Mindset affects treatment outcomes. Full stop. I’ve treated patients for over 25 years and in this field mindset is everything. Not in the ‘willpower’ moralizing way, but in the way we think – our self-awareness, biases, curiosity, logic, and emotions – that framework determines how we filter information, assimilate it, and execute on it.
Many patients come in knowing they need a new system. They’re self-aware enough to admit the old way isn’t working. They listen to the science beyond ‘eat less,’ ask good questions, roll up their sleeves, and apply new strategies to their lives. These visits are productive. We analyze habits, brainstorm obstacle plans, and recalibrate when strategies fall apart
These visits light me up. Patients that come in ready to do the work – focused more on system change than goals – typically see dramatic changes – in weight, in how they feel, and in how they view themselves. They shift long-term expectations from a target weight to wanting control over their bodies and relief from the constant feeling of not being enough.
However, others don’t have this same trajectory. Others stay stuck in a loop tied to the personal responsibility narrative. They believe excess weight is their moral failing or lack of willpower. That’s unscientific and emotionally destructive. Because they think they already ‘know’ what to do, they don’t open the book or watch the emails. They lose a bit of weight, plateau around 5–10% without medication, or 10–15% with medication, then the body’s hunger response takes over and regain begins. They become distressed and say ‘I’m trying,’ but they don’t hear the different story we offer
If you’ve ever been our patient you know that one of the first things I say is we’re not going to talk about calories or portion control. We focus on hormonal responses to inputs and adjust those inputs. Prioritize protein to optimize hunger hormones. Avoid non-nutritive sweeteners because they stimulate insulin. Eat whole foods that influence hormones and gut bacteria. Control the environment to minimize temptations. These are the big levers that go way beyond restriction and motivation.
My goal is to help patients reapply the energy they spend staying stuck into productive strategies. I’ve trained in coaching and behavior change to do this. If someone is married to the personal responsibility story and refuses new information, there’s only so much I can do. But most people who watch these videos and read emails are hungry for new paths. The work requires us to examine our sacred stories about who we are. That self-work is foundational to long-term success.