What If I Need to Lose Weight for My Health?

This episode comes directly from a listener question, one I hear in some form regularly. What do you do when your doctor has told you that losing weight is medically necessary, but everything you've tried has kept you stuck in the same cycle? 

With her permission, I share a message from a listener who has been in the binge and restrict cycle for over 45 years and is navigating real health consequences. We discuss why restriction, even for medical reasons, keeps the cycle spinning, and what it actually looks like to work toward health when the scale has been the only measure you've ever known.

What You'll Discover:

• Why restriction backfires even when the medical reason for it is real and serious
• How to hold both truths at once: your doctor's concern is valid, and another diet is not the answer
• What to focus on instead of body size and why these behaviors directly support the health markers that matter
• Why what you focus on expands, and how shifting from "what to lose" to "what to add" changes everything

If you've ever felt caught between a medical recommendation and the knowledge that dieting makes things worse for you, this episode is for you.

Previous episode referenced: Supportive Structure

If you would like to explore getting support with your eating challenges, schedule a Breakthrough Call today.

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Transcript

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Today's episode comes directly from a listener question. And it's a question that I have been asked in different forms more times than I can count. Here's the question: What do you do when your doctor has told you you need to lose weight for your health? But everything that you've tried has kept you stuck in the same cycle. That's the question, so let's dive in. Welcome to Binge Eating Breakthrough, the podcast to help you stop feeling out of control around food and build trust with your body. If you've tried everything but still feel stuck, you're not alone. I've been there too. I'm Jane Pilger, and I'm here to help you see binge eating in a new way so you can finally break free. Each week you'll get the tools and insights to create peace with food and your body. Your breakthrough starts. Hello, trusted listener. I consider you a trusted listener because I trust that you bring real, complicated, and sometimes even painful questions to this podcast. I trust that you are not looking for a quick fix or for someone to just tell you what you want to hear. And I trust that you're willing to sit with me in some nuance today, because this topic has a lot of it. So I'm going to start by reading a portion of an email. This is an email that I received from a listener named Katie a while back, and she gave me permission to share this with you. So, in part, she wrote, Hi Jane, I'm listening to your podcasts from the very beginning, and I'm writing notes as I go. It is utterly amazing. And as someone who has binged regularly for over 45 years, it has changed my outlook for the first time in my life. I am left, however, with being morbidly obese, with high blood pressure, high cholesterol, arthritis, and fibromyalgia. I have been told by my doctor that losing weight is vital, and I also can't take a GLP1 medication as it induces severe depression. Do you have an episode that tackles the need to lose weight and how to cope with this? Thank you so much for everything you do. You are the only person I feel who really understands this awful condition. Your very trusted listener, Katie. So, Katie, this one is for you. And I know you are not alone because I hear versions of this question regularly. So even if you are not Katie, but you are very much like Katie in any way, whether a doctor has told you you need to lose weight, whether you find yourself with a lot of health conditions that are brought upon as a result of decades or more of binge eating, or whether you just for yourself are like, but what if I really need to lose weight? What do I do? This episode is for you. Now, I also want to be very clear with you as you are listening to this about what this episode is and what it isn't. I am not going to give you a weight loss roadmap. That is not my lane. And honestly, I don't think that another roadmap is what you need. But what I am going to do is offer you a perspective that I believe is both honest about the medical realities you might be facing and honest about what actually needs to happen underneath the surface and ways that you can very practically think about this that will be supportive to you, that will give you some very clear next steps that won't keep you stuck in the same cycle that you may have found yourself in over and over again. Now, first, I want to be really clear that I am not dismissing any doctor's concern. So if you have been told by a medical professional that your weight is affecting your health, that is a real and serious thing. High blood pressure, high cholesterol, conditions that affect your mobility and your quality of life, these things matter. Your health matters. And I want you to know as you are listening to this, I take that very seriously. And at the same time, I want to offer something that I think gets missed in a lot of medical conversations about weight. The question of what to do about it is much more complicated than it might appear on the surface. And for anyone who has been in a binge and restrict cycle for a long time, the answer is almost certainly not another diet, even a medically supervised one, even a sensible one, even one with the best intentions behind it. And here is why. When you have been in the binge and restrict cycle for years, and for some people, decades, your body has adapted. Your nervous system has learned that restriction is a real and recurring threat. And when your body believes that a threat is coming, it prepares for it. It becomes more efficient. It holds on. It sends stronger hunger signals. It makes food more compelling, not less. And this isn't a character flaw. It's not weakness. It is your body doing exactly what bodies do when they have experienced repeated cycles of not having enough. It is trying to protect you. So when a well-meaning doctor says you need to lose weight, eat less, and move more, or go on this diet that average people go on. And you try to do that, and your body responds with intense hunger, strong urges, and eventually a binge, that is not you failing. That is your nervous system doing what it has been trained to do. The restriction triggers the response. The response leads to a binge. The binge leads to shame. The shame leads to more restriction. And the cycle continues. You know what it feels like. If you are listening to this podcast, I have no doubt that you know exactly what that merry-go-go-round feels like. That cycle that Katie was describing. And I want you to understand why that merry-go-round keeps spinning, because understanding it is the first step to being able to step off of it. So I want to pause here and I want to name something very clearly. Your doctor is telling you that your weight is a health concern. Or maybe Katie's doctor is for sure. Perhaps your doctor has told you to. And I am telling you that restriction is likely to make things worse and not better. And I realize that it can feel like those two statements feel like they're pointing in opposite directions. And that can be very confusing. It can be overwhelming, and it can lead to uncertainty as to what to do. What do I do? My doctor is saying I need to lose weight. Jane is saying restriction is going to make things worse, not better. What do I do? So here's how I hold both of these truths at once. Your doctor is right. If your doctor has told you your health needs to be improved, I'm going to guess your doctor is probably right. What the medical conversation often misses is that body size or weight is not the only lever available to pull. And for someone with a long history of binging, it may be the very least effective one to focus on. Research increasingly supports that health-promoting behaviors, independent of whether they produce weight loss, can improve the very markers that your doctor is concerned about: blood pressure, cholesterol, inflammation, mobility, mental health. So this isn't about ignoring your doctor. It's about expanding the picture of what working on your health actually means. So I want to offer up an alternative today, a reframe of what to focus on instead of weight loss. So I want you to really sit with this for a moment as I offer you this invitation for a reframe before you decide what you think. So here's a reframe I want to offer you. What if instead of focusing on what you need to lose, what if you focused on what you could add? Now, I know this sounds almost too simple, but stay with me. So I'm going to repeat this before I go deeper. The invitation is instead of focusing on what you need to lose, I'm going to invite you to focus on what you could add instead. So let me explain. When somebody is deep in a binge and restrict cycle, it almost always affects far more than just food. Sleep is often disrupted. Movement sometimes feels impossible. Sometimes it's kind of an all or nothing. I'm either out there exercising, maybe I'm trying to make up for whatever I've eaten, or I literally cannot get myself off the couch. Stress is high and it is rarely addressed directly. It's just there, humming under the surface at a very high volume. Social connection shrinks because shame around food and eating makes it hard to be around other people, especially if you have shame around your body size. If your body size has changed significantly since seeing certain people, that social connection often shrinks. The nervous system is chronically activated. And mental health, the things that make life feel worth living often gets pushed to the bottom of the list because food is taking up so much space. Every single thing I just mentioned is health. All of those things are connected to the markers that your doctor is watching. And all of those things are things you can actually work on without triggering the survival response that makes restriction so counterproductive. So what might that look like? Let's start with sleep. Sleep is one of the most powerful health interventions available, and it costs nothing. When we're not sleeping well, hunger hormones shift, stress hormones rise, and the urge to eat for energy and comfort increases. A consistent sleep and wake time, even just moving toward one, is a legitimate health behavior. So even right now, as I offer you this invitation, okay, what can I add instead of what do I need to lose? Do you have a consistent sleep and wake time? If the answer is no, what if we start by adding a consistent sleep andor wake time? We could start with one of them. This is something you could add. Now, it's not just the sleep and wake time that matter. The habits around your bedtime matter tremendously. Scrolling through your phone, excessive screen time late at night can affect both the quality and quantity of sleep in ways that are so easy to underestimate. So think about what might signal to your brain and body that it's time to wind down. Maybe it's a book, maybe it's a guided audio, something that helps you transition out of the day, that signals to your brain, to your body, okay, the day is over. So many people, they literally watch TV until, and then they turn it off and then they expect their body to just be boom, ready to sleep. Or they scroll and they scroll and they scroll and then they turn the lights off. Do you think your brain and your body really know? Like, okay, now it's time to sleep and can just turn a switch like that? No. Your nervous system needs time to wind down to get that message. It is safe to rest. So that's the first lever and a huge one, sleep. Now let's talk about movement. What can you add in terms of gentle, enjoyable movement? Not exercise as punishment, not movement designed to burn off what you ate or make up for anything, but movement that your body actually finds pleasurable. A walk outside, gentle stretching, time in nature, movement that connects you to your body rather than waging war on it. This can improve your cardiovascular health, support your mood, reduce inflammation, and it helps regulate the nervous system, regardless of what the scale does. Now, if you're in a situation like Katie, Katie shared, I am morbidly obese. It is possible if you are in a larger body, if you are morbidly obese, it might be that there is no such thing as enjoyable movement for you. It's certainly possible. Now, that does not mean, though, that we don't move at all. Because if you don't move at all, the less you move, the more your body really gets used to that kind of stagnant state. Here's the beauty of this age of the internet. You can absolutely search for gentle movement for morbidly obese. There's all kinds of things that you can search for, gentle stretching for whatever your body limitations are. There are so many options out there. The invitation, what can you add? Any type of movement. Any type of movement. So again, what can you add around gentle, enjoyable movement or movement that will help your mobility? Here's something else we can add. Stress management. Chronic stress keeps the nervous system in a state that works against almost every health goal that you have. So what think about this for yourself. What helps you come down from stress? What genuinely settles you? This is worth taking as seriously as any other health behavior. So many people think I'm just stressed, but they don't stop to think about what I could add to help me with manage this stress. Something else we can add: social connection. Isolation feeds shame. And shame feeds the cycle, the binge restrict cycle. Finding even one person, one community, one space where you feel genuinely less alone in your struggle, in your life, is not a luxury. This is health. Something else we can add. Mental health in the broadest sense. Gratitude practices. Do you have a regular gratitude practice? Spending time doing something that you truly enjoy. Maybe it's time outdoors. These aren't just nice to have. These are things that shift your nervous system, your mood, your relationship with yourself and your relationship with food. I did an episode a while back on supportive structure, including morning and evening routines and how to build consistency in a way that actually supports you rather than becoming another thing to fail at. And if this feels relevant to where you are, if you're thinking, oh, maybe I could add some supportive structure, I'll link that episode in the show notes. I think it was episode number 138. Now, we've talked about a lot of different things that you can focus on adding instead of things that we have to lose. And I want you to know this what to add approach applies to food also, not just the other areas of your life. So rather than focusing on what to cut out, what to reduce, what to avoid eating, what would happen if you focused on what to add? More vegetables, more fruit, more of the foods from the outer aisles of the grocery store. Not as a rule, not as a diet, but as a gentle orientation toward nourishment. When you naturally eat more of those things, you may find that you eat less of other things without ever deciding to restrict or limit them. Not because you're controlling yourself, but because your body is actually getting something that it needs. And this is a very different experience than white-knuckling your way through a list of foods you can't have. And it doesn't carry the restriction signal towards your nervous system that sets the cycle spinning. So the point in all of this is not to distract you from your health goals, it's to redirect your focus toward things that actually move the needle without triggering the very cycle that has been working against you. So there's something I say often in my work, and it applies so clearly here. What you focus on expands. When you focus on what you need to lose, what you can't eat, what you're doing wrong, food becomes the center of everything. The restriction mentality, even when it's wrapped in health language, keeps pulling your attention back to food. And that focus, that constant food noise, it's part of what perpetuates this cycle. But when you shift the focus towards how you want to feel, what you want to be able to do, what would make your daily life more enjoyable and more sustainable, something different becomes possible. You start moving towards something instead of running away from something. And that is a fundamentally different experience in your body and in your nervous system. What would it mean for you to wake? Up with more energy, to sleep through the night, to take a walk without pain, to have one meal that felt genuinely peaceful. Those are real health outcomes. Start there. Small steps taken consistently over time can have a huge impact that no short-term diet ever will. And it's not because they're magic, but because they're sustainable, because they don't trigger the survival response, because they build something instead of taking something away. So the invitation here is to think about what you can add to your life, to your day-to-day routines and habits that will truly have a positive impact on your health. Now, those changes might result in weight loss, but the focus is on how you feel and creating more support, nourishment, and connection with yourself. Now, I want to say this as we wrap up, I want to say this gently but clearly. If you are someone like Katie, who has been in this cycle for a very long time and whose physical health is genuinely being affected, a podcast is one piece of support. But it's typically not enough on its own. The layers involved in a history this long, the nervous system patterns, the emotional pieces, the relationship with your body, and the other factors underneath the surface go far beyond what any podcast can offer. So working with someone one-on-one, whether that's a coach who specializes in this work, a therapist who understands eating behaviors, or a doctor who can take the full picture seriously, is worth pursuing if it is at all accessible to you. Now, if you want to explore what that would look like with me, you can schedule a breakthrough call at janepilger.com slash breakthrough. And I'll make sure there's a link to that in the show notes as well. But what I want you to take from today is knowing that your body is not broken. Your body has been responding to potentially decades of a difficult cycle in the most logical way it knows how. The fact that you are still here, still listening, and still trying to find a different way forward after however many years it has been, that is not failure. It is extraordinary persistence and resilience, which is one of the most important qualities on this journey. So the question isn't what do you need to lose? The question is, what do you want to add to your life? What would feeling better actually feel like? What is one small step, not toward a number, but toward that feeling. Start there and then keep going. So next week, we're gonna talk about something that comes up a lot when people start trying to give themselves more freedom around food, around the rigidity and the rules and the restrictions. We're gonna talk about what happens when it doesn't go the way that you hoped and when food freedom starts to feel like it's backfiring. I think it's a conversation a lot of you will recognize. So be sure to tune in for that next week. All right, that's what I have for you today. I'll see you next week. Thank you for listening to Binge Breakthrough. If you want to understand why you feel out of control with food sometimes, I've created just the thing for you. Discover the number one reason why and get three things you can do today. Visit binge breakthrough.com forward slash quiz, and you'll have your answer in your next steps within minutes. That's binge breakthrough.com forward slash quiz.