(Originally published as a three part series.)
The overweight problem in America isn’t news to anyone. It gets a huge amount of media attention. The main concern voiced by the medical community is that being overweight or obese is a risk factor for serious health problems (diabetes, coronary heart disease, stroke, hypertension, some forms of cancer, snoring/sleep apnea, and more). From speaking to my overweight patients, I’d say that what it does to one’s mental state is at least as damaging. Most overweight folks have gotten over not looking like Kate Moss. The psychological distress associated with being overweight is more than the disappointment of realizing your body doesn’t match the physical ideal portrayed in glamour magazines. It tends to be a more personal concern of not being attractive to your partner, to a prospective partner, or to yourself.
Then there’s the chronic low-level anxiety that comes from knowing about the health risks but feeling they’re unavoidable. Even worse, I believe many overweight (and especially obese) people have the feeling that the world blames them for being wrong by being overweight, for not fitting the mold, for being a burden on the medical system, and finally, for having no excuse because they’ve done it to themselves. What a guilt trip!
This is not to say that someone else is to blame if we’re overweight. But let’s take fault and blame out of the conversation entirely. They add an unnecessary element of emotional poison to the issue, and they certainly don’t help people embrace healthful habits.
Excessive weight gain usually occurs through a combination of biological factors and lifestyle choices. Let’s review some of these factors:
• Sleep debt: The amount of sleep we get has decreased in the past few decades. Insufficient sleep is related to higher body mass index and obesity.
• Exogenous endocrine disruptors: These are manmade chemicals that disrupt our hormonal system. One example is bisphenol-A, a common additive to plastic bottles and also used to line virtually all metal cans. Endocrine disruptors are increasingly prevalent in the environment and evidence shows they can increase body fat.
• Thyroid disorders: The thryoid secretes thyroid hormone, which essentially sets our metabolic rate. More thyroid hormone means more energy and warmth and less body fat; less thyroid hormone means less energy, feeling colder, and weight gain. There has been an increase in cases of low thyroid function (hypothyroidism), probably due to several reasons, including the disruptors explained above, immune system malfunction, iodine deficiency, and stress.
• Reduced variability of ambient temperature: Exposure to very hot and very cold temperatures encourages us to shed fat, but in the past thirty years Americans have reduced the degree to which we expose ourselves to these temperatures. We live mostly in climate controlled cars and buildings.
• Decreased smoking: Smokers tend to weigh less than non-smokers and weight gain follows quitting smoking. But the many health risks of smoking clearly outweigh any of its merits. If you plan to quit smoking (congratulations) have a plan in place to keep your weight stable.
• Pharmaceutical iatrogenesis: “Iatrogenic” means caused by the actions of a physician. The past few decades have seen a great increase in the administration of drugs that cause weight gain (such as antidepressants).
• Increased age at which women get pregnant: The age of pregnancy is rising globally and it’s associated with an increased risk of obesity in our children.
• Obesity and diabetes while pregnant and nursing: Being obese and/or diabetic at these times contribute to the same conditions in our offspring.
• Dietary changes: Over the past several decades Americans have been increasing portion sizes, eating more meals at restaurants, eating more quickly, eating more irregularly, eating more while engaged in other activities such as driving, conferencing, or watching television, eating late at night, and eating more sugar and flour. All of these contribute to weight gain. In particular, intake of high fructose corn syrup, a popular sweetener in soda, juice, sauces, candy, peanut butter, and lots more, causes fat synthesis by our liver.
• Stress: Stress influences weight gain in many ways. It increases levels of the stress hormone cortisol, which actually supports fat metabolism in the short term, but with chronic stress, this trend moves in the opposite direction. High cortisol levels reduce our cells’ sensitivity to insulin, which is the basis of type 2 diabetes. Stress degrades the quality and duration of our sleep (see “Sleep Debt” above). It leads us to make poor food choices. It contributes to our eating too fast and too much.
As you can see, overeating and underexercising, the factors you hear the most about, are just two of many. Most of these are biological factors. While we can think of overeating as a biological or physical factor, its origin is usually psychological. Not everyone who’s overweight eats excessively, but for those who do – for anyone who overeats, whatever your weight – it’s worth taking a look at some of the psychological mechanisms that might be involved.
Consumption of food is an attempt to fulfill a need. As we all know, the behaviors we use to get our needs met are not always the most direct or effective. We frequently consume food in an attempt to meet a non-nutritional need: a need for comfort, love, groundedness, connection, stimulation, control, etc. This is usually more of a band-aid than a solution, because the actual need doesn’t get met by eating. If we don’t recognize that our eating is a misguided attempt to address some other need, we may just keep eating. Since overeating often goes along with a belief that we are lacking something, let’s take a look at the psychology of sufficiency.
There is a major cultural thrust toward excess. Don’t just aim for what you need, we’re told, go for having more than enough – more than enough money, more than enough food, more than enough comfort. Why get the medium size when we could have the large? Having more than enough is not necessarily a problem – we can give the excess to charity or we can save some for later. But the failure to recognize and be grateful for the fact that we already have enough is one of the primary sources of unhappiness and overconsumption.
Lynne Twist, author, fundraiser and activist, writes and speaks on what she calls the Principle of Sufficiency: “When you let go of trying to get more of what you don’t really need, it frees up oceans of energy to make a difference with what you have.” Her book, The Soul of Money: Transforming Your Relationship with Money and Life, is worth reading. Twist studied with Buckminster Fuller, who, besides inventing those futuristic geodesic domes, was an eloquent and outspoken critic of the ubiquitous mentality of scarcity.
Scarcity, Fuller believed, has had a tremendous impact on human consciousness. It has perpetuated the notion that there is not enough for everyone; that for one person to survive or succeed another has to starve or fail. Only from the perspective of scarcity does one person’s gain imply another person’s loss. Periods of true scarcity tend to have a lasting impact on human behavior. Fuller asserted that technology has now made it possible to produce enough food for the planet, yet humans are so deeply entrenched in the consciousness of scarcity that our behaviors may take decades to change.
When we suspect there is not enough of something – food, love, approval, money – there is a tendency to snatch up as much as we can of whatever is available. Scarcity consciousness leads to a belief that more is better. Ideas like, get two just in case and fill up while you can, stem from this. This is a survival mechanism, and it makes sense to a point – when there is an actual food scarcity. But many people who grew up during the Great Depression – or whose parents or grandparents grew up then – have never let go of their scarcity mentality. We feel we must always clean our plate. As we find ourselves again in tough economic times, let’s not reinforce this pattern.
The more we start paying attention to the fact that we have enough, in all areas of our life, the less likely we are to consume more than we need. An added benefit of recognizing that we are enough and have enough is that we experience gratitude. The flip side is that when we invite gratitude into our lives, we can’t help but recognize how much we have.
As for the many other reasons we eat to fulfill non-nutritional needs, it’s beyond the scope of this article to address them individually, but there are several valuable approaches available to us. These include things like self-inquiry, counseling, meditation, acupuncture, hypnotherapy, and many others. I believe some form of personal inquiry is an important practice for everyone. Whether or not we resolve our non-nutritional needs in a healthy way, it would be a major step just to stop letting them interfere with how we eat.
To me, in the simplest terms, this means being relaxed and present while eating. The obligatory ritual of eating is an utter gift. The more we pay attention to what’s going on the more we enjoy it. As if the act of feeding ourselves weren’t miraculous and fortifying enough, at the same time we get to savor a wonderful variety of flavors and textures. Unless we’re somehow stuck eating bad food (and even then) eating has the potential to be one of the most consistently pleasant parts of our lives. When we eat very quickly or in excess, this is a sign that we’re disconnected from the act. The more we admire and relish the food itself, and the more we notice our body’s interaction with the food – how we respond to it, how it changes our energy, how it feels in our stomach and throughout our body – the harder it is for us to tune out and overeat or make poor food choices.
Now, let’s look at some specific additional measures that can be taken to help shed fat and regulate our weight.
• Get enough sleep (but not too much). Since insufficient sleep is associated with weight gain, make sure you’re getting enough sleep that you feel well rested in the morning. If you tend to feel more groggy after a certain time in bed (usually over 9 hours), you may be oversleeping.
• Get enough sustained, yet mild exercise. The best form of exercise for generalized fat burning is 30 or more minutes of brisk walking a day. Your heart rate should be slightly elevated, your breathing should be full and deep, but you should not be panting, wheezing, or in pain.
• Don’t skip meals. When you skip meals your metabolism slows down to adjust for the decreased supply of calories. Also, you’re more likely to overeat at your next meal.
• The amount you eat per meal is more significant than your total daily calories. If you eat two meals of 1000 calories each per day (that’s 2000 calories total), you most certainly are supplying your body with more than it can handle at each meal, and the excess will be stored as fat. On the other hand, if you divided those same 2000 calories into four 500-calorie meals spaced out evenly over the day, you are more likely to under-supply your caloric need. Then the body will burn fat for extra energy.
• The goal of eating is not to fill the stomach to its capacity. When you feel full you have overeaten. In the same way that it’s difficult to efficiently toss a salad or mix a bunch of ingredients in a bowl that is totally full, optimal digestion cannot occur in a stomach that is completely packed with food. Stop eating before you feel completely full. If you find it difficult to do this, it’s especially important to avoid distraction when you eat. Stay conscious, don’t tune out. Feel what’s happening in your body. The not-quite-full feeling is actually more pleasant and gives you more energy than eating to capacity.
• Allow enough time between meals for the stomach to empty and your body to burn the calories you have consumed. This means at least two and a half hours with no food whatsoever (water is okay). If you tend to get hypoglycemic between meals, trying eating more protein and fewer simple carbohydrates.
• Never microwave anything in a plastic container or plastic wrap; reduce your consumption of foods that come in plastic containers (dry goods in plastic are okay) and cans. Plastics may interfere with our hormone function.
• Make as much of your own food as possible. Avoid processed foods. Eat simply.
• Stay relaxed when you eat. Always eat sitting down, turn off the music, turn off the television, and put down your book or newspaper. It’s a good idea to stay relaxed after eating, too.
• Concentrated sugars should be consumed as minimally as possible. This means ALL simple sugars – fructose, agave nectar, corn syrup, evaporated cane juice, beet sugar, honey, fruit juice concentrate, maple syrup.
• Flour-based foods (bread, muffins, cake, bagels, pancakes, waffles) should also be consumed at a minimum. They are mostly empty calories.
• Dessert is not healthy stuff – that’s why it’s a special treat. When we eat dessert every day, or multiple times a day, it’s not really a treat anymore – we just have a crappy diet. Let yourself have dessert just once a week and it will feel like a treat again. If you feel the need to eat sugar after a meal, it’s likely that you have a sensitivity to something you ate.
• Sugars allow the amino acid tryptophan to enter your brain. There it is converted into serotonin, which elevates our mood. Without adequate carbs, there may not be enough tryptophan entering the brain, and consequently not enough serotonin. This is why some people feel depressed when eating a low carbohydrate diet. This can be addressed by eating slightly more complex carbohydrates (vegetables!, moderate amounts of whole, raw fruits, or small amounts of whole, unrefined, cooked grains) and/or taking supplemental tryptophan (1500 mg twice a day or 3000 mg at bedtime, always taken apart from protein-rich foods).
• Consider having your thyroid tested, particularly if you feel cold, tired, melancholy, or have been losing more hair than usual (even from your eyebrows). (Don’t let them just test your TSH, an indirect marker of thyroid function – insist that they do a complete thyroid panel.)
• Don’t stop eating fats. It’s a good idea to avoid margarine and deep fried foods, since they’re unhealthy, but moderate amounts of animal and vegetable fat supply essential nutrients. They give us energy, support nervous system function, and are useful in promoting satiety. That is, they help us feel full. Most people would feel full – perhaps even bloated – after eating a piece of cheesecake (which has plenty of fat), but meanwhile you could probably drink a glass or two of soda or bottled juice and still eat a meal with it. The soda/juice has no fat, so it doesn’t fill you up much, but it has maybe two-thirds the calories per can as a piece of cheesecake!
Finally, just because you may prefer a slimmer body, don’t withhold love and approval from yourself. This is like depriving a sick person of medicine because you dislike sickness. Think about how you would treat a loved one with a weight problem. Even if you thought they would fare better with different eating habits or more exercise, would you reject them or stop loving them? You are so much more than the shape of the body you reside in. When you stop loving yourself, the impact on your health can only be negative. Practice a combination of discipline and compassion. You can do it!
Dr. Peter Borten