Eating Mindfully

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Doomed to Weight?

A response to Fat Trap and Young, Obese, and In Surgery

Two recent articles in the New York Times have painted a gloomy portrait of weight loss. To start off 2012, the New York Times Magazine ran a cover story by Tara Parker-Pope titled "The Fat Trap." The article essentially summarized the biological mechanisms that work against us in our battle of the bulge. Specifically, our body fights to regain weight that has been lost (through the release of hormones and other biochemical processes), making it difficult to maintain weight loss. It was a fascinating article that relied on solid research (some of which was conducted by my collegues at the New York Obesity Nutrition Research Center, Columbia University). However, on a day when millions of people had made resolutions to lose weight, this article left many feeling discouraged.  

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I had mixed feelings about this article. On one hand, it validated the difficulties that people have in losing weight and provided evidence that it is not simply a matter of eat less and exercise more. I even mentioned the article during a recent support group for people preparing to undergo bariatric weight loss surgery in response to a patient's complaints that her family thought she could lose the weight without surgery if she would just eat less. If it were that simple, our bariatric surgeons' offices would be empty. Nonetheless, this is a common misperception and people who are obese are often stigmatized as lazy, stupid, or weak-willed. I began to worry about the effects of the article when I heard people saying things to the effect of "its impossible to lose weight so why even try?" It seemed that people had taken the challenges of weight loss that the article elucidated and interpreted that to mean their fate had been sealed. I wonder how many people threw their newly minted resolutions out the window after reading this.

The following Sunday, the New York Times ran "Young, Obese, and In Surgery" by Anemona Hartocollis, this time on the front page of the newspaper. The story detailed the journey of a young woman (17 years old at the start of the story) who underwent laparoscopic gastric banding surgery, commonly known as "lap-band." Lap-band is a type of bariatric weight loss surgery in which patients lose on average 40% of their excess body weight. By the end of the story, the patient had regained much of the weight that she had initially lost. This disappointing result is not uncommon; the sad truth is that many people who undergo weight loss surgery eventually regain some or all of the lost weight. However, the situation is far from hopeless.

What both of these articles leave out is the importance of psychosocial support throughout the weight loss process. It doesn't matter whether you lose weight through weight loss surgery, using medications, or through diet and exercise alone. It is an extremely difficult process, not completely unlike substance abuse recovery. However, weight loss lacks the emphasis on aftercare that is common in substance abuse. Walk into any AA meeting and you're likely to hear "keep coming back [to meetings], it works if you work it" meaning that it is important to stay involved in the AA community if you want to stay sober. I believe that the same is true for weight loss. Many weight loss programs and bariatric surgery centers have aftercare programs like support groups which patients tend not to utilize. Most insurance companies provide some type of psychotherapy benefits that frequently go unused by people on their weight loss journey. It's a new year. If your resolution was some variation of "lose weight," I suggest that you give yourself a fighting chance and utilize every resource that is available to you. Take a course in mindful eating. Find a good psychotherapist. Join a support group. It works if you work it. 



Alexis Conason, Psy.D. is a clinical psychologist in practice in New York City and a researcher at the New York Obesity Nutrition Research Center at St. Luke's-Roosevelt Hospital.


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