It’s not that we want to be fat. In fact most of us find ourselves gaining weight and are struggling to find ways to stop it. But these energy drinks, sport drinks and just plain ole’ drinks taste so good and are so cleverly marketed to us that we can’t stop drinking them. At least we can’t stop drinking them unless we think about it and use our own free will a little bit.
What a lot of people don’t realize is that big jolts of simple carbohydrates make us fat. Not immediately of course, not that day or that week even, but over time. Big doses of simple carbohydrates, say those in the sucrose and high fructose corn syrup of an energy drink or other soft drinks, the simple carbohydrates are digested quickly and enter the blood stream quickly and result in a very rapid surge of circulating blood sugar or serum glucose level. This also leads to a rapid spike in the important hormone insulin and leptin followed by a rapid fall of the blood sugar level. The next step is a sense of hunger which is often even stronger than before the jolt of sugar. It is no wonder this cycle leads to obesity as it repeats itself over and over.
The make-you-fat drinks have awesome, inspired and expensive Madison Avenue advertising and marketing. They look cool, we think they’re cool and, of course, they taste great. Some of us even like that rapid spike and jittery feeling; the surge of energy, even if it is very short lived, but with a little thought we could all do a lot better.

There has been quite a bit of press coverage about Kevin Smith’s experience while flying on southwest airlines. For those of you that are unaware of what happened:

Kevin Smith was asked to exit the aircraft after flight crew had deemed him to be too large to safely fly in one seat. This is in accordance to a “customer of size policy” implemented 25 years ago which requires said passengers to purchase a second seat when traveling to accommodate their larger size. The interesting nuance here is that Mr. Smith was aware of this policy and had purchased a second seat.

He was flying stand-by to get on an earlier flight which had only one seat available. When asked to exit the plane. Kevin Smith was obviously embarrassed and insulted. He immediately began expressing his feeling on his Twitter account. With over 1.5 million followers it wasn’t long before everyone was watching this situation unfold pretty much as it was happening.

Now there are several aspects to this story that probably warrant their own blog posts and perhaps I will spin back to touch on those at a later date. But I wanted touch on something in this post regarding the treatment of obese individuals during travel. There are two sides to this story and both have very valid arguments.

The “customers of size” are people with feelings who have paid to fly or ride on whatever means of transportation. They are not intentionally infringing on the space of fellow travelers nor do they choose to be a safety concern. Often they are willing to pay more for additional seating space to accommodate their size and adhere to the policy of the company they are traveling with. Do they not deserve to be treated better? If and when a situation arises that is caused by a violation or concern related to their weight or physical size should that situation not be handled with greater discretion?

On the other hand, put yourself in the seat next to the “customer of size”. Did that traveler not pay for the entire seat? Should that traveler be forced to be more uncomfortable then today’s air travel can already be?

What could be a better solution to this problem?

What if we simply charged people as if they were freight. I think most of us would agree that air travel today often feels like you are being treated as human cargo anyway. Why not use the same model for pricing. Instead of weighing your bags to determine if they qualify for penalty fees or charging for extra baggage, just have the traveler and their bags get on the scale and charge per pound. This would be a fairly easy equation to figure out. Airlines can simply set the per pound price they would need to charge to make their targeted profit on a given flight. The traveler would simply stand on the scale with their baggage. Total weight x price per pound = Ticket price. In this case if a “customer of size” takes up more space on the plane then a smaller traveler, well, they paid extra money to do so, and there would be no reason to treat that person with insensitivity after they had boarded. Of course, a thoughtful method of weighing us all with our baggage might have to be conjured up, to avoid casting unwanted attention on anyone at the ticket line. Lots of issues here: is our weight our own private matter, or does it become relevant when jet fuel costs more per pound and we plan to fly? Can a better way to accommodate larger people be found than simply yanking them off airplanes?

Logistically, speaking there are obvious issues that may occur from this suggestion, but what can we as travelers think of to make this situation better for all involved?

Here is a funny thing: When the time comes around for us to eat, let’s say lunchtime, many of us can think of only one thing: food. Plus, when the opportunity arrives to eat that food, most of us can hardly contain ourselves as we anticipate the satisfaction of eating it. It is furthermore difficult to stop midway through a meal with so much more food, delicious food, still available to eat on our plates or on the table or in the serving area. In fact, many of us experience this phenomenon something akin to a biological imperative. We feel a strong compulsion to eat the food that is presented to us. One could imagine some biological programming that speaks to ensure we do in fact the calories that become available because one could never know if a reliable source of calories would be available later. Such a strong behavioral instinct to consume the calories currently available, would serve to guarantee a strong nutritional intake for a species that struggled to obtain reliable sources of food through difficult harvests, bad weather, poor hunts, etc.
So if we are seeking to lose pounds and achieve a healthier overall weight, how in the world are we supposed to overcome such a strong and deeply engrained behavior to eat at mealtime and to eat all the food available to us? Well, here is one trick that works well and has served many of my patients well. Put simply, think of the next meal.
What I mean by this is force yourself to stop focusing on the food that is currently right in front of you and instead think about the meal you are going to eat in just a few hours. For example, it is lunchtime and you are being served a mediocre burger with some nothing-special side dishes and wilted lettuce salad, nothing great here, right? Yet, of most of us are driven to eat that meal and we take satisfaction from eating most of it or all of it. It is very difficult to overcome that drive, and instead simply eat a small portion of the meal that would be more appropriate for achieving weight loss. But if you stop focusing your mental energies on the meal that is currently in front of you and instead think about the next, that is the really delicious dinner, that is something you actually look forward to, say, your favorite marinated meatballs with yummy spices, then it becomes far easier to overcome the temptations to overeat in the present meal.
I know this all might sound a little strange, but is it a behavioral trick that often works. Let me give you an extreme example and you will see how you might use this in your day-to-day weight loss efforts and your goal of cutting down portion sizes. Let’s say you have a dinner planned for a special evening at your very favorite restaurant. Now if you are at all like me, you love those special meals with your favorite chef cooking your most favorite recipe (think of a mouthwatering sizzling steak from your favorite steak joint or think of what you know as your special favorite dish). Many of us with such a special, special meal coming up would “save room” and eat less during the day approaching the special meal in order to more fully enjoy the dinner. Many of my patients and I, myself even have entirely skipped lunch and all food through the afternoon on a day when a special gourmet feast was planned. So the trick here is to tap into that sort of thinking on a more regular basis and when you are presented with food at mealtime, pause for a second and think about the next meal. Then remind yourself you have a plentiful steady supply of food and it is really not important for your health or nutrition to eat everything on your plate at lunch, in fact it is really not that important that you eat any of it. But a small healthy portion is good for you to maintain your metabolism and stave off hunger later in the afternoon. Reminding yourself that a whole other meal is just a few hours away will often help you find the willpower it takes to cut down your portion size and stop eating. This type of psychological trick is just the sort of thing that may help you regularly avoid excess lunchtime calorie consumption and lead to a healthier new you over the course of the year.

There is no doubt that a certain satisfaction comes from eating a large quantity of food. I will be the first to admit I have overindulged in some meals when the food was particularly delicious and I found it satisfying, albeit in a strange way. For example my favorite Indian, Thai or Chinese food seems to be gobbled up so fast that it practically vanishes from the plate and I find myself dishing out more from those white cardboard boxes before I even know what I’m doing. Or a really great pizza made from terrific dough and delicious sauce is so hard to resist before 3, 4, 5 or 6 pieces disappear.
More disturbingly, however, we often find ourselves overeating quantities of food that isn’t really that great. Think about it: How many times have you been served a lukewarm burger and lousy fries, but for some reason continued eating until every last crumb was devoured?
What I am saying is it is time for a new way of thinking about food. Pure and simple, it is time to start thinking about quality and not quantity. At first, you will have to trust me that it can be at least as satisfying to emphasize quality over quantity. You will probably have to take it on faith to begin with that a few bites of something truly amazing, enjoyed slowly, can be equally as satisfying as demolishing a large quantity of something mediocre, but it can be and it is. Once you begin to enjoy the real satisfaction that comes from watching the number on the scale move downward, watching your body look healthier and seeing a person in the mirror who feels better and more energetic, then you will truly begin to see the light.
Be selective, be choosey, don’t eat anything that isn’t truly delicious, emphasize quality and not quantity.

After some delays, we have received the shipment of my newly released book: Life Changing Weight Loss. In these times, everyone could use a guide to real, successful weight loss.

In radio interviews on stations around the country, I have been so pleased at the reception the book has received so far. One of the common threads I hear is that media people are inundated at this time of year with weight loss books and information, most of which has very little basis in the practical science of what truly works. Much of it is based on wishful thinking, marketing plans or fanciful obsessions with obscure root extracts and proprietary blends of unregulated secret, magical herbs. The truth about successful weight loss is much simpler and yet, also much more complicated.

At the end of the day, to solve a weight problem and keep the pounds off, we must find a successful strategy to consume less calories every single day, burn more calories every single day, and find satisfaction and contentment despite this. Many of us can muster the motivation on a short term basis to consume less calories and burn more calories, but we feel like we are starving ourselves or doing the impossible. That won’t work for the long term. Long term success lies in mustering that motivation, but making an internal life change, a new look at how we view ourselves, our weight, our diet and our activity. Only then does the “light switch” flip on, only then do we successfully lose the weight and keep it off for the long term.

I have often wondered why I see so many seriously overweight and morbidly obese vegetarians in my clinical practice. I realize the answer is mainly because I specialize in weight loss, both with medically based methods and with surgical weight loss. So it stands to reason the cross-section of people with obesity will be seeking my help, this will include vegetarians as well as all kinds of other eaters.
Yet, when speaking to these individuals who are struggling with unhealthy weight gain that is wreaking personal havoc on their heath, I have delved into some of the details of what it is they are eating and drinking specifically to help understand why they suffer from obesity. A few of the points that have emerged from these conversations are offered here in hopes that other people may be able to avoid this unfortunate progression to morbid obesity.
The primary danger of choosing a philosophy of vegetarianism is in believing that doing so will lead to improved weight control or even weight loss. That is very unlikely to be the case. Simply shifting from animal sources of nutrients to vegetable sources will have very little to no impact on a person’s weight.
The second danger of vegetarianism and the risk of obesity is that so many so-called vegetarian foods contain high amounts of the very nutrients that are most closely associated with obesity: simple carbohydrates. Many snacks and treats, juices, fruit based products, syrups, flavorings, pastas, rice, noodles and a host of other foods consumed as vegetarian consist mainly of high calorie, high carbohydrate food sources, precisely the kind of nutrient most closely associated with the obesity epidemic. On the other hand, a healthy vegetarian may consume whole grains, legumes, a wide range of beans, vegetables and a wide array of fruits while avoiding all of the previously listed simple carbohydrates and find themselves losing weight and becoming much healthier.
The third danger is the psychology of “good food vs. bad food”. In the “good food/bad food” syndrome, we tend to help ourselves stick to a particular dietary plan by labeling certain foods as “bad foods” and acknowledging other foods as “good foods”. The problem with vegetarianism is that often all animal based foods become as labeled as “bad foods”, leaving all of the non-animal products available as “good foods”. The trouble here is that many of these non-animal foods are absolutely terrible. I am thinking of Twinkies, fruit juice drinks and French fries just to name a few of the millions of obesogenic foods many vegetarians do consume. Don’t get me wrong, if your goals of being vegetarian are purely to avoid animal products then you may succeed with this strategy, but if your goal is to lose weight and be healthier, such a strategy is doomed to failure unless your focus is on reducing foods that cause obesity.
Number four; I call this the danger of the white foods. Many of the obese vegetarians I have met gravitated toward the dreaded white foods: foods that tend to be white in color and dominated by simple carbohydrates. These include potatoes, potato chips, French fries, white sugar, white rice, white pasta, treats with vegetable based frostings and, of course, all sorts of baked goods…breads, crackers, cookies and treats made with white flour. I can throw in high fructose corn syrup, but what’s the point? These are the most harmful foods and nutrient sources in our diet, the ones most closely associated with hunger, fat storage, weight gain, diabetes and obesity. In terms of health and weight, it is a very poor trade-off to get rid of animal products, but gravitate toward these white foods. In fact, it is a recipe for obesity and diabetes.

Recent reports offered some disturbing news: a series of drugs commonly prescribed to treat mental health conditions in adolescence cause weight gain as a side effect. This is not terribly surprising news as it has long been noted that many of the antidepressants and anti-psychotic drugs have been associated with weight gain in numerous previous studies. What is disturbing is there has frequently been lack of full recognition of the deleterious effects of weight gain on the mental health conditions themselves. This is perhaps most aptly demonstrated in the relationship between obesity and depression. It is well known depression itself often leads to over-eating, inactivity and weight gain. Likewise, it has been demonstrated that weight gain and obesity lead to depressive feelings and a cycle of downward mood spiral.
These latest reports offer further disturbing news that sometimes our pharmacologic answers to serious health conditions can often have a dangerous side effect: obesity. It also speaks to the fact that when any prescribers are offering drugs to treat one condition, it would be terribly helpful to consider the negative effects of weight gain just as other side effects are factored into the decision of the prescribing the medication. In the past, weight gain has often been thought of as a relatively minor side effect, but in today’s obesogenic environment, I don’t think that should be the case any longer. Obesity is more widely recognized now as a quite serious health problem in its own right and drugs that lead to weight gain and obesity as a side effect must be scrutinized closely before they are prescribed. I would argue that patients, who are embarking upon any drugs that include weight gain as a typical side effect, should concomitantly enroll in a weight controlled program or weight reduction program to actively combat the effects of the drug.
Some of these drugs directly stimulate appetite. Others lead to inactivity, but many of them have in common the empirically noted finding that patients on the drug gain weight when compared to patients on placebo.

In my practice serving seriously overweight people seeking medically based solutions, I see a very high number of obese patients who described themselves as vegetarians. Many of these individuals chose vegetarianism out of a belief that doing so would help them lose weight or maintain a lower weight. Unfortunately, that is not usually the case.
While there are many reasons a person chooses vegetarianism, selecting this diet to lose weight will be unsuccessful as a strategy in and of itself. At the end of the day, or at the end of the year, one’s weight is determined by the balance of net calories in, against the net calories the body has burned. A great many vegetarians are consuming far more calories than their bodies’ burn through the course of the year and are thus gaining weight. The successful strategies for losing weight or maintaining a healthier weight involve a conscious, mindfulness of overall calorie intake and a reduction in the net calorie intake to levels below that which the body is burning through resting activity and exercise. One can dramatically improve that equation by increasing exercise, using muscles and cutting down on the types of foods that tend to stimulate appetite and stimulate fat storage, namely simple carbohydrates.
Evidence has mounted over many years that simple carbohydrates serve to provide rapid, transient satisfaction when we consume them, but this is followed by increases in our appetite and even cravings for those nutrients, in addition to the hormonal cascades stimulated so potently by the simple carbohydrates leads, in fact, to storage of fat and stimulus of more appetite. Epidemiologic data reinforces the understanding of simple carbohydrates as being the most closely linked nutrient group to the obesity epidemic. There is a virtual parallel increase in the prevalence of obesity in the last thirty years and the per capita consumption of high fructose corn syrup and other sweeteners over the same time period (something that is not the case for consumption of fats and proteins).
If a person wishes to change his/her diet to lose weight, the most compelling strategy would appear to lie with a shift away from the consumption of simple carbohydrates to other nutrient classes. Certainly, this strategy is further born out in our clinical practice where we have success employing such a strategy in the real world of medically based weight loss programs. There is little data to support a shift away from animal nutrients toward vegetable nutrients as a successful weight loss strategy.
This is not to say that a vegetarian philosophy cannot be a successful weight loss strategy if one works not only on the vegetarian aspect, but also on the weight loss aspects, which should be viewed as independent objectives.

A recent study in the British Journal of Sports Medicine confirms the findings of many previous studies showing that vigorous, supervised, aerobic exercise programs also result in very disappointing weight loss. In the study, fifty-eight obese individuals completed twelve full weeks of vigorous, supervised, aerobic training without changing their diet, and each individual lost an average of around seven pounds.
What gives?
The truth is that it is exceptionally difficult to burn high amounts of calories through exercise. For example, for most people, thirty minutes of vigorous exercise is only going to result in 200-350 calories burned. Sadly, but indisputably, we all replace those few hundred calories in a few seconds with a sports drink, a snack or one cookie.
In counseling, overweight and obese individuals seeking to lose weight, I often find that a great many of them are prepared for a monumental challenge, but they imagine the wrong challenge. Many times people envision what it will take to lose the weight now that they finally decided to get serious about it and they picture themselves undergoing a Rocky Balboa type training regimen and enduring long and difficult training regimens, physically pulling sleds and doing an unfathomable number of push-ups. The truth is, the real challenge is equally monumental, but, in many ways, far more difficult. The challenge actually consists of cutting out large numbers of carbohydrate calories from our diet day in and day out. We are typically very unprepared for that sort of challenge. It involves living with hunger, retraining our minds and bodies and sacrificing to achieve rewards that are difficult to see for weeks or months. In the end they are well worth it.

I had a great conversation with Louie Free, the Ohio talk radio host, who himself is a vegan. He said something I thought was very important to point out and that was he knew, as a vegan, he had to eat a “healthy” vegan diet and pay attention to all of his food selections to avoid weight gain. As he mentioned, it is possible to eat snack chips and soda pop and be “vegan” and yet such a diet would be unhealthy and would lead to weight gain and obesity.
I, myself, see a great many people who are vegans with obesity.
It is not veganism that is healthy per say. A vegetarian or vegan diet is not going to prevent obesity or solve obesity or even lead to weight loss. The food choices that will lead to weight loss are a shift away from high calorie, high carbohydrate foods and toward foods with a lower glycemic index and lower overall calories. Then combine that change with increased exercise and you have a winning formula.
It’s certainly possible to eat a nutritionally sound diet that is a vegan diet. And it is certainly possible to maintain a healthy weight and be fit and well nourished as a vegan. It is also quite possible to do the same while eating meat as part of a healthy diet. The key for vegans is to not be lulled into a sense of “healthy dieting” in believing that a vegan diet that is high in simple carbohydrates and high in calories in somehow better for the body than a diet that is lower in these things or one that might even contain meat. As I have discussed elsewhere, there are many reasons individuals choose to pursue a vegetarian diet including ecological choices, environmental awareness and an appreciation of the role that animals play on this earth and how humans should interact with them. But as a physician specializing in weight loss and the treatment of type 2 diabetes , I must point out that the real enemies for human health are not animal proteins, but are high calorie, high carbohydrate foods, especially including the sweets, treats and snacks that are packed with simple sugars. Those are the worst culprits that lead to rampant obesity, diabetes, high blood pressure, sleep apnea, hypertension, blindness, renal failure, amputations and early heart attacks, even among vegans.