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Comedian George Carlin made waves in the ’70s with his “seven words you can never say on television.” Female hip-hop group Salt-N-Pepa stoked controversy in the ’90s with their hit song, “Let’s talk about sex.”

I am a healthcare provider, not an entertainer. But I do want to talk about another loaded “F word” – FAT!

I am starting this blog after working more than a decade in medical and surgical weight management. And I hope it will become a resource for patients looking for good, reliable information on low carb and ketogenic diets, which, yes, include fat.

Honestly, I am more than a little annoyed with the standard, low-fat diet recommendations mindlessly tossed around for the last 40 or so years. Such guidance often has been given by well-meaning health care professionals (doctors, nurses and dietitians). But too little time has been spent thinking about what the rationale (and science) for dispensing such advice. Why? In part, we can thank US Senators in the 1970s for stoking fears and typecasting fat as the “villain.”  But we also all drank the Kool-Aid! The low-fat campaign has been so effective that when prospective patients come to my office, nearly all say: “I know what I need to do. Eat less, exercise more.”

But nearly all of my patients already have TRIED VERY HARD to eat less and exercise more. For the vast majority, this over-simplified doctrine has failed. And most of my patients previously have attempted an average of 10 diet/exercise plans. Many did lose weight – sometimes a lot of weight. But they were not able to keep it off. Why? Why didn’t they maintain the weight? The reasons are usually multiple…

  • Major life stress: changes in a job or work location, a divorce, illness, injury…
  • Hunger
  • Sticking with diet was too much work or too time consuming
  • Lost motivation
  • Progress plateaued
  • Got off track and couldn’t get back

What is less common to hear is that the diet didn’t work. Diets do work, eating plans work, self-monitoring what we eat works, being mindful works, measuring and weighing food works, meal replacement plans work, pre-packaged food works, low-fat can work, low-carb can work and whole foods can work.

There, I said it, low-fat diets can work! BUT they also can leave people feeling hungry and unsatisfied, because fat (after all) is what transfers the taste of food and is satiating.

So if diets work, why don’t people read a book, follow the plan, lose weight and keep it off forever? Because they have not changed their relationship with food. Most weight loss plans, whether based on diet or exercise, are quick fixes and are meant to be temporary. Why? Because telling someone “this is what you have to do for the rest of your life” is daunting.

Changing one’s relationship with food is a difficult, non-linear process. It starts with education and getting accurate information to patients so they can make better, healthier choices. We have to redefine “healthy choices” to include butter, eggs and cheese! We also need strategies for the real world.

In the coming weeks I plan to lay out a series of posts (teach-ins) about how the body’s natural chemistry reacts to the food we eat. They might at first appear technical, but don’t be daunted. After all, we only get one body in this life! And yours will thank you for taking the time to understand how it – and it’s relationship to fat – actually works.


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