211.Understanding Ghost Fat: The Invisible Struggle After Weight Loss with David B. Sarwer, Ph.D.

Did you know that our perceptions of body image and weight can significantly impact our mental and physical health? 

In this episode, Dr. Adrienne Youdim interviews David B. Sarwer, Ph.D. an academic psychologist, to explore the intricate relationship between body image, self-perception, and behavioral change in the context of weight management.

They discuss how societal pressures and personal biases can distort our self-image, leading to negative health outcomes. Dr. David shares actionable strategies for fostering self-acceptance and resilience while navigating the challenges of weight loss and body positivity.

Who is David B. Sarwer, Ph.D.?

• Academic psychologist specializing in body image and obesity
• Advocate for mental health and behavioral change
• Experienced in helping individuals overcome self-stigmatization and improve their relationship with food and body

What You'll Discover:

• The impact of social comparisons on self-esteem and body image
• Practical strategies for overcoming cognitive distortions related to weight and appearance
• The importance of self-compassion in the journey of weight management
• Insights into the psychological effects of weight loss and the phenomenon of "phantom fat"

Why This Episode Matters:

In a society that often emphasizes unrealistic body standards, Dr. David's insights remind us of the importance of self-acceptance and mental well-being. His expertise will equip you with the tools to:

• Challenge negative self-perceptions and biases
• Cultivate a healthier relationship with food and body
• Embrace personal empowerment and resilience in the face of societal pressures

🎧 Tune in now and take the first step towards understanding and improving your body image and mental health!

"There's oftentimes a disconnect between what we see when we look in the mirror and how we see ourselves in our own mind's eye. When our bodies change, whether it's because of weight loss or other factors, it can take people a period of time for their minds to catch up to their bodies." - David B. Sarwer

Ways that Dr. Adrienne Youdim Can Support You

1. Join the Monthly Free Mind-Body Workshops: Participate in engaging mind-body practices designed to help manage your stress response. Register here.
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3. Freebie alert. Register for our monthly free MindBody Workshop and receive a downloadable guide on emotional labeling to help you manage your emotions effectively.

Connect with Dr. Adrienne Youdim

• Website :https://www.dradriennespeaks.com/
• Instagram: https://www.instagram.com/dradrienneyoudim/

Transcript

Adrienne Youdim

So I'm so glad to have you, David, a colleague and really an old friend. I've always admired your work and it's a full circle to have you here on the Health Bite podcast.

David B Sarwer

And it's a pleasure to be here too, Adrienne. You're right. We've been knowing each other for a long time. We haven't seen each other in a while, but we've known each other for a long time. And it is really kind of fun for me as well to kind of see how your career has evolved the way that it has and have the opportunity to spend some time with you today.

Adrienne Youdim

Well, we were joking before we recorded, you're a academic psychologist in this space. And I joke how as a medical doctor, I've been untrained psychologist in this space.

David B Sarwer

Well, and you know, it's funny, because I do think everybody from time to time likes to think of themselves as, you know, a wannabe psychologist or mental health professional. But I'm very much thrilled that you've kind of gone in this direction, because I think when we look at the treatment of obesity and the management of eating behaviors, so much of this is behavioral and or psychological. And whether it's making a behavioral change and sustaining it over time or figuring out a way in this world where we can be so critical of people's body types and sizes and having excess weight, it is so critical to find a way to turn the noise down on that and be able to really kind of go about your day-to-day life and enjoy life, even while you may be still trying to lose weight for health reasons.

Adrienne Youdim

I think it's really important to point out the bias and the stigma I think it's maybe even more important to point out our own biases against ourselves and how this often shows up in terms of our relationship with our bodies, which I know we're going to talk about. But really, it is a kind of a window or a mirror into our perfectionism and into our biases in our professional space, in our relational space. So I really think this conversation will be helpful, not only for people who are thinking about or concerned about their weight or looking at it through a weight loss lens, but really how do we apply these principles to the way we want to live and show up in the world abroad.

David B Sarwer

Yeah, and I think that's actually a great place to kind of launch into this. And if you can indulge me for just a few seconds, let me stay and set the stage a little bit here. So one of the things that we know from the body of literature in general is that we engage in a lot of social comparisons. And a lot of the comparisons we make, perhaps not surprisingly, are upward comparisons. So if we walk into a room, we might see the most attractive person in the room and say, oh, that person's so much better looking than I am. And as a result, when we make those comparisons, we feel less good about ourselves. We might discount the fact that we are, in fact, of average attractiveness in that room, above average attractiveness in that room. But our default is to make that upward comparison, which leaves us feeling unhappy with ourselves and our bodies. And this is not just women, it's women and men. We know children do this. We know teenagers do this. We know people across the lifespan do this. You know, as we're taping this kind of in the beginning of Hollywood and television award seasons, You know, it's hard not to think about all the coverage, the red carpet shows and the shows themselves and the debrief of who wore what and the next day. And I think what we always forget when we see those images is how much time, effort and money went into making that celebrity look the way they did that night. And we, most of us commoners, we don't have the time, energy, and money to do that. We have to do the best of what we can with what we have. But as we're sitting at home watching this, we can feel very unhappy with ourselves saying, well, I never looked that good. I've never worn a tuxedo that well or an evening gown that well. And we discount and conveniently forget, maybe inconveniently forget, all that time and energy and money that made that person look that good. But instead, we wallow in feeling bad about ourselves.

Adrienne Youdim

I'm so glad you brought this up because it made me think, you know, in the office, how many times has a patient come in and said to me, either Everybody else is losing weight, or everybody else is thin, or nobody else is having this problem with their weight. And I'm thinking to myself, really? Because the data shows that 70% of people in the United States is having this issue. or they they say something like everyone else can lose weight so easily or eat everything that they want right and not gain weight which also is a fallacy two-thirds again if people are are right where this person is right we're all in it so you're absolutely right to point out that we compare ourselves not only upward to somebody who we aspire perhaps to be, but also in doing so we forget that the majority of the people were all back here, right, dealing with the same struggles.

David B Sarwer

Yeah, and I think about that issue a lot, that 70%. Also, when we think about the role of stigma and bias, because usually the groups of people who are subjected to stigma and bias are usually small minorities of our overall population or of a subgroup. We're talking about people who are disfigured or lost of limb and are in amputees, for example, and yet, Here we have an example where that 42% of Americans meet the clinical definition of obesity that others 30% have overweight and therefore risk to developing obesity over time. So we're really talking about the vast majority of Americans. And yet we still have that stigmatized view. You know, another example I get, you know, where I live out in Philadelphia, a lot of people spend their summers down the New Jersey shore to about an hour from here. The beach towns become very, very popular. And so this becomes a very common time of year for people to start coming in saying, I want to lose weight because I want to look great for the beach season this summer. And they realize that the beaches at the Jersey Shore, like most beaches around the world, are not filled with supermodels that we see on television ads and depicted in television shows and movies. It's everyday people of all different sizes and shapes. And yet, there can be people who remain so self-conscious about their weight, they might have a house down on the beach, but never go to the beach because they're so self-conscious about how they look, that people are going to look at them, they're going to stare. And I think it's one of those cognitive distortions, you were talking about some of those distortions clinically just a moment ago, that often happen in daily life as well. So our decision-making of, what I'm going to wear, where I'm going to go, how I'm going to present myself can be colored by how we feel about our weight and shape at any given point in time.

Adrienne Youdim

The other area that I think about is the gym. I mean, I don't know how many patients have you had who've said, I don't want to go to the gym because I feel bad about how I look in front of those people. Again, who are those people? Those people, to your point, are the majority of us, those people. And so it is important to point out because this self-imposed bias and discrimination not only makes us feel bad, but it gets in the way of a productive effort in engaging in change. And the data shows that it has some really important health consequences. It can even impact mortality, that negative bias towards oneself can actually make you live shorter than if you were more self-accepting or self-loving.

David B Sarwer

It's fascinating. It's fascinating and I think it's a really, really important point because I think when we start talking about things like stigma or bias or teasing, if we don't scratch the surface, we can be really quick to say, well, everybody's been teased. Everybody's had a social situation that didn't go quite the way they wanted. Everybody's had maybe even an encounter with a physician that wasn't the warm and fuzzy one that they wanted to have. And the reality, though, is that these negative interpersonal experiences really can affect not only our mental health, but as you said, can affect our physical health as well. And I think As I think about my work in obesity, but also my work with body image, I think one of the things that I'm pleased with, if I reflect back on the last 30 years of doing this, is the fact that we probably have figured out that those words, those negative comments, those slights, they can't be readily dismissed. They really can be psychologically and physically harmful to people.

Adrienne Youdim

Well, I want to say from my end that I'm always warm and fuzzy in the office. But you know, even if your physician isn't, and I do think it's really important for medical professionals, it's important for all of us to acknowledge our biases and our stigma. I'm also very much a proponent of not only self, not only like personal responsibility, because then that also has kind of a negative vibe to it. That's not what I'm trying to say, but personal empowerment, right? So it is important for the people with whom we interact to not impart their biases on us. But I again feel like so much of this is our own biases against ourselves. And so that's where I think we can really be empowered to do the work, to take note of where we are badgering and self-deprecating, what that impact is on our mental, emotional, physical health and wellbeing, and how we can be proactive about turning that around.

David B Sarwer

And I think the work that I do is very cognitive behavioral, which means we focus much more in the here and now and maybe spend less time than other mental health professionals looking back at someone's history. But one of the things that I find myself thinking about and have seen clinically more than I wish I would have is I think for many people, the number of successes is in their lives kind of as they move through childhood and adolescent and early, the number of successes, the number of wins is often dwarfed by the number of unsuccessful experiences. And those unsuccessful experiences, we know clinically, those are the ones that sting. Those are the ones that hurt. Those are the ones that stay with them. As I sometimes say to my patients, I don't think as humans, we are really good at celebrating our victories. And in fact, we spend much more time wallowing in our defeats and our disappointments than we do celebrating our victories. Something good happens and modesty kicks in for most of us. But when something bad happens, we can really let that linger. And we can also give it a lot of power over the future of our lives. So somebody says something that's disrespectful or insulting or gives us an askance look, and we let that negative experience color us for days, weeks, years, days, weeks, months, years, and we've given all that power to that singular event that could have been just a random occurrence. And I do think part of it is just kind of our mindset of how we think about ourselves. And then when we apply this to weight control, which we know is such an emotionally laden issue, then it becomes even more complicated. And I think when working with people through more of a behavioral change mental health lens, there can often be a lot to chip away at there in terms of giving people the opportunity to have some successes and feel good about the things that they're accomplishing.

Adrienne Youdim

So I would love if you could, and I know we can't do a therapy session in, you know, the 40 minutes that we have, but the podcast does like to bring actionable bites for people. So with that CBT lens in mind, can you talk about how you go about doing that and maybe one of the exercises or practices that you perhaps suggest?

David B Sarwer

Yeah, I'll start with kind of a discreet example that came up where I was with a patient years ago who had the habit of buying, as I'm sure all of us have done, the family size bag of M&Ms. And so she'd go to the grocery store, she'd buy them. And one of the behavioral targets we gave her as treating her in a group setting was to, not buy them in one week, just say, can you just not go down that aisle of the grocery store? And she comes in the next week and the group says, so how did it go? And everyone's talking about their specific behavioral focus. And she's kind of downcast and she goes, well, she goes, I bought the M&M. and she paused and she goes, but I left them in the trunk of my car and they're still there. So she bought the M&Ms, but she didn't bring them in the house and she didn't eat them. And so she was beating herself up about the fact that she bought the M&Ms, but really the whole purpose of not buying the M&Ms was not to eat them. And as long as she keeps them in her trunk, Now that gives us a little something to work with. So do you want to keep him in your trunk? Do you think you could find a time to go into your trunk, grab him and just throw him out or give him to a neighbor or something? And I think that's an example of some of the cognitive shifting that needs to take place. So it can be wrapped around a discreet behavior. But I share that anecdote because how she was, you know, she She had a successful week. She didn't see it as a successful week, but the rest of us, myself and the rest of the people in her group, we certainly saw that as a success. And I think that's an example of where some of those cognitions can be rattling around in people's heads and really trip them up. She had trouble claiming that victory for herself.

Adrienne Youdim

And as you say it, you know, I wonder if maybe listeners will say to themselves, like, oh, well, this is such a trivial, you know, example, like M&Ms in the trunk. But I think it's important to, to show kind of the resilience building that happens when you have, because it's not only to me, the success of being able to overcome that challenge of craving the sweets, right? But it's also kind of building that mental muscle that I think allows you to be more successful the next time and the next time if you are in fact able to lean in and really savor that win.

David B Sarwer

Yeah. And I'll add to the mental muscle, which I really like. I use the phrase cognitive horsepower, that we use kind of the smart analytical side of our brain. But I would also say a big thing to add with the mental muscle is mental flexibility. And let me use another clinical example that maybe will resonate with people. So, you know, sometimes people will say, you know, they're undertaking a weight loss effort and, you know, we sometimes target the lowest hanging fruit, no pun intended. So, you know, let's see if we can get you off of regular soda. Let's see if we can get you to reduce the number of nights of the week where you eat a bowl of ice cream while watching television. And some people will hear that and they'll say, well, I don't want to give up ice cream. And so think of all the different paths that we can go to get somebody to make a behavioral change that would put them in a caloric deficit and allow them to start losing some weight. So it might be maybe instead of every night, they have it every other night. Could they, if they insist on having it every night, can they switch from maybe, you know, a full fat calorically dense version to something that's a frozen yogurt and a lower fat version? Can we get them to reduce their portion size? Can we get them to move to the point where after dinner desserts are just for special occasions when they're out to dinner in a restaurant with friends or family? And so sometimes people will make the stake of saying, well, you, my health provider, you're telling me to make a change. You're telling me just to get rid of this thing. And while certainly there's value in doing that in some cases, sometimes there's different pathways that we can take to get people to be more flexible in their thinking and ultimately have a behavioral change that strikes the balance between enjoying food, but not overindulging to the point that it's contributing to weight gain and the development of weight-related health problems.

Adrienne Youdim

Right, just basically dismissing that all-or-nothing mindset.

David B Sarwer

And perhaps I think one of the most common cognitive distortions that we see when people are trying to lose weight is, you know, it's either, it's all or nothing and there's no middle ground. And I think that's where that flexibility comes in. But then, you know, to go back to your phrase, that mental strength, you know, it's one thing to be flexible, but we need to exercise that muscle day after day, week after week, month after month in order to have sustained success, particularly in this food environment where, you know, let's be really candid, it is really, really hard to say no to all the different times throughout the day that we're exposed to food or commercials or, you know, for people who are listening who are football fans, you know, there's this really clever commercial out right now talking about how all of the language around football is actually code to get you to order Uber Eats. It's a very clever commercial, a lot of former players in it. But there's truth to that. When we're kicking back on the weekends watching movies or watching sporting events, there's a lot of advertisements having to do with foods and beverages. In this world where we can have these things delivered to us so very quickly, becomes even more difficult than ever before to kind of not give into that impulse and say, you know what, let's go order a pizza.

Adrienne Youdim

We're inundated. We're inundated by ads and by visual cues, you know, on the TV, as you mentioned. But we're also inundated by what's brought into the office. I remember when I was, you know, the director of the Weight Loss Center at Cedars-Sinai, they would bring us cookies and, you know, cake. and also, you know, in the workplace and, I mean, so many, so many areas in which it's just available. And I also want to add that, you know, to people who don't, who may be listening, who don't really see themselves as having a food or a weight issue, again, this can be extrapolated to anything. We're in January right now, right? A lot of people are doing dry January, The US general just put out a advisory on alcohol as a carcinogen. And try watching TV while you're doing Dry January. Every single episode, there is wine or scotch in virtually every scene. So this kind of, I think we do have to have a level of, again, self-compassion, acknowledging that our environment is not only built to help us go astray, but is intentionally acting to make us make the wrong choices.

David B Sarwer

And, you know, there is a subliminal element to that. But you are absolutely right that while we you know, we can say that we go to the movies because we want to check out mentally for a while and kind of escape. But the reality is, if we see, you know, whether we're talking about behaviors around food and drink or whether we're talking about body image and physical appearance, while we may be thinking that we're engaging in you know, mindless entertainment for a period of time, the reality is our brains are picking up on those messages. And it's almost like, you know, the soundtrack in the background that's kind of saying, oh, wow, that scotch looks really good. Or, oh, wow, you know, I had this great bottle of red wine at home that I haven't opened yet. I'll do that when we get back from the movies. And it, you know, when we're bombarded by those messages, they can shape our behavior very, very powerfully.

Adrienne Youdim

You brought up the movies and you brought up awards season four. So I think it is a perfect segue to talk about the, not just the advent, but the explosion of the use of these very effective anti-obesity medications or weight loss drugs, as people like to call them, the injectables. And pretty much every award show, I don't watch awards, but I always hear the clip where they're joking about Ozempic. It's happened, you know, for the last year plus now. And there's also this been this kind of conversation that has come about, I think also in terms of like the shift in the narrative around obesity and weight loss, where, you know, when I was young, We were drinking Slim Fast cans because we were watching, looking at 17 magazine and felt a lot of shame for not looking like the girl in the magazine. And then very recently there was this kind of counterculture that as a mother of two daughters, I somewhat appreciated, which was like against all of that, but went very much under the term body positivity. And then under the phrase, of health at every size. And so body positivity, I'm all for that. But health at every size, I'm not so much for because it is, as we know, in medicine, a total fallacy. While you can be healthy at every size, just like you cannot get lung cancer, if you smoke or breast cancer, if you drink alcohol, that's a link that people don't know about the likelihood of getting those. Illnesses or diseases, if you smoke or if you drink are higher, just like the likelihood of having cardiovascular disease is higher if you have excess weight. So health at every size is not really what we're trying to sell people. maybe compassionate every size is what we should really be, you know, proclaiming. So I'm curious from a psychologist perspective, because psychologists are always, they're always viewed as nicer than us doctors, right? More compassionate. So speaking from a psychologist perspective, can you speak to this, like, How do you kind of hold in mind the fact that yes, we should have body positivity, but no, it's health at every size is not necessarily true. And then maybe also talk about what you think is going on socially in terms of how the advent of these drugs have changed our views. Have we swung back to Slimfast and Seventeen magazines?

David B Sarwer

Yeah, let me start with the body positivity and the health at every size. I'm right with you on this. I do think that, you know, it's a subtle distinction, but it's an important one. I do, you know, I sometimes am struck by the fact that we do see greater representation of a range of body shapes and sizes in the mass media and in our culture than ever before. And so I do think that when I started out 30 years ago, people would often camouflage themselves and wear big baggy sweatshirts because they were concerned about their weight and shape. And I don't see that as much as I used to. I do see people who are even with degrees of overweight and obesity are choosing to wear more form-fitting clothes and showing off more of their skin than they used to. So I do think there's an element of improved body positivity, but I'm completely with you on the health and the concerns about the health at every size movement because I think it's also important, even as a psychologist, that you take an empirically based approach to look at this. And the evidence is incredibly compelling that there's a relationship between your body mass index and morbidity and mortality. So whether it's an early death or some of the diseases you mentioned in the other couple hundred that you didn't. And so I do think that people who say, well, we should be accepting. I think if you put a period at the end of that word, I think we're all in agreement. But if it's accepting and don't change your behavior or don't try to promote greater health, that I am less comfortable with. And I'll give you just one other example. You know, there's some people who believe that we should not even use the word, the term obesity. And I kind of look at this and maybe it's overly simplistic. If you're diagnosed with cancer, chances are the provider who shares that news with you is going to use the word cancer. They're not gonna say you have some funky cells and we're not, you know, they're not gonna dodge the issue. They know they're gonna be delivering painful if not life-altering news to you. If we're going to recognize obesity as a disease and the disease that it is, we probably should be using the same approach, that not sidestepping calling the disease what it is because we want to hurt somebody's feelings. We're not trying to be disrespectful, but I think it's important that people realize that obesity is a disease and thus we need to treat it with the tools that we use to treat other diseases. In terms of the kind of shifting and kind of where we are culturally, I'll say this. A year or so ago, I was very concerned that the hype around the new generation of weight loss medications was out ahead of the science. And I do feel like with a pretty consistent regularity, we're seeing almost week after week a new report saying, look at the benefits of these medications, not just in terms of the size of the weight losses, but the improvements in the weight-related comorbidities. So I am actually becoming more and more encouraged that the evidence base is there and is going to continue to grow. However, let's go back to the award show example again. At the same time, these medications are a bit of a punchline right now. They've become the kind of, you know, the ozempic face and that, you know, it's the things that the hosts of the late night talk shows talk about. And I worry that because it's part of that part of our mass media culture right now, it's not being seen as the life-changing medication that it is, and it's seen almost being more analogous to a cosmetic surgical procedure or an aesthetic procedure. And you and I, I'm sure, are in agreement that's certainly not what these medications should be taken for. I mean, they're important medications, they're powerful medications. We have a lot of unanswered questions about long-term use and Who's going to pay for these over longer periods of time? How do we get them to the people from underserved communities who need them the most? But I do worry that right now there's still a pretty strong drumbeat of this is all about making me look better, not helping me get healthier.

Adrienne Youdim

And I think that's on the public, but that's also on prescribing physicians and providers. In many circumstances, practicing in Beverly Hills, in kind of a, you know, posh, I guess, area, where I've had to say no. And it's really uncomfortable to say no. People are coming to you for something. And to let them walk out of your office disappointed at you and empty handed is really hard to do, particularly if you're in a profession where you're there to serve or please. But I think the onus is on us. to make the right decisions and to be good stewards of prescribing these medications in the right way. Not only for these reasons that we've already discussed, but also I think it dismisses, to your point a little bit, the people who really need these medications, the people whose lives and health and longevity will be positively impacted by the use of these medications, it kind of trivializes what the medication does. And I think even that is a form of bias, right? You're again, not acknowledging that person who really needs the help to treat something that we've seen by and large diet and exercise alone is not going to cover.

David B Sarwer

Yeah, I think your, your point about saying no is so really important. You know, I think regardless of your discipline when you go into a health, you become a healthcare provider, your instinct your impulse your training is. what tools do I have in my toolbox to help reduce the suffering and improve the life of the person in front of me? And so what the instinct then is, and the default is, I'm going to say yes, and I'm going to do whatever I can to reduce this person's suffering. But there are times where we have to say no, or maybe not now, or this may not be the most appropriate treatment for you. But we're also in an era where we don't, when one of our patients gets upset and they get upset with something we did, which happens, we have to acknowledge that. It can be, it takes a different set of skillsets to kind of recover that relationship for when that happens. And I also think that this is why, while you have some physicians and oftentimes in specialties that are not trained in obesity management, who are now offering these medications, I also think that there are many providers out there who shy away from appropriately addressing obesity with their patients because they're afraid they're going to hurt their feelings. And they're afraid that the comment, while perhaps coming from a good place, will be seen as stigmatizing. or discriminatory and the patient is going to leave upset and the patient's never going to come back. And that's where I think, as I look to the future, training of the next generation of medical students on the importance of nutrition and physical activity in promoting health and being important tools that can be used to push back against the obesity problem gives me some degree of optimism that hopefully our next generation of providers will be better at it as a whole than we currently are today.

Adrienne Youdim

Yeah, that is a good hope. I hope so alongside you. I do want to end on kind of the other side of this equation which is until now we've kind of been talking about strategies or impediments to getting ourselves to the place of successful weight loss or let's just say successful habit change if you want to apply this to other things in your life. There is this phenomena that you've spoken about of what happens on the other side of weight loss. Once people have lost weight, and what they do with that information or with that outcome, we we seem to think that if we were just to lose the 20 pounds, just like if we were just to be able to afford that car or, you know, marry that good-looking guy or get that degree, right? All those things we think if we can just get our hands on, we will be happy. But we know that to not be true, particularly in this space, because we have data that when people lose weight, they still, not only will they be dissatisfied, there's great data that came out many years ago that we know about by Foster, but But not only that they may not be satisfied, but they also may have this, well, we call it ghost fat or phantom fat. So they're not actually even seeing the reality of their weight loss. They are still seeing fat, and I don't like to use the F word, but we'll do it anyway. They're still seeing fat that doesn't even exist. And this is also very fascinating. So can you speak to that a little bit? What is phantom fat? And talk about that a little.

David B Sarwer

Yeah, so this brings us almost full circle for when we started talking about body image, because we know that there is oftentimes a disconnect between what we see when we look in the mirror and how we see ourselves in our own mind's eye. And when our bodies change, whether it's because of weight loss, whether it's because of aging, whether it's because of physical injury or insult, or even undergoing a cosmetic procedure, It can take people a period of time for their minds to catch up to their bodies. And I think that it's this is very common with weight loss because for the reasons that you said, I mean, we've been talking about that, you know, for many people, this has been a struggle over an extended period of time. For some people, it's lifelong. They're used to seeing themselves a certain way. And so even when they have success, they often focus on the thing that's still not perfect. So it's not good enough. And it gets back to that social comparison, except now you're making a comparison to your former self and your current self or your ideal self. We know that that's very common for people too, that they say, you know, the ideal me looks exactly like this, and this is how my body is shaped, and this is what my face looks like, and yet everything is working against us when it comes to our ideal selves, right? As we age, we get farther from that ideal. As we get our bumps and bruises and scrapes and scars throughout our lives, it takes us further from that ideal. And, you know, going back to the issue with celebrities, those who are willing and have been, and I think it's more than it used to be, who are willing to talk about kind of the charade that is Hollywood in terms of how people look at an awards show on a television show in a movie and how they look in real life. takes a village to make people look that good on the big screen. And in reality, while some of them have won the genetic lottery and have flawless features and great bone structure, many of them often look no different than the rest of us.

Adrienne Youdim

Right. It's like one of those things that you just have to, like, we all know this, but I think it's, again, like so many of the things that we've discussed, we have to build that muscle of like reminding ourselves of what we know to be true.

David B Sarwer

Right, right. And I would just add to that, well, building that muscle is hard because you've got those environmental pressures that are constantly bumping up against you, reminding you of what the ideal is, or, oh, my colleague brought cookies into the office today. And so we have all these little subtle threats to our ability to focus on building that muscle. And so when we think about behavioral change from that perspective, I always remind my patients to give themselves a sense of grace, to realize that this isn't about, you're not gonna do this perfectly. Changing your behavior is going to be hard. It's going to take some time. One of my favorite anecdotes I like to tell people when they're changing a behavior and they stumble and they come in and they're disappointed in themselves, I say, no, no, no, no. I said, this is actually a good thing. You stumbled, but now you and I are still working together and I can help you recover from that stumble and keep moving forward. Because if we had ended our work, I might not be in that position to help you when you stumble. And I think it's one of the great things about being a healthcare provider, right? Is that we get to work with people to improve the quality of their lives, to make their lives better, to make them as healthy as they can be. And it's a privilege to get to do the things that we get to do, right?

Adrienne Youdim

It is a privilege. And to reframe that conversation, the conversation on the outside, but also the conversation in our heads. Well, it's really been such a pleasure to have you with me, David. This has been such a fun conversation. I could talk to you on and on and on. But perhaps we'll have you back another time on the show to continue the conversation. Thanks again for joining me.

David B Sarwer

You're welcome. I had a blast, Adrienne. Thank you so much. And it was a pleasure talking to you as well.

Adrienne Youdim

Likewise. OK.