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?

Finally frustrated and out of patience, Roy handed me a copy of a report by Dr. Michael Weintraub. That moment was the beginning of a revolution in my thinking that has changed Roy's life, those of my patients, and perhaps most of all, my own.

In my years of practice since then, I've treated nearly 12,000 patients for their overweight condition, with close to a 95 percent success rate. All of those patients have driven home one fact for me that may contradict everything you have ever heard on the subject: Dieting and exercise have nothing to do with weight loss.

I know it sounds unlikely. I know it goes against common sense. But it's true. Don't take my word for it. Just look at the world around you.

Diet books are perennial bestsellers, even though they very often contradict one another. One proposes high carbohydrates; another, high proteins; still another, high fats. Some claim that simply balancing your meals will do the trick. Others suggest changing your eating habits according to your blood type or the season of the year. In the meantime, we spend millions of dollars on treadmills, tummy-toning exercise machines, and health-club memberships.

Unfortunately, despite all this effort, we don't seem to be losing any weight. Nearly everyone who loses weight through diet and exercise gains it back within five years.

In my own practice, patients often come to me in utter confusion and despair after years of exhausting exercising and restricted eating with little or no weight loss to show for it. In fact, many have watched in horror as the needle on the scale actually moved upward when they cut their calories back. They feel weak and out of control.

"What's wrong with me?" they'll say. "What diet should I be on and how much should I exercise?" Or "Maybe I should just give up and accept myself as I am."

My answer is usually not what they expect to hear. In fact, it's something that most people have never heard before: The sizes of your meals don't matter, but the size of your appetite does. It's not the degree to which you consume food, but the degree to which you crave and desire food that controls your weight. It's not so much the steaks, chocolate, and fries, but rather the obsessions with them that ultimately add fat to your frame.

Why? Insatiable hunger tells your body to go into its fat-storing mode. Your system feels the symptoms of starvation, so it stops "wasting" precious calories by burning them and stockpiles them instead.

So, I tell my patients, don't worry about eating that piece of chocolate, but rather how much you crave it.

What controls how much you crave and obsess over food? It has nothing to do with your diet; it has to do with your parents. It's not your exercise program that matters; it's your genetic program. The solution to your problem doesn't lie in willpower, self-control, or pushing away from the table. It lies turning off your appetite, and your appetite center is located in your brain.

Once you do that, chocolate and sweets will instantly lose their appeal. You'll feel full after eating only a small portion of a meal. Food thoughts and compulsive eating stop. It's instant, dramatic, and works exceptionally well.

So put away your weight-loss books, throw away your tummy toners, and learn how to turn off your hunger switch. The day of the diet is over.

Excerpt of Turn Off the Hunger Switch , copyright 2001, reprinted with permission from Prentice Hall Press, Paramus, N.J.