How to Lose Weight: An interview with Stephen Gullo, therapist to the rich and famous

Posted by .(JavaScript must be enabled to view this email address)
Tuesday, November 18, 2003 6:20 am Email this article
The author of THIN TASTES BETTER discusses Food Control Training

Stephen Gullo, PhD, a health psychologist practicing in New York, is the author of the national best-seller THIN TASTES BETTER: Control Your Food Triggers And Lose Weight Without Feeling Deprived. Dr. Gullo has treated over 11,000 patients during his 28 year career.

Twenty of those years he was on the faculty and staff at Columbia University. Perhaps most impressive of all are the results of a survey conducted by The New York Times. After interviewing fifty of his former patients The Times reported that five years after treatment 45% had maintained weight losses of 20 to 100 lbs. Not bad, considering most weight loss programs have success rates of only 3-5% after five years. He can be reached as follows:

Stephen P. Gullo, PhD
16 E 65th St, Suite 2A
New York, NY 10021
(212) 734-7200
(212) 717-6548 fax

Larry Hobbs: Dr Gullo, tell me a little about your background and how you became interested in obesity.

Stephen Gullo, PhD: I was a co-director of the Family Bereavement Study at the Institute for Cancer Research at Columbia Presbyterian. In studying women who had lost their husbands one of the things that I looked at was eating behavior. So I really just stumbled into this field. This was not a path that my destiny had ever called me to since my great-grandfather was one of the pioneers in the process that made possible the mass production of pasta. For centuries my family has been involved in the production of Italian food. So I never thought that I would be helping people with their eating behaviors. Starting in 1974 I started using motivational and advertising psychology to change eating behavior.

Hobbs: What do you mean by advertising psychology?

Gullo: Some of the greatest motivators in the world are found in the advertising agencies on Madison Avenue. They motivate people to spend $70,000 for a Mercedes and those people don’t feel deprived of their money. They feel privileged. So I tried to figure out how I could apply the same psychology to help people part with their savored foods without feeling deprived.

Hobbs: Why do so many people regain their lost weight?

Gullo: Most people don’t have diet problems, they have compulsive eating problems. The high rate of weight regain is due to the failure to differentiate between the dieters and compulsive eaters. Trying to teach compulsive eaters to eat “just a little” simply doesn’t work. No one has ever taught us how to have just a little of a compulsion. There is also backwards thinking about deprivation. Choosing not to eat certain foods is not deprivation, it’s a smart investment. I try to help people see that when they eat certain foods it hasn’t made them happy, it has only made them fat.

Hobbs: What percentage of people have compulsive eating problems?

Gullo: This topic does not appear to have been studied empirically, but I would estimate the number at well over 50%. In my practice that number is closer to 90%. But a vast majority of my patients do. That is they compulsively abuse certain foods. It’s like the Fritos commercial “Bet you can’t eat just one.”

Hobbs: Do you think compulsive eating is more of a problem now than it used to be?

Gullo: Yes. Society is going a transformation from one that dines to one that eats on the run. Because people feel short of time they skip or delay meals. This leads to picking and noshing. I don’t use the term compulsive eating as a mental health judgement. That is, I don’t think that it is based in some kind of psychopathology. I think that it is triggered by phenomena such as insulin resistance, food texture such as crunch, etc. People don’t compulsively eat shrimp or chicken. But they do compulsively eat sweets, flour products and finger foods.

Hobbs: What are the most commonly abused finger foods?

Gullo: Baked goods such as cookies and crackers along with chips, chocolate candies and peanuts. And some people abuse the bread basket. Certain behaviors can also be “addictive”. And the compulsive personality tends to be very prehensile, that is they have a lot of finger movement, and they can’t sit still. They rush even when there is no reason to rush. I think that science will discover a compulsivity gene that also influences eating behavior.

Hobbs: Do you use food diaries?

Gullo: Yes. I think that they are necessary because it is a natural tendency for people to forget, to deny, and to lose focus. Writing it down helps people focus on what they are doing. It also helps me see their eating print. When I put it in this context they realize this is not a mountain to climb, just a few patterns to master.

Hobbs: What is an “eating print”?

Gullo: It’s the what, when and where a person eats. I find this very helpful in guiding a patient. Often it’s not obvious to the patient until it’s pointed out. Most people don’t abuse all foods in all situations. It’s usually just 3 or 4 trigger foods in 3 or 4 trigger situations and 3 or 4 trigger behaviors.

Hobbs: How do you break this pattern?

Gullo: My program is very targeted. I focus on “boxing in”, i.e. trying to limit the amounts, situations and behaviors that trigger overeating. If I don’t have success with this approach then moderation has failed and I work on “boxing out” these foods from a person’s menu. To this end I employ cognitive re-training techniques and food management strategies tailored to the individual’s life-style. I also design an individualized cassette, of about 5 minutes, to reinforce these strategies. It’s a strong coaching/motivational model.

Hobbs: Why do you rely on “boxing techniques”?

Gullo: If a person doesn’t want to give up a certain food then I try to limit it to certain places or “box it in”. Such as, they can eat cake on birthdays or special events, but not at home. Some people can eat these foods at home as long as it’s not frequently. But for some people “boxing it in” doesn’t work and it’s easier just to “box it out”. I try to teach people that feeling good about oneself comes before taste.

Hobbs: What is “foodie-ism”?

Gullo: To live one’s life being food-centered, food-oriented, and food-glorifying. When food comes before health, appearance and the quality of life, that’s foodie-ism. Our society has a very strong foodie bias. One of the reasons people came to this country is to escape hunger. Our society places a tremendous value on not wasting food, and eating everything on your plate. People see it as a sin to waste food. Even the language of love is filled with terms about food. Words like “honey”, “sweetie”, “cookie” are terms of affection, and when we fall out of love we say that they are a “crumb”. Society is very food-oriented.

Hobbs: You told us about the most common trigger foods. But what are the most common trigger situations?

Gullo: For women it’s their own home. Very few women overeat in public. For men watching TV is a classic trigger situation. Stress or boredom are also common trigger situations. So is unstructured free time at home on the weekends.

Hobbs: Do you ever substitute foods for trigger foods?

Gullo: Yes, sometimes. This is called countering behavior. They can substitute carrots or celery or even shrimp. Beverages like Lipton Cup-A-Soup or sugar-free hot chocolate are also helpful. I substitute low caloric liquids in lieu of nosh foods.

Hobbs: How do you help patients deal with cravings?

Gullo: I focus a great deal on cravings. People need to realize that a craving is not a command but just a feeling and feelings pass. The average craving lasts 4 to 12 minutes. The availability of trigger foods creates cravings. When people have those foods in their house they are more likely to crave them. To deal with them I take a very mechanical approach. First, it’s necessary to break eye contact with the food and physically separate yourself from it. It’s critical to realize the importance that the power of vision plays in creating cravings. I’m total against the idea of patients keeping food that they abuse in their house. Cravings are very predictable. You can also avoid them by eating every 3 to 4 hours.

Hobbs: How do you have patients deal with temporary losses of control?

Gullo: I try to teach containment or damage control. Everyone makes mistakes, but that shouldn’t be an excuse for making more mistakes. I tell them to go ahead and finish whatever it is that they are eating but don’t carry it into the next hour, the next meal, the next day. This is very critical to emphasize to patients over and over. I don’t know of any other weight control program that makes error correction a primary teaching goal. It’s also important to get away from the moralistic model of judging eating behavior as good or bad. It’s just realizing that these foods don’t work for your body or eating style.

Hobbs: What percentage of patients are able to use the boxing technique without having to give up these foods?

Gullo: About half. The other half have voluntarily given up certain foods because they are not able to control them. Some patients who eat out a lot have given up the bread basket. Almost all of my patients have given up finger foods like peanuts, pretzels and chips. They are too easy to abuse.

Hobbs: What is the “F-Q Principle”?

Gullo: An increase in frequency leads to an increase in quantity. This is very important to understand. It took me about ten years to realize this. At first when people told me that they were eating “just a little” of certain foods I thought this was a success. But then when those same patients came back year after year gaining back the same weight I finally got it. That if someone starts frequently eating “just a little” of a trigger food it is only a matter of time before “just a little” isn’t enough and they regain their lost weight. Eating just one cookie a day starts a pattern that leads to craving and food control problems. At first people feel proud that they are eating just one cookie a day. But their success of only eating one encourages them to do it again the next day and the next and the next. Then they start eating more each day. So when people are sliding back first frequency increases then quantity. I used to tell my students at Columbia that every addict can be moderate, they just can’t stay moderate very long.

Hobbs: Tell me about the audio cassettes that you use.

Gullo: During a patient’s session I prepare a 5 minute cassette summarizing the critical points of our session and preparing them for any upcoming events. They listen to it each day to keep them focused. If the patient is going to attend a special event such as a wedding I will focus on that also. Some situations like holidays, vacations, PMS, and stress management could be generic tapes. Also if a patient has slipped, I zero in on why this has never worked for them in the past. I tell them to look back in their life and ask if they have ever kept the weight off when they have gone back to eating these foods? Have they ever had good control over these foods? So the tapes are to teach, to remind, to encourage, to set clear boundaries and to motivate.

Hobbs: Explain “tomorrowisms”.

Gullo: St. Augustine is reported to have prayed “Dear Lord, make me pure, but not today.” Many people are willing to change, but not today. This is especially true of people with food control problems. They say “I’ll start tomorrow” or “I’ll just have a little” or “Just this once”. They want to remain thin and in control, but they want to wait until tomorrow to do what it takes. But control problems have to be addressed today.

Hobbs: What do you think about the idea of people being carbohydrate cravers?

Gullo: The Hellers, authors of do The Carbohydrate Cravers Diet, do good work, but I don’t understand why they tell people that they can eat their problem carbohydrate foods for one hour a night. The same is true of Weight Watchers who say that you can take the weekends off. Can you imagine if we allowed alcoholics to do this? It doesn’t make any sense to me. These individuals have had years and decades of abusing these foods and it still hasn’t been enough. So why would one hour or one weekend suffice?

Hobbs: Do many patients negotiate with you about foods?

Gullo: Absolutely. I equate a lot of my work to placing chess. I make one move and they make another. I try to get rid of one food and they bring in another.

Hobbs: Do you treat children?

Gullo: No. I don’t take teenagers or children because they don’t understand control. They relate to the world as being black or white. They only see this as deprivation. People need to have struggled for years before they are willing to accept the truth of their eating behavior.

Hobbs: You’re famous for your slogans. How did you decide to use them?

Gullo: It goes back to the advertising. Slogans are very effective for selling things. Slogans like “Don’t leave home without it” or “Don’t squeeze the Charmen” stick with people. So I decided to use slogans to motivate people and help them remember. That’s why my book is titled Thin Tastes Better. Patients would tell me “But this tastes so good”. I needed to give them another hook to grab onto so I started saying yes, but “Thin tastes better”.

Hobbs: What are some of your favorite slogans?

Gullo: One by John Drybread which goes: “For those who are given to excess, abstinence is easier than moderation.” Another is “It’s better to wear Italian than to eat it.” I also like “Did I come this far in life to take orders from a cookie?” and “Don’t be worry about being normal, it’s the preoccupation of the insecure.” I like this one because one of the biggest problems in the weight control industry is treating people with compulsive eating problems like they are normal and they will suddenly just learn to “have a little” of foods they have absolutely no history of ever having a little of. “History” is the most important word for losing weight and keeping it off, not what is “normally done”.

Hobbs: I understand that some of your patients live out of state. How do you work with them?

Gullo: By fax. They fax us what they are eating. I think that the fax and email are great tools for doctors to utilize. One of my slogans is “Better fax than fat.”

Hobbs: Do you have patients weigh themselves?

Gullo: During maintenance I do, but not during weight loss. During weight loss it can be very demoralizing if it’s done every day or so and the person expects to see a weight loss. Also, some individuals may find a license to eat excessively after a big weight loss. But it is very helpful during weight maintenance.

Hobbs: What is a “calorie unit”?

Gullo: A “calorie unit” is the amount of calories that a person is likely to eat of a certain food. If a person has a history of eating a bag of potato chips then the calorie unit of potato chips for that person is maybe 1000 calories or however many calories are in that bag. I have my patients calculate the calorie units of their trigger foods.

Hobbs: What is the “new scale”?

Gullo: A weight scale is an inadequate tool. So the “new scale” is having patient asking themselves 4 or 5 questions like:

1. Have I indulged or thought about indulging in any trigger foods today?
2. Am I abusing any allowable foods?
3. Am I negotiating with food or using “tomorrowisms”?
4. Am I thinking like a fat person and allowing foodie-isms to influence my decisions?
5. Am I remembering that thin starts in the market and finger control is an essential part of weight control?

That is the new scale that I have people weigh themselves on. It is an easy weighing system that predicts which way the numeric scale will go.

Hobbs: Do you treat severely obese people differently than those who are moderately overweight?

Gullo: Yes. I require that obese patients are monitored by their doctor every 2 or 3 weeks.

Hobbs: Do you give exercise advise?

Gullo: I don’t design exercise programs, but I work with exercise physiologists who do that.

Hobbs: Tell me about your use of natural appetite suppressants. What, when, and how much do you use them?

Gullo: I use guar gum, glucomannan and spirulina. As far as dosage I follow whatever the manufacturer recommends. I’ll have them try one for a week to see if it’s helpful. If it’s not then I have them try another and then the other. If a person tells me that they feel hungry first I’ll add a low calorie forth meal such as a soup, egg white omelette or salad with shrimp. If they still feel hungry then I have them try the supplements. Most people find this approach very helpful.

Hobbs: How do you feel about prescription diet pills?

Gullo: I don’t think that long-term success will be found in a bottle. People need to learn how to break their patterns of abusing trigger foods. But drugs are necessary for some people. Sometimes I have patients start losing weight with the medications and then wean them off as their control eating control skills increase.

Hobbs: When do recommend they use prescription drugs?

Gullo: If a person has a life-threatening illness and it’s important to get the weight off more quickly. Or if a person is not successful with food control. I also recommend them for patients who re having a “control crisis”, i.e. gaining back a large amount of the weight which will put their health at risk and they have failed to respond to other intervention strategies. Some women may also need something before their period. I’m not against the diet drugs for the right situation, but I don’t think that they should be used for people trying to lose 10 or 15 lbs or for cosmetic weight loss.

—END

Articles on the same subject can be found here:

• Glucomannan (konjac root)

• Interview with Stephen Gullo, PhD

• Interviews with Doctors