Mind Over Appetite Health Article

Pull up to Amarillo's Big Texan Steak Ranch ("Home of the free 72-ounce steak") and you step into a microcosm of modern American eating.

Here, if you can down a 72-ounce sirloin (4 1/2 pounds!), complete with baked potato, salad, shrimp cocktail and a dinner roll within an hour, the meal is yours free, compliments of the house. Some 30,000 people have tried the feat, and almost 4,800, including a 69-year-old grandmother, have won the free meal.

"The youngest winner was an 11-year-old boy," bemoans behavioral psychologist John Foreyt, who for 30 years has watched the eating patterns in this country change. In his own home state, serious eaters throng to the Big Texan, and a quick look at the recent winners of free 72-ounce steaks shows them to be, on average, 34-year-old males, standing six feet tall and weighing in at 264. The body mass index of these diners is 35.8. Obese. Foreyt, a nationally known expert on eating habits and weight loss, says they are far from alone in a country where bigger portions, fast food, fewer meals at home and more lonely eating are contributing to a national health emergency.

At Baylor College of Medicine in Houston, Foreyt has helped thousands of patients lose weight, published hundreds of research studies and helped to revolutionize the field of behavior modification to sustain weight loss. He has taken the field from focusing purely on dropping pounds to focusing on lifestyle intervention, in which the total person, with all of his or her individual quirks and challenges, is considered and given a sense of empowerment to help themselves.

Q: You warn that with the path we are taking, by the year 2040, 100 percent of Americans will be overweight; by 2100, 100 percent will be obese. Do you truly believe that?

Yes, I do. I just projected out from the NHANES data [National Health and Nutrition Examination Survey], which records real heights and weights of a random sample of the United States adult population. They show that we're getting fatter, one percentage point a year. There's always going to be a small group of people who are protected genetically, but that number will be quite small and not significant. Remember, two-thirds of us are already overweight.

Q: How much extra weight is unhealthy?

Physiologically, with just 15 pounds of extra weight your blood pressure begins to go up, your cholesterol goes up, your good cholesterol, the HDL, goes down, your blood glucose starts going up. By the time you get up to 30 pounds overweight, most people will have either hypertension, hyperlipidemia or type 2 diabetes.

Psychologically, you're definitely in trouble by 15 pounds overweight, especially women. The damage comes in poor self-esteem, which can lead to anxiety, depression and stress. Your work is affected by it, and you may have a lower quality of life and that's very serious. Men sometimes aren't as aware of weight gain. They can get really heavy and deny it, or they don't even notice.

Q: How does psychology factor into obesity and weight loss?

It's not that people just eat because they're hungry, but they eat for so many other reasons: stress, tension, anxiety, loneliness, depression, anger, boredom. So in order to lose weight you have to focus on diet, but you also have to deal with those emotional factors. Following a healthy diet and an exercise program is all motivation and behavior.

Q: How can someone who has been eating the same way for 30 years make changes to lose weight?

The problem is that most of us want to lose weight tomorrow. So you have this cognitive dissonance between what is practical and possible versus what you really want to do. All of us want to be skinny, but the way to achieve that is not overnight.

If people make big changes they can lose weight, but the rebound tends to be quite quick. We counsel people to make small changes they can live with—start with a little less salad dressing or a little less mayonnaise or butter on your bread, and add a little bit of physical activity.

Q: Many people are claiming they've found success on the low-carbohydrate Atkins diet, but it entails rather large changes.

I'm just a data person so if you say that you like this or that diet, just show me the data. There's no evidence to support that radical changes make a long-term benefit.

I think that we'll see data within the next couple of years that these diets are probably not very healthy long-term. But we don't know yet. Until then, I certainly wouldn't recommend that anyone stay on one of these diets long-term.

Q: Sometimes, when people want to quit smoking, it helps if they change their environment as much as possible. Does this also apply to successful weight loss?

It can help. I always tell people when they're making changes with their weight to keep their old friends but find new friends who didn't know you when you were heavy. A different environment, of course, would be ideal for all of us. But the practicality of it all is that we have to go back to day-to-day existence. Environmentally you can make some changes to make the job easier—don't drive past the doughnut shop on your way to work.

Q: You claim small changes are the key to successful diet changes, but many of those small changes take significant effort, using an entirely different way of thinking.

If it were easy, everyone would be skinny.

Q: I just saw an appealing ad with sizzling shrimp tumbling out of a pan onto a plate, and an all-you-can-eat-message for a local restaurant. We know it's unhealthy to gorge: what is the appeal?

Americans want to get their money's worth. What better way to get your money's worth than a bottomless shrimp bar or a buffet?

We teach people to stay away from places where they'll be tempted. It's like the addicted gambler who goes to Las Vegas for the buffet—not a good idea.