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So many diet doctors are frauds. I am not, haven’t been, and never will be a diet doctor — but I was a fraud, too. As I wrote in our first post, I honestly thought that I was giving useful medical “advice” about weight loss by espousing the usual platitudes of eating less and moving more. But what good does it do to tell someone that calories-in/calories-out is a simple equation? What good does it to do tell someone that they should exercise? How do those words help someone to become motivated to change and to develop strategies to help sustain the success? Here's the answer: they don’t.
It never occurred to me that not only was I not encouraging my patients in a helpful way, but I was also just adding to the discouragement they felt in their struggles with weight. It took my own experience with becoming overweight and then finding my own path to losing weight to have a better appreciation of my patients’ challenges and then to be able to help them in a meaningful way. Let me tell you how it happened.
I didn’t really have a weight problem until I was 40, after the birth of my second baby. But that doesn’t mean that I didn’t have food issues before that. I had always had a “sweet tooth,” and I ate large portions, but I could get away with that when I was young. My mother was a fabulous baker, and Friday was her baking day. I’d come home from school every Friday, and there would be two pies on the counter: one for the family and one just for me. My pie was smaller — but not by a whole lot. I ate the whole thing right then and there. And I remained slim.
I never enjoyed exercise either. Years ago, when I was a teenager, girls didn’t have to participate in gym if they had their periods. Somehow, my gym teachers never seemed to notice (or perhaps just pretended not to notice, since I was so pathetic at sports) that I seemed to have my period just about every week. Later, when I was in my 20’s and 30’s, I was grateful that I was slim and didn’t “need” to be physically active.
Somehow, I got away with these habits. Until I didn’t. Eventually, my age and my changing metabolism caught up with me. I had no idea what to do. Don’t get me wrong — I knew full well what I “should” eat. I was a doctor, after all — an expert! I would try one diet or another, and each one did work for a while. Until it didn’t. There was always something that would derail my efforts. I was frustrated and furious with myself for not having more “willpower.”
One day, in 2013, after years of this pattern, I found myself on a stepladder in my kitchen, trying to reach into the back of the cabinet over the refrigerator. I was foraging for some old Halloween candy or any other chocolate I could lay my hands on. I knew that it was going to be uncomfortable coming down off the ladder because my knees hurt. I knew that my knees hurt in part because I had gained weight — a lot of weight — and now weighed exactly what I had weighed when I was nine months’ pregnant. Just baby fat, right? Except that the baby was now 23 years old. I also knew that in four months from this time, I was going on a trip to Switzerland with my two daughters, and I had been hoping to go hiking with them.
It was at this moment that something clicked for me: it was the realization that being disgusted with myself was not going to motivate me to change in a sustainable way, but that wanting to take good care of myself might be just the thing. I decided to shift my thinking. I would think about being more active with my daughters and with my future (please, God) grandchildren. I would think about being able to live an independent and vigorous life as an old lady. I would make more space in my brain by not playing the continuous loop in my head about what I wanted to eat but shouldn’t eat or shouldn’t have eaten and now felt ashamed and undisciplined and hopeless — that undermining voice of the "Evil Twin.” It dawned on me — finally — that I would never lose weight by hating myself or feeling ashamed of myself. Never. Then I climbed down, uncomfortably, from the stepladder and wrote down some lists:
List 1: what are the reasons that I want to lose weight?
List 2: how do I go about this in a self-compassionate way?
Once I reframed wanting to lose weight into a new paradigm of wanting to take care of myself, the day-to-day strategies fell into place. I gave myself constant, gushy positive feedback. I got rid of all the chocolate in the house. I started every meal with vegetables. I planned ahead for what I was going to eat at the next snack and at the next meal. I created short-term goals that were achievable and sustainable. It had to be a positive experience! Goal-setting was a strategy that Jay and I have talked about before, and I will share these strategies with you in greater detail in future posts.
Three months later, I had lost 15 pounds and gotten myself into better shape — and then I hiked the Alps with my daughters! After six months, I had lost a total of 30 pounds, which I have not regained (except for a brief “Trump Ten” relapse, but I reversed that, too). Since that time, in working with my patients, I have come to believe even more strongly in the importance of kindness and compassion toward oneself as key to losing weight in a sustainable way.
More than I have helped my patients, though, my patients have helped me to deepen my understanding of the connection between food and shame. This came as a result of starting a group for students at the University of Pennsylvania, where I work, to address issues around healthy eating and weight loss. I talked a little about this in our introductory post,. The big issue wasn’t weight, and it wasn’t food. It was shame.
I no longer discuss with my patients what they “should” weigh. I talk about eating and moving in a physically and emotionally healthy way. I talk about strategies to reinforce positivity and to negate shame. Here are a just few examples:
- Every time you notice that you’re thinking negatively about yourself, reframe the thought into something positive. You ate a second piece of cake after dinner and now you're a failure? Uh-uh. You ate a second piece of cake, that’s all. You don’t like how that feels, and so for now, you’ll make your kitchen a no-cake zone and have cake on special occasions when you’re at a restaurant.
- Every single time you make a healthy decision — fruit instead of cookies, going to the gym instead of to the mall — thank yourself and congratulate yourself.
- Don’t eat anything unless you’ve decided ahead of time — even if it’s five seconds — that you want to eat it.
These are the kind of strategies continue to work for me and for my patients. That’s the reason this blog exists, as well as why Jay and I are writing our book. There’s no place any more for shame.
Saying that you have a goal to lose fifty pounds is sort of like a Miss America contestant saying that her goal is for there to be world peace. Neither “goal” says anything about strategies and behaviors that will help you achieve that goal. But goals really are important. So let’s figure this out so that you can be sure that you choose goals that will work for you and are not some notion of what you think your goals should be:
Jay — You don't want to just try something because someone else said to do it — think about it critically. Is it realistic for you? Is it something that you can actually do with your schedule, responsibilities, and other concerns? For example, someone once recommended to me that I order meals from a food delivery service and eat that food exclusively. But the food cost $30 a day! Damn, that was over half my grocery budget for the week because I was a student putting myself through school. Instead, I spent some time looking up good recipes and healthy substitutions in cooking online, and I incorporated those into my meal prep. Even if friends have the best of intentions, they may not be practical or feasible for you right now at this stage in your life. A good friend suggested I sign up for a class with her at a gym that costs $200 for two weeks of sessions. Hell, I'm not about to spend that much money! Instead, I go for walks or runs or hike on trails — something that fits in the constraints of my life.
Set Short-Term Goals to Achieve Long-Term Results
Janice — When you’re enthusiastic and committed to changing your life, it’s hard to take small steps. As one of my patients explained it to me, “the long-term goals feel so far away, and the short-term goals don’t seem worth it.” In fact, though, short-term goals really are essential to prevent you from experiencing what my college-age patients refer to as “rage quit.” Apparently, the term is usually used in the context of video games; but I think it sums up what a lot of people experience on diets. You lose your way, and you quit in a state of rage toward the person or book or commercial that recommended yet another unsustainable or even idiotic diet. And then you feel rage toward yourself. You deserve better than that.
Another reason to appreciate short-term goals is that for any goal you set, achievability is paramount. In this way, there are many opportunities for success, and the process continues to be reinforced because successes build on one another to move you toward your larger goal. A study of overweight men and women showed that “setting small, achievable behavior change goals” was associated with weight loss (1). Again, it’s a matter of maximizing opportunities for success.
Jay — In a previous post, I explained how I knew that having an “ultimate goal” of losing a hundred pounds wouldn’t help me figure out where to begin. The idea felt overwhelming to me — a hundred pounds is a big number! So I re-evaluated what my goal would look like in my mind: I wasn’t going lose a hundred pounds — I was going to lose one pound, and I would do it a hundred times, one week at a time. By identifying my ultimate goal and then chunking it into smaller, manageable pieces, I now had a powerful tool for turning my aspirations into reality.
It's up to you to decide what a “short-term” goal means to you. Maybe you will set a goal of taking two brisk walks this week. Maybe your goal will be to choose, shop for, and cook a healthy dinner over the weekend. When you’re going through a tough time, you may want a really short goal: tonight, for example, you’ll have berries for dessert instead of pie. You decide —they’re your goals. Think about how great it will feel when you're successful. Here’s another thought: if the over-arching goal is to eat and move in a physically and emotionally healthy way, then you are already living your goal. The weight loss is a by-product that is sure to follow.
What keeps you going isn't some fine destination but just the road you're on, and the fact that you know how to drive.
Imagine this: you've just eaten berries instead of ice cream. This happened because you made a choice, you set a goal, and you achieved the goal. In fact, you know that you can do it again. Pause for a moment, and congratulate yourself. Thank yourself for taking care of yourself and for carrying out your intention. Think about how your body is thanking you. This is success.
Saying “I’ll try to do this” is not setting a goal — it’s just wishy-washy and cheats yourself out of summoning up resolve. We’re not talking about self-punishing grim determination here — just a certainty that declining this cookie, ordering grilled vegetables instead of French fries, not buying the chips “for your family” — these are achievable worthwhile goals that you have set for yourself and that this time, today, that goal will not be derailed.
How do you reward yourself when you reach a goal?
Jay — buy that cute workout outfit you’ve seen in the storefront, get that tattoo you’ve always wanted, plan the trip you’ve dreamed about. I’ve heard of some people who will buy a charm bracelet; and when they reach a certain milestone, they add a charm. It’s the visual reinforcement and something to work towards that motivates them, and not the food.
Janice — thanks, but I’ll skip the tattoo. Maybe some new underwear or makeup would be nice, though.
This Can Be Tough
What if you don’t meet your goal? What then? Suppose you have set a goal that you will not eat ice cream tonight, and then you do eat the it. Are you a failure? No, you are not a failure. You ate ice cream, that’s all. Perhaps your goal simply wasn’t realistic at this time. An “achievable” goal means that it’s achievable for you. What was the barrier? Was it that there was ice cream in the house and you heard it calling to you from inside the freezer? Was it that you thought you could watch everyone in your family eat a sundae after dinner while you had strawberries? Then maybe in order for this goal to be truly achievable for you, the ice cream has to go. At least for now. Maybe for now, your family eats ice cream only outside the house. Maybe for now, everyone eats strawberries for dessert at home (which is a good thing anyway).
So now you’ve figured out how your plan got derailed. Okay then! Now you’ll get rid of the ice cream, and tomorrow you’ll be ready for your achievable goal. You’re feeling positive; you’re looking forward to what comes next. There is no place here for telling yourself that you’re lacking will-power or that you’re a failure. Neither is true. Starting right now, you’ll have lots of other opportunities for success. Stay with us.
Oh, by the way, the photograph of the gorgeous beauty contestant in this post? She’s a transgender woman. We all travel different paths to reach our goals.
(1) Kozica S et al. Initiating and continuing behaviour change within a weight gain prevention trial: a qualitative investigation. Plos One/DOI 2015: 1-14.
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