*know what you’re up against
            *make the habit changes you can
            *exercise
            *be kind to yourself
            *address emotional overeating
           *do all you can to keep it up
 

  These ingredients have also formed my working definition of sane eating for the past several years.  You’ll find this in the Eat Sanely workbook’s first pages:

We must find a way to eat that maintains a healthy enough weight,
 without worry or guilt,
  that we can more or less stick with forever,
 not just for the course of a diet.

            And the steps then outlined for eating more sanely:

1.      Know This Problem is Overdetermined (it’s not just you)
2.      Start With an Understanding of How You Change
3.      Know What Kind of Eating Plan Works for You (what’s to eat?)
4.      Obstacles Will Occur and Must be Understood and Resolved
5.      Movement Has to Happen
6.      Keep it Up and Get Help Where Needed The components this definition and plan mesh with the “what can you do about it” conclusions.  It may well prove, for example, that many overweight and chronic dieters will lose weight only slowly and with difficulty.  Realistic weight loss goals, though, improve chances of success.   Focus on what’s achievable, and you’re more likely to relax and feel good about progress.  You’ll less likely give up in frustration.  You’ll be building the kind of consistency that leads to change that can finally last.

Being kind to yourself, too, weaves into the sane eating definition.  Easing the worry and guilt, while hard, now proves essential to the whole business of change (see the 4/11/11 blog for more on this).   In other words, you’re less able to exercise self-control and stick with new plans when you’re beating yourself up and wearing yourself down psychologically.   Reducing emotional overeating, a key goal as well, goes hand-in-hand.  While we overeat in many different emotional situations, worry often tops the list.   And guilt often lurks undetected in any emotion-fueled binge.

Sticking with it, of course, forms part of sane eating, and part of long-term weight maintenance.  It’s never going to be easy, and the vast quantities of junk food around us won’t vanish any time soon.  We acknowledge how hard it is to keep weight down and healthy habits in place.   It’s got to be a forever effort, then, or it simply isn’t going to work.  The weight will return, plus some, and so will the bad feelings.  This, in fact, is part of what the newest research cited in “The Fat Trap” impresses upon us.  So part of the prescription is to find ways to pick ourselves up when we slip, and to keep strong supports in place.

 I’m closing today with another related workbook excerpt.  Here are the introduction’s last words:

            If this sounds like a lot, it is.  Eating sanely, for a lifetime, can transform you.  If you need to lose weight or stop binging, you will feel encouraged and gratified in reaching those goals.  They can be extremely important goals in themselves.  But beyond that, know that feeding yourself well and carefully, day after day, year after year, allows for even more.  Your physical health will certainly benefit.  Your mood and emotional life may feel more stable.  And, you’ll have built a foundation of self-care and self-respect that in time can permeate all parts of life.

Just as we all start resolving to lose, we’re hit with the news that it may never work.  If you’ve been overweight for a while, if you’ve dieted only to keep regaining, the problem may well exceed willpower.

In this season of “20 Lbs in 20 Days!”  other headlines ask “Do You Have to be Superhuman to Lose Weight?”  Or, “Are We Programmed to Pack on Pounds?”  Unpopular questions, for sure, but ones to which science increasingly answers “probably”.

Research from around the world concurs.   Once we’ve carried the weight, our bodies seem to adjust to that new “normal”.  Our chemistry then seems to fiercely defend the larger body size.  We’ll experience this as relentless hunger as well as painfully slow losses and discouragingly quick regain.    The ramped-up hunger, the sluggish metabolism, the rapid accumulation of fat:  all of these are hormonally driven, arising from the extra weight itself.  Losing weight, then, becomes at the very least a mighty struggle against biology.

Long-term studies have emerged from obesity labs at  Brown, Yale, and other U.S. sites as well as from Britain and Australia.  They do agree on the complexity of the problem, and they’ve identified some hormonal culprits.  No one, however, is telling people to stop trying to manage their weight.  The health benefits, all will point out, accrue even with small (5 or 10 percent of body weight) losses.  Plus, key questions about what might help remain unanswered.  It’s not entirely clear, for example, whether or not losing slowly aids in permanent loss.  It’s also not clear whether or not a single episode of gain and loss lead to the “packing on the pounds” phenomena, or whether this requires repeated episodes.

While this news can seem to dash all hope for those who seek slimness, researchers don’t necessarily see it that way.  “It’s helpful for people to know what they’re up against,” summarizes the concensus.  Some dieters do succeed, after all, against the biological odds, even if they represent a minority.  And, it does indeed seem that those who keep weight off are those who hold no illusions about the problem.   In the “Do You Have to be Superhuman….” article, New York Times’ Tara Parker-Pope interviewed people from the National Weight Loss Registry.  The registry, uniquely, follows people who’ve kept weight off.  Kelly Brownell, Ph.D., of Yale, points out there that thousands who’ve kept weight off don’t register for the data bank.  However, nowhere else can we look at what many (10,000) dieters do to maintain losses.   (To register, one must have kept off at least 30 lbs. for at least a year; on average, 70 lbs. have been lost for over six years.)

What’s clear is that the work of keeping weight off never stops.   Those who successfully maintain losses, whether 30 or 130 lbs., exercise, a lot.   They continue to keep track of what they eat.  They allow little or no room for “treats” or holiday lapses.  They treat weight maintenance as if they’ve known all along what science confirms:  that without such care, they’ll regain, plus some.

The “Are We Programmed….” article appeared recently in my local paper.  Based on some of the international studies, a smaller sample of anecdotes and case studies suggested, additionally, what many therapists, diet coaches, nutritionists, personal trainers, and physicians tell you from experience.   That is, that getting help or support can move the process of lasting change along.  And that often small changes, to start with, open doors to new habits.  Those who keep weight off for good change how they think and behave, solve problems as they arise, and stick with it despite occasional setbacks.

In the end, we’re left with this question:  “What can I do then, if my body resists my efforts to slim?”    Knowing what you’re up against now seems crucial.   Then, set out to make habit, ultimately lifestyle, changes.  Think of them as forever ones, if you don’t want to be stuck with pounds forever returning.  Know that you may not reach size 6, and that none of it will happen overnight.  Get help if you need it and pick yourself up, again and again, if you fall.

Finally, consider that “Thin From Within” remains important.  Whatever weight you can ultimately reach, you’ll feel better about yourself if you’re not binge eating.  You’ll feel more confident and peaceful if you aren’t medicating emotions with food.  And hard as it is, learning to handle feelings and stress without food may prove more achievable than a 70 lb weight loss.    Reducing those behaviors alone will shed some pounds and minimize gains, in any case, even if some unwanted poundage remains.

None of this is popular news.  But it confirms the difficulty of the enterprise—familiar to any chronic dieter.  And dealing with this reality may allow for a freedom from self-blame and a new degree of self-acceptance.  You do what you can, and stop making things worse by fighting what may not fully, always, be in your control.      

New Year’s diet resolutions usually fizzle quickly. The goals we set may be too broad and sweeping, too out of touch with reality to last. They don’t factor in the inevitable complications and challenges. They don’t consider whether or not we’re really prepared or ready. Grand resolutions—say, to eat every day in a way that keeps weight down, for good, forever, period—require understanding and preparation. I’ll return to those in my next blog. Here, I offer some ideas for smaller resolutions.

Those who follow my blogs will know that I believe in the power of small changes (related blogs listed below). Changing one or two specific habits may or may not lead immediately to lost pounds. They open the door to other and bigger changes, though. And they usually have value in themselves, however they affect the scale in the short run. Perhaps most important now, they’re likely to stick. They’re less likely to fizzle out in two weeks. So they’ll leave you feeling confident about your ability to make future changes.

Previous blogs, like those listed here and others, offer plenty of ideas for small changes to integrate into your life right now. Here are ten additional ones, most gleaned from recent studies on weight management. The idea is to start doing this one thing. Assess how the change has worked after a week. If it’s working well enough, keep it up. If not, reassess whether or not this particular practice makes sense for you right now. If not, choose another. When the new behavior feels like it’s become habit, target another change to integrate into your routine. You’ll be surprised how good succeeding with such changes can feel. They do make a difference.

1. Eat with fewer distractions. Recent studies confirm what we’ve pretty much known all along—if you eat while on the computer or with the TV, you’re going to pay less attention to how much you eat. Further, you’re going to feel less full than if you had paid attention. Resolve to eat only when you can attend to eating–for example, sitting down at a table.
2. Take a walk when you have a craving. Here again, research confirms an old recommendation. Taking a brisk walk proves to reduce cravings—for junk food, chocolate, even cigarettes. Resolve to take ten minutes (or more if you like) outside or on a treadmill when cravings arise. Do this repeatedly, even if it works less than 100% of the time at first. The practice will grow ever more effective.
3. Tell someone what you’re aiming to change. New books focus on the power of making public, or stating your commitment to change. Developing new habits is not always easy, and temporary discomfort can sometimes break resolve. Knowing you’ll have to account for a lapse can help you hang in.
4. Drink two glasses of water before your meals. In a study of dieters aiming to reduce portion sizes, those who drank two glasses of water before their meals consistently lost more weight, and they kept it off more reliably. So building this habit into your regime is a relatively simple way to boost your chances of success.
5. Move more! Moving more—whether in formal exercise or simply in your daily routines—helps manage weight directly and indirectly. Identify one way to increase movement in your life that doesn’t necessarily require a challenging time and energy commitment. In the long run, this will matter.
6. Write down what you eat. Do this for a week or two, even, and you’ll surely get a better picture of what and where you need to target diet changes. Most of us eat more than we realize, and nearly everyone reports this activity as helpful in increasing awareness. Those who keep it up, in fact, are more likely to keep weight off over time.
7. Plan more of your meals. Thinking ahead about what you’ll eat can mean the difference between meeting weight goals and not. Resolve to take a quarter or half hour each week to think about what you’ll bring for lunches, have for dinners, etc.
8. Add more vegetables to your diet. Even if you changed nothing else, increasing your vegetable consumption would benefit your health and weight goals. Choose a realistic number of portions (one, two, six?) to add to your weekly diet. Even better, resolve to try a new type of vegetable each month if your repertoire is limited. Or aim to eat a vegetarian meal once a week if you don’t already.
9. Add protein to your snacks. If snacking gets you into trouble, resolve to have some protein each time you eat between meals. Planned snacks tend to reduce overall calorie consumption. And, including protein keeps you full longer, less likely to overeat at your next meal, and free from blood sugar spikes that worsen metabolism.
10. Eat on a schedule. Related to item 9.), grazing, or between-meal snacking accounts for much of the extra weight we struggle with. Resolve to eat at meals, or at planned snack times. This is another of those “even if you changed nothing else….” habits that can lead to an overall reduction in calorie intake.

Many previous eatsanely.com blogs have offered “one change” ideas or addressed similar issues. In particular, check out:
9/7/10 – Fall Changes
4/9/10 – The Weight Loss “Jump-Start”
3/5/10 – Change One Small Thing…and Lose Weight?
1/4/10 – One Small Thing This year, I’ll again be blogging alternatively at eatsanely.com and at “Thin From Within” at psychologytoday.com http://www.psychologytoday.com/blog/thin-within

One commentor sent information on a DVD, tip cards, discussion strategies, etc. available for parents to talk to kids on a host of health-related subjects.  This includes weight, eating disorders, and other topics that parents may feel at a loss to tackle.  In some cases, as with weight, parents may even fear  that talking will worsen things–”if I mention weight, she’ll feel bad….”, for instance.   As I stressed in my last blog, this need not be true.  However, what a help to have some concrete guidance.  Parents can indeed help kids care for themselves.  And they can help guide them toward healthier choosing.  Check out these resources at  http://www.wordscanwork.com

Good luck to all parents, kids, and families working to eat–and live–more sanely!

On the one hand, we know mothers who’ll militate against birthday cupcakes in school.   At the same time, we still see an awful lot of Doritos and Sponge Bob Roll-Ups in the lunch kits.   Sometimes, you’re reluctant to admit that your kids refuse any whole wheat version of anything.  Other times, you feel rigid and bossy saying “no” to more cookies.  You don’t want to damage your child’s self-esteem by mentioning the chubbiness.  Yet you don’t want health or social problems to result.  What’s a parent to do?

 You can extract some practical advice from what’s written these days for parents, and Mills’ article brings these ideas together well.  For starters:  keep healthy food in the house.  Encourage plenty of exercise.  Don’t increase the allure of sweets by using them to reward vegetable eating.   Keep the treats in their proper place as just that—treats—not everyday nutrients.  Try to keep your own attitude toward food relaxed.   And remember that it can take kids several tries before they grow accustomed to and accept a new food.  It’s fine if they don’t like it right off the bat; try again another time.

To all that, I would add something not always mentioned in the “how to get your kids to eat healthy” books.   Simply put:  talk to them.   Kids, even very young ones, can understand that some foods are for growing and health, and that some foods are fun but not good in great quantities. 

 Also, kids won’t necessarily hear any conversation about overeating as a criticism of their  size.  In fact, avoidance of the obvious, if a child has gained weight, communicates something questionable in itself.  And pre-teen girls, especially, are often helped by some education about body changes, so that they don’t panic about the common thickening that can occur before puberty.

Overweight kids, in fact, are more likely to change habits if invited to discuss and participate in any change plan (on this, also see http://www.npr.org/blogs/health/2011/11/28/142672879/ ).   It’s especially helpful to talk in terms of the whole family looking at health and activity levels.  This not only relieves pressure on the “fat kid”, but acknowledges that grown-ups, including parents, struggle to get it right these days.  (Here, honest discussion beats any anxious parental effort to role model perfect eating.)

 Finally, kids can not only understand, but may benefit greatly from discussing some of the problems in our world that cause obesity.   These discussions might touch on junk food advertising.  They might address the problem of huge portion sizes, or how sweets and additives can make people crave more.  They might cover how and why we move and exercise less in today’s world.   Some of these topics will spark kids’ interest more than you might think.

In the end, it comes down to treating kids as if they’re smart, and as if they can and should care about their own bodies.  Will it result in your child’s never wanting ice cream?  No.  But that’s not the point.  Kids are geared to like such sweets, and they’re fun.  We’re looking for better, not perfect, and that’s what will prepare them best for the future, too.     

So eating sanely:  learning to eat the foods and amounts that support healthy weight.  That nourish the body and keep it strong.  That don’t cause suffering and worry and loss of control.  All that becomes much more possible when we’re not fighting ourselves.   Revisiting the OO materials, I think of the work on self-compassion and diet that I wrote about earlier this year (4/8/11, 4/11/11), as several new books on that topic emerged.  Change happens more easily when we’re calm and accepting.   And it’s hard to tolerate abuse of the body—which overeating and weird diets both do—when we’re caring about it.

We’re so immersed in the culture of craziness around food and body size, especially for women, that can be hard to imagine getting comfortable with a less-than-perfect-physique.   Fighting it doesn’t work, though.  Paradoxically, we can care for ourselves better when we accept where we’re starting from.  Easier said than done, yes.  But not impossible—and there’s help, too, as  more people recognize the craziness for what it is.

As a therapist, you tend to see less joy and fun this time of year than worry and strain. Yes, it’s a biased outlook, but the stresses of the season are certainly real. People trying to keep their health and weight in check, especially, face a daunting array of triggers and challenges. Many simply say, “Forget it!” and let go of goals and good self-care for weeks.

If you’ve followed this blog, you’ll know that I don’t think “forgetting about it” makes sense—for a lot of reasons. On the other hand, neither does striving for perfection. One idea I’ve discussed with many clients this season is that of “just maintaining”. That is, if you’re working to lose weight, and/or to change your habits for the better, this may not be the best time for full-steam ahead progress. After all, most of us will confront some potent combination of parties, extra tasks and running around, family pressures, and of course all those cookies, candies, special drinks, etc.

If you aim to “just maintain”, though, you won’t need to view this stretch in all-or-nothing terms. In other words, you’ll discern something in between the extremes of resisting everything vs. letting go of all your hopes and progress. This will most likely mean picking and choosing the events you attend, the foods you go for, the types of things you cook or contribute. It might mean carving out exercise time even while life and schedule get crazy.

You might even think of this “just maintain” time as an opportunity to experiment with one new behavior, however small, that could yield interesting results….or that could make future holiday seasons a bit less stressful. For example, try some “assertive dieting” techniques with your family (see references below for more help with that….) On a (maybe easier!) note, you could try some 5- or 10-minute exercise “bites” (also see references) at work. Or, you could simply make a less fattening version of one favored food.

Just maintaining may not give you that rush of pride and excitement that can come with more measurable results. In the big picture, though, it often represents significant progress in and of itself.

REFERENCES:
“5-Minute Workout,” by Kate Hanley, Body & Soul, December 2008
“Avoiding the Holiday Spread,” Suzette Glasner-Edwards, O the Oprah Magazine, December, 2008 – A great review of “assertive dieting” techniques to help you survive all kinds of challenges to your change efforts.

Weight loss surgery, as Dr Oz’ book You, On a Diet says, is not “the easy way out”. Nor does it mean “you never have to worry about dieting again”. Losing weight (and not gaining it, for that matter), requires just about everyone in today’s world to pay attention to what and how they’re eating. If you have weight to lose, it’s going to take a lot of attention, and the often uncomfortable work of making lasting habit change. That’s really the only way.

That said, the effort it takes to reach and maintain a healthy weight rewards you. Better health, more energy, a longer life: these are among the rewards. And for some—especially those facing the most difficulty–bariatric surgery offers a viable way to lose weight. The surgical change prevents overeating for a time. However, people can and do eventually regain (at least some) lost weight unless new habits are firmly rooted. The best way to think of surgery, then, is as a tool to help weight off relatively quickly, while you learn and practice and reinforce the habits that will keep it off for good.

 These habits resemble those we all should adopt. With surgery, though, some take on much greater importance. For the post-surgical body must live on a small number of calories. Yet it still needs key nutrients and muscular strength. And given the body’s easy tendency to gain weight (pretty much a given here), overeating and stomach-stretching must be avoided. I outline here the habits most likely to ensure long-term success after surgery. And by success I mean weight loss. But I also mean little or no regain, and a feeling of better health and well-being. Those who achieve this kind of success are most likely to:

1. follow nutritionist’s recommendations for pre-and post-surgery quite closely. When they don’t, they figure out what went wrong, pick themselves up and start again. “Progress not perfection”, in other words.
2. learn to think and plan ahead. This means bringing the right foods, in the right amounts, with them at times. It means keeping the right foods at home, too.
3. develop alternate means of coping with stress and feelings. Emotional overeating can undo a person’s best efforts lose. It’s crucial to seek a therapist’s help if emotional eating persists.
4. get help for binge eating. Reducing, if not completely eliminating, this behavior goes far in avoiding post-surgical problems.
5. think about, and anticipate, what this change will really mean for the rest of one’s life. There may be no way to fully do this ahead of time, but thinking and talking about it helps prepare the mind. Most practices require some pre-surgical contact with a psychologist. This clinician, or one’s own therapist, can help here.
6. exercise—in some form, even when physical limitations (such as arthritic knees) exist.
7. make sure they have supportive people in their lives. This might mean avoiding or not telling people who would be very unsupportive. It might mean going regularly to a support group (usually offered by the surgical practices). It might mean teaming with a friend or two who’s also post-surgery. It certainly means enlisting the understanding of one’s spouse or significant other, for practical purposes (like cooking and shopping) and emotional support.
8. seek help if they’re struggling. With the altered stomach as a weight loss “tool”, it can be easy to get back on track with a little support. Those who recontact their nutritionist or therapist early on, before a problem drags on, fare best.

(Part 3 of this article will address resources, and life after surgery.)

Recent statistics suggest that about two thirds of American adults qualify as obese (with children’s rates catching up).  Nearly 250,000 people had bariatric (weight loss) surgery last year alone.  Increasingly, the overweight turn to surgery as procedures become safer, insurance-covered, and effective against illnesses like diabetes.  Given these facts, a discussion of sane eating, and how to achieve it in life, must make room for these realities.  To fit them into the discussion, we first must confront those harmful misconceptions. 

“If you can eat like that to get ready for surgery, why not just keep at it and do it yourself?”  That’s one question people often face when considering surgery.  And the universal response is “If I could keep it up, I wouldn’t be thinking of surgery!”  And that’s the problem in a nutshell.  We live in a food environment that simply doesn’t work well with our bodies’ genetic programming.  And while it’s not necessarily impossible for the long-term obese to lose those 75, 100, 200 pounds, it’s very, very difficult.  Few succeed in the midst of an unsupportive environment, a body that constantly signals hunger, and a metabolism unprimed for weight loss.   The physical change imposed by surgery, for some, creates the conditions for facing these challenges more successfully.

Emotional problems, it’s true, often do factor into weight gain and diet failure.  And surgery won’t eliminate them.  For surgical solutions to last, these issues need to be addressed.  However, it’s also true that not all weight problems correspond to emotional problems.  And weight won’t necessarily dissolve once problems are dealt with, anyway.  Sometimes, too, the restraint provided by the surgical procedure acts as a behavioral modification tool, with emotional changes following.  In short, the decision to seek weight loss surgery is not simple.  It must consider a host of individual factors.  It’s not a great solution for everyone, and it carries risks.  At the same time, it does help many who’ve faced frustrating and demoralizing weight loss failures, and who want their health and mobility back..

If some think of surgery as a shockingly drastic option, a lot of others think it will erase struggles forever.    Procedures can usually be counted on to minimize hunger considerably, and to limit the amount that can be eaten at any one time.  Most people will lose weight and see weight-related health conditions improve.  However, surgical solutions don’t remove the need to think about how or what one eats.   On the contrary.

Success following surgery, especially over the long-term, absolutely demands conscious thought and attention:   to how and what and when and where one will be eating.  The surgical change can make some aspects of this change easier.  But it also introduces new challenges that require careful ongoing attention.  Nutrition, exercise, choosing wisely—all of these things take on even greater importance when living on a post-surgical regime.  Those who do well put the time and energy into learning and practicing, and they use the support services usually offered by weight-loss and surgical practices. 

 After weight loss surgery, it’s a whole new way of life.  It has great benefits, to be sure.  But it also has its risks and struggles.  My next two posts will address what sane eating looks like for those pre- and post-surgery, as well as resources for those who’ve made this choice.