Myth of the Day: You Must Eat Less to Lose Weight
It’s generally a bad idea to write an advice column about weight loss. It’s a sensitive subject for many. Especially for people with disordered eating, a post like this can trigger tough emotions.
But one of the most valuable things I’ve learned as a physician is that tackling hard topics head-on is generally healthier than tip-toeing around them. Plus, the health effects of overweight and obesity are real.
Yet in my experience, patients with obesity have been woefully mistreated by the medical and wellness industries, perpetuating false associations between weight and worthiness. I suspect it’s why so many of you asked me to write about this subject.
So here we go.
This is week #2 of my three-week myth-busting series on diet, exercise, and weight loss.
Last week I wrote about the limitations of BMI. Today is about food and eating.
MYTH #2: YOU MUST EAT LESS TO LOSE WEIGHT.
I’d like a word with the 3.8 billion dollar weight loss industry. It banks on the fact that calorie restriction by itself doesn’t work – and sets too many of us up for failure. It also capitalizes on our wobbly relationship with food. It profits off our vulnerability and shame about weight.
I don’t mean to suggest that all diets are bad. Or that cutting calories never “works” to shed pounds.
But anyone who has tried unsuccessfully to lose weight can tell you that restricting food isn’t a sustainable or effective solution on its own. They will attest to how infuriating it is when medical professionals suggest that they “just do the math” in order to lose weight. Restricting also commonly backfires — hence the explosion of diet culture, an accelerated obesity epidemic, and dissociated bodies and minds.
First off, it’s important to understand that weight is not simply calories in = calories out. The number you see on the scale is the integrated sum of genetic, hormonal, behavioral, social-emotional, and environmental factors – of which food is only one part. Some of these factors are beyond our control. We cannot alter our genetics. The food industry in the US also isn’t helping: combined with hustle culture and a strained economy, many of today’s food sources conspire to feed us quick, calorie-dense, nutrient-depleted foods that we eat on the run.
But the problem isn’t just the diminishing quality of what we eat; it’s about why, how, and when we eat.
This takes us to a central problem: Most of us have a relationship with food that isn’t just about hunger and satiety.
Assuming first that we have access to nourishing foods, our relationship with food often reflects our emotional state. For most of us, food represents comfort, joy, sadness — a veritable rainbow of emotional landscapes. We eat to soothe. We eat to celebrate. We eat to numb uncomfortable feelings. I find that when patients try to lose weight without 1) understanding their emotions and 2) connecting the dots between their thoughts, feelings, and behaviors around food, they inevitably have difficulty losing weight and keeping it off.
Second, how we eat is often determined by patterns learned in childhood. For example, many of my adult patients internalized the “clean plate club” mentality from their childhood and, out of habit, have trouble turning down food. For others who grew up in poverty, hunger triggers a primitive urge to overeat, even when it is no longer scarce. Later in life, these patients have difficulty losing weight by restricting calories alone, because their hunger and well-worn habits override their best intentions, setting them up for failure.
And last, many patients don’t even recognize their own hunger cues. As a result of chronic dieting, their mind has excommunicated their own body. Instead of listening to their body, these patients punish it. Instead of nourishing their body, they deprive it of what it needs. Their relationship with food is tethered to rules that are overly rigid, unsustainable, and/or unhealthy. When these patients actually need to lose weight, their reflex to restrict only slows their metabolism, increases their emotional and physical fatigue, and perpetuates the cycle of weight gain and restrictive eating. A subcomponent of a failure to recognize hunger cues is fatigue itself – how many of us, exhausted at 4 PM or 8:30 PM, reach for a sugary or fatty, salty snack to give us an energy jolt?
So when a patient who has long struggled to lose weight asks me for advice on how to finally “crack the code”, I tell them there’s no quick fix. I then ask a bunch of questions about their relationship with food, their emotional vulnerabilities around eating, and their ability to sense hunger and satiety, and how tired they are. I remind them that extra weight is not a personal failure but rather an opportunity to look “under the hood.”
In other words, I see this math every single day: Complex relationship with food + chronic calorie restriction + dulled/absent hunger cues = weight gain (not loss).
These patients may not be hungry in the morning; they vaguely restrict calories during the daytime (coffee in the morning, a yogurt or nutrition bar mid-morning, maybe a salad or something on the run for lunch); they power through the day unaware of their bodily needs, desires, or hunger cues, until the levees break between 6 and 8 o’clock, at which point they are flooded with hunger buried under workday stress and worn-down willpower that they eat quantities of calorie-dense food they wish they wouldn’t, but, because they are human, they do.
And the cycle starts over again the next day.
No wonder these patients aren’t hungry the next morning! If the majority of our calories are consumed in the evening, our bodies aren’t ready for food when the rooster crows. Moreover, our metabolism slows when we deprive ourselves of adequate nutrients during the day.
My advice for these patients?
Eat more to lose weight. The cycle of inadequate daytime eating must be broken! To run like well-oiled machines, our bodies need regular hits of protein, fiber, healthy fats, and whole grains. Ideally, breakfast would be the largest meal of the day — and dinner the smallest — so that we wake up hungry and fill up our gas tank for the day ahead.
Stop dieting. Rigid adherence to rules, rituals, and/or the notion of “clean” eating set people up for failure. Not to mention there is no such thing as clean or dirty eating! These are made-up words that perpetuate the inappropriate moralization of food. If you have two kidneys and a liver, you are “cleansing” your body just fine! When we stop dieting and eat more intuitively, our body and mind can finally act as a team.
Practice mindfulness around eating. Just like we’re told to notice our emotions, normalize our feelings, and create space to consciously decide which emotions to react to, the same concept applies to hunger. When we don’t pay attention to our hunger cues (because we’re too busy or we’re trying to suppress them), they start to recede. The problem with not recognizing hunger is that, because we must eat to survive, hunger then manifests itself in other ways — for example as anxiety, irritability or poor focus. And if we don’t recognize hunger, we also don’t recognize fullness. Getting back in touch with our bodily signals is the key to helping us eat more intuitively and give our body and mind what it actually needs.
Get satiated. Satiety, the sensation of fullness and bodily calm, is crucial — not only to quiet hunger but also to quell anxiety and to stabilize mood. Because diet culture has trained us to avoid fullness (equating satiety with fatness) and because many of us are stressed and poorly rested, we walk around grazing on foods without ever fully filling the gas tank. Imagine going on a long car trip. Would you stop at the gas station every hour to fill up, or would you fill up your tank at the outset of the journey to drive, uninterrupted, without worrying about fuel along the way? Let’s treat our bodies like we do our cars.
Focus on behaviors over BMI. Chasing a number on a scale sets us up for failure. Instead, we should aim to recognize the inherent value of nutritious eating for our mental and physical health. As I wrote about last week, some of my healthiest patients are technically “too high” on the BMI scale — and if they were to manipulate their already healthy habits for the sake of dropping a dress size, they might only succeed in sabotaging their own health.
We all have relationships with food. Who doesn’t notice that ice cream actually tastes better with escalating political rhetoric before election day? Who doesn’t feel a wave of gleeful virtuousness when tossing out leftover Halloween candy in November?
The obesity epidemic is not about personal failings. To solve this crisis we need to work on structural changes from the top down. On an individual level, my job is to help people carve out agency where they can — and to abandon shame about the things they cannot change (and move on).
To me, obesity isn’t really a diagnosis; it’s a symptom of other issues — an opportunity to begin reclaiming agency over one’s body and mind — and to accept some of the fixed genetic, social and environmental determinants of one’s health.
But until we address these deeper issues, patients with obesity and overweight will hop on and off the diet culture treadmill to no end. I vote to reject diet culture — and to re-elect ourselves as governors of our own bodies.
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This week on the podcast! I am thrilled to welcome my friend and best-selling author, Jeffrey Blount.
Jeffrey is an Emmy-award-winning story-teller. During his 34 years at NBC News, he directed a decade of Meet The Press, The Today show, and NBC Nightly News. He was the first African American Director of the Today show and credits his success to his parents’ insistence on quality education.
Keenly aware of the toll of racial injustice on one’s mental and physical health, Jeffrey left his television career to directly reach people of all ages and races with his poignant and emotionally robust novels. Through his writing, he is helping Black youth feel seen, heard, and empowered to realize their full intellectual capabilities. His latest best-selling book, The Emancipation of Evan Walls, mirrors his own upbringing in segregated rural Virginia in the 1960s and shines a light on the importance of education — and a sense of belonging — for our health and well-being. On this episode of Beyond the Prescription, Jeffrey and I discuss his work, his life, and his mission to empower young people of color.
As always, my newsletter subscribers get early access to the pod every Monday night before the official Tuesday launch. Give it a listen now on Apple, Spotify, or wherever you find podcasts. And I’d be thrilled if you could rate and review the show. It helps me a ton!
I will see you next week. Until then, be well.