“Your Health Checkup” is our online column by Dr. Douglas Zipes, an internationally acclaimed cardiologist, professor, author, inventor, and authority on pacing and electrophysiology. Dr. Zipes is also a contributor to The Saturday Evening Post print magazine. Subscribe to receive thoughtful articles, new fiction, health and wellness advice, and gems from our archive.

Order Dr. Zipes’ new book, Bear’s Promise, and check out his website www.dougzipes.us.

Calculating how to lose weight is as easy as calculating how much money is in your bank account. If you deposit more money than you spend, your bank balance increases. If you spend more than you deposit, your balance decreases.

Weight loss is based on the same principle. Burn more calories than you take in, and you lose weight. Take in more calories than you burn, you gain weight.

Seems simple, right? I wish it were.

I would love to lose ten to fifteen pounds. I try to eat less and exercise more, but nothing seems to work, especially during the inactivity caused by the COVID-19 pandemic. It has been estimated that by 2030 nearly 1 in 2 U.S. adults will be obese.

Exercise alone won’t accomplish weight loss and must be accompanied by dieting. The reason is obvious. Depending on your weight and type of exercise, an average individual can burn in the range of 6 to 13 calories per minute. For example, a 140-pound person burns approximately 13 calories per minute running, while walking would burn a little more than half of that per minute. So, a half-hour run would burn almost 400 calories compared to 230 calories walking.

Since you need to burn about 3,500 calories to lose one pound, if you averaged 10 calories per minute exercising you would need to exercise 350 minutes or almost 6 hours to lose a pound. Running would require four-and-a-half hours to lose a pound.

As I have written previously, if I cut just 300 or so calories a day — roughly two slices of buttered white toast, or three large scrambled eggs, or a large bagel, or two glasses of red wine — I would lose a pound in about two weeks. Kept up for a year, I’d shed over twenty pounds, which would be fantastic and would improve my health and sense of wellbeing.

There are additional things— simple things—that might help you take off a few pounds. After all, every little bit helps.

1. Avoid soft drinks made with artificial sweeteners, like aspartame and saccharin. Even though you may dodge a few calories with them, they may increase your desire for sugary foods and have been associated with larger waists.

2. If you dine with others, pick people who are as calorie conscious as you. We tend to mirror the eating habits of people dining with us.

3. Eat off a smaller plate because you’ll pile on and eat less food.

4. Take brief breaks from your diet. You’ll return to it with increased vigor to comply, but equally important, you may avoid the weight loss plateau we’ve all experienced during dieting.

5. Avoid using computers and smart phones before bedtime. The blue light from the device suppresses melatonin needed to induce sleep. Sleep loss is a known risk factor for obesity.

6. Sleep in cool rather than warm room to increase energy expenditure during sleep.

7. Eat more slowly and stop eating when you feel about three quarters full. There is a lag time between eating and when that food tells your brain you are full. So, give the food a chance to send that message.

8. Avoid fad diets and pick one you will stick to long term. Switching to the Mediterranean Diet can result in weight loss as well as reduction in heart attacks, strokes, and death from cardiovascular disease.

9. Avoid between-meal snacks, skip dessert, and shun ultra-processed foods loaded with calories and little nutrition.

I need to practice what I teach. Happy weight loss!

Featured image: kurhan / Shutterstock

## Cartoons: Weighty Matters

Want even more laughs? Subscribe to the magazine for cartoons, art, inspiring stories, fiction, humor, and features from our archives.

Want even more laughs? Subscribe to the magazine for cartoons, art, inspiring stories, fiction, humor, and features from our archives.

## Wit’s End: Losing Weight with Liz Taylor

In January, many of us pledge to shed excess weight, but as we all know, that’s easier said than done. After my first child was born, I found myself 40 pounds heavier and, after losing half, hit a plateau. The fitness books were filled with hideous prescriptions: counting calories, weighing food, and doing an unpleasant-sounding activity called “reps.”

But I did not want to do any of those things, and the books spooked me. Finally, I stumbled upon one called French Women Don’t Get Fat, by Mireille Guiliano. Its breezy tone assured me that I didn’t have to change my entire personality just to lose weight. A Frenchwoman wouldn’t dream of moving faster than a languid sashay, let alone do “reps.” How absurd!

It was the Francophilic pep talk that I needed, and it got results. But to address the steady upward creep of the scale in my 40s, I need more than the mental image of “being French.”

Enter the American movie star Elizabeth Taylor, one of the most celebrated beauties of all time. Unlike the prototypical Frenchwoman, she did get fat, especially during her marriage to politician John Warner from 1976 to 1982. Stuck at home in Washington, D.C. while Warner worked long hours, Taylor turned to comfort food (and other substances) for solace. “Eating became one of the most pleasant activities I could find to fill the lonely hours and I ate and drank with abandon,” she wrote later.

Taylor was publicly ridiculed for putting on weight in her 40s, but by her 55th birthday was en bonne forme and more glamorous than ever, having “dropped from 180-odd to 122 pounds.” Her 1987 book, Elizabeth Takes Off, tells the story of how she did it and, more importantly, of her extraordinary life. When I saw it in a used bookstore, I pounced on it like a frosted sugar cookie.

Reading the book is like having a vivacious aunt show up at your door, dripping in diamonds, to tell you if she can pull it together, so can you. Born in 1932, Taylor was nine years old when she made her first film, and she spent her childhood working on movie sets. Feisty from the start, in her early teens she told Louis B. Mayer to “go to hell” because she didn’t like the way he spoke to her mother. As a famous young star, she led a sheltered life, guarded by protective parents and studio bosses.

At 17, eager for independence, Taylor entered her first marriage, with seven more to come. Elizabeth Takes Off dwells fondly on her favorite husbands: producer Mike Todd, who died tragically in a plane crash one year after their 1957 wedding; and actor Richard Burton, with whom Taylor shared 11 films and married twice, in 1964 and 1975. She had three children and enjoyed motherhood so much that she adopted a fourth.

“I’ve always admitted that I’m ruled by my passions,” Taylor writes, explaining not just her many marriages but her love of parties, jewelry, and, yes, food. While today’s film actors subsist on soy crumbles and arugula, Liz was a meat-and-potatoes girl who loved burgers, steaks, mashed potatoes, and fries. She once asked a friendly ex-husband to visit her at Dulles Airport during a layover. “And maybe bring some leftover fried chicken. You do have some fried chicken around, don’t you?” Charmed, the ex-husband fried up some chicken and brought it to the airport with a side of fresh corn. And they lived happily ever after.

As she matter-of-factly describes a wild ride of films, marriages, divorces, hospitalizations, and dress fittings, Taylor is a likeable narrator. Despite having owned a giant rock called the Krupp Diamond, she seems an earthy, unpretentious woman with a zest for life. “I confess I love being surrounded by beautiful things and I love being looked after,” she writes (and I confess that I, and every woman strolling the aisles of a Bed, Bath & Beyond, love these things, too).

“When I gained weight, I just bought more clothes,” she writes sensibly. (Nodding.)

When anyone tried to help me, I’d say, ‘Look, I know what I’m doing. I’m going through a phase. I can’t diet until I’m ready, and if you push me, the minute you finish your lecture I will go in and have some hot fudge.’

The minute you finish your lecture, I will go have some hot fudge. I am so using that.

Taylor’s sometimes out-of-control life masked an inner strength, the mental toughness that comes through in her films. After a long run of overeating and other addictive behaviors, she took a hard look in a mirror and didn’t like what she saw. A stint at the Betty Ford Center addressed her alcohol abuse, and with a clear head Taylor realized that she had “been doing a lot of harm to [my] body for an awfully long time . . . . I had actually tossed away my self-respect.”

Husbandless and sober, she came up with her own personal plan for food and exercise. While the first half of Elizabeth Takes Off is autobiography, the second half describes her weight-loss regimen. But first, some general advice: “Get out that full-length mirror,” she instructs in her best bossy-aunt manner. “When you’re trying to diet, it’s no time to play games.” Taylor also advises to “look your best while losing.” She continues:

I know plenty of big ladies who are positively glorious-looking. They may wear a size sixteen or eighteen, but they’re always well groomed, neatly coiffed, and radiantly glamorous. Yet many dieters will throw on anything as long as it’s dark in color. Their philosophy is ‘I’m fat so it doesn’t matter how I look.’ Rubbish. It always matters how you look.

It always matters how you look. Strong words for my drawerful of ratty black yoga pants, Liz! But I hear you.

The diet itself is a curious artifact of the mid-’80s. Breakfast is fruit and whole-wheat toast or a bran muffin; lunches feature low-fat cottage cheese and skinless chicken breasts; and coffee is lightened with “a splash of skim milk.” For someone who liked her hot fudge sundaes, the menu is extremely disciplined, coming in at 1,000-1,200 calories a day. Desserts include a baked apple and something called an orange soufflé, made with “3 tablespoons low-cal margarine,” “2 packets artificial sweetener,” and grated zest.

Even at 30 years’ distance, it’s hard to criticize this diet, though it includes odd items like “barbequed squab” and not one, but two, types of “curried mayonnaise.” If Elizabeth Taylor happily consumed such foods on a tufted divan in her orchid-filled Bel Air estate, with a cabinet of acting awards to her right and an original Renoir to her left, planning her next charity ball on a gold phone, who are we to say Curried Mayonnaise #2 and a tray of raw broccoli is not quite up to par in 2020?

And anyway, you don’t read Elizabeth Takes Off for the recipes. It’s just inspiring to spend 200-plus pages with Aunt Liz, who hastens to add that her low-fat diet allows for occasional “pig-outs,” as she puts it with typical bluntness.

“Guard the assets you were blessed with like a miser,” Taylor instructs, but in the end, she is not unduly obsessed with beauty or weight. “Happily,” she wrote in her 50s, “God made me incredibly resilient and I was able to bounce back. In fact, when someone recently asked me what was my proudest accomplishment, I said with all sincerity: ‘Just being alive.’”

Featured image: Elizabeth Taylor in 1987 (Photo By John Barrett/PHOTOlink.net/MediaPunch/Alamy)

## Con Watch: Avoiding Weight Loss Scams

Steve Weisman is a lawyer, college professor, author, and one of the country’s leading experts in cybersecurity, identity theft, and scams. See Steve’s other Con Watch articles.

Weight loss scams are among the most common, and with good reason. Many people want to lose weight, and most of the scam products promise to do that for you easily without diet or exercise. The unfortunate truth is that there is no magic formula for fast and easy weight loss, but con artists continue to prey on people looking for that quick solution to their weight difficulties.

In 2014, the Federal Trade Commission (FTC) and the State of Connecticut settled a case against the marketers of LeanSpa and refunded money to its victims. Now the FTC is making further refunds to people who lost money to them. LeanSpa promoted ineffective açaí berry and colon cleanse weight-loss products, falsely telling consumers that they could get free samples of these products if they paid a small shipping and handling cost. The truth is that the consumers were not only charged \$79.95 for the “free” products, but also were billed monthly for additional products that were extremely difficult to cancel.

Weight loss scammers use a variety of methods to lure you into purchasing their worthless products. Many create websites that appear to feature articles from legitimate magazines or news organizations touting the miraculous weight loss products. Often they will use photos of celebrities and suggest that these celebrities endorse their products, which in many cases, they do not. Recently, a phony weight loss advertisement appeared on Instagram that contained photos of movie director Kevin Smith, who lost 60 pounds in the last year. The advertisement also contained Smith’s endorsement for the particular diet pills. However, while the before and after photos of Smith were real, having been taken from Smith’s own Instagram account, Smith took to Instagram to vehemently deny he had ever taken the diet pills or endorsed the product.

Even if a celebrity does endorse a product, it does not mean that it is effective. The FTC took legal action against former baseball great Steve Garvey for endorsing a weight loss product that was totally ineffective. Although a federal court ruled that Garvey did not knowingly misrepresent the effectiveness of the phony weight loss product, the fact remains that the product itself was worthless.

Many of the advertisements for phony weight loss products appear on social media. In June, Facebook changed its algorithm to reduce the distribution of phony weight loss products, although their efforts have not been totally effective.

As exemplified by the LeanSpa scam, many of the weight loss scam products are advertised as free trial offers. However, these free offers also ask for your credit card number, allegedly for identification purposes. The scammers then enroll the victim in monthly subscription programs that regularly charges their credit card. They also make it all but impossible to cancel the order or get a refund.

So how can you determine if a weight loss product is a scam or not? Here are the ten commandments of avoiding phony weight loss products.

1. Be wary of any weight loss product that is sold exclusively either over the Internet or through mail-order advertisements.
2. Don’t believe the claims of any weight loss product or program that promises that you can lose large amounts of weight quickly without dieting or exercise.
4. Weight loss body wraps that purport to melt fat away don’t work. If you lose any weight, it is merely water loss. Once you rehydrate, you will gain back the lost weight.
5. No product can block the absorption of fat or calories. There is no magic potion that will help you lose weight while still eating a high calorie diet.
6. Spot reducing of hips, thighs or anywhere else is impossible.
7. Seek advice from your doctor before starting any weight loss program or using any weight loss product.
8. If a company touts scientific studies that support the miraculous claims they make for their product, you should check to see if there are any legitimate scientific studies that support their position.
9. Be skeptical of celebrity endorsements. Often, as in the case of Kevin Smith, the celebrity didn’t endorse the product. Even if a celebrity endorses a product, it doesn’t mean the product is effective.
10. Be particularly wary of weight loss products that claim to have a secret formula to drop weight without diet or exercise. There are no such secret formulas and if there were, they would not remain a secret for long.

Featured image: Shutterstock

## Healthy Weight, Healthy Mind: The Wise Weight Manager

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.

## Healthy Weight, Healthy Mind: Actions, Not Words

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.

## Carol: Actions Not Words

When we met, Carol seemed to be a no-nonsense, just-the- facts kind of woman. During our first few sessions she appeared to endure our back and forth chit-chat about her weight as a requirement to get to the bottom line — a plan. Unlike clients who leave a session saying, “That gives me something to think about,” Carol likes to leave saying, “That’s something I can use.”

During the first four months of treatment we stuck with a well-planned progression to reach her desired weight. We sometimes joked that we were following the manual’s instructions, keeping up with the manufacturer’s recommended scheduled maintenance, building what she wanted brick by brick.

Over the two years we worked together, Carol broadened her perspective. Although remaining true to her cut-the- fluff approach, she gained an appreciation for stepping back from her detailed goals enough to see the bigger picture of her journey. She became more comfortable sharing what lies behind her eating behavior — her beliefs, emotions, and personality — and learned to appreciate all those behind-the-scenes factors involved with weight management. Combining our discussions and her plans helped Carol identify exactly where she had problems with eating, and she learned what works and what doesn’t.

Although we looked for explanations for her behavior, we didn’t get bogged down by the why. Instead, we chose to look at how things happened and then made plans for how she wanted things to happen. I learned that Carol is polite, smart, and driven to succeed — someone you’d want on your team. Carol shows great commitment to managing her weight and has an uncanny ability to consolidate information, put a plan together, and then take action.

Carol has never been morbidly obese, but was at an unhealthy weight before starting our sessions. She didn’t like the way she felt or the size of her clothes, and she knew unhealthy behavior was to blame. After several years of persistence and remarkable success, she was kind enough to share her recipe for success:

• Track food daily. Carol suggests using a mobile app because most people always have their phones nearby.
• Develop some sort of external accountability. Without someone to check in with, it’s too easy to fall back into old behavior, regain weight, and ignore things that contribute to a relapse.
• Weigh daily; it will keep you honest. Stepping on the scale each morning makes it easier to observe day-to-day fluctuations without freaking out about one measurement. You’ll learn to look for trends and modify your behavior accordingly.
• Make exercise a priority. If you’re always trying to fit exercise between other activities, it often gets squeezed out. Instead, plan your days with exercise at the top of the to-do list. Carol suggests taking a fitness class, which also provides social support, or having a set time for your routine.
• Plan and pre-prep meals as much as possible. Use weekends to slice and dice, pre-portion, or cook foods that take a long time to prepare. When your busy week is in full swing, healthy foods are at your fingertips and meals only take minutes to assemble.
• If you drink alcohol, develop strategies to control it. Otherwise your calories can get out of control in a hurry. Not only do the drinks contain calories, but your inhibitions to eating not-so-healthy foods often fly out the window as well. Carol recommends thinking ahead about which social events will lend themselves to drinking and prioritize within a budget of two to three drinks per week.
• Work functions, family pitch-ins, or holiday gatherings can often be part of a downhill spiral for someone trying to manage weight. Bring a healthy dish with you and never take home tempting, high-calorie leftovers.

Limit desserts. Carol admits to struggling with the sweet stuff. She found that only buying what she wants to eat at one sitting is a good strategy. She rarely bakes because the temptation is too much work to manage.

## Healthy Weight, Healthy Mind: Practical Advice from a Personal Trainer

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.

## Bill: The Practical Personal Trainer

If I wanted to hire a personal trainer, I would choose Bill Dean. He has never been a bodybuilder, followed a diet centered around protein shakes, canned tuna, or egg whites, nor does he have much interest in six-pack abs. He’s a fit guy in his mid-40s who believes in an honest day’s work, a good laugh, and making a difference in people’s lives. His clients range from professional athletes to stay-at-home moms. He’s worked with multi-millionaire executives and average wage earners who are making financial sacrifices to get help with improving their health and well-being. Some of Bill’s clients come to him tremendously overweight and out of shape, while others are relatively fit and want to stay that way.

Despite missing opportunities to make a quick buck, Bill hasn’t conformed to an industry driven by promises to get ripped, turn eyes in a bikini, or serve only those who want to have a “status” trainer.

So what drives Bill? People. He has a knack for tapping into the core reasons people want to get fit or improve their health. When he asks clients about their why he tells them to think three levels deep. People want to get healthy, but not just to be healthy; they want to do things, create something, or feel a certain way.

Bill told me people miss out when they compare themselves to others or focus on numbers. He doesn’t get fired up about body fat percentages, progress on the scale, or how you compare to others on a fitness test. Numbers are just numbers and they don’t mean anything. Feeling better means something and so does having more self-confidence or less back pain. It means something when you can sleep better at night or feel less overwhelmed by your busy lifestyle.

Bill illustrated this point with a story about one of his clients who, on days when she isn’t training with him, does an indoor cycling class at a local gym. The cycles are connected to an electronic board in the front of the room that displays how much work each cyclist is performing compared to other people in class. This client is a hard worker and leaves the class exhausted; nevertheless, she’s usually last on the leaderboard. Focusing on the fact that she’s a last place finisher discourages her. She leaves the gym feeling like a boxer knocked out in the final round of a hard-fought contest.

“It makes no sense for her to feel this way,” Bill told me. She’s up early on a Saturday morning working hard while most people are still in bed. Most of those who are up at that hour don’t have plans to exercise, or if they do, they won’t push themselves like she does. He helps her remain focused on her why, which has little to do with seeing her name at the top of a list in a cycling class. Most likely, if she can keep this focus, her fitness will continue to improve and she won’t stay at the bottom of the list. But in the grand scheme of things, does it really matter? We can always find stronger, faster, thinner, smarter, and richer people than us. On the other hand, there will always be people with fewer of these qualities. We get to choose our comparisons, or decide not to compare at all.

Lastly, Bill commented on how challenging yourself with fitness goals builds resiliency, self-confidence, and mental toughness. Exercising on the days you don’t feel like it builds confidence as you realize things that may seem too difficult are actually rewarding. “I’ve never had a client finish a workout and say, ‘I wish I hadn’t done it,’” he said. Instead, people are proud of themselves and begin to feel comfortable with excellence.

Bill sees parallels between success in many areas of life and staying fit. Want to have a successful business? Getting and staying fit will teach you persistence. Want to be a better parent? Commit to regular physical activity — it will make you a more patient caregiver. Want to become more confident and self-assured? Challenge yourself in the gym, on the bike, or walking through your neighborhood. In short, Bill’s recipe for success with physical activity is as follows:

• Know your why (at least three levels deep) and don’t get sucked into numbers or comparisons.
• After each workout, remind yourself what you just did, even though you didn’t have to do it.
• Dedicate yourself to consistent regular physical activity just as you’d take a medication that keeps you alive.
• When your confidence wanes, let exercise be a reminder that you’re capable, functional, and willing to persevere despite life’s challenges.
• Don’t take yourself or exercise too seriously. Whenever possible, tap into your childlike instincts and make physical activity a playful and enjoyable experience.

Don’t be afraid to hire a trainer, but own your fitness. You are the decider, the driver, and the one who explains why your health is worth the effort.

## Healthy Weight, Healthy Mind: A Formerly Overweight Physician Offers Her Advice

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.

## Jessica: The Formerly Overweight Physician

Do you ever wonder if your physician has a clue? Time after time he says you need to lose weight, but does he know how hard that is? Has he ever walked in your shoes? Although no two people ever have exactly the same experience, it’s reassuring to know that people who give advice truly understand your situation and emotionally connect with what you’re trying to achieve. When it comes to managing weight, Dr. Jessica can relate.

As the youngest of three girls and the child of a mother who had a love/hate relationship with food and exercise, Jessica became well-versed in dieting lingo at a young age. Jealousy between her normal weight and overweight sisters taught her that a thin body was something to be coveted. All the while, her mom’s on-again-off-again diets led to inconsistency in what food was available at home. At family gatherings the women always talked about food and diets they were on, or about to start. Jessica recalls climbing on top of the bathroom sink so she could have a full-length mirror to determine if her chubby legs looked unattractive in her soccer uniform. She was only five years old.

Her weight history is like a neon sign flashing in her memory bank. When all the first graders at her school were weighed as part of fitness testing, Jessica was one of only three girls who topped the 100-pound mark. At that time, in her town, childhood obesity was not as prevalent as it is today, and her size was something she couldn’t hide. As a middle schooler she tried to restrict calories and follow the lead of everything she learned about dieting from her family. This led to some yo-yoing of her weight, but soccer was what really prevented her weight from ballooning out of control. Though a bit heavier than the other girls, she was a good player. Lots of practice, games, and all-day weekend tournaments kept her on the move and made it difficult to consume more calories than she burned. She loved the sport and continued playing through high school and even competed at the small university she attended.

But when college soccer ended and Jessica began medical school, things began to change. Long hours of studying, stress, and less physical activity led to steady weight gain. Her family medicine residency only made things worse, demanding even longer hours and more pressure to perform well. By her third year of residency she was 40 to 50 pounds overweight.

Despite gaining weight, Jessica never lost her dieting mentality. If she ate the wrong things, she was aware and felt guilty. She tried to manage her weight, but seemed to be just spinning her wheels. As a physician she knew the dangers of obesity and feared the plight of many women in her family.

During her third year of residency, Jessica’s approach to dieting turned on its head. She heard Dr. Michelle May, the author of Eat What You Love, Love What You Eat, present a different perspective on weight management. Dr. May’s non-restrictive, mindful approach to eating taught Jessica to pay attention and eat when she was hungry, slow down, and pay attention to fullness. She became more aware of her relationship with food and learned to avoid emotional eating. She stopped having negative feelings if she decided to eat less-healthy food in moderation. She began exercising because it made her feel good, rather than exercising just to burn off something she shouldn’t have eaten.

As a result, Jessica lost 45 pounds over 18 months. Ten years and three kids later, Jessica has maintained her weight without returning to yo-yo dieting or guilt-driven behavior. As a family physician she works closely with her patients, helping them lose weight and maintain their success. Her personal experiences shaped the recipe for success she promotes.

• Stop using food as a consolation for a bad day or as a reward for hard work. Instead, find other rewarding, pleasurable things to do. Jessica encourages people to make a list of ten non-food treats to replace food. Five of them should be quick and easy things that can be “go tos” after a tough day, or a reward for a job well done.
• Cope with problems rather than using food to tamp down negative emotions. Understand what drives your eating and tackle those things head on. Jessica quotes Dr. May and says, “If a trigger doesn’t come from hunger, eating will never satisfy it.”
• Exercise because it makes you feel good, not to burn off calories.
• Enjoy things in moderation without guilt. Anything forbidden is alluring. Take the power away—everything is permissible, but not beneficial.
• Keep the environment clear of triggers. Even though Jessica doesn’t make anything off limits, she suggests keeping high-risk foods out of arm’s reach.
• Realize that your approach may need to change in each season of life. Sometimes it’s most helpful to focus on planning our behavior, while at other times we have to think more about handling our emotions, being mindful of our reactions, or making the best of a less-than-ideal situation.

## Healthy Weight, Healthy Mind: 5 Components of Long-Term Weight Management Success

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.

### Bill: The Experienced Psychologist

Over the years, Bill Hilgendorf has treated many patients with a variety of psychological disorders. He works full-time for a bariatric center and has a small private practice on the side.

Bill is a great listener, with no urgency to jump in and give his opinion. He slides into conversation with caring words or his sense of humor, which often involves a witty play on words. He is a skilled clinician and caring person. I would send a patient or a family member to him without hesitation.

When summing up his recipe for success, Bill referred to the characteristics of the 30 or so patients who serve as mentors to others involved in his program. He noticed these superstars seem to have five things in common. He uses a hand illustration to describe the components of long-term weight management success: The thumb represents what we eat and the four fingers are connected to these choices:

• Thumbs up reminds us to choose food that will nourish our bodies and provide energy.
• Tapping your index finger gently on your temple can remind you to eat mindfully. Think when you eat. Pay attention to feelings of hunger and fullness rather than simply eating by the clock, eating because food is available, or eating because others are doing it.
• Of course the middle finger is physical activity. Sticking your middle finger in the air by itself can lead you to think exercise is a dirty word. But when we look at the middle finger as part of a hand, it’s at the center of everything. Without that finger a hand doesn’t work efficiently. Without regular physical activity, we’re unlikely to lose weight and keep it off. Our focus can be on both regular exercise (working out) as well as staying active during a typical day.
• The ring finger is Bill describes getting support with the three I’s.
• Inspirational support: Find people, groups, or activities that motivate you to keep on keeping on. These are often our friends who listen to us, encourage us, or simply provide a shoulder to cry on.
• Informational support: Seek out friends, mentors, or professionals who can offer advice or provide education to enhance the weight management journey.
• Instrumental support: This type of support comes from people who aren’t afraid to get their hands dirty. They help you prepare healthy meals, exercise with you, or babysit your toddler so you can go to the gym regularly.
• The pinkie reminds us of small things that make a big difference. They fall under the category of self-awareness and include food and activity tracking, self-weighing, measuring portion sizes, journaling your thoughts, and getting regular feedback from a professional.

## Healthy Weight, Healthy Mind: A Recipe for Weight Loss Success

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.

This article presents an overview of everything we’ve discussed about weight management. I hope you’ll be reminded of ideas that resonated with you, and perhaps you’ll decide to reread a particular article.

As I wrap up what I have to say on the subject of weight, I’m reminded of a valuable lesson from my parents: Just like money and status, weight isn’t the most important thing in life. A number on the scale is just that.

Hopefully you know what’s most important in your life. Maybe your list would include family, faith, feeling at peace, close friendships, feeling your life has purpose, or leaving the world a better place. Perhaps you just want to be happy, calm, or live without physical or emotional pain. Maybe you’ve discovered that unhealthy eating is tightly connected to something on your list and you want to change that. You can.

## Weight Loss is a Holistic Process

You may have told yourself, “If I can just lose X number of pounds, I’ll be happy.” I’m reminding you that weight loss alone will not lead to sustained happiness. It won’t give you a ticket to the Magic Kingdom where all your wishes are granted. Instead, our weight often changes as a result of finding inner peace. When our lives are purposeful, we can view health as a vehicle that takes us where we want to go. Without this perspective, the positive feelings we get from

weight loss quickly fade or become overshadowed by the chaos of life. When everything competes for our attention, eventually we lose focus on weight. But living purposefully lets us integrate health into the most valuable parts of our lives. The competition between health and other life demands comes to a halt and we’re no longer managing weight in a vacuum: We’ve connected it to things that are already important to us.

The path of weight management has many obstacles. We each have a body we were born with, complete with genetic factors that can impact our journey. These influences are a normal part of the trip and we can’t eliminate them, even when they slow our progress.

Plus, side trails can take us in the wrong direction. For example, forever searching for the holy grail of food combinations that will melt away pounds gets in the way of developing a sensible eating style. The most important aspects of weight management are not found in the minutia of the effect of a single food, the time of day you exercise, or whether or not you swear off pasta.

Instead, we succeed by using strategies to create a lifestyle that includes balanced eating and regular physical activity. The best plan will promote health and also embrace your schedule, your likes and dislikes, your personality, and your biological tendencies.

On the other hand, sometimes our lifestyle and personal preferences create so many barriers that it is nearly impossible to fit in healthy eating and exercise. If this is true for you, you may benefit from altering major parts of your life. Making job or relationship changes and letting go of unhealthy hobbies can create a suitable environment for change. Weight management is not a short-term effort; it’s a commitment with some sacrifice. But each sacrifice brings a reward as you lose weight, feel better, look better, and enjoy more activities.

Commitment grows stronger when we focus on benefits and rewards instead of grumbling about what we’ve given up. Motivation naturally has peaks and valleys, but your journey will be easier—and faster—if you celebrate your success and remind yourself of the reason for daily discipline.

## Goals

Setting and achieving goals is a fulfilling experience, but we need to select the right goals because these targets can make or break our attitudes. Realistic, short-term goals are crucial in the early stages of changing behavior. Before focusing on a goal you need to know why it’s important. Goals should be specific and measurable, helping us focus on behavior related to weight.

## Monitoring

Self-monitoring the food we eat, how much physical activity we engage in, and numbers on the scale are essential for most weight-loss maintainers. These tracking strategies can make you more aware of your relationship with food.

## The Pleasure of Eating

Eating is one of the pleasures of life, and each of us has a personal relationship with food. As we explore these connections to food, we can address the pleasure aspect of eating. People who manage to lose weight and keep it off have discovered how to stop using food as a main source of pleasure. Instead, they use food to fuel other aspects of their lives that are satisfying and rewarding. Redefining pleasure by considering it in a broad, long-term way can also make your weight management journey more fulfilling.

Flavor isn’t the only thing that makes eating a pleasure. We can also enjoy the color, texture, and life giving, restorative properties of what we consume. Learn to eat slowly and mindfully (not while doing other things), so you can savor your food in guilt-free portions.

Look for more ingredients to the recipe for success next week.

## Healthy Weight, Healthy Mind: Someone Is Watching—and You Want Them to

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.

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
• Hospitals
• Churches
• Battered women’s shelters
• Food pantries and soup kitchens
• Coaching youth sports
• Homeless shelters
• YMCAs
• Political campaigns
• Event volunteering
• Schools
• 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.

## Healthy Weight, Healthy Mind: Relapse Prevention, Part 2

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.

## Realistic Expectations

Our hospital-sponsored weight loss program includes 20 sessions over seven months. During the first ten sessions patients see a physician and a behavioral specialist every week to work on specific nutrition, exercise, and psychological goals. The appointments spread out to every other week after the first ten weeks. Patients often lose 10 to 15 pounds during the first month and another 5 to 10 pounds during weeks six to ten. If you needed to lose 60 pounds, this would put you one-third of the way to your goal — an exciting accomplishment.

This is when expectations rise. Buoyed by their success, many clients say, “I’ll bet I can lose another forty pounds during the second half of the program. I just need to keep working hard, get a little more consistent with my exercise, and I think I can do it.”

I never like raining on anyone’s parade, but our conversation usually ends with at least a few sprinkles. The goal is possible, but highly unlikely for a variety of reasons, including metabolic changes, neurochemicals affecting appetite, and psychological factors such as restraint fatigue. What will happen to these folks if they only lose five more pounds or no weight at all in the next ten sessions? What if they gain back five pounds?

When our expectations are too high and we miss a goal, it’s easy to lose sight of what we’ve already accomplished. Losing 20 pounds and gaining back five is still progress and will improve your health. Imagine if every time you lost weight and regained just a little of it, you could view this as a success, not a fatal setback to your plans.

Suppose you get through a season of travel softball for your daughter, an injury to your back, the holiday season, or long work hours with only a few pounds gained? In my book, that’s a big accomplishment. Good for you!

Of course you don’t want to ever regain any weight, but it will happen at some time. People regain a little weight with nonsurgical interventions, the use of appetite suppressants, and after bariatric surgery. Expecting it to never happen is unrealistic and leads to anxiety-provoking fear. If you get married, you’ll argue with your spouse. If you have children, they will misbehave. Invest in the stock market and sometimes you’ll lose money. Lose weight, and a portion of it will be regained. If we accept this as normal and treatable, you needn’t fear it — especially if you have a back-up plan.

## Contingency Planning

Fire safety is a big deal where I work. Fires in a hospital can be devastating, so our administrators work hard to prevent them. They also consider worst-case scenarios and give us contingency plans in case of a fire, natural disaster, or other danger. We can do the same thing with weight loss. Just as fire alarms and smoke detectors give warnings of fire, we can set up an early detection system for danger in our weight management efforts.

At the beginning of a relapse your weight begins drifting upward, often without your awareness. Perhaps you’re distracted by a change in your life that takes precedence over diet and exercise. Before you know it, your body adds ten pounds. This is when your bathroom scale turns into a smoke alarm: “Danger! Weight gain!”

Frequent weighing can help avoid this scenario. When the patients I work with decide to stop treatment after successful weight loss, we discuss the future: How they’ll recognize trouble and what they’ll do to self-correct. Weighing ourselves is a simple, easy way to sound an alarm that signals us to take action.

The action part of this process is slightly different for each person. Often the first bullet point after In case of fire: is remain calm. The same goes for a slip in your weight management. Stay calm, and problem-solve. Fretting over weight gain, putting yourself down, and overreacting will not help. Ignoring the problem won’t help either. Stay calm and follow the rest of the plan you created. Preventing a slip from becoming a catastrophic fall usually contains such elements as self-monitoring your diet, planning meals and physical activity, and examining the thinking process that led to this point.

Sometimes you may need professional help to get back on track, such as visiting with a registered dietitian, a physician, a therapist who specializes in weight management, or a personal trainer. The use of appetite suppressants may also be part of the plan.

Neil lost 60 pounds in a year of treatment and decided, because of finances and a one-hour drive to our center, that he would try to maintain this weight loss (and hopefully lose another 20 pounds) without his individual appointments. We created a contingency plan for him based on these warning signs:

• Exercising less than three times per week.
• Drinking alcohol more than twice per week, or to excess.
• Snacking between meals when not hungry.
• Weight gain.
• Current weight: 200; Weight below 205 is acceptable.

## Neil’s Specific Plan:

• Weigh daily.
• If weight hits 205 for three consecutive days, I will begin recording my food again to determine the problem and/or increase my awareness of eating.
• I will do this until my weight and behavior are stabilized.
• If I’m unable to do this or if my weight hasn’t returned to less than 205 within two weeks, I will email you with a more specific plan.
• My note will include a three-day meal plan and my plan for exercise over the next three days. I will do this for two weeks.
• If this isn’t successful, I’ll make an appointment to come back to the center.
• If at any time my weight hits 210, I’ll make an appointment right away.

As I write this, I’m reminded that I haven’t heard from Neil. I hope that means he’s doing well. I’ll give him a call and report back in a later article.

## Do Something Quickly to Get Back on Track

Larry was a great guy; a caring soul who along with his wife had raised three biological children and had numerous foster kids, four of whom they adopted. He loved conversation and had a great interest in other people. My role was to help him get a handle on his diabetes, lose weight, and get physically active. I often redirected our conversation to strategies Larry could use to make his life healthier.

One day after about nine months of treatment Larry said, “You know what I’ve learned since starting in this program?”

“First, I’ve learned that I screw up every day. I make a poor food choice or I have two drinks when I only planned to have one. I miss planned workouts. I deviate from my plan. But I already knew that before I came to see you. What I really learned here is how to handle my screw-ups. I used to get so discouraged I’d go way off track and then make a plan to start over at a later time. I don’t do that anymore.”

“So how do you handle it now?”

“As soon as I realize what I’ve done, I ask myself, “What can I do, right now, to get back on track? And then I do something right away.”

“Can you give me an example?” I asked.

“The other night, I had a second drink when I only planned to have one. So I took the dog for a walk. Last Friday I ate a doughnut at the office. I wasn’t happy about it. Well, I was sort of happy while I ate it, but not pleased with my decision. I took three minutes and wrote down what I was going to eat for lunch and dinner. Right away I started feeling better about myself and my ability to stay on track. Psychologically, this is much easier than getting way off track and then trying to overcompensate. I feel like I’ve become pretty good at making corrections when I mess up.”

## Healthy Weight, Healthy Mind: Relapse Prevention, Part I

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).

## Batter Up

Weight management is unlike many disciplines in the medical field. When a surgeon operates to remove a gallbladder, the operation is almost always successful. When you take an antibiotic for an infection, you usually get better. When you wear a cast, the bone generally heals. Weight management is more like baseball than medicine. If you’re a good major league hitting coach, your players may get a base hit three out of ten times. Your hitter may only hit a home run once every 20-30 at bats. Like hitting a 90-mile per hour fastball, weight management is hard. The National Health and Nutrition Examination Survey (NHANES) is a program of studies that includes ongoing assessment of weight. One study from data including over 14,000 people sheds light on how difficult weight management can be.

The figure below shows the percentages of people able to lose weight and keep it off for at least one year. As you can see, losing and keeping off 5 percent of weight (a 12-pound weight loss if you weigh 240 pounds) happens for just over one-third of people. This is sort of like hitting singles. The probability of losing and keeping off 20 percent of your body weight (48 pounds if you weigh 240 pounds) is similar to the average professional baseball player’s chances of hitting a homerun at any given at bat — 4.4 percent, or 1 out of 23.

One big problem with weight management is that most of us want to hit a home run; we forget that singles matter. Additional research tells us that a 5 to 10 percent weight loss improves health, helps prevent diseases like type 2 diabetes, and improves other health conditions such as high blood pressure.

It’s important to point out that the NHANES data don’t differentiate between people who had bariatric surgery and those who lost weight without it. However, during the time of the study only about one out of every 2500 people had bariatric surgery, suggesting almost all these data relate to people who chose not to have surgery.

Weight loss after bariatric surgery is much greater than this, but those patients also risk short and long-term complications. In addition, most bariatric surgery procedures aren’t appropriate for people who have less than 75 pounds of excess weight (gastric banding procedures are exceptions and can be performed for people with various medical conditions who are 30 to 40 pounds or more overweight).

The following section on relapse prevention isn’t about hitting home runs or being happy with singles. Instead, I want to explore your approach to hitting with questions such as these:

• Can you keep your head in the game even after consecutive strikeouts or making an error in the field? That is, how do you handle holiday mishaps without falling back into old habits for an extended period of time?
• What is your approach to vacations, eating chocolate, or getting back on track after a binge?
• Do you continue to exercise even when you’re struggling with your eating?

You may hit homeruns with the amount of weight you lose — or you may hit singles. The important part is staying in the game without giving up, and continuing to focus on your health while balancing other parts of your life.

As previously discussed, bariatric surgery is a bigger bat, so to speak, and only certain folks should use it. Surgery is not better in all cases, and many of you will be using a smaller bat. However, all great baseball players have common characteristics to their swing, no matter what size bat they use. Along those same lines, we need certain attributes for successful weight management.

Research shows that frequent weighing helps prevent relapse. People who keep weight off tend to step on the scale at least weekly. By comparison, those who are unsuccessful with their weight often view the scale as a tripwire that punishes them if they take a step in the wrong direction. They weigh when they know they’re following a safe path, but avoid the scale when they veer a little off course.

In previous posts we covered ways to adjust our thinking in order to view the scale as a dependable friend giving us positive feedback to help correct our course. I encourage each client to use these skills and eventually reach a point of weighing regularly, especially when the body reaches a natural plateau after weight loss.

Even though regular weighing is extremely helpful to prevent relapse, weight doesn’t tell the whole story about progress. For example, a 40-pound weight loss can represent different things for different people, based on starting weight and weight-loss treatment. If a 400-pound man has gastric bypass surgery, loses 40 pounds, and then has a six-month weight plateau, he has probably relapsed. His lack of expected weight loss tells us there are problems. He probably returned to unhealthy eating patterns that might include high-fat snacks, sweet tea, or fast food.

Let’s compare this surgery patient to a woman who is less overweight, lost 40 pounds, and kept it off for three years without bariatric surgery. In her case, the weight plateau is probably a sign that she’s following a healthy eating plan and regular physical activity — even if she’s still 30 pounds overweight by medical definition. Her metabolism and appetite have adjusted to her new weight, so the plateau isn’t necessarily a sign of unhealthy habits.

As the previous figure suggests, most people who lose weight are still considered overweight or obese by body mass index (BMI), a simple weight to height calculation. It’s crucial for you to remember that maintaining weight loss has many health benefits even if the charts still indicate you’re overweight. Just because your weight plateaus at a number higher than you desire (or a BMI chart recommends) doesn’t mean you’re doing something wrong or you relapsed into old behavior. The only way to truly evaluate how you’re doing is to look at what you’re doing.

We can rarely define weight-related relapse with one behavior, so you need to look at many daily decisions when examining your lifestyle.

Comparing eating behavior relapse to drug abuse gives us another way to look at this concept. With drug use, an addicted person relapses when he returns to using drugs. It’s usually black or white — he’s either clean or relapsed. Although the addict often starts behaving in ways that predict relapse, we define relapse with specific behavior: He’s using again.

Weight management is different because the behaviors aren’t black and white. Eating cheesecake can be part of an overall healthy eating plan — or it may be one of many signals that someone has relapsed into old patterns. For successful long-term weight loss, you need to maintain a variety of healthy practices such as regular exercise, portion control, balance between food groups, and limiting calorie-dense foods.

Frequent weighing is a simple and helpful way to create a centerpiece for your relapse prevention plan. But remember, we weigh ourselves to become more aware of our behavior. And behavior should be the focus of our plan to get back on track when we struggle.

## Identify and Plan for High-Risk Situations

If you have an important work-related meeting at eight o’clock in the morning and a snowstorm is supposed to hit your area at 4:00 a.m., what would you do? If you’re planning a long car trip, how do you prepare? What if your child complains of a stomachache before bed? Experienced snowy weather residents, veteran travelers, and wise parents understand each of these situations is high-risk for something undesirable to happen. Being on time for a meeting may require getting up early to shovel the driveway and allow for a longer commute. An experienced traveler packs in advance and has the car serviced before a long trip. When a child complains of stomach problems before bedtime, parents soon learn to prepare for a possible upchuck in the middle of the night. (My mother sent us to bed with “puke sacks,” and my wife’s family used bowls, which makes me leery of eating soup when visiting them.)

When it comes to exercising and eating the right foods, high risk situations are all around us.

My point is, most of us know how to identify, plan, and prepare for high-risk situations in our lives. We know what works and what doesn’t. Based on experience, we change our approach over time.

When it comes to exercising and eating the right foods, high risk situations are all around us. What events jeopardize your weight management goals? Weekends, vacations, holidays, celebrations, stress, and any life transition can lead to lapses and even full-blown relapses. Think about the last time you lost weight and then began regaining it. What was going on? If similar things happened again, how could you prepare beforehand and how could you handle things differently?

Some high-risk situations are small, day-to-day events that throw us off course. Matt told me he had an issue with overeating cashews at work. He always kept a can of nuts in his desk drawer in case he worked late or missed lunch. But during normal work hours when he did have lunch, the cashews presented a problem. When things got hectic or he felt a bit hungry he’d help himself to “just one handful.” That small snack turned into mindlessly picking at cashews all afternoon until the entire can was empty. He could keep other foods at his desk without a problem, just not cashews. He said cashews weren’t a problem at home. But the combination of his work environment, plus cashews, created a perfect storm for Matt.

Other people may be overcome by shopping when hungry, having homemade cookies at home during a stressful time, driving with snack food in the passenger seat, and a dozen other scenarios that can be avoided by planning ahead.

Other high-risk situations are unavoidable. Only a hermit could totally avoid social events that challenge healthy eating. Still, we need to anticipate problems whenever possible and have a plan to stay on track. Every stressful event you prepare for is helping you develop skills to handle future situations, even the toughest ones. The longer you practice those coping behaviors and the more natural they feel, the less likely you are to fall apart when your life changes.

## Healthy Weight, Healthy Mind: The Story of Dan

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.

“HI, Dan, how are you today?”

Dan walked toward me with his arthritic limp, grinned, and held out his hand. “Better than I was,” he answered predictably, “but not quite where I wanna be.”

Dan was a client I always looked forward to seeing. A witty 46-year-old, he owned a flooring business in a nearby town. He’d managed to finish college after a childhood of poverty, worked hard, and built his business from the ground up. He often smiled as he talked about his loyal employees, many of whom had stayed with him since the business opened 15 years earlier. When he talked about his family, Dan’s eyes would soften and shine. “My wife is the greatest woman in the world. My daughter’s getting married in the fall and my son will graduate with his engineering degree next spring.”

Dan was living a life that far exceeded his childhood dreams. Though not wealthy by Wall Street standards, in his mind he was the richest man in the world. However, while living the American dream Dan had ignored his health to focus on business and family. Although his doctor advised him to make lifestyle changes, Dan didn’t follow that advice. His wife worried about his weight, bad knees, and rising blood pressure. He responded to her concerns with his usual you-only-live-once, happy-go-lucky attitude and continued his unhealthy patterns.

Dan’s eating habits were to blame for his worsening health. He often bought lunch for his entire office staff and would eat whatever they ordered on any given day. Although his wife was willing to cook, Dan enjoyed taking her out to eat. He spent most evenings winding down with one or two rum and cokes and a salty snack or two. This lifestyle led to a steady weight gain over ten years.

An eye-opening experience led Dan to seek treatment at our center. One morning after a restless night of sleep, he decided to check his weight. Maybe the seeds planted by his wife or doctor had started to germinate, or perhaps for some reason he noticed the dusty scale tucked away in the bathroom closet. He dragged the old analog scale out from behind a box of cleaning supplies, set the scale on his tiled floor, and stepped on the black rubber surface. The red dial quickly snapped to the 300-pound maximum and vibrated slightly as it tried to go beyond its limits.

Dan was shocked. He had no idea he weighed that much. “This is really bad,” he muttered. “I can’t even weigh myself on a normal bathroom scale.” All day he thought about his weight, his blood pressure, the difficulty he had playing a round of golf, and the sleep apnea that left him feeling drowsy throughout the day, even occasionally dozing off at his desk during work. And he had pain. A once-in-awhile ibuprofen pill had become a regular medication to help him walk during the day and control the knee pain that awakened him in the middle of the night.

Dan’s wake-up call came from seeing that red dial max out on his bathroom scale. He realized if he didn’t stop this weight trajectory, he wouldn’t be able to live the way he wanted — and he had a lot to live for.

Dan’s motivation translated into action. Every two weeks he came to my office, down another four or five pounds. Occasionally Sheila, his office manager, called to tell me Dan was running five or ten minutes late, but he never missed.

After five months of treatment, Dan had lost 60 pounds. He was playing more golf, helping prepare dinners at home, and his office staff had shaped up too, keeping the refrigerator stocked with fruit, raw veggies, and low-fat dip to accompany the sandwiches they ordered for lunch. Dan told me Sheila and one of his salesmen had lost over 20 pounds each since he started the program.

Even though he’d found his groove for weight loss, Dan wanted to keep meeting with me every other week because it kept him accountable. We discussed that at some point in time things would get harder and he accepted this as a challenge.

Then one day Dan didn’t show up for his usual Tuesday afternoon appointment; Sheila didn’t call either. Somewhat concerned about his out-of-character absence, I called his personal phone and office phone, but nobody answered, so I left messages. No one returned my call. A week went by and I called his home phone and again had to leave a message. A month had passed and I had thought a lot about Dan. Why did he stop treatment? Although I don’t make a habit of harassing patients who no longer want to remain in treatment, Dan wasn’t a typical patient and his absence didn’t make sense. “I’ll try one last time,” I thought. Like before, six rings and voice mail. Three weeks passed and finally I got a return call.

“Hello Dave, this is Suzanne Smith. My husband Dan Smith was one of your patients at the weight loss center.”

“Of course, Suzanne, thank you for calling me.”

“You left a couple of messages for Dan and he wanted me to call you. He would talk to you himself, but he’s very sick and weak. A few days after you last met with him he started to have abdominal pain and nausea that wouldn’t go away. He went to his doctor and at first they thought it was his gallbladder. Then they ran some other tests and found out he had pancreatic cancer.” She spoke in a matter-of-fact, well- rehearsed tone.

My throat tightened. “Oh, no, I am so sorry, Suzanne.”

Her voice softened as she explained his prognosis. “The cancer is progressing fast and there isn’t much we can do other than try to keep him comfortable. We wanted to thank you for your help; Dan felt so good until his symptoms came on all of a sudden.”

“I can only imagine everything that’s going on for you guys right now, and your call means a lot to me. Please tell Dan hello for me.” I hung up the phone and stared at my office wall.

The news shattered my expectations. Dan worked so hard to change his lifestyle — and what was his reward? The things we both believed would prolong his life probably wouldn’t give him a single extra second on this earth. Everything he worked for was taken away without warning. I wondered if he had regrets. If Dan had known he’d become so ill, would he have tried to lose weight? About three weeks after my conversation with his wife, Dan died.

I decided to attend his wake with the plan of quietly signing the registry, introducing myself to his wife, and then leaving. I wanted to pay my respects, and to be honest, I needed to find closure to my relationship with him. I arrived at the funeral home to find the parking lot overflowing with cars and a mass of people gathered outside. I quickly realized what I learned about Dan in a clinical setting only scratched the surface of who he was and the impact he made on people in his community. The visitation line stretched from the front to the back of the seating area and then twisted back and forth in the foyer like an amusement park line. The length of the line told me it would be hours before I reached the front to pay my respects. On another night I might have been able to wait, but that night I needed to lead a bariatric support group.

Even though I wouldn’t be able to see Dan or his family members, I wanted to stay as long as possible. So I stood in the back of the barely moving line, far from the seriousness of what was taking place at the front of the funeral home. No one was crying, hugging, or being introduced to family members. I couldn’t hear anyone saying “I’m so sorry” or “If you need anything, please let me know.” At the back of the line I was in a space somewhat removed from the emotion, stuffed into the foyer with seventy or eighty other people. I saw middle- aged people with their young adult children waiting in line. These were probably families who knew Dan through his kids. I spotted a few fidgety men wearing khakis and three-button shirts who seemed to be talking about sports or something more superficial than the event of the evening. “Golfing buddies,” I told myself.

I listened to the conversation from a small group of Dan’s close friends in front of me. They had seen him regularly over the past year and began discussing his intentional weight loss as well as the weight loss he suffered from cancer.

“He looked and felt so good before he got sick,” one man said.

“Yeah, I’d never seen him that trim,” another responded before changing the subject.

After hearing those brief comments, I felt a sense of accomplishment. Even though our time together was short, I had a part in helping Dan feel better and achieve something important to him. Dan was not on a miserable diet, denying himself everything he wanted. He didn’t isolate himself from others to eat special food or to spend hours at a gym. In fact, it was quite the opposite. Dan unintentionally became a health advocate, a leader of sorts. People saw what he had and they wanted it, too.

Dan’s death reminded me that our time on this planet isn’t guaranteed and can be cut short for no apparent reason. As a result, I became less interested in helping people follow pitifully unpleasant diets. I focused more on encouraging people to find a peaceful balance in their journey to a healthier weight.

Purposeful living often means finding joy in self-denial. The daily satisfaction we feel when overcoming challenges, caring for ourselves, and knowing we’re an inspiration to others far outweighs the feelings we get from feeding our immediate desires. Although Dan didn’t reap all the long-term benefits of losing weight and living a longer life, the short-term effects of his efforts were just as meaningful. He lived life fully until he became sick and his weight loss was part of a broader personal transformation that made an impact on others, even me.

I began to wonder what would have happened with Dan if the cancer cells hadn’t invaded his body. Could he have kept the weight off? Or, like most others, would he have succumbed to the neurochemical, metabolic, psychological, and environmental   influences that contribute to weight regain? Would those weight-gain promoting factors have been as powerful and persistent as his unstoppable cancer cells?

Even though statistics tell me Dan would probably have regained his weight, he seemed to have a perspective that could defy the odds and prevent a relapse into old patterns. My time with Dan led me to think a great deal about who succeeds long-term with weight management efforts. I began considering relapse prevention early in my work with other clients, focusing on behavior and perspectives they could sustain long-term.

## Healthy Weight, Healthy Mind: Use B-SMART Goals for Weight Loss Success

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.

## The B Is for Behavior

Outcome goals are king in weight management, but they shouldn’t be.

I will lose 30 pounds and keep it off

I’m going to get off my blood pressure medication.

This year I will run a 10k race.

There’s nothing wrong with these goals. Losing weight, getting off medication, and fitness events are all good things. But if this is the extent of goal setting you may fall short. Each outcome goal we set should be coupled with specific actions to support the goal. These actions are called behavioral goals. Although a baseball coach may have a goal to win the championship, nothing is going to happen without specific behavioral goals for the team. Likewise, if your desire to lose 30 pounds isn’t coupled with clear-cut behavioral goals, it probably won’t happen. Action-oriented goals for weight management can include anything that directly or indirectly impacts weight:

 Self-weighing Food journaling Weighing/measuring food Shopping from a grocery list Meal planning Tracking steps Going to the gym Walking the dog Rating/hunger Sleep Time spent watching TV Alcohol intake Dining out Playing in a sports league Eating less at night Eating at the table Walking on lunch hour Prayer habits Meditation Journaling thoughts Batch cooking Seeing a therapist Taking an exercise class Attending a support group

## Specific (S) and Measurable (M)

Setting criteria you can measure is an excellent way to find and define specific goals. People frequently tell me their weight-related goals are to exercise more this month, eat better, or get back on track. What do these mean? One more step, one more bite of broccoli? Is getting back on track just a frame of mind or an actual set of behaviors?

Suppose you want to focus on increasing vegetables, eating breakfast, and reducing your calorie intake late at night. Specific and measurable goals could be:

• I will eat two cups of vegetables at least four days this week.
• I will eat something before 9:30 a.m. six days this week.
• I will track the calories in my snacks after dinner and stay under 300 for at least five days this week.

If your goal involves physical activity, take a few minutes to think about what you’ll do, how often you’ll do it, and the amount of time you’ll spend. Also consider factors that affect your activities, such as thunderstorms (if it’s raining I will walk on the treadmill instead of riding my bike outside). For example:

• This week I will walk outside or on my treadmill before work for at least 30 minutes.
• I will go to Zumba class on Saturday.
• I will wear my Fitbit every day this week and reach 10,000 steps on at least five days.
• I will walk on my lunch hour on Tuesday, Thursday, and Friday.

Generally speaking, the more specific and detailed the plan, the better. On one occasion, however, I got more information than I bargained for. Marie told me her plan was to continue doing resistance training three times per week with rubber tubing. I asked her what days and times she would work out and which exercises she would do. Marie told me she waited until the evening to do her exercises because that’s when her husband was home and he liked to watch her workout. Straight faced she added, “He likes it because I work out in the buff.” Since the success rates for maintaining marriages and fitness programs aren’t so great, I supported this plan. I decided to forego my usual questions about exercise form and technique and assumed she was working all her major muscle groups. Since that day, I always feel the need to wipe down rubber tubing before I use it at the gym!

## A = Attainable

This step of goal setting is where things often fall apart. In our minds we know what’s recommended, ideal, or possible — and so we set goals accordingly. We ignore that the planets would have to align in perfect order to create the circumstances for us to achieve these goals. If you typically eat three vegetables per month, immediately transitioning to five servings per day is highly improbable. Even though 10,000 steps is recommended, increasing from 4,000 to 6,000 may be more realistic in the beginning. This approach worked well for Janet.

When Janet told me she was wearing her pedometer faithfully, I didn’t really believe this was true. I couldn’t imagine she was truly walking only 900 to 1,200 steps each day. She must be only wearing it a few hours during the day; maybe the pedometer is a lemon or the batteries are bad. The average American, who is notoriously sedentary, accumulates five times as many steps. Although she was overweight, Janet wasn’t disabled in any way. Her knees seemed to be in shape to handle walking and she didn’t complain of any other limitations. Janet would have to increase her walking by a factor of 10 to reach the recommended 10,000 steps per day.

When she described her lifestyle things began to make sense. She was a busy account manager at her firm but worked from home. She parked at her desk all day, only getting up to go to the bathroom or kitchen, both near her office. When she finished working, she would sometimes run an errand or do some light house cleaning, but that was about it for physical activity. In the evening Janet often returned to her computer to finish work, fall into the abyss of social media, or play solitaire. She and her husband would also watch an hour or two of TV. She’d never been an exerciser but was open to the idea of becoming more physically active. She had recently lost weight without exercise but knew her chances of keeping it off were not good unless she moved more. Janet also wanted to feel better. She felt sluggish. Like a toddler who can’t sit still, her body yearned for movement.

She started with a goal of 3,000 steps each day, which she achieved easily just by getting out of her chair more during her work day and doing a daily errand that required some walking. After several weeks of this, we set a goal of 5,000 steps per day at least five days per week. She was able to accomplish this on the weekend by doing yard work and more housecleaning. On work days she decided to walk for 20 minutes when she took a break for lunch. Janet enjoyed the concrete aspect of tracking her steps and the challenge of reaching her goals. She was also motivated by the fact that she felt more energetic, could concentrate better throughout the day, and slept soundly at night.

Sometimes our goals yield observable positive results and
sometimes they simply keep us from sliding backward.

The next goal was to reach 8,000 steps at least three days per week. Again, the weekends were easier. Janet added a 40-minute walk to her already established weekend routine. She also began taking a 40-minute walk with her husband on Wednesday or Thursday evenings. Janet and I continued to set progressive goals and after six months she took 7,000 to 11,000 steps at least five days per week. We didn’t quite reach 10,000 steps every day, but we were close. Janet was now walking in place during long conference calls and enthusiastically signed up for her first 5K. She was always excited to tell me about her new step record, which finally hit 15,000 per day, thanks to a 40-minute Saturday walk plus a trip to the flea market.

Setting attainable goals requires setting aside our should thoughts and all or nothing thinking and focusing on progress, not perfection. Goals need not be like a light switch we flip on and off, going full force and then regressing back to nothing. Instead our goals can be more like a dimmer switch that’s always turned on, sometimes shining brightly and at other times softly illuminating. No matter the intensity of our goals, the act of setting them helps keep us mindful of long-term objectives. Each month, week, or day, consider what you can realistically accomplish. During a busy week of travel, you may focus on maintaining your weight by getting to the hotel gym three times and avoiding dessert and alcohol when dining out in the evening. When you’re at home with better control of the environment, you can turn the dimmer switch up to more frequent exercise, lower-calorie food preparation, and a greater variety of vegetables than were available while traveling. The famed Scottish novelist Robert Louis Stevenson put it this way: “Don’t judge each day by the harvest you reap but by the seeds that you plant.”

## “T” Is for Time Frame

Short-term and long-term goals are both important, especially when we focus on losing a substantial amount of weight. Losing 30 pounds means you have to create a 105,000 calorie deficit over an extended period of time. Unfortunately, once you lose weight, the hardest part of weight management awaits you — maintenance. To keep the weight off you’ll need to sustain most of the behavior that helped you lose weight in the first place. A 30-pound weight loss from conventional treatments may take six months to a year as you consistently burn more calories than you consume. Therefore, you’ll need to set many short-term goals along the way. You will have to manage your weight, just as supervisors manage a business, frequently evaluating success and failure while readjusting your goals and objectives.

A common error in goal setting is to have long-term goals without setting enough goals for the short run. In some circumstances I discourage long-term goals, such as overall weight loss, until a client has a chance to set short- term behavioral goals and see how much work weight loss requires. A healthy weight is the weight you reach when you do healthy things over an extended period of time. This can’t be determined by a chart, a formula, or even the weight you felt great at 20 years ago. You’re setting yourself up for disappointment if you set a weight goal you can only reach if you behave in a way that isn’t healthy or realistic to sustain.

That’s why specific shorter-term goals with a wait-and-see approach are often more effective. You’ll get immediate returns by feeling better and becoming more fit, instead of holding onto a distant “pie in the sky” goal. The idea of that goal may still exist, but it won’t be your main focus.

Because obesity is a chronic, relapsing condition, I

Although no secret formula exists for timing your goals and reviewing progress, I encourage at least weekly goal-setting sessions during the early stages of weight loss. Once a week you can either meet with a professional, a peer, or yourself to review how you did with the previous week’s goals. If you achieved them, how did you do it? If you didn’t, why not? Were your goals unrealistic, not specific enough, or maybe not that important to you? Or was it a problem with execution? Do you need a more specific action plan, such as making sure you go to the grocery store over the weekend and stock up on food to cook healthier meals? Perhaps your goal of exercising in the morning will only work if you have a plan that helps you get to bed earlier the night before. Did you put everyone else’s needs in front of your own? You might reevaluate your thinking.

Over time, accomplishing these short-term goals may lead to habits you follow without thinking. When this happens, weight management becomes easier. However, because obesity is a chronic, relapsing condition, I encourage you to be diligent about frequently evaluating your progress. If your behavior starts to drift in the wrong direction, you can quickly identify the problem areas and use goal setting to help you get back on track. This may be as simple as weighing daily and observing your weight graph once a month to spot trends. Some of my long-term clients, even if they’re doing well, return to the office every month or two for exactly this reason.

## Healthy Weight, Healthy Mind: Writing It Down Can Help Improve Your Progress

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.

As you work on changing your thoughts and “friending” yourself, creating a Thought Log with the ABCDE format will help you analyze events in your life and track progress. You might dedicate a special journal just for this exercise.

1. When something upsets you, jot down the activating event (A), dysfunctional beliefs (B), and emotional consequences (C) of your thoughts.
2. Consider what thinking category causes you to feel bad (all or nothing thinking, emotional reasoning, etc.).
3. Now you can dispute (D) the thought and replace it with a kinder, factual, probable, and useful perspective.
4. Finally, you can evaluate (E) how strongly you felt the initial emotion. Perhaps in the beginning you felt frustrated at an intensity of 90 on a scale of 1 to 100.
5. Record the new rating of frustration (1 to 100) after you begin thinking differently.

You may not like keeping a journal with this much structure, and that’s okay. But I do recommend you take time to evaluate how this information affects your life.

Sit down with paper and pen, or at your computer, and write about which fallacies of thought have kept you from losing weight and sustaining that weight loss. You don’t need to write a novel. Don’t worry about spelling or grammar and feel free to use bullet points instead of sentences.

I suggest you start with writing how the environment and your thinking influenced you to regain weight in the past. Suppose you gained weight after a combination of events — you hurt your foot in October, followed by the stress and social events of the holidays, and then you felt discouraged and gave up. What if you changed your interpretation of those events — your thoughts and beliefs? Would the story have a different ending?

Write about how you could have changed the environment to ensure better success. Then try writing how you could change your thoughts if you couldn’t change the environment. How could this situation end with a better outcome? While you’re at it, write about several of those possible good outcomes. This will show you how changing your thoughts could lead to much better results.

This writing exercise will be like a dress rehearsal for similar challenges in the future. Instead of falling into the same traps as before, you’ve prepared yourself to respond in a healthier way. As with anything you practice the right way, you’ll soon develop thinking skills and new confidence to overcome future challenges to maintaining a healthy weight.