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Obesity: Don’t separate mental health from physical health
“The patient is ready,” the medical assistant informs you while handing you the chart. The chart reads: “Chief complaint: Weight gain/Discuss weight loss options.” You note the normal vital signs other than an increased BMI to 34 from 4 months ago. You knock on the exam room door with your plan half-formulated.
“Come in,” the patient says, almost too softly for you to hear. Shock overtakes you as you enter the room and see something you never imagined. The patient is holding their disconnected head in their lap as they say, “Nice to see you, Doc. I want to do something about my weight.”
You’re baffled at how they are speaking with a disconnected head. Of course, this outlandish patient scenario isn’t real. Or is it?
Patients with mental health concerns don’t literally present with their head disconnected from their bodies. Too often, mental health is treated as separate from physical health, especially regarding weight management and obesity. However, studies have shown an association between mental health and obesity. In this pivotal time of pharmacologic innovation in obesity care, we must also ensure that we effectively address the mental health of our patients with obesity.
Screening
Mental health conditions can look different for everyone. It can be hard to diagnose a mental health condition without validated screening. For example, depression is one of the most common mental health disorders. The U.S. Preventive Services Task Force recommends depression screening in all adults.
The Patient Health Questionnaire-2 (PHQ-2) is one screening tool that can alert doctors and clinicians to potential depression. Patients with obesity have higher rates of depression and other mental health conditions. It’s even more critical to screen for depression and other mental health disorders when prescribing these new medications, given recent reports of suicidal ideation with certain antiobesity medications.
Stigma
Mental health–related stigma can trigger shame and prevent patients from seeking psychological help. Furthermore, compounded stigma in patients with larger bodies (weight bias) and from marginalized communities such as the Black community (racial discrimination) add more barriers to seeking mental health care. When patients seek care for mental health conditions, they may feel more comfortable seeing a primary care physician or other clinician than a mental health professional. Therefore, all physicians and clinicians are integral in normalizing mental health care. Instead of treating mental health as separate from physical health, discussing the bidirectional relationship between mental health conditions and physiologic diseases can help patients understand that having a mental health condition isn’t a choice and facilitate openness to multiple treatment options to improve their quality of life.
Support
Addressing mental health effectively often requires multiple layers of patient support. Support can come from loved ones or community groups. But for severe stress and other mental health conditions, treatment with psychotherapy or psychiatric medications is essential. Unfortunately, even if a patient is willing to see a mental health professional, availability or access may be a challenge. Therefore, other clinicians may have to step in and serve as a bridge to mental health care. It’s also essential to ensure that patients are aware of crisis support lines and online resources for mental health care.
Stress
Having a high level of stress can be harmful physically and can also worsen mental health conditions. Additionally, it can contribute to a higher risk for obesity and can trigger emotional eating. Chronic stress has become so common in society that patients often underestimate how much stress they are under. Assessments like the Holmes-Rahe Stress Inventory can help patients identify and quantify potential stressors. While some stressors are uncontrollable, such as social determinants of health (SDOH), addressing controllable stressors and improving coping mechanisms is possible. For instance, mindfulness and breathwork are easy to follow and relatively accessible for most patients.
Social determinants of health
For a treatment plan to be maximally impactful, we must incorporate SDOH in clinical care. SDOH includes financial instability, safe neighborhoods, and more, and can significantly influence an ideal treatment plan. Furthermore, a high SDOH burden can negatively affect mental health and obesity rates. It’s helpful to incorporate patients’ SDOH burden into treatment planning. Learn how to take action on SDOH.
Empowerment
Patients who address their mental health have taken a courageous step toward health and healing. As mentioned, they may experience gaps in care while awaiting connection to the next steps of their journey, such as starting care with a mental health professional or waiting for a medication to take effect. All clinicians can empower patients about their weight by informing them that:
Food may affect their mood. Studies show that certain foods and eating patterns are associated with high levels of depression and anxiety. Limiting processed foods and increasing fruits, vegetables, and foods high in vitamin D, C, and other nutrients is helpful. Everyone is different, so encourage patients to pay attention to how food uniquely affects their mood by keeping a food/feeling log for 1-3 days.
Move more. Increased physical activity can improve mental health.
Get outdoors. Time in nature is associated with better mental health. Spending as little as 10 minutes outside can be beneficial. It’s important to be aware that SDOH factors such as unsafe environments or limited outdoor access may make this difficult for some patients.
Positive stress-relieving activities. Each person has their own way of reducing stress. It is helpful to remind patients of unhealthy stress relievers such as overeating, drinking alcohol, and smoking, and encourage them to replace those with positive stress relievers.
Spiritual well-being. Spirituality is often overlooked in health care. But studies have shown that incorporating a person’s spirituality may have positive health benefits.
It’s time to stop disconnecting mental health from physical health. Each clinician plays a vital role in treating the whole person. Just as you wouldn’t let a patient with a disconnected head leave the office without addressing it, let’s not leave mental health out when addressing our patients’ weight concerns.
Dr. Gonsahn-Bollie is an integrative obesity specialist focused on individualized solutions for emotional and biological overeating. Connect with her at www.embraceyouweightloss.com or on Instagram @embraceyoumd. Her bestselling book, “Embrace You: Your Guide to Transforming Weight Loss Misconceptions Into Lifelong Wellness,” (Baltimore: Purposely Created Publishing Group, 2019) was Healthline.com’s Best Overall Weight Loss Book of 2022 and one of Livestrong.com’s 8 Best Weight-Loss Books to Read in 2022.
Dr. Gonsahn-Bollie is CEO and Lead Physician, Embrace You Weight and Wellness, Telehealth & Virtual Counseling. She has disclosed no relevant financial relationships.
A version of this article first appeared on Medscape.com.
“The patient is ready,” the medical assistant informs you while handing you the chart. The chart reads: “Chief complaint: Weight gain/Discuss weight loss options.” You note the normal vital signs other than an increased BMI to 34 from 4 months ago. You knock on the exam room door with your plan half-formulated.
“Come in,” the patient says, almost too softly for you to hear. Shock overtakes you as you enter the room and see something you never imagined. The patient is holding their disconnected head in their lap as they say, “Nice to see you, Doc. I want to do something about my weight.”
You’re baffled at how they are speaking with a disconnected head. Of course, this outlandish patient scenario isn’t real. Or is it?
Patients with mental health concerns don’t literally present with their head disconnected from their bodies. Too often, mental health is treated as separate from physical health, especially regarding weight management and obesity. However, studies have shown an association between mental health and obesity. In this pivotal time of pharmacologic innovation in obesity care, we must also ensure that we effectively address the mental health of our patients with obesity.
Screening
Mental health conditions can look different for everyone. It can be hard to diagnose a mental health condition without validated screening. For example, depression is one of the most common mental health disorders. The U.S. Preventive Services Task Force recommends depression screening in all adults.
The Patient Health Questionnaire-2 (PHQ-2) is one screening tool that can alert doctors and clinicians to potential depression. Patients with obesity have higher rates of depression and other mental health conditions. It’s even more critical to screen for depression and other mental health disorders when prescribing these new medications, given recent reports of suicidal ideation with certain antiobesity medications.
Stigma
Mental health–related stigma can trigger shame and prevent patients from seeking psychological help. Furthermore, compounded stigma in patients with larger bodies (weight bias) and from marginalized communities such as the Black community (racial discrimination) add more barriers to seeking mental health care. When patients seek care for mental health conditions, they may feel more comfortable seeing a primary care physician or other clinician than a mental health professional. Therefore, all physicians and clinicians are integral in normalizing mental health care. Instead of treating mental health as separate from physical health, discussing the bidirectional relationship between mental health conditions and physiologic diseases can help patients understand that having a mental health condition isn’t a choice and facilitate openness to multiple treatment options to improve their quality of life.
Support
Addressing mental health effectively often requires multiple layers of patient support. Support can come from loved ones or community groups. But for severe stress and other mental health conditions, treatment with psychotherapy or psychiatric medications is essential. Unfortunately, even if a patient is willing to see a mental health professional, availability or access may be a challenge. Therefore, other clinicians may have to step in and serve as a bridge to mental health care. It’s also essential to ensure that patients are aware of crisis support lines and online resources for mental health care.
Stress
Having a high level of stress can be harmful physically and can also worsen mental health conditions. Additionally, it can contribute to a higher risk for obesity and can trigger emotional eating. Chronic stress has become so common in society that patients often underestimate how much stress they are under. Assessments like the Holmes-Rahe Stress Inventory can help patients identify and quantify potential stressors. While some stressors are uncontrollable, such as social determinants of health (SDOH), addressing controllable stressors and improving coping mechanisms is possible. For instance, mindfulness and breathwork are easy to follow and relatively accessible for most patients.
Social determinants of health
For a treatment plan to be maximally impactful, we must incorporate SDOH in clinical care. SDOH includes financial instability, safe neighborhoods, and more, and can significantly influence an ideal treatment plan. Furthermore, a high SDOH burden can negatively affect mental health and obesity rates. It’s helpful to incorporate patients’ SDOH burden into treatment planning. Learn how to take action on SDOH.
Empowerment
Patients who address their mental health have taken a courageous step toward health and healing. As mentioned, they may experience gaps in care while awaiting connection to the next steps of their journey, such as starting care with a mental health professional or waiting for a medication to take effect. All clinicians can empower patients about their weight by informing them that:
Food may affect their mood. Studies show that certain foods and eating patterns are associated with high levels of depression and anxiety. Limiting processed foods and increasing fruits, vegetables, and foods high in vitamin D, C, and other nutrients is helpful. Everyone is different, so encourage patients to pay attention to how food uniquely affects their mood by keeping a food/feeling log for 1-3 days.
Move more. Increased physical activity can improve mental health.
Get outdoors. Time in nature is associated with better mental health. Spending as little as 10 minutes outside can be beneficial. It’s important to be aware that SDOH factors such as unsafe environments or limited outdoor access may make this difficult for some patients.
Positive stress-relieving activities. Each person has their own way of reducing stress. It is helpful to remind patients of unhealthy stress relievers such as overeating, drinking alcohol, and smoking, and encourage them to replace those with positive stress relievers.
Spiritual well-being. Spirituality is often overlooked in health care. But studies have shown that incorporating a person’s spirituality may have positive health benefits.
It’s time to stop disconnecting mental health from physical health. Each clinician plays a vital role in treating the whole person. Just as you wouldn’t let a patient with a disconnected head leave the office without addressing it, let’s not leave mental health out when addressing our patients’ weight concerns.
Dr. Gonsahn-Bollie is an integrative obesity specialist focused on individualized solutions for emotional and biological overeating. Connect with her at www.embraceyouweightloss.com or on Instagram @embraceyoumd. Her bestselling book, “Embrace You: Your Guide to Transforming Weight Loss Misconceptions Into Lifelong Wellness,” (Baltimore: Purposely Created Publishing Group, 2019) was Healthline.com’s Best Overall Weight Loss Book of 2022 and one of Livestrong.com’s 8 Best Weight-Loss Books to Read in 2022.
Dr. Gonsahn-Bollie is CEO and Lead Physician, Embrace You Weight and Wellness, Telehealth & Virtual Counseling. She has disclosed no relevant financial relationships.
A version of this article first appeared on Medscape.com.
“The patient is ready,” the medical assistant informs you while handing you the chart. The chart reads: “Chief complaint: Weight gain/Discuss weight loss options.” You note the normal vital signs other than an increased BMI to 34 from 4 months ago. You knock on the exam room door with your plan half-formulated.
“Come in,” the patient says, almost too softly for you to hear. Shock overtakes you as you enter the room and see something you never imagined. The patient is holding their disconnected head in their lap as they say, “Nice to see you, Doc. I want to do something about my weight.”
You’re baffled at how they are speaking with a disconnected head. Of course, this outlandish patient scenario isn’t real. Or is it?
Patients with mental health concerns don’t literally present with their head disconnected from their bodies. Too often, mental health is treated as separate from physical health, especially regarding weight management and obesity. However, studies have shown an association between mental health and obesity. In this pivotal time of pharmacologic innovation in obesity care, we must also ensure that we effectively address the mental health of our patients with obesity.
Screening
Mental health conditions can look different for everyone. It can be hard to diagnose a mental health condition without validated screening. For example, depression is one of the most common mental health disorders. The U.S. Preventive Services Task Force recommends depression screening in all adults.
The Patient Health Questionnaire-2 (PHQ-2) is one screening tool that can alert doctors and clinicians to potential depression. Patients with obesity have higher rates of depression and other mental health conditions. It’s even more critical to screen for depression and other mental health disorders when prescribing these new medications, given recent reports of suicidal ideation with certain antiobesity medications.
Stigma
Mental health–related stigma can trigger shame and prevent patients from seeking psychological help. Furthermore, compounded stigma in patients with larger bodies (weight bias) and from marginalized communities such as the Black community (racial discrimination) add more barriers to seeking mental health care. When patients seek care for mental health conditions, they may feel more comfortable seeing a primary care physician or other clinician than a mental health professional. Therefore, all physicians and clinicians are integral in normalizing mental health care. Instead of treating mental health as separate from physical health, discussing the bidirectional relationship between mental health conditions and physiologic diseases can help patients understand that having a mental health condition isn’t a choice and facilitate openness to multiple treatment options to improve their quality of life.
Support
Addressing mental health effectively often requires multiple layers of patient support. Support can come from loved ones or community groups. But for severe stress and other mental health conditions, treatment with psychotherapy or psychiatric medications is essential. Unfortunately, even if a patient is willing to see a mental health professional, availability or access may be a challenge. Therefore, other clinicians may have to step in and serve as a bridge to mental health care. It’s also essential to ensure that patients are aware of crisis support lines and online resources for mental health care.
Stress
Having a high level of stress can be harmful physically and can also worsen mental health conditions. Additionally, it can contribute to a higher risk for obesity and can trigger emotional eating. Chronic stress has become so common in society that patients often underestimate how much stress they are under. Assessments like the Holmes-Rahe Stress Inventory can help patients identify and quantify potential stressors. While some stressors are uncontrollable, such as social determinants of health (SDOH), addressing controllable stressors and improving coping mechanisms is possible. For instance, mindfulness and breathwork are easy to follow and relatively accessible for most patients.
Social determinants of health
For a treatment plan to be maximally impactful, we must incorporate SDOH in clinical care. SDOH includes financial instability, safe neighborhoods, and more, and can significantly influence an ideal treatment plan. Furthermore, a high SDOH burden can negatively affect mental health and obesity rates. It’s helpful to incorporate patients’ SDOH burden into treatment planning. Learn how to take action on SDOH.
Empowerment
Patients who address their mental health have taken a courageous step toward health and healing. As mentioned, they may experience gaps in care while awaiting connection to the next steps of their journey, such as starting care with a mental health professional or waiting for a medication to take effect. All clinicians can empower patients about their weight by informing them that:
Food may affect their mood. Studies show that certain foods and eating patterns are associated with high levels of depression and anxiety. Limiting processed foods and increasing fruits, vegetables, and foods high in vitamin D, C, and other nutrients is helpful. Everyone is different, so encourage patients to pay attention to how food uniquely affects their mood by keeping a food/feeling log for 1-3 days.
Move more. Increased physical activity can improve mental health.
Get outdoors. Time in nature is associated with better mental health. Spending as little as 10 minutes outside can be beneficial. It’s important to be aware that SDOH factors such as unsafe environments or limited outdoor access may make this difficult for some patients.
Positive stress-relieving activities. Each person has their own way of reducing stress. It is helpful to remind patients of unhealthy stress relievers such as overeating, drinking alcohol, and smoking, and encourage them to replace those with positive stress relievers.
Spiritual well-being. Spirituality is often overlooked in health care. But studies have shown that incorporating a person’s spirituality may have positive health benefits.
It’s time to stop disconnecting mental health from physical health. Each clinician plays a vital role in treating the whole person. Just as you wouldn’t let a patient with a disconnected head leave the office without addressing it, let’s not leave mental health out when addressing our patients’ weight concerns.
Dr. Gonsahn-Bollie is an integrative obesity specialist focused on individualized solutions for emotional and biological overeating. Connect with her at www.embraceyouweightloss.com or on Instagram @embraceyoumd. Her bestselling book, “Embrace You: Your Guide to Transforming Weight Loss Misconceptions Into Lifelong Wellness,” (Baltimore: Purposely Created Publishing Group, 2019) was Healthline.com’s Best Overall Weight Loss Book of 2022 and one of Livestrong.com’s 8 Best Weight-Loss Books to Read in 2022.
Dr. Gonsahn-Bollie is CEO and Lead Physician, Embrace You Weight and Wellness, Telehealth & Virtual Counseling. She has disclosed no relevant financial relationships.
A version of this article first appeared on Medscape.com.
Emotional eating isn’t all emotional
“Food gives me ‘hugs,’ ” Ms. S* said as her eyes lit up. Finally, after weeks of working together, she could articulate her complex relationship with food. She had been struggling to explain why she continued to eat when she was full or consumed foods she knew wouldn’t help her health.
Like millions of people struggling with their weight or the disease of obesity, Ms. S had tried multiple diets and programs but continued to return to unhelpful eating patterns. Ms. S was an emotional eater, and the pandemic only worsened her emotional eating. As a single professional forced to work from home during the pandemic, she became lonely. She went from working in a busy downtown office, training for half-marathons, and teaching live workout sessions to being alone daily. Her only “real” human interaction was when she ordered daily delivery meals of her favorite comfort foods. As a person with type 2 diabetes, she knew that her delivery habit was wrecking her health, but willpower wasn’t enough to make her stop.
Her psychologist referred her to our virtual integrative obesity practice to help her lose weight and find long-term solutions. Ms. S admitted that she knew what she was doing as an emotional eater. But like many emotional eaters, she didn’t know why or how to switch from emotional eating to eating based on her biological hunger signals. As a trained obesity expert and recovering emotional eater of 8 years, personally and professionally I can appreciate the challenges of emotional eating and how it can sabotage even the best weight loss plan. In this article, I will share facts and feelings that drive emotional eating. I aim to empower clinicians seeking to help patients with emotional eating.
Fact: Emotional eating isn’t all emotional
It’s important not to dismiss emotional eating as all emotion driven. Recall that hunger is hormonally regulated. There are two main hunger pathways: the homeostatic pathway and the hedonic pathway. The homeostatic pathway is our biological hunger pathway and is driven by the need for energy in calories. Conversely, hedonic eating is pleasure-driven and uses emotional stimuli to “bypass” the physical hunger/satisfaction signals.
Emotional eating falls under the hedonic pathway. As clinicians, the first step in helping a patient struggling with emotional eating is empathetically listening, then assessing for any physiologic causes.
Several factors can disrupt physiologic appetite regulation, such as sleep disturbances; high stress levels; and many medical conditions, including but not limited to obesity, diabetes, and polycystic ovarian syndrome. Such factors as insulin resistance and inflammation are a common link in these conditions. Both contribute to the pathophysiology of the changes in appetite and can influence other hormones that lead to reduced satisfaction after eating. Furthermore, mental health conditions may disrupt levels of neurotransmitters such as serotonin and dopamine, which can also cause appetite changes.
These settings of physiologically disrupted appetite can trigger hedonic eating. But the relationship is complex. For example, one way to research hedonic eating is by using the Power of Food Scale. Functional MRI studies show that people with higher Power of Food Scale readings have more brain activity in the visual cortex when they see highly palatable foods. While more studies are needed to better understand the clinical implications of this finding, it’s yet another indicator that “emotional” eating isn’t all emotional. It’s also physiologic.
Feelings: Patterns, personality, places, psychological factors
Physiology only explains part of emotional eating. Like Ms. S, emotional eaters have strong emotional connections to food and behavior patterns. Often, physiologic cues have been coupled with psychological habits.
For example, menses is a common physiologic trigger for stress-eating for many of my patients. Studies have shown that in addition to iron levels changing during menses, calcium, magnesium, and phosphorous levels also change. Emotionally, the discomfort of “that time of the month” can lead to solace in comfort foods such as chocolate in different forms. But this isn’t surprising, as cacao and its derivative, chocolate, are rich in iron and other minerals. The chocolate is actually addressing a physical and emotional need. It can be helpful to point out this association to your patients. Suggest choosing a lower-sugar form of chocolate, such as dark chocolate, or even trying cacao nibs, while addressing any emotions.
But physiologic conditions and patterns aren’t the only emotional eating triggers. Places and psychological conditions can also trigger emotional eating.
Places and people
Celebrations, vacations, proximity to certain restaurants, exposure to food marketing, and major life shifts can lead to increased hedonic eating. Helping patients recognize this connection opens the door to advance preparation for these situations.
Psychological conditions can be connected to emotional eating. It’s important to screen for mental health conditions and past traumas. For example, emotional eating could be a symptom of binge eating disorder, major depression, or generalized anxiety disorder. Childhood trauma is associated with disordered eating. The adverse childhood events quiz can be used clinically.
Emotional eating can lead to feelings of guilt, shame, and negative self-talk. It’s helpful to offer patients reassurance and encourage self-compassion. After all, it’s natural to eat. The goal isn’t to stop eating but to eat on the basis of physiologic needs.
Putting it together: Addressing the facts and feelings of emotional eating
1. Treat biological causes that impact physiologic hunger and trigger emotional eating.
2. Triggers: Address patterns, places/people, psychological events.
3. Transition to non-food rewards; the key to emotional eating is eating. While healthier substitutes can be a short-term solution for improving eating behaviors, ultimately, helping patients find non-food ways to address emotions is invaluable.
4. Stress management: Offer your patients ways to decrease stress levels through mindfulness and other techniques.
5. Professional support: Creating a multidisciplinary team is helpful, given the complexity of emotional eating. In addition to the primary care physician/clinician, other team members may include:
- Psychologist
- Psychiatrist
- coach and/or certified wellness coaches
- Obesity specialist
Back to Ms. S
Ms. S is doing well. We started her on a GLP-1 agonist to address her underlying insulin resistance. Together we’ve found creative ways to satisfy her loneliness, such as volunteering and teaching virtual workout classes. Her emotional eating has decreased by over 60%, and we continue to discover new strategies to address her emotional eating triggers.
Conclusion
Despite being common, the impact of emotional eating is often minimized. With no DSM-5 criteria or ICD-11 code, it’s easy to dismiss emotional eating clinically. However, emotional eating is common and associated with weight gain.
In light of the obesity epidemic, this significance can’t be overlooked. Thankfully we have groundbreaking medications to address the homeostatic hunger pathway and physiologic drivers of emotional eating, but they’re not a substitute for addressing the psychosocial components of emotional eating.
As clinicians, we can have a meaningful impact on our patients’ lives beyond writing a prescription.
*Name/initial changed for privacy.
Sylvia Gonsahn-Bollie, MD, DipABOM, is an integrative obesity specialist focused on individualized solutions for emotional and biological overeating.
A version of this article first appeared on Medscape.com.
“Food gives me ‘hugs,’ ” Ms. S* said as her eyes lit up. Finally, after weeks of working together, she could articulate her complex relationship with food. She had been struggling to explain why she continued to eat when she was full or consumed foods she knew wouldn’t help her health.
Like millions of people struggling with their weight or the disease of obesity, Ms. S had tried multiple diets and programs but continued to return to unhelpful eating patterns. Ms. S was an emotional eater, and the pandemic only worsened her emotional eating. As a single professional forced to work from home during the pandemic, she became lonely. She went from working in a busy downtown office, training for half-marathons, and teaching live workout sessions to being alone daily. Her only “real” human interaction was when she ordered daily delivery meals of her favorite comfort foods. As a person with type 2 diabetes, she knew that her delivery habit was wrecking her health, but willpower wasn’t enough to make her stop.
Her psychologist referred her to our virtual integrative obesity practice to help her lose weight and find long-term solutions. Ms. S admitted that she knew what she was doing as an emotional eater. But like many emotional eaters, she didn’t know why or how to switch from emotional eating to eating based on her biological hunger signals. As a trained obesity expert and recovering emotional eater of 8 years, personally and professionally I can appreciate the challenges of emotional eating and how it can sabotage even the best weight loss plan. In this article, I will share facts and feelings that drive emotional eating. I aim to empower clinicians seeking to help patients with emotional eating.
Fact: Emotional eating isn’t all emotional
It’s important not to dismiss emotional eating as all emotion driven. Recall that hunger is hormonally regulated. There are two main hunger pathways: the homeostatic pathway and the hedonic pathway. The homeostatic pathway is our biological hunger pathway and is driven by the need for energy in calories. Conversely, hedonic eating is pleasure-driven and uses emotional stimuli to “bypass” the physical hunger/satisfaction signals.
Emotional eating falls under the hedonic pathway. As clinicians, the first step in helping a patient struggling with emotional eating is empathetically listening, then assessing for any physiologic causes.
Several factors can disrupt physiologic appetite regulation, such as sleep disturbances; high stress levels; and many medical conditions, including but not limited to obesity, diabetes, and polycystic ovarian syndrome. Such factors as insulin resistance and inflammation are a common link in these conditions. Both contribute to the pathophysiology of the changes in appetite and can influence other hormones that lead to reduced satisfaction after eating. Furthermore, mental health conditions may disrupt levels of neurotransmitters such as serotonin and dopamine, which can also cause appetite changes.
These settings of physiologically disrupted appetite can trigger hedonic eating. But the relationship is complex. For example, one way to research hedonic eating is by using the Power of Food Scale. Functional MRI studies show that people with higher Power of Food Scale readings have more brain activity in the visual cortex when they see highly palatable foods. While more studies are needed to better understand the clinical implications of this finding, it’s yet another indicator that “emotional” eating isn’t all emotional. It’s also physiologic.
Feelings: Patterns, personality, places, psychological factors
Physiology only explains part of emotional eating. Like Ms. S, emotional eaters have strong emotional connections to food and behavior patterns. Often, physiologic cues have been coupled with psychological habits.
For example, menses is a common physiologic trigger for stress-eating for many of my patients. Studies have shown that in addition to iron levels changing during menses, calcium, magnesium, and phosphorous levels also change. Emotionally, the discomfort of “that time of the month” can lead to solace in comfort foods such as chocolate in different forms. But this isn’t surprising, as cacao and its derivative, chocolate, are rich in iron and other minerals. The chocolate is actually addressing a physical and emotional need. It can be helpful to point out this association to your patients. Suggest choosing a lower-sugar form of chocolate, such as dark chocolate, or even trying cacao nibs, while addressing any emotions.
But physiologic conditions and patterns aren’t the only emotional eating triggers. Places and psychological conditions can also trigger emotional eating.
Places and people
Celebrations, vacations, proximity to certain restaurants, exposure to food marketing, and major life shifts can lead to increased hedonic eating. Helping patients recognize this connection opens the door to advance preparation for these situations.
Psychological conditions can be connected to emotional eating. It’s important to screen for mental health conditions and past traumas. For example, emotional eating could be a symptom of binge eating disorder, major depression, or generalized anxiety disorder. Childhood trauma is associated with disordered eating. The adverse childhood events quiz can be used clinically.
Emotional eating can lead to feelings of guilt, shame, and negative self-talk. It’s helpful to offer patients reassurance and encourage self-compassion. After all, it’s natural to eat. The goal isn’t to stop eating but to eat on the basis of physiologic needs.
Putting it together: Addressing the facts and feelings of emotional eating
1. Treat biological causes that impact physiologic hunger and trigger emotional eating.
2. Triggers: Address patterns, places/people, psychological events.
3. Transition to non-food rewards; the key to emotional eating is eating. While healthier substitutes can be a short-term solution for improving eating behaviors, ultimately, helping patients find non-food ways to address emotions is invaluable.
4. Stress management: Offer your patients ways to decrease stress levels through mindfulness and other techniques.
5. Professional support: Creating a multidisciplinary team is helpful, given the complexity of emotional eating. In addition to the primary care physician/clinician, other team members may include:
- Psychologist
- Psychiatrist
- coach and/or certified wellness coaches
- Obesity specialist
Back to Ms. S
Ms. S is doing well. We started her on a GLP-1 agonist to address her underlying insulin resistance. Together we’ve found creative ways to satisfy her loneliness, such as volunteering and teaching virtual workout classes. Her emotional eating has decreased by over 60%, and we continue to discover new strategies to address her emotional eating triggers.
Conclusion
Despite being common, the impact of emotional eating is often minimized. With no DSM-5 criteria or ICD-11 code, it’s easy to dismiss emotional eating clinically. However, emotional eating is common and associated with weight gain.
In light of the obesity epidemic, this significance can’t be overlooked. Thankfully we have groundbreaking medications to address the homeostatic hunger pathway and physiologic drivers of emotional eating, but they’re not a substitute for addressing the psychosocial components of emotional eating.
As clinicians, we can have a meaningful impact on our patients’ lives beyond writing a prescription.
*Name/initial changed for privacy.
Sylvia Gonsahn-Bollie, MD, DipABOM, is an integrative obesity specialist focused on individualized solutions for emotional and biological overeating.
A version of this article first appeared on Medscape.com.
“Food gives me ‘hugs,’ ” Ms. S* said as her eyes lit up. Finally, after weeks of working together, she could articulate her complex relationship with food. She had been struggling to explain why she continued to eat when she was full or consumed foods she knew wouldn’t help her health.
Like millions of people struggling with their weight or the disease of obesity, Ms. S had tried multiple diets and programs but continued to return to unhelpful eating patterns. Ms. S was an emotional eater, and the pandemic only worsened her emotional eating. As a single professional forced to work from home during the pandemic, she became lonely. She went from working in a busy downtown office, training for half-marathons, and teaching live workout sessions to being alone daily. Her only “real” human interaction was when she ordered daily delivery meals of her favorite comfort foods. As a person with type 2 diabetes, she knew that her delivery habit was wrecking her health, but willpower wasn’t enough to make her stop.
Her psychologist referred her to our virtual integrative obesity practice to help her lose weight and find long-term solutions. Ms. S admitted that she knew what she was doing as an emotional eater. But like many emotional eaters, she didn’t know why or how to switch from emotional eating to eating based on her biological hunger signals. As a trained obesity expert and recovering emotional eater of 8 years, personally and professionally I can appreciate the challenges of emotional eating and how it can sabotage even the best weight loss plan. In this article, I will share facts and feelings that drive emotional eating. I aim to empower clinicians seeking to help patients with emotional eating.
Fact: Emotional eating isn’t all emotional
It’s important not to dismiss emotional eating as all emotion driven. Recall that hunger is hormonally regulated. There are two main hunger pathways: the homeostatic pathway and the hedonic pathway. The homeostatic pathway is our biological hunger pathway and is driven by the need for energy in calories. Conversely, hedonic eating is pleasure-driven and uses emotional stimuli to “bypass” the physical hunger/satisfaction signals.
Emotional eating falls under the hedonic pathway. As clinicians, the first step in helping a patient struggling with emotional eating is empathetically listening, then assessing for any physiologic causes.
Several factors can disrupt physiologic appetite regulation, such as sleep disturbances; high stress levels; and many medical conditions, including but not limited to obesity, diabetes, and polycystic ovarian syndrome. Such factors as insulin resistance and inflammation are a common link in these conditions. Both contribute to the pathophysiology of the changes in appetite and can influence other hormones that lead to reduced satisfaction after eating. Furthermore, mental health conditions may disrupt levels of neurotransmitters such as serotonin and dopamine, which can also cause appetite changes.
These settings of physiologically disrupted appetite can trigger hedonic eating. But the relationship is complex. For example, one way to research hedonic eating is by using the Power of Food Scale. Functional MRI studies show that people with higher Power of Food Scale readings have more brain activity in the visual cortex when they see highly palatable foods. While more studies are needed to better understand the clinical implications of this finding, it’s yet another indicator that “emotional” eating isn’t all emotional. It’s also physiologic.
Feelings: Patterns, personality, places, psychological factors
Physiology only explains part of emotional eating. Like Ms. S, emotional eaters have strong emotional connections to food and behavior patterns. Often, physiologic cues have been coupled with psychological habits.
For example, menses is a common physiologic trigger for stress-eating for many of my patients. Studies have shown that in addition to iron levels changing during menses, calcium, magnesium, and phosphorous levels also change. Emotionally, the discomfort of “that time of the month” can lead to solace in comfort foods such as chocolate in different forms. But this isn’t surprising, as cacao and its derivative, chocolate, are rich in iron and other minerals. The chocolate is actually addressing a physical and emotional need. It can be helpful to point out this association to your patients. Suggest choosing a lower-sugar form of chocolate, such as dark chocolate, or even trying cacao nibs, while addressing any emotions.
But physiologic conditions and patterns aren’t the only emotional eating triggers. Places and psychological conditions can also trigger emotional eating.
Places and people
Celebrations, vacations, proximity to certain restaurants, exposure to food marketing, and major life shifts can lead to increased hedonic eating. Helping patients recognize this connection opens the door to advance preparation for these situations.
Psychological conditions can be connected to emotional eating. It’s important to screen for mental health conditions and past traumas. For example, emotional eating could be a symptom of binge eating disorder, major depression, or generalized anxiety disorder. Childhood trauma is associated with disordered eating. The adverse childhood events quiz can be used clinically.
Emotional eating can lead to feelings of guilt, shame, and negative self-talk. It’s helpful to offer patients reassurance and encourage self-compassion. After all, it’s natural to eat. The goal isn’t to stop eating but to eat on the basis of physiologic needs.
Putting it together: Addressing the facts and feelings of emotional eating
1. Treat biological causes that impact physiologic hunger and trigger emotional eating.
2. Triggers: Address patterns, places/people, psychological events.
3. Transition to non-food rewards; the key to emotional eating is eating. While healthier substitutes can be a short-term solution for improving eating behaviors, ultimately, helping patients find non-food ways to address emotions is invaluable.
4. Stress management: Offer your patients ways to decrease stress levels through mindfulness and other techniques.
5. Professional support: Creating a multidisciplinary team is helpful, given the complexity of emotional eating. In addition to the primary care physician/clinician, other team members may include:
- Psychologist
- Psychiatrist
- coach and/or certified wellness coaches
- Obesity specialist
Back to Ms. S
Ms. S is doing well. We started her on a GLP-1 agonist to address her underlying insulin resistance. Together we’ve found creative ways to satisfy her loneliness, such as volunteering and teaching virtual workout classes. Her emotional eating has decreased by over 60%, and we continue to discover new strategies to address her emotional eating triggers.
Conclusion
Despite being common, the impact of emotional eating is often minimized. With no DSM-5 criteria or ICD-11 code, it’s easy to dismiss emotional eating clinically. However, emotional eating is common and associated with weight gain.
In light of the obesity epidemic, this significance can’t be overlooked. Thankfully we have groundbreaking medications to address the homeostatic hunger pathway and physiologic drivers of emotional eating, but they’re not a substitute for addressing the psychosocial components of emotional eating.
As clinicians, we can have a meaningful impact on our patients’ lives beyond writing a prescription.
*Name/initial changed for privacy.
Sylvia Gonsahn-Bollie, MD, DipABOM, is an integrative obesity specialist focused on individualized solutions for emotional and biological overeating.
A version of this article first appeared on Medscape.com.
What’s the ‘secret sauce’ to help patients move more?
“Just Do It” is a cute marketing slogan. But let’s face it: Clinically, it doesn’t work well. Most people just don’t exercise. according to recent data from the Centers for Disease Control and Prevention.
Furthermore, when surveyed about aerobic exercise and strength training, only 24.6% meet these weekly recommendations. These low rates of physical activity are alarming, given the immense benefits of exercise in improving mental and physical health and well-being.
Many people know that exercise is good for them but struggle to go workout consistently. I know firsthand how challenging this can be. In addition to being an integrative obesity specialist, I have gone from 0 minutes of physical activity in 2014 to becoming a fitness enthusiast who’s run more than 5,300 miles over 8 years. I know that as doctors and clinicians, we can profoundly influence our patients’ exercise journey.
Here are five tips to help motivate your patients make the change from “I Won’t Do It” to “I’m Doing It.”
Tip 1: ‘[Clinician], heal thyself’
Data don’t lie. Doctors who move more are more likely to counsel patients on exercise. I’ve been the doctor on both sides of the exercise spectrum. At my heaviest weight and lowest physical activity level, I felt hypocritical counseling patients on exercise.
If and when I counseled my patients on exercise, it was very directive and impersonal. When I started running consistently, I went to the opposite end of the spectrum. In my running zeal, it took a while for me to understand that not everyone wants to run dozens of miles a week. Shocking! Some people can’t handle intense workouts. The “I did it so you can too” perspective wasn’t helpful for long-term change in most patients.
What has been beneficial is recalling the obstacles and emotions I had (and still have) with staying consistent with physical activity. When physicians and clinicians move regularly, we’re more equipped to give our patients genuine counseling based on practicality rather than theory.
Now that self-reflection has been addressed, let’s get to patient counseling.
Tip 2: Motivate, don’t berate
Lectures on why patients should exercise are less helpful than asking, “Why aren›t you able to exercise more often?”
Asking open-ended questions is essential in motivational interviewing. Motivational interviewing promotes behavioral change through collaborative conversation.
Instead of telling the patient what to do, motivational interviewing seeks to establish a person’s why and create an effective plan based on their motivation. Asking open-ended questions is also helpful in determining any challenges to regular exercise, rather than calling these challenges “excuses,” which can be counterproductive.
I encourage patients to embrace challenges as opportunities for improvement. If they say: “I can’t find time to work out,” I suggest that they create time to work out by walking 10-15 minutes during lunch or after dinner. The information gleaned from open-ended questions helps set practical SMARTER goals, which we will discuss next.
Tip 3: Set SMARTER goals
After assessing the patient’s motivation and barriers, use this information to transform their desire to change into an actionable plan through a SMARTER goal. SMARTER stands for Specific, Measurable, Attainable, Relevant, Time-Sensitive, Enjoyable, and Rewarding. Practical goals have each of these components. That’s why “Just Do It” or even “Exercise 150 minutes a week” isn’t a clear path for actionable change. SMARTER goals go beyond what to do and help people personalize how to change.
For example, the SMARTER version of “exercise 150 minutes a week” for a busy person who works 50 hours a week may look like this: “My goal is to incorporate 150 minutes of physical activity through 60 minutes of aerobic exercise Monday through Friday (20-minute lunch walks) and 90 minutes of combination resistance training on the weekend (two 45-minute sessions) while listening to my favorite music. To meet my goal, I will reward myself by calling a friend to catch up or buy myself a new workout outfit.”
Exercise prescriptions are another helpful way to empower patients with a realistic exercise strategy. In my practice, I developed my own exercise prescription which focuses on overcoming time barriers to exercise and finding personally enjoyable exercises. To enhance self-directed physical activity, I›ve found it useful to have patients complete part of the “exercise prescription” on their own before or after their visit.
Tip 4: Use accountability tools
Making a SMARTER goal is one thing, but sticking with it takes regular reinforcement. Even with the best plan, once patients leave the office, there are many distractions from their goals. Accountability is the secret sauce to cultivating consistency. Fitness trackers are an affordable form of accountability. Studies show that wearing a fitness tracker can help people get up to 40 minutes of extra walking, compared with people who don’t wear trackers.
Additionally, clinicians can use different ways to offer exercise accountability. For example, more frequent check-ins, individually or in groups, can be helpful. The increase in telehealth has made interval visits easier. Reimbursement and time can limit clinician-level accountability, however. Other options are referring patients to online support groups or programs sponsored by the government or organizations. For years, I coled a Walk With a Doc chapter in Richmond, Va. There are chapters throughout the country.
Tip 5: Prepare and PLAN for setbacks
Breaking news: Most plans don’t go quite as envisioned. Accounting for the potential of setbacks early on helps patients set realistic expectations. As physicians and clinicians, we can help our patients anticipate a few likely obstacles. This may lessen the impact when a setback occurs. Also, it’s helpful to have the patient prepare for a setback with a PLAN for recovering quickly. PLAN stands for Ponder what happened; Learn from it; Adjust the original goal; Now get back on track. Getting back on track as soon as possible is important to keep patients motivated and prevent muscle deconditioning.
Exercise is medicine. Physical inactivity is a leading contributor to many preventable diseases. Although the physical activity statistics are disappointing, improvement is possible. Many systemic changes are needed to increase physical activity on a population level.
While waiting for more extensive changes, we have the power to equip patients with personalized, actionable tools for improving and maintaining physical activity.
We can transform one person at a time through our clinical encounters. Let’s use effective tools to help patients shift from “I Won’t Do It” to “I’m Doing It.”
Sylvia Gonsahn-Bollie, MD, DipABOM, is an integrative obesity specialist focused on individualized solutions for emotional and biological overeating. Her bestselling book, “Embrace You: Your Guide to Transforming Weight Loss Misconceptions Into Lifelong Wellness,” was Healthline.com’s Best Overall Weight Loss Book of 2022 and one of Livestrong.com’s 8 Best Weight-Loss Books to Read in 2022. She reported no conflicts of interest.
A version of this article first appeared on Medscape.com.
“Just Do It” is a cute marketing slogan. But let’s face it: Clinically, it doesn’t work well. Most people just don’t exercise. according to recent data from the Centers for Disease Control and Prevention.
Furthermore, when surveyed about aerobic exercise and strength training, only 24.6% meet these weekly recommendations. These low rates of physical activity are alarming, given the immense benefits of exercise in improving mental and physical health and well-being.
Many people know that exercise is good for them but struggle to go workout consistently. I know firsthand how challenging this can be. In addition to being an integrative obesity specialist, I have gone from 0 minutes of physical activity in 2014 to becoming a fitness enthusiast who’s run more than 5,300 miles over 8 years. I know that as doctors and clinicians, we can profoundly influence our patients’ exercise journey.
Here are five tips to help motivate your patients make the change from “I Won’t Do It” to “I’m Doing It.”
Tip 1: ‘[Clinician], heal thyself’
Data don’t lie. Doctors who move more are more likely to counsel patients on exercise. I’ve been the doctor on both sides of the exercise spectrum. At my heaviest weight and lowest physical activity level, I felt hypocritical counseling patients on exercise.
If and when I counseled my patients on exercise, it was very directive and impersonal. When I started running consistently, I went to the opposite end of the spectrum. In my running zeal, it took a while for me to understand that not everyone wants to run dozens of miles a week. Shocking! Some people can’t handle intense workouts. The “I did it so you can too” perspective wasn’t helpful for long-term change in most patients.
What has been beneficial is recalling the obstacles and emotions I had (and still have) with staying consistent with physical activity. When physicians and clinicians move regularly, we’re more equipped to give our patients genuine counseling based on practicality rather than theory.
Now that self-reflection has been addressed, let’s get to patient counseling.
Tip 2: Motivate, don’t berate
Lectures on why patients should exercise are less helpful than asking, “Why aren›t you able to exercise more often?”
Asking open-ended questions is essential in motivational interviewing. Motivational interviewing promotes behavioral change through collaborative conversation.
Instead of telling the patient what to do, motivational interviewing seeks to establish a person’s why and create an effective plan based on their motivation. Asking open-ended questions is also helpful in determining any challenges to regular exercise, rather than calling these challenges “excuses,” which can be counterproductive.
I encourage patients to embrace challenges as opportunities for improvement. If they say: “I can’t find time to work out,” I suggest that they create time to work out by walking 10-15 minutes during lunch or after dinner. The information gleaned from open-ended questions helps set practical SMARTER goals, which we will discuss next.
Tip 3: Set SMARTER goals
After assessing the patient’s motivation and barriers, use this information to transform their desire to change into an actionable plan through a SMARTER goal. SMARTER stands for Specific, Measurable, Attainable, Relevant, Time-Sensitive, Enjoyable, and Rewarding. Practical goals have each of these components. That’s why “Just Do It” or even “Exercise 150 minutes a week” isn’t a clear path for actionable change. SMARTER goals go beyond what to do and help people personalize how to change.
For example, the SMARTER version of “exercise 150 minutes a week” for a busy person who works 50 hours a week may look like this: “My goal is to incorporate 150 minutes of physical activity through 60 minutes of aerobic exercise Monday through Friday (20-minute lunch walks) and 90 minutes of combination resistance training on the weekend (two 45-minute sessions) while listening to my favorite music. To meet my goal, I will reward myself by calling a friend to catch up or buy myself a new workout outfit.”
Exercise prescriptions are another helpful way to empower patients with a realistic exercise strategy. In my practice, I developed my own exercise prescription which focuses on overcoming time barriers to exercise and finding personally enjoyable exercises. To enhance self-directed physical activity, I›ve found it useful to have patients complete part of the “exercise prescription” on their own before or after their visit.
Tip 4: Use accountability tools
Making a SMARTER goal is one thing, but sticking with it takes regular reinforcement. Even with the best plan, once patients leave the office, there are many distractions from their goals. Accountability is the secret sauce to cultivating consistency. Fitness trackers are an affordable form of accountability. Studies show that wearing a fitness tracker can help people get up to 40 minutes of extra walking, compared with people who don’t wear trackers.
Additionally, clinicians can use different ways to offer exercise accountability. For example, more frequent check-ins, individually or in groups, can be helpful. The increase in telehealth has made interval visits easier. Reimbursement and time can limit clinician-level accountability, however. Other options are referring patients to online support groups or programs sponsored by the government or organizations. For years, I coled a Walk With a Doc chapter in Richmond, Va. There are chapters throughout the country.
Tip 5: Prepare and PLAN for setbacks
Breaking news: Most plans don’t go quite as envisioned. Accounting for the potential of setbacks early on helps patients set realistic expectations. As physicians and clinicians, we can help our patients anticipate a few likely obstacles. This may lessen the impact when a setback occurs. Also, it’s helpful to have the patient prepare for a setback with a PLAN for recovering quickly. PLAN stands for Ponder what happened; Learn from it; Adjust the original goal; Now get back on track. Getting back on track as soon as possible is important to keep patients motivated and prevent muscle deconditioning.
Exercise is medicine. Physical inactivity is a leading contributor to many preventable diseases. Although the physical activity statistics are disappointing, improvement is possible. Many systemic changes are needed to increase physical activity on a population level.
While waiting for more extensive changes, we have the power to equip patients with personalized, actionable tools for improving and maintaining physical activity.
We can transform one person at a time through our clinical encounters. Let’s use effective tools to help patients shift from “I Won’t Do It” to “I’m Doing It.”
Sylvia Gonsahn-Bollie, MD, DipABOM, is an integrative obesity specialist focused on individualized solutions for emotional and biological overeating. Her bestselling book, “Embrace You: Your Guide to Transforming Weight Loss Misconceptions Into Lifelong Wellness,” was Healthline.com’s Best Overall Weight Loss Book of 2022 and one of Livestrong.com’s 8 Best Weight-Loss Books to Read in 2022. She reported no conflicts of interest.
A version of this article first appeared on Medscape.com.
“Just Do It” is a cute marketing slogan. But let’s face it: Clinically, it doesn’t work well. Most people just don’t exercise. according to recent data from the Centers for Disease Control and Prevention.
Furthermore, when surveyed about aerobic exercise and strength training, only 24.6% meet these weekly recommendations. These low rates of physical activity are alarming, given the immense benefits of exercise in improving mental and physical health and well-being.
Many people know that exercise is good for them but struggle to go workout consistently. I know firsthand how challenging this can be. In addition to being an integrative obesity specialist, I have gone from 0 minutes of physical activity in 2014 to becoming a fitness enthusiast who’s run more than 5,300 miles over 8 years. I know that as doctors and clinicians, we can profoundly influence our patients’ exercise journey.
Here are five tips to help motivate your patients make the change from “I Won’t Do It” to “I’m Doing It.”
Tip 1: ‘[Clinician], heal thyself’
Data don’t lie. Doctors who move more are more likely to counsel patients on exercise. I’ve been the doctor on both sides of the exercise spectrum. At my heaviest weight and lowest physical activity level, I felt hypocritical counseling patients on exercise.
If and when I counseled my patients on exercise, it was very directive and impersonal. When I started running consistently, I went to the opposite end of the spectrum. In my running zeal, it took a while for me to understand that not everyone wants to run dozens of miles a week. Shocking! Some people can’t handle intense workouts. The “I did it so you can too” perspective wasn’t helpful for long-term change in most patients.
What has been beneficial is recalling the obstacles and emotions I had (and still have) with staying consistent with physical activity. When physicians and clinicians move regularly, we’re more equipped to give our patients genuine counseling based on practicality rather than theory.
Now that self-reflection has been addressed, let’s get to patient counseling.
Tip 2: Motivate, don’t berate
Lectures on why patients should exercise are less helpful than asking, “Why aren›t you able to exercise more often?”
Asking open-ended questions is essential in motivational interviewing. Motivational interviewing promotes behavioral change through collaborative conversation.
Instead of telling the patient what to do, motivational interviewing seeks to establish a person’s why and create an effective plan based on their motivation. Asking open-ended questions is also helpful in determining any challenges to regular exercise, rather than calling these challenges “excuses,” which can be counterproductive.
I encourage patients to embrace challenges as opportunities for improvement. If they say: “I can’t find time to work out,” I suggest that they create time to work out by walking 10-15 minutes during lunch or after dinner. The information gleaned from open-ended questions helps set practical SMARTER goals, which we will discuss next.
Tip 3: Set SMARTER goals
After assessing the patient’s motivation and barriers, use this information to transform their desire to change into an actionable plan through a SMARTER goal. SMARTER stands for Specific, Measurable, Attainable, Relevant, Time-Sensitive, Enjoyable, and Rewarding. Practical goals have each of these components. That’s why “Just Do It” or even “Exercise 150 minutes a week” isn’t a clear path for actionable change. SMARTER goals go beyond what to do and help people personalize how to change.
For example, the SMARTER version of “exercise 150 minutes a week” for a busy person who works 50 hours a week may look like this: “My goal is to incorporate 150 minutes of physical activity through 60 minutes of aerobic exercise Monday through Friday (20-minute lunch walks) and 90 minutes of combination resistance training on the weekend (two 45-minute sessions) while listening to my favorite music. To meet my goal, I will reward myself by calling a friend to catch up or buy myself a new workout outfit.”
Exercise prescriptions are another helpful way to empower patients with a realistic exercise strategy. In my practice, I developed my own exercise prescription which focuses on overcoming time barriers to exercise and finding personally enjoyable exercises. To enhance self-directed physical activity, I›ve found it useful to have patients complete part of the “exercise prescription” on their own before or after their visit.
Tip 4: Use accountability tools
Making a SMARTER goal is one thing, but sticking with it takes regular reinforcement. Even with the best plan, once patients leave the office, there are many distractions from their goals. Accountability is the secret sauce to cultivating consistency. Fitness trackers are an affordable form of accountability. Studies show that wearing a fitness tracker can help people get up to 40 minutes of extra walking, compared with people who don’t wear trackers.
Additionally, clinicians can use different ways to offer exercise accountability. For example, more frequent check-ins, individually or in groups, can be helpful. The increase in telehealth has made interval visits easier. Reimbursement and time can limit clinician-level accountability, however. Other options are referring patients to online support groups or programs sponsored by the government or organizations. For years, I coled a Walk With a Doc chapter in Richmond, Va. There are chapters throughout the country.
Tip 5: Prepare and PLAN for setbacks
Breaking news: Most plans don’t go quite as envisioned. Accounting for the potential of setbacks early on helps patients set realistic expectations. As physicians and clinicians, we can help our patients anticipate a few likely obstacles. This may lessen the impact when a setback occurs. Also, it’s helpful to have the patient prepare for a setback with a PLAN for recovering quickly. PLAN stands for Ponder what happened; Learn from it; Adjust the original goal; Now get back on track. Getting back on track as soon as possible is important to keep patients motivated and prevent muscle deconditioning.
Exercise is medicine. Physical inactivity is a leading contributor to many preventable diseases. Although the physical activity statistics are disappointing, improvement is possible. Many systemic changes are needed to increase physical activity on a population level.
While waiting for more extensive changes, we have the power to equip patients with personalized, actionable tools for improving and maintaining physical activity.
We can transform one person at a time through our clinical encounters. Let’s use effective tools to help patients shift from “I Won’t Do It” to “I’m Doing It.”
Sylvia Gonsahn-Bollie, MD, DipABOM, is an integrative obesity specialist focused on individualized solutions for emotional and biological overeating. Her bestselling book, “Embrace You: Your Guide to Transforming Weight Loss Misconceptions Into Lifelong Wellness,” was Healthline.com’s Best Overall Weight Loss Book of 2022 and one of Livestrong.com’s 8 Best Weight-Loss Books to Read in 2022. She reported no conflicts of interest.
A version of this article first appeared on Medscape.com.
Commenting on weight’s not rude. It’s dangerous.
It was the start of the fall semester of my sophomore year of college.
At my small women’s college, the previous semester’s gossip had been about our classmate, S*. She had gone from being very thin to noticeably gaining a lot of weight in a few months. The rumors were that S was pregnant and gave birth over summer break. As a busy biology premed major, this was my first time hearing the news. So when I saw her standing in the hallway, back to her previous weight, I was excited for her.
In true extravert fashion, I commented on the baby and her new size. But no sooner had the words left my mouth than I regretted them.
The hall grew awkwardly silent as S’s face flushed and she asked, “Excuse me?!” Instantly I knew that the rumors weren’t true.
Thankfully, at that moment, the classroom opened and we walked in. Whew! After class, S asked if we could talk. She explained that she had a thyroid tumor and struggled to adjust to the treatments, which caused her weight fluctuations. She had never been pregnant.
My awkward statement had been the first time anyone on campus had directly mentioned her weight, though she suspected that people were talking about her. We became fast friends after this rocky beginning. Although we lost touch after college, S taught me an invaluable lesson about making assumptions about people’s weight: Ask before you assume.
Now, years later, as an internist and obesity specialist, this lesson continues to be reinforced daily.
In daily life, comments about weight can be perceived as rude. In the clinical setting, however, assumptions about weight are a form of weight bias. Weight bias can lead to weight stigma and even be dangerous to health care.
Let’s discuss the insidious influence of weight bias in health care through two commonly used phrases and then look at a few solutions to address weight bias in health care individually and systematically.
Common weight bias assumptions
“Great job, you lost weight!” In checking your patient’s vital signs, you notice that this patient with obesity has a significant weight change. You congratulate them upon entering the room. Unfortunately, their weight loss was a result of minimal eating after losing a loved one. This isn’t healthy weight loss. One of the adverse effects of weight bias is that it infers that weight loss is always a good thing, especially in people with larger bodies. This is a dangerous presumption. Let’s remember that the body favors fat storage, hence why “unintentional weight loss” is a recognized medical condition prompting evaluation. We have to be careful not to celebrate weight loss “at all costs,” such as fad diets that haven’t been shown to improve health outcomes.
Furthermore, patients who lose weight quickly (more than 4-8 lb/month) require closer follow-up and evaluation for secondary causes of weight loss. Patients may lose weight at a faster rate with the new antiobesity medications, but clinicians still should ensure that age-appropriate health maintenance screening is done and be vigilant for secondary causes of weight changes.
“Have you tried losing weight yet?” Three times. That’s how many times Chanté Burkett went to her doctor about her painful, enlarging firm stomach. She was advised to continue working on weight loss, which she did diligently. But Ms. Burkett’s abdomen kept growing and her concerns were dismissed. A visit to urgent care and a CT scan revealed that Ms. Burkett’s excess abdominal “fat” was a 13-lb mucinous cystadenoma. Sadly, cases like hers aren’t rare, isolated events. Weight bias can cause anchoring on one diagnosis, preventing consideration of other diagnostic possibilities. Even worse, anchoring will lead to the wrong intervention, such as prescribing weight loss for presumed increased adiposity instead of ordering the appropriate testing.
It’s also essential to recognize that, even if someone does have the disease of obesity, weight loss isn’t the solution to every medical concern. Even if weight loss is helpful, other, more pressing treatments may still be necessary. Telling a person with obesity who has an acute complaint to “just lose weight” is comparable to telling a patient with coronary artery disease who presents with an 80% vessel occlusion and chest pain to follow a low-fat diet. In both cases, you need to address the acute concern appropriately, then focus on the chronic treatment.
Ways to reduce clinical weight bias
How do you reduce clinical weight bias?
Ask, don’t assume. The information from the scale is simply data. Instead of judging it positively or negatively and creating a story, ask the patient. An unbiased way to approach the conversation is to say, “Great to see you. You seem [positive adjective of choice]. How have you been?” Wait until the vitals section to objectively discuss weight unless the patient offers the discussion earlier or their chief complaint lists a weight-related concern.
Order necessary tests to evaluate weight. Weight is the vital sign that people wear externally, so we feel that we can readily interpret it without any further assessment. However, resist the urge to interpret scale data without context. Keeping an open mind helps prevent anchoring and missing critical clues in the clinical history.
Address weight changes effectively. Sometimes there is an indication to prescribe weight loss as part of the treatment plan. However, remember that weight loss isn’t simply “calories in vs. calories out.” Obesity is a complex medical disease that requires a multimodal treatment approach. As clinicians, we have access to the most powerful tools for weight loss. Unfortunately, weight bias contributes to limited prescribing of metabolic medications (“antiobesity medications” or AOMs). In addition, systemic weight bias prevents insurance coverage of AOMs. The Treat and Reduce Obesity Act has been introduced into Congress to help improve life-transforming access to AOMs.
Acknowledge your bias. Our experiences make us all susceptible to bias. The Harvard Weight Implicit Association Test is free and a helpful way to assess your level of weight bias. I take it annually to ensure that I remain objective in my practice.
Addressing weight bias needs to extend beyond the individual level.
Systemically, health care needs to address the following:
Language. Use people-centered language. For example, “People aren’t obese. They have obesity.”
Accessibility. Health care settings must be comfortable and accessible for people of all sizes. Furthermore, improvements to access the services that comprehensive obesity care requires, such as AOMs, bariatric procedures and bariatric surgery, mental health care, nutrition, fitness specialists, health coaches, and more, are needed.
Education. Medical students and trainees have to learn the newest obesity science and know how to treat obesity effectively. Acknowledge and address biased tools. Recent data have shown that some of our screening tools, such as body mass index, have inherent bias. It’s time to focus on using improved diagnostic tools and personalized treatments.
We are at a pivotal time in our scientific understanding of body weight regulation and the disease of obesity. Clinical weight bias is primarily rooted in flawed science influenced by biased cultural norms and other forms of discrimination, such as racial and gender bias. We must move past assumptions to give our patients the optimal individualized care they need. So next time you observe a weight change, instead of commenting on their weight, say, “Great to see you! How have you been?”
S*: Initial has been changed to protect privacy.
Dr. Gonsahn-Bollie is an integrative obesity specialist focused on individualized solutions for emotional and biological overeating. Connect with her at www.embraceyouweightloss.com or on Instagram @embraceyoumd. Her bestselling book, “Embrace You: Your Guide to Transforming Weight Loss Misconceptions Into Lifelong Wellness”, was Healthline.com’s Best Overall Weight Loss Book of 2022 and one of Livestrong.com’s 8 Best Weight-Loss Books to Read in 2022. She has disclosed no relevant financial relationships. A version of this article originally appeared on Medscape.com.
It was the start of the fall semester of my sophomore year of college.
At my small women’s college, the previous semester’s gossip had been about our classmate, S*. She had gone from being very thin to noticeably gaining a lot of weight in a few months. The rumors were that S was pregnant and gave birth over summer break. As a busy biology premed major, this was my first time hearing the news. So when I saw her standing in the hallway, back to her previous weight, I was excited for her.
In true extravert fashion, I commented on the baby and her new size. But no sooner had the words left my mouth than I regretted them.
The hall grew awkwardly silent as S’s face flushed and she asked, “Excuse me?!” Instantly I knew that the rumors weren’t true.
Thankfully, at that moment, the classroom opened and we walked in. Whew! After class, S asked if we could talk. She explained that she had a thyroid tumor and struggled to adjust to the treatments, which caused her weight fluctuations. She had never been pregnant.
My awkward statement had been the first time anyone on campus had directly mentioned her weight, though she suspected that people were talking about her. We became fast friends after this rocky beginning. Although we lost touch after college, S taught me an invaluable lesson about making assumptions about people’s weight: Ask before you assume.
Now, years later, as an internist and obesity specialist, this lesson continues to be reinforced daily.
In daily life, comments about weight can be perceived as rude. In the clinical setting, however, assumptions about weight are a form of weight bias. Weight bias can lead to weight stigma and even be dangerous to health care.
Let’s discuss the insidious influence of weight bias in health care through two commonly used phrases and then look at a few solutions to address weight bias in health care individually and systematically.
Common weight bias assumptions
“Great job, you lost weight!” In checking your patient’s vital signs, you notice that this patient with obesity has a significant weight change. You congratulate them upon entering the room. Unfortunately, their weight loss was a result of minimal eating after losing a loved one. This isn’t healthy weight loss. One of the adverse effects of weight bias is that it infers that weight loss is always a good thing, especially in people with larger bodies. This is a dangerous presumption. Let’s remember that the body favors fat storage, hence why “unintentional weight loss” is a recognized medical condition prompting evaluation. We have to be careful not to celebrate weight loss “at all costs,” such as fad diets that haven’t been shown to improve health outcomes.
Furthermore, patients who lose weight quickly (more than 4-8 lb/month) require closer follow-up and evaluation for secondary causes of weight loss. Patients may lose weight at a faster rate with the new antiobesity medications, but clinicians still should ensure that age-appropriate health maintenance screening is done and be vigilant for secondary causes of weight changes.
“Have you tried losing weight yet?” Three times. That’s how many times Chanté Burkett went to her doctor about her painful, enlarging firm stomach. She was advised to continue working on weight loss, which she did diligently. But Ms. Burkett’s abdomen kept growing and her concerns were dismissed. A visit to urgent care and a CT scan revealed that Ms. Burkett’s excess abdominal “fat” was a 13-lb mucinous cystadenoma. Sadly, cases like hers aren’t rare, isolated events. Weight bias can cause anchoring on one diagnosis, preventing consideration of other diagnostic possibilities. Even worse, anchoring will lead to the wrong intervention, such as prescribing weight loss for presumed increased adiposity instead of ordering the appropriate testing.
It’s also essential to recognize that, even if someone does have the disease of obesity, weight loss isn’t the solution to every medical concern. Even if weight loss is helpful, other, more pressing treatments may still be necessary. Telling a person with obesity who has an acute complaint to “just lose weight” is comparable to telling a patient with coronary artery disease who presents with an 80% vessel occlusion and chest pain to follow a low-fat diet. In both cases, you need to address the acute concern appropriately, then focus on the chronic treatment.
Ways to reduce clinical weight bias
How do you reduce clinical weight bias?
Ask, don’t assume. The information from the scale is simply data. Instead of judging it positively or negatively and creating a story, ask the patient. An unbiased way to approach the conversation is to say, “Great to see you. You seem [positive adjective of choice]. How have you been?” Wait until the vitals section to objectively discuss weight unless the patient offers the discussion earlier or their chief complaint lists a weight-related concern.
Order necessary tests to evaluate weight. Weight is the vital sign that people wear externally, so we feel that we can readily interpret it without any further assessment. However, resist the urge to interpret scale data without context. Keeping an open mind helps prevent anchoring and missing critical clues in the clinical history.
Address weight changes effectively. Sometimes there is an indication to prescribe weight loss as part of the treatment plan. However, remember that weight loss isn’t simply “calories in vs. calories out.” Obesity is a complex medical disease that requires a multimodal treatment approach. As clinicians, we have access to the most powerful tools for weight loss. Unfortunately, weight bias contributes to limited prescribing of metabolic medications (“antiobesity medications” or AOMs). In addition, systemic weight bias prevents insurance coverage of AOMs. The Treat and Reduce Obesity Act has been introduced into Congress to help improve life-transforming access to AOMs.
Acknowledge your bias. Our experiences make us all susceptible to bias. The Harvard Weight Implicit Association Test is free and a helpful way to assess your level of weight bias. I take it annually to ensure that I remain objective in my practice.
Addressing weight bias needs to extend beyond the individual level.
Systemically, health care needs to address the following:
Language. Use people-centered language. For example, “People aren’t obese. They have obesity.”
Accessibility. Health care settings must be comfortable and accessible for people of all sizes. Furthermore, improvements to access the services that comprehensive obesity care requires, such as AOMs, bariatric procedures and bariatric surgery, mental health care, nutrition, fitness specialists, health coaches, and more, are needed.
Education. Medical students and trainees have to learn the newest obesity science and know how to treat obesity effectively. Acknowledge and address biased tools. Recent data have shown that some of our screening tools, such as body mass index, have inherent bias. It’s time to focus on using improved diagnostic tools and personalized treatments.
We are at a pivotal time in our scientific understanding of body weight regulation and the disease of obesity. Clinical weight bias is primarily rooted in flawed science influenced by biased cultural norms and other forms of discrimination, such as racial and gender bias. We must move past assumptions to give our patients the optimal individualized care they need. So next time you observe a weight change, instead of commenting on their weight, say, “Great to see you! How have you been?”
S*: Initial has been changed to protect privacy.
Dr. Gonsahn-Bollie is an integrative obesity specialist focused on individualized solutions for emotional and biological overeating. Connect with her at www.embraceyouweightloss.com or on Instagram @embraceyoumd. Her bestselling book, “Embrace You: Your Guide to Transforming Weight Loss Misconceptions Into Lifelong Wellness”, was Healthline.com’s Best Overall Weight Loss Book of 2022 and one of Livestrong.com’s 8 Best Weight-Loss Books to Read in 2022. She has disclosed no relevant financial relationships. A version of this article originally appeared on Medscape.com.
It was the start of the fall semester of my sophomore year of college.
At my small women’s college, the previous semester’s gossip had been about our classmate, S*. She had gone from being very thin to noticeably gaining a lot of weight in a few months. The rumors were that S was pregnant and gave birth over summer break. As a busy biology premed major, this was my first time hearing the news. So when I saw her standing in the hallway, back to her previous weight, I was excited for her.
In true extravert fashion, I commented on the baby and her new size. But no sooner had the words left my mouth than I regretted them.
The hall grew awkwardly silent as S’s face flushed and she asked, “Excuse me?!” Instantly I knew that the rumors weren’t true.
Thankfully, at that moment, the classroom opened and we walked in. Whew! After class, S asked if we could talk. She explained that she had a thyroid tumor and struggled to adjust to the treatments, which caused her weight fluctuations. She had never been pregnant.
My awkward statement had been the first time anyone on campus had directly mentioned her weight, though she suspected that people were talking about her. We became fast friends after this rocky beginning. Although we lost touch after college, S taught me an invaluable lesson about making assumptions about people’s weight: Ask before you assume.
Now, years later, as an internist and obesity specialist, this lesson continues to be reinforced daily.
In daily life, comments about weight can be perceived as rude. In the clinical setting, however, assumptions about weight are a form of weight bias. Weight bias can lead to weight stigma and even be dangerous to health care.
Let’s discuss the insidious influence of weight bias in health care through two commonly used phrases and then look at a few solutions to address weight bias in health care individually and systematically.
Common weight bias assumptions
“Great job, you lost weight!” In checking your patient’s vital signs, you notice that this patient with obesity has a significant weight change. You congratulate them upon entering the room. Unfortunately, their weight loss was a result of minimal eating after losing a loved one. This isn’t healthy weight loss. One of the adverse effects of weight bias is that it infers that weight loss is always a good thing, especially in people with larger bodies. This is a dangerous presumption. Let’s remember that the body favors fat storage, hence why “unintentional weight loss” is a recognized medical condition prompting evaluation. We have to be careful not to celebrate weight loss “at all costs,” such as fad diets that haven’t been shown to improve health outcomes.
Furthermore, patients who lose weight quickly (more than 4-8 lb/month) require closer follow-up and evaluation for secondary causes of weight loss. Patients may lose weight at a faster rate with the new antiobesity medications, but clinicians still should ensure that age-appropriate health maintenance screening is done and be vigilant for secondary causes of weight changes.
“Have you tried losing weight yet?” Three times. That’s how many times Chanté Burkett went to her doctor about her painful, enlarging firm stomach. She was advised to continue working on weight loss, which she did diligently. But Ms. Burkett’s abdomen kept growing and her concerns were dismissed. A visit to urgent care and a CT scan revealed that Ms. Burkett’s excess abdominal “fat” was a 13-lb mucinous cystadenoma. Sadly, cases like hers aren’t rare, isolated events. Weight bias can cause anchoring on one diagnosis, preventing consideration of other diagnostic possibilities. Even worse, anchoring will lead to the wrong intervention, such as prescribing weight loss for presumed increased adiposity instead of ordering the appropriate testing.
It’s also essential to recognize that, even if someone does have the disease of obesity, weight loss isn’t the solution to every medical concern. Even if weight loss is helpful, other, more pressing treatments may still be necessary. Telling a person with obesity who has an acute complaint to “just lose weight” is comparable to telling a patient with coronary artery disease who presents with an 80% vessel occlusion and chest pain to follow a low-fat diet. In both cases, you need to address the acute concern appropriately, then focus on the chronic treatment.
Ways to reduce clinical weight bias
How do you reduce clinical weight bias?
Ask, don’t assume. The information from the scale is simply data. Instead of judging it positively or negatively and creating a story, ask the patient. An unbiased way to approach the conversation is to say, “Great to see you. You seem [positive adjective of choice]. How have you been?” Wait until the vitals section to objectively discuss weight unless the patient offers the discussion earlier or their chief complaint lists a weight-related concern.
Order necessary tests to evaluate weight. Weight is the vital sign that people wear externally, so we feel that we can readily interpret it without any further assessment. However, resist the urge to interpret scale data without context. Keeping an open mind helps prevent anchoring and missing critical clues in the clinical history.
Address weight changes effectively. Sometimes there is an indication to prescribe weight loss as part of the treatment plan. However, remember that weight loss isn’t simply “calories in vs. calories out.” Obesity is a complex medical disease that requires a multimodal treatment approach. As clinicians, we have access to the most powerful tools for weight loss. Unfortunately, weight bias contributes to limited prescribing of metabolic medications (“antiobesity medications” or AOMs). In addition, systemic weight bias prevents insurance coverage of AOMs. The Treat and Reduce Obesity Act has been introduced into Congress to help improve life-transforming access to AOMs.
Acknowledge your bias. Our experiences make us all susceptible to bias. The Harvard Weight Implicit Association Test is free and a helpful way to assess your level of weight bias. I take it annually to ensure that I remain objective in my practice.
Addressing weight bias needs to extend beyond the individual level.
Systemically, health care needs to address the following:
Language. Use people-centered language. For example, “People aren’t obese. They have obesity.”
Accessibility. Health care settings must be comfortable and accessible for people of all sizes. Furthermore, improvements to access the services that comprehensive obesity care requires, such as AOMs, bariatric procedures and bariatric surgery, mental health care, nutrition, fitness specialists, health coaches, and more, are needed.
Education. Medical students and trainees have to learn the newest obesity science and know how to treat obesity effectively. Acknowledge and address biased tools. Recent data have shown that some of our screening tools, such as body mass index, have inherent bias. It’s time to focus on using improved diagnostic tools and personalized treatments.
We are at a pivotal time in our scientific understanding of body weight regulation and the disease of obesity. Clinical weight bias is primarily rooted in flawed science influenced by biased cultural norms and other forms of discrimination, such as racial and gender bias. We must move past assumptions to give our patients the optimal individualized care they need. So next time you observe a weight change, instead of commenting on their weight, say, “Great to see you! How have you been?”
S*: Initial has been changed to protect privacy.
Dr. Gonsahn-Bollie is an integrative obesity specialist focused on individualized solutions for emotional and biological overeating. Connect with her at www.embraceyouweightloss.com or on Instagram @embraceyoumd. Her bestselling book, “Embrace You: Your Guide to Transforming Weight Loss Misconceptions Into Lifelong Wellness”, was Healthline.com’s Best Overall Weight Loss Book of 2022 and one of Livestrong.com’s 8 Best Weight-Loss Books to Read in 2022. She has disclosed no relevant financial relationships. A version of this article originally appeared on Medscape.com.
Staving off holiday weight gain
Five pounds of weight gain during the holidays is a disproven myth that pops up annually like holiday lights. But before you do a happy dance and pile that extra whipped cream on your pie, you should know two things. One, people do gain weight during the holidays. Two, the extra pounds tend to stick around because most people never lose their holiday weight. Over time, these extra pounds can lead to obesity and weight-related conditions such as diabetes and hypertension.
Let’s be clear. Your weight is one of many markers of your wellness and metabolic health. However, weight changes can indicate that your health is off balance. Holiday weight gain often comes from indulging in increased rich foods, less physical activity, higher stress levels, and sleep disruption.
Optimizing lifestyle factors and trying to lose weight is challenging any time of the year. However, the holiday bustle makes losing weight during this time even more challenging for most people. But maintaining your weight and overall wellness is manageable with three simple shifts in mindset, mindful eating, and meal strategy. Let’s discuss each.
Mindset
From personal and professional experience, I see two primary attitudes regarding holiday eating. They are either “I’ll wait till January to go on a diet” or “I’m on a diet, so I can’t eat anything I like during the holidays.” Both attitude extremes prevent enjoyable and healthy eating during the holidays because they place the focus on food. With both mindsets, food is in control, which leaves you feeling out of control. Rather than having an “all or none” mindset during the holidays, I encourage you to ask yourself:
- “What matters most to me during the holidays?” In a recent survey, 72% of Americans said they look forward to during the holidays. Although food often accompanies family celebrations, it’s the time with family that matters most. Choose to savor sweet time spent with loved ones instead of stuffing yourself with excess sugary sweets.
- “How can I enjoy myself without food or alcoholic beverages?” So often, we eat or drink certain foods out of habit. Shift your mindset from “we always do this” to “what could we do instead?” Asking this question may be the doorway to creating new, non–food-centered traditions.
- “How can I have the foods I love during the holidays and still meet my weight and wellness goals?” This question helps you create opportunities instead of depriving yourself. Rather than depriving yourself, you could cut back on snacking or reduce your sugar intake elsewhere. Or add an extra workout session or stress reduction practice during the holidays.
Mindful eating
The purpose of mindful eating isn’t weight loss. Some studies suggest it may help maintain weight. More importantly, mindfulness can improve your relationship with food and promote wellness. Traditional tips for mindful eating include doing the following as you eat: Being present in the moment, not judging your food, slowing down, and savoring the taste of your food. During the holidays, asking additional questions may enhance mindful eating. For instance:
- “Am I eating to avoid uncomfortable emotions?” The holidays can trigger emotions such as grief, sadness, and anxiety. Also, preexisting can worsen. Decadent foods become a quick fix leading to more emotional eating during this season. Addressing these emotions can help you avoid overeating during the holidays. For mental health resources, visit the
- “What food or drink do I most enjoy during the holidays?” Trying to resist your favorite holiday treats can be an exhausting test of “willpower.” Eventually, and psychological reasons, and you “cheat” on your plan to not eat holiday treats. To prevent this painful battle of treat versus cheat, plan to eat your “indulgence food” in moderation. Savor the foods you enjoy. Then cut out the rest of the food you don’t like or feel you must eat because “Aunty Sarah will feel bad.”
Meal strategy
Many holiday treats and parties are unavoidable unless you plan to hide in a cave for the next few weeks. Rather than torturing yourself nibbling on celery and sipping on sparkling water during your holiday event, create a strategy. For 8 years, I’ve been on my weight loss and wellness journey. I have a holiday strategy that helps my patients, clients, and me maintain our weight and wellness during the holidays. One critical part of the strategy is to anticipate indulgence events. Specifically, look at all the planned holiday events and choose three indulgence events. The rest of the time, do your best to stay on your plan. Knowing your indulgence events to look forward to gives you a sense of control over when you indulge. On non-indulgent days, think, “I can eat it but choose not to” instead of the limiting thought, “I can’t eat that.” Choice is a powerful tool. Once at an indulgence event, I focus on mindful eating and enjoying people around me, which cuts down on overeating just because “I can.”
This holiday season is a reunion time for many people, after enduring long separations from family and friends due to the pandemic. Relishing time with loved ones should be your focus during the holidays – not eating yourself into worse health or worrying about dieting. Even if you choose not to make all the shifts in mindset, mindful eating, and meal strategy mentioned, choosing even one change to focus on can help you both enjoy the holidays and have increased control over your weight and wellness. Whatever you do, may you and your loved ones have a safe, healthy, and enjoyable holiday season.
Sylvia Gonsahn-Bollie, MD, DipABOM, is an integrative obesity specialist who specializes in individualized solutions for emotional and biological overeating. She is CEO and lead physician at Embrace You Weight and Wellness, Telehealth & Virtual Counseling. She has disclosed having no relevant financial relationships. A version of this article first appeared on Medscape.com.
Five pounds of weight gain during the holidays is a disproven myth that pops up annually like holiday lights. But before you do a happy dance and pile that extra whipped cream on your pie, you should know two things. One, people do gain weight during the holidays. Two, the extra pounds tend to stick around because most people never lose their holiday weight. Over time, these extra pounds can lead to obesity and weight-related conditions such as diabetes and hypertension.
Let’s be clear. Your weight is one of many markers of your wellness and metabolic health. However, weight changes can indicate that your health is off balance. Holiday weight gain often comes from indulging in increased rich foods, less physical activity, higher stress levels, and sleep disruption.
Optimizing lifestyle factors and trying to lose weight is challenging any time of the year. However, the holiday bustle makes losing weight during this time even more challenging for most people. But maintaining your weight and overall wellness is manageable with three simple shifts in mindset, mindful eating, and meal strategy. Let’s discuss each.
Mindset
From personal and professional experience, I see two primary attitudes regarding holiday eating. They are either “I’ll wait till January to go on a diet” or “I’m on a diet, so I can’t eat anything I like during the holidays.” Both attitude extremes prevent enjoyable and healthy eating during the holidays because they place the focus on food. With both mindsets, food is in control, which leaves you feeling out of control. Rather than having an “all or none” mindset during the holidays, I encourage you to ask yourself:
- “What matters most to me during the holidays?” In a recent survey, 72% of Americans said they look forward to during the holidays. Although food often accompanies family celebrations, it’s the time with family that matters most. Choose to savor sweet time spent with loved ones instead of stuffing yourself with excess sugary sweets.
- “How can I enjoy myself without food or alcoholic beverages?” So often, we eat or drink certain foods out of habit. Shift your mindset from “we always do this” to “what could we do instead?” Asking this question may be the doorway to creating new, non–food-centered traditions.
- “How can I have the foods I love during the holidays and still meet my weight and wellness goals?” This question helps you create opportunities instead of depriving yourself. Rather than depriving yourself, you could cut back on snacking or reduce your sugar intake elsewhere. Or add an extra workout session or stress reduction practice during the holidays.
Mindful eating
The purpose of mindful eating isn’t weight loss. Some studies suggest it may help maintain weight. More importantly, mindfulness can improve your relationship with food and promote wellness. Traditional tips for mindful eating include doing the following as you eat: Being present in the moment, not judging your food, slowing down, and savoring the taste of your food. During the holidays, asking additional questions may enhance mindful eating. For instance:
- “Am I eating to avoid uncomfortable emotions?” The holidays can trigger emotions such as grief, sadness, and anxiety. Also, preexisting can worsen. Decadent foods become a quick fix leading to more emotional eating during this season. Addressing these emotions can help you avoid overeating during the holidays. For mental health resources, visit the
- “What food or drink do I most enjoy during the holidays?” Trying to resist your favorite holiday treats can be an exhausting test of “willpower.” Eventually, and psychological reasons, and you “cheat” on your plan to not eat holiday treats. To prevent this painful battle of treat versus cheat, plan to eat your “indulgence food” in moderation. Savor the foods you enjoy. Then cut out the rest of the food you don’t like or feel you must eat because “Aunty Sarah will feel bad.”
Meal strategy
Many holiday treats and parties are unavoidable unless you plan to hide in a cave for the next few weeks. Rather than torturing yourself nibbling on celery and sipping on sparkling water during your holiday event, create a strategy. For 8 years, I’ve been on my weight loss and wellness journey. I have a holiday strategy that helps my patients, clients, and me maintain our weight and wellness during the holidays. One critical part of the strategy is to anticipate indulgence events. Specifically, look at all the planned holiday events and choose three indulgence events. The rest of the time, do your best to stay on your plan. Knowing your indulgence events to look forward to gives you a sense of control over when you indulge. On non-indulgent days, think, “I can eat it but choose not to” instead of the limiting thought, “I can’t eat that.” Choice is a powerful tool. Once at an indulgence event, I focus on mindful eating and enjoying people around me, which cuts down on overeating just because “I can.”
This holiday season is a reunion time for many people, after enduring long separations from family and friends due to the pandemic. Relishing time with loved ones should be your focus during the holidays – not eating yourself into worse health or worrying about dieting. Even if you choose not to make all the shifts in mindset, mindful eating, and meal strategy mentioned, choosing even one change to focus on can help you both enjoy the holidays and have increased control over your weight and wellness. Whatever you do, may you and your loved ones have a safe, healthy, and enjoyable holiday season.
Sylvia Gonsahn-Bollie, MD, DipABOM, is an integrative obesity specialist who specializes in individualized solutions for emotional and biological overeating. She is CEO and lead physician at Embrace You Weight and Wellness, Telehealth & Virtual Counseling. She has disclosed having no relevant financial relationships. A version of this article first appeared on Medscape.com.
Five pounds of weight gain during the holidays is a disproven myth that pops up annually like holiday lights. But before you do a happy dance and pile that extra whipped cream on your pie, you should know two things. One, people do gain weight during the holidays. Two, the extra pounds tend to stick around because most people never lose their holiday weight. Over time, these extra pounds can lead to obesity and weight-related conditions such as diabetes and hypertension.
Let’s be clear. Your weight is one of many markers of your wellness and metabolic health. However, weight changes can indicate that your health is off balance. Holiday weight gain often comes from indulging in increased rich foods, less physical activity, higher stress levels, and sleep disruption.
Optimizing lifestyle factors and trying to lose weight is challenging any time of the year. However, the holiday bustle makes losing weight during this time even more challenging for most people. But maintaining your weight and overall wellness is manageable with three simple shifts in mindset, mindful eating, and meal strategy. Let’s discuss each.
Mindset
From personal and professional experience, I see two primary attitudes regarding holiday eating. They are either “I’ll wait till January to go on a diet” or “I’m on a diet, so I can’t eat anything I like during the holidays.” Both attitude extremes prevent enjoyable and healthy eating during the holidays because they place the focus on food. With both mindsets, food is in control, which leaves you feeling out of control. Rather than having an “all or none” mindset during the holidays, I encourage you to ask yourself:
- “What matters most to me during the holidays?” In a recent survey, 72% of Americans said they look forward to during the holidays. Although food often accompanies family celebrations, it’s the time with family that matters most. Choose to savor sweet time spent with loved ones instead of stuffing yourself with excess sugary sweets.
- “How can I enjoy myself without food or alcoholic beverages?” So often, we eat or drink certain foods out of habit. Shift your mindset from “we always do this” to “what could we do instead?” Asking this question may be the doorway to creating new, non–food-centered traditions.
- “How can I have the foods I love during the holidays and still meet my weight and wellness goals?” This question helps you create opportunities instead of depriving yourself. Rather than depriving yourself, you could cut back on snacking or reduce your sugar intake elsewhere. Or add an extra workout session or stress reduction practice during the holidays.
Mindful eating
The purpose of mindful eating isn’t weight loss. Some studies suggest it may help maintain weight. More importantly, mindfulness can improve your relationship with food and promote wellness. Traditional tips for mindful eating include doing the following as you eat: Being present in the moment, not judging your food, slowing down, and savoring the taste of your food. During the holidays, asking additional questions may enhance mindful eating. For instance:
- “Am I eating to avoid uncomfortable emotions?” The holidays can trigger emotions such as grief, sadness, and anxiety. Also, preexisting can worsen. Decadent foods become a quick fix leading to more emotional eating during this season. Addressing these emotions can help you avoid overeating during the holidays. For mental health resources, visit the
- “What food or drink do I most enjoy during the holidays?” Trying to resist your favorite holiday treats can be an exhausting test of “willpower.” Eventually, and psychological reasons, and you “cheat” on your plan to not eat holiday treats. To prevent this painful battle of treat versus cheat, plan to eat your “indulgence food” in moderation. Savor the foods you enjoy. Then cut out the rest of the food you don’t like or feel you must eat because “Aunty Sarah will feel bad.”
Meal strategy
Many holiday treats and parties are unavoidable unless you plan to hide in a cave for the next few weeks. Rather than torturing yourself nibbling on celery and sipping on sparkling water during your holiday event, create a strategy. For 8 years, I’ve been on my weight loss and wellness journey. I have a holiday strategy that helps my patients, clients, and me maintain our weight and wellness during the holidays. One critical part of the strategy is to anticipate indulgence events. Specifically, look at all the planned holiday events and choose three indulgence events. The rest of the time, do your best to stay on your plan. Knowing your indulgence events to look forward to gives you a sense of control over when you indulge. On non-indulgent days, think, “I can eat it but choose not to” instead of the limiting thought, “I can’t eat that.” Choice is a powerful tool. Once at an indulgence event, I focus on mindful eating and enjoying people around me, which cuts down on overeating just because “I can.”
This holiday season is a reunion time for many people, after enduring long separations from family and friends due to the pandemic. Relishing time with loved ones should be your focus during the holidays – not eating yourself into worse health or worrying about dieting. Even if you choose not to make all the shifts in mindset, mindful eating, and meal strategy mentioned, choosing even one change to focus on can help you both enjoy the holidays and have increased control over your weight and wellness. Whatever you do, may you and your loved ones have a safe, healthy, and enjoyable holiday season.
Sylvia Gonsahn-Bollie, MD, DipABOM, is an integrative obesity specialist who specializes in individualized solutions for emotional and biological overeating. She is CEO and lead physician at Embrace You Weight and Wellness, Telehealth & Virtual Counseling. She has disclosed having no relevant financial relationships. A version of this article first appeared on Medscape.com.
When do we stop using BMI to diagnose obesity?
“BMI is trash. Full stop.” This controversial tweet received 26,500 likes and almost 3,000 retweets. The 400 comments from medical and non–health care personnel ranged from agreeable to contrary to offensive.
As a Black woman who is an obesity expert living with the impact of obesity in my own life, I know the emotion that a BMI conversation can evoke. Before emotions hijack the conversation, let’s discuss BMI’s past, present, and future.
BMI: From observational measurement to clinical use
Imagine walking into your favorite clothing store where an eager clerk greets you with a shirt to try on. The fit is off, but the clerk insists that the shirt must fit because everyone who’s your height should be able to wear it. This scenario seems ridiculous. But this is how we’ve come to use the BMI. Instead of thinking that people of the same height may be the same size, we declare that they must be the same size.
The idea behind the BMI was conceived in 1832 by Belgian anthropologist and mathematician Adolphe Quetelet, but he didn’t intend for it to be a health measure. Instead, it was simply an observation of how people’s weight changed in proportion to height over their lifetime.
Fast-forward to the 20th century, when insurance companies began using weight as an indicator of health status. Weights were recorded in a “Life Table.” Individual health status was determined on the basis of arbitrary cut-offs for weight on the Life Tables. Furthermore, White men set the “normal” weight standards because they were the primary insurance holders.
In 1972, Dr. Ancel Keys, a physician and leading expert in body composition at the time, cried foul on this practice and sought to standardize the use of weight as a health indicator. Dr. Keys used Quetelet’s calculation and termed it the Body Mass Index.
By 1985, the U.S. National Institutes of Health and the World Health Organization adopted the BMI. By the 21st century, BMI had become widely used in clinical settings. For example, the Centers for Medicare & Medicaid Services adopted BMI as a quality-of-care measure, placing even more pressure on clinicians to use BMI as a health screening tool.
BMI as a tool to diagnose obesity
We can’t discuss BMI without discussing the disease of obesity. BMI is the most widely used tool to diagnose obesity. In the United States, one-third of Americans meet the criteria for obesity. Another one-third are at risk for obesity.
Compared with BMI’s relatively quick acceptance into clinical practice, however, obesity was only recently recognized as a disease.
Historically, obesity has been viewed as a lifestyle choice, fueled by misinformation and multiple forms of bias. The historical bias associated with BMI and discrimination has led some public health officials and scholars to dismiss the use of BMI or fail to recognize obesity as disease.
This is a dangerous conclusion, because it comes to the detriment of the very people disproportionately impacted by obesity-related health disparities.
Furthermore, weight bias continues to prevent people living with obesity from receiving insurance coverage for life-enhancing obesity medications and interventions.
Is it time to phase out BMI?
The BMI is intertwined with many forms of bias: age, gender, racial, ethnic, and even weight. Therefore, it is time to phase out BMI. However, phasing out BMI is complex and will take time, given that:
- Obesity is still a relatively “young” disease. 2023 marks the 10th anniversary of obesity’s recognition as a disease by the American Medical Association. Currently, BMI is the most widely used tool to diagnose obesity. Tools such as waist circumference, body composition, and metabolic health assessment will need to replace the BMI. Shifting from BMI emphasizes that obesity is more than a number on the scale. Obesity, as defined by the Obesity Medicine Association, is indeed a “chronic, relapsing, multi-factorial, neurobehavioral disease, wherein an increase in body fat promotes adipose tissue dysfunction and abnormal fat mass physical forces, resulting in adverse metabolic, biomechanical, and psychosocial health consequences.”
- Much of our health research is tied to BMI. There have been some shifts in looking at non–weight-related health indicators. However, we need more robust studies evaluating other health indicators beyond weight and BMI. The availability of this data will help eliminate the need for BMI and promote individualized health assessment.
- Current treatment guidelines for obesity medications are based on BMI. (Note: Medications to treat obesity are called “anti-obesity” medications or AOMs. However, given the stigma associated with obesity, I prefer not to use the term “anti-obesity.”) Presently this interferes with long-term obesity treatment. Once BMI is “normal,” many patients lose insurance coverage for their obesity medication, despite needing long-term metabolic support to overcome the compensatory mechanism of weight regain. Obesity is a chronic disease that exists independent of weight status. Therefore, using non-BMI measures will help ensure appropriate lifetime support for obesity.
The preceding are barriers, not impossibilities. In the interim, if BMI is still used in any capacity, the BMI reference chart should be an adjusted BMI chart based on age, race, ethnicity, biological sex, and obesity-related conditions. Furthermore, BMI isn’t the sole determining factor of health status.
Instead, an “abnormal” BMI should initiate conversation and further testing, if needed, to determine an individual’s health. For example, compare two people of the same height with different BMIs and lifestyles. Current studies support that a person flagged as having a high adjusted BMI but practicing a healthy lifestyle and having no metabolic diseases is less at risk than a person with a “normal” BMI but high waist circumference and an unhealthy lifestyle.
Regardless of your personal feelings, the facts are clear. Technology empowers us with better tools than BMI to determine health status. Therefore, it’s not a matter of if we will stop using BMI but when.
Sylvia Gonsahn-Bollie, MD, DipABOM, is an integrative obesity specialist who specializes in individualized solutions for emotional and biological overeating. Connect with her at www.embraceyouweightloss.com or on Instagram @embraceyoumd. Her bestselling book, “Embrace You: Your Guide to Transforming Weight Loss Misconceptions Into Lifelong Wellness,” is Healthline.com’s Best Overall Weight Loss Book 2022 and one of Livestrong.com’s picks for the 8 Best Weight-Loss Books to Read in 2022.
A version of this article first appeared on Medscape.com.
“BMI is trash. Full stop.” This controversial tweet received 26,500 likes and almost 3,000 retweets. The 400 comments from medical and non–health care personnel ranged from agreeable to contrary to offensive.
As a Black woman who is an obesity expert living with the impact of obesity in my own life, I know the emotion that a BMI conversation can evoke. Before emotions hijack the conversation, let’s discuss BMI’s past, present, and future.
BMI: From observational measurement to clinical use
Imagine walking into your favorite clothing store where an eager clerk greets you with a shirt to try on. The fit is off, but the clerk insists that the shirt must fit because everyone who’s your height should be able to wear it. This scenario seems ridiculous. But this is how we’ve come to use the BMI. Instead of thinking that people of the same height may be the same size, we declare that they must be the same size.
The idea behind the BMI was conceived in 1832 by Belgian anthropologist and mathematician Adolphe Quetelet, but he didn’t intend for it to be a health measure. Instead, it was simply an observation of how people’s weight changed in proportion to height over their lifetime.
Fast-forward to the 20th century, when insurance companies began using weight as an indicator of health status. Weights were recorded in a “Life Table.” Individual health status was determined on the basis of arbitrary cut-offs for weight on the Life Tables. Furthermore, White men set the “normal” weight standards because they were the primary insurance holders.
In 1972, Dr. Ancel Keys, a physician and leading expert in body composition at the time, cried foul on this practice and sought to standardize the use of weight as a health indicator. Dr. Keys used Quetelet’s calculation and termed it the Body Mass Index.
By 1985, the U.S. National Institutes of Health and the World Health Organization adopted the BMI. By the 21st century, BMI had become widely used in clinical settings. For example, the Centers for Medicare & Medicaid Services adopted BMI as a quality-of-care measure, placing even more pressure on clinicians to use BMI as a health screening tool.
BMI as a tool to diagnose obesity
We can’t discuss BMI without discussing the disease of obesity. BMI is the most widely used tool to diagnose obesity. In the United States, one-third of Americans meet the criteria for obesity. Another one-third are at risk for obesity.
Compared with BMI’s relatively quick acceptance into clinical practice, however, obesity was only recently recognized as a disease.
Historically, obesity has been viewed as a lifestyle choice, fueled by misinformation and multiple forms of bias. The historical bias associated with BMI and discrimination has led some public health officials and scholars to dismiss the use of BMI or fail to recognize obesity as disease.
This is a dangerous conclusion, because it comes to the detriment of the very people disproportionately impacted by obesity-related health disparities.
Furthermore, weight bias continues to prevent people living with obesity from receiving insurance coverage for life-enhancing obesity medications and interventions.
Is it time to phase out BMI?
The BMI is intertwined with many forms of bias: age, gender, racial, ethnic, and even weight. Therefore, it is time to phase out BMI. However, phasing out BMI is complex and will take time, given that:
- Obesity is still a relatively “young” disease. 2023 marks the 10th anniversary of obesity’s recognition as a disease by the American Medical Association. Currently, BMI is the most widely used tool to diagnose obesity. Tools such as waist circumference, body composition, and metabolic health assessment will need to replace the BMI. Shifting from BMI emphasizes that obesity is more than a number on the scale. Obesity, as defined by the Obesity Medicine Association, is indeed a “chronic, relapsing, multi-factorial, neurobehavioral disease, wherein an increase in body fat promotes adipose tissue dysfunction and abnormal fat mass physical forces, resulting in adverse metabolic, biomechanical, and psychosocial health consequences.”
- Much of our health research is tied to BMI. There have been some shifts in looking at non–weight-related health indicators. However, we need more robust studies evaluating other health indicators beyond weight and BMI. The availability of this data will help eliminate the need for BMI and promote individualized health assessment.
- Current treatment guidelines for obesity medications are based on BMI. (Note: Medications to treat obesity are called “anti-obesity” medications or AOMs. However, given the stigma associated with obesity, I prefer not to use the term “anti-obesity.”) Presently this interferes with long-term obesity treatment. Once BMI is “normal,” many patients lose insurance coverage for their obesity medication, despite needing long-term metabolic support to overcome the compensatory mechanism of weight regain. Obesity is a chronic disease that exists independent of weight status. Therefore, using non-BMI measures will help ensure appropriate lifetime support for obesity.
The preceding are barriers, not impossibilities. In the interim, if BMI is still used in any capacity, the BMI reference chart should be an adjusted BMI chart based on age, race, ethnicity, biological sex, and obesity-related conditions. Furthermore, BMI isn’t the sole determining factor of health status.
Instead, an “abnormal” BMI should initiate conversation and further testing, if needed, to determine an individual’s health. For example, compare two people of the same height with different BMIs and lifestyles. Current studies support that a person flagged as having a high adjusted BMI but practicing a healthy lifestyle and having no metabolic diseases is less at risk than a person with a “normal” BMI but high waist circumference and an unhealthy lifestyle.
Regardless of your personal feelings, the facts are clear. Technology empowers us with better tools than BMI to determine health status. Therefore, it’s not a matter of if we will stop using BMI but when.
Sylvia Gonsahn-Bollie, MD, DipABOM, is an integrative obesity specialist who specializes in individualized solutions for emotional and biological overeating. Connect with her at www.embraceyouweightloss.com or on Instagram @embraceyoumd. Her bestselling book, “Embrace You: Your Guide to Transforming Weight Loss Misconceptions Into Lifelong Wellness,” is Healthline.com’s Best Overall Weight Loss Book 2022 and one of Livestrong.com’s picks for the 8 Best Weight-Loss Books to Read in 2022.
A version of this article first appeared on Medscape.com.
“BMI is trash. Full stop.” This controversial tweet received 26,500 likes and almost 3,000 retweets. The 400 comments from medical and non–health care personnel ranged from agreeable to contrary to offensive.
As a Black woman who is an obesity expert living with the impact of obesity in my own life, I know the emotion that a BMI conversation can evoke. Before emotions hijack the conversation, let’s discuss BMI’s past, present, and future.
BMI: From observational measurement to clinical use
Imagine walking into your favorite clothing store where an eager clerk greets you with a shirt to try on. The fit is off, but the clerk insists that the shirt must fit because everyone who’s your height should be able to wear it. This scenario seems ridiculous. But this is how we’ve come to use the BMI. Instead of thinking that people of the same height may be the same size, we declare that they must be the same size.
The idea behind the BMI was conceived in 1832 by Belgian anthropologist and mathematician Adolphe Quetelet, but he didn’t intend for it to be a health measure. Instead, it was simply an observation of how people’s weight changed in proportion to height over their lifetime.
Fast-forward to the 20th century, when insurance companies began using weight as an indicator of health status. Weights were recorded in a “Life Table.” Individual health status was determined on the basis of arbitrary cut-offs for weight on the Life Tables. Furthermore, White men set the “normal” weight standards because they were the primary insurance holders.
In 1972, Dr. Ancel Keys, a physician and leading expert in body composition at the time, cried foul on this practice and sought to standardize the use of weight as a health indicator. Dr. Keys used Quetelet’s calculation and termed it the Body Mass Index.
By 1985, the U.S. National Institutes of Health and the World Health Organization adopted the BMI. By the 21st century, BMI had become widely used in clinical settings. For example, the Centers for Medicare & Medicaid Services adopted BMI as a quality-of-care measure, placing even more pressure on clinicians to use BMI as a health screening tool.
BMI as a tool to diagnose obesity
We can’t discuss BMI without discussing the disease of obesity. BMI is the most widely used tool to diagnose obesity. In the United States, one-third of Americans meet the criteria for obesity. Another one-third are at risk for obesity.
Compared with BMI’s relatively quick acceptance into clinical practice, however, obesity was only recently recognized as a disease.
Historically, obesity has been viewed as a lifestyle choice, fueled by misinformation and multiple forms of bias. The historical bias associated with BMI and discrimination has led some public health officials and scholars to dismiss the use of BMI or fail to recognize obesity as disease.
This is a dangerous conclusion, because it comes to the detriment of the very people disproportionately impacted by obesity-related health disparities.
Furthermore, weight bias continues to prevent people living with obesity from receiving insurance coverage for life-enhancing obesity medications and interventions.
Is it time to phase out BMI?
The BMI is intertwined with many forms of bias: age, gender, racial, ethnic, and even weight. Therefore, it is time to phase out BMI. However, phasing out BMI is complex and will take time, given that:
- Obesity is still a relatively “young” disease. 2023 marks the 10th anniversary of obesity’s recognition as a disease by the American Medical Association. Currently, BMI is the most widely used tool to diagnose obesity. Tools such as waist circumference, body composition, and metabolic health assessment will need to replace the BMI. Shifting from BMI emphasizes that obesity is more than a number on the scale. Obesity, as defined by the Obesity Medicine Association, is indeed a “chronic, relapsing, multi-factorial, neurobehavioral disease, wherein an increase in body fat promotes adipose tissue dysfunction and abnormal fat mass physical forces, resulting in adverse metabolic, biomechanical, and psychosocial health consequences.”
- Much of our health research is tied to BMI. There have been some shifts in looking at non–weight-related health indicators. However, we need more robust studies evaluating other health indicators beyond weight and BMI. The availability of this data will help eliminate the need for BMI and promote individualized health assessment.
- Current treatment guidelines for obesity medications are based on BMI. (Note: Medications to treat obesity are called “anti-obesity” medications or AOMs. However, given the stigma associated with obesity, I prefer not to use the term “anti-obesity.”) Presently this interferes with long-term obesity treatment. Once BMI is “normal,” many patients lose insurance coverage for their obesity medication, despite needing long-term metabolic support to overcome the compensatory mechanism of weight regain. Obesity is a chronic disease that exists independent of weight status. Therefore, using non-BMI measures will help ensure appropriate lifetime support for obesity.
The preceding are barriers, not impossibilities. In the interim, if BMI is still used in any capacity, the BMI reference chart should be an adjusted BMI chart based on age, race, ethnicity, biological sex, and obesity-related conditions. Furthermore, BMI isn’t the sole determining factor of health status.
Instead, an “abnormal” BMI should initiate conversation and further testing, if needed, to determine an individual’s health. For example, compare two people of the same height with different BMIs and lifestyles. Current studies support that a person flagged as having a high adjusted BMI but practicing a healthy lifestyle and having no metabolic diseases is less at risk than a person with a “normal” BMI but high waist circumference and an unhealthy lifestyle.
Regardless of your personal feelings, the facts are clear. Technology empowers us with better tools than BMI to determine health status. Therefore, it’s not a matter of if we will stop using BMI but when.
Sylvia Gonsahn-Bollie, MD, DipABOM, is an integrative obesity specialist who specializes in individualized solutions for emotional and biological overeating. Connect with her at www.embraceyouweightloss.com or on Instagram @embraceyoumd. Her bestselling book, “Embrace You: Your Guide to Transforming Weight Loss Misconceptions Into Lifelong Wellness,” is Healthline.com’s Best Overall Weight Loss Book 2022 and one of Livestrong.com’s picks for the 8 Best Weight-Loss Books to Read in 2022.
A version of this article first appeared on Medscape.com.