Transcript of WNYE interview on The Thinderella Syndrome

With host Madeline Gage and co-host Dr. Dennis Gage, M.D.

Teachers & Writers Collaborative presents "Everything Goes?" I'm Madeline Gage. I am a Nursing Educator and I would like to introduce my co-host and husband, Dr. Dennis Gage, M.D. Dr. Dennis Gage is author of The Thinderella Syndrome: A Practical Guide to Individualized Permanent Weight Loss. Dr. Gage is Board Certified in Internal Medicine, Endocrinology, Metabolism, and Clinical Nutrition. He is a Clinical Instructor at the New York University Medical School and is a Clinical Attending at Lenox Hill Hospital.

Madeline: Dr. Gage, Welcome
Dr. Gage: Thank you, how are you doing?
Madeline: Great. Well, I'd like to begin. Your book, The Thinderella Syndrome, it's a great title. How did you come up with this title and what does it mean?
Dr. Gage: We wrote this book over the last eight years. I actually was writing this book and was coming up with a methodology to describe the obesity epidemic and as you know, one of the biggest problems that people have with diets is they never keep the weight off, so just like in the fairytale, Cinderella, we have Thinderella who is the patient who goes on a fad diet, loses the weight, they get into a magical thinking that they are going to keep it off and then of course, just like in the fairytale, everything turns back into the original pumpkin and the horses turn into the mice, so these people you know start to regain.
Madeline: Okay, but how is your book different from other weight loss books? There are so many out there.
Dr. Gage: There are a lot of guru-type books out there that are essentially looking at one methodology and you know one of the problems with these books is that they look at a technique, if you look at something like Atkins or if you look at The South Beach diet for example, most of these diets are restrictive diets. They really use one technique. Most people who use these techniques never ever change lifestyle patterns. They are just forcing themselves to eat a certain way and they never take on the patterns that must change in order for them to maintain the weight off. So, one of the things that distinguishes The Thinderella Syndrome is that it is totally individualized and it is not just looking for the weight loss, it's actually guiding the patient to permanent weight loss and that is the key to our book.
Madeline: And also in your book, you describe "The Red Alert of Defensive Eating", now this is your innovative technique. How did you come up with this technique and explain it?
Dr. Gage: This technique was really developed through the numerous patients that I have had in my office who have gone through many many weight control programs. I have trained at St. Luke's-Roosevelt and seen lots of different types of diets, behavioral patterning, formula diet, medication; it's all been out there, I have seen it in use and one of the biggest things that I have seen that every diet has in common is that 97% of these patients regain their weight and it goes around and around in a circle and these patients really were lacking the key focus for not regaining weight is "defensive eating style and the red alert". It comes down to the ability of a patient to have a strong signal that is either external or internal, where they are alerted that they have hit a number in their weight that is substantially lower than what patients hit when they "yo-yo". The average patient who comes to me says "I have done the formula diet, I lost 100 pounds, but I regained it all". And one of the things that occurred to me is that why do these patients wait? What happens to a patient or anybody on a diet, why do they wait till they gain their weight back? And that's where we describe the "Red Alert Number". We tell patients that they can only gain or have a buffer zone of about 3 to 5 percent in their weight. So a patient who is let's say 150 pounds may go up to 155 or 157 but if they hit the 160 mark, they have to sound this Red Alert and this is the critical feature that patients have never done before. I myself you know when I lost 40 pounds in weight and this goes back 25 years, had to sound a Red Alert probably about a half a dozen times where I regained maybe six pounds and I hit that magic 160 number which I assigned to myself as the Red Alert and I was originally about 190 so I did not want to wait till I regained all the weight. And the Red Alert is the critical number that we assign to every single patient in our practice. It's individualized, it's really customized, and every single patient in the office is practicing different habits, different patterns to maintain their weight and to lose their weight.
Madeline: So Dr. Gage, this Red Alert Number can be used for every physician in every office for their patients.
Dr. Gage: That's absolutely correct. One of the biggest problems we have and certainly in NYC is that the physicians in New York are so busy, running around, trying to see many many patients, we have the HMO's who don't want to cover obesity per se, so you can imagine patients coming in with diabetes or hypertension, being put on a slew of medications, many of which are going to work, but unfortunately never getting back to the realistic problem which is that these people have to lose weight to get rid of their illnesses and that's lost in the shuffle, and of course you've got the heavy marketing of the pharmaceutical industry and in my book, I call this "Patchwork Medicine". I think that the old fashioned medicine treated patients for illnesses. Obesity was never looked at as a key illness and for many years was just looked at as a contributor but not an illness. And so physicians have been speedy in seeing their patients, they put patients on medications, and they never address simple patterns, simple ideas that can be instituted right from every single office.
Madeline: So Dr. Gage, because physicians are poorly trained to identify and treat obesity in their practice, what type of suggestions can your book and you make to physicians to help in prevention of obesity?
Dr. Gage: Well, first of all physicians have to be aware that the problem is substantial and that medication is just a motivator. We really do not have medications that are going to cure obese patients. They may help to get the patient to lose weight, perhaps get the weight down to a certain number but if the patient does not practice pattern changes which I describe very simply in The Thinderella Syndrome book, you know it's only 150 pages, but it's not a bunch of diets. We really tell the physician to basically share the information in the book or even have the patient read the book and the patient will understand that we break it down into some simple motifs and we start with the "Three R's of Behavior Modification" which is the Realization that you have a problem, the Regimentation phase which is the practicing of techniques, not one diet but a whole host of different patterns that can be practiced and what happens during this phase by the way, is the patient is going to select the patterns that work for them. Simple patterns like: pre-planning meals, smaller plates, strict avoidance technique, and not having "danger foods" in front of you, may sound simple when you look at each one but when patients practice these, they are going to find that there are four or perhaps five patterns that if they persistently change in their diet, this will yield a successful weight loss and maintenance. And one of the critical things in my book, not only is it easy to read and not only is it informational for every patient with a weight problem, and that's even for people who are ten pounds overweight, not just for people who are fifty or one hundred pounds overweight, but they can essentially incorporate this into their lifestyle and they don't have to feel that, it's not like doing a diet, you are living the diet. And that's the critical feature is after you regiment your patterns and you understand the patterns that work for you, the most important thing you have to be able to say to yourself is the third R, this is the R that nobody has done, Reorientation. Everybody has practiced Realization and Regimentation and unfortunately the Regimentation usually is just a strict diet, you know I'm going to eat starch or I'm not going to eat starch, or I'm going to eat lean meats only and they don't practice any other patterns and they lose weight successfully while they are motivated, but they all fall off and they all fall off when they realize this is not me, this is not my lifestyle. Reorientation is the gist of maintenance, it's the ability to say that I can take these patterns, incorporate it into my lifestyle, not be overwhelmed, and maintain a healthy weight, not a goal weight, but a healthy weight and each pattern that is practiced really produces a different weight that you can maintain. That's why when a patient asks me, "Can I get down to 130 pounds?" I really say "I don't know. I say "You are 250 pounds now, don't look at a specific number, look at a specific style. What patterns are you going to really practice? How long will they last? Don't rush the process because the people who are in a rush generally don't do well." And Reorienation says, do you accept this pattern in your lifestyle? Now a lot of people have always asked me, "Dr. Gage, you have successfully kept your forty pounds off, I know that you are running now and that's one of the things you do as your exercise" and I didn't do that before age twenty seven, but I knew that the running was an alternate activity for me that I actually enjoyed and it really helped me get rid of a lot of the stresses of medical internship and medical school but people always say, "How do you maintain the weight?" And I say "Your maintenance of the weight is, you continue exercising, because I enjoy it, I may not do as much as I used to do, I eat a certain way and part of what I do is what's called "Strict Avoidance technique". That's one of the techniques that I incorporated into my lifestyle. So I can eat my fruits and my nuts and work and you know I'll have a fruit for breakfast and people say, is that your breakfast? I say, yes. I have several little meals and then I can come home and eat a healthy meal, a piece of fish, salad, the usual healthy type meal during the week, and what I do is I "bank", I actually save enough calories during the week to still use another technique called "Preplanning and Banking Calories" and I spend it on usually the weekend. So what I have done is I have taken the stress of being on a rigid "black and white" diet off my back. I don't say, I can never eat a piece of cake again. I don't frequently go for the big desserts, I mean during the week, you know I just have maybe fruit and I just don't have the time to really go for the "danger foods" and that's part of the rule here, is that you can't have everything all the time. By practicing techniques eighty to ninety percent of the time, I have the mobility to now have a meal out on the weekend. And that in sum shows you the plasticity of the diet, in other words, you are not pressured to just stick with one pattern. You could switch styles and patterns depending on situations. Patients unfortunately are looking at the scale. The biggest problem I have in the office is I say "You want to live a diet and maintain your weight off, of course you do." Patients on the other hand when they are faced with losing weight want instant gratification like all us New Yorkers, we want it immediately if not sooner, and the first thing they will say is "Do you have something that I can get started with?" And this is why I added the chapter in the book called "Motivators" and they are just motivators. They are not the answer. Formula diets, pre-packaged foods, and medications are all motivators to get somebody more excited about the diet that they are going to really live for the rest of their lives and the danger is that it can backfire because they can really feel very good on some of the medications or even the diet and unfortunately lose a certain amount of weight and all of a sudden they get "routed" as I say, kind of like somebody who has gone on the offensive in a war, they have taken territory that they cannot hold onto. One of the worst feelings for a patient is to realize that they have gone down in weight and that they know in the long run, they are not going to be able to maintain it. It is self-defeating to go beyond what you are able to maintain and part of what the fad diets have done in the United States, it has set up a spiral of failure and patterns of failure that can lead to just a depressed patient who even before the diet starts is saying, " I don't know, this is just another diet, here we go again". So that's basically the difference between individualization and patterning your lifestyle and just doing a diet.
Madeline: You're absolutely correct. And what I love about this book is that you are empowering not only physicians but individuals because they are so used to failing and you are setting them up for success if they just take simple steps. Can you tell me how you can convince people to change their lifestyles to live healthier lives?
Dr. Gage: Well, you know the first step is you know they have the Realization because they have come to the office. Convincing a patient to change their lifestyle is not hard, you basically look at the patient and say "You know you are "x" amount of weight, you are diabetic, your blood pressure is up, your feet get swollen at the end of the day, there are two paths that you can follow, this is the "patchwork" path of taking your medication or five medications, or even 10 medications", and believe it or not, you would be surprised at how many people are on ten or more medications for various conditions or you can say "I'll take the path of lifestyle change and get off these medications and maintain a healthy lifestyle which will support my health and maybe I won't need more than one, two medications, or no medication. That's pretty convincing. You know when former President Clinton had his heart attack or almost heart attack I should say and found out he had ninety five percent blockage of his heart, everybody scrambled, you know this awareness of seeing it in a famous person, somebody who literally could have just dropped dead right on the door there, really has an impact. I had a lot of patients come in and say "Doc, I am worried about my heart, should I get a stress test?" And what we do in the office is say "You can get a stress test and it will tell me if you have a severe blockage in your artery, but you could also get some fancier blood tests". We do the Berkeley Heart panel which is a special lipid panel looking at a whole host of particles of cholesterol and inflammatory particles that can cause damage many many years before the patient develops the plaque that is going to kill him. And I think by doing this and bringing it up to the patient, there is an awareness and patients suddenly become concerned and fortunately the concern occurs way before they develop the disease. That's really the critical feature here. And you know the reason I think the concept of diet and exercise is so critical, it's something you can do your whole life to prevent you from having to really go to the doctor for patchwork medicine. I would love to see my entire office patients come in preventatively, healthy, just getting their cholesterols checked, their sugars checked, and not getting the heart attack, the stroke, the gallstones, and everything else that you see out there. There is an epidemic of obesity here that is so severe that our nation is going to spend probably several hundred billion, yes billion dollars on healthcare. Well, I mean you know this is going to bankrupt our economic force here. We are not going to be able to support this. We are going to have children that die younger and are sicker than our own generation. And this gets into the school system here. I mean you know we have a bunch of initiatives to healthy school issue of having the appropriate lunch, not having junk foods readily available to kids but having healthy wholesome foods have become a critical preventative for our youngsters. And you know, this is where you have to start. Don't say that I'm gonna be a kid that I am going to eat the junk and I will wait till I am an adult to worry about my heart because the very patterns that you form as a child get carried over to adulthood. And worse than that, guess who your kids are learning from, who do you think they follow when you eat? They follow their parents, their mentors, and that's one of the biggest problems.
Madeline: So that's the key that we really have to focus on in prevention is getting to our children because adults, you know like you say, they've been through this, gone through it, have failed, we really have to focus on the children.
Dr. Gage: The earlier somebody learns the proper way to eat and not only the proper way to eat but to feel excited about eating properly, it empowers you to become confident. It's part of being confident in growing up in a healthy fashion and it's not to say, you know a lot of people say, oh you know I can't eat fruits and nuts my whole life. Well obviously I don't either. I enjoy ice cream. I enjoy a piece of cake here and there. But it's the issue of the habit and unfortunately the habit is the "fast food", the rapid lifestyle pace in New York, you grab what you can get. You are in Starbucks, you grab the Danish, grab the bagel, and a lot of people don't realize how unhealthy these foods are and this is the problem. You've got to make a little bit of time for yourself and you've got to pre-plan.
Madeline: I also want to say that a positive self-image is very critical in weight loss. Because a positive body image requires you to have a realistic image of yourself, not a Thinderella image as you say in your book, The Thinderella Syndrome. What you and I are doing in our children's school is that we have been part of a Nutrition Committee that has been formed through the PTA. This is a wonderful committee that empowers teachers and parents to start working with the school in providing healthy lunches for the kids, etc. This is a start.
Dr. Gage: Yes, we are starting to see this in a lot of schools across the country. And that is the concept of saying "We can do without these vendor commisions, you know that go back to the school district". Obviously the schools that are poor have a harder time with it but I think if you speak to any parent in a school district, their child's health is really the most important thing that they have going and also they want their kids to excel in school and there are numerous studies showing that good nutrition is one of the basic features for a healthy child growing up with a healthy neurologic system, being able to learn and attend school and part of the problem has been that the vending machines and the vendors have invaded the society so much that you can walk into hospitals in this country and get McDonalds. You can actually have "junk food" and that's because the concessions pay the hospital to rent space and they sell. This is the type of thing that people have to be aware of and unfortunately the food lobbyists are pretty powerful and I think this is only going to come when people at the grassroots level realize that it cannot be this way and start demanding healthier food in our schools, at our playgrounds, and in all our social events. When there is a demand, things change. If you go to the opera and you say you want a whiskey sour, you are going to have a bar in between intermission. If you ask for a healthy piece of fruit, that's what you are going to get. And it really is going to come from the consumer. It has to be consumer-driven. And so empowering the consumer, the schools, the teachers, and the educators is critical. We started with it. Robert Woods Johnson was very successful with their initiative on tobacco and they have been able to really get people out of the cigarette smoking angle and were very successful there. I just want to mention again that people who are interested in this individualized approach should look up The Thinderella Syndrome. That's www.thethinderellasyndrome.com right on the internet and you can get a very interesting amount of information and connections to some of our live audios that we have had and of course you can go on amazon.com to get the book or right at the website www.thethinderellasyndrome.com
Madeline: You also have another website: www.theweightlossdoc.com.
Dr. Gage: Right, that was my original website. The weight loss doc is a website that described our holistic approach to taking care of the patients and not just looking at one disease but looking at as correcting disease states with good nutrition both from a vitamin standpoint and a food standpoint. We have been very successful. We used some very successful motivators in our office. Our Metagenic product "UltraMeal" formula has been a great motivator simply because it's not really a strict all formula diet but it incorporates the concept of small, frequent meals, healthy-based soy shake or soy bar, but it has the legitimate foods that you should eat, fruit, salads, and the non-glycemic type foods that are healthy for weight loss. We have been extraordinarily successful with this. We are going to actually be doing a Retrospective study in the office looking at patients who have started with different motivators and looking at how successful people have been. We know that people have been maintaining weight off now in my office for over twenty years. We are even thinking of starting a little club of those weight loss people, who we call "The Losers" but they are really the winners. It's very exciting to get the feedback from these people when you hear from somebody who has lost 200 pounds and has not regained it after losing all this weight. It's pretty exciting. And even more exciting is when you have a patient, and I am not going to mention her name, but we had a patient who lost 210 pounds and she came into the office with diabetes, on about five medications, who could barely breathe and get to the other side of the office. Well now, it's unbelievable, she has done walk-a-thons, she has done all kinds of group things, and she has gotten out. Her entire life has changed and more than that, she is no longer diabetic. She is a healthy woman with the rest of her life to look forward to.
Madeline: So you are saying that weight loss can cure chronic diseases?
Dr. Gage: Yes, most of America's chronic diseases are caused by obesity. If you look at it, it's hypertension, diabetes, high cholesterol, heart disease, and stroke. If you cure obesity, or if you know, put it into remission, you would reduce this country's illnesses by fifty percent. It's enormous. As I said, "If you packaged a pill and called it exercise and weight maintenance and sold it, it would be the most powerful pill in the world".
Madeline: That sounds great. Well, what has given you the greatest satisfaction in your work?
Dr. Gage: I have to say it's just that when you get patients who do so well and lose the weight, and you know you check their blood tests and they do well, and they no longer have the problem and you realize that they have done this with no medication and with just diet, it's really exciting. It's almost the reverse of the movie "Supersize Me" where the guy is out there and he basically does the opposite. He gains thirty pounds and look what happens to him, he gets every illness in the books. It is satisfying to know that there is essentially a healthy way to get the weight off, maintain it, and take care of a host of Western civilized illnesses. And that's really the major thing that I am excited about and the fact that you are in one hundred percent in control of what you eat. Nobody is forcing you to eat something, you are in control.
Madeline: So Dr. Gage just going back to the main topic of your book, the Red Alert number, that's going to be a very wonderful idea that you will be incorporating not only in your practice but in many other practices?
Dr. Gage: Absolutely. We are going to have the Red Alert number incorporated in many many practices and I think it's going to make it much easier for the physician to take care of their patients.
Madeline: And for patients to take care of themselves.
Dr. Gage: Absolutely.
Madeline: So I want to close, again, thank you so much Dr. Gage, author of The Thinderella Syndrome and Everything Goes? is directed by Chad Bernhard and produced by Irwin Gonshak in the studios of WNYE FM New York and this is Madeline Gage and Dr. Gage, thank you for listening.
 

 

 

 

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