Recently I watched the 3 hour long Making the Shift conversation by Weight Watchers and Oprah Winfrey regarding conversations about diet culture. The "making the shift " conversation explored the complexities of diet culture, and both Ms Winfrey and Weight Watchers' CEO and director Ms. Sistani, admitted their roles in contributing to diet - culture. Ms. Winfrey spoke about her experiences with shaming and discussed the shame felt by individuals who use GLP-1 medications to lose weight. The discussion whilst interesting felt more like an international sales pitch for GLP-1 medications. 

Ms. Winfrey expressed her opinion about using medications for weight-loss stating emphatically "That I am done with the shame!". She argued that each person should respect "grown individuals choice". I agree with that. I agree that we all need to respect the decisions made between an individual, their family, their nutritionist, their therapist and their families. No matter what the choice was, whether that individual chose to use obesity medications only, or to use a combination of exercise, nutritional changes and therapy to treat obesity or to do nothing at all. However, we know that diet-culture feeds on deeply held psychological and emotional wants and needs. The pain that often accompanies compulsive behaviors often lead to feelings of shame, grief and hopelessness. Those very same feelings often drive the negative cycle that perpetuates a feeling of a loss of control. 

The recommendations from Doctors usually include referrals to a nutritionist, which can for some accelerate the obsession with food. Were it as simple as choosing to eat nutrient dense foods and minimize processed foods, we would not be facing an epidemic of Obesity. The reality is that when it comes to lasting behavior change, change often takes years; and most of us who struggle with compulsive behaviors are impulsive and impatient. These traits further fuel the negative binge-restrict cycle. In many situations, our choices are influenced by multiple factors including deeply held underlying beliefs about our selves and food. Further complicating the issues, is the role of persuasive advertising that is strategically geared towards targeting our psychological needs and wants. On an explicit level, we all know this. We know that when we sit in front of the television and see the latest diet commercial, or food advertisement, that on some level our emotional needs and wants to be accepted, to feel better about our selves and to be attractive to our spouses is often a hard call to resist. For a compulsive eater however, commercials that target the needs for belonging and acceptance can all be triggers for unmet needs and wants to be admired, accepted and to feel good. Most of us are born with those innate desires, and there is nothing wrong with that. However, because commercials are geared towards the impulsive parts of our brains, we may tell ourselves "this time I will succeed". We approach the next diet plan with iron willed determination which sadly often falls flat with the first sign of an obstacle. This one set-back can often be the start of the binge-diet-cycle that often leads to feelings of loneliness and low self-worth - and the cycle continues.

As I watched the 3 hour long Making The Shift conversation, I had mixed feelings about it. On the one hand, the use of GLP-1 Medications to treat obesity and help individuals reduce their risk of heart-disease is life-changing. I full support informed decision making with your doctors and family members. However, I know that often if something sounds like it's too good to be true, it might be. I am reminded of a close friend who told me about her story with the drug Fen-Phen. We sat on the beach talking about her near death experience and her struggles with obesity. She shared that she lost a great deal of weight, but also suffered with issues with her heart valve. I felt saddened and shocked for my friend who was now left with a scar following cardiovascular surgery to repair her heart valve. I wondered what could the solutioon be? 

During the making the shift broadcast, I listened with wrapped attention to professionals and individuals talk about the medical, emotional and physical complications of obesity. I cried throughout the discussion as I saw myself in many of these women and men. I felt deep empathy for all of us who shared in the solidarity of the pain that can be caused by lack of acceptance. However, I wondered whether or not we had learned anything from the side-effects of the drug Fen Phen - and I thought about my friend who thankfully survived a life threatening event, due to a weight-loss drug designed to cure all her obesity problems. I observed that the claims touted by GLP-1 medications sounded eerily familiar to those of the drug Fen-Phen. 

In the early 1990's it was the drug Fen Phen which was advertised as the miraculous weight-loss cure. The reports of weight-loss were truly touted as miraculous, until millions of people, mostly women were seriously affected and the drug was pulled from the market. I wondered whether or not that behavioral changes in conjunction with these weight-loss drugs were being strongly encouraged. 

In my work in mental health, I work with clients struggling with the pain of emotional, spiritual and psychological problems including body image issues and binge eating behaviors. It is not lost on me, what the struggle is like, because much like the old men’s hair club commercial famous quote says; “I am not just the President, I am also a client". You see, I am a compulsive overeater and I work with clients who struggle with compulsive eating. For as long as I can remember, body image issues and weight has been a public discourse for over 60 years. Weight gain and the long-term effects of obesity are now a national crisis. Medical studies show that physical consequences of long-term obesity affects the brain, contributes to arthritis, and many devastating medical conditions such as Type II Diabetes. What we seldom pay attention to, is the impact of cultural beliefs promoted through advertising that often perpetuate ideals of beauty that may not be healthy. For instance, at my heaviest weight I was 445 pounds. My doctor told me that an ideal weight for me was 135 pounds. I intuitively knew, that I would not be able to reach that ideal. American culture had shifted over the last 60 years to define worth based on body-image. This might be based on what was deemed desirable at that time. A more curvaceus figure, was at one point more appealing. Being muscular was condiered a sign of virility. Today, we are influenced by the beliefs that a woman's body should be extremely thin and devoid of any fat or definition. 

External societal pressure based on the beauty standards that are often culturally based are promoted by the media. For instance, over 50 years ago, commercials encouraged women to gain weight and men to build muscle. The skinny woman was labeled as "unattractive". Is it no wonder that today, we have so much shame around our bodies and search tirelessly for the next fad-diet? Men are equally affected by diet-culture and struggle with the never ending feelings of "not good enough". Further complicating the issue of weight gain are hormonal changes including the stress hormone cortisol that contribute to some of the biological and environmental pressures that can exacerabte psychological stressors and contribute to weight-gain or difficulty losing weight.

The solution for many has always been an external approach to an internal problem. This has included numerous weight-loss pills, diets, surgeries, weight-loss or weight-gain injections. During the 2000's we saw an increase in every diet for weight loss imaginable. The Atkins diet re-branded, Jenny Craig continued to offer at home pre-package food with personal support. Following behind was Nutri-System which redesigned their packaging and began advertising on HSN and QVC. Then we saw the weight-champion Weight-Watcher's up their marketing by offering flexible payment plans, and joined forces with Media Mogul Ms Oprah Winfrey! We also saw the miraculous transformations of bodies on the Paleo, Keto, Carnivore, and Fruit diets. Then, entering the ring as the life saving of them all is intermittent fasting and vegan dieting. At every turn, we were bomboarded by the alluring promise of health and acceptance through weight-loss. For many of us who tried one or all of these diets, success was short-lived, and the weigh returned with a vengence. Feeling defeated many return to the binge-restrict patterns that create hopelessness and despair.

The message though is still the same in 2024 as it was in the 1990s with Fen-Phen. We, the people are enticed by the alluring promise of GLP-1's as a cure all for the obesity epidemic. Whilst GLP-1's are not new, and there have been several studies on the positive impact of the medications to improve cardiovascular disease and several other health markers, I am concerned about the lack of behavioral, emotional and spiritual changes of individuals who use GLP-1s without working on many of the reasons that led them to this point. Naturally, one doesn't have to do anything they don't want to. However, I can tell you that many individuals want a magical fix to an internal problem and shy away from addressing some of the deeper beliefs that resulted in chronic obesity. Seldom do behavior changes accompany the benefits from using GLP-1s or any other diet aid. We hope for a magical solution that will enable us to eat anything we diesure without the consequences that accompany that type of behavior. Our hope is that simply losing weight will now fix years of unhelpful behaviors. Sadly, many people taking GLP-1's for weight-loss, do not change their exercising and eating behaviors and eventually over-eat the effects of the drug, or lose significant muscle that can often lead to further medical complications. 

This isn't to suggest that GLP-1s are not helpful. I have seen this medication help individuals lose weight, but It would be equally important to address the unresolved issues that led to obesity including trauma, over consumption of processed food and environmental factors that continue to impact the quality of life of millions of Americans. Simply taking a GLP-1 medication without addressing both the hormonal and psychological issues accompanying weight will only lead to the same diet-binge-cycle. In my practice, I deal with many mental health issues such as depression and mood disorders. One of the things I share as part of my skills training with all clients, is pills whilst helpful, don't take the place of skills. Might it be possible to apply a similar logic with individuals prescribed GLP-1 medications. We must use a holistic approach to the weight-gain epidemic that stresses life-style, nutritional, spiritual and critical thinking changes. I do agree with Ms Winfrey- "it is not only one thing"! 

We need to learn from the past, or we are doomed to repeat it. If 60 years of medicating ourselves through pills, surgeries, diets and medications have not resolved the obesity epidemic, why do we think that this time it will be different? I am reminded, that the definition of insanity is doing the same thing, but expecting a different result. In my treatment of bingeating and body-image issues, I explore the emotional, spiritual and physical impact of compulsive eating through a holistic, integrative and faith-based approach. It is slow work, and sometimes unpopular and difficult-but it is worth it, because you are worth it.

I hope you know that your journey is as unique as you are. God formed you and has the blueprint for your life, yes, even matters of body image, weight and nutrition. Change is not a quick fix. It is a lifetime process of discovery, meant to transform confusing and painful messages about your body into purpose! I want you to know, it is possible to make peace with food, to make peace with the hurtful messages you received and to identify ways to reduce self-sabotaging behaviors. If that’s what you want to do. If you are struggling with body image issues, overeating and binge eating, I can help.

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