A Surprising Fix for Weight Gain, Digestive Woes & Skeletal Pain
There's no pill for self-compassion 💊
ICYMI 👉
Are you ready to learn about another CRUCIAL ingredient for health? One that is vitally important yet under-appreciated?
Let’s go.
Last week I wrote about the importance of sleep. In my opinion, an equally important element for our nervous system—and indeed our whole health—is: self-compassion.
How do I know? In 20 years of seeing patients, I regularly see whose symptoms might be ameliorated with a prescription medication. Sometimes the patient even comes in knowing what they want—a diet drug, a sleep aid, a pain pill.
And sometimes they are right.
Drugs can work wonders. Ozempic is a highly effective medication for the right patient. Trazodone can help with sleep when used in the proper clinical situation. Pain medications are an essential part of the pharmacopeia. I love chemistry so much that in addition to my medical degree, I have a masters degree in pharmacology.
However, medications only go so far.
Which is why I commonly prescribe non-pharmacologic interventions first—or in conjunction with medications—for complex problems such as weight gain, insomnia, fatigue, and chronic pain. For example, I often suggest strength training (in addition to HRT) to help address menopausal belly fat, alcohol cessation (in addition to SSRIs) to mitigate depression symptoms, and a low-sugar, high-protein diet (in addition to Trazodone) to help with insomnia and fatigue.
But sometimes these behavioral tweaks only do so much.
A true story
Take, for example the patient I recently saw (and who gave me permission to tell her story): a successful professional woman in her 60s who came in with a number of complaints—digestive issues, joint pain, and difficulty losing weight. We discussed her symptoms in detail. We reviewed her sleep habits, exercise routine, nutrition and eating habits, medications and supplements, her family history and past medical issues, and her recent normal colonoscopy and GYN exam.
Her weight was 10 pounds higher than it had been in her 40s, however, her BMI was still in the normal range. Her physical exam was normal except for a warm, swollen knee. Her laboratory testing was normal except for one of her liver tests, which was slightly elevated.
This led to a conversation about her drinking and her consumption of Advil. She wasn’t abusing alcohol but admitted she drank “more than I should” in order to relax after work. She used Advil regularly to treat exercise-induced knee pain. We decided that the combination of Advil and alcohol was irritating her liver, so I suggested she cut back on both. But when I explained that her knee pain didn’t look like anything serious and would probably improve with ice and a short hiatus from her running, she looked at me with a blank stare.
What about the weight gain? She asked.
I explained that from a medical standpoint, her weight was actually normal—and that her cholesterol, blood pressure, and metabolic indices were excellent. She welled up with tears. I realized I had touched a nerve. It was the perfect opening to ask her, “So what’s going on?”
She admitted that she came in to see me hoping for “fixes”—a prescription for Ozempic to help her lose weight, a stronger pain medicine to enable her to keep running (“my mental health depends on it”), and a sleep aid to get rest.
I told her I appreciated her honesty. I reassured her she’s not alone in her desire to lose weight, even when it’s not medically necessary. I made a bad joke about the price of womanhood in America. (She eked out a smile.) I explained that while I’m of course open to her ideas about what she needs, we might start with a fundamental question: What’s behind the desire to keep running despite the pain, and to lose weight despite being lean?
She paused and began connecting her dots—and my advice—to a much deeper issue: for the majority of her childhood and adolescence, she had been bullied by her father. He had called her “fat” since she was six years old and berated her any time she got less than an A in school. Even as as adult, and well after he had died, his voice—and the fear of disappointing him—lived on in her head. It had propelled her to achieve professional success. It drove her to restrict calories and stay thin. It kept her running, literally and figuratively.
Which is why my recommendation to take a break from running, to rest her knee, to cut back on alcohol, and not to worry about her weight felt so completely wrong.
I understand completely, I told her.
The solution
It wasn’t more psychotherapy. My patient was well aware of her father’s abuse and its outsized influence on her wellbeing. It wasn’t a prescription for Ozempic, which indeed can tamp down ruminations about food (a.k.a. “food noise”) for the appropriate patient. It also wasn’t a stronger pain pill which would have only enabled the cycle of shame, running, and more pain.
My best prescription? A dose of self-compassion.
It turns out that despite being in therapy for 20 years, my patient had mostly focused on the intellectual exercise of talking back to her father’s voice. What she hadn’t done enough of—and in fact, she had avoided with a vengeance—is to feel the feelings of helplessness and hurt. To go back to the moment when, at age 9, her father stood her in a corner and told her not to move until she apologized for making him upset. To go back to the moment when, at age 12, he teased her for developing breasts and told her she was getting fat. And, most importantly, to sit with those painful, overwhelming feelings, and give that little girl a whopping dose of love.
It’s only by forgiving yourself for being human—and by empathizing with your childhood hurt and shame—that you can start to practice resting your nervous system.
She thanked me for giving her permission to practice self-compassion. “Apparently I needed to be told.”
The sad thing is that my patient is not alone. I could fill an auditorium or small stadium with patients whose thoughts are filled with constant chatter about body image and other forms of self-flagellation; people who have lived by a set of rules that were written by another person or by society’s unrealistic expectations; and whose set of limiting beliefs have kept them safe in some ways but, ultimately, have kept them trapped. Departing from those rules and beliefs can feel intensely scary, even decades later.
Are you okay?
If you’re anything like my patient (regardless of your age, gender, and the source of your inner critic), maybe it’s time to have an honest conversation with yourself about the root causes of some of your problems, because they may be affecting your health. Maybe it’s a set of limiting beliefs, maybe it's an unrelenting perfectionism, or maybe it's the fact that you’ve measured yourself by someone else’s unfair standards.
Maybe you need more insight about your origin story—how you were raised, what happened to you as a child, what formative experiences influence how you conceptualize yourself now? What parts of your story need fact-checking? What elements of your childhood and early adult history are missing or intentionally forgotten?
Maybe you do need medication to help quiet the inner critic, for ruminations that negatively affect your health and wellbeing. Fluvoxamine, for example, is a highly effective medication for people with obsessions that interfere with their quality of life. It works particularly well when used in conjunction with psychotherapy and behavioral modifications. Maybe you need Advil for your aching joints on the days you don’t drink alcohol—in addition to a little physical therapy. Maybe you’d lose weight with the help of a prescription medication when the moment is right.
Sometimes our bodies need fresh chemistry, new behaviors, and deeper self-awareness all at once. Two (or more) things can be true at the same time. But no prescription will work efficiently without a dose of self-compassion.
So, I don’t know about you, but maybe the most effective remedy is as simple as forgiving and loving yourself first.
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Disclaimer: The views expressed here are entirely my own. They do not reflect those of my employer, nor are they a substitute for advice from your personal physician.
How remarkable are your insights into the root causes of a person's behavior. When I apply your approach to my Father and his Mother, or to my wife and her Mother, or to my wife and our full of conflict raising of our 2 Daughters, I see such a jumbled complexity of influences that our Daughters have absorbed in one way or another. Yes, forgiving myself is just the starting point of a conscious reconciliation for all of us. A thousand thanks to you, Dr. McBride !
Dr. McBride, that's my story! Thank you so much for this reminder. I'm almost 58, former high-altitude runner for decades coming back from Covid for the second time. Fighting the ten pounds around my belly. My doctor, a man my age, and you would be buddies. He won't give me Ozempic and asks me what's really going on. How fortunate am I to have him and your great advice. Thank you so much.