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I Know I Am Obese; Where Do I Begin??

This is the question I am most often asked. My patients come dragging in reluctantly, sent to Obesity Clinic by the primary care doctor or their own frustration and failing health. They are certain they will be given a lecture and a diet or told to go have surgery. They are surprised when they leave my office with directions to eat chocolate, take these supplements, get some more rest, and stop working out so hard.

“WRONG” says the medical world and the diet industry and every magazine you read. Restrict your diet! Quit eating things you crave! Work out harder! No pain, no gain! YOU MUST SUFFER!!!

Puhleeze. As if obese people aren’t already suffering.  Apparently all those skinny trainers and nutritionists and doctors think we were having a great time during those lonely nights by the refrigerator or trying to run in gym class with our thighs chafing.

I have news for you if you are obese. You have suffered enough. You have struggled enough. It isn’t difficult to lose weight, it’s just different than what you have been told.

By the time a person has become obese, they have an ailing body, even if there are no visible end-stage diseases such as diabetes or hypertension. Pain, inflammation, changes in metabolism, nutritional deficiencies, altered brain chemistry. It’s not fun to be morbidly obese. It hurts physically and emotionally.

If you push a broken body (or a broken car) too hard, it breaks down further. To your body, exercising and nearly starving feels like incredible stress. So does divorce, bankruptcy, unemployment, problems with your kids, or working two jobs. Your brain doesn’t make a distinction between one bad stressor and another bad stressor. To your million-year old brain, bad stress means the famine is coming. (Remember that one? 7 lean years?) “OMG,” says your brain to each one of your body’s many trillion cells, ”We’re starving to death…HOLD ON TO OUR FAT!!! We need it!”

Ever see the program where the fat people stop losing weight as the workouts get harder, until they go home, relax and eat? It’s called stress relief.

Welcome to the No-Stress Zone. Here’s where you start, and this is the first of many blogs that will help.

You start by determining what very small change in your food you can make today that will not send your brain into a starvation frenzy. If you drink 5 sodas a day, can you drink 4 and one water? If you skip breakfast and binge every night, could you move a little food earlier in the day? My first change was drinking coffee instead of lattes. And if I really wanted a latte, I would have one.

Next, what movement can you do that WILL NOT HURT?? Can you stretch a little in your chair? Can you walk a little? I started out cycling my legs in the bathtub – it was the only place I didn’t have pain.

Finally, what joyful or relaxing moment can you treat yourself to today? When’s the last time you heard music you loved, or called someone you care about? Or took 10 minutes to read something beautiful?

And when you wake up tomorrow, do this again. A little further. A little longer. And again the next day, and the next.

That’s it.

That’s the secret to losing weight with obesity.

Small, easy, sequential changes that add up over time. And give your body and your mind a chance to heal with each small adjustment.  From my husband who lost over 100 lbs: “Tell them this is the first of many small changes they’ll make, and they’ll be surprised how easily they rack up.”

Now that didn’t hurt, did it?


24 Responses to “I Know I Am Obese; Where Do I Begin??”
  1. Chris Heidel says:

    Baby steps is right! It is OK to be gentle with yourself so that the changes will stick. It is also OK to take two steps forward and one back!

  2. Diana says:

    The last two check-ups with my doctor I discussed my weight, and her final recommendation was check out lap band or gastric bypass surgery. She referred me to the seminars for these procedures, and I would not go. My final stand was that I have not been kind to my body, resulting in excess weight; alteration of my body to create a dysfunctional digestive system would only be more unkindness.

  3. Sara says:

    Surgery can be a wonderful tool, but it’s not for everybody, and it’s not foolproof. About 1/3 of patients gain back weight or develop secondary addiction. It’s also an option you can have at any time in your weight loss journey, so you don’t have to make a final decision about it. I chose not to have surgery until I figured out what was causing the weight gain. After that, I didn’t need the surgery.

    Your brain will guide you toward what your body needs about every two hours. The answer is often not food – it may be rest, fresh air, relaxation, movement, laughter. You might simply be thirsty or hot or cold. It may be food, in which case look for the most specific ingredient. If you are craving nuts, is it the nuts? the salt? the oil? And give your brain what it wants to balance your mood and energy. But nothing more. And expect another signal in about 2 hours while you’re awake. If you go too long, you will start grabbing counterfeit energy in the form of junk food because your brain will start to scream.

    It’s actually kind of fun once you get the hang of it. I’m still trying to keep up with the right shopping list! LOL!

  4. Debbi says:

    I just finished the book, marking the first time I have highlighted and bookmarked anything on my Kindle yet! there were too many things I want to re-visit while learning. Sara, your ideas of ditching torture and deprivation normally prescribed are radical and put me in mind of Adelle Davis. She, too, was a proponent of healing your body first and her “food plan” was radical in the amount of food on it, good, natural food, not processed food, yet people lost weight eating that much because they were eating what their bodies needed. After reading OFTH, my goals have changed to working on healing my mind, spirit and body the natural, healthy way instead of making weight-loss my number one goal! No, I’m not looking at this as an opportunity to eat more, but to be mindful of what I’m putting into my body. thanks!

  5. Sara says:

    Thanks for your comment! I hadn’t thought of Adelle Davis, she was a pioneer in natural nutrition, but she died youngish of cancer, so all of her information fell off the radar. It was good information about how food processing depletes essential nutrients. My best piece of advice that I give daily is to make only changes that feel comfortable, and after you get used to that one, make another comfortable change. Good eating!

  6. Mike says:

    You hit the nail right on the head! I’m an obese man at 420 pounds. I was 442 pounds a month ago, but I started a similiar plan to lose the weight – starting with small changes and slowly ramping up. I’m determined to lose 200 pounds by focusing on gradual and consistent changes to my diet and slowly incorporating exercise into my routine as well. Excellent post. Thanks, Mike.

  7. Sara says:

    My thoughts are with you, Mike! Follow along on Facebook/SaraLSteinMD for a daily stream of information that may (or may not) be useful. Pay attention to your cravings – it is your brain hitting the urgent need button, and focus on your health first, pounds second. You will always succeed! Best, Sara Stein

  8. aaron says:

    I need help I’m 35 6’7 500lbs and in so much pain I went to the Dr. Recently and he did some tests and said I’m not diabetic and my blood pressure was alittle high. He did xray on my knees and said I have arthritis. My problem is I’m in so much pain I’m a machanist and its so hard to get threw the day and once I get home all I am really able to do is shower and sit down. I’m scared and don’t know what to do

  9. Sara says:

    Hi Aaron – Start by making a small change everyday. Example if you drink 5 cokes a day, drink 4 and one water. Then make another change when you’re comfortable. Make sure you take a good multivitamin, 3 omega fish oil twice daily and also a Vitamin D supplement. If you have chocolate cravings, eat a couple ounces of 70% dark chocolate daily – only catch is you’re not allowed any other type of chocolate. Eat some healthy protein every 2 hours, like nuts or pumpkin seeds or a protein bar or shake. A really good person to follow is Russ Lane http://www.secondhelpingonline.com Russ lost almost 200 lbs over 5 years. Good luck!!

  10. Ashleigh says:

    Thank you so much for this post! I am 28 years old, have two young kids and weigh 260 lbs. I am aware i need to lose weight but i feel like setting goals and concentrating solely on the number is so detrimental for me. my sister has been trying to convince me to do weightwatchers for a couple years and a close friend of mine is a diet and gym rat to the extreme. They always lecture me about what i should and shouldnt be eating or doing. I want to lose weight for so many reasons but mostly i want to be comfortable with myself. I flat out refuse to diet. I grew up in a very unstable childhood where unfortunatly fast food was the main dish most nights. I never even knew how to peel an orange until i met my husband 8 years ago!! I know it sounds crazy but i actually feel addicted to it now. Sometimes i will even wake up in the middle of the night and want it so badly its the first thing i do in the morning, or leave at all hours of the night to get it. I’ve always been a night owl and thats when i tend to want junk the most. my major problem is sitting up until 4 am snacking, Last week i decided to join a gym and i have made myself go to bed at a decent hour and wake up at 5:30am and workout for about 1/2 hr to an hour. i feel good when i do this. I feel energized! I am only doing the treadmill or eliptical so far but I have not deprived myself of anything i want to eat. Although i did quit buying cans of pepsi. It is soooo nice to hear that my small efforts are not for nothing as everyone keeps telling me. i just feel like I would rather focus on getting up and feeling better rather than if i hit that 3 lb mark this week. I plan on sharing your article with everyone who thinks I’m crazy 🙂

  11. kathy says:

    Hi, I just turned 50 and I am sick of being obese! I am 5’11” and I weigh 324lbs. I have read all the comments above, and I am going to start making small changes. I could really use a support group of some kind. Any suggestions??

  12. Hi! Not sure where you’re located – online Sparkpeople.com or ediets has groups related to how much weight a person wants to lose, in person TOPS is generally kind. Food Addicts Anonymous is 12 step based and often too regimented for people to sustain. I would start with an online group and go from there – good luck!
    Sara Stein MD

  13. erik rook says:

    My mother-Law is morbidly obese. She is 63 and her quality of life is deteriorating everyday. She is pretty much house bound and when she does move, it is from a chair to another chair.
    My wife is very upset, as well as the family. I believe she needs to be with people that know what she is going through, see a health professional, not only with exercise, and eating right but developing a life style change. I am asking for any advice on a good clinic, Health physiologist, or organization to help.

  14. Hi Erik, depends where you are located. She sounds like she might qualify for bariatric surgery. Often people who are housebound prefer to start with the Internet – Sparkpeople.com is a great site for social support around weight loss. In town groups are TOPS, Food Addicts Anonymous, Overeaters Anonymous. Also look for a bariatric medicine doctor who specializes in weight loss. It’s lovely that you would like to help her, but it’s her own individual struggle, so she may not accept your help. Still she would have some resources.

  15. christine says:

    Thank you for this. I needed to read this tonight!

  16. Maryanne says:

    Finding you thru google has been a godsend. I know Im obese, and family and friends make random comments like if you wanna lose the weight just do it. Thanks sounds easy, but no.. its not. Trying to look past the nasty little remarks and sniggers is hard, but small changes are what I need. Thanks 🙂

  17. bibi says:

    hi i’m 19 and weight 210lbs. i live in a place where most of everyone is tiny. they (girls) weight around 100lbs. i’m so stressed because i’m just different. since i was a kid, everyone laughed at me. i never show this feeling to anyone else because i’m afraid. they see me as a clown and it irritates me every time i see them laughing at me. i actually want to follow your tips, but if i change myself, will they laugh at me even more? :'(

  18. Follow your heart, and begin to improve your health. It takes great strength and courage to exist in a thin world as a heavy person, and it takes great strength and courage to make changes. Best of luck to you. Sara Stein MD

  19. Alex says:

    I’m 31 and weight 630 pounds. I’ve always been overweighted I have a thyroid disease. Doesn’t matter how much I try to loss weight I can’t. Lately I’ve been eating more and I know I’ve gained more weight. Being obese has stop me from living a normal life. My life is completely darkness because I’m obese. I couldn’t even go to college because of my weight when I graduate from high school. Knowing that hurts me more then anything. I wanted to be successful in live have a career and family. Their are so many things I want to do but can’t. I’ve never had a friend and lived a normal teenage life. Now I’m a adult in my earlier 30s and have nothing to show for still living with my parents. Being obese is like have a disease that can’t be cured. I’m so lonely till the point I’ve thought about killing myself but I know that’s a sin and my parents would never forgive me. I have the best parents anyone could ever want there always here for me and giving me the courage to move forward. I only leave to house if I have a doctor appointment or to do some shopping once a month. But even those I weight that much I can do for myself. I can walk I clean, cook do my on shopping I get around good for a person who weight that much and I only have high blood pressure and take a pill for my thyroid diease. I’m at my breaking point and don’t know what to do. I’ve tried diet pills, diet plans still the same. I don’t want to have a weight surgery. I try to exercise but I’m body hurts. The last diet I was on I lost around 7 pounds but gained it back. I don’t want to die overweighted PLEASE HELP if you can.

  20. Kat says:

    I am 30, I am at my wits end. I thank you for this article it seems to be one of the first I have read where you are actually compassionate. I am 6’0 and around 450-500 lbs I hurt all the time. It hurts to stand more than 3 minutes and I used to enjoy showers, well not anymore. I always start off with the best intentions counting calories (allow myself about 2400 a day) and doing floor exercises for about a month before I end up giving up. Even though I felt better working out and stuff. My mood greatly improved. But I always give up. Then I hate myself and think “How can you not be sick of this life” because hey I must not be sick of it if I can’t keep up with the controlled eating and exercising. But I am so tired of it. I don’t leave my apartment for fear of being made fun of! I want to go into stores but people stare and laugh and make fun of me. I got into a car accident about 5 yrs ago and I have slipped disks in my back which makes walking hurt and the weight is compacting the problem but how do I stop from going in this circle how do I get the motivation up to keep going cause when I exercise I am in pain when I walk I am in pain. I am just at my wits end.

  21. Stop dieting. It’s killing you. Start by adding in a basic vitamin supplement and some 3-omega fish oil, and counting your protein grams – aim for 80 grams minimum daily (20 grams each meal and 10 grams each snack). Change what you’re drinking, no juice, soda, milk – don’t drink your calories. Make sure you drink 8 glasses of water daily. Give yourself a goal that is very easy each day for movement, maybe standing up a few times an hour – something you can meet by noon. No more fast food, buy your food prepared and assemble it if you cannot cook. Join an online support group like sparkpeople.com and find a group of people who have the same amount of weight burden as you. Find yourself a free meditation program and listen to it every night when you go to bed. Lastly, take advantage of the new insurance reimbursement for obesity and see if your doctor or hospital has a program you can attend at least once a week. Anything you can do differently will help you. Don’t worry about what you cannot do at this time, it will change. Good luck!

  22. Stop trying so hard. Find big yoga to help stretch your back – DDPyoga.com is a good start – you will need some props like chair and bolsters. Download a free meditation program and use it every night before bed. Stand up several times an hour and stretch. Count your protein – minimum 80 grams daily assuming normal kidney function. Join an online support community with people who have similar weight issues. There are newer medications on the the market including one for food addiction (Contrave) that may be helpful. Good luck!

  23. Porchia says:

    Im 23 years old, recently had a son, and I’m desperate to lose weight. I’m 5’2 and I weigh 300 lbs. I’ve always struggled with my weight. Obesity runs in my family and I gained 60lbs with my son. I was diagnosed with gestational diabetes during my pregnancy but I never struggled with high blood pressure. I’m tired of being sick and tired but I don’t know where to begin any more. I’ve trained dieting and I’ve tried eating right but financially the healthier foods hit my pockets hard. I need help.!! Every time Im stressed my body screams for sugar and I always give in

  24. Tanith says:

    Thank goodness for finding this place. For months I’ve thought I was going crazy. Thought about starting a plan but couldn’t find the will power to do so. I’ve tried many different diets and bounce back to becoming overweight. Except that this time I reached the obese mark in the chart. I’m 5’5″ and weigh 185 pounds. My knees hurt. Sugar and cholesterol levels are high. Hypothyroidism and fibromyalgia are part of this wonderful combo. So starting by changing just one thing at a time sounds like a relief. Reading your words mean that I am not crazy, or lazy. It’s just so frustrating when people around judge you for not having willpower or the strength to follow a restrictive diet. Restrictive diets feel like a prison, a deprivation of freedom. I just can’t stand them. But changes, yes, I can go for small changes. Thank you do much! Apparently there’s a book so I am going to look it up!

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