Warren L. Huberman PhD.

The dramatic changes in our daily lives caused by the COVID-19 virus is likely the greatest crisis of our lifetime. Hopefully, you and your family are safe at home and can avoid harm. It would be easy to focus on all of the negativity and be glued to the news 24/7 but that would be a mistake. As someone working to lose weight or maintain your weight loss, this crisis presents a number of challenges but also several opportunities. First the challenges: Many of us are either working from home or are not working, but still at home. Being home presents a bunch of food and eating challenges. You may be more sedentary than usual, without your commute to work, and possibly unable to be out and about or go to the gym. Being home means that the refrigerator and the kitchen are only a few feet away. Your schedule is probably different. Without a regular schedule, unplanned eating and more frequent trips to the kitchen may occur. For those unaccustomed to working from home, it may be harder to focus on your work, and possibly wandering around the house and once again, back in the kitchen. The emotional toll this situation is taking on all of us is significant. If you have a tendency to eat in response to anxiety or loneliness, this can be a very difficult time. The challenges are clear. What about the opportunities? Before this crisis, many people were so busy with their jobs that they did not have time to make better food choices. Too much fast food. Too much take out. Too many dinners at 10 pm. Now there may be more time to buy and prepare healthy food and eat at a healthier time. Many restaurants are closed so you need to go to the supermarket where more fresh foods and healthier choices are available. Learn to cook! If you have more time, you can break out some of those cookbooks you’ve been meaning to read or find simple recipes online to try. While you’re in the supermarket, this could be a good time to experiment with new foods. Some of your favorites may be out of stock. This is a good time to explore different and potentially healthier alternatives to your old, less healthy favorites. While you are home, you may have more time to exercise. If you are restricted from going to the gym, you can still go out for a walk or a bike ride. Even if you walk with one or two friends, it is possible to practice safe social distancing while exercising. Learning to change your emotional relationship with food. It’s certainly tempting to make trips into the kitchen to manage your anxiety and other emotions, but this is a great time to learn and practice alternatives to emotional eating. Here are some ideas to try to implement in the coming weeks: Try to create and maintain a schedule including setting aside times for meals and snacks. If you already have an eating routine that was working, try to maintain it. If you don’t yet have a routine, examine your upcoming schedule and create one. If you are not used to working from home, it is important to structure your day to avoid working in an erratic “when I’m in the mood” manner. The latter is not very productive and will also lead you to wander around the house more often...and we know what room you’re likely to wind up visiting. If you are able to get out to the supermarket, buy healthy and smart! Make a commitment to using this time for positive change. If you continue to buy chips and cookies, this is going to cause weight gain. However, if you make healthier food choices in the supermarket, you can use this period at home to your advantage. If you’ve been looking for an opportunity to help your family start eating healthier, this is a perfect opportunity! Many restaurants are closed, so if you stock the house with healthy choices, you’re more likely to stick to your plan. It’s probably not advisable to go to the supermarket every day as we try to keep our social distance, so try to make a list and do a weekly shopping. Think about meal prepping. What could you buy for a few breakfasts, lunches, and dinners? Make the healthiest choices you can. Experiment in the supermarket. Some of your old favorites might be unavailable. Even if they are there, check out other alternatives. Have you ever wondered if riced cauliflower was a good alternative to white rice? Now’s the time to give it a try. What about that all-natural, lower sodium and low-sugar spaghetti sauce? Maybe bring home a jar or two. We are all wired to buy what we’ve always bought. They’re probably the same items you grew up with in your parents’ home, but it doesn’t have to be that way. Use this opportunity to experiment with healthier and maybe even tastier choices. Get outside and walk or bike a few times per week if possible. Many gyms are closing down so if you have a home gym you have an advantage. However, even without a home gym there’s always the great outdoors. Walking and biking are excellent forms of exercise. It’s more important to try to build a habit of getting out there a few times per week than it is to walk a specific number of steps or burn a specific number of calories. In fact, it is possible that you make this a habit that endures long after this crisis ends. Learn to manage your emotions in ways that don’t involve going to the kitchen. It is completely understandable that you are feeling more anxious these days, but neither the current situation nor your anxiety is going to be helped by eating. Instead, use this time to learn mindfulness skills to manage your anxiety. These skills actually help reduce anxiety and don’t contribute to weight gain. Research demonstrates that learning mindfulness skills helps reduce compulsive eating. There are a number of great apps available like headspace or calm where you can get started. Similarly, if you did a quick search for “mindfulness techniques,” the internet has 100’s of free modules available. Just experiment until you find a few that work for you. Limit the amount of time you watch television and spend watching the news on your computer and phone. You know the news isn’t great, and more importantly, it can be emotionally harmful. The purpose of the news is to provide information, but many people watch news programs as a form of entertainment. However, today’s news is not at all entertaining, it’s quite upsetting. Worst of all, some news programs focus on how things can get worse. While you may need an update or two per day, you don’t need to watch any more than that. It’s very likely to upset you and may trigger emotional eating. Even if you don’t have a tendency to eat in response to anxiety and emotional upset, who wants to experience emotional upset more than necessary?! Instead, use this time to be closer to loved ones within your home or via facetime, teleconferencing or the good old telephone. If you are among loved ones or can use facetime or video conferencing to be with them “virtually,” break out those board games, color in a coloring book, create art projects or do other things that put a more positive spin on what is certainly a challenging time. To be sure, there is nothing good about this crisis and how it is affecting our daily lives. However, it is possible to take advantage of the opportunity that being at home provides. If you make some changes in your behavior, you can use this time to stay on track with your weight loss or weight maintenance goals, and maybe even develop some new healthy habits that provide benefits that last long after this crisis is over. May you all be safe and well during this difficult time. Warren L. Huberman, PhD. Is a Clinical Psychologist licensed in New York and New Jersey. • Clinical Assistant Professor in the Department of Psychiatry at the NYU School of Medicine. • Affiliate Psychologist at the Langone/NYU Medical Center • Consulting Psychologist to the NYU/Langone Health Weight Management Program • Affiliate Psychologist in the Department of Psychiatry at Northwell-Lenox Hill Hospital. • Maintains a private practice in Clinical Psychology in Manhattan and Rockland County, NY. Author of the book 'Through Thick and Thin: The Emotional Journey of Weight Loss Surgery.' Dr. Huberman can be reached at 212- 983-6225 or at wh@warrenhuberman.com.

I spoke to some friends yesterday and asked about their Thanksgiving holiday. Not surprisingly, a few commented that they ate a bit more than they believed they should. One friend commented, “I ate way too much. I felt disgusting. I’m such a fat pig.” The intensity of my friend’s comment was striking. As she spoke those words, she was shaking her head from side to side, looking at the ground. The expression on her face was one of disgust and shame. She looked as if she was on the verge of tears. It got me thinking. My friend’s comments to herself were very cutting. Acknowledging that she “ate too much” may be a statement of fact. Thanksgiving is infamous for leading us to over indulge. This experience is hardly unique to my friend. It was her comments about feeling “disgusting” and “a fat pig” that are far more problematic, and likely explain the look of shame and disgust on her face. Human beings engage in thousands of different behaviors each day. Eating or overeating is just one of them. No one behavior defines you. Labels like “disgusting” and “fat pig,” are a whole other matter. Labels are self-statements or beliefs about our overall worth and value. They are snap, global assessments about who we are, not just what we do. That’s what makes labels so dangerous. “I ate too much” becomes “I’m worthless” in an instant. Labels represent a “fusing” between an arbitrary thought or statements about ourselves (“I’m a fat pig” or “I’m disgusting”) and our overall feeling about ourselves. Strong negative feelings such as disgust and shame come from making global statements about who we are as a person. Consider the difference between shame and embarrassment. We have all done things that have caused us to be embarrassed. Embarrassment is a feeling about a behavior. If you burp at the Thanksgiving table, you’re embarrassed, but it doesn’t change the way you feel about yourself as a person. Embarrassment is an “oops!” Shame and disgust are a different story. Shame isn't about a behavior. It’s about you. In your efforts to lose weight and keep it off, never lose sight of the fact that your worth as a person is not defined by your weight. Your worth is not dictated by how you ate at a given meal. In fact, your worth is not dictated by what you’ve eaten at all of your meals combined. Remember that old ad campaign that said, “You are what you eat?” Health wise this may be true. In terms of your worth or value as a human being, it’s nonsense. Ask your friends if the joy you bring to their life goes up or down with your weight. Or if they like you less when you eat more at a meal. Unlikely. The language you use when you talk to yourself is very important. If you feel “disappointed” or “upset” that you ate too much, that’s fine. If you’re embarrassed that you had two pieces of pie instead of one that’s ok too. Just avoid telling yourself that you’re “a fat pig” or “gross.” It’s actually very simple. Talk to yourself the way you would talk to a friend. It’s unlikely that you would tell a friend she’s “disgusting,” “a fat pig,” or “gross.” You wouldn’t use labels that define your friend based upon how she ate at one meal. You wouldn’t make comments about your friend that made her feel ashamed. Extend yourself the same courtesy. Perhaps most importantly, recognize that it is exactly this type of negative self-talk and these feelings of disgust and shame that contribute to more overeating or binge eating. The cycle is familiar. You overeat, you tell yourself that you’re “disgusting” or “gross,” you feel ashamed, and then you try to cope with these unpleasant feelings by eating. Instead, cut shame off at the pass. Recognize that you have acted in a manner that you want to change, label it appropriately and tell yourself how you plan to address it. For example: “I overate tonight, so I guess I’ll go for a walk tomorrow morning and take it easy on the leftovers tomorrow.” Notice how this statement addresses the undesired behavior and the actions you intend to take to move forward. There is no name-calling, no labeling. As a result, there’s no shame and self-loathing and you can simply put the undesired behavior behind you and move forward. That’s how you break the cycle. I forgot to mention that when my friend told me that she overate and felt disgusting and gross I told her I overate a bit as well. I told her it was just one meal and that there was nothing to be ashamed of. Friends take care of each other. Make sure that you’re a good friend to yourself. That would be something we could all be thankful for.

Eating is a great source of pleasure for many people. The pleasures of eating push our “happy buttons.” Eating is pleasurable on many levels. Many foods taste delicious, eating feels good in our mouth and belly, eating soothes our emotions, and the act of dining, especially in restaurants or other special settings, can be a wonderful experience. This isn’t just true for some people; it’s true for everyone to some degree. Unfortunately for some, eating can become a disproportionately pleasurable experience, one of a few or perhaps their only "happy button." Many of our pleasures, passions, hobbies and interests develop during childhood and adolescence. As a child we’re a bit like an empty chalkboard – nothing has been written on it yet…a blank slate. Our parents are often the ones who first write on the chalkboard. If they like to ski, they probably brought you along. If they like music and art, they probably tried to instill a love of music and art in you as well. And kids eat it all up…eager to explore and discover their world. Every experience is new to a young child. This is not to say that you will necessarily enjoy every experience they introduce you to, but good parents create opportunities for their children to share in their passions and encourage them to develop those of their own. While it is certainly possible to develop sources of pleasure later in life, it can be much more complicated. We get stuck in our comfort zones and if some of our previous sources of pleasures fall away or never really developed – that comfort zone can become awfully small. What if your parents had few passions to share with you or worked such long hours that they had no time to share? What if your parents were not around or perhaps were not the best parents in the world? It’s also possible that you never had the opportunity to develop sources of pleasure and enjoyment for yourself. You never discovered what pushed your “happy buttons.” Alternatively, perhaps you had some “happy buttons” but can no longer participate. For example, skiing can be physically demanding and also expensive. Skiing might have been accessible at one time in your life and not as accessible in another. There are many explanations for why passions and pleasures at one time in your life don’t last throughout your lifetime. Eating is a “happy button” for everyone. For some it’s a small pleasure and for others it’s their biggest pleasure. We are genetically wired to enjoy eating. Our species would not have lasted very long if that wasn’t the case. So the desire to eat and the rewards of eating are a “built in happy button.” In modern terms, it’s an app that comes with our iBrain. We like food. We love food. But if food is one of your only “happy buttons” and you push it too often…well….we know how that story goes. Developing new happy buttons takes a great deal of work. Begin by asking yourself; “What would I like to do?” or “What could give me pleasure?” or “What used to give me pleasure that may once again?” Don’t be surprised if you draw a blank. If it was that easy you’d have a panel full of “happy buttons” to push by now. It’s understandable that skiing might not pop into your head if you’ve never been skiing before or if you’re still struggling with your weight and are questioning if you even could ski (you probably can!). Avoid that old impulse to shoot down everything that pops into your head. Reasons you CAN’T do things always seem more available than reasons you CAN. Don’t be discouraged. Remember back when you were a kid and everything was new and everything was cool? Try to recapture that spirit. Two other ideas are to consider the many hobbies and interests that your friends and family enjoy as well as to discover the many things that are going on in your community. What do your friends and family do for fun? What kinds of activities are they involved in? What events are being promoted online and in your local newspaper? Instead of trying only to think of what you might enjoy, consider investigating what’s out there. Film festivals, concerts, street fairs, talks, classes, etc. Potential new “happy buttons” abound! Generate as many ideas as you can before editing them down. Again, work diligently to avoid the impulse to immediately say “no” to any of your great ideas. It’s so easy and maybe even automatic to think of why something ISN’T for you. Let the doors of your mind be open to let it in what COULD be. With an open and curious child-like mind, the sky is the limit. I know…you’re sighing and saying things like, “It’s so hard,” or “I tried that already,” or “I’m not a “joiner”,” or maybe “I just don’t feel like it.” I understand, but consider this: OF COURSE YOU DON’T FEEL LIKE IT!!! As adults, we rarely feel like doing things we’ve never done before. The adult brain doesn’t like the new; it prefers the familiar…the comfortable. The adult brain prefers to run on autopilot. That is exactly why we keep going to the refrigerator or ordering take-out even though we know it is precisely what we SHOULDN’T be doing. If you are struggling with depression, anxiety or feelings of self-consciousness regarding your weight you might have an extra dose of “I don’t feel like it.” Fortunately, you don’t have to feel like it. Feel the feelings and try it anyway. Have you ever not wanted to do something and were either encouraged to do it by a friend or pushed yourself to do it and found you actually enjoyed yourself? Of course you have. Because feelings are often WRONG! You’re not a fortune-teller and your initial feelings are not facts. Also consider that if you never try anything new and only do what is comfortable and familiar, you can’t possibly discover new “happy buttons.” The “new” often feels scary and uncomfortable. That does not mean that it is scary or uncomfortable or that it will remain so. When you first tried to ride a bike, your enthusiasm was likely mixed with fear and anxiety that you might crash or hurt yourself. With encouragement after a few minutes, when you figured out how to steer away from the bushes and use the brakes, that feeling of anxiety was replaced with exhilaration and pride. The big scary waterslide at the amusement park that you refused to go down the first time quickly became the same slide you wanted to go down 50 times into the evening before you had to go home. Yes, developing new “happy buttons” to replace eating isn’t easy. It can also be a little scary. You are fighting inertia and you are fighting your brain’s instinct to stick to what is safe and familiar. Comfort zones aren’t called comfort zones by coincidence! However, with consistent effort it is possible to change your thoughts and actions. You are in change of your own control panel and the buttons you put on panel. Your life is in your hands. Start experimenting, just as a child would and start pushing lots of buttons until a few become new “happy buttons.”

If you’re keeping up with the news on weight loss, it’s becoming very clear that most efforts at long-term weight loss do not work. This suggests that most of the behavioral changes people attempt to make are unsustainable over the long term. We are also learning that this difficulty has much more to do with a number of biological factors and much less to do with willpower. Recent research on the resting metabolic rate and leptin levels (and other factors) of those who have lost large amounts of weight suggest that the human body fights efforts to keep weight off. It’s as if the body tries everything in its power to put the weight back on! The good news is that you can stop blaming yourself. It’s not you; it’s biology. While these facts are discouraging, it’s not necessarily a lost cause. Perhaps the big takeaway message for those trying to lose weight AND keep it off is this: Do not make changes in your behavior that you are not prepared to maintain for the rest of your life. Notice that I’m focusing on behavior, not losing weight. Consider that you do not actually try to lose weight. You try to change certain behaviors that you believe will eventually lead to weight loss. Weight loss is the desired outcome of a number of changes in behavior, some involving what you eat, some involving how you eat, and others involving your level of activity. It is critical to keep your focus on your behavior, not the scale. That same research also indicates that the body fights efforts to keep weight off for many years after the initial weight loss…maybe even for the rest of your life. You’re going to experience hunger. You are going to have cravings. Your body is going to keep fighting. Therefore, you are going to need to keep fighting. We also know that despite all of this new research, reducing your intake of calories and burning off more of them remain two of the pillars of weight loss success. Your strategy to lose weight and keep it off must incorporate those two factors. With all of this information in mind, you can see why it’s silly to try to discover “the best diet.” First of all, “diets” are short-term interventions that you certainly know by now will not work. Second, we illustrated that whatever behavior changes you make, you would need to keep them going for many, many years. It’s simply not possible for one set of behavior changes to work for everyone. It really comes down to figuring out what the best strategies are for you to reduce your calorie intake and to burn off more of them for many years to come. This is something you should give a great deal of thought. I know its January, but avoid jumping on the first idea that all of your buddies are considering. Now that you have read this article (and others), you probably have a lot more information that they have. Perhaps you can share this information with your friends who also want to lose weight and you can all put your collective heads together and come up with some strategies for one another. I have some suggestions. Consider that you do not have to get it 100% right on day one and you probably should start small and try to build a pattern of success. Try to hit singles, not home runs. For example: If you decide that cutting carbs is going to be one of your strategies, start by trying to cut your carbohydrate intake by 10% for the first few weeks and work your way up to 50% or whatever your long-term goal will be. If you start by going no-carb on day one, I can introduce you to 100’s of people that were back to carbohydrate-rich diets and total weight regain by week four. Similarly, if increasing exercise is one of your goals, consider focusing on the number of days per week that you exercise, not how many calories you burn on the treadmill. Build a pattern of success. Over the weeks, try to increase your time and make it a point to find types of exercise that you enjoy…not necessarily the ones that burn the most calories, but rather the ones you believe that you can stick with over the long-term. Also, consider making changes in your eating behavior rather than just in your diet. In other words, focus on how you eat not just what you eat. If, for example, you consume a great deal of calories by impulsively picking at food throughout the day, a good goal would be to eat only three meals and one snack per day and to avoid eating at other times. Here are some other suggestions: always go to the supermarket with a list and avoid purchasing anything not on the list; keep fruits and vegetables out on the counter for snacking; drink more water especially if you’re not certain if you are hungry or thirsty. You get the idea. If you think about it, you may know all of this already. If you are fortunate to know someone who has lost over 25 pounds and kept it off for many years, I would bet that this person has made some permanent, dramatic changes in his habits. He’s a vegetarian. She exercises five days a week, every week. He doesn’t eat dessert anymore. She doesn’t drink anything with sugar. In other words, she’s not on a diet and it’s not with a short-term goal weight in mind. Her approach to food, eating and activity is fundamentally and permanently changed. That’s the goal. In summary, think long-term. All signs point to the need for a consistent, sustained battle for long-term weight loss success. Take your time and discover some small but significant modifications you can make in your diet, eating behavior and activity level and try to build on them week by week. The ultimate goal is to make changes that can last year after year. Now that’s a winning New Year’s resolution.

Many people describe emotional eating as a special type of eating. The truth may be that emotional eating isn’t really special at all. What seems special and mysterious about emotional eating is that it’s often insidious and not at all obvious. We don’t necessarily feel anxious (for example) and think to ourselves; “I’m very upset right now so I am going to have some ice cream.” It is more likely that we feel anxiety and our brain just steers us to the refrigerator because we’ve practiced that behavior so many times before. This is called a habit. In this way, emotions are just one trigger for eating no different than any other. For example: If you are in the habit of having a snack while watching television at night, any time you watch television at night, you are likely to experience a desire to eat shortly after you sit down. Are you “in the mood” to eat? Not necessarily. Are you experiencing positive or negative emotions that are triggering a desire to eat? Not necessarily. Are there food cues on television that planted the urge to eat in your mind? Not necessarily. All that happened was that you sat down and turned on the television. But if you’ve sat in front of a television while having a snack over 5,000 times in the past, there’s a very high probability that you will want a snack in situation 5,001. Emotions, like television are cues. Another word for cue is “stimulus.” If you keep repeating the behavior of eating while watching television, eating eventually becomes a “response” to watching television. This is called Pavolvian Conditioning, which you may remember from a psychology class in high school or college. After enough pairings of television/eat or feel anxious/eat, the occurrence of one triggers the occurrence of the other. However, there is another part of the story. For the vast majority of us, the immediate consequence of eating is quite positive. Food tastes good and eating feels good. We enjoy eating in restaurants. We enjoy all of the many flavors and textures of food and eating. It is those positive consequences of eating that keep us coming back for more. Learning that occurs through the experience of consequences is called Operant Conditioning. So emotions can be a cue for eating and they can also be a response to eating. Generally, when people speak about emotional eating, they are referring to unpleasant emotions as a stimulus for eating and temporary relief from those unpleasant emotions that the act of eating provides. When we eat certain foods in response to an emotional cue we often feel better. When you’re upset and you have a bit of chocolate (for example) you experience some pleasure from the taste of the chocolate and perhaps a little relief from your unpleasant feelings. The “pleasant taste” and “relief from unpleasant feelings” reward the behavior of eating and strengthen it over time. If you eat chocolate here and there it’s not a problem. If you do it too often, and rely upon eating as a means of coping with unpleasant emotions, it can quickly become a big problem. It is interesting to note that the “feeling a little better” part is usually quickly replaced with the “feeling guilty and upset with myself” part. This demonstrates how powerful experiencing positive consequences and getting relief from negative emotions can be in maintaining a behavior. But if we know that in the long term this type of eating is unhealthy and self-destructive, why can’t we stop? Why can’t we just learn to let ourselves feel a little uncomfortable or learn other coping strategies? You can. It just takes a greater sense of awareness and a lot of practice. It also requires a change in how we think about emotions. In our culture, we put our emotions or feelings on a pedestal. We tend to worship our emotions and feelings and talk about them with reverence. We try to break them down and understand and change them, and while there may be some benefit to expending all of this time and effort, with regards to eating, it may be simpler to just think of emotions as just another cue for eating…no different than watching television. So what can you do about emotional eating? The first step in addressing emotional eating is to learn to be aware that you’re doing it WHEN you’re doing it. Think of it as “freezing time.” Not only is this the first step, it is also the most important step. It is not possible to proceed to the other steps without mastering this step first. In fact, for many people, just noticing that they are eating in response to an emotional cue is enough to stop. Make it a habit to stop for 30 seconds just before every episode of eating. “Freeze time” and ask yourself, “What am I doing? Am I hungry? Am I upset? Am I bored? What am I experiencing that is leading me to want to eat?” Maybe it’s not an emotion at all. Perhaps you’re hungry. Perhaps you can notice that you’re watching television and it’s as simple as that. If it is an emotion, try to figure out which one it is. Anger? Anxiety? Sadness? Depression? See if you can put a name to what you are feeling so that you can identify your specific stimuli or cues for eating. Consider keeping an emotional eating diary and write down whatever emotions/feelings you experience before you eat, every time you eat. The second step is to sit with the emotion. Now that you’ve frozen time, just experience the emotion you are feeling. Observe it and think about it a little. Notice the physical sensations in your body. Survey the thoughts you are having in conjunction with the feeling. Be present. Maybe even have a dialogue with yourself about it as if you’re watching yourself from above. “Gee that’s interesting. I’m feeling a little nervous about that meeting I have tomorrow and here I am holding a chocolate donut in my kitchen. Wow, I sure have done this many times before. It’s funny. I do really want this donut right now and I’m not even sure why. I wonder what’s going on? My muscles feel a bit tight. I’m thinking about what I’m going to say at the meeting and who will be there. I’m a little uncomfortable, but it’s not really that bad.” The third step is to practice walking away from the kitchen and considering an alternative to eating that actually better addresses the emotion you’re experiencing. While chocolate donuts may taste good and eating one may temporarily provide a calming effect, it also provides a whole lot of unnecessary calories and chocolate donuts have never been clinically proven to enhance one’s ability to prepare for a business meeting. Depending on the emotion, there are a number of strategies that could be helpful. Some strategies help with many emotions. Going for a walk, calling a friend, and trying a brief relaxation strategy can help with anxiety, depression and anger. There are an endless number of strategies that you can discover that actually help reduce the emotional upset you are experiencing much better than eating and with fewer weight and health consequences. This is a big leap for many people. We hold emotions to be sacred and mysterious things and while they are a special part of the human experience, with regards to eating it may be helpful to think of them as just another cue or stimulus…no different than watching television. If you can make that leap then it’s just a matter of becoming more aware of when eating in response to emotions is occurring and learning new responses to replace eating as a means of coping. You’ll feel better that you did!

It is now five days into the new year and if you’re like many people, you may be having some difficulty sticking to your resolution to lose weight, improve your diet or increase your exercise. Many studies have been conducted on New Year’s resolutions and the research suggests that approximately 20% of people have broken their New Year’s resolution within a week and that almost 90% fail to keep their resolution for a full year. There are many reasons we struggle to keep our resolutions, including problems with the very concept of what a resolution is as well as how we go about trying to achieve them. What is a resolution anyway? A resolution is a formal expression of opinion or intention. It is kind of like saying “I intend to lose weight.” Many a famous quote has included references to problems with “good intentions,” all of which conclude that good intentions are of little benefit without follow through. The concept of making resolutions is an ancient one, often involving making promises to a higher power. In modern times, the resolutions we make on New Year’s Day are typically ones we make to ourselves. However, whether we call them resolutions or promises, they often become dashed hopes and dreams that crumble within a few weeks. To keep to your resolutions, you’re going to need a really good plan. Fortunately, there are well-studied methods to increase your chances of success. The first, and perhaps most important question to ask yourself is, “Am I really ready to begin?” This may be the #1 reason New Year’s resolutions fail…you simply were not mentally prepared to start. Think about it for a second. Why New Years Day? Sure, it’s a new year…a clean slate…a fresh start….but it’s silly to assume that just because 2014 has become 2015 that you’re magically prepared to make the big audacious changes that resolutions generally involve. Ask yourself how confident you are that this time you’re going to be successful. Are you 80% confident, 50% confident, even less than that? Have you prepared? Do you have a well-conceived plan? If you’re not very confident, it makes more sense to dedicate more time to thinking about what has and has not worked in the past and what needs to be done differently this time. It would be much better to have 80% confidence and start on your resolution on February 1st than to start today with 25% confidence. If you are confident and feel ready to go, begin by eliminating the concept of resolutions altogether. Remember, a resolution is only an intention or a promise not a plan. Instead, think of setting goals. There’s a great deal of research on how to set better and more achievable goals. A common acronym used for well-set goals is “SMART,” which stands for goals that are: Specific, Measurable, Achievable, Realistic, and Time-based. So let’s use America’s number #1 New Year’s Resolution, losing weight, as an example. Specific could mean identifying the actual amount of weight you intend to lose. It could also refer to specifying exactly what foods you intend to increase or decrease in your diet. Better than saying “I will eat less fried foods,” would be saying which specific foods you intend to eat more of in place of fried foods. Perhaps saying “I plan to eat 7-10 servings of fruits and vegetables every day and no more than 5 servings of carbohydrates per day.” Now that’s specific!! I would argue that it is much better to focus on changing your eating behaviors like the ones just described rather than focusing on numbers on a scale. While weighing yourself on occasion may be a necessary evil, it is one that causes many people a tremendous amount of emotion including anxiety, self-loathing and others. Believe it or not, you can lose weight successfully without ever stepping on a scale. Your pants, skirts, suits and blouses will be more than happy to tell you if you’re moving in the right direction. Measurable goals are those that involve numbers. Rather than saying “less” or “more,” use numbers as I did in the example above regarding fruits and vegetables. And if you are someone who feels strongly about stepping on the scale from time to time, that’s a number too. Achievable and Realistic goals are those that consider where you are starting from and what is reasonable given your track record. Rather than shooting for huge audacious goals, think about what you can really commit to doing. A major reason to set small achievable goals is that you get rewarded and feel good about your accomplishments more often. If you feel strongly about a target weight, start with a number that is 5-10 pounds away rather than one 25 or more. If your goal is to lose 5 pounds, you get to feel good 5 times on your way to 25 pounds. If you only feel good when you hit 25 pounds, you only get rewarded once and might lose your motivation along the way. Regarding changing your food choices, if you rarely eat more than one serving of fruits and vegetables per day, setting the goal at 7-10 servings is probably not going to work for you right away. That’s a nice goal to strive for down the road, but it probably makes more sense to shoot for 3-5 at the outset. Even better would be to think about what fruits and vegetables you like or that you think you might like and go from there. Some people can’t even think of 7-10 fruits and vegetables they like! You might just start by trying a few different ones each day to see what’s realistic for you. In that same line of thinking, a great goal might be to commit to bringing two pieces (or small bags) of fruit to work each day. If you have a banana and a small box of raisins with you every day, you’ll be more inclined to eat those than going to the vending machine. Time-based goals have deadlines built in. “I’d like to lose 25 pounds by June 1st.” “I’d like to be regularly eating 5-7 servings of fruits and vegetables every day by the end of the summer” are two examples of time-based goals. Deadlines help motivate behavior and they keep your eye on the target. This is why large companies often have short-term goals as well as a “five-year plan.” You need to focus on what you’re doing each day, but also need to look down the road to make sure you’re heading in the right direction. In addition to setting goals that adhere to the SMART rules, there are other criteria of well-set goals to consider. Always set goals for what to do, instead of what not to do. This is often referred to as “the dead person’s rule.” Never set a goal that a dead person could accomplish. A dead person can “not drink soda.” Only a live person can “drink 6-8 cups of water per day.” A dead person can “stop eating fried foods.” Only a live person can “eat 4-5 servings of lean protein per day.” Finally, consider going on record with your goals both to yourself and others. Document your daily behavior and consider telling a few key people about your goals. Why? It enhances your commitment to your goals. Study after study shows that one of the #1 ways to improve your success in losing weight is to write down everything you eat. The accountability factor is certainly one reason, but another is that writing down what you eat is a way of keeping tabs on your behavior. Think about it for a second. Weight loss is actually an outcome measure. It is the end product of your behavior. Losing weight is not a behavior, eating is the behavior…specifically eating less and eating healthier. So if you just kept track of your weight by weighing yourself every day, this would not likely lead to weight loss. It’s changing the behavior of eating that counts. In the age of smart phones, this is becoming quite easy. There are apps that will calculate the calories in the foods you eat for you and set up daily caloric targets to shoot for. If your goals include exercise, there are now at least 100 products out there that can monitor the number of steps you take, your heart rate, even how many times you rolled over in your sleep!! If you’re really committed to your goals, consider making an investment in one of these products to help you along. Regarding telling others about your goals, it’s not so much that you need others to keep and eye on you (which can be a negative factor) but that you can gain their help and support to stay on track. Be thoughtful of who you tell, but your closest friends and family can be a big asset. Studies show that when people pursue goals in groups or with the help of others, they are often more successful than those who go it alone. Also, writing your goals down as well as letting others know about your goals makes them more real. If you think about it, a goal is a very abstract concept. It’s not a tangible item. However, when you write your goals down or tell them to others, they become more real. So, in summary, if you want to have greater success in achieving your New Year’s goals (or resolutions if you must) here is the formula. Write goals that are: Specific, Measurable, Achievable, Realistic, and Time-based. Also, make sure the goals are stated in terms of what to do rather than what not to do. And finally, give strong consideration to writing your behavior down each day and letting others know about what you are trying to achieve. Best wishes for a happy and successful 2015!

Attempting to lose weight can be thought of as engaging in a complicated battle with your brain. Consider all of the various factors that are involved: hunger, cravings, appetite, emotions, memories, environmental cues...the list is seemingly endless. Neuroscientists tell us that these factors are controlled by many different parts of our brain, making it even more complicated. This helps explain why the quest for a truly effective weight loss drug has been so elusive. The drug would have to address so many different parts of the brain to truly hit every target. Not an easy task. Despite the fact that losing weight would have so many health benefits; our brains seem to have no interest in helping. In the battle to lose weight, your brain is not your ally. Your brain wants chocolate, potato chips and pizza, not the fruits, vegetables and grilled fish we know would be healthier for us. The struggle to lose weight demonstrates the reluctance our brains seem to have to learn new behaviors when it is comfortable with the old ones. But why? One reason, albeit perhaps not the whole story, is that brains are lazy. Brains don’t seem terribly motivated to learn new habits. Once we learn to do something that either provides pleasure or avoids pain, the brain just wants to keep doing the same old thing. The brain does not urge you to go out of your way to do things differently when the current way is fine. The brain wants to put as much of our behavior on autopilot as possible. Consider this. How much of your daily behavior occurs with no thought whatsoever? It’s much more than you may wish to believe. When you walk down a flight of stairs do you have to decide which foot to move next or do you just seem to glide downward effortlessly? Ever arrive at work after a 30-minute drive and not remember over half of the details of your commute? How did you remember to stop at the red lights? How do you avoid getting into an accident? Like walking downstairs and even driving a car, eating can easily become a mindless activity…from choosing what you eat, to preparing the food, to consuming the entire plate, without a single thought. Similarly, when a behavior becomes part of our repertoire we are very reluctant to change. For example: If you grew up using one brand of toothpaste, it’s very unlikely that you will switch to another in the future. Marketing experts know that changing brand loyalty is extremely difficult. Coke drinkers usually stay Coke drinkers and Pepsi drinkers usually remain Pepsi drinkers. While we would honestly like to believe that we make willful choices at every turn, more often than not the reason we do what we do is because that’s what we’ve always done. It’s not really a free choice at all. The complexities of the brain will continue to be explored for many years and while we may never fully understand how to control each of the areas within the brain that affects our eating behavior, the good news is that we do have the ability to change our brains…by changing our behavior. Although your brain may not want to change on its own volition, with a concerted effort you can make it change. It’s called learning. Learning occurs when we discover something new. Learning is change. It’s figuring out the solution to a problem for the very first time. Once you know how to do something correctly, there is no more learning…its just repetition and autopilot. Ironically, all of your bad eating habits were learned to. You would never crave pizza if you had never tried it. You can’t crave what you’ve never tasted. Cravings are learned. Earlier I mentioned that your brain doesn’t want to change, which is true. But if you put in the time and effort, our brains are quite malleable to acquiring new skills. The premise is really quite simple, but if you listen to how people explain why they do what they do, you might be confused. Many folks seem to believe that our feelings govern our actions. When asked why he didn’t take out the garbage, the young boy replied, “I didn’t feel like it.” When asked why she didn’t accept the invitation to go to the party, the woman said, “I wasn’t in the mood.” When asked why he couldn’t go on stage, the man replied, “I was too nervous.” One could falsely be led to believe that changing behavior requires changing one’s mood or emotions. While a change in our emotions clearly would help change behavior, it is often a very unreliable method for doing so. We can’t control our emotions very easily, but we can change control the other two aspects of our human experience…our thoughts and behaviors. Stated differently, “To change a thought, move a muscle.” To lose weight, you must become aware of as many of the “cues” or “triggers” that influence your eating as possible. These are the things that “push your buttons” to eat. Keep a journal and write them all down, especially in the moments before and while eating. Here are some examples: External or Environmental Cues: What food choices were available in your environment? What time of day is it? What day of the week is it? What eating cues are in your environment (television, window shopping)? What foods can you smell in your environment? Where are you? Avoid standing in the kitchen and other food-related areas. Cost. What was on sale in the market? Are you influenced by “new and improved” or other food marketing tricks?” What’s left in the fridge? Social Influences: What are your friends and family eating? Cultural Influences: What food do you have a history of eating? Holidays…special foods for special occasions Internal Cues: Beliefs: Old internalized messages from childhood. “Clean your plate,” “Don’t waste food, there are starving children in Africa.” Self-defeating messages. “What’s the point…I already blew my diet. I might as well eat what I want and start over on Monday.” Biology: What is your current level of hunger? Some foods trigger the desire for others (salt – sweet) Emotions: Current mood state and emotional factors Comfort foods associated with certain emotions or situations Habits: Do you have dietary restrictions (kosher, low-salt)? Learning history…what have you eaten in similar situations in the past? Current and past consequences of eating certain foods. What tastes good? While the above list may look comprehensive, there are others so be eager to discover as many as you can. Then, get started with the process of changing as many triggers associated with eating as you can so that you are making thoughtful decisions every time you eat and are operating on autopilot as little as possible. Making substantial changes in your eating-related behaviors over time will eventually change what your brain asks from you. Your new autopilot will change the foods you crave, your triggers for eating, your food choices and maybe even the way you eat as well. As you develop a comprehensive list of eating cues and triggers, try to employ some of the suggestions below to start making real changes in your eating behavior: Keep a food and eating diary. Write down what you ate, how much, when and what was going on. All of these are triggers you need to recognize and learn to change or control. Formalize your eating. Plan your meals and snacks so you can be focused, rather than eating when you “feel” like it. Rehearse reasons for improving eating habits…why am I doing this? Change and control as many food-related cues in your environment as possible. For example: Stop keeping cookies and cake in your house if you really don’t want to be eating them. Put less on your plate. Many people are “see-food” eaters. They see food and they eat it. See less…eat less. This helps the “clean your plate” problem. Eat slowly: Be mindful while you eat and avoid engaging in other activities so you can “tune in” to your body. If you read or watch television, you are focusing on those things…not signals of fullness, satiety and satisfaction. Discover alternatives for emotional eating and bored eating It’s hardly a quick fix and it is admittedly easier said than done, but with consistent effort, you can learn to partner with your brain rather than battle with it and accomplish your weight loss and weight maintenance goals. Keep up the fight!

There is a significant amount of variability as to how much weight people lose following weight loss surgery. Research indicates that up to 20% of patients fail to lose the expected amount of weight following surgery. While there are surely surgical and medical explanations for this outcome, patient behavior has also been shown to play a role. Therefore, it is important for anyone having surgery to anticipate and understand factors under their control to improve outcome. I often tell patients, “The surgery does what the surgery does.” What I mean by this is that weight loss surgery almost certainly will affect how much food you can eat, but may do little to change what you eat. Weight loss surgery does not make you suddenly crave healthier and less caloric food. You have to make those choices for yourself. Additionally, while losing weight may make it easier for you to adopt a more active lifestyle, surgery itself will not make you suddenly fall in love with exercise. So making health behavior changes in addition to having surgery remains critical. So what specific health behavior changes have been shown to improve outcome? 1. Document what you eat – Many people strongly dislike writing down what they eat but there is evidence that this helps people after weight loss surgery as it does with non-surgical approaches. The reason is likely that documenting what you eat gives you valuable information about your behavior and allows you to make changes when necessary. Consider that your actual weight is the end product of what you eat, so weighing yourself gives you the results, but not the information necessary to make changes. For many, weighing themselves is a pass-fail exam. Either I’m a good boy or a bad boy. Consider that you can’t actually change your weight…you change what you eat and/or exercise, and that is what helps change your weight. Many people seem to have little or no objection to weighing themselves so why do so many people despise writing down what they eat? Writing down what you eat is the truth teller. It forces you to acknowledge what you are doing. To avoid seeing the truth, you can either change what you eat or stop writing it down. Unfortunately, many people choose the latter. The good news is that in the smartphone era, there are literally dozens of apps and other technological devices that can make documenting your food and activity level extremely easy. If you do a little research you can find one that is right for you. 2. Exercise – You probably saw this one coming as well because it makes sense. Regular exercise is a way of burning calories and losing weight that does not involve changing what you eat. Given how difficult it is to lose weight and keep it off, it would be silly not to take advantage of one of the few methods known to work. Ironically, it might not work the way you would expect. Many people who lose weight through exercise notice that it helps them not just by burning off calories, but also by affecting their food choices. In other words, when you discover how difficult it is to burn off 250 calories on a treadmill, you may think twice before having that chocolate bar afterwards. Not everyone finds this effect, but for those who do, it can make a big difference. When deciding what form of exercise to do, consider that you don’t need to become an Olympiad or a marathon runner. Many of the positive effects of exercise have been documented with just walking 30 minutes 3-4 times per week. If rigorous exercise is enjoyable for you, that’s great. But any time spent engaged in activity is beneficial...especially if you would otherwise be sitting on the couch watching all of those tempting food advertisements on television! 3. Stress Reduction – An increasing amount of research has documented a relationship between stress and weight gain. The obvious connection is that many people use food as a means of comforting themselves from distress, commonly called “emotional eating.” An interesting new discovery is that is that some people who report high levels of stress gain weight even when their calorie intake is unchanged. How is that possible? There is the suggestion that stress hormones and other chemicals may affect how our body metabolizes food and stores food. So even if you’re eating the same foods and the same number of calories, what your body does with those calories can vary. If you’re going to be successful in reducing stress, you need to begin by discovering what “pushes your buttons” and take steps to change. One first step could be to document the things that you find to be stressful. Sometimes just writing down your problems makes them less frightening now that they’re just words on a page. For other people, writing their sources of stress naturally leads them to write what they might do about them. Another good idea is to investigate some simple stress management techniques. Many refer to them as relaxation or meditation exercises. As discussed earlier, there are a number of excellent smartphone apps and other technology-based methods of relaxation that you can explore. No one is better than the rest so just find one that works for you and begin to incorporate relaxation/meditation into your daily routine. If reducing your stress requires more than practicing relaxation techniques, consider speaking to a psychologist or other mental health professional to get the help you need. 4. Get some sleep – Here’s another suggestion that you’ve probably seen in the media recently. There is growing consensus of an obesity-sleep connection. Like exercise, the benefits of sleep are more than meets the eye. The obvious connection is that if you’re up longer, you become hungrier and are likely to eat late at night. This interpretation is not wrong, however, new research suggests that people who get 7 or more hours of sleep tend to maintain lower weights even when people with fewer hours of sleep consume the same amount of calories. How is that possible? Again, it’s not just how many calories we eat…but what our bodies do with those calories. Unfortunately, an increasing number of people are so busy between their work and social lives (not to mention all those tempting television shows) that sleep is not a priority. Just know that making sleep the last priority comes at a cost. Consider how we train children to sleep. We create a nighttime ritual to ease kids to bed. There’s dinner, wind down time, then bath time, maybe reading a story or two in bed, and then lights out. Many adults however have a terrible routine. Eat a big dinner at 9pm, catch up on emails and pay bills, watch television for an hour or so and then fall asleep on the couch and stumble into bed at 2AM only to have to wake up three or four hours later. Try to change your sleep habits by changing your nighttime ritual. Eat an earlier dinner. Try to pay bills and check your emails at another time. Use the evening as wind down time. Rather than fall asleep on the couch, watch a set amount of television or Internet time and then turn it off and “put yourself to bed.” Begin by trying to go into bed a half-hour early every night for a week and see how you feel. If you notice some improvements in your level of energy, mood, appetite or other factors, see if you can make it permanent. 5. Join a Support Group – Some research has demonstrated that patients who participate in support groups lose and maintain more weight than those who don’t. Of course it may depend on the content of the group and who attends, but adding a social element to your weight loss and weight maintenance goals seems to help. This may relate to the accountability factor discussed earlier. If “we’re all in it together,” there may be more of a commitment to stick to your goals to help out the group. Or perhaps it motivates you not to be the one group member who is falling behind. Either way, participating in support groups seems to have benefits both in terms of weight loss as well as emotional well being after surgery. There are other suggestions of course, such as improving your diet by reducing carbohydrates in favor of lean protein and a more plant-based diet. However, for many people, changing their diet can push all of those emotional “diet” buttons; so before you make those changes (or in addition to making those changes), strongly consider some of the changes recommended above. There is evidence that the benefits are additive. For example, many people find that when they exercise, they sleep better and in turn these changes help them manage stress better. The key is to acknowledge whether or not some of the factors above are problem areas for you and to begin making small changes. Sometimes small changes can lead to big results!

I am frequently asked about whether certain foods should be completely avoided or if it is essential to learn to eat all foods responsibly. Individuals who believe they are “addicted” to certain foods (like sweets) or certain ingredients of food (like sugar) commonly ask this question, and it’s a great question. The most common method of dealing with addiction to substances such as nicotine, alcohol and cocaine is complete avoidance of the substance, referred to as abstinence. Abstinence from these types of substances, while difficult to achieve, is far easier than the alternative of trying to moderate one’s intake of the substance. In the case of nicotine, heroin, cocaine and “hard drugs,” nobody challenges this approach because there is no benefit in continuing to use them. These substances are just plain bad for you so abstinence is completely rational. Alcohol has often been shown to be healthy when consumed in moderation, but for people who have battled with alcohol abuse and dependence it’s just not worth it and once again, abstinence is the preferred approach. In the case of specific foods or certain food ingredients, the story can become much more complicated. There is an ongoing battle as to whether or not certain foods or food ingredients are “addicting.” Is sugar an addictive substance in the same way as nicotine, cocaine and alcohol? Can someone actually be “addicted” to sweets or carbohydrates? The jury is still out, but a definitive answer may not be necessary. What’s important is for you to consider how you plan to change your behavior given that the environment seems to be making little effort to eliminate the availability of these foods. Almost everyone has one or more foods that they are prone to eat compulsively, whether they consider themselves to be “addicted” to them or not. Often these foods include sweets that are high in sugar (like cake, cookies, or ice cream); however, many people struggle to control their intake of a variety of foods like deli meat, pizza, peanut butter, nuts or even beef jerky. For many people, sugar isn’t the big problem. What is interesting to consider is that most people have trouble controlling their intake of foods that they believe they shouldn’t be eating. Over and over I hear stories of people who binge on exactly the foods that they were told they couldn’t have as a child. These are often called “forbidden foods.” Whether it is peanut butter, ice cream, potato chips, cookies, pizza, or cheese doodles, it may be their “forbidden-ness” that makes us eat them compulsively and not their content of sugar or other ingredients that’s the problem. The literature on binge eating lends some support to this hypothesis as a very high percentage of binge eaters describe a history of restrictive dieting and/or deprivation. Indeed, a overwhelming number of patients I have seen over the years who describe themselves as binge eaters describe histories of either chronic over-restrictive dieting or having grown up in homes where their parents or others denied their access to certain foods. Some patients jokingly referred to one or both their parents as the “food police.” Once they were free from such restrictions (either by moving out to live on their own or by going “off” the diet) their consumption of these foods seemingly became uncontrollable. It seems that avoidance or total abstinence from such foods might actually be causing the binge eating. There is an all-or-nothing quality to this behavior. One possible explanation for this pattern is that the individual has never actually had the opportunity to eat these foods in moderation but rather to be forced to avoid them or eat them like there was no tomorrow. They were never allowed to eat them, so when they were finally available, they overindulged. So again I ask: “Is this type of compulsive eating or bingeing due to an “addiction” or to over-restriction, and what should you do about it in either case?” Should you continue to avoid certain foods or food ingredients or try to learn alter your behavior? The answer really depends on your personal philosophy and how much distress the whole matter is causing you. Do you want to learn to eat certain foods more responsibly or would you rather continue to try to avoid them? Does it cause you great distress to think of a life without your favorite foods? Does it cause you great distress to make constant efforts to avoid certain people, places and events because your “trigger foods” will be available? If you decide that you would like to learn to eat certain foods more responsibly, you need to accept that this will take some work. To be successful, you need to become a bit of a scientist and experiment with different approaches. Perhaps you are experiencing anxiety about the proposition of trying to learn to eat your “trigger foods” responsibly because you have never had the ability to do. This is completely understandable. Also, consider that if the foods you find to be triggers are inherently unhealthy (like “junk food),” maybe abstinence isn’t such a bad idea. After all, like heroin and cocaine, it’s hard to make the argument that chocolate covered cheesecake is good for you. You could try to learn to eat chocolate covered cheesecake responsibly, but life will continue even if you permanently take it off the menu. However, many people believe that they shouldn’t have to live the rest of their lives without chocolate, peanut butter, cashews and other foods or perhaps they just don’t want to. They are aware that most people do not need to resort to such levels of restriction. If you think in this way, then you need to learn how to eat these foods responsibly. You have to practice a new way of eating to get better at it and strengthen your ability to do so just like you would any other skill. One approach to strengthen new eating skills is to eat certain foods in a limited number of circumstances and in a different manner. For example, if you believe that cashews are a “trigger food” and you have no history of eating cashews responsibly, it would be silly to continue to buy the one-pound jar of cashews from the bulk food store. You know how that story is going to end. Similarly, it may not be wise to bring a gallon-sized container of ice cream into your home if ice cream is a “trigger food.” However, it may be possible for you to learn to eat a responsible amount of cashews or a single serving of ice cream if you buy a small container of either when you’re at a convenience store. This is a good way to learn with a much smaller chance of bingeing. You don’t have to completely avoid cashews or ice cream for the rest of your life. Just don’t buy them in large quantities and bring them home for the time being. Many people adopt this approach. They’re not averse to eating these foods and don’t avoid them completely; they just don’t bring large quantities of them into their home. Many a patient has told me a similar story about pizza. When they want pizza, they go to the pizza parlor and buy a slice or two. They just don’t have a whole pizza delivered to their home. These are examples of altering behavior rather than avoiding certain foods altogether. This is how you learn to eat responsibly…you practice. Another approach gaining a great deal of attention is called “mindful eating.” There is a growing literature on the merits and effectiveness of mindful eating in the treatment of binge eating as well as for those who simply want to learn better eating habits even if they don’t have concerns about their weight or eating behavior. Mindful eating is an approach where one learns to be more present-focused while eating, and can be especially helpful when eating “trigger foods.” A primary objective of mindful eating is to learn to develop an ability to control one’s eating behavior. Mindful eating involves slowing down and focusing on the thoughts, feelings and sensations you are experiencing while eating to be in better control of your behavior. Mindful eating is the antithesis of avoidance. Much has been written about mindful eating, so do some research if you’re interested in learning a powerful method to alter your eating behavior so that you may be able to develop the ability to enjoy eating certain foods without experiencing distress and anxiety or leaving them off the menu completely.

In my work, I find that one of the most common explanations people give for their struggle with diets and with obesity is “I’m a food addict.” When asked what this means, most people explain that their inability to maintain the weight lost from diets and the fact that most or all of the weight eventually returns is proof of their “food addiction.” Additional evidence they cite is that their eating is “all or nothing,” that they can completely avoid so-called “forbidden foods” or binge on them with regularity, but nothing in between. This kind of reasoning is called reasoning from the converse. This is where you have a conclusion or an end state and you then go backwards to explain the cause and use the existence of the end state as proof of the cause. This invariably leads to circular logic that goes nowhere. Here’s how it works: “I am a food addict which explains why I cannot moderate my intake of certain foods, and my inability to moderate my intake of certain foods proves that I am addicted to them and am therefore an addict.” But does it? There is actually another, more accurate explanation. There are three facts that must be considered: 1) 95% of people will regain most or all of the weight they have lost on a diet within five years. 2) Many, if not most diets teach avoidance of “forbidden foods,” not moderate consumption of them. 3) Very few diets or weight loss regimens are successfully maintained indefinitely. These facts are very important to our discussion because they are true for almost EVERYONE who has tried to lose a significant amount of weight. Therefore, either everyone who has failed to keep their weight off following a diet or eventually resorts to eating “forbidden foods” is a “food addict” or there are other explanations for this phenomenon. But why is it that so many of the people I meet are eager to call themselves “food addicts?” Most people are uncomfortable acknowledging that they are addicted to alcohol or illicit substances such as cocaine or heroin, so why is being a so-called “food addict” easier to acknowledge? I believe it is because the label “food addict” removes the feelings of guilt and shame that so many people experience when they regain weight after all of the work they expended in losing it. It is absolutely heartbreaking to lose the weight, have people notice that you’re thinner and then a year later you’ve regained the weight and everyone knows it. It would be very tempting to blame this on a disease called “addiction.” “It’s not my fault that I regained the weight and am obese again…I’m a food addict.” I can certainly understand the desire to be free from responsibility from your obesity or weight regain; however, it’s not necessary to fall back on the explanation that you are a “food addict.” Perhaps if we looked at the facts about weight loss, there would be no need for all of the guilt and shame and the resulting need to explain it away by calling it an addiction. Review the facts that I mentioned earlier. The overwhelming majority of people regain the weight they have lost from a diet, very few diets teach moderate eating of “forbidden foods” (so you’re left with only knowing how to eat them or not eat them), and most people find it very difficult if not impossible to stay on a regimen of controlled eating for extended periods of time. These are the problems faced by almost all human beings who try to lose weight, not just those who are “food addicts!” So what is the explanation when someone actually succeeds in losing weight and keeping it off? Great question…and the answer is not that these rare souls are not “food addicts” or that they are “recovered food addicts.” The National Weight Control Registry (NWCR) is an organization that keeps tracks of “successful weight losers” who have lost 30 pounds or more and have kept it off for at least one year. What should immediately catch your eye is that “success” is defined as losing 30 pounds and keeping it off for one year. So if losing 30 pounds and keeping it off for one year is considered “successful,” if you’re morbidly obese and manage to lose 100 pounds and keep that off for several years that would be incredibly successful! Extensive research has been done on these folks over the years and the most recent study has discovered 7 common habits which most of the 6,000 people studied have in common. 6,000 participants in a study is a strong number of people and one where the conclusions drawn are likely very robust. Interestingly, the researchers noted that 90% of the folks in this study who finally lost the weight and kept if off had a previous history of losing weight and putting it back on. Therefore, the overwhelming majority of people were not successful on their first try. The seven habits of successful “losers” were: 1. Engaging in 200+ minutes of exercise of moderate intensity per week, 2. Limiting TV watching to less than 10 hours per week, 3. Eating a low-calorie, low-fat diet with less than 30% of calories from fat, 4. Consistency – relatively little food variety and the same daily pattern of eating, 5. Eating breakfast, 6. Avoiding emotional eating and binging and limiting consumption of fast food to less than once weekly and, 7. Monitoring yourself such as documenting calories and/or fat. Notice that every one of the seven habits is just that…a pattern of behavior. There is no mention of the characteristics of the 6000 people. It’s not about who they are, but rather what they did and continue to do. So what do we make of this “food addiction?” Neuroscience is recognizing the difficulty human beings have in resisting certain foods that we can call “engineered foods” that are high in sugar, salt and other additives. These foods are designed by fast-food companies and food manufacturers to be irresistible because they cause certain reactions in the brain that make it hard for us to say no. But these are challenges for us all. In fact, mass consumption of these “engineered foods” is likely one of the great contributors to the obesity epidemic. They explain why we, as a society, are getting fatter. Perhaps we will discover that some individuals (for neurological or other reasons) have a more difficult time resisting these “engineered foods” enriched with sugar, salt and other additives, and that these individuals are the true “food addicts.” But what would knowing that you are one of these individuals change? What would a “food addict” do differently to lose weight and keep it off? The addiction model says that the addict should completely abstain from using the substance or drug. Should “food addicts” avoid all food (impossible) or just the ones they are “addicted” to? And how would we know which ones those would be? The most commonly cited addictive “substance” in food is sugar, but we’re not at all certain. There is also another problem. Much of the research on binge eating indicates that designating certain foods as completely “forbidden” and avoiding them results in feelings of deprivation and their becoming even more desirable which often results in binging on them when you finally give into temptation. Perhaps someday there will be treatments for true “food addicts” if “food addiction” actually exists. What is more likely however; is that these folks will simply have to work even harder than most of us to stick to the seven habits that are detailed above. In the meantime, consider giving up the label of “food addict” and instead, recognize that losing weight and keeping it off is a tremendous challenge, but an achievable one. If you’re thinking of beginning to address your own personal “battle of the bulge” either for the first time or the twentieth time, or if you’re feeling hopeless and thinking there is no point in even trying, fear not…most successful losers apparently made several unsuccessful attempts before they finally got it right. And if you are thinking of starting yet again…the seven habits detailed above are a great blueprint to follow.

I’ve always despised the term “willpower” because it’s one of those words that seems to say something, but says nothing. Applied to weight loss or keeping weight off, willpower is always cited as something you must have to be successful. When patients struggle to lose weight, they tell me it’s because they have no willpower. Willpower is spoken of as if it is the secret weapon in the battle of the bulge but nobody seems to be able to define what willpower is or how to acquire it. What truly bothers me is that willpower is often explained as something intrinsic…that you either have it or you don’t. This is nonsense. Anyone who has ever lost weight can recall at least one time when they thought “This is it! This is the time I’m really going to keep it off!” You felt as if you were in a groove. You turned away from cake and potato chips. You said no to second helpings. You were invincible! You even bought the smaller jeans to punctuate your accomplishment! But then there was a wedding, or a cruise or just a little, harmless piece of chocolate that you let yourself enjoy. Suddenly, your “willpower” seemed to be gone and you didn’t know how to get it back. Well that ends today. I have news for you. Successful weight losers do not have more willpower than you do. Unsuccessful dieters do not have less willpower than you do. The popular conception of willpower is nonsense. There is nothing magical about willpower. It is not something that you have one day and lose the next. I’m going to teach you how to make your own willpower. First, let’s expose the myth of willpower. Willpower found! When you lost all that weight way back when, it began with a conscious decision and a few key factors lined up in your favor. While it may seem that you suddenly had the willpower to start the diet and successfully begin to lose weight, what actually occurred was that emotion (motivation) and an awareness of the positive and negative consequences of weight loss were both in focus. Often by chance, the emotional energy to persevere is so strong that we tolerate hunger, frustration, cravings, etc. You might think that you were not feeling hunger, cravings, or frustration when you were losing the weight but in fact you were. They were simply dwarfed by the high level of emotion and motivation you had to tolerate them. Willpower lost! Unfortunately, this initial emotional thrust eventually wears off if there’s nothing else to give it more fuel. When willpower seems to suddenly disappear what has happened is that the equation has shifted. Reasons to eat the chocolate and the desire to eat it are suddenly greater than the initial emotional thrust to tolerate this discomfort. At this point, you begin giving yourself permission to go off track. You find yourself in an environment where temptations seem greater than before. You tell yourself things that enable a setback. Willpower didn’t go anywhere. And as you well know, from that point on, it was only a matter of time until the weight returned. You probably remember that awful feeling of powerlessness that you couldn’t grab hold of the reigns and turn things around. Of course, there are also times where an overwhelming emotional event may occur that throws your motivation out the window. 9/11 was such an unfortunate example for many of my patients. Making your own willpower whether it is losing weight, quitting smoking, or accomplishing any other endeavor, there are a few specific actions that successful people take that make them successful: 1) Create measurable goals and write them down. If you’re not willing to write them down then you’re not really serious about success. Keep reading your goals every day or they won’t stay in the front of your mind. If they’re not in the front of your mind, they’re in the back of your mind. If they’re in the back of your mind, they’re useless. 2) Motivate yourself to accomplish each goal. Ask yourself “What’s in it for me (WIIFM) to accomplish this goal?” Then ask yourself “What is the consequence of failing to accomplish this goal?” Identify short and long-term goals as well as short and long-term consequences. Don’t dance around this issue…be honest. There are real negative short-term consequences of dieting and keeping weight off. Hunger, feelings of deprivation and temporary emotional distress are a few. Fear of being without food as a comfort is another. Having a clear list of benefits that you will gain in the future in exchange for tolerating these negative consequences in the short-term can help you through these tough times. Ask yourself “What do I stand to gain, both now (within a few days) and in the future if I stick to my goal of losing weight.” This is the real definition of willpower: being able to tolerate frustration or discomfort in the present in exchange for a desirable outcome in the future. Perhaps a better phrase for willpower is discomfort tolerance or frustration tolerance. Take your time with this step. Remember, in order to have the ability to tolerate frustration and discomfort when they strike, you need to be acutely aware of “what’s in it for me?” 3) Make clear action steps that you plan to take to accomplish the goal. The goal itself is not as important as understanding the behavioral steps you plan to enact in order to accomplish them. Ask yourself “what am I going to do to accomplish my goal. Also ask, “What do I need to stop doing or do differently if I am to accomplish this goal. For example, don’t ask yourself “How am I going to find the time to exercise?” Ask yourself “How am I going to make the time to exercise.” Then take out your blackberry or schedule book and figure out exactly what you are going to shift around to create the time to exercise. 4) Practice your strategies. Ever notice that the best athletes practice almost EVERY DAY?! Batting practice, free throw practice, the driving range, and on and on. Practice is what makes people successful. It’s not willpower. In case you’re telling yourself that it’s the money, you’re mistaken. There are plenty of highly paid athletes that are bums. Our favorite athletes are generally the ones that practice the most. They try harder and give a little more than the “prima donnas.” We tend to like the players who are shorter, slower, injured, or who are older but simply refuse to give up. Its constant effort, and a refusal to quit, not talent that makes the difference. 5) Think like a winner. When a winner has a setback, they don’t pack it in. They start over. Don’t “catastrophize.” Don’t categorize everything into good or bad, pass or fail. Stop being critical and demeaning of your shortcomings and missteps. If you have a bad day at the Chinese buffet, it’s just one high-calorie meal. It doesn’t mean a thing…unless you tell yourself it does. If you tell yourself it’s a bad day, it becomes a bad day. Tell yourself that your Chinese meal ruined the weekend and you’ve ruined the weekend. Suddenly you’re telling yourself that Friday is a wash and that you might as well give yourself the weekend to have some fun promising that you’ll get back on track on Monday, only Monday never comes. How you think is everything. There you have it…the mystery of willpower unraveled. The power to make real change and MAINTAIN real change is well within your grasp. You don’t suddenly get it and just as suddenly lose it. Make a commitment to your goals, write them down, document what’s in it for you, read your goals daily, diligently engage in behaviors that support each goal, think like a winner and you will be successful. I know that some of you are reading this and sighing, saying that it’s not so simple. It doesn’t have to be so complicated either. Take a bold step. Start writing some goals down right now and follow the steps I’ve outlined above before you log off. You have the power to change right at this very moment. No willpower required!

Most of the folks that I have seen after weight loss surgery describe some anxiety about weight regain. The effects of weight loss surgery are most robust during the first year after surgery. There are a number of reasons for this fact, including increased motivation, anxiety about eating and the need for significant and immediate behavior change. This first year is often referred to as the “honeymoon phase” because, like new love, it’s all good. Then things begin to change…not overnight, but gradually. Through time, you notice that you can eat more, either because the physical changes created by the surgery are changing, or perhaps because you’ve learned what you can eat more easily. Of course it is important that you continue to try to maintain the dietary changes your nutritionist and surgeon have recommended, and if you have a gastric band to ensure that it is properly filled. Interestingly, I’ve noticed that a great number of patients stop there. What else can you do? Wouldn’t it be great if there was some secret formula for keeping weight off, or an easy to follow list of things to do to improve your chances of success? Well, you’re in luck. The National Weight Control Registry (NWCS) has tracked the weight loss of over 5000 people who have kept a significant amount of weight off for over a year. Their membership has lost an average of 66 pounds and kept if off for an average of 5.5 years. If you’re “serious” about losing weight, it would seem that following in the footsteps of these folks would be a wise move. So what are some of the secrets of NWCS members? 1. Exercise Every Day Numerous studies as well as your own experience have likely taught you that exercise alone isn’t going to be enough for you to lose weight and keep it off. However, cutting calories without incorporating exercise is making your goal of keeping the weight off that much harder. It just makes sense that if you’re performing activities that burn a few hundred calories a day, it would make it easier to stay on track. Case in point, 90% of NWCR members exercise every day on average for an hour. The most popular exercise is walking. I find that the two greatest obstacles that patients cite for their inability to follow this recommendation are finding the time to exercise and not enjoying exercise. Consider that NWCS members do not have 25 hours in their day, they have the same 24 as we all do…they just make exercise a priority. Similarly, it would be ridiculous to believe that the 5000+ members of the NWCS enjoy exercise more than the average human being; they simply push themselves to do it. 2. Keep track of what you put in your mouth and what you weigh 75% of NWCR members weigh themselves at least once per week. This highlights the need to keep track of your behavior. The problem with the number on the scale is that your weight reflects the consequence of another behavior…eating. Therefore, simply tracking your weight is inadequate. Several studies have demonstrated that self-monitoring (the fancy name for keeping track of what you eat) alone has contributed to weight loss. How? If you know that you’re going to write down everything you eat, you might think twice before eating a candy bar…especially if you’re going to write down the calories in that candy bar. The power of self-monitoring your food intake in particular is that it makes you mindful and aware of your actions and helps keep you in the present moment, which is the only time that you can choose to behave differently. Not in the past or in the future, but right now! You can’t change behavior unless you are in the present moment and fully aware of the choices you are making. Writing down what you eat requires mindfulness and being in the present moment which will help you make better choices. I find that the two greatest obstacles to self-monitoring are that it is inconvenient or annoying and the belief that “I shouldn’t need to write down what I eat in order to control my behavior.” If you consider obesity to be a chronic condition and writing down what you eat to be a treatment strategy for that condition, you would likely have a difficult time complaining about your treatment to someone who has kidney failure and requires dialysis three times a week for a few hours per visit. Folks who require dialysis don’t have the luxury of complaining that it is time consuming, inconvenient and annoying. Am I being dramatic? Absolutely! Is what I’m saying accurate? Yes. Again, ask yourself if you’re serious about keeping the weight off. If you are, I’m confident that you will agree that keeping track of your food intake in a little booklet or online and getting on a scale once a week is not that big of an inconvenience. As far as the notion that you “shouldn’t need to write it down,” I strongly disagree. Behavior change usually occurs gradually and with great effort. Behavior doesn’t change on its own; it changes when you consistently work to make it change. Therefore, you “should” need to keep track of your behavior in order for it to change. If you’re not actively trying to change your eating behavior, it’s foolish to believe that you will eat any differently than you always have. Write it down!! 3. Be consistent If you look at some of the statistics about the behaviors of members of the NWCR you’ll notice that they are very consistent. Consider some of the statistics that I’ve already mentioned. 90% exercise every day, 75% weigh themselves every week and add to those that 75% report that they eat Breakfast every day. They didn’t exercise “when they had the time.” They didn’t eat breakfast “here and there.” Whatever it is that you’re doing to lose weight and keep it off; you need to be doing it most of the time. And some things you should be doing very rarely…like eating treats. Consider the word “treat” for a moment. Most of us would consider things like cake, candy, chips and chocolate to fall into the category of “treats.” The Merriam-Webster definition of a “treat” is “an especially unexpected source of joy, delight or amusement.” Something that you eat every day or even a few times per week cannot possibly be considered “especially unexpected.” Treats, therefore, would be things that you ate very rarely…and this would be a good policy if you’re serious about losing weight and keeping it off! Please note that no one is saying that making these changes is easy. In fact, it’s quite challenging. However, if you focus on how hard it is to make these changes or how unfair you feel it is that you need to make these changes, it’s taking your energy and focus away from discovering how you can actually make these changes. While there is no guarantee that following these steps will ensure lasting weight loss, there is an old adage that states that “If you want to be successful, do what successful people are doing.” Members of the National Weight Control Registry definitely qualify as successful, and if you’re truly serious about losing weight and keeping it off, it would be wise to follow in their footsteps.

Keep up the good effort!

One of the most common questions I am asked is “How long does it take for before a new behavior feels normal?” Much has been written on this topic. I’ve read that it takes 18 days for a new behavior to become a habit and I’ve read 21 days as well. The answer is that we don’t really know. What we do know is that it takes awhile…probably more than a few weeks. The reason so many people ask this question is quite understandable; everyone wants to know, “How much longer am I going to have to put forth so much conscious effort before things get a little easier?” The greatest challenge of losing weight is that so many behaviors need to be changed and most of our eating behaviors seem automated. Like a computer’s hard drive that automatically runs programs without our input, our brains guide us to perform many of our behaviors, seemingly without our effort. So changing behavior patterns is a bit like reprogramming a computer’s hard drive. Here’s a true story. Earlier this year I stopped drinking diet cola. For a long time I wanted to stop consuming this chemical concoction and I finally decided to take action. Every day for over ten years, I’ve been going to the same deli in the morning to pick up a cup of coffee and a diet cola for later in the day. After making the decision to stop drinking diet cola, I noticed that every morning in the deli, after I poured my coffee, I continued to take a few steps towards the cooler containing the diet cola before realizing that I don’t drink diet cola anymore. How long did it take before I stopped taking that step towards the cooler? By six weeks I was no longer taking that step and simply walking out the door with only a cup of coffee. Think about that. My brain’s hard drive was running on autopilot for 45 days even after I made a firm decision. Once I stopped taking those few steps towards the cola cooler, controlling my diet cola intake became much easier….at least in that situation. There were also many other situations where buying or drinking diet cola had commonly occurred and I had to endure and change my behavior in those situations as well. As you know, the first few weeks are always the hardest, and then it gets easier. The “easier” part everyone is familiar with. We have all started a diet and stuck with it long enough that it started to feel like we finally beat the bully. “This time I’m going to finally lose the weight and keep it off!” (I’m envisioning Charlie Brown running towards the football Lucy is holding thinking “this time I’m really going to kick the football!). But as we all know, somehow the hard drive seems all too willing to revert back to its original setting. For some reason, even after we seem to be on easy street for a while and drop 20 or so pounds, and make significant behavior changes…something happens. We slip, we slide and seemingly overnight the 20 pounds has found its way back onto our midsections. What happened? What happened is the answer to our original question. “How long does it take to reprogram my hard drive? Maybe forever. The problem is thinking that behavior change and losing weight is a finite objective…that you can actually stop trying at some point. That you can wipe out the old hard drive and completely replace it with a new one. This is why diets fail…we start diets believing that there will come a time that we can stop diets…and then act surprised when the weight we’ve lost comes back! In theory, there may come a time where it simply never occurs to me to have a diet cola…but it’s now well over six months and that time is nowhere in sight and I am no longer waiting for it. Rather than waiting and hoping that I will one day simply no longer yearn for a diet cola I have substituted a host of other drinks for diet cola. Water actually tastes great now. I’ve even decided every now and then to go to a new deli where I’ve never purchased diet cola before. I try not to eat in my office as often and actually go outdoors for 10 minutes to enjoy my lunch. I’m breaking old connections and building new ones, but I try not to ask myself when it is going to end because it’s better to think that it never ends and that I always need to be on my toes…even though it does get easier with each day. So don’t diet. Don’t start what you know you can’t finish. Make small behavior changes every day while keeping an eye on unwanted old habits and stop looking over every horizon to see if you’re close to the finish line where you can finally let your guard down. There is no finish line…but I assure you that it can be an enjoyable journey that you can tolerate for the rest of your life…even without getting a new hard drive. :frown:

I’m a runner. I’ve been a runner since I was a teenager. I’ve run five or more miles three times a week for the past four years and rarely take a day off. Many of my runs have been over ten miles. I’m the crazy guy you’ve seen running in the rain and the snow on the side of the road at 7 AM. I’ve learned a lot from running and many of those lessons I have applied to life in general. I’ve shared much of what I’ve learned about running with many of my patients because I believe that there are a number of parallels between long-distance running and the journey through weight loss. Many of my patients agree. I’d like to share some of these parallels with you to provide you with a helpful way to think about all that you’ve gone through and may still experience going forward. I should make an admission to you first. I’ve never actually run a marathon. It’s something I very much want to do someday but have yet to attempt because of some nagging injuries and such. However, I know enough about long-distance running and have spoken to enough marathon runners to understand the psyche of the marathon runner. Therefore, I feel comfortable speaking of it here. Consider the entire journey of weight loss surgery from before surgery to years afterwards as a marathon. For those of you who are unfamiliar, a marathon is a race of 26.2 miles. The modern Marathon commemorates the run of the soldier Pheidippides from a battlefield at the site of the town of Marathon, Greece, 26.2 miles to Athens in 490 B.C. It is seen by many as the ultimate test of endurance (although there are now ultra-marathons that can go for 100 miles or more!). There are many things one must do to prepare for the running of a marathon. A marathoner has to complete several practice runs and work up his stamina and endurance to get into peak physical condition for the race. A marathoner is encouraged to make dietary changes, especially in the few days before the race. A marathoner has to mentally prepare for the grueling 26.2 run and plot out the course and a strategy of how he is going to make it from start to finish. The process of weight loss surgery is quite similar. There are many steps to take before your big day. There is research to do. Perhaps you will talk to doctors or to those who have had surgery to better understand what you will be experiencing. When you decide that surgery is for you, there are pre-surgical assessments, medical tests and other things that must be done to ensure that you are prepared for what lies ahead. You are instructed to make dietary changes in anticipation of your surgery…perhaps a liquid diet for a week or more. And certainly you must mentally prepare for all of the physical, behavioral and emotional changes that lie ahead. For the most part, your surgery date is the starting line. You’re nervous. You’re excited. You’re hopeful. Similarly, the marathoner heart is pounding long before the starting gun is fired. The gun is fired and suddenly…they’re off! The first few days after surgery, you’re just trying to do as told. Listen to what the surgeon, the nurses and other professionals’ tell you and get home from the hospital as soon as you can. The marathoner is just putting one foot in front of the other and trying to find a good pace…a comfortable groove. Nothing fancy, just moving ahead. The first few weeks after surgery are like the marathoners first few miles…nice and easy. Learning to chew, learning what to eat and what not to eat…adjusting to the new pace of eating and making other changes in your life to improve your chances of success. Much of the journey lies ahead and thinking too far ahead can be daunting. Keep your head in the present. At some point, there will be bumps in the road. The runner may have a side-stitch, a cramp, pain, fatigue, a pebble in his shoes; some complications to be addressed. The marathoner understands that some of these discomforts will come and go. Sometimes, if you just let it be and shift your focus to other aspects of the running experience and away from the discomfort…the discomfort goes away. It is important that the marathoner not panic about the situation. The journey through weight loss surgery will also have its discomforts. Like the marathon, many will simply come and go. Some days may be more difficult than others. On some days eating may be more difficult than other days. On some days, cravings will seem stronger than others. In most instances, the discomfort will be temporary. Avoiding “catastrophic” thinking is the key. I am speaking of the mental demons that we all must deal with. Often while running, it seems as if a little devil appears on my shoulder whispering negative comments in my ear. “You’re never going to make it.” “You can’t do it.” “What were you thinking trying to run so far!?” “You’re not into it today…just go home and try again tomorrow.” Weight loss surgery patients also hear the voice of a little devil who attempts to derail you. “How am I going to avoid eating some of those foods that I love?” “What am I going to do at the holiday barbeque…I’m going to go nuts!” “I can buy a pint of ice cream and just have a little…what’s the big deal.” “A few cookies couldn’t hurt.” Part of your preparation for the marathon of weight loss surgery needs to include maintaining a positive attitude that can help you last the equivalent of 26.2 miles and to develop strategies for coping with these mental “cramps” and “side-stitches.” What am I going to tell myself when and if things get a bit complicated? What you tell yourself is immensely important in determining how and whether you will reach the finish line. Believing that you can cope with some of the temporary and unpleasant bumps in the road is essential for your success. Many of my patients initially get quite deflated by setbacks or slips. Most times, they are engaging in what I call “black and white thinking.” In this way of thinking, eating one serving of ice cream immediately becomes “I’m sabotaging my surgery!!” One day of feeling deprived or hungry becomes “My band isn’t working!” or “I’m never going to be able to live this way!” It is dramatic, exaggerated and self-defeating thinking. The marathoner’s mindset needs to be focused on “how I can” not “why I can’t.” There is nothing propelling the marathoner forward other than his or her own desire to persevere. He can stop with one step, but CHOOSES not to. He tolerates the discomfort. You also can stop. You can “cheat.” You can avoid getting your band adjusted. You can eat around the bypass. You can drink your calories. You can eat sweets. But you won’t finish the race and you’ll feel terrible for it. Several miles further down the road, the marathon becomes a strange combination of harder and easier. The marathoner has plenty of discomfort. Discomfort is probably an understatement. His body aches, his feet burn and his mind is often numb…but at the same time, he is beginning to almost taste the finish line. There are fewer miles ahead than behind. There is a mild euphoria as he considers that he might actually make it!! The surgery patient has lost a lot of weight several “miles” into her race. Perhaps most of the weight has already been lost…or maybe it’s already all off and now she’s focused on keeping it that way. But perhaps there are still some discomforts. Maybe some people continue to make annoying comments, or you have some body image concerns, or are experiencing other sources of anxiety and insecurity. It will be ok. Keep the focus on the here and now, avoid catastrophic thinking, and address what needs to be addressed. Try to taste the finish line. It’s not much farther now. This is where the analogy ends. The marathoner raises his arms as he crosses the finishing line and gasps in a combination of exhaustion and euphoria….I did it!! It is an incredible accomplishment. He is finished. But as a person who has had weight loss surgery, you will always be running your race. Through time, your pace will hopefully become more predictable and steady, but the journey of weight loss surgery never truly ends. There are always “side-stitches” and “cramps” and little “pebbles in your shoes.” Rub out the cramps. Take a few breaths to relieve the side-stitches. Step off the track for a moment and shake out the pebbles in your shoe. Focus away from whatever the source of discomfort. There’s no timer anymore so there’s no rush to the finish line. Take each day as it comes, some better than others. Just keep a steady pace, a clear focus, and a positive attitude and you will successfully cross a thousand finish lines. Important lessons to remember: · Stay focused in the present. Avoid thinking of how far you still have to go. Instead, focus on how far you’ve come. You cannot effect change in any moment other than the present one, so thinking about and certainly worrying about the future is in many ways both pointless and counterproductive. It only creates anxiety and ruins the present moment. By focusing in the present, you will get to the future faster than you think. When I run, if I focus on the fact that 90% of the distance lies ahead, I immediately feel tired and overwhelmed. When I simply take it one step at a time and enjoy the run, by the time I next think about my distance I’m that much further along and confident that I’ll get through it. · Keep your “qi” (pronounced “chee”) about you. Qi is the circulating life energy that in Chinese philosophy is thought to be inherent and flowing in all things (it’s like “the force” in Star Wars). I think of qi as being a peacefulness, and being at one with the world around me. When I run, I feel more alive than at any other time. I am at one with the world around me. I am moving through the world and feel the world moving through me. Live in the current moment and allow yourself to experience all that you are experiencing. Be present in the present. Avoid thinking of what is wrong or what could go wrong. Instead focus on what is wonderful right now. · Most of the physical and emotional discomforts that you will experience on your journey will come and go. Maybe not right away or even today. But most discomforts do not last forever. Just as many of the runner’s side-stitches and cramps work themselves through, so will yours. · Avoid focusing on small and meaningless detail. Don’t weigh yourself incessantly and get down on yourself for every calorie. Do not become overly disappointed if you do not achieve these silly and arbitrary goals. The marathoner can choose to obsess about his slightly slow pace and tragically turn a remarkable event into an unbearable trek. · Believe that you can “stand” some discomfort. Telling yourself “I can’t stand it” will lead you to not stand it. The marathoner perseveres through extraordinary physical and psychological challenges to reach the finish line. It is not an easy path. Your path too will be littered with obstacles. Trust in yourself and believe that you “can stand it” as well. · Focus on the journey and the big picture. The transformation. The accomplishment of weight loss surgery is not in losing a certain amount of weight. It is about being able to make positive, meaningful change in your life that is now possible at this lower weight. Success isn’t achieved through a number on a scale; it’s by being able to live the life you’ve always dreamed of. · Enjoy the run, not just crossing the finish line. In every moment of the race and in every moment of your journey…take a look around. Breathe in what is beautiful and enjoy each moment. Don’t live your life only in anticipation of crossing the finish line. When you have reached the finish line, I promise you that you will look back and think very fondly of the race you’ve run. :thumbup: