It usually starts with a date on the calendar.
The medical conference. The class reunion. The trip where you’ll see people you haven’t seen in a year. You count backward, do some quick math, and land on a number you need to hit. And for a week or two, you’re locked in.
Then life happens. You get sick. You’re up all night with a sick kid. You have the kind of clinic day where the only thing that gets you home is a drive-through. And one off day quietly becomes the end of the whole thing.
If that’s a pattern you know by heart, you are going to want to hear my conversation with Brian Baumal on this week’s episode. Brian is a registered psychotherapist in Toronto who works with weight management and disordered eating — and who has managed his own relationship with food and his body for years. He’s not coming at this from theory. He’s been in it.
The chain reaction nobody names
Brian has a simple way of explaining why “trying harder” keeps failing. It goes like this:
Shame → wanting it fast → all-or-nothing thinking → failure.
Most of us only see the last two steps. We set a fast, big goal. The first slip-up feels like total failure. We quit.
But Brian points to the very first link in the chain, the one we skip right over: shame.
Why do we want the weight gone yesterday? Not for our cholesterol. Brian said something that landed hard: your better blood pressure doesn’t stop the comment from your insensitive uncle. Your friend doesn’t know your numbers improved. The world still looks at your body and makes remarks.
So we rush to outrun the shame. We rush so the clothes fit by the trip. We rush so we’re not the one who feels biggest at the table. And rushing is exactly what sets us up to fail.
“It’s not shame. It’s just a fact.”
Here’s the part I see all the time with the people I work with. When I name the shame, they don’t always recognize it as shame. It doesn’t feel like shame. It feels like a plain fact.
It’s a fact that I always fail. It’s a fact that I’ll gain it back. It’s a fact that after three weeks I fall apart.
Brian made a great point about this. You can’t argue someone out of a “fact.” If you tell them “just think about it differently,” they’ll tell you that’s the whole problem — it’s not a thought, it’s reality. And they’ll win that argument every time, because to them, it’s lived experience.
So he doesn’t argue. He gets curious. Instead of “let’s fix that thought,” he says, “tell me more about what’s going on for you.” That one shift — curiosity instead of correction — is the whole game.
The fix is way simpler than you think
Here’s where I leaned in.
Brian’s first step isn’t “change your diet.” It isn’t “cut this out” or “swap that.” His first step is to slow you all the way down and have you plan only two things: when you eat and where you eat.
Not what. Not how much. Just when and where.
And you plan to eat the way you already eat.
So if you know Sunday is a shift and the only food around is the hospital cafeteria, you plan the exact thing you always get there. If you know Saturday is your aunt’s place and she makes the best brownies on the planet, you plan to have the brownies. You write it down with zero pressure to be “good.”
Why on earth would that help? Because it takes the restriction out. It stops the panic of “I have to overhaul everything.” And it lets you start seeing your patterns — not just what you eat, but the situations you eat in.
Catching shame in the act
Once you’re tracking, Brian watches for one thing. He calls it shame driving the bus.
You slip from even this loose plan. Watch what your brain does:
- “Well, I blew it.” → shame is driving the bus
- “I might as well toss the whole plan now.” → shame is driving the bus
- “This always happens to me.” → shame is driving the bus
And the truth? You didn’t fail. You just ate the way you’ve always eaten. As Brian put it, that’s a perfectly fine place to start.
Then something quietly shifts. After a few weeks of writing down the same donut, the same run to the cafeteria, you start to feel the absurdity of it — and that’s when the urge to change shows up on its own. Not because you forced it. Because you got ready.
This is a long game, not a race
One more thing from Brian that I think every physician needs to hear.
He’s been at this for years. And he told me, plainly, that he’ll never again be at his lowest weight — because his body now is not the body he had five years ago. His knees are different. His stamina is different. So he adapts. He has grace with himself. He stays flexible.
That’s the part diet culture never tells you: what works for you now isn’t what you’ll be doing in five years. Your body changes. Your meds might change. Your life changes. This isn’t start line, finish line. It’s figuring out how to stay in the general area you want to be in — even as everything around you shifts.
And as physicians, we’re actually in a great spot for the long game. We can manage the metabolic side with medication when we need it, and have honest conversations with our own doctors when we’re already doing what we can.
You can start from right here
If you’ve been waiting to “get serious” again — to find the perfect plan and white-knuckle your way through it — I’d gently invite you to do the opposite.
Slow down. Plan the when and the where. Watch for shame driving the bus. And let one bad day just be one bad day.
Go have a listen to my full conversation with Brian Baumal on the Thriving As A Physician podcast, on whatever app you use.
You can find Brian at alivapsychotherapy.com.
Brian Baumal is a Registered Psychotherapist in Toronto, Canada. His practice focuses on weight management, eating disorders, food addiction and supporting patients using GLP-1’s and/or bariatric surgery. Brian’s clinic, Aliva Psychotherapy, was founded based on Brian’s own experience in losing and maintaining a 100-pound weight loss for almost 14 years, and effectively addressing cholesterol and blood pressure issues. Brian will grow Aliva psychotherapy to five therapists by the end of 2026, and his therapeutic style, which will be on full display in the podcast is a blend of incisive intellect, humble humour and deeply curious caring for his patients and those around him.
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