Excerpt: Turn Off the Hunger Switch

After years of preaching otherwise to his overweight patients, Dr. Paul Rivas concluded that weight loss is all about what is going on in your brain, as opposed to what is on your plate. In his new book, Turn Off the Hunger Switch, Rivas explains how he came to that conclusion, and what it means for people trying to lose weight.

Introduction to Turn Off the Hunger Switch:

I am a bariatrician, a doctor who treats people who find it difficult to control their weight, and today, I am a successful bariatrician. My patients actually lose weight and keep it off. But it hasn't always been so.

Like most weight-loss doctors, when I first began my practice, I immediately ran up against a brick wall. I had gone through standard medical training at a good medical school, so I offered everyone who came to see me the standard medical advice I had learned: Eat less and exercise more. The problem was that my advice didn't work. Most of my patients weren't getting any thinner, and those who were didn't stay that way for long.

Then one patient, Roy M., came in one day and did something that would forever change the way I practiced medicine.

Roy had been coming to my office for years, desperately looking for a way to control his weight, but he just couldn't seem to make any progress. The problem was that he loved Italian food, craved it so much, in fact, that he felt completely helpless to resist when in the presence of a beckoning bowl of pasta. Finally, at my wits' end, I accused him of being a bad patient. He didn't bother to point out my failure as a doctor. He simply asked me for pills to control his appetite.

If you have ever gone to your family physician, or even a bariatrician, and asked for diet pills, you already know this story. Pills are precisely what you do not get. What you probably do get is a stern look (or if you're lucky, a benevolent one) and a pamphlet that tells you to count your calories, cut down your fat intake, and do more exercise. What you probably also get is the feeling that your doctor does not take your problem seriously. You are not like his or her other patients, patients who are genuinely sick.

So it was with Roy. I told him I did not believe in diet pills and had never prescribed them in ten years of practice.

Why not?

Until recently, most diet medications came from the amphetamine family. These drugs are powerful appetite inhibitors, but they are also dangerous and addicting. People who use them over an extended period of time often become restless and nervous. Many develop the "shakes," a chronic and noticeable trembling of the hands. Insomnia is common. Overdoses can cause depression, psychosis, and death. These were not drugs I would give to people I care about, and I care very much about my patients. I didn't realize at the time that science was already discovering new tools, many of them natural supplements as powerful as medications, in the fight against obesity.

As for Roy, I was convinced that, for some odd reason, he was choosing ravioli over self-esteem and good health. Losing weight, I thought, was simply a matter of making better choices and keeping one's self under better control. Not such a difficult thing for a person to do. After all, I controlled my eating habits, didn't I? Surely his temptations were no worse than mine.

Or were they?

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