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.
After having twin boys, Ted and Linda hoped to become pregnant again. Neither of them hid their desire for a little girl. After five years of trying, they accepted that another child wasn’t in the cards for them. Once they reached their 40s, Ted and Linda were enjoying their teenage boys and had long given up on trying to increase the size of their family. Then they received amazing news — Linda was pregnant — and they were having a girl! They named her Emily, a name they picked out ten years earlier.
For the first five years of her life Emily lived in a fast-paced home, often eating on the run and snacking on junk food like her brothers. She accompanied her parents as they traveled out of town to watch the boys play tennis and baseball. During these trips everyone ate fast food and consumed not-so-healthy snacks. Soon after Emily’s sixth birthday her brothers moved away to college. Emily and her family no longer traveled to sporting events, and their home life became much calmer. In essence, Emily suddenly became an only child.
I met Emily four years after her brothers moved out of the house, when she was ten and the family no longer needed to eat on the run. Although the always-starving teenage boys hadn’t lived there for years, Emily and her parents still ate out frequently and kept the same types of food in the pantry. As a result, Emily had become quite overweight.
Her concerned parents and pediatrician enrolled Emily in our children’s weight management program. Although Emily’s mom came to the initial consultation, her work schedule and frequent travel made it difficult for her to attend regular sessions. Since her father Ted did the shopping, meal planning, and cooking as a stay-at-home dad, our staff worked with him in our efforts to help Emily lose weight. We soon realized Dad’s habits and perspective were a big part of Emily’s struggle with her weight. For instance, he regularly purchased large bags of tortilla chips, mainly for his personal late-night snacking. Because Dad wanted to keep snack foods in the house for himself, the conversation turned to Emily’s motivation and self-discipline. Emily respectfully listened to her father and tried to explain she wanted to do well in the program. After her father continued suggesting she could avoid the chips or only have a small serving for her after- school snack, she uncharacteristically snapped at him, “Dad, I have willpower, but I also have arms!”
We can all relate to Emily’s sentiment. The environment in which we live can make or break weight loss efforts. While Emily’s father wanted her to practice restraint and use willpower, Emily knew the environment was more than she could handle. Focusing on a ten-year-old’s willpower seemed a little silly when a more reasonable solution was to modify the food in the pantry. Doing so would also show support for Emily’s struggle.
On the other hand, Emily’s father couldn’t create a perfect environment, nor can you. At some point we all have to stop blaming the environment and using it to excuse our actions — at least according to a client named Marty.
In a discussion group of 12 people, Marty and I were the only men. One evening, as we discussed the challenges of weight management, ten ladies did a nice job of describing how their home environments, workplaces, and fast-paced lifestyles got in the way. Marty sat quietly for the first half hour, but toward the end of our time he began squirming in his chair. Finally, he sat up straight and sighed loudly to let everyone know he had something on his mind. We all looked at the 40-something chemist who’d gained 50 pounds since beginning work at a pharmaceutical company six years earlier. We already knew his long work hours and the addition of two children to his family created a lifestyle conducive to weight gain. We also knew Marty was irritated with himself for gaining weight and even more frustrated that he had to join a weight management group for help. In a previous session he had told us that obesity treatment seemed “stupid” because the solution was simple — eat less and move more. Now we all eagerly awaited his opinion on why weight management was so difficult. He took another deep breath, probably to swallow the four-letter words on the tip of his tongue.
Marty’s frustration showed in his furrowed brow and restless fingers that curled into a fist. “I hear what you’re all saying. But never, not once, has someone tackled me, pinned my arms to the floor and shoved food down my throat. Never! No person or situation makes us do anything — we’re doing this to ourselves.”
Marty had a valid point. Despite our food-centric society, we all have freedom to make choices. Although I’ve heard more than a few troubling stories from my patients about being forced to eat as children, most adults are entirely free to refuse food or eat in whatever quantities they want. Although the environment can limit our options or make certain behavior difficult to carry out, it does not force us to do anything. If we intentionally pay attention to hunger, fullness, our calorie needs, and the nutritional quality of our food, we can maintain a healthy diet despite the availability and ease of obtaining highly pleasurable, unhealthy foods.
But we live in a fast-paced world where it’s difficult to always self-monitor every food decision; to constantly be on alert regarding our calorie budgets and how well we’re sticking to them. Instead of being proactive, we easily get distracted and just react to our surroundings. In most industrialized nations the surroundings are obesogenic — teeming with food and conveniences that promote obesity.
In the United States, two-thirds of adults are overweight or obese, at least partly because of the environment we created. Consistent with human instincts, we tend to make choices based on what’s available, convenient, pleasurable, and socially acceptable. It’s no stretch to say that unhealthy foods are easier to find than healthier alternatives —think restaurants, gas stations, vending machines, sporting events, and the check-out lines of grocery stores.
Adding to the problem, modern technology has engineered physical activity out of our lives. Many of us drive to work and then sit at desks most of the day. We drive home, push the garage door opener, and walk a short distance to the mailbox. Exhausted from our busy-but-inactive day, we spend another few hours relaxing in front of the TV. To change the channel, we push a button the remote control. We even have robotic vacuum cleaners to clean our floors and entertain the cat. We take escalators and moving walkways to get through airports, perhaps to conserve energy for putting our tray tables in the upright position.
Sometimes our environment promotes unhealthy eating and inactivity at the same time. The Indiana State Fair, and most other state fairs, offer excellent examples. In Indianapolis, a long trolley pulled by an enormous John Deere tractor gives free rides around the fairgrounds. This is a helpful service for people with disabilities, but healthy people also jump at the opportunity to save a few steps. The remarkable part of this is that many people go to the fair primarily to sample the food. So a trolley provides transportation to the corn dog hut only to pick you up and take you to another area where you can have an elephant ear, a fried Snickers bar, deep fried macaroni and cheese, or a funnel cake. If you get too hot waiting for the trolley you can purchase a giant cup of lemonade filled with a little fresh squeezed lemon and a fourth cup of sugar. Bottled water is always an option, but it costs almost as much as the lemonade, and besides, it is the State Fair.
This all seems normal, even to those of us in the health field. When I attend large obesity or fitness conferences I like to observe the behavior of attendees. People leave a presentation with many good ideas after hearing a talk on the benefits of decreasing sedentary behavior and increasing patients’ motivation for physical activity. After they leave the room to go to another part of the conference hall, where they will again sit through a 90-minute symposium, they need to go up or down to another floor. When these attendees reach the escalator with a spacious carpeted set of stairs beside it, almost everyone stops walking and rides the escalator. This shows me how persuasive the environment is, even among people who are highly educated on the benefits of healthy behavior.