An Obesity Medicine Specialist on the Impact of Having a Weight Loss ‘Why’
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If weight loss were simple, countless Americans wouldn’t resolve to pursue it each January — often for the second, fifth, or 10th time. But the goal is notoriously challenging, riddled with practical barriers like scant time for healthy cooking and psychological blocks like waning motivation.
Indeed, in Everyday Health’s recent survey, which included more than 3,000 American adults who tried to lose weight in 2023, more than half cited a lack of motivation as the leading obstacle in their journey. Many also reported wanting a better support system, more information (on topics like how to break through a plateau or prepare healthy foods), access to tools like gyms and medication, and an app to track their progress.
RELATED: Everyday Health’s Survey and Special Report: Weight Loss Reframed
That’s not to say all respondents fell short: While everyone faced barriers, those who did lose weight were more likely to use multiple tactics — like limiting indulgent foods and increasing exercise — and stick to those tactics instead of jumping from one strategy to the next, the survey found. (Find more interesting tidbits from the survey in Everyday Health’s Weight Loss Reframed Report.)
To learn more about why motivation can be so hard to come by, and sustain, during a weight loss journey, and how a strong weight loss “why” works for people, Everyday Health talked to Sean Hashmi, MD, a nephrologist and an obesity medicine specialist in Woodland Hills, California, and a member of Everyday Health’s Health Expert Network. Dr. Hashmi serves as the regional director for clinical nutrition and weight management at Southern California Kaiser Permanente and, among many other affiliations, is a member of the American College of Lifestyle Medicine. This conversation has been edited for length and clarity.
Everyday Health: How long have you been in the field of obesity and weight loss, and what got you interested in the first place?
Sean Hashmi: I’ve been in the field for about 23 years. Even when I was in medical school, I was doing research into nutrition, obesity, and weight loss.
Part of the reason is I had a lot of health issues growing up in Pakistan. I had measles when I was about 5 or 6 years old. At that time, we didn’t have any modern medicine. I remember hearing, “Your kid’s not going to make it.” For whatever reason, I made it, but I had all these nutrition deficiencies. It wasn’t until I was in high school here in the States that I finally had my growth spurt and I was doing well.
Meanwhile, my sister had epilepsy. She unfortunately died, and I was the one who tried to revive her. I tried to do CPR, but I didn’t know how.
And so I developed this keen interest in trying to discover how to improve people’s lives, and nutrition was fascinating. Even when it comes to things like epilepsy, there’s some very good data on how nutrition can help. For example, a ketogenic diet can lower the frequency of seizures in kids.
And so as I did more and more research, what I started to learn was if you begin to eat a diet filled with predominantly fruits and vegetables and rely less on processed meats, you become healthier and feel better. And what’s fascinating about that is: It’s not very complicated.
Now I have a nonprofit called the SELF Principle: sleep, exercise, love, and food. The principles come from what I’ve observed about the habits of folks in the blue zones. In this framework, food is very important, but in the grand scheme of things, it’s just 25 percent of the overall picture.
EH: How has the conversation around weight loss changed since you began practicing? Are people’s barriers to weight loss more or less the same?
Over the years, I have found that people are looking more often for quick fixes and are less willing to work on root causes.
There is less focus on prioritizing sleep, healthier eating, regular exercise, and finding ways to de-stress. Instead, people want to sleep less, exercise less, work more, and add a prescription to deal with weight gain.
What’s getting in the way of success isn’t that they don’t realize the food they’re reaching for is unhealthy and could lead to weight gain, heart disease, or diabetes. They reach for it because it fills a void.
In fact, if you look at some of the new drugs, like GLP-1s, there’s a warning label saying they can increase the risk for depression and suicide. Why? Because when a drug reduces appetite, it also reduces pleasure. This is a real risk we have to warn patients about.
EH: What other common misconceptions do people have when they start a weight loss journey?
SH: Everyone always focuses on what. They say, “Doc, I want to lose 10 pounds.” And I always tell them, “Your why has to be stronger than your what.”
A why could be: “I went through all sorts of issues growing up, and I don’t want to pass my demons onto my kid. I want to be the right example for them.” That’s a very powerful why.
Our job as physicians is to help our patients to discover the why. Because at the end of the day, all diets can help with weight loss. Weight maintenance is the real monster, the real battle. So the challenge is: How do we keep the weight off? And to do that, you’ve got to have your why.
We’ve also got to get this idea out of people’s minds that they need to rely on willpower. Willpower is the worst — the idea that, “I’m just not going to eat this thing.” Okay, that’s great right now, because you feel good, but what happens if you fight with your partner or some other emotionally triggering event happens? Now that same “no” becomes very difficult.
But if we create habits, you’ll wake up and have them on autopilot. Have you ever gotten in your car, driven somewhere, and not even known how you drove there? You stopped at all the stoplights, you turned right when you needed to turn right, you didn’t get into an accident. You did all those things because you were so used to it that it’s a habit.
EH: Relatedly, the survey found that a lack of motivation is the leading obstacle to weight loss. What’s your impression of that?
SH: The problem is not so much that it’s a lack of motivation for weight loss; it’s that there are so many things that are taking that motivation away from weight loss.
In other words, our world is filled with bright shiny objects that are distractors. And if you don’t have a strong enough inner why, which is another word for your inner motivation, you’ll already have exhausted your limited willpower by the time you want to make a healthy decision.
EH: What role do you see motivation playing in someone’s weight loss journey?
SH: Motivation is essential to start the journey, but it is not enough to maintain it. Motivation quickly wanes. It’s the rocket needed for liftoff, but then habits are what help the rocket to stay on track and get to where it needs to go.
This is why we try to get people to make habits, so that when you make that decision, it’s not about motivation. You already know what you’re going to do for breakfast. You’re not looking for pleasure from food, you’re looking for pleasure from life. Motivation is no longer a factor.
EH: Common motivators to lose weight among the Everyday Health audience included improving physical health, feeling better, and having more energy. Are these the types of “whys” that can help someone lose weight?
SH: Wanting more energy is great, but there’s a lot that can get in the way of that. What happens when you come home from work and you’re too tired to exercise and make a healthy meal?
So let’s dive deeper. What does that mean for you? If you had more energy, what would you do with that? When I work out, I feel better about myself. I’m a better husband, son, father — I’m talking about myself here — and how I look at myself and feel directly translates to how others feed off me.
EH: How do you counsel patients on finding their weight loss why?
SH: It all starts with a conversation, and what I want to get into with patients is: What do you think has prevented you from taking those steps in the past? What have been the barriers?
We dive into the why, but more importantly, the why now? What changed? And then you start to find out some fears.
In this way their why becomes stronger and deeper, and you’ll find out that every single one of them has something stronger — they may not even know it — but if you help them discover it, you have just won the battle. Heck, you’ve just won the war.
EH: In your experience, what motivators are most effective at helping patients lose weight?
Motivation, by its very definition, is a fleeting commodity. It’s only enough to get you through the door. But what’s going to keep you going when you run out of that initial drive? When you go to the gym but wake up the next morning and you look the same? When, a week in, your pants aren’t as loose as you thought they would be?
That’s why I’m a big believer in intrinsic motivation (loving what you do) over just extrinsic motivation (outcomes or rewards). Don’t get me wrong: It’s nice to focus on looking better as an outcome of weight loss, but that can lead to disappointment quickly. But when we add in the joy of working out, the fun of cooking healthy meals with family, the passion of building a better future — this creates a motivation that is much more sustainable.
EH: Can you share an example of the power of having a weight loss why?
SH: People come back with the most incredible stories. I have a patient who’s 72 years old, and she came to me with type 2 diabetes and severe kidney disease. Her A1C (her average blood sugar levels over a two- to three-month period) was through the roof.
I had a talk with her about understanding that this is a very serious thing, and here’s what could happen if we keep going down this road. Here’s what could happen if we change it. What are you ready to do? She said she was ready to change, and I’ve heard that a thousand times before.
But I saw her 30 days later. She’d lost about 20 pounds, and that brought her A1C down so dramatically that we cut her insulin dosage by 50 percent. The protein in her urine went down by like 80 percent, which means her kidneys were doing a much better job filtering blood.
But what was so remarkable for her was, she said, “I couldn’t even walk across the room to use the restroom before, and — something that I’ve never said to anybody — I couldn’t clean myself after the restroom. And just the fact that I can do that, that shame has gone away and you have given me my dignity back.”
Do you know how powerful that is? And now she’s setting goals for herself. She wants to get off insulin completely. That’s very aspirational, but at the same time, if you reach for the stars, you’re going to get the moon handed to you every time. And who knows? Maybe she gets the stars.
EH: What happens when somebody’s “why” fades and they start to lose motivation? How do you get them to either find a new why or reconnect with that original one?
SH: The first thing that’s really important is to understand that you’re going to fall down, and that’s okay. The average smoker has to try quitting six to seven times before they actually quit.
So if you “fail,” you didn’t fail. You just learned one more way not to do it. And I’m glad you learned it early enough so that we have more time to do what may actually work better. If we celebrate people’s failures, we celebrate people’s success.
EH: How do these new classes of weight loss drugs, the GLP-1s and GLP-1 and GIP receptor agonists, influence people’s motivation?
SH: Everyone who comes to see me, the first thing out of their mouth is, “I want Ozempic.” And I tell them, “I want you to be successful.” And for some people, drugs like Wegovy, Zepbound, and Ozempic can be very effective in creating that jump-start effect by, for example, helping to reduce food noise and develop better habits.
However, without working to establish the proper habits, many people either gain all the weight back the second they stop the drug or eventually overcome the effects of the meds. For example, I have folks who started on oral weight loss medications, then they graduated to injections, and now Ozempic doesn’t work anymore, and they want the newest kid on the block. Where we’re missing the boat here is the idea that we can do better.
We’re basically creating a generation of drug addicts, and I think that’s a shame.
How do we figure out a way to get around that? We look at weight loss drugs as a tool in your tool belt. You use it if you need it, but you look at it as a guest in your house. It’s okay if they come in, but you don’t want them to become permanent residents and stay rent-free.
These drugs have a significant number of side effects that we’re just discovering. For example, what if there are long-term consequences to the brain? We know they’re affecting the pleasure centers. What if they cause us to essentially rewire our brain chemistry in a way that reduces our ability to experience pleasure? We just don’t know that yet.
EH: What motivates you?
SH: We’re on this planet for such a short time, and all of us have a purpose. I’ve got two daughters. One is 6, one is 10, and the greatest joy I’ll ever have is one day when they’re old enough and they get to think about their father, they can say, “Hey, my father did some real good for people.” That’s it.
EH: Is there anything you’d like to add?
SH: Sometimes, the fastest way to get what you want is to slow down.
And as much as that’s a cliché, it couldn’t apply more to weight loss. The faster the weight loss, the faster the rebound. The slower the weight loss, the more it allows your body to adjust, the more it allows your brain to adjust.
If you look at it as, “I’m doing this in a slow sustainable way for the rest of my life,” you are more likely to stick to it, and you’re more likely to make those things into habits.
Everyday Health‘s Weight Loss Reframed Survey queried 3,144 Americans nationwide ages 18 and older who had tried losing weight in the previous six months. The study was fielded between July 10 and August 18, 2023, across demographic groups, genders, and health conditions. Survey recruitment took place via an online portal, in app, and via email. The margin of error for the sample size of 3,144 is +/-1.7 percent at a 95 percent confidence level.
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