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Episode 12. Today on the podcast, I got to talk to my very dear friend and incredibly talented colleague Dr. Sapna Doshi.
Dr. Sapna Doshi is a licensed clinical psychologist and owner of Mind Body Health. Dr. Doshi earned her Ph.D. from Drexel University and completed her internship at Duke University Medical Center. In 2015, she opened her private practice, Mind Body Health which now operates in Arlington, VA and Washington, DC and is staffed with 25 psychologists and dietitians. Mind Body Health specializes in providing evidence-based treatment in the areas of eating disorders, insomnia, obesity, chronic pain, anxiety disorders, and mood disorders.
What We Cover
- What is the field of clinical health psychology doing well?
- Where are we missing the mark?
- How can people balance working on improving their relationship to food and their bodies when they have difficulty letting go of weight loss as a goal?
Health at Every Size and Intuitive Eating
Dr. Doshi talks about the positive effects of the Health at Every Size movement and Intuitive Eating as an alternative approach.
We also discuss a controversial topic which is the effect she and I have seen where some members of a social movement can come across as shaming to others.
She talked about the environment she has created within her practice where they can have conversations between professionals that are respectful, even if they ultimately disagree. This has created a community where collaboration and focus on the client remains the top priority.
Striking the Balance Between External Suggestions and Internal Cues
Dr. Doshi talks about the balance and difficulty of this in the real world. She discusses her own personal experience with having a diagnosis of small intestinal bacterial overgrowth (SIBO) and how challenging it is to tune inwards while having to avoid certain foods she enjoys.
Considerations for the Body Mass Index in South Asian Community
Dr. Doshi talks about her experience as a South Asian woman growing up in the United States. We also talk about her dissertation research and the fact that South Asian women on average actually have higher body fat percentage at a lower body mass index (Doshi, 2012). So again we see the limitations of the body mass index in actually predicting health.
She also discussed a finding from her dissertation that more cultural conflict (that is, more conflict between the South Asian and standard American culture) was associated with higher levels of disordered eating (Doshi, 2012).
Ways to Improve Cultural Adaptations to Improve Care
Dr. Doshi shares a story of her experience being told how to treat her SIBO and the lack of cultural adaptation and flexibility in the standard medical approach.
She also shares about the fact that South Asians are underrepresented in the mental health field. Therefore, it’s important to work towards increasing diversity in different health professions.
Why Does Behavioral Weight Loss so Often Fail?
We talked about our experiences with behavioral weight loss trials, and ways in which we were part of methods that were ultimately rarely successful long-term.
“Deprivation is not a state we can constantly be living in.”
Dr. Sapna Doshi, PhD
She also discusses the fact that prior weight loss attempts can sometimes be romanticized, leaving people to forget the negative and focus on all the positive (e.g., “I think I was happy… I must have been, I was thin!”)
Is Long-Term Weight Loss Possible? What Do We Know?
We talked about the National Weight Control Registry. This is a registry for people who have lost at least 30 pounds and kept it off for at least a year, though on average they have lost more weight and kept it off longer than that (Thomas et al., 2014).
What Have We Learned from this Registry?
- Regularly active
- Modifying their eating in some way
- Most eat breakfast regularly
- They aren’t watching a ton of television
What are We Not Considering When We Look at These Folks?
- Are they obsessing about food and preoccupied with it?
- Are they depressed or anxious?
- How is their quality of life?
We want to be incredibly cautious generalizing the findings from this research. That is, first the sample is incredibly small and there are many reasons to question whether this could apply more than a small subset of folks. Additionally, more research is needed before we can truly understand if folks are really feeling freedom and peace with their relationship with food before we glorify this outcome as “success” just because they are maintaining some degree of weight loss.
Let’s Talk Outcomes
We talked about how rare it is for us to work with folks who lose a significant amount of weight and keep it off in her individual work. She talks about her focus on helping people navigate their relationship with food and their body and viewing weight loss as more of a secondary outcome or byproduct of their work together.
We cover the following strategies:
- Challenging all-or-nothing thinking
- Making goals of cooking more at home, but not in an all-or-nothing way and having more control over what you put into your body
- Stress management
- Avoiding meal skipping
- Looking for ways to enjoy the process
- Finding ways to cope with emotions other than eating
Themes for What Works
- Less restriction, what to add
- More flexibility and sustainability
- Less deprivation
- Focused on learning and growth
How to Turn a Should to a Want To
We talked about how Sapna turned staying on top of her work from a “should” to a “want to.”
- Tackling the task and confront avoidance
- Moving away from perfectionism
- Shifting from thinking “I should do this” to “I want to do this because it will make me feel better.”
- Integrated into her value to take care of herself and have more freedom and joy, not less
References
Doshi, S. (2012). An Investigation of Motivations Associated with Eating and Weight Concerns Among South Asian and European-American Young Adults. [Dissertation, Drexel University].
Thomas, G. Bond, D. S., Phelan, S., Hill, J. O., Wing, R. R. (2014). Weight-Loss Maintenance for 10 Years in the National Weight Control Registry. American Journal of Preventive Medicine, 46, 17-23.
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Disclaimer: This blog and podcast is for informational and educational purposes only. It is not a substitute for individual professional advice or treatment, including medical or mental health advice. It does not constitute a provider patient relationship.