NOOOOO!!! An Open Letter to Oprah on Obesity

NOOOOOO!!! That eardrum shattering scream you just heard was mine after I listened to Oprah Winfrey (I adore her) talk about her very public weight gain with emotional eating maven Geneen Roth. (Oprah on a Time She Forgot Her Loveliness, 5-11-2010)

I hear the thundering herd of hoof beats running for a book THAT IS NOT MEANT FOR OBESITY. And I hear the collective thud a month or two from now, of millions of copies tossed into the failed diet books collection. (Yes, we have those).

Don’t get me wrong – Geneen’s elegantly worded conversation on emotional eating is entirely appropriate for someone with 30 pounds to lose, or binge eating, or anorexia-bulimia. She even says that. Yet the audience was stocked full of morbidly obese people. Like me. And Oprah, God love her.

Certainly obese people have emotional eating that needs to be worked through for successful weight loss. But it is NOT the predominant driving force behind sustained obesity.

“I shamed my fat self”, Oprah said, “when I put myself on the cover of O and said how did I let this happen again”.

OPRAH! YOU DIDN’T LET IT HAPPEN! Anymore than you LET your bladder fill or LET your body go to sleep. This is your brain and body we’re talking about, not your soul.

Yo-yo dieting and weight regain are NOT the result of weak wills. THEY ARE THE RESULT OF AILING BODIES. And frantic brains trying to heal them.

Obesity is NOT a state of feeling badly about oneself – it is a MEDICAL CONDITION…with:

1) Chronic Inflammation, Pain and Exhaustion –  Addicted to sugar and caffeine? Maybe you’re an ENERGY addict! It takes additional energy in the form of calories to move your extra-large aching, swollen, inflammed self down the hall. The worse your end-stage illnesses of obesity are (such as sleep apnea, diabetes, arthritis, fibromyalgia, hypothyroid), the longer that hallway becomes. Even if the end-stage illnesses have not yet manifested, the inflammation of obesity is simmering inside you, and exhausting you.

2) Altered Metabolic Pathways – abnormal insulin, leptin, cortisol metabolism (and others) cause the obese person to hold on to weight, be hungry all the time, have higher blood sugar and insane food cravings. Your continuously elevated stress hormones have convinced your trillions of cells to HANG ON TO EVERY BIT OF FAT BECAUSE WE”RE IN A FAMINE!! Don’t you wish you could explain grocery stores to them?

3) Altered Brain Chemistry – Depressed and anxious brains screaming for serotonin and GABA and dopamine driving you possessed toward the chocolate counter. Searching for oxytocin love in all that comfort ice cream and macaroni and cheese. Driven by sleep deprivation, changes in genetic expression and medication effects. Responding to toxic food injury from junk food as addicting as crack cocaine in your brain. This is not emotional eating; this is your brain directing your chemistry ingredients.

4) Severe Vitamin and Mineral Deficiencies – such as (but not limited to) D, B12, A, iodine, fatty acids:

Vitamin D from the sun – a prehormone – manufactured by the cholesterol in your skin when exposed to that beautiful yellow orb in the sky. Vitamin D that gives us energy and happiness and relaxation and protects us from diabetes and heart disease and cancer and obesity. You don’t get credit if you stay indoors and look out the window, or if you live in Cleveland like I do and there isn’t any sun half the year, or if you’re African American and your skin acts like sunscreen. And you’re never going to be able to lose weight with Vitamin D deficiency until it is corrected.

Vitamin B12 from animal proteins (not vegan diets). Blocked from absorbing by all those prescription reflux medications. Vitamin B12 that gives us energy, memory, concentration, happy moods, relaxation.

Vitamin A from fruits and vegetables for our skin and eyes – night blindness, psoriasis, eczema – the 5th leading cause of blindness in the world – not found in junk food, you can be sure, but a good carrot or sweet potato might help.

Mineral and element deficiencies like Iodine – Iodine that keeps your thyroid running and your breast tissues healthy, essential for the production of every hormone. Added to salt in the early 1900’s so you wouldn’t get a thyroid goiter, but now you eat fancy non-iodized kosher salt and sea salt or no salt at all. Iodine that used to be in flour until the 1970’s when it was replaced by bromine (the stuff they gave soldiers in World War II to kill their sex drives!)  Makes you tired, in pain, obese, dull.

Essential fatty acid deficiency – I know you’re eating fish 3 times a day, right? Essential means brain function – attention deficit disorder, memory, mood. Essential means skin – eczema, rash, dryness. Essential means inflammation and immune function – cancer, heart disease, arthritis, dementia. My grandmother frying those smelts every week – she knew something!

5) Food sensitivities like 1) gluten from all that fake wheat processed stuff used to thicken, texturize and cheapen your food, 2) corn from the high fructose corn syrup that makes you gain MORE weight than the same caloric amount of sugar; 3) processed soy that slows your thyroid down because it’s no longer recognizable to your immune system. 60% of people with obesity have food sensitivities, aka allergies.

Now…does that sound like ‘”only eat when you’re hungry in a quiet room focused on food” is really going to make a difference?? Treating morbid obesity with emotional eating techniques is the same as treating cirrhosis of the liver with 12-step programs. The proverbial peeing in the ocean.

Here are some suggestions if you are obese.

Get your vitamin and mineral levels checked. Be careful of those who tell you what you should be eating. Pay attention to when you feel sick, what did you eat in the last 24 hours? The hell trinity of obesity is gluten, dairy and sugar. Purify your food and water sources. If you can’t pronounce it or picture it, don’t eat it. It’s making you fat, and that INCLUDES artificial sweeteners. Forget gourmet, aim for plain. Like grandma used to make. Whatever you’re doing now…do the opposite. Get out of the chair. Sleep more. Eat grapes. Watch less TV. Spend more quiet time. Work less. Work out less. Play more. Do nothing that causes physical or emotional pain. Take baths. Dance in a chair. And if you cannot do anything at all, at least get a little sun.

Try 70% dark chocolate EVERYDAY to fool your body about that famine delusion. The heavenly trinity that treats depression…exercise, Vitamin D and dark chocolate. Can you add one in?

There is hope and healing from obesity. One medical condition at a time. Give your emotional soul a rest.

Sara L. Stein, M.D., is a bariatric and integrative psychiatrist  who runs Obesity Clinic at Kaiser Permanente in Cleveland, and is the author of Obese From The Heart: A Fat Psychiatrist Discloses (2009). Learn more at http://obesefromtheheart.com

Comments

19 Responses to “NOOOOO!!! An Open Letter to Oprah on Obesity”
  1. shirley says:

    I am not sure that the reason for morbid obesity does not include emotional eating as the main cause of morbid obesity. Oprah also stated the reason why she overeats – she was beaten as a child. Every woman in the audience at the Oprah show clearly stated an emotional reason for her obesity. (I was at the taping, and the second show will air July 12).

    While I agree your recommendations are all excellent, I also think that once people understand the emotional reason for overeating, then they will be able to partake in the dietary measures, tests, etc that you recommend here. I think Roth’s book is a starting place for being able to even get yourself to a DR. to have blood tests performed. Many of these people are afraid of Dr’s because that’s where the shaming often begins – in the doctor’s office – when the patent steps on the scale. Roth also recommends daily meditation, which seems to be beneficial in stress reduction.

  2. Diana says:

    You and Geneen Roth are not that opposing on healing from obesity, a complex condition. I think you have much in common. She has said “It takes a long time to realize that quick fixes have quick endings.”

  3. Sara says:

    Thank you Shirley and Diana for your comments!
    I agree wholeheartedly – Geneen is elegant on emotional eating. But for long-term or morbid obesity, emotional eating is only a small part of inability to lose weight. Emotions are the tip of the iceberg in obesity – they feel like the driving force because we cannot feel the enzyme and metabolic abnormalities occurring – we only feel the end-stage illness. The emotional eating component in morbid obesity rivals the emotional drinking component in cirrhosis. It needs to be addressed, but the physical illness is much larger at that point. I believe that is the piece of obesity treatment that has been missing.
    Thanks for reading! Sara

  4. My cousin recommended this blog and she was totally right keep up the fantastic work!

  5. Nina L. Diamond says:

    As a 98-lb (born skinny) health journalist with a focus on natural/alternative treatments, let me weigh in (pun intended, of course) on your open letter to Oprah: Personally and professionally, I agree with everything you said. And it’s refreshing that an M.D. is as well-versed as you are regarding how the body really works and isn’t just a conduit for prescription medication. As for the emotional connection to eating — that may be how it all began, but the body took over long ago, somewhere after that extra first 30 pounds. People ask me all the time how I stay slim. Because, afterall, being genetically slim (thanks, Dad) is just a starting point. Plenty of born-skinny people haven’t stayed that way. The answer is that I do all the good things for my body you talk about and don’t do any of the bad ones. And, yes, dark chocolate is the nectar of the gods!

  6. How great to hear your voice. I received a Winston Churchill Fellowship Award to visit the USA in 2007 to meet various obesity-led groups. They were all fantastic to me and i was both appalled and shocked at how little psychosocial support was available to help. As a counselling therapist and Charity Director in the UK I am often a lone voice in making a case for the morbid obese who are ignored and ridiculed so openly due to the vast ignorance of those who repeat the mantra ‘eat less, move more’. How do world leaders like the USA & UK allow themselves to do this and destroy themselves in the process?

  7. Lynette Neal says:

    Thank, Thank you for this incredible web site and book. I totally agree with you about Roth’s plan to stop compulsive eating. I tried her method and found you to be so accurate about what all is needed to cure obesity. How could I know intuitively what I wanted when my brain is all scrambled from lack of vitamins and years of dieting and gaining back the wt? I have made an appt to have my blood levels done for allergies and other imbalances and feel so much more optimistic after reading your comments Sara. Thank you, keep up the good work. I feel like I have found a resource that is heaven sent.

  8. I screamed when I saw Oprah’s headline in O Magazine, and saw that she’d latched on to Geneen’s new book. Although I greatly admire all of Geneen Roth’s work, I can’t count the number of clients who’ve sat in my office crying who desperately wished that Roth’s approach was enough for them. I’ve never met anyone who could tame the beast of emotional overeating OR obesity without dealing with the chemistry of it all. I agree that there will be a virtual “thud” when readers of the new book come up against their chemistry and their brains/bodies/hormones in the throes of addiction.

    I actually don’t find dark chocolate part of what helps- for me personally, I’m really sensitive to it, and do much better without any sugar at 53.

    I wish Oprah all the best, she does so much for so many, and yet she’s still barking up the wrong tree and it can be hard to watch.

    Sarah- I take my Vitamin D, the omega-3’s, eat 2+pounds of vegetables/salad daily (the one thing my teen sons brag about me) and find daily exercise invaluable for moving out energy. I also believe in big daily doses of nature, and getting a solid night’s sleep. Starting each day with reading that inspires me is another foundational practice. I also try to meditate most days, and to do some form of writing- ( I teach clients to “purge” through journaling, moving out negative energy via writing is powerful).

    I love your work and your strong position on obesity- like you, I am committed to my clients and women struggling with overeating, and understand their experiences well, because of my own.

    In love and service,
    Lisa

    http://www.IntuitiveBody.com
    Breaking The Spell of Overeating
    New ebook on The Energy of Weight Loss- my gift to you!

  9. Joyce Mahl says:

    Don’t forget what the food industry does to addict our bodies to fat and sugar- check out “The End of OverEating” by David Kessler MD. I think a lot of us think i “emotional eating” must be the reason for our obesity because we don’t know the nutritional facts and nothing we taught about how to eat healthy makes any sense in the real world of trying to eat and be healthy.

  10. Debbi says:

    Sara, I’ve been reading all over your Facebook site today, purchased Obese From The Heart for my Kindle based on what I read and, obviously, found this site because of it. I am morbidly obese at 330 lbs with a BMI of 55. Although, in spite of the weight, I’ve always been fairly healthy, it’s catching up with me big-time. I’ve dieted, oh, lord, have I dieted, and lost weight in varying degrees, but always gained it back and then some until I’ve made it here to my highest weight ever.

    I know it all. I can write out a diet based on almost any principle out there. I can recite the theories backwards and forwards. Knowing what should work isn’t my problem, putting it into practice is! The one thing they all have in common is that they don’t look at the whole person, the whole problem; they all lack.

    I’ve read Geneen Roth and agree with her take on emotional eating. I won’t go into my sad background, but I did this to myself on purpose and there are a lot of emotional factors in my obesity. I’m trying to find balance and when I read what you’re saying above, it gives me pause. You can’t treat someone successfully without treating the whole person. Yes, my body is broken, but so is my spirit, so are my emotions and let’s not even discuss my mental cloud! What I read in this open letter seems to be dismissing Mind and Spirit in order to focus solely on Body.

    Thoughts? In the meantime, I’ll be digging into your book because that’s what I do … I’m always searching for that elusive help!

  11. Sara says:

    Wow. I’m overwhelmed with your responses. It makes me believe that I’m on the right track and that my message is important for many people.

    Sometimes my posts tend toward physical, sometimes psychological, sometimes spiritual – I think they’re all equally part of the obese experience; maybe just not represented equally in every blog.

    From this I take away the joy of knowing that I am never alone in my struggle. Not ever, even behind a closed door with a cookie. Someone else is right there with me, together. That is my higher self, the us, to which I respond. And that is the most healing part of this. We’re all in this together.

    Thank you all for being there.

    Namaste, Sara

  12. hans keer says:

    Since obesity can be “cured” so easily, I think you cannot call it a disease. Watch this http://bit.ly/duSiUK VBR Hans

  13. Alise says:

    I joined a forum for emotional eaters about 2 years ago — I think… It was a great help to me on my path to healing, but (and this is a big but – haha), it didn’t really help me lose any weight. Yes, it helped my outlook, my relationship with food, my self image tremendously, beyond words. But I only lost maybe 8 lbs. when all was said and done. Technically, according to those thoroughly inaccurate BMI charts, I was obese.

    Then last year I started working with a chiropractor who told me all about, well, basically everything in this post. And I’ve lost 20 lbs. since November without any dieting or any focus on emotional eating. I was a poster child for this post: years of eating soy, severe vitamin D deficiency, chronic pain and inflammation, unknown food sensitivities (wheat primarily).

    So I really just want to say yes, yes, YES — you are so right! And thank you!!

  14. jennifer says:

    Sara-I just discovered this website. I want to thank you for just existing. I have struggled with my weight since childhood. I have been successful in my struggle. How? You may ask. I live on the list of vegetables we all know as the “unlimited” list. I walk 4 hours a day. That is how I maintain, yes maintain, my weight. I am 61 years old and I weigh ll0 lbs. I look terrific and feel terrific. If anyone with a weight problem thinks that to be successful takes less than a total obesession, they are deluding themselves. I will continue to read what you have to say.
    Thank you again.
    Jennifer

  15. uma narayana says:

    dear sara,
    I agree with all your points. especially with vitamin D, B12 , essential fatty acids, dark chocolate. You never mentioned about including one serving of bean protein daily in the diet. All nutrional labelling specifies the amount of saturated fat, unsaturated fat, complex carbohaydrate and sugars. Well, do you think it would be better to make a separate group for bean protein in USA – Daily Recommended Allowance and recommend one serving of bean protein in daily diet. would also combat malnutrition. When making it a separate group, just need to reduce one serving of carbohydrate and increase one serving of fat. Have read that bean protein has some hormonal effect. Is that true and would that help weight reduction?

  16. Donna says:

    This is fabulous. I have such good docs at KP. They did the labs, checked out the D levels, put me on B12, etc, etc… I am so blessed to be nudged in such good directions. With the fibromyalgia, they did sleep study… etc, etc. And I was directed to Emotions Anon. I got a nice ph call from Dave Roadruck, and someone hooked me up with a nutrition/wellness class that begins in Dec. And here YOU are putting things in simple terms so everyone might understand the needs of the body under stress, inflammation, etc. Thank you, thank you!!! You bless us all!

  17. Dana L says:

    Dear Dr Stein,

    I have been fighting obesity since I was a child. I was 168 pounds in the fourth grade. My parents thought that because I was enrolled in South-Euclid-Lyndhurst Schools in the 70’s that I was exempted from torture from other kids. They were wrong! You are the only doctor that has ever seemed to understand all issues that I’ve ever had. You gave me a few golden tips three months ago and I am 30 pounds lighter today from your direction on vitamins and specific simple eating habits. Thank you for being such a great doctor, instructor, tutor, friend, and example to everybody you help! God bless you and the work you accomplish. I wish that we would have crossed paths many years earlier.

  18. That makes me so happy to hear Dana! Thank you so much – isn’t amazing how easy it is!

  19. M. E. Bon says:

    I am now 67 and recall that since I was 9 years old I have felt “Obese from the heart” like you titled your book Dr. Stein. I just read about you in a check-out register magazine and started investigating on the web what it was all about that you said, experienced and wrote about, and I started finding a compilation of all my symptoms, states of heart, states of mind, and at unison my heart and mind wanted to let out the biggest primal scream ever to sound in the universe…… I finally read about an MD who is familiar with the complexity of the obesity condition and in a comprehensive manner can guide me to address my condition. I just ordered your book and your DVD program and I can hardly wait for them to arrive so that I may learn and improve my condition. Historically, I have done all the diets on earth in my lifetime (including the ones endorsed by some physicians or medical centers) …. I am tired of the deprivation, I am tired of the obsessive/compulsiveness of counting points, counting calories, counting carbos, spending un-natural times and contortions in physical fitness… all for naught. I am tired of feeling guilty about food and my body beating me to the results of the latest “diet” competition and rewarding me with more pounds as soon as it deems it appropriate to let me know that “I won the prize”. I am tired of being in plateaus that once broken (sometimes after months of maintaining) I start gaining the weight back…. even while “maintaining in the program”….. I am now a diabetic of 4y, glucose controlled for over a year, lost 40 lbs in the last 2 years (have another 60 to go), in a plateau for about 6 months, still counting my points and terrified of the yo-yo pattern repeating itself anytime soon….. Yes it is one emotional rollercoaster parallel to the physical one. I am anxious to learn what you have to teach me Dr. Stein so that I can assertively discuss with my physician MY next steps to prepare and proceed coherently to my successful management of my obesity…………. I am happy to do what is necessary to “stay as healthy as possible” and perhaps in this lifetime get below a size 18 dress. Thank you for your sharing your reality, your program, your understanding and your compassion. Sincerely.

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