so in my practice, i have a lot of female patients interested in losing weight. they usually come in asking for some pill they heard about. unless they have a pretty good reason for wanting to drop just 10-20 pounds in a short amount of time (for a short amount of time, since they're likely to put it all back on) (e.g. "need to fit into my wedding dress" - a popular one), i veto "quick weight loss" schemes.
instead, i try to recruit them to my "cult of dr leigh
life-transformation plan" which focuses on
1. taking the long view,
2. taking the wide (holistic) view,
3. considering body image and function as one and only one aspect of their unique and dynamic life and lifestyle,
4. encouraging consideration, if not construction, of a long term (five year) plan, in addition to a short term (until next visit) plan,
5. looking at "my food pyramid dot gov" and "mayo clinic healthy weight pyramid" online together, and
6. making them fill out food diaries and bring them back in regularly, which secretly is an opportunity to progressively process their feelings and actions around food and their bodies.
most of my patients are poor, stressed, traumatized, dangerously obese, and medically ill or on the verge of it (those young diabetics and young people with kidney failure you read about), as well as smart, brave, funny, creative, proud, and ridiculously good-looking (those young black women with cool names you read about). practically everyone has some degree of eating and/or dysmorphic disorder. plus, practically everyone is some kind of sexual trauma survivor, and whenever bodies are an issue, that trauma is an issue.
i ask them about the other women in their lives, and how they feel about how those women look, and whether those women also have issues with their weight, their bodies, eating; what good family meals have been like for them in the past; how they feel when they try on new clothes; how they feel when they have to go out to their exercise program, whether they were athletic in high school or grade school, how active their kids are physically...
i tell them that losing weight changes everything, and no matter how much you want to be thin, you might not really be ready for everything to change, and one theory is that it might be intolerable and you might unconsciously make it so you change back. and you could maybe counteract this by considering carefully all of the things about your life you'd like to change, and how quickly you can expect to change them, and what it will take, and what it would be like on the other side.
we discuss, for example, how old you'll be in five years, how old your children will be and how you want your relationship with them to be, and how old your parents or grandparents will be and what their needs will be; what you don't want to be afraid of any more by the time you're that old, what you always wanted to be able to do (play piano? bench press your own weight? have a flower garden?) and how you might truly expect to be doing it every day, in the future.
so every opportunity to process is an opportunity to affirm. and not only that, but these are opportunities to demonstrate my confidence in their abilities to get a grip on their lives. after all, limiting oneself to 1200 calories a day is full of fail, while strategizing creatively about how you want your life, your work, your relationships, and your self-image to change, in five years - plenty of time! - is full of promise.
but will it help them lose weight? frankly, i don't think that's the point. how much worse could i do, with my cultish machinations, than all the other current weight-loss plans? how much worse could i do than other doctors? for years i have asked other doctors how they help their patients lose weight, and what i've learned is that doctors are very cynical on the subject - from decades of fail. patients who "ask their doctor," women in particular, adopt an austerity program, lose 25 pounds fast, then gain back 35 and hate themselves double, and stay at home eating ice cream to live with the shame.
not only that, but the bigger you get, the harder it is to lose weight. the bigger you get, the longer it stays, the harder it is to work off.
and there's a big bunch of trauma - child abuse, sexual abuse, spousal abuse - behind compulsive eating that will never be reduced by reducing diets.
and there's a big bunch of that trauma that is caused by living in a white supremacist culture that is violent to women and children.
and there's a bunch of billion-dollar scambag maneuvering behind the amount of trans fat, palm oil, and high fructose corn syrup in "the american diet."
and there's more than one reason nobody knows how to cook from scratch anymore, but the number one reason is that real weekly wages of $277 for nonfarm workers in 2004 are less than was the real weekly wage of $302 in 1964, while a box of cornflakes that cost twenty-nine cents in 1964 cost $2.99 in 2004. who has time to cook, when you've been doing your own job as well as your laid-off coworker's job all day, or you're just home for a few hours before starting your second shift? who has time to teach your kid to cook (your kid goes to her day job when she gets out of school in the afternoon)? who has time to go to the store? and who has the money for the "diet food" experts recommend, the skinless boneless chicken breasts, sea bass fillets, fresh asparagus, 5-inch portobello mushroom caps, prawns, soba noodles and ginger sauce, edamame, fresh nectarines, pork tenderloin, pomegranate juice, artichokes, casaba melon with sweet creamy curry...
i also retain an uneasy skepticism about what it is we want, we doctors, when we want women to "lose weight." more than once i have seen a woman seem to lose in authority what she gained in self-conscious sex appeal, by losing weight. then again, i'm skeptical of the particular way in which we let women off the hook when they stay dangerously big or get bigger. after the thyroid and fasting glucose tests, after the "exercise prescriptions" and lists of low-fat treats, after the stern warnings and documentation, and especially after the 3-month trial of amphetamine and orlistat, doctors rest easy in the notion that their patients "failed" due to "noncompliance" (whether they refer them to surgery or not).
then i come along and ask, newbie to sage, "how do you help your patients with weight loss?" and they tell me they've tried everything but nothing works. one cardiologist told me that the only thing that ever made a difference, was to tell his patients to "Eat Half": "if you usually eat 2 bowls of ice cream, just eat one. if you usually eat a footlong sub, just eat a six-inch." he said that was the only piece of advice that people seemed to be able to understand and remember. then he said he was so glad he was retiring next month.
so i do tell people Eat Half, if they are looking for a very quick guideline and do not want to get into a whole involved cultish program. i have also been on a crusade for two years now to get people to drink water instead of - instead of everything else. instead of soda. instead of sugar-free soda. instead of sweet tea. instead of juicy juice. everybody tells me water tastes bad (the city water is actually just normal water, not horrible fish-water or rust-water), so i keep a supply of water bottles and generic individual zero-cal flavor packets in the office, and show them how to mix them up and carry them along. i figure eventually they'll run short of flavor packets and be stuck drinking water instead. i truly believe that people who are addicted to soda - they drink it before they brush their teeth in the morning, for crying out loud! - have a harder time cutting out other sources of sweets and salties. when actual water tastes bad to you, you know your palate is somehow way out of whack.
i think the final phase of my cultish life-transformation program will arrive when i have the time to just walk over to people's houses and go through their cupboards with them, and assess that they have for staples, equipment, and storage, and then sit down and show them how to make a shopping list. right now, in the hamster wheel, with the fifteen-minute appointments and the collapse when i get home at 7 pm, i am unable to muster up the energy to do this - and thus i will not, in fact, be able to "help them lose weight" to the degree that i should... but in the meantime - and i share with them, in fact, when it comes up, that i was a single mom too, i dropped out of high school too, i was on food stamps too, i survived sexual assault and domestic violence too - i am showing them that it is in fact possible, at least in theory, to get a grip on your world.
five years from now, when i am _____ years old,
i want to live (where):
my living space will have:
i will live with (who or what):
if i live with animals, i want them to be:
my main daily transportation will be:
i'll spend my weekends:
i'll spend my winter holidays:
i'll spend my summers:
five years from now, when i am _____ years old,
i want my main work to be:
i'll feel committed to this work because:
the challenging part of this work will be:
if i have a job that's different from my work, i want that job to be:
that job will help me with my real work by:
five years from now, when i am _____ years old,
i want my closest relationship to be:
i want most of my other relationships to be:
people will be comfortable calling on me for:
people will think of me as:
five years from now, when i am _____ years old,
when i want to have fun, i will:
when i want to unwind, i will:
i want to have enough time to:
my most creative activity will be:
i'll spend about this much time in creativity:
my most satisfying spiritual practice will be:
i'll spend about this much time in spirituality:
i want sleep to be:
five years from now, when i am _____ years old,
i want to be strong enough that i can:
i will have enough endurance to:
i will be physically flexible enough to:
i want to be able to walk, run, or roll (how far and how fast):
i want to be able to lift or carry (what):
i will enjoy doing these kinds of fitness activities:
i will enjoy playing these kinds of games:
five years from now, when i am _____ years old,
i want my body to be:
i want my face to be:
i want my hair to be:
i want my eyesight to be:
i want my hearing to be:
i want my arms and legs to be:
i want my hands to be:
i want my heart to be:
i want my appetite to be:
i want my weight to be:
i want my back to be:
i want my breathing to be:
most of the time i'll feel:
most of the time i'll look:
five years from now, when i am _____ years old,
i will no longer worry about:
i will no longer regret:
i will no longer be angry about:
i will no longer wish i were:
i will be ready to forgive (person/s):
for (action/s):
i will have been be forgiven by (person/s):
for (action/s):
i won't feel like doing this anymore:
i won't be afraid to do this anymore:
i will have left these things behind:
i will be so glad i chose to:
