We are pleased to bring you this regular column by Dr. David Creel, a licensed psychologist, certified clinical exercise physiologist and registered dietitian. He is also credentialed as a certified diabetes educator and the author of A Size That Fits: Lose Weight and Keep it off, One Thought at a Time (NorLightsPress, 2017).
Do you have a weight loss question for Dr. Creel? Email him at AskDrCre[email protected]. He may answer your question in a future column.
A recap of my workweek reminds me that social support is critical to relapse prevention.
- Last night I joined an exercise class for bariatric surgery patients. As we worked on a cardio routine some people were exactly in step with the leader, while others, like me, struggled to follow her. Nobody cared. Betty who had her surgery eight years ago, worked out beside Jason who had surgery six weeks ago. A lady six months post-op brought her husband who had surgery a week ago. He sat and watched us, planning to join the class in a few weeks. Matt, a single guy, has been a regular in this group for five years.
- Although he met the weight qualifications, George chose to lose weight without bariatric surgery. This week he showed up for an individual weight management session after being away for a month. His doctors are trying to understand why his painful medical condition doesn’t respond to treatment as expected.
“The pain is excruciating, but I’m on the upswing,” he told me.
“Many people will let these types of things weaken their determination, but not you. Why did you decide to come in today?” I asked.
“I’m not giving up. I know I’ve had a lot of health problems, but I won’t quit. I need the accountability and support you guys off I really appreciate having a place to come that reminds me of why this is important.”
- A mother and her 300-pound 14-year-old son, Tristen, started treatment.
“I think we know what to do, but we just can’t seem to pull it together and keep it together,” his mom told me. “We need support so we can work with each other and stay accountable for our goals.”
“What about you, Tristen? Why did you decide to show up tonight?” I asked.
“I want to play basketball this year for my school, but I can’t run up and down the court without getting tired. Although I can shoot, I’m too slow. Like Mom said, we need somebody to coach and encourage us, so we don’t quit like before.”
- I facilitated a bariatric surgery support group.
“Please introduce yourself and tell us why you decided to come tonight,” I said as we began our meeting. Person after person revealed they needed support. As I asked them to tell me a bit more, I heard:
“You guys understand.”
“I feel comfortable talking about my struggles here.”
“I don’t feel judged.”
“I can’t get away with any BS in this group.”
One member apologetically wept as she explained she lost her mother three months ago and reverted to emotional eating, gaining 20 pounds. Others chimed in, explaining how they recovered from similar lapses. They encouraged her to not give up. Toward the end of the meeting, several people mentioned the importance of forgiveness in their weight management process.
“We often think about forgiving others or asking God for forgiveness—but we have to forgive ourselves,” one man added.
I was amazed that most of the attendees had surgery over five years earlier and several were almost 15 years post-op. They still came to the group because weight management is hard and almost impossible to do alone. Even many years later, they still need support.
- I also spoke to Neil, the guy who lost 60 pounds, going from 260 pounds to around 200 during twelve months of treatment. If you recall, he decided to try and manage things on his own, so we developed a specific contingency plan to help him prevent relapse. Until yesterday I hadn’t spoken to him since his last visit six months ago, so I called him.
“Doctor Creel, what’s going on?” he answered in his usual upbeat tone.
“I’m just calling to check in on you—I want to see how you’re doing with your weight-loss goals.”
With his usual laidback attitude, he responded in a surprised but friendly manner, “Oh man, thanks so much for calling, that’s awesome. I’m doing good man, how are you?”
Neil sort of has a “cool factor” about him, making communication easy. “Things are good here, too,” I said, sounding less hip, I’m sure.
“Oh, wow, well I’ve been doing pretty well since I stopped coming in. I actually lost another five pounds or so and then Thanksgiving rolled around and you know, I just relaxed a bit, drank a little too much and gained about ten pounds. I actually took about five of those pounds off and then Christmas and family get-togethers and all of that hit. I put on some more weight and actually hit 210. I said, that’s my limit and have been doing well since. I’m back down to between 200-205 and I’m feeling good. I just have to keep weighing and make adjustments when my weight heads in the wrong direction. The exercise is still happening. I religiously use my elliptical and I’m thinking about adding strength training.”
“It sounds like the scale and your exercise equipment are your friends!”
“Absolutely. I still struggle sometimes with eating cheeseburgers and drinking too much around the holidays or when I hang out with my friends, but you know, I don’t feel good when I do that. I just keep reminding myself of that.”
“Is there anything we can do to help out?”
“Not right now, but I may come next month just to check in and have some accountability. I really appreciate your call.”
“Well, thanks for talking with me, and congratulations on your success. I look forward to seeing you next month, Neil.”
Even though Neil didn’t follow our contingency plan to perfection, he’s doing a lot of things right. He continues to weigh himself and assess the behaviors that lead to weight gain. Our conversation told me he was concerned about weight gain, but didn’t get overly upset about it. Instead, he took a practical approach. Sure, he could have had a more specific plan for his deviations around the holidays, and perhaps in time he’ll respond a bit quicker to weight gain, but things didn’t move too far out of control before he got back on track. His response to my call shows the importance of support for anyone who wants to maintain weight loss. I hope Neil will make it back to the office so we can provide ongoing help.
Humans are social creatures. Solitary confinement is punishment. Children placed in timeout don’t like it, because even negative attention is better than being away from the action. Trying to manage your weight without the help of others can feel like solitary confinement at times—like a continual timeout when everyone else is living a full life while you’re stuck in a corner because of some indiscretion or personal weakness. When it comes to something as challenging as managing your weight, feeling alone in a crowd increases your chances of relapsing.
For most of us, the default is to fall prey to unhealthy food and an inactive lifestyle. Having the right kind of support can protect you from pitfalls and inspire you when times get tough.
Perhaps you’re already surrounded by people who help with your weight loss efforts. Thank them. Others of you are surrounded by people who want to help but aren’t good at it. And some of you don’t have anyone to help with your journey.
For those of you who have Dennis the Menace supporters (want to help, but seem to make things worse), there is hope. Although it requires a little work, being an effective weight manager requires communication with the people around us. Tell your willing supporters what they can do to help, rather than complaining about how their help is annoying. If a person’s heart is in the right place he’ll listen to you and try to adjust his approach.
Remember that positive reinforcement goes a long way. If your husband every once in a blue moon does something that supports your efforts, tell him exactly what he did and why it helped you. On the other hand, when he tries to assist you with an unhelpful comment such as, “Is that something you should eat?” try hard to communicate you appreciate his willingness to help. Instead of losing your temper, coach him in what to say or do when he notices you eating something that isn’t healthy. If you want him to say nothing, let him know that. Over time a caring spouse, friend, or even a professional will get better at providing support when you provide them with feedback and gentle instructions.
If you don’t have adequate support or feel as if you need more than your friends and family can reasonably provide, consider joining a group of like-minded people such as:
- Weight Watchers
- TOPS (Take off Pounds Sensibly)
- Overeaters Anonymous
- Hospital sponsored bariatric or general weight management support groups
- A walking club
- Fitness classes
- Cycling clubs
- Recreational sports
- Online support groups
Although the above suggestions can lead to friendships with people who are interested in fitness and healthy weight, you can also find kindred spirits in social activities without a health theme. People can be supportive even if they don’t share all your health interests. Volunteering and becoming involved with local groups is a great alternative to pleasure or stress eating and may lead to friendships that will help with your weight management. A quick internet search for volunteer opportunities will show you many ways to get involved, including:
- The United Way
- The Red Cross
- Animal rescue organizations
- Retirement communities
- Battered women’s shelters
- Food pantries and soup kitchens
- Coaching youth sports
- Homeless shelters
- Political campaigns
- Event volunteering
- Boys and Girls Clubs
If you’re like me, your life already seems full, and getting involved with a group may sound overwhelming. Even friendships may be a challenge because of your busy life. If so, this busyness probably makes it harder to manage your weight. Are there responsibilities you can let go of so you have time for true friendship? Is perfectionism keeping you in an overwhelmed state so you don’t have time to connect with other people? We all have different needs when it comes to human interaction, but everyone benefits from meaningful relationships—if we slow down and make time for them.
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