“I can’t. I won’t. I shouldn’t. I want to.”

I often wonder what to say to my patients who have a legitimate story about why they won’t, can’t or shouldn’t follow health advice. One example was a man who was a holocaust survivor. When I was recommending to him to curtail his portions, he looked at me and said, “I was starved almost to death in the Holocaust and then I had no money to eat and now FINALLY I have enough money to give myself whatever my heart desires. But you’re telling me I can’t or shouldn’t have an abundance of carbohydrates. I’m 80 years old, what do I care”. So, my fellow readers, what would YOU say to that? He obviously has a valid argument. I simply tell him what I would tell anyone else: do not omit, just modify. Why open yourself up to a slow demise, complications that make you miserable? Instead, give yourself all you want – in moderation!

Another woman came in with uncontrolled diabetes and was looking to lose about 100 or more pounds. “I will not diet or cut out my favorite foods and I have trouble saying no to a food when it is in my house”. I gave her options: she can have bariatric surgery to physically make her stomach smaller, or she can modify (there’s that dirty word again). Her husband was sitting next to her, nice and thin and in shape. “Do you need those foods in your house to tempt her?”, I asked. “No”, he said. He turned to his wife¬†of 50 years and said, “I will work with you. We will only bring foods into this house that can help you reach your goals”.

The couple left and I made sure my patient knew I was there for her by phone, email, or next appointment and her husband would support her too. That’s how we succeed.