The psychology of successful weight loss



Warning: you may find the following section to be somewhat troubling or insulting, but I suggest that you read it anyways.


It is very important that when you change your diet, you have the right mindset.  I remember long ago when I was a first year medical student, I worked with an experienced family practice physician.  He had an obese patient who complained about knee arthritis, and my preceptor told her [quite brashly] that she must lose 100 pounds if she hoped to improve.  The patient asked if she could be hospitalized so that she would have constant guidance and all her food provided to her.  My preceptor informed her that her insurance company would not pay for it and proceeded to give her some dietary advice.  I asked my preceptor afterwards if he thought she would succeed, and he told me something like this:


"No.  She's looking for the easy way out.  No one like that every achieves anything."


At the time, I thought he was a cold-hearted jerk, but ten years later, I realize that he is essentially right.  I have never had a single patient lose weight with this sort of mentality.  All of my patients who lost weight had one thing in common: an appreciation of personal responsibility for their situation and a willingness to make sacrifices to improve their health.


All the time, I hear from my overweight or obese patients quotes like those listed below...


“I eat a healthy diet.”

“I exercise regularly.”

“I’m not overweight. I just have a lot of muscle.”

“I only eat 1,000 calories per day.”

“I have a slow metabolism.”

“The prednisone made be gain weight.”

“The hypothyroidism made me gain weight.”

“My whole family is overweight. It’s genetic.”

“I’m getting older. Older people naturally gain weight”


Now, the problem with the above statements is not necessarily that they are untrue.  The problem is that they represent an extremely unfavorable and negative way of thinking. They represent the idea that something external to you is preventing you from achieving your weight loss goals. In reality, you have the power to lose weight if are sufficiently dedicated and are using the right plan.  Being overweight is not due to moral weakness. You probably gained weight simply by eating foods which were readily available to you until you felt full.  This is completely normal and expected behavior.  Americans are not gaining weight over time due to our increasing gluttony or lack of discipline; rather, our diet and lifestyle is changing.  Everyone is different.  Some people have a bigger appetite. Some people have a lower metabolic rate. Some people are in the habit of eating high caloric density foods.  Some people eat whatever they want and don’t gain weight.  I hate those people.


I’ll respond to some of these quotes:


“I eat a healthy diet.”


I highly doubt this.  The typical American diet is awful.  Unless you are eating a diet which is MUCH MUCH healthier than the typical American, than your diet is very poor.  Eating “healthy” in our culture involves being VERY VERY picky about what you put into your mouth and is difficult to achieve.  Everyone you know would think you are an unusually healthy eater.  You would not be able to go out to most restaurants, including those who claim to serve healthy food.  Your views about what is “healthy” are probably highly inaccurate and swayed by marketing.


I’ll give you some help:


The sandwich you ate was NOT healthy

The fiber cereal bar you ate was NOT healthy

The thin crust gluten free pizza you ate was NOT healthy

The bran muffin you ate was NOT healthy

The trail mix you ate was NOT healthy

The lean cuisine frozen dinner you ate was NOT healthy

The frozen yogurt you ate was NOT healthy

The fat free cookies you ate were NOT healthy

Even most granolas, commercial salads, and fruit smoothies are not healthy from my perspective


All of these foods have healthy aspects to them such as being low in fat or high in fiber, but none of them are low in caloric density.  Generally speaking, you are not as savvy as you think you are, and most of what you believe about nutrition was told to you by companies trying to sell food.   If you gained weight over the years, then you must have consumed more calories than you burned, and the extra energy was stored as fat.  It is as simple as that [for the most part].


“I exercise regularly.”


That’s great!  Exercise is the number one modifiable health behavior according to the world health organization.  It is well known that overweight people who exercise have lower morbidity and mortality than normal weight people who do not exercise.  Active NFL players, despite often having a terrible diet, only have about a 0.1% risk of type II diabetes during their career (about 10% of people in the general population have type II diabetes). Many of these players develop type II diabetes after retirement when they continue the same diet and decrease their activity level.   Exercising regularly does increase your metabolic rate which can assist in weight loss, but you can easily negate this effect by eating.  For instance, you can run 20 miles and burn 2,500 calories, but you can consume 2,500 calories of modern processed food in about 20 minutes (or at least I can).  I personally once managed to gain weight while running 50 miles per week to train for a marathon.  Don’t whine to me about your slow metabolism.


“I’m not overweight. I just have a lot of muscle.”


Only a very small percentage of men have enough muscle mass to make the body mass index a poor tool for determining whether or not someone is overweight.  You wouldn’t be reading this if you looked like Arnold Schwartzeneger.


“I only eat 1,000 calories per day.”


If you weigh > 140 lbs and consume less than 1,000 calories per day, I guarantee that you will rapidly lose weight regardless of your metabolic rate or coexisting medical conditions. 1,000 calories is a very small amount of modern processed food, and a typical person would be very hungry throughout the day eating so little food.  Various studies have found that when people are asked to estimate the number of calories they consume, they will systematically underestimate the number of calories they have consumed.  The reason for this is that food products are often marketed in a deceptive way to make us think that they are healthier.  Also, food product labeling systematically underestimates the number of calories in foods! (10) (Check the source if you don't believe me)


I'll give an example.  The Calories listed for subway sandwiches exclude cheese, oil, and dressing (all of the calorie dense items) which leads to absurd underestimation of the amount of Calories consumed by a typical patron.  Here is a list of single food items with over 1,000 calories (Calories in parentheses) [source = huffington post]

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Burger king triple whopper (1020)

Cinnabon’s Caramel pecanbon (1080)

Wendy’s caramel frosty shake (1000)

Quiznos veggie deluxe [size large] (1060)

Burger King Ultimate breakfast platter (1070)

Wendy’s Triple Beef patty burger (1070)

Dairy queen turtle pecan cluster blizzard [medium size] (1030)

Quizznos Classic Italian sub (1130)

Boston Pizza’s Crispy Chicken pecan salad [with dressing] (1150)

Dairy queen veggie Quesadilla basket with onion rings (1040)


Would eating one of these items fill you up for an entire day?  1,000 calories is almost nothing.  Calorie counting will only work if you are very knowledgeable, disciplined, and accurate in your recording.


“I have a slow metabolism.”


I highly doubt that this is your problem.  Being overweight actually increases metabolic rate because basal metabolic rate is closely linked to body weight (6).  As you lose weight, it becomes more difficult to lose further pounds because your basal metabolic rate is decreasing and you burn fewer calories during exercise.   Also, fat cells release leptin, a hormone which produces satiety which helps to prevent us from gaining too much

weight. As you lose weight, your decrease your leptin levels.  Have you ever watched the show, “The biggest loser”?  A lot of contestants probably at one point believed that they had a “slow metabolism”, yet they universally lose weight rapidly with strict adherence to a diet and exercise program.


“The prednisone made be gain weight.”


Weight gain is a known side effect of corticosteroid medications including prednisone, solumedrol, and dexamethasone.  The reason for this is that these medications increase appetite and increase salt and water retention and change fat distribution.  The salt and water retention can account for 3-5 or maybe 10 lbs in some cases.  The remainder of the weight gained is fat tissue.  It is more difficult to maintain a healthy weight while taking these medications due to increased hunger, but it is not impossible.


“The hypothyroidism made me gain weight.”


Hypothyroidism can cause weight gain.  Most of the weight gained is salt and water. Patients who are newly diagnosed with hypothyroidism and treated very rarely lose significant amounts of weight simply due to initiation of hormone replacement.


“My whole family is overweight.  It’s genetic.”


While it is true that there are genetic factors in weight loss, families also tend to share similar dietary and lifestyle habits.  It is not uncommon for two siblings or even identical twins to have a very different body weight (49).


“I’m getting older.  Older people naturally gain weight”


It is true that basal metabolic rate decreases with age which means that older people must consume less calories or exercise more to maintain a given body weight.  However, activity level also decreases with age in many people which may be a larger factor.  The point is that it is not “normal” to gain weight as you age.  


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You need to adjust your lifestyle to maintain a healthy weight.   You need to change your attitude so that you accept total responsibility for your well being.  Empower yourself and have the confidence to improve your health.  Stop making excuses.  You can’t always look for the easy way out.   You can’t always look for the next pill or simplistic trick.  Losing weight is difficult and takes effort.  People who are looking for the easy way out are rarely successful.  People are willing to put in the work and make the sacrifices will eventually succeed.  This entire website is all about the most efficient and practical approach to long term weight loss, but even the most efficient method is very hard to carry out in practice.


"Serenity is not the absence of conflict, but the ability to cope with it." – Alcoholics Anonymous


This is what you should say instead of the quotes above:


“I am overweight due to poor diet.  I am confident in my ability to lose weight with the right plan, and I will change my dietary habits in order to lose weight.  Nothing will stop me.”


While you are losing weight, it will unfortunately not go smoothly and swimmingly the whole time.  You will have periods of plateaus where your weight remains fixed.  You will experience day to day fluctuations in weight due to salt and water shifts.  You will break your diet and eat garbage from time to time.  You must stay determined and not quit.  Do not get bogged down by short term fluctuations in weight.  They are mostly determined by salt and water.  You will probably lose a lot of weight in the first weeks simply because you will decrease the high-salt processed foods that you are used to eating.  Do not expect to maintain this rate of rapid weight loss.  If you break the diet, just go back to the diet the next meal.  Try not to get frustrated or discouraged.  Just continue where you left off.  If you hit a plateau, stay confident and continue the diet.   You will not fail.  I guarantee you success.  Your body cannot violate the first law of thermodynamics.  You will lose weight.