Confessions from an Obesity Physician Part 1
Confessions from an Obesity Physician Part 1
As an obesity expert, I provide plenty of personalized advice to help my patients reach their health goals. While these tips are highly effective for weight management, there are a few that I don’t always follow myself.
In this episode, I'm spilling the beans on five things I often tell my patients to do but don't always do myself. I'll share my own experiences and explain why I sometimes stray from the standard advice I give.
We’ll also unpack why certain advice that works for many might not be the best fit for you. Plus, we'll talk about how you don't have to be perfect to be healthy or maintain your weight.
Confession #1: The Nighttime Snack Dilemma
As an obesity expert, one of the most common pieces of advice I offer is to avoid eating too close to bedtime. This advice stems from a few key reasons.
First, people often make poorer food choices at night. It's rare that someone craves a garden salad at 9 PM—more often, it's snack foods or junk foods that we reach for. Additionally, eating late at night can aggravate acid reflux, especially if you have GERD. For those on GLP-1 medications, which slow down digestion, this can be even more problematic, as food remains in the stomach longer and may exacerbate reflux symptoms.
Another reason to avoid late-night eating is related to insulin resistance. Many people, especially those I work with, have some degree of insulin resistance. Every time we eat, our bodies release insulin to manage the food. If you're eating throughout the day, say from breakfast to a late-night snack, your body is constantly releasing insulin. For those with insulin resistance, this continuous demand on the pancreas can contribute to weight challenges.
However, despite all this, I have a confession: I often eat close to bedtime. And I do so while maintaining a healthy BMI. The reality is, there isn't a one-size-fits-all rule that determines your success in managing weight. For me, if I don't eat something between dinner and bedtime, I get hungry, and that hunger makes it hard to sleep. And we all know how important good sleep is for overall health.
So, what do I do? I aim to be intentional with my nighttime snack. Instead of reaching for unhealthy options like ice cream or crackers, I choose something moderately healthy—maybe an apple with peanut butter, a yogurt, or an acai bowl, which has been a recent favorite. This approach helps me stay full, sleep well, and maintain a balanced relationship with food.
When I work with patients who struggle with late-night eating, I explore what's driving it. Is it stress? Did their dinner not fill them up? Or are they genuinely hungry? It's crucial not to fight your body's natural signals too much, as doing so can often backfire. If not eating before bed leaves you feeling deprived and ultimately leads to less healthy choices, it's worth reexamining whether this rule works for you.
In short, while the general advice is sound, it doesn't mean it's a hard and fast rule for everyone. The key is to find what works for you, be intentional with your choices.
Confession #2: The Standing Desk Conundrum
When it comes to managing weight and boosting metabolism, one piece of advice I often give to my patients is to increase their NEAT—Non-Exercise Activity Thermogenesis. NEAT encompasses all the movement we do throughout the day that isn’t planned exercise, like walking to the mailbox, pacing during a phone call, or even fidgeting at your desk. Increasing NEAT can have significant benefits for both metabolism and weight management.
For those with sedentary jobs, using a standing desk is a popular recommendation to help boost NEAT. Many people find that standing desks help alleviate low back pain and keep them more active during the day. In fact, all the other doctors in my office swear by their standing desks and use them daily.
Here's my confession: I don’t like using a standing desk. During my medical training, we spent long hours on our feet, particularly during rounds. If you’ve seen doctors on TV shows discussing patients in the hallway, that’s what rounds look like. These sessions could last for hours, with a mix of standing and brief walking. I found that standing for extended periods made it hard for me to concentrate—I’d start to zone out, and my brain would struggle to stay focused.
While I fully acknowledge the benefits of standing desks and highly recommend them to others, they’re just not for me. Instead, I prefer to sit and fidget to get my NEAT in. It’s what works best for me, allowing me to stay comfortable and focused throughout the day.
Standing desks are a fantastic tool for many people, but they’re not a one-size-fits-all solution. If a standing desk works for you, that’s great—embrace it! But for those like me, who find standing desks uncomfortable or distracting, it’s okay to find other ways to stay active and keep your NEAT levels up. Ultimately, the most effective approach is one that you can maintain consistently and that supports your health and happiness.
Confession #3: The Screen Time Struggle
It probably won’t come as a surprise, but I spend too much time on screens. Like most people today, screens are an integral part of my work. Beyond that, I also enjoy engaging with my colleagues and the public on social media. When it comes to screen time, there are some valid concerns.
Spending excessive time on screens can be hard on our brains and emotions. And as I’ve mentioned on the podcast before, if you’re glued to your phone or TV, you’re likely missing out on other activities that could benefit your health. Whether it’s going for a walk, knitting, or gardening, there are plenty of things we could be doing instead of getting lost in screen time.
Reducing screen time is a goal I’m continually working on. I aim to be more intentional with how I use screens, whether for work or leisure. I love the idea of intention—setting a goal with purpose, whether it’s related to food, exercise, or any other behavior. It’s important not to beat ourselves up if we fall short. Instead, we should ask ourselves why we didn’t reach that goal and adjust accordingly.
It’s worth considering how much screen time you’re logging each day. If you’re spending hours on your phone or computer, chances are you’re not moving as much and might be missing out on other activities that support your health, like connecting with people in your community or preparing healthy meals. By being more intentional about screen time, you might find the time to engage in other important aspects of life.
Here's my third confession: I’m definitely guilty of too much screen time. While there are professional reasons that keep me on my phone, I know I could benefit from setting more boundaries. It’s something I’m actively working on, and it’s a challenge many of us share in this digital age.
Confession #4: My Sleep Struggles
Sleep has always been my weakness, but I’ve made significant improvements over the years. Growing up, I was a night owl, staying up late to chat with friends or finish last-minute homework. This habit persisted through college and medical school—nighttime was my most productive period. However, in the professional world, where early mornings are the norm, I often didn’t allow myself the recommended seven to eight hours of sleep.
For much of my life, I routinely got around six hours of sleep, which is far from ideal. The more I learned about the importance of sleep and noticed how much better I felt with more rest, I knew I had to make a change. Sleep was always the first thing I’d sacrifice when life got busy. I’d still make time for exercise and cooking, but sleep would take the hit.
As I’ve gotten older, I’ve become more aware of how much better I feel with seven or more hours of sleep. This awareness has motivated me to prioritize sleep more consistently. While I’m still a work in progress, I’m sleeping much more now than I did five or ten years ago. It’s an example of gradual progress—we don’t have to overhaul everything at once.
For instance, if you currently get five hours of sleep, aiming for six hours is a great start. Once you’ve consistently reached six hours, try to bump it up to six and a half, then seven, and eventually hit that seven-and-a-half-hour mark that most adults need. Most of us think we can get by on less sleep, but the reality is that very few people thrive on six hours a night. I had to convince myself of that over time, and I’m glad I did.
Recognizing the areas where we struggle is powerful. When life gets busy or stressful, it’s important to focus on those areas. I know I’ll find time to exercise unless I’m injured, but I have to be more intentional about sleep. It’s crucial to think about what time I need to start winding down to get those seven and a half hours.
And just a side note: kids need even more sleep—about ten hours a night. It’s something that doesn’t get emphasized enough. So, while I’m doing much better with sleep than I used to, it’s still an area where I have to stay vigilant.
In short, getting enough sleep is essential, and while I’ve improved, it’s still my biggest challenge.
Confession #5: I Don’t Like Logging My Food
This one might be a bit controversial among my colleagues, but here it is—I don’t like to log my food. Yet, I fully believe it’s incredibly important for most people to do.
Why don’t I like it? I’ve logged my food extensively over the years, on and off, since I was a teenager. Food as medicine and understanding its relationship with our bodies has fascinated me for as long as I can remember. I’ve spent years logging my meals and have reviewed thousands of food logs from my patients. Because of this experience, I can pretty much estimate my daily macronutrients and calorie intake without writing it down.
For me, logging food doesn’t help with weight loss or even making healthier choices. My brain doesn’t like following rules—it looks for loopholes. If I’m logging with a specific calorie or macronutrient goal in mind, I can get overly fixated on hitting that target, even when it doesn’t make sense. For example, I might force myself to eat more protein even when I’m not hungry, just to meet my protein goal. Or, if I’m under my calorie goal, I might “reward” myself with a Snickers bar, which I wouldn’t normally do.
Another reason I don’t log is that it disrupts my ability to eat intuitively. Given my background, I already have a good sense of what I should be eating, and I try to listen to my body’s cues. If I’m craving fruit or beans, I’ll go for it because I trust my body to tell me what it needs. That’s the essence of intuitive eating—listening to your body’s signals and responding accordingly. I’ve learned what I needed from logging, and now it feels like it gets in the way.
However, if you’ve never logged your food or don’t have a clear understanding of what you’re consuming, I highly recommend it. Logging is a powerful tool for gaining insight into your diet—how much protein you’re getting, where the fat is coming from, and your total calorie intake. This knowledge is empowering.
That said, if you’ve logged extensively and it’s no longer helping you, it’s okay to stop or try a different approach. Some of my patients log in a more general way—tracking whether they ate five servings of fruits and vegetables or if they had three meals that day. Others might just focus on one thing, like protein intake.
I’ve seen patients achieve incredible weight loss and health transformations simply by logging their food. They find accountability and value in knowing exactly what they’re consuming. If that’s you, fantastic! Logging is a skill worth encouraging because it helps you understand your food and can serve as a great accountability tool.
But if logging isn’t working for you, that’s okay too. We just need to find a method that does. For some people, logging becomes a burden or even counterproductive, and in those cases, we should explore other ways to create accountability and make healthy choices.
There you have it—my confession. While logging food is a fantastic tool for most people, it’s not the right fit for me anymore.
Catch the full episode to hear all my confessions and learn how these personal challenges shape the advice I give. I’ll share more stories and strategies that may help you find the balance that works best for you. Even as an obesity physician, I have my struggles, and that's perfectly okay. We’re all on this journey together, finding our own path to health and happiness. Don’t miss out—listen now and see how these insights might just inspire your next step toward a healthier lifestyle.
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