I’m not proud to say that before I gained weight myself, I would tell my patients in my gynecologic practice things like,
“Eat less, move more.”
“Eat more vegetables and less junk food.”
“You would be healthier if you lost weight.”
I wish I could personally apologize to each one of those patients. Until I struggled with weight myself, I didn’t have the vaguest idea of how to be helpful to other people. In fact, I was harmful. If your doctor tells you that your weight is detrimental to your health, the implication is that you don’t already that, or that you haven’t tried, or that you just need to try harder.Are you ever again going to trust that doctor as a person who might be able to really help you with your challenges? In fact, why should you trust them at all, when all they have done is to pile on even more shame?
I imagine my words only made my patients feel worse about themselves and more discouraged about their prospects for change. I expressed warnings, but offered neither strategies nor support. Even worse than that, while I may not have overtly attributed their symptoms to obesity, that didn’t stop me from at least partially believing that was the cause. We live in a fat-shaming culture, and doctors are most definitely a part of that culture. I certainly was.
Before I gained weight myself, I just didn’t get it. Beginning at age 40, I gained 30 pounds over the course of 20 years. Like most of my patients, I knew what I should be eating. Like most of my patients, I tried various diets that worked — until they didn’t.
I became increasingly angry with myself, which only made things worse. Finally, thank goodness, something within me clicked: it was the realization that being disgusted with myself was not going to motivate me to change in a sustainable way. Instead, I decided to shift my thinking. I would think about being more active with my kids. I would think about being able to live an independent and vigorous life as an old lady. I was going to make more space in my brain by not playing the endless loop in my head about what I wanted to eat but shouldn’t eat or shouldn’t have eaten and now felt ashamed and undisciplined and hopeless.
Most of all, I made a commitment to stop body-shaming myself or anyone else.
Once I reframed wanting to lose weight into a new paradigm of wanting to take care of myself, the day-to-day strategies fell into place, most of which consisted of reframing what I “wanted” to eat. I gave myself constant, gushy positive feedback. I started every meal with vegetables. I planned ahead for what I was going to eat at the next snack and at the next meal. I committed to 30 minutes of physical activity every day. Aside from those practicalities, though, the truly significant change for me was insisting that I stop playing the self-loathing tape in my head. I became my own no-shame zone.
In six months, I had lost 30 pounds. And here’s the important part: it’s now seven years later, and I have not regained the weight. Sure, I’ve had temporary “relapses.” But I refuse to go back to that shaming, negative space again; and that’s what’s made all the difference. I get back on track with the mindset of wanting to take care of myself – because I owe that to myself and the people I love.
Once I had achieved success with my strategies, I then tried out my ideas with patients who were struggling with being overweight and who were open to trying something new. Together, we would devise short-term and long-term goals that were achievable and sustainable. The experience had to be positive. I was moved and excited by how many of these women were able to make significant changes – not just in their weight, but much more importantly, in how they thought about themselves and their bodies.
Along with a nutritionist and a therapist, I then started an education/support group for patients who were struggling with issues related to being heavy. We never talked about actual weights or calorie counts. Instead, we talked about changing our relationship with food. Every week for six weeks, these people shared their frustrations, their struggles, and their shame. But by the end of those six weeks, their mindsets had shifted dramatically. They began to learn that feeling good about themselves would result in, not result from, weight loss. Eventually, I even wrote a book with a former patient and current reddit user/u/Jarmani729, who lost 140 pounds and has been maintaining for five years. I urge you to read her story if you haven’t already – she’s so amazing!
I’m grateful to my patients for letting me enter a dialogue with them where I can offer support and encouragement. My suggestions may work, or maybe they won’t. Goals change. Strategies change. The important things, however, do not change: there is no judgment or blame or failure. There are only difficulties that are followed by new opportunities. It is all positive.
Here’s what I would say to my patients now:
· Your body is not enemy territory, and it has not betrayed you.
· Don’t body-shame other people, and don’t body-shame yourself. Don’t be your own bully.
· Being obese not a moral failing, and you do not deserve to be in solitary confinement.
· Reframe the way you think about your body. Move from “I hate my body” to “I appreciate what my body can do.” Do you have to love your body? That’s up to you. But surely, you can acknowledge what it’s doing for you right now.Your brain and eyes work — here you are, reading. Your body works — it got you out of bed this morning. You can take it from there toward moving in the direction of something closer to love.
· Honestly, I don’t care what you weigh. I care that you eat healthy food and that you incorporate movement into your life. I care that you don’t hate yourself. I care that you get enough sleep. I care that you spend time with people you love. I care that you go to the dentist twice a year and practice safe sex. The rest is up to you.
Feel free to contact me and ask questions. While I’m a physician, I will not give you medical advice. But I’m happy to talk about the medical research that’s out there and about my own journey. I am not extraordinary – I just got tired of letting all that self-criticism take up so much space in my brain, and I figured out a path that worked – and works – for me.
