – send them on over.
http://theweightitis.blogspot.com Sarah
Huh, not a fan of this article. As a formerly morbidly obese woman this is exactly the kind of thing that I wouldn’t want to hear. My ah-ha moment came when at 345lbs. my PCP told me I couldn’t feel my fingertips because the fat in my wrists was pushing on the nerves.
11 years later, 6 of maintenance and I am happily at a normal BMI. I eat differently, smaller portions and I walk, but I don’t exercise. When I see crap advice like this though it irritates me and I can’t let it pass. There is so much more to it that just eat less. It’s great that you practice what you preach, but know that not everyone is like you. Motivated & driven. If they were we’d all be doctors or lawyers or whatever. And we’d all be thin.
All the rest of the advice up there is pretty valid but what I think doctors fail to understand and relate to patients is that it is not one size fits all. No one goes about losing weight (and keeping it off) in the same way. It takes more than 5 minutes in the office of telling someone, you need to fix this. You can inform and cajole and threaten or whatever…. but the motivation has to come from within.
http://www.nallyfamilypractice.blogspot.com Adam Nally
I appreciate the attempt at changing eating habits, but this is about the worse weight loss advise I have heard in a long time. Just telling people to “stop eating” is just like telling a woman, “just concentrate really hard and don’t have your period this month.” I have yet to see a woman that can do this, and I have yet to see an overweight or obese patient successfully loose weight by just “not eating so much.”
We’ve been telling people “stop eating so much” for the last 40 years and a significant number of my patients have followed this advise and they just keep gaining weight. In fact, many of my patients follow low calorie low fat diets and exercise to the letter and still gain weight.
Weight gain is hormonal and until you individually identify the hormonal cause and treat that defect, weight loss WILL NOT occur. As a point of constructive criticism, you would be better served if your advise was to have the overweight or obese patient see their doctor or a trained bariatrician to assist them in loosing weight effectively.
http://RebelWithaFork.com Rebel With a Fork
Adam, you touched at my sore point again. The figures 30 & 40 years ago keep coming up. It wasn’t like this then. What changed?
Packaged, processed, easily available food. You can stuff yourself full of toxic chemicals 24×7 without a second thought. The results are people that can’t lose weight – unless they start making their own fresh food.
For me – I happily eat the way we did 30 & 40 years ago, except with more fresh fruits and vegetables. At 54 years old, I’m a size 2 and take no meds.
Call me a food snob – but I don’t like the taste of chemicals. But I’ve found that others have redeveloped their taste buds after they get away from the toxic stuff. They are amazed at how awful the stuff tastes once their tastebuds have healed.
Now if we could just find a way to get people to at least try…

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