With the recent buzz about weight loss after the NY times article about Biggest Loser contestants regaining their weight I took out this long overdue draft of a blog post and decided to buckle down and get it done. For those of you who have not read the Times article, in a quick synopsis it relays research being done on weight loss that shows that the vast majority of people who lose weight put it back on and that this is not an effect of willpower but of a combination of metabolism, hormones and food cravings. Essentially, the body puts in place a combination of factors that encourage you to put back on the weight and if you want to keep it off you’ll be working against these on a daily basis. This is very important for people to understand as it explains why it is so hard to maintain weight loss and counters the naïve notion that it is due to weak willpower. On the other hand, it is sad because it means that many people cannot maintain a weight that they want. So, as a psychologist specialized in eating, here is what I tell my clients who are living with obesity and want to lose weight:
1) Manage expectations. I know this is hard, very hard. I see it over and over again as the number one factor that contributes to giving up: Disappointment with results and feelings of failure when people are doing the very best that they can and not getting the results that they want. It’s true that most people who lose weight end up putting the weight back on. But, studies suggest that through behavioural modification, which focuses on teaching skills to help identify and modify eating and activity behaviors, people can lose and maintain a weight loss of about 5-10% of their original body weight. This requires persistent effort and can have significant health benefits (Wing & Phelan, 2005). And findings might be more hopeful than this as suggested by the American National Weight Control Registry in which over 10,000 people have lost an average of 33 kg and maintained the loss for more than 5 years. The biggest misconception about weight loss is that it should be do-able to reach an “ideal weight” according to BMI charts and that it’s your fault that it’s not working. This leads to guilt, shame, and ineffective behavioral measures that yo-yo between rigid over-control and giving up. It has a devastating impact on people’s self-worth, and can make strong, hard working, resilient, and smart people believe that they are a failure solely because of their weight. So, if you are living with obesity and want to lose weight the Canadian Obesity Network suggests focusing on attaining your “best weight”, which is whatever weight you achieve through healthy lifestyle changes. So, instead of buying into diet ads that say it should be easy to reach an ideal weight, look at this as something challenging that you can do if you figure out how to make it work for you, prioritize yourself and accept realistic outcomes. People do it and they practice every day to maintain it.
2) Find your internal motivation. The number on the scale is not a good motivator. It is an external reward like money, which will not sustain motivation on a daily basis. Sustained motivation comes from something more personal than an external reward (Koestner, 2008). The two types of internal motivation we are looking for are intrinsic motivation and integrated motivation. Intrinsic motivation is when you do something out of pure fun or pleasure. If you can tap into some things that help you and are intrinsically rewarding YES! Do that. For example, some people learn to really love cooking, others find out they love playing squash, some find they enjoy writing about food in their blog. However, this will not likely be the only thing that will carry you through because some things will not be pleasurable (like eating salad when others are eating fries or going to the gym at 6am on a cold winter morning), so as important or more than intrinsic motivation is integrated motivation which is WHY is this important to me? What personal value does this uphold or strengthen? Why are healthy eating, exercise, self-regulation, planning, cooking, and grocery shopping important to me on a daily basis? For example, because it is important for me to play outside with my children, travel and explore new places, learn new things and challenge myself, be a good role model for my daughter, etc. If you can find this reason or these reasons the daily changes you are making will feel less effortful. When it gets hard and you feel like giving in to temptation or making excuses or giving up entirely you will know why you WANT to keep going with this lifestyle. At these moments, because I SHOULD is not enough. At these moments you need to know why you WANT to, why this is so important to YOU.
3) Plan ahead and write down your plans. There is ample evidence to suggest that if we can write down a plan for HOW we will reach our goals we will have a significantly greater likelihood of success (Gollwitzer, 1999). Iron out your daily systems rather than focusing on your long-term goals. “I want to lose weight” will do nothing for you, except for maybe a few days, weeks or sometimes months of deprivation riding on sheer willpower. But, it will not last. The key is to invest in creating daily routines that will require less effort once they have become habits. It is an accumulation of different daily habits that will make things change. So, instead of focusing on losing weight focus on setting up a healthy daily habit like walking a certain number of steps per day or bringing a healthy lunch to work. Don’t try to break a bad habit like no more croissants for breakfast because bad habits don’t really go away (for more on habits read the Power of Habit) but we can replace bad habits with new habits that we want to have. So, if breakfast is a trigger for having a croissant, turn breakfast into a trigger for having something healthier like a poached egg and avocado on a piece of whole wheat toast with a side of fruit & cottage cheese. The good thing is that the more we do these new habits the more they will become automatic and eventually stronger than old habits. Start with one change at a time and when you feel like you’ve nailed one down (let’s say after a week of repeated practice) then move to another change in your system.
4) Plan for things that will upset your system. Because there will be things that upset your system and you will need to know what you will do to stay on track. We call these If, Then plans. For example, IF on the weekend it is harder to exercise at the gym because my young kids are at home, THEN instead of going to the gym those days I will go biking with my family or cross-country skiing or simply take a long walk along the path. I cannot emphasize how important planning is. You will not always follow your plan and this is normal and ok, but those experiences when you go off track or something comes up to upset things should be treated as learning experiences rather than evidence of failure. These experiences are the most important ones in helping us grow and achieve success. We need to adopt what researcher and professor Carol Dweck has labeled a growth mindset that rewards effort, strategy & progress, rather than a fixed mindset, which leads to thoughts like “I’ve either got it or I don’t”. So, each off-track moment is an opportunity to reflect, learn, ameliorate and create another If, Then plan.
5) Set up your environment to help you. Seriously, you have to do this. We live in a toxic environment when it comes to food and physical activity (Wadden, Brownell, & Foster, 2002). There are triggers for eating high calorie foods everywhere and the more you eat those high calorie foods the more sensitive you are to all the triggers around you. The other day one of my clients told me all the restaurants around my office in a few blocks radius. Not necessarily because she had been to them but because in parking and walking here so many times her brain picked up on all the cues for food. Another friend of mine could probably name all of the clothing stores around my office because she shops a lot and that is what her brain will pick up on. My husband sees a Starbucks everywhere we go and I spot the wine bars from a mile away :) Realize that if you have the habit of buying food, or eating certain foods you are more vulnerable to the triggers all around you and unfortunately there are a lot! A toxic amount. So, it is in your best interest to protect yourself at least for a good long while until your brain sees things a bit differently (and even then to some extent since habits die hard). So, set up your environment to eliminate cues for eating that will be tempting. For example, if you make cookies plan how many you will eat yourself beforehand, how many will go to your children and husband and then give the rest away. Do not keep them sitting out on the counter. If you have leftover pizza put it in the fridge in the basement out of your sight. Your family can walk downstairs to get it tomorrow. If you are going to a restaurant and there will be an abundance of choice go online to check the menu and make your choice ahead of time. You can even tell the waiter you don’t want a menu when you get to the restaurant. There are also ways to avoid physical activity all around us, escalators, cars, elevators, etc. so it is helpful to set up ways to ensure we get our physical exercise. One of my favorite ones is to make a plan with a friend or join a league of some sorts so that you have a commitment. Another good one I use personally is to ensure I have no car present at work so that I have to walk or run home. Get creative and find out what’s going to work for you.
6) Figure out how to deal with the feeling that this is not fair. It may seem to you that this is unfair and you may feel restricted. If this is the case these are normal feelings to have. It is unfair, because some others don’t have to put as much effort into eating as you and appear to eat what they want when they want (that may or may not be true) but in all honesty if you are living with obesity and are losing weight or maintaining weight loss yes you will be putting in more effort, self-awareness and possibly eating less treats than those who never had a weight problem. It may help to know you are not alone in this and that others are faced with this same challenge. It may help to hear from someone else who is doing the same thing as you, and maintaining weight loss. It may also help to remember that other people who do not have the same challenges with weight have their own challenges (likely ones you don’t have) because we all have our own challenges. It will help to remember why you are doing this – your personal reason and to turn that feeling of “I can’t” or “I shouldn’t” into “I am doing this because…” and remember that all this planning and safeguarding your environment is in this aim and a self-compassionate act to keep you safe, in line with what’s important to you and helpful for you.
7) Prioritize effectiveness over fear of judgment. We do not pursue our goals in a vacuum. You most likely cannot lose weight and keep this to yourself. You will need to take the risk and tell some people for the sake of effectiveness. One of the big barriers I see with people is that they don’t want people to know they are trying to eat healthier because they are scared that people will judge them if they don’t lose weight – which is absolutely understandable. I think the most unfair thing about this challenge is that everyone can see it as opposed to a different challenge, that people cannot see as evidently. But, it is indeed a reality and so it takes a lot of courage to come out and say, “I’m eating healthier”. Yes, you leave yourself open to judgment if you don’t change physically but the fact is you will likely do much better if you use social support to your benefit. Jane McGonigal, author of the book Super Better (described more below) calls it recruiting allies. For example, at a dinner party you will likely be too vulnerable if you do not know what is coming out ahead of time so it is in your best interest to call the host ahead of time and ask her what will be on the menu. I had a client recently who told me she kept thinking it was the last course so she kept treating each one like it was her main meal. Sometimes if there are no healthy options it is in your best interest to bring something with you that you can add to the dinner party (e.g. a healthy quinoa, vegetable, or chicken dish). And it is often in your best interest to ask for help or accept help from other people. For example, one of my clients has a partner in her lunch group and they remind each other each day of something important for them (e.g., take your time when eating). Another one of my friends started a group with his friends in the morning to do physical activity before work. People who care about you likely want to be helpful but may not know how, so tell them how to help. For example, if they are nagging you about something or making you feel guilty tell them that this is not helpful. If they want to be helpful you will let them know how they can best do this when the time comes (if you want to put it off or just get them to back off) or tell them right away what they could do to help (e.g., cook that dish you love once a week and freeze a batch of it). If someone seems to really be sabotaging you or does not want you to succeed this can be very difficult – you will have to either address this with them or create a separation from this person.
8) Get creative. This is not a one rule fits all process by any means. It is a personal journey. And it is not something that has to be a terrible struggle every day. In his response to the NY Times article about the Biggest Loser Dr. Yoni Freedhoff says, “Liking the life you're living while you're losing weight is the key to keeping it off”. There will undoubtedly be moments of struggle but don’t go into this thinking everything is inevitably a struggle. Yes, it requires sustained effort and self-awareness but get playful and creative. Find ways to enjoy your new systems. Find ways to make things that are difficult into fun challenges. Adopt a playful, game mindset about things. For example, check out Jane McGonigal’s SuperBetter website about adopting a gameful mindset. She has you think of things as challenges (like in a sport or game) rather than chores and turns things like drinking water into Power-Ups so that you feel like you’re gaining power each time you do something good for yourself. I also think you can add value to things by pairing up something you don’t necessarily like or want to do with something that is internally motivating, so either something you enjoy or something that is important to you. For example, one of my clients loves podcasts so she pairs up her walk to work in the morning with a podcast episode. We call this a 2-in-1. Elizabeth Gilbert describes this (in her book Big Magic: Creative Living Beyond Fear) as developing your trickster mindset. Find a creative way to get something done in a way that will be more fun, and more motivating.
9) Develop self-compassion and acceptance. If your daily system is pretty good, you’re still learning and tweaking but you are pretty much incorporating the most important elements for weight loss (eating healthy and being active) you may want to learn to accept that this weight is your best weight. This is a long post in and unto itself so I won’t go into too many details about self-acceptance. I will instead direct you to a post on learning to love your body more by Lisa Linardatos (part 1 & part 2). I will say briefly that body acceptance is a process that involves developing compassion, appreciation and gratitude towards your body. Some practices that may be helpful include mindfulness and yoga. Now, if your daily system is in place and you have persistent health problems that would warrant further weight loss, please consult a trained professional in obesity management (dietitian, psychologist, medical doctor) to look over your system to see if there are any ways you can change it further (in a realistic and not life-ruining way). You may be able to improve your system by improving your sleep and better managing your stress. For people with severe obesity or significant obesity related health problems you may also consider bariatric surgery. Adding surgery to behavioral modification can help people lose significantly more weight. If surgery is appropriate for you it is something to consider very carefully, educate yourself about thoroughly, weigh the pros and cons, and talk with family members and friends about. It is by no means a magic weight loss pill, but it is a helpful tool as it works on the biological aspects that you have limited control over such as appetite and cravings. For more on bariatric surgery see Dr. Sharma’s Obesity Notes “Why I Support Bariatric Surgery” and “Why Bariatric Surgery Can Fail”.
10) Make it part of your identity. The people I know who have lost a significant amount of weight and kept it off have something in common, their daily system is a big part of their identity. They have become a healthy cook, an avid exerciser, an active grandmother, a mountain climber, a food blogger etc. You will not be this at first but you must believe that you can become this and act as if along the way. Too many people I see continue to say things like “I have such a sweet tooth”, “You know me, I can’t resist chocolate”, “Don’t put those in front of me you know I’ll eat them all”. We develop these types of self-deprecating dialogue as a means of self-protection: I’ll call myself out on it before other people can. But, the problem is two-fold: 1) we believe what we say to people and, 2) it gives us an easy out when things get tough. In order to be effective it helps to talk and act as if we are the change that we want to make in ourselves. So, when someone at the table says, “Anyone know any healthy recipes?” YES in fact you do, you know lots of them so share this. When someone talks about a new cross-country skiing club with friends YES in fact you do cross-country ski and are looking for some buddies to do this with. When your grandkids ask you to play soccer with them (even if you play goalie for now) YES you are interested in doing this with them. Leave the dishes for later and go play because that’s who you are (or who you are becoming). Acting as if we are the change that we want to make in our life will lead us to be that way, whether it’s sporty, healthy, an avid reader, a good cook etc. Changing your systems in a way that will result in being healthier is a challenge that takes daily, sustained awareness, effort, planning, creativity, and support so you will need to integrate this change into your person. You are not helping yourself saying and believing that you are “lazy”, “cannot resist temptation”, “don’t like exercise” etc. Act as if and you will come to believe. And remember all the times you have made changes in your life before and have come to be the person you are today!
Let’s all band together and stop judging people based on their weight. It would make it much easier for people who are actively trying to lose weight or maintain their best weight to persist in their efforts if they were supported rather than judged. Shaming is never a helpful motivator for behavior change, so please, if you are shaming yourself based on your weight try a more compassionate attitude towards yourself and if you are shaming others based on their weight try to educate yourself about obesity and support all individuals, all shapes and sizes, in their attempts to live a healthy, balanced, enjoyable lifestyle.