A few years ago, I spent a Saturday afternoon hiking the Barton Creek Greenbelt with family. I woke up on Sunday morning with a nasty poison ivy rash on both of my legs, arms, and face. After several days of itching, scratching, and repeated rounds of ivy wash and cortisone creams that were not clearing up the rash, I decided to visit my family physician. When I called the Austin Regional Clinic, my primary family doctor was on vacation, so I took the first available opening. I wore shorts to the appointment, which put my nasty, oozing rash on full display. The nurse who took my blood pressure looked a little horrified. Two framed photos of electric guitars hung on the wall. The doctor entered the room and examined my horrible rash and assured me I was not going to die. He was handsome and funny with an excellent bedside manner. He prescribed an oral steroid that cleared up my poison ivy within a week. He looked over my chart and then asked me about my last visit with my regular doctor. He then said, “It’s my job to tell you to lose weight.” I thought it would be much more fun to talk to him about music over tacos and margaritas. Fortunately, flirting is not one of the seven deadly sins, and he couldn’t read my mind. Advice about weight loss comes from everywhere – doctors, pastors, celebrities, friends, and family. The missing puzzle pieces for many people struggling with obesity are the genetic deck of cards we have been dealt, and the millions of years of evolution that have hard-wired our brains and bodies for survival.
The pediatrician who treats my son addressed his obesity by saying, “Our bodies are built for hardship, and we don’t need a lot of calories to survive.” As a scientist, her words rang true. In times of food scarcity, animals with bigger brains who can find food more successfully and have a slower metabolism that conserves calories will survive to pass on their genes. Besides our chemical soup of regulatory hormones, the other significant factor in obesity is our brain’s reward center. It’s our nicotine brain, our sugar brain, or whatever gets you high. Ask anyone who has tried to quit smoking. Spend an afternoon with a group of kindergarteners who have eaten three cupcakes.
I recently downloaded the Noom app, and I have been impressed with its psychology-based approach to food and weight management. I lost five pounds the first month on the program by eating grapes and berries in place of other more calorie-dense foods. I also like that there is no food shaming in this program; it’s an honest approach to food mindfulness and balance. Knowledge is power, and it’s beneficial to understand the calorie density of the foods I am eating each day. The program also encourages you to increase other healthy activities you enjoy that activate your brain’s reward center like a massage, a warm bath, a long bike ride, a comedy show, or a movie. When I made a list of things I enjoy doing besides eating, I realized I need to incorporate more of these activities into my daily life. We often think of self-care as a luxury, but we need to consider it as a long-term survival mechanism for managing our physical and emotional well-being.
I was a teenager in the ’80s, and a famous anti-drug public service message showed a close-up of an egg dropping into a frying pan that said, “this is your brain on drugs.” Food is also a powerful drug. It’s not enough for doctors to tell patients to lose weight. We need education and strategies real people can adopt. Doctors need to share their weight management ideas and stumbling blocks with their patients. We need monetary rewards and lower-cost health insurance for people who are taking positive steps to improve their health. I know my daily choices and behavior will have the most significant positive impact on my children. Cake brain, say hello to carrots.