Melanie W. Rotenberg M.D., Mitch Rotenberg Ph.D. - Laugh Yourself Thin - Making Happiness, Fun, and Pleasure The Keys To Permanent Weight Loss (2010) PDF

Laugh Yourself Thin
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Laugh Yourself Thin
Making Happiness, Fun,
and Pleasure the Keys
to Permanent Weight Loss
Melanie W. Rotenberg, MD
With Mitch Rotenberg, PhD
Copyright 2010 by Melanie W. Rotenberg, MD
All rights reserved. No part of this publication may be reproduced, stored in a retrieval
system, or transmitted, in any form or by any means, electronic, mechanical, photocopying,
recording, or otherwise, except for the inclusion of brief quotations in a review, without
prior permission in writing from the publisher.
Library of Congress Cataloging-in-Publication Data

Rotenberg, Melanie W.
Laugh yourself thin : making happiness, fun, and pleasure the keys to permanent weight loss /
Melanie W. Rotenberg with Mitch Rotenberg.
p. cm.
Includes bibliographical references and index.
ISBN 978-0-313-38636-7 (hard copy: alk. paper) — ISBN 978-0-313-38637-4 (ebook)
1. Weight loss—Psychological aspects. 2. Weight loss—Humor. 3. Laughter—Health
aspects. I. Rotenberg, Mitch. II. Title.
RM222.2.R675 2010
613.2'5—dc22 2010020178
ISBN: 978-0-313-38636-7
EISBN: 978-0-313-38637-4
14 13 12 11 10 1 2 3 4 5
This book is also available on the World Wide Web as an eBook.
Visit www.abc-clio.com for details.
Praeger
An Imprint of ABC-CLIO, LLC
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This book is printed on acid-free paper
Manufactured in the United States of America
The information published in this volume or any related e-book, Web site, or database is
provided for informational purposes only and is not intended to supplement or replace the
advice of a trained medical professional. The information provided here should never be
used for the purpose of diagnosing or treating a medical or health condition. Readers should
consult their own physicians before making any decisions or taking any actions that might
affect their health.
This book is dedicated to our son.
Aaron, growing up in our joyful and off-beat household,
you have happily borne the brunt of our jokes. But, in so
doing, you have learned the ways of the humorist.
Your comedic talents and level-headed disposition have
led us to conclude “Our work here is done.”
“I can’t see my shoes.”
—Aristotle*
*Just not that Aristotle.

Contents
Acknowledgments ix
Introduction: Laugh the Pounds Away Forever xi
PART I: ATTITUDE AND BEHAVIOR
ONE: Turn Your Head and Laugh: Happiness, Joy,

and Pleasure in the Pursuit of Weight Loss 3
TWO: I’m Allergic to Food, It Makes Me Swell:
Thought and Mind for Success 23
THREE: Tossing Your Cookies: Food Behavior That Works 45
FOUR: Laugh Your Butt Off: Activity Behavior That Works 67
FIVE: I’m on the Duct Tape Diet: Handling Hunger 83
PART II: INPUT—FOOD AND DRINK
SIX: Eat Right, Die Anyway: What Are Good Foods? 105
SEVEN: Put the Muffin Down and Slowly Back Away:
What Are Not-So-Good Foods? 125
viii Contents
EIGHT: Water Intolerant: The Right Drinks 143

NINE: Living Extra Large: How Much, When, and How to Eat? 153
PART III: OUTPUT—METABOLISM AND ACTIVITY
TEN: That Which Doesn’t Kill You Makes You Fatter:

Increasing Metabolism 173
ELEVEN: Dinosaurs Refused to Exercise and Look What
Happened to Them: The Right Activity 195
Conclusion: I Told You That There Would Be a Quiz at the End! 215
Notes 221
Resources and Further Reading 229
Index 231
Acknowledgments
First and foremost, I must thank my agent, Ellen Pepus, of Signature

Literary Agency. Without her terrific guidance, great advice, and gen-
tle coaching, this project would never have come to fruition.
Thank you as well to my editor, Debbie Carvalko, and all the won-
derful people at Praeger/Greenwood for encouraging my passion to
teach and entertain.
And a big thank you to all who offered stories and advice or their
time by reviewing the manuscript. The friends and family who assisted
include Debbie Bernier, Joe Bernier, Amelia Torre, Marcia Weinstein,
Marylee Fennell, Terri Hamilton, Laura Fausone, Dawn Mineo, Pam
Wheeler, Dawn Fuller, Bob Taylor, Rick Fennimore, Fred Mullins,
Christine Folkes, Susan Jackson, and Sherri Garafolo.
I am truly grateful to all the enthusiastic participants of the annual
conference of the Space Coast Writers’ Guild. You people helped me
ferment this crazy plan, and I do appreciate all the wonderful guidance
through the maze of the book industry.
Real gratitude goes out to comedian Kevin Hughes, for inspiring
my husband and me to start writing humor and for encouraging me to
get up in front of a crowd and tell jokes.
And I’d like to give a huge thank you to my son, Aaron Rotenberg,
and my husband, Mitch “Long-Suffering” Rotenberg, for putting up
with me all these years.
x Acknowledgments
Finally, the biggest thanks goes out to my patients, who inspire

me to write, to teach, to learn, and to grow. Where would I be with-
out you?
Melanie Rotenberg, MD (aka “Dr. R”)

Introduction: Laugh the
Pounds Away Forever
Roller Coaster Haiku

Oh my Freaking God
I think I’m Going to Die
Oops, There Goes my Lunch
The weight-loss journey, for most people, is a lot like a theme park
ride, a very stressful and scary one. It doesn’t have to be. Ideally, it
should be more like a fun, exciting adventure, with a safe and pleasant
outcome.
Although I hope you will think this book is funny, please realize that
the weight-loss concepts are serious. Healthy skinniness can’t occur
without laughs, since negative emotions undermine successful weight
loss. Laughter is the hallmark of a life lived better, a life full of pleasure
and joy.
LIFE IS ALL ATTITUDE—LUCKILY, I’VE GOT LOTS OF THAT

A warning to my readers: my husband, Mitch, has a black belt in humor,
and I use his material every chance I get. If you aren’t in the mood to
xii Introduction
laugh while you read, put the book down and back away. I am intent on
making the experience enjoyable for you. In my spare time, when I’m
not seeing patients, I’m writing or practicing comedy. I started doing
stand-up routines just after my 40th birthday; you could say I’m hav-
ing an unusual midlife crisis.
When I asked Mitch if he would help me write this book, his re-
sponse was “I’d rather put eye-hooks through my hands.” The man
blurts out funny stuff all day long, and then I run and write it down.
Let’s just get it straight—his blurting got him credit for co-authorship,
but I did the hard work, and that’s why the book is written from my
perspective.
I also have to tell you this: most of the stories here about my pa-
tients, friends, and family are true, but the names have been changed to
prevent unwelcome visitors to our house in the middle of the night.
GONE WITH THE CHIN

One other thing you need to know: this is not a quick-fix diet book. If
you are looking for a way to lose a few pounds and then want to go
back to your previous lifestyle, look elsewhere. This book is meant for
people who are tired of traditional dieting and are now looking for
permanent, healthy weight loss. I’ll teach you how to do it by taking a
humorous, positive, joyful approach.
Here you will find information about wellness. I discuss not just food
choices but approaches to eating, exercise, behavior, and thinking. I
talk about mood and activity. I don’t tell you what to eat and what not
to eat, but I do advise on good choices and not-so-good choices.
I will talk about activity and exercise. I have to because, ultimately,
regular exercise is how successful people lose weight and keep it off
permanently. Besides, I am an exercise doctor, and I’d be a fool if I did
not talk about something near and dear to my heart. Activity works,
and in this book I’ll tell you why it works and how you can make it
successful for you, even if you’ve never thought of yourself as an exer-
ciser. Many of my patients in my medical practice can’t even get out of
a chair on their own when they meet me, yet they all learn to exercise.
I’m very creative.
Most people gain back all the weight they lose through a traditional
diet plan shortly after going off the diet. In fact, the saddest part of
weight-loss research reveals that the majority of dieters not only gain
back their lost weight; they gain even more than what they lost. This
Introduction xiii
does not have to happen. It will not happen to you if you follow the
scientifically based suggestions in this book.
It’s like everybody and their brother has written a diet book or a cook-
book. Even dead people and fictional characters are getting in the act.
I’m afraid it won’t be long until we see Noah Cooks for Two.
People gain back their lost weight for one very important reason: they
haven’t embraced weight loss through a thinking and behavioral whole-
life approach. For most people trying to lose weight, the word “diet”
implies a temporary state of food restriction. Either types of foods or
amounts of foods are restricted until the desired weight is achieved.
However, there are three parts to successful and permanent weight
loss: (1) thinking and behavior; (2) input, as in food and drink calo-
ries; and (3) output, as in metabolism and activity calories. Most diet
books, even those written by physicians, have an overemphasis on the
“input” part of the equation. A typical diet book will give you pages
and pages of food rules and recipes. These books rarely talk about the
behavior, attitude, and cognitive processes that go into how and what
we choose to eat. They rarely give more than a page or two to the issue
of activity and exercise. Weight loss can’t be permanent unless all three
areas are addressed in a balanced manner.
Now remember, health advice works only if you act responsibly with
the information. Which reminds me of the time my hospital offered
a breastfeeding course but had to cancel it because more men signed
up than women.
Back to weight loss: calories are just a convenient way to measure

our bodies’ fuel. Weight loss occurs when there is more fuel burned
than taken in. Activity (output) is just the way we burn the fuel that we
get through food (input). If we put out more calories than we take in,
we lose weight. Maintaining that loss permanently is just maintaining
the balance between input and output. It’s really very simple.
xiv Introduction
STUDIES SHOW THAT WOMEN PHYSICIANS

ARE 100 PERCENT MORE LIKELY THAN MALE
PHYSICIANS TO HAVE BABIES
I have a lot of experience with health and weight loss, personally and
professionally. When I was pregnant, I suffered severe morning sick-
ness and ate anything I could to calm my queasy stomach. (Patients
don’t think it’s very professional when the doctor barfs on them.) By
the time I gave birth, I was 50 pounds heavier than before my preg-
nancy. It took me a long time to lose that extra weight, but I’ve kept it
off for more than a dozen years. More important, I’ve been a disabil-
ity physician for a couple of decades, and I’ve counseled thousands of
patients on weight-loss techniques. Obesity is the number one cause of
disability in the United States and also the leading cause of prevent-
able death.
Youthful figures and activity levels are not just for the young but
can be in the grasp of anyone who is willing to make health a priority.
My goal is to teach people how to avoid becoming chronically sick or
disabled in the first place and then stay in great shape for the rest of
their lives. I have a wild fantasy that if enough people read this book,
I’ll put myself out of the disability business for lack of patients. Truly,
that would make me ecstatic. Read this and enjoy a slimmer, more vi-
brant, fun, and happy life, permanently.
The key to weight loss is to start from a good point and go to a bet-
ter one—the joy, laughter and happiness that you develop will be all
your own.
—Melanie Rotenberg, MD
(Oh, and one more thing: pay attention throughout. My husband

and I are professors. Don’t be surprised if there’s a quiz at the end.)
PART I
Attitude and Behavior
ONE
Turn Your Head and Laugh:
Happiness, Joy, and Pleasure
in the Pursuit of Weight Loss
People want quick results, but there are no healthy ways to rapidly slim
down. Health spas often promise serious weight loss with only one ex-
pensive session of an exotic treatment. Usually it involves being slath-
ered, enveloped, and heated. None of those techniques really work; they
are only sucking water out of your system. However, I guarantee that
you will experience rapid and dramatic weight loss with the piranha
swim.
Laughter is the key to weight loss. Well, really, it’s those things that
cause laughter, like happiness, fun, and pleasure. But we can use laugh-
ter as a good gauge of how happy and content we are. Stress, negative
emotions, and misguided thought patterns are a leading cause of obe-
sity. Yet diet books almost never address an overweight person’s men-
tal state or level of joy. They might have pages of dietary restrictions
and recipes, but rarely is there more than perfunctory prose on reliev-
ing negative emotions. There might be a chapter or two on exercise, but
nowhere is there a description of the cardiovascular benefits of a good
pillow fight.
And we all need a good pillow fight on a regular basis. The way to
lose weight and to keep it off permanently is to lower stress, depression,
4 Laugh Yourself Thin
and other negative emotions through positive thinking, humor, fun, and
lots of laughter. A lighter approach to life leads to a lighter waist line.
A recent study by Dr. Mark Wilson at Emory University brings home
this point. He offered unlimited nutritious food to two groups of mon-
keys, high-status, contented, happy ones and their miserable, stressed-
out, low-status subordinates.1 All the monkeys ate about the same
number of calories. However, when Dr. Wilson substituted high-fat and
sugary junk food pellets in unlimited supply, the high-status monkeys
ate about the same calories as previously, but their stressed-out brethren
couldn’t stop munching. Those miserable primates continued to eat the
junk food all day long and well after sundown, similar to human snack-
food grazers. The researcher concluded that eating high-calorie foods
is a common coping mechanism to deal with daily life stressors, even
in those who don’t have a cranky boss, prolonged commute, or nasty
mother-in-law.
YOUR PERSONAL WEATHER FORECAST—CHANCE

OF SCATTERED BRAINS
Unfortunately, the majority of modern people live stressed-out, de-
manding lives. Most of us spend our days rushing from responsibil-
ity to responsibility, with little time to relax, enjoy, or meditate. A
while back, my son saw my driver’s license and read the words “organ
donor.” He exclaimed, “Oh, cool, mom, which organ did you donate? ”
That’s when I informed him that normally people wait until they’re
dead to donate their organs, but, in my case, I had already given my
brain at the office.
The biggest stress in my life is keeping house. I’m not much of a domes-
tic engineer. I was completely stumped one time when I had to wash
a black-and-white-striped sweater and the instructions said to “wash
with like colors.” To me that was a laundry IQ test, and I had to be Ein-
stein to figure it out.
And, speaking of chores around the house, I’ll never forget the pa-
tient I had who went home from the hospital with hospice care. That
nurse was so terrific, she took days to help the elderly gentleman clean
his completely unkempt house before he died. Exhausted, she finally
reached the bottom of a huge pile of junk. The last thing she picked up
was a book titled How to Clean Practically Anything.
Turn Your Head and Laugh 5
HELP! I’VE EATEN AND I CAN’T GET UP

People say they want to lose weight for a lot of reasons, like “I want
to look better in my clothes” or “I just want to get back to my college
weight.” But the real reason is only twofold—either it’s for health or it’s
for happiness. There’s no point to being thin, sick, and miserable. We
all know people who are like that. Generally they’ve got cancer or they
hate themselves, and, either way, you don’t want that for yourself.
Mental and physical health is the primary goal in permanent weight
loss. This book is about accomplishing both. When you set yourself on
the path of mental and physical health, the weight loss will follow. If
you try to shortcut the process, you won’t get very far. A positive at-
titude and a focus on pleasure and joy are an integral part of losing
weight forever.
Laughter is a key component to weight loss. There have even been
research studies looking at laughter as a weight-loss technique. But
I’m not particularly interested in seeing how many calories a day you
can burn by watching reruns of television sitcoms. I’m more interested
in the bigger picture—how can positive thinking and happiness bring
about better health?
We medical types know a lot about the physical implications of being
overweight. We know that obesity leads to all sorts of bad medical out-
comes, including cardiac disease, diabetes, arthritis, and cancer. Hav-
ing extra belly fat even increases your risk of developing Parkinson’s
disease! However, we’ve had a tough time getting people to lose weight.
Even those who lose the weight usually can’t keep it off. But the focus
has been lopsided. Most weight-loss programs concentrate on the physi-
cal issues, usually the food and sometimes the exercise. It is my belief
that the most important component is often ignored: the brain. Our
thoughts, emotions, and behaviors drive every action and decision that
we make, and they certainly drive our weight problems. The bottom line
is this: we know that permanent weight loss will not occur in people full
of fear, unhappiness, and boredom.
IF STRESS CAUSES HIVES, I OUGHT TO BE ONE

GIANT RED BUMP
So if a person is stressed, depressed, or bored with life, attempts at per-
manent weight loss will be futile. The best hope we have for true success
is to start with our most critical fat-preventing organ, our brain, and
whip it into the best shape possible. The rest of the body will follow.
This chapter is about ways to increase happiness, lower stress, improve

coping mechanisms and social relationships, and reduce self-critical
behavior in pursuit of thinness. All of these are crucial to mental and
physical health and permanent weight-loss success. Even if you think
your life is going well emotionally and mentally, there are things you
will learn in this chapter and the next that will make the journey to nor-
mal weight much easier. Take the time to read Part I of the book (Atti-
tude and Behavior, Chapters 1–5) before delving into the later sections.
Chapter 2 deals with the proper mindset for weight loss, and Chapters 3
and 4 address the behavioral aspects (Chapter 5 is about hunger). Once
you have read the entire first section of the book, you will have a much
better foundation to approach the specifics of the rest of the equation,
that is, the input and output of fuel. When you have a good understand-
ing of the thoughts and actions that lead to success, you can apply them
to your own situation and immediately start making positive changes.
THE UNIVERSE IS EXPANDING, AND SO AM I

A study done at Northeastern University, in Boston, in 2003 showed
that the more depressed adolescent girls were, the more likely they were
to become obese later in life.2 That same year, Johns Hopkins published
a study showing that in adults, there is a strong link between depression
and weight, particularly in those who are very obese.3
I have a patient who is extremely overweight, as is his wife. Recently,

the wife underwent surgery. While coming out of anesthesia, she was
particularly anxious and upset. Her doting husband offered all his emo-
tional support. Later that day, apparently still suffering the effects of
the medications, she turned to her spouse and said in her most grate-
ful manner, “Oh, honey, thank you for being there for me when I really
needed you. You are my Rock of Giblubber.”
I’VE ALREADY LOST THREE SIZES:

SMALL, MEDIUM, AND LARGE
Think about ways to increase your pleasure and happiness in day-to-day
life. Fun with food will lead to weight loss, not weight gain, as is often
assumed. It’s an exciting paradox: the more you truly love and enjoy
food, the less you will eat of it. (We’ll talk more about that in Chapter 9.)
Weight loss should be approached as painless. Eating is pleasurable.
Having fun and laughter around meals and playing with food are im-
portant. Additionally, exercise and activity are not burdensome but in-
vigorating. Those who are most successful with permanent weight loss
are those who consider regular physical activity an enjoyable, integral
part of their daily life forever.
WHO KNOWS IF A CLAM IS REALLY HAPPY?

So what are the keys to happiness? In my experience, there are several
keys that drive most people toward happiness. Loving and sharing in
meaningful relationships is a big one. Having a purpose is very impor-
tant. Being present-centered, living life here in the moment, is another.
(Don’t dwell in the past or constantly dream of the future.) Having au-
tonomy and control over one’s life is extremely important to happiness,
as is being rewarded for effort.
All of these keys to happiness are relevant to weight loss. People who
are in meaningful, supportive relationships are more likely to follow
good health habits. People who feel that their actions have a purpose
are more driven and motivated and stick with a plan. Those who live
now, in the present, are more attuned to their bodies’ needs. It’s been
shown that personalities that are more autonomous and independent,
sometimes called “having an internal locus of control,” are less likely
to be obese. Finally, those who feel that they are getting positive feed-
back for their efforts are more likely to continue those efforts. That’s
why there is so much emphasis in some diet programs on the regularly
scheduled weigh-ins.
THE CABLE COMPANY SAID THEY’D BE RIGHT OVER,

SOMETIME BETWEEN BIRTH AND DEATH
If you want to get skinny for the long term, it’s time to embrace laugh-
ter, compassion, and contentment and abandon anger, cynicism, and
pressure. There is a very clear and consistent relationship between how
stressed and unhappy people are and how obese they are. Stress also re-
sults in anxiety; people who have the most work and life stress are the
most anxious and overweight.
A study by Paula Rhode, PhD, of the University of Kansas, showed
a direct correlation between the frequency of everyday life stressors (like
arguments with family members, waiting for the repairman, or being

stuck in traffic) and obesity.4 Her results demonstrated that for weight
loss to be permanent, one must address the psychological factors of
daily stress and loss of control, thus preventing the need to soothe fraz-
zled emotions through eating.
When people have passion in their lives, true meaning, deep pleasure,
and feelings of living a worthwhile life, it is much easier to achieve goals,
including weight-loss goals. Ah, I know what you are thinking: “Sounds
great, but I live in the real world.”
So do I, and I’m a physician, mother, wife, daughter, sister, friend,
comedian, volunteer, bad golfer, worse surfer, writer, speaker, and con-
sultant, and I play a host of other roles. We all live in the real world, with
loads of responsibilities. Unfortunately, sometimes people use their roles
and responsibilities as an excuse to stay unhappy and not work toward
changes. Don’t do that.
I believe eliminating stress is one of the keys to permanent weight
loss. You can be very busy and not be stressed. They are not the same
thing. Indeed, having too little meaningful work to do results in bore-
dom, which is a pervasive but often overlooked cause of stress.
CUSTOMER SERVICE IS OUR MIDDLE NAME.

NOPE, WE DON’T USE IT EITHER
How can you eliminate stress in pursuit of permanent weight loss? Learn
more about yourself by carefully studying your reactions to everyday
events. Start examining what really makes you happy and what turns
you off. Gravitate toward those things that really give you pleasure, and
don’t worry about what others may expect of you.
Nothing aggravates me more than dealing with rude and incompetent

companies. I swear some of them must use the motto “Why buy from
the best when you can buy from us?” The worst is when I want to talk
to a real live person, and I have to navigate an unending phone mes-
saging system or leave a message and hope that someone will call back.
A friend of mine told me that her church recently got rid of purgatory,
and now I understand why. We don’t need purgatory anymore; we have
voice mail.
Are there things that you do that feel purposeless? Realize that a role
that feels important and satisfying to you (such as work or houseclean-
ing) may feel unfulfilling to others. Examine your own values and emo-
tions while in those roles. What do you enjoy about them, and what do
you dislike? Are there responsibilities that you could eliminate, that give
you too little pleasure? Are there ways to make them more pleasurable?
Are there roles that you enjoy and would like to expand? Much of our
lives is spent fulfilling functions that we never question. One of the best
ways to decrease stress is to question assumptions that you have made
about your day-to-day activities. Examine everything you do, take a
step back, and begin to look for ways to increase your happiness and
pleasure.
IF YOU’RE NOT BUSY LIVING, YOU’RE BUSY WORKING

There are some pressures that may be daunting to you to change, such
as work environment or overload. Back in 1976, psychologists demon-
strated that if you stress lab rats by pinching their tails repeatedly for
weeks on end, they will become severely overweight, much more than
those rats that weren’t stressed.5 Do you come home from work feeling
like the equivalent of that pinched rat? Americans are the most over-
worked, and therefore overstressed, people on the planet. It’s no sur-
prise that they are also the fattest.
Some people’s idea of work stress is different from others’. I’ll never for-
get the attendant who ran the canoe rental at my favorite remote vaca-
tion site. She sat under a palm tree and read novels in between handling
her three or four customers a day. Last time I saw her, she was com-
plaining about how she couldn’t wait to go on vacation. I wonder where
she goes to relax: Manhattan’s Friday afternoon rush hour?
Take stock of what isn’t joyous and humorous, and approach rea-
sonable ways to fix the pressures. Note that if you constantly worry
about your weight, you can take the issue so seriously you stress your-
self into weight gain. Conversely, many people who are chronic dieters
report that they feel exhilaration when they start a new diet. The excite-
ment of a new diet likely comes from the enjoyment of envisioning your
new body, your new energy level, and perhaps all the other things you
think a slimmer body will bring to you (perhaps an improved social life).
Unfortunately, traditional dieting is all about deprivation and discom-
fort. Abandon that mindset. But if you are the type that has gotten some
enjoyment at the beginning of a new diet because you are envisioning
what a thinner, healthier you will do, maintain that vision, but without
all the pain.
While you are examining what brings you more joy and less stress,
think about things like walking, biking, singing, dancing, meditating,
music, and sounds of the beach or the woods. I’m always surprised how
few people I see outside enjoying nature and using their muscles. Exer-
cise is an antidepressant and works as well or better than medications,
so not only will it help you to lose weight, it will also relieve stress and
improve mood.
HAVE A FOOD FIGHT, BUT STOP FIGHTING YOUR FOOD

Traditional dieting doesn’t allow eating to be pleasurable because it
comes with a deprivation mindset. But eating the healthiest foods for
the body isn’t restrictive and is always sensual. (That subject is covered
in detail later in the book.) Make a point to have fun around meals, with
lots of laughter. One of my favorite memories from middle school was
the day the cafeteria erupted into a food fight, I remember laughing so
hard I almost split my seams. (Yes, I am giving you permission to have
a food fight, but, no, I am not coming over to your house to clean up.)
What’s wrong with playing with your food? Try doing this with a
straight face: put black olives on all your fingers, then eat the rest of
your meal. You’ll be laughing so hard, you might forget to clean your
plate.
Eating for pleasure can come from the company you keep at your
meals or the silence and quietness of the moment. In Chapter 9 we talk
about increasing the enjoyment of savoring what you are eating with the
art of meditation.
MY BOSS IS HAVING A NEAR-HUMAN EXPERIENCE

I am good friends with a lot of nurses. Nurses are some of the most
stressed-out people on earth because of all the problems in health care.
It seems that no matter how hard they work, someone above them is
saying that it isn’t good enough. As a physician, I observe the coping
mechanisms of great, loving, smart people under tremendous pressure.

What I’ve discovered is a very high rate of lousy coping mechanisms,
including smoking, eating, and drinking to excess. These are very de-
voted people, putting everybody else’s needs ahead of their own. Does
this sound like someone you know? If you are the caring, compassion-
ate, put-everybody-else-first kind of person, perhaps you are using self-
destructive coping mechanisms to deal with the stresses in your own life.
Just remember, you are no good to those you love and care for if you are
running down a self-destructive path.
It’s time to put your needs first, even if others aren’t used to it. You
have the right and the responsibility to take care of your health first.
Think about the instructions you are given when oxygen masks drop
on an airplane. You are told by the flight attendant to put your mask
on before helping others. Treat all aspects of your health that way. The
stronger you are physically and emotionally, the better you are for those
you love.
There is so much aggravation built into health care. I was scheduled to

see my eye doctor for a checkup. Before the appointment, his office sent
me a list of things to bring with me that day. You know you are going
to be in the waiting room a long time when they tell you to bring your
lunch, a sweater, a book, and a tent.
You have coping mechanisms for each major person in your life and
each part of your life. But are they successful, positive coping mecha-
nisms, or are they self-defeating? Do they reduce stress in the long run
or add to it? If you take a drink when you get home from work and
then a couple more before you can face the kids or the spouse and make
dinner, is that the best way to treat your body and your mind? What
would benefit you both physically and spiritually and be better for you
and your family? How about stopping for yoga class on the way home,
walking in the park on the good weather days, meditating for 15 min-
utes in pure silence before the gang gets home, or dropping that extra
project at work that’s been causing you all those extra hours? Perhaps
your best coping mechanism could be setting limits for the superwoman
or superman inside of you and refusing to push yourself harder or re-
fusing to let others push you into responsibilities that you don’t want
or need.
HEY, DID THE BED GET SMALLER?

Once you’ve targeted self-defeating coping mechanisms, you must re-
place what you don’t want with something that is uplifting. If you only
vow to stop doing the destructive habit, you will not succeed. You must
find something that is extremely pleasant to do instead. When one of
my overweight friends whom I coached finally admitted that she and
her husband were drinking too much every night after work, she wasn’t
able to eliminate the habit until they came up with other fun activities to
substitute for their nightcaps (hint: let’s just say it involved more calo-
rie expenditure). She and her husband have both lost substantial weight
from just that simple substitute in behaviors.
WHAT’S IT GOING TO BE LIKE WHEN THESE WERE

THE GOOD OLD DAYS?
Think of a list of easy, stress relieving good-for-you activities. These
can be as simple as taking a walk, getting into nature, listening to calm-
ing music, or having game night with the family. They might include
reading a joke book, calling a supportive family member, or sharing
time with friends. These do not need to be time-demanding activities but
should be included every day in your schedule. Add more active things
to do, not because you have to but because you want to.
Try to laugh, joke, sing, dance, or find pleasurable activities for at
least an hour a day. Keep it positive and mentally and physically ac-
tive. If you are doing something more passive, like television or movies,
choose uplifting and humorous or silly topics. Avoid the depressing—
search out comedy, joy, giggling, friends, and spontaneity.
When picking good-for-you music, be selective. I was a child in the

1960s. Everybody always thinks the 60s was about people doing drugs
and that the music was a consequence of that. There’s this idea that Jimi
Hendrix and “Puff the Magic Dragon” came out of heavy inappropriate
drug use. In reality, what people don’t realize is that it was the other
way around. Folks did the drugs because the music was so bad. If you
don’t believe me, we could test this. Take a bunch of laboratory scien-
tists and expose them to 60s music for 18 hours straight and see if they
don’t start drinking hydrochloric acid right from the beakers.
I’m a big believer in a daily regimen of at least 15 minutes of what I

call “nonactive moments.” Perhaps this could be prayer, meditation, or
something that you would otherwise feel is indulgent time. For me, it’s
time at the beach just watching the waves. Increase your “me” time away
from energy- and mood-sucking activities. Practice a habit of quiet mo-
ments, whether it is sitting on your porch and listening to the birds sing
before you begin your day, or listening to some calming music while sit-
ting in a dimmed room, or soaking in a warm bath before bed. This sim-
ple daily activity will not only lower your blood pressure; it will lower
your stress level and improve your coping skills. Defend that time daily,
and don’t let anyone, particularly yourself, steal it away from you.
The way that you cope with life is critical to your weight. Back in
1990, the University of California and Kaiser Permanente showed that
obese women who confronted problems directly were much more likely
to lose weight and keep it off permanently.6 Ninety percent of the for-
merly obese women who successfully lost the weight used that coping
mechanism, whereas only 10 percent of those who gained the weight
back did so! That’s a remarkable statistic. In fact, if you take away noth-
ing else from this chapter, understand that the way you choose to cope with
life’s challenges will determine your weight. This fact is more important
than what you eat or how you exercise.
A brand-new speech therapist was working on cognitive tasks with a pa-

tient of mine to determine whether the patient had good coping skills.
The dear old lady had macular degeneration in one eye and glaucoma
in the other. The therapist quizzed her with a theoretical scenario to
find out how well she could problem solve. She said to the patient, “You
drive your car to Wal-Mart and get out, realizing that you’ve just locked
your keys in your car. What would you do?” The patient responded, “I’d
say, thank God. I’m blind and I shouldn’t be driving.”
SHE WAS SO MATERIALISTIC, SHE WENT OFF

THE SHALLOW END
Another way to decrease negative emotions is to give up materialistic at-
titudes. The pressure to acquire the trappings of status tends to increase
stress. Besides, more things cause more aggravation, more bills, more
fights, and more work. Ask yourself, “What can I give up that might be
stressing me and making my life less fun? ” Then start searching for
nonmaterialistic friends and have heart-to-heart talks with your family
about what your real monetary goals need to be. Consider moving to a
less fancy neighborhood if you have the opportunity to move. Even if
you can afford the luxuries and a high-end neighborhood, what unwrit-
ten messages are being transmitted to you and your family? Find places
that “fit” your personality; whether they fit your fiscal abilities should be
secondary. I truly believe that materialism is rotting the American soul
and leads to a great deal of unnecessary stress, anxiety, and depression.
THE BEST THINGS IN LIFE ARE FREE—OR

AT LEAST LESS THAN $1.99
You’ll notice throughout the book that I emphasize frugal ways to ac-
complish weight-loss goals. That is a reflection of my personality. It
is unnecessary to spend large quantities of money to be healthy. The
most precious gift that you can give yourself, the gift of excellent health,
should not be expensive.
And there’s nothing wrong with a modest lifestyle, most of the time. I
read about a famous director who named all three of his kids after the
locations where they were conceived. I think one was named Houston
and another, something like London. Obviously, he traveled a lot. I
wanted to do that with my own kid, but Motel-6 Rotenberg just didn’t
have the right ring to it.
Another way to decrease negative emotions is to encourage your

own positive health behaviors with what I term “beneficial self-reward.”
There is a difference between materialism and self-reward. When you
pamper and love yourself with positive behaviors, it is not decadent
or hedonistic. During your weight-loss journey, when things are going
right, like you slip into those jeans that haven’t fit since forever, it’s time
for self-reward. No, I’m not talking about the trip to Dunkin’ Donuts.
But I am talking about the 30-minute bubble bath, the drive to the lake
to go fishing, or the afternoon off to be utterly indulgent with your time.
Ask your partner for a luxurious massage, or drive an extra couple miles
to that really nice park for a walk or bike ride under the trees. Better yet,
plan to meet a friend there to join you. These types of rewards are best
when they don’t involve excess calories or monetary expenditures. Find

behaviors that are truly rewarding and that will not result in additional
stress on your waistline or your wallet.
WHEN OUT IN THE COLD, LET YOUR NUCLEAR

FAMILY GENERATE HEAT
Remember that University of California study that I mentioned earlier
about those study subjects who lost weight permanently versus those
who gained it back? The women who permanently lost the weight were
much more likely to lean on social support than those who gained it
back.7
Find connectedness with people who are helpful to you and give you
proper encouragement. At the same time, move emotionally away from
those who generate negativity. Search out a positive community to sur-
round yourself with, and constantly gauge if this community continues
to be positive and inspire you. Avoid those who give unwelcome advice
and criticism. Find people who will listen in a nonjudgmental manner,
and use a support group if you find it helpful.
Not everyone in your social circle will support your endeavor as you
think they should. Sometimes family members get comfortable with
a certain familiar lifestyle or partner, and they may be threatened by
your attempts to change your habits. Friends can quickly become jeal-
ous. They may be intentionally or accidentally undermining your suc-
cess. Sometimes it’s just a lack of education and understanding (such
as a well-meaning but misguided “Let’s go out for ice cream to cele-
brate the 10 pounds you just lost.”). Often the family member or life-
long friend may have the same old self-defeating habits that you are
trying to change. You may need to do gentle re-education with them
to encourage behaviors that are useful to you. Don’t get defensive if
they are being well-meaning but stupid. However, if repeated education
on your part doesn’t change their behavior, you need to find someone
else (or just rely on yourself) to continue your progress. You can even
look online for support groups that will help you feel less alone in your
journey.
Under the category of “people with good intentions doing stupid things”
would have to be the people who planned the annual fundraiser at our
local zoo. It was a big evening barbecue. They called it the Zoo-b-q.
They should have called it the “Let’s Celebrate Animals by Eating Them
Night.” I’m glad Habitat for Humanity isn’t doing anything similar:
“This weekend, we’re having our annual cannibalism social!”
Approach social occasions (especially with food) with a positive, joy-

ful approach and concentrate on receiving pleasure from your dining
companions. Enjoy the small moments of life. Take the time to notice
not just the smell of the flowers but the smile of a co-worker, the hug of
a child or lover, the sound of new music. Concentrate more on enjoying
these little pleasures, working them into a part of your daily life.
Find new ways to recommit to your lover or spouse. Be there more
fully in your attention, and truly listen. Be creative in your signs of af-
fection, and act like you did when you were first dating. Be on your best
behavior, and don’t expect anything back (but don’t be surprised if your
new activities get a very positive response). Spend more time really lis-
tening to your significant other and your family members; take special
time out for a friend that you haven’t made enough time for.
A MIND IS LIKE A PARACHUTE. IT WORKS BEST

WHEN OPEN—OR WHEN FALLING FROM A PLANE
Don’t hesitate to ask yourself daily, “What is my passion? What is my
purpose, and what gives meaning to my life?” Answer carefully, always
keeping an open mind. A happy life is driven by meaning and purpose.
The best, easiest stress-reducing activity that also lowers blood pres-
sure and improves daily coping skills is physical touch. This includes
hugs and cuddling. A fun little study done by the University of North
Carolina and the University of Pittsburgh showed that women who
hugged and touched their partners most frequently had the lowest
blood pressures and the highest oxytocin levels.8 The hormone oxytocin
is thought to be involved in trust, relationships, sexuality, bonding, and
maternal behaviors. It is believed to decrease anxiety. There has been
research to demonstrate the health benefits from physical contact and
the need to hug and touch others, from the time we are born until the
time we are aged and dying. Yet our modern world scorns physicality,
leaving it for only a bedroom activity or the interaction between parent
and child. Adults have inadvertently sexualized touching and hugging,
even when it is meant platonically. Unfortunately, because of abuses by
the perverted few, the rest of us are forced to abandon physical signs of
appreciation with most of the people we interact with on a daily basis.
In the proper and acceptable setting, put physical touch back on your
“to do” list.
As a physician, I sit at the bedside and touch my patients on the arm
or hold their hand just to connect with them and make certain they un-
derstand that I care. (With the use of high-tech equipment, doctors have
almost eliminated the need to touch patients. Some of us have gotten
lazy and have forgotten that medicine is still as much an art as a sci-
ence.) Healing touch does matter. I do hug my patients and their fami-
lies often, and they appreciate and ask for it.
There is one precaution I have about doctors touching patients. It seems

some don’t bother to wash up between patients, transmitting diseases. I
wipe my stethoscope between each patient I examine. What’s amazing
is that most doctors don’t. In fact, a study was done a few years ago that
found that the typical physician cleans his stethoscope once a month,
say about every 300–400 patients. So why does he bother to wash his
hands? Next time a physician comes at you with a stethoscope, remem-
ber to yell, “Have you washed that? Where’s that thing been?” Just
make sure you are pointing at his stethoscope and not any lower.
If you truly find that you cannot increase your hug factor with family
or other situations, then by all means get yourself a huggable pet from
the animal shelter. Do a good deed and save an animal from destruc-
tion, and watch that animal save you, as well.
My husband offered to get me a pet; he wanted to know which animal I

liked. I suggested an elephant. That way there would be more than one
gray and wrinkled creature around the house.
Overweight people feel less huggable because of the stigma society

attaches to fatness. Heavy people feel less desirable and less accept-
able to others, resulting in less physical interactions, both sexually and
nonsexually. If you believe that this may be a problem for you, avoid-
ing the issue is not going to help. Talk about this with your significant
other or make honest, frequent attempts to correct your unwanted habit
with others. Often we are our own worst enemy and undermine our own
mental health. Everyone needs to feel wanted and loved, and physical
touch is one of the most immediate ways to express this.
I’M FOUNDER OF THE ORGANIZATION DOCTORS

WITHOUT BOUNDARIES
Another very important way to bring more positive emotion into your
life is to give more of yourself to others, but not in a stressful way. Make
a positive difference through volunteering, giving, and showing com-
passion. Donating time and money is not only emotionally rewarding,
it’s been shown to increase immune function! Practice random and de-
liberate acts of kindness. Put yourself in situations that allow you to see
the life of those who are less fortunate or who are struggling. There are
always those who have less. It makes it easier to feel grateful for what
you have, rather than dwelling on what you are lacking or have lost.
WHY DON’T WE DO FUN RAISERS?

When we are concentrating on the needs of others, we are less full of
ourselves and our own problems. Then our personal fulfillment soars. I
believe that’s why there are so many problems with wealthy celebrities,
particularly the young, hedonistic types. They haven’t learned that the
more you try to feed your own emotional needs (particularly with ma-
terialistic objects), the hungrier you become. Self-obsession, hedonism,
and materialism inevitably lead to self-loathing. This often results in de-
pression, anxiety, and, for many, addictions to food and other things.
When you are tending to the needs of the less fortunate, you have the
opportunity to build empathy. There is a strong relationship between
empathy and one’s level of happiness. When you feel for others, your
own positivity rises.
Lessen negative emotions with gratefulness, including gratitude for
food. Whether you use words prior to eating, such as saying grace, or
just pause in the realization that you are lucky to have food, this act
brings joy. We are blessed to live in a land of plenty, but don’t forget
the hundreds of millions who don’t. Gratitude should become a practice
for you, if it isn’t now, for the health that you do have and for the abil-
ity to make it even better. In my family, we practice a ritual of gratitude
by getting together weekly and reciting the special things that we are
grateful for at that moment, including our freedoms, our friends, and
our community.
REMEMBER, THE FAMILY THAT LAUGHS TOGETHER

IS LESS LIKELY TO KILL EACH OTHER
When stressed and overwhelmed by work, family, or life, remind your-
self of the big picture. Keep proper perspective on the small stuff and
the little bumps in the road that we too easily enlarge. A sense of humor
is especially important here. People who are able to laugh at the smaller
annoyances of life cope better in general.
In terms of my own family life, I have to admit that I’m not your typi-
cal mom. I’ve never been someone who fits neatly into the traditional
mothering role. So when my son was younger, I used to teach him nurs-
ery rhymes that were a little different, imbued with my own odd sense
of humor. For example, “The queen of hearts made some tarts. She ate
them all and got the farts!” Which was great fun, that is, until the pre-
school principal called me. And then I had to pretend I’d never heard
that rhyme before.
I believe in what I call the “art of contentment.” Much of daily stress

is self-induced by dissatisfaction with ourselves or others. Expect less,
look at the positive side of life, and don’t be so hard on other people and
yourself. But, at the same time, work toward steady improvement. You
don’t need to be a perfectionist, but also don’t settle for mediocrity.
NEWSPAPER HEADLINE: MODERATES DEMAND

TO BE HEARD, AT LEAST A LITTLE BIT
Eliminate negative thinking. Be constantly aware of how your cogni-
tion is framed, in positive approaches or with a sarcastic, negative,
pessimistic, undertone. Optimistic, positive thinking attracts success
in all areas of life. Our society tends to focus on the negative, cynical,
and sarcastic. Note that the news emphasizes the violent, the angry,
the ugly, and the unusual—that’s what makes it news. Learn to tune
out that emphasis, and embrace the beautiful, the compassionate, and
the positive. Guard your brain from assaults by those who dwell on
the darker, pessimistic side of life, and guard your own emotions to
keep from dwelling on this. Being positive-minded in your thinking is
not improper or unrealistic any more than dwelling on the negative,
the violent, and the miserable is proper (even if it has become “nor-
mal” in our society).
THAT NEW TRAVEL AGENCY NAMED

“JUST DON’T GO THERE”
Concentrate on losing weight for the joy of feeling and looking better,
rather than because of the fear of illness or the fear of being lonely.
Toss guilt, fear, and shame (the three most common emotions in diet-
ing) out the window, and embrace joy, compassion, and contentment
as part of your new attitude about weight loss. Learn to accept and
like yourself as you are right now. Understand that you are not perfect
and are a “work in progress.” We all are. Do not become defeated by
lapses in judgment while you are on your weight-loss journey. Don’t
go there. If you learn to like yourself right now, even with imperfec-
tions, this will lead to greater happiness and better follow-through
with weight-loss behaviors.
Eliminate self-criticism. Overweight people contribute to their nega-
tive emotions by being very harsh on themselves. In the business world,
it has been demonstrated that an uplifting management style is a much
more effective way to change behavior permanently than a negative
one. Concentrate on positive feedback when things are going right, and
leave it at that.
Successful permanent weight loss occurs through laughter and happi-
ness. Develop joy through positive physical and social activity. Happy
people are busy, unself-conscious, productive, fulfilled, and realistic in
setting goals. Accept mistakes. Forge close, loving relationships, and
focus on the positive. Then watch how easy it is to slim down forever.
WHAT YOU SHOULD REMEMBER FROM THIS CHAPTER

• You will lose weight permanently with happiness and laughter.
• Stress, negative emotions, and mistaken thinking are leading causes
of obesity
• Concentrate on mental and physical health, and the weight loss will
follow.
• The fatter you are, the more likely that you are depressed.
• To get thin, believe that eating is pleasurable and exercise is invigo-
rating.
• There are several keys to happiness, and they impact weight loss.
• To decrease stress and anxiety, eliminate unfulfilling work and
boredom.
• Increase pleasure with music, dance, fitness, and nature.
• You are no good to those you love if you use self-destructive coping
mechanisms.
• Search out comedy, joy, giggling, friends, and spontaneity.
• Use daily nonactive moments away from energy and mood-sucking
activities.
• The way you choose to cope with life’s challenges will determine your
weight.
• Decrease negative emotions by giving up materialistic attitudes.
• Encourage your own positive health behaviors with beneficial self-
reward.
• Those who lose weight permanently lean on good social support.
• The easiest stress-reducing activity: hugs, touches, and cuddling.
• Give more of yourself to others, and practice gratefulness.
• Be positive-minded in your thinking; guard against pessimists and
self-criticism.
TWO
I’m Allergic to Food, It Makes
Me Swell: Thought and
Mind for Success
I’m a big believer in integrating delight, fun, and happiness into every-
day life. We humans underutilize our natural abilities to enjoy life. I
bragged to my husband one day, “I have an organ whose only purpose
is pleasure and you don’t.”
He retorted, “True, but at least I have two organs for thought.”
This book is about lifestyle change; it’s not about a “diet.” Good food
choices and increased activity feel positive and are not restrictive. When
you follow the ideas of the book, you will say to yourself about your new
habits, “I choose this lifestyle because of the wonderful way it makes me
feel.” There is no guilt, nor are there any absolute restrictions or com-
mands. You will behave in a certain way because you are positively mo-
tivated to do so. Nobody will watch over you, because you will learn to
motivate yourself. That’s how permanent weight loss is achieved. As a
physician, I see myself as an advocate for my patients. I don’t command
or even cajole; I only advise. In this book, I can give you advice, but the
ultimate responsibility for your health and habit choices is your own.
Once you make positive new habits your own, you will achieve a new
level of health, happiness, and easy weight loss that is truly enjoyable,
for a lifetime.
A BALANCED DIET IS NOT SNACK CRACKERS IN ONE

HAND AND AN ORANGE SODA IN THE OTHER
I work with a nurse who is a 40-year-old single mom of two teenage
boys. Her kids are the center of her universe, and she proudly recites
their latest perfect report cards and amazing athletic achievements every
chance she gets. She has more energy than anyone I know. In fact, re-
cently I asked her, “Linda, are you taking anything that makes you
hyper?” She shook her head, laughed, and replied that people ask her
that all the time. “I’m high on life!” she exclaimed. Then she showed me
a photo of herself from five years ago. I didn’t recognize the person in
that picture. That woman was 80 pounds heavier and looked absolutely
miserable.
Linda told me about how, when she was fat, her mom used to call her
lazy because she had so little energy. Finally, her sluggishness got to her,
and she was determined to be a healthier person and a better role model
for her sons. She walks every day, drinks green tea, limits her sweets, and
eats a balanced diet. Now, she has boundless energy and an amazing
positive attitude about life. What an inspiration she is to her two boys,
teaching them that they can reach any goal with patience, optimism, and
perseverance. She’s so happy and healthy, why wouldn’t she want to feel
like this the rest of her life?
Linda is African American. When she was 80 pounds overweight, not
only did her obesity put her at risk for heart disease, but her misery and
sluggishness put her at risk for a stroke. Yes, the Centers for Disease Con-
trol published a study in 2000 showing that depression is an independent
risk factor for strokes, and that risk is significantly higher in blacks than
whites.1 Linda’s lifestyle changes are self-propagating. She feels better
mentally and physically, and she carries that old photo of her miserable
former self to remind her of how far she has come.
LIFE’S A JOURNEY, NOT A RACE

Weight loss and maintenance are lifestyle management issues. You aren’t
going to keep the weight off if you don’t practice a lifestyle that includes
healthy eating and activity, as well as stress reduction. Attitude adjust-
ment is crucial for permanent weight loss. Those who are still thinking
in the back of their minds, “When I get to my goal weight, I can go back
to my old eating and exercise behaviors” won’t succeed. Don’t even try
the ideas in this book if that’s your mindset. You have to accept that this
I’m Allergic to Food, It Makes Me Swell 25
new pattern of eating, exercising, and living is just the way it is, forever,
and it’s going to be terrific for you.
Daily exercise works because it decreases stress, anxiety, and depres-
sion. People who exercise as part of a weight-loss plan feel better physi-
cally and mentally and are more likely to reach their goals. And, since the
goal should be to enjoy the journey as much as the destination, I can’t
emphasize this habit enough.
People say to me, “I wish I were thinner, but I don’t have time to ex-
ercise and eat right, even though I know I should.” Do you like feeling
tired and stressed and fat and out of shape? If not, then you have time to
exercise and eat better because, in the long run, you haven’t much time
for anything else.
Exercise would be much more acceptable to the masses if we saw more

regular people exercising on television, not just the elite athletes. In
fact, the Olympics ought to go back to being just amateurs only. And
let’s make it so all the contestants have to be naked because that’s the
way it was originally. Think of what that would do for the TV ratings!
Of course, then the Olympic rings wouldn’t be the only things inter-
locking.
Throughout the book I avoid using the word “diet” as much as possi-
ble because that word implies short-term and restrictive behavior. When
talking about intake of calories, I prefer to use the term “food choices.”
This implies active, positive, lifelong behavior.
The truth is, most traditional diets do work for weight loss, but only
for a little while. And none has been proven to be superior to the others.
That’s because they all do basically the same thing; all diets make us
think about what we stick in our mouths.
But traditional diets fail eventually because we stop thinking about
what we put in our mouths. The only way to modify the input perma-
nently is to ingrain the new eating habits. But the bigger reason that tradi-
tional diets fail is that we hate restrictions and commands. When a human
feels forced to do a behavior but doesn’t learn to enjoy it, eventually the
behavior stops.
MY SON PRACTICES RANDOM ACTS OF GROOMING

Most weight-loss books are traditional diet books because they con-
centrate on the “diet component,” that is, the food part of the equa-
tion for weight loss. Yes, food choices are important, but they’re only
a third of the formula. The biggest component of successful weight
loss is the mind (behavior), not the food component. And just as big
a component as food intake is the activity. An overemphasis on what
to put in the mouth misses the truth about permanent and successful
weight loss.
So now you understand my mentality: “dieting” is not the goal. Rather,
the goal is learning permanent good habits for a lifetime. The great news
is that you don’t need any willpower for this kind of weight loss, unless
you need willpower to brush your teeth! When you were a kid, someone
had to remind you to practice hygiene habits. As an adult, nobody forces
you to brush your teeth. You do it because you realize that it makes you
feel better. Good food choices and proper exercise really will make you
feel wonderful. If you follow the advice in this book, you will seek out
good habits voluntarily.
THE DISHWASHER DIET: USE THE HOT WAX

SETTING (THE FOOD SLIDES RIGHT OFF)
I put an emphasis on semantics. Saying “food choices” is so much bet-
ter than the word “dieting,” which is very negative. Dieting implies a con-
stant battle of restriction, denial, and restraint, rather than positive
choices. The joy of choices makes a world of difference in people’s ability
to stick to a healthy program and takes away the damaging effects of oc-
casional liberties. One doesn’t feel punished or bad for making a differ-
ent food choice, whereas failing to follow a restriction is something that
obliges one to feel upset or angry.
Strangely, restricted diets for weight loss are tremendously popular.
Each diet has strict rules about what you cannot eat or drink. Many re-
strict even when you can eat or limits items at certain stages. Many peo-
ple respond well to lots of restrictions and rules in the short run but feel
deprived and fail in the long run. Very few people stick to those plans
for years, and certainly far fewer stay on them for a lifetime. Your job is
to learn to make wise choices for yourself, where nothing is completely
off limits and nothing is periodically restricted. Surprisingly, it’s not that
difficult, and it works better for physical and emotional good health. We
become more vested in our own health when we understand and make
our own decisions. I encourage you to be educated and unafraid of this

freedom.
Speaking of being unafraid of freedoms, a friend of mine started dating

again after a long marriage and a nasty divorce. Her kids are grown and
gone. The guy that she’s dating just got divorced after 30 years of mar-
riage. Over lunch recently, she told me, “Safe sex used to mean ‘use a
condom,’ but now it’s ‘oh, good, we didn’t break a hip!’ ”
It’s been shown in the weight-loss literature that when you set up a
bunch of strict rules of how, when, or what to eat, the perception is that
when you break a rule (which happens inevitably), a tendency to binge-
overeat occurs. This is what researchers Janet Polivy and C. Peter Her-
man, from the University of Toronto, call the “what-the-hell effect.”2
Banishing foods from a person’s diet usually results in increased cravings
for that food. Never think of any food as forbidden; then it will never
be coveted in an unhealthy or excessive way. Eating without guilt is
the goal.
Good habits are not stressful and demoralizing; they are uplifting and
invigorating. Drop the “do I have to do this the rest of my life” thinking.
It’s self-defeating. Nope, you don’t have to do anything. But healthy
weight-loss behaviors, done right, mean you’ll want to do them the rest of
your life. They’re fun.
THE DANCE INSTRUCTOR WAS SO FAT,

HE COULD ONLY TEACH THE CHA
Our bodies are built for physical activity, as much as they are built for
breathing. To say “I hate exercise” is like saying “I hate breathing”; it just
doesn’t make any sense. (We’ll talk more about this point in Chapter 11.)
Exercise, done right, builds endurance and self-esteem and lowers stress;
it makes you feel mentally and physically better.
Duke University did a study that demonstrated a relationship be-
tween increasing exercise and lowering stress.3 Overweight individuals
were put in a regular exercise program. After six months, the participants
in the exercise groups not only had improved heart function and blood
pressure but also became less stressed when put into an emotionally chal-
lenging situation. They dealt with the everyday stresses of life better than
those who didn’t regularly exercise. Walk every day before work, and you
will be able to handle both the difficult commute and your annoying co-
workers!
When you exercise, think about the positive changes your body is go-
ing through. Recognize the improvements that you see and feel on the
outside, and envision the improvements that are happening on the inside.
Note that the blood vessels are opening, the muscles are building up, the
fat is truly melting away every time you move. Your brain is growing
clearer and sharper. The hormones are happily signaling youthful mes-
sages to your private parts (ah, what a vivid imagination you have—keep
going with that thought . . .) Even though you need to visualize those
improvements that you can’t see, they are just as important as what you
can see.
I HAVE NO CONTROL, I LOST MY REMOTE

People who have chronically dieted with restriction often feel they can-
not trust themselves around food. The attitude is “why should I trust
myself, when I’ve failed to lose weight so many times before?” The abil-
ity to trust yourself to eat what you want, when you want, and how much
you want is extremely basic. You must have this belief to be successful at
permanent weight loss. Abandon the battleground in your head.
What do you love to eat? Self-trust leads to self-respect. How can you
respect yourself if you don’t even let yourself enjoy your meals? What if
you ate only food that was tasty and pleasurable? Do you do that now?
Chances are that if you are overweight, not only do you deprive your-
self of your favorite foods, but you might not even remember what they
are. Spend time relearning and rediscovering what foods you truly love
to eat, both those that are nutritionally packed and otherwise. Try new
tastes, new combinations, new textures, and new spices. Don’t be afraid
to experiment; explore and enjoy. Learn to love food and eating again
and you will learn to respect your body and yourself.
People who chronically diet have increased feelings of failure, lowered
self-esteem, and social anxiety. Dieting makes you feel lousy about your-
self. When you constantly “cheat” on a restriction diet, you lower your
self-esteem. This leads to anxiety and depression, which lead to obesity.
It’s a vicious cycle that is rampant in our society.
I have a good friend who is very overweight and swings from one fad
diet to the next. Two years ago, she went on an all-fish diet and lost
60 pounds, then gained it all back, plus 20 more. Usually fish is one of
the better foods for weight loss, when eaten in moderation, except for
swordfish, which is high in mercury. It should be eaten only rarely. But
the good news is that, when cooking swordfish, you don’t have to check
the temperature—it tells you what it is.
A SIGHT FOR BLIND EYES

Remember to treat yourself with kind and gentle words. Think and be-
lieve that you have the right to be fed and nourished, body and soul. This
means avoiding disparaging remarks from the person who is most likely
to dish them out—yourself. How often, honestly, do you look in the mir-
ror or at your reflection in a window and self-criticize? Most overweight
people do it all day long, often not even realizing it.
Focus on the person you are and the inner strengths that you have.
Pick specific character traits or accomplishments that have made you
proud. Move away from self-damaging mental scripts that many people
run over and over in their heads. The first step is becoming aware that
you do it. The next step is replacing the script with words that nurture.
The third step is repetitive practice and devotion to positive thought.
Interestingly, although the mental script is entirely your secret
thoughts, I guarantee that if you convert those mental comments from
constant negatives to positives, others will notice your improved atti-
tude. People who think positively about themselves (without being gran-
diose) are extremely attractive to others. Those whose internal thoughts
are negative and critical subtly drive others away.
It’s amazing how much your spirit and emotions can be detected by other
people, and sometimes in the most unusual ways. A woman who lives by
me advertises that she is a spirit photographer. She says that she can take
photos of the colors of your natural aura for you, your kids, and even
your pets. The more money you have, I guess, the greener your aura.
Weight loss and maintenance are an ongoing process, so don’t think

in terms of “mistakes.” When either eating or activity isn’t pleasurable,
take the time to ponder why and learn from that, without guilt or self-
recrimination. Even binging one time won’t destroy a body. Learn and
move on, but lose the habit of chronically binging and restricting. Eat
smaller amounts of yummy food without the emotional chains that drive
people to feel deprived.
Realize that most people who lose more than 20 pounds do it suc-
cessfully over a period of 6 to 24 months. Quick, permanent weight loss
does not happen, and it is dangerous and damaging to the body to at-
tempt it.
THERE’S NO ACCOUNTING FOR WAIST

Some people are internally driven, that is, they use their own thoughts
and emotions to assess and motivate themselves. But many people are
externally motivated. They need others to tell them their accomplish-
ments, tasks, and self-worth and to encourage motivation. This is an
important point: those who are externally driven are more likely to
be overweight, since so many cues to eat surround us in our modern
existence.
If you are externally driven, you may undermine your ability to lose
weight by blaming others for your own behavior. You may say that
you can’t lose weight because “my husband likes to eat out a lot” or “I
have to keep junk food in the house for the kids.” Nobody forces you
to put food in your mouth, and nobody forces you to sit on the couch
at night except yourself. (However, if people are tying you to the couch
and force-feeding you potato chips, I suggest you put this book down
and call 911.)
DEFINITION OF LAZY: WHEN YOU THINK

“A NEW EXERCISE” MEANS MASTURBATING
WITH YOUR LEFT HAND
You will not reach permanent normal weight until you take responsibil-
ity for your own actions or inactions. The buck stops with you now. If
you are externally motivated, you will need to outline specific steps, mea-
sure outcomes, and set up your own external cues to succeed. In later
chapters, I’ll talk about how to do this, but you should be aware that
you need a major revision of your environment for your new lifestyle
habits. This may include putting more emphasis on limiting exposure to

the not-so-good-for-you foods and being selective about your exposure
to friends and family who do or don’t support your efforts. This may
also include things like placing obvious cues to exercise, such as the sta-
tionary bike in front of the television.
Take steps to put yourself back in the driver’s seat of your health. The
more control you have, the more likely you will get to your goal. And
note that research has shown that people who exercise regularly while
losing weight feel more in control of the process and are more likely to
lose the weight permanently.
Beware, there are exceptions to the rule that exercise makes you feel
more in control. Golf is not an exercise that breeds that feeling. What
is it with golfers and those little head covers they put on their drivers?
They’re thinking, “It protects my club so it won’t get scratched.” Then
they take the cover off, whack a hard ball as fiercely as possible, hit a
really bad shot, wrap the club around a tree . . . then put the head cover
back on.
Why is control so important in weight loss? It’s because not every per-
son who succeeds does it the same way. This book is a description of the
best proven techniques that lead to sustained weight loss. However, no
program is “one size fits all.” Take what works for you and make it your
own. To keep weight off permanently, you should individualize the ideas
from this book to fit your own style so that you can maintain your suc-
cess through the years.
Persistence is the key. Keep trying different ideas from this book, until
you find the best fit for you and your lifestyle. Those who succeed keep
trying different approaches until they find the methods that work for
them. Then they stick to those methods.
THE THIN-YOUR-WALLET DIET

Many people are under the impression that they can lose weight only
in a special program, whether it is a diet center or a costly food plan.
Interestingly, the research shows that the majority of long-term losers
of major amounts of weight have traditionally done it on their own,
outside a special weight-loss program.4 I believe this is because people

who learn to take their signals from their internal environment and are
self-motivated will do better. They accomplish this without the struc-
ture of a specialized weigh-in program or using diet-program foods and
supplements.
There are so many dietary supplements that don’t work. People don’t
realize there’s no government regulation for checking the effectiveness
of the claims of any type of nutritional supplement. People out there
are selling supplements that are supposed to boost memory and cogni-
tive function by “increasing blood flow to your brain.” The funny thing
about that claim is the real medical research shows that the better your
brain is functioning, the less blood flow it requires. Psst, want to be
Einstein? I’ll sell you something better than a supplement. I’ll sell you a
tourniquet to put around your neck.
Some people initially lose weight with a structured program, such as

Nutrisystem, Jenny Craig, or Weight Watchers, but then most design
their own maintenance program for the long term, for the years after-
ward. Very few people who lose weight and keep it off stay in a struc-
tured weight-loss program for years. Occasionally, people who were in
such a program return to it when they notice their weight creeping up.
There is no relationship between the cost of a weight-loss program and
its long-term success. Realize that there is a difference between a struc-
tured weight-loss program and groups that offer only social support and
encouragement. A study published in 2009 in the journal Evidence-Based
Nursing found that structured diet groups sometimes worsened par-
ticipants’ feelings of low self-esteem, negative feelings, and self-blame.5
However, the National Weight Control Registry found that groups that
offer positive social support are very useful to successful big-time weight
losers in both the short and the long term.
Stop blaming your body parts. I hope you aren’t thinking, “If it
weren’t for my big belly, I’d be happier.” That’s silly. Realize that you are
more than your weight. Do not base your self-esteem on a number on a
scale.
HE WHO HESITATES—IS LATE

Don’t procrastinate on happiness or on making changes. Having goals
is important, but, if you delay your happiness until you reach your goal,
you’ve missed the point of life. Concentrate on your happiness along the
way and the journey will be more enjoyable. If you postpone happiness
until you reach your goal, it is likely you will never reach it or that you’ll
still be miserable when you get there.
Life is a balance. Denying oneself pleasure in the present so as to live
a pure life mentally and physically is demoralizing. The best solution is
to seek physical, intellectual, and emotional pleasures that are not harm-
ful at work and in personal relationships, as well as in eating and exer-
cise. Find physical pleasures that you can do now that are positively
rewarding.
It is difficult for many overweight people to accept that they eat too
many calories. Most obese people want to blame slow metabolism, hor-
mones, or increasing age. If you are overweight, you are eating too much
for your body and its present activity level. There is no way to get around
that fact. You will never succeed in permanent weight loss until you are
willing to accept the fact that you are ingesting too many calories for
your body at this point in time.
YOU LOOK LIKE YOU BELONG IN HOT AND SOUR SOUP

One of the most common reasons that people take in too many calories is
emotional eating. Dr. Edward Abramson, author of the book Emotional
Eating, describes anxiety, depression, boredom, loneliness, and anger
as the major emotional triggers. He says that emotional eating usually
takes the form of spontaneous snacks, not planned meals, since the calo-
ries ingested are in response to immediate emotional distress. Often these
snacks are eaten after a regular lunch or dinner, when the person has
recently eaten and is clearly not truly hungry. If you find that you fre-
quently eat when you are not hungry or overstuff yourself, you may need
to ask yourself if you are eating to satisfy a deeper spiritual need.
Men do not report emotional eating as much as women. This may be
because they do less of it or because they just don’t recognize that their
emotions are tied to their eating. Boredom, the biggest cause of emo-
tional eating, is probably one of the biggest triggers for male overeating.
Yet men do not see boredom as a root cause of excess calories. Boredom
comes with fewer physical signs than other emotions and gets missed as
an emotion.
FRANKENSTEIN WAS LEVEL-HEADED

How do you avoid emotional eating? If you find yourself reaching for
food and you aren’t truly hungry, identify the emotion. At home, perhaps
you need to go out and garden, sit by the fire with a cup of herb tea, take a
walk, call a friend or family member, write something inspirational, read,
or clear your mind. Would meditation or music help? How about just
deep breathing and relaxation? Maybe you need heavier breathing and
some great sex?
When you “phone a friend” for comfort, just remember to eventually

hang up. I have a relative who calls frequently and never stops to take
a breath. They’ve invented a pedometer to count the number of steps
you take in a day, but there’s no wordometer to measure words spo-
ken in a day. Can you imagine how many husbands would buy that for
their wives? Husband (ears bleeding, checks device): “Honey, you’re at
you’re 10,000 word limit, now shut up!” I could make millions on that
invention.
Meditation, which we talk about in a later chapter, allows you to be

more aware of your physical and emotional states and satisfies needs
other than hunger. It tunes you into those needs and makes you less in-
clined to indulge in emotional eating. Emotional eating is a response to
poorly understood agitation of the mind. Becoming aware of your inner
states decreases that muddle.
How to deal with anger? If you are angry, decide if it’s serving a pur-
pose. Do you need to be angry? How can you defuse the anger? Would
relaxation and meditation work, or do you need to confront the focus
of your anger? Would writing down your feelings help, or would exer-
cising help you to blow off steam? Should you go for a walk and calm
down? Do you need to read about anger management or even take a
course on it?
Anxiety can feel like “butterflies” in the stomach. Some people feel
those butterflies and try to feed them, mistaking the feeling for hunger.
If you are chronically anxious, you may subconsciously feed your but-
terflies, rather than deal with your anxiety. (Chronic anxiety disorder
is the most common undiagnosed and untreated psychiatric illness.)
You should identify what makes you anxious and find ways to reduce
the anxiety either by seeking treatment or by dealing with the source.
Or you should practice reducing anxiety through breathing exercises or
meditation. Then you will succeed in avoiding this common cause of
overeating.
There’s no doubt that modern life leads to a lot of difficult emotions and
stressful situations. Did you ever wonder about Rapunzel’s reaction to
being saved if she were a modern woman? She’s locked up in a tower,
away from kids, boss, stress, and traffic. Hey, it sounds pretty good to
me. Modern Rapunzel: “Go away! I don’t want to be rescued. And get off
my freaking hair!”
Are you lonely? Get on line and find someone decent to chat with.
Join a class or a support group, or arrange to teach a skill at your local
community center. Sign up for a hobby club, exercise class, or the rac-
quetball league. Volunteer at a school, hospital, nursing home, or
pet shelter. Make yourself useful to others and they will reward you
10 times over.
What if you are bored? If you find yourself rummaging in the cabi-
nets for food and you are not hungry, you are very likely bored. Go for
a bike ride, call a friend, visit a neighbor, do crafts, grab a fun book, or
watch the educational channel on television. If you are bored at work,
ask for more challenging assignments or learn new skills. Do something
that stimulates your mind and your heart.
MEET MY FRIEND, THE INCREDIBLE SULK

Are you depressed? If seriously depressed, seek professional help. If more
mildly depressed, the best treatment is daily moderate aerobic exercise.
A walking program works as well as medications, and the research is
pretty consistent on that point.6 Exercise is mood-enhancing, so you’ll
treat your mind and body in one fell swoop. Call people who make you
laugh and write to people you love. Seek out friends and helpful support.
Take a mental health day from work and responsibilities, but not to sit
home and brood. Instead, do something positive and uplifting with your
day off. Go to the park and ride the swings. Walk in nature. Play, laugh,
sing, and force yourself to get out of your depressed comfort zone. Rec-
ognize that your mood is down and make a deliberate effort to change
it with positive activity. Read about depression on university Web sites
and ways to recognize if it’s serious enough to warrant professional inter-
vention. Depression causes most people (normal weight and overweight
individuals) to eat more, but people trying to lose weight who are de-
pressed overeat the most calories.
I believe in communing with nature to lift the spirits. But here in Florida,
the nature often comes to me. I’ve had snakes in my closets and a wolf
spider that was bigger than a tarantula in my baking pans. I’ve had large
frogs come up from my sewer akin to a biblical plague. The nickname of
Florida is “The Sunshine State,” but the motto should be “What the hell
is that in my commode?”
If you think you are emotional eating, do the following:
1. When you are about to eat, ask yourself, “Am I truly hungry? ” If
yes, go ahead and eat.
2. If not, think about why you feel the need to eat; pin down the emo-
tional triggers.
3. When you have determined the underlying cause, act on the triggers,
and ignore the urge to eat. Find another constructive outlet that isn’t
taking in calories. Remind yourself that you are in control of your
behavior and that you have the capacity to break old habits, no mat-
ter how ingrained.
4. “Groove” the habit by practicing steps 1–3 each time you are about
to eat until the process becomes automatic. Your goal is to eat only
out of hunger.
EAT, DRINK, AND BE BURIED

If you avoid dealing with what is bothering you or use escapism as your
form of coping with difficult problems, you are more likely to overeat
and gain weight. People with escapist and avoidance tendencies also
tend to excessive drinking as well as other addictive behaviors. Over-

sleeping, excess television watching, and similar behaviors are often used
to numb emotions when someone is unwilling to confront problems.
Recently, a news program announced that researchers are very close to

producing human babies without men’s help. Soon, women will have
no purpose for men, they claimed. That’s not true. Women need to have
men—who else would we have to blame?
Some people use food like an addiction. Food becomes another de-
structive way to soothe the hurting soul. Dr. Mark Gold at the University
of Florida has stated that he believes hedonistic overeating is an addic-
tive disease and needs to be treated the same as other addictions.7 His
research shows that, in obese people, beef broth does nothing for brain
chemicals, but Kobe beef lights up functional brain scans as if an addic-
tive drug were being given. Food causes dopamine release like sex does.
Receptors light up in PET brain scans as they do in cocaine and alcohol
abusers. When overeaters are shown a photo of the Golden Arches, their
brain brightens like a fireworks display at Disney World.
Interestingly, the portion of the brain devoted to the sensations of
texture, taste, and feel of the mouth and tongue is also enlarged in over-
eaters, thereby reinforcing the sensual pleasures of food. In Chapter 9,
you’ll see why this isn’t a bad thing.
Addiction is one of the greatest scourges of humanity. I don’t under-

stand the push by some people to make illicit drugs legal. What’s next—
forcing the drug cartels to dispose of their old cocaine by using it as
bricks on their enemies? Then the coke will have to have a stamped
“best if snorted by” date.
If you think you are suffering emotionally, get help. People with real
psychological problems that need treatment lost only half the weight of
those without emotional problems in the same weight-loss study. Don’t
focus just on your weight. You need mental and physical strength and
healing to achieve your weight loss goals.
Addictions are a serious problem in my patient population. Still, as a

physician, I have a problem with the euphemism “substance abuse.” I’m
fairly certain that chocolate and peanut butter are both substances. And
I will admit I’ve occasionally used them for the euphoric mood they pro-
duce, not because I was hungry. I’ve even used them together. Does that
make me a multiple substance abuser? Someday you’ll find me in a dark
alley whispering, “Ghirardelli dark and Jif creamy, oh God, I need it
quick.”
Emotional eating is not always a negative. Sometimes we are feel-

ing emotions that we don’t want to admit, even to ourselves. If you are
reaching for food and aren’t hungry, use that behavior to analyze what
is bothering you. Let it become a positive signal, as if you have an early
warning system for your emotions. Then act on them before they over-
whelm you or lead you into crisis.
JEWISH AND CATHOLIC GUILT IS SIMILAR,

EXCEPT CATHOLICS HAVE ORIGINAL SIN AND
JEWS HAVE EXTRA CRISPY
There are a lot of mind games that people play with themselves that un-
dermine their success. Teach yourself that food isn’t the enemy, and nei-
ther is your waist or the scale. Learn that weight loss shouldn’t be painful
and that pleasure in food and activity is safe and encouraged. Eliminate
guilt and enjoy physical indulgences and you will actually eliminate
“yo-yo” dieting.
There are a lot of myths in weight loss that aren’t substantiated by the
health research. Here are the myths and the truths:
Myth: I’m fat because of my genes.
Fact: Yes, some people certainly gain weight more easily than others,
but our present obesity epidemic has nothing to do with a sud-
den appearance of fat genes in our DNA. Look at the old photos
or videos of slim people from the 1970s and earlier. These people
have your genes. Get them back.
Myth: I was fat as a kid, so I’ll be fat my whole life.
Fact: It’s harder to lose weight the longer you have it, but that’s prob-
ably due to lifelong behaviors that become more ingrained over
time. You can always change behavior. (Interestingly, according
to a 2005 article in the American Journal of Clinical Nutrition,

it’s also easier to stay thin the longer you’ve been thin. This is
true even if you were very obese when you were younger.)
Myth: There’s a 95 percent failure rate for diets, so why bother to try?
Fact: That oft-quoted statistic comes from the toughest cases at uni-
versity centers and also from measuring each attempt at a short-
term restrictive diet. We already know those don’t work. Duh!
Myth: I’m fat because I have character flaws and no willpower.
Fact: You are overweight because you have learned lousy behaviors
that aren’t any fun, lowering your self-esteem and increasing guilt.
These behaviors have nothing to do with character flaws or will-
power and can be changed with simple behavioral intervention.
IF WE COMBINE THANKSGIVING AND PASSOVER, WE

CAN HAVE THE NEW HOLIDAY OF “LEFTOVER”
Myth: I can lose weight only if I have a target date to be thin.
Fact: Many people target specific life events or holidays in their weight-
loss goals, for example, “I want to lose 25 pounds by Christmas” or
“I want to fit into a size 6 wedding dress.” This is outrageous and
self-defeating behavior. If your mindset is to “be good” just until
you can fit into those special clothes on that special day, then you
will face only frustration afterwards. You must think long term.
Your target date is everyday and no day; it’s the rest of your life.
If you can’t get your head around that idea because of a lifetime of
crash dieting, please work on it. Accept this important point, and
you will eventually enjoy lifelong normal weight success. Ignore
it, and you commit yourself to a lifetime of yo-yo dieting and un-
happiness.
The wedding day is still the most common target date for crash diets.
But due to changes in society, weddings are less common than they used
to be. On the other hand, things are looking up for the funeral industry,
as baby boomers are dying in droves. In fact, wedding planners are now
doing funeral arrangements so they can stay afloat. This is a quote from
an article in my local paper, given by a funeral director: “Other than the
fatality, what’s the difference between a wedding and a funeral?” Well,
in one case, you’re less likely to have kids afterwards.
Myth: If I start gaining weight, even a little bit, it will all come back.
Fact: People who successfully maintain long-term weight loss monitor
themselves constantly. As soon as they notice a slight weight gain,
they have an action plan to reverse the trend. This is a normal part
of the process, not a failure.
Myth: I can’t quit smoking because then I’ll gain weight.
Fact: If you dispose of addictive behaviors, you gain control over your
life. And the more you practice healthy habits, the more likely you
are to lose weight permanently.
I have patients who insist on smoking while wearing oxygen. I’ve been
thinking of opening Doctor R’s Institute of Patient Rocketry.
This reminds me of an 89-year-old patient of mine who explained
that she started smoking as a child when her mother forced ciga-
rettes on her. Up in the mountains, they thought it got rid of intestinal
worms. The lady is still smoking 80 years later. I said to her, “Isn’t it
funny that worms are smarter than people? They know to leave when
tobacco is around.”
Myth: I can’t have a baby and lose the weight afterwards.

Fact: Most women who are successful long-term losers do it. You
can, too.
Myth: I’m fat because I love food.
Fact: Food and love are four-letter words, and sometimes we treat
them like that. Most overweight people actually have many neg-
ative emotions tied into food, like guilt, fear, and anger. Loving
food isn’t evil. It’s not foul-mouthed or even wrong. It’s okay
to love food. We’re born with the capacity to suckle the breast;
that first food we encounter is comforting. So don’t be hard on
yourself if you truly love food. It’s normal.
IF WORDS DIDN’T MATTER, THEN ALL LOOSE

WOULD BE BREAKING HELL
Once again, notice the semantics that I use. This is a “journey,” not a
“battle” against obesity. Don’t downplay the importance of the phrases
playing in your head. Think about how differently you feel when you
say to yourself that you are in a “fight” rather than a “learning ex-
perience” about your weight. Reframe the words and thoughts that
you use, to yourself and to others, when thinking about eating, exer-
cise, and your approach to weight loss. You are not “avoiding” cer-
tain foods; rather, you are “choosing” more of this food or less of that
food. When things don’t go quite right, it’s another “learning oppor-
tunity,” not a “failure.”
AND ON THE EIGHTH DAY, GOD MADE CHOCOLATE
Remember, no matter how bad life is, it can always be better with choc-
olate. Unless, of course, you are severely allergic to chocolate; then it
will be over.
Good self-esteem is needed when weight loss begins and is often

propagated by losing weight. Don’t live for the day when you lose the
amount of weight that you want; start living and enjoying today. People
who deprive themselves of pleasurable food often get into a habit of de-
priving themselves of other joyful things like dancing, riding a horse, or
even taking a vacation. How emotionally damaging is that?
Not every vacation is full of fun and joy. The last cruise I went on, the
economy was at its worst. For many people on board, they were looking
at a lifetime of investments and retirement savings suddenly gone. Ev-
eryone was so depressed that at the muster station, the crew was teach-
ing people how to take their life jackets off.
Be careful with focusing on negative body image; this can lead to self-
criticism and unhappiness. Overweight people often delay socializing or
having enjoyable experiences, like going to their high school reunion,
waiting until they have their idealized body. Take steps to say and be-
lieve that you have a positive body image now and always. Have those
special experiences now, as that will lead to more happiness, which leads
to more success in weight loss. Buy the clothes that make you feel beauti-
ful and handsome now, not when you are a size whatever smaller. Enjoy
them; this will bring you closer to thinness and to mental and physical
health. Misery, self-deprivation, and neglect certainly won’t. Take the
time to make yourself look your best now, every day. Do what you can now
to improve your self-image, both inside and out. Don’t wait until some
nebulous future time.
Chinese fortune cookie: “Over every mountain there is a path although
it may not be seen from the valley.” You may feel like you are looking
upward at a very steep mountain to reach your weight-loss goals. If so,
redirect your view. Start looking at the lovely foothills right in front of
you. Then you can enjoy the path along the way.

• Good food choices and activity are desirable and not restrictive.
• Attitude adjustment is crucial for permanent weight loss.
• Saying “food choices” instead of “diet” implies active, positive
behavior.
• Traditional diets fail because we hate restrictions and commands.
• Healthy behaviors done right are fun. You’ll want to do them the rest
of your life.
• There is a direct correlation between increasing exercise and lowering
stress.
• When you love food and eating again, you learn to respect your body
and self.
• Traditional dieting makes you feel lousy; eat without guilt.
• Treat yourself with kind and gentle words.
• Weight loss is an ongoing process, there are no mistakes. Learn and
move on.
• If you are externally motivated, you are more likely to be overweight
• Individualize the ideas here to fit your own style, and be persistent.
• Most big-time weight losers lose weight on their own, outside a struc-
tured program.
• Your self-esteem isn’t a number on a scale. Don’t procrastinate on
happiness.
• Anxiety, depression, boredom, loneliness, and anger are major eating
triggers.
• Escapism and addictions are destructive forms of coping and lead to

overeating.
• Address the myths and mind games of weight loss. The truth will make
you thin.
• Use upbeat words and positive body image and thoughts, right from
the beginning.
• People who deprive themselves of pleasurable food deprive themselves
of other joyful things. Live and enjoy today.
THREE
Tossing Your Cookies:
Food Behavior That Works
People who are fat have fat kids. We know that. The argument is whether
that is the effect of nurture (environment) or of nature (genes). Since fat
families also tend to have fat pets, I’m betting it is more nurture rather
than genetic predisposition. Unless, of course, you are related to your pets.
If you have been blaming your obesity on your lousy genes, it’s only go-
ing to make your ancestors feel bad, and it’s not going to help you get
healthy and skinnier. Leave Aunt Tillie out of this.
However, if Aunt Tillie was the one who taught you to always eat din-
ner at 8 p.m. and never to leave the table until you clean your plate and
that exercise is only for athletes, then Tillie is in the doghouse after all.
MY BIRTHDAY SUIT IS TIGHT

I firmly believe that it doesn’t matter how much a person exercises or
how little he or she eats if there isn’t change in the fundamental underly-
ing behaviors that result in weight problems. Short-term successes will
be lost every time. Those behaviors are the result of habits, as well as ex-
pectations and assumptions about food, eating, weight, and activity.
Most of these behaviors are formulated in childhood, reinforced in adult-
hood, and carried onward for a lifetime. Permanent weight loss occurs
when we examine and change our actions. In this chapter, we discuss
proven successful food behaviors. In the next chapter, we talk about best-
known behaviors for activity.
If you are not certain which actual foods are the best for your body,
don’t worry; we’ll discuss that in the “good food choices” section of
the book. However, I can give you a few hints here. If you buy most of
your foods at Nutrition Whorehouse, you’ve got a problem. If you fre-
quently visit restaurants with names such as Seat’s Up Bar & Grill,
Crème de la Phlegm, or the Poached Roach, you definitely need help.
And don’t be afraid to get educated if your favorite diner has a sign
outside that says, “Try our rib-eye steak, our black-eyed peas, and our
blue-eyed waitress.”
A great resource for anyone aiming for permanent thinness is the Na-
tional Weight Control Registry.1 The brainchild of two researchers at
Brown Medical School and the University of Colorado Health Sciences
Center, it collects stories of successful weight losers and analyzes their
behavior. What makes their research important is the size and perma-
nence of the weight loss among the participants. Registry members, so
far, have lost an average of 66 pounds and kept it off for more than five
years. About half the participants lost weight without any outside help
or formal program. Almost all modified their food intake, and 94 per-
cent increased their activity (most of them still walk, exercising about an
hour a day). The majority eat breakfast regularly, get on a scale weekly,
and watch less than an hour and a half of television a day. These peo-
ple changed their behaviors and continue to follow their new practices,
years after they originally lost weight. They developed permanently good
habits and eliminated their bad ones. That’s the way to get thin and stay
thin forever.
You can call bad habits anything you want, but they are still bad be-
haviors that lead to rotten outcomes for your health. Not that long ago,
Minnesota passed a law that banned smoking in public places, except
for actors on a stage. Some bars got the wise idea to set up stages and
began calling their patrons “actors” to get around the ban. One estab-
lishment said the patrons were performing The Tobacco Monologues.
Gee, I’d hate to think where they were puffing from. “Oh, look, smoke
rings!”
Tossing Your Cookies 47
IF WE LIVE EVERY DAY AS IF IT IS OUR LAST,

THE LAST ONE COMES QUICKER
I can’t emphasize enough how important it is to examine the habits that
drive your behavior. Eating and exercise behaviors are mostly habits.
These habits keep us fat or thin. The nice thing about habits is that once
the good ones are learned, they can be maintained for a lifetime. They
definitely get easier over time, as they become completely ingrained. You
may feel a bit overwhelmed or defeated by previous attempts at weight
loss. But if you truly follow the advice in this book, someday you will be
thin permanently and without effort.
That’s the thing about following advice. You have to choose wisely
whose sage advice you follow. I remember once being told, “Whatever
doesn’t kill you makes you older.” I’m still not certain how useful that
was. Perhaps a more relevant quote here is what FDR said: “The only
thing we have to fear is fear itself—and cupcakes—cupcakes are evil.”
Look, okay, just follow my advice.
Thin people may not have a naturally higher metabolism than those
who are fatter. But they may be more active on a daily basis and stop
eating when they are no longer hungry. They may naturally practice all
the behaviors of successful permanent weight losers; they just never got
fat to begin with. Thus, next time you think about someone who is thin
and has never had a weight problem, realize that the person may have
a metabolism just like yours but a behavior pattern that is different. Un-
derstanding this message will change your life.
THIS DIET NOT FIT FOR HUMAN CONSUMPTION

Many of us were raised at a time when families ate together. If you are a
boomer like me, you probably ate with your parents, at least for din-
ner, most nights. The entire family got together around the table and
laughed at one another. Then we ate lots of overcooked vegetables, fatty
chicken, meats, and lard-laden breads. And don’t forget the tons of
mashed potatoes and syrupy-sweet desserts. Ah, ignorance was bliss!
In my family, as in most families at that time, dinner was at a specific
time. You didn’t eat beforehand, or you might “ruin your dinner.” You
also ate what everybody else ate (and you didn’t complain if you knew
what was good for you). You cleaned your plate of whatever was served
to you or you would not get dessert. Take a moment to think about each
one of those eating behaviors and the dangerous assumptions that go
along with them.
CPR—IT’S WHAT’S FOR DINNER

Dinner was the biggest meal of the day. It was usually served fairly late,
when everybody was finally home. That makes sense on a social level.
One of the complaints of the present-day family is that no one has time
to talk and families now rarely eat together more than one night a week.
People should talk, and they should eat together. But saving most of your
calories to be eaten shortly before bed is not good for you because it
may cause indigestion and reflux. In fact, eating first thing in the morn-
ing and making your breakfast and lunch your biggest meals is safer and
may burn more fuel, although that last point is still far from proven.
Even though I’ve painted a picture of perfect familial togetherness,

nothing could be further from the truth in my family. I was convinced
I was adopted. You see, I really wanted to be. My brother, sister, and I
couldn’t be more different. Sometimes I think I nearly drowned in my
family’s gene pool. Which reminds me of a sign on a liquor store that I
saw recently: “We treat you like family.” I hope it’s not like my family,
because then if you bought a bottle at that store, it would have already
been open with only a few drops left.
Eating before dinner was a crime in my family. If you had a piece of

fruit or drank a glass of tomato juice before you sat down for the meal,
you would eat less, a lot less. Mom and Grandmother would get mad
because they had worked so hard to cook the food. (They were both
overweight, by the way). Now we know that if you eat or drink certain
low-calorie foods just before sitting down to your meal, you will signifi-
cantly reduce how much you feel like eating. (We’ll discuss which foods
are scientifically proven to be helpful and why in Chapter 6.) When you
are trying to cut back on calories, that hunger suppression effect is a
big plus.
THE PRUNE DOESN’T FALL FAR FROM THE TREE

You may have been taught to eat what was served to you, when it was
served to you, whether you liked it or not. There is a certain convenience
to that for the cook. But learning to eat what everybody else is eating can
be dangerous, especially if that becomes an ingrained habit. You go to
parties and eat, even if you are not hungry, because everyone around
you is eating. You eat pizza and drink beer at the Super Bowl party be-
cause you think you are supposed to. You go out for lunch with co-
workers and start eating the bread when your boss grabs a piece and
proceed to keep right on eating through dessert because Sandra from
Marketing ordered the cheesecake. You wouldn’t want her to have to eat
her dessert all alone.
It’s like we’re all giant starfish. In order to eat, the starfish must throw
up its entire stomach. The stomach then grabs lunch by surrounding it
and the organ and meal then return inside the animal to digest. Imag-
ine if humans did that—the cafeteria line at work could get very en-
tertaining. That’s one way to clean your plate.
One of the most dangerous behaviors that many of us were taught as

children was the command to “clean your plate.” Often we are told that
leaving food on a plate is considered rude. A popular phrase when I was
young was “Finish that food, children are starving in China.” Some-
times my friends’ parents told them that children were starving in Africa.
I never did understand why if my friends or I overate, that would help
those malnourished kids on another continent.
LEFTOVERS GALORE—WASN’T THAT

THE NAME OF AN OLD STRIPPER?
My husband claims that the “clean your plate” command resulted from
the Depression-era households that couldn’t afford to waste food and
couldn’t even store leftovers properly. If you didn’t eat the food that was
in front of you, it would spoil. So eat now, or be hungry later. Perhaps that
was true then. But, even when I was a kid, we had Tupperware and re-
frigerators.
I HEARD THAT PARENTING GETS EASIER WHEN YOU DIE

The end of the meal for most children comes complete (they hope) with a
dessert. But often that dessert is only for the “good” child who eats every-
thing he is served prior to the sweet. “If you finish your broccoli, I’ll give
you chocolate pudding” seems like a great parenting idea until you think
about the underlying message. That unspoken message is “If you overeat
from those calories still on your plate, I’ll let you eat even more unneces-
sary calories as a reward.”
Most of us who have struggled with a weight issue have learned to eat
beyond when we are hungry. Cultures that are thinner don’t do that.
Bradley Willcox, MD, of the University of Hawaii, has published exten-
sive research on Japanese longevity, weight, and health habits and com-
pared them to those of the Western world.2 The people of Okinawa are
some of the healthiest, longest-lived, and least overweight people on the
planet. Traditionally, they practice the concept of hara hachi bu, which
means “eat until you are 80 percent full.” Never eat until stuffed or burst-
ing, they tell their kids. The French, it is claimed, learn to gauge their
internal signals for when they are satiated (no longer hungry). It is ac-
ceptable to stop eating, even if everyone around you continues to gob-
ble down the brie, baguettes, and wine. There is now good evidence to
show that people who are overweight no longer check their signals for
hunger, according to Dr. Walter Willett, professor of epidemiology and
nutrition at the Harvard School of Public Health.
ON A SCALE OF ONE TO TEENAGER,

HOW HUNGRY ARE YOU?
It is a rare person who is born without the signal to stop eating when full.
Most babies come with those signals hard-wired in at birth. Honestly, I
have never read one medical report about a baby who ate until her stom-
ach burst. As infants, we cry when we are hungry and we stop feeding
when we have had enough. Even the baby who eats a little too much
learns to vomit it up. My son was an expert in projectile vomiting—he
could hit the opposite kitchen wall so well that I considered taping up
bright red targets. Eventually, even he learned to judge when his stomach
couldn’t handle any more; the embarrassment and discomfort of vom-
iting teaches us to stop eating before we get to that point. Those signals
to stop eating when satiated come from our stomachs and our brains via
stretch receptors, nerve signals, and hormones.
The exact process behind satiation is still unclear. However, scientists

have isolated the mosquito feeding regulation gene. Eliminate it and
the bugs suck blood until they literally explode. That would be one
way to solve the mosquito problem. I suppose the insect rights people
might put up a fight about that. If so, we delete the gene in them too,
and then they eat until they explode.
Beyond the age of five and for the rest of our lives, we humans turn to
external cues (our environment) to tell us when and how much to eat.
We learn to ignore our stretch receptors in our stomach that tell us to
stop before we have had a second helping of turkey on Thanksgiving. We
become oblivious to our hormonal levels that tell us our calorie intake
is already sufficient and there is no need for dessert at that fancy anniver-
sary meal. It may even become routine to eat until stuffed, instead of
80 percent full because that is what we were taught as children. Eventu-
ally, those extra daily and routine unnecessary calories add up. We start
to fatten.
People eat for all sorts of reasons, hunger being just one of them. Get-
ting back to eating because you are hungry and stopping when you are
full will go a long way toward your goal of permanent weight loss.
I NEVER MET A CALORIE I DIDN’T LIKE

Stress, emotions, and habits cause people to take in too many calories.
According to Dr. Brian Wansink, the head of Cornell University’s Food
Laboratory, it is very common for people to begin to eat even when they
are not hungry.
Some people tend to eat when they come home from work or school.
Many of us eat at scheduled times for our meals or snacks, whether we are
hungry or not. At work it becomes automatic to head to the break room
for that bagel or donut mid-morning and to return mid-afternoon for the
vending machines. At home, before bed, or in front of the television, you
reach for the chips or crackers. It’s a habit you’ve had for years. You are
probably feeling fatigue or boredom more than hunger, but it’s just the
way you’ve always done things. We all have times when we eat on au-
topilot.
My circadian rhythm is such that by early evening I might still be
awake but not genuinely conscious. After 8.30 p.m., I make an excellent
paperweight. This is one of my traditional food-rummaging times. It is

for a lot of people.
For many of us, it’s those automatic behaviors that drive our weight
problems. It seems so simple to say, “Well, then, I’ll just start eating
when I’m hungry and stop when I’m not.” The difficulty lies in the fact
that we may not even know when we are hungry anymore or remember
how to tell when we truly need to eat. If you aren’t hungry at dinner-
time, then why eat? Many overweight people have forgotten the inter-
nal signals that tell them whether or not they are truly hungry. It sounds
almost ridiculous, but medical research supports this fact. (See Chap-
ter 5 for details.)
BEER, PIZZA, AND CHOCOLATE, THE UNHOLY TRINITY

Slow down when you eat. The body takes its time deciding when it is
full. There is quite a delay between the time the hormonal signals travel
from our stomach and small intestine through the bloodstream to the re-
ceptors in our brain. It can be 15 to 20 minutes from when our stomach
starts yelling, “Help, I can’t take anymore, close the chute!” to when our
brain gets the message to tell the hands to stop shoveling food into the
mouth. If you are shoveling rapidly with lots of high-calorie foods, like
pizza or cake, you can do a lot of excess calorie damage before your
sluggish system reports, “All full, sir, and ready for shut down.”
In the days before beer, pizza, and chocolate, our system had that de-
lay because foods tended to come in lower-calorie packages. Our an-
cestors were often hungry from famine and the food they ate was not
calorie-dense. They were eating things like vegetables and fish. There
wasn’t a strong need to tell the mouth to shut down due to overfeeding.
Evolution hasn’t created the mechanism to clamp the mouth quickly
enough to stop the entire box of chocolate chip cookies from heading
down the hatch. We have to use our brains, habits, and behaviors to limit
overfeeding until evolution works out the chocolate cookie gene (tempo-
rary name of gene: BigButtB52).
Slowing down the meal creates time for the hormonal signals to get
to the brain and for us to consciously feel full. Do what the French are
famous for—practice the art of drawn-out conversation. We modern,
rushed types no longer know how to eat luxuriously. (Doctors are the
worst. We get in the habit of eating quickly during our frantic medical
training and then never slow down. Come visit the doctors’ dining room
at a busy hospital sometime for bizarre entertainment. The food goes
down so fast, the forks look like they are training for NASCAR.)
MY KID ACTS LIKE HE’S USING HIS SKULL AS A PLANTER

My adolescent son is naturally thin because he is a very slow eater. In
addition, he has been taught to eat only on his own schedule, when hun-
gry, and to stop when full. He takes between 30 and 60 minutes to eat a
meal. The average American meal is over in less than 10 minutes. We had
a real problem when he was in elementary school, as the school scheduled
only 15 minutes for lunch. What a horrible habit to teach young, impres-
sionable children! Here, kids, gobble your food quickly. This is the mod-
ern American way, is it not?
Deepak Chopra once said that we need to get quiet and listen to our
bodies. Unfortunately, most people can’t hear their bodies over the
scream of a Krispy Kreme donut.
Eat a plate of salad or fruit or vegetables first or a thin soup. These

foods are less calorie-dense and take longer to eat, so they will slow you
down. You have to chew vegetables a lot more before swallowing; you
have to sip your soup (no slurping, don’t pick up that bowl, young man,
watch your manners). We will discuss using soups, fruits, and salads as a
method to lessen caloric intake in Chapter 5, but suffice it to say that this
simple approach can make a big difference in successful weight loss.
THE MISS-YOUR-MOUTH DIET

One research study at the University of Rhode Island had a group of
women eat as much as they wanted at two different meals.3 The only dif-
ference was that at the first meal the group was instructed to eat very
quickly, using large utensils. The second time, the group was instructed
to use small utensils, to take small bites, to put the utensil down between
each bite, and to chew each bite at least 20 or 30 times. The first time, the
group took only 9 minutes to eat the meal; the second time, the group
took 29 minutes. But what’s really special is that at the second meal, the
group members ate 10 percent fewer calories for the meal and stated that
they felt fuller when they were finished! Think about that! If you are a
fast eater, just by eating slower, you could feel completely satisfied and
lose up to 24 pounds a year! No starvation; in fact, you’ll feel more sati-
ated. No effort; just slow down your eating. Relax; it’s that simple.
I have a T-shirt from a vacation that says, “I’m on island time.” Eat like
you are on island time. Better yet, eat like you are on contractor time;
it’s even slower.
It really is the case that people in Western societies are eating more
calories than they used to. It sneaks up on us in ways we don’t know. Ac-
cording to USDA food data, the average American eats 300 calories
more in an average day than he did several decades ago. Since it takes only
about 3,500 excess calories to add a pound of fat to the hips, belly, or
buttocks, that’s less than two weeks of overeating. It doesn’t take many
months of routine excess calories before the pants get too tight to button.
There are a host of simple tricks that can keep you from overeating.
Most of them cut the number of calories you eat in a painless manner. I
recommend incorporating as many of them into your life as you can.
THE OBESITY EPIDEMIC—LONG LIFT THE FORK!

I mentioned one of the simplest but most effective and painless methods
to lesson caloric intake just a moment ago. That is the method of using
smaller plates, cups, and utensils. This technique seems so simple that only
an idiot would fall for it. Yet, in study after study, people who are very
smart and even those who are professionally trained food preparers man-
aged to be fooled by different-size or -shape food containers.4 Our eyes
do tell our stomachs how much to eat, and anyone who has ever been a
fan of optical illusions knows that we can fool our eyes quite easily. I first
noticed this myself many years ago, when we ran out of big forks around
the house and I had to resort to little salad forks for a while. Suddenly, I
observed, I wasn’t eating as much. Yes, food behavior studies do bear this
out. We all eat less with smaller forks.
If you really want to slow down eating to permit time to lessen the
hunger pangs, eat with a utensil you don’t know how to use, like
chopsticks. Better yet, eat with only one chopstick. If nothing else, I
guarantee it will keep your eating partners entertained.
A word of caution: my husband finally switched to smaller forks
recently. Not only has he lost weight, but he’s gotten much more col-
orful clothing as a result. He spends more time feeding his shirts
than his mouth, which has made him smaller but his shirts bigger.
They like my cooking, apparently.
Smaller plates and tall, thin glasses also do the trick. Over the past 50
years, the plate industry has caught on to our rapidly increasing appe-
tites. It has obliged us by creating larger and larger dinner plates. It is the
case that the salad plate of today is almost as large as the dinner plate
of our grandmother’s china set. What do most people do when presented
with a large plate? Fill it up, of course! Brian Wansink, MD, of Cornell
University, one of the nation’s most famous food researchers, has pub-
lished extensively on this subject. If you switch to seven-inch plates for
dinner (instead of the common nine-inch plates), you may reduce your
caloric intake without even feeling it. Have you ever been to a fancy res-
taurant where they scribble edible designs all around the edges of your
dish? That’s just a form of optical illusion to make the portion size ap-
pear larger (and your bill appears more reasonable). Using tall, thin
glasses when you drink a calorie-laden liquid will reduce how much you
drink. Even bartenders fall for that old optical illusion. Take away those
short fat mugs for your beer or cola. Better yet, drink water or unsweet-
ened green tea.
I’LL HAVE THE CAROTID FRIES

Deliberate eating behaviors are especially useful when confronted with
food challenges, particularly those times when we are tempted to over-
eat. Restaurants are a great place to practice new behaviors related to
what we eat and how much. It is very easy to order calorie-dense foods
but even easier to order too much. Restaurants have moved toward big-
ger portions because society demands it and they need to compete. It is
important to order carefully to prevent the presentation of too many cal-
ories in front of your eyes and mouth. Order two appetizers only, or split
an entree. Note that most people tend to overeat when eating in restau-
rants. Figure out what will work for you ahead of time before ordering,
and stick to it routinely.
It would be easier on us if the restaurants were forced to label their
food items more truthfully. Instead of calling the five-eggs/ham/bacon/
hash-browns/toast/pancakes platter the “Home Run” or something
similar, shouldn’t the breakfast place have to call it “The Coronary”?
My kid always provides entertainment when we eat out. Once we went

to a fondue place. The establishment had a choice of cheese, choco-
late, or beef fondue. My son told the waiter he didn’t want that last
one, since the idea of dipping your food into liquid beef wasn’t very
appealing to him.
And last time we took him out to a fancy restaurant, he mentioned
something he learned in biology class: that a cockroach and a two-pound
lobster are essentially the same thing since they’re in the same family. I
told him that’s not quite correct because, in a restaurant, you expect to
pay a lot for the two-pound lobster, but the cockroach you get for free.
TO TIP A COW, DO YOU USE 15 PERCENT?

Restaurant eating, in general, is fattening. The sight of other people eat-
ing around you and the photos of scrumptious, high-calorie food on the
restaurant menus tends to cause people to order and eat much higher-
calorie meals than they would consume at home.
I talked to a woman recently who had weight-loss surgery and stopped
eating out every night with her family. An interesting consequence is
that her husband and son, who used to accompany her out every night,
also stopped eating in restaurants nightly. They felt guilty about leaving
her home by herself at dinnertime. All three of them have now lost sub-
stantial amounts of weight even though only one of them went through
the weight-loss surgery!
PEOPLE WITHOUT BORDERS

Buffets are a special problem. They are attractive to the overeater, and
you will often see the morbidly obese gravitate to the all-you-can-eat
restaurants. I’m surprised they don’t have seating sections divided into
one-, two-, or three-chair customers. It is better to avoid buffets, as the
temptation to “get your money’s worth” at the expense of your waistline
is very great. If you must eat at a buffet restaurant, always fill your first
plate with large helpings of salad or vegetables, and then proceed to eat
them slowly before going back for more. (Or you can do what I did last
night and eat at a really dreadful buffet restaurant. No one at our table
wanted to go back for seconds, ever. Not the best weight-loss plan, but
perhaps the All-You-Can-Eat-Stinky-Lousy-Food Restaurant has its
place in the weight-loss armamentarium.)
HOW TO ATTRACT A MAN—HIDE IN THE BUSHES

AND MAKE A SOUND LIKE A CHEESESTEAK
We eat more in groups than alone. This is as true in the lunchroom at
work and at the Friday night card party at a neighbor’s house as in a tra-
ditional restaurant. Just being aware that you are in a challenging situa-
tion is more than half the battle. Allow yourself the festive enjoyment of
the social moment without the baggage of excess calories. Concentrate
on your internal signals of hunger and satiety (see Chapter 5 on hunger
for specifics). Ignore the external signals of other peoples’ hunger and eat-
ing patterns and you will accomplish a true defense against social over-
eating.
Americans love to eat and socialize. According to psychologists, we
are the most group-joining society on earth. Perhaps it’s because we are
so transient in our lifestyles. Since we are constantly moving, we feel the
need to build minisocieties in social groups and organizations wherever
we happen to put down temporary roots. A recent phenomenon is the
Red Hat Ladies, a group of older women who dress up in badly matched
clothing and take Jenny Joseph’s poem to “spend my pension on brandy”
wickedly to heart. Feeling left out, my husband thinks that men need their
own group of self-embarrassment and compromised couture. He’s
starting the Men with Shorts and Black Socks Society.
I often refer my patients to support groups; however, that social phe-

nomenon has gotten completely out of hand. Look in the community
section of the local newspaper; there’s a support group for everything.
Last week I saw a meeting announcement for People without Tonsils.
Get out of the habit of obligatory eating when at other people’s

houses or when at support groups, social events, or holiday celebrations.
No matter what your cousin or best friend cooked up, slaving all day in
the kitchen, it’s your health that is the priority. Take tastes of the food
without taking whole portions, and compliment the host or hostess, then
stop when no longer hungry.
Preemptively strike: if you know certain situations present an over-
eating challenge, don’t go there extremely hungry. Before parties, wed-
dings, or festive dinners, eat soup or salad before leaving the house so
that you’ll be less likely to overindulge. Then distract yourself from the
food with the real reason you are there—for conversation, dancing, and
socializing. Keep away from the dessert and food tables, and don’t be
afraid to tell the wait staff “no” to offerings for certain courses or hors
d’oeuvres. Save yourself for the really special stuff, and skip the rest.
One of my favorite memories of a religious holiday food celebration

gone weird involves what happened at a relative’s house a few years
back. I’m at the table for the Passover Seder, sitting next to an older
gent I don’t know, and someone mentions that I’m a doctor. Instantly,
this old man spreads out his napkin, pulls out a pen, and—I kid you
not—starts drawing the shape of his prostate at the dinner table. At
least he didn’t try to sculpt it from a matzo ball! I don’t even remember
the guy’s name, and he’s demonstrating for me exactly where his nod-
ule is that his urologist just biopsied. Luckily, he did that part on the
napkin, too, and didn’t expect me to stick a finger up his thingamajig
Still, that’s too much information, especially before dessert. Needless to
say, I ate less than usual that night.
I REGRET THAT I HAVE ONLY ONE BITE

TO GIVE TO MY CUPCAKE
A major reason that restaurants and social situations cause overeating
is that there is an accessible variety of food. Dr. Wansink claims that the
average American is faced with a food-related thought or image hundreds
of times a day.5 The more exposure to food in thought or image, the more
likely you are to eat. Accessibility of food is a major cause of weight gain.
It’s so easy to find food everywhere we are, so make it less accessible to
yourself. If you tend to go to the vending machines, don’t keep change
and small bills handy. If you snack on junk food at work, avoid the break
room. If you tend to impulsively stop at the convenience store near your
house, take a different route home. If you tend to grab the first thing you
see handy in the pantry and fridge, then make the nonnutritional food less
easy to grab (or get rid of it completely). It is true that if you buy it, it will
get eaten.
Eat only in the kitchen, and otherwise stay out of there as much as
you can. The sights, sounds, and smells of the kitchen will make you feel
hungry even when you are not. Your subconscious will trick you into be-
lieving you are hungry through those environmental triggers, so stay
away until you are truly hungry.
IF YOUR FOOD IS CALLING, STAY OUT OF EARSHOT

A research study by dietitians back in 2002 looked at which personality
profiles are more likely to be obese. What they found is that people who
get hungry at the sight of food are more likely to get fat and stay fat.
That’s because people who are highly suggestible when exposed to food
are more likely to grab calories and overeat more than their body re-
quires. Thus, design your day and your activities so that you don’t see
food. This seems like a “duh” comment, but you would be surprised how
easy it is to get in the habit of unnecessarily exposing yourself to food.
Do you stop on the way to work or back at the convenience store for
a cup of coffee or the newspaper? Do you find that you often impulsively
pick up other edible items while in line, even if you weren’t hungry when
you walked in? Does the sight of a familiar fast-food restaurant make
you pull into the drive-through, even when you don’t feel that hungry?
Do you watch a lot of television with food commercials that make you
get up and raid the refrigerator? Do you work or live in an environment
where there are constant visual triggers for food? Do you tend to food-
shop and buy more than you intended, and eat as soon as you get home
(or in the car on the way home)?
Fast-food restaurants use enchanting ads, huge mouth-watering post-

ers, and catchy slogans to get you in their doors. Then they feed you
high-calorie, nonnutritious, preservative-laden nastiness. But if God
had a restaurant, his slogan would be “We didn’t invent the chicken
sandwich, just the chicken.”
A BREAKFAST PLACE, THE HOUSE OF SEVEN BAGELS

Spend a few days this week just noting how often you are exposed to the
sights of food and whether any of it makes you hungry. Think about
when you eat as it relates to your exposure to the sights (and possibly
smells) of food. Then start to think about what you can do to modify
your environment or your daily activities to reduce the barrage of visual
(and other sensory) triggers to which you are exposed. Can you get some-
one else to food-shop for you? Perhaps you can trade off the laundry or
other chores if food shopping is a trigger. Can you drive a different route
to work or school to avoid the bagel shop or the fast-food restaurants that
have become a habit? Can you put away the candy dish at work and the
box of donuts that sits on the counter in the kitchen? Can you brew your
coffee at home before work to avoid the convenience store line? Can
you record your favorite television shows and zip through the mouth-
watering food commercials?
It dawned on me that women like to food-shop because it’s just a mod-

ern version of the cave woman art of hunting-gathering. I imagine
that, back then, the women came out of their caves in the morning and
went scrounging around in the dirt looking for turnips on sale at Wal-
Grub. Personally, I can’t stand supermarkets and make my husband do
all the food shopping. Modern food stores are so big, with endless se-
lections, that I get overwhelmed. For instance, there’s so much variety
in women’s sanitary products that it can get awfully confusing. Usu-
ally my husband’s pretty good at getting the right stuff, but, last time,
he accidentally got me panty liners with breaded wings.
NO NERVE CELLS WERE HARMED IN

THE MAKING OF THIS THOUGHT
On the other hand, don’t get in the habit of keeping the cupboard bare.
Place nutritious foods in the house so that you don’t come home to an
empty fridge or pantry. This eliminates the tendency to starve and then
binge-eat or run out to the fast-food emporium. Plan ahead what you’ll
eat for meals. Simply planning and keeping nutritious, low-calorie foods
available to grab, heat, and eat will eliminate excess calories by the hun-
dreds. A little bit of thought goes a long way. Do this regularly, week af-
ter week, and you will see a remarkable lowering of both your weight
and your stress level.
You’ve probably heard the advice not to food-shop when you are
hungry. This is good advice. People who shop when hungry buy higher-
calorie foods than those who are not hungry. Always stick to the shop-
ping list. Interestingly, people who are overweight are less likely to use a
shopping list at all. Lincoln University did a study back in the 1980s that
showed that if you teach an overweight person to plan meals and food-
shop on the basis of shopping lists, the obese person can lose up to
10 pounds in three months.6 Some of the participants in the study re-
duced the number of impulse purchases (which are usually high-calorie
and low-nutrition) and excess calories by almost half.
THE CEREAL KILLER DIET

One way to deal with less-nutritious and higher-calorie fare is to make it
a challenge to eat. The more hassle it is to eat, the less we eat. Indeed, put
a lid on a container and it will decrease how much and how often we eat.
This has been demonstrated in medical study after study. Food stores
know this. Close the see-through top on a freezer case in the mini-mart and
sales of ice cream plummet. Just the act of having to open the case (even
when the treat is staring right at us) decreases how many people reach for
ice cream! Make your home “food environment” less friendly and con-
venient. Better yet, eat less accessible food. If all you ate were crabs in
the shell and fish you had to catch yourself, you would get skinny fast.
At least make your high-calorie-density foods more effort to obtain.
Convenience food and frozen ready-to-eat meals are a danger to the
waistline.
Overweight people tend to keep a greater variety of junk foods around
their houses than normal-weight people. We know that variety encour-
ages overeating. Decrease the assortment of junk food around the house
and you will decrease the temptation to eat the stuff too often. Keep one
type of sweet and one type of cracker or chips around, and get rid of the
rest. Eliminate the multiple assortments of sugary, processed breakfast
cereals in the pantry. At the same time, increase the diversity of fruits,
vegetables, and good-for-you foods. Avoid routinely going to places
that might offer you a tempting variety of the nasty stuff.
The food industry has done a great job of creating all sorts of innova-
tive ideas and combinations. One night, I was eating this new type of
“all natural” sausage for dinner. But it was kind of a strange food item,
chicken sausage in pork casings. I imagine the chicken parts were in
there talking to each other: “You know Bill, this just doesn’t feel right.”
WHATEVER YOU DO, DON’T LOOK IN THE GRAVY

Portion size is going up. Not just in restaurants, but at home. Foods
packaged for home use may appear to be for one or two people but of-
ten contain many more portions. Nowhere is this more evident than in
the soft drink industry, where the traditional eight-ounce portion has be-
come almost nonexistent. This is true, however, throughout the spec-
trum of the food industry. The creation of the “family pack” may have
seemed a good idea to the busy family, but it has resulted in grave risk.
Nutrition research repeatedly shows that if you give people a large con-
tainer of food and ask them to help themselves to a portion size, that por-
tion will be much larger than if they had started with a smaller original
container.7
Those crazy but fun researchers at Cornell University did a study of
unsuspecting moviegoers in which the patrons were offered free popcorn
in medium or large buckets.8 Yes, those who had the larger buckets ate
more during the film, 45 percent more. But the real catch was that some
of the participants got 14-day-old stale popcorn that tasted horrible. The
moviegoers still ate a third more if they were given the larger bucket, even
though the food was downright unpalatable! In other words, don’t serve
yourself out of huge family-sized cereal boxes, and don’t eat out of the
one-pound packages of chips. You will eat a lot more than you need.
Don’t serve food family style, passing the giant bowl of mashed potatoes.
People around the table will take a much bigger glop than they other-
wise would have taken.
This is a big problem on cruises. Not only can you eat anytime, as
much as you want, but the buffet lines have enormous platters of delec-
table delights. By the end of our last cruise, my husband had eaten so
much that he claimed he would be thinking outside the pants. The truth
is, most men would benefit from thinking outside their pants.
Just as you don’t want to serve yourself from huge bowls of food,
don’t eat directly out of the package of chips, cookies, or pretzels, ever.
Always take the portion you want and place it on a small plate first;
never dip back into the package. An easy alternative is to divide up snack
food into small portions as soon as it is bought. Or buy the individually
wrapped limited portions of junk food. Even ice cream now comes in
very small individual packages, for a reasonably sized snack.
That concept reminds me of an idea I had recently for new ways to

make energy. My local county is building a small methane plant that
captures the gases given off by the local landfill and converts them
into usable electricity to power thousands of homes. I’m thinking we
broaden that idea to attach hoses to people to power their cars. Sud-
denly lactose intolerance becomes wildly popular. People drive up to
the gas station, but not for petroleum; they want ice cream: “Give me
three scoops. I’m going on a long trip.”
Get in the habit of serving yourself smaller portion sizes than you are
currently doing, at every meal and snack. Automatically cut out at least
a fifth to a third of your usual portion. The bigger the serving, the auto-
matically larger amount that people eat, ignoring their own internal sig-
nals that they are no longer hungry. If you are overweight, there is no
getting around the fact that you are eating too many calories for your
body and ignoring your internal signals.
FAVORITE CHINESE RESTAURANT, THE KA-CHING

SUPER BUFFET
Leave empties on the table as a reminder of what you drank and the re-
mainders of what you ate. In a restaurant, don’t let the waitress clean
your table of dishes or beer bottles until you’ve completed the meal. This
will encourage you to eat and drink less, as it reminds you of what you’ve
already had. Studies have shown people will eat and drink less if they
have the debris of the meal still in front of them.
Interestingly, people tend to eat more of food that they think should
taste good, even if it isn’t any better than usual. So, if the restaurant is
fancy or the food has an elaborate label attached to it (e.g., “mélange of
passion fruit, kiwi, and star fruit” rather than “fruit salad”), people will
eat more of it. Be aware of this tendency, and be more attuned than ever
to your own internal signals of fullness.
MISERY LOVES COMPANY, BUT SO DOES LAUGHTER

Social eating may make you automatically eat more when others are
around, but heavy people who are self-conscious will sometimes eat
less around others. If you are one of those, then make plans to eat more
meals with others. Pick eating partners who will help you eat less by
their own behavior if you have a choice in this. Obese people tend to pick
other corpulent people to eat with, which encourages overeating. That’s
why fat couples get fatter together and have fat kids. Being overweight
is contagious because of the behaviors that we encourage in those
around us.
We surround ourselves with people who reinforce our social tenden-
cies, including overfeeding and lack of exercise. Therefore, if you want
to lose weight, you need to start choosing to spend more time with peo-
ple with healthier attitudes and waistlines. But be careful—not all thin
types are healthy. I don’t know anyone who really enjoys being sur-
rounded by skinny, crack-addicted smokers, unless you are an addiction
counselor being paid by the hour. Hang out in places that encourage
healthier behaviors. Meet a friend by the lake or in the park for a walk af-
ter work, rather than at the usual happy-hour bar or restaurant.
GOT BRAINS?
There are many diet and weight-loss books on the market. There are
many fads and many programs. People who lose weight but then gain it
back later are more likely to have been in a structured diet program or
on a fad diet or a fasting diet. They are also more likely to restrict whole
categories of foods and to eat more fat and sugar in their diets. They are
unlikely to exercise regularly. Finally, people who gain the weight back
are less likely to eat fruits and vegetables but more likely to have used diet
pills or hypnosis to initially lose the weight. Don’t do what they do.
I went to a business program recently where I met a local hypnotist

planning to open her own weight-loss practice. She told me that her
experience consisted of a one-week seminar and trying out her tech-
niques on a few family members. She had no health care background.
So if you hire a hypnotist, beware when she says, “Look at this swing-
ing watch—you are getting very poor.”
It bothers me when I see the number of ridiculous fad diets that have
come and gone and the number of desperate people who have been vic-
tims of these ideas. Fad diets are never based in good scientific or medi-
cal knowledge. I’m surprised some shyster hasn’t published the Eye Color
Diet (“If one eye is a different color than the other, eat the blue-eye diet
until noon and the brown-eye diet until bedtime.”). I’d like to try out the
Phrenology Diet on some of those fad-diet authors. That way I can
whack each one of them on the head and tell them it’s for their own good:
“Look, a new lump. Now you can eat broccoli on Wednesdays!”
The recommended behaviors described here are the best-known
methods that work permanently. They ask a lot of the reader. A person
who wants to lose weight forever must change the behaviors that led to
the weight gain in the first place. There is no instant solution that will
last. Use the suggestions here to enact healthy behaviors that work, per-
manently, for your lifetime.
WE’RE THE BEST EVOLUTION COULD DO

Finally, I must apologize to Aunt Tillie. She was the one we wanted to
blame for the genes and the habits that got us here in the first place.
When it comes to being overweight, our genetic predispositions do mat-
ter, a little bit. Heredity is involved in taste preferences for food and for
psychological coping responses, although often these are learned, as well.
Genes also account for how well or how poorly we process our foods
(for example, diabetics don’t process sugars as well as others). It is said
that genetics account for about 30 percent of our risk for obesity. The
other 70 percent is the environment and our own behavior toward it. We
can’t change our heredity. We can change our environment and how we
react to it. It’s time to stop blaming Aunt Tillie and those who gave us our
genes or taught us the behaviors we first learned in childhood. It’s time
to grow up and take responsibility for our own destiny. Grab hold of
new behaviors, and hang onto them for your new thin, healthy life!

• Overweight people eat too many calories daily, even when not hungry.
• Obesity is caused by behavior, although genes play a role.
• Everyone has the capacity to analyze his or her own behaviors and
change them.
• Habits formed from childhood admonitions like “clean your plate”
should be re-examined.
• Instead of eating until stuffed, eat until 80 percent full.
• Don’t eat automatically, out of obligation, or because you are fatigued.
• Slow down your eating, and use smaller forks, plates, and glasses.
• Restaurant eating is fattening; be prepared with a plan.
• Surround yourself with people who encourage good eating and exer-
cise habits.
• Avoid food exposures that encourage overeating.
• Stock the pantry and fridge with healthy foods, and cut out the vari-
ety of junk.
• Use a list when food shopping to cut down on high-calorie impulse
purchases.
• Make junk food hard to get.
• Avoid family-size containers and overgenerous portions.
• Be aware of your food behaviors, and you will be successful.
FOUR
Laugh Your Butt Off: Activity
Behavior That Works
I’m really glad that the tourist industry is designing more ways to stay
physically active while on vacation. But not all the ideas are so well
thought out. I was on a cruise ship with an ice rink. Let’s take an in-
stance where people normally fall down and hurt themselves and then
take away normal ground stability. I’m surprised there wasn’t a sign
that said, “This activity sponsored by Earth, Wind & Lawyer.”
As mentioned previously, overeating is only half the story of obesity.

The other (often ignored) half is just as important. That’s the activity
side of the equation. Overweight people do not get enough activity for
the amount of calories that they take in. There’s no way around that fact
and essentially no exceptions. If you are always very active, you won’t
be overweight.
THE VOCABULARY GAME SHOW, BROUGHT

TO YOU IN HI-DEFINITION
The television set is a contributor to our obesity epidemic. We love our
reality shows, soaps, and game shows. TV is fattening for multiple rea-
sons: we snack more in front of the television and are more sedentary,
and the commercials remind us about food (suggestibility). There is a

strong relationship between the number of hours of television watched
and childhood obesity. Johns Hopkins doctors demonstrated in the
1990s that the more hours of TV watched, the fatter the kid.
Strangely, video gaming hasn’t been found to have the same relation-
ship. Perhaps it’s the fact that the games don’t suggest that you eat
food, and your hands are busy doing things other than feeding your
mouth. My son is working on the design of an action video game,
but I told him it couldn’t have any sex or violence in it—Grand Theft
Stroller.
BOREDOM COMES TO THOSE WHO WAIT

Watching television usually is done in your own home. But even home-
bodies who don’t own televisions are more likely to be fat. Stay-at-home
work (whether or not you are a parent) is very fattening. Those who work
in their house are more likely to be obese. This is because they have un-
limited access to food, and the job requirement often includes shopping,
cooking, and cleaning up (an increased regular exposure to food). Also,
stay-at-home workers report that their jobs are more boring and that
they don’t get as much positive feedback as those out in the regular work
world. People who work at home have less varied social interaction and
less pressure to dress up for the job. This leads to lower self-esteem. The
psychology research backs this up.
The whole concept of self-image and self-esteem is a bit of a minefield.

But there is pretty good evidence, as we’ve discussed earlier in this
book, that people with low self-esteem are more likely to be overweight.
A local Hispanic nonprofit holds an annual Miss Latina contest, com-
plete with a scholarship for the winner. According to the organizer, the
contest is supposed to “provide self-esteem for young ladies,” appar-
ently as long as those ladies’ self-esteem looks good in a bikini. What
you never see is a Miss Jewish American contest with gorgeous Jewish
women in bikinis. I’ve always wondered why that is. I guess our self-
esteem looks better in a deli.
Laugh Your Butt Off 69
It isn’t just workers from home who get into self-esteem problems.
Gee, even doctors can suffer from ego issues, as well. The American Col-
lege of Physician Executives sent a letter asking me to join. It came
from their president, a woman whose name was followed with, “M.D.
M.M.M. F.A.C.R. C.P.E. F.A.C.P.E.” I threw it away. Personally, I’m se-
riously suspicious of anyone who feels the need to put 17 letters after
her name. Perhaps she is having a bit of a self-esteem issue. Or maybe
she’s discovered that people will treat her with more respect with all
those extra letters. So I’m going to try it. You may now call me Melanie
Rotenberg, MD XYZ PDQ *€ §»¥. I’m thinking of changing my name
to an unpronounceable symbol (looks like sunset over a beach with
the Greek letter theta with two slashes through it). This loosely means
“I’d rather be walking the beach than parallel parking.” You must now
refer to me only as “the physician formerly known as Dr. R.” I’ve come
up with new categories of trailing letters that you might want to give
your own physicians: MD JRK, MD STU PID, and MD PUTZ. I believe
many of our physicians in the medical community deserve more let-
ters, so please be generous.
But let’s get back to the subject at hand, self-esteem and work. I’m not
suggesting that you have to get a job outside the home to lose weight, but
you need to be aware of a tendency to suppress your self-esteem if you
spend lots of time at home. This is true for men and women. In addition,
people who work at home just don’t need to move as much to do their
daily responsibilities, so they are more sedentary. I’ve been at home with
my kid, and it certainly didn’t seem like I was getting less exercise than
when I worked outside the home, but, overall, it was. Getting out, socializ-
ing, and interacting with others does increase confidence and self-esteem.
It also increases physical activity. Finally, interacting with others, espe-
cially with those less fortunate and people from all walks of life, takes the
focus off one’s own problems and helps to increase one’s feeling of grate-
fulness. If you work at home, you need to concentrate on finding time to
exercise outside the house and also to interact with people separate from
your own small social circle. Increase your volunteer or social connec-
tions, or join clubs and exercise groups, or develop hobbies that will
bring you into conversation with more than the usual suspects.
THE GERBIL IN YOUR SHORTS DIET

Believe it or not, putting a small rodent in your pants is effective as a
weight-loss technique. If you aren’t really hungry but find yourself head-
ing toward the pantry out of habit or emotion, use distraction or substi-
tute behaviors. Build an armamentarium of things to do when you feel
the urge to grab food out of habit or emotional reasons. For example, put
on music, dance, go for a walk, grab a fun book, talk to the kid or spouse,
call a friend, give yourself a list of happy and fulfilling behaviors to do
that are easy. This is one of the most common methods employed by
those who have permanently conquered obesity. The Karolinska Insti-
tute in Stockholm, Sweden, and the researchers at the National Weight
Control Registry both found that cognitive approaches to permanent
weight loss do work.1 If putting a gerbil in your shorts will make you for-
get you are hungry (and the gerbil doesn’t mind), consider the action. I’ve
always told my headache patients that I’d be glad to stomp on their feet
to help them forget their headaches. It works every time.
Okay, perhaps stomping on the feet isn’t pleasurable or fulfilling, at
least to the recipient of the stomp. This brings me to the next effective be-
havioral method for successful, permanent weight loss: associate plea-
sure with good health habits. Every time you do something positive for
your body and mind, link it in behavior with something pleasurable.
When you come home from work and climb on the treadmill or take a
walk around the block instead of heading for the bag of chips or dialing
for pizza, then make certain that you associate this behavior with posi-
tive feelings. Listen to your favorite music while exercising, follow (or
substitute for) your exercise with great sex, or call your best friend to
share a joke every time you work out. You will quickly link pleasure with
your increased activity.
My friend went to have a gynecological procedure done. The physi-

cian told her not to engage in any extracurricular activities until her
follow-up appointment. So she did have sex but skipped her bowling
night.
CHESS IS A FUN SPORT WHEN PLAYED

WITH LOADED GUNS
How can you make activity something enjoyable? I’ve always scratched
my head when chess and other sedentary activities are broadcast on the
sports channels. But what if you took one of those staid activities and
livened it up a bit? This is one of the keys to permanent successful life-
style change. The reason that regular exercise behaviors extinguish (go
away) is that most people don’t associate exercise with something fun or
positive. Okay, loaded guns might be fun, but they’re not very positive.
My son and I used to play a game we called “toaster chess” where the
pieces, once captured, were flung far and away about the room. This
brought a whole new level of physical exertion to a generally sedentary
game. If activity is just another chore or responsibility, it will be ignored.
If you list physical activity on your “to do” list, it will be an item to be
avoided. Rather than make it a “to do” item, make it a “want to do” item
by always designing the physical activity to be fun and pleasurable. In
the same way, you should associate all positive health behaviors with
pleasure, joy, and laughter.
They held the national rock-paper-scissors championship. The winner

got $5,000. I hope he also got a life.
The more you link positive health behaviors with pleasurable things,
the more you will succeed in changing your life and slimming down.
When you decide to eat the lower-calorie menu item, when you leave
food on your plate because you feel “80 percent full” instead of com-
pletely stuffed, when you park on the opposite side of the parking lot at
Wal-Mart instead of in the closest space, make certain that you imme-
diately link that behavior to something that is emotionally pleasurable
to you. For me, that might be something as simple as imagining myself in
a pair of new skinny jeans that turns heads or playing my favorite mu-
sic in my car when I get back from the store. Make certain you select
thoughts and behaviors that are truly pleasurable for you. Avoid any-
thing that might inadvertently make you anxious. Go for real rewards
in thoughts and behaviors, and you will succeed in turning good health
habits into lifetime habits.
Don’t just tell yourself, “I’m not going to do that bad habit anymore.”
Create an acceptable and pleasurable substitute. It must become “I
will do this instead of that.” If you remove behaviors and foods that are
pleasurable to you (for example, “I won’t eat chocolate donuts for break-
fast anymore”), your new behavior (no chocolate donuts) will not win
out in the long run. In that example, all you did was take away some-
thing that gives you pleasure without substituting another pleasurable
behavior. It doesn’t have to be the same type of behavior; you don’t have
to substitute one food for another. It is very difficult to find a food that
gives as much immediate short-term pleasure to a carbohydrate addict
as a chocolate donut. So, instead of trying to find a healthier alternative
food that gives the same pleasure rush as the donut, find another accept-
able behavior that can get those brain chemicals dinging on the pleasure
centers.
ALL WORK AND NO PLAY MAKES ME BEHAVE THIS WAY

Let’s say that you usually grab a chocolate donut and a flavored latte at
the coffee house next to your office on the way to work during the week,
since this gives you the jolt of sugar and caffeine you need to face the
work day. What could be an equally pleasurable substitute to get you in
a good mood for work but cause less damage to your long-term slimmer
goals? How about listening to comedy routines in your car on the way in
to work, but only on the days that you eat a piece of fruit and a handful
of nuts with your home-made coffee on the way in? It has to be a good
switch to something that leaves you feeling truly uplifted and happy, not
just less guilty, or the new behavior will not last.
Immediately link pleasure with good habits. Don’t promise yourself
something down the road for good behavior now. And don’t focus on
the negatives, the punishments for “bad behaviors.” Life is too short to
constantly berate yourself for your slip-ups. Be gentle with yourself, and
focus on the positives. You will be much more successful.
Perfectionism is a dangerous game. Let go of any notion that you can’t

make mistakes. Imperfection is what makes us human. No matter how
much progress we personally make or society makes, we will still get
things wrong. In science, we make assumptions that turn out to be way
off base. I find it humorous how much archaeologists try to conclude
about ancient civilizations from little bits of cloth or shards of broken
pottery. I worry that 20,000 years from now, archaeologists will find
that the only remnants of our present-day society are plastic pink lawn
flamingos. They will then conclude that we were a primitive people that
worshipped a bird god.
It’s not like physicians are much better. I don’t know why people are
always suing doctors. Hey, we admit we’re not very good. That’s why
we call what we do “practice.” Doesn’t that imply something, like that

we haven’t gotten it right yet? One hundred years ago, doctors routinely
prescribed cocaine. It was supposed to be good for you. Not that long
ago, back in the early 1990s, a physician at the Harvard Medical School
published a “landmark” study that referred to exercise as unconventional
or alternative medicine.2 Ah, yes. It is an alternative—an alternative to
disability, ill health, and lots of visits to the pharmacy.
Activity is a mood-enhancer in and of itself. If you tend to eat when
you are stressed or at certain times of the day, work in fun exercise as
your habit to be done during those stressful times. If you find that you
automatically eat after work, meet a good friend at the basketball court
or yoga class on a regular basis at that time of day. An added bonus is that
exercise is appetite-suppressing, so when you do eat dinner, you will
eat less.
Don’t avoid socializing; instead, do the opposite, since that also is a
mood enhancer. But change how you socialize, by making it more ac-
tive. Do fun, physical activities instead of going out to dinner or to the
mall shopping. Play volleyball or tennis or go hit golf balls on the range.
Invite a friend to go horseback or bike riding. Take a walk in the park
with your lover or even your spouse. Just don’t arrange to meet both in
the park at the same time. You’ll be sprinting instead of walking.
My friend wanted to get more active, so she bought a large sailboat,

only she doesn’t know how to sail. Luckily, our river is really shallow.
By the third time out, marine rescue knew her on a first-name basis. I
suggested she innovate for the local tourist trade and offer submarine
sailboat tours. Call it “20,000 Millimeters under the Sea.”
PUSH UP OR SHUT UP
Here’s the next big take-home point: exercise is the single biggest factor
in losing weight and keeping it off forever. Those who do it regularly re-
main slim, with no more yo-yo dieting. This is according to data obtained
through the National Weight Control Registry. Even the Mayo Clinic
lists 30 to 60 minutes of daily exercise as its number one recommenda-
tion for permanent weight loss. Your mission is to find activities that
you love and to do them regularly, and never stop. Later on in this book
we discuss specific exercises that are most effective for permanent weight
loss. The key, though, is to do something enjoyable just about every day,
forever.
Increase your activity at the office, not just during your free time.
Work more motion into your work day. Chuck, a tall, skinny physical
therapist who sees some of my patients, mentioned that he once meticu-
lously counted the number of paces he took in a typical work day at the
hospital. When he added them all up, he figured out that he walks an av-
erage of three to five miles a day during his work hours! I walk close to
that number during my work day but also put in an additional three to
four miles daily during my morning walk with my husband. No, I don’t
feel tired; I feel invigorated. In fact, I become antsy and frustrated if I
don’t get my usual physical activity at work or home. Chuck mentioned
that he could retire soon but is hesitant to do so because he fears he
would get out of shape and become disabled without all that work activ-
ity to keep him moving.
MY WORKPLACE IS AN EQUAL OPPORTUNITY ANNOYER

Another friend of mine, Joan, a physician, mentioned to me that she re-
cently worked in a clinic for several weeks. Her entire day consisted of
walking no more than 10 feet between her desk and a couple of examina-
tion rooms. Joan was used to walking the gargantuan hallways of our
hospital, normally putting on the kind of mileage that Chuck and I walk.
Suddenly, her enforced “desk job” caused her to feel sluggish. And in a
matter of weeks she gained more than a bit of weight without changing
anything else in her life. Needless to say, Joan was thrilled to be back to
the busy halls of our hospital after her stint in the clinic. She quickly lost
the “desk job” weight.
How much can work and programmed daily activity help you to lose
weight or maintain a thin shape? Chuck has one more story that reflects
how an active job can allow weight loss. Back when he was in his 20s,
he quit his regular day job to work on a ski patrol at one of the famous
Rocky Mountain ski resorts. Chuck noticed that he was eating all the
time, much more than when he was back East. Finally, being the scienti-
fic mind that he is, Chuck bothered to count the number of calories he
consumed on a typical day while on patrol. Turned out he was eating an
average of 10,000 calories a day just to maintain his slim physique and to
prevent becoming emaciated! That’s roughly five times what the average
person eats. If Chuck had eaten only 9,000 calories a day, he would have
been losing about eight pounds a month.
Now I’m not saying that you need to quit your desk job and become a
ski bum. However, there is something to be said for gradually working
more and more regular activity into your life, night and day. We’ll discuss
the ways you can do that in more specifics in Part III, the metabolism
and exercise section of this book.
I STILL HAVE THREE HOURS AND FIFTY NINE MINUTES
Erectile dysfunction drugs say in their commercials, “Ask your doctor

if you are healthy enough for sexual activity.” I know what most phy-
sicians are thinking when they are asked that question: “How would I
know? I work 100-hour weeks. I don’t get any, either.”
How do you know if you are healthy enough for sex? The truth is, it
depends on who you are with and what you are planning to do. It is a
known medical fact that a patient is much less likely to have a cardiac
complication during sex if he is with his wife than if he’s having illicit
sex. (Presumably the excitement of being with another woman is more
taxing on the heart.) I guess in worst-case scenarios, I can just say to
my patient, “I’m not certain. Grab your wife and let’s see. . . .”
IF TIME IS INFINITE, WHY IS THERE NEVER ENOUGH OF IT?

If you have it, put exercise equipment where it will be used. As you do
with good-for-you foods, you need to make activity more accessible and
user friendly. Equipment should not be in the dank basement or in a
claustrophobic spare room or used as a clothes hanger. The treadmill or
elliptical needs to be parked front and center in your bedroom, living
room, or family room in front of the television or set up with a place to
put your music, books, and magazines. Make the equipment part of your
daily living situation, appealing and easy to use. Make it as easy as the
remote control and the television and as comfortable as the couch. Then,
make the time to use it. If your health is important to you, you will find
the time.
One leading professional golfer claimed that his stretching and exer-
cise program was so successful that he got taller. He claims he got so
much taller he needed a new putter that was an inch and a half longer.
I’m wondering what exercise machine he was using—the rack? In that
case, he’s better off leaving his exercise equipment in the dank base-
ment. I’m afraid we’ll be seeing ads someday that say, “Top Pro Golfer
endorses the Medieval Beach Diet.”
Interestingly, it doesn’t take more time to exercise if you attach it to

something else that you are already doing regularly. I’ve seen treadmills
placed in front of computer work stations. We’ll discuss the NEAT stud-
ies in Chapter 11, the exercise chapter. Those were done by researchers
at the Mayo Clinic who studied fidgeting and its relationship to weight-
loss. Suffice it to say that humans were meant for constant activity, not
sitting at a desk or a couch. Obviously you can’t run and type at the same
time, but if you are not using your treadmill now and you are on your
computer for more than 15 minutes a day, start thinking about the easy
calories you can burn while cruising the Internet or answering e-mail.
While you’re ambulating at an easy pace, mindless movement adds up
to a svelte figure.
If you don’t have the equipment, join a gym or a walking group. Many
overweight people admit that they avoid socializing and external activi-
ties because of their body size. Does obesity keep you from doing the
things that you like to do? Do you find yourself refusing to join others be-
cause you fear how you look or how short of breath you would become
during an activity? How can you get back to doing those things now?
How can you plan to do more of what you want to do in the future? Move
your life from the “should do” back to the “want to do.” Start slowly, but
challenge yourself to find new ways to be active.
I’m thinking about taking up skydiving. I saw on television that there’s

a safer contraption that gives the sensation of jumping out of a plane
without all that height. It’s a giant fan underneath, and it blows up-
wards; it’s supposed to be great exercise. All one has to do is step off of
a platform and float. But what happens if I fly too close to the fan? I’m
worried that the next thing I know, I’m Chinese-made dog food.
THE GRASS IS ALWAYS GREENER, UNTIL I TAKE CARE OF IT

Once you begin the weight-loss journey, never let yourself gain back more
than 5 or 10 pounds or let your clothes get more than a little tight. Con-
stantly self-monitor so that you nip weight gains in the bud. Put that fa-
vorite pair of jeans on frequently enough to monitor yourself, or get on
the scale weekly, if that’s your technique for self-monitoring. Whatever
it is, have a routine for catching weight gain early, and stick to it, always.
However, if you do start to put on more than a few pounds, don’t look
at it as a failure of your system; see it as an opportunity to try new
foods, exercise equipment, or activities. Try new recipes; go for a bike
ride instead of your daily walk. Sell the riding mower and get one of
those environmentally friendly push mowers. Turn every challenge into
an opportunity. Always, always keep positive. Keep laughing, keep
smiling.
I went on a river-rafting trip. When I signed up for it, they told me

that they went out, rain or shine. But if there’s lightning, they give you
your money back—or they give you an urn.
I FEEL SO FAT, EVEN MY CONTACTS DON’T FIT

I strongly believe in using clothing for self-monitoring. Buy new clothes
when you get down a size and give away the large ones right away.
Don’t keep them around or you are giving yourself permission to gain
the weight back. If you start putting on weight, it’s a lot harder to get
dressed in the morning if you really don’t have a larger-size pair of pants
to put on. Thus, you have a built-in system to catch problems quickly. If
you keep elastic-waist pants and stretchy or bigger-sized clothes around,
you give yourself the opportunity to grow wide without having to take
action.
Yes, everyone needs objective feedback with weight control, so if
you don’t like the clothing idea, at least weigh yourself weekly. Any more
often and changes in water weight might drag you down emotionally.
Much less often (such as monthly), and you can gain a lot of weight with-
out realizing it.
Scales can be misleading and really aren’t a great measure of suc-
cessful, healthy weight loss, particularly when you are starting out. The
reason is that healthy weight loss is really “adipose loss” (fat cells). When
you eliminate calories, eat well, hydrate yourself properly, and increase
activity, you might very well gain weight, but it’s good weight. It’s the
lean muscle weight that will serve you well in the long run. If you follow
my advice, you are likely to get thinner but heavier at first before you lose
actual weight! We’ll discuss why this is the case in Part III, on metabo-
lism and exercise. For now, understand that if you are following good
health behaviors, the scale may just upset you. That’s why I recommend
using clothing as your feedback mechanism. Pick your pants as care-
fully as you do your friends. Then enjoy them as they grow loose on you
(your pants, not your friends). Let them be your guide if the scale is too
anxiety-producing.
When you listen to your pants, avoid scrubs or elastic drawstring
pants, as they do lie. Avoid baggy clothes that allow you to hide your fig-
ure to yourself and to others. Those are the clothes that will let you ex-
pand your size without notice. Insist on wearing a fitted waistband on
most days. Dress nicely to impress yourself, your lover, and your friends.
Baggy clothing is often a sign of someone who is hiding from the world.
Stop hiding, and dive right in.
The men’s sensitivity final exam: You are presented with the inevita-
ble question from your significant other. She asks you, “Does this make
me look fat?” Please choose the correct answer: (a) No, darling, you
look wonderful; (b) No, but it does make my eyes thicken; (c) Excuse
me while I go TASER myself; (d) What do you say we go get ice cream?
BEHIND EVERY GREAT MAN IS A GREAT WOMAN’S BEHIND

During your weight-loss journey, reward yourself regularly for keeping
a healthy lifestyle but not necessarily for losing 10 pounds. I know peo-
ple who’ve gone out for hot fudge sundaes when they get to a certain
goal weight. Do you hear that obnoxious buzzer sound? Yikes, wrong
approach. Reward yourself for not slipping back into old, unhealthy
habits. Make it nonfood rewards, like a night out at the movies, a soak-
ing bubble bath, a couples massage, a new special piece of clothing or
perfume or a new piece of sports equipment. You should plan to do
something that makes you feel special, sexy, and powerful. Disconnect
that old habit of starvation and deprivation followed by overindul-
gence.
Do not be afraid of your inherent sexiness. Use it as a positive motiva-

tor of behavior. As you trim down, don’t hesitate to grab your butt,
thighs, belly, and other slimmer, toned, and trim areas and note even the
subtle improvements in a very positive way. (Avoid doing that in public,
and don’t offer your parts to your significant other for inspection with-
out checking for privacy!) Remember that you will trim parts before you
trim numbers on the scale, so use those firmer parts as a reinforcement
technique to keep on track with your new behaviors. Remember that
funny movie Freaky Friday, with Jamie Leigh Curtis? When she suddenly
finds her mind in the body of her teen-age daughter (played by Lindsay
Lohan), she grabs her new rear and declares, “That’s definitely not
mine!” Turn that comment around and make it your positive mantra:
“This is definitely mine!”
Not every attempt at turning up the heat will be a success. I decided to

try wearing thong underwear because, you know, it’s supposed to be
sexy. I spent my whole life trying not to give myself a wedgie when I
pull up my undies. Suddenly I have butt floss. Would someone please
tell me what’s sexy about that?
A positive attitude will keep a positive lifestyle on track. Ask your-

self what makes life meaningful and enjoyable and fulfilling for you now.
Spend more time with family and friends who are good to you and sup-
portive and do things that make you smile. Go places that you love to go
or want to visit. Plan activities that you love to do or always dreamed of
doing. Don’t put them off; can you make them a “now” rather than a
“someday” part of your life? The more positives you instill in your life
now, the more successful you will be with those seemingly tougher goals,
including permanent weight loss. Success and joy breed success, joy, and
health.
Constantly challenge yourself to find new ways toward happiness and
fun. Avoid depression and sluggishness with music, dance, and walking
in nature. Use prayer and meditation. Allow worthy causes to fill you
up. Build emotional strength, and work those habits into everyday life.
WHAT DO THEY READ IN THE BATHROOM

AT THE LIBRARY OF CONGRESS?
There’s another behavior that should be part of your weight loss life-
style. It’s keeping a food and activity log. It’s a good idea to do a food/
drink and activity/exercise log for at least one to two weeks. Some peo-
ple stick to their logs permanently. Many formerly obese people use this
technique, either forever or when their weight creeps back up. A recent
study by Victor Stevens, Ph.D., at the Kaiser Permanente Center for
Health Research, showed that people in a weight-loss study who wrote in
their logs daily lost twice as much weight as those who kept their logs
one day of the week or less.3 Be honest, and mark all exercise and every-
thing that you eat and drink. No one else has to see it unless you want
them to. It’s not meant to be fascinating reading or to be published in the
Congressional Record. However, use it to carefully evaluate your intake
and how many minutes of nonroutine activity you accomplish.
And speaking of nonroutine activity: my son attended an archery

camp. I had some concerns about the instructor when he said, “Okay,
archers, everyone gather in a circle.”
For many people, the act of logging changes their behavior. People
avoid bad habits when they make a written record. If this is the case, you
may need to continue the log indefinitely, either to pinpoint problem be-
haviors or to encourage yourself to move toward healthier ones. If you
find that the act of writing down your food, drink, and exercise is chang-
ing what you do, that in itself is an important clue. This gets back to the
idea that most of our eating and exercise choices should be in the front of
our awareness, not mindless afterthoughts. Once we do that, it becomes
much easier to reach our goals for normalizing our weight.
Perhaps the most important reason for this log is that people tend to
distort their memory of their behaviors. Often, when I ask patients about
their nutrition or exercise and activity level, they are very inaccurate, even
for recent events. When I ask them to focus on specific examples or in-
clude family or spouses in the conversation, I frequently get a very dif-
ferent scenario. Take away your reliance on memory and the emotional
underpinnings that you might attach to your behavior, and jot it down.
Then periodically go back and review this log. Are you really working in-
creased activity into your daily habits? Are you including more of the
good foods and eliminating the frequency and amounts of the not-so-
good foods? Can you see a pattern to behaviors that needs attention?
Do you find that you are making real strides in a healthier lifestyle? Be
objective; don’t be overly critical. Be constructive and honest. You are
your best friend and biggest supporter when it comes to weight loss.
Use the logs to help yourself into your new permanently thin body.
IT LOWERS YOUR BLOOD PRESSURE, BUT

SO DOES A KNIFE THROUGH THE HEART
Set specific goals that are attainable, and track them so that you moni-
tor whether you are reaching them. Don’t set unrealistic goals. Don’t
state, “I’m going to exercise one hour a day starting today” if you’ve
never exercised regularly in your life. Start at 10 to 20 minutes every day
or 30 to 40 minutes three days a week. Start gently and slowly. Be kind to
yourself. Then track your progress. Gradually work up to more activity
as you tolerate it. If you do it correctly, you’ll find you are looking for-
ward to the activity and want to expand your time exercising. You’ll find
you like the way it makes you feel and look. Read Chapter 11 on exercise
and activity for more specifics.
No matter how out of shape you are feeling right now, I guarantee you
that there are people who have come back from worse. Every once in a
while, I am asked to see someone for rehabilitation in the intensive care
unit. I always want to say to those patients, “Drop and give me zero!”
On the other extreme, my favorite event on sports television is the

world’s-strongest-man competition. That’s where incredibly overmus-
cled men hold up buildings and carry cars and such. I watch it with
this morbid fascination, waiting to see if one of the contestant’s arms
will rip off, right out of its socket. I’m sure they don’t show everything
on TV, like the announcer shouting, “Gentlemen, check your scrotum;
next up, the gonad drop, followed by the longest entrails competition.”
You don’t need to become the world’s strongest person. And you
don’t need to get in perfect shape anytime soon. Aim for multiple small,
new habits. Each new positive routine encourages more changes as you
see great results. Each habit gradually added in will result in permanent
success. Don’t ask yourself to perform an overnight complete overhaul.
Pick one or two small changes that are easy to enact at first, and, as
they become ingrained and habitual, add one or two more. This will en-
sure life-long results. This chapter gives you the activities and behav-
iors for permanent weight loss. Remember to laugh, sing, dance, and
enjoy every moment.

• If you are always active, you won’t be overweight.
• The more hours of television watched, the fatter the kid.
• Stay-at-home workers tend to be fatter.
• Improving self-esteem improves weight loss.
• Distraction is a technique commonly used by those who used to be
obese.
• Associate pleasure with good health habits, and immediately link
them; don’t wait.
• Avoid perfectionism, and aim for being positive in your health behav-
iors most of the time.
• Activity is a mood-enhancer in and of itself.
• Exercise is the single biggest factor in losing weight and keeping it off
forever.
• Make your exercise equipment accessible, appealing, and easy to use.
• You may get thinner but heavier at first, before you lose weight.
• Use clothing as a feedback mechanism to monitor your progress; it’s
better than the scale.
• Do not be afraid of your inherent sexiness.
• Find things that make life meaningful and enjoyable and fulfilling for
you now.
• Keep a food/drink and activity/exercise log, at least at first.
• Each habit gradually added in will result in permanent success.
• Laugh, sing, dance, and enjoy every moment.
FIVE
I’m on the Duct Tape Diet:
Handling Hunger
Some female spiders are so hungry that they eat their mates. Very
aggressive fishing spiders sometimes eat their intended mates before
actually mating, a definite disadvantage in the Darwinian Olympics.
Scientists blame the lady spider herself for being genetically too as-
sertive. But maybe it isn’t her fault; maybe he just didn’t take out the
garbage again.
Hunger is normal; it’s part of being human. People who are overweight,
unfortunately, have come to think of hunger as the enemy. It’s not the
enemy, and “fighting hunger” isn’t a battle.
Satiety (pronounced “say-tie-et-tea”) is the medical term for the oppo-
site of hunger, for feeling full. As I mentioned earlier, it takes the body
about 20 minutes to register fullness after you have taken in enough cal-
ories. Thus, if you are eating quickly, you might overeat. This is an im-
portant concept. If we understand how our body registers hunger and
satiety, we can meet its needs without overeating. We can feel happy, sat-
isfied, and well cared for and become thin. No need for deprivation, ever.
Dr. Barbara Rolls of Penn State estimates that obese people begin
eating due to hunger only 20 percent of the time and finish eating a meal
due to internal signals of satiety less than 40 percent of the time. If you
are overweight, it is very likely that you eat beyond when your internal
signals should have told you to stop. Relearning your body’s own signals
may be the most important step you ever take to permanent thinness. The
nice thing about this approach to weight loss is that self-deprivation and
starvation aren’t necessary.
So you don’t think that you are a person who judges how much to eat
by your eyes, rather than your stomach? Cornell’s Dr. Brian Wansink
performed an extremely clever research study on multiple groups of av-
erage adults.1 He rigged up soup bowls on a table to refill automatically
by hidden hoses under the table. The test subjects were then told to
eat until full. The adults who had the specially rigged soup bowls ate
75 percent more than those who had normal soup bowls! Both groups
claimed they felt the same amount of satiety at the end of the meal. Thus,
Dr. Wansink was able to demonstrate that most people, even those who
aren’t fat, decide to stop eating not when their body tells them to but
when the plate or bowl is empty.
I like reading Dr. Wansink’s research, he always seems like he’s having
a lot of fun in his lab. I never had that much fun when I was a medi-
cal researcher. Of course, it might have been because I spent my time
sitting in a walk-in refrigerator injecting tiny bits of DNA into maggot
butts (really, that’s what I did). I used to go home at night and dream
about wriggling maggots. Recently I heard about a research study that
was done to determine if penis size truly is related to foot size. Now
that sounds like fun medical research. I hope it was a female scientist
doing the study: “Okay, gentlemen, put your feet and your organs up
on the counter and let’s get you measured!”
OPEN SKULL, INSERT THOUGHT

All right, let’s get back to the subject of hunger and satiety. Think about
how you end a meal. Do you finish eating when your plate is empty or at
the end of a TV show? Become aware of feelings of fullness while you
are still eating, even at the beginning of the meal, and ask yourself fre-
quently, “Am I full?” You might be surprised how often your response
will be “yes” earlier than it would have been if you had not made the
conscious effort to decide. In fact, you should start noticing that you will
eat less at almost every meal.
I’m on the Duct Tape Diet 85
People who are externally driven by signals to eat are more likely to be
overweight. I strongly feel that this process can be relearned, however,
and that, once a person realizes that this is a problem, he can retrain him-
self to pay attention only to his internal signals—it takes time and real ef-
fort, but it’s worth it.
THE SOUTH BITCH DIET: ANY DIET MAKES ME BITCHY

Many obese people don’t even remember what it feels like to be truly hun-
gry and are disconnected from their inner physical feelings. The person
who chronically diets becomes used to eating or starving himself accord-
ing to outside, externally imposed rules. The dieter will say to himself,
“I can’t have food for two more hours no matter how much I want to
eat.” Eventually, the person becomes dissociated from hunger signals
and starts to forget what it feels like to be hungry until he is ravenous.
Hunger sensations include a growling or pain in the stomach and feel-
ings of lightheadedness or faintness. You may have difficulty con-
centrating, be irritable, or get a headache. Spend time refamiliarizing
yourself with your own body signals. Be open to the idea that you need
to relearn those signals you knew when you were very young. Pay active
attention at every meal, at every snack, to stomach fullness, your comfort
level, your emotional state. Deliberately ignore external signals like time
of day, portion sizes, plate size, and other people’s eating expectations
(or your own expectations). Remind yourself to avoid eating out of
boredom, fatigue, or emotional causes.
IF GOD WANTED US TO DIET, WE WOULDN’T

HAVE MOUTHS
It is also important for you to understand the sensation of being un-
comfortably stuffed, of being overfilled. People who chronically starve
and then binge often don’t even know what it feels like to be full without
being overstuffed. Become aware of when you feel satisfied without feel-
ing overly full. Then stop. If you habitually clean your plate, start inten-
tionally leaving food on the plate, even if it’s just a smidgen at first. Get
out of the habit of eating until nothing is left. However, when you are
truly hungry, eat until the last morsel is gone from the plate. Give your-
self choices, and monitor your inner physical state constantly.
Ask yourself, “Am I really hungry, or am I thirsty, and, if I’m thirsty,
would plain water do, or am I really craving caffeine, sugar, or salt (like
in a sports drink?).” Substitute herb teas to relax and get a flavored

decaffeinated tea at night or chamomile, which naturally relaxes without
the calories. This is also a good way to finish off a meal with a treat that
isn’t calorie-rich (substitute it for dessert). Vary your flavors, and go
shopping in the natural food aisles for some fun variety.
Talk to your stomach, and wait for it to answer on fullness level. Just
remember, when in a restaurant, always use a low tone of voice when
talking out loud to your stomach, and try very hard to act like you are
speaking on your cell phone if you are sitting alone. Otherwise, your
next meal may be psychiatric hospital food.
Consider yourself successful when you stop eating earlier than you
used to—because you no longer attend to the external signals and are
back to listening to your body.
Once you have relearned the sensations of hunger and satiety and feel
pretty certain you can regularly monitor yourself, you will want to keep
your hunger level within a certain range. It is best for your mental and
physical state to never allow yourself to be very hungry or very full. Cul-
turally, Americans are more prone to eat “until stuffed” than other peo-
ple in the world. It is not uncommon for us to eat until we are suffering
physical signs of reflux or regurgitation, like belching or coughing at the
end of a meal.
THE GARBAGE MAN COMETH AND THE GARBAGE

MAN TAKETH AWAY
Fidget during meals, take breaks if you need to while eating to give your-
self time for the food to register with your brain, and then decide if
you’ve had enough. Two-thirds of the way through your usual meal, get
up and move around. Make a phone call; open your e-mail. Throw in a
load of laundry, or take out the garbage. Then come back and decide
if you are still hungry. Chronically fidgety people are thinner than those
who don’t move constantly. It isn’t just because of the increased basal
metabolic rate from constant movement. I suspect it may have to do
with their inability to sit still during a meal, giving their bodies time to
register “full.”
In my household, I’m The Laundress. That’s my name and my job. I’m

convinced that, as soon as I finish the laundry and go to work, our
clothes run around the house until they get sweaty and then they hurl
themselves into my hamper. I get home and there’s laundry to do
again! One of these days, I’ll arrive home early and catch my hus-
band’s underwear running on the treadmill.
Eat until mostly full, not stuffed, and get in that habit. You don’t have
to starve, but there is nothing inherently wrong with practicing feeling a
little hungry. Societally, we’ve grown to accept that hunger is a bad thing
and to believe that we need to appease it immediately. Rethink your
thinking about this; then do what is comfortable for you. But don’t let
hunger impair your ability to function or worsen your mood.
THE PACIFIST’S GUIDE TO FIGHTING FAT

Perhaps the biggest myth in weight loss is that certain food groups, such
as fats or sweets, protein or carbohydrates, are to be avoided. When a
person feels deprived, he or she is less likely to be successful in losing
weight permanently. Diets don’t stick. That’s why I differ from “diet
doctors” in refusing to ban high-calorie foods or entire food groups.
However, there is no doubt that some foods will make it easier for you
to feel full on fewer calories. My recommendation is to become famil-
iar with those foods and habitually to eat them at the beginning of
every meal. I introduce the various choices here and expand the discus-
sion in Chapter 6.
In the next chapter, I delve into the details of the “four great
choices.” These foods are the most important food choices you can
make at the beginning of every meal. Pick a whole fruit, a salad, a thin
soup, or a tomato juice drink, like V8. Each one of these, for reasons ex-
plained in Chapter 6, is nutritional and will significantly decrease your
desire for calories. You will feel full after every meal and eat a whole
lot less. You can drop weight without starving yourself. How awe-
some is that?
In addition, there are other helpful foods that truly do allow you to
feel full on fewer calories. Whole grains are more filling than processed
grains. I eat whole cooked oatmeal for breakfast but never processed
cereals. The difference in satiation is amazing.
THE FARTMAN’S DIET: FEEL FULL

AND FRIEND-FREE ALL DAY
Along those same lines, fiber in vegetables slows the processing of food
and the emptying of your stomach, so you feel full longer. Eating foods
that are high in fiber is a great way to feel full without taking in a lot of
calories. But watch out—one of the techniques that the diet bars and
diet drinks try to do is fill you up with fiber that is poorly absorbed. As
a result, many people do feel full but later are gassy and miserable. It
is best to eat vegetables rather than diet bars or drinks. You are looking
for permanent techniques that are good for your body, not short-term
diet solutions.
The propane company near me advertised a clearance sale. Heck, my

husband does that. When he has extra gas, he clears the room.
Good nutritional foods, like vegetables, satiate you and make you
feel full, but foods lacking in nutrition make you hungrier through
several mechanisms. Good foods ameliorate the desire for nutrients
you might be missing. Yes—and this is common—you can be extremely
overweight and still be malnourished! Junk food lacks nutrition and
won’t stop a malnourished body from searching for minerals or vita-
mins that it is missing. I believe that’s why some people become food-
obsessed despite being extremely obese and chronically overeating.
Strangely, it’s well documented that people who are malnourished will
eat the wrong things (even nonfood objects like paint, paper, and paste)
in a compulsive search for the nutrients their body is missing. In my
own clinical experience with thousands of overweight patients, I have
found many who had severe protein, vitamin, and mineral deficiencies.
Their malnutrition explains why they came to me: serious wounds,
infections, neurological problems, or broken bones caused by osteo-
porosis. Once they started eating more nutritionally sound diets, they
lost their compulsive hunger and lost weight! They felt better, and they
healed.
TASTES LIKE DIABETES

In addition, foods and drinks that are high in processed sugars (high-
fructose corn syrup, which is used in soft drinks and many prepared
foods) or highly processed grains (most breads, crackers, and snack

foods) send your blood sugar spiraling quickly upwards, sending you
into a sugar-induced stupor followed by a crash and the rebound
munchies two hours later. That’s why some people claim they are always
hungry; the typical American diet produces chronic hunger. Sugar-
packed foods aren’t the only thing that can send you on a calorie roller
coaster. Caffeine overuse does the same thing. Unfortunately, the pre-
dominant caffeine drinks now used are high-calorie sodas and energy
drinks, flavored coffees, and prepackaged teas. These are discussed fur-
ther in Chapter 8.
Finally, on the subject of how proper nutrition for your body can
make you eat less: if you are allergic or sensitive to certain foods, those
foods may wreak havoc with your system and promote overeating. For
instance, although whole wheat is promoted by most nutritionists as
healthy eating, it’s horrible for those who suffer celiac disease. Celiac
patients have an intolerance to wheat and other grains containing a type
of protein called gluten. This protein creates damage and inflammation
throughout the body, as well as chronic fatigue. Exhaustion leads to
overeating in an effort to give oneself a burst of energy to counter feel-
ings of sluggishness. It’s a vicious cycle because those grains actually
produce malabsorption syndrome and malnutrition in those who are
susceptible.
When I go visit my friends, I like to bring a gift. In the old days, I used
to bring a bottle of wine, but a lot of people are alcoholics in recovery.
So then I was giving candy. But I found that so many of my friends are
diabetics. Then I was stuck bringing a nice loaf of bread. But seems
like everybody has a gluten intolerance. So now I just give something
that everyone needs—health insurance.
COVER YOUR FOOD WITH INGREDIENTS THAT

SUPPRESS YOUR APPETITE—CINNAMON IS SAID
TO DO THAT—EVEN BETTER, TRY SUPER-GLUE
A lot is written about the best combinations of foods to eat to promote
a feeling of fullness. Some authors maintain that a meal with a lot of
fat and protein increases satiety by reducing the speed of stomach emp-
tying. Fats and proteins take longer for the body to process, so, theo-
retically, you get to “full” faster. This is thought to contribute to the
short-term successes of those who follow an Atkins-type diet. The long-

term research, however, doesn’t support the idea that people lose more
weight on this type of diet.2 And certainly the cardiologists and the
kidney doctors cringe because of the long-term damage that a high-fat
and high-protein diet does to the body. Finally, there are those experts
who claim that constantly eating fatty foods actually suppresses the
usual satiation response, resulting in an increase in caloric intake.
Some authors insist that meals should include a certain percentage
of protein, carbohydrates, and fat to promote satiation. Complex car-
bohydrates, such as fruits and vegetables, are water-containing and so
help with satiation because they are higher in volume. The stomach
registers fullness not just according to the calories and the composition
of the food (e.g., fats) but also by its volume. I’m not convinced, how-
ever, that those diet bars and foods that are supposedly “balanced” with
the proper percentages of fats, protein, and carbohydrates are that
useful. They are still missing the water content in the food itself and, as
mentioned earlier, may not have easily absorbable nutrients, as do plain
whole fruits and vegetables. The closer the food is to the soil, the less
processed it is, the better it is for you. (Or, as my husband likes to say,
the closer you eat to the ground, the shorter you are.)
I LOVE NUTS—THAT’S WHY I MARRIED ONE

Nuts are a great food to suppress the appetite. Eat a handful at the be-
ginning of a meal, or 20 minutes before you plan to eat, or as a fast snack.
You will eat less later on. The problem is that most people don’t just
eat a handful; they eat a canfull. Nuts are packed with nutrition and
calories—so a handful is 6, not 60. Avocados and foods rich in unsatu-
rated fats (like olive oil) can also curb hunger pangs. There’s research
that shows that foods like these break down in the small intestine to
form appetite-suppressing chemicals.3
Nuts are actually a high-calorie-dense food, that is, they pack a lot
of calories in a little itty-bitty package. That’s why you have to go easy
on them, despite their nutritional value. Eating low-calorie dense foods
routinely will make losing weight much easier because you can eat your
fill, without ever having to feel starved or deprived. This is an approach
that will work permanently to help you keep the weight off even after
you have completed your weight loss and that is crucial to long-term
success. Complex fiber-containing fruits and vegetables give you the
most satiation for the number of calories of any type of food. Eating an
apple or a snack bag of carrots helps immensely and is great for your
body. Increasing soups, stews, fruits, fish, casseroles, vegetables, and
natural fibers cuts calories and increases satiety.
A glass of water by itself doesn’t help reduce your appetite unless
you are truly thirsty instead of hungry. But water, when mixed in with
other foods, is very helpful, especially when it is warm and part of the
dish being served. Water mixed in with a food increases satiation and
lowers the calorie density of what you are eating. On the other hand,
foods that are dry and sugary or full of fat or alcohol increase calorie
content and intake.
Recently, I saw a cooking show chef make a concoction of deep-fried

hamburger between two donuts. She’s going into the restaurant busi-
ness, I hope in partnership with Cardiologists R Us.
THE WORLD ISN’T FLAT, IT’S FLUFFY

As Dr. Barbara Rolls wrote in her excellent book Volumetrics, taking
in water is the most common way to increase satiation without increas-
ing calories. In addition, an often overlooked way to increase fullness
without adding calories is to mix air in with your food. Air-filled foods,
like dry popcorn and smoothies, work to improve satiety with rela-
tively few calories. (Blenders mix lots of air into the liquid.) The air in
the food or drink fools your stomach into thinking you ate more than
you did. That’s why the rice-cake industry was born. Rice cakes are
good for an occasional munch but don’t help in the nutrition depart-
ment. Smoothies, often higher in calories, are also much higher in pow-
erful nutrients. Do what’s best for your body. Your body will thank
you for it.
As I’ve already mentioned, if you slow the rate at which the stomach
empties its contents into the small intestine, food will fill you up faster
and you will eat fewer calories. Gastric emptying is influenced not only
by the composition of the food but also by such things as whether you
have eaten solids or liquids. Liquids empty quicker since there is no
grinding to be done to process them. A soda or an alcoholic drink is
loaded with calories and will go right on through. It won’t fill you up,
but it will pack on the calories. But liquids that have a more complex
composition (like a soup that has a protein base such as a beef or chicken
broth or milk) will dump slower. Add a little solid meat or vegetables,
and you’ve got a soup or stew. The additional sensory stimulation of

multiple complex flavors and aromas and the act of chewing will in-
crease satiety much more than a plain drink will.
Here’s a caution, though. People can become overzealous in their de-

sire to eat nutritious foods. One of my son’s friends is a third-genera-
tion strict vegetarian. His mom feeds him salads, pureed as smoothies,
for lunch. I tried them once—eeeehhh, yuck! The boy is very tiny as a
result. He’s so small that I have to tell my kid, “Aaron, check the sofa
seat cushions—George’s mom just called, and he’s missing again.”
Interestingly, warm foods and drinks may stick around in the stom-
ach longer than cold foods and drinks. Cold foods and liquids have
been shown in some studies to stimulate thermoreceptors in the stom-
ach to empty the meal early. I’ve been postulating that Asians may tra-
ditionally be thinner than Westerners because there is a strong cultural
bias against eating cold foods and drink—perhaps they just fill up faster
on less food because it’s warm. Americans and other Westerners who
insist on cold food and drink with meals are more likely to empty their
stomachs prematurely and eat more food at each meal. Warm food
makes the stomach muscles relax and retain the food, thus giving peo-
ple a feeling of being fuller on fewer calories. That may be only one of
the reasons that hot oatmeal fills up the tummy with far fewer calories
than a cold bowl of cereal (besides, it’s a whole-grain product). Finally,
there is a little bit of research that shows capsaicin (the chemical that
makes hot peppers taste hot) may decrease appetite, but the thermal
heat produced in the stomach may have more to do with it than the
peppers.4
THAT GREAT ITALIAN, DR. PLACEBO DOMINGO

There are other ways to feel fuller during or after a meal that don’t in-
volve food choices. The most common techniques are medications to
suppress the appetite or surgery to restrict the stomach. We discuss sur-
gery a little later and medications in the next section. There are less fre-
quently used approaches that don’t involve the expense and danger of
surgery or pharmaceuticals. Unfortunately, we don’t know if they work.
One of the most fun concepts is the idea of Professor Luigi Ambro-
sio, lead researcher on a study at Italy’s National Research Council.5
He’s testing a powder pill made up of cellulose called hydrogel. After

it’s swallowed, the hydrogel turns into a large glob of indigestible jelly
in the stomach. It gives a sense of early satiety. You need to swallow the
hydrogel pill at the beginning of every meal, and long-term studies for
safety aren’t completed. The concept is really very similar to the gastric
banding idea, without the mess of surgery. There’s not enough infor-
mation yet to know if it’s cheaper or safer in the long run or if it’s truly
effective. Also, we don’t know how your digestive system or your house
plumbing will hold up to a three-times-a-day gel poop. Dr. Luigi isn’t
saying.
TAKE TWO PLACEBOS AND CALL ME IN THE MORNING

I have to tell you right away: I’ve never prescribed a medication specif-
ically for weight loss. I don’t like the concept of diet drugs because that’s
exactly what they are, medications to promote a temporary condition,
a diet. They are never intended to be permanent and therefore don’t
help a person learn long-term solutions to overeating and underexercis-
ing. Also, medications have side effects and can be dangerous. On the
other hand, obesity is very dangerous, too. So, with that in mind, I re-
view some of the commonly used drugs here.
RED HERRING PHARMACEUTICALS—OUR

PRODUCTS HAVE BEEN CONFIRMED IN CLINICAL
TRIALS TO REDUCE SWELLING OF THE WALLET
Phentermine was a popular diet pill for a while in the 1990s. It gives
modest help to control hunger and is relatively well tolerated. Still, it
can cause heart palpitations, high blood pressure, nervousness, and an
upset gastrointestinal system. That’s a lot of complaints for a modest
eight-pound weight loss over six months, and it’s really not intended to
be used for more than three months.
I don’t want you to think I hate pharmaceuticals. That’s just not true. I
prescribe other types of drugs every day for my patients and take some
medicines myself. My allergies get to me a lot. I get sneezy and itchy.
Then I take medicine and become hungry and sleepy and dopey from
the side effects. And, since I’m already doc, I’m practically the whole
damn crew of seven dwarfs, all at once!
Another weight-loss drug that has held a lot of promise but that
hasn’t really delivered is sibutramine, also known as Meridia, Reductil,
or Sibutrex.6 It was designed to be an antidepressant but failed miser-
ably. However, during the drug trials, subjects were noted to complain
of anorexia (feeling like they would rather not eat). Thus was born a
new diet drug. According to the British Medical Journal,7 you will lose
about 7 to 10 pounds more than if you took a placebo, but you stay on
the medication continuously for half a year. Its main side effect is heart
rate increase.
Another, more successful antidepressant, fluoxetine (best known as
Prozac or Sarafem), is thought to produce weight loss of between 2 and
20 pounds if you take it for six months.8 The problem is that this drug
has a lot more side effects, including nervousness, sweating, tremors,
nausea, vomiting, fatigue, insomnia, and diarrhea. Oh, and let’s not for-
get one of my favorite ignored side effects of this drug class, sexual dis-
interest. With all those delightful symptoms, I’d choose the placebo
section.
Speaking of sexual side effects, I’ve always wondered what the emer-
gency room does with all those guys who take Viagra, Levitra, or Cia-
lis and end up with that infamous side effect, the four- hour erection
that won’t go down. Are the nurses in the back room playing ring
toss?
And, on that note, the average dose for Viagra used for erectile dys-
function is 25 milligrams. But that same exact drug is used for a
lung condition called pulmonary hypertension at much higher doses,
around 60 milligrams.9 It turns out that’s convenient in Florida,
where I live. On sunny days, the patients can double as beach um-
brellas.
TV ANNOUNCER: SIDE EFFECTS MAY OCCUR,

INCLUDING BLOATING OR RASH, AND YOUR HEAD
MAY FALL OFF. LUCKILY, YOU WON’T COMPLAIN
Orlistat (Xenical, or Alli, as it’s sold over the counter) is a drug that
doesn’t have all the neurological or cardiac side effects of the medica-
tions mentioned earlier. The reason for that is that it isn’t really absorbed
into the body and so has limited effects on organ systems outside the gas-
trointestinal system. It will help you lose about one extra pound a month.
It blocks fat absorption, and the result is that fat gets flushed through
your intestines, resulting in diarrhea, flatulence (farting), bloating, pain,
oily stools, and regurgitation.10 Oh, and if that weren’t enough, there’s al-
ways the very popular bowel incontinence and anal leakage. I know I
want to worry about that when I go to parties.
Which reminds me of the rumor that I heard: that the drug companies
are also working on a diet drug that combines that appetite-reducing
hormone leptin and the stool softener FiberCon to produce a medicine
called Lepricon. You do realize that gold is not the only thing you’re
gonna find in that pot.
So now you know how I feel about diet drugs. They are only for short-
term use and generally are more trouble than they are worth. None of
these are “happy pills” for dieting. They are not adding to your plea-
sure or joy, and the weight loss that results is very minimal. Finally,
most research shows that you will gain the weight back as soon as you
go off the medication if you haven’t developed other ways to deal with
overeating and underexercising. Personally, I don’t see the point to us-
ing them.
NEW SURGERY: IT’S MORE EFFECTIVE THAN

STOMACH STAPLING; WE STAPLE YOUR ASS
SHUT. GUARANTEED YOU WON’T WANT TO EAT
Bariatric (obesity) surgery is becoming acceptable as a successful al-
ternative to lifestyle changes, particularly for those who are very over-
weight. These surgeries still have a 1 percent or more one-year mortality
(death rate) and a high complication rate (such as wounds and neuro-
logical problems as a result of malnutrition). A proper diet and regular
exercise are much safer and have no mortality, if done correctly. Life-
style changes will make you healthier, permanently. If you can change
your habits and forgo the risk of surgery and all the complications that
go with it, obviously you are much better off.
ROCK, PAPER, CIRCUMCISION
And surgical complications are no joke. Except here. My friend told

me the true story of her first husband’s vasectomy. They used to tell
you to shave the area before you showed up that day. So he shaved his
entire area, all the way to his knees. Then for some reason, he decided
to apply cologne. Suddenly, she heard screams and found her husband
bent over the toilet splashing water on himself. Stifling a laugh, she
blurted out, “Oh, hon, wasn’t the dog just drinking out of that?” The
funny thing is, the whole point of shaving before surgery was to make
the process more hygienic.
After the procedure, he was given a prescription for a support, in
case he had a lot of swelling. He took it to the medical supply com-
pany, and they asked him what size he needed: small, medium, or
large. Wouldn’t you know it, every guy asks for extra large. But, in
this case, he was probably a little swollen.
DOCTOR PERFORMS SURGERY BY TEXT

MESSAGE—IT’S CUTTING-EDGE TECHNOLOGY
One of the most common types of bariatric surgery is the gastric by-
pass, officially called the Roux-en-Y, which is a procedure that bypasses
most of the stomach and the first portion of the small intestine. It causes
food to be absorbed and processed differently. It reduces the size of the
stomach by more than 90 percent. A normal stomach can hold more than
1,000 milliliters of volume, whereas the bypassed stomach may only
hold as little as 15 milliliters of food. So the patient feels full very easily
after only a little bit of food. Eventually, the small intestine connected to
the bypassed stomach will stretch to hold more food; that’s why bypass
patients don’t lose weight forever. This surgery creates significant nu-
tritional deficiencies because the stomach and small intestine, which is
mostly bypassed as well, are where many nutrients are absorbed. By-
pass patients often fight lifelong nutritional deficiencies of calcium, iron,
B12, thiamine, and vitamin A. They may also have protein malnutri-
tion from eating less protein than they should after the surgery.
The gastric band (lap band) procedure places a band around the top
portion of the stomach that restricts how much a person can eat and
causes a person to feel full earlier. Nutritional malabsorption is less of
a problem. However, the weight loss may not be as extensive, quick, or

permanent. Obesity and diabetes are less likely to be cured, but the com-
plication rate of this surgery, both short and long term, is lower than for
other forms of weight-loss surgery.
The sleeve gastrectomy, another type of surgery, reduces the size of
the stomach by as much as 80 percent. It can require a second surgery
and often comes with permanent complications.
There are a lot of different names for surgeries, and it gets confusing,
even for physicians. I had a patient who had a diagnosis on his chart of
“failed sex change operation.” I wasn’t sure what that meant. so I did
an Internet search for that phrase “failed sex change operation.” All I
got was an ad for Valentino’s Pepperoni.
The complication rates from bariatric surgeries range from less than
1 percent mortality to as high as 14 percent for other types of complica-
tions (e.g., nonhealing wounds). This is more common in the old-style
“open” surgeries,” where a traditional scalpel incision is made, than with
laparoscopic procedures (the bigger the incision, the more risk of com-
plications).
INTERNAL GPS DEVICES: “ TURN RIGHT AT THE APPENDIX”

There are many different ways surgeons get to your internal organs. The
old-fashioned way was by an open surgical incision. Frequently now,
surgeons are using laparoscopic tubes placed through tiny holes to get
at organs. The next phase is “incisionless” surgery, where instruments
are snaked through catheters into natural orifices.
They aren’t doing incisionless surgery yet for bariatric surgery, but I
have read about gallbladders coming out through vaginas (those two
organs are nowhere near each other). I’m not certain of the advan-
tage of that procedure, except that you can return to the beach in
your bikini the next day. I’m waiting to hear about the testicular can-
cer biopsy being done through the ears. This is the major reason that
hospitals have doctors’ lounges—so that surgeons can sit around and
say things like, “Hey, I bet you can’t do this one. . . .”
I’ve seen first-hand the short and long-term complications suffered

by patients who have had bariatric surgery. Often the patient does not
follow up permanently with the surgeon and does not follow the long-
term recommendations for proper nutrition. This problem will only get
worse as more of these surgeries are done. Even after surgery, you still
have to take care of your body, change your eating and exercise habits,
and develop nutritional awareness. Bariatric surgery is only one step in
the process of successful weight loss, even if you do choose that route.
TAKE SURGERY SERIOUSLY—DON’T GET LASIK

OR A BOOB JOB AT THE MALL—OR YOU MIGHT
BE LEFT WITH CINNAMON BUNS FOR BRAINS
Long-term studies of bariatric surgery patients reveal that, 10 years af-
ter the procedure, there were no improvements in blood pressure, de-
spite the weight loss.11 In other words, the long-term consequences of
surgery may be weight loss but not better health. So, at least when it
comes to improving cardiovascular health, surgery has not been proved
to help. There is research to show that diabetes can be reversed in the
short term, but the long-term studies aren’t convincing. Unfortunately,
the complications of the surgery itself may negate any health benefits.
The success of any of the surgeries that create smaller stomachs is de-
pendent on the patient learning different eating and lifestyle habits. If
a patient grazes constantly on high-calorie foods and never exercises, he
or she will defeat the effectiveness of the surgery. This is a common cause
of surgical failure. For the very obese, unless you have extensive psycho-
logical and nutritional counseling and commit to lifestyle changes, in-
cluding regular exercise, you will not lose weight permanently, even with
surgery. Most of the research on these surgeries does not follow the pa-
tients for years afterwards to examine the long-term successes and com-
plications. This is where the real problems come in, so keep that in mind.
SEX AND OTHER EXERCISE

Exercise (including sex) decreases hunger temporarily but increases
hunger later. There’s a lot of controversy as to whether the net gain is
beneficial to weight loss. Since I’m a big believer in sex (and other forms
of exercise), I strongly recommend it. However, you might find that you
need to plan the timing of your exercise to get the most appetite sup-
pression. Sexercising and other activities might just work best before
bedtime, at least to decrease hunger and the evening munchies.
“SQUARES”: A GYM FOR MIDDLE-AGED

MEN IN SHORTS AND DARK SOCKS
A lovely little study done at the School of Sport and Exercise Sciences
at Loughborough University in the United Kingdom in 2007 found that
ghrelin, a hormone essential for appetite regulation, is significantly al-
tered for up to nine hours after one hour of vigorous exercise.12 (They
used running, not sex, in the study, probably because it’s easier to con-
trol calorie expenditure.) Unfortunately, the test subjects felt less hun-
gry only for three hours afterwards, not for the full nine hours, and
the researchers used only young men. In fact, in most studies that have
looked at exercise and appetite suppression, the researchers have either
found no change in the intake of food after exercise (65 percent of the
time) or a modest increase (19 percent of the studies). It is fascinating
that some of the research shows that appetite suppression by exercise
works better for men than women but that it depends on the exercise
(high intensity or low).13 Men respond better to high intensity, women
better to low, uh, maybe. Depends on which research you read and
which scientist you talk to. Oh, and if you had any health problems, were
obese, more than 25 years of age, or drank alcohol, you weren’t in these
studies. As usual, the research doesn’t necessarily tell us much about
the real world.
HARDLY DAVIDSON
As an exercise doctor, this is one of my pet peeves. Research on ac-

tivity is usually done on the young, fit, and perfectly healthy. But the
people who most benefit from exercise are those who aren’t in the
best shape. Our society doesn’t encourage getting fit, either. Remem-
ber when a biker was someone on a bicycle? Now, it’s someone on a
$25,000 Harley. Come to think of it, bikers used to look young and
cool, like James Dean. Now a lot of them look older, fat, and suburban,
more like Jimmy Dean.
I’VE EXERCISED MY SELF-RESTRAINT,

AND NOW I CAN’T GET OUT
Generally, studies on eating patterns after exercise have found that the
increase in calories taken in, even in those few studies where people ate
more in the exercise group, was less than the calories that they expended
by exercising. Thus, the increased noshing did not cancel out the benefits
of the burn of exercise. And note: a person continues to burn calories
at a higher rate for up to 24 hours after vigorous exercise. No one seemed
to be calculating for the higher metabolic rates produced by daily exer-
cise; they just looked at the caloric work done during the one activity
hour. Personally, I think there may be both a reasoning and a math
problem here.
THE SUMO AND YOU DIET

What is known is that people who decrease the amount of exercise
that is normal for them don’t decrease the amount they eat and thus fat-
ten quickly! Also, people who skip meals make up most of the calories
in the next 24 hours, but people don’t make up all the calories that they
expend while exercising. Thus, starving doesn’t help you lose weight,
but exercising regularly does. We’ll discuss the specifics in Part III.
Ultimately, you need to be aware of your own body. Most people do
experience appetite suppression after exercising, but it depends on the
type of exercise and the timing. You need to listen to your body. It’s
talking to you.

• Relearn your body’s own signals for permanent thinness.
• People who are overweight are more likely to use external signals for
eating.
• Eat when hungry, and never wait until you’re starving.
• Stop eating before you’re stuffed. Eat until pretty full, not very full.
• Don’t restrict food groups, but realize that some foods are more fill-
ing than others.
• The “four great choices” plus whole grains and fiber-rich foods in-
crease satiation.
• Nutrition-loaded foods are more satisfying than those that contain
empty calories.
• Foods high in sugar or caffeine or that create sensitivities cause over-

feeding.
• Eating foods closer to Mother Nature results in better health and in-
creases satiation.
• Water- or air-containing foods or a handful of nuts will help you feel
full.
• Thin liquids like soft drinks or alcohol will not register as calories as
well as solid food or complex liquids like smoothies or soups.
• Warm food and drink may fill the tummy better than cold substances.
• Diet drugs help you lose a pound a month, are for short-term use, and
have side effects.
• Weight-loss surgery has complications and may not have benefits. You
still have to exercise regularly and learn better eating habits for the
surgery to work.
• Exercise decreases and then increases hunger, but the calories eaten
later do not make up for the calories burned off by exercise, so you
have a net loss.
PART II
Input—Food and Drink
SIX
Eat Right, Die Anyway:
What Are Good Foods?
One of the problems here where I live is that, until recently, you could
call yourself a nutritionist and not have any real training at all. Florida
is a place where they practice the separation of state and knowledge.
Understanding nutrition is important for everybody—if you under-

stand the content of what you put in your mouth, you are less likely
to eat junk. We can do the same with the nasty food industry that was
done to the cigarette industry: the death stick manufacturers lost
many of their potential customers when teenagers became educated to
the 300 toxins inhaled in every cigarette. If we can do the same with
nutrition, people will be less inclined to indulge in the toxins from the
food industry and will instead eat the quality foods that the industry
does produce.
I’ve already mentioned the three basic parts of food that give us fuel:
carbohydrates, proteins, and fats. All the energy of our body, the fuel
that allows us to move and build our body parts and carry out our
physiologic activities, comes from these substances. It’s important to
understand that the use of the word “energy” in nutrition and food
descriptions is not always a good thing. The other word for energy is
“calories.” Humorously, some in the food industry like to label things
high in calories as “energy foods,” implying that they’ll give you a boost
of energy. In reality, they’ll give you a boost to your hip size.
MY FAVORITE DELI HAS AN AWESOME DESSERT

CALLED KILLER CAKE—NOW WITH 90 PERCENT
MORE LAWSUITS!
When eaten, carbohydrates are broken down the quickest and fats the
slowest. Carbohydrates are broken down into sugars, proteins into
amino acids, and fats into fatty acids and glycerol. Complex carbohy-
drates (like whole grains, beans, and vegetables) take longer to break
down and so don’t give the sugar rush into the bloodstream that sim-
pler sugars do. Carbohydrates that are processed (such as white bread,
sweets, or pretzels) are stripped of their nutrition and fiber. These types
of foods may often have vitamins and minerals put back in by the food
companies, but it’s not clear that those vitamins and minerals are ab-
sorbed and used as well as those from the unrefined versions. There has
been a deluge of data showing that a diet high in simple and refined
carbohydrates results in obesity and diabetes.
Proteins are the building blocks of your body parts and also make
up the enzymes for body functions. Proteins and enzymes are made up
of various amino acids, about half of which your body can produce on
its own. The other half must be eaten in your food. If you are on a very
restricted diet, you may be missing some of these amino acids and will
be malnourished.
DANGER, HAZARDOUS WAIST

Fats in your diet are very important. Animal fats tend to be saturated
and are not as good for you as other types. (The type of saturation re-
fers to a type of chemical bond.) Saturated fats lead to heart disease. In
general, plant-derived fats are mono- or polyunsaturated fats and are
healthier. If the fat is a solid at room temperature, it’s not a great choice.
However, liquid vegetable fats (and fish oils) can have a very positive
impact on the body. Dietary fats are intensely full of energy (that’s why
you don’t need a lot of them in quantity) and are extremely useful for
physiologic processes like hormonal regulation and immune function.
Take in too much or too little fat, and you will be asexual and prone
to infection or cancer. When you eat too much carbohydrate, protein,
or fat, you make more fat (adipose tissue), as that is the way the body
Eat Right, Die Anyway 107
stores excess energy. Understand this: any overindulgence in calories,

whether it comes from fried bacon (protein and fat) or snack crackers
(carbohydrate) will be processed into the spare tire around your belly or
cellulite in your thighs.
Manatees eat 16 hours a day and feed exclusively on plants that are like
lettuce. They weigh up to 3,500 pounds. Imagine how much they would
weigh if they ate fried chicken.
Calories are the way that we measure quantities of energy. The more
calorie-containing a food, the more fuel you get. Eat too much fuel, and
your body stores it for later use. It’s an exquisite system that was de-
signed at a time when humans suffered long periods of drought and
famine. When there was relative plenty, people ate as much as possible
to store fuel for the lean times. Evolution hasn’t caught up with the ap-
pearance of the convenience store. Even in developing countries, obe-
sity is becoming a bigger health threat than starvation and famine.
IF MASS CAN NEITHER BE CREATED NOR DESTROYED,

WHY AM I ALWAYS ON A DIET?
Please don’t aim to be perfect with your approach to nutrition. The
goal should be to be healthy and eat healthy most of the time. Realize
that it’s okay to eat nonnutritious foods on occasion. My definition of
healthy eating is to eat food that is good for you and to have a good rela-
tionship with what you eat. Talk nice to your dinner, and don’t forget to
apologize to the pork.
As mentioned in Chapter 2, I don’t believe in restricting food groups
or timing food choices to stages. There are no proven long-term weight
loss benefits to such diets as Atkins, South Beach, or Ornish beyond
their causing a person to become conscious of the amount and type of
foods that are eaten. Research studies have not shown that one type of
restricted diet is much more successful for weight loss than any other,
when you are looking at more than a month or two at a time.1 Indeed,
there is a lot of concern that eliminating food groups is detrimental to
your health and unsustainable in the long run.
IF I EAT EVERYTHING, SOME OF IT HAS

TO BE GOOD FOR ME
So what is a healthy diet? It seems that a straightforward question like
that ought to have a straightforward answer. The problem is that nu-
trition research is much more complicated than health workers have
been willing to admit. Suffice it to say that the traditional food pyra-
mid that we were taught in elementary school has fallen out of favor.
It is no longer believed that a diet based on grains is as safe as a diet
based mostly on fruits and vegetables. Meats, dairy, grains, oils, and
sweets are to be eaten in smaller amounts. Fish might be okay to eat
in large quantities, but it’s not clear whether it is safe to eat lots of
shellfish.
People really love shellfish, whether it’s shrimp, scallops, or mussels.

Supposedly, oysters are an aphrodisiac. Personally, I think they taste like
a bad head cold.
The more you know about nutrition, the more you realize that eat-
ing “nasty” foods is true deprivation. Your body thrives on fruits, veg-
etables, and low-salt, low-sugar, and low-fat foods. When you serve it
anything else, your body lets you know that you have deprived it of what
it really needs. Listen to your body. If you feel tired after a meal, it
wasn’t the right food, or you ate too much. Food, like exercise, should
make you feel energized, not sleepy.
Older studies examining Eastern cultures where people are thinner
than Americans find that rural Asians tend to eat more calories than
people in the United States, yet the Asians are thinner. Why is that?
Dr. Dean Ornish, the proponent of a very low-fat diet, said it’s because
thin Chinese eat less fat. He didn’t mention that, per capita, they also
have fewer televisions, cars, and convenience stores than Americans.
Presumably, a thin, rural Asian has to walk to get places, buy food, and
work his farm. There’s a good chance he might exercise more than the
typical American. The Chinese farm worker probably eats more fresh
fruits and vegetables grown in his own backyard.
FAMOUS HEALTHY DEAD PEOPLE: EUELL GIBBONS IS STILL

DEAD, DR. ATKINS IS STILL DEAD—HELL, GENERALISSIMO
FRANCISCO FRANCO IS STILL DEAD
On the other hand, Dr. Robert Atkins thought that as long as we ate
lots of fat and protein we’d burn more calories processing those types
of foods than if we ate carbohydrates. Thus, he reasoned, we could
eat more calories of some types of foods than others. Dr. Atkins was
probably correct that too many processed carbohydrates are not good
for the body, but he missed the point about the natural carbohydrates,
like fruits, vegetables, beans, and legumes, which are extremely impor-
tant to the health of our bodies. His theories also alarmed many in the
health care community because of his emphasis on eating saturated
fats and animal products. There’s no epidemiological research to show
that eating large amounts of saturated fats and animal products is safe
for the long term; there’s lots to show that it is dangerous. What good
is losing weight if your diet causes you to end up in the cardiac inten-
sive care unit or on dialysis?
THE ELVIS DIET: EAT ANYTHING YOU WANT, YOU’LL

PROBABLY DIE ON THE TOILET ANYWAY
As far as I’m concerned, a person should be able to eat any food he or
she has the desire to eat, but the person might want to restrict how much
of it he or she eats. Most weight-loss programs concentrate on the
“what” of food—-which foods you can and cannot eat. They don’t place
enough emphasis on the behavior of eating (limiting amounts) or mov-
ing your body to burn fuel. That’s the failure of diet plans. The vast ma-
jority of dieters fail because they have a mindset that all that matters to
weight loss is the type of food. There’s the myth.
Dr. Ornish (the low-fat guru) and Dr. Atkins (the low-carb guru) both
stated in their bestsellers that their diets are based on the way humans
evolved to eat. Dr. Ornish says that people used to eat mostly fruits,
vegetables, and grains but not meat. Dr. Atkins wrote that people used
to eat mostly veggies, fish, poultry, and meat but not grains. The truth is,
they both may have been correct; it depends on the ancient human you
ask. Go ahead, ask one.
In the very cold northern climates, historically humans didn’t have a
lot of vegetables growing out of the permafrost. They subsisted on fish
and whale blubber. In the tropics, people found wild fruit and green
leafy things to eat. One thing we do know is that cavemen weren’t eat-
ing goose liver spread or potato chips.
The Tutankhamun (“King Tut”) display came to a nearby museum. It

had a viscera coffin, which held mummified preserved internal organs.
It even contained the young Pharaoh’s preserved last meal of noodles—
Tutan-Ramen.
There is a lot of controversy about what constitutes a nutritionally

sound modern diet. One of the reasons is that it is hard to run experi-
ments in which humans eat only limited types of food for months or
years on end, unless it’s my son. If anyone ever wants to do an experi-
ment on a person subsisting on pizza and chicken fingers for more than
a decade, I have a ready-made volunteer.
I’M ON THE HELLO CARB DIET

Widespread carefully controlled experiments on large numbers of peo-
ple eating only certain food items have not been done. Our conclu-
sions on nutrition come from epidemiological research of populations.
This means that we look at what large groups of people tend to eat,
look at their overall health, and try to draw conclusions from this. Of
course, we can make the wrong conclusions, since we often assume that
the diet had something to do with the health outcome, whereas in fact
it may not have. We medical types think we know that the Mediterra-
nean diet is healthier because the people of that area of the world who
eat a lot of fresh fruit and vegetables, olive oil, lean meats, and limited
processed grains seem to do better. There are even theories about why
this is, related to protective naturally occurring chemicals in the oils
and plants ingested, but we don’t have hard scientific evidence in hu-
mans to back it up.
THAT NEW NUTRITIONIST UP THE STREET, DR. BURYME

Some of the reasons for the controversy in nutrition advice has to do
with the agenda and point of view of the adviser. This helps explain why
there are such dramatic differences among nutritionists, physicians,
and other health care workers when it comes to dietary advice. For in-
stance, according to a 2007 article in the Journal of the American College
of Clinical Nutrition, although a high-fat diet may actually promote
faster weight loss initially, it contributes to an increase of C-reactive
protein, a well-known marker for inflammation and cardiovascular
risk. If you are a cardiologist, this matters more than the rate of weight
loss. If you are someone like me, who sees a lot of people disabled by
stroke and heart disease, it matters a lot. If you are one of those pseu-
do-“nutritionists” working in a storefront weight-loss clinic and all
you care about is the quick result, you might advise someone to be on
a high-fat diet; you are not worrying about being around when your
patient has a stroke or heart attack.
Interestingly, the hard scientific evidence about nutrition in people
is really pretty lousy. That’s because nutrition is incredibly compli-
cated and foods are made up of thousands of various chemicals. That
doesn’t give us permission to throw our best guesses out the window.
I will say that the jury is far from done deliberating on the ideal type
of diet to follow. Since I have to make some decisions today that are
based on questionable and incomplete data, I do recommend that peo-
ple who are seeking sound weight loss eat lots of fruit and vegetables
and limit excessive salt, fat, and sugar. I believe in limiting processed
grains, also. This advice comes from my personal experience as a phy-
sician and the best synthesis of the medical data. It seems to work for
people all along the health spectrum and for all ages, from the elderly
to young children.
And, speaking of kids, I don’t understand why people name their chil-
dren after food. You just can’t take that person seriously. Take the name
Candy, for instance. What are parents thinking when they name their
kid Candy? What if Adam and Eve’s kids were named Candy and Cain?
People wouldn’t have read the rest of the Bible! I know a couple of Candys
who have important administrative positions, but you can’t help but
doubt their abilities. You might as well name your kid Flapjack. An-
nouncer’s voice, “And the winner of the Nobel Peace Prize—Flapjack
Jones.”
And speaking of flapjacks and other pancakes, I think more data

will emerge that show that processed grains (and perhaps most grains)
are not as healthy as the traditional or updated food pyramid leads us

to believe. Many modern versions of wheat, corn, and rice cultivated
for mass consumption are not nutrition-packed and may cause danger-
ous allergies. The priority in a healthy diet is to eat nutrition-packed
foods.
In the same vein, I believe that choosing foods on the basis of the
glycemic index misses the point. The glycemic index is the measure-
ment of blood sugar after a food is ingested. Often foods that are high
on the glycemic index are low in nutritional content, but not always.
I’m annoyed by authors who decry such wonderful foods as bananas,
sweet potatoes, carrots, and peas for being too high on the glycemic
index; they are all packed with important nutrients and have a place in a
nutritionally sound diet. One of the problems with the glycemic index
is that more recent research has shown it is not very accurate.2 The
measurement varies by as much as 20 percent, depending on the type
of blood drawn, the numbers of repetitions of the draw, and whether
and when the subject ate food or drank any alcohol previously.
On the other hand, for those with diabetes or who have gestational
diabetes, a low-glycemic-index diet has been shown to help avoid the
use of insulin.3 It may help diabetics avoid progression of cardiac dis-
ease, as well. But, the relationship between diet and disease was found
to be the same as if the person were on a high-fiber and whole-grain
diet. Finally, there is some meta-analysis data ( pooled research from
multiple studies) to show that a low-glycemic-index diet can help dia-
betics avoid other diseases, such as breast cancer and gallbladder dis-
ease. That makes sense —if you are a diabetic who eats foods that spike
your blood sugar, your body may not be able to defend itself against
illness. The bottom line: avoid processed grains, and you’ll do better.
ANCIENT CHINESE SAYING: MAY THE

WIND BE AT YOUR CRACK
Many people believe (wrongly) that healthy food is boring or unpalat-
able. The traditional Asian and Mediterranean diets are not unpalat-
able by any means, and they are both considered healthy. Ever been to
a Thai restaurant? The food is spicy, not bland. How about a real au-
thentic Italian place? There’s a spot near me that Tony Bennett (born
Anthony Dominick Benedetto) would eat at every time he came to
town. Supposedly, he claimed it reminded him of food like Momma
used to make. It’s real Mediterranean fare. The food at that restaurant
isn’t anything like Americanized Italian places, and it’s not boring
or unpalatable. It doesn’t go heavy on the pasta and bread, instead em-

phasizing vegetables, olive oils, and spices.
MY NEW VEGETARIAN COOKBOOK,

STOP AND EAT THE ROSES
I’ve noticed that a lot of Americans (and, unfortunately, some Ameri-
can restaurants) seem to think that health food consists of plain tofu
and steamed vegetables, which, I will admit, are boring. But, luckily,
there is a lot more variety to healthy and nutritional food items than
that. In fact, I’ve found that food unencumbered by the intense flavors
of salt, fat, and sugar is much more interesting, as the more subtle and
varied underlying tastes aren’t drowned out. The palate gets a better
workout and has more fun. You will, too.
Sometimes people use the phrase “Eat like a cave man” since we have
evolved to eat the foods our ancient ancestors ate, not modern pro-
cessed and packaged foods. I say, “Screw that; instead, eat like a cave
woman.” While Cave Man was out doing macho things, like clubbing
the heads of poor, helpless, little mammals, Cave Woman was scroung-
ing around in the dirt for berries, vegetables, nuts, and tubers. Cave
Woman had a healthier and more varied diet and less fur between her
teeth. And note: neither one was baking sweet rolls.
THE FLATULENCE DIET—LOSE WEIGHT AND FRIENDS

I have heard the complaint that healthier foods can be harder to digest.
That’s part of the beauty of a good diet— our bodies have to work to
digest it. The slower digestion results in slower emptying of the stom-
ach; thus, it fills faster during a meal, and you eat less. Also, the slower
digestion of a meal results in lower spikes in blood sugar and insulin,
which we know is healthier, as well. Make your stomach and intestines
work—that’s what we pay them to do!
Along those lines, I get complaints that healthy foods result in gas. Flatu-
lence is a favorite topic of mine. We didn’t spend a lot of time talking
about it in medical school, but we should have. In fact, given the inter-
est that the average patient has in avoiding gas, you’d think there would
be at least a semester spent on this topic. Two courses that should have
appeared on our transcripts at graduation: “Farts and Belches 101”and
“Write Indecipherably, Like a Doctor.” I would also have liked a course
called “Screaming Effectively at Insurance Executives.” That one I would
have passed with flying colors.
I EAT ONLY FREE-RANGE TOFU

Back to farting and belching: when a person starts eating foods his body
is not used to, it will sometimes fight back and complain. Fruits, veg-
etables, beans, and legumes are healthy and high in fiber. They are im-
portant to a balanced diet and to losing weight permanently. But they
can create gas. That is why it is important to introduce high-fiber foods
into the diet gradually, particularly if you are noticing that your fam-
ily and friends have started to choose seating on the other side of the
house at dinner time. Use Beano, a digestion aid that works for beans
and other foods, including cruciferous vegetables (broccoli and cau-
liflower). It may even help with soy products, tofu, lentils, and hum-
mus, some of my favorite gas-producing foods. Beans can be soaked
before cooking to reduce their gas-producing effects (throw the soak
water away).
THE FOUR GREAT CHOICES: MEMORIZE THESE.

THERE’S A TEST AT THE END!
There is a very simple way to decrease the number of calories you eat
every day and not even feel it. I call it “the four great choices.” Before
each meal, eat or drink one of the following: a glass of V8 or tomato
juice, a whole fruit, a bowl of thin soup, or a salad. It is such an impor-
tant concept, and it really works, so it is worth repeating and elaborat-
ing. There is significant research to show that this is one of the simplest
ways to eliminate calories painlessly. The reason is that each one of
those foods has been demonstrated to suppress the appetite and make
a person feel full more quickly. If you pick one of those four choices
before each of your meals every day, you will likely trim enough calo-
ries from your diet to lose weight painlessly without feeling hungry or
like you are “dieting.” And each one of these choices is very healthy
and packed with nutrition. Add in a daily walking or other moderate
exercise program that you enjoy, and you will have significant perma-
nent weight loss without pain, starvation, or feelings of self-neglect. I
like that. You should, too.
Tomato juice, unlike other fruit juices ( yes, tomato is technically a
fruit) is low in calories and is a great suppressor of appetite, without the
sugar high and rebound that other fruit juices give. One eight-ounce
glass of tomato juice or V8 (low-salt preferably) has about 50 calories
and likely will cause you to eat hundreds of calories less. They are also
packed in serving sizes that are convenient for work and travel. Bring a
six-pack to work with you, and keep them in your desk or in your car.
As if calorie-losing isn’t a good enough reason to drink them, tomato-
based juices are rich in nutrients and lycopene, a natural chemical
thought to be associated with health benefits ranging from eyesight
improvement to cancer prevention. Interestingly, the research seems
to point to the fact that lycopene in tomato products works for cancer
prevention but not when taken in pill form.4 Again, all the more reason
to choose healthy foods and drinks.
COLLEGE STUDENT’S BUMPER STICKER: PAID THE

TUITION—NOTHING LEFT FOR MY NUTRITION
If you would prefer a fruit other than tomato, you must eat it whole,
not in juice form, to get the calorie-decreasing benefit. This is a good
one to do first thing in the morning, at breakfast, before your oatmeal,
eggs, or low-fat cheese or meats. The reason orange, apple, and grape-
fruit juice won’t work but the whole fruit will has to do with the body’s
ability to process the pulp and fiber of the whole fruit. Whole fruit takes
a lot longer to get broken down in the stomach. Fruit juice is so full of
available natural sugar that, when dumped into the stomach, it slides
immediately into the intestine and the blood, creating a sugar rush
(and lower blood sugar and the rebound hunger later). There’s a rea-
son that, even today, in an emergency, health care workers and dia-
betics still use orange juice to get low blood sugar up quickly. Orange
juice is one of the fastest ways to give yourself a sugar high. Skip that
traditional glass of OJ with your breakfast. However, when an orange
is eaten whole, and especially when it is paired with a protein like tofu,
eggs, meat, or cheese, you won’t get that kind of rush. Vary your fruit so
that you don’t get bored, and grab the best fruit in season to keep your
wallet and your stomach happy. This will work with pears, bananas,
apples, or any other whole fruit.
And speaking of breakfast: humans find spirituality anywhere, particu-

larly Floridians. I was in Clearwater a number of years ago, and there
was a church set up in a car dealership’s parking lot. The Virgin Mary’s
image had appeared on an oil stain on one of the big glass windows of
that business. People came from miles around to pray to the Virgin and
to donate money, of course. The other morning, I found Richard Nixon’s
image on my French toast. It was a religious experience. I wonder how
much my old breakfast will sell for on eBay?
If it’s cold or if you just can’t bring yourself to do the fruit thing,
soup is a great alternative as a starter for meals. It’s best to use a thin
soup, not creamed or thickened, since they tend to be calorie or fat-
laden. To suppress the appetite, use chicken rice, vegetable, or tomato
soup or just a plain broth. Have a cup before sitting down to your meal;
you will notice a difference in how much you want to eat of everything
that follows. There is research to prove that the protein and vegeta-
bles combined with the fluids and broth in soups trigger the satiation
signals early in the meal.
I used to be a vegetarian, which is a difficult thing in the South, where

they throw ham in everything, including the vegetables and even the
dessert. Yes, last week I went to a party where they served ham apple pie
(I’m not kidding). When you go to a restaurant, you never see ham soup
on the menu because every soup is ham soup, including the vegetable
soup. There’s ham in the damn chicken soup.
Last time I was in a restaurant eating French onion soup, it dawned on
me that there’s no polite way to eat all that stringy, half-melted cheese
on the top. Is it more correct to wrap it around your fingers or your
eating partner? I realized that Spider Man’s secret to web-slinging was
probably French onion soup.
IS CHICKEN SALAD FULLY DEVELOPED EGG SALAD?

Finally, my old stand-by is still one of the best. I love a salad before or
instead of my meal. You don’t even have to make it very big, if it’s just
the first course, but make certain you eat it all before you eat anything
else. The salad takes work for you to chew and for your stomach to
grind up, giving your body time to decrease its hunger signals. Also,
the volume in salad, particularly of the greens, helps the stretch recep-
tors in the stomach to work with fewer total calories in a meal. It’s
very important that your salad be based on dark green lettuce and not
be covered with a calorie-laden dressing or snuggled up to a mound of
mayonnaise-based creatures like potato or pasta salads. I’m astounded
how often I see overweight people eating “salad,” which they think
will help them lose weight and which they’ve drowned in a high-calorie
dressing or that’s accompanied by some god-awful mushy lump that
was once identified as a food item. I’ve always found those mayo-laden
dishes to be true misnomers. In my mind, a salad should be something
fresh, crunchy, and good for you. If it can’t sit in your garden for the
afternoon without spoiling, it shouldn’t be called “salad.”
Tuna Fish Haiku

I Live in a Can
Some Day I’ll Be a Sandwich
I Hate Mayonnaise.
FAVORITE VEGETARIAN RESTAURANT—THE

INTERNATIONAL HOUSE OF SPINACH
I have a wealth of salad hints to make a vegetable-based diet more ap-
pealing. Variety and quality do matter. I’ve found that when I talk
to people about how much they hate salad, it often has to do with the
fact that they have one simple recipe for it and have never varied it in
40 years. I, too, was scared by a head of iceberg lettuce as a child. If you
are still using iceberg lettuce and light-colored mass-market tomatoes
as the basis to your salad, then go ahead and hate it, since that type of
salad deserves to be hated! Iceberg lettuce has almost no taste or nutri-
tion. Go for the dark greens, and experiment with the variety you can
find in the supermarket or at the produce stand. I’m a big spinach and
baby leaf lettuce fan, but I love to experiment. Use bagged, prewashed
lettuce to speed up the process and those lovely little sweet grape toma-
toes to avoid chopping.
MAD COW DISEASE HAS A VEGETARIAN

EQUIVALENT—DISTRAUGHT ARTICHOKE DISEASE
If your life is stressful and harried, use pre-cut items like broccoli and
cauliflower. Throw on baby carrots, shelled edamame, nuts, raisins,
cranberries, and sliced mandarin oranges or grapes to limit cutting time
and increase the interest of the salad. Leave the skins on the cucum-
bers; it increases nutrition and fiber and simplifies preparation. Chop
green beans into one- to two-inch lengths, and cut up fruit like pears or
peaches to throw in. Add seeds, beans, or chickpeas on top. To be dif-
ferent, don’t even bother with dressing; top with salsa, green Tabasco
sauce, slices of sweet banana peppers or jalapeño peppers, hummus,
or guacamole. These will decrease the calories and increase the nutrition
and vary the flavors. Always use the freshest ingredients and bright
colors to attract the eye, nose, and mouth. Avoid high-calorie top-
pings like croutons and fried noodles or high-fat or high-sugar dress-
ings. Experiment with dressings that you’ll look forward to using (we’ve
found some that I even mail-order, they are so special, healthy, and
low-calorie).
THE WASTE-REDUCING DIET

Use fruit and vegetable life extenders like special bags or drawer in-
serts to decrease your waste and costs. Wash everything carefully to
decrease pesticides, particularly in the nonorganics. You can wash away
about 80 percent of the pesticides remaining on produce with good
technique if you can’t afford organics. Products from produce markets
and roadside stands can be quick to prepare and much fresher and
cheaper than those in the supermarkets. Look for in-season produce
and local supplies for the best taste and cost. Learn how to pick the best
produce by asking questions of knowledgeable people, be they family,
friends, or the produce guy, so you get the best taste for your money.
Experiment with new fruits and vegetables that you’ve never had be-
fore and with new ways to serve them. (My friend told me he doesn’t
like anchovies on his pizza because he doesn’t like the leaves. Hello,
friend, let me introduce you to Mr. Artichoke.)
Experiment with steaming, roasting, and stir-frying, and use lots of
different healthy sauces, dips, mixes, and seasonings to give your veg-
gies acceptable flavor for you. Search the Internet for new ways to pre-
pare them and for new flavors to add; don’t accept boring as part of
the vegetable mantra. And, by the way, frozen vegetables are almost
as good as fresh, in terms of the nutrition, if you don’t have access to
fresh.
Good eating doesn’t have to be complicated. If you just want a
steamed plate of a simple vegetable instead of salad before your meal
(or something raw and crunchy), that’s fine. Just avoid the butter,
salt, and not-so-good toppings that will negate the positive choice that
you’ve made.
I HAD A PATIENT AT THE NURSING HOME WHO

SWALLOWED HIS DENTURES WHOLE;
NOW HE DOESN’T HAVE TO CHEW
Finally, if you are not “good” at eating whole fruits and vegetables, at
least drink them in the form of vegetable and tomato juices or smoothies.
My son, the kid who eats only a few foods, avoids malnutrition with
twice-a-day smoothies full of mixtures of frozen fruit.
Watermelons are called that because they are round and full of water.
Humans are round and full of water, so why aren’t we called water-
melons?
Many people do not realize how important fruit is to skin, immune-

system, and bowel function. I often hear women in particular tell me
how they avoid fruit, thinking it is high in calories, when it is not. Fruit
is very high in important nutrients, antioxidants, and natural protec-
tive chemicals. I’m very irritated with the many diet books that tell
readers to cut out all fruit for a certain phase of the diet or altogether.
There is no good medical research to prove that cutting out whole fruit
from a normal diet is ever healthy; the more types and colors of fruit,
the better. Try to vary the colors of the fruits, since the colors are a hint
to the types of phytochemicals (natural plant substances) they con-
tain, and presumably the more types, the better.
If you aren’t a fruit lover, find some way to make yourself love them.
Freeze the fruit and eat it as dessert, plain as a substitute for ice cream
or mixed with a small amount of low-fat sour cream. Add fruit to cere-
als or plain yogurt, or top it with a little bit of granola.
IT WAS THREE BELOW ZERO IN MONTANA

TODAY—THEY KEEP THEIR MEAT IN THE
FREEZER WHILE IT’S STILL ALIVE
Perhaps the most important point in all of this is to automatically cut
portions at each meal for the processed starches and meat (or poultry)
dish and to increase the portions of vegetables and fruit that you are
eating. If your dish is at least half full with vegetables and fruit, then
you are well on your way to a healthier, slimmer waistline.
The exception to the rule about limiting your entrée size is when you eat
fish. You shouldn’t eat more than about a deck-of-cards-size amount of
meat, pork, or poultry. But the research has not shown that we need to
limit how much fish we eat. Certainly, bears don’t do that. When I was
up in Alaska, I saw a salmon hatchery. When salmon swim upstream,
they make huge leaps into the air, sometimes right into a grizzly bear’s
mouth. I bet the salmon feel pretty stupid when they do that. Their last
thoughts: “Hey, I guess I should have paid more attention in school.”
EAT ONLY ONE FOOD, BE IT SUGAR

APPLES OR SUGAR GLIDERS
There is an ongoing debate raging about what is better for weight loss,
eating a monotonous diet or eating a variety of foods. To me, there is
an easy answer: it depends on how long you want to lose the weight. If
you need a short-term fix, the monotonous diet is the way to go; that’s
why there are so many of those one-food (cabbage) or one-category
(protein) diets. In the short term, life is simpler if all you are eating is soy
bars or soy beans. However, in the long run, your body is healthier with
the diet that is varied. And the restricted diets inevitably fail in the long
run; people almost always gain the weight right back when they loosen
their restrictions. That dieter has not learned permanent life lessons.
If you believe that your life will be simpler and less stressed and you’ll
eat fewer calories on a restricted diet, then perhaps that will work for
you in the short term, but it won’t help you in the big picture. Everyone
must learn to eat a varied diet with moderation; eventually, you will
be exposed to real food situations and will have to learn to eat in the
real world.
My cousin claims he keeps thin by eating a monotonous diet. Like one

day he had only a bagel and six cups of coffee. I would eat less on that diet
because I wouldn’t be able to stop vibrating long enough to open the
refrigerator.
THE PASSION OF THE RICE DIET

Some people are comfortable only with limited familiar foods. My son
eats the same foods every day and likes it. He despises anything else.
His response to new foods is, “Okay, if you force me to.” But if you are
like most people and crave variety and adventure during your meals, a
restricted diet is equivalent to deprivation.
A varied diet comes with precautions, as more variety tempts most
people to increase calories consumed. That’s why buffet restaurants are
so damaging to the person trying to practice moderation in calorie in-
take. By all means, if you are feeling deprived, please aim for variety in
your food consumption, and never restrict yourself in types of food. Be
honest with yourself about whether the increased variety is helping you
move toward your goals. You will need to watch your fuel consumption
with a little more enthusiasm, but, in the long term, you will be more suc-
cessful and healthier. Limiting what you eat of the good-for-you foods
will result in malnutrition. It will also result in boredom, and where is
the joy in that?
A true caution: Dr. Rena Wing, a professor at Brown University and
the creator of the National Weight Control Registry, notes that most
long-term losers of large amounts of weight do tend to eat an unvaried
diet, more restricted than the diets of people who recently lost weight.
They found from their own personal experimentation what works for
them and the limited diet keeps their weight from ballooning back up-
ward. My concern with that approach is the extent of malnutrition that
I see in the obese and the previously obese. Our bodies don’t make
certain amino acids necessary for enzymatic processes and rebuilding
tissue (like muscle and skin), and we need to get certain vitamins and min-
erals from our food that we can’t generate ourselves.
The best approach is to give yourself unlimited variety of the good
food choices but to limit your opportunities for eating the not-so-good
food choices. In other words, spend your time at the produce stands
and the fruit section of the supermarket, and don’t even head down
the snack and bakery aisles. Use what you now know to your advan-
tage, and modify your behavior accordingly. That way you will be suc-
cessful, and healthy, without feeling deprived.
Some animals naturally eat only one food. Scientists discovered an un-
dersea worm that feeds exclusively on deceased whale bones at the bot-
tom of the ocean. The give-away to the new discovery was the little sign
that said “Eat at Willy’s.”
The reason the monotonous diet plans are so popular for quick
weight loss has to do with sensitization. In a monotonous diet, we be-
come desensitized to the interesting taste of most foods and we desire
less of them. Essentially, we bore ourselves into weight loss. However,
it doesn’t always work for comfort foods and high-calorie sweets. Our
taste buds don’t get bored with them. I can personally attest to that.
When I was 19, after my freshman year in college, I had the Job of My
Dreams: I worked in a hand-made chocolates store. Although I earned
only minimum wage, I was allowed to eat any of the store’s products to
my heart’s content. For three months, I ate exquisite hand-made choc-
olates all day, every day, and never got bored with it. I still daydream
about that job when I’m having a particularly bad day at the hospital.
Really.
SUCCULENT BROCCOLI DONUT

I advocate eating lots of variety but smaller amounts of the not-so-good
choices. This will lead to more pleasure. When you limit your variety
or deprive yourself of the foods that you want, you may find that you
gorge yourself on the foods that you are permitting (although I doubt
anybody pigs out on broccoli donuts). There is only so much enjoy-
ment in eating the entire bag of rice cakes. Don’t get pleasure from
engorgement; get it from taste, and texture. Never restrain your food
choices; limit only the amounts. I still eat chocolate donuts, just
on rare occasions. It’s a special treat then, and fully enjoyed, without
any guilt.
YOU NEVER SEE A SALAD-EATING CONTEST

One of the funny things about healthier food is that people make as-
sumptions about it. If you label a food as “healthy,” people will auto-
matically give it a lower score in taste-testing but will tend to eat more
of it. They think that they can consume more calories without the guilt.
According to the Nutrition Action Newsletter, put out by the Center for
Science in the Public Interest, you can eat all you want of whole fruits
and vegetables. They are essentially “free foods.” For anything else
(even if it’s labeled “healthy”), you have to limit the quantities.
Which brings me to my final point for the chapter—healthy snacking.
If you eat fruit or veggies as a snack, you are free to move about the
refrigerator. Stick to the “four great choices” I mentioned earlier as a
between-meal snack, such as a can of tomato juice or a cup of instant
soup, and you are okay, too. Or bring a bag of baby carrots and salsa to
work for munching, or small individual bags of spiced or lightly salted
nuts; an ounce of low-fat cheese or a cup of all-natural yogurt is great.
Have a bottle of iced green tea if you feel like you need the buzz of caf-
feine for a boost at work or home. Mild caffeine is certainly a better al-
ternative than a candy bar when you are feeling an energy dip. If you
need the oral stimulation of something crunchy, go for the apple or
pear or celery sticks (I eat them with hummus dip) instead of the po-
tato chips.
Wherever you are, always have good food snacks handy so that you
don’t allow yourself to get too hungry and you aren’t tempted by the
availability of the not-so-good foods. This makes the vending ma-
chines, chips in the pantry, and the donut tray in the break room less in-
viting. It’s okay to dive into your own personal snack bag when you
need it; just make a habit of going there first, rather than in the direction
of the not-so-good foods.

• Understanding nutrition helps you to eat healthier and to lose weight.
• Calories are a measure of fuel and come from protein, fats, and
carbohydrates.
• We need all three types of fuel for our bodies to function properly;
don’t restrict any type.
• Overindulging in any of the three results in increased fat tissue in
the body.
• Don’t be perfect, but aim to eat food that is mostly good for you, and
have a good relationship with what you eat.
• You should eat a diet based on fruits and vegetables, less on every-
thing else.
• There is so much confusion in nutritional advice because foods are
complex.
• Healthy food is as tasty as the nasty stuff and makes your body feel
better.
• High-fiber and healthier foods can be harder to digest, for good
reason. Increase them slowly, and find ways to make eating them
comfortable.
• Start every meal with one of the “four great choices”: tomato juice, a
whole fruit, a cup of thin soup, or a salad. This will decrease hunger
and increase nutrition.
• There is no excuse for a boring salad or vegetable dish.
• You can, and should, eat as much fresh or frozen fruit as you want.
• Cut the processed starches and meat/ poultry part of each meal, and
fill up more of your plate with produce.
• Monotonous (one-food or restricted diets) are popular for quick
weight loss because they bore you into weight loss. For most people,
they don’t work in the long run, and they are dangerous to health.
• Always have healthy snacks at hand so you don’t resort to not-so-
good-choices.
SEVEN
Put the Muffin Down and
Slowly Back Away: What
Are Not-So-Good Foods?
You have to watch the food labels carefully. In New York, there’s a
food company that sells something that they label as “real vegetarian
liver.” Now, I don’t pretend to be a vegetable anatomist, but I’m fairly
certain that there aren’t ANY vegetables that grow livers.
Our bodies want good nutrition. Often our bodies will tell us when we
are not eating correctly or if we are lacking in a certain important min-
eral or vitamin. However, we might not know how to correct the prob-
lem. Strangely, though, in many cases our bodies might not even give us
a hint. As mentioned in chapter 5, it is not uncommon for people, both
children and adults, who are nutritionally deprived to eat nonfood items
like paper or paint chips in the subconscious search for the nutrient their
bodies are missing. Don’t send your body down the wrong path looking
for poor food substitutes because you haven’t fed it the right foods. I be-
lieve a well-balanced nutritionally sound diet will help you avoid many
cravings for junk foods, not just paint chips. If you judiciously spend
your calories on proper food, your spouse won’t need to restrain you
from a late-night run to Dairy Queen or find you chowing down on the
morning paper.
Listen to your body; it will often give you clues to nasty food and
drink. If you are nauseous or have an upset stomach after eating some-
thing, that’s an important hint. Perhaps the food was bad, as in old and
stinky, or perhaps it wasn’t meant to be ingested by you. Your body will
feel better when it eats food that energizes it.
THAT WHICH DOESN’T KILL YOU MAKES

YOU WISH YOU WERE DEAD
It seems that animals know what to do when they are not feeling well,
when they eat something that doesn’t agree with them. First of all, they
learn to avoid eating it again. Scientists have done rat studies that show
that if you give a rat a food that makes it sick to its stomach, it will never
eat that food again. Why don’t people learn that? We’ll keep eating the
junk because somehow we’ve learned to ignore those signals. But they
are there; you can become more attuned to them.
Animals are pre-programmed with cures for bad food that results in an
upset stomach. People, unfortunately, are clueless. Dogs know to eat grass
if their stomach gets upset. Why don’t humans do stuff like that? If we’re
the top of the evolutionary ladder, we should inherently know these sim-
ple cures. Wouldn’t it be cool if a guy is at work and he says to his buddy,
“Man, my stomach is upset from this hangover. Hey, Joe, watch my monitor
for a second. I’ve got to go outside and eat some grass”? Even NASA ought
to get in on stuff like that. Space crews should take a patch of sod with them
on every mission. Hey, space dude, don’t forget the fork—and a putter.
In general, the simpler the ingredient label, the better, as the food is
less likely to have chemicals you don’t want. However, if the list looks
like “fat, sugar, salt,” that food item probably isn’t good for you, either.
(The label is required by law to rank ingredients in order, with the main
ingredient first and the rest in descending order according to quantity.)
I was eating salad with low-cal dressing, and I made the mistake of read-
ing the label. It had a list of ingredients too numerous to count, the last
one being titanium dioxide. Which means, I guess, if I eat enough of it,
I’ll have buns of steel.
Put the Muffin Down and Slowly Back Away 127
Fats have gotten a bad rap. I think it has to do with the word. People
have come to believe that you get fat by eating fat. The truth is you get
fat by eating too much and not moving. Fats are not the only culprit, but
they’ve certainly taken their hits by health professionals and the media.
Don’t eliminate fats, but choose them wisely and you can leave your fat
buttocks behind.
THAT NEW BREAKFAST FOOD, PIGS IN AN ARTERY

Trans fats are mostly a modern invention. They are found in food natu-
rally only in trace amounts, but they are found in restaurants, ice creams,
puddings, prepared foods, and baked goods in larger amounts. There
has been evidence to show that trans fats promote cardiovascular disease
and are not known to be beneficial to the body. Avoid them.
Many of us are more familiar with saturated fats. That’s what my
grandmother and mom used to cook with when I was growing up. They
used butter, lard, and animal fat liberally. I never knew my grandfather;
he keeled over of a massive heart attack in middle age. I suspect it was at
least partially because of his diet.
WHY WAS POPEYE’S GIRLFRIEND NAMED OLIVE

OIL—WAS IT BECAUSE SHE WAS EXTRA VIRGIN?
The good fats are believed to be the ones that are less saturated and are
made from nonanimal fats. That means you should cook with olive or
vegetable oil or use products made from them. Margarine got labeled
as “evil” for a while, but that was before they started making margarine
out of canola oil (a vegetable oil). One of the concerns that nutrition-
ists have had is that people try to avoid all fats and end up substituting
more simple carbohydrates for their calories. The result is that they make
themselves fatter and sicker. Thus, you need to make certain that you get
the good fats.
The easiest way to do this is to add canola oil margarine to your bread
or to add olive or vegetable oils to your salad (as part of your dressing).
Use these oils to sauté vegetables and add them to your recipes. Just
don’t re-use cooking oil; that’s when you start to get a breakdown of the
chemicals, resulting in those dangerous trans fats. (That’s why you get
trans fats in restaurant food—restaurants use the same oil over and over
and over again—yuck!) Eat unsalted nuts and seeds, and throw them
into your salads. Fish oils are great fats, too, especially from salmon and
sardines.
WHICH IS A BIGGER ISSUE, WINGS-WISE, THE MILLIONS

OF AMPUTEE CHICKENS OR ALL THOSE FLYING BUFFALO?
One of the things that many people don’t realize about animal fats is that
they, too, are mostly a modern invention. Traditionally, when humans
hunted wild animals and birds, they didn’t eat a lot of fat. That’s because
true game creatures aren’t very fatty. They are not penned up, they have
very strong muscles from flying, running, and escaping predators, and
they are in much better shape than their modern food-item equivalents.
(There’s something strange about modern man making our food as lazy
and out of shape as our own damn selves.)
To be healthy, trim the fat from your animal diet. Use whole cuts of
poultry, pork, or meat, and trim off as much fat as possible. When you
use ground meat, select the highest quality (least fat). Prepared foods like
hamburgers, hot dogs, and sausage have the animal fat mixed in and will
coat your arteries faster.
Did you ever wonder why, when you eat an animal, it gets a different
name, like cow becomes beef and pig becomes pork? Deer is suddenly
called venison, but chicken is still chicken. It should be called something
like shlemiel. “Here, have some grilled shlemiel.”
HUMANS, THE OTHER WHITE MEAT

The truth is, it’s best to eliminate meat, particularly red meat, from your
diet as much as you can. Studies have shown that you cut your risk of
dying from heart disease and cancer by about a third over 10 years just
by eliminating most red meat from your diet. And young women who
eat a lot of red meat increase their risk of early breast cancer. By the way,
the government classifies pork as a red meat, no matter what the adver-
tising tells you.
Just as with other foods, the more processed and packaged the meat
product, the more likely it will give you trouble. Research has demon-
strated a link between eating sausage, bacon, ham, hot dogs, and deli
meats and the development of diabetes.1 No study has yet been done to
determine whether poultry versions of those (for example, turkey sau-
sage) are any safer.
There is research that shows that on our planet, cow belching and fart-
ing are among the biggest producers of that highly volatile gas, meth-
ane (a major cause of global warming). Using that knowledge, I have a
new idea that would solve two major international problems at once. The
next time there’s a mad-cow outbreak, instead of slaughtering all those
innocent bovines, pack them up and send them to the war zone du jour.
Then simply use the methane that the cows produce as a new weapon—
moooo—BOOM!
The controversy about meat sometimes centers on getting enough

protein in our diets. Most people use beef, pork, and poultry to get ad-
equate levels of protein. High-protein diets (for example, Atkins) got a
bad reputation because of the concern that they could damage kidneys.
We’re not certain that they can in perfectly healthy people, but a high-
protein diet definitely can cause damage in those with kidney problems.
Why should that concern you? Because more than 13 percent of Ameri-
cans now have kidney disease, and the vast majority of them don’t know
it! And here’s the real kicker: being overweight is the number one cause
of diabetes, and diabetes is the number one cause of kidney disease. So
if you are obese, you might not have the healthy kidneys that you think
you do. Don’t stress them needlessly.
LIVING LARD
I’ve got some really good medical research to back me about the relation-
ship between high-protein diets and kidney disease. The Nurses’ Health
Study from the Harvard Medical School looked at 1,600 middle-aged
women with mild kidney disease.2 Those who ate the most protein faced
a risk of losing kidney function that was 350 percent greater than the risk
of those who ate the least amount of protein. (If you lose enough kidney
function, you end up on dialysis or a transplant waiting list.)
The Third National Health and Nutrition Examination Survey, done
at Stanford University, looked at both men and women ages 20 to 80,
a much broader population. What they found is that those who ate the
most protein didn’t necessarily develop more kidney disease, unless they
also had hypertension and diabetes.3 Since overweight people are the
most likely to have those diseases, it may very well be dangerous to you
to eat large amounts of protein.
Are you still with me? This is where the data get more interesting.
When the authors of Harvard’s Nurses’ Study looked at what types of
protein were being eaten, they could find a correlation only between pro-
gressive kidney damage and animal flesh protein, not vegetable or dairy
protein.4
Fancy restaurants in our Western culture tend to promote an animal

protein diet. Last cruise I went on, the food was so bad I was convinced
the dinner entrée was whatever birds happened to land in the ship’s
smokestack. I swear our server said, “ Tonight’s special, Cornish puffin.”
Why does protein matter to you? Because people who are cutting
calories to lose weight tend to cut calories uniformly, resulting in pro-
tein malnutrition. Your body needs as much protein now as it did when
you were younger, to build muscle and keep body processes flowing.
In fact, chronic dieters (and the elderly) are some of the most protein-
malnourished people in the developed world. If your body doesn’t get
enough protein from your food, it resorts to breaking down its own mus-
cles to continue body functions. Thus, if you don’t eat enough protein,
you’ll actually cause muscle wasting and weakness, which is the last thing
you want! But, unfortunately, an animal-protein diet might promote a
three-day-a-week schedule on dialysis. Luckily, there just might be a
solution.
THE CHICKEN WAS ON SALE; I GOT IT IN

THE NATURAL CAUSES SECTION
Make the effort to substitute beans, nuts, seeds, soy nuts, tofu, and non-
animal protein sources as often as you can for your meats and poultry
dishes (again, watch the nuts on quantity, since they are calorie-dense).
Put a small amount of the meat, pork, or poultry on top of a bed of let-
tuce or a crunchy salad, and add fruit or melon to the platter. There’s
your whole meal—it’s as fast and simple as that. (Note, there’s no need
for white rice or potato, bread or starch.) You’ll be completely full, with-
out any effort, and no starving later. Or, use small amounts of dairy, in
the low-fat version, such as cottage cheese, hard cheeses, yogurt, or milk,
instead of eating animal flesh. Just watch out for the fruit yogurts, which
can have up to five teaspoons of added sugar in each cup or added chem-
ical sugar substitutes. Get the plain or natural versions, and add your
own fresh or frozen fruit—it’ll taste much better that way.
I wish nutrition labels were easier to understand. Shouldn’t food labeling

be simpler, such as “Nutrition Facts: none” or “Nutrition Facts: don’t eat
this”? Why do we have to be registered dietitians to understand them?
It’s really very simple: just don’t eat any food with a mattress tag on it.
Sugar is another area that’s gotten a bad reputation. Our bodies natu-
rally crave sugar and are programmed to want and eat it, even if we can’t
taste it! A study published by Duke University in 2008 looked at mice
that had been genetically altered to be unable to taste or smell sweets.5
Yet, when those mice were given real sugar water, their brains responded
with a burst of the neurotransmitter dopamine, the same chemical that is
released in the brains of addicts when they get their favorite drug. When
presented with an artificial sweetener, sucralose, in the water, the mice’s
brains didn’t respond. This means that the brain centers that are involved
in reward and pleasure respond to both calories and sugar separately,
whether the sugar is tasted or not.
What’s interesting about the study is that the normal animals that
could taste the sucralose artificial sweetener also had a brain surge of
chemicals in their pleasure centers of their brains, even without the calo-
ries. Both types of animals wanted more of the sugar-type taste (when
they could taste it) and wanted the calories (when their bodies had time
to register the calories). This has many implications, the most obvious of
which is that sugar taste (real or artificial) may drive people to want to
eat or drink more calories. It may explain why drinking diet sodas and
eating artificial sweeteners does not result in weight loss.
1774 WAS THE FIRST CONTINENTAL CONGRESS,

FOLLOWED BY THE FIRST CONTINENTAL BREAKFAST
There’s been a lot of bad press about high-fructose corn syrup, which
is just a combination of fructose and glucose, made from corn starch.
Fructose and glucose are two normal sugars that naturally occur. The
combination, as far as we know, is not any more dangerous than table
sugar. But it is a problem because it is sugar, and we eat too much

of it. Since 1970, Americans have increased their intake of all calorie-
containing sweeteners by almost 50 percent. But because high-fructose
corn syrup is cheaper to produce than regular sugar, the food industry
has been using it more and more; the use has more than quintupled in
the past 30 years. And those food companies have noticed that we like
the taste. Foods from health cereals to spaghetti sauces to breads to salad
dressings have it. Even foods like crackers and baked beans have it. I find
this hard to believe, but the per capita consumption of sugary soft drinks
is around 50 gallons a year! (Since I don’t drink any, someone out there is
practically floating away on a liquidy sugar high on my ration.) What’s
scary about that is the highly positive correlation between the consump-
tion of processed food and drink sweeteners and the obesity epidemic.
A study by drug manufacturers of a new diabetes medicine has been

stopped a year early because too many people were dying. Apparently the
sugar pills really were full of sugar.
The natural sweet taste in fruits and vegetables is also made up of

fructose and glucose, but in lower levels than in processed foods, and
is thought to be acceptable. According to the research on diabetes and
nutrition, there doesn’t appear to be the same problem with whole pro-
duce with spikes of blood sugar or a higher risk of developing chronic
illness that there is with processed foods or even fruit juice. Harvard’s
Nurses’ Health Study looked at exactly that question in an article pub-
lished recently in the journal Diabetes Care.6 The study followed more
than 70,000 women over 18 years and noted that those women who ate
higher quantities of whole fruits and vegetables were less likely to get dia-
betes. Those who drank fruit juice were more likely to get it.
BETTER THAN DEEP-FRIED COTTON CANDY

I talk to patients all the time about improving their diet by eating more
fruits and vegetables, particularly fruits, because we all like sweet tastes.
I’m astounded by how little whole fruit people actually eat, instead sub-
stituting fruit juices or canned, syrupy fruit for the real thing, the whole
product. The syrupy canned product is more likely to have additives and
preservatives and is not as safe to eat as a simple whole fruit. You like
sweets? So do I. Get them naturally, and your body will thank you, for
a lifetime.
All right, I’m willing to admit it; “natural” does not necessarily mean that
something is good for you. The black plague is all natural, and so are
cobra venom and pond muck—mmmm, want some?
I eat frozen fruit frequently, pretty much daily, since I make my son’s
smoothies from frozen fruit. I usually sneak some of the fruit, popping
the pieces directly in my mouth while I’m preparing the smoothies. It
gives the same yummy brain chemical rush as any other sweet dessert,
without the guilt. Buy big bags of your favorite fruits already frozen, and
prepare bowls whenever you want. A cup of frozen blueberries has about
80 calories and is a to-die-for delight. Peel bananas and throw them in
bags in the freezer, then microwave them briefly and munch on down. It’s
so much cheaper and healthier than any other dessert, and you can eat
it all day long! Fantasizing about eating three scoops of rich ice cream?
Eat a huge bowl of frozen blueberries, strawberries, and cut-up bananas.
Top it with a little bit of chocolate syrup and chopped nuts, and you have
the best-tasting sundae on the planet. (Better yet, drizzle the chocolate
syrup on your significant other and eat the fruit off him or her. Just give
a warning before you do it. Oh, and don’t use frozen fruit or you’ll be
facing shriveled, unhappy parts and an unhappier partner.)
Medical researchers have explored the headache that you get from ice
cream, better known as “ brain freeze.” It turns out that it runs in fami-
lies; if your parents suffer from it, you are likely to get it, as well. (Which
brings up the delicate subject of genetic counseling.) There is another
term for brain freeze; it’s called video games. As in when my son’s mouth
is going at 100 miles an hour: “ Here kid, have this video game control-
ler.” Ta daa, instant brain freeze.
Dried fruit isn’t as good as whole fresh or frozen fruit because you
are missing the water, which is what’s so helpful. Eat grapes instead of
raisins, plums instead of prunes, and give the kids cut-up cantaloupe in-
stead of fruit roll-ups. Sugar is everywhere, and it’s something that we
naturally crave. Eat it with gusto, just the way nature gave it to us, in the
purest form. Enjoy!
SUGAR-ENCRUSTED BLACK HOLES AND OTHER

INTERSTELLAR TEMPTATIONS
Sugar really is everywhere, even in places you don’t expect it. According
to the National Radio Astronomy Observatory, an eight-atom sugar mol-
ecule has been found in an interstellar gas cloud near the center of our
celestial Milky Way. The Mars confectionery company may have been
onto something when it named its candy bar the Milky Way.
USE IT WITH A GRAIN OF SALT

Salt has been highly valued for thousands of years. It was the first
preservative, improving humanity’s ability to store food for the fu-
ture. It has been a major cause of international trade and bloody wars.
Salt is a food delight, and our bodies crave and need it, in small doses.
But it is definitively associated with high blood pressure and cardiac
disease, the number one killer in Western society. The simplest way
to eliminate excess salt from the diet is to limit restaurant food and
processed, prepared, and canned food. When you use canned and
prepared foods, choose the low-salt variety. Realize that not all salty-
tasting foods are high in salt; they might just have a coating of salt on
the outside (for instance, popcorn). Also understand that some high-
salt content foods don’t taste salty (like cottage cheese) since the salt
is buried inside. It behooves you to take a quick read of the sodium
content on the labels.
Everyone should cut back, even if you don’t have hypertension or
heart disease. There’s now evidence that the high salt content of a West-
ern diet may result in diseases ranging from osteoporosis (brittle bones)
to stomach cancer and, yes, even diabetes. The best alternative to salting
foods is to use other spices, peppers, lemon, or lime. Take the salt shaker
off the table and out of your life. As you move your diet toward eating
more fresh fruits, vegetables, and unprocessed items and less of the nasty
stuff, the salt drops away.
IT’S GOOD ENOUGH TO DIE FROM

Speaking of nasty stuff, MSG (monosodium glutamate) is a “flavor en-
hancer” found in many products at home and commonly in restaurant
food. It works to enhance flavor by screwing with your taste buds and, in
some people, with brain chemistry. Personally, my brain chemistry can’t
take any more screwing up. I avoid it.
Other additives, like artificial sweeteners such as aspartame, acesul-
fame potassium, and saccharin, may be linked to cancers. How about
artificial colorings? Many of them, from Blue 2 to Yellow 6, are known
to increase cancer risk, but they are still on the shelves in your local su-
permarket.7 On the other hand, naturally colored foods from plants are
cancer protective. Go to my Web site, doctorRcomedy.com, for more
information about the latest research on all of this.
Chinese food factories have been caught putting all sorts of nonedible
contributions into their products: chemicals, plastics, parts of animals we
don’t want to eat. Perhaps they thought that when we name our product
Bob Evans, we mean it. As in, “Oh, look, there’s Bob now.” Their motto
could be “We stand in each and every one of our products.”
A BUN PAIN REALLY MEANS A PAIN IN THE ASS

Whole grains will help you permanently lose weight and lower your risk
of heart disease, cancer, and diabetes, but what is a “whole” grain? It’s
the seed of a cereal plant like barley, wheat, rye, rice, corn, or oats that
hasn’t been pulverized and had the nutritional content removed by pro-
cessing. When you look for whole-grain products such as bread and
cereal, the label “whole” should appear in the first (and usually the sec-
ond) ingredients. Except for oats, which are assumed to be whole grain,
most others won’t be, unless it specifically says otherwise on the ingredi-
ents label. Unfortunately, the food industry gets liberal use of that word
“whole” on the front of a box or carton and will tell you something is
“whole grain” when most of it is not. That’s why turning the box around
and reading the true ingredients label is worth the effort.
The reason whole grains help with weight loss is that they hold water,
and processed grains (often called refined grains) do not. Notice that
theme again of increased water content in food? When the water is mixed
into the food item, you feel full on fewer calories, and you never starve.
Traditional breakfast cereals, pizzas, bagels, breads, pastries, cookies,
cakes, pies, crackers, chips, and pretzels are usually made from refined
grains, and that’s why they have a bigger calorie load and won’t satisfy
the appetite. White rice is stripped of its nutrition; brown rice is fiber-,
vitamin-, and mineral-rich. Unprocessed oatmeal is a whole grain and
absorbs a bunch of water, and it’s heavy in the stomach. Eat a big bowl
of steaming fresh-cooked old-fashioned oatmeal (about 300 calories in
a double serving) and you’ll be full for hours. Eat too many take-out
muffins from a typical chain bakery shop (about 600 calories each), and
you’ll still be hungry while you’re waggling your tush right into the emer-
gency room.
I LOVE THAT ICE CREAM FLAVOR. WHAT’S IT CALLED,

SNAIL TRACKS?
Other common foods that can be disagreeable include dairy products.
Most of us could tolerate cow’s milk foods when we were young kids,
but many people develop lactose intolerance by adulthood. This is the
inability to digest the sugar in dairy products. Symptoms include abdom-
inal pain, bloating, gas, and diarrhea. In fact, it’s estimated that there are
almost 100 million people in our country with lactose intolerance. Most
minorities, including blacks, Hispanics, Native Americans, and Asians,
avoid dairy products since lactose intolerance is very common in their
populations. As a result, millions of Americans have serious deficiencies
of protein and calcium. (Seventy-five percent of the calcium in our diet
comes from dairy products.) As mentioned earlier, low-fat dairy prod-
ucts may be one of safest ways to get adequate protein in the diet when
you are trying to lose weight, and we know that protein itself suppresses
the appetite. This may partially explain why the obesity epidemic is even
greater in minorities.
LEM’S FREEZIE 32ND FLAVOR: BULIMIC’S DELIGHT!

Funny thing about lactose intolerance: the more you avoid dairy, the
worse you make the problem. If you eat a small amount of dairy at each
meal (about a cup of milk) or even just once a day, you’ll develop the
ability to digest the dairy without disagreeable symptoms. You actually

train your colonic bacteria to work for their money! All this time, they’ve
been thinking that they get a free intestinal ride, but, no, give them some
regular activity, and they’ll do it. In addition, eating dairy with other
foods during a meal makes it easier to digest. Delayed gastric empty-
ing helps the enzymes to work more efficiently. That’s why that run to
the ice cream shop on an empty stomach is vile for many people. (Un-
less it’s that you had the 2,300-calorie-super-large shake with three days
worth of saturated fat. Yes, those do exist.) In addition, some forms of
dairy, such as yogurt and hard cheeses, are easier to digest than others.
Finally, digestive aids, such as lactase tablets, which contain the enzyme
that you’re missing if you can’t digest dairy, or lactose-free products are
a good choice, particularly if you’re going to have a bigger amount of
dairy. The point is this: if you are skipping dairy entirely, you may be
making your road to thinness a harder journey.
Lactose intolerance is normal. For most of history, humans didn’t drink

milk or eat dairy products after they were weaned, at about the age of
three. Then northern Europeans started making cheese, and adults there
developed the ability to digest it. That happened sometime in the past
10,000 years. Some scientists claim that adults’ ability to make lactase,
the enzyme that digests milk, is an example of human evolution in prog-
ress. That is, unless you believe in intelligent design. And then God just
started in northern Europe first. I guess he’s been too busy to get to the
rest of us.
While we’re on the subject of protein and food myths, let’s talk about
eggs. The poor misunderstood egg. I never really questioned what I had
been taught in medical school about the bad effects of cholesterol from
the egg yolk, that is, until I met my patient, the “Egg Man.” Mr. Egg
Dude was addicted to eggs; he ate them morning, noon, and night. On
an average day, he had a six-egg omelet for breakfast, several egg-salad
sandwiches for lunch, and up to a dozen hard-boiled eggs for dinner. (As
Dave Barry likes to say, I am not making this up.) Yet the man had low
total blood cholesterol, was thin, and was in the hospital due to trauma,
not because of any heart or medical illness. His mother insisted that I do
a thorough medical and blood evaluation because she wanted some
ammunition to get him to change his eggy ways. Strangely, I couldn’t

find anything medically wrong with him, and I reluctantly told her that.
What we’ve learned since then, from epidemiological studies in Japan
and the United States, is that whole eggs are safe for most people.8 There
is a slightly increased risk of death if you eat more than an average of one
egg a day (sorry, Egg Dude), particularly if you are a diabetic. But what
we now know is that it is probably safe to eat up to seven eggs per week,
and not just the egg whites. There’s no research to show that eating whole
eggs results in a higher risk of stroke or heart attacks. That’s a choles-
terol myth. One large egg has as much protein as a cup of yogurt and has
fewer than half the calories. Don’t give up on the egg; boil some and pop
them in your purse or briefcase as a quick, nutritious snack. Okay, use a
lunch box. I don’t want you e-mailing me, complaining about smashed
eggs on your tampons, car keys, or legal briefs.
ATTACK OF THE KILLER POTATOES

Now it’s time for you to think about restaurants and meal planning at
home. How do you decide what’s a better choice and what’s a not-so-
great choice? First of all, when going to restaurants, think about por-
tion size. Split an entrée, or order a kid’s meal or sample portion. Run
like hell when you see the word “buffet,” unless it’s just the salad bar.
Avoid or limit most white foods: fried foods (trans fats) and items that
are stuffed, pasta, pizza and other doughs, bread, white potatoes, pas-
tries, breaded foods, white and fried rice, and sour cream and butter
sauces. (A plain white baked potato with the skin on is fiber-, mineral-,
and vitamin-rich. The problem is that few people eat it that way. If you
eat your potatoes the way most Americans do, fried or mashed, salted
and slathered in sour cream or butter, just say “NO.”) And, when eat-
ing out, avoid most cheese products, as they’ll really add on the calories
when they aren’t low-fat.
Did you know that French fries were invented in Belgium by the Flemish?
I guess Flem fries just didn’t sound appetizing.
Instead, when ordering and at home, use lean meats, poultry, fish,
tofu, and soy products that are boiled, baked, or slow-grilled (lower
temperatures). Lower-temperature cooking is thought to be safer; it
produces fewer toxins in the animal protein. Again, this may have to do
with keeping the moisture in the animal flesh, so try not to dry out the
meat or poultry when cooking (and it will be more filling that way). Try
to avoid smoked meats and fish, since the nitrites (or nitrates) haven’t
been proven to be safe.
Some Floridians eat smoked alligator. There’s a whole back-swamp tech-

nique to catching one of those razor-toothed monsters. We’ve had a
number of people from my state distinguish themselves with Darwin
awards for their stupidity. Traditional Floridian hunters sometimes use
the ancient method involving the car battery, zapping swamp water to
get their kill, occasionally while sitting in a metal boat. The alligators
peacefully hide in the reeds and exclaim, “Oh, look, bar-b-q for lunch!”
At home or away from your kitchen, look for salsa, marinara, olive
oil, lentils, hummus, guacamole, beans, legumes, vegetables, and fruits.
Get the noncreamed soups, the plain eggs, and the crunchy salads. Use
salsa and hot and sweet peppers for flavorings on potatoes, eggs, or veg-
etables or as a salad dressing.
HORROR-THEMED EATERY’S MENU: LAST VEGETABLE

ON THE LEFT, NIGHTMARE ON PASTA, CHILDREN
OF THE CORNDOGS, HALLOWIENERS
If you do go to a buffet restaurant, I encourage you to do what I do
both at the beginning of the meal and between courses. Get up and non-
chalantly walk around the restaurant looking at all the really morbidly
obese people. Be careful, it can be scary. You will normally find a much
higher percentage of them at buffet restaurants than at regular restau-
rants. Scout out what they have on their plates, which are generally piled
with high-calorie foods. See what that does to your appetite and your
own behavior. I’ve been told by others that it has the same dampening
effect on them that it has on me.
Which brings me to the dessert table: some empty-calorie junk is obvi-
ous, like cookies, cake, and ice cream. But other foods are disguised by
the restaurant industry as “good for you.” Realize that bagels, big bowls
of pasta, and most wraps, panini, burritos, sandwiches, and pita chips
are not full of nutrition but are full of empty calories.
Even at home, understand that those granola and energy bars that
you buy at the convenience store to eat on the run or for breakfast—big
buzzer sound—they’re really not so good for you. The advertisers love to
produce commercials with buff models on mountain bikes at the edge of
cliffs munching on those “health bars” so that you’ll believe you’re eating
something more than candy bars dressed up in Halloween costumes.
My version of convenience food is old pizza sauce in the back of the

refrigerator that grows its own toppings. “Hey, honey, you like mush-
rooms, right?”
A funny thing about pizza, pasta, bagels, and dessert items is that they
are often a comfort food, brought out in times of strong emotions or
stress. Comfort foods don’t have to be bad for you, although they do
tend to be high in calories and fat and are often simple carbohydrates.
Determine what your comfort foods are and don’t abandon them, but
do use them more judiciously. Pick your comfort foods and save them
for special times, and always pair them with healthier foods, like a salad
before the pizza. Then you will literally be able to have your chocolate
cake and eat it, too, without stress, guilt, or undue physical or mental
costs.
Which brings me to the last point, whether to eat sweets and yummy
desserts at all? Of course you should! Just realize that it is my sincere
belief that it is better to eat a small amount of the authentic item (reg-
ular cookie, real ice cream, or rich high-quality chocolate) than larger
amounts of the imitation stuff. Fat-free foods are not necessarily better
for you, as they are often high in sugar. Low-sugar foods are often loaded
with bad-tasting chemicals. The real thing tastes better and is more sat-
isfying. You’ll end up eating less junk food and feeling better about it
in the end. My favorite food, high-quality chocolate, is something I eat
often, in small amounts, and completely enjoy. No deprivation neces-
sary, and no binging. Because I know I’ll be eating it again soon. How
beautiful is that?

• Eat nutritionally and you won’t crave junk food.
• Listen to your body; it will tell you if you are eating the nasty stuff.
• Not all fats are bad for you; vegetable and olive oils are beneficial.
• Animal protein leads to a wide range of health problems in the
overweight.
• Vegetable-based proteins, dairy, and eggs are safer and will get you
thinner.
• Added sweeteners, either sugar or high-fructose corn syrup, make
you fat.
• The natural sweetness in whole fruits is safe.
• We eat way too much salt for our health; eliminate excess salt by lim-
iting processed, prepared, canned, and restaurant food.
• Read the labels and avoid MSG, artificial sweeteners, and colors.
• A true whole-grain diet will get you to slimness and keep you there
permanently.
• The lactose intolerant can train their bodies to eat dairy again.
• Use everything you’ve learned for better restaurant ordering and meal
planning.
• Eat small amounts of your favorite authentic sweet or comfort food
regularly so you don’t feel deprived.
EIGHT
Water Intolerant:
The Right Drinks
Occasionally I will debate with other health care workers which organ
is the most important one in the body. Personally, I think it’s the colon.
It stores stuff and absorbs water. Without it, you’d be dehydrated and
incontinent. It’s a maligned organ; you don’t know how much you
need it until you lose it. This is unlike the brain, which is totally over-
rated. We’ve all known people who seem to get along just fine without
their brains—they often become bosses.
An important type of intake fuel to think about is not food at all; it is

drink. Generally, when people concentrate on losing weight, they con-
centrate on the goal of limiting what type of food or how much food
they will take in. They put little thought into their drink. People who are
dieting might switch to a diet cola or change the creamer that they put
in their coffee, but they’ll leave it at that. There needs to be a lot more
thought into the type of liquid that enters the mouth, all day, every day.
Something that I’ve known for years is that calories in liquid form
are easier to disguise than those in solid form. The way I first became
aware of this was through my work in the nursing home population,
with people who are too skinny. Often, frail, elderly patients in a nursing
home aren’t getting enough calories. They don’t feel well and they don’t
want to eat enough, so we find ways to “sneak” extra calories into their
diets. The main way to slip extra calories into the diet of a person who
is not very hungry is to give the person high-calorie liquid supplements
between meals. Did you know that the body does not register most liq-
uids as extra calories? So when the next meal rolls around, my patient is
hungry again and the weight comes back up. Conversely, liquid “secret
calories” are often the easiest target to eliminate in a person who is over-
fed calories.
In the person who is overweight, the secret calories may come in the
form of colas, sweetened coffees or teas, juice, alcohol, energy drinks, or
sports drinks. I’m a strong believer in eliminating all high-calorie bever-
ages from the diet permanently.
THE ARSENIC DIET (IT’S GUARANTEED)

Over the past two to three decades, sweetened beverages have become
a much bigger part of Americans’ daily calorie intake. This is especially
problematic among the young and minorities, but it has occurred across
the social spectrum, even among those who label themselves as “diet-
ing.” Science has shown that calories in the pure nutritionally empty liq-
uid form are not recognized the same way by the body and therefore
result in chronic overfeeding. Barbara Rolls, PhD, a professor of nutri-
tion at Penn State, has done years of research into this.1 Your body does
not understand Coke, Sprite, Dr Pepper, and Mountain Dew; since they
contain no nutrition, they are not recognized as normal calories. Ga-
torade, Red Bull, Arizona tea, and Snapple slip right on through your
stomach’s natural calorie counter. But the sugar still gets absorbed and
converted quickly into adipose tissue, where it snuggles up to your hips,
thighs, and waist.
Coca-Cola is used for all sorts of things other than drinking it. In the
hospital, we use it to unclog feeding tubes. Mechanics use it to get rid
of gunk on engines. I’ve even heard of women trying to give themselves
abortions with it. That doesn’t work. The gynecologist: “Well, you’re still
pregnant, but you don’t have any rust.”
GROWTH RINGS DON’T GO AWAY

According to researchers at Harvard University, it’s not unusual
for teenagers to drink between 500 and 1,000 calories a day in sugar-
Water Intolerant 145
containing beverages.2 They see this as a contributor to the obesity epi-

demic among children. They have also found a strong correlation between
consumption of sugar-containing drinks and the development of obesity
and diabetes in adults. The scientists at Harvard have gone so far as to
declare the need to curb the consumption of soft drinks and other sweet-
ened beverages to fight our national epidemic of obesity (and the resul-
tant diabetes).
According to the Harvard School of Public Health, cranberry juice
cocktail (something that a lot of people think is good for them) has the
most sugar of any beverage type.3 It has a whopping 12 teaspoons of
sugar in a 12-ounce beverage. Orange juice and orange soft drinks have
slightly fewer, at 10 or 11 teaspoons, and that’s the same as what’s in one
12-ounce can of cola. A sports drink typically has about 5 teaspoons of
sugar in that same size beverage.
If someone handed you a glass of water and then asked you to care-
fully spoon in 10 or 12 teaspoons of sugar and then to drink it—well,
would you? Of course not; you would think the request was gross, dis-
gusting. But that’s essentially what you are doing every time you down a
can of Coke or a glass of fruit juice.
Juices range from 150 to 250 calories a cup, except for tomato juice,
which has only 40 calories a cup. Colas and other sodas are about 120 to
180 calories for a standard 12-ounce can, but many people now drink the
20-ounce bottle, which has 250 calories in it. Fruit punches and drinks
run between 120 and 240 calories for 12 ounces. Sports drinks contain
between 90 and about 250 calories. Even a bottle of store-bought iced
tea can run up to 135 calories, and a Starbucks Frappuccino runs almost
400 calories!
EAT, DRINK, AND BE STERILE

My concern is that sugary beverages are often advertised as exciting,
sexy, and good for you. That excess sweetener results in diabetes, which
in turn results in impotence. There’s nothing sexy about that. Here you
think you are doing something healthy for your body, and those ad writ-
ers laugh all the way to the bank.
I went to a dermatology lecture where the doctor said that duct tape
works to eliminate warts. Diabetes is largely reversible with weight loss;
its treatment is the same as for warts. Use duct tape, just in a different
place.
Artificial sweeteners are not the solution. Harvard has said on its
public health Web site that the beverage industry needs to get more re-
sponsible and develop attractive sweetened drinks with fewer calories,
preferably without zero-calorie sweeteners. However, a lot of health pro-
fessionals have been counseling people to switch to saccharine, sucral-
ose, aspartame, and the other low-calorie chemicals. I’m not sure that’s
a good answer. The reason lies in new evidence suggesting that ingestion
of artificial sweeteners may also create obesity.
Purdue University psychologists Drs. Susan Swithers and Terry Da-
vidson found that rats exposed to diet sweeteners are more likely to con-
sume excess calories than those who drink sugar-containing beverages!4
Their saccharine-fed rats gained more weight and put on more fat than
those fed a simple sugar. Those fatter rats never cut back in their eating
habits later. The researchers believe that the use of artificial sweeteners
causes a break in the body’s ability to regulate intake and metabolism.
Since the substances are sweet, the body believes it’s about to get a lot of
calories; when it doesn’t, it actually spurs feeding to get those calories it’s
anticipating. This would explain why other studies of artificial sweeten-
ers have not conclusively demonstrated that they help in weight loss.
TRUTH IN LABELING: “CONTAINS

UNPALATABLE SUBSTITUTES”
But there’s one more concern about artificial sweeteners: they might slow
metabolism. Usually, when the body is exposed to food, the core body tem-
perature rises in anticipation of burning ingested fuel. The Purdue gang
found a blunted response in core body temperature in the saccharine-
fed rats. They didn’t rev up their metabolism when they ate sweet foods
like the sugar-fed rats did. It might be that a body used to being fooled
by artificial sweeteners disconnects from the signal of a calorie load and
never bothers to burn fuel as it should. If that’s the case, then the sooner
you get off of artificial chemicals, the better. Learn to live with less sweet
flavorings in general; that’s how our ancestors lived. Our bodies are not
built for this modern deluge.
TAKE CARE OF YOUR PARTS, AND

THEY’LL TAKE CARE OF YOU
If you are a big cola or soda imbiber, you might initially switch to the diet
version and then cut the number of ounces you drink daily. Or, better
yet, just substitute healthier beverages. One of my favorite substitutes

is green, black, or herb tea. Green or black teas have caffeine, unless they
have been decaffeinated, so they make a good substitute for caffeine
junkies. Herb teas without caffeine are great at night. Don’t add sugar
or sweeteners to the tea! Teach yourself to enjoy the flavors without the
sweeteners. Make your own green tea, and store it in the refrigerator. Take
it to work or school with you in a sport bottle or thermos, rather than
grabbing the high-priced vending version. And remember, hot drinks
may suppress the appetite more than cold, so make your tea fresh and
hot if you can.
Green tea is one of my favorite drinks. It’s thought to suppress can-
cer and arthritis and also the appetite. The University of Chicago has an
herb research center that demonstrated that a component of green tea is
a powerful appetite suppressant, at least in rats.5 The rats lost up to 40
percent of their body weight when injected with that component.
People think that the Japanese live so long because they drink green tea
with antioxidants. But it’s really all the exercise they get running away
from Godzilla.
If you are a flavored-water, juice, juice drink, or sports drink person,

switch to plain water or seltzer. Add a spritz of juice in various flavors to
liven it up. If buying pre-packaged types, look for companies that avoid
using extra sweeteners and chemical additives.
Now onto another form of beverage, sports drinks. There is never a
need for the average person to use sports drinks, despite what the bever-
age industry says. If you are an aggressive athlete who is in training for
more than 60 minutes at a time or if you are outside sweating buckets on
a very hot day, these may be the only exceptions. Occasionally, sports
drinks might be useful if you are working at high altitudes. If you are ex-
ercising and you take in adequate water and eat nutritionally before and
afterward, you have no need to use a sports drink. I never have, and I
exercise everyday and can teach classes on the art of sweating.
Skip the energy drinks, too. They have as much sugar as colas and
contain caffeine levels that can be dangerous. I have no clue why anyone
would ever use an energy drink. If you are that tired, you need to sleep
more and take better care of your body, not use stimulants to force your-
self awake.
COFFEE SHOP—SUMMA CUM LATTE

Coffee is another area of secret (and useless) calories. I drink coffee every
morning, plain or with a little skim milk. Black coffee is naturally almost
zero-calorie, but nobody seems to have plain black coffee anymore. In a
specialty coffee, it is the additives, the high-fat milk or cream, the sweet-
eners, and the flavorings that can add a tremendous number of unnec-
essary calories. Even if you make the coffee yourself, a simple flavored
liquid creamer adds 40 to 50 calories to your beverage. Add a heaped
teaspoon of sugar (another 25 calories) and your three cups of coffee a
day adds on a whopping 30 pounds of fat to your body in a year!
I’m amazed that people will spend four or five dollars for a cup of espresso
or cappuccino, which is essentially coffee with a fancier name. In a recent
study, people thought a wine labeled as inexpensive tasted worse than a
costlier one, even though it turned out to be the same wine in both bot-
tles. This is known as the Ripple Effect.
Many people have no idea that their daily whipped flavored coffee
or latte from their favorite coffee shop adds up to 500 or more calo-
ries a day, with none of those calories doing anything beneficial for the
body. Plain black coffee with a little skim milk has 450 fewer calories
and gives the same caffeine jolt. Talk about avoiding secret calories!
Save your money and brew your own; then be judicious with what you
add to it.
I’ll never forget an interview that I read. A famous singer was extolling
the virtues of coffee enemas. I’m thinking to myself, “You’re supposed to
drink it, not stick it up your ass.” Are there different types of coffee en-
emas, based on the day that you’re having? Does the therapist give you
a double espresso when you have a deadline looming? A flavored latte
when you’re feeling down? Decaf when you’re stressed? I’m wondering
if drive-through colon therapy isn’t too far behind (pun intended). The
drive-through attendant: “All right, back it up here!”
MILK CARTON INGREDIENTS: COW SECRETIONS

Milk alone can suppress appetite because it has protein in it and sits in
the stomach longer than most other types of beverages. Use only skim
milk. Anything more is not worth the excess fat.
Mother cow berating cud-chewing teenage cow: “And don’t bring it up

again!”
Except for tomato-based and vegetable juices (which suppress appe-

tite), most juices and juice drinks ought to be avoided if you are trying to
eliminate unnecessary calories. There is nothing wrong with fruit in the
solid form, but liquid fruit juices are loaded with calories and don’t have
the fiber to slow down digestion. (Even juices with pulp aren’t going to
help you much.) Fruit juice and juice drinks are definitely unwanted se-
cret calories.
WISCONSIN’S OFFICIAL STATE MOTTO IS “FORWARD.”

IS THE UNOFFICIAL STATE MOTTO
“I CAN’T FEEL MY LIVER”?
Finally, let’s discuss alcohol. Alcohol dulls the senses and the sensibility,
causing people to ingest more nasty junk food than they would other-
wise. In addition, I see many people who are overweight and severely
malnourished. Sometimes it’s from alcoholism. A person who imbibes a
lot of beer, wine, or hard liquor can take in thousands of empty calories
daily, and eventually that will suppress their appetite for nutritional solid
foods like vegetables or dairy. Strangely, Wisconsin, “America’s Dairy-
land,” is also the binge capital of the United States.6 I guess the tourists
keep the cows busy making milk.
I frequently see heavy alcohol users with thinking and balance prob-
lems or chronic wounds and immune deficiencies, all from severe mal-
nutrition. Yet they are obese, and they and their families don’t even
suspect how malnourished they are. Alcohol should be limited to one
or two beverages a day, at the most. Even in the nonalcoholic, cutting
back on alcohol is one of the easiest ways to eliminate nonnutritional
secret calories.
I was on a cruise ship in Croatia, and it had a sign over the toilet on how
to flush and what not to flush. There was one of those universal sym-
bols of a red circle with a line across it, only it was a drawing of a person
tossing a champagne bottle into the commode. You’d have to drink the
whole bottle to be that stupid, right?
Professional football player LenDale White learned the hard way how
much alcohol can affect body shape. According to an Associated Press
article, when White decided his pudgy physique was affecting his perfor-
mance and that it was time to lose weight, all this NFL player did was
cut out tequila. In six months in 2009, he lost more than 35 pounds. He
admits he did nothing else to lose the weight but cut out his favorite bev-
erage. By the beginning of the next pro season, he felt he was in the best
shape he had been since high school.
There are those who insist that daily alcohol intake is important to
health since moderate alcohol ingestion decreases the risk of heart dis-
ease and diabetes. But that same amount increases your risk of breast
and colon cancer. So don’t imbibe purely for your health.
MY FRIEND WAS ALWAYS THE DESIGNATED DRINKER

It is a good idea to cut back on the amount of alcohol that you ingest
when losing weight for a number of reasons. Let me tell you the true story
about one person that I coached on weight loss. She is a very smart, tal-
ented, middle-aged woman with a history of fatty liver, from obesity. She
likes her alcohol after work, especially on those high-stress days. After a
particularly bad day, she and a few workmates stopped at the local fes-
tive chain restaurant on the way home. She stuck to her calories, limiting
the excess junk food her friends scarfed down, but had her usual cognac
or two. They then went their separate ways, but she realized that she felt
more far gone from the alcohol than usual. On the way home, a very nice
policeman, whom she recognized, tapped on her window at a stop light.
She rolled down her window. The policeman recognized her and asked if
anything was wrong since she had been sitting at the stop light for more
than 30 minutes! My friend was drunk on alcohol amounts that in the
past wouldn’t have touched her judgment. Luckily, she made her way
home safely, with the help of the policeman, but that incident rightfully
alarmed her.
DO TURKEYS DRINK WILD HUMAN?

My friend had erred in judging how much alcohol she could safely con-
sume for at least two reasons. One was that she weighed less than she had
in the past and so could tolerate less alcohol, as smaller people need less
to get drunk. The second reason was that she had her usual beverages
on an unusually empty stomach because she had limited her food calo-
ries (but not her liquid calories). Thus, the alcohol was absorbed faster.
As another friend said after that incident, “You didn’t have your bread
to sop up your liquor.” In a way, that statement isn’t far off base. Food
in the stomach does slow down the rate of alcohol absorption into the
blood.
People fall into one of three categories for the ability to process alcohol.
Most people can drink moderate amounts before getting drunk. People
who imbibe heavily rev up their enzymes and can process more, until
their liver starts to fail. My liver is essentially decorative; I get drunk on
nonalcoholic beer. I like to say that my liver is a placeholder waiting for
a better organ to come along.
Cut back on the liquor along with the food, and you will be much
safer, as will those around you. Finally, and this is a very serious issue
medically, obesity can lead to fat in and around the liver, which may
change the way the liver processes alcohol (and other toxins and medi-
cations) over time, even sometimes leading to permanent liver damage.
Thus, simply being overweight can cause a person to stop being able to
handle liquor. Being fat is never a benign condition, and it should never
be accepted as medically safe. Obesity (without alcoholism) is now one
of the biggest causes of cirrhosis, from fatty liver, and of the need for
liver transplantation.
A good rule of thumb for all beverages, alcoholic or not, is that they
should never have more than about 50 to 100 calories in them for an
eight-ounce glass. And you should try to limit your total drink calories
to no more than 200 calories (for a small woman) to about 300 calories
(for a tall man) a day at the most. That helps to limit your intake of those
surprise calories that add nothing to your body except fat tissue. Drink
water, skim milk, simple tea or coffee, or tomato or vegetable juice prod-
ucts (and watch the salt). There are plenty of opportunities and varieties
in the supermarkets and the health food stores, so don’t complain to me

that you are bored. I don’t want to hear it. I get enough whining from my
teenager.

• Calories in a liquid form are easier to disguise than those in a solid
form.
• There is a relationship between ingestion of sweetened drinks and
obesity.
• Most sweetened beverages have 5 to 10 teaspoons of sugar and 100 to
250 calories.
• Artificial sweeteners may make you fatter.
• Substitute healthier choices, like simple coffee, green or herb teas, or
water.
• Green tea is an appetite suppressant.
• Most people never need a sports drink, and nobody should be using
energy drinks.
• Coffee is best when drunk black or with a minimal amount of skim milk
or sugar.
• Milk is an appetite suppressant and is healthiest as skim milk.
• Fruit juice and juice drinks should be drunk sparingly, if at all.
• Vegetable and tomato juices are low-calorie and are an appetite sup-
pressant.
• Limit alcohol-containing beverages to no more than two a day.
• Even moderate alcohol is not necessarily safe, particularly for the
obese.
• Limit calories from all drinks to no more than 200 to 300 a day.
NINE
Living Extra Large: How Much,
When, and How to Eat?
I was rummaging through my friend’s freezer late one night, looking

for something to eat, when I discovered a package of frozen free-range
turkey meatballs. It dawned on me that giving a farm turkey a free-range
lifestyle is a lot like taking a guy on death row and putting him in a five-
star hotel for a few weeks before his execution. Hey, you still come out
frozen meatballs.
EAT THIS BOOK

If you are a monkey, and I feed you about 20 to 30 percent fewer calo-
ries than others in your species are used to getting, you will be skinnier
and live longer than normal. And you will be less likely to get diseases
of aging like Alzheimer’s, diabetes, cancer, and heart disease. Chroni-
cally restricting calories will make you permanently thin and extend
life span, at least in animals other than humans. Longevity has been
shown to be extended in calorie-restricted creatures from flatworms
to rodents to primates. In California, there is a group of individuals
who practices severe daily caloric restriction permanently, not to lose
weight (they are already very thin people) but to extend their lifespan.
They are cold all the time, appear listless, and have very little muscle
strength and lousy sex lives.
In a study done at Washington University of St. Louis, participants
on a two-year caloric restriction diet lost plenty of weight (some were
overweight), became food obsessed, and lost bone mass.1 But they
had much better blood pressure and cholesterol. It’s too early to tell
whether humans live longer on fewer calories.
In one scientific study on mice, the low-fat, calorie-restricted mice lived

three times longer than those critters on the regular diet. However,
when asked, the calorie-restricted mice said it felt like they were living
an eternity—in hell, that is.
THE JOY OF DIETING—NONE

Pure food-restriction diets don’t work any better than any other types
of dieting weight-loss approaches and likely are more harmful in the
long term. The reason is that your body’s metabolism will slow down
when confronted with far fewer calories. That’s why those Californians
who are in their own longevity experiment are cold, listless, and not in
the mood. Everyone has a basal metabolic rate. That is the baseline level
at which your body’s cellular mechanisms work. It hums along, burn-
ing fuel (calories) to build and repair tissue, digest food, make neurons
think, and energize your muscles. Hormones released by your brain and
glands control your basal metabolic rate. When you are put on a se-
verely restricted diet, your hormonal controls scream “famine” and slow
metabolic mechanisms. By doing this, the body can save fuel to be
used for only the most necessary bodily functions.
When starvation was common, slowing down metabolism worked
well for our ancient ancestors; survival was the priority. This still works
for the areas of the world where famine remains a problem. However,
in cultures where our biggest food worry is a glut, not an undersupply,
our inborn famine mechanism undermines our efforts to normalize our
weight. We slow down our body processes, burn fewer calories, and re-
set our basal metabolic rate to a lower level. Then, it takes even more
activity above our baseline activity to burn the same amount of fuel
(calories).
Living Extra Large 155
SEND ME YOUR TIRED POOR CALORIES,

YEARNING TO BE ME
I went to a women’s business center class, and I sat next to an enor-

mously fat businesswoman who was selling—you guessed it—weight-loss
products. Surprisingly, she hadn’t been too successful, so she wanted to
learn how to market on line. I wondered what would be her advertising
angle: “Get skinny when you send me all your food.”
Going through cycles of relative starvation and plenty results in a

body that is constantly resetting its cellular mechanisms to lower and
lower levels of activity. That is why yo-yo dieting wreaks havoc on the
system. This makes it even harder to lose weight every new cycle of se-
verely restricted caloric intake.
THE TRUTH ABOUT DIET BOOKS IS THAT THEY ALLOW

THE AUTHORS TO LIVE OFF THE FAT OF THE LAND
Most diet books surreptitiously encourage yo-yo dieting since they have
you starve and restrict yourself up front, frequently in “phases.” I just
finished reading a weight-loss and exercise book written by a retired
lawyer. It was full of really bad health advice. This was just another in
a series of self-hurt books.
Dieting “plateaus” occur commonly in those who yo-yo up and

down in their weight. When a person restricts her calories a great deal,
the body will usually adjust to that new level of calories in/ calories
out. The plateau has been reached when the basal metabolic rate has
dropped and the same number of calories eaten and expended no lon-
ger results in weight loss. Even worse, at that lower metabolic rate, a
relatively small increase in calories will result in an even larger amount
of weight gain. Thus, those who constantly diet through fasting or se-
vere caloric restriction will eventually complain that they gain weight
with almost no increase in calories. At least that’s the theory. It’s a
myth that once you hit a plateau, you cannot lose weight beyond it.
However, a plateau generally takes an adjustment upward in activity
to boost metabolism (see Chapters 10 and 11, on metabolism and exer-

cise, for details).
Even though I do not think it is wise to tell people what they can
and cannot eat (I hate absolute rules), I do think it is helpful to point
out how to eliminate the unnecessary intake of calories. Ultimately, a
successful weight-loss plan must include thought on how best to spend
the daily allotment of calories (intake). The most successful permanent
weight-loss regimen restricts the daily intake of calories to between
1,400 and 1,700 calories a day, depending on the size and goals of the
individual. On average, 1,400 calories a day will allow most people to
lose weight consistently, and 1,700 calories will allow most people to
maintain their weight loss permanently. Note that this is a gross gen-
eralization, based on a gestalt of the literature. However, the National
Weight Control Registry, my favorite place to get long-term data on
the really big permanent losers of weight, reported that previously
obese people in their study have kept that range as their target intake,
forever. In 1998, the University of Pittsburgh looked at some of the
early participants in the NWCR and found that women in that study
ate about 1,300 calories a day permanently, men closer to 1,700 calo-
ries.2 And most kept a low-fat lifestyle, as well (that is, fewer than a
quarter of their calories came from fat).
Obviously, as mentioned earlier, there are some active or high-
metabolism individuals who can lose weight on much higher inputs of
daily calories. The research from the 1970s and 1980s in rural China
showed that the typical Chinese man ate an average of 3,000 calories a
day and still was thin. T. Colin Campbell, PhD, author of The China
Study and a professor at Cornell University, felt that the Chinese could
eat so much more because they were essentially vegetarians.3 He felt
their protein-poor, low-fat diets led to a higher basal metabolism. Es-
sentially, he believes that it takes more work for the body to digest
vegetables; therefore, vegetarians are thinner.
Now remember, vegetarians are going to be thinner only if they actu-

ally eat vegetables. My husband tried being a vegetarian for a month,
but he gave up meat and ate brownies instead. He gained 10 pounds.
I like Dr. Campbell; he’s a really passionate, smart scientist. Un-

fortunately, his book completely ignores the fact that almost all rural
Chinese in the 1980s walked or road a bike, and very few had cars, cable
television, or desk jobs. I bet that kept them burning fuel, too. (I’d
hate to think that Dr. Campbell spent so much time thinking about
vegetables that he started to imagine that his subjects were as active
as vegetables. His book is a brilliant compilation of some very impor-
tant research, but he completely missed a big issue in weight loss—
exercise. This gets back to my point about the problem with nutrition
and obesity research. Everybody has his own very different agenda,
background, and point of view, which then skews his interpretation of
the data.)
IF YOU SPOUT OFF THE TOP OF YOUR HEAD, SHOULDN’T

YOU GET A MOUTH FULL OF HAIR?
Still, being the physician and past science researcher that I am, I feel
compelled to consult the research, rather than spouting off the top of
my head (like a lot of diet book authors do). The studies tell us that a
body can lose, by calorie elimination alone, between a half-pound and
one and a half pounds a week without triggering metabolic slowdown.
(Any more than that and you defeat yourself.) Eliminating about 300
calories a day won’t be noticeable to you, using the techniques we’ve
already discussed in this book. If you add into the calculation resetting
your basal metabolic rate slightly upwards (what you’ll learn about in
the next two chapters), you can easily lose at least three pounds of fat
a month, without any deprivation or feeling like you are on a diet. In
a year, that’s 36 pounds without any pain! If you are able to reset your
metabolism higher, with a more concerted effort, you might be able to
lose even more than that, possibly up to 72 pounds in a year. Go away,
fatty butt, hips, and belly, all gone permanently. No more plateaus and
no more yo-yo dieting, ever. And you’ll still have an enjoyable sex life,
unlike those poor starving fools in California.
That’s assuming you have a sex life. When I was in medical training,
the doctors were forced to work 80 to 100 hours a week. I’d come
home completely exhausted. When my husband would indicate he was
in the mood for a romp, I’d tell him the only feel he was getting was
necrophilia.
Unfortunately, counting calories is not a lot of fun, and most peo-

ple are unwilling to do it for very long. In addition, subjects in studies,
including the experts, are usually very far off in their estimates of their
calorie intake! In a New England Journal of Medicine article from the
early 1990s, 10 overweight people were asked to estimate their calorie
intake. They were off by about 50 percent, estimating that they were
eating about 1,000 calories a day when they were actually eating 2,000
calories. That’s a remarkable difference. In fact, overweight people tend
to be more inaccurate in estimating calories than normal-weight indi-
viduals. This may be due to denial, or a lack of practice, or the fact that
obese people eat more calories, so their margin of error is greater.
However, even professionals, like dietitians, are usually off by around
20 percent, about the same amount that normal weight people mis-
estimate.
Calorie counting isn’t difficult, but if you need help, there’s lots of ways
to get it on line. For instance, wolfromalpha.com allows you to get the
answer instantly to the question “How many calories are in a cubic
light year of ice cream? ” You can even specify if your cubic light year
is made up of Breyer’s French vanilla or Healthy Choice pralines and
caramel.
As I just mentioned, overweight people generally eat more than

normal-weight individuals, but that depends on metabolism. If you
have the genetic predisposition for a very slow metabolism, have done
a lot of yo-yo dieting, don’t ever exercise, or take medications that
keep it slowed, you may not need to eat more than a normal weight
person to get heavy. It really doesn’t matter if you eat only what a nor-
mal-weight person eats; what matters is what is the right amount for
you. See Chapters 10 and11 for ways to speed up your metabolic rate
and burn more calories.
I’M NOT FAT, I’M GRAVITATIONALLY ENHANCED

Perhaps one of the most common ways to chronically overindulge in
calories is to assume that you can eat as much as you did when you
were younger. Unfortunately, most bodies don’t work that way. If
you continue to eat the same portions for meals that you did when
you were in your 20s when you hit middle age, you will gradually and
continuously put on pounds. Most people do not lessen their intake
enough as they age, and this causes middle-age spread. As the body
ages, it has less lean muscle mass and tends not to move as much. When
was the last time you rode your bike, walked to work, played tennis,
or jogged a few miles? Maybe you used to do that when you were
younger, but you are very likely more sedentary now. Interestingly,
spontaneous movements (fidgeting) decrease as we age. So, between
the reductions in our planned exercise and unplanned movements, we
get less activity. This results in reduced caloric needs. Meal portions
need to go down or activity must go up so that the intake and output
equalize.
There’s been a new theory floating around that viruses cause obesity.
It just reinforces the denial syndrome and lack of responsibility that
many people have toward their health. It’s so much easier to blame a
virus than one’s own habits. “Oh, great, it wasn’t the triple cheese-
burger with supersized fries I’ve been eating for lunch every day for
the past three years; that’s a relief.” I love those people suing the fast-
food franchises over their obesity because they don’t know how to shut
their mouths and walk out the door. What’s next, suing the Centers for
Disease Control for not curing my “fat virus”?
Remember to carefully assess portion sizes. As discussed earlier in

the book, from restaurants to supermarkets to bulk food clubs, prod-
uct packaging and labels often mislead consumers on calorie content.
Even nutrition experts will underestimate calorie consumption be-
cause of misleading labeling. You have to be vigilant. Watch out for
oversized servings, packages, and platters. We eat the amount we are
given and assume the portion size is the package size. (We’ll drink a
12- or 20-ounce bottle of Coke and assume both are one portion.) Di-
vide packages, think about how much is the right amount to eat before
starting, and then remove the rest before you begin.
And, speaking of bulk food clubs, there was a recent Harvard Univer-
sity economics study that found that people sometimes spend exces-
sively when they go to wholesale stores. The reason is that consumers
purchase stuff in bulk that they don’t really need. Somewhere in Amer-
ica, right now, a husband is explaining to his wife why he needed to
buy the 100-quantity package of puppy butt corks.
Something to think about when choosing portion control: larger

meals make you want to eat more later on, particularly if you focus on
foods that put you on a sugar high-low roller coaster. If your body eats
a lot at one meal, it is more likely to want excess calories at the next
meal. Binging begets binging.
PEOPLE TELL ME I MUST EAT LIKE A BIRD.

RIGHT—LIKE A CONDOR
So am I telling you to count calories for the rest of your life? No, be-
cause I don’t do it, and I don’t know anyone who does it permanently.
But many former fatties do count calories when their weight trends up-
ward. It’s a good idea to get educated and to train yourself to guess
how much a food item is in calories and then check the ingredients
label or go online to look it up (search the words “calorie count”). Make
a game of it; if you are within 10 percent, give yourself a little gold star
sticker. The better you get at it, the more educated and accurate you
will become about portion control. And that’s the whole point, isn’t it?
You might be surprised to find what the food industry calls one por-
tion. For instance, the whole-wheat Triscuit cracker is a relatively good
snack, according to the Nutrition Action Newsletter (published by the
Center for Science in the Public Interest). However, some versions of
the Triscuit have as much as 120 calories in six crackers, which is a very
small portion. I know I never stop at six crackers when I have a box
in front of me.
MY COOKING IS PRETTY BAD. YESTERDAY

I ASKED MY HUSBAND IF HE WANTED
HIS EGGS SCRAMBLED OR TOSSED
Now that we’ve discussed how much to eat, we need to know when to
eat our calories and how often. Entire treatises have been written on
those subjects. Is skipping breakfast bad for you? Yes, it probably is.
According to the European Journal of Clinical Nutrition, breakfast
skipping is seen in fatter people, both adolescents and adults.4 In fact,

of those who used to be heavy and permanently lost the weight, only
4 percent (four!) skip breakfast now. If you eat breakfast, you are less
likely to binge on lousy, high-calorie food later. Besides, breakfast is
your fuel to get your brain going. I hate working with people who left
their brains at home.
I was thinking about buying an old historic house and renovating

it, then opening an inn. But I don’t like to cook, so it can’t be a Bed &
Breakfast. Maybe it could be a way station for hypochondriacs, a Bed &
Examination. I’ll call it “Up Yours.”
Are 2, 3, or 17 meals a day better? Dr. David Jenkins, in a study pub-

lished in the New England Journal of Medicine, had two groups of peo-
ple eat the same food every day. One group ate 3 meals a day, while the
other group ate the same food but broken up into 17 meals a day. In-
terestingly, the “nibblers” had lower cholesterol, cortisol (a stress hor-
mone), and insulin levels. Supposedly, that’s because constant feeding
drove those levels down. In my opinion, I suspect the nibblers were
much less stressed, resulting in those numbers. Since they were in the
kitchen constantly to prepare and eat their 17 meals, they probably
never went to work, did laundry, diapered the kids or mowed the lawn.
Voila, no stress! This eating pattern has real possibilities if you don’t
want to accomplish anything in life or earn a living; I’m not convinced
it’s realistic for the real world.
LIFE IS A BOWL OF CHERRIES — OVERPRICED

I do suggest eating more frequently than usual but consuming smaller
amounts at each feeding. Never let yourself get terribly hungry; that
way, you are less likely to gulp down more calories than your body re-
quires. Nibblers who eat all day everyday feel fuller than those who eat
only three meals a day, even when given the same number of calories.
Snack frequently, but always on such things as fruit, veggie sticks with
low-cal dip, nuts, or low-fat cheese. These things won’t give you the sugar
rush, followed by the low later. I personally eat all day long, at least
every three hours; it keeps me from getting cranky. And you really
don’t want to see me cranky.
Fruit roll-ups are so popular among kids that it seems there ought to
be an adult equivalent: Carnivores’ quick snacks, new Cow by the Hoof.
Some thin people are an exception to the “eat frequently” rule. They
do better if they eat only two meals a day and have no problem skip-
ping meals. What I do know is that most people will not eat with con-
templation and proper meal preparation if they have let themselves
get too hungry. Making decisions about proper “good-for-you” foods
and proper amounts are best made when one isn’t starving. Dr. Ancel
Keys found, in a famous study done years ago, that people who chroni-
cally fasted and felt very hungry tended to then binge-overeat and be-
come food-obsessed.5 Interestingly, when I worked on an adolescent
eating disorders ward, the anorexics and bulimics loved to talk about
cooking and the recipes that they would make for others. Then they
would skip meals and starve themselves.
I’m not a big fan of meal skipping; however, there has been some re-
search showing that people who routinely fast will lose weight. People
who skip eating for an entire day will make up some, but not all, the
skipped calories the next day. When fasting on a regular basis, such as
every other day, most people will end up eating fewer calories overall.
I can’t concentrate when I’m hungry, and I don’t think most people
function well when extremely hungry, so, if you are like most people,
you are better off losing weight and keeping it off by eating small meals
regularly. If you are the exception and don’t mind skipping meals, you
might succeed with less frequent feedings. The key is to remain func-
tional and pleasant to be around, without binging later; most people
can’t do that when they are chronically severely hungry.
A new movie is coming out for the self-starvation passive-aggressive

types, Gandhi vs. Predator. The plot: Gandhi eats nothing, Predator
eats Gandhi.
You are better off if you don’t go more than five hours without eat-
ing during the day, because it reduces the risk you’ll overeat at the
next meal. Snacking is not linked to obesity, but what you snack on
is. If you snack on fresh whole fruits or veggies, low-fat cheeses, a cup
of soup, unprocessed low-fat meats, all-natural yogurts, a handful of
nuts, or tomato juice, you will be fine. If your snacks are cold pizza,
pretzels, chips, bagels, donuts, or half a can of nuts and 20 ounces of
juice or cola, you will likely become (or stay) obese.
People are always talking about how vending machines are causing
obesity in schools and the workplace. I have a solution: vending ma-
chines should be rigged up with a camera that measures waist circum-
ference before it dispenses the treat. If you’re fat, you get your money
back but no snack. Suddenly, in break rooms all over America, you hear,
“Hey, Dave, come over here, stand in front of this machine.” If the cam-
era needs a fish-eye lens to see both sides of your body, you’ll hear a
machine voice say, “Access denied.”
Bedtime snacks are the exception to frequent eating. Often we eat

just before bed out of habit. Or we are afraid to go to bed hungry. Do
not be afraid of hunger at night. There are still at least a billion people
on this planet who are forced to fall asleep hungry (we have not cured
poverty). Don’t go to bed if you are ravenous and starving; you’ll not
sleep well and may wake up with a headache in the morning. Obvi-
ously, then, you need to feed yourself. However, in general, stop eating
at least three hours before bedtime; then don’t eat again until the morn-
ing. If you have twinges that are distracting prior to bed, try some
chamomile tea, which often suppresses the urge for food. Avoid any
caffeinated beverages, and don’t add sugar to your drink.
RECENT STUDY FINDS THAT CHOCOLATE HAS A

100 PERCENT FATALITY RATE—EVENTUALLY
There is no research to prove that avoiding bedtime snacks will make
you lose weight. However, I strongly feel that most people who eat at
night don’t eat because they are hungry. Mental fatigue, stress, and
sleep deprivation often lead to eating to decrease physical and mental
discomfort. We try to get the bump of pleasure from the food when
what we really need is rest and mental comfort. If you check your hun-
ger level before eating every time, you will know whether it is appro-
priate to eat before bed.
Fatigue is what drives us to eat at night. A recent study found that one
ounce of dark chocolate will help improve chronic fatigue syndrome
almost as much as being chased by a very large lion. So, both must be
good for you, right?
Unless you are a diabetic or are prone to morning headaches from a

lack of food, overnight fasting will serve you well. There is some data
to show that short courses of fasting, even for 12 to 14 hours or so (a
typical overnight fast), may be beneficial physiologically. I don’t think
there is enough data to say this for certain, but it probably wouldn’t
hurt. It is best to fast when you are asleep since you have higher de-
mands for fuel during the day to operate your working brain and mus-
cles. If you are a habitual nighttime snacker, gradually try to cut back
your evening snack, or switch to lower-calorie foods that are not pro-
cessed carbohydrates. Then, cut out the snack altogether and see how
you do. It may take some getting used to, but it can be a very impor-
tant technique. This is the time when your body will switch to break-
ing down some of your adipose tissue and liver fat, which is a good
thing. Overnight fasting may avert and ameliorate fatty deposits and
clean your liver.
SOME MEN WEAR A ROLEX. MY HUSBAND

WEARS A ROLAIDS
I can’t leave the discussion of nighttime snacking without mentioning
gastroesophageal reflux disease (GERD). Overweight (and pregnant)
people suffer from GERD more than anyone else. When stomach
or bile acids backwash up into your food pipe (the esophagus), they
cause irritation, including heartburn, difficulty swallowing, asthma,
and coughing. Everyone can have this happen on occasion, but when
this happens more than twice a week, it’s given the name of GERD.
The funny thing about reflux disease is that the symptoms can make the
sufferer eat more food, trying to alleviate the symptoms. It’s another
one of those vicious cycles.
GERD is more common in smokers, alcohol and caffeine imbibers,
and those who eat a lot of foods like citrus, chocolate, tomatoes, fried
foods, mints, hot spices, garlic, and onions. It probably occurs in those
with a high-salt diet, too. However, if you have a big belly, then your
abdomen is pushing your stomach contents back up toward your

mouth, and that’s the major reason for reflux disease. So you need to
eat smaller meals and quit before bedtime since lying down will also
push the foods and acids back up the wrong way. When you eat, your
stomach makes lots of acid for digestion; when you are fasting, there’s
very little acid to go up into the esophagus. That’s why I recommend
you quit eating at least three hours before you lie down.
SAVOR EVERY BITE, AND YOU WILL NEED TO BITE LESS

Finally, we need to discuss how to eat. Weight loss is made easiest when
food is pleasurable. There is no better way to truly enjoy eating than to
meditate on it. Meditation encourages focusing completely on the ex-
perience of eating, including the sights, sounds, smell, texture, and taste
of food. By creating a sensory experience and feeling the response of
the body to eating, you will relearn pleasure during mealtime. At the
end of a meal, you should feel refreshed, rather than sleepy, bloated,
and guilty.
We don’t realize how important it is to give food the right texture.

Funny thing about health care: we do some pretty barbaric things, like
ordering pureed food for our patients. We routinely force the patient
to eat blenderized meatloaf and then wonder why he is losing weight.
People don’t like to eat mashed-up animal, unless it’s haggis, the na-
tional dish of Scotland. (For further fun, I suggest you read Robert Burns’s
1787 poem “Address to a Haggis.” And you thought I was the only one
who wrote poems about my food.) I liked haggis, until I found out that
it’s a combination of sheep’s heart, lung, and liver, along with mutton
fat, oatmeal, and spices simmered in the animal’s stomach for a few
hours. That recipe put a damper on my appetite.
DON’T JUST DO SOMETHING — STAND THERE

When you live in the present, rather than thinking about what’s hap-
pened in the past or worrying about the future, you fully enjoy your
life. Be in the present, and enjoy the sensuality of food. If you don’t
think sensuality and sexuality are part of eating, rent the movie Tam-
popo, my favorite film about food (input) and sex (activity).
Thoughtful eating means really concentrating on the pleasurable ex-

perience of the food. To me, gratitude is part of the pleasure. I feel very
blessed and lucky to be one of the fortunate ones who do not have to go
to sleep hungry due to poverty. Mindful eating increases the enjoyment
and decreases the need for food. May I suggest some truly revolution-
ary ideas in eating behavior: while ingesting your next few meals, turn
off the television and put down the newspaper. Ignore the computer
screen. Eat the food slowly, savoring it, and think about the smells,
tastes, and textures. You will eat less and be more satisfied. Don’t eat un-
til engorged. Once a day, if you need it, complete the meal with a small
bite of a favorite sweet, savored slowly and completely. Enjoy how
you feel at the end of the meal: healthy, happy, and joyous.
THE POWER OF NOW WHAT?

I recommend taking a class or retreat to learn meditative techniques.
An alternative is to obtain audio programs on meditation from your
local library or bookstore. Just don’t practice the exercises while driv-
ing, especially those that require keeping the eyes closed.
I went on a meditation retreat a number of years ago. At meal time,
for the entire week, hundreds of adult campers came into the dining
room and sat down, waiting quietly for their food. When it was placed
on the table, everyone began to eat slowly, contemplating the food in
silence, chewing thoughtfully. The food was completely vegan, yet no
one complained about the taste or quality (except my son, over in the
kids’ camp). No one overate, either. People spent the meal quietly to-
gether, enjoying the peacefulness and gratefulness of having food. I
had never experienced anything like it.
IS IT POSSIBLE TO RAP THE OOMPA LOOMPA SONG?
I don’t always get to enjoy my meals in peace. I’ve got this neighbor’s
kid who insists on practicing the trombone in the evening, badly, at his
house, with all the windows open. He is truly awful. Why can’t his par-
ents insist that he go out in the garage and close all the doors—and
leave the engine running?
I have another neighbor’s kid, who comes home from high school
every day and practices on his bass guitar for two or three hours so
loudly it actually makes my house vibrate. I finally went over the other
day and asked him if the name of his band was Crack the Paint.
When you eat thoughtfully, you decrease automatic feeding while

increasing connectedness and joy. If you improve your environment, both
internal and external, you’ll improve your joy and health. Meditation
decreases blood pressure and curbs stress and negative thinking. It
eliminates impulsive eating behavior that results in overeating and a
loss of control. You become alert to signs of hunger and satiation.
You are attuned to when you have had enough. You shut off the eat-
ing process earlier than otherwise because you are aware of the sensa-
tion of fullness much sooner.
MEDITATION—DON’T GIVE IT A THOUGHT

I use meditation techniques in such disparate situations as when dealing
with challenging people at work, sitting in rush-hour traffic, allowing
myself to fully enjoy a walk through the woods, or intensely enjoying a
small piece of chocolate. Meditation is not distancing oneself from
the world but becoming much more connected and aware of the world
and one’s own interaction with it. I’m not less emotional (dispassion-
ate or withdrawn, as some believe occurs with meditation) but am able
to feel more in control and to participate in my world. But I am less
buffeted by the negative effects of the world. I become more of a par-
ticipant and also more of an observer at the same time. There’s less
boredom and more joy. It’s very healing. Use it.
I wrote an essay in which I said that I sometimes resort to meditation to

stay calm around difficult patients and families. But my son thought it
said “medication.” He read it and said, “Gee, Mom, you shouldn’t tell
people you need to take drugs to deal with your patients.”
THE OFFICE SUPPLY COMPANY ADVERTISED IT

HAD THE “EASY” BUTTON. WHAT I REALLY
NEED IS THE MUTE BUTTON
Food research has clearly demonstrated a strong relationship between
eating environments and how much is eaten.6 You probably don’t re-
alize this, but when you go into a chain restaurant, the management
has designed the setting according to what they want you to eat and
how long they hope you will stay. When you eat, the environment
should be relaxed and fun, not high-stress, loud, or bright. Research
has shown that people instinctively eat faster (and therefore are prone
to eat more) in a bright and noisy environment. That’s why fast-food
places look and sound the way they do.
Nurses’ stations are very noisy places: lots of activity, buzzers, talking,
and alarms ringing. Our local hospital’s administrators got the genius
idea of putting a noise meter at each nurses’ station to discourage noise
so that the patients can rest easier. Guess what happens if we surpass the
acceptable noise level? Yep, a piercing alarm sounds! This explains why
a hospital administrator has never won the Nobel Prize in medicine.
Unlike fast-food joints, romantic high-priced restaurants are softly

lit. In a quieter, calmer place, like Chez Expensive, you are more likely
to linger over your food and order more alcohol. So, at work or home,
hold the alcohol and calm the lights and noise. Add some calming,
pleasant background music. When you slow down and linger over
your food, you tend to fill up on less of it.

• Severe caloric restriction results in a slower metabolism and isn’t
much fun.
• Yo-yo dieting results in slowing your basal metabolic rate and is self-
defeating.
• The average American who loses weight eats 1,400 to 1,700 calories
daily.
• You can eat a lot more and lose weight if you speed up your me-
tabolism.
• You can lose two to six pounds of fat a month without slowing your
metabolism or expending much effort.
• Using the techniques in this book, you should never feel like you are
dieting.
• Counting calories isn’t necessary, but learning calorie content will
help you make good food choices and not-so-good choices.
• Eat less than when you were younger, and always pay attention to
portions.
• Don’t skip breakfast, and eat frequent small meals all day long. Stop
after dinner.
• Snacking isn’t related to obesity, but what you snack on is.
• Nighttime snacking is related to fatigue, not hunger, and leads to re-
flux disease.
• There is no better way to truly enjoy eating than to meditate on it.
• Turn down the lights and noise, play soft music, and eat mindfully,
and you will eat less.
• Improve your internal and external environment and you will im-
prove your joy and health.
PART III
Output—Metabolism
and Activity
TEN
That Which Doesn’t Kill
You Makes You Fatter:
Increasing Metabolism
I saw an ad for a weight-loss patch, so I looked into it for one of my

patients. It turns out that the patch works well because it goes over the
mouth. There’s fine print on it that says, “Do not open until Christmas.”
Practically every diet book, plan, and product on the market prom-
ises quick weight loss. But that isn’t the kind of weight loss that you
want; it’s only water weight, not fat tissue. That’s why quick-weight-
loss programs aren’t sustainable and are unsuccessful. You can dehy-
drate your body only so much, and eventually you will reabsorb that
water back into your tissues. The next time you see a promise of quick
weight loss in any type of diet plan or product, run like heck in the
other direction. That program or supplement won’t help you in the
long term, and it could very well hurt you.
Slow, sustained, and permanent weight loss is what you should want
because that’s the type of weight loss that results in adipose tissue loss.
Permanent, healthy weight loss involves shrinking fat tissue and oc-
curs through slowing calorie intake and increasing metabolic rate. If
you try to lose weight too quickly, you will damage yourself by losing
muscle mass (that’s the stuff you want to keep) or causing electrolytes,
such as sodium or potassium, to be imbalanced.
CUT-YOUR-LEG-OFF DIET PLAN—YEP, THAT WORKS, TOO

When you lose weight the correct way, you will thin out your fat cells
and bulk up your muscle cells. If you weren’t very active before and
you start an exercise program, you may even gain weight initially
because of those bigger muscle cells—that’s great! Eventually, those
healthy, well-hydrated muscle cells will tackle your adipose tissue and
trim it away. If you do it right, you may not even lose much weight on
a scale at first, but you will lose inches in your fatty areas. In the long
run, the slower approach will make healthy progress toward the goal
of permanent weight loss.
I DON’T KNOW THE DIFFERENCE BETWEEN

A CARBOHYDRATE AND A HYDROCARBON,
BUT I THINK THEY BOTH GIVE ME GAS
There has been a lot of attention paid to low-carbohydrate diets. They
provide false success quickly because when you eliminate carbohy-
drates from your diet, you also eliminate the water weight that is as-
sociated with the storage of those carbohydrates. Those molecules are
turned into glycogen in your muscles and are paired with three times
their weight in water molecules. So, when you eliminate that glycogen,
you eliminate the water weight. But as soon as you go back to eating
carbohydrates, the water weight returns. The research has shown that
a low-carbohydrate diet doesn’t lead to any more permanent weight
loss than any other restricted diet.1 Some other types of diet plans con-
centrate on having you cut out salt (not a bad thing to do) or MSG or
preservatives or just hype you up on lots of caffeine, a diuretic. In any
case, it’s false weight loss since you aren’t losing the fat weight.
If you try to exercise too much with too little intake of calories or
eliminate too much water by those methods mentioned earlier, you
can damage your body. Your system will start to break down its own
muscles or stop functioning properly. People get ill and die in the single-
minded pursuit of dieting. Please don’t do that. There are plenty of
healthy ways to speed up your metabolism and make weight loss fun
and a positive experience.
THAT DRESS DOESN’T MAKE YOU LOOK FAT, BUT

NASA IS PLANNING A FLYBY OF YOU NEXT YEAR
I’ve noticed that many overweight people get bogged down in their ge-
netics. They spend too much time worrying about their family history
That Which Doesn’t Kill You Makes You Fatter 175
of thick thighs and not enough time contemplating how to move those
thighs. Yes, twin studies and adoption studies show that people are
more likely to have a metabolic rate that is similar to those of their bi-
ologic parents than one like their adoptive parents’. So your quick or
slow metabolism is somewhat determined by genes. However, this can
be modified by nurture, by what you do to speed up your metabolism.
Heredity is not destiny.
Speaking of genetics, I’ve been wondering what my kid would have

been like if, instead of marrying the guy with the doctorate in molecular
biology, I had married the first guy who proposed to me, the mechanic
who lives in a trailer park. I guess instead of having Geek Boy 2000, I
would have had a waffle iron.
You can control your own metabolism, and you have a lot of power
in this regard. We’ve discussed a little bit in earlier chapters about how
metabolism is affected by such things as starvation and eating cycles
and also perhaps by ingested chemicals like artificial sweeteners. In
addition, metabolism is affected by exercise, sedentary activities (like
television watching), temperature, foods, hormones, medicines, and
muscle and adipose tissue.
By now, you are probably getting the idea that exercise is the pre-
dominant way to increase your metabolism. I go into specifics in the
next chapter, but suffice it to say that the more that you move your
body, the more you can increase your metabolism—to a limit.
A WATCH DOG YOU WEAR ON YOUR WRIST

The funny thing about activity is that our bodies expend a great deal
of energy doing things that we don’t think of as exercise. And the nice
thing about that is that we really can increase our metabolism without
doing a true workout. Most of our daily basal metabolism, the energy
used to expend the calories we ingest, is used for maintenance events.
In other words, our body burns a lot of our fuel just maintaining itself.
If you add on a little bit of extra activity all day long, you can burn
quite a bit more fuel without any pain or feeling like you are working
out. The hardest part is removing the mindset of inactivity and creat-
ing a permanent mindset of increased regular activity.
And it doesn’t take much of an increase in activity to start making a dif-

ference. There’s this cute neighbor of mine, a very, very old lady who
walks an ancient dog down the street every day, one of those tiny min-
iature Yorkies. The dog has no teeth, and the woman purees the dog’s
food so it can eat. (We nicknamed the pooch “Killer.”) Both walk ex-
tremely slowly. I wonder what she’s going to do when that dog finally
passes away. She’s not exactly spry enough to keep up with a puppy.
I envision her at the pet store: “Do you have anything that’s already
dead?”
You’ve probably heard or read about the advice to park your car
further away from your destination or to take the stairs on a regular
basis, rather than the elevator. Yes, these do increase activity in little
bits (plus, you can test whether you are developing improved exercise
tolerance). But what about those hours that we spend in sedentary
activities, like when we’re tied to our computer desk, reading chair,
or couch? Amazingly, research on fidgety and quiet kids reveals a tre-
mendous difference in the energy people expend in a typical day.
NEAT, or non-exercise activity thermogenesis, is the energy that a
person expends in activities not usually thought of as exercise. This is
the fuel that you burn every day when you are standing up and holding
your posture while talking to a friend or fidgeting in your chair during
a boring television show or lecture. Some people move a lot more than
others every day; they are more fidgety. Those people, it turns out, may
have an advantage in metabolism.
We solved our problem with the annoyance factor with my son on long
car rides. When he gets really fidgety, we just make him get out and run
alongside the car. That way he gets his exercise.
Research has looked at both children and adults and their NEAT
expenditures and has found that those who fidget more (measured by
motion sensitive devices) lose weight or prevent weight gain more eas-
ily, even when deliberately overfed. So now the question you need to
ask yourself is: how do I learn to fidget more, all day every day?
DO “GOOD” CHILDREN GROW UP TO BE FAT ADULTS?

Interestingly, as schools and work sites have moved more people to
desk activities, people formally or surreptitiously get evaluated on how
much or little they fidget. “Good” kids in the traditional classroom
setting are rewarded if they sit still. That’s one reason my son was sent
to a Montessori preschool. Dr. Maria Montessori believed that chil-
dren should move and use their kinesthetic learning (movement learn-
ing) actively in the classroom. As a doctor, parent, and homeschool
mom, I believe that children should move, all day, every day, and not
sit still for the best learning and health. Movement itself fosters learn-
ing and thinking for most people, at any age. This has even been dem-
onstrated in research on the frail, demented nursing home population;
those who keep moving are the ones who keep thinking much longer
and better.
I MET AN ENGINEER WHO WORKED FOR A

COMPANY THAT BUILDS TIME MACHINES.
SHE QUIT WHEN HER BOSS TOLD HER TO
HAVE THE DESIGN ON HIS DESK YESTERDAY
But what about movement in the adult population? Do you find your
life encourages you to take the “stone statue” approach and not to
fidget? At work, are you stuck in a cubicle, slaving to meet a deadline?
Do you find yourself tied to a seat much of the day? If so, it behooves
you to consciously make more movement decisions—that is, to relearn
to fidget. Remember what I said earlier? Kids naturally have more
spontaneous nonpurposeful movements than adults. It’s time to get
ants in your pants again! Take frequent breaks from your chair, and
take walks on your breaks. Form a “walk and talk” group before or af-
ter work or school. Find ways to move more in place.
Huh? Move more in place? Yep, that’s the next phase of raising your
NEAT. Dr. Jim Levine at the Mayo Clinic (up in Minnesota, where
they fidget to stay warm) has found that people who are naturally thin
gyrate their bodies and wiggle their toes a lot more than those who
are obese.2 In fact, fat people in his studies sit a lot more than thin
people—by about two and a half hours a day! Dr. Levine strapped
specially designed underwear to his subjects, complete with motion
and position sensor monitors, to determine how much people fidget.
He found that fat people instinctively move less than people who
are naturally thin. Indeed, even after the fat people lost weight, they
continued to move less than naturally thin people. (So now you know
why television watching is directly related to obesity. Studies show
that the more you watch, the less you move and the more you weigh.)
This might explain why formerly obese Americans eat almost half
the number of calories daily that thin rural Asians eat. I believe those
Chinese farmers move more all day, every day, although I haven’t
strapped any special underwear to them to prove it. (If you remember
the Cornell scientist Dr. Campbell from The China Study, he asserted
that eating vegetables makes you burn more calories and implied that
perhaps you might even move more! I have yet to find any research to
show that veggies make you wiggle, but it’s an interesting idea.) Eat
more beans. It isn’t just the gas that might propel you forward.
The great thing about being a scientist is that, if you play your cards
right, you can get people to do all sorts of ridiculous things in the name
of science. I’ve been meaning to call Dr. Levine and ask him where he
got his special gyroscope-equipped underwear. Think of the uses! But
it’s not just those literally smarty-pants geeks in ivory towers who can
do great experiments in the name of progress.
True story: one of my friends has a husband who is a contractor by
trade, but his dream was to become a scientist. Shortly after they had
their last baby, her physician gave her a free box of sample condoms. She
took it home and threw it in a drawer and forgot about it. Unfortu-
nately, her hubby didn’t. He had a peculiar interest in trying a novel ex-
periment, his curiosity having been piqued by an article about a concept
the Chinese are using—biogas. They are converting methane from sew-
age into useful energy. Mr. Science Wanna-Be decided to measure the
amount of methane the trap produces in his house. Picture this—my
friend driving up to her suburban home with a minivan full of kids,
only to find fully inflated condoms attached to her roof, flying in the
wind, in full regalia.
By the way, the last time I saw a photograph of Dr. Levine, the Mayo
Clinic researcher, he was cruising the Web on his computer while walk-
ing gently on his treadmill. That’s right, his treadmill. He doesn’t even
have a seat in front of his computer in his office! And, yes, that geek
researcher is one skinny dude.
We’ll discuss exercise programs in the next chapter. There’s good

evidence to show that you increase your metabolism for up to 24 hours
after a moderate to strenuous exercise session. Suffice it to say, for now,
start bouncing your legs while you read, run around the couch while
watching Two and a Half Men reruns, and nail a mini-bicycle-pedal
device under your desk at work.
I RECENTLY WENT TO FREEZE-YOUR-BUTT-OFF,

NORTH DAKOTA. THAT’S A PLACE WHERE THEY
PRACTICE FULL FRONTAL FRIGIDITY
While I was contemplating Dr. Levine’s work in the frigid climate of
Minnesota, I stumbled upon an article about colder science: fun-loving
researchers at the University of Maastricht, in the Netherlands. Back
in 2002, those guys managed to recruit a group of young men to spend
multiple sessions of 60 hours each sitting in a cold room, with a rectal
thermometer strapped to them, forced to do prescribed activities and
eat only a limited amount of food.3
What those scientists found was that basal metabolism increases
in a colder environment due to increased movements during sleeping
and increased energy used to process the food after eating. When they
finally let the young men eat as much as they wanted, they ate more
in the cold rooms rather than the room-temperature settings, mostly
making up for the increased fuel they’d burned. Interestingly, in both
the warmer and the colder rooms, the young men overate their calo-
ries, probably out of physical distress and boredom! I’m sure the study
subjects were thinking to themselves, “I knew I should have read the
fine print on the consent form more closely. I missed the part about
the thermometer . . .”
METEOROLOGISTS PLAY WEATHERSTRIPPING POKER

Perhaps lowering the temperature while you sleep may kick up your
metabolism a bit, although you are likely to eat more the next day. But
don’t do anything uncomfortable; it’s not worth suffering in freezing
temperatures for the few extra calories that you might burn. If you
make the ambient temperature cold enough, shivering will help burn
off some calories too, but that’s about as much fun as giving yourself a
fever (which also increases metabolism).
YOU CAN HAVE ALL THE M&M’S YOU WANT,

BUT THEY’RE LETTUCE FLAVORED
Do you remember that I said vegetables may help you to burn more
calories? That’s called the thermic effect of food. Legumes, fruits, and
vegetables have a lot of cellulose and fiber in them. These are things
that the body can’t easily digest, so it burns more fuel just to break
down your meal. It’s claimed that celery is so hard to digest that your
body burns more calories to break it down than the food has in it. Pro-
tein is also hard to digest and takes a lot of energy to break down, once
in the stomach. Fats are easiest to digest and cause the least amount of
thermic energy to be expended. Thermic energy accounts for a signifi-
cant amount of your daily fuel burned, your output.
We usually lump mushrooms into the vegetable category, but, techni-

cally, they are fungi. But a mushroom is a good fungus, full of nutri-
tion and fiber. I was watching a science program on TV, and I learned
something cool: mushrooms breathe oxygen, just like people. (If you
remember from biology class, green plants breathe in carbon dioxide
and breathe out oxygen.) I realize some of my relatives are a lot like
mushrooms: they’re round and white, grow bigger every day, don’t do
very much, and sit in waste, and breathe oxygen.
What’s fascinating is that the type of food isn’t the only thing that
is responsible for how much fuel you burn when you eat. There’s now
evidence that your health determines how many calories you expend
to break down your food—the more fit you are, the more your body
burns fuel to process the same exact lunch. Your level of fitness might
account for up to 40 percent of the thermic energy expended. This is
an amazing finding and helps explain why fat and unfit people gain
weight at a faster rate than people who are in shape. No, it’s not all in
your head; if you are a couch potato, that bag of chips you’re eating
will stick to your butt more than to Mr. Super Jock’s. You may have
suspected it, but now you know the truth: your own adipose tissue is
working against you.
The good news is that you can destroy the fat cells that are work-
ing against you with exercise (and perhaps with regular doses of
vitamin C, which seem to increase thermogenesis in sedentary folks).4
This increases metabolism chronically, and as you lose adipose tissue,

your metabolism may very well continue to speed up—finally, a posi-
tive cycle leading in the right direction! And, as this same great group
of researchers at the University of Colorado at Boulder demonstrated,
when you get in shape, the adrenaline stimulation from exercise makes
you burn more calories than if you were fat-laden, too. Food and ex-
ercise both cause you to burn, baby, burn—and you burn more when
you lose those fat cells.
When you burn energy, you generate a lot of heat. That’s why exercise
makes you warm up and sweat. Sweating is your body’s mechanism for
dissipating heat. This fact makes me wonder whether that whole story
about the Land of Oz might just have been a fantasy. Look, even if the
Wicked Witch of the West never exercised, why didn’t she just melt
on a high-humidity day? Really, if the Munchkins had thought about
it, they didn’t need Dorothy. They only needed a decent humidifier.
I’ve found myself wondering if caffeine, which also stimulates the

production of adrenaline, can itself increase metabolism. Unfor-
tunately, although caffeine does increase heart rate and acts as a
stimulant in the short run, it doesn’t seem to do much for increasing
metabolism in the long run. When caffeine is ingested by athletes, it
actually decreases the use of glycogen stores from the muscles initially
and then ramps up its use later. That does allow athletes to exercise for
longer amounts before they fatigue and so might be useful if you are
training for the Olympics. For the rest of us, its use should be limited
to minimal amounts in the morning as a wake-up call.
THE GROUNDHOG DAY DIET—SLEEP FOR SIX MONTHS,

THEN EAT UNTIL YOU SEE YOUR SHADOW
Per the National Sleep Foundation’s Sleep in America Poll, 81 percent
of the general population drinks caffeinated beverages daily, an aver-
age of three servings a day. And that’s not even addressing the caffeine
that’s now present in so many nonbeverage food items that are on the
grocery store shelf, like energy bars, coffee-flavored yogurt, and choc-
olate snacks. Why does this matter to a fat nation? Because caffeine
ingestion seriously impairs sleep, and a lack of sleep makes you fat.
My son’s school library has one couch that’s always occupied by sleep-
ing students. They fight to get it on their breaks between classes. I think
it ought to be reserved through a reward system, like what businesses
do for special parking spaces. A sign above it should say, “This couch
reserved for Jane DoGooder, student of the month.” Annually the dean
announces, “And the winner of the Golden Cot award is. . . . ”
Americans are the most sleep-deprived people on earth and also

the fattest. Columbia University presented research in 2004 showing
a statistical relationship between the number of hours of sleep daily
and the risk for obesity.5 Those who get less than four hours of sleep a
night have a 73 percent greater risk of being severely overweight. Any-
one who gets less than seven hours of sleep a night is at increased risk
for becoming overweight, and there is a strong inverse relationship—
the less sleep you get a night, the fatter you will become. Do you think
you are the only one not getting enough sleep? Americans report an
overall decrease in sleep by about two hours a night in just the last
four decades.
The theory is that sleep deprivation increases ghrelin and decreases
leptin, two hormones thought to have a significant role in appetite and
weight regulation. Hormones are just chemical messengers in the body
that help various organs and tissues communicate; they regulate body
functions. Ghrelin, which means “growth” and is released by the stom-
ach, stimulates the appetite. Leptin, a hormone that is released during
sleep, is suppressed when laboratory rats or humans are sleep deprived.
Those lab subjects then become hungry and overeat calories. Interest-
ingly, the tired human subjects in particular crave sweets, starches,
and salty snacks.
I AM WOMAN. I AM INVINCIBLE. I AM TIRED

It’s believed that a lack of sleep directly contributes to making the
body less sensitive to a much more famous hormone, insulin. That’s
the chemical messenger that is instrumental in sugar management. In
fact, if you take normal, nonobese healthy people and force them to get
only four hours of sleep a night for about a week, you can induce a
prediabetic metabolic state in them; essentially, the tissues stop listen-
ing to insulin. If your muscles and organs no longer “hear” the insulin
your pancreas is putting out, eventually you develop diabetes. Impor-
tantly, there’s new research to show that fat cells may also release hor-
mones that make muscle cells deaf. (Picture those adipose cells stuffing
cotton in the ears of the muscle cells. The cells become like an old mar-
ried couple: “I can’t hear you, I don’t wanna talk to you. Leave me
alone, I’m having a bad day.”) Unfortunately, that bad day can trans-
late into a lifetime of pills and injections, not to mention amputation
and blindness.
A study at Washington University in St. Louis bred fruit flies to be
insomniacs. The resultant flies show symptoms of chronic sleep de-
privation.6 The fruit flies sleep only an hour a day, as opposed to the
normal 12 hours, and as a result have poor memory, fall over a lot, and
are fat. (Since I read that article, I’ve been envisioning some frustrated,
underpaid researcher sitting in a lonely lab trying to measure an obese,
staggering, stupid fruit fly on a teeny-tiny scale . . . and you think
your job sucks.)There are easy things that you can do to improve your
sleep. Proper rest is important not just to lose weight but to improve
your immune system. There are no short cuts. Get enough sleep, at
least seven hours a night. As a pain physician, I strongly believe that
chronic pain diseases like fibromyalgia are directly related to too little
and poor-quality sleep. I see a lot of chronic pain syndromes in over-
weight patients.
If you are having difficulty falling asleep or staying asleep, you
might need to improve your “sleep hygiene.” That’s the environment
that you rest in and where you prepare yourself to rest. It’s more im-
portant than you realize. Don’t watch television or stare at computer
screens before bedtime; the light from the monitors causes insomnia.
Don’t read or listen to stories that are too exciting or frightening be-
fore bed; it’s better to listen to quiet music to calm the brain. Sleep on
a good bed in a dark room.
The topic of proper sleep environment reminds me of the time my hus-

band and I went shopping for new furniture for our guest room. The
salesman said, “We have some very comfortable day beds.” My hus-
band retorted, “We don’t want that. It’s for my mother-in-law. Do you
have anything in a bed of nails? ”
Avoid alcohol before bedtime. It will make you fall asleep, but dur-
ing the night you’ll wake up more easily, and your deep sleep will de-
crease. As mentioned earlier, avoid caffeine and chocolate in the late
afternoon or evening. Avoid taking medications late that may stimu-
late you to stay awake, like theophylline, Prozac, or Ritalin. Sleeping
pills do the same thing as alcohol; they may get you to sleep more
quickly but not improve the quality of your sleep. Nicotine is a stimu-
lant, too. Do I need to tell you again? Please quit using tobacco, and
never smoke close to bedtime.
I was having insomnia, so my doctor suggested I try a certain herb

tea. I checked the ingredients; it has chamomile, ginger, and catnip. It
works great, but I find myself spending hours scratching the couch and
batting the cord on my window shade for no reason.
For many people, exercising right before bed produces too much
adrenaline to fall asleep, so plan your vigorous activity for earlier in the
day. Daily aerobic exercise of at least 35 to 45 minutes will improve the
quality of your sleep. I find that when I walk every day for about three-
quarters of an hour, I sleep better, but for shorter amounts of time,
closer to seven hours than eight. The end result is that I don’t use up
any more free time between my exercise and my sleep. So there, now
you truly have no excuse not to exercise. Don’t tell me that you don’t
have time!
Finally, on the subject of sleep, I need to mention sleep apnea. That’s
the syndrome that results in a lack of oxygen from not breathing prop-
erly during sleep. Often overweight people don’t sleep well and they
don’t know why, when the reason is that they aren’t getting enough
oxygen to their brains. Obese people have a much higher rate of sleep
apnea than the general population. There is now research to show
that if you snore (a common sign of sleep apnea) or have known sleep
apnea, losing just 10 percent of your body weight may cure you of the
condition.7
Putting more emphasis on your rest may be one of the most useful
things you do to improve your health and one of the most effective
steps toward permanent thinness. Don’t underestimate how important
it is to sleep well.
CUSTOMER SERVICE SLOGAN: I’M SORRY,

THERE’S NOTHING LESS WE CAN DO
Stress itself is a major producer of hormones, particularly cortisol,
known as the predominant stress hormone. It’s thought that chronic
ongoing stress causes your body to produce too high levels of that
hormone and results in abdominal obesity and damage to the body’s
normal metabolism. There’s a theory gaining popularity that, as corti-
sol levels rise, a person seeks highly palatable, calorically dense foods
(e.g., junk foods and processed carbohydrates) to relieve the stress he
or she feels. It’s thought that junk foods that are eaten when stressed
may work on the same neurological mechanisms as narcotics to relieve
suffering.
Speaking of stress, wouldn’t it be great if businesses had to be named

after the personalities of their owners, such as Real Bastard Pools or
You-Want-It-When Dry Cleaning? A sign on the door says, “Our motto:
service with a grimace.” When you get their voice mail, you hear the
message: “Press 3 if you want to scream in frustration. Press 4 if you’re
ready to commit suicide.”
WHAT DID CAVEMEN HAVE AS COMFORT

FOOD, SABER-TOOTH POPPERS?
Our brains have what is called “endogenous opioids,” that is, we make
our own narcotics in our brain to relieve physical and mental pain.
When junk foods continuously make us feel better in our chronically
stressed state, we develop compulsive overeating. Unfortunately, this
condition leads to dysregulation of our appetite hormones, like leptin,
and our sugar-regulating hormone, insulin. Junk food gives us happy
brains in the short run, but, in the long run, it’s a disaster. Interestingly,
there are some researchers who believe that chronic food restriction
in this situation actually backfires and leads to worsening stress and
perpetuates the cycle. If you are in that cycle, this book should help
you break out of it.
CAUTION: I’VE GOT PMS, AND I KNOW HOW TO USE IT

Now I have to discuss female hormones. Women have a higher rate
of obesity than men, and it may have to do with our unique, pesky
chemical messengers. Fluctuations in hormone levels during the men-

strual cycle can lead to overindulging in calories; this is extremely
common. What’s interesting is that even basal metabolic rate changes
throughout the cycle. I mentioned at the beginning of this book that
I developed a serious weight problem with my pregnancy. This is one
of the most common times for women to gain weight, and often they
stay heavy afterward, particularly if they have more pregnancies in
quick succession.
I have an idea for a new type of wall clock. It doesn’t tell time or even the
moon phases or the ocean tides. It’s an estrogen clock. Get one for every
woman in your life or for that special person who is tied to her. The
clock runs on a four-week cycle. At what would be the noon position, it
says, “Oh, crap.” At three o’clock, it says, “All better now.” At the six o’clock
position on the dial, it says simply, “Getting close.” And at nine o’clock,
it declares, “Just leave chocolate and tiptoe quietly out of the room.”
CHURCH SIGN: HE IS RISEN, BUT SHE IS BLOATED

Women often have to deal with hormone-related mood swings that can
contribute to weight gain. Sometimes this is seen in postpartum de-
pression. Later on in life, women are at greater risk to gain weight during
menopause, as well. After menopause, the lack of female hormones is
thought to cause a shift of adipose tissue from the rear end and thighs
to the abdomen. This results in a more metabolically active, danger-
ous type of fat and may lead to a higher rate of medical complications
for women in later life.
A research study by a psychologist says that men also suffer from post-
partum depression, and that it’s due to changes in family structure,
economic pressures, and a lack of sleep after the baby is born. He claims
that women don’t get depressed for those reasons. The only reason we
get depressed, he says, is that women are hormonal. I tried to contact
that psychologist to discuss his findings, but his wife answered the
phone. She said she had a bad case of PMS and her husband was tied to
the couch, and he would have to call me back later.
Finally, while I’m on the subject of hormones, I must mention the

thyroid. It’s the most common organ to be maligned when people gain
weight, but it’s rarely the underlying cause. There is no doubt that
when a person develops an underactive thyroid gland, he or she is
more likely to gain weight. But, the vast majority of overweight peo-
ple in the United States have normal levels of thyroid hormone. If you
notice you are suddenly and inexplicably adding a lot of weight to
your frame, have dry skin and hair and constipation, and are get-
ting dull in the head, you should have your thyroid hormone levels
checked. This is an easy blood test, and low thyroid hormone is easy
to treat. It would be nice if obesity could be solved with a small daily
pill, but for most of us, being overweight is not a simple glandular
problem.
The reason that the thyroid gland is often suspected or talked about
in this field is that it is one of the primary organs that regulates our
metabolism. When we have too little thyroid hormone, our metabolism
slows down, and our bodies burn less fuel per day. However, taking
extra thyroid hormone is extremely dangerous if the thyroid is func-
tioning normally. Too much hormone can lead to heart rhythm ab-
normalities.
A 90-YEAR-OLD MAN’S CHART SAID HE’S ALLERGIC

TO VIAGRA. I WANTED TO ASK HIM, “IS THAT A
HIVE OR ARE YOU JUST HAPPY TO SEE ME?”
It is important to be aware, though, that many medications pre-
scribed to us for other medical issues can affect the metabolism, often
negatively. The most common medicines to do that are the group of
heart drugs called beta blockers. These medicines are also prescribed
for a number of other maladies, including migraine prevention and
tremors.
Many psychiatric drugs can cause a slowing of metabolism and
subsequent weight gain, although it’s not clear from the literature
whether this reflects true metabolic changes or results from an ef-
fect on appetite. Narcotic pain medications also may slow metabo-
lism, causing weight gain, but the effect is usually minor. If you are
on a prescription that you suspect may be leading to weight gain,
please talk to your doctor about it, as many medicines do stimulate
the appetite or cause fluid retention, even if they aren’t slowing your
metabolism.
Not only is it important to get the right medication, but it must be taken
the right way. Recently, the nurse screwed up giving my patient the two
shots I ordered. He got the right medicine, just in the wrong place: the
flu shot in the forehead, the Botox in the butt. Okay, he won’t get the
flu, but now the man has no crack.
MY HUSBAND PLAYED HIGH SCHOOL FOOTBALL. NO, NOT

QUARTERBACK, NOT RECEIVER—HE PLAYED LEFT OUT
I’ve skirted the issue, but I haven’t confronted it directly. Now we must
discuss one of the clearest ways to increase your basal metabolism:
get more muscle. Obviously, everyone has some muscle, but if you are
significantly overweight, you may not realize how little you have since
your lean muscle tissue is now padded or infiltrated with fat. When
you were younger or skinnier, you might have noticed your muscles—
they were round, firm, and well delineated. You see them on televi-
sion, in fitness infomercials, and in movies, rippling on the stars. Once
in a while, you see them bulging on our national sports heroes, even
those who aren’t steroid-built.
Most of our daily calories are burned up every day on activities like
breathing, churning our intestines, thinking, maintaining core body
temperature, and repairing damaged tissue. But our muscles use a lot
of calories every day to keep warm and to move our skeleton for our
activities of daily living. Even when resting, muscles burn a lot of calo-
ries, particularly compared to adipose tissue. Fat is relatively inert; it
sits there and jiggles and puts out hormones to wave at passing cells,
but it doesn’t burn much fuel. Belly fat in particular is thought to use
those chemical signals to slow the body’s metabolic rate. On the other
hand, muscle is too busy to sit around and talk; it burns fuel to keep
the body upright and warm.
I’ve read that each pound of fat burns about 2 calories a day and
each pound of muscle burns anywhere from 6 calories to 60 calories a
day (once again, that value varies widely and depends on which nerd
scientist you believe). Thus, just a five-pound conversion from adipose
tissue to muscle might be enough to help you lose substantial weight
over a year’s time. That’s why the exercise chapter, coming up next,
will help you raise your metabolism by burning fuel through aerobic
exercise and increasing your basal metabolic rate by losing fat and
gaining solid muscle.
TEENAGE BOYS AND THEIR EATING HABITS, OTHERWISE

KNOWN AS THE 17-YEAR-OLD LOCUSTS
The average American loses almost seven pounds of lean muscle mass
for each decade of life. That lean muscle is replaced with much more than
seven pounds of fat tissue. That’s why you gain weight over the de-
cades and may not realize how much muscle that you have lost. Much
of that muscle loss, I believe, results from inactivity, not the “normal”
processes of aging. This creates an enormous downward shift in me-
tabolism as we age. According to the literature, the basal metabolism
rate of the average person slows by up to 20 percent for every 10 years
of life. Thus, a 45-year-old man may burn only half the calories daily
that he did when he was 20, especially if he is now sedentary. So when
you think to yourself, “All I have to do is look at that piece of cake
and I get fat, but when I was a teenager, I could eat the entire cake,”
you aren’t far off the mark. It doesn’t have to be that way, and you have
the capacity to change it. Even the Mayo Clinic Web site for patients
claims that aging causes a slowing of metabolism, and you just have to
accept it.8 I disagree. Don’t accept it—just get moving.
And movement is important, all across the age continuum. According

to a New England Journal of Medicine article, a study of 75- to 85-
year-olds’ sexual activity revealed that about one-third admitted to
participating in oral sex, one-third couldn’t remember, and the rest
recalled an embarrassing denture incident.
The funny thing about the Mayo Clinic is that its own endocrinol-
ogy department recently published research showing that most aging-
related changes in muscle result from inactivity, not true aging.9 The
number of mitochondria, the individual powerhouses of cells, declines
only in inactive muscle but can be increased if the subject exercises.
This was demonstrated by an elegant study done more than a decade
ago in the United Kingdom, at the University of Newcastle upon Tyne.10
The researchers compared muscle function in young and old, in sed-
entary and in active people, and were able to conclude that in those
older folks who stayed active, the metabolic markers for “aging mus-
cle” were absent. Build those muscles, maintain them, and make them
work for you, even when you are resting, by burning off your fuel.
And then you can have your cake and eat it, too!
I’VE GOT A MIND LIKE A STEEL SIEVE

Ahhh, well, I can’t leave the subject of moving up metabolism without
discussing one of my favorite activities—thinking. What about think-
ing and burning calories? Our three-pound brains are a constant en-
ergy drain, buzzing through huge amounts of blood sugar and using
25 percent of our daily calories, on average. (Kind of reminds me of the
United States, which has only 2 percent of the world’s population but
uses 25 percent of its energy.) So, do intense thinkers use more calories
than stupid people or chronic TV watchers? Was Einstein thin in later
life because he was busy writing keynote addresses and meeting with
heads of state and wasn’t sitting home watching The Honeymooners?
My husband likes to play private investigator in our house. The other

night, he asked my son if he could remember exactly when he first no-
ticed that his brain was missing.
Well, it turns out that deep thought might just burn more than a
few calories. According to reports, television watching uses as little as
5 calories an hour, but doing the crossword puzzle burns up to 90 cal-
ories during that same time. If you eliminated much of your passive
thinking time, you might stave off Alzheimer’s disease, become more
interesting to your friends, and help yourself fit into a slimmer ward-
robe. Keep this idea in mind. As Winnie the Pooh likes to say, “Think,
think, think.”
THINGS THAT COME OUT, BUT NOT OVER DINNER

I’m fascinated by what lengths people will go to for weight loss. The
conquest of the scale can come at tremendous cost. In medical school,
I worked in an adolescent eating disorders unit of a hospital. There,
girls and young women were hospitalized after they had starved or
purged themselves to lose weight. Purging consists of forced vomiting
or using diuretics or laxatives. All are dangerous, of course, and some-
times result in death or brain damage. It has been written that the
famous court battle centering around Terri Schiavo (the longest right-
to-die case in U.S. history) began with her dangerous bulimia in pur-
suit of permanent thinness.11 It is thought her dieting behavior resulted
in electrolyte imbalance, heart attack, and subsequent severe brain

damage. Her husband and parents then spent more than a decade
fighting in court over her feeding tube. There’s more than a little irony
that those around her spent the rest of her life battling over her intake
of nutrition.
I HAD A PATIENT WHO PUT DULCOLAX IN HIS EARS TO TREAT

WAX. IT’S AMAZING WHAT A GOOD LAXATIVE CAN DO
We must discuss another type of purging—colonics. If you are a ce-
lebrity or are from California, it’s called that. Everywhere else, we still
call it an enema. Truly, a colonic is just a method to flush the colon,
which is an organ that is the end part of our intestine. The large intes-
tine’s only responsibilities are storage of our already-processed poop and
absorption of water. So, like any enema, a colonic is just a form of
purging of waste and water, which will quickly build right back up any-
way. It is neither a useful or safe form of weight loss and has no place
in a healthy regimen. Despite what the colon therapists and some weirdo
writers on the Net would have you read, there are no “toxins” that
are drawn out by a colonic, except the toxins of an overstuffed wallet.
DON’T WORRY, NO REAL BREASTS WERE

USED IN THE MAKING OF THAT BODY
Before the Academy Awards, there was a show on television about

the beauty secrets of the rich and famous. It demonstrated how they
put cucumber slices on their eyes to decrease puffiness and rub coffee
grounds on their thighs to decrease cellulite. I have this image of star-
lets rummaging through their neighbors’ compost piles in the middle
of the night yelling, “Isn’t there anything here to put on my ass?”
Sweating off the pounds is another popular and dangerous pastime

for those who desire quick weight loss. Boxers do it before weighing in
for the big fight. Stars do it before the Academy Awards. It isn’t safe.
Our bodies are meant to be at least 70 percent water. Losing weight
rapidly through sweat evaporation that results in multiple pounds lost
means danger. It indicates that, somewhere in the system, the metabo-
lism is going haywire. Enzymes stop functioning, sodium gets too con-
centrated, the muscles and the brain seize up.
Sweat lodges fascinate me. They are very popular in a community just
south of where I live. Even some physicians have them in their back-
yard, for spiritual communion. They’ve become a New Age phenom-
enon, mimics of Native American rituals. I’ve never quite understood
the desire to force oneself to dehydrate to the point of hallucinating in
order to have a spiritual moment. It seems like God wouldn’t want us to
go to all that trouble. If you’d like to teeter on the brink of brain injury,
it’s less trouble to just slip a plastic bag over your head, but remember
to pull it off before you kill yourself. If you don’t, there’s a chance
you’ll get to heaven and find out that God is the check-out person in
the great grocery store in the sky. His first words to you are, “Paper,
plastic, or brimstone? ”
Finally, let’s discuss the future of metabolism. The Imperial Col-

lege in London, along with help from the Nestle Company (yep, that
Nestle, the one that makes candy), has developed probiotics that may
improve metabolism and weight loss.12 Probiotics are good bacteria
that live in our gut and help with digestion, among other things. This
group of researchers is looking into developing bacterial strains that
break down our food more efficiently or change the way fat is ab-
sorbed. I suppose their idea is that we’ll absorb fewer calories, even if
we overeat chocolate bars. Need I say more?

• Quick weight loss is just water weight and can be very damaging.
• Metabolism is determined to some degree by heredity but more by
things you can control.
• Small amounts of activity done all day long add up to big effects on
metabolism.
• Cold environments spur the body to burn more calories and increase
metabolism.
• The more difficult a food is to digest, the more calories you burn.
• The more fit you are, the more fuel you burn to digest your food and
to exercise.
• The less sleep you get a night, the fatter you become.
• A lack of sleep may directly lead to diabetes, as well.
• To get good rest, you may need to improve your sleep hygiene.
• Stress itself produces hormones that damage the body’s normal me-
tabolism.
• Female hormones affect metabolic rate, weight gain, and fat dis-
tribution.
• Thyroid gland problems can cause weight gain but isn’t the issue for
most people.
• Medications can affect the metabolism or cause weight gain for other
reasons.
• Even when resting, muscles burn a lot of calories, much more than fat.
• Age-related slowing of metabolism is a result of inactivity, not true
aging.
• Intense thinking burns a lot more calories than passive intellectual
activities.
• Purging behaviors don’t work and are very dangerous.
• Someday we might be able to let bacteria in our gut speed our me-
tabolism.
ELEVEN
Dinosaurs Refused to Exercise
and Look What Happened to
Them: The Right Activity
My husband had a 300-plus-pound friend who used to play rac-

quetball with him. The guy drove a subcompact vehicle that probably
weighed less than he did. He would apologize while trying to extract
his body from behind the wheel: “Excuse me while I take my car off.”
The only way to lose weight is to burn up more energy than we take in.
Exercise is the easiest and healthiest way to do that.
I am astounded, when I read diet books, including some of the most
popular books, at how few pages are devoted to the behavior of moving
our bodies through space. Both Dr. Atkins and Dr. Ornish were cardi-
ologists when they wrote their bestseller diet books, and both devoted
fewer than 10 pages to a conversation about exercise and behavioral ap-
proaches to losing weight and keeping it off. However, both devoted
more than half their books to recipes for their eating plans! This is akin
to trying to empty a bathtub by letting less water run into it but never
removing the stopper from the drain.
I like the analogy of the bathtub. I think it is a useful one when it
comes to thinking about calories and exercise approaches in weight loss
and weight maintenance. Your body is the water in the bathtub. If you
want there to be less water in the tub, you should try to slow the amount
coming out of the faucet. That’s your food and drink that goes into your
mouth. But, in addition, you had better unclog the hairball in the drain.
The hairball is a sedentary lifestyle. Most traditional diet plans and
weight-loss centers place almost all their emphasis on food and calories.
They concentrate on the spigot. They ignore the hairball.
WELCOME TO LEMMINGS LEAP FAT FARM—WHEN

WE SAY “JUMP,” WE MEAN IT!
I’m going to give it to you straight: it is nearly impossible to lose weight
and keep it off long term without a daily exercise regimen, permanently.
Yes, there are people who do it, and you may know them, but they are
a very small minority of the successful normal weight individuals of the
world. And, besides, just because they are normal weight doesn’t mean
they are healthy. My approach to weight loss is to do it for the sake of
health, not just for the great-looking figure. The great-looking body is a
wonderful side effect.
Exercise is not optional. Is brushing your teeth optional? If you went
two or three days without brushing your teeth, you would have green,
slimy teeth. That’s gross. Think of what is going on inside your body
when you don’t move it for two or three days, or longer. You get green,
slimy insides. (That’s figuratively speaking, of course; the truth is, we
are all the same on the inside—mushy and red, except for the parts that
are mushy and brown.)
WILD HAMSTERS CAN RUN 10 MILES A DAY,

BUT WHERE DO THEY GET THE BALL?
One hundred years ago, most people led very active lifestyles out of ne-
cessity. The vast majority of the world’s population lived on farms. They
exercised the equivalent of jogging up to 7 to 10 miles a day. Our bodies
have evolved to want and need that much activity; we are not that far
removed biologically from our animal brethren. When we are inactive,
our bodies break down rapidly, both physically and emotionally.
At least three-quarters of those who lose any weight permanently do
so by exercising regularly at least three days a week for the rest of their
lives. Walking is by far the most common exercise, and many do it daily
to lose the weight and keep it off forever.
Walking is one of the safest and most effective regular exercises. I rec-
ommend regular walks in nature parks to improve mood and overall
Dinosaurs Refused to Exercise 197
health. Not far from my house is a beautiful setting that is an ancient

sinkhole more than 120 feet deep. It is a state park in an area called
Alachua, which is Native American for “Hey, where’s Grandma?”
The research shows that up to 90 to 95 percent of those who’ve lost

more than 30 pounds and kept it off still exercise three to seven times a
week, forever. That’s according to a Kaiser Permanente study from the
early 1990s and also, more recently, from the National Weight Control
Registry’s (NWCR) data.
For those who’ve lost significant weight permanently, then started
to gain weight back, almost all use an increase in exercise as their pri-
mary method to get their weight back down. It is crucial to get active,
stay active, and increase activity when needed. That’s what works for
those who’ve tried everything and succeeded.
DOES A FAT BALLERINA WEAR A THREE-THREE?

The simplest exercise program is to walk daily, and, interestingly, that’s
where the research is the most definitive on exercise and weight loss. In-
dividuals who participated in studies that had people walk daily lost
weight. The longer the research study went on, the more weight lost.1
No other exercise has been shown to be as useful. Don’t want a compli-
cated exercise prescription? Walk at least 30 to 40 minutes every day
more than you have been up until now. According to the NWCR, the
most common type of exercise by those who lost significant amounts
of weight and kept it off was walking. This was followed in popularity
(distantly) by bicycling, aerobic exercise classes, and weight lifting.
Those who stop exercising at the end of a “diet” are more likely to
gain all their weight back than are those who continue to exercise regu-
larly, no matter what else they do with their food intake. Find the ac-
tivities that you love, whether it’s walking, kayaking, or dancing; then
do them every day and never stop.
THE MOST SERIOUS SIDE EFFECT

OF REGULAR EXERCISE—LAUNDRY
As implied, the ideal exercise for permanent weight loss is aerobic ex-
ercise, like walking. The definition of aerobic exercise is any repetitive
motion that moves your major muscle groups in a rhythmic manner to

increase your heart rate. Walking, swimming, bicycling, jogging, using
elliptical machines, and step aerobics all fall into this category.
When you do this type of exercise, you are increasing your endur-
ance for more exercise, even of a different type, because you are training
your heart, lungs, and muscles to work more efficiently. That’s why this
type of exercise is the most important for long-term health.
And aerobic exercise is what gets your metabolic rate up, not only
while you are doing it but for up to 24 hours after you’ve finished. That’s
why the recommendation of daily aerobic exercise matters to weight
loss. Want to keep your body’s metabolism constantly revved, even
while you are asleep or sitting at your desk? Move it aerobically for at
least 30 to 40 minutes every day. Daily exercise places you in a higher
metabolic category, burning more fuel throughout the day.
OUR METABOLIC PROGRAM: ULTRA-CANNIBALISM.

YOU RUN UNTIL WE CATCH YOU
Purdue University and the University of Vermont looked at their cross-
country teams and other highly trained runners and compared them to
sedentary students. What they found is that those who were endurance
athletes had a higher basal metabolic rate. But what’s really interesting
is that each pound of muscle burned more calories in the trained ath-
letes, even when the researchers controlled for the amount of lean mus-
cle in the two groups! Thus, it isn’t just building muscle that’s important;
it’s the aerobic exercising of the body that matters, too, if you want to
get the biggest possible increase in metabolic rate.
I’ve been wondering why most of the great marathoners come from
Africa. I think I’ve figured it out: it’s a different lifestyle there. They
are all lean muscle, they eat right, and they are constantly on the
move. When a marathoner comes here to compete, he risks his career
ending when someone hands him a remote control. Suddenly he can’t
get farther than the minibar.
As we mentioned in the previous chapter, you need to have solid

lean muscle along with endurance training. Your increased resting mus-
cle constantly burns calories, even days and weeks after you’ve built it.
Strength or resistance training is how you build lean muscle the

fastest. It’s not just for jocks. Don’t worry, increasing muscle by pump-
ing iron won’t make you look like an Olympic weight lifter, but it will
make you look sexier. There are many ways to build muscle, and it
doesn’t have to be with traditional weights. Resistance training can be
done very effectively with exercise bands or tubing. These are small,
lightweight, inexpensive devices that have different levels of resistance
and are meant specifically to build strength.
The idea is to do a set of strength exercises about two or three times a
week, but not daily. The goal should be to repeat each exercise about a
dozen times without resting. If you can do a lot more in a row, it’s too
easy for you and you won’t build much muscle. If you can’t do a dozen
without resting, you are risking damaging your muscles instead of
building them. Make sure you use proper form, and don’t do the same ex-
ercises every day, as the muscle needs time to build and repair between
sessions. Don’t be afraid to ask for advice from someone who is trained
on the equipment or is a certified fitness instructor, especially when you
are first starting out.
I’M WATCHING THAT FAMOUS GOLFER, GUNNA STEPINIT

The nice things about the resistance band or tubing method is that it
can be done just about anywhere and at anytime (except while driving—
definitely not advised). I’ve taken them with me while traveling. I usu-
ally use my tubes in front of the tube, while watching golf or the news.
Try them. If little old ladies can do exercise bands in physical therapy
after a stroke, you have no excuse. They can be bought at discount de-
partment stores or sporting goods store. If you are really cheap, use old
underwear (wash first) and pull the waistbands out.
A friend of mine said that she was going to get dumbbells to exercise,
but she had been too busy to shop. I suggested she start with a 16-
ounce can of beans in the meantime. That way, if she drops the can on
her head, she can put a steak on her eye and have a ready-made meal.
If you aren’t very active, you can build muscle simply from walking,
swimming, or other aerobic exercises (like walking in water, one of my
favorite exercises to prescribe). I find it funny how often doctors will say
water exercises are not resistance training. Have they ever done a water
aerobics class? Think about how much a gallon of water weighs (about
8–9 pounds). Now imagine trying to push through all that water by jog-
ging or using a water aerobics paddle. There’s a lot more resistance
than you get holding a light dumbbell out of the water! I like exercises
done in the water because you can get a great cardiovascular workout at
the same time you are doing resistance training. I’m always encourag-
ing my patients to get in the pool because water supports an overweight
body more easily than air and warms and supports arthritic knees and
backs. But always exercise with a buddy, or have someone watching
you exercise when you are in water.
I WENT TO A VERY STRENUOUS STRETCHING

CLASS, TYPE-A YOGA
Another component of exercise is flexibility. The more flexible you are,
the less likely you are to injure yourself. That’s why it’s good to stretch
before or after aerobic or strength workouts or to do flexibility training
separately (like yoga). A lot of people talk about core strengthening, too.
All that means is to concentrate on the muscles in your torso, including
your back. I believe core strengthening is particularly important to the
overweight population, since it prevents or reduces back pain.
HE EXERCISES; HE HAS A THREE-PACK.

HE’S SCULPTED LIKE FINE LIVERWURST
I should make a point about spot reduction exercises—they don’t work,
because the body decides where to break down fat according to its met-
abolic needs. It may not take the fat from your adipose tissue with extra
cellulite in your thighs, no matter how much you want to get rid of those
lumpy thighs. If you are someone who gains and loses weight first in
your belly or chin, that’s where your body will go looking for fuel first.
But, as you lose fat tissue overall, you will lose those cellulite deposits
eventually. Exercising a particular spot will increase the muscle in that
area, giving it more definition and a sexier shape that will be emotionally
beneficial when you look in the mirror (and when others look at you).
If you find that you are in a plateau and cannot lose more weight, it
means you need to ramp up or change your exercise activities. Increas-
ing time or intensity will burn additional fat by increasing your metab-
olism. Adding a second type of exercise or a regular strength program
or doing interval training will help by challenging the muscles more.
Interval training involves high-intensity exercise done in short bouts,

interspersed with lower-intensity exercise or rest periods. An example
would be alternating walking and sprints. The University of Guelph,
in Canada, showed that just two weeks of interval training will help the
body to burn more fat tissue than regular moderate exercise.2 However,
the study used young, healthy women.
And, speaking of young, healthy women, I saw a lady going down a

busy street on inline skates, wearing protective knee and elbow pads,
and talking on her cell phone. She was paying absolutely no attention
to the cars while she weaved through traffic. No matter how much
protective equipment you wear, this behavior won’t keep you healthy
for long. It’s a lot like driving a car with dual airbags while wearing
a blindfold.
In 2008, the Norwegian University of Science and Technology did

a similar interval training study using middle-aged subjects with meta-
bolic syndrome, a common problem in the obese.3 (Metabolic syndrome
involves having some or all of the following: abnormal cholesterol or
triglycerides, high blood pressure or blood sugar, or a big waist circum-
ference.) They found their subjects burned considerably more fat with in-
terval training than through regular moderate exercise. But don’t start
a new exercise program with interval training. Do it once you’ve devel-
oped endurance and are in better condition.
The intensity of exertion in your exercise is just as important as the
time you spend doing it. I’ve had people tell me that they walk their dog
everyday for 60 minutes, but when I see them walk, they can barely make
it across the room. In their hour of exercise, they get down the street and
back! Certainly, swimming at a good clip for three-quarters of an hour
is not the same as moving silly putty around a table for 45 minutes.
That’s why you need to monitor your intensity and exertion with the
talk test. It’s part of what we rehab types call the Borg exertion scale.
Don’t worry, it won’t turn you into a Star Trek alien. It’s a subjective
rating of how hard you think you are working, in terms of physical
stress, effort, and fatigue. What the exertion scale teaches is that you
should be able to converse or sing comfortably while exercising for mild
to moderate exercise. This is where you want to start an exercise pro-
gram, if you are not a regular exerciser. Moderate to severe exertion
should make you feel that you are working hard or very hard and that
you will fatigue quickly. This is for the more fit and in-shape or those
who are being medically supervised. Leave the harder exertion to those
who are experienced in their exercise, because that’s where the trouble
usually comes in.
SORE, THE GREEK GOD OF INJURY

Any exercise is better than not exercising at all. Start somewhere, any-
where, and don’t give up. Then, as you get more energy, time, or comfort,
expand your commitment. The key here is to do something regularly.
Start slowly. People who do an intense exercise program are more likely
to drop out and more likely to get injured. You never have to get to the
“intense” level of exercise. In fact, unless it thrills you to smash racquet-
balls in a competitive league, you are better off concentrating on mod-
erate exercise as your ultimate goal. You’ll stick to it in the long run, and
you won’t get injured. Start with five minutes a day, if that’s all you can
muster, and then go from there.
Intense levels of exercise may actually increase fatigue and worsen
tension, pain, anxiety, and insomnia. This is the level of exercise that also
causes more cardiac complications and sudden death. The weekend
warriors who are out of shape but insist on exercising intensely on rare
occasions are the ones most likely to end up in the obituary column at a
young age.
Some competitive sports are more dangerous than others. Ice hockey
is pretty violent. It’s the only sport where there’s an actual penalty
for causing an amputation. You have to carry the limb around for
two minutes.
People tend to exercise vigorously when starting a new diet, a New

Year’s resolution, or a new gym membership. Then they get hurt or sore
and become unhappy and give up. Don’t do that. Prevent noncompli-
ance by starting slowly and doing only short bouts of reasonable ac-
tivities. You don’t need to feel sore afterward to accomplish a good
workout. You don’t even need to feel tired. You should feel happy and
refreshed, if you did it right.
INTERNATIONAL SPORT OF ULTIMATE PILLOW FIGHTING—

IT CONSISTS OF THREE 2-FEATHER ROUNDS
Exercise does not have to be defined narrowly in the traditional sense.
Toss aside the notion of tight clothes, health club memberships, and
barking fitness instructors, unless that appeals to you. Throw away your
“Kvetching and Stretching with Shoshanna” DVDs. Exercise doesn’t
have to be burdensome or expensive. It should be fun. When my son was
young, we bought a “jumping couch.” It was meant specifically for my
kid and his friends to jump and wrestle on and enjoy during lots of pil-
low fights. It was overstuffed and supplied with tons of pillows. Ten
years later, the jumping couch is worn and sagging, but no one wants to
part with it—too many excellent memories. Many of those memories
involve vigorous exercise (all of it G-rated, mind you). But we’ve had
fun and laughed until we couldn’t breathe thanks to the jumping couch.
I’m a big believer in the fine art of skipping. That’s right, skipping.
Why do people think that a person has to stop doing it around the age
of six? Try skipping into the mall or around the block like a kid. You
won’t be able to stop smiling, and you’ll probably get the neighbors
smiling, too. Talk about great exercise!
BEWARE OF YOUR DOCTOR’S EXERCISE

PRESCRIPTION IF IT SAYS, “RUN DOWN TO
THE CORNER AND GET ME A BURGER”
Don’t become an exercise slave, thinking that you have to do it, or
overdo it, to the point of exercise burnout. Also, don’t get into the “I ate
a donut so now I have to jog for 30 minutes to burn it off ” mindset. Then
exercise becomes a punishment for what you perceive as guilt-laden di-
etary indiscretions. Oh, no, you’ve fallen back into diet-hell mentality!
Guilt and punishment are detrimental and self-defeating. Always asso-
ciate exercise with pleasure. It should be a reward in and of itself.
So what do I think is the perfect exercise prescription? Ideally, it con-
sists of moderate aerobic activity for 60 minutes every day, plus two to
three sessions a week of strength training with flexibility and stretching.
Am I telling you to do that starting this week? Heck, no, but understand
that’s the ideal to get you permanently slim and to stay that way and to
be in the best health of your life.
My son thinks that exercise and hygiene work the same way. If you
can exercise once a week for 60 minutes or three times a week for 20
minutes and get the same benefits, then, he assumes, you can do the
same with hygiene. In his mind, a shower taken once every three days
for 45 minutes must be the same as a daily shower of 15 minutes.
There are some things to focus on after you start your exercise pro-
gram to ensure it is effective and helping you. Ask yourself, “Do I sleep
better, do I have more energy, or do I hurt afterwards? ” A little ache is
okay, but real soreness or hurt is unnecessary and a warning sign. I don’t
believe in the philosophy of “no pain, no gain.” Be careful of advisers who
push that mantra. Ask yourself, “Do I feel more in control, less stressed,
and happier after doing this?” or “Do I find myself smiling during or af-
terwards, or am I bitchier?” Don’t be afraid to question “Do I feel better
physically, and can I do things now (like climb stairs easily) that I couldn’t
do before?” Use these newfound skills to remind yourself why you ex-
ercise. Modify your program if you aren’t getting enough positive feed-
back from your body and your mind.
BOTOX IN YOUR ARMPITS STOPS SWEATING,

BUT SO DOES BOTOX IN YOUR HEART
Daily exercise must be in the mindset of everybody, no exceptions. There
are only a few contraindications (that’s the medical term for “reasons not
to prescribe it”) to exercise. The biggest contraindication in the over-
weight population is a dangerous, unstable heart condition. Since I rou-
tinely see patients in the hospital just after major heart attacks and open
heart surgery, I’m familiar with this situation. Here’s a revelation: even
those horribly sick patients get out of bed and exercise within days of
when they were admitted to the hospital! If they don’t move, they get
sicker.
What if sports teams were named after common medical diseases, like
the Peoria Psoriasis or the Hyannis Hypertension? They could have
numbers on their uniforms like 160/90 or 200/80.
I believe our medical establishment has overblown the necessity of

“check with your doctor before beginning an exercise program.” I’ve
always been irritated by that statement when I see it in a magazine or
hear it on TV. Given the fact that many people wait to see a physician un-
til they are having a near-death experience (men more than women do
this), telling people to “check with their doctor” throws a huge hurdle in
front of couch potatoes. Those potatoes are more likely to stay on the
couch; it gives them a great excuse to procrastinate.
What I’d love to see is blaring television ads and front-page headlines
screaming, “Check with your doctor if you want to stay a couch potato.”
Believe me, in our modern culture, inactivity kills many more people than
exercise.
I’VE ALWAYS THOUGHT CLOGGERS REFERRED TO

ARTERIES. NOW I FIND OUT IT’S A FORM OF DANCING
Okay, here’s the caveat: you should check with your physician before
starting a new exercise program in a few simple cases, such as if you have
poorly controlled blood pressure or a heart condition, get dizzy with ex-
ercise, or have significant kidney or liver disease or brittle diabetes. If you
are 45 or older and smoke or have high cholesterol or a family history
of early heart disease, you should get checked out. If you’ve had joint re-
placements, just remember to follow the surgeon’s advice on complying
with any restrictions on movements. If you have severe osteoporosis, I
usually don’t recommend weight lifting. But you should do something
that helps the bones to get stronger (that’s why weight-bearing exercises
like walking are better). If you are pregnant, have a discussion with your
doctor or midwife.
Remember, use some common sense when exercising. There are ac-
tivities that aren’t safe and aren’t smart. For example, Canadians have
never won an Olympic diving competition—ice diving doesn’t have
many survivors.
You should also seek medical advice if you are exercising and notice
chest pain or pressure, arm pain, jaw or back pain, nausea or unusual
sweating, or overwhelming fatigue. In those cases, you need to call 911 or
get medical help immediately. Those are all signs of a lack of blood flow
to the heart’s arteries and can result in a heart attack or sudden death if
ignored. Also, if you find that you are wheezing or having more lung
symptoms, call your doctor. Finally, if it hurts, stop doing it! If walking
on concrete is too tough on the knees, start bicycling or water exercise.
Find a form of movement that makes you and your body feel good.
IF YOUR LIFE IS TOO STRESSFUL TO EXERCISE,

THAT’S WHEN YOU NEED IT THE MOST
Exercise has been shown in innumerable studies to improve mood by
decreasing stress, anxiety, and depression. Exercise is an antidepressant
and works as well as or better than prescription medications for mild to
moderate depression. And, according to German researchers, daily phys-
ical activity makes antidepressant medications work three times as effec-
tively for severe depression.4 It will allow you to make your weight-loss
goals because you feel better mentally and physically. Dr John Foreyt, a
professor of psychiatry and an authority on obesity at Baylor’s College
of Medicine, has said, “I deserve to enjoy exercise regularly.” He encour-
ages walking as a form of relaxation.
Researchers at the University of Missouri-Columbia demonstrated
that high-intensity exercise decreases anxiety better than moderate or no
exercise.5 Interestingly, women, particularly “older” women (up to age
45 in the study) got the most emotional benefits from exercise.
One of my favorite Olympic women’s sports is synchronized swimming.

I was watching the competition, and the competitors were in a circle
throwing one of their teammates up in the air with their legs, while
they were face down in the water. Apparently, you got extra points for
throwing one of the gals high up in the air. How much would they have
gotten if they shot each other? Hey, what if we could combine sports,
synchronized swimming, and skeet shooting: “Okay, pull!”
Exercise releases norepinephrine in the brain, which decreases stress

and induces relaxation. The brain also emits endorphins during physical
activity. Endorphins are the brain’s natural pain relievers and happy
chemicals, and they stimulate the pleasure centers. Exercise also increases
a sense of control and self-esteem, which is a huge component of a suc-
cessful weight-loss program. It’s also been shown that a regular exercise
habit helps maintain and improve other healthy habits. Think about it—
have you ever seen a jogger smoking?
Exercise decreases naturally occurring cytokines, inflammatory
chemicals, in the joints and in circulation. This probably explains why ex-
ercise decreases the risk of heart attack and stroke. These same toxic
chemicals have been linked to arthritis, fibromyalgia, and chronic pain.
Research on people with painful arthritic knees who were considering
total knee replacements shows that a regular exercise program can de-
crease pain sufficiently to avoid surgery. In fact, in overweight middle-
aged women with disabling knee pain, exercise and a 10- to 15-pound
weight loss resulted in large improvements in pain and function.
I HEARD A NURSING HOME EXERCISE INSTRUCTOR BEGIN

CLASS BY YELLING, “OKAY, EVERYBODY, POP IN YOUR
TEETH, STRAP ON YOUR DEPENDS, AND LET’S START!”
Physical activity can reverse peripheral arterial disease in the legs and pre-
vent amputations. It can help reverse heart disease by decreasing inflam-
mation, blood pressure, and cholesterol. In one study, older people who
walked at least 60 blocks a week at a moderate pace lowered their risk
of developing atrial fibrillation, a dangerous heart rhythm, by almost
half.6 Since atrial fibrillation is a very common cause of stroke, you can
see how walking can dramatically lower your risk of stroke (and perhaps
Alzheimer’s and other dementias). Walking 10 blocks a day is not very
hard to do and should become part of your healthy lifestyle.
It doesn’t take much to walk that far. If you play golf, just get out of
your cart. Recently, I was playing on a municipal course near my house
and the sign said, “Beware of water moccasins.” As if the alligators
weren’t bad enough, now I have to fear the attack shoes.
Exercise has been shown to decrease the risk of multiple cancers, par-
ticularly colon cancer. In 1995, the brilliant Walter Willett, MD, chair of
nutrition at Harvard, and his group published an article looking at the
health of more than 47,000 male health professionals. What they found
was an inverse relationship between the amount of activity and the like-
lihood of developing colon cancer (the more you exercise, the less likely
you are to get cancer).7 In addition, they found a separate direct relation-
ship between the amount of abdominal fat and colon cancer risk.
Thirty minutes of daily walking is known to decrease breast cancer
risk.8 Are you like many women, terrified of breast cancer? Stop thinking
that regular mammograms are the only thing you can do to prevent dy-
ing of that dread disease. Eat more fruits and vegetables, consume fewer
animal products, and get moving. I’m amazed every year that, dur-
ing Breast Cancer Awareness Month, doctors drone on and on about
frequent mammograms and breast self-exams, which haven’t been shown

to save many lives, particularly in women under 50.9 (In fact, the research
is clear that breast self-exams at any age haven’t been shown to do a
damn thing to keep you from dying of breast cancer!)10 Yet they forget
to mention the great research showing a connection between lifestyle
habits and cancer. Get moving so fast that your cancer awareness pink
ribbon is flapping in the breeze.
SEXERCISE, ANYONE?
I’ve already told you that aerobic exercise will improve sleep and cure
insomnia, but did you know that a daily exercise program might help
with that other bedroom activity? Yep, regular physical activity helps
men avoid impotence and gives you better stamina in the bedroom, not
to mention makes you more flexible.
And sex is a form of exercise, for now, anyway. I wonder if research-

ers will ever figure out which neurotransmitters (brain chemicals) are
released during orgasm. Then you could have all the fun without any
of the work. Of course, nobody would get any real work done, either.
I can just see it: the clerk at the front desk in a hotel greats you with a
big smile. You say, “Excuse me, I’d like to check in.” She says, “Sorry,
I’m in the afterglow, I just took one of those new orgasm pills. You’ll
have to wait maybe, say, half an hour.” Nobody would ever eat; they’d
be too busy glowing. Whole segments of society would starve to death,
but they’d die happy. Oh, my God, I see the future. All brain research
must stop right now! People worry about the secrets of the bomb fall-
ing into the wrong hands, but it’s really the secret of the perfect or-
gasm falling into the wrong hands that spells our eventual doom.
Our greatest fear is not dying; it’s not even getting up in front of an
audience and doing stand-up comedy. It’s becoming a burden to those
we love. The surest way to become just that burden is to be sedentary.
Get fat and stay fat and you will become disabled; eventually you and
I might meet in a nursing home (I’ll be the one writing the orders on
your care). If you don’t want that, then get going. What are you doing
sitting there? Drop the book and march!
SAYING, “I HATE EXERCISE” IS LIKE

SAYING, “I HATE BREATHING”
In Oprah Winfrey’s Foreword to Bob Greene’s excellent book The Best
Life Diet, she said, “I still work out even though I really hate it.”11 I re-
spect Oprah so much, but I have to admit I was taken aback when I read
that. Moving your body through space is like moving your lungs in and
out; the body doesn’t do well when you stop it.
If you approach exercise as if it’s detestable or drudgery and an ob-
ligation, you will never achieve permanent weight loss. If you believe
that you “hate exercise,” I suggest you go and seek out people who love
it. I’m certain that if you spend time around people who are having fun
while burning calories, you will catch their enthusiasm.
Start by expanding your definition. Open your eyes; check the news-
paper or online listings for less obvious sites of activity. Get up early for
the start of your community’s local fund-raiser 5k race or walk-a-thon.
Go to the river and watch the kayakers paddling across at sunrise or sun-
set. Stop by your skating rink on “cheap skate” night and watch kids of
all ages dancing on their wheels or blades. (My friend Cyndi’s dad took
up roller skating on his 90th birthday because he wanted to improve his
balance. He was still windsurfing, too, by the way.) Head to the mall be-
fore opening time and watch the chatty mall walkers race around the
perimeter. Redefine for yourself what exercise is and what you need to
do to achieve a higher metabolism.
There’s an inane sport called chess boxing; it’s popular in Europe. Op-
ponents play four minutes of chess, followed by a round of boxing. I’d
like to see more outrageous sports like that. For instance, leaf blower
hockey. It’s also real, played in the street with wiffle balls. I think we
should make it more challenging. We’ll call it Electric Air Hockey. Put
it on ice, with skates. And use electric leaf blowers with extra-long ex-
tension cords. ZAP! AAAAH! Now that’s competition. Run your skates
across the cords and you won’t care about the penalty box. Television
announcer: “Today in electric air hockey, the Chicago Charred take on
the Cincinnati Cinders . . . ”
There’s no doubt that overweight people have more negative asso-

ciations with exercise. People who are not naturally athletic or who were
stereotyped as nonathletic as children rebel at the thought of activity.
Get rid of your old memories of the gym class (and P.E. teacher) from
hell and of not getting picked for the team. If you were in the military, you
might remember exercise as punishment, taking laps or doing push-ups
for infractions. Discard all those associations, all the negative feelings
that you have about exercise. They keep you from healthy thinness.
People often push back emotionally when others tell them what to do.
If you are constantly being told by others, “You should exercise,” then
you might dig in your heels and put your own health in jeopardy.
In the past, if the only time that you ever exercised was when you were
attempting to lose weight and then you didn’t succeed, you may have
very negative feelings about exercise. If you starved yourself of calories
as part of a diet program, then tried to exercise, you probably felt lousy.
The body needs calories, particularly from carbohydrates, to do activi-
ties. If you were on a low-carbohydrate diet and then exercised, you felt
like crap, even if you were taking in enough calories. My approach is very
different. Exercise to feel good. Eat enough calories to feel good. Eat
your complex carbohydrates, too. Follow the suggestions in this book
and you will feel and look wonderful. Exercise will become something
that you look forward to doing.
EASY DANCE SCHOOL—WE’LL TEACH

YOU THE TEXAS ONE-STEP
Think about what will increase your chances of sticking to a program of
daily exercise. What do you enjoy? What isn’t costly? What is conve-
nient? Experiment; try different activities. Think outside the traditional
exercise box.
Start defining yourself as physically active. Most overweight people
define themselves as sedentary. They immediately discount opportuni-
ties to play games in the park or to do intramural activities or informal
pick-up sports. “No, you go ahead without me,” they say to their co-
workers heading out to throw a Frisbee at lunchtime. Obese people get
notices for local organized sports, exercise camps, or open pool times at
the YMCA and immediately chuck those notices into the trash bin. You
might be someone who watches others be active without ever envision-
ing yourself in those activities. The first step is the vision.
I was going to take a belly-dancing class, but my husband didn’t want

me to. He said that belly dancers look like bees trying to communicate
where the pollen is.
Learn to set up your exercise environment as a reward activity so that

you don’t need extra motivation to want to do it. Set up your time so
that you listen to your favorite music, read your favorite types of books,
or watch your favorite show only when you are exercising. This instills
a sense of fun and reinforces the likelihood that you will look forward
to the activity tomorrow. Make your exercise time special, and, if you
want, make it so that you exercise with a special friend or your favorite
spouse.
Unless you have an unstable heart or orthopedic condition (you just
broke your leg in three places), there are no excuses! You are never too
old to exert yourself. My oldest patient in rehab was 105; she exercised
in the gym and went back home again. Don’t tell yourself, “I look aw-
ful” or “I’m too self-conscious.” And I don’t want to hear that you have
no time—you have time to breathe, don’t you? It’s just as crucial to your
health, so stop thinking any other way.
I was on a cruise ship that had a rock-climbing wall. One of the crew
members told me that they had a 75-year-old woman get to the top.
It’s amazing what you can do with Denture Grip.
If you truly can’t fit exercise in to your schedule, then you need to ask
yourself the hard question “What are my priorities in life, and how can
I get them on track?” If your health isn’t a priority, then you are screwed
up. If you are that time pressured, start by scheduling 10 minute blocks
daily. Gradually increase as you see the emotional and physical ben-
efits.
If you aren’t getting support from your friends or relatives, surround
yourself with those who are supportive. Join groups that encourage your
activities, and avoid those that demean your efforts.
Even your sedentary activities should include more stories about an

active life. I’m reading a great new book, The Power of Personal Im-
pact, a Skydiver’s Memoir. Chapter 1: “Crater Angels.”
Exercise is not expensive. All it takes is a good pair of walking shoes

and a set of old clothes. Heck, you don’t even need that, if you’re on the
beach. Just watch which beach you go to without your clothes. I’m not
paying for your indecent exposure ticket. (Hey, if you get jail time for
being naked, where do they grab you to haul you away?)
MY DOG ATE MY ELECTRONS

People get pretty creative when it comes to making excuses. With the
prevalence of computers in schools, you’d think we’d be beyond the
“my dog ate my homework” era. But the excuses are still there. It’s the
same way with exercise. People will find excuses if that’s what they want
to find. I hear it all the time: “I’m running around all day and exhausted
when I get home. That’s enough exercise.” Or, “I stand on my feet all day;
that counts for my exercise.” Maybe it’s something, but it’s not enough.
If you are overweight, you are taking in more calories than you are ex-
pending in your daily activities. Up the burn with increased activity and
you will up your basal metabolic rate. What you are doing right now ev-
eryday isn’t enough. That’s why you are fat. Don’t try to make it more
complicated than that.
Don’t even try to pull the excuse about being too tired. I’m not go-
ing to fall for that one. Exercise, done correctly, is invigorating and gives
you more energy. I have never heard that Lance Armstrong complained
that fatigue kept him from a bike ride.
What now? It’s too hot/cold/humid/dry/whatever. We always find
time, energy, and money to do the things that are truly important to us.
The excuses fade away when you really want to make a difference in your
own life. Now is that time. Just remember, the most important exercise
you can do is the one that you are willing to do.

• Few people lose weight permanently without exercising regularly.
• Our bodies are designed mentally and physically to need exertion.
• No other exercise is shown to be as useful for weight loss as walking.
• Stop exercising at the end of a “diet” and you will gain the weight back.
• Aerobic and strength training both increase metabolism.
• Aerobic exercise is best done daily, strength training every other day.
• Flexibility, core strengthening, and interval training all have benefits.
• Never start an exercise program with intense levels of exertion.
• Start slowly and gradually build up both time and intensity.
• Exercise should be fun and make you feel great when you are done.
• Inactivity kills more people than exercise does.

• Physical activity decreases stress, anxiety, and depression.
• Exercise decreases pain, prevents cancer and heart disease, and im-
proves sex.
• Staying fat and not exercising will lead to disability.
• Hang out with people who enjoy activity, and you will love it, too.
• Redefine yourself as an active person, and redefine what a fun activ-
ity is.
• Choose exercise that is inexpensive, enjoyable, and easy to do.
• Set up your physical activity so that you feel rewarded when doing it.
• Don’t look for excuses. Your health is too important for you to be
sedentary.
Conclusion: I Told You
That There Would Be a Quiz
at the End!
1. There are several keys to happiness and they:

A. all start your tractor
B. accidentally fell through the sewer grate
C. impact weight loss
D. open your cell door
2. Traditional diets fail because we hate:

A. everything and everyone because we’re on a freakin’ diet
B. pureed Brussels sprouts
C. restrictions and commands
D. shopping for new clothes
3. When you are trying to lose weight, what’s the most important part
of your body?
A. your mouth
B. your anus
C. your brain
(Hint: it’s the part that doesn’t have a hole in it, we hope)
4. If you are externally motivated, you are:

A. more likely to be overweight
B. currently being chased by a mountain lion
216 Conclusion
C. facing a tax deadline

D. frequently perusing naughty Internet sites
5. Although genes play a role, obesity is caused by:

A. Aunt Tillie’s holiday dinner get-togethers
B. behavior
C. participation in the annual hot dog eating challenge
D. failing to grow to a height of nine feet
6. Instead of eating until stuffed, eat until:

A. the game starts
B. you can catch another smoke
C. 80 percent full
D. the restaurant closes
7. Surround yourself with people who:

A. encourage good eating and exercise habits
B. prevent you from getting to the buffet line
C. steal the food from your plate
D. squeal on you whenever you overeat
8. Don’t eat out of:

A. your dog’s food bowl
B. obligation
C. your retirement savings
D. your spouse’s navel
9. Relearn your body’s own signals for:

A. turning right
B. showering more often than once a week
C. tiredness (no, that’s not a winged dragon in your coffee)
D. permanent thinness
10. The “four great choices”:

A. are top sellers at fast-food restaurants
B. increase satiation
C. are a popular rock band
D. decrease gravity with the square of the distance
Conclusion 217
11. Eating closer to Mother Nature will result in:

A. a quick slap in the face
B. the desire to graze in your backyard
C. better health and increased satiation
D. arms and legs that are as strong as tree trunks
12. Always have healthy snacks at hand so you don’t resort to:
A. digging through sofa cushions for old candy corn
B. drooling outside bakery dumpsters
C. not-so-good food choices
D. sampling that green fuzzy stuff at the back of your fridge
13. Listen to your body. It will tell you if you:
A. should warn others that you had beans for dinner
B. slept the entire night on your left arm
C. should increase your life insurance benefit
D. are eating junk
14. Read the labels and avoid:
A. MSG and artificial sweeteners and colors
B. men in trench coats
C. toaster pop quadruple-chocolate hash browns
D. that chatty greeter at your local discount market
15. There is a relationship between ingestion of sweetened drinks and:
A. emergency roadside stops
B. frequency of bee stings
C. obesity
D. temper tantrums in parents of the very young
16. Milk is an appetite suppressant and is healthiest:
A. while still in the cow
B. when mixed with high-calorie, flavored syrups
C. after three days in the sun
D. as skim milk
17. Artificial sweeteners may make you:
A. fatter
B. listen to 80s disco music
218 Conclusion
C. question your reasons for living

D. both B and C
18. Nighttime snacking is related to fatigue, not hunger, and leads to:
A. nightmares about carnivorous manicotti
B. frequent light-bulb replacement
C. unexpected dips in the swimming pool
D. reflux disease
19. Metabolism is determined to some degree by heredity but more by:

A. your handheld remote
B. alien beings with antennae and bushy ear hair
C. your personal aura
D. things you can control
20. The less sleep you get at night, the:

A. fatter you become
B. better you’re known on the Internet
C. more bizarre your office presentations
D. more attractive those dark rings under your eyes
21. Age-related slowing of metabolism is mostly due to:

A. decades of appeasing your crazy family
B. global warming
C. inactivity, not true aging
D. licking too many envelopes
22. Few people lose weight permanently without:

A. eating only desert shrubbery
B. opting for unnecessary limb amputation
C. using a single chopstick as their utensil for all meals
D. exercising regularly
23. Our bodies are designed mentally and physically to need:

A. heaping dollops of whipped cream
B. quarterly vacations to warm, sunny climates
C. exertion
D. daily exposure to multiple electronic devices
Conclusion 219
24. Inactivity kills more people than:

A. the local greasy spoon restaurant
B. have ever lived
C. long-term exposure to elevator music
D. exercise does
Go to my Web site, doctorRcomedy.com, for the answer key and

for more fun questions related to the book!
Notes
CHAP TER 1
1. Holly Jarrell et al., “Polymorphisms in the serotonin reuptake transporter
gene modify the consequences of social status on metabolic health in
female rhesus monkeys,” Physiology and Behavior 93 (2008): 807–819.
2. Debra L. Franko et al., “Does adolescent depression predict obesity in
black and white young adult women?” Psychological Medicine 35 (2005):
1505–1513.
3. Chiadi U. Onyike et al., “Is obesity associated with major depression?
Results from the Third National Health and Nutrition Examination Sur-
vey,” American Journal of Epidemiology 158 (2003): 1139–1147.
4. Lynn Haley, “Daily stress and depression linked to weight regain and
obesity,” Diabetes, Obesity and Cardiovascular News 3 (2006): 8.
5. Neil E. Rowland and Seymour M. Antelman, “Stress-induced hyperphagia
and obesity in rats: A possible model for understanding human obesity,”
Science 191 (1976): 310–312.
6. S. Kayman, W. Bruvold, and J. S. Stern, “Maintenance and relapse after
weight loss in women: behavioral aspects,” American Journal of Clinical
Nutrition 52 (1990): 800–807.
7. Ibid.
8. Kathleen C. Light, Karen M. Grewena, and Janet A. Amicob, “More fre-
quent partner hugs and higher oxytocin levels are linked to lower blood
pressure and heart rate in premenopausal women,” Biological Psychology
69 (2005): 5–21.
222 Notes
CHAP TER 2
1. Bruce S. Jonas and Michael E. Mussolino, “Symptoms of depression as
a prospective risk factor for stroke,” Psychosomatic Medicine 62 (2000):
463–471.
2. Todd F. Heatherton, Janet Polivy, and C. Peter Herman, “Dietary re-
straint: Some current findings and speculations,” Psychology of Addictive
Behaviors 4 (1990): 100–106.
3. K. A. Brownley et al., “Sympathoadrenergic mechanisms in reduced
hemodynamic stress responses after exercise,” Medicine and Science in
Sports and Exercise 35 (2003): 978–986.
4. Rena R. Wing and Suzanne Phelan, “Science-based solutions to obesity:
what are the roles of academia, government, industry, and health care?”
American Journal of Clinical Nutrition 82 (2005): 222–225.
5. “People who were obese tried diets but felt they needed ongoing support
to empower them to make lifestyle changes,” Evidence-Based Nursing 12
(2009): 92, http://ebn.bmj.com/content/12/3/92.extract.
6. James A. Blumenthal et al., “Effects of exercise training on older pa-
tients with major depression,” Archives of Internal Medicine 159 (1999):
2349–2356.
7. Mark Gold, “Addictions and eating disorders,” lecture presented at the
U.S. Psychiatric and Mental Health Congress, Orlando, FL, October 11,
2007.
CHAP TER 3
1. Wing and Phelan, “Science-based solutions to obesity.”
2. D. Craig Willcox et al., “Caloric restriction and human longevity: what
can we learn from the Okinawans?” Biogerontology 7 (2006): 173–177.
3. Ana M. Andrade, Geoffrey W. Greene, and Kathleen J. Melanson, “Eating
slowly led to decreases in energy intake within meals in healthy women,”
Journal of Nutrition Education and Behavior 108 (2008): 1186–1191.
4. Brian Wansink, “Environmental factors that increase the food intake and
consumption volume of unknowing consumers,” Annual Review of Nu-
trition 24 (2004): 455–479.
5. Brian Wansink and Jeffery Sobal, “Mindless eating: The 200 daily food
decisions we overlook,” Environment and Behavior 39 (2007): 106–123.
6. W. M. Beneke, C. H. Davis, and J. G. Vander Tuig, “Effects of a behav-
ioral weight-loss program food purchases: Instructions to shop with a
list,” International Journal of Obesity 12 (1988): 335–342.
7. Wansink, “Environmental factors.”
8. B. Wansink and J. Kim, “Bad popcorn in big buckets: portion size can
influence intake as much as taste,” Journal of Nutrition Education and
Behavior 37 (2007): 242–245.
Notes 223
CHAP TER 4
1. L. Stahre and T. Hallstrom, “A short-term cognitive group treatment pro-
gram gives substantial weight reduction up to 18 months from the end of
treatment. A randomized controlled trial,” Eating and Weight Disorders
10 (2005): 50–58.
2. David M. Eisenberg et al., “Unconventional medicine in the United
States—prevalence, costs, and patterns of use,” New England Journal of
Medicine 328 (1993): 246–252.
3. Victor J. Stevens et al., “Design and implementation of an interactive
Website to support long-term maintenance of weight loss,” Journal of
Medical Internet Research 10 (2008): doi:10.2196/jmir.931.
CHAP TER 5
1. Brian Wansink, Mindless Eating: Why We Eat More Than We Think
(New York: Bantam Dell, 2007); see the section titled “The Bottomless
Soup Bowl,” pp. 47–52.
2. Gary D. Foster et al., “A randomized trial of a low-carbohydrate diet for
obesity,” New England Journal of Medicine 348 (2003): 2082–2090.
3. Gary J. Schwartz et al., “The lipid messenger OEA links dietary fat intake
to satiety,” Cell Metabolism 8 (2008): 281–288.
4. Mayumi Yoshioka et al., “Effects of red pepper on appetite and energy
intake,” British Journal of Nutrition 82 (1999): 115–123.
5. Nicole Martinelli, “Jelly in the belly: A diet pill that expands so you
don’t,” Wired.com, June 08, 2007, http://www.wired.com/medtech/health/
news/2007/06/dietpill.html.
6. Paul Crane Arterburn and David Veenstra, “The efficacy and safety of
sibutramine for weight loss,” Archives of Internal Medicine 164 (2004):
994–1003.
7. John Wilding, “Science, medicine and the future: obesity treatment,”
British Medical Journal 315 (1997): 997–1000.
8. David Goldstein and Janet Potvin, “Long-term weight loss: the effect of
pharmacologic agents,” American Journal of Clinical Nutrition 60 (1994):
647–657.
9. S. C. Mathai et al., “Addition of sildenafil to bosentan monotherapy
in pulmonary arterial hypertension,” European Respiratory Journal 29
(2007): 469–475.
10. H. Cavaliere, I. Floriano, and G. Medeiros-Neto, “Gastrointestinal side-
effects of orlistat may be prevented by concomitant prescription of
natural fibers (psyllium mucilloid),” International Journal of Obesity 25
(2001): 1095–1099.
11. Lars Sjostrom et al., “Life style, diabetes and cardiovascular risk factors
10 years after bariatric surgery,” New England Journal of Medicine 351
(2004): 2683–2693.
224 Notes
12. D. R. Broom et al., “Exercise-induced suppression of acylated ghrelin in

humans,” Journal of Applied Phsyiology 102 (2007): 2165–2171.
13. Marjorie Pomerlean et al., “Effects of exercise intensity on food intake
and appetite in women,” American Journal of Clinical Nutrition 80 (2004):
1230–1236.
CHAP TER 6
1. Gary D. Foster et al., “A randomized trial.”
2. B. J. Venn and T. J. Green, “Glycemic index and glycemic load: mea-
surement issues and their effect on diet–disease relationships,” European
Journal of Clinical Nutrition 61 (2007): 122–131.
3. Alan W Barclay et al., “Glycemic index, glycemic load, and chronic dis-
ease risk—a meta-analysis of observational studies,” American Journal
of Clinical Nutrition 87 (2008): 627–637.
4. Edward Giovannucci, “A review of epidemiologic studies of tomatoes,
lycopene, and prostate cancer,” Experimental Biology and Medicine 227
(2002): 852–859.
CHAP TER 7
1. M. B. Schulze et al., “Processed meat intake and incidence of Type 2
diabetes in younger and middle-aged women,” Diabetologia 46 (2003):
1465–1473.
2. Eric L. Knight et al., “The impact of protein intake on renal function
decline in women with normal renal function or mild renal insufficiency,”
Annals of Internal Medicine 138 (2003): 460–467.
3. E. Wrone et al., “Association of dietary protein intake and microalbumin-
uria in healthy adults: Third National Health and Nutrition Examina-
tion Survey,” American Journal of Kidney Diseases 41 (2003): 580–587.
4. Knight et al., “The impact of protein intake.”
5. Ivan de Araujo et al., “Food reward in the absence of taste receptor sig-
naling,” Neuron 57 (2008): 930–941.
6. Lydia A. Bazzano et al., “Intake of fruit, vegetables and fruit juices and
risk of diabetes in women,” Diabetes Care 31 (2008): 1311–1317.
7. “Chemical cuisine,” Nutrition Action Health Letter, Center for Science
in the Public Interest, May 2008, p. 4, http://www.cspinet.org/nah/05_08/
chem_cuisine.pdf; Morando Soffritti et al., “Life-span exposure to low
doses of aspartame beginning during prenatal life increases cancer effects
in rats,” Environmental Health Perspectives 115(9) 2007: 1203–1297;
M. M. Andreatta et al., “Artificial sweetener consumption and urinary
tract tumors in Cordoba, Argentina,” Preventive Medicine 47 (2008):
136–139; M. R. Weihrauch and V. Diehl, “Artificial sweeteners—do they
bear a carcinogenic risk?” Annals of Oncology 15 (2004): 1460–1465.
Notes 225
8. Frank B. Hu et al., “A prospective study of egg consumption and risk

of cardiovascular disease in men and women,” Journal of the American
Medical Association 281 (1999): 1387–1394.
CHAP TER 8
1. Diane M. DellaValle, Liane S. Roe, and Barbara J. Rolls, “Does the con-
sumption of caloric and non-caloric beverages with a meal affect energy
intake?” Appetite 44 (2005): 187–193.
2. Y. Claire Wang, Sara N. Bleich, and Steven L. Gortmaker, “Increasing
caloric contribution from sugar-sweetened beverages and 100% fruit
juices among U.S. children and adolescents 1988–2004,” Pediatrics
121(2008):1604–1614.
3. For more information, see The Nutrition Source, http://www.hsph.harvard.
edu/nutritionsource/healthy-drinks/.
4. Susan E. Swithers and Terry L. Davidson, “A role for sweet taste: Calorie
predictive relations in energy regulation in rats,” Behavioral Neuroscience
122 (2008): 161–173.
5. Yung-Hsi Kao, Richard A. Hiipakka, and Shutsung Liao, “Modulation
of endocrine systems and food intake by green tea epigallocatechin gal-
late,” Endocrinology 141 (2000): 980–987.
6. Dirk Johnson, “Some see big problem in Wisconsin drinking,” New York
Times, Nov. 16, 2008, page A16.
CHAP TER 9
1. Edward P. Weiss et al., “Lower extremity muscle size and strength and
aerobic capacity decrease with caloric restriction but not with exercise-
induced weight loss,” Journal of Applied Physiology 102 (2007): 634–640.
2. S. M. Shick et al., “Persons successful at long term weight loss and main-
tenance continue to consume a low-energy, low-fat diet,” Journal of the
American Dietetic Association 98 (1998): 408–413.
3. T. Colin Campbell and Thomas M. Campbell II., The China Study: The
Most Comprehensive Study of Nutrition Ever Conducted and the Startling
Implications for Diet, Weight Loss and Long-term Health. Dallas, TX:
BenBella Books, 2006.
4. A. Keski-Rahkonen et al., “Breakfast skipping and health-compromising
behaviors in adolescents and adults,” European Journal of Clinical Nutri-
tion 57 (2003): 842–853.
5. A wonderful article on this famous World War II study is Leah M. Kalm
and Richard D. Semba1, “They starved so that others be better fed: re-
membering Ancel Keys and the Minnesota Experiment,” Journal of Nu-
trition 135 (2005): 1347–1352.
6. Wansink, “Environmental Factors.”
226 Notes
CHAP TER 10
1. Gary D. Foster et al., “A Randomized Trial.”
2. James A. Levine et al., “The role of free-living daily walking in human
weight gain and obesity,” Diabetes 57 (2008): 548–554.
3. M. S. Westerterp-Plantenga et al., “Energy metabolism in humans at a
lowered ambient temperature,” European Journal of Clinical Nutrition 56
(2002): 288–96.
4. Christopher Bell, Nicole R. Stob, and Douglas R. Seals, “Thermogenic
responsiveness to ß-adrenergic stimulation is augmented in exercising
versus sedentary adults: Role of oxidative stress,” Journal of Physiology
570 (2006): 629–635.
5. J. E. Gangwisch et al., “Inadequate sleep as a risk factor for obesity:
Analyses of the NHANES I,” Sleep 28 (2005): 1289–1296.
6. Laurent Seugnet et al., “Identifying sleep regulatory genes using a
Drosophila model of insomnia,” The Journal of Neuroscience 29 (2009):
7148–7157.
7. Kari Johansson et al., “Effect of a very low energy diet on moderate and
severe obstructive sleep apnoea in obese men: A randomised controlled
trial,” British Medical Journal 339 (2009): b4609, http://www.bmj.com/
cgi/content/full/339/dec03_1/b4609.
8. Ian R Lanza and K Sreekumaran Nair, “Muscle mitochondrial changes
with aging and exercise,” American Journal of Clinical Nutrition 89
(2009): 467–471.
9. E. J. Brierley et al., “Effects of physical activity and age on mitochon-
drial function,” QJM: An International Journal of Medicine 89 (1996):
251–258.
10. Francois-Pierre J Martin et al., “Probiotic modulation of symbiotic
gut microbial–host metabolic interactions in a humanized microbiome
mouse model,” Molecular Systems Biology 4 (2008): 157.
11. Donald Hensrud, “Slow metabolism: Is it to blame for weight gain?”
www.mayoclinic.com/health/slow-metabolism/AN000618.
12. William Thompson, “Terri’s Law: The limit of the Florida legislature to
decide an individual’s right to die,” New England Journal on Criminal and
Civil Confinement 31 (2005): 485–490.
CHAP TER 11
1. Caroline R. Richardson et al., “A meta-analysis of pedometer-based
walking interventions and weight loss,” Annals of Family Medicine 6
(2008): 69–77.
2. Jason L. Talanian et al., “Two weeks of high-intensity aerobic interval
training increases the capacity for fat oxidation during exercise in women,”
Journal of Applied Physiology 102 (2007): 1439–1447.
Notes 227
3. Arnt Erik Tjønna et al., “Aerobic interval training versus continuous

moderate exercise as a treatment for the metabolic syndrome, a pilot
study,” Circulation 118 (2008): 346–354.
4. K. Knubben et al., “A randomised, controlled study on the effects of a
short-term endurance training programme in patients with major depres-
sion,” British Journal of Sports Medicine 41 (2007): 29–33.
5. Richard H. Cox, Tom R. Thomas, and Joseph E. Davis, “Delayed anxi-
olytic effect associated with an acute bout of aerobic exercise,” Journal
of Exercise Physiology 3, no. 4 (October 2000), http://faculty.css.edu/
tboone2/asep/Coxv2.pdf.
6. Dariush Mozaffarian et al., “Physical activity and incidence of atrial fi-
brillation in older adults,” Circulation 118 (2008): 800–807.
7. Edward Giovannucci et al., “Physical activity, obesity, and risk for colon
cancer and adenoma in men,” Annals of Internal Medicine 122, no. 5
(1995): 327–334.
8. C. M. Friedenreich and A. E. Cust, “Physical activity and breast cancer
risk: impact of timing, type and dose of activity and population sub-
group effects,” British Journal of Sports Medicine 42 (2008): 636–647.
9. Karla Kerlikowske et al., “Efficacy of screening mammography: a meta-
analysis,” Journal of the American Medical Association 273 (1995):
149–154.
10. David B. Thomas et al., “Randomized trial of breast self-examination
in Shanghai: Final results,” Journal of the National Cancer Institute 94,
no. 19 (2002): 1445–1457.
11. Bob Greene, The Best Life Diet (New York: Simon and Schuster, 2006),
p. xviii.
Resources and Further Reading
For lots more fun information, go to my Web site, doctorRcomedy

.com.
The following resources are great further reading. I am indebted to
the authors for their ideas, which have been an inspiration to me. They
have allowed me to be a better physician to my patients and, I hope, a
better adviser to my readers.
Mindless Eating by Brian Wansink

The Volumetrics books by Barbara Rolls
The Best Life Diet by Bob Greene
Thin for Life by Anne Fletcher
Intuitive Eating by Evelyn Tribole and Elyse Resch
Emotional Eating by Edward Abramson
Living without Dieting by John Foreyt and G. Ken Goodrick
The China Study by T. Colin Campbell and Thomas M. Campbell II
And a special mention goes to the Center for Science in the Public
Interest and its very informative Nutrition Action Health Letter. I am
a big fan of executive director Michael Jacobson and his efforts to im-
prove the safety and health of the public. Go to www.cspinet.org, and
get a real education.
Index
Abramson, Edward, 33 hydrogel pills, 92 – 93; medications as,

Activity log, 79 – 81, 82 92; protein as, 136
Addiction: controlling, 40; as coping Armstrong, Lance, 212
mechanism, 43; to food, 18, 37, 72; Art of contentment, 19
neurotransmitters and, 131 Artificial colorings, 135
Adipose tissue. See Fat Artificial sweeteners, 131 – 32, 135, 141,
Adolescent issues, 6, 53, 162, 190 145 – 48, 152, 175
Aerobic exercise: for depression, 35; Asian diets, 92, 108, 112, 136, 156 – 57,
frequency of, 203; metabolism 178
and, 188, 197 – 200, 212; sleep and, Atkins, Robert, 109, 195
184, 208 Atkins diet, 90, 107, 109, 129, 195
African Americans, 24 Atrial fibrillation, 207
Air in foods, 91, 101 Attitude. See Negativity/negative
Alcohol consumption: before bed, 184; emotions; Positivity/positive
calories from, 91; excessive, 11, 37, thinking
149 – 51, 152; processing, 150 – 51, 164
Alzheimer’s disease, 153, 190 Bariatric (obesity) surgery, 95 – 98, 101
Ambrosio, Luigi, 92 – 93 Basal metabolic rate. See Metabolism
Anger issues, 7, 33, 34, 40, 42 Beano (digestive aid), 114
Animal protein, 130, 139, 141 Bedtime snacks, 163 – 64
Anxiety: coping with, 18, 33 – 35, 42, 71; Behaviors: changing, 46, 80; “clean
exercise and, 25, 202, 206, 213; oxy- your plate” command, 49; family
tocin and, 16; social, 28; stress and, meals, 47 – 48; goal setting, 81; habits
7 – 8, 14, 21 and, 45 – 47; obesity and, 65; rewards
Appetite suppressants: exercise as, 73, for, 78 – 79; social conditioning of, 49;
98 – 100; foods as, 48, 90, 114 – 16, weight gain and, 64; weight loss and,
147, 152, 163; hormones for, 99; 109. See also Addiction; Coping
232 Index
mechanisms; Eating; Exercise; exercise, 207–8, 213; fat and, 106; with
Habits; Laughter; Overeating green tea, 147; with lycopene, 115;
The Best Life Diet (Greene), 209 obesity and, 5; by restricting calories,
Bicycling, 10, 179, 197, 198, 205 153; salt and, 134; with vegetarian
Binge eating (binging), 27, 30, 60, 85, diet, 128
140, 160 – 62 Carbohydrates: complex, 90; energy
Body image, 41 – 42 from, 105 – 6, 123; fat and, 106 – 7;
Boredom: calories and, 179; emotional low-carb diets, 174, 210; natural,
eating and, 33 – 35, 42, 51, 68 – 69, 85; 109; pleasure from, 72; simple, 127,
meditation and, 167; stress and, 21; 140; weight loss and, 87, 90, 164
taste and, 121 – 22, 152; weight loss Cardiovascular disease: alcohol and,
and, 5, 8 150; eggs and, 137 – 38; exercise and,
Borg exertion scale, 201 – 2 205, 213; preventing, 3, 111, 153, 207;
Brain factors, 5, 28, 37, 50, 52, 72, 131, risks for, 24, 128, 135, 150; salt and,
185 134; saturated fats and, 106; trans fats
Breakfast: energy bars for, 140; foods and, 127
for, 61, 87, 115, 136; juice with, Celiac disease, 89
115; regularity of, 46, 48; skipping, Center for Science in the Public Interest,
160 – 61, 169 123
Breast cancer, 112, 128, 207 – 8 Centers for Disease Control (CDC), 24
Breast Cancer Awareness Month, 207 – 8 Childhood eating, 6, 49, 50, 53, 162,
Breathing exercises, 27, 34 – 35 190
British Medical Journal, 94 The China Study (Campbell), 156
Cholesterol levels: calories and, 154;
C-reactive protein, 111 eggs and, 137 – 38; exercise and, 205;
Caffeine: from coffee, 148, 152; diets lowering, 161, 207; metabolic syn-
and, 174; from green tea, 123, drome and, 201
146 – 47; sleep and, 181 – 82 Chronic anxiety disorder, 35
Calcium deficiency, 96, 136 Cirrhosis, 151
Calorie intake: aging and, 158 – 59; from “Clean your plate” command, 49
alcohol, 91; boredom and, 179; cho- Clothes, as self-monitoring technique,
lesterol levels and, 154; counting, 77 – 78, 82
158 – 60, 168; emotional eating and, Coffee, 148, 152
51 – 52; empty calories, 100, 139, 149; Cold vs. warm foods, 92
energy and, 105 – 7, 123; estimating, Colon cancer, 150, 207
157 – 58; habits and, 51 – 52; high / Colonics, 191
low-calorie dense foods, 48, 90; Comfort foods, 122, 140, 141, 163
liquid calories, 143 – 44; from liquids, Complex carbohydrates, 90, 106
143 – 44, 152; metabolism and, 146, Contentment. See Art of contentment
154 – 58, 173 – 74; reducing, 54 – 55, Control: exercise and, 206; over habits,
114 – 15, 153 – 54, 157, 168; salads 36, 40; over hunger, 93, 160; impor-
and, 117; “secret calories,” 144, 148; tance of, 7 – 8, 31, 175, 192; medita-
with varied diets, 121. See also Diet / tion and, 167
dietary choices; Exercise; Food/ food Coping mechanisms: for anger, 34;
choices eating as, 4, 36, 43; effectiveness
Campbell, T. Colin, 156 – 57 of, 10 – 11, 13, 21; heredity and, 65;
Cancer prevention: alcohol and, 150; improving, 6, 12 – 13; laughter and,
artificial sweeteners and, 135; with 19; self-defeating, 12
Index 233
Dairy products: dietary needs of, 108; Eating: binging, 27, 30, 60, 85, 140,
lactose intolerance and, 136 – 37, 141; 160 – 62; in childhood, 50 – 51; child-
milk, 149; protein from, 130 – 31 hood issues with, 6, 49, 50, 53, 162,
Dancing, 10, 12, 21, 41, 57, 70, 79, 81, 190; as coping mechanism, 4, 36, 43;
82, 197, 209 disorders, 190–91; enjoyment of, 7, 10;
Davidson, Terry, 146 fasting, 164; frequency of, 161 – 63;
Department of Agriculture (USDA), 54 hara hachi bu concept, 50; before
Depression: emotional eating and, meals, 47–48; meditation and, 166 – 67;
33; exercise and, 25; lowering, 3 – 4; mindful eating, 165 – 67; “nibblers,”
stroke risk from, 24; treatment for, 161; obligatory, 57 – 58; purging and,
35 – 36; weight gain and, 21 190–91, 193; skipping meals, 161, 169;
Desserts, 47 – 51, 58, 119, 133, 139 – 40 social eating, 63 – 64; speed, 53; stop-
Diabetes: alcohol and, 150; develop- ping, 84, 87; triggers for, 42. See also
ment of, 128, 129; glycemic index Breakfast; Calorie intake; Diet /
and, 112; insulin and, 112, 113, 161, dietary choices; Digestion; Drinks/
182 – 83, 185; natural sugar and, 132; drinking; Emotional eating; Food /
preventing, 153; sleep problems and, food choices; Healthy eating; Hun-
182 – 83, 192; sweetened beverages ger / hunger triggers; Overeating;
and, 145 Snacking
Diabetes Care (journal), 132 Eggs, 137 – 38
Diet /dietary choices: exhilaration Emotional eating: avoiding, 34 – 35;
with, 9 – 10; fasting as, 64, 155, 162, boredom and, 33 – 35, 42, 51, 68 – 69,
164 – 65; health and, 110; hunger and, 85; calorie intake and, 51 – 52; causes
85; as lifestyle change, 23; low-carb of, 33 – 34; music therapy for, 34, 70,
diets, 174; metabolism and, 154 – 56; 71; negativity and, 38; treatment for,
negative connotation of, 26 – 27; 36 – 38
obesity and, 3 – 4; plateaus, 155 – 56; Emotional Eating (Abramson), 33
primate studies and, 4; restricted, Emotions: anger, 7, 33, 34, 40, 42; bore-
26 – 27, 106 – 7, 120 – 24, 154, 174; self- dom, 8, 33 – 34; hugging and, 16 – 18,
esteem and, 28, 32; vegetable-based, 21; materialistic attitudes and, 13 – 14,
117 – 19; weight gain and, 64; “yo-yo” 21; positivity/positive thinking, 4, 21,
dieting, 38, 155, 157, 168. See also 29, 78 – 79; as triggers, 33. See also
Drinks /drinking; Eating; Food /food Depression; Happiness; Laughter;
choices; Healthy eating; Junk food Negativity/negative emotions
Diet pills, 93 – 95 Empty calories, 100, 139, 149
Dietary supplements, 32, 144, 173 Endogenous opioids, 185
Digestion: of dairy products, 136 – 37; Endorphins, 206
healthy foods and, 113 – 14, 124, 149, Energy: basal temperature and, 179;
156, 180, 192; of hydrogel pill, 93; from caffeine, 89, 123; calorie intake
indigestion and, 48; metabolism and, and, 105 – 7, 123; from dieting, 10;
154; process of, 165, 192 exercise and, 195, 202, 204, 212; fats
Dopamine release, 37, 131 and, 105 – 6, 123, 180; from food, 105,
Dried fruit, 134 140, 179 – 81; laughter and, 24; from
Drinks /drinking: energy drinks, 144, protein, 105, 106–7, 115, 123. See also
147, 152; fruit juice, 115, 132, 145, Metabolism
147, 149, 152; green tea, 24, 55, 123, Energy drinks, 144, 147, 152
146 – 47, 152; milk, 149. See also Environmental influences, 167 – 68, 183,
Alcohol consumption; Caffeine 192
234 Index
Escapist /avoidance tendencies, 36 – 37, Fats: in dairy, 119, 123, 130, 136,
43 148 – 49, 161, 163; energy and, 105 – 6,
European Journal of Clinical Nutrition, 123, 180; fat-free foods, 140; good
160 – 61 fats, 127, 141; high-fat diets, 109,
Evidence-Based Nursing (journal), 32 111, 118; low-fat diets, 108, 115, 138,
Exercise: activity log, 79 – 81, 82; aero- 156; from meat, 47, 128; in meat,
bic, 197–98, 200, 208, 212; anxiety 128, 138 – 39, 163; satiety and, 89 – 91;
and, 25, 202, 206, 213; appetite and, saturated, 106, 137; trans fats, 127,
98–100, 101; before bed, 184; bicycling, 138; types of, 106 – 7, 108, 127 – 28
10, 179, 197, 198, 205; breathing as, Female hormones, 185 – 86, 193
27, 34 – 35; depression and, 35 – 36; Fiber-rich foods, 88, 90
effectiveness of, 25, 67, 73 – 75, 82; Fibromyalgia, 183, 206
enjoyment of, 7, 10, 70 – 71, 209 – 10, Fidgety people, 86, 176 – 78
212; equipment for, 75 – 76; excuses Fish oil benefits, 127
for, 211–12, 213; frequency of, 204 – 5; Flatulence, 113 – 14
intense levels of, 202; interval train- Fluoxetine (diet pill), 94
ing, 200 – 201, 212; jogging, 159, 196, Food /food choices: air in, 91, 101;
198, 200, 203, 206; necessity of, cold vs. warm, 92; comfort foods,
195 – 96; resistance training, 199 – 200; 122, 140, 141, 163; desserts, 47 – 51,
self-esteem and, 27, 206, 210; sexer- 58, 119, 133, 139 – 40; diet vs., 23 – 25,
cise, 99, 208; for stay-at-home work- 42; enjoyment of, 6 – 7, 37; good-for-
ers, 69; strength training, 199, 203, you foods, 31, 61, 75, 121 – 22, 162;
212; stress and, 25, 27 – 28, 42, 206 – 7; intake modification, 46, 101; label-
swimming, 198, 199, 201; walking, ing, 126; leftovers and, 49; log for,
10, 12, 196, 197 – 98; weight loss and, 79 – 81, 82; nutrition and, 100 – 101,
196 – 97, 210, 212. See also Energy; 123, 125 – 26; portion sizes, 61 – 63,
Metabolism 65, 120, 159 – 60, 168; in restaurants,
138 – 39, 141; satiety and, 89; shop-
Fad diets, 64 ping for, 60, 65; thermic effect of,
Family time: emotional eating and, 34; 180; variety in, 120 – 22; water in, 91,
enjoyment of, 12, 14, 16 – 19, 47 – 48, 101, 136; weight gain and, 58, 59;
79; meals, 47 – 48 weight loss and, 26, 87. See also Diet /
Famine, 52, 107, 154 dietary choices; Drinks /drinking;
Fast-food restaurants, 59 – 60, 168 Eating; Healthy eating; Junk food;
Fasting, 64, 155, 162, 164 – 65 specific foods
Fat (adipose tissue): artificial sweet- Food pyramid, 108, 112
eners and, 146, 152; belly fat, 188, Foreyt, John, 206
207; breaking down, 28, 164, 200; Fructose, 88, 131 – 32, 141
dangers of, 5, 45, 63, 186; depres- Fruit juice, 115, 132, 145, 147, 149, 152
sion and, 17, 21, 24; from food, 51, Fruit nutrition, 115, 119, 124, 132 – 34,
54, 56, 64, 106 – 7, 123; hormones 141
from, 183, 193; hunger and, 59; in
liver, 150, 151, 164; myths about, Gallbladder disease, 112
38 – 40, 87; shrinking, 173, 174, 181, Gastric bypass, 96 – 97
192, 200 – 201; sleep and, 181 – 82; Gastric emptiness, 91, 137
from sugar, 144; TV and, 67 – 68, 82. Gastroesophageal reflux disease
See also Metabolism; Weight gain; (GERD), 164 – 65
Weight loss Genetics and obesity, 45, 65, 174 – 75
Index 235
Gestational diabetes, 112 185 – 86, 193; ghrelin, 99, 182; happi-
Ghrelin hormone, 99, 182 ness and, 28; insulin, 182 – 83; leptin,
Glucose, 131 – 32 182, 185; metabolism and, 186; oxy-
Gluten, 89 tocin, 16; stress and, 185; weight gain
Glycemic index, 112 and, 186, 193
Gold, Mark, 37 Hugs / hugging, 16 – 18, 21
Good-for-you foods, 31, 61, 75, Hunger/ hunger triggers: control over,
121 – 22, 162 93, 160; exercise and, 98 – 99; fat and,
Grains: diet based on, 108, 109; pro- 59; food shopping, 60; frequent eat-
cessed, 89, 110 – 12, 136; whole, 87, ing and, 161 – 63; overeating vs., 59,
92, 100, 106, 112, 135 – 36, 141 85 – 86; satiety vs., 83 – 84, 86, 100;
Gratitude rituals, 18 – 19, 21 signals of, 85; starvation and, 49,
Green tea, 24, 55, 123, 146 – 47, 152 53, 60, 78, 84 – 85, 154 – 55. See also
Greene, Bob, 209 Starvation
Hydrogel pills, 92 – 93
Habits: behaviors and, 45 – 47, 71 – 72; Hypertension, 129, 134
breaking bad ones, 72 – 73; calorie
intake and, 51 – 52; choices and, 23; Infant eating, 50
control over, 36, 40; social support Insomnia, 94, 163 – 64, 183 – 84, 202, 208
for, 49, 57, 63 – 64 Insulin hormone, 112, 113, 161, 182 – 83,
Happiness: behaviors for, 70, 72, 79, 83, 185
204; empathy and, 18; endorphins Interval training, 200 – 201, 212
and, 206; hormones and, 28; impor-
tance of, 33, 42, 166; junk food and, Japanese longevity, 50
185; keys to, 3 – 9, 16, 20 – 21; unhap- Jenkins, David, 161
piness vs., 41 – 42, 202; weigh loss Jogging, 159, 196, 198, 200, 203, 206
and, 5, 23, 70 Joseph, Jenny, 57
Hara hachi bu concept, 50 Journal of the American College of Clin-
Healing touch, 16 – 17 ical Nutrition, 111
Healthy eating: assumptions about, Juices. See Fruit juice; Vegetable juice
123; calories and, 114 – 15; digestion Junk food: alcohol and, 149; happiness
and, 113 – 14, 124, 149, 156, 180, 192; and, 185; limiting, 31, 61, 62, 65, 140;
enjoyment of, 112 – 13; flatulence nutrition vs., 105, 108; overeating
and, 113 – 14; nutrition and, 107 – 10; and, 61, 88, 185, 192; primate stud-
snacks and, 90 – 91, 123, 138, 160 – 61, ies and, 4; rat studies and, 126; stress
163. See also Breakfast; Cancer and, 185
prevention; Hunger / hunger triggers;
Nutrition/nutritional concerns;
Protein; Vegetable-based diet Kaiser Permanente Center for Health
Heart disease. See Cardiovascular Research, 13, 80, 197
disease Karolinska Institute, 70
Herman, C. Peter, 27 Keys, Ancel, 162
High-fat diets, 109, 111, 118 Kidney disease/damage, 90, 128–30, 205
High-fructose corn syrup, 88, 131 – 32,
141 Lactose intolerance, 136 – 37, 141
High-protein diets, 128 – 29 Lap band procedure, 96 – 97
Hormones: as appetite suppressants, Laughter: as coping mechanism, 35 – 36;
99; from fat, 183, 193; female, eating and, 10; exercise and, 203; as
236 Index
healthy, 71, 77, 81, 82, 145; stress and, Montessori, Maria, 177
12, 19; as weight loss key, 3 – 8, 19 – 20 Motivation. See Self-motivation
Leptin hormone, 182, 185 Muscle mass/weight, 78, 188–89, 198 – 99
Levine, Jim, 177 – 78, 179 Music therapy: for emotional eating,
Liquid calories, 143 – 44 34, 70, 71; exercise and, 75, 79, 211;
Longevity experiments, 153 – 54 for insomnia, 183; for stress, 10,
Low-calorie foods, 48, 90 12 – 13, 16, 21, 168, 169
Low-carbohydrate diets, 174, 210
Low-fat diets, 108, 115, 138, 156 National Research Council, 92 – 93
Low-temperature cooking, 138 – 39 National Sleep Foundation, 181
National Weight Control Registry
Malabsorption syndrome, 89 (NWCR), 32, 46, 70, 73, 121, 156, 197
Malnutrition, 88, 89, 95, 96, 119, 121, Natural carbohydrates, 109
130, 149 Negativity/negative emotions: body
Mayo Clinic studies, 76 image and, 40 – 42; elimination of,
Meat diet: at breakfast, 115; fats in, 19 – 20; emotional eating and, 38;
128, 138 – 39, 163; food pyramid and, exercise and, 209 – 10; medical issues,
108; Mediterranean diet and, 110; 187; meditation and, 167; in obesity,
reducing, 120, 124, 130; satiety and, 3 – 4; self-reward and, 13 – 15, 18, 21,
92; traditional, 47; vegetarian 29, 72; weight loss and, 32
diet vs., 109, 128 – 29 Nestle Company, 192
Medications, 187, 193 New England Journal of Medicine, 158,
Meditation: for depression, 79; eating 161
and, 166 – 67; emotional eating and, “Nibblers,” 161
34 – 35; enjoyment and, 10, 13, 165, Non-exercise activity thermogenesis
167 (NEAT), 76, 176 – 77
Mediterranean diets, 112 – 13 Nurses’ Health Study, 129, 130, 132
Menstrual cycle hormones, 186 Nutrisystem (weight loss program), 32
Mental health, 5, 6, 18, 36 Nutrition Action Newsletter, 123, 160
Metabolic syndrome, 201 Nutrition /nutritional concerns, 89;
Metabolism: aerobic exercise and, 188, approaches to, 107–10; carbohydrates,
197 – 200, 212; artificial sweeteners 106; controversy over, 110 – 11;
and, 146; calories and, 146, 154 – 58, energy, 105 – 7; fats, 106, 127; food
173 – 74; cold temperatures and, 179; choices, 100 – 101, 123, 125 – 26; junk
control over, 192; of endurance ath- food vs., 105, 108; malnutrition vs.,
letes, 198; fat and, 173 – 74, 180 – 81; 88, 89, 95, 96, 119, 121, 130, 149;
fidgety people and, 86, 176 – 78; proteins, 106; salads and, 87, 117 – 18,
genetics and, 158, 175; hormones 119, 130, 132, 139 – 40; scientific stud-
and, 186; medication and, 187, 193; ies on, 111 – 12; in tomato juice, 115.
muscle mass and, 188 – 89, 198 – 99; See also Calorie intake; Fats; Protein
probiotics for, 192; thinking and, Nuts, benefits, 90 – 91, 127, 130
190, 193; thyroid gland and, 187;
weight gain and, 155, 187. See also Oats /oatmeal, 135 – 36
Energy; Exercise; Weight loss Obesity: artificial sweeteners and, 146;
Milk protein, 149 bariatric surgery for, 56, 95 – 98, 101;
Mindful eating, 165 – 67 behaviors and, 65; factors in, 3 – 4,
Monosodium glutamate (MSG), 135, 20; food availability and, 61; genetics
141, 174 and, 45, 65, 174 – 75; health problems
Index 237
from, 5; liver problems with, 151; Red Hat Ladies group, 57

processed sugar and, 132; sleep Resistance training, 199 – 200
apnea and, 184; social eating and, Restaurant eating: fast-food restau-
63 – 64; stress and, 3 – 4, 6, 20; sweet- rants, 59 – 60, 168; food choices and,
ened beverages and, 144 – 46. See also 138 – 39, 141; limiting food intake, 63;
Fat; Overeating; Weight gain overeating, 55 – 57, 58
Obligatory eating, 57 – 58 Restricted diets, 26 – 27, 106 – 7, 120 – 24,
Orlistat (diet pill), 94 – 95 154, 174
Ornish, Dean, 108, 109, 195 Rhode, Paula, 7 – 8
Ornish diet, 107, 109, 195 Rolls, Barbara, 83, 91, 144
Overeating: allergies and, 89; behaviors, Roux-en-Y gastric surgery, 96
63, 65; binge eating, 27, 30, 60, 85,
140, 160 – 62; in childhood, 50; Salads: as appetite suppressant, 53 – 57,
depression, 36; exercise and, 67; 114, 116 – 17, 124; good fats and, 127;
hunger and, 59, 83, 85 – 86; junk food nutrition and, 87, 117 – 18, 119, 130,
and, 61, 88, 185, 192; medication 132, 139 – 40
for, 93, 95; nutrition and, 89; in res- Salt usage, 134 – 35, 141, 174
taurants, 55 – 57, 58; slowing, 52 – 54, Satiety: achieving, 91–92, 116; fats and,
57 – 58, 167; triggers, 33, 35 – 37, 43 89–91; hunger vs., 83–84, 86, 100;
Oxytocin hormone, 16 meat and, 92; protein and, 89–90, 116
Saturated fats, 106, 127
Parkinson’s disease, 5 Schiavo, Terri, 190 – 91
Passion for life, 8, 16 – 18 School of Sport and Exercise Sciences,
Peripheral arterial disease, 207 99
Phentermine (diet pill), 93 “Secret calories,” 144, 148
Physical activity. See Exercise Self-esteem: dieting and, 28, 32; exer-
Physical health. See Exercise; Healthy cise and, 27, 206, 210; improving, 82;
eating; Nutrition /nutritional low, 39, 68, 69; raising, 41, 42, 82
concerns Self-monitoring techniques, 14 – 15, 40,
Polivy, Janet, 27 77 – 78, 82, 210 – 11
Portion sizes, 61 – 63, 65, 120, 159 – 60, Self-motivation, 30 – 31, 79
168 Sexercise, 99, 208
Positivity/positive thinking, 4, 21, 29, Sibutramine (diet pill), 94
78 – 79 Simple carbohydrates, 127, 140
Prayer, 13, 79 Singing, 10, 12, 36, 81, 82, 201
Probiotics, 192 Skipping meals, 161, 169
Processed grains, 89, 110 – 12, 136 Sleep in America Poll, 181
Protein: animal, 130, 139, 141; Sleep issues: aerobic exercise and, 184,
C-reactive protein, 111; deficiencies 208; caffeine, 181 – 82; diabetes and,
in, 88, 96, 136, 156; digestion of, 180; 182 – 83, 192; insomnia, 94, 163 – 64,
from eggs, 137 – 38; energy from, 105, 183 – 84, 202, 208; sleep apnea, 184;
106 – 7, 115, 123; high-protein diets, “sleep hygiene,” 183, 193
90, 109, 128 – 30; intolerance, 89; low- Sleeve gastrectomy procedure, 97
temperature cooking of, 138 – 39; Snacking: at bedtime, 163 – 64; healthy
from milk, 149; satiety and, 89 – 90, choices for, 90 – 91, 123, 138, 160 – 61,
116; vegetable-based, 130, 141; 163; hunger and, 85; on junk food,
weight loss from, 87 58; at night, 164; portion sizes,
Purging, 190 – 91, 193 62 – 63; TV and, 67
238 Index
Social support /socializing, 15 – 16, 21, Varied vs. restricted diets, 120 – 22
49, 57, 63 – 64, 73 Vegetable-based diet: benefits of, 88,
South Beach diet, 107 117 – 19, 128 – 29, 156, 180; meat diet
Spot reduction exercises, 200 vs., 109, 128 – 29; metabolism and,
Starvation: with binging, 85; eating 156; protein from, 130, 141; variety
slower and, 53; exercise and, 210; in, 113; weight loss and, 120, 123,
guilt over, 49; as habit, 78, 85, 87; 124. See also Salads
metabolism and, 154 – 55, 175; Vegetable juice, 114 – 15, 152
nutrition and, 60, 90, 130, 162; purg- Visual food triggers, 59 – 60
ing and, 190 – 91, 193; sleep and, 163; Vitamin C therapy, 180
water and, 136; weight loss and, 84, Volumetrics (Rolls), 91
100, 115
Step aerobics, 198 Walking, 10, 12, 196, 197 – 98
Stevens, Victor, 80 Wansink, Brian, 51, 55, 58, 84
Strength training, 199, 203, 212 Water in foods, 91, 101, 136
Stress: anxiety and, 7 – 8, 21; eating Weight gain: behavior and, 64; depres-
and, 51; exercise and, 25, 27 – 28, sion and, 21; diets and, 64; fidgeting
42, 206 – 7; hormone levels and, 185; and, 176; foods and, 58, 87; hor-
housekeeping, 4; junk food and, mones and, 186, 193; metabolism
185; laughter and, 4 – 8, 12, 19; and, 155, 187; monitoring, 40, 77;
music therapy for, 10, 12 – 13, 16, muscle weight, 78; stress and, 9
21, 168, 169; in obesity, 3 – 4, 6, 20; Weight loss: behaviors, 109; carbo-
obesity and, 3 – 4, 6, 20; weight loss hydrates and, 87, 90; exercise and,
and, 8 – 9; from work environment, 196 – 97, 210, 212; fidgety people and,
10 – 11 86; laughter and, 3 – 8, 19 – 20; myths,
Stroke, 24, 138 38 – 40, 43, 87; as ongoing process,
Sugar: artificial sweeteners and, 131 – 32, 30, 40 – 41; passion and, 8, 16 – 18;
135, 141, 145 – 48, 152, 175; brain programs and, 31 – 32, 173; reasons
processing and, 131; glucose, 131 – 32; for, 20; rewards for, 78 – 79; starva-
high-fructose corn syrup, 88, 131 – 32, tion tactics and, 100; stress and, 8 – 9;
141; processed, 88 – 89; sweetened surgery for, 56, 95 – 98, 101. See also
beverages, 144 – 46 Diet /dietary choices; Exercise; Food /
Swimming, 198, 199, 201 food choices
Swithers, Susan, 146 Weight Watchers (diet program), 32
“What-the-hell” effect, 27
Talk test, 201 – 2 White, LenDale, 150
Tea. See Green tea Whole grains, 87, 92, 100, 106, 112,
Television (TV), 67 – 68, 82 135 – 36, 141
Thermic effect of food, 180 Willcox, Bradley, 50
Thinking and metabolism, 190, 193 Willett, Walter, 50, 207
Third National Health and Nutrition Wilson, Mark, 4
Examination Survey, 129 Winfrey, Oprah, 209
Thoughtful eating, 165 – 67 Wing, Rena, 121
Thyroid gland, 187, 193 Work environment, 9, 10 – 11, 177 – 78
Tomato juice, 114 – 15
Trans fats, 127, 138 “Yo-yo” dieting, 38, 155, 157, 168
About the Authors
MELANIE W. ROTENBERG, MD, is a medical school professor and

stand-up comedian. She is in private practice in Melbourne, Florida,
and holds a volunteer faculty appointment at the University of Cen-
tral Florida College of Medicine in Orlando. She has counseled thou-
sands of people on weight-loss techniques.
MITCH ROTENBERG, PhD, is a research professor and a humor

writer. He holds a volunteer faculty appointment in the Department
of Biology at the Florida Institute of Technology in Melbourne.
Melanie and Mitch live with their son, Aaron, on the beach.
For more great comedic health advice and free audio downloads, go
to doctorRcomedy.com.

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Laugh Yourself Thin

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*Just not that Aristotle.

PART I: ATTITUDE AND BEHAVIOR

ONE: Turn Your Head and Laugh: Happiness, Joy,

PART II: INPUT—FOOD AND DRINK

EIGHT: Water Intolerant: The Right Drinks 143

PART III: OUTPUT—METABOLISM AND ACTIVITY

TEN: That Which Doesn’t Kill You Makes You Fatter:

First and foremost, I must thank my agent, Ellen Pepus, of Signature

Finally, the biggest thanks goes out to my patients, who inspire

Melanie Rotenberg, MD (aka “Dr. R”)

Roller Coaster Haiku

LIFE IS ALL ATTITUDE—LUCKILY, I’VE GOT LOTS OF THAT

GONE WITH THE CHIN

Back to weight loss: calories are just a convenient way to measure

STUDIES SHOW THAT WOMEN PHYSICIANS

(Oh, and one more thing: pay attention throughout. My husband

YOUR PERSONAL WEATHER FORECAST—CHANCE

HELP! I’VE EATEN AND I CAN’T GET UP

IF STRESS CAUSES HIVES, I OUGHT TO BE ONE

This chapter is about ways to increase happiness, lower stress, improve

THE UNIVERSE IS EXPANDING, AND SO AM I

I have a patient who is extremely overweight, as is his wife. Recently,

I’VE ALREADY LOST THREE SIZES:

WHO KNOWS IF A CLAM IS REALLY HAPPY?

THE CABLE COMPANY SAID THEY’D BE RIGHT OVER,

arguments with family members, waiting for the repairman, or being

CUSTOMER SERVICE IS OUR MIDDLE NAME.

Nothing aggravates me more than dealing with rude and incompetent

IF YOU’RE NOT BUSY LIVING, YOU’RE BUSY WORKING

HAVE A FOOD FIGHT, BUT STOP FIGHTING YOUR FOOD

MY BOSS IS HAVING A NEAR-HUMAN EXPERIENCE

mechanisms of great, loving, smart people under tremendous pressure.

There is so much aggravation built into health care. I was scheduled to

HEY, DID THE BED GET SMALLER?

WHAT’S IT GOING TO BE LIKE WHEN THESE WERE

When picking good-for-you music, be selective. I was a child in the

I’m a big believer in a daily regimen of at least 15 minutes of what I

A brand-new speech therapist was working on cognitive tasks with a pa-

SHE WAS SO MATERIALISTIC, SHE WENT OFF

THE BEST THINGS IN LIFE ARE FREE—OR

Another way to decrease negative emotions is to encourage your

when they don’t involve excess calories or monetary expenditures. Find

WHEN OUT IN THE COLD, LET YOUR NUCLEAR

Approach social occasions (especially with food) with a positive, joy-

A MIND IS LIKE A PARACHUTE. IT WORKS BEST

There is one precaution I have about doctors touching patients. It seems

My husband offered to get me a pet; he wanted to know which animal I

Overweight people feel less huggable because of the stigma society

I’M FOUNDER OF THE ORGANIZATION DOCTORS

WHY DON’T WE DO FUN RAISERS?

REMEMBER, THE FAMILY THAT LAUGHS TOGETHER

I believe in what I call the “art of contentment.” Much of daily stress

NEWSPAPER HEADLINE: MODERATES DEMAND

THAT NEW TRAVEL AGENCY NAMED

WHAT YOU SHOULD REMEMBER FROM THIS CHAPTER

A BALANCED DIET IS NOT SNACK CRACKERS IN ONE

LIFE’S A JOURNEY, NOT A RACE

Exercise would be much more acceptable to the masses if we saw more

MY SON PRACTICES RANDOM ACTS OF GROOMING

THE DISHWASHER DIET: USE THE HOT WAX