Friday Q&A: Correcting internal narratives about Weight; Alcohol & Social Anxiety; Unknown Family History; Hormones & Heart Disease; & “Keto” Dieting

You ask the best questions!

It’s Friday Q&A time!

Thanks for your questions about how to fact-check internal narratives about health. And WOW!—thanks for your feedback on this week’s newsletter and podcast, both about the stories we tell ourselves. See below!

What stories do you tell yourself?

The first question (about weight loss) is free for everyone. The remaining questions (about social anxiety, family history unknowns, HRT and heart disease, and keto diets) are for paid subscribers.

Don’t forget to check out my recent Q&As on:

• Risks After COVID; Booster Shots; New Vaccine Formulas; & COVID During Pregnancy

• Help with Infertility; When to Freeze Eggs; Anxiety about So Many Pills; & Finding a Therapist

• Diet Coke; Stomach Woes; Strength Training for Beginners; & Finding the Right Doctor for Menopause

Click here to submit your questions (about anything) for future Q&A posts!

Photo by mk. s on Unsplash

Let’s dive in!

QUESTION #1

I am 40 years old and have struggled with weight my whole life. When I was young, my parents were very strict about everything my sister and I ate. We were put on diets in middle school when neither of us was overweight. I developed a lot of shame around eating and (you won’t be surprised about this) I developed bulimia in high school. I have struggled with eating and weight since then. Nothing seems to work. My doctor tells me I need Ozempic. My therapist wants me to work on body image. What should I do?

- AM

Dear AM,

You are not alone. Shame is an exceedingly powerful emotion that, for so many women, informs body image, the relationship with food, and sense of self. The messages we receive as children about our bodies can loom large even as adults. Even the most well-intended parents can do harm when conversations about weight or food are attached to worthiness. I agree with your therapist that in order to take control of complicated thoughts and feelings about weight, you need to rewrite the script. Overweight isn’t a personal failure. Weight loss isn’t a sign of moral virtue. Food is fuel. Eating is an essential, non-optional everyday experience.

Yet many of my patients who suffer from obesity have convinced themselves that they don’t “deserve” to experience satiety, thus resulting in a vicious cycle of calorie restriction, compensatory over-eating, and guilt. Sometimes the hardest part of weight loss is feeding ourselves three solid meals a day. Indeed the first step toward breaking a body shame cycle is listening to hunger cues, experiencing satiety on a regular cadence, and not apologizing for having basic biological needs. For the appropriate patient, Ozempic can be a nice addition to a larger arsenal of tools to manage overweight and obesity. Not only can it help with satiety and insulin sensitivity, it can help break the cycle of helplessness and despair that many people who struggle with weight loss experience. An improved sense of agency can help lift the weight of shame.

---

QUESTION #2

Since I was a child, I have always been different. I didn’t have many friends and I got teased a lot. In my 30s I was diagnosed with anxiety and Asperger’s, and it explained everything - the social challenges and all. The problem is I developed a pretty bad alcohol habit. It helps me cope. Now I am in my 40s and my doctor says I need to give it up for my blood pressure and weight. It’s hard because alcohol helps me fit in socially. Your post about dry January was great, but what about when I want to see friends? It’s not that easy to have friends and be sober.

- Paul