A couple of years ago I started a weight management clinic at the University of Chicago. By starting the clinic, my initial goal was to help people navigate the weight-unfriendly food environment that’s typical throughout America. I started the clinic with the same idealism I had when I was a medical student—an earnest desire to help people. There was no grand vision of accolades, books, research, or TV shows. Throughout my medical career, I saw our relationship with food as the most important, yet least addressed contributor to health problems. In good conscience, I couldn’t practice medicine without acknowledging both the positive and negative impact of food on our health.
I gave up academic time to accommodate extra time and space for the clinic. My goal was to start slowly and only see a few patients per half day, but things changed quickly. The clinic began to grow immediately.
After participating in the clinic for 2 years and seeing hundreds, if not thousands of patients, I’ve learned a lot as a doctor and as a person. In this post, I’ll share a few of those lessons and tidbits.
10 Things I learned in my weight management clinic
1. Fat-shaming is real, and it hurts people.
I knew this years before starting the clinic from personal experience when I had some weight to lose. I was never really comfortable with friends, family, church members, etc., commenting on my weight or appearance—especially considering that most of these comments were not invited. Though I found these comments annoying, the clinic showed me how truly damaging fat-shaming can be.
Telling people ‘congratulations on their pregnancy’ when they aren’t pregnant doesn’t do much for one’s self-esteem—especially if that person is a man. I’ve seen people stop going to the doctor because their doctors call them fat. I’ve seen people stop going to church because their pastor calls them fat. I’ve also seen people not go to the gym because people at the gym call them fat. You get the picture.
I have never seen anyone get fat-shamed into losing weight. For most people, experiencing negativity is more painful than it is motivating. Other physicians, especially need to know how harmful their comments can be.
As an aside, I’m not surprised by doctors fat-shaming. Many years ago, when I was a first-year medical student, I took a required class on cultural competency in healthcare. One of our assignments was writing about our negative stereotypes and sharing them with the class. As the lone black dude in the class, I knew this was not going to be an enjoyable experience.
Black men, overweight people, and the homeless were the groups that had the most negative stereotypes—just think about the health implications of this. For the record, I wrote about people who specifically work at Fox News (race or ethnicity didn’t matter).
2. Insurance companies don’t care about dieticians.
I have the privilege of working with 2 of the dopest dieticians in the history of ‘dieticiandom.’ Despite how great they are, insurance companies won’t pay them to save your life. They could spend hours explaining what carbs are and highlighting healthier food options without any hopes of reimbursement. If you have Medicare or Medicaid, it’s even worse. Considering the importance of food in health outcomes, it’s truly a travesty that the people who specialize in helping folks navigate issues with food can’t get paid.
You won’t find the solution in this post, but being aware of the problem is an excellent place to start.
3. Bariatric surgery is not “the easy way out.”
A lot of people have this misconception that bariatric surgery is cheating or the “easy way out.” This is absolutely false for many reasons. First, for many people who are candidates for bariatric surgery, engaging in the amount of exercise that engenders weight loss is tough—try doing burpees with 200 lbs sandbags tied to you (please don’t literally try this).
When we gain weight, we can also gain comorbidities like arthritis. It’s tough exercising when you have excruciating knee pain or back pain.
Second, even if people lose weight with lifestyle modification, it’s sometimes hard to keep the weight off for hormonal reasons—just look at the “biggest loser” study.
I’m not saying that weight loss isn’t possible with lifestyle modification. However, there a clearly times in which bariatric surgery is 100% the right decision.
4. People who are trying to lose weight need support from friends and family.
It takes a village. Losing weight when your family brings you fast food every day is a challenge. Further, losing weight when your family blatantly encourages you not to lose weight is even harder.
A person’s weight loss journey is undoubtedly easier when friends and family are onboard. FYI, fat-shaming is not a sign of support.
5. Skipping breakfast is way too common.
I haven’t formally done a study that focused on breakfast skipping in my patient population. If I had to guess how many people were breakfast skippers before seeing me, I would honestly say 90%.
Yes, I get it—mornings suck. Getting kids ready, waking up early, and getting off to your job make breakfast a challenge. But, in some people, skipping breakfast is more detrimental than convenient. I’m not saying we should start eating waffles, sugary cereals, and bagels every morning. Those are all unhealthy items. However, breaking your nighttime fast with some healthy foods in the morning may have some health benefits.
6. Food addiction is real.
Food addiction is as real as the “struggle” is. I remember years ago when I did a psychiatry rotation at the Jesse Brown VA Hospital; I encountered ‘real deal’ drug addiction. Some of the Vets were ready to give up drugs and go through withdrawal; others weren’t. For the ones who weren’t ready, the mere mention of stopping cigarettes, alcohol, or drugs was enough to trigger an altercation.
My experience with food addiction is no different than my experience with those Veterans. In people who aren’t ready to address their food addiction, simply mentioning eating less of ‘food x’ is negatively provocative. FYI, we are actively trying to hire a psychologist solely dedicated to our clinic. (Check out my post on chip addiction.)
7. Trauma is a risk factor for weight gain.
One of the most important questions I ask people in the clinic is “when did you start gaining weight?” This question helps me understand the factors contributing to one’s weight gain. Some of the responses are deeply troubling. I often hear about weight gain after a sexual assault, the murder of a loved one, divorce, etc.
Trauma as a factor undergirding weight gain highlights a couple of things. One, it shows how much of a jerk you can be by fat-shaming someone. For fat-shamers, you may have no idea about the story behind someone’s weight gain—tread carefully.
Two, it also demonstrates the comforting aspects of food. I hate to say it, ‘hamburgers’ are anti-depressants, they just so happen to promote weight gain and raise cholesterol levels. Ironically, many of the medications we give as anti-depressants also promote weight gain and increase cholesterol levels—hence the struggle is real.
8. Men really don’t understand the impact of cat-calling.
As a man, I thought I had gender issues, toxic masculinity, and sexual violence figured out (at least as well as any man could). I dated feminists with PhDs in Women’s Studies. My wife is an obstetrician-gynecologist. I read works by bell hooks, Toni Morrison, and Alice Walker. I fancied myself a progressive black male womanist. I thought I was ‘woke.’ Better yet, I mistakenly thought I was ‘woke AF.’ My clinic proved that I had some lessons to learn.
Weight loss is a complicated journey. Sometimes people lose weight then gain a little back. Every time I see someone who has gained weight after losing it, I always inquire about some of the factors that may be contributing to weight gain. In a million years, I would have never suspected cat-calling as a reason for gaining weight after losing it. Let me explain.
I’ve had multiple patients whose weight loss eventually led to unwanted attention from men. This discomfort with “Hey, girl,” random physical contact, and men following them around public places led to my patients intentionally gaining weight back to avoid this type of attention. They used the weight as a protective blanket against being #Metoo’d.
Hearing these stories from multiple people is heartbreaking. I don’t want to take part in male bashing and promoting “men are trash” tropes, but…some dudes are trash (#facts).
9. More doctors need to focus on weight issues
As I write this, there is a 275-day wait for a new patient to get into my clinic. Is this because I’m the dopest doctor to don a stethoscope? No. Don’t get me wrong, I try to provide exceptional care. Ultimately, this wait is mostly a reflection of a lack of physicians that focus on nutrition and weight. We as a profession need to do better.
10. Working the night-shift is not good for your health. In fact, it’s dangerous AF.
I’ve seen countless people gain weight after switching over to night work. “What we eat” is important. “When we eat” probably deserves almost as much attention. Our circadian clock dictates more than just our sleep habits. Our circadian rhythms also affect how we process food.
Eating lunch at 2 am isn’t the best long-term health strategy. Human beings were meant to sleep at night, not eat at night.
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I am a physician and trained chef. I specialize in gastroenterology and nutrition. Currently I work as the Associate Director of Adult Nutrition at the University of Chicago.