Reevalution
BY ARJUNE RAMA, MD Every January, Americans nationwide start the year off with a new diet and exercise regimen. I am confident that almost all of these will fail. I am loath to bet against the underdog, as I have found myself in that very position multiple times in my life, but with this one I can’t help myself. This approach to change is simply fundamentally flawed because it does not acknowledge that being overweight is an addiction. Like so many other addictions, being overweight is merely the tip of the iceberg below which myriad other addictions reside. Not only are we addicted to the transient hyperglycemia/ caffeine high from our high-sugar cereals and coffees, we are addicted to the speed with which our cars take us to our parking spots as this allows us to sleep in just a bit longer. We are addicted to the convenience of the elevator that whisks us to our comfortable desk where we will work our sedentary jobs that keep us at a comfortable heart rate. We are addicted to the productivity we feel as we motionlessly work while eating our lunches at these desks and eventually reverse the entire trip home all the while jonesing for the largest meal of the day, the calories from which will transform directly into fat as we slip into sleep. Then the cycle begins again. With all of these micro-addictions, it makes sense that wholesale change is Herculean at best and Sisyphean at worst. I don’t blame people for failing; the entire enterprise is destined for failure. I don’t mean to say that change is impossible but I think the only way to approach the kind of change most people seem to want (lower BMI, definition of skeletal
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Why (most) diet and exercise regimens fail musculature, higher exercise tolerance, lower daytime fatigue, improved mood, etc.) is to assess every change you are considering instituting as something you will do for the rest of your life. For example, ask yourself, “Will I wake up every day for the rest of my life and run thirty minutes before work?” or “Is it realistic for me to never eat sugar again?” The answer is most likely no. Nothing frustrates me more than to see new diet programs advertised on television. These programs propose a precisely opposite approach to what has been proven to help people overcome addiction. We don’t need more options. We need better ways to utilize the ones we already have. I think we should approach our addiction to food and our sedentary lifestyles via the Alcoholics Anonymous model for change. Alcoholics Anonymous has been demonstrated to work in the long term. In the market of ways to curb alcoholism this program has the largest body of evidence for success. In AA, successful members of the
program acknowledge first that they are powerless to alcohol. I love the seriousness of that word: powerless. I have never heard a dieter say that they are powerless to food. But its true. The truly amazing part of AA is despite the rigor with which they have achieved their longlasting effects, even the most stalwart participants have relapsed twenty and thirty years after sobriety. This is how devastating addiction really is. I also love that alcoholics consider themselves alcoholics for life as a way to internalize the disease and remain constantly vigilant. To approach such a difficult change with any less intensity is like trying to fight a lion with an overcooked noodle. You might as well put an apple in your maw and lie down on a plate. So what the hell are we supposed to do? I have an idea. If being overweight is a multifaceted addiction, why not approach each part individually as opposed to some kind of all encompassing diet/ exercise regimen. I would employ a multistep method akin to AA. The first step could simply be taking the stairs to your office every single day for a few months. That’s it. Eat anything you want day-in and day-out but you no longer use elevators. You don’t even remember what that box with sliding doors and buttons does. I know that sounds incredibly slow on the scale of weight loss progress but I guarantee you many would fail. I don’t say that to be harsh; the odds are stacked against people as its not easy to even find the stairs in many buildings. Also, you’re busy. You are expected to be somewhere quickly all the time. I think if you can do that for a couple months