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

Stephen Gullo, PhD: 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.

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Larry Hobbs: What percentage of people have compulsive eating problems?

Stephen Gullo, PhD: 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."

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

Stephen Gullo, PhD: 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.

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Larry Hobbs: What are the most commonly abused finger foods?

Stephen Gullo, PhD: 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.

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Larry Hobbs: Do you use food diaries?

Stephen Gullo, PhD: 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.

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Larry Hobbs: What is an "Eating Print"?

Stephen Gullo, PhD: 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.

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Larry Hobbs: How do you break this pattern [of people abusing 3 or 4 trigger foods in 3 or 4 trigger situations and 3 or 4 trigger behaviors]?

Stephen Gullo, PhD: 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.

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Larry Hobbs: Why do you rely on "boxing techniques"?

Stephen Gullo, PhD: 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 [and thus, the title of my book is Thin Tastes Better.]

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Larry Hobbs: What is "foodie-ism"?

Stephen Gullo, PhD: 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.

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Larry Hobbs: You told us about the most common trigger foods, but what are the most common trigger situations?

Stephen Gullo, PhD: 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.

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Larry Hobbs: Do you ever substitute foods for trigger foods?

Stephen Gullo, PhD: 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.

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Larry Hobbs: How do you help patients deal with cravings?

Stephen Gullo, PhD: 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.

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

Stephen Gullo, PhD: 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.

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

Stephen Gullo, PhD: 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.

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Larry Hobbs: What is the "F-Q Principle"?

Stephen Gullo, PhD: 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.

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

Stephen Gullo, PhD: 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.

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Larry Hobbs: Explain "tomorrowisms".

Stephen Gullo, PhD: 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.

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

Stephen Gullo, PhD: The Hellers [Rachael and Richard Heller], authors of The Carbohydrate Addict's 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?

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Larry Hobbs: Do many patients negotiate with you about foods?

Stephen Gullo, PhD: 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.

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Larry Hobbs: Do you treat children?

Stephen Gullo, PhD: 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.

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

Stephen Gullo, PhD: 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".

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Larry Hobbs: What are some of your favorite slogans?

Stephen Gullo, PhD: 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".

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

Stephen Gullo, PhD: 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."

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Larry Hobbs: Do you have patients weigh themselves?

Stephen Gullo, PhD: 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.

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Larry Hobbs: What is a "calorie unit"?

Stephen Gullo, PhD: 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.

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Larry Hobbs: What is the "new scale"?

Stephen Gullo, PhD: 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.

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

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

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Larry Hobbs: Do you give exercise advise?

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

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

Stephen Gullo, PhD: 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.

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Larry Hobbs: How do you feel about prescription diet pills?

Stephen Gullo, PhD: 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 eating-control skills increase.

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When do recommend your weight loss patients use prescription diet pills?

Stephen Gullo, PhD: 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.

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In an interview I did with the very successfull Stephen Gullo, PhD, author of Thin Tastes Better, he said that cravings are very predictable and will pass within about 12 minutes. He also said that you can prevent cravings by eating every 3-4 hours. Here is the section of his interview where he talks about cravings. Read the entire article | 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. Read the entire article | Email this article