Tell Me Your Eating Habits

How Y’all Doing?

YOU NEED TO LOSE SOME WEIGHT.

My sincere condolences to those who loved Kelly Mason.

You need to lose some weight.

After a polite Texas greeting, Dr. Nowzaradan gets straight to the point.


Tell me about your eating habits.

Dr. Nowzaradan’s patients are seldom able to describe their eating habits with specificity. They are unable to accurately report what they eat, how much they eat, and when they eat. During their first meeting with Dr. Nowzaradan, they tend to talk about why they overeat. I keep waiting for someone on the program to mention food journals.

Nutrition consultants usually ask their clients to log meals. Keeping a food diary allows eating habits to be described in terms of what foods are eaten, when they are eaten, and how much of them are eaten. They can also help track the “why” of overeating.

Surprising Benefits of Keeping a Food Journal
https://www.getqardio.com/healthy-heart-blog/food-journal/


New Reasons for Keeping a Food Journal
https://www.wsj.com/articles/new-reasons-why-you-should-keep-a-food-journal-1463419285

Food journals are powerful tools in the attempt to change eating habits. Don’t reject the idea without trying.

There are so many ways of logging meals that I need to discuss the “how to” in a separate post. If someone can commit to logging meals for a specified period of time, there is a method for them.

The Diet Plans

Dr. Nowzaradan does not offer a singular diet plan. At the first office visit Dr. Nowzaradan provides his patients with customized dietary plans based on their current eating habits, weight, how much they need to lose, age, and gender.

Marty does an excellent job of explaining and illustrating how these diet plans can differ and why it is necessary to be skeptical about websites claiming to present Dr. Nowzaradan plan. https://www.celebrityhealthcritic.com/dr-nowzaradan-diet-plan/


The scale does not lie. People lie.

Some patients return for their second visit claiming that they followed Dr. Nowzaradan’s diet instructions yet did not lose weight. He adopts an empirical approach that relies on the scale. He calls these patients liars. He tells them how many calories per day they must be eating in order to achieve their current weight. Sometimes they are eating 6000-7000 calories per day.

This is the type of information that I must look up. I use the calorie calculator at calculator.net.

https://www.calculator.net/calorie-calculator.html

I empathize with Dr. Nowzaradan’s patients because they cannot weigh themselves. Weighing on a more frequent basis would help them stay on track. I think these patients, like other overweight people including me, would benefit from keeping a food journal. They would benefit from measuring their food intake. Then they would know how far their eating habits are from Dr. Nowzaradan’s prescription.

When I see one of the patients using food measuring tools, I applaud. When dealing with a surgeon you too must adopt an empirical empirical.

That which is measured improves. That which is measured and reported improves exponentially.” – Karl Pearson.


You are delusional!

Some of Dr. Nowzaradan’s patients suggest that their dietary intake has little to do with their weight. He refers to these patients as delusional. The television program has featured people who appeared to be out of touch with reality.

These patients are also the most likely to question Dr. Nowzaradan’s recommendations and conclusions. They say, “It’s just his opinion.” That always makes me laugh. Professionals get paid for their opinions.

Other patients seem to engage in common forms of distorted thinking. I am sharing a list of cognitive distortions from a website devoted to eating disorders.

I want to emphasize that you don’t have to weigh more than 600-lbs or have an eating disorder in order to engage in distorted thinking about food. Human beings use distorted thinking to get through the day. Help is available.

10 COGNITIVE (THINKING) DISTORTIONS THAT SUPPORT EATING DISORDER BEHAVIORS
https://more-love.org/2018/10/29/10-cognitive-thinking-distortions-that-support-eating-disorder-behaviors/

Those who are obese can be battling cognitive distortions without having an eating disorder. https://www.ncbi.nlm.nih.gov/pubmed/17272943

You Want Us to Do the Work For You!

Making longterm changes in lifestyle is a complex and difficult process. The person who wants to be healthier is the person who must put in the effort. The surgeon, the therapist, the nutrition educator do not have a magic weight loss wand. These professionals make recommendations and offer their opinions. Then they wait for the person hiring their services to put in some work.

Every professional has protocols and processes. Sometimes the people they serve must step out on the belief that the professional really does have the required expertise. Patients leave Dr. Nowzaradan’s office the first time swearing that the weight loss goal he gave them is impossible. Those who take his instruction are pleasantly surprised with the results. Sometimes patients refuse to take the advise that Dr. Nowzaradan offers and they must be dismissed from the program.

Some people take longer than others to decide to do the work. To see hard work in action, watch Dr. Nowzaradan’s patients followed up beyond the first year. My 600-Lb. Life: Where Are They Now? https://www.tlc.com/tv-shows/my-600-lb-life/videos/where-are-they-now

I think that calling patients liars and saying that they are delusional is confrontational. I tend to believe that Dr. Now uses these confrontational tactics because the extreme morbid obesity of his patients is an imminent threat to their lives.

It definitely makes for dramatic television. It also provides a learning opportunity for those who are watching even if they are not as overweight as the participants on My 600-lb Life. Don’t waste a professional’s time. Take their advise or stop talking to them about the problem.


You need to see a psychotherapist!

Many of Dr. Nowzaradan’s patients report adverse childhood experiences, which are known to be associated with overeating and obesity (ACE – https://acestoohigh.com/2012/10/03/the-adverse-childhood-experiences-study-the-largest-most-important-public-health-study-you-never-heard-of-began-in-an-obesity-clinic/). These patients turned to food as a way of coping with trauma and stress and experienced the onset of obesity during childhood. They have not learned other coping strategies. Since their lives are always stressful, they are always eating. They clearly need to see a therapist.

Dr. Nowzaradan has started to introduce the need for therapy earlier in his relationship with patients. I applaud that decision. People who come to him benefit when he explains, early in the game, that they need both therapy and surgery. They need to know that he does surgery and not therapy.

Many people who want to lose weight, even if they are not as heavy as Dr. Nowzaradan’s patients, might also benefit from psychological intervention. This does not mean that they are “crazy.” It simply means that there are psychological skills that can help them achieve their health and wellness goals. They can be taught, for example, to counter disordered thinking. They can learn strategies for coping with stress that don’t cause weight gain.

Trying Noom

The idea that anyone can benefit from coaching, group support, increased clarity of thought, and improved coping skills lead me to Noom. I am currently engaged in the two week trial of the app. I recommend that others give it chance. If Noom seems expensive consider the general pricing structure of one on one health coaching.

One on One Coaching Pricing Structure

Most coaches offer two sessions per month, and the session time ranges from 45 – 60 minutes.

New coaches that are just starting out charge around $50 – $75 per session.

More experienced coaches charge $100 – $200 per session.

There are also coaches that charge by the package ($1,200 – $2,400) so there is quite a range.

The more concierge services you require, the greater the cost.

What Is the Noom Diet? A Nutritionist Explains https://www.health.com/weight-loss/noom-diet

What is the Noom Diet? A Nutritionist Explains How the App Can Help You Lose Weight https://www.goodhousekeeping.com/health/diet-nutrition/a26023584/noom-diet-plan-review/

We Tried Noom: The Weight Loss App for Millinealss https://people.com/health/we-tried-it-noom/

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Inspired by 600-lb Lives

As 2018 came to an end, I realized that I needed to become more physically active. So, I took an online class. Yes, I see the irony in that decision. I need to move, so I sat and read and took exams. Yet, when the course was over I had reviewed the recommendations for physical activity, set a few SMART goals, and purchased a very simple step counter (1).

During January of 2019, I counted steps and I counted calories. I also made the arrangements for the trial of a spinal cord stimulator (scs). A psychiatrist completed the psychological evaluation required before the trial. My pain management specialist agreed to conduct the trial and we set a date. Everything was going along smoothly. Then a set of new but familiar symptoms flipped my script.

On January 30, 2019 these symptoms sent me to Patient First, an urgent care facility. Laboratory tests indicated that I had a urinary tract infection. The need for antibiotics required that my spinal cord stimulator trial be postponed. The infection was a reminder of a kidney birth defect, another surgery, and a very dark period in my life. I felt deflated. When I returned home, I climbed into bed and went to sleep.

I awoke to a voice describing a life of full body pain and limited mobility. I immediately identified with the speaker and continued to listen. When I opened my eyes, I had a very up-close-and-personal view of a human being who was obese in the extreme. The auto-play function of Hulu had taken me to My 600-lb Lifehttps://g.co/kgs/YxKGV. When the scene shifted to Dr. Nowzaradan’s consulting room, I knew that this could be a meaningful viewing experience.


How Y’all Doing?’

Watching Dr. Nowzaradan and his patients reinforced my commitment to resist the barriers to physical activity. I needed this reinforcement because my brain and my mind hold two very dissonant cognitions about movement. My brain is constantly receiving the message that movement is both painful AND dangerous. This is not a message that I can ignore because it is true. I have the falls, the fractures, the concussions, and the surgical scars to prove that this is the reality in which I live. The pain signals that reach my brain are not delusions.

The compression of nerve roots in my lumbar spine produces pain, weakness, and numbness in my lower back, buttocks, thighs, legs and feet. Since my last surgery, my right leg no longer collapses unexpectedly. However, it has not fully recovered and my brain, wisely, does not trust it. I cannot walk and chew bubble gum at the same time. Every step, every foot placement requires the active participation of a brain that has been traumatized on multiple occasions. Unfortunately, the brain, my brain, now insists that the proper course of action is to find a comfortable position and stay in it. My brain is a strong advocate for a sedentary lifestyle.

I am not naïve enough to consider being sedentary as a long term solution. I have 62 years of personal experience in coping with chronic pain. I know that my brain can exaggerate and sometimes lie to me. I have a master’s degree in health and nutrition education. I am a lifelong learner and continuing education is something about which I am passionate. I also have a mind that tends toward the rational. That mind, my mind, knows that physical activity is essential to life. At this point, my logical mind believed that if I did not move more, I would become sicker and die sooner than expected. I needed a specific type of push to break free of the uncomfortable dissonance produced by the contradictory cognitions held by my brain and my mind.

Dr. Nowzaradan and his patients provided the inspiration that I needed. Dr. Nowzaradan encourages movement using a rational approach that resonates with me. When his patients explain that movement causes pain, Dr. Nowzaradan’s response is “So what?” I have been adopting that approach to negotiate an amicable agreement between my brain and my mind.

When I first bought my step counter I was taking between 200 and 1200 steps per day. Two weeks of binge watching My 600-lb Life and my average was up to 3000 steps per day. Occasionally, I reach 6000-7000 steps in a day. This is acceptable progress for a 72 year old woman coping with multiple autoimmune diseases, lumbar radiculopathy, and a problematic kidney.

The bargaining starts every time that I stand up. My brain is uncertain that my legs will support me. It anticipates a fall with every step. My mind fights the prediction of catastrophe. I can only reach about 2000 steps before the peace talks between my brain and my mind break down. At that point I must sit and recover before moving again or the brain will make its prophecy self fulfilling. If you don’t understand how that works, I can’t help you.

Taking steps then resting several times throughout the day, requires a commitment to time and planning. It also requires that I give up some of those activities that promote a sedentary lifestyle. I just don’t have time for them.

I have an appointment for a CT Scan and a consultation with my kidney surgeon in late March. In the weeks leading up to that appointment, I need to move. As a 72 year old adult with chronic illnesses, I need to be as physically active as my abilities and conditions allow. I have definitely been inspired by Dr. Nowzaradan and his patients.

How many steps per day are enough? https://www.verywellfit.com/how-many-pedometer-steps-per-day-are-enough-3432827

ADDITIONAL RESOURCES


Sit Less, Get Active
https://www.coursera.org/learn/get-active


Physical Activity Guidelines for Americans
https://www.hhs.gov/fitness/be-active/physical-activity-guidelines-for-americans/index.html

SMART Goals
https://www.mindtools.com/pages/article/smart-goals.htm

Fitbud Step Counter
https://sites.google.com/site/smartdigitalsportpedometer/3dfitbud-simple-step-counter-walking-3d-pedometer-with-lanyard-a420s-black