Patricia Yarberry Allen, M.D. is a Gynecologist, Director of the New York Menopause Center, Clinical Assistant Professor of Obstetrics and Gynecology at Weill Cornell Medical College, and Assistant Attending Obstetrician and Gynecologist at New York-Presbyterian Hospital. She is a board certified fellow of the American College of Obstetrics and Gynecology. Dr. Allen is also a member of the Faculty Advisory Board and the Women’s Health Director of The Weill Cornell Community Clinic (WCCC). Dr. Allen was the recipient of the 2014 American Medical Women’s Association Presidential Award.

Dear Dr. Pat,

I began a diet just before Thanksgiving and lost three pounds in 2 weeks by giving up bread, sugar and wine and eating smaller amounts. I saw my GP before starting the diet and found that my cholesterol was high, my triglycerides were high and my diabetic monitoring test, hemoglobin A1C, was in the borderline range…almost diabetic.  My thyroid tests were normal.  There are many diabetics in my family, aunts, uncles and my mother.  I know that the weight I have put on does increase my risk for this terrible disease.  I have gained 45 pounds in the last decade, most of it around my waist.  I am only 5’2” tall.  I weigh 185 pounds. And I can’t wear any of my nice clothes.

I am 50 and have a good marriage, but I am so ashamed of my body that I don’t want my husband to even see me without my clothes on. My husband never gains weight and doesn’t understand why I eat so much.  He doesn’t know that I even eat in secret.

I have three teenage sons and when I am not working full time at my day job, it seems that I am either shopping or cooking.  No one helps me in the kitchen and the moment I come home, there they are, mouths open, wanting food.  Is there any hope for a woman my age that lives this way?  This is not a crackpot letter, I am really desperate.

We entertain family and friends with dinners all the time.  With the stress of the holidays, I gained the three pounds back that I lost before Thanksgiving.  I spend most of my time wanting to run away.  Since I won’t do that, I eat too much and I have 2 or 3 glasses of wine every single night.  I have tried Weight Watchers, the cabbage soup diet, and even the Atkins Diet.  I lose a few pounds then just can’t take the stress of measuring points and making choices.  I like the support at Weight Watchers and always feel that the other women struggling with weight there really understand why I try and why I eventually fail.  Now, I want to start my New Year right.  I am ready to change something so that I can have a healthier life.  Where should I start?


Dear Peggy,

My, my.  You do have many difficult issues to deal with.  How is that for validation?  And, your life story is not so different from the thousands of women who struggle with weight gain and hope for weight loss across our ever expanding nation.
I really enjoy working with women who have decided to lose weight and get in shape at mid-life.  I believe that how we eat and how we take care of our bodies is a clear metaphor for how we have chosen to live our lives. Often, we become resigned to life as it is and see ourselves as victims. We no longer see ourselves as capable of changing anything in our lives.
In my practice, patients email their food choices, how much, what and when they eat, the daily exercise and their morning weight, along with saboteurs that cause them to make unhealthy choices.  Over time we learn a great deal about each woman’s life, not just what she is eating and drinking. Each woman’s daily email conversation with me becomes a diary for her to re-read as she begins to unravel the badly knitted scarf of choices that certainly is no longer attractive or healthy for her at this stage of life.
Peggy, you need to take back your life and focus on the positive change that is truly possible for you.  This is going to be a very long answer to your question so I am glad that I am writing to you because you can read this over and over when you become disheartened, overwhelmed, disappointed in yourself, judgmental, and a very long list of other negative words.  Negative and self judgmental thoughts and language will never work.  Self awareness, self monitoring, self control, self care are the keys that will unlock your ability to lose weight and give you the strength to put yourself before the care of others.

People eat and drink more than they need for all kinds of reasons.  They eat because they are bored.  They eat because they feel devalued by others, and then view themselves as people of little worth.  They eat because they are enraged. They eat because they see themselves as victims.  They eat because they feel hopeless. They eat because they believe nothing will ever change. They eat because everyone else around them is eating.  They eat because they feel that they can no longer control anything in their lives. They eat when something good happens.  They eat more when times are bad.  They eat mindlessly, mostly.  Of course, we all enjoy wonderful food for special occasions.  But if we choose to eat this way daily, it is no longer special.

People become caught in the vicious cycle of eating too much which causes a brief spurt of energy followed by an energy crash that spurs them to eat again.  When they are responding to the energy crash, people often consume foods and drinks that make this energy roller coaster even worse. It is my belief that we eat mostly because we do not engage our brain before opening our mouths.  Mindless eating must be changed before any weight loss plan will succeed.
I suggest that you consider the following steps in order to have a successful weight loss program.

  1. Ask your husband for his help.  Let him know that without his help in restructuring this flailing family, that your ability to lose weight will be greatly handicapped.. Let him know that you cannot lose weight if you are going out to dinners, to cocktail parties or entertaining with food at home.  Explain that you understand that this will be a real sacrifice for him but that you cannot lose weight if you are surrounded by people constantly eating.  Invite him to help you create ways to be with friends and family and work associates that do not involve eating.
Let him know that at 50 with your family history, that your weight alone is likely to cause you to become a diabetic. Let him know that this weight loss plan will take 9 months.  Don’t tell him the real truth:  In 9 months you will give birth to the real adult you that you can choose to be and that you will incorporate these life changes of the next 9 months into the rest of your life.  Too much information can be overwhelming to spouses. Do let him know that you have become ashamed of your body and that this has affected your interest in intimacy. 2.  Call a family council and as the culinary CEO give the bad news to the crew straight. Let them know that you have a health crisis.  Tell them the stories of the aunts, uncles and grandmother who were obese and became diabetic.  Be vivid in your descriptions of blindness, amputations of limbs due to diabetic blood vessel change, strokes, heart attacks, kidney failure and dialysis.  Don’t hold back.  Let them know that your recent blood tests indicate that you are headed for the same diseases if you don’t change your life. Remind them that they have this genetic tendency to diabetes as well, so as you are helping yourself in crisis, they can help themselves before the crisis hits them. Let them know that in order to change your life, the family has to change as well.

3. Tell these three young men that there will be no forbidden foods in the house for the next 9 months.  If they want junk food, soda, ice cream, deserts and any other foods that are easy for you to find in times of emotional hardship, they must buy and eat them elsewhere.  What are they going to do?  Hate you?  Move out?

Tell them that you expect that they are going to help in the kitchen.  They are old enough to do some of the heavy lifting:  shopping with a precise list, participating in food preparation with you and then in the clean up.

Leave food for the boys that they must eat every afternoon before you come home so that you are not met at the door by a crew of HUNGRY MEN.  Adolescent boys need more calories and healthy sandwiches or pizza after school will calm their appetites and prevent you from being attacked by the daily chorus of “What are we having for dinner; I am starving; I don’t like that: we always have that”.

Let them know that you are treating your obesity as if your life depends on it, and that you expect them to love you enough to help you with your weight loss program.  Tell them about emotions and eating, tell them about saboteurs and temptations.  This is a real chance for your sons to begin to part of an adult and thoughtful family life.  This is a real gift that you will be giving them.

If anyone had the perfect diet, then everyone would be thin!  There is no perfect way to lose weight and to keep it off.  But, there are important connections between the mind and the mouth that will help you find a way to shop and prepare your special foods in advance, to choose food carefully, to control portions completely, to identify the saboteurs in your life that cause you to deviate from the diet, to use the diet as a way of evaluating how you are living and whether or not you really want what you say you want.  Choose your weight goal and really own it and the process of weight loss will be so much easier.

I feel that the frequent small meals that form the structure of a diabetic diet are really the best way for all of us to eat.  This way of eating delivers a small amount of food to be metabolized and used by the body and prevents wild swings in insulin as long as the food choices are sound.  Eating frequently also prevents out of control hunger that causes random binging. Choose a diet that has no sugar or sugar substitutes, combine a small portion of fruit with cottage cheese each time to prevent the glucose in the fruit from over stimulating the pancreas and causing too much insulin to be produced.  I like V-8 juice twice a day since it is low in calories, has fiber, is quite filling and is a controlled amount of fuel.  Eat only 4 oz of protein for lunch with a salad and a cup of non starchy vegetables.  The protein should be poached, grilled, baked or broiled.  The vegetables should be steamed or microwaved.   Repeat at dinner.

4. You said that you frequently had 2-3 glasses of wine at night.  This is a common way to deal with stress and “unwind”.  But, it is a disaster, especially for women.  So, no weight loss program works with booze.  Cut it out.  If you can’t eliminate alcohol, finding one excuse after another for why your saboteurs caused you to have one or two glasses at a work or festive event, then Houston, we have a bigger problem than weight here.

If the diet you devise is simple, easy to prepare and take with you in an insulated thermal case, and is totally boring with no substitutions, choice is not the frequent saboteur that it becomes in many diet failures.  Never be without an apple and a small container of cottage cheese or a low fat individually wrapped cheese wedge (I like Laughing Cow Low Fat Swiss, 30 calories!)  and V-8.  Then you will never be forced to eat food that will sabotage your diet plan.

Now I have a contentious suggestion.  Weigh daily.  I know, I know, that thousands of nutritionists say that it is wrong to weigh yourself daily.  But, I argue that you can’t know where you are going if you don’t know where you are.  The number on the scale is not an emotional event, it is a guide to the choices you will make based on the response that your body has made to the past three days of food consumption.
Aerobic exercise and toning are a serious part of weight loss.  Find a way to work in 30 minutes of aerobic activity once or twice a day.  Find 10 minutes to aggressively climb stairs at work when there is no other way to burn some fuel.  Exercise increases the metabolism and improves your mood.   As you continue to lose weight it would be terrific to add abdominal Pilates-based core work to your exercise routine.

This way of eating requires constant mindfulness.  Never open your mouth unless you engage your mind.  Find a trusted friend who will monitor your daily weight and food diary with you on line or in person.  We all work harder to achieve our goals when we have someone who believes in us and is willing to help us change our lives.  I know that you are ready to get your life and your health back.  This diet is really just a metaphor for that.

I can predict that the diet industry will hate this letter to you, Peggy.  But, they have more to lose than you do.  They don’t have pounds to lose; they have money to lose!   If all Americans could understand  that self control, good food choices with frequent small portions, no alcohol, daily exercise, and mindful eating cost nothing and gave them the opportunity for good health and an opportunity for self care, well,  that would be priceless.

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  • Dr. Patricia Yarberry Allen May 7, 2012 at 7:12 am

    Sure. Just watch the portion size and make sure you get enough protein. The diet secret is always finding the ‘why’ of weight gain.
    The “how” part is much easier.

    Good luck.

    Dr. Pat

  • lou May 6, 2012 at 9:32 pm

    Thank you for this. I too just finished Dominique Browning’s Slow Love. Job stress, care-giving responsibilities, debt, etc…have all contributed to my gaining 50 lbs in 2 years. I’m hoping this can help. Is there a vegetarian version? Could I substitute beans or tofu for the chicken? Thank you.

  • R LEE June 2, 2010 at 12:10 pm

    I have also found this dialogue very refreshing and enlightening – to be in such wonderful company.

    I am 45 and very active rock climber. I run during the week, work with a trainer, and take spin classes. I find as I have entered into the periomenopausal stage (and i had a partial hysterectomy a few yrs ago), my hunger seems to have increased.

    i do eat frequent small meals, and am interested in your eating guidelines, Dr. Pat. But wonder how to be sure I’m supplying my body with enough fuel for my daily workout needs.

  • Laura Lollar Wolfe May 29, 2010 at 7:29 pm

    I just finished reading Dominique Browning’s Slow Love that spotlighted Dr. Pat’s diet, and that drove me to find out more. I am 48 and was laid off from job last August after surviving a year with a new, high stress producing boss. I had gained 10 lbs during the stress year and since then have gained another 10. For the first time I have a muffin top. Luckily my 30 years high school reunion is Labor Day, so I have some great incentive to follow this diet and two classmates to serve as support. I plan to practice with the plan starting Monday, but won’t dive in until June 21 when I return from a special trip with my 18 year old son to NYC. Any advice and success stories would be appreciated!

  • Leslie Parham May 13, 2010 at 8:51 am

    Thank you so much for this valuable information. Your patients are so lucky to have such a wonderful, caring doctor.

  • Terry January 6, 2009 at 10:39 pm

    A year ago I was a neglected and anemic 46 year old who had let 25 extra pounds creep onto my otherwise gorgeous frame. Dr. Pat encouraged me through my transformation. Losing the weight became a journey, less about will-power and more about self discovery. My eating plan is to eat every two hours ie. nurture, pay attention, be conscious, be mindful. My capacity to eat has diminished and, more importantly, I’m feel cared for. Having the email exchange, the buddy system, helped me to identify the saboteurs in all areas of my life. Noticing, for example, I took that piece of cake, because someone made it. I learned I was too obedient to take control. The dialogue regarding the saboteurs was not guilt producing. It was interesting. “How curious. That situation caused an interesting reaction in my behavior”. I became my own research subject. And, by taking control of what I eat, I found my power in other aspects of my life. I also learned that I can be what I create. In other words, I had resigned myself to the belief that ‘as we age, the weight is harder to take off’. I replaced that with a belief that I can choose to take the weight off or leave it on. When I go off my eating plan, I gain weight. If I go to a party hungry, I eat more than I had intended to eat. These are about choices I make and not about aging or comparing my 47 year old body to my 20 year old body. I would love to hear from other women on this blog, smart and accomplished, who are going through or have been through a similar transformation.

  • Karen O'Kane January 6, 2009 at 10:38 pm

    Thanks for all the common sense advice. So many of us know what to do but run into the saboteurs from time to time–such as the holidays and all that goes with it. Mindful eating as described by Dr. Pat is key. There most likely will be slip ups along the way, but you can get back on track. Timely article–time to get back to mindful eating.

  • Karen O'Kane January 6, 2009 at 10:38 pm

    Thanks for all the common sense advice. So many of us know what to do but run into the saboteurs from time to time–such as the holidays and all that goes with it. Mindful eating as described by Dr. Pat is key. There most likely will be slip ups along the way, but you can get back on track. Timely article–time to get back to mindful eating.

  • Karen O'Kane January 6, 2009 at 10:38 pm

    Thanks for all the common sense advice. So many of us know what to do but run into the saboteurs from time to time–such as the holidays and all that goes with it. Mindful eating as described by Dr. Pat is key. There most likely will be slip ups along the way, but you can get back on track. Timely article–time to get back to mindful eating.

  • Jennifer January 2, 2009 at 10:37 pm

    Dear Dr. Pat and friends,
    Tonight, as I am hovering over my five year old son to ensure he brushes his teeth, he asks me, ” How old are you, Mummy?”
    “40” I lie. (A white lie. I am really 46)
    “What will happen to you when you are 100?”
    “100?” ( i dread to think about) ” whatever happens, I will love you more than ever/”
    “But you do have all those lines on your face, Mummy. Will they still be there?”
    I know I am older. I know I have lines. I know that I am sleep deprived and stressed. But somehow, when your 5 year old comments on it, agh.
    What do we do?
    I am so opposed to going into surgery or “under” if you do not have to — sorry ; but why would anyone take such a risk? And yet. I don’t want to look older.
    But I feel older. wiser. yes. smarter. yes. And happy in my marriage and well, basically, in a good place. But why can not I take the time for me? Just to chill. To help erase those lines?
    Any suggestions, anyone?
    Happy New Year.

  • Gregory Anne Cox January 2, 2009 at 1:06 pm

    Wow, there is so much helpful information here it could be a white paper or report. My experience is that midlife is a time when we must evaluate everything we do and think to see if these things are serving us–meaning, are our actions giving us the results we want in the form of a healthy body, healthy relationships, healthy self image?
    So much of what we did to get here is not going to work. No matter how you decide to start making different food and other choices I echo what Dr. Pat said–get support. Get it from a friend, your spouse, online, wherever but your chance of long term success is far greater if you don’t go it alone.
    Great blog!