ROTATION DIET: BUILDING WEIGHT - MANAGEMENT CONFIDENCE

Chocolate-flavored foods, as well as other sweet and fatty dessert foods, are designed to turn on appetite even when your hunger has been satisfied. When such foods appear, you begin to salivate, and your pancreas begins to secrete extra insulin in preparation for dealing with the sugar in the food. Both of these reactions actually make you feel hungry, even though you have already eaten. Indeed, every cell in your body seems to turn on all over again and scream, "Eat, eat!"

Candy and most other foods that fall into what is called the "junk-food" category are very hard to resist because of their "supernormal" status. If you have a choice of one of these foods (candy, cake, pie, cookies) or a more natural food, such as fruit, the supernormal food is almost certain to win out. Thus, it becomes very hard for an overweight person to exercise an appropriate choice of foods for weight control when "supernormal" foods are present to compete with normal foods at any given meal or at snack-time.

After I hand out the bar of chocolate to our group of weight-management participants, I ask them whether they can, even in their imagination, see themselves doing exactly what it will take to live with that candy (or whatever food tempts them the most to overeat) and not eat it when it is constantly present in their environments. You might take a moment and do the same thing: can you, in your imagination, see yourself in situations with all of the foods that tempt you the most doing exactly what you are going to need to do for the rest of your life to control your weight?

If you can't even imagine yourself doing what you need to do to deal with these situations effectively, how can you ever expect to do it in reality?

Because it is a natural physiological reaction to "turn on" in the presence of "supernormal" foods, the very best strategy for permanent weight management is to control their presence, that is, rarely allow yourself to be in their presence so that you do not have to battle constantly with temptation.

But such control over yourself or your environment is not always possible. I know many of you will have families that bring junk food in unexpectedly, and you may feel that the persons in your family who do not have a problem with their weight should not have to be inconvenienced by your desire to eliminate junk food in the home. Besides, wouldn't it feel great to know that you can control your "binging" without gaining weight? Although we normally do not keep quantities of high-calorie foods around the house, right now we have been celebrating the Christmas holidays with visiting house guests and dinner parties. We have one of my wife's incomparable chocolate cheesecakes in the refrigerator, one of my daughter's delicious pumpkin pies right out on the kitchen table, and a quart of my own homemade rum-raisin ice cream in the freezer. (The ice cream is pretty good, too.) Twenty-two years ago I might have overeaten and gained weight with all of these delicious desserts around the house, but not today. I am enjoying these creations - every single one of them - but in moderation.

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When should drugs be used?

Medication can be considered for use as an adjunctive treatment to supported lifestyle changes in the following circumstances:

  • After 3-6 months of compliance with dietary, behavioural and activity advice.
  • If a patient has failed to achieve 10% loss of body weight.
  • To enhance further reduction in symptomatology, such as breathlessness or weight-bearing joint pain.
  • To achieve further improvements in markers of comorbidity, such as hyperlipidaemia or raised blood pressure.
  • To improve exercise tolerance and promote increased physical activity.
  • To improve diabetic control, lower fasting blood glucose and other diabetes indices.

For psychological reasons: for some patients, the support provided by medication can act as a powerful motivating factor, increasing their confidence to be more physically active and enhancing their desire and ability to exercise dietary restraint.

When are drugs inappropriate?

  • When the patient profile lies outside licensing guidelines.
  • When weight loss achieved through lifestyle change is satisfactory.
  • If a patient has a history of previous adverse reactions to the chosen medication.
  • Where there are contraindications to use of the chosen medication.
  • For non-medical motivating factors: e.g. for short-term weight loss prior to a holiday or a wedding.
  • When a patient fails to exhibit serious attempts at lifestyle modification.
  • With a recurrent history of cyclical (yo-yo) dieting.
  • When a patient has unrealistic expectations of excessive weight loss.
  • With a history of eating disorders such as anorexia nervosa or bulimia.

Underlying psychological or psychiatric disorders should be addressed prior to any contemplation of the use of medication, but their use might be appropriate after further, sometimes specialist, assessment.

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