2. Personal Dietary Disclosures:
– I have tried and failed Weight Watchers, low fat diets, and found
personal success with LC diets and IF
Personal Financial Disclosures:
– I work as the medical director of a practice that supports patients
with low-carbohydrate dietary approaches
www.doctortro.com
– I am the co-host of a podcast which accepts ABSOLUTELY ZERO
payments from commercial interests
www.LowCarbMD.com
Family Financial Disclosures:
– My wife is the founder of a company that sells low-carb, no-sugar
baking mixes
www.RosettesMix.com
Financial & Personal Disclosures
3. Our Clinical Team
Dr. Tro Kalayjian is a board-
certified physician practicing
internal and obesity medicine,
with a focus on diabetes,
hypertension and lipid
management.
Dr. Tro Kalayjian, MD
Medical Director
Dr. Laura Buchanan, MD, MHP
Physician
Amy Eiges
Program Director,
Health Coach
Brian Wiley
Health Coach
Dr. Buchanan is a third-year
resident at Wake Forest. She is
a certified metabolic health
practitioner (MHP) and a founding
member of the Society of Metabolic
Health Practitioners.
Amy Eiges is a certified health
coach and reformed chronic dieter
who is passionate about helping
others recover from the diet-binge-
gain-shame cycle
she struggled with for years.
Brian Wiley is a certified health
coach who has struggled with
food addiction and battled with
obesity for most of his life.
4. Our
values
Our
vision
Our
mission
To provide unmatched medical care that reverses and prevents diabetes
and obesity in as many people as possible by employing an integrative
medical approach that relies on health coaching, real-time biometric
monitoring, asynchronous education delivery and social support in the
form of an online, interactive community.
A life that is free of diabetes, obesity and metabolic disease.
We are bold and inventive in our approach to medical care.
We act with experience and understanding.
We are honest and human first.
We are dependable and make ourselves accessible, so our patients succeed.
6. Understanding the Obesity Trap
– Patients who suffer from obesity and/or food addiction blame themselves
– Corporate, medical and wellness messaging have enforced that weight loss is due
to discipline/willpower, and weight gain is due to lack of discipline/willpower.
“I just need more willpower,” “I just couldn’t do it,” “I already messed up, so I figured
what’s a little more,” “I’ll start again Monday...next month...after New Years”
– Yo-yo dieters are more likely to fall for the “blame yourself” messaging since they
have had several successful attempts which they often attribute mistakenly to their willpower, and
their subsequent tribulations to their lack of willpower and lack of discipline. “I keep falling off the wagon,”
“Last time I counted my macros perfectly,”
“I just wanted it,” “It’s me,” “It’s just how I am”
7. Understanding the Obesity Trap
– Patients with food addiction don’t have insight into what their journey needs; they are
a vulnerable population
– Weight loss and dieting attempts reliably cause increased hunger, cravings, feelings of deprivation. “Every
time I diet, I crave ice cream,” “I just can’t do it,” “I am a chocoholic”
– Most patients are not prepared to deal with this hunger. Furthermore, they don’t have
the tools to manage social situations, business meetings, vacations. “After vacation, I just
couldn’t get back on track,” “I was planning on eating a salad, but they had pizza at my gym”
– Given patients are hungry, have intense cravings, and feel deprived, and given that many
are not prepared to manage social situations, holidays, and vacations, they inevitably fail
– The failure results in an excess of self-blame, often guilt/shame, and very little
introspection, insight, or growth
8. Hunger, Cravings, Feeling of
Deprivation, Inability to
Manage Social Situations,
Vacations, Holidays
Loss of Control, Binge
Eating
Shame, Guilt, Powerlessness,
Excessive Self-blame, Learned
Helplessness
Unaware of food
addiction, myopic focus
on willpower, counting
calories, points, etc.
Inability to successfully
implement lifelong,
sustainable behavior
change
Weight Gain
Another Attempt to
“Diet” or “Lose
Weight”
Understanding
The Obesity
Trap
9. Profiteering Supplement
Industry
Incompetent
Wellness
Practitioners /
Nutritionists
Ignorant Medical
Providers
Dogmatic
Dietitians
Processed Food
Companies /
Restaurants
Weight
Gain
Personal Trainers
with no
nutrition training
Hunger, Cravings, Feeling of
Deprivation, Inability to
Manage Social Situations,
Vacations, Holidays
Loss of Control, Binge
Eating
Shame, Guilt, Powerlessness,
Excessive Self-blame, Learned
Helplessness
Unaware of food
addiction, myopic focus
on willpower, counting
calories, points, etc.
Inability to successfully
implement lifelong,
sustainable behavior
change
Weight Gain
Another Attempt to
“Diet” or “Lose
Weight”
Understanding
The Obesity
Trap
10. Culture &
Traditions
Habits
Conditioning
Social Triggers
& Sabotage
Poor Mental
Health
Costs &
Resources
Societal
Norms
Understanding
The Obesity
Trap
Supplement
Industry
Wellness
Practitioners /
Nutritionists
Medical Providers
Dietitians
Processed Food
Companies /
Restaurants
Weight
Gain
Personal
Trainers
Hunger, Cravings,
Feeling of Deprivation,
Inability to Manage
Social Situations,
Vacations, Holidays
Loss of Control,
Binge Eating
Shame, Guilt,
Powerlessness, Excessive
Self-blame, Learned
Helplessness
Unaware of food
addiction, myopic
focus on
willpower,
counting calories,
points, etc.
Inability to
successfully
implementlifelong,
sustainable
behavior change
Weight
Gain
Another
Attempt to
“Diet” or “Lose
Weight”
12. Let’s juxtapose our relationship to food and our desire for a healthy lifestyle,
with other things that require attention and upkeep.
*Emotions *Logic *Outlook *Self-Advocacy *Tenacity
Food & Health Car
Understanding the Hallmarks of
Food Addiction
Money
13. Food & Health Money
Car
Angry – leave my alone
Agitated – I know what I am doing
Ashamed – I am a grown man/woman
Stubborn – I can make my own choices
Defiance – Don’t tell me what to do
Gratitude – Thank you
Supported – You’ve got my back
Loved – You love me
Cared For – Thanks for caring
Gratitude – Thank you
Supported – You’ve got my back
Loved – You love me
Cared For – Thanks for caring
*Emotions *Logic *Outlook *Self-Advocacy *Tenacity
Understanding the Hallmarks of
Food Addiction
Will a nutritional
program explain these
differences?
14. Food & Health Money
Car
This logic/outlook is pervasive:
– We shouldn’t waste food
– You’re eating to solve world hunger?
– I have been on plan, I deserve a treat
– You deserve health
– I have been off plan, a little more wont hurt
– How can both be true?
– I screwed up, so I will keep eating this way
over the weekend, I will start again on Monday
Nobody has this logic/outlook:
– I have been driving so well, I deserve to
smash some windows & stab some tires?
– I have so many speeding tickets, a couple
more won’t hurt?
– I have gotten so many flats this month, a
couple more can’t hurt
– I got a flat, so I will smash the windows,
stab my other tires & I’ll call AAA on
Monday
Nobody has this logic/outlook:
– I spent a little more than I
wanted to this week, so I will
make it rain at the ATM, go on a
shopping spree and call the
accountant on Monday
*Emotions *Logic *Outlook *Self-Advocacy *Tenacity
Understanding the Hallmarks of
Food Addiction
Will a nutritional
program explain these
differences?
15. Understanding the Hallmarks of
Food Addiction
Food & Health Money
Car
Lack of Self-Advocacy:
– We are often not prepared for when
willpower fades…
– We go back to Weight Watchers, counting
calories, counting carbs
– We go back to making ourselves hungry, and
feeling deprived
– We do not address the root cause in as close
to real-time as possible…
– We accept “eat less, move more”
A high degree of Self-Advocacy:
– Our cars can literally drive themselves for
when we are distracted
– Real-time alerts about our tires, engine,
oil change
– We have embedded spare tires, triple
AAA services, On-Star, warranties
– If we reached out for help and were
blamed/shamed and told to drive better
& fill more air into our tires than we let out,
we would demand BETTER help.
A high degree of Self-Advocacy
– Our bank accounts have fraud
detection, alerts, minimums and
maximums
– We have real-time apps to see our
situation and make better
choices
– If something was wrong with our
bank account, the teller wouldn’t
tell us we must “make more money
than we spend”, and if they did, we
would demand BETTER help.
*Emotions *Logic *Outlook *Self-Advocacy *Tenacity
Will a nutritional
program explain these
differences?
16. Money
High Resilience/Tenacity:
– I need to fix this NOW
– There is no NEXT WEEK
– Nobody would be allowed to
shame and blame us
– We would demand the help we
need
– Trouble shoot with mechanic if
the issue is still ongoing
*Emotions *Logic *Outlook *Self-Advocacy *Tenacity
Understanding the Hallmarks of
Food Addiction
Food & Health Car
No Resilience/Tenacity:
–“F-ck it, I will keep eating off plan and start
again next week”
– Next week, never comes
– Stuck in shame/guilt, self-blame so further
help and tools aren’t cultivated
– Tendency to withdraw, suffer in secret, not
seek out help
High Resilience/Tenacity:
– I need to fix this NOW
– There is no NEXT WEEK
– Nobody would be allowed to shame and
blame us
– We would demand the help we need
– Trouble shoot with mechanic if the issue is
still ongoing
Will a nutritional
program explain these
differences?
17. Food Addiction can fundamentally
MANIPULATE:
– Emotions
– Logic
– Outlook
– Self-advocacy
– Mentality
What makes food EVEN HARDER than alcohol,
cigarettes or other addictions?
– We need food to survive. Every cell needs protein,
fats, vitamins and mineral to survive!
– In fact, many people with obesity are nutritionally
deplete,
– Low vitamin D, low vitamin C, low
folate, low B12
– This is an addiction that we CANNOT abstain from,
and we HAVE TO LEARN to manage
– Our cultural and societal norms promote eating
– Gesture of kindness, romance
– Something to enjoy and celebrate
– Social scenarios, business meetings,
parties, vacations all revolve around food
– A stress-coping mechanism
Understanding the Hallmarks of
Food Addiction
19. Food Addiction Management
Education & Counseling
– Education & counseling are the cornerstone of management
– Patients need to understanding the various drives to eat: biologic, social, personal, cultural
– Dieting will not change your childhood memories of Grandma’s apple pie
– Dieting will not change the way our society gets together daily to eat dinner
– Dieting will not change cultural foods and societal norm
Unbiased Feedback
– The role of health coaching and counseling is so critical to maintain the lifelong journey
– Given the emotional and psychological issues intertwined with eating, it is important to
get outside feedback
– AA uses sponsors
– Our practice uses empathy and health coaches
20. Food Addiction Management
Community & Support
– The tendency for those with addiction is to withdraw and suffer alone
– Having a community/tribe to strategize, uplift, provide hope and support is critical
to breaking out of the isolating obesity trap
Tenacity & Resilience
– Patients need to cultivate the need for a lifelong journey, with a lifelong commitment
– Their drive to eat will NEVER completely disappear much like the drive to breathe or urinate!
– People can hold their breath or hold their urine for a finite period, eventually nature calls!
21. Food Addiction Management
– Like an alcohol or drug dependence, food addiction is not going away, but can be
effectively managed.
– Perfection is the enemy of the good: manage food addiction, don’t waste time and energy
trying to cure it.
– Respect the brain's ability to seek the rewards it so richly believes it deserves. There is
no diet, no matter how healthy, physically satiating or well-constructed, that the brain
will not work overtime to manipulate, sneakily looking for a loophole in which to get its
way.
– The first step is building an awareness of what you are up against and how food
addiction will manipulate everything one knows to be true in order to get its way.
22. Food Addiction Management
– Take an honest self-assessment of problem foods, situations, people, places and times
of day. Once a list of triggers has been identified, systematically build up defenses to protect and
support health goals. Prepare for the worst day, not when motivation is high,
and things are easy!
– The specific defenses needed will change day to day or even hour by hour, but very often
this will require eating more, not eating less. Diet culture and the failed model of “eat less,
move more” diet-brain advises over-restriction, but this has never worked in any kind of
sustainable way.
– Eat more of the low carb foods that don’t cause residual hunger -> eat to satiety so hunger
and cravings are satisfied in ways that meet health goals and after the stressors/triggers pass, go back
to “being good”
– Have low carb/low sugar replacements foods available for all the foods that are difficult to
restricting
– Once you have effectively stayed low carb for long enough it will be easier to buy some
time - distraction and distance are helpful tactics to avoiding a binge
23. Food Addiction Management
– Be aware of the ways hyperpalatable processed foods (even the low carb versions)
can cause one to eat more
– These processed low-carb foods are an effective tool to help remove high carb foods
from diet, but can trigger food addiction; the first line of defense is to remain full from whole foods
– Connection. The opposite of addiction is not abstinence, but connection. Reach out to a
community of like-minded people, a sponsor or trusted friend; vulnerability is scary,
but it leads to growth
– Pay close attention to how foods feel in the body. The food addicted brain will tell us to “just
eat one” or “Grandma made this just for me,” but our body will tell us otherwise: that it is nearly
impossible to “just eat one” or that we get an upset stomach, headache or insatiable cravings when
we eat certain foods. Listen to these messages.
– Avoid the judgment and shame spirals that keep us isolated and stuck in the addiction cycle.
24. Keep it Simple
– Are carbs low enough?
– Are you snacking, or eating more frequently?
– Are you adding fats to your meals?
– Are you regularly exercising?
– Would PSMF or Extended Fasts be
appropriate?
– How is your stress and overall mental health?
– How is your sleep?
– Are there any other underlying factors that
you need to review with your medical team?
Medications, Surgery, etc.
Lifestyle Management
25. Our expert team understands the
challenges of food addiction and
metabolic disease firsthand. We will
advocate for you no matter what and
show you that it is possible to overcome
your challenges. It's never too late to
make a positive change.
We are a leader in telemedicine with a
novel research driven approach to weight
loss that is published and peer reviewed.
Our Physicians and Health Coaches will
work with you to create a strategy for
you to meet your goals using the
most up-to-date research, data and
guidelines.
Our practice is compassionate and
judgment-free with dedicated support
from our entire team. We will make sure
you understand that you are not to blame
and educate you on how to sustain
positive lifestyle changes for optimal
wellness.
We’ve
Lived It.
Our Approach is
Evidence-based.
Small Practice. Big
heart.
Empathy is the missing ingredient…
26. Our expert team understands the
challenges of food addiction and
metabolic disease firsthand. We
will advocate for you no matter
what and show you that it is
possible to overcome your
challenges. It's never too late to
make a positive change.
We are a leader in telemedicine with
a novel research driven approach to
weight loss that is published and
peer reviewed. Our Physicians and
Health Coaches will work with you
to create a strategy for you to meet
your goals using the most up-to-
date research, data and guidelines.
Our practice is compassionate
and judgment-free with
dedicated support from our
entire team. We will make sure
you understand that you are not
to blame and educate you on
how to sustain positive lifestyle
changes for optimal wellness.
24-Week
Medical
Weight Loss
Asynchronous
Education & Social
Community
Small Groups to
Sustain Your
Lifestyle
A different program…
Patients start learning before
they reach their first
appointment. We get patients
started in real-time with
education and engagement on
our app, as we onboard them
medically, and get them
connected with our health
coaches.
Introductory Video
Series & unique
App
