The Psychiatry of Weight Loss

It started off like any other family dinner at the Weinberg household. I believe I was in the 11th grade at the time, give or take a year. We assembled at the kitchen table to partake in our evening family meal. Father had returned from a long day of seeing patients at his family medicine practice. I just returned from a difficult track workout running intervals. Mother was grading freshman composition essays. Sister was looking over college magazines to determine which in-state Virginia schools she should apply to.

There have been many psychiatric studies about how people’s memory function when they receive catastrophic news or have near-death experiences. One empiric theory states that people have almost photographic memories during times of crisis. This theory states that people will remember where they were, what they were wearing, and who was with them when receiving catastrophic news or experiencing a severely traumatic event. Shortly after John F. Kennedy was assassinated, a group of psychology graduate students rapidly put together a research study and went out into the world to interview people.

The questions they asked varied from, “Where were you when heard the news…what did you have for breakfast that day…and what were you wearing?”

In the second phase of the study, the researchers waited five years and then interviewed the same group of people. In addition, they asked the participants to rate the surety of their answers on a scale from 1 to 100. A score of 100 meant the rater was absolutely certain, and a score of 0 meant not sure at all.

Memory can be a tricky thing. We rely on memory to feel safe and allow us to have a basic understanding of the world. If you woke up every morning and had no memory of the way foods tasted, how would you order breakfast? If you had no ability to consolidate spatial memories, how would you find your way to work? If you couldn’t remember basic social cues, how would you interact with your coworkers? The thought of losing our memory as we age can be terrifying. How do you think you would perform if you were placed in the JFK study?

I will not spoil the suspense. I am positive that as soon as you are done reading my article you will immediately explore the Internet for the answer. Go ahead and write down your best guesses. What percentage of participants were able to recall where they were when John F. Kennedy was assassinated? What percentage of participants remember what they had for breakfast that morning? Lastly, what percentage of participants remember what they were wearing that day? Are you optimistic about mankind’s cognitive abilities to recall events five years in the past or are you a cup-half-empty type of person?

I don’t have a long list of worldly catastrophic events that have occurred across my lifespan. I did not live through Pearl Harbor. No president has been assassinated while I have been alive. I was too young to remember anything about when Ronald Reagan was shot. I have vague recollections of the World Trade Center and Oklahoma City bombings, but I cannot tell you what year they occurred. I have experienced many personal traumatic events in my life. However, I prefer not to talk about them. Perhaps if we write a sequel to A Little Left of Center, I will be able to relate some of those events to you. In all fairness, we would have to call the sequel A Little to the Right of Center. Kassidi and I had no intention of titling our book with any sort of political slant. We did not realize the optics of our chosen title until we started receiving feedback.

The most dramatic world event that has occurred in my life is the destruction of the Twin Towers in New York City. I am 100% positive about what city I was in. I was in medical school at the Albany Medical College of New York. Many of my fellow students had friends and family living and working in the area surrounding the Twin Towers. My good friend, Tony, lived two floors below me. We usually met outside our apartment building and walked to class together. Tony grew up and went to school in New York City. This was where he had spent the majority of his life. He had obtained a 3rd-degree black belt through years of studying martial arts in NYC. He was apprenticed to the sensei who ran a dojo mere blocks away from the twin towers. Tony often spoke of his sensei as a friend, a mentor, a brother, and a father.

I was traumatized, catastrophized, and unbelieving when the first plane hit the first tower. It paled in comparison to what Tony went through. We were told that the first building had been hit while waiting for class to start. It was around eight o’clock in the morning. Somebody came in to inform us of what had happened and that classes were canceled for the day. I remember a large number of my classmates immediately picked up their cell phones and called their loved ones to make sure they were not currently in the burning building plastered across every television in the country. On the walk home, I listened to Tony describe his life in New York City. He told me about all the great people he knew currently living there. I had no TV in my apartment, so I followed him to his. We were watching TV with his wife when the second tower was hit. There are no words to describe the emotions he went through. I tried to find words to console him, but they never materialized. There was nothing I could say. I remember sitting with him for several minutes and then excusing myself so that he and his wife would have privacy.

I know what I had for breakfast that morning because I did not eat breakfast in medical school. I have no idea what I was wearing. I can tell you that my recounting of the previous story is a hundred percent accurate. I would bet a large amount of money on it. What percentage of people in the JFK study felt the same way I did when asked five years later…and were wrong?

Family dinners in high school were fairly simple. They usually lasted around 15 minutes. Everybody was busy with their own lives both before and after the shared dining experience. On that fateful night, I remember clearing my plate and then fixing myself a large bowl of ice cream. I returned to the table and happily began consuming my after-dinner dessert. My mom glanced at my bowl of ice cream and then turned to stare at my father. “I eat like a bird,” she said.

“Excuse me, honey?” my dad replied.

“I eat like a bird. He eats a giant bowl of ice cream every night and doesn’t gain weight. I eat like a bird, and I cannot lose a pound.”

“Yes, you do love,” he consoled her. “You’re right. It’s not fair.”

“Yeah, you eat like a bird,” I said sarcastically. “Just like a vulture.” I then raised my arms up to shoulder level and craned my neck towards the bowl of ice cream. Imitating the movements of a vulture.

My father’s jaw hit the table. The fork fell out of his hand and clanged to the tile floor. I could see his pupils dilate and perspiration bead up on his forehead. In retrospect, that was the closest I have been to dying. I saw the look in my mother’s eyes. I should have run, but I was a young, invincible adolescent.

“You know, Mom? We learned in physics class today that matter can neither be created nor destroyed, only altered. But I’m sure you are the one exception to the laws of physics.” I flashed a smile to her. I was quite pleased with my vulture impression and display of witty intellect.

I don’t remember what we ate for dinner that night. I don’t know what I was wearing. I do know that I almost lost my life.

Throughout my career, I have counseled many patients on weight loss. Many of them have expressed the same exasperation my mother did on the eve of what was almost the last night of my life. It is very common for frustrated dieters to exclaim that they eat next to nothing but cannot lose any weight. Have they found a way to violate the laws of nature? Probably not.

The basic principle of human homeostasis states that the amount of caloric intake minus the number of calories that we expend during the day leads to either a daily net increase or decrease in our mass. Simply put, to maintain current weight, calories in equal calories out.

There are some hormonal and endocrine disorders that can make it extremely difficult to lose weight by altering our metabolism or changing the distribution of storage fat. I recommend anybody who is struggling to lose weight on a consistent diet see their PCP for a basic metabolic workup. But don’t hold out too much hope, it’s not common for your family physician to find a medical reason to explain the lack of weight loss.

Please, do not misunderstand me. I have struggled with weight gain throughout my life as well. I am very sympathetic. In addition, I have done hundreds of psychiatric screenings for patients needing clearance for bariatric surgery. I have seen life-altering and amazing results with these surgeries. If you suffer from morbid obesity and have failed multiple attempts to lose weight by yourself, then it’s definitely worth consulting with a bariatric surgeon to see if a weight loss surgery is appropriate for you.

But let’s get real for a few moments. You are likely not going to like what I have to say next. Most people can lose weight if they follow a strict diet and do a modicum of daily exercise. The former part of that statement is infinitely more important than the latter. Meaning, it’s not possible to do enough exercise in one day to account for the calories taken in by an unhealthy diet. However, a modest amount of walking a day can burn enough calories to add up to pounds of weight loss over weeks and months.

But do not fear, my noble food-loving reader. There is a psychiatry to losing weight. I have discovered several approaches and methods that you can follow to lose weight. These methods are not a crash diet. They are part of a lifestyle change. You’re not going to lose 20 pounds in one month. You will gradually lose 10 to 15 pounds over a 3-to-6-month period. Rapid weight loss rarely stays off. The faster it goes off, the faster it goes back on. Slow, purposeful weight loss over months demonstrates a lifestyle change that leads not only to a healthier existence but a more reliable and advantageous waistline.

Let’s get into it.

1. Open Your Wallet — There is no inexpensive way to lose weight. Healthy food is expensive. Prepackaged meals and shakes sold as trendy fads may be low on calories, but they lack the taste and flavor of long-term sustenance. Eating is one of the most social things we do during our day. The joy of breaking bread with others is part of sustaining important emotional relationships. Dopamine in the brain is released by eating delicious foods and consuming them until satiated. This dopamine release makes people feel happy. You will not get a warm, fuzzy dopamine release by eating a $5-dollar pre-frozen meal. Unhealthy food is inexpensive and healthy food is expensive. Budget appropriately and plan meals out a week in advance. A couple of high-calorie meals of inexpensive fast food a week can destroy your hard work and effort.

2. Stop Drinking — Alcohol is loaded with calories. These are not healthy calories that are easily burned. Losing weight and drinking alcohol do not mix. However, you also need to stop drinking beverages other than black coffee, tea, and water. It’s difficult to measure how many calories we’re consuming in liquids. Drinking juices, sodas, and other flavored beverages can easily add 500 calories to our daily intake. If you’re seriously trying to lose weight, that is 1/3 of your daily caloric regimen.

3. Drink Water — I know water is not the most exciting drink. In contrast, unnatural additives, flavorings, and preservatives in 0 cal beverages stimulate our appetite and cause sugar cravings. You cannot cheat your body into losing weight. By consuming water at most of your meals, you will train your brain to a more sensible pallet. You can also drink as much water as you want. I have never seen anybody remain hungry after drinking a gallon of water. If you finish your nightly meal and still feel hungry. Drink a couple of glasses of water to fill you up.

4. Walk Away from the Table — The concept and expectation that you will feel full before you leave the table is a wives’ tale. A chemical reaction occurs in your body when your stomach extends. Chemical signals from your stomach travel down nerves and upwards into your brain. These chemicals are then released at the primal areas of your brain. When enough activation of neurons in these primal areas of your brain occurs, then a different chemical is produced and sent to a different part of your brain. The neurochemicals in that area of the brain then produce the sensation of being full. Does that sound like a quick process? It’s not quick. The whole process can easily take 10 to 15 minutes from start to finish. Plan out what you are going to eat, eat it, and then get up and walk away from the table. Find something to distract yourself. Give your body time to tell your brain it no longer needs food before you think about consuming more.

5. Salad Dressing (A Blessing and a Curse) — My personal weight loss success is centered around eating salads at lunch. It’s a necessary evil. I would much rather eat the meals loaded with carbs and dairy that the younger medical students rotating with me consume. Unfortunately, as I got older my body stopped metabolizing carbohydrates and fats as rapidly. I have learned that I can moderate my weight better if I eat salads at lunch. However, I will not lose any weight if I put half a bottle of salad dressing on my salad. I’m not going to lose weight if I load my salad up with croutons and shredded cheese. Don’t cheat yourself. You have to count the extra calories you put into your planned meals. And they add up very quickly.

6. Accept Defeat — Sometimes temptation gets the better of us. An occasional brownie, cookie, or ice cream happens to all of us. Slipping up day after day and week after week will prevent weight loss. However, there are times when you need to throw in the towel for the day and get your dessert. Go to sleep that night accepting the defeat of losing the cookie battle of the day, and when you wake up in the morning, go back to winning the war. One relapse does not mean that your diet is destroyed. You will have moments of weakness, but do not give up on yourself.

7. Give Yourself Hope — Planning out your meals days or weeks in advance can be enormously depressing. Staring at my salad day after day after day leaves (no pun intended) me little hope that I will get any joy or dopamine release from consuming lunch. One day a week, I eat what I want. I don’t intentionally go out of my way to overeat, but I don’t hold back either. This slows the weight loss process down, but it also gives us the joy of eating what we love. The key to success is consistency and sustainability. This has to be a commitment to a healthy lifestyle that still brings you some joy. Stating that you’re not going to eat any of the things you like for the rest of your life is ludicrous. Pick a day, usually Saturday or Sunday, and enjoy your life.

If you can follow the above guidelines, you will exponentially increase your chances of losing weight and keeping it off. If the sound of being able to eat whatever you want one day a week sounds too good to be true…it’s not. Over the months, your stomach will gradually shrink in size, and your appetite/satiation receptors will adjust and normalize to your new amount of daily food intake. I still enjoy my high-fat and sugary foods on Sunday, but I normally feel ridiculously full afterward and don’t eat nearly as much as I used to. There is a psychiatry of medicine to tricking your mind into accepting weight loss first and then modifying your bodily functions afterward.

Good luck, friends.

Dr. Daniel Weinberg, Board-Certified Psychiatrist