Over the past few years it has become clear that weight is an important
health issue. Being overweight is a risk factor for health problems such as
diabetes, high blood pressure, high cholesterol and triglycerides, arthritis,
gall bladder disease, gynecologic problems, some cancers, and even lung
problems. Some people who need to lose weight for their health don't recognize
it, while others who don't need to lose weight, want to get thinner for
cosmetic reasons. We understand that in some ways your weight is different
from, for example, your cholesterol level or your blood pressure, because you
can't see what these are by looking at someone. Many patients have had
health-care providers who approached their weight in a less-than-sensitive or
helpful manner. Some patients may have had health-care encounters in which they
felt blamed, but not helped. Please be assured that when we bring up your
weight, it's because we know that this is an important aspect of your overall
health care. We understand, though, that successful weight management is a
long-term challenge.
By the same token, we may discuss weight goals that are different from those
you select. Weight can affect a person's self-esteem. Excess weight is highly
visible and evokes some powerful reactions, however unfairly, from other people
and from the people who possess the excess weight. The amount of weight needed
to improve your health may be much less than you wish to lose when you consider
how you evaluate your weight. If we suggest an initial weight goal that seems
too heavy for you, please understand that our major emphasis is on your health
and that your health can be greatly improved by a loss of 5-10 percent of your
starting weight. That doesn't mean you have to stop there, but it does mean
that an initial goal of losing 5-10 percent of your starting weight is both
realistic and valuable.
Set The Right Goals
Setting the right goals is an important first step. Most people trying to lose
weight focus on just that one goal: weight loss. However, the most productive
areas to focus on are the dietary and exercise changes that will lead to that
long-term weight change. Successful weight managers are those who select two or
three goals at a time that they are willing to take on, that meet the following
criteria of useful goals:
Effective goals are 1) specific; 2) attainable; and 3) forgiving (less than
perfect). "Exercise more" is a commendable ideal, but it's not
specific. "Walk five miles everyday" is specific and measurable, but
is it attainable if you 're just starting out?" Walk 30 minutes every
day" is more attainable, but what happens if you're held up at work one
day and there's a thunderstorm during your walking time another day? "Walk
30 minutes, five days each week" is specific, attainable, and forgiving.
In short, a great goal!
Nothing Succeeds Like Success
Shaping is a behavioral technique in which you select a series of short-term
goals that get closer and closer to the ultimate goal (e. g., an initial
reduction of fat intake from 40% of calories to 35% of calories, and later to
30%). It is based on the concept that "nothing succeeds like
success." Shaping uses two important behavioral principles: 1) consecutive
goals that move you ahead in small steps are the best way to reach a distant
point; and 2) consecutive rewards keep the overall effort invigorated.
Success (But Not With Food)
Rewards that you control can be used to encourage attainment of behavioral
goals, especially those that have been difficult to reach. An effective reward
is something that is desirable, timely, and contingent on meeting your goal.
The rewards you administer may be tangible (e. g., a movie or music CD or a
payment toward buying a more costly item) or intangible (e. g., an afternoon
off from work or just an hour of quiet time away from family). Numerous small
rewards, delivered for meeting smaller goals, are more effective than bigger
rewards, requiring a long, difficult effort.
Balance Your (Food) Checkbook
Self-monitoring refers to observing and recording some aspect of your
behavior, such as calorie intake, servings of fruits and vegetables, exercise
sessions, medication usage, etc., or an outcome of these behaviors, such as
weight. Self-monitoring of a behavior can be used at times when you're not sure
how you're doing, and at times when you want the behavior to improve.
Self-monitoring of a behavior usually changes the behavior in the desired
direction and can produce " real-time" records for review by you and
your health care provider. For example, keeping a record of your exercise can
let you and your provider know quickly how you're doing, and when the record
shows that your exercise is increasing, you'll be encouraged to keep it up.
Some patients find that specific self-monitoring forms make it easier, while
others prefer to use their own recording system.
While you may or may not wish to weigh yourself frequently while losing
weight, regular monitoring of your weight will be essential to help you
maintain your lower weight. When keeping a record of your weight, a graph may
be more informative than a list of your weights. When weighing yourself and
keeping a weight graph or table, however, remember that one day's diet and
exercise patterns won't have a measurable effect on your fat weight the next
day. Today's weight is not a true measure of how well you followed your program
yesterday, because your body's water weight will change much more from day to
day than will your fat weight, and water changes are often the result of things
that have nothing to do with your weight-management efforts.
Avoid A Chain Reaction
Stimulus (cue) control involves learning what social or environmental cues
seem to encourage undesired eating, and then changing those cues. For example,
you may learn from reflection or from self-monitoring records that you're more
likely to overeat while watching television, or whenever treats are on display
by the office coffee pot, or when around a certain friend. You might then try
to sever the association of eating with the cue (don't eat while watching
television), avoid or eliminate the cue (leave coffee room immediately after
pouring coffee), or change the circumstances surrounding the cue (plan to meet
with friend in non-food settings). In general, visible and accessible food
items are often cues for unplanned eating.
Get The (Fullness) Message
Changing the way you go about eating can make it easier to eat less without
feeling deprived. It takes 15 or more minutes for your brain to get the message
you've been fed. Slowing the rate of eating can allow satiety (fullness)
signals to begin to develop by the end of the meal. Eating lots of vegetables
can also make you feel fuller. Another trick is to use smaller plates so that
moderate portions do not appear meager. Changing your eating schedule, or
setting one, can be helpful, especially if you tend to skip, or delay, meals
and overeat later.