Bill B: We need to bring this to a close, And every time we need to bring it to a close by quoting Perry.  We just got to keep sinking so that people get so fed up with it that they demand change!  Somewhere it has got to get darker so that the light can begin to shine. At some point, people are going to say: “I’m not going to put up with this anymore!” Is that a fair and accurate quote?

Perry: I think that it is true.  We have to get to a certain crisis level before people will actually respond.  However, I will share something about obesity. I took an advanced nutrition course. This savvy nutritionist noted that there is one thing we should remember when talking about nutrition and diet and when treating obesity. The old man who wouldn’t eat beets when his mother told him to is not going to eat beets when his dietitian tells him to.  Behavior change is real hard.

Mitch: But if you tell him that this increases the nitro-oxide more than the drugs we take for increasing nitric-oxide then you might have a better impact.   The pharmacology of nutrition is compelling . . .. [laughter]

Perry: You have to hit the right motivators.

Jeremy: If you tell them that it might make their wrinkles do away, then you might get some positive results.

Bill B: Well I recall one thing I have mentioned in a previous session.  I had a physician who was helping me deal with the issue of weight.  I went to her office in fear. I was supposed to lose weight but hadn’t done so.  I didn’t even want to see my physician. I was embarrassed.   I revealed to her that I had not lost weight. She then said: “but you didn’t gain weight.  So lets explore what you are doing that has enabled you not to gain weight. Maybe you can use that strategy to lose weight.”  She got me!  I could not do the guilt trip. She was being appreciative. You know, you are doing something right.  Let’s figure what it is and find ways for you to do it more.  So, what can physicians do to motivate? Does it help if they are appreciative and encouraging? What can you [the patient] do to break out of the usual patterns of guilt and remorse? You eat more food because you are ashamed of your weight.  It gets into this repetitive cycle. Alternatively, you can be an agent of change (as several of you have suggested)>

Jeremy: I want to thank Bill G. for bringing up such a large topic.  I like that we are taking on these enormous, systemic, societal challenges. I think one of the frustrations for anyone who is providing direct clinical services is trying to teach something quite challenging to those who are going to be providing these services in the future. We are conveying some hope while also conveying the sense of overwhelm regarding societal issues that are making it difficult for the therapeutical windows to open up.

Bill B: Most importantly, we all have to move to Europe. Next month we will all be eating in a beautiful restaurant somewhere outside Paris, after everyone has departed from the Olympics.  We will all grow thin and happy.

Bill G: In Amsterdam, we can all go to the coffee shop and buy our butter-filled pastries.