Mind Over Appetite Health Article

Q: You place more importance on "lifestyle intervention" rather than simple weight loss. Where do they differ?

There are a million ways to lose weight—but the focus for most of us should be on a healthy lifestyle. To me that means eating healthy all the time—or nearly all the time—exercising regularly and dealing with the stresses of daily living. The way to do that is through behavioral strategies: self-monitoring, stimulus control, cognitive restructuring, stress management, social support.

Q: What does socializing do?

Meals are part of the whole ritual of rebuilding relationships with family and friends. It's a critical element to health. You feel better about yourself when you're around other people and you tend to pace yourself at a much better rate. You won't overeat, gobbling down food, when the person next to you is not. And food becomes less salient than when you eat alone. We've lost that here in America. We eat for the food itself, not for the family or friends.

Q: What if your friends overeat?

Well, make new friends. I had a patient who had made changes and was losing weight successfully but her husband was afraid she would leave him if she kept losing weight. So he would bring home her favorite loaded pizza and plop it on the table in front of her. We see that kind of sabotage regularly. You try to deal with the sabotage. If not, change your lifestyle. Get rid of the jerk. That's what she did, by the way. You make choices.

Q: How important is it to get on a scale every day, and to count calories?

Self-monitoring is the most critical element in this whole business of managing one's lifestyle. For someone to change what they eat, they've got to know what they're eating—it raises awareness.The ideal would be to carry a food diary, a notebook, write down everything you eat, look up the calories (one of those little paperbacks would be fine) and make adjustments.

You can argue the validity of this business. You're not going to get the right portion size, so precision doesn't matter, and you're going to underreport your calories by a third. I don't really care about whether it's true or not. It's just raising awareness that I'm interested in.

Now, along with self-monitoring, of course, is weighing yourself daily and keeping track of minutes of exercise, or using a pedometer.

Q: Do you wear a pedometer?

I have one on right now. I aim for 10,000 steps a day for weight maintenance. Ideally, 10,000 additional steps would lead to a pound-a-week weight loss—50 pounds a year. Ten thousand steps is equal to about 5 miles, and you burn about 100 calories a mile.

Most people tend not to get more than 3,000 steps per day. Most of my steps happen in the morning when I jog for 45 minutes. I'm a slow jogger, I'm not a runner. And I don't always do it—the goal is I try.

Q: You say that while people generally underreport calories by one-third, they also overreport physical activity by one-half. Is that an active deception?

Most of us are just not aware of how much we're eating or how inactive we really are.

Q: What other behavior strategies help individuals keep control of their weight?

The next step in weight control is controlling the stimuli that are associated with overeating or underexercising. It's laying out exercise clothes or putting that sign on the refrigerator door to remind you to stick to a regular schedule. I have one on my refrigerator, a picture of a pig, that says, "You back again?" It's just to remind me, do I really want to take out that yogurt?

Also, you can change the way you think about yourself and set realistic goals. In a study by nutrition researcher Gary Foster at the University of Pennsylvania, most people said they wanted to lose 36 percent of their weight when in reality they could lose 8 to 10 percent. Aim to lose a pound a week rather than three, and give yourself positive encouragement, telling yourself: I can do this today, I will do this today.

Q: You claim that the true secret to weight loss and maintenance is "eternal vigilance." What does it mean?

Eternal vigilance is constant awareness of what you eat, of when you exercise. Our most successful patients watch themselves from the minute they get up in the morning.

Q: That seems exhausting.

Managing weight is exhausting. Part of the challenge is the way we've all chosen to live—we're all too busy, we've all taken on too much.

Q: How much does stress factor into weight?

Stress is the number one predictor of relapse. But there are lots of ways to reduce stress, including physical activity, meditation and progressive muscle relaxation, which is tensing and relaxing different muscle groups. Practicing stress-reducers in two 15-minute sessions a day can really help.

Q: Over the many years you've been helping people lose weight, what are some of the lasting philosophies you've put together?

Make small changes, one day at a time, and be realistic. There is no magic, but all of us have the power, within ourselves, to be healthy, to focus on eating correctly and being active.

The real issue today is the low activity level for all of us, but especially our children. Remember, when you're exercising or being more active you feel good about yourself, and people who feel good about themselves have an easier time eating healthfully than people who don't. Even if you don't lose a single pound, it's still important to exercise for the psychological state of well-being.

Finally, we're all human. Your weight is important but there are things that are even more important—loving your family and getting on with living.

Biggest Challenges:

I travel a lot—up to half of the year. I have no trouble maintaining my diet when I'm in the office or at home but the traveling is a real problem. I counsel others to pack a food bag and carry it on the plane, but I haven't been able to do it myself—it's a time issue. I'm not perfect.