What a specialist GP wants you to know about the myth of ‘eat less, move more’

Posted on 11 April, 2024

Dr Helena Morris has spent the last two years working on the front-line battling the prevalence of eating disorders in the ACT.

As a GP with a Masters in Public Health, Dr Morris spends part of her working week at the ACT Eating Disorders Clinical Hub, which is the centralised service hub for people suffering from a range of eating disorders such as anorexia, bulimia and binge-eating. She also sees patients at the Barton General Practice.

But since December, Dr Morris has fulfilled a professional desire to provide specific treatment to disordered eating of another kind – overweight and obese patients –through her new clinic, Renovo Health, based at the Barton General Practice.

“The last few years have led me to realise there is a huge cohort of untreated eating disorders in people with larger bodies which nobody pays particular attention to because they don’t suffer the high mortality rates of the underweight patients. These eating disorders go largely undetected and untreated.”

Renovo is a specialist service for those Canberrans who have tried everything to lose weight and never been able to make lasting change.

“I am dedicated to the medical management of weight and weight-related health issues and offer a variety of treatment options, working with clients to develop an individually tailored treatment plan to address each person’s specific circumstances.”

Dr Morris is one of the few clinicians in Australia to be SCOPE Certified in obesity management, and she knows that weight management is also hugely connected to mental health outcomes.

She says the science of body weight is far more complex than the accepted wisdom of “calories in, energy out”.

“If weight really worked like that, every diet and exercise programme people have tried would be successful. Countless studies over the past 50 odd years have shown the same result – ‘Eat Less, Move More’ simply does not work.”

Instead, Dr Morris says the body controls far more than the conscious mind.

“Body weight is the end result of the interaction of a number of complex hormonal and psychological systems that are autonomous; that is, you do not consciously control them. It is the same as many other bodily functions, like sweating. When you get hot, your body automatically produces sweat to help cool you down. You don’t have to consciously think ‘I’m getting hot here, might turn on my sweat glands!’”

“There are lots of hormonal systems involved in regulating aspects of your weight, from feelings of hunger or fullness to your resting metabolic rate and how your body stores or uses fat. When it comes to trying to lose weight, these systems have a far greater say than if you simply diet or join a gym.”

Unfortunately, for people who have lived a life in constant battle with their weight, the frustration, confusion and failure to lose weight can take a heavy emotional toll.
Since starting Renovo, Dr Morris has seen numerous patients who report feeling extreme distress in their relationship with their body, and her mental health counselling experience is required during consultations.

“Yes, there are often tears.”

One of the things that concerns her is the length of time most Australians take to seek medical intervention over long-standing weight issues, which is three years longer than the international average.

“For reasons of stigma and barriers around weight in Australia it takes almost nine years for someone to seek medical help. I really want to help change that and create a place to help people find a path forward, before they hit rock bottom.”

Dr Morris approaches weight management in two distinct phases–treatment and maintenance.

The treatment phase is undertaken in long consultations (unlike standard GP visits) in which she studies a detailed medical history to determine all the potential background factors to weight gain. Many patients will require blood tests focussed on hormonal and metabolic health, and to identify if there are any specific medical conditions that could be affecting weight. Sometimes, Dr Morris has to address trauma-based reasons for body weight which can require further specialist psychological support.

Each treatment plan is made in collaboration with the patient and must be sustainable. Then she supervises the move into the maintenance phase.

“Most diets and exercise programmes ultimately fail because they are too restrictive and cannot be kept up long term. This is why you see so many ‘12-week programmes’ because nobody can keep it up past 12 weeks. And as you now know, once you stop your body takes you right back to where you started.”

While Dr Morris does believe that all weight can be managed to allow people to live full and healthy lives, she says there is no getting away from the fact that “lasting weight loss requires lifestyle changes.”

This is even the case after bariatric surgery, which sadly has a high percentage of patients who regain most of their pre-surgery weight.

“But lifestyle changes do not have to hurt. We won’t be forcing you to give up food groups forever. You won’t have to run marathons. You won’t even be on a diet for the rest of your life. We will help you to be much more aware of the real causes of weight gain and help you to learn habits to avoid them. You can have the exact same type of life as you had before treatment, but with a much higher quality of life and health.”