Stop Trying to Lose Weight

May 14, 2020

I used to perform weight loss surgery.

Did you know that?

It’s true!

As you more likely know, I’m a vascular surgeon. But the road to vascular surgery includes training in general surgery. And weight loss surgery is a huge program at NYU where I began my training.

During my time there, the LapBand was having its moment. We placed dozens each week. We performed other surgeries too - like the gastric bypass - but the LapBand was definitely a fave.

It was most often a short, straight-forward, effective surgery. You know that arcade game where you manipulate a mechanical arm inside a plastic box in order to grasp one of the cheapest stuffed animals you’ve ever seen with a mechanical hand? You know … the game that seems like a total scam?

Well, that’s kinda what it’s like to place a LapBand! While the patient slept, I would stand at the foot of the operating table while the attending physician would stand to the left of the patient. With a laparoscopic tool in each hand, I would tunnel the open silicone ring, the LapBand, behind the stomach and fasten it like a belt around a waist.

The LapBand cinched the stomach such that it made a tiny pouch. That way, just a fraction of a typical meal would fill the newly formed stomach pouch. The patient would get full really quickly and therefore eat less. The Band, as we called it, restricted their eating.

Weight loss surgery is a diet that’s super hard to cheat.

And it works.

(Disclaimer #1: the LapBand actually did not work as well as we’d hoped. The majority of patients regained all their weight over the long term. Other surgeries perform much better.)

(Disclaimer #2: Honestly, most typical diets don’t work long term either. Dozens of publications in medical journals demonstrate participants weigh as much or equal to their starting weight at the 10-year mark.)

Bariatric surgery, as the field is called, helps patients achieve the outcome they’ve been hoping for: massive weight loss. But more than that, it helps reverse serious, chronic conditions like diabetes, high blood pressure and high cholesterol.

(Disclaimer #3: This is not an ode to weight loss surgery. I know that it’s effective but I’m not promoting it. My point is coming … I promise.)

The reason that weight loss surgery worked seemed obvious:

smaller food intake → calories in < calories out → weight loss → SUCCESS

But it wasn’t that simple. Before too long, we realized that it wasn’t simply the food restriction that led to dropping the pounds. More than that, we’ve learned that weight doesn’t really correlate with health.

The LapBand, the sleeve, the gastric bypass - they all restrict eating, but more importantly, they change metabolism. Your metabolism - a symphony of cyclical, coordinated chemical reactions that are constantly taking place inside you - determines what you perceive as your weight. And your health.

Ghrelin is the star of the hormone show in bariatric surgery. But hormones don’t work in a vacuum. Again, it’s a symphony. There’s leptin. Insulin. Vitamin D (yup, that’s a hormone.) And so many more. They all work together to turn your food into energy. Put another way, if food is fuel, hormones determine how you burn it.

And teaching your body what to burn is the key. Not the number the scale reads.

At least 80% of my community comes to me to lose weight, but that’s not the goal that’s going to give them the body and life they truly desire. They’re been barking up the wrong tree.

So, if you have a stubborn 10 or 20 or 30 or 100 pounds that you’ve been struggling to lose, I see you. Don’t lose hope. You can feel confident in your skin. In my experience, these are the top three reasons you haven’t been successful yet.

#1 You don’t want to feel loss.

Before you even get started, you’re grieving over all of the foods you believe you can’t have. All of the experiences (socially distant, of course) that you’re telling yourself you’ll have to miss or only half-enjoy.

Are you excited to eat less, feel hungry, and fear missing out?

Of course not!

And you don’t have to. You don’t have to restrict your food. You don’t have to count calories or points or whatever! It doesn’t work long term.

#2 You’re convinced you have to self-flagellate through a work-out regimen.

Eating less has to be paired with exercising more, right?

Fitness pros are yelling at you through the interwebs to run faster (!), lift heavier (!), push harder (!). Ugh! My ears are ringing just thinking about it. And if that drill sergeant behavior doesn’t appeal to you, I imagine yours are too.

So please hear this: you don’t have to go beast mode with your workout. Move your body, yes. But release yourself from the expectations that it must feel difficult or painful.

You can be gentle with yourself. You can move your body in a way that brings you joy.

#3 You’ve been trying to lose weight.

Yes! You read that right. If your focus is losing weight, you're setting yourself up for disappointment.

Weight is pretty subjective, especially as you mature. And it doesn’t inform you about your deep inner health. I’ve treated plenty of skinny, sick people!

Have you been hoping for a solution that will help you:

love how you look in your jeans?
have energy to play in the yard with your kids?
stop taking all of those medications?
change the generational course of disease in your family?

Then, you get to change the way your body uses food.

You get to quit the calories in-calories out weight loss hustle. You get to get off the roller coaster.

Now, THAT is exciting! You get to use nutrition and lifestyle changes to build the body and world you’ve been craving.