A Different Approach to Weight Loss

Medcan’s weight-loss team uses psychology, science and common sense to help you shed the pounds—and keep them off.

Sometimes the news that one is about to become a parent can prompt an evaluation of the way one lives. That’s what happened in insurance executive Greg Smith’s case. His wife became pregnant with the couple’s first child in the spring of 2011, and soon after that Greg found himself heading into Medcan for his annual Comprehensive Health Assessment. Aged 35, and standing six-feet tall, Greg Smith discovered during the Assessment that he weighed 335 pounds.

So when Mr. Smith’s doctor asked whether he was interested in learning more about Medcan’s new weight-loss program, the answer was yes. Medcan’s personalized and holistic 12-week program realizes that everyone is different when it comes to weight loss. Clients meet weekly with program coordinator Adele Tevlin, a nutritionist, and physician Dr. David Macklin, a weight-loss specialist, allowing the pair to create a custom lifestyle strategy that aims for a steady and sustainable path to health.

By combining the science of reward circuitry with behavioral psychology, we can help an individual understand what underlies their overeating patterns.

Mr. Smith’s initial appointment happened May 30, 2011. The first task was to determine Mr. Smith’s resting energy expenditure—the amount of calories his body burned simply to run itself at rest. That information, in turn, helps to determine the daily caloric intake that optimizes the body for sustainable weight loss. Eat too much, and the body gains weight. That’s common sense. But eating too little can be almost as bad. If you eat too few calories, you will feel hungry. Hunger works against sustainable weight. The body goes into starvation mode, a state humans have evolved over millennia to conserve energy during famine or drought. Starvation mode also makes weight loss extremely difficult.

The Bod Pod gives the most accurate view of an individual's body composition.

To determine the optimal number of calories Mr. Smith should consume each day, Dr. Macklin and Ms. Tevlin asked Mr. Smith to sit inside the Bod Pod, a computerized, egg-shaped chamber that uses a technique called Air Displacement Plethysmography to determine body-fat composition. By analyzing the volume of air a body displaces, the Bod Pod is able to determine an individual’s resting energy expenditure. With all this information, Dr. Macklin determined that Mr. Smith’s personalized calorie prescription was 1,800 calories per day.

Next, Ms. Tevlin and Dr. Macklin set about determining how to help Mr. Smith hit that target. “It became clear that Greg wasn’t over-eating 24-7,” says Dr. Macklin. “His problem calories were in pockets throughout the day.” One “trigger spot” was restaurant lunches, for example.

Ms. Tevlin found that Mr. Smith was setting himself to overeat at lunch thanks to the food he consumed every morning. Breakfast tended to be cereals, and then in his car, between appointments, he tended to stop at coffee shops for high-carbohydrate snacks like pastries or muffins. The problem? Digesting a pastry can cause insulin spikes, which causes blood sugar to crash only a short time later. “So Greg would be just ravenous heading into lunch,” Ms. Tevlin says. “And no one makes good choices about food when they’re ravenous.”

To beat the cycle, Ms. Tevlin “front-loaded” Mr. Smith’s eating by making sure he ate a protein-rich breakfast, such as eggs, Greek yoghurt or cottage cheese. Then, two or three hours later, she encouraged him to have a mid-morning snack—but rather than the coffee-shop pastries he once consumed, Mr. Smith should have protein-rich nuts, and some fruit. Lunch didn’t entail huge changes. Ms. Tevlin encouraged Mr. Smith to eat sandwich-and-salad combos, with the sandwiches made with whole-wheat bread around a protein, such as chicken, turkey or tuna. Or perhaps lunch was a protein-rich salad, with the dressing on the side.

Mr. Smith could still go out for restaurant lunches—but before he left the office, he should plan in advance what he was going to order.

Meanwhile, Dr. Macklin worked a lot on the behavioral science behind Mr. Smith’s eating. Lunch at a restaurant or a pub could prime Mr. Smith for an atmosphere of indulgence, Dr. Macklin discovered—an attitude of “just this once” that could lead Mr. Smith to order high-calorie ice-cream desserts, or burger-and-fry entrées. So Dr. Macklin engaged in some behavioral psychology. “For years, Greg’s brain has associated this lunchtime-restaurant setting with sugar and fat, which in turn creates a powerful dopamine response in the ancient reward brain,” Dr. Macklin says. “It’s addictive. But by combining the science of reward circuitry with some behavioral psychology, we can help an individual understand what underlies their overeating patterns—and then counteract them.”

According to Dr. Macklin, Mr. Smith could still go out for those stress-relieving restaurant lunches—but before he left the office, he should plan in advance what he was going to order. And he should do that by calling up the restaurant’s menu, online, and writing down his order before he ever left the office. “The idea is to create a plan without any options,” Dr. Macklin says. “All that is left is to execute the plan.”

“So I know walking in the door I’ll have a steak salad with dressing on the side,” Mr. Smith says. “That was a big breakthrough for me. Planning in advance was a tool that empowered me more than I knew I could be empowered. I found that incredibly fascinating—each time I saw Dr. Macklin it was like a miniature course in the science of human behavior.”

Eating high-carb snacks can sabotage your plan at meal times.

Mr. Smith also could use similar planning techniques during his other trigger times, such as dinners out with his family. To counteract night-eating, Ms. Tevlin and Dr. Macklin encouraged Mr. Smith to snack several times in the afternoon, so that he’d already consumed three-quarters of his daily calories before he started dinner. The strategy, once again, was designed to ensure that Mr. Smith wasn’t ravenous when he sat down for one of the day’s major meals.

Dr. Macklin assessed Mr. Smith with the Bod Pod for the second time in November. At that point he’d lost 70 pounds—and with the help of the Bod Pod, Dr. Macklin was able to determine that most of that weight was fat, rather than muscle.

Since then, Mr. Smith has lost another 15 pounds, bringing his total weight lost to 85. From a start weight of 335, he now weighs 250 pounds, and he’d like to get down to 235 or 220. Mr. Smith and his wife celebrated the arrival of their first child, a baby girl, on December 1. Now he’s certain he’ll be able to keep up with her.

“It’s amazing,” Mr. Smith marvels. “This January was the first in years that I didn’t resolve to lose some drastic amount of weight. There’s nothing crazy or unnatural about what I’m eating. I’m not hungry. Yet I feel a hundred per cent better. I sleep more soundly. I have way more energy. You don’t realize how good you can feel until you lose the weight.”

Interested in crafting a personalized weight-loss strategy with Dr. David Macklin, weight-loss coordinator Adele Tevlin and the rest of the Medcan team? Contact bookings@medcan.com or 416-350-3621 today.