Why It's Harder for MDs to Lose Weight

Sarah Yahr Tucker

November 04, 2022

Katrina Ubell, MD, listened with growing skepticism as the dietician outlined her weight loss plan. "You're going to have to eat a snack in the afternoon," she instructed. Ubell refrained from rolling her eyes. The afternoon was in the middle of clinic. "I'm not ever going to do that," she tried to explain. "I can't."

Dr Katrina Ubell

"Of course, you can," the dietician insisted. "You shouldn't think that way. You get to decide."

"She wasn't wrong about that," Ubell concedes years later. But the well-meaning dietician couldn't understand the reality of life as a physician. As a pediatrician, Ubell could visualize how her afternoon would play out. "You're already 40 minutes behind. This mom needs to get home to get her kid off the bus. This mom, her toddler is losing his mind because he needs a nap. You're not going to say, 'Sorry, I need to eat some carrots and hummus.' "

Most of what the dieting realm recommends for weight loss, Ubell discovered, seems only relevant to people with a consistent 9 to 5 schedule. That was not her life. Neither was she looking for one of the many diet plans based on self-denial and will power. Having already lost and gained back 40 pounds several times, she knew these methods were not effective long term.

What were other overweight doctors doing? she wondered. Someone must know how to help doctors lose weight. But her Google searches revealed...nothing. No one was offering a useful diet or exercise plan specifically for physicians.

Ubell's search for answers led to the world of life coaching, and eventually she became a master-certified life and weight loss coach, working exclusively with women-identifying physicians.

The field is small. Very few weight loss programs are solely for physicians, whose stress levels, unpredictable schedules, and high-achieving mindset pose unique challenges. Among the constantly changing diet fads, few would likely work for the surgeon confined to an operating room for 9 hours at a time or the anesthesiologist who can't even manage to drink water during the workday.

Ubell set out to create a weight loss program rooted in the physical and mental demands of medical practice. In the process, she lost 45 pounds.

Step 1: Acknowledge That Doctors Are, Unfortunately, Human

Ubell's approach to food combines concepts from cognitive-behavioral therapy with personalized eating plans, coaching, and support from a community of doctors.

All of this stems from her own experience with emotional eating, which she says many doctors use to process their stress and exhaustion. This is a direct result, she feels, of needing to repress emotions while caring for patients but lacking guidance on how to manage those feelings outside of work.

"That kind of behavior, being what we call 'professional,' but really emotionally shut down, is prized and valued in medicine," Ubell says. "I'm not saying we should be open all the time. But we're not given any tools for what to do at the end of the day. In my case, it was eating. For other people, it's drinking more than they would like, spending money, gambling, basically just numbing behavior."

Ubell says only 20% of her work with clients revolves around what to eat. The other 80% is about managing the thoughts, beliefs, and emotions that negatively affect their lives, teaching them how to cope "without food as the crutch." Once the problems regarding eating are resolved, clients can begin to address all the problems they were using food to obscure.

"A lot of my clients really have to work on self-love, self-acceptance, self-compassion," Ubell says. "They're such high achievers, and often many of them think that they've achieved so much by being harsh with themselves and driving themselves hard. They think it's causal, but it's not. They have to learn, How can I be accomplished while being nice to myself?"

Step 2: Reassess Your Mindset

Ali Novitsky, MD, an obesity medicine physician and now full-time life coach, calls this attitude the "heaven's reward fallacy." Observed by renowned psychiatrist Aaron Beck, MD, this cognitive distortion involves imagining that hard work, struggle, and self-sacrifice must ultimately pay off, as if suffering entitles us to compensation in the future. For physicians, who are embedded in a culture of selflessness and dedication to the health of others, this often means forfeiting their own health and well-being.

Dr Ali Novitsky

For many, there is also a sense of secrecy and shame regarding health and fitness problems. As doctors, they are experts in the human body. They should already know how to lose weight. Right? And so not knowing or being unable to muster the will power for a diet plan while on call overnight or working 12-hour shifts feels like a professional failure as well as a personal one.

"As physicians, we're so afraid to fail," Novitsky explains. "It's more comfortable just to not know. Maybe we've failed before, or maybe we didn't get the result that we wanted, so now we can't bear to have that happen again. It's just way too painful."

Dr Novitsky focuses on weight-loss issues specific to the physician life.

Novitsky ― who has herself lost 50 pounds and have kept it off for 20 years ― provides weight loss, intuitive eating, and fitness programs for female physicians. Her evidence-based approach aims to optimize body composition rather than hitting a number on a scale. Conscious of the physician lifestyle, she offers night and weekend meetings, sessions that can be replayed, and even an "on-call workout" series designed for being in the call room.

Novitsky notices that many of her clients are stuck in an "all or none" mindset. If they can't do something perfectly with total commitment, they would rather not do it at all. With so many demands on their time and energy, something has to give, and putting their health first begins to seem selfish or hopeless. "I can speak to this," Novitsky admits, "because I did it to myself"

Like Ubell, Novitsky says that "most of the stuff we're coaching on is not about their food. It's about how they feel undervalued at work, how their relationships are suffering, how they feel super guilty as a parent. They feel like they look good on paper, but this is not the life they signed up for."

Step 3: Life Change = Physical Change

Siobhan Key, MD, an obesity medicine and family physician, sees her own weight loss struggle as a symptom of a former lifestyle that, frankly, "sucked."

Her grueling schedule and lack of self-care left her feeling stuck on a "hamster wheel" of work and family responsibilities. There was no space for herself. She craved the dopamine burst from junk food and felt powerless to stop reaching for Wendy's French fries as a frequent reward. It took realizing that she was on track to develop type 2 diabetes to motivate her to change.

Where she lived also affected her struggle. Living in the small community of Prince George, British Columbia, local weight loss programs were difficult for Key. It was likely that she would encounter some of her patients, which would not be a safe space to reveal her personal challenges. Searching for an expert who could explain how to eat healthy meals while on call and then working a full day afterward also yielded no solutions.

Unlike Ubell and Novitsky, Key still practices medicine. But she is also a weight loss coach. She takes an unconventional approach by not proposing any specific diet rules or plans. Dictating which foods you can or cannot eat is like trying to fit a square peg into a round hole, Key says. It will never work long term. Instead, she wants to help her clients use both their medical knowledge and life experience to make healthy eating fit into their lives.

"Let's stop doing things that makes our lives worse just to lose weight, because it will never be sustainable," says Key. "Rather, let's choose paths of losing weight and managing our eating that actually make our lives better. And those exist. They're just not the classic diet paths that we've been taught before."

Key's program also includes advice from other physician coaches on professional struggles. For example, charting is a big one, Key says. The pressure of completing patient notes, often outside of working hours, is a major source of stress that triggers a lot of eating.

Weight loss doesn't happen in a vacuum, Key points out. It isn't the simple "eat less, exercise more" equation that physicians learned in medical school. "The reality is, weight loss and eating happen in conjunction with the rest of your life," she says.

Find ways to make your life easier and the benefits will follow, she says. "As your life gets better, you feel more empowered. You feel less stressed. Your eating choices start to be simpler, and the cravings start to go down. You can't have one without the other."

Weight Is Just a Symptom of a Bigger Problem

Ubell, Novitsky, and Key all say they have seen dramatic transformations among their clients. They don't mean just physical ones. Ubell remembers an emergency medicine physician so miserable at work that she considered defaulting on her student loans. Novitsky recalls an anesthesiologist so insecure that she nearly passed up a scholarship to a fitness program. Key has seen clients so obsessed with what they should and shouldn't eat that food dominated their thoughts every free minute of the day.

All these doctors, the coaches say, have been able to regain a sense of control over their lives, rethink how they show up at work and at home, and even rediscover their joy in medicine.

These changes are less about body mass index and more about confidence and self-love. For weight loss to last, according to Ubell, Novitsky, and Key, there must be permanent mental shifts that redefine one's relationship with food.

"There's no finish line when we're talking about long term weight maintenance," Key tells physicians. "You have to be able to do it for the rest of your life."

For more news, follow Medscape on Facebook, Twitter, Instagram, and YouTube.


Comments on Medscape are moderated and should be professional in tone and on topic. You must declare any conflicts of interest related to your comments and responses. Please see our Commenting Guide for further information. We reserve the right to remove posts at our sole discretion.