Bill B: So, let me just comment.  As a psychologist I would suggest that there is something else in that large drink other than sugar. It is caffeine.  My colleague and former Vice President John Preston, who ended up being a best-selling author, in the areas of depression and psychopharmacology, developed a list of levels of caffeine in all of the Starbuck drinks.  I have since revised his list.  As a psychotherapist, John told other therapists that before you start working with your client, you need to look at their level of caffeine intake every day.  It relates to what Perry was talking about regarding stress.  If their intake of caffeine is very high, they won’t be able to handle the stress that is going to come from psychotherapy.  So, before you start doing therapy with someone who consumes a large amount of caffein each day, you need to help them reduce their level of caffeine intake. Since then, when I am doing work with people who do coaching, and have published quite a few articles on coaching,  I do the same thing. I suggest to people who are doing coaching that one of the first things they ought to do is administer the caffeine checklist to their coaching client. If their client’s caffeine score is very high then the first thing the client needs to do is reduce that intake because they are going to become trigger-happy.  So, it is very powerful. You are talking about the sugar levels.  We also need to consider the caffeine that is involved. And what happens to people who are caffeinating themselves?  I was thinking that the list of some of the drinks that Starbuck offers includes drinks with an unbelievable high level of caffeine.

Perry: Bill, you raise an important issue. Caffeine is a big one with regard to what we consume.  In the olden days it was just drinking a lot of coffee,  but now it is energy drinks –five hour energy.  I have been essentially immune to caffeine. Caffeine never worked for me.  It doesn’t keep me awake. A cup of coffee makes me sleepy.  What we don’t talk about is sleep. Everything I have read about during the last decade suggests that sleep deprivation plays a major role in fat metabolism and satiety.  I know for myself that I was often eating to stay awake while working for long hours. I wonder now that many of us are retired and are starting to sleep the number of hours we are supposed to sleep. We might start losing weight like I did simply because I wasn’t eating to stay awake.

Bill B: was this common with physicians?  Is this one of the specific pathologies of physicians?  You work long hours and keep awake with caffeine.  Are you modeling bad behavior as physicians?

Perry: Physicians are terrible role models as a population! Do as I say, not as I do. [laughter]

Bill B: As a psychologist, I would say that which you are doing bad is that which you are ignoring with other people.  Are you less likely to encourage people to get off caffeine because you yourself are heavily dosed with caffeine.

Bill G: that is a good point about the physician community being able to address these challenging issues. It is going to be a very hard sell regarding obesity being defined as a chronic illness on every registry.  Physician heal thyself.  The medical associations suggest that you really need to accept some agency for your own lifestyle—particularly around obesity and other metabolic disorders.