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 [email protected]. He may answer your question in a future column.
In the next few articles, patients and colleagues provide their own recipes for weight loss success. The stories and advice are down-to-earth and powerful. I learned a great deal from them, and I believe you will too.
Joanna: The Wise Weight Manager
Twenty-two years have passed since Joanna hired me as a personal trainer. Unlike some clients, I had no problem getting her to talk about her struggles with weight. In fact, many of her stories straddled the line of too much information and left me either bent over with laughter or on the verge of tears. She never shied away from attention and praise, and she also wasn’t afraid to earn it. She was a hard worker who wanted me to push her physical limits during training sessions. After an intense workout Joanna would often smile and say, “Look at this!” as she flexed her biceps that were becoming shapely. She was results oriented; her head always seemed full of big ideas and she usually had the intellect, drive, and persistence to accomplish what she set out to do.
Her career was marked by one success after another. She was a visionary who subscribed to the idea that “If it ain’t broke, break it, and make it better.” She grew an organization beyond anyone’s wildest dreams and had a positive impact on hundreds of thousands of people because of it. This drive carried over into her personal life. But the attitude that yielded so much career success led to frustration with her never-ending desire to maintain a healthy weight. She approached each diet full steam ahead with outcomes in mind, often ignoring the fact that this would be a lifelong journey rather than a project she could accomplish and then move on.
Many years ago, near the end of our work together, Joanna wrote about her battle with weight. At the time of her writing she had experienced prolonged success with her weight and had a clear perspective of why weight loss maintenance is so difficult. Through all my moves since then, I kept her notes in a white three-ring binder, tucked in a box of memorabilia. The slight yellowing of the pages and the floppy discs in the notebook remind me of how many years have passed since Joanna asked me to help her become healthier. Despite the passage of time, her words are poignant and represent many beliefs of my current patients.
Do you ever wonder how many tomorrows there are in a lifetime? However many I’m allowed, I was certain I’d used my allotment. If children yell “do-over” quickly enough after making a mistake in jacks, tetherball, hopscotch, or some other game, they get to take their turn again—without penalty. Well, my adult life was constantly a “do-over,” but with costly penalties. Every morning I told myself, “Today is the day I’m going to succeed.” Success meant I was going to do without. But without usually turned into with, and countless days ended with feelings of failure and a promise that things would be different tomorrow. After 47 years I had accumulated a lifetime of failed yesterdays.
When I decided to try losing weight just one more time, I convinced myself it was my last chance. My last tomorrow had arrived. I was truly in my all-or-nothing mode of behavior, which is how I lived my life. If I were describing a movie I’d just seen, it was either phenomenal or the worst ever. When I finished a book, it was the most incredible book I ever read or a total waste of time. If I went out with friends, it was the most spectacular evening or truly the pits. My love for my dear husband even fluctuated from unconditional adoration to hate. I was like the children’s nursery rhyme, “When she was good she was very good, and when she was bad she was horrid,” with nothing in between. I had no middle ground, and this all-or-nothing attitude had proven to be destructive.
How this all-or-nothing attitude relates to weight loss and exercise is easily illustrated. Whenever I began a new diet plan, I stuck to the plan to the letter. I recorded everything I ate. I weighed and measured everything. No one or nothing could make me eat what I wasn’t supposed to. I was in my “all” stage. But when I fell off for God knows what reason, I fell off completely and my “nothing” approach to life kicked in. If I swallowed one morsel of food I wasn’t supposed to eat, then I felt I’d failed, and since the day was already screwed up, I might as well eat anything and everything I wanted. My day was ruined, my diet was over, my program was a bust, I was a failure again. Then it would take me weeks, months, sometimes years to get back on a program.
My psychological makeup focused largely on unrealistic expectations. I could convince myself that if I just worked harder at not eating, if I could be more disciplined, I’d look like the fashion models whose pictures plastered my refrigerator door. In addition, I had no realistic timeline. It wasn’t unusual for me to expect to lose five pounds a week, or 20 pounds a month. Or 80 pounds in four months. Anything short of that sent me into depression and sometimes derailed whatever more realistic success I was having at the time.
Over the years, Joanna and I occasionally stayed in contact, with several years often passing between communication. Our conversations or brief e-mails were usually more about our families or life changes, not weight. Despite not working together professionally for over two decades, many fond memories of our time together are etched clearly in my mind, as if they happened yesterday. Looking back, I probably learned as much from Joanna as she did from me.
Her willingness to be honest and vulnerable about how weight touched all aspects of her life taught me valuable lessons not found in textbooks or the results section of journal articles. Our training sessions and nutrition counseling rarely felt like work and the questions she asked that I couldn’t answer inspired me to learn as much as possible about the field I now enjoy so much. Without our work together, I might not have chosen this career path—and had I chosen it without knowing Joanna, my perspective would be less complete.
Even though I felt a little guilty about not keeping in touch with her, I recently contacted Joanna and asked her if she’d provide an update on her perspective for effectively managing weight. With the same support I remember from years past, she responded, “I’d walk on hot coals for you, Dave.”
I’ve always seen Joanna as a wise woman with strong leadership qualities so I was curious to know if her view on things had changed over the years. She recently retired and is enjoying it much more than she and all her friends and family expected. She cherishes time spent with grandkids who live out of state. She helps her husband with his business and has more time to reflect on her health goals. She told me she doesn’t feel 66 years old and has an image of herself that’s only challenged when she sees her reflection. Although she occasionally finds herself staring into the mirror trying to figure out the timeline and progression of an emerging wrinkle or two, her appearance is no longer a driving force to manage her weight.
She described how many people her age were having serious medical problems related to unhealthy lifestyles. Some die prematurely and others simply keep living, but not really. They can’t do what they want to do, their schedules are filled with one doctor’s appointment after another. Health problems are all they ever talk about. She has no interest in living that way and it is her primary motivation to stay healthy.
So what has Joanna learned after many years of trying to manage her weight, and what advice would she give others? She learned to never say never about regaining weight. At the time she wrote the passage above, she was telling herself she’d figured things out and would never be heavy again. But it wasn’t that easy. Weight regain is part of the process and if you tell yourself it will never happen, you won’t be adequately prepared to handle the situation when it does. If you don’t know how to fix a small leak, eventually it becomes much worse and the damage is substantial. Joanna is more pragmatic now than ever before. “My weight will always be a struggle,” she told me. Although she wants healthy eating and regular exercise to be as habitual as brushing her teeth, it isn’t easy and requires intentional persistence. If Joanna was coaching you about managing weight, you’d become familiar with the following themes:
- Managing weight is not about intelligence. If you’re overweight it doesn’t mean you’re stupid, incompetent, or less of a person. Obesity is a complex condition influenced by genetics, our environment, upbringing, and psychological reactions to life.
- Expect to regain weight after losing it, but have a plan to stop it before the gain is substantial. This plan has to include specific behaviors related to getting back into an exercise routine and eating better. More importantly, your psychological response will determine whether or not you incorporate these behaviors.
- Balance immediate gratification with long-term goals. It’s okay to love food but not at the expense of everything else that’s important to you—your health, your ability to engage in physical activities you enjoy, or simply feeling energetic.
- Master the art of portion control. Eat slowly, and when you aren’t quite full, wait a while and you probably will be. Use a smaller plate and don’t eat everything served to you in a restaurant.
- Choose your professional help wisely. Joanna suggests finding someone who understands the basics of nutrition and exercise, but she feels it’s even more important to work with someone who has an in-depth knowledge of the psychology of weight management. Work with someone who understands the power of thoughts and can guide you through times of high and low motivation. She encourages you to find someone you can connect with, knowing that person truly cares. If someone tries to fake authenticity, move on to another helper.
- Patience and forgiveness. Weight is something you manage long-term. It’s a marathon, not a sprint. Understand that your day-to-day victories with food and physical activity won’t immediately show up on the scale. When you mess up, and you will, learn to forgive yourself and have a plan to handle things differently next time.
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