Tuesday, June 25, 2013

To Lose Weight, Get Your Head Into the Game

Altogether now. "If your head is not in the game, the game is over before you start."

Last evening, I came across an article about a new analysis of a study called the Look AHEAD (Action For Health in Diabetes) trial that purported to show that lifestyle intervention had no (yes, I meant no) benefit in reducing heart disease for type two diabetics. The study was a randomized study in which one group, the control group, received up to three yearly educational sessions dealing with their diabetes, while the second group, the study group, received regular counseling about reducing their calories and exercising more.

This may surprise you, but I wasn't surprised by the results.

About fifteen years ago, a study was done called the Adverse Childhood Experiences (ACE) study. The  ACE study showed a direct link between adverse child events and unhealthy behaviors. The number of adverse child experiences, which include physical and sexual abuse, the death of a parent, living with an alcoholic parent, etc.correlated almost perfectly with the number of unhealthy behaviors demonstrated during later adult life.  The landmark study showed the absolute relationship between mind and body, psychology and physiology, what's going on in your head, and your overall health.

When I rook a close look at the Look AHEAD study, it was very clear that although a psychologist was suppose to be part of the team at each medical center that participated in the trial that involved over 5,000 patients, psychological counseling and behavioral modification was not an intrinsic part of the study.

Most health conscious people know that simple caloric reduction does not guarantee weight loss, let alone good health because the source of the calories is as important as the number of calories. Case in point. A recent medical case revealed a woman who drank only soda for a number of years and became deathly sick. Another example is the Atkins Diet which proves that calories derived mostly from meat does produce weight loss, but at the cost of heart health.

The lesson here should be clear. Simply telling people to restrict their calories is a failed experiment in the making. Getting them to exercise more without concomitant changes in other aspects of their lifestyle provides marginal benefits at best.

Having now counseled hundreds of patients about their weight and the lifestyle changes they need to make to get healthier and lose weight, I can tell you with almost absolute certainty that simply telling patients what to do does not work.  Virtually every human being has a story unique to him or her. Understanding that story, identifying rationales for the decisions made, exposing motivations to make change, and acknowledging the challenges faced to modify behaviors are equally important to helping a person make changes.

In the Look AHEAD trial, it should have come to no surprise to any of the researchers that many of the participants either regained or were regaining the weight they earlier had lost as the trial progressed. Why? They had followed directions, not made fundamental changes to their mind-body connections. Their relationship to food had not changed. They had simply denied themselves calories for an extended period of time and eventually resumed bad habits. Nothing had really changed and the weight came back. Their hearts were essentially no better off than before the trial began.

Back in March, I wrote a blog titled "The Main Reason You Can't Lose Weight is EXACTLY What You Think!," which can be found at http://mdprevent.blogspot.com/2013/03/the-main-cause-of-weight-gain-is-exacty.html.

I think the Look AHEAD study does an admirable, if clearly not intended, job of proving the point that lifestyle interventions that don't include psychosocial counseling are often doomed to fail.

Discussing the mind-body connection is more than new age mumble-jumble. It is the key to good health and those who ignore the connection do so at their own peril.  If you are one of those people who has tried everything possible to lose weight through the mouth and you just can't seem to get a handle on it, maybe it's time to switch your focus to whats going on in your mind. It may change everything.


  1. Boy, am I ever learning the truth of this. Finding Dr. Charlap and his team has been a gift beyond measure. It really does take a whole village to help me 'stay on track'. Thanks to the MD Prevent physician, psychologist, nutritionist team, I am on track to a better life. I could be the case study for what Dr. Charlap writes in this blog. Losing the same 60-100 lbs. over and over again just didn't work for me any more! Now I have the tools to both lose the weight and change my attitude toward life...thanks to the MD Prevent team and OA to which they referred me! Kol HaKavod as it is said in Hebrew...All the honor!

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