Noted physician and public health expert, David Katz posted an interesting article on how eating well is a key to weight management, and how pharmaceutical solutions may not be the desirable or effective way to go. I commented as follows:

Food choices are certainly one part of the weight management equation. The failure of rimonabant due to elevated suicide risk is an important clue to another hugely significant part of that equation: Human beings are hard-wired to use food for comfort and stress reduction, and when you take away such an important resource, it can have catastrophic effects. Food represents our first experience of the outside world, and more importantly of that first person who loves, comforts, and protects us. From that moment on, it is inextricably woven into every relationship and every experience.

Food and eating are powerful psychological metaphors, e.g., expressions such as being unable to “swallow” some statement or “stomach” some person. And it is no coincidence that Valentine’s day is often represented by chocolate! It is also no coincidence that eating disorders are not really disorders of eating but mental disorders that are reflected in eating.

There has been speculation that all addictions are, in the end, displacements of the original “drug” of choice, food. And it is certainly irritating when people who smoke, or gamble, or drink to excess, or shop themselves into bankruptcy, have the gall (Hmmm….another digestive reference) to look down on fat people and snicker with contempt. Most of us soothe the pain of living with something, and we are certainly designed to use food for that purpose.

As a result, the real underpinnings of obesity are ultimately psychological, and the failure to address that reality will continue to produce the astonishing recidivism (between 80-98% depending on the study) that we have seen in all efforts to lose weight. There is nothing “common sense” about weight management. Exhortations to “Eat better, eat less, exercise more” are simplistic answers usually promoted by those who don’t suffer from the problem. While they may be absolutely true, they are also nearly useless in telling us HOW to implement them. It’s like telling a poor person that there is no mystery to getting rich: “Work hard, spend less than you make, invest the remainder wisely”. Then life gets in the way…..