Our host, Gabe Howard, used to weigh over 550 pounds. These days, he maintains a healthier weight — and has done so for over 20 years. Many people, including Gabe, feel that binge eating is an example of self-medicating. Using something — in this case food — to mask the symptoms of bipolar disorder.
If you feel that you may binge-eat as a way to deal with the symptoms of bipolar disorder, this episode is for you. Listen now to find other alternatives and understand the psychological mechanisms at play.
Gabe Howard is an award-winning writer and speaker who lives with bipolar disorder. He is the author of the popular book, “Mental Illness is an Asshole and other Observations,” available from Amazon; signed copies are also available directly from the author.
He is also the host of Healthline Media’s Inside Mental Health podcast available on your favorite podcast player. To learn more about Gabe, or book him for your next event, please visit his website, gabehoward.com.
Dr. Nicole Washington is a native of Baton Rouge, Louisiana, where she attended Southern University and A&M College. After receiving her BS degree, she moved to Tulsa, Oklahoma to enroll in the Oklahoma State University College of Osteopathic Medicine. She completed a residency in psychiatry at the University of Oklahoma in Tulsa. Since completing her residency training, Washington has spent most of her career caring for and being an advocate for those who are not typically consumers of mental health services, namely underserved communities, those with severe mental health conditions, and high performing professionals. Through her private practice, podcast, speaking, and writing, she seeks to provide education to decrease the stigma associated with psychiatric conditions.
Find out more at DrNicolePsych.com.
Producer’s Note: Please be mindful that this transcript has been computer generated and therefore may contain inaccuracies and grammar errors. Thank you.
Announcer: You’re listening to Inside Bipolar, a Healthline Media Podcast, where we tackle bipolar disorder using real-world examples and the latest research.
Gabe: Hey everyone. My name is Gabe Howard and I live with bipolar disorder.
Dr. Nicole: And I’m Dr. Nicole Washington, a board-certified psychiatrist.
Gabe: Dr. Nicole, I know we’ve worked together for a while, but have I ever shown you my quote unquote, fat picture?
Dr. Nicole: No.
Gabe: So, I used to weigh over 550 pounds. I know that it was over 550 pounds because when I stood on the scale that went to 550 pounds, it flashed. I don’t actually know my top weight because even at the weight loss center, I was too big for the scale.
Dr. Nicole: Wow. So at least 310 pounds down at least.
Gabe: Yep. Yep.
Dr. Nicole: We’re not really sure, but at least 310, which is a significant amount of weight for anybody to lose and then keep off. And over what period of time have you been able to keep it off?
Gabe: Almost 20 years now.
Dr. Nicole: Oh.
Gabe: Yeah. Like. Like over 20 years. Yeah. Yeah. I’ve kept it off for over 20 years.
Dr. Nicole: That’s a long time. That’s very impressive. Gabe, I mean, that is a very,
Gabe: Why, thank you.
Dr. Nicole: Very long time. So, tell me at 550 plus, what was it that made you say, I can’t keep doing this?
Gabe: I would love to give you a mature answer and tell you that I was looking long term. I cared about my health, living a long time and being not incapacitated. But it was largely how I looked. I just I was going through a divorce, so I knew I would be hitting the dating market soon. And I thought, well, I’m so morbidly obese. And then you tack on to that. Just the other things. I didn’t fit in booths at restaurants. I didn’t fit in movie theater seats. I didn’t fit in concert seats. I couldn’t walk the distance from the parking lot to like concert and sporting venues because that’s a really long walk. And it just it really was a culmination. But I would be lying if I didn’t say that. I looked at myself in the mirror and I just thought, I am so, so fat and ugly that no one will have me. And that was a huge driving force.
Dr. Nicole: Wow. So, I would imagine that you were this size for several years.
Gabe: Yep. Yep.
Dr. Nicole: So, was it the divorce, were there other things or people in your life that kind of encouraged you to take a step towards doing something different?
Gabe: There was really nobody in my life that encouraged me to do anything. Because, see, here’s the thing you’re wondering, Gabe, this isn’t called inside binge eating disorder. This is called inside bipolar. What does this have to do? So as many people have heard the stories on this, this show of me losing friends and me doing things, etc., that was happening at the same time that the weight was going up. And this is where these two things intersect. As I lost friends, I needed something else to do. And eating made me feel better. So, as I as I made people mad, as people got angry, as I got, you know, grandiose or manic or depressed or whatever, food was the constant. So, anyone who could actually run any sort of interference was much less concerned about my weight and much more concerned about my behavior. It was a tumultuous time, both mentally and physically. And I think everything became a distraction to everything else.
Dr. Nicole: Hmm. So, it sounds like nobody was putting two and two together.
Gabe: That is accurate. I think what people were more focused on was getting the hell away from me. I really think that needs to be said. I was a nightmare. I, I was a person with bipolar disorder who was untreated. So, I kept no promises. I took no responsibility. The mania made me do things that were an embarrassment to people. My family had moved away. I want to give my family cover. They had moved 700 miles away when my father got transferred, leaving me in that place. I was the oldest child, so they only saw things in clips and phrases or heard things on the phone. This was this was pre-Facebook. This was this was back when calling your mom, who lived in another state, cost $0.15 a minute. And I didn’t have anything good to tell her anyways. And I didn’t want to spend $0.15 a minute to talk to her. So, it was a it was a mess. But here’s the thing that I want to focus on. I self-medicated with food and people talk about self-medication a lot with bipolar disorder, and it’s almost exclusively drugs and alcohol, drugs and alcohol. I self-medicated with drugs and alcohol. I self-medicated largely with food,
Dr. Nicole: Yeah.
Gabe: And I also celebrated with food. And that’s a that’s a that’s a that’s a lethal combination.
Dr. Nicole: Absolutely. I mean, we all have coping skills, right? Good and bad. Good or bad, we all have them. So, it sounds like food became one of your more maladaptive coping skills that you used. Was it mostly during depression? Could it also occur during mania? Did phase matter for you as far as your eating?
Gabe: I think phase mattered ever so slightly, and here’s why I say that. Let’s talk about mania first. We all celebrate with food, but I had a lot to do when I was moving around a lot, so therefore I ate less. I think the motivation was there, but it came out differently. So, when I was manic, I wanted steak, I wanted high end celebratory foods because I was good. I wanted to go to the expensive place. I wanted to get the good quality foods. I’m the man, right? And when I was depressed, I wanted foods. I wanted comfort foods. Right. They have a name. I mean, just I don’t think I need to convince anyone whether they have an eating disorder, whether they have weight issues, everybody understands comfort food.
Dr. Nicole: Mm-hmm.
Gabe: Everybody. Even the healthiest marathon runner in the world is like, yeah, man, do I love my mom’s meatloaf or, you know, my dad’s, whatever, or my grandma’s cookies or just so we all have. But see, I. I don’t want to weaponize that isn’t the right word. Medicated that? Self-soothed that? So, for example, birthdays were always a big deal in my family.
Dr. Nicole: Okay.
Gabe: Whenever somebody had a birthday, we did all the things right, which meant cake. So, whenever I was depressed, I wanted to cheer up. Birthdays were always happy. Therefore, I ate the foods from birthdays, which was cake. I ate a lot of cake, and the heavier I got, the more cake I needed to get that sensation in my chest and my stomach. And after a while, I was eating full sheet cakes. I would just go to the store, buy a sheet cake, go home and eat it with a fork because it would make me feel better.
Dr. Nicole: Okay. So, some people that I see during their depressions, they are definitely more drawn to carb heavy foods, the comfort stuff, the stuff that makes us feel good, right? They’re more drawn to those things. Do you think it was that or do you feel like you tipped over into more of a binge eating disorder kind of situation?
Gabe: It was definitely binge eating disorder. Of course, I have I have hindsight on my side. Right. I was diagnosed with binge eating disorder. I was treated for binge eating disorder. Understanding the mechanisms that I sought out food, the reasons I wanted to eat, etc. I’ve had I’ve had years and years and years of therapy and reflection on these things. So, I know it was that. But see, the food was instant, right? Working through these feelings took a long time. So, picture here’s a common scenario with bipolar disorder. The depression. Right. I was I was feeling suicidal and I was depressed and nobody loved me. My depression really manifested itself in why do I need to be here? No one loves me anyway. So, then I would think, okay, well, my family doesn’t love me anymore. Okay, well, how can I feel love for my family? Well, they always loved me on Christmas. Okay, So I will replicate Christmas menus because it’s tactile. The smells are there, the mouthfeel is there, the taste is there. So then as I’m eating, this nostalgia is I’m really trying hard not to say nostalgia is a drug, but it’s I think we all understand the value of nostalgia in our lives. So, as I’m eating that food, all of a sudden, it’s like, no mom and grandma and dad and my brother and my sister, they do love me. I remember that happy time.
Dr. Nicole: Mhm.
Gabe: And during the eating, even during the seeking of the food, and for a tiny amount of time after, I would be happy.
Dr. Nicole: Mhm.
Gabe: And that was wonderful. It never lasted.
Dr. Nicole: I was going to say.
Gabe: And clearly weighing over 550 pounds. It was an unsustainable coping skill, as you say. But in those moments, it could get me through an evening and then I would sleep. And sleep is powerful as well in the treatment of bipolar disorder. So, all of this could maybe buy me an evening or even buy me a couple of days. And then, of course, the whole thing would tank again.
Dr. Nicole: And this is no different than if you were drinking or if you were doing any kind of illegal drug to fill that hole. This is no different. I do want to take a minute to go through some language kind of definition things. We love to put labels on things. We love to know specifically what it is that I have. What is this? Because there’s somebody out there listening who’s thinking, Oh, that’s me. I do that. Like, I do that. That sounds like me. Is this just my depression or do I have binge eating disorder? I think what teases those two disorders out if the binge eating is happening, regardless of phase, mania might stop it because mania is its own beast. But if the binge eating is happening during normal moods and depressions and maybe gets a little bit worse during depression, so binge eating disorder, we’re looking at the person who eats when they’re not hungry. They eat to the point that they’re uncomfortable. They may even eat in in, in in solitude because they’re embarrassed. They don’t want anybody to see them eat a whole sheet cake. You don’t you don’t want anybody to see that.
Dr. Nicole: So that’s you going to the store or going through the drive through, going to a park and eating, you know, value meals that you don’t want your family to know about because you also know that you’re going to go home and eat dinner in addition to what you ate in the park. So, there’s a lot of shame and guilt that comes with binge eating disorder, but it’s just eating even when you’re not hungry, just eating, eating, eating. And it’s not affected by mood state If you’re only having this during depression, maybe this is just part of your depression that you’re eating because you are trying to fill a hole, because you are trying to make yourself feel better. So, I just want to make sure that we understand kind of the differences between binge eating disorder, like defined binge eating disorder, and a symptom of your depression because the treatments for binge eating disorder can interfere with your treatment for your bipolar disorder. So, we want to make sure we know what it is that we’re treating and identify it so that we can come up with a very, very good treatment plan.
Gabe: I want to ask you, Dr. Nicole, do you see people in your practice who are using food to self-medicate or using food as a coping skill? Because I’ve really been surprised, looking back, to this moment, I don’t know how much of my binge eating disorder is because I have bipolar disorder or because I just developed binge eating disorder or an unhealthy relationship with food. And truthfully, I think it’s so interwoven that it’s really stupid to try to figure it out for me.
Dr. Nicole: I do see a lot of people who have unhealthy relationships with food and, you know, nobody ever develops a vegetable obsession when they’re depressed or when they’re when they’re binge eating. Nobody does. Nobody’s ever said to me, oh, I ate a lot of carrots and cucumbers and peppers and hummus when I was on a binge. It’s never that stuff. It’s always burgers and fries and pizza and cake and sugary carb-filled things. So, there is a link there, you know, and I think that’s one of those things that we’ll continue to learn more about, you know, as more research is done. But what happens is a lot of times these people will blame it on their medicine. And so that’s where we get into a battle because they will say to me like, oh, I’ve gained all this weight. It has to be the bipolar. It’s got to be my medicine; it’s got to be my medicine. They’re like, Are you sure it’s your medicine? And then you ask them to do a food diary and kind of document everything they’re eating. If they really do it, they come back really shocked at what their diets like and how it plays a part. And then that’s a whole separate issue to have to deal with on top of the medication and weight and all that stuff. But a lot of people will have those issues, but they’ll look for it to be everything other than a food issue. It’s the medicine. It’s I’m not working out like I should. It’s because I’m so depressed, I can’t get up to exercise. They will try to find any reason they can. A lot of us don’t want to deal with food issues because believe it or not, tons of folks have food issues, whether they have bipolar disorder or not.
Gabe: I’m really glad, Dr. Nicole, that you touched on this idea of blaming everything but ourselves, because even as I sit here knowing that I was binge eating because of bipolar disorder, that I was self-medicating to mask the severe symptoms and emotions and pain and even that I know that it’s this convoluted mess. It’s still my responsibility. It’s still my fault. I ultimately had these feelings and chose to treat them, making air quotes, with well sheet cake and pizza and trying desperately to make mom’s meatloaf. Right. I went down that path on my own. I have to take responsibility for that. And I think that’s a really powerful thing to do because if I go all the way back and said, okay, I was depressed, I was sad, I felt worthless, and I made the choice to go after food to solve this problem, I now know that that was a mistake. But I also know that I have the ability to make a decision in these worst moments, in these bad moments. So now I can work on making a different decision. And that’s largely been the secret to both keeping the weight off and managing bipolar disorder is finding those little moments where I made the wrong decision and realized that if I work really, really hard, I can replace them with I don’t want to say the right decision. I just want to say better decisions, healthier decisions, decisions that serve me better. And I think that so often, as you and I talk about, people are like, well, it’s not my fault. It’s bipolar. Well, it’s not my fault. It’s depression. Well, it’s not my fault. It’s X, Y, Z. And that’s got to be very difficult for someone like you because there is a component of symptoms of the medication can cause weight gain. So, you can’t just immediately say, no, no, it’s on you because it’s not that clean.
Dr. Nicole: Overeating, having a food addiction, even though it’s not a DSM recognizable addiction, it’s a disease process. I mean, I see it. People don’t get to 550 plus pounds without there being a disease process in place. And so, I do think it’s important to recognize that people do get there. Gabe got there, but I think your story is empowering in that you didn’t stay there. So that’s why I do want to touch a little bit on what did you do, you know, what did you do? What did your team decide was the best course of action for you?
Gabe: So, here’s the part of the story that’s not so great. And I and I only tell this part of the story not to discourage people, but because I want people to be thinking more broadly. I got diagnosed with binge eating disorder and the weight issue before I got diagnosed with bipolar disorder. And I went to an eating disorder clinic and they did not pick up on the bipolar disorder in any way. They were all too focused on the fact that I weighed over, you know, 550 pounds, that I was really heavy and I had this unhealthy relationship with food. And they never delved deeper Now, again, 20 years ago, I do think that we have a better understanding of the interconnectedness of physical and mental health today than we did 20 years ago. But when I look back on my story, that is a bummer for me. I was in front of a lot of professionals who did not pick up on that.
Dr. Nicole: Did they require you to have any kind of psychiatric evaluation in this process?
Gabe: Yes, I was seeing a therapist. Now, she was an eating disorder therapist, but I had been seeing her for almost a year when I was ultimately admitted to the psychiatric hospital. And in fact, she was the one who got the call that said Gabe was admitted to the psychiatric hospital for suicidality. And she did say after the fact that she wondered if something was up. But again, we still have to. And I loved her. She is one of my favorite therapists ever. She taught me so much and she helped me control this devastating disorder that was, frankly, controlling my life. But I do have to question that one part of you saw something but didn’t say something? Like, you were my person. I was counting on you. And how can we improve that? Again, this isn’t to throw anybody under the bus. It was just that it wasn’t considered. Now I, I do want to tell that part of the story because I think that it’s super, super relevant to take a more holistic approach. And maybe that wasn’t done for me and maybe it is done now. Again, 20 years is a long time.
Dr. Nicole: We’ve learned so much over the last 20 years as it relates to eating disorders in general, binge eating, mood disorders. I would like to think that your experience would have been very different, you know, from then compared to now.
Gabe: I think so as well.
Dr. Nicole: But that person helped you, it sounds like, through a lot. So, you’re seeing a team to help you with your weight. You’re seeing a therapist. And then what kind of options did they give you as far as how to help you get the weight off?
Gabe: One of the first things that they did that was really illuminating to me was I saw a nutritionist. The first thing that they wanted me to understand is why I was eating. We did cover this idea that that I was eating to fill a void. And the thing that we landed on was BINGE, Because I’m Not Good Enough. There’s this little piece of Gabe that rolls his eyes at that because I’m not good enough? But there’s also this other little piece of Gabe that’s like, like, that’s. That’s. That’s why you were doing it. You did not like yourself, and this provided relief, so stop mocking it. I, I do go back and forth as I think that many people who have gone through this process do. And what I really learned through the process is how stupid I was with food. One of the first things that the nutritionist did was hold up these cards and each card would have a food, right? And you pick the food with the lower amount of calories and she held up a donut or a muffin. And I picked the muffin as having the lesser amount of calories because muffins are healthy. And she was like no muffins have in some cases 3 to 4 times the calories because they’re bigger, they’re denser, they don’t have as much air in them. And I’m like, but no, muffins are the healthy alternative. And she’s like, Yeah, people have taught you that, but it is not true. You would be better off eating the donut. This I lost almost every one. Now I understand that she did this on purpose. She knows the ones that people are going to pick.
Dr. Nicole: Right.
Gabe: But I was really shocked to find out that Snickers, which is packed with peanuts because it really satisfies, is not a health food. But I’m like, no, it has peanuts. It really satisfies. It gets you over that mid-morning hump. Nope, nope. Turns out Snickers is not a health bar. It is just a straight up candy bar. But it was marketed as this, and I believed it to be so well, largely because I wanted to. That was very shocking to me.
Dr. Nicole: Absolutely, because advertising works. The media is doing their job. It all works. I think it’s great that education was the first piece of it because if you don’t have the right educational foundation, anything you do after, it’s probably not going to be successful. You need that education. So, you see this nutritionist, you get education, you feel stronger about your knowledge about food, and then you all decide to do what?
Gabe: After learning about the reasons that I eat and learning about, well, frankly, just everything that I knew about food was wrong. So, learning how to make better choices, the very first thing that we tried was a calorie reduction, and this failed miserably. I was unable to control my own food intake even when I would make better decisions, meaning I would I would choose the donut over the muffin. I would still eat a dozen donuts. I would still keep eating until I got this feeling in the pit of my stomach. And I just it was it was extraordinarily difficult for me. And ultimately, we made the decision to seek a medical solution, and ultimately, had gastric bypass. And listen, if one more person tells me that I took the easy way out.
Dr. Nicole: Oh, wow. They’ve obviously never been around. Anyone who’s had gastric bypass surgery is one of the most difficult things that a person can go through.
Gabe: People really don’t know how devastating gastric bypass is. And here’s where this intersects with bipolar disorder. I was diagnosed with bipolar disorder before I had the gastric bypass. I was I was on the path towards getting the gastric bypass, but I had not yet had the surgery. I get diagnosed with bipolar disorder. That’s fantastic. I get put on my first psychiatric medications and I start getting help. And that’s like we’re nailing it, right? We’re firing on all cylinders and I’m super happy. And then about nine months after being diagnosed with bipolar disorder, I finally have the gastric bypass, which is which is wonderful and no doubt saved my life because of the physical damage I was doing. Now, for those who don’t know what gastric bypass is, it rearranges your stomach. I had the Roux-en-Y procedure, so I officially have two stomachs. Right. And this, this, this, this lowers your intakes of food, changes how your food is processed. And here’s the important part. It changes how your food is processed. Therefore, it changes how your medication is processed. So, all of a sudden, the medication that they were working to get me stable on it completely changed the dynamic literally overnight. And even as we were moving forward and doctors were trying to decide, it became the doctor Nicole It became a real, real big problem.
Dr. Nicole: Yeah.
Dr. Nicole: And I think we knew a whole lot less 20 years ago, again, you know, than we do now about procedures and how they affect medication processing and things like that. And the other the other thing to think about is we always talk about avoiding stress. Avoiding stress. When you have bipolar disorder, avoiding stress to prevent episodes, there is no bigger stress on the body than a surgical procedure, even if it’s for a positive reason, even though you know the results are going to be, you know, great and put you into a healthier space, it’s still a stress on the system. So, then you have to worry about having a mood episode because you put this stress on the body.
Gabe: And in Dr. Nicole, I want to ask you because I think this is really important. My body was all messed up and doctors, they base what they’re prescribing you on sort of a I’m telling you how to do your job now. So, you know like how much do we start Gabe on. Well Gabe is six foot three and he weighs 550 pounds. So, he needs this dose, right? But now my insides are rearranged and I’m not absorbing all of the stuff. That’s one of the hallmarks of the Roux-en-Y surgery is you don’t absorb everything in your stomach.
Dr. Nicole: I will say there are certain bipolar medications that are weight based. So, we have to consider weight when we’re dosing. There are some that are not necessarily weight based, but don’t argue with facts. So even if a medication is not supposed to be weight based, if a person after having bariatric surgery experiences, changes in stability or changes in symptoms, you know, we have to think about that as a possibility. But there is also the possibility that just the surgery itself has just led to an episode because it’s a huge stress on the body. It affects how you absorb certain nutrients; it affects vitamin levels. And we have to make sure you’re taking those like you’re supposed to because some vitamin deficiencies can look like mental health symptoms. There’s a whole lot of moving parts, a whole lot of puzzle pieces. And we just have to be able to make sure we’re all working together. But yes, it is a little scary to think about prescribing higher doses of something because of absorption, especially 20 years ago, we just didn’t we didn’t know as much. So, it made it a little bit scarier back then.
Dr. Nicole: And we’re back discussing bipolar disorder and overeating.
Gabe: I was very fortunate to have bariatric surgery. I was very fortunate to go to an eating disorder clinic. I was very fortunate to go to a nutritionist. I was very, very fortunate to get help for all of these things. But here’s the here’s the co-morbidity. I want to use a I want to use a doctor word. Dr. Nicole.
Dr. Nicole: I like it.
Gabe: Here’s the problem with the comorbidity in this case. There’s no titrating down when you have surgery. So, for example, I was using in a very unhealthy way food as a coping skill. So, if I was feeling anxious, depressed, suicidal, lonely, hopeless, I would use food. Now a therapist would normally be like, okay, look, we got we got to we got to titrate you down, right? No therapist in the world would say, stop it. Just don’t do that anymore. Right? So, if you if you listen to that, no therapist would ever say, stop it, don’t do that anymore. But gastric bypass says, stop it. You can’t do that anymore. So, I had to learn all new coping skills by quitting the previous coping skills, however unhealthy. They were cold turkey. And this led to me literally breaking down in a parking lot crying because I was under so much stress from the surgery. I was under so much stress from my parents being there. I was under so much stress from not having any coping skills that I was just I was just in a parking lot crying. And my friend who was trying to console me said, What’s wrong? And I said, I’m so unhappy and I don’t even have food to help.
Dr. Nicole: Mhm.
Gabe: And she didn’t know what to say. And this is one of my friends that always knows what to say. And she’s like, Yeah, I got I got nothing. It’s a lot more involved than it than you think. And I really don’t think that there’s a way necessarily to get ahead of it. We can all agree that weighing over 550 pounds is unhealthy. We can also agree that using food as your primary well, frankly, only coping mechanism is unhealthy. And we can all agree that it’s very difficult to treat bipolar disorder when your patient is not going through so many physiological changes in a short period of time. And now you’ve got to push all those together. But I want to say this it’s still worth doing. I look back at all the challenges that I had and it was still worth doing. And even as messy as what I just described was, I still felt that I had control, not as much control as I wanted, but more control than zero. And I want to touch on that for a minute because I hear a lot of people with bipolar disorder, especially when it comes to weight, saying things like, well, there’s nothing I can do. The medication made me gain weight, I’m stuck. And they really have this very defeatist attitude that that they are the victim of this weight gain. And the first thing I do want to be very clear, they are a victim of the weight gain, right?
Dr. Nicole: Mhm. Yes, yes.
Gabe: Two things can be true. You can both be the victim of something and have power to change your space. And I think we do a really good job of telling people it’s not your fault, it’s not your fault. You have bipolar disorder. It’s not your fault you gained the weight. But we don’t do such a good job of saying, but you have power to fix it. There are things that you can do, however, difficult, hard, even nearly impossible they are. I still think it’s a really, really good message for people who have binge eating disorder or weight issues because of their medication or because of bipolar disorder to encourage them that they can push forward but still acknowledge that it’s incredibly unfair. And it’s certainly very, very difficult. What are your thoughts on that when you work with patients?
Dr. Nicole: Absolutely. Everyone isn’t at the 550-pound mark. But I do see a lot of people who are significantly overweight and they just kind of give up. There is nothing to be lost by learning about nutrition. We talked about your education process. There is no downside to learning about nutrition. There is no downside to modifying your diet to a healthier one. There is no downside to developing an exercise program. Even if you don’t get the weight results that you want. You can’t argue with the fact that there are still health benefits from learning about nutrition and from actually implementing some of the things you learn. So, you may not end up losing that 100 pounds, but I would focus on other parameters. I would look at maybe inches instead of pounds. I would go to your primary care doctor and say, okay, I’m starting a diet program. Let’s look and see what’s my cholesterol looking like? What’s my glucose looking like? Let’s see if we can get those numbers down. Sometimes it’s about being healthier, not necessarily about being smaller. And I think medicine in general is moving more in that direction. There is a healthy at every size movement because let’s face it, there are people whose BMIs are perfectly normal, who have high cholesterol and high blood pressure and all kinds of things. And then there are people who may be 300 pounds and have lipids that I would stab somebody for. They just are when you look at labs and they look great on labs.
Dr. Nicole: And so, then it’s hard to say, well, your weight’s killing you when everything looks perfect. There is a way to be healthy at every size that you’re at. If weight is a goal for you, I think that’s fine. We all have a number on a scale. We have a size dress or pants. We all have something. But really our focus should mostly be on being healthy. And I think there’s nothing that you did initially, even if it didn’t give you the results, that still couldn’t have helped with that. Now, there are times when you reach a size where it’s hard for you to move. It’s hard for you to do the exercise. It’s embarrassing when you have to, you know, ask for a seatbelt extender on an airplane. For a lot of my patients, that’s the that’s what happens to make them say, oh, no, I got to do something different. There’s a lot that goes with it. And a lot of it is just the stigma and shame that we put on people who are overweight. But I see it all the time and you do have control. So, if we can focus on the things that you have control over, that’s amazing.
Gabe: One of the things that I think about a lot internally is how excited I was at the idea of weighing 400 pounds. And I once said to somebody when I was going through this process, if I can just weigh 350 pounds, I will be happy for the rest of my life. Because remember, I weighed over 550 pounds. So that’s a 200 plus pound weight loss.
Dr. Nicole: Right.
Gabe: And I did I did get to the 350, obviously. And then I wanted more. Now, on one hand, that’s good, right? I’m super glad that I’m able to maintain a body weight of about, you know, between 240 and 250. I think that’s a very healthy weight for me and I feel very good. But one I want to point out that I’m still in the obese category. I’ve gotten down to 250 pounds. And according to that BMI chart, I am still obese. I think I look fine. But I according to the magic BMI, I am still obese. Considering where I came from, I’ll take it. But considering when I got to 350, I still wanted more. And like I said, I think that is good. But it is also a little bit dangerous. Right? The reality is, is losing those 200 pounds that that put me in a much better position to lead a healthier life and to be healthier and to go for I could fit in the chair again. I didn’t need the seat belt extender anymore. I could fit in a booth. So, it’s dangerous to always be thinking this. I need more because a chart says so or I need more because I’m supposed to be this size. And I got to tell you, this is embarrassing. Being a 46-year-old man who lives in Ohio. That song, Victoria’s Secret is a lie song? That. Have you ever heard this song?
Dr. Nicole: No,
Gabe: I know Victoria’s secret. Girl, you’re not going to believe it. He’s an old man, lives in Ohio, making money off of girls like me.
Dr. Nicole: [Laughter]
Gabe: Cashing in on body issues. I love that song.
Dr. Nicole: Never heard of it.
Gabe: I just love that song. Because her whole point of that song is Victoria’s Secret is it’s an old dude from Ohio who’s cashing in on women with body issues. And,
Dr. Nicole: Yeah.
Gabe: You know, she talks about how she misses Hot Girl Summer and she starved herself because she thought she was supposed to look a certain way. And this really resonated with me, even though I am not the target audience, because I think of all the things that I missed being too big. And again, I want everybody to be healthy. I do. It is not okay for me to be 550 pounds plus. I was going to put myself in an early grave. But where’s the cut? Right. And I think a lot of people living with bipolar disorder, there’s this idea of doing things in excess. There’s this idea that we have to be perfect in order to get any credit. And I want to give a little push back against this because one diet, culture and body issues in our culture is already like a really big thing. It’s a problem whether or not you have bipolar disorder. And when you live with bipolar disorder, you’re often taught that you have to be perfect. You can never have an episode; you can never relapse. So, I think it’s an easy message to absorb that if you’re having issues with your diet and you live with bipolar disorder, that that maybe you’re not doing the things that you’re supposed to do. And then we just wash our hands of all of it.
Dr. Nicole: Yeah.
Gabe: I think that’s a scary thing.
Dr. Nicole: Hey, we give up. And so, then patients say, well, I don’t care. It’s fine. Like everybody I know who’s got bipolar disorder is fat from the medicine. I’m just going to be fat. Those are the kind of things that people say to me. They can convince themselves it’s not that big a deal. They can convince themselves they have no control over it and that that’s just how life is going to be for them with the medicine. And I can’t even tell you. The bipolar medications are not a sexy bunch to hang out with. A lot of them have weight gain as a potential side effect. I completely understand when I treat somebody long term, like from their initial diagnosis and I see them for years, I see the changes, I see it, I can see it from visit to visit that the weight is changing and it’s just hard to figure out what to do about it. You don’t want to say go off your meds. And if anything, I just want everybody listening to know that you do have some control though. So, let’s work on it together and see if we can help you kind of stand in that power and in that control and do the best you can do with the hand that you’ve been dealt.
Gabe: I want to hit two things that you said really, really hard. One, I never like it when anybody abdicates their own control and their own power. I don’t like it in any area. But this is a bipolar podcast and I really don’t like it when I hear my folks with bipolar disorder say, Well, I can’t. Well, it just because. I really think that we have a lot more control. And when we start thinking that way and we give up our power, yeah, it’s really, really, really easy to become hopeless real quick. But the second thing I want to talk about is most people with bipolar disorder understand that sort of compromise, for lack of a better word. Like, for example, I have chronic dry mouth and I have a tremor. Now I’m okay with a tremor and chronic dry mouth because I’m not a flutist. Right? I’m not a fine artist. I’m not a pianist. That slight tremor does not stop me from doing the things that I want to do. And the dry mouth does not stop me from doing the things that I want to do. I just I just carry around liquids all the time. And that’s the way that I’ve gotten over it. And in exchange for that, I have stability. I have stability on my medication, stability in my mood, stability in my life and my relationships. So that’s a good trade for me. However, when we get over to the weight gain side, we’re often told by well-meaning people like, oh, you’re 20 pounds overweight, you should lose it, but it might be part of your compromise, right? Healthy at every size. It has more meaning than we give it credit. And many people, especially younger people, are like, no, I’m not at the right weight.
Dr. Nicole: Mm-hmm.
Gabe: I’m not willing to make that compromise. And maybe I cannot make decisions for you and I’m not trying to, but maybe being 20 pounds overweight or whatever, I’m just making up numbers. I want to be very, very clear. Maybe being slightly overweight, but not being suicidal, not being manic, being stable in your life and your relationships, maybe that’s a trade that you would be willing to make if there wasn’t this unfair societal pressure, if there wasn’t this, this again, saying the Victoria’s Secret song like it’s now my anthem.
Dr. Nicole: [Laughter]
Gabe: Again. I know it was not written for me, but it really, really resonated with me. Plus, it’s good. You should look it up. Dr. Nicole. It’s a good song. It’s a good song. I’m sorry I had to sing it to you.
Dr. Nicole: I had never heard of it before, but I’m going to go look it up.
Gabe: It’s a good song. But. But the specific question that I have for you, Dr. Nicole, is if somebody is overweight, but they’re stable on their medications? Because we’ve been sort of framing this, you know, Gabe was 350 pounds overweight. We can all agree that’s not okay. That’s very, very dangerous. But if somebody is overweight but stable, is that a trade that you would encourage them to make or are you worried about their physical health now?
Dr. Nicole: It really depends. I mean. So, it needs to be a very individualized conversation. One person’s over might lead to increased blood pressure, hemoglobin A1C and blood sugars rising, lipid profile numbers rising for one person. Another person could do that and those numbers still look okay and they’re still okay. It really is just going to depend on what that means to that person. I have people who tell me I don’t care how much weight I gain. This is the best I felt, this is the most like mental stability I’ve had in years. So, I’m going to go talk to my PCP about something for hypertension and something for something for my lipids. And that’s a tough conversation to have. A lot of primary care doctors will then kind of push back like, well, don’t you think you just need to change your mental health meds? Because on the surface it does seem really silly to say to somebody, hey, I’m taking this medicine that’s causing me all these problems, but I want you to treat all those problems instead of changing the medicine. So, it’s a conversation that sometimes I have to have with the primary care doctor and say, hey, this person has tried 50,000 things and this is the one thing that’s made them not want to kill themselves and helps them get out of bed every day and stops them from being manic to the point that they’re going to go to jail.
Dr. Nicole: I feel like we need to support them on the other side, so sometimes we do have to support them on the on the other side, whether that’s medication to help curb appetite, whether that’s all the efforts, the nutritionist, the referrals, all the things to try to help make this better. But it’s very individualized. I have people who would much rather take a medication has low risk of weight, gain higher risk of mouth movements because they don’t care, they’re more concerned about their weight. And then somebody else would say, well, I just, you know, I don’t want the mouth movements. So, it just you just have to figure out for that person what’s their thing? What is it that bothers them the most? What side effects can they handle? I don’t think one group of medicine has a good side effect profile over another. I think they’re all just different and we just have to work with people on an individual basis to figure out for them what can they handle and what do they not want to deal with.
Gabe: And there’s that empowerment piece, right? You have to work with your doctor and find those and search internally and make those decisions and land on the right things. And even that’s not a guarantee. I don’t want anybody listening to think, oh, Gabe said, if I work really, really hard, I’ll absolutely get what I want. Unfortunately, the world does not work that way, and bipolar disorder certainly doesn’t work that way. And I did not succeed at everything that I did. I don’t have time to tell my whole weight loss journey, you know, in a in a short amount of time and a short podcast. But I had lots of setbacks, lots of dangers, lots of problems. I gained some of the weight back and then had to lose it again throughout the years. I’m chronically watching it.
Gabe: I still have eating disorder symptoms because again, this isn’t measured in perfection. I’m always leery that people are going to hear this and they’re going like, well, Gabe did it and he won. And he has no problems anymore. No symptoms, no setbacks. No, no, no. I’m going to I had a setback a month ago. I’m going to have a setback a month from now. Resiliency isn’t about not having setbacks. Resiliency is getting through the setbacks. I do want to ask you, Dr. Nicole, how do you work with those folks when they come to you and they’re like, hey, it turns out when I’m sad, I eat an entire sheet cake of pizza and that makes me feel better for a couple of days. What do you do? What’s your first step?
Dr. Nicole: My first step is I’m going into. I’m going into fix it mode and I’m going to try to figure out how in the world do we get you out of this deep sadness and is this sadness, depression that we need to adjust medication? Is this a situational kind of sadness? And you’ve just developed this coping skill over your life? That will determine how we do it. If it’s depression, we will look at medication, see if we can keep you from having a depression episode in the first place. If it’s something more related to upbringing, trauma history, the way you’ve learned to cope over the years, I’m going to definitely then have you work with someone, a therapist, to kind of help you during these moments. Medication will only take you so far. That combination together is sometimes what it takes. So that’s my first step. My first step is to figure out is this depression? Is this binge eating disorder? Is this just a bad coping skill that you’ve picked up over the years?
Gabe: And Dr. Nicole. Many people, myself included, were embarrassed about the amount of food that we eat, so much so that we I came up with ways to hide it. I wouldn’t go order a whole bunch of food at the local hamburger restaurant. Right? I would order a whole bunch of food and then three drinks. And that way they would think that this was food for three people. I would find myself ordering pizzas and literally I’d be completely alone in my house and I’d say things like what? Oh, yeah, yeah, yeah. We want breadsticks here. Yeah, we’re having a party. They didn’t even care. But I would find myself doing this as some sort of justification for how much food I was ordering. I think a lot of people do this, especially with binge eating disorder and in eating disorders in general. Does this phase you when somebody comes in and says, hey, I ate three large pizzas, I ate a sheet cake, does it do you think less of them? Do you judge them? Does it, does it even make your eyebrows raise?
Dr. Nicole: Gabe, I have heard, seen and smelled things that would surprise the majority of people on earth. There is very little a person can do or say that I am going to be surprised by. So, anybody out there who thinks that their psychiatrist is going to be fazed or going to look down on them, it’s in the DSM. Like you can’t be the only one because nobody just put it in the DSM because they just knew you were the only one on earth dealing with this issue. It’s an issue that a lot of people have. So, you’re not going to faze us one way or the other.
Gabe: Dr. Nicole, you know, I love hanging out with you, and I’m so glad that I could finally tell you that I used to be super morbidly obese. I know that you are. Someday I will show you the picture where I am the same size as one of those gigantic Vegas slot machines.
Dr. Nicole: Oh, my God.
Gabe: Is my friends’ favorite pictures, but it’s. It’s super embarrassing. So, I. I promise I will. You know, I might even use it as a cover art for this episode. You just never know.
Dr. Nicole: Wow. Okay. I am just still very impressed that you were able to figure out a plan, get the weight off. Even though you kept falling down, you kept getting back up. And here you are today. And I think that is the most inspiring part of this whole podcast episode. And the thing that I would like people to take away. One, it can be done. Two, there will be setbacks, but three, you can be successful in the end.
Gabe: All right, Dr. Nicole, we’re out of here. My name is Gabe Howard and I am the author of “Mental Illness Is an Asshole and Other Observations.” I’m also a worldwide public speaker who will travel anywhere you want if I am available. And listen, I wrote a book called Mental Illnesses and Asshole and Other Observations, and you can get a signed copy by heading over to my website at gabehoward.com.
Dr. Nicole: And I’m Dr. Nicole Washington. You can find me on all social media platforms @DrNicolePsych to see whatever in the world it is I’m doing at any given moment.
Gabe: And hey, everyone, Dr. Nicole and I need a big favor. Share the show. Share it on social media. Share it in an email. Share it in a support group. Hell, send a text. Sharing the show is absolutely how we grow. We will see you next time on Inside Bipolar.gabehoward.com
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