When you say that once you start eating, it's hard to stop

What follows combines several people's visits into one reconstructed account. It is not any one person's story, and anything that could identify someone has been removed.

How do people describe it when they come in?

Once they start eating, the bowl is empty in no time, and afterward they're left with regret. The next day they start their diet again, but the same thing happens.

They also say hunger suddenly floods in, yet drops off sharply when they're stressed. It rises and falls regardless of mealtimes — that's the telltale sign.

They don't come in just to talk about weight. They also mention gas in the belly, not feeling done after the bathroom, a flushed face and heavy sweating.

Is it really a lack of willpower?

Often it isn't. Your body decides "that's enough" only once what you ate has been properly absorbed, and if absorption is slow, that signal arrives late.

Your stomach is full, but the signal hasn't come through yet. That's why you keep reaching for more even when you're not really hungry. We describe this as the gut being clogged with buildup.

What do we look at?

We start by asking about your bowel movements: whether you need the bathroom right after eating, whether you have loose stools several times a day, or, on the other hand, go days without one.

We also write down exactly what you eat. In particular, we always ask how many sweetened coffee drinks you have a day. For some people, that alone keeps the body switched "on" all day.

We also look at how heat moves in your body. If your face turns red and you sweat when it isn't hot, and you sweat at night too, we see it as heat gathering above while the lower body runs short. We compare it to an engine running hard with too little coolant.

How do we treat it?

We break it into stages. First, we bring down the heat that has gathered above and replenish what's lacking to restore balance; then we open up the blocked metabolic pathways; and then we get the gut doing its job.

We check body composition first. We start by looking at body fat and muscle separately, not just weight.

For diet, a staff member who is a licensed dietitian works with you one-on-one. Rather than telling you what to cut out, we first sort out what you eat and when.

How did people do?

What usually changes first is the pattern of appetite. The irresistible urge to reach for certain foods eases first, and weight follows after that.

Gas in the belly and night sweats tend to settle along with it. But it takes time for the body to find its balance, and some people carry on with some of it still remaining.

What are the limits of this approach?

Difficulty stopping eating has other causes too, such as emotional problems or the effects of medications. What we look at is just one of those paths.

If you make yourself throw up after eating, or eating is disrupting your daily life, see a psychiatrist first. If you take any medication, don't stop it on your own.

Blood sugar, liver levels and cholesterol are checked with blood tests. If anything is off there, it needs to be addressed too, so it helps to bring your results.

If you share the same concern

1. Often it isn't a matter of willpower.
2. When absorption is slow, the "that's enough" signal arrives late.
3. We ask about your bowel movements first — that's where the clues are.
4. We start by looking at body fat and muscle separately, not just weight.
5. If you make yourself throw up or daily life is falling apart, see a psychiatrist first.

We don't look only at the number on the scale. Why the weight went up differs from person to person, so we start by finding that reason.

If you keep losing weight and gaining it back, come and see us. Before the number on the scale, we first look for why the weight went up. It's different for everyone.

Because there are many possible causes, progress differs from person to person, even with the same care.