I am on an Obesity Mission. I’m going to single handedly (with lots of great help) change the way we treat obesity. And the way we treat obese people. The following is an open letter to all the skinny doctors, trainers, dieticians and therapists in the world …
WITH ALL DUE RESPECT DOCTORS AND COLLEAGUES…YOU ARE WRONG ABOUT THE MEDICAL EVIDENCE!
Listen up. (That’s me BEFORE circa 2003). A fat doctor. Imagine. (Scroll down to see the AFTER).
Obesity is NOT simple thermodynamic imbalance. It’s not how many calories we eat and how little we exercise. That may be true for people who are overweight and have 20 or 30 or 40 pounds to lose. Any diet and exercise program that is basically healthy nutrition and movement will work for them; it’s just a matter of matchmaking – the right program for the right person.
For the rest of us, the obese…Eat Less Move More fails 95% of the time. Worse yet, severe restrictive diet and exercise may worsen, not improve, the obese person’s health. Emotional Eating and Behavioral Control don’t fare any better, but at least they don’t ruin someone’s health!
Here’s me with a recent 2010 AFTER (down 100 lbs). Winning an award because I figured out how to lose weight and how to apply that knowledge to every patient I see and how to teach to anyone who will listen. (Thanks Kaiser!)
Here’s what I know about Obesity. I’ll share it all with you in the hopes that you will go back to your exam rooms and order some labs for starters.
Obesity is a medical condition of serious inflammation, chronic pain, disordered endocrine function, changes in insulin metabolism, altered brain chemistry, food sensitivities, serious vitamin and mineral deficiencies.
Obesity is a psychosocial condition of depression and hopelessness and isolation and loneliness.
Obesity is a spiritual condition of broken hearts and broken souls and broken families. It’s not how we feel inside, but it’s how the outside sees and reacts to us. It hurts to be fat. Physically, psychologically, socially and spiritually.
Now…does that sound like gluttony to you?
Yet, if I go to any one of you, even the most esteemed physician or medical center, you will tell me Eat Less, Move More. Or you’ll send me to your behavioral health department because clearly there’s something wrong with me. There I will receive medication for depression and six weeks of therapy about how I’m a good person and I should love myself and not eat chocolate. Or you’ll throw up your hands and say I can have surgery, but I’m not sick enough to qualify yet. Wait a few years.
You can treat obesity, it’s easy. You already know how. But it’s not Eat Less Move More. And it’s not emotional.
It’s replacing Vitamin D, detecting Vitamin B12, A, Zinc, Iodine deficiencies, finding food allergies even when the lab tests are not sufficiently sensitive, treating pain and weakness with gentle movement therapy, jumping on that sleep disorder, correcting inflammation and insulin resistance, helping that sluggish thyroid, changing obesigenic medications to those with a more neutral weight profile. And yes, sometimes it’s sending us to behavioral health, but not nearly as often as you think.
You can treat obesity by understanding the many pathways and reactions that have been altered in response to excess inflammatory adipose and its causes. And one by one, correcting them. Just like you learned in medical school. Imagine that.
And I’m here to tell you, if you do that, your patients will lose weight. And feel better. And love you forever.
Announcing the opening of Stein Wellness Centers in May 2011, dedicated to comprehensive and integrative treatment of obesity. In person and distance.
Offering free consultation to any medical professional.
See one, do one, teach one.
Sara Stein, M.D.
Stein Wellness Centers (opening May 2011)
http://SteinWellness.com (under construction)
Stress is society’s greatest modern affliction. We have completely lost control of our workdays. A workday used to be dawn to dusk. It used to be from the time you arrived at your workplace until you went home. It used to be 5 days a week. Not anymore. We work constantly, 24 hours a day, 7 days a week. We work at our jobs, in our homes, at school, in traffic, at the grocery store. We work shopping on the Internet.
When we are resting, we are working: making lists, setting goals, reviewing today, and planning for tomorrow. We are not resting.
We continually increase our workload because work is addicting. We physically experience an increase in adrenalin, and energy and focus that expands our productivity. It’s a rewarding feeling to do a good job at something.
We add more work so we can feel even better. We start multi-tasking: the dishes, and the laundry, and the homework and the science project.
We add more forms of communication: television, radio, email, Internet, regular mail, newspapers, magazines, cell phones, voicemail, text messaging.More lives to keep track of, including people we don’t even know. Pretty soon, there is no time and we are multi-tasking every task, including some that should be enjoyable.
We read while we eat, we talk while we drive, we work on three things at once. Simple pleasures are eroded by a sense of urgency and the need for more adrenalin to keep us going. No time to say, “Hello”, “Goodbye”.
We work this hard because our society sets up overwork as a model of success. “Supermoms”, mandatory overtime, full-time students with full-time jobs.
One day I saw a 40-ish single mom who was working two jobs, going to school full-time and raising her children. She was exhausted, stressed, depressed, gaining weight and forgetting things.
“Why are you doing all of this”, I asked.
“For my kids, so I can get a better job.”
I looked at her without any humor, and replied, “If you live long enough”.
We are operating at a level of INTENSITY that causes DISEASE.
We have lost our ability to play, and live and love. We have lost our ability to experience emotion because we are so busy working. We have lost the ability to relax, and think and be alone with ourselves. We have lost the ability to feel content with our circumstances. We have forgotten how to look at the sky and wonder about the stars.
We have lost the ability to experience emotion when we are under severe chronic stress.
Hard at work and numbed out to everything and everybody.
When it’s time for me to relax and have fun, I often cannot. Unless I eat. Then I relax. The food pours out dopamine and GABA and serotonin and acetylcholine into my parched brain until I am positively serene. Am I relaxing because I’m healthy? Or am I relaxing because the food just drugged me into forgetting what I was doing.
For the five or ten minutes that you are stress-eating, your brain is transported to a lower-stress zone. You give your body, your brain, and everyone else in your life a break from the jagged energy you are projecting.
If you are eating all the time in response to stress, “all the time” is simply a reflection of HOW STRESSED YOU ARE!
Just in case you thought this was only about your own personal stress, there’s more. You can also absorb other people’s stress, particularly if they are close to you. Stressed people have a tendency to pour out their problems in rapid-fire succession, one after another, with great energy and emotion.
Relief from stress is about learning to say no: no to demands, no to internal goals, no to family expectations, no to overzealous work projects. Saying no does not mean quitting your job in a bad economy, nor does it mean walking away from a difficult supervisor and getting fired. Saying no means acknowledging your physical and emotional limits and respecting them.
Relief from stress is about recognizing your body’s signals. When you cannot sleep, and you cannot relax, and you cannot stop thinking about work, you are overworked.
The solution to stress and overwork lies in learning and practicing proper endings. To be able to say this is my workday and I am now off. This is my homework time and it is now over. The day’s work has ended and this is my sleep time. This is my stress, and this is yours and I cannot accept it. These are boundaries, yours, mine, and ours.
The solution for stress is to recognize that for your body, rest is as essential as exercise.
For your brain, quiet is as vital as thinking.
For your spirit, solitude is as healing as company.
The solution to stress is to accept your humanity and all its limitations.
excerpt from Obese From The Heart: A Fat Psychiatrist Discloses ©Sara L. Stein, M.D 2009 http://obesefromtheheart.com