Easting Disorders

Weight Management and
other Medical Risk Factor Reduction

Besides my personal struggle with weight my professional experience in this field goes back to the late 1970s and the early 1980s. I worked with the largest pre-AIDS National Institutes of Health Project ever funded: MRFIT. That stood for the Multiple Risk Factor Intervention Trial. The project was designed to intervene in the major risk factors for heart disease. Though weight was not one of the risk factors it contributed to high cholesterol and high blood pressure and so it was treated under those risk factors. Smoking cessation was also included.

At the conclusion of the program I began the Metabolic Nutrition Program (MNP) with a group of Endocrinologists. They designed the formula and medical protocols and I designed the psychology program. It was quite a learning experience. Over the years I treated over 3,000 people personally and supervised the care of 30,000 nationwide.

MNP often had patients swear they were not eating a lot. However, when put on a controlled calorie diet (a liquid supplement was all they had while on MNP.) Lo and behold everyone lost weight pretty much as expected. They kept it off longer than on any other previous program - but they did not keep it off. I didn't feel comfortable with those long-term results since losing weight and regaining it again is worse for health than being and remaining heavy. We will explore those reasons in a moment.

Diet and exercise must be part of the weight normalization journey. If you are not willing to incorporate these into your life on a permanent basis... you are better off not beginning. If you chose to diet and not exercise in order to lose weight you have chosen only to loose weight. You have not chosen to keep it off. And you have essentially chosen to make yourself less healthy and (for reasons to be discussed) more fat and heavier in the future.

When you go on a diet without exercise you lose weight; however, that consists of both fat and muscle (remember that not only biceps but hearts arteries, organs etc. are muscles). Now fat requires about 2-4 calories/pound/day to maintain. Muscles takes about 10-12 calories/pound/day to maintain. So if your weight today (before you make any changes in diet) requires 1700 calories/day to maintain; and you go on a diet and loose weight in the form of muscle and fat, and then you go off the diet and resume 1700 calories/day you will end up fatter than you began. Why? Because when you regained weight you did not regain muscle, since you are not exercising. You now are a larger proportion of metabolically less active fat to metabolically active muscle. If you diet and exercise, you spare muscle and may even add some. When you go off the diet and still exercise, you maintain a higher calorie/day requirement - not to mention you have protected your organs etc. and therefore your health.

Again we hear," I can't control my weight." Sorry, but it just ain't so. People feel that if they succeed in their business it is because they worked hard for it. And yes that may be true but there are many who have worked hard and not succeeded. Much business success has to do with luck. But with your weight you are exactly the result of your choices. Period. With weight loss; if you eat the correct amount and exercise enough you will loose weight. Period. You can do it with low carbs, low calories, or what ever diet you chose. But it is the thing MOST IN YOUR CONTROL IN YOUR LIFE (save perhaps suicide.)

While writing this I was listening to a program called Ultra - Metabolism and if you listen between the line it says absolutely nothing different. It just packages it slightly differently. Whatever you listen to it will work - as long as the changes are permanent so will the weight loss be permanent.

The absolute best way to accomplish permanent weight loss is to get on to the amount of calories you will need to maintain your weight at the lower weight right from the get-go. And to exercise from the beginning to the end. Period. Exercise can be walking, gardening, playing with kids, whatever. It is body movement.

Now, if all this is so straight forward and simple - why do so many have so much difficulty with weight management.

Psychological Accounting

For many reasons people seem to have to convince themselves they are out of control. We have established that weight is in essence one of the things in life that each and everyone of us is in most control. And since most of us are relatively intelligent - what is going on here?

It is my belief that at some level - perhaps barely in our awareness, or even out of our awareness - the results we are living with are at the bottom line those with which we are the most comfortable.

I have meet abuse and incest survivors to whom being heavy represents strength and safety (either by sheer size or by what I call "chastity fat.") I worked with one woman who had lost 150 pounds and was doing well on the MNP fast. Her husband picked her up by the pool one night and she remembered being abducted by a group of young men and raped in the back of a van. She had vowed never to be light enough to lift again. She unfortunately, went on to sabotage her program and promptly regained all she had lost and then some.

Numerous people I have worked with found weight a way to deal with the unresolved scars of sexual abuse and or incest. If they became unattractive (in their minds) by getting heavy the risks were reduced. Moreover, some men and women have become heavy so that they were uncomfortable being naked and that served to keep their relationships safe from their own appetites.

The lists go on and on but I think it becomes clear that being heavy was either less negative than being thin or being thin was potentially more negative than being heavy. Either way it is a matter of the individual's psychological accounting.

I think it becomes apparent that many of these issues won't be resolved with a good diet and exercise plan. Other issues need attention. Those "emotionally corrective experiences" discussed in the "What Is Psychotherapy?" link are needed.

And even then there is still the issue of forgiveness to themselves and others. So let me say quite clearly: COMING TO ME WON'T GET YOUR WEIGHT OFF. It is a very difficult road that requires long-term attention. I can help. But the responsibility rests solely with you and your commitment to the work.

I can help expose the red and black ink in your personal psychological accounting (if you will). But only you can effect the bottom line.

Many of the other controllable risk factors follow the same therapeutic logic. From MRFIT, to MNP, various addictive disorder programs including The Haight - Ashbury Free Clinics, and my training in my Post - Doctoral Masters of Science in Clinical Psychopharmacology have provided me with an understanding of medical risk factors, including their at times seeming intractability and have led to understanding the subtleties of treatment strategies.

All that I have written here barely even touches the surface of the problem. If what I have said rings a bell and you are intrigued well then: I look forward to working with you.