"The Intuitive Eating Road Map" (AKA Basic Philosophy)

Are you excited?  Are you ready to live in a gentle universe? 

This is the blue print.  Four gentle, positive things you can do be permanently slim.

Because this program is gentle.  Instead of NO, CAN'T, and SHOULDN'T, everything is positive.

You CAN eat when you're ideally hungry, until you are IDEALLY satisfied.

You MAY, and you SHOULD eat when you're hungry.

It’s that simple.

And that hard.

If your mind was brainwashed to "you can't, you shouldn't..." it can be really hard to turn the switch in your brain.

Sometimes when we go from "can't" to "can", we just go to the opposite of deprivation ---which is---you guessed it---indulgence.

Often my clients go from famine to feast.

You can see the problem.

Feasting can actually cause weight gain.  And then comes the guilt, the shame, the frustration, and the panic.

But just because this program is about CAN instead of CAN'T, doesn't mean you go from famine to feast.

Oh no.  Remember the instructions?  You should eat whenever you are IDEALLY hungry until you are IDEALLY satisfied. 

For us moderately active, average height women, that mean a 400 - 500 calorie meal every 5 hours or so with a 350 calorie snack. 

But don't get me wrong.  This program isn't about counting calories.  Although that can be a helpful guide when you're switching from the pendulum to trust.

What pendulum you ask?

The pendulum of "in-control"-to-"out-of-control".  The pendulum of feast or famine.

This program isn't about control.

It's about "tuning in" it’s about trusting your body.

Our bodies were made to keep a steady state when it comes to weight the way it does when it comes to oxygen.

We don't stop breathing for a minute and then gulp down a ton of air (of course I'm talking to those of us with healthy lungs...).

We breathe whenever we need oxygen (oh, I know the urge actually comes from rising CO2--don't worry about this though if you're not a medical type). The fact is that the goal is to keep our oxygen at a healthy level.

Maybe you think it's absurd to talk about oxygen.  Maybe you think it has nothing in common with food.

And you might be right.  But, the only thing that's different is that you can store food (calories) but you can't store oxygen.

Because we can store food we run into problems.  Oh, it was helpful for the early humans who didn't always have food around. 

If they knew they were going to be up against lean times, they would feast.  The extra weight would tide them over until they were out of the famine.

Fortunately (and ironically, unfortunately) for those of us lucky enough to live without famines, feasting is not necessary.

For us lucky ones, Mary Poppins' adage, "enough is as good as a feast" is a wonderful rule to live by.

So.  This is all you have to do.

1.  Have a variety of delicious, healthy food available whenever you are ideally hungry. (That means salad AND mashed potatoes, AND sometimes even chocolate).

2. When you are ideally hungry, please DO eat whatever your body craves (out of that potpourri of flavors) until you are ideally satisfied.

This means NO SKIPPING meals or other strategies that will make you very hungry or extremely hungry. 

It is way too hard to eat only until ideally satisfied when we're starving.  Remember early human? 

Skipping meals was only done when there was NO FOOD (read: famine).  

And the physiology (that's right it's not just willpower), is to get you to overeat when you're really hungry.

 Notice how much you eat at dinner if you've had to skip lunch? 

So now you're probably wondering, "How do I know when I'm hungry?"

For many of my clients, hunger was a necessary evil, and so they turned off the sensors.

This is one of the things that will make it hard.  You have to turn on your sensors.

1.  How do you know when you're ideally hungry?

First of all, it's usually 1 - 2 hours after you wake up unless you went to bed hungry (read: without a snack) or 4 1/2 to 6 hours after a substantial meal.

You can do the hunger test:  Drink a cold glass of water and feel it go down into your stomach.  If you can feel it go all the way to the bottom of your stomach you are at least IDEALLY hungry.  Of course, if you already have a rumbling stomach or hunger pangs, you're beyond ideally and are either very or EXTREMELY.

2.  How do you know when you're ideally satisfied?  Well for some of you, this will be difficult.  You will be used to eating bulky food (read: salad, soup, course, bulky stuff) until your stomach gets stretched.  But you won't have had enough calories to tide you over for 5 hours. 

That's why you need to provide yourself with a variety of healthy and delicious food, both bulky and dense (read: cheese, chocolate, raisins, hotdogs, calorically dense stuff).  And do the TASTE TEST. 

The TASTE TEST:  Wait until you are ideally hungry.  Take a bite of a really delicious food, close your eyes, and think about it.  Let the flavor coat your tongue and really notice how delicious it is.  Then eat your meal.  Wait ten minutes.  Take a bite of the SAME delicious food and notice the flavor. 

It won't be the same.  Your memory will recognize it.  But it won't taste as good.  Promise.  Cross my heart.  I know it's hard to believe.  I've had clients who say, "yogurt covered raisins will ALWAYS taste delicious" but not so delicious as when your body needs them.  Try it.

So please remember, this is the road map.  You may get frustrated in the beginning.  

 

You may even get panicked. 

 

If you do, please come back to this “Road Map” and ask yourself if you are really doing everything.

 

It always amazes me that people go back again and again to dieting, or to “Weight Watchers”, never thinking that a strategy of ignoring or overriding survival cues (read: torture) FAILED them.  They always believe that failed it.

 

Well, this program WILLNOT FAIL YOU if you really treat your body well.  If you really treat your body the way you would treat your three year old, then please be patient.

 

Melting doesn’t happen overnight.  But it will happen.  Please try to think of this as an experiment, and try to stay unattached to the outcome.

 

And if you want to leave, then leave, and if you want to come back, then please come back.

 

Because a life is a terrible thing to waste.

 

 

 

Newsletter 1:

Focus On Flavor

What people were saying about Effortless Weight Control this month:

"It's really fun. It doesn't feel like a chore. I'm eating so much less." HH, at her second visit.

Will Focusing on Flavor Help You Live Longer?

I was listening to an interview on NPR the other day with a young journalist who had just finished a book on centagenerians (People who had lived into their hundreds). I was struck by one of the commonalities that she noted among the people she had interviewed. She found them all to be 'optimistic'. In hearing this, I wonder, can optimism be felt on a cellular level? And if so, how can we all be optimistic?

And you can't just decide to be optimistic. But, I believe that if you can find the universe a gentle, wonderful place, you'll end up feeling pretty secure that most things will turn out okay. That's why as parents we try to meet our kids needs as quickly and as fully as we can. As adults we may realize that our own needs weren't met as quickly and as fully as we might have liked. And yet, now we're adults, we can meet our own needs. We have the power to do that, and that's a wonderful thing.

Now, I can hear some of you saying right now, "What on earth could this have to do with flavor?". So I will tell you. Optimism is pretty illusive. There are no pills you can buy that will give it to you.

Meeting your body's need for food is no means a small thing. If you do it right, you can really make your body happy.

Fear of Hunger? Focus on Flavor.

Dear Dr. Lauren,
I know you ask us to eat when we're ‘ideally hungry'. But I don't know what that feels like, I don't think I really ever let myself get hungry.
In the questionnaire on the website, you ask if you were fed on a schedule as a baby. I was raised in the 50's and I know that when I was a baby, my mother was told by her pediatrician to feed me only every four hours. Does that have something to do with it? And how can I allow myself to get hungry enough to tune into that ‘delicious flavor'? I'm not overweight, but I want to stop counting calories

Sincerely,
Struggling Baby-boomer

Dear Struggling,

My heart really goes out to you. Having just spent the last two years feeding a baby, I know that four hours is often too long to wait for a baby to eat, especially during growth spurts. And if you've ever heard a baby cry from hunger, it's pretty intense. With my son, I know he cried more intensely from hunger than he did when he got hurt. My guess is that you have been avoiding that unpleasant feeling of hunger. And I know many who have been committed to avoiding the torture of being hungry and powerless for the whole of their lives.

There is hope. And that is to take the word ‘hunger' out of your vocabulary, and just focus on waiting until your taste buds are primed. By focusing on flavor, my guess is that you'll end up eating similar amounts of food to what you are eating now, but the difference will be that you won't have to count calories, or obsess about food. You can just eat whatever you're hankering for as soon as your palette is ready.

Take care,
Dr. Lauren
Effortless Weight Control TM
Dr. Lauren Outland
1460 7thStreet #206
Santa Monica, CA 90401
www.innerresource.com
lsoutland@aol.com
310-394-6838

About Dr. Lauren

Dr. Lauren Outland, has a doctorate in public health from UCLA. She has worked as a researcher, a midwife and professor for over 9 years. She opened up her private practice Effortless Weight. Control in 2000 serving the Pacific Palisades and Santa Monica, and has helped many clients melt into their naturally healthy weights without struggling or deprivation.

In the news

This February, Dr. Lauren is featured in First for Women, which is on the stands now. Also, Dr. Lauren had a letter published in the Jewish Journal on January 31, 2003. It was in response to an interesting article on spirituality, combating overeating, and the Jewish community. It had a fairly mainstream take on the struggle, interviewing a Weight Watcher's leader and a Rabbi who was in OA. The spiritual message was to acknowledge our evil inclinations and to take one day at a time. Dr. Lauren's response is as below.

The January 24th issue had an interesting article that had a spiritual take on obesity and Jews. I have a slightly different take on the concept that to maintain a healthy weight you have to overcome the yetzer hara (evil inclination). As a Doctor of Public Health and a weight control coach, I have been inspired by the wisdom of the human body, and by the spiritual experience of being able to listen to your ‘miraculous' body.

Remarkably, just as the universe allows us to feel satisfied breathing no more than our bodies need, the universe allows us to feel physical satisfied eating no more than our bodies need. Scientists have discovered hormones that help us be our ideal weights by eating based on flavor. This "flavor-ometer" is turned on by hormones that are released when we get hungry, and turned off when our stomachs are full and our blood sugar rises. You too can be naturally slim if you start listening to your body by eating when you get hungry, until the flavor fades. If you do this you'll find your appetite is really quite small. And if you find it hard to believe, try tuning into flavor the next time you eat a delicious meal on an empty stomach. You'll notice that the flavor really does fade as you get satisfied. And what better way to live than to the inspired wisdom of the human body.

Mission

The goal of the Effortless Weight Control newsletter is to bring science and spirituality into the lives of readers to help them to attain effortless weight control.

Newsletter 2:

The Essential and Elusive: Non-compulsive Exercise

Being the mother of a toddler, I have found myself asking the question, "when did exercise stop being fun?" Even if you aren't the parent of a toddler, maybe you can remember back to a time when it was more fun to kick a ball around the yard than it was to eat. Or more fun to jump rope than to play solitaire. My two year old seems to think he's being tortured if he ‘s made to stay still for more than 20 minutes. In fact his reaction is so intense that I have to believe that a need for exercise is programmed into our DNA the way that a need for sleep or sex is.Or how about historically. Which century did exercise become a chore for Western civilization types? Characters in British novels were always going for walks, presumably because it was entertaining, and not because they were trying to get their 3rd hour of aerobic exercise in for the week. My guess is that there exists Western and non-Western types alike who like to move because its fun. Who like to go dancing because it's fun, or hiking because it's spiritually refreshing, and not because they depend on an endorphin rush. And when did it become depressing to go for a ride on a bicycle if we don't do 50 miles in less than 2 ½ hours?

While I don't have all the answers to the apparent flight of exercise need from our DNA, I do notice a few differences between those who are thrilled to exercise and those who are driven. The first thing that strikes me is that my son, unlike many of my clients, does not cut his sleep short by two hours to dance to Sesame Street. It strikes me that it is hard to enjoy exercise when it competes with another need, like sleep. If your life is too busy to sleep and to move-maybe you need to rearrange your life. I've found that doing more doesn't necessarily get you more, but this is the subject of whole books, or even volumes. Pretending that you can find the time, this is what I recommend:

1) Do "exercise" that is fun! It's much more likely you'll stick to an exercise if it is it's own reward and you're not just doing it for the endorphin rush or out of compulsion. Also, finding an activity that you can do with others can make a moderately interesting activity even more fun. Even a book on tape, especially if it's a page-turner, can make you long for that evening walk, even if you're alone.

2) Try to do something super accessible. Studies show that people are more likely to stick to exercise that doesn't require a lot of preparation, which leads me to question why the gym is so attractive. Maybe the social factor makes it so much fun that it overrides the arduous preparation of putting things into a bag, getting into your car, driving, parking, getting out of your car, going into a locker room, and then finally getting to the exciting pieces of sweaty equipment. Anyhow, if you feel guilty not going to the gym you might want to consider all of the contributing factors to why the gym is so distasteful before you leap to the conclusion that you're just lazy.

3) Please, try to find a way to exercise without having it compete with other needs, i.e., seeing loved ones, sleeping, having fun, etc.

4) Rearrange your way of thinking. I know a lot of you are extremo-philes when it comes to exercise (at least when you're not sinking into couch potatoe-dum), and you find it hard to do ‘mild' exercise. You believe you should teach high impact aerobics 4 hours a day, or climb Mount McKinley, or prepare for a black belt in Tae Kwon Do.

And yet the health benefits are there with even the most modest exercise. Studies show that any kind of movement is better than none. Try to remember that your body was programmed to move. Maybe your task is just to find the best match for you. Maybe you'd rather play hopscotch than run 4 miles. Maybe you'd rather go rock climbing than swim 50 laps. Maybe you'd rather go dancing than do 20 miles on your stationary bike. I will allow that you may actually prefer to run, swim, or bike. But before you jump to that conclusion, you may want to let your imagination run just a little bit wild. For example, did you know there are skipping clubs?

The goal of the Effortless Weight Control newsletter is to bring science and spirituality into the lives of readers to help them to attain effortless weight control.
"I just had to call to tell you that what you predicted came true. I never could have done it without you! I got an administrative job...I'm making $35,000 more than I was before! I have a beautiful new house , my health is stable. I'm getting the life I want. It's fascinating ...what focusing on giving your body what it wants will do for the rest of your life! ... I couldn't have done it without you." - Allison Berman ( Former Radiology Tech,Currently Health Care Administrator,Alta Dena, CA)

We're on the web! www.innerresource.com

Newsletter 3:

What Could Karen Carpenter And Roseanne Barr Possibly Have In Common?

Well, first of all, since I have little or no specific information on either of these celebrities, I could just as easily have entitled this piece, "What could an anorexic and an overweight person have in common?" The point being that often the icky feelings that drive an anorexic to starve are sometimes the same ones that drive someone who's overweight to eat. An anorexic could feel scared, angry, alone, misunderstood, unseen, could have the same underlying feelings of inadequacy and powerlessness as someone who's overweight. In fact, in my practice, both disorders come from a desperate need to be seen, acknowledged, empowered, and loved. In both the anorexic and the obese, their needs and/or their essences were ignored by those who mattered most. The anorexic pretends it doesn't matter because she doesn't really need anything, the overeater pretends that it didn't really matter because he can make up for it by stuffing himself full of food as a substitute for sustenance and love.

Sadly, to err is human, and often parents unwittingly neglect their children's needs. Maybe their own needs compete with what their children need. Maybe they're in denial, wandering around pretending all is well, and are therefore blind to what their children really need from them. Whatever the cause the result is similar. If our parents our ignorant about what we need we find ourselves faced with a dilemma, We can't just simply conclude that our parents are unreliable. That makes us too unsafe, feel too powerless. We want to come up with an answer that gives us some power. So guess what? We try to get power by changing ourselves. We may change our attitude: talk ourselves out of our needs and often reducing all of our needs to food. Hoping to believe that if "I don't really need to eat when I'm hungry" then I'm actually safe, and I can hold onto the illusion that my parents are reliable. It all comes down to needs. In the case of anorexia we deny our needs, in the case of overeating we overcompensate for them.

BUT, at the same time, our survival instincts kick in making us long for more love, attention, nourishment, and food. And then we might decide to change our behavior. We might opt to live under the illusion that, "I only need food to make up for all the needs that aren't being met", or "At least I feel fulfilled when I'm eating", or "I feel like Mom loves me when she's feeding me, so if I eat I will feel loved and complete". In the case of anorexia we deny our needs, in the case of overeating we overcompensate for them. In both cases we try to make food solve the problems of emptiness, powerlessness, and the fear we feel.

And sometimes, we alternate between both strategies. We grow up with a war going on inside us. We only feel safe when we're full, and/or we feel unsafe if we're full. We only feel safe if we're starving, and/or we feel unsafe when we're starving. I know I don't need to tell you that this is a torturous way to live, damned if you do and damned if you don't. Some of us choose starving, some of us choose gorging, and some of us alternate between starving and gorging, sometimes in the same day. For others of us, the cycles last years.

So what's the solution? Well, while Hollywood would have us believe that skinny is the opposite of heavy, or that Karen Carpenter is the opposite of Roseanne Barr, this is not true. In both cases food is used to solve life's problems. And I'm here to tell you that the solution isn't to banish one way of thinking in favor of another.

The solution isn't to banish denial in favor of overcompensating, or banish overcompensating in favor of denial. You'll never get off that merry-go-round. The solution instead is to reprogram yourself to meet your true emotional needs, and listen to your body to meet your true nourishment needs. Tune in next month to find out how!

Ask Dr. Lauren: Eat What I Want!?

Dear Dr. Lauren,
I still have a "you are evil" reaction to you telling me to eat whenever I want. I am still struggling with trusting that this will work and that I won't have to starve to get thin. But my belief system about eating, whenever and whatever, is severely being challenged. I don't see a way to get thin by this model, but I am trying to trust that it will magically happen somehow.

Sincerely, Doubting in Hollywood

Dear Doubting,
The advice is not eat whenever and whatever you want. This muddles up emotional cravings with physical hunger… The advice is rather, "eat only when the flavor is ‘wow'". This message is much different. This message says that when you listen to the wisdom and the miraculousness of the human body, you will eat what you are divinely inspired to eat, and weight what you are divinely inspired to weigh. In doing this you are following the divine wisdom of the universe (G-d).

I know many of my clients struggle with being able to trust their bodies, and I'm sure many of them immediately dismiss what I tell them about the "flavor-ometer". So determined they are to believe that their bodies are untrustworthy. And like you, I even had one client admit that whenever she heard me say, "most people find that they need three meals a day", a voice popped in her head that told her I was the devil.

Perhaps you also believed like her that the human body has an insatiable appetite, and that if she notices a delicious flavor she'll go off the deep end and eat everything in sight. But it probably goes even deeper than this. As the lead article (What Could Karen Carpenter…) says, children often prefer to believe "I don't really need to eat when I'm hungry", than that they couldn't trust their parents.

The advice is not, "Eat whenever and whatever you want"
The advice is rather, "eat only when the flavor is 'wow'".

You may want to ask yourself if you too are determined to rewrite history by believing that your own, divinely inspired, miraculous body betrayed you instead of noting that your mother couldn't be counted on….And also like the article, perhaps also underneath your ‘don't need anything' view is the opposite one that you did need more, that you didn't get enough food or love. Maybe this voice thinks your anorexic views are unsafe. This reaction may cause you eat just a little more or a lot more than you need to when you do allow yourself to eat.

The key is, if only your body could trust you, you could trust your body.
Sincerely,
Dr. Lauren

What the Universe Doesn't Want
Quote of the Month

"Whenever I watch TV and see those poor starving kids all over the world, I can't help but cry. I mean I'd love to be skinny like that, but not with all those flies and death and stuff."
-Mariah Carey

Profile of a Naturally Slim Person: 14 Year Old "Shuli"
LO: What's your favorite food?
Shuli: I guess barbecued Chicken.
LO: When do you normally eat?
Shuli: At meal times, before bed and sometimes in the afternoon if I'm hungry.
LO: Do you normally skip meals?
Shuli: Oh no, sometimes I'll eat breakfast late. And one time I fasted for 30 hours to rase money for world hunger projects…
LO: When do you normally think about eating.
Shuli: Maybe 15 minutes before the meal. But my family tells me I sometimes forget and don't know that its dinner time until I'm called to go to the table.
LO: Aare you hungry when you eaat your meals?
Shuli: Usually I'm hungry. If I'm not I just eat a little.
LO: When was your last memorable meal?
Shuli: Probably at my birthday last month, we had take out pizza. LO: Hmm, take out pizza..? Shuli: Well, we don't have that very often.
LO: How do you know you've had enough to eat?
Shuli: When there's no more food on my plate and I don't feel like another serving?
LO: You mean like the 'clean plate club?'
Shuli: Oh no, it's just that I usually put very small helpings on my plate.
LO: Can you describe how it happens that you don't feel like eating anything more?
Shuli: Well, I notice things don't taste as good as they did when I began.
LO: Do you ever feel stuffed after a meal?
Shuli: Well, sometimes on Thanksgiving.
LO: Do you feel guilty when you do eat too much?
Shuli: No, just Ooh, stomach ache
LO: What do you fantasize about doing when you're doing your homework.
Shuli: Well, like sometimes I like doing homework, but sometimes I can't wait to do ballet or play a computer game like Roller Coaster Tycoon.
LO: How do you keep your slim figure for ballet?
Shuli: I don't know, I really don't think about it, or worry about it.
LO: Have you ever gone on a diet.
Shuli: No.
LO: Do you know any one who has?
Shuli: I think my mom did once. The goal of the Effortless Weight Control newsletter is to bring science and spirituality into the lives of readers to help them to attain effortless weight control.

We're on the web! www.innerresource.com

Newsletter 4:

Are You Afraid to Be Slim?

Do you reel in horror at the thought that you could actually be afraid to be slim? Or do you simply pooh-pooh the idea before you even let it sink in? If so, you may be doing yourself a disservice. It's true that most of us connect to the "thin mantra" that flows through almost everything we see in our culture. And it's true that most of us hear our conscious minds crying out to be thin, or feel shame at being heavy. And yet, believe it or not, there are many reasons why being bigger would be beneficial at another level. Fortunately or unfortunately, we are more than our conscious minds. We often have complex, conflicting beliefs or feelings.

Reason #1: Safer if Bigger

(also known as Size as Safety if you do the online questionnaire). It may be hard to imagine how you could feel safer or better in any way in a world where thinness is worshiped so. But remember, beliefs about size and safety don't develop in our minds when we're rational adults; they are created when we are helpless, irrational children.

One of the most common reasons why a child would want to be bigger is to deal with abuse. When a little kid is beaten up by the neighborhood bully, how does he fantasize about stopping it? Does he imagine taking a class in diplomatic skills? Does he imagine hiring a bodyguard? Does he imagine moving to a different neighborhood? Not usually. Kids don't have that much power. They generally just want to be bigger than the bully. And you don't necessarily have to be beaten up to wish for bigness.

Smallness can be a metaphor for lack of opportunity, weakness, and helplessness. For example, Tom Hanks' character in Big wanted to be bigger after being turned away from a roller-coaster ride at the carnival.

Extra size can make women feel safer sexually. Oprah had an interesting show a couple of years ago, when she had survivors of sexual abuse (many of whom were very overweight) close their eyes and imagine how they would feel if they were confronting their abuser. She then had them imagine themselves becoming smaller and smaller as they stood there in front of their abuser. Many of the survivors began to cry.

Children who were molested often fantasize about or creating a buffer of protection or becoming sexually invisible. That often translates as "add more fat". Even if you weren't molested, you still might find comfort in becoming bigger or by getting super thin.

To cap off the Size as Safety rationale, is the desire to undo scarcity. For those people who have weathered famines, either true geo-political famines, or those caused by a careless parent, extra weight can be like an insurance policy. For any family that lost a child to diarrhea and malnourishment, there becomes an unspoken rule to overfeed that may last for generations.

And the experience of scarcity doesn't need to be that tragic or severe. For me, being a poor student, led me to gorge myself on the occasional free meals I'd get working in the student union. That experience forever changed how fast I ate, how full I got, and added an extra five pounds, presto.

Reason #2: A Way to Communicate:

Imagine, if food = comfort, and you're big, that could send pretty powerful message. The message you could want to send is that everything is not okay. And, if you take it one step further, you could be saying, "I need comfort (love, nurturance, etc)". But does it get you comfort, love, and nurturance? I doubt most overweight adults would say that they get more TLC from friends, family, or strangers because they're fat. It's not a strategy that a rational adult would choose.

Instead, like the other reasons for being attached to weight, it is a strategy that developed when we were powerless, children. It's another strategy that doesn't work for us as adults. And it's sad that we would have to harm our bodies with unwanted fat just to put out a call for help.

If you think that this belief is sabotaging you, you could find ways to take care of yourself, and express your needs. Consciously you may want to be slim, but subconsciously you may not want to give up being rescued from the harsh, lonely grind. If you find yourself using food as one of the few ways to get nurtured, you might want to ask yourself how you would feel if everyone saw you as slim?

We're on the web! www.innerresource.com

Reason #3: A Way to Pacify a Jealous Mother:

Many years ago, when I was still an undergraduate, I bumped up against this tragic reason for being bigger. One weekend I went to stay at a friend's house a couple of hours from our college and when I met her family, I was shocked. Here were three big daughters, an average dad, and one very skinny mom. I guess I expected her mother to be a big Italian mother, like her big Italian girls, but she was not. Her mother was extremely thin, and you knew she liked it that way.

When I looked through a family photo album, I saw that Amy*(not my friend's real name) and her two other sisters had been huge even as babies. I remember thinking, "How did her mother get them to eat so much?" And I remember finally getting this eerie intuition that her mother must have unconsciously feared competition from her three gorgeous daughters.

It was just a hunch; I had no training in psychotherapy or eating disorders. But it is a hunch that was probably accurate, as I have seen it over and over again in my clients.

How can a daughter shine without outshining her mother? Well, if the mother believes success equals slimness, the daughter can be fat. Or the daughter can be a failure and be thin. Or the daughter can redefine success and slimness and eventually find freedom, but this is no easy task. The only way out of this terrible trap is to remember that you have an obligation to share your special gift with the world.

The more you feel a spiritual mandate for ‘success', the less terrifying it is. The more you make life about realizing your soul's purpose, and less about finding glory or standing in the spot light, the easier it is to be free. The easier it is to let your body determine your weight. And the easier it is to let your special gift determine your destiny.

Reason #4: Weight as an Excuse:

And finally, weight can be used as an excuse. As one of my clients quoted from one of his readings, "For many people, a good excuse is more valuable than accomplishing something good" (Eric Hoffer: Passionate State of Mind).

The sad thing is that many people don't even realize that they're holding on to those last 20 pounds because of fear. Fear that if they lost the weight, they'd have to start dating, or find a new job, or go climb a mountain, etc. If losing weight or controlling your weight can make you feel successful, then it can also be a nice excuse for why you're not successful. And sometimes, it actually helps relieve the pressure of performing, so that some people are very successful precisely because they have extra weight.

Whatever the reason for being afraid to be slim (and this list is by no means exhaustive) the bottom line is, its helpful to pay attention to compulsive eating. Do you find yourself compulsively eating? Or do you get anxious when you lose a few pounds? If so, you may want to ask yourself if extra weight is helping you in any way, however warped the reasoning might seem. Or if you feel you're "eating correctly" and stubbornly holding onto weight—use your imagination and ask yourself if you might be using weight to solve a problem. Also, feel free to go to the website and take the questionnaire, or email me.

There are practically no problems in this day and age, or time and place, which can be solved by being bigger. On the other hand, it is always a good time and place to tune into the wisdom of the human body when satisfying a physical need. Making weight control effortless, frees up a lot of energy, makes the universe a gentler place, and helps you realize your soul's purpose and your life's dreams.

Profile of a Naturally Slim Person:Veterinarian "Janet Berens"

LO: You know Janet, some people may look at you and think, "She can't possibly like food as much as I do, look how slim she is". How do you feel about food.
JB: I love food! My favorite food is spicy ethnic food, like Thai or Mexican.
LO: What was it like growing up in your family? Was everybody slim? What messages did you get about food?
JB: Both my parents were slim. In fact, my dad was kind of small, and he wanted my brothers to be bigger. He would make us sit at the table until our plates were clean.
LO: I guess you rebelled against that.
JB: (Continued) We all seemed to except for one of my brothers. For my brothers, sometimes that meant staying there until everyone else left the table and the dishes were washed.
LO: No wonder you all rebelled it sounded like torture! What's an ideal day of eating like for you?
JB: Ideally, I'd wait a few hours to eat breakfast, and then I'd have a large breakfast, either pancakes or a brunch where there is a wide variety of things. Then I'd probably have a small lunch and then a later dinner. Ideally, I'd go to an ethnic restaurant where they had spicy food, oh, and I ‘d have a glass of red wine.

Ask Dr. Lauren:

Is Your Suffering Actually Sabotaging Your Weight Loss? Dear Dr. Lauren, I am so frustrated with myself. I understand the principles of how I should be eating. I know I should eat when I'm hungry, stop when I'm full and eat what my body wants. I think about these principles every day and even though I am eating what my body wants, I get over full at least ¾ of the time, wait way too long to eat at least half the time. I just can't do it! I feel stuck and I'm so frustrated. I know I am a self-saboteur, but I did start a business last year that's doing pretty well. Can you help me? Own Worst Enemy Dear OWE, How interesting that you can give your body what it needs but not when it needs it. My guess is that the extra pounds creep on when you wait too long, because waiting too long causes your body to go into rebound eating usually, of an extra 60 –200 a meal. If you stop to think that an extra 100 calories a day = 10 pounds over the course of a year, that adds up. Waiting too long also puts your body into ketosis, which could send a signal to your hypothalamus to slow down. And we all know a slower metabolism makes it harder to burn up the calories you do eat. So unless you're incarcerated, you really do have control over how and when you eat. Sometimes the weight comes off like magic as soon as you honor your hunger. Naturally slim people manage to eat as soon as they get hungry almost all of the time. It's a priority. The question is, "why isn't it a priority with you?" You pointed out that you are a "self-saboteur" which to me means that you have a very critical voice in your conscious mind that tries to talk you out of fulfilling your soul's desire. The fact that you launched a successful business tells me that; 1) either your desire for business success was greater than your desire to be fit, and/or 2) you had more negative chatter about weight and fitness than about business. Whatever the exact reason, the point is that you now have a blue print for success. You, an admitted self-saboteur have realized one of your life's dreams, to start a successful business. My guess is that your conscious mind was full of negative chatter while you were getting it off the ground. You probably had plenty of doubts and fears. But you were able to make huge strides in spite of them. With food you're able to give your body what it needs in terms of nourishment. That's another blue print. You could apply that to giving food to your body when it needs it. You don't need to listen to the chatter. You can just ignore it. And in doing so, can you have the life you want, AND the healthy and fit body you crave. Sincerely,
Dr. Lauren We're on the web! www.innerresource.com

Newsletter 5:

In the News: Emotional Eating in Fitness, featuring Dr. Lauren

Back in February, after interviewing yours truly, journalist, Kristyn Kusek wrote an article on emotional eating for Fitness Magazine called, "Beat Your Eating Triggers" (p. 68)

Some of the readers were so moved, I actually received phone calls about it. One caller said, "when I read the article in Fitness, I realized I ate out of sadness. I knew then I had to do something about it."

Now, most of you are aware of emotional eating. This is the one category of overeating that gets a lot of attention. A TV character breaks up with a boyfriend and has to eat a gallon of Haagen-Dazs. And most of us also know that eating to feel better doesn't work.

"...The habit of using food as a way to change your state of mind usually backfires. ‘ Those who eat to get happy usually feel worse—not better—after a binge' says Outland.(continued on page 2) The first step to conquering emotional eating is to identify what triggers your binges.‘Once you figure out what fuels your binges you can develop healthier ways to cope', says Debra L. Franko, PhD., program director of the Harvard For more insights into your eating patterns, take our short quiz, devised with the help of Lauren Outland, PhD, owner of Effortless Weight Control and a life coach in Santa Monica CA

Part A: Trigger: Sadness * Why do you do it? *

'People who aren't ‘emotionally full' eat to become physically full to create a satisfying, calming feeling', Says Outland. Unfortunately, the habit of using food...usually backfires. ‘Those who eat to get happy usually feel worse— not better after a binge', says Outland.

Break the habit:

Sometimes the only way to lift your spirits is to let yourself feel sad for a while, so have a good cry, write down what's bothering you, watch a sappy movie, or call a friend. (Or splurge and do something really nice for yourself like get a massage)

Part B: Trigger: Boredom * Why do you do it? *

Using food as entertainment is common among women. ‘When we're at a loss about what to do with ourselves, it's easy to revert to our old patterns of finding something nurturing and pleasant to occupy our time,' says Outland.

Break the habit:

The next time you catch your hand in the cookie jar, ask yourself if you're truly hungry. ‘Do something else for 10 minutes and then see if you still want the food', suggests Outland.

Part C: Trigger: Stress/Anxiety * Why do you do it? *

For starters, eating allows you to focus on food, so you can literally tune out the source of stress by putting hand to mouth...Also certain foods like carbohydrates...raise levels of serotonin [a brain chemical that de-stresses]….

Break the habit:

To ease stress more productively, shift your focus from the source of your anxiety for a few minutes. Play a game of solitaire on your computer, or stomp out your worries with a walk around the block, suggests Outland. (Also) becoming more mindful of what you're doing can help. Use as many of your senses as possible to really get into the moment. For example...smell the potpourri on your desk, feel the nubby carpet under your feet...

Part D: Trigger: Anger * Why do you do it? *

'Chewing may be an easier way to release tension than dealing with what's really got you upset…'Explains Franko. (And we often punish ourselves as a form of revenge—more on this later).

Break the habit:

When you feel your emotional temperature rising, determine the real cause of the problem and face it directly', advises Outland…‘If you're upset with someone, write that person a letter. Just getting your thoughts on paper can help you deal with your feelings.'

Part E: Trigger: Food as a Reward * Why do you do it? *

You might have grown up in a family that commemorated (or rewarded) every special event with food. Or it might be a symptom of what Outland calls "busy woman syndrome," in which eating is the only indulgence you have time for: When you finally finish that report, you swing by the Dairy Queen for a sundae.

Break the habit:

The next time you need to celebrate, choose something non food related that will enhance or prolong your good mood. (And for goodness sakes, take time to smell the roses—you only get one life).

Part F: Trigger: It's Within Reach * Why do you do it? *

'Exercising self-restraint can be especially difficult if you faced with something you really like,' says Kimball." (I would say amend that by saying, if you're faced with something you're ‘wired' to like. Naturally slim people choose food only when they're hungry because it tastes best at that time. They generally don't have to exercise ‘self restraint'.

Break the habit:

Once you have gotten attached to eating when the flavor is wow, you still may find yourself reverting back to old habits, especially when your plate has a ton of food on it, or you're exposed to delicious free food. I don't believe in making people swim upstream. For restaurant dining, my recommendation is to either order things a la carte or put half your food in a to go back as soon as you get it. For free food, ask yourself when you think it might taste best, and then let your body decide when it wants to eat the goodies; when the flavor's wow or just so-so

Ask Dr. Lauren: No Time, No Money

Dear Dr. Lauren,

I'm a single mom with no extra time and no extra money. But I don't want to be penny wise and pound foolish. I know I spend a lot of energy obsessed about not eating or obsessed about eating too much. What can I do?

Sincerely,
Ambivalent Mom

Dear Ambivalent,

The answer is FOCUS ON FLAVOR! I know you've heard me say this before (March 2003 Newsletter) but you can really get a lot of mileage by tuning into flavor. The fact is you really can't go wrong if you eat when the flavor is wow. However, I also know that many of you are disconnected from hunger and flavor. This often happens under the culture of deprivation. When you steel yourself for a diet, your body becomes your enemy, and you don't want to think about how hungry you are or how good food tastes.

And now I'm telling you that that's your salvation. If you can truly become "addicted" to eating food when the flavor is wow, you will eat only what your body needs. And that means no extra weight. Because eating when the flavor is wow means no extra calories. Hmm.

Now, the key is knowing when the flavor is wow. And for those of us who have tuned out—it's sometimes tricky to tune back in. I know many of you say, "ice cream is always a 10". And while Ben & Jerry's Praline Pecan may be stellar in terms of quality, it may not always be a 10 for everyone or even you.

It may be a 10 after a small dinner of poached salmon and spinach salad. It may not be a 10 first thing in the morning, or at 4:00 if you skipped lunch. Humans usually prefer intensely sweet things after a bit of protein, not on an empty stomach. How about you? When do you enjoy ice cream most?

Flavor depends not only on the quality of the food and your level of hunger, but on how well it matches what your body wants and needs.

Most of us want some carbs in the morning. Notice what happens when you eat protein—the flavor may fade quickly—but then with a bite of toast or potato, your taste buds are rejuvenated. Isn't that interesting?

In any event, what ever you hanker for, or whether or not you believe me, just try tuning into the three components of flavor. Also try to remember that your body just may be your ally. And the universe just may be a gentler place to live.

Sincerely,
Dr. Lauren
drlauren@innerresource.com
310-394-6838

Profile of a Personal Trainer: Helping People Look Good from Inside Out

Deborah Stern, in just four years has created a thriving personal training business. Her background? Psychology and nutrition, and the fact that "I have been training myself forever".

LO: I know I'm in the minority, having never set foot in a gym in my entire life, so I especially want to know, what makes people want to see a personal trainer?
DS: Sometimes it's hard to get motivated to go to a gym unless you have an appointment. Also, with me they get more out of the gym. And a lot of my clients think all day long. When they come into see me, I do all their thinking for them, they get a good workout and don't have to think about it.

LO: What do you look for in a client?
DS: I used to think I wanted them to want to become healthy and aware. However, I have many resistant clients and I love them dearly. Now, all I want is for them to be willing to set foot in a gym. LO: You came here from Chicago 4 years ago, do you notice any differences between LA and the Windy City?
DS: People are way more obsessed with looks here.And the constant comparison with others really kills a person's inner self. On the other hand, even though there's more shallowness out here, people are more conscious of their health.
LO: How do you deal with the comparison mentality?
DS: If some body comes to me, I help them become more aware of their body, connecting to their body, not just their looks. By focusing on how they feel instead of how they look, everything else falls into place. I like to say I help people look good from the inside out.

Newsletter 6:

Losing Your Soul as You Lose Weight?

Pretend you're given a choice between two ways of controlling your breathing. The first choice allows you to hook into the body's miraculous, automatic system. If you need more oxygen, you will automatically breathe more deeply and more often. The second choice is to consciously count the number of breaths you're taking and try to keep it between 12 and 20 times a minute. To successfully do this, you'll probably need a pulse oximeter (a machine to check oxygen levels) in case you forget to breathe, or in case you hyperventilate. Of course, no one would want to have to consciously control their breathing.

Not only would it be dangerous, but it would waste so much energy! Imagine, always having to count the number of breaths. And yet so many of us choose to count the number of calories, or the number of carbs, or the grams of fat.I know breathing is not exactly the same as eating. There clearly are differences between food and air. You can store food and you can't store air . And counting calories isn't as dangerous as counting breaths. Nor does it take quite so much energy, as you can go longer without eating than you can without breathing.

But eating does satisfy a physical need. And taking over conscious control does take a lot of energy. Also, it takes even more energy to control your weight the more mixed up messages you have around food .(see issue 4, "What Could Karen Carpenter…" or Issue 5, for a description of common mixed up messages. Or take the quiz on the Website). Simply put, body centered eating frees up energy for your goal.

Relying on our miraculous bodies to control physical needs also helps us resonate with trust. Whereas relying on our puny minds to feed us properly keeps us living on the edge. I am reminded of Maslow's hierarchy of needs. Remember him? Well, Maslow said that it's hard to be actualized if your basic safety needs aren't being met.

What I would like to know, is why anyone would want to waste precious energy controlling a physical need when the need could be controlled automatically. And, in turning over control, so much blessed, psychic energy could be released.

What I would like to know, is why anyone would want to waste precious energy controlling a physical need when the need could be controlled automatically. And, in turning over control, so much blessed, psychic energy could be released.

I have seen so many clients become actualized and change their lives as they learn to turn eating back over to their bodies. They have started businesses they'd always dreamed of starting. They have found creative solutions for educating their children. They have increased their salaries and found better jobs. They have gotten promotions, met the loves of their lives… And in freeing up energy, you could be that much closer to being the person you were meant to be. Maria Nemeth in her book The Energy of Money points out that most of us want to think that we did what we were meant to do on this earth.

The bottom line question is, "Can your soul really afford to be trapped in a conscious struggle over food?" You decide.

What Stage Are You In?

Many of my friends and clients are dismayed when they don't become naturally slim overnight. When we want something desperately, it is hard to wait, I'll grant you that. In fact, that's probably why the miracle "diet" pill industry makes millions of dollars each year, while the obesity rate just keeps increasing. This usually results in losing a few pounds in the beginning, only to have rebound weight gain later on.

Another pitfall is to mistakenly believe Effortless Weight Control® means you can eat everything and anything anytime. This usually causes you to gain weight in the beginning. In reality, learning to tune into your body's needs after a life time of ignoring them, takes time. The more insight, courage, and faith you have, the faster you might learn these skills. But for everyone, there is a process to go through.

And yet, some of the most rewarding things in life, we have plodded away at. Many of us have spent years getting university degrees, starting a business, healing in therapy, or mastering a sport. When we can see that all of life is a journey, it's easier to surrender to the idea any worthwhile transformation has a natural life course.

But of course there's also the opposite tendency to want to rush our way through something. And there are pitfalls when we do that.One pitfall is to use Effortless Weight Control® like a motivational speaker to help you muster up will power to control your weight.

To describe these stages I cite the body centered eating guru, Geneen Roth. She has noted that previously control/out of control eaters go through stages as they begin to trust their bodies to tell them when to eat. Of course, not everyone goes through each stage in exactly the same order, this is just a guide after all. In fact I've seen some clients stuck in three stages at the same time. The following represents excerpts reprinted from the book, Why Weight? Plume, 1989.

Stage I:

Acknowledging That There is a Problem, that the problem is more complex than simply being overweight, and that dieting does not, and will never, resolve it.

Stage II: Beginning/Rebelling Against the Years of Deprivation

Physical Aspects:

• Eating mainly "forbidden" foods; eating all the time—not just when hungry and until satisfied.Learning what hunger, satisfaction, and fullness feel like.
• Learning what makes eating pleasurable (not reading or watching TV, eating slowly, etc)
• Possibly gaining weight

Emotional Aspects:

• Relief and exhilaration at not dieting.
• Panic and fear that this stage will go on forever, and that because this looks like a binge, breaking free is no different from bingeing. Sometimes there will be a feeling of hopelessness, a feeling that there is no end to compulsive eating.

Tips:

• Don't Panic at the weight gain. It is not atypical, and it is a natural reaction to years of deprivation. You will not gain a hundred pounds.
• Throw away your scales, or paste your ideal weight on them.
• Try to distinguish between foods you think you want (because before you weren't allowed to have them) and foods you really do want in the present.
• This stage will end. Do not go on another diet because you are afraid the stage will never end.

Stage III: "The Middle" Nitty Gritty/Learning-to-Trust-and-Befriend-Yourself Stage

Physical Aspects:

• Eating without guilt
• No more bingeing
• Weight Stabilizes.
• Distinguishing foods you really like/want from those that were previously hummers/beckoners).
• Ability to eat only a bite or two of chocolate.
• Foods other than sweets begin to taste good—you learn what nourishes you.
• You begin to have faith in body-wisdom as you see that you can eat what you want and not gain weight.
• You eat when you are hungry although, often, don't stop at just enough.

Emotional Aspects:

• The mind still wants more food than the body, which is a little difficult to accept.
• A lot of joy in realizing that after all these years, your body can still get hungry.
• A sense of power develops as you see that you can control food—it no longer controls you…..

Stage IV: The Joys of Breaking Free

Physical Aspects:

• Weight loss occurs—slowly!
• You eat what you want, stop when you're satisfied.
• What you want has drastically changed from Stage II. What you want now are usually nourishing foods with occasional or small bites of sweets instead of large amounts of sweets and occasional scrambled eggs.
• You enjoy your body. You accept your body, even though it is not perfect.
• Food becomes delightful, rather than a source of pain.
• When you're not hungry, you don't think about eating.
• You can go anywhere, have any kind of food in front of you, without going on a binge/eating compulsively.

Emotional Aspects:

• You ask for what you want as well as eat what you want.
• You feel better about yourself than you ever imagined you could feel. You are self-confident, self-trusting.
• This confidence and trust extend into many other areas of your life—your work, your relationships.

You must admit, the "Joys of Breaking Free"sound pretty wonderful. Even miraculous. You decide if you want to spin your wheels searching for magic, or pay your dues and embracing a miracle

Newsletter 7:

Ask Dr. Lauren: The Torment of Tallness

Dear Dr. Lauren,

I'm 5'9" and weigh 150 pounds (yikes!). I could be okay with this, but I want my clothes to fit better. I was 130 a few years ago, which was probably too thin, and it was very hard to maintain, but I'm struggling now and I'm not even being rewarded for it. Can you help me?

Sincerely,
Struggling!

Dear Struggling,

Your plight is indeed very sad. No wonder you're struggling. It appears that you have decided to swallow our sick society's view that you need to be a size six. This is an unrealistic expectation, and if you meet it you will be UNDERWEIGHT! It's all about proportion. You should weigh more at 5'9" than you should weigh at 5"3". At 5'3", a size 6 would be a healthy size. At 5'9", it frankly verges on freakish.

You are right At 5'9", 130 pounds is too thin, for someone with average bone size. The weight you should be and hence the size you should be, depends on your height and your bone structure. In fact, the height to weight ratio for someone 5'9" who weighs 130 is the same as someone at 5'1" who weighs 100!

What really saddens me is that you aren't giving yourself a break. Aside from the grossly morbid fashion industry, everyone else takes your height into consideration. Why can't you? Why do you evaluate your worth based on the fashion industry's skewed view? Why can't you feel good about how intrinsically wonderful your healthy weight body is: how your body moves you, it agility and stamina?

What if you wore size 10 and the clothes hung really well on you and you looked great? What if you could stop struggling, and free up enough energy to do the things you were meant to with your life? Wouldn't that be the best reward?

Sincerely,
Dr. Lauren

Newsletter 8:

Is Your Thyroid making You Fat? Book Review & Commentary

After much deliberation, I decided to share this landmark book with you. Sandford Siegal, MD wrote Is Your Thyroid Making You Fat? After working for more than 40 years as a weight control expert.

Motivated by the desire to help his clients, he developed a way to diagnose low thyroid without depending on blood tests. Like me, Dr Siegal was convinced that many of his patients were hypothryoid even though the blood test said that they were normal. And to him I say, "Right on!" Hormonal blood tests are notoriously variable from day to day, or even hour to hour. And the single test of TSH (thyroid stimulating hormone) may not tell the whole story.

Unfortunately, Dr. Siegal still believes in diets and part of his diagnosis strategy involves a 1000 calories a day diet for 28 days! Yikes.

For this reason, I had misgivings about showcasing his book. I know the idea of diets can be so appealing…And yet, they are what I suspect is at the root of much hypothyroid these days.

If you suspect you are hypothryoid, you can begin today with some self diagnosis.

1) Buy a basal body temperataure thermometer, and record your temperature every morning before you get out of bed, or drink or eat anything, for 28 days.

2) Keep a calorie count for 14 days, weighing yourself at the beginning and at the ened. For women, if you still get your period, begine the 14 days mid cycle. Or, if you have a lot of weight fluctuation, keep a calorie count for 28 days. Next month we'll tell you how to interpret the results, or you can call the office.

The Mystery of Weight: A Review of the Thyroid Literature

Doing a lit review from the archives of the Santa Monica Public Library from my living room is a rewarding but distinctly different experience than searching for articles from one of the stsools in the bio-med Library at UCLA.

But alas, I did turn up a number of interesting things. The first of which is a confirmation of the appalling phenomenon in Medicine of the right hand not knowing what the left hand is doing.For example, I was always disturbed by the scientists who kept studying weight loss and gain in American adults, who didn't seem to know anything about catch-up growth in Egyptian children. If they had, they would have latched onto the truth about diets long ago—they just don't work.

The human body was meant to "catch up" to it's previous weight. That's how we as humans have withstood famines and survived. Part of the puzzle as to why we are so good at returning to our previous weights has to dowith thyroid.

And the recent studies show some interesting things. First of all, I found mega info that the human body is smart (big surprise). We we eat a lot, our thyroid revs up. Two studies on obese children show higher levels, not only of the thyroid hormones T3 and T$, but also of the pituitary, thyroid stimulating hormone (TSH). This is interesting because conventional, medical, wisdom says that TSH only goes up if T3 and T4 are low—the classic negative feedback system. Clearly there are other triggers to increasing TSH than simply low T3 and T4.

The other interesting thing in both of these studies is that after the kids lost weight, their T3 and T4 levels went down, but their TSH levels remained high. This is an interesting finding, because once again, in medicine, high TSH meant hypothyroidism a condition for which the doctor would prescribe thyroid medicine. Other studies whoed that among healthy adults, weight loss decreases thyroid hormones and adrenaline, where as weight gain increases adrenaline production and thyroid hormones. What is the bottom line? All this research just goes to show you that you can't fool mother nature!

Giving into Hunger—The ticket to Permanent Weight Loss

Do you find it hard to believe that doing the opposite of dieting will help you keep your weight down? Do you subscribe to the school of thought that says you have to suffer to be slim? Well, you may want to rethink this.

Fifty years of scientific studies show that when you go on a diet, you are likely to gain back more than you lost. A hallmark study done after World War II, put normal weight men on a strict diet. They all lost a lot of weight. But guess what? One year later, they all weighed an average of ten percent more than before they dieted. Diets are brutal -- and they have the opposite effect in the long run.

So, the first thing you have to do is treat your body nicely. When you do that, it trusts you. When your body trusts you, it needs very little. When it doesn't trust you, it wants to splurge.

Imagine the wife who's married to a man who comes home every night with a rose and a kiss. It's not much, but my guess is that his wife is pretty happy with him. Imagine another wife. Her husband goes to singles bars until all hours of the morning. Probably not even a dozen roses nor a dozen kisses would make that wife happy.

Well, it's the same principle with your body and hunger. If you starve it, it will never be satisfied. But if you feed it as soon as it is hungry, it will be satisfied with very little. Bottom line: If your body can trust you, you can trust your body.

Start: Tuning into your body by drinking a glass of cold water 4-6 hours after your last meal. If you feel the water go all the way down to the bottom of your stomach, it's time to eat.

Stop: Toughing it out by skipping or postponing meals. If you want to prove to yourself that you can trust your body, try this. Check in with it throughout your next meal. Have you noticed that as soon as you're full, your tongue registers a drop in flavor? If you eat as soon as you get hungry, you'll notice it doesn't take much to make your body satisfied. Your physical appetite only gets out of hand if you don't treat your body nicely.

Start: Taking your cues on portion control from how full your body feels.

Stop: Counting calories.

If you deprive your body of what it wants when it needs it, then it becomes addicted to fats and carbohydrates. It becomes a raving maniac, going in for the big-ticket items. It's a simple survival mechanism.

Start: Noticing how much less food you need to eat when you're not starving.

Stop: Expecting you won't want a "gulp" of food after depriving yourself.

If you want permanent weight loss, you need to do the opposite of dieting. You need to give into your body's hunger instead of trying to ignore it.

Can you believe it could really be that simple? Can you believe that following your body's impulse to eat -- the way you follow your body's impulse to breathe -- could be the ticket to permanent weight loss? It's a little like Dorothy and the Wizard of Oz. She risks her life trying to get home, and all the time she was wearing the ruby slippers. And to think, all she had to do was click her heels together three times…

Newsletter 9:

Thyroid Power

written by Richhard Shames MD and Karilee Halo Shames, RN PhD, is yet another great resource.

Thyroid Power is very compelling, and written in a more scholarly fashion than the book I reviewed last month by Dr. Siegal. The maian point of Thyroid Power can be summarized by the first paragraph in the preface.
"Although extremely common, low thyroid is largely an unsuspected illness. Even when suspected, it is frequently undiagnosed. When it is diagnosed, it often goes untreated. When it is treated, it is seldom treated optimally".

The authors poinit out that hypothyroidism may be missed because the range of what is considered normal is so wide that it practically includes everyone regardless of one's unique metabolic needs.

What the authors and I both agree on is that low thyroid is widespread and underdiagnosed. The Shameses also believe that the cause of every case of low thyroid is autoimmune. However, I tend to agree with Shera Raisen, MD, that there is an autoimmune type, caused by fluorides, goitragens, metals, stress, etc, and another type of low thyroid that is not autoimmune. I believe a lot of low thyroid is actually caused by dieting.

What do you think? If you find that what you eat doesn't cumpute with what you weigh—try taking the self-diagnostic test from the Shames' website, www.thryoidpower.com

The Science Behind the Failure of Diets:

Introduction

The advice to "increase caloric expenditure and decrease caloric intake" continues to be the standard of care for patient education of overweight and obese patients.  Whether or not the focus is on limiting calories or expending calories, the goal is the same: reduce calories.  A focus on reduction of calories is by nature "restrictive" leading to a mentality in providers as well as patients that less is better. 

This "restrictive" approach to weight control must have intense intuitive appeal, because it continues to be the preferred approach in spite of mounting evidence that it does not lead to sustained weight control.  This paper examines potential psychologic and physiologic reasons for the failure of the restrictive approach. Deprivation is examined for its sabotaging effects on the human body's homeostatic weight control mechanisms. 
Restraint Oriented Strategies: Current Practice Guidelines
According to Dalton (2006) the U.S. Dietary Guidelines of "Eat less. Move more" is a recommendation from a Roman physician espoused 2000 years ago.  This recommendation has proven quite tenacious as restrictive strategies for weight control are still recommended by health promotion institutions (U.S. Preventive Service Task Force, 2003, Daniels, Arnett, Eckel, et. al, 2005, Nawaz and D.L. Katz, 2001).  Nurses, physicians, dieticians and nutritionists are still being asked to teach their patients restraint in order to achieve healthy weight (Surgeon General, 2001; American Dietetic Association).  The National Heart, Lung, and Blood Institute (1998) created an obesity panel and published a booklet describing how primary care providers can help their patients effectively lose weight (Goodwin, 2002).  The booklet advocates reducing calories and provides menus and recipes that are "lower calorie, lower fat". 

In 2003, Risser and Murphy performed a literature review that showed a dismal performance in reducing obesity by only cutting calories, and concluded that "to promote weight loss, we must aggressively promote activity."  This theme has been further echoed by other authors who point to the fact that activity levels have declined more than caloric intake has increased (Blair & Nichaman, 2002).

However, whether providers are being asked to help their patients decrease calories, or increase activity, sustained weight loss eludes most people struggling with obesity (Lowe, 2003). Several recent studies have investigated the futility of dieting.  Mann, and colleagues, (2007) in a review of the literature investigating the effectiveness of diets found that overall, one-third to two-thirds of people gained more weight back than weight they lost.  The authors further assert that this is probably an underestimate due to the methodological problems plaguing many of the studies; the most important of which is that the follow up time is often less than two years.  They concluded that "there is little support for the notion that diets lead to lasting weight loss or health benefits.  Jehn, Patt, Appel, and Miller (2006) set out to compare an intensive life style intervention with a less intensive "monitoring" approach on long term weight loss.  What they discovered was that both groups had gained weight back in the subsequent year, forcing them to conclude that short, intensive lifestyle intervention was ineffective for sustained weight loss. 

Two landmark studies are showing not just a futility in dieting, but a causal relationship between dieting and rebound weight gain.  This new research is demonstrating that restrictive eating may actually lead to weight gain.  Researchers from Harvard (Field, Aneja, Austin, Shrier, de Moor, et. al. 2007) published the results of a study where they set tested the relationship between dieting and weight change in adolescents and whether gender or ethnicity had any effect on the association.  What they discovered was that girls who dieted gained more weight (measured as BMI five years from start of study) than girls who did not diet.  This association was most pronounced among the African-American adolescents.  They were forced to conclude that "not only is dieting ineffective, it is associated with greater weight gain".  Neumark-Sztainer, Wall, Haines, Story, and Eisenberg (2007) also found dieting to be associated with weight gain in adolescents.  In their study of over 2000 adolescents, they discovered a relationship between dieting, bingeing and overall increases in BMI over a five year period.  This study also supports the claim that dieting leads to weight gain.

Psychological Reasons for Failure

This seeming paradox of purposeful weight loss followed by weight gain exceeding baseline has been the focus of psychologist Polivy and Herman for over twenty years. In their study of the emotional impact of deprivation, Herman and Polivy (1990) asserted that it is the perception of facing dietary restraints that causes the rebound behavior of binge eating. In a more recent study, Polivy, Coleman, and Herman (2005) studied chocolate deprivation in restrained and unrestrained female undergraduates. They found that chocolate consumption was highest among the restrained eaters. They explained their findings in much the same way as they had previously, pointing to the disinhibiting effects of deprivation on the deprived.

Physiologic Reasons for Failure

Based on homeostatic research, there may be a similar rebound phenomenon in response to deprivation occurring at the physiologic level.  There appear to be negative physiologic consequences to overriding homeostatic signals of hunger and/or satiety of disrupting the delicate feedback loop that keeps human weight within a stable, healthy range. 

In 1969, Hervey published the first article to outline presumed homeostatic mechanisms regulating weight in humans.  Much of his article in Nature was supposition based on the observation that maintaining body weight within a few pounds "requires physiologic regulation of some precision" (Hervey, 1969).  Hervey presumed that there were orexigenic and anorexigenic signals from periphery communicating with a central regulator, the hypothalamus to regulate energy balance.
With a surge in the obesity epidemic many physiologist have been investigating homeostatic signals that may lead to pharmacologic/physiologic ways to reduce climbing obesity rates (Popovic & Duntas, 2005; Jequier, 2002).  The result has been a plethora of physiologic research identifying substances involved in peripheral communication of hunger and satiety to the hypothalamus. 

One group of afferent signals is involved in meal cessation (satiety) or initiation.  Most of these are humoral signals circulating in the blood, communicating with the brain and other organs directly, are comprised of nutrients including glucose and protein (Yamada & Katagiri, 2007).  Higher levels of these humoral factors would act as ‘anorectic' stimuli.  There are also anorectic or ‘anorexigenic' hormones that communicate with the hypothalamus.  Cholecystokinins (CKK) were discovered to decrease appetite in rodents as early as 1981 (Smith, Cushin, Eterno, & Simansky).  Another peptide, PYY3-36, is known as the satiety hormone (Koda, et. al. 2005).  It is secreted in the intestines after a meal and inhibits gut motility, thereby decreasing appetite. In addition, the physical act of gut distention sends an afferent signal via the vagal nerve to the hypothalamus that acts to decrease appetite.

In addition to factors leading to immediate satiety and meal cessation is the hormone leptin.  Leptin is an adipokin produced by the fat cells.  Leptin levels rise diurnally and in response to a meal.  Saladin and colleagues (1996) in a study with rodents discovered as expected, that as leptin levels rise, appetite decreases and energy expenditure increases and vice versa.  Another interesting finding was that a very small decrease in the percentage of fat cells (10%) resulted in a 53% decrease in leptin levels.  A finding that led Jequier (2002) to point out that "leptin secretion in humans is not acutely modulated by single meal ingestion" it does respond to chronic fasting or food limitation.  Presumably this could cause a reduction in energy expenditure and thermogenesis (metabolic rate). "Hence, a sharp decline in leptin plasma levels plays a major role in the body's short-term adaptation to starvation."

A finding not discussed in depth by the authors was that among the rodents who were place on restrictive diets until they lost 10% of their body weight, leptin levels rose to previous levels during a four week period of weight maintenance.  Leptin returned to previous levels despite no commensurate increase in leptin producing adipocytes.  Given that leptin levels are higher in obese human subjects than nonobese subjects (Considine, et. al. 1996), one wonders if the reason might at least in part be due to repetitive periods of deprivation rather than simple over feeding.  Weight cycling (the loss of more than 50 pounds followed by rebound weight gain back to baseline weight or more) is more prevalent in obese subjects (Gaesser, 2003).  Ultimately, ignoring homeostatic signals of hunger and/or satiety disrupts the advantageous effect of leptin.  Overweight humans are resistant to the anorexigenic effects of leptin (Considine, et. al. 1996, Scarpace & Zhang, 2007).
Among the ‘orexigenic' communicators, the amino acid peptide ghrelin is known as the ‘hunger' hormone.  Ghrelin is a growth hormone that stimulates appetite in both rodents and humans when injected into the blood (Tschop, Smiley, & Heiman, 2000; Wren, Seal, Cohen, Byrnes, Frost, et. al. 2001).  Ghrelin levels increase before each meal and fall after each meal in humans (Cummings & Schwartz, 2003).  In individuals who neither starve nor binge, healthy levels of ghrelin are achieved without producing excess weight (Popovic & Duntas, 2005).  ‘Healthy' level is mentioned because besides appetite inducing qualities, ghrelin has sleep promoting factors and promotes a healthy cardiovasculature.  Once again, we see a paradoxical reaction in overweight individuals, with the orexigenic hormone levels being less overweight individuals than in normal weight individuals.  In individuals with a stable normal weight, ghrelin is negatively correlated to body size (Popovic & Duntas, 2005).  And once again, whether this is strictly due to overeating, or periodically undereating, it is clear that this unhealthy imbalance has occurred because satiety cues were ignored.  Yamada and Katagiri (2007) in their review of energy homeostasis were compelled to conclude that "disturbance of this coordinated control system may be implicated in the development of metabolic disorders such as obesity, type 2 diabetes, hyperlipidemia, and the metabolic syndrome." Popovic and Duntas (2005) were likewise forced to conclude that homeostatic mechanisms "resist the loss of body fat".

Summary

While the results presented in these studies may compel many researchers to search for hormones that can be used in pharmaceuticals to reduce weight, another compelling message can be gleaned.  Prevention of obesity may be as simple as heeding internal, homeostatic signals of hunger and satiety.  Perhaps the message we should be sharing with all our patients, overweight and normal weight is to listen to internal cues instead of overriding them through low calorie, restraint oriented diets (Gast & Hawks, 1998).

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